Acta urologica Belgica最新文献

Objective: To evaluate indications and long-term results of ureteral reimplantation with psoas hitch bladder.

Materials and methods: Between January 1985 and December 1997, we performed psoas-hitch ureteral reimplantation in 18 patients (13 females and 5 males). Mean age was 48 years old. All ureteral injuries involved a pelvic portion of the ureter. The indication was: ureteral injury during gynecological procedures in 5 cases, stricture following open uretero-lithotomy in 3 cases, avulsion of the ureter during ureteroscopy in 1 case, stricture following prior ureteral reimplantation in 3 cases, prostate cancer involving the distal ureter in 1 case, megaureter in 1 case, radiation therapy in 1 case, pelvic and ureteral endometriosis in 3 cases. Treatment consisted to adequate mobilization of the bladder, fixation of the posterolateral corner of the bladder to psoas and ureteral reimplantation with anti-reflux system. In all cases, psoas-hitch ureteral reimplantation has been performed because of an inability to perform end-to-end uretero-ureterostomy or direct uretero-neocystostomy.

Results: No complications were observed. At follow-up of 7 months to 12 years (mean 5.7 years) we noticed 13 success (72.4%), 4 improvements (22.2%) and one patient (5.4%) was lost at follow-up. No nephrectomy was done.

Conclusion: Psoas-hitch bladder ureteral reimplantation is simple, effective and a first-line procedure for the replacement of the long defects of the lower ureter.

Objective: The aim of this study is to evaluate the safety and effectiveness of conservative management in stage III renal trauma.

Material and methods: We reviewed the records of 150 patients who presented in our institution with renal trauma between 1986 and 1995.

Results: Minor injuries (stage I and II: 100 cases) were treated with expectant management. Only 3 patients required nephrectomy in this group. Stage III injuries were seen in 40 patients. The great majority (85%) were treated conservatively with renal sparing procedures such as endourologic techniques (14 cases), nephrorraphy or partial nephrectomy (20 cases). Total nephrectomy was performed in 15% of the cases and only for severely injured kidney or major associated intraabdominal injuries. In this group, none of the patients suffered from hypertension at follow-up. All patients (10 cases) with pedicle injury (stage IV) required total nephrectomy.

Conclusion: Stage III renal trauma with urinary extravasation can safely be treated conservatively.

The management of posterior urethral obliteration remains a surgical challenge. We report our experience with 5 patients treated endoscopically for posterior urethral obliteration. We performed endoscopic reconstitution of the urethra followed by temporary self-dilation in five patients with complete short posterior urethral obliteration (less than 3 cm). Average follow-up is 31 months (21-53 months). During follow-up 4 of these patients required 1 or 2 internal urethrotomies within the first 4 to 24 months after treatment. But, any urethral stricture has not been established until the average 23.2 months (21 to 27 months). The other fifth patient has no complication at twenty-first month postoperatively. One patient had impotence after the injury. Impotence continued and total incontinence developed after the endoscopic treatment. We believe that endoscopic treatment followed by temporary self-dilation could be a reasonable alternative to open urethroplasty in patients with an impassable short stricture.

This study evaluates the effectiveness of desmopressin renal spray, an antidiuretic drug, in treating patients with acute renal colic. One hundred and eight patients admitted to the emergency room of our hospitals with acute renal colic were included in the study. Each patient, except those with hypertension or other cardiac insufficiency, received 40 micrograms desmopressin intranasal spray. In 58 patients (53.7%) pain was eliminated 30 min after desmopressin administration. Forty-four patients (40.7%) did not respond to desmopressin and received prostaglandin synthesis inhibitors, while another 6 patients required intramuscular pethidine for pain relief. No patient showed any side effects. We conclude that the simplicity and effectiveness of intranasal desmopressin spray in treating renal colic makes this simple method a useful means of confronting a frequent and disturbing urological problem.