Archivio italiano di urologia, nefrologia, andrologia : organo ufficiale dell'Associazione per la ricerca in urologia = Urological, nephrological, and andrological sciences最新文献

Ureteral malformations that concern adults are very few. The aim of this review is to value the real clinical incidence and to illustrate etiology, diagnosis and therapeutical management advised in the literature.

The ureteral complications after renal transplantation are urine leakage, stenosis and vesicoureteral reflux. The treatment is influenced by immunosuppression and difficult surgery (for bleeding and fibrosis). We report 8 cases with ureteral complication after renal transplantation. Stenosis were present in 5 cases: we performed ureterocystoneostomy by Politano-Leadbetter technique in 4 and pyelocystoanastomosis in 1. Vesicoureteral reflux were present in 3 cases: we preformed ureterocystoneostomy by Politano-Leadbetter technique in 2 and endoscopic infiltration with teflon of ureterovesical junction in 1. At present all patients have a normal renal function and absence of urinary tract infection.

The injuries to the ureter, whether from external trauma or iatrogenic, are rare. Some problems are common to this type of pathology, independently from the causes of injuries. It is necessary a prompt diagnosis of the lesion to avoid the urinar leakage, the infection and the fibrosis of the ureteral's stumps. If the diagnosis is not prompt, the clinical pattern may be silent for some days; after, many complications will arise up: sepsis, urinomas and fistulas. When the lesion is incomplete, and there is no devascularization, the urine drainage alone, positioned above the level of the lesion, is indicated for spontaneous repairing. When the ureteral tissue loss is extensive, it is not enough a simple anastomosis between the ureteral's stumps; in these cases is necessary a more complex repair surgery or ureteral substitution.

The function of the ureter is to transport urine from the renal pelvis toward the bladder and to protect the renal parenchyma from distally generated backflow and back pressure. The ureter manifests peristaltic activity and can adapt its mechanical characteristics to diuresis amount. The changes in ureteral function resulting from obstruction are dependent on the degree and duration of obstruction. Even the rate of urine flow, the mechanical and anatomic properties of the ureter, the nature of disease process and the age of the patient influence the response of the ureter to obstruction. It is the purpose of this report to correlate the anatomic and physiologic properties of the ureter with normal and pathologic clinical situations.

Ureteral injuries are an uncommon complication after gynecological procedures. The Authors consider separately direct lesions during surgery and those following radiotherapy. For both these situations preventive criteria, which permit a lower incidence in ureteral injuries, are considered. Early diagnosis and intraoperative repair are the most important tool for surgical lesions while the exact stage of neoplasm and N.E.D. status are fundamental for lesions resulting from radiation therapy. In our opinion, best treatment of stable lesions is surgery, while endourology is not usually a definitive treatment and has only a temporary and palliative role.

Idiopathic retroperitoneal fibrosis is generally held to be uncommon. Its etiology is unknown. The disease continues to present with early bilateral ureteric involvement. Nowadays imaging techniques permit so a timely diagnosis to preserve and reduce renal damage. The optimum method of management is still controversial. Controversies on pharmacological, endourological and surgical treatment are debated. The advantages of various types of surgery are reviewed. In the urological department of the Civic Hospital in Brescia from February 1984 to June 1992, 87 patients (6 females and 2 males) with IRP were observed. Surgical treatment was combined with corticosteroids in 6 patients. Ureterolysis was performed with omental wrapping in 5 patients, with ureteric intraperitonealisation in 2 other ones. In the last case an ileal loop replacement was performed. In 5 out of 8 patients the ureteral stricture was resected and a termino-terminal anastomosis was necessary. Long-term follow-up is satisfactory. The authors conclude that omental wrapping is the safest method of choice.

We relate our experience about ureteritis, especially non specific ureteritis. The traumatic, radiation ureteritis will be discussed in others chapters. Most cases of ureteritis are infective, and may be due to any of the organism normally found in urinary tract infections, particularly Escherichia Coli, staphylococci, streptococci, enterococci, proteus and pyocyaneus. It is really primary, but it usually ascending from an associated cystitis, descending from pyelonephritis, or due to direct spread from and adjacent inflammatory lesion such as appendicitis or salpingitis. The infection may also reach the ureter by lymphatic spread, particularly from the prostate and seminal vesicles. Any associated abnormalities of the ureter, such as stricture, megaloureter, ureterocele, and so on, will naturally predispose to infective ureteritis. As ureteritis is rarely primary, the first step in treatment must be toward the elucidation and cure of any underlying lesion. Thus calculi, cystitis, pyelitis, and so on, will need appropriate therapy, and this in itself will considerably improve or cure the ureteritis, and specially in the more acute cases. In the chronic cases with stricture formation, dilation or even excision of the stenosed portion may be required. For the treatment of the strictures we want emphasize the role of the ureteral stenting thinking its use is necessary to preserve the renal function.

From 1983 to 1992, 29 patients with primitive ureteral tumors have been recovered in our department. All the tumors were urothelial. Urography, spontaneous and selective urinary cytology, retrograde ureteropyelography permitted a correct diagnosis in 86% of them. Ureteroscopy is not performed routinely but only when conventional radiology is doubtful or a conservative treatment can be proposed. Controlled trials on endoscopic therapy of ureteral tumours are very few and even if our results are encouraging we believe that this therapeutic option is effective and safe only in selected case and nephroureterectomy is the treatment of choice.

Ureteral pathology is reviewed in 297 urinary diversions, which were performed consecutively in our Department, in the last 9 years. Either cutaneous or intestinal anastomosis stricture was the most common complication. Our attempts to cure definitely this problem by endourological techniques were unsatisfactory. So the Authors conclude that surgery is usually the best option.