OPERATIVE TECHNICS AND THEIR INDICATIONS IN POSTOPERATIVE AND POSTIRRADIATION URETERAL LESIONS (in Spanish)
Urinary tract damage of radiotherapeutic origin is the cause of uremia and death in approximates 40% of cancer patients who have presumably been cured of their primary disease. Uterine cancer treated by irradiation or hysterectomy, with lymphadenectomy, frequently brings about a sclerotic transformation of subperitoneal tissue giving rise to ureteral compression, complex fistulae, and other urinary symptoms. Ureteral obstruction has also been observed after radium application or x-ray therapy in benign processes, e.g., uterine fibromyomatosis. It has been proven that the ureter is much more vulnerable to irradiation after a total hysterectomy has been performed because disection around the ureter deprives it of its vascular, lymphatic, and nervous connections. Secondary ureteral lesions caused by irradiation should be treated by ureteroileoplasty and only exceptionally by the Boari operation. Ureteroileoplasty is indicated for the following conditions: stenosing periureteritis due to fibrosclerosis of retroperitoneal tissue; and radiotherapeutic sequelae with damage to the ureter extending beyond 9 cm. The small intestine has all the necessary qualifications to make it an ideal substitute for the damaged ureter. Its caliber is appropriate and its contraction wave is similar in amplitude and frequency. A necessary requisite for its adequate function is the correct placement of the graft to insure occurrence of peristalsis in the requlred direction. A new modification of an older technique has been used, and is described, which corrects its inadequacies. For bilateral ureteral repair, a U-shaped loop of ileum is joined to the upper remnants of the two damaged ureters by its two ends, and to the bladder in its middle section. To correct the right antiperistaltic position of the right-half loop, lateral invaginations are provided at different levels. These provide a valvular action, which on micturition prevents upward reflux. The urine column on colliding with the walls of these valves produces an antiperistaltic wave that moves the refluxed urine back to the bladder. The loop, which should not be excessively long, is fixed to the posterior peritoneum. Ureteroileal anastomoses are situated extraperitoneally. Bilateral ureteroileoplasty, as described here, is a simple operation without complications and gives consistently good results. It also allows the radiotherapist to use max sclerosing radiation doses without causing postradiation urinar complications of possible fatal outcome. (BBB)
- Research Organization:
- Facultad de Medicina, Barcelona
- NSA Number:
- NSA-17-038777
- OSTI ID:
- 4645492
- Journal Information:
- Cir. Ginecol. Urol., Journal Name: Cir. Ginecol. Urol. Vol. Vol: 16
- Country of Publication:
- Country unknown/Code not available
- Language:
- Spanish
Similar Records
Ureteral peristalsis in pediatric urology
Therapeutic ureteral occlusion in advanced pelvic malignant tumors