Aktuelle Urologie · 2011
[The Importance of De- /Vascularisation of the Ureter during Reconstruction after Trauma].
Клинический случайАннотация на английскомСтатьяНазвание и аннотация: Перевод в очереди
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Аннотация
BACKGROUND: Serious errors may occur in the reconstruction of injured ureters if the degree of -devascularisation is not taken in account.
MATERIAL AND METHODS: The problems involved in ureter reconstruction after traumatic reconstruction are presented by means of two case -studies reviewed by the Expert Committee for Re-viewing Errors in Medical Treatment of the Ärztekammer Nordrhein.
RESULTS: In a 55-year-old man there was a persistent drainage disorder of the left kidney following implantation of a Y-prosthesis with "lateralisation of the ureter". Following renewed splint-ing of the ureter and percutaneous nephrostomy, operative ureterolysis with partial resection of the ureter and end-to-end anastomosis resulted in anastomostic necrosis with a ureter-skin fistula. Fol-lowing a renewed nephrostomy, the left kidney had to be removed because of considerable loss in function. In a 66-year-old woman with right-sided salpingo-oophorectomy and right-sided -colonectomy there was extensive devascularisation of the right ureter with complete -severance in the lower third. An emergency uretero-uretero anastomosis led to scar-induced stenosis of the anastomosed segment of the ureter. Following unsuccessful attemps at splinting, the ureter was reimplanted using the psoas hitch procedure. Because of a fistula to the small intestine, relaparotomy with segmental resection of the small intestine and opening of an abscess -because of wound infection were necessary. A satisfactory final result was obtained after about nine months.
CONCLUSIONS: When reconstructing damaged -ureters, numerous factors must be taken into account, e. g., the type, extent and location of the -damage to the ureter(s), the time of detection, the duration and severity of the sequelae for the kidney(s), the patient's concomitant condition and the suitability of the reconstruction procedure. Further-more, the degree of de- / vascularisation is of decisive impor-tance.
MATERIAL AND METHODS: The problems involved in ureter reconstruction after traumatic reconstruction are presented by means of two case -studies reviewed by the Expert Committee for Re-viewing Errors in Medical Treatment of the Ärztekammer Nordrhein.
RESULTS: In a 55-year-old man there was a persistent drainage disorder of the left kidney following implantation of a Y-prosthesis with "lateralisation of the ureter". Following renewed splint-ing of the ureter and percutaneous nephrostomy, operative ureterolysis with partial resection of the ureter and end-to-end anastomosis resulted in anastomostic necrosis with a ureter-skin fistula. Fol-lowing a renewed nephrostomy, the left kidney had to be removed because of considerable loss in function. In a 66-year-old woman with right-sided salpingo-oophorectomy and right-sided -colonectomy there was extensive devascularisation of the right ureter with complete -severance in the lower third. An emergency uretero-uretero anastomosis led to scar-induced stenosis of the anastomosed segment of the ureter. Following unsuccessful attemps at splinting, the ureter was reimplanted using the psoas hitch procedure. Because of a fistula to the small intestine, relaparotomy with segmental resection of the small intestine and opening of an abscess -because of wound infection were necessary. A satisfactory final result was obtained after about nine months.
CONCLUSIONS: When reconstructing damaged -ureters, numerous factors must be taken into account, e. g., the type, extent and location of the -damage to the ureter(s), the time of detection, the duration and severity of the sequelae for the kidney(s), the patient's concomitant condition and the suitability of the reconstruction procedure. Further-more, the degree of de- / vascularisation is of decisive impor-tance.
Предметные рубрики MeSH
AgedAnastomosis, SurgicalAortic Aneurysm, AbdominalBlood Vessel Prosthesis ImplantationColectomyExpert TestimonyFallopian TubesFemaleGermanyGuideline AdherenceHumansMaleMedical ErrorsMiddle AgedNephrectomyNephrostomy, PercutaneousOvariectomyPostoperative ComplicationsProsthesis ImplantationPlastic Surgery ProceduresReoperationRisk FactorsSurgical Wound InfectionUreter