Late urologic complications in aorto-iliac reconstructions.

ABSTRACT

Aortoiliac reconstructive hydroureteronephrosis after surgery may be due to an incorrect position of the .0.prosthesis, anteriorly to the ureter, to a reactive retroperitoneal fibrosis or to a sclerotic outcome caused by vessel and ureter dissection. It is important to consider the possible correlation of hydronephrosis with recurrent prosthetic infections, both as a consequence and as a pre-existing cause of the infective process itself. In the present study, 100 patients were examined, all affected with chronic peripheral obstructive arterial disease and operated on for aortoiliac reconstruction by the same surgeon. A clinical, laboratory and echographic study was performed, after a follow-up period from surgery ranging between 23 and 146 months (72 months on average). Four of them (4%) showed unilateral hydronephrosis, always asymptomatic and resulting from a retroperitoneal fibrosis. When hydronephrosis was moderate or severe, an intravenous pyelography was performed. Only one patient required ureterolysis and "wrapping" of the ureter with adipose tissue, and insertion of an indwelling ureteral catheter, due to marked hydronephrosis and a reduction in the diameter of contralateral kidney. From this retrospective study, the opportunity and the prognostic importance of a perspective study of the patients undergoing aorto-iliaco-femoral reconstruction for an obstructive or aneurysmal disease is evidenced.