RESUMEN
Peritonitis by fistulization of a pyonephrosis is an extremely rare complication usually diagnosed perioperatively. Treatment is by immediate or deferred nephrectomy after ensuring the functional condition of the contralateral kidney.
Asunto(s)
Cavidad Peritoneal/fisiopatología , Peritonitis/etiología , Pielonefritis/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Nefrectomía , Pielonefritis/cirugía , Rotura EspontáneaRESUMEN
Incrustations may develop on ureteral catheters and cause obstruction. We report a case in which obstruction was relieved by laser lithotripsy inside the lumen of the catheter. This completely noninvasive technique may prove to be useful in selected cases.
Asunto(s)
Terapia por Láser , Obstrucción Ureteral/terapia , Cateterismo Urinario/efectos adversos , Catéteres de Permanencia , Humanos , Litotricia/métodos , Litotripsia por Láser , Masculino , Persona de Mediana Edad , Obstrucción Ureteral/etiologíaRESUMEN
A new technique for electroincision of a strictured ureterointestinal anastomosis is described that uses a sphincterotome and high frequency current. After placement of a percutaneous nephrostomy tube a 7F "wire guided" sphincterotome was placed into the stenosis. The cutting wire was then deflected while cutting current was applied intermittently. Injection of contrast medium through the papillotome probe assessed the depth of the incision. A 10 mm. angioplasty balloon was inflated at low pressure to verify that the anastomosis had been incised to a depth of 1 cm. The anastomosis was then stented for 8 weeks with an 18F stent. The operative time did not exceed 45 minutes. A total of 9 stenoses was treated in 7 patients: 4 were ileal conduit diversions and 5 were enterocystoplasties. No immediate complication was observed. In 1 case a small urinoma was surgically drained at removal of the stent. Six stenoses are patent with 2, 3, 4, 4, 10 and 13 months of followup after removal of the stent. One patient died of bladder tumor metastases during the stenting period and 1 with bilateral incision still has a stent. The technique can be performed without major complication (bleeding or digestive fistula). Long-term results remain to be assessed.
Asunto(s)
Electrocirugia/métodos , Íleon/cirugía , Complicaciones Posoperatorias/cirugía , Obstrucción Ureteral/cirugía , Derivación Urinaria , Constricción Patológica/diagnóstico por imagen , Constricción Patológica/cirugía , Fluoroscopía , Humanos , Íleon/patología , Riñón , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico por imagen , Obstrucción Ureteral/diagnóstico por imagenRESUMEN
A new technique of electro-incision of ureteral stenoses and strictured uretero-enteric anastomoses is presented. Incision is performed with a papillotome, routinely used to achieve endoscopic retrograde sphincterotomy of the duodenal papilla. Group I: 7 ureteral stenoses were performed, on a dog model after surgical ligation of the lumbar ureter. Ten days later, through a percutaneous approach, the papillotome was placed through the stenosis, deflected, and cutting current was applied to incise the stenosis. The IVP performed one month later showed disappearance of the stenosis in 4 cases, a residual stenosis without obstacle in 2 cases and a residual stenosis with obstacle in one case. Group II: 7 strictured uretero-enteric anastomoses on 6 patients. After placement of a percutaneous nephrostomy, a wire guided papillotome was placed into the stenosis. Cutting current was then applied to cut the stenosis. A 18 F ureteral stent was subsequently placed for 8 weeks. Two patients have a patent anastomosis, 7 and 10 months after removal of the stent. One patient died from metastases of bladder tumor. The three remaining patients are still stented. An urinoma occurred in one patient the day following removal of the stent, and was surgically drained. This new technique which combines electro-incision and stenting with a large caliber stent may be proposed as an alternative to surgery or balloon dilatation for the treatment of strictured uretero-digestive anastomoses.