Reconstructive microsurgery of the upper urinary tract.

The applications of microsurgery in the reconstruction of the injured ureter using a double-layer end-to-end anastomosis and in the repair of ureteropelvic junction obstruction using modified pyeloplasty techniques are described in detail. The advantages of the use of microsurgical techniques in reconstructive surgery of the upper urinary tract are elimination of routine urinary diversion, shorter duration of hospitalization and a higher success rate. Therefore, the application of microsurgery is cost-saving.

Renal autotransplantation for idiopathic retroperitoneal fibrosis.

Extensive loss of the ureter is a potential complication of surgery performed to relieve ureteral obstruction caused by retroperitoneal fibrosis. The authors describe the twelfth case managed successfully by renal auto-transplantation and review the literature.

[Diarrhea]. / Diarrhöe.

A 50-year-old female patient complained about watery diarrhea for two weeks. Because of back pain nonsteroidal antirheumatics had been prescribed for months before. The endoscopic and radiologic investigation demonstrated a large gastrocolic fistula due to NSAID-induced gastric ulceration and an acid-induced colitis in the transverse colon. Treatment consisted in partial gastric resection and resection of the transverse colon.

[Muscle weakness]. / Muskelschwäche.

A 61 year old man complained initially about pain in the left lower leg with increasing swelling of the entire left leg. A slight swelling of the left ankle and knee and an erythematous skin change of 5 cm diameter developed and disappeared after a few hours. Two days later the patient complained about a sudden and massive weakness of the proximal skeletal muscles, progressive disturbance of swallowing, hoarseness and dark red to bluish erythematous skin eruptions on the right knee and buttock. An elevated creatinine-kinase and lactate-dehydrogenase were found. Dermatomyositis was diagnosed and treatment with high dose steroids initiated. Under this treatment the patients condition deteriorated dramatically. A treatment with plasmapheresis and cyclophosphamide was begun. A significant improvement occurred over three weeks. The patient was discharged, rehabilitated and remains free of symptoms on 10 mg cortisone. A neoplasm has so far not been detected.

[Spontaneous kidney parenchymal rupture--etiology, symptoms, diagnosis and therapy]. / Die spontane Nierenparenchymruptur--Atiologie, Symptomatik, Diagnostik und Therapie.

Spontaneous rupture of the renal parenchyma with perirenal hematoma occurs rarely. A review was made of 85 cases published in the literature, including 2 of our own. Tumors were the most common cause followed by vascular diseases of the kidney. The most common symptoms were an acute onset of flank or abdominal pain (65%), microscopic or macroscopic hematuria (43%) and signs of hemorrhagic shock (33%). In all cases a tender flank and/or mass were palpable. Urography reveals a mass, distorted collecting system and/or non-visualization of the kidney. Nephrectomy when possible should be performed expeditiously since conservative therapy is uniformly unsuccessful and life-threatening.

[Spontaneous rupture of the kidney pelvis calix system--causes, diagnosis and therapy]. / Die Spontanruptur des Nierenbeckenkelchsystems--Ursachen, Diagnostik und Therapie.

The symptoms, diagnosis and management of the spontaneous non-traumatic rupture of the urinary collecting system are described. It is important to distinguish this frank rupture of the diseased renal pelvis from extravasation due to pyelosinusal or fornical backflow. Most cases of the latter variety are caused by acute calculous ureteral obstruction and observed during intravenous pyelogram with abdominal compression. They can be managed conservatively. Frank rupture of the renal pelvis are caused by an acute obstruction in a collecting system affected by infection, chronic obstruction, calculous erosion or tumor and is usually of grave significance and requires early surgical intervention. If the therapy is adequate, the prognosis seems to be favourable and nephrectomy seldom necessary.

[Use of microsurgery in the operative treatment of primary hydronephrosis]. / Anwendung der Mikrochirurgie bei der operativen Behandlung primärer Harnstauungsnieren.

Ureteropelvic junction obstruction is a congenital anomaly commonly afflicting the pediatric population, however, it is also more frequently than generally appreciated in the adult population. The method of postoperative urinary diversion - to divert by nephrostomy tube and/or splint or not to divert - was a matter of debate during the last twenty years. Through the application of microsurgery in pyeloplasty an external urinary diversion under commonly circumstances is not necessary. The Culp vertical flap pyeloplasty was modified by means of microsurgical instruments, ophthalmologic loupes (X 2, 6) and fine absorbable polyglactine sutures and used in 7 cases in 1984. The top of the flap is fixed in the distal ureteral incision by a U-shaped suture of 5-0 or 6-0 Vicryl followed by 2 continuous watertight sutures of the flap and the ureter and pyelon respectively. Only an extrarenal drainage for 4-8 days postoperatively was used. The mean duration of postoperative hospitalization was 10 days. The short-term radiographic, functional and clinical results after microsurgical pyeloplasty are excellent in 4 patients and good in 1 patient. The mean follow-up was only 4 months. Further experience, long-term follow-up and comparison with conventionally operated patients are necessary to evaluate the advantage of our microsurgical technique.

[Obstructive urine transport disorders of the upper urinary tract--pelvi-ureteral obstruction]. / Obstruktive Harntransportstörungen des oberen Harntraktes--die pelviureterale Obstruktion.

In the present paper a review is given on etiology, pathology, morphology and pathophysiology of ureteropelvic junction obstruction. According to own experience and a literature review the current diagnostic and therapeutic procedure are evaluated with respect to their clinical relevance.

[Obstructive disorders of urine transport in the upper urinary tract--vascular and inflammatory causes]. / Obstruktive Harntransportstörungen des oberen Harntraktes--Vaskuläre und entzündliche Ursachen.

Vascular and inflammatory causes of ureteral obstruction may be difficult in diagnosis and are recognized often too late. Symptoms, diagnostic approach and therapeutic measures are described in detail.

[Obstructive disorders of urine transport of the upper urinary tract--benign and malignant retroperitoneal fibrosis]. / Obstruktive Harntransportstörungen des oberen Harntraktes--Benigne und maligne Retroperitonealfibrose.

Our experience in diagnosis, treatment and follow-up course of patients suffering from benign and malignant retroperitoneal fibrosis are reported. Especially in idiopathic fibrosis the initial placement of percutaneous nephrostomy and long-term immunosuppression is the treatment of choice. In the follow-up ultrasonography and computerized tomography are valuable methods.

[Optimized follow-up after kidney pelvis-plasty using sonography and functional scintigraphy]. / Optimierte Verlaufskontrolle nach Nierenbeckenplastik durch Einsatz von Sonographie und Funktionsszintigraphie (FSG).

The results of the operative treatment in 33 patients suffering from pelviureteral obstruction and of the follow-up control using ultrasonography and renography are presented. A reduced radiation exposure and diminished treatment costs are the results of this changed diagnostic and therapeutic strategy.

[Percutaneous nephrostomy and temporary immunosuppression in treatment of idiopathic retroperitoneal fibrosis (Ormond disease)]. / Perkutane Nephrostomie und temporäre Immunsuppression in der Behandlung der idiopathischen Retroperitonealfibrose (M. Ormond).

Our experiences in the diagnostics, treatment and follow-up-course of 10 patients suffering from idiopathic retroperitoneal fibrosis are reported. The ureterolysis and temporary nephrostomy, initially as percutaneous nephrostomy, and a long-term immunosuppressive therapy is the treatment of choice. In the follow-up control ultrasonography and computerized tomography are valuable and the prognosis of the disease quoad functionem is good.

Management of ureteropelvic junction obstruction using a microsurgical technique.

The use of microsurgery in the treatment of 20 patients with ureteropelvic junction obstruction is described. The Culp-DeWeerd vertical flap pyeloplasty and the dismembered Anderson-Hynes technique were modified by means of microsurgical instruments, optical magnification and fine absorbable polyglactine sutures, described in detail and used in 11 and 8 cases, respectively. In a further patient a similar modified Kucera pyeloplasty was performed. The advantages of the application of microsurgical technique in reconstructive surgery of the renal pelvis and the ureter are the following: no routine use of urinary diversion; shorter hospitalization time; higher success rate, and a cost-saving therapy.

Disturbed urinary transport in the pelvi-calyceal system in calcium-oxalate stone patients.

This study is intended to elucidate the process of urinary transport through the pelvi-calyceal system (PCS). PCS-motility of a total of 28 PCS was qualitatively and quantitatively determined in 9 stone patients and 14 control persons by examination of contrast medium excretion. From X-ray videograms recorded by means of Siemens urography, four different urinary transport types could be distinguished as well as the duration of the contraction periods and the intervals between the PCS-contractions. In stone patients physiological types of urinary transport are less common (33%) than in control subjects (81.25%). In stone patients the PCS is often characterized by reduced or even absent motility. Calyceal reflux is usually found in the systolic phase of PCS-contractions, which may apparently be regarded as a physiological process.

[Experiences with new methods for the preoperative localization and surgical removal of complicated kidney calculi]. / Erfahrungen mit neuen Methoden zur präoperativen Lokalisation und operativen Entfernung komplizierter Nierensteine.

In a survey is described the inpatients suffering from urolithiasis of the urological clinic Berlin-Friedrichshain of the last three years from 1 April 1975 to 31 March 1978. Especially the cast calculi of the renal calyx were analysed and the therapeutic approach was discussed. For the complete removal of coral calculi in our clinic preoperatively made tomographies and adequate graphs of the cast concrement in its relation to the hollow system at two levels also stood the test as the intraoperative use of the X-ray device "Renodor". The two methods were described in detail. Also in multiple and movable concrements in the system of the renal calyx the Renodor stood the test. Here we could make good experiences also with the fibrin pyelolithothomy--the indications and results of these methods are represented.