Journals / Üroloji Bülteni / 1999 / Cilt: 10 - Sayı: 2
The use of various reconstructive techniques in urinary undiversion
- Journal
- Üroloji Bülteni
- Pages
- 103–108
- DOI
- —
Abstract
Contemporary reconstructive techniques made undiversion possible for many previously diverted patients. The present study reviews the experience of our clinic on urinary undiversion. Of the 21 patients with permanent supravesical diversion, 14 with a mean age 8.9 years were suitable for undiversion. All patients had hydronephrosis or persistent vesicoureteral reflux. Posterior urethral valve or neurogenic bladder was the primary problem leading to urinary diversion in 8 patients. After a detailed preoperative evaluation, various reconstructive techniques including ureteroneocystostomy, ileocystoplasty, Mitrofanoff procedure, transureteroureterostomy, ureteral remodelling, gastrocystoplasty, ileal ureter replacement, and ■ artificial urinary sphincter were used in the undiversion processes. The mean follow-up period was 47.6 months, and no patient needed rediversion. Renal functions remained stable in all, except two cases. The urine storage at lower pressures and timed voiding were achieved in all. In conclusion, urinary undiversion seems feasible in many previously diverted patients. We believe that careful patient selection, detailed preoperative evaluation and liberal use of appropriate reconstructive techniques as well as long term close follow-up are essential for a successful outcome.
Özet
Yeni rekonstruktif tekrijkjer diversiyonlu hastalarda uriner devamliligin tekrar saglanmasina olanak saglamistir. Bu calisrnada, bir merkeze ait andiversiyo'n deneyimi sunulmaktadir. Supravezikal diversiyonlu 21 hastadan yas ortalamasi 8.9 yil o|an 14'Qne andiversiyon uygulandi. Diversiyon sirasinda hastalann tumunde hidroureteronefroz ve/veya tekrarlayan vezikoureteral reflu vardi. Diversiyon nedeni olgulann 8'inde posterior uretral valv veya norojenik mesane idi. Diversiyon tipi cogund^a lup ureterpkutaneostomi idi. Andiversiyon gerekcesi 9ogunlukla sosyal veya tekrarlayan uriner infeksiyo^oldu. Detayli preoperatif degerlendirme yapildi. Andiversiyon sirasinda veya izlem boyunca gerekli olgularda ureteroneosistostomi, ileal ogmentasyon, Mitrofanoff proseduri), transtireteroureterostomi, valv ablasyonu, iireteral remodeling, gastrosistoplasti, ileal ureter ve artifisyel uriner sfinkter uygulandi. Ortalama 47.6 aylik izlem suresince rediversiyon gerekmedi. Renal fonksiyonlar iki hasta disinda stabil seyretti. Hepsinde du§uk basincli idrar depolama ve duzenli bosaltma saglandi. Bu ?ali§ma, diversiyonlu hastalann gogunda andiversiyonun mumkun oldugunu gostermektedir. Hasta segiminde dikkatli olunmasi ve andiversiyon sirasinda veya izlem boyunca uygun rekonstruktif yontemlerin odun vermeksizin kullanilmasi yaninda, hastalarm sabirla yakindan takibi, basarimn ko§ullandir.