Medicinski vjesnik, Vol. 33 No. (1-4), 2001.
Review article
Thirty years of enteroplastic urological surgery
Ruđer Novak
Antun Tucak
Abstract
During past thirty years (1960-1990) at the Urology Clinic of the University Hospital "Sisters of Charity" in Zagreb and Urology Clinic of the University Hospital Osijek, as well as at some other urological departments in our country, the total of 622 enteroplastic surgeries were performed - "enteroplastic operations" is an xpression we use in jargon for use of bowel during reconstructive urological procedures. The most frequently used procedure of that kind was reteroileostomy according to Bricker, and a total of 203 such operations were performed. The least frequently used procedure was substitution of the ureter by an isolated ileum segment (13 patients) and the newest one - the use of the hypotonic bowel instead of the urinary bladder, with self-modification (14 patients). The choice of the method, i.e. the type of the bowel used, as well as the position of the bowel segment in the pelvis, were being changed during the time, paralelly with our new notions and acquired experience. This has lead to some paradoxical revelations. For example, in the past, bowel segment hypotony was perceived as weakness of some substitution methods, and today, according to plan, precisely hypotonic bowel segment is being used. Common complications for all methods are hyperchloremic acidosis, ascending infection, chronical impairment of renal function, ureterointestinal stenosis, as well as the intestinorenal reflux at the same level. Intensity, as well as the frequency of the complications varies among certain methods, with a remark that nowadays we are more familiar with the prevention and control of those complications. The most frequent indication by far was urinary bladder carcinoma, right after that - the advanced malignant disease in the pelvis and the least frequent one were congenital anomalies of the lower urinary organs. Postoperative mortality varies from 0 (hypotonic bladder) to 13.6% in "sigmoid bladder". The most frequent cause of death was peritonitis after dehiscence of bowel suture. The majority of early complications occurred by "rectum-bladder" (15,9%), out of which the first place took the dehiscence of bowel suture. The majority of late complications occurred by ureterosigmoidostomy (72,8%) and they are for the most the electrolyte disorders and chronic urosepsis with renal insufficiency.
Keywords
Hrčak ID:
190607
URI
Publication date:
1.12.2001.
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