17 URETEROCALICOSTOMY FOR THE TREATMENT OF SELECT CASES OF URETEROPELVIC JUNCTION OBSTRUCTION

Abstract

INTRODUCTION AND OBJECTIVES: Hydronephrosis can be a serious complication of aortic reconstructive surgery, presenting in early or late postoperative period. The incidence and treatment tactics for this infrequent complication are still debated in literature. Our study tries to answer these questions. METHODS: 450 patients following aortofemoral and aortoiliac reconstruction were included. There were 382 (84.9%) males and 68 (15.1%) females with a median age of 65.7 8.3 years. Patients were investigated preoperatively and at 1 week, 3, 6 and 12 months after vascular surgery. Two urologists performed clinical and ultrasound examination, intravenous pyelograms assessment. Patients with preoperatively diagnosed urological pathology were not included into this study. RESULTS: We revealed unilateral hydronephrosis in 8.0% (36/ 450) of patients. 83.3% (30/36) of them had a history of aortic aneurysm resection with aortofemoral bypass grafting and 16.7% (6/36) underwent aortofemoral bypass only (p 0.05). There were 44.4% (16/36) patients with mild obstruction and 55.6% (20/36) patients with extensive ureteral strictures. The mild asymptomatic obstruction resolved spontaneously following 1 month of observation. Patients with late (6–12 months) obstruction developed ureteral strictures and required for active management. They underwent ureterolysis and ureteral resection with ureteroureterostomy. Four of them developed stricture relapse postoperatively. Intraureteral metallic self-expanding endoprosthesis placement was performed to eliminate the obstruction in 3 cases. One patient with obliteration of ureter underwent subcutaneus nephrovesical bypass. CONCLUSIONS: Ureteral obstruction can be a serious complication of reconstructive aortic surgery. This especially concerns to aneurysms of abdominal aorta and patients with graft complications. Early mild asymptomatic obstruction may resolve spontaneously or require ureteral stenting. Late hydronephrosis may contribute to retroperitoneal fibrosis associated with periureteral inflammatory process and extensive ureteral strictures. Intraureteral metallic self-expanding endoprosthesis or subcutaneus nephrovesical bypass placement can be appropriate in patients with contraindications to open reconstructive surgery.