Ureterosigmoid Anastomosis Research Articles

Наблюдение развития рака сигмовидной кишки после уретеросигмостомии

Colonic neoplasia occurring in an uretero-sigmoid anastomosis is a rare case of colon cancer in the clinical practice of Russian colorectal surgeons and urologists. The article presents a case of sigmoid adenocarcinoma causing obstructive pyelonephritis.

Asynchronous bilateral anastomosis site sigmoid colon cancer after ureterosigmoidostomy: a case report

BackgroundWe present a case of asynchronously occurring adenocarcinomas 29 and 36 years after ureterosigmoidostomy for bladder cancer, respectively, at both anastomosis sites.Case presentationA colonoscopy that was performed on a 69-year-old man because of bloody stool and an elevated carcinoembryonic antigen (CEA) level revealed a polypoid lesion at the right ureterosigmoid anastomosis site 29 years after the patient’s ureterosigmoidostomy. Endoscopic resection was performed, and the lesion was diagnosed as adenocarcinoma. Seven years later (36 years after ureterosigmoidostomy), an elevated lesion was detected at the left ureterosigmoid anastomosis site by colonoscopy performed after detection of high CEA levels. Biopsy revealed an adenocarcinoma that was immunohistologically positive for CDX2; sigmoidectomy and ureterectomy were subsequently performed. The pathological diagnosis of the second tumor was adenocarcinoma arising in the ureterosigmoid anastomosis site and invading the left ureter.ConclusionsDiligent long-term follow-up of patients who underwent ureterosigmoidostomy is essential.

Half Century of Followup After Ureterosigmoidostomy Performed in Early Childhood

We studied clinical outcomes, especially regarding colorectal adenocarcinoma, in patients who underwent ureterosigmoidostomy in early childhood between 1944 and 1961. A total of 25 consecutive patients underwent ureterosigmoidostomy at a mean age of 3.1 years. The most common indication for ureterosigmoidostomy was bladder exstrophy-epispadias complex. The study period ended in 2010. Patient files were retrospectively evaluated, personal telephone interviews were performed and colorectal histology was reevaluated. One girl who died 4 days postoperatively was excluded. Of the 24 patients 17 were alive in 2010 with a mean age of 59 years (range 48 to 67), and 2 still had a functioning ureterosigmoidostomy. A total of 20 patients with a mean age of 33 years had undergone re-diversion at a mean of 30 years postoperatively. Invasive colorectal adenocarcinoma developed in 7 patients and colorectal adenocarcinoma in situ in 1. Five patients died due to generalized colorectal adenocarcinoma. Mean time from ureterosigmoidostomy to diagnosis of invasive colorectal adenocarcinoma was 38 years (range 23 to 55). Three cases were diagnosed at 1, 21 and 25 years after re-diversion. One patient with colorectal adenocarcinoma in situ was 22 years old at polyp resection, which was 20 years after re-diversion. A carcinoid tumor developed in 1 patient. Of the 7 cases of invasive colorectal adenocarcinoma 6 were low differentiated. After a half century of followup in 25 individuals undergoing ureterosigmoidostomy during childhood 17 were still alive and 20 had undergone re-diversion. Compared to the general Swedish population, the risk of colorectal adenocarcinoma was increased 42 times and the incidence of low differentiation was extremely high.

Rectosigmoid Pouch (Mainz Pouch II) in Children

Continent anal urinary diversion is a therapeutic option in bladder exstrophy. We report our long-term results with the rectosigmoid pouch (Mainz pouch II), a modification of the classic ureterosigmoidostomy. A total of 38 children with a mean age of 5 years (range 0.5 to 17) underwent a Mainz pouch II procedure between 1991 and 2004. Most patients (33) had bladder exstrophy or incontinent epispadias. In 14 children (37%) urinary diversion was performed after failed primary reconstruction. In 6 children conversion was performed from an incontinent type of urinary diversion. Renal function, continence and metabolic changes were analyzed. A total of 35 children were followed for a mean of 112 months (range 5 to 147). All children were continent during the daytime but 3 (8.6%) suffered from nighttime incontinence requiring pads. With respect to the upper urinary tract, 6 children (15.8%) had development of pyelonephritis, mostly with stenosis of the ureterointestinal anastomosis. Reimplantation of the ureter was required in 10 of 69 RU (14.5%), of which 7 (10.1%) were due to ureterointestinal stenosis and 3 (4.3%) were due to reflux. Serum creatinine was within normal limits in all children. During followup acid-base balance was monitored, and early alkali supplementation was initiated in 24 of 35 children (69%) when the base excess was less than -2.5 mmol/l. One child had development of clinical acidosis requiring hospitalization. After followup of more than 10 years annual rectosigmoidoscopy was performed in 16 children/young adults without pathological findings. The Mainz pouch II procedure for children with genitourinary anomalies promises excellent continence rates. However, periodic followup studies are important to check the upper urinary tract and prevent metabolic acidosis. Due to the risk of malignancy at the ureterointestinal anastomosis, endoscopy should be performed annually beginning at postoperative year 10. The Mainz pouch II procedure is safe in the long term. Without stoma, appliance or catheterization this type of continent urinary diversion is specifically suitable for children.

Surgical repair of genital fistulae.

Genital fistula is one of the serious childbirth injuries that can occur among women in the developing countries. Complex fistulae still represent a challenging management problem. We report our experience of managing genital fistulae at the Aga Khan University Hospital (AKUH), Karachi, Pakistan. Eighty-seven women with genital fistulae were managed between January 1988 and December 2002. Sixty-eight cases were urogenital and 19 were rectovaginal fistulae. Three women had concomitant urogenital and rectovaginal fistulae. The position of patients for surgery and the route of repair were individualized according to the appropriate access to the fistulae. Of the 68 cases of urogenital fistulae, 54 were successfully repaired at first attempt. Three patients were cured at second repair. A success rate of 83.8% was achieved. Four patient with ureterosigmoid anastomosis and seven patients who were lost to follow-up, were considered as failures. All of the 19 rectovaginal fistulae (100%) closed after single repair. With an experienced uro-gynecologic team using conventional approach and meticulous repair, a high percentage of patients with genital fistulae can be rendered dry and continent.

Replacement of the urinary bladder

The problem of how to replace the funct ion of the urinary bladder when it has to be removed or has been rendered useless or dangerous by disease has been investigated by urological surgeons for over a century. Solutions initially included simple anastomosis of the ureters to the rectosigmoid colon I or the creation of simple intestinal conduits connect ing ureters to skin. More recently urologists have undertaken reconstruct ion of the bladder with intestinal segments, the formation of cont inent diversions (figure 1), or more complex types of ureterosigmoid anastomosis. 2 Work continues on more esoteric solutions, such as completely artificial bladders.

Endourologic Management of Ureterosigmoidostomy Anastomotic Stricture

A 47-year-old woman presented with a stricture of a ureterosigmoid anastomosis. After through-and-through access had been established from a nephrostomy tract to the anus, an Acucise cutting balloon catheter was positioned retrograde and used to incise the strictured area. Twelve months postoperatively, the patient is doing well. Monitoring for colon adenocarcinoma continues.

Induction of carcinoma at ureterosigmoid anastomosis--with and without faecal stream.

The induction of tumours at the site of uretero-intestinal anastomosis was investigated in Hannover: WISTAR rats. The rats were divided into 3 groups. In one group (n = 70) the ureter of the left kidney was implanted into the colon, using microsurgical techniques developed for humans. In 13% of the rats in this group benign tumours developed; in 16% malignant tumours occurred. In a second group (n = 76) the ureter was implanted into a rectal bladder; the faeces were excluded from the anastomosis by a descending colon anus praeter. In this group benign tumours developed in 17% and malignant tumours in 8%, all of them being situated at the site of the anastomosis. In a control group (n = 80) no colonic tumour could be identified.

Percutaneous Balloon Dilation of Ureteral Strictures after Failed Surgical Repair in Children

We attempted treatment of long-standing strictures of ureterovesical or ureterosigmoid anastomosis in 6 children by percutaneous balloon dilation. The 4 girls and 2 boys were between 2 and 19 years old (mean age 9 years) at the time of dilation. Obstruction occurred at the ureterosigmoid anastomosis in 3 patients and at the ureterovesical junction in 3. Obstruction was confirmed by diuresis renography, antegrade pyelography and pressure perfusion studies. An attempt at dilation was unsuccessful for 1 patient. For the remaining 5 patients the ureter has remained patent for a followup period of 7 to 18 months (mean 12 months).Percutaneous balloon dilation of established ureterointestinal and ureterovesical obstruction after failed surgical repair can be successful. The hospital stay is reduced and major surgery with its accompanying morbidity is avoided. If balloon dilation is unsuccessful, surgical repair remains an option. Balloon dilation should be seriously considered as an initial form of treatment in this group of patients.

The role of the colon in the pathogenesis of hyperchloraemic acidosis in ureterosigmoid anastomosis.

1. The composition of urine-faeces mixture in seven patients with ureterosigmoid anastomosis has been studied by a dialysis in vivo method using cellulose bags. Urine—faeces dialysate obtained from these patients contained much greater amounts of both bicarbonate and total ammonia than has been reported for faecal dialysate in normal subjects. 2. Total ammonia concentrations in urine– faeces specimens obtained by catheter suggest that urine excreted by the kidneys in these patients becomes increasingly acid with increasing systemic acidosis. The highly alkaline nature of urine-faeces mixtures, especially in acidotic patients, indicates rapid alkalinization of the mixture in the colon. It appears that colonic secretion of bicarbonate is a direct consequence of the acidity of urine excreted by the kidney and draining into the colon. 3. The study suggests that the development of hyperchloraemic acidosis in patients with ureterosigmoid anastomosis is due to bicarbonate secretion by the colonic mucosa, with concomitant chloride absorption. With the development of metabolic acidosis, rapid alkalinization of the urine still occurs in the colon, but during further retention of the urine-faeces in the colon some reabsorption of bicarbonate occurs, probably in part by ionic diffusion since chloride concentration in the lumen increases. 4. Evidence suggestive of non-ionic diffusion of ammonia was found in only one patient. It seems probable that higher rates of urea breakdown in other patients mask the expected relationship between total ammonia and bicarbonate.

EXSTROPHY OF THE BLADDER

Exstrophy of the bladder is the most common example of a spectrum of related anomalies. The pelvic skeletal changes in all of these disorders may vary in degree but are similar in type. The kidneys and urinary collecting systems are almost always normal in patients with untreated exstrophy, and the usual “hurley” appearance of the lower ureters should be regarded as a physiologically normal variant, not as indicative of significant ureterovesical obstruction. There are three main types of surgical therapy. Primary closure of the bladder remains the ideal to be aimed for. Unfortunately, diminished capacity of the bladder and incontinence are major problems, and there is a risk of malignancy of the bladder. Ureterosigmoidostomy and cystectomy constitute the second mode of therapy, and the one most widely accepted. Complications which must be carefully sought for by the radiologist include sigmoid-ureteral reflux and ureteric obstruction. The latter may be due to calculus, stricture, inflammation, polyp, or malignancy at the site of the ureterosigmoid anastomosis. Finally, urinary diversion by an ileal or colonic conduit may be undertaken if ureterosigmoidostomies are not possible or fail. Regardless of the type of surgical management, periodic (e.g., annual) intravenous urography is mandatory throughout the patient's life. Following ureterosigmoidostomies renal destruction and colonic malignancy are the two major threats to life. Radiology plays an extremely important role in their detection.

Follow-up of 13 children after ureterosigmoidostomy.

Follow-up of 13 children who had had a ureterosigmoid anastomosis 3 1/2 to 10 years previously and whose initial urogram had been satisfactory, showed that growth was normal and that there was no serious metabolic disorder. In particular whole-body potassium did not differ significantly from normal values (as given by Langham, 1961). Asymptomatic urinary infection is the chief hazard in these cases but is difficult to diagnose and may lead to progressive dilatation of the ureters.

The long-term management and social consequences of ureterosigmoid anastomosis.

It is regrettable that while the recognised complications of ureterosigmoid anastomosis - recurrent urinary tract infection, and acidosis- can be avoided and obstructive uropathy can be recognised early and so treated, the operation frequently condemns the patient to a restricted life with an unpleasant ritual of bowel frequency and incontinence. It seems that the lack of awareness of this bizarre life-style and the occasional true successes have allowed the operation to remain in use. Our experience confirms the unpredictability of the end result of ureterosigmoid anastomosis and suggests that the operation should be largely abandoned, in favour of the conduit type procedure.

Sigmoid Stenosis and Colonic Calculus: An Unusual Complication of Ureterosigmoid Anastomosis

Sigmoid Stenosis and Colonic Calculus: An Unusual Complication of Ureterosigmoid Anastomosis

Neoplastic Obstruction of the Ureterosigmoid Anastomosis

No AccessJournal of Urology1 Sep 1961Neoplastic Obstruction of the Ureterosigmoid Anastomosis Arjan D. Amar Arjan D. AmarArjan D. Amar More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)65171-1AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Neoplastic Obstruction of the Ureterosigmoid Anastomosis." The Journal of Urology, 86(3), pp. 334–335 © 1961 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited ByLeadbetter G, Zickerman P and Pierce E (2018) Ureterosigmoidostomy and Carcinoma of the ColonJournal of Urology, VOL. 121, NO. 6, (732-735), Online publication date: 1-Jun-1979.Parsons C, Thomas M and Garrett R (2018) Colonic Adenocarcinoma: A Delayed Complication of UreterosigmoidostomyJournal of Urology, VOL. 118, NO. 1 Part 1, (31-34), Online publication date: 1-Jul-1977.Rivard J, Bedard A and Dionne L (2018) Colonic Neoplasms Following UreterosigmoidostomyJournal of Urology, VOL. 113, NO. 6, (781-786), Online publication date: 1-Jun-1975.Mueller C and Thornbury J (2018) Adenocarcinoma of the Colon Complicating Ureterosigmoidostomy: A Case Report and Review of the LiteratureJournal of Urology, VOL. 109, NO. 2, (225-227), Online publication date: 1-Feb-1973.Oetjen L, Campbell J, Thomley M and Parsons R (2018) Carcinoma of the Colon Following Ureterosigmoidostomy: Report of a CaseJournal of Urology, VOL. 104, NO. 4, (536-537), Online publication date: 1-Oct-1970.Kozak J, Watkins W and Jewell W (2018) Neoplastic Stomal Obstruction: A Complication of UreterosigmoidostomyJournal of Urology, VOL. 96, NO. 5, (691-696), Online publication date: 1-Nov-1966.Amar A (2018) Squamous Cell Carcinoma of Ureteral Stump 40 Years After NephrectomyJournal of Urology, VOL. 91, NO. 4, (337-339), Online publication date: 1-Apr-1964. Volume 86Issue 3September 1961Page: 334-335 Advertisement Copyright & Permissions© 1961 by The American Urological Association Education and Research, Inc.MetricsAuthor Information Arjan D. Amar More articles by this author Expand All Advertisement PDF DownloadLoading ...

URETERO‐SIGMOID ANASTOMOSIS

Medical Journal of AustraliaVolume 1, Issue 24 p. 903-903 Current Comment URETERO-SIGMOID ANASTOMOSIS First published: 01 June 1961 https://doi.org/10.5694/j.1326-5377.1961.tb69301.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume1, Issue24June 1961Pages 903-903 RelatedInformation

Pregnancy after uretero-sigmoidal anastomosis.

Pregnancy after uretero-sigmoidal anastomosis.

Ureteroileal sigmoidostomy: Control of ureteral reflux in ureterosigmoid anastomosis

Basic problems inherent in ureterosigmoid anastomosis are discussed. A case report is presented describing the use of ureteroileal sigmoidostomy in a patient with far advanced carcinoma of the cervix with ureteral obstruction as a palliative maneuver to avoid permanent nephrostomy. The possibility of utilizing this type of anastomosis to decrease colonic ureteral reflux and ascending infection when the urinary stream is diverted to the colon is discussed and its merits considered.

Substitute for urinary bladder.

Occasionally it becomes desirable to develop a new outlet for urinary drainage. The indications for such an operation are not numerous but have been increasing in scope with our ability to perform successfully more extensive and radical surgical resections. Currently the most commonly used procedure is ureterosigmoidal anastomosis; however, the incidence of obstruction and ascending infection among adults is high with this procedure, and at best it has not proved to be ideal. Surgeons have made numerous attempts in the past to create an artificial substitute for the bladder, hoping thereby to overcome difficulties inherent in the transplantation of the ureters to the bowel, which is left in continuity. Gilchrist described a procedure in which the terminal ileum and ascending colon were isolated and the ileocecal valve was utilized as a sphincter mechanism.1This report reviews the subject of substitutes for the urinary bladder and describes our experiences with

An Evaluation of Ureterosigmoid Anastomosis By Mucosa-to-Mucosa Method after Two and One-Half Years’ Experience

An Evaluation of Ureterosigmoid Anastomosis By Mucosa-to-Mucosa Method after Two and One-Half Years’ Experience