Ureterocalicostomy: last resort in the treatment of certain forms of ureteropelvic junction stenosis. Report of 5 cases
Ben Slama, M.Riadh.; Zaafrani, R.; Ben Mouelli, S.; Derouich, A.; Chebil, M.; Ayed, M.
Progres en Urologie Journal de l'Association Francaise d'Urologie et de la Societe Francaise d'Urologie 15(4): 646-649
2005
ISSN/ISBN: 1166-7087 PMID: 16459679 Document Number: 592739
Iatrogenic stenoses of the ureteropelvic junction are now essentially treated by endoscopic techniques. However, conventional surgery is sometimes required to treat severe or extensive stenosis. The authors report the use of ureterocalicostomy to treat 5 patients with complex lesions. Between 2001 and 2003, the authors treated five patients with iatrogenic stenosis of the ureteropelvic junction. Two of these patients had a history of percutaneous nephrolithotomy and the other three had undergone conventional pyelotomy, complicated by pyelocaliceal avulsion in one case. The diagnosis was confirmed by double anterograde and retrograde opacification in four patients and intravenous urography in one patient. It was decided to perform ureterocalicostomy due to the extent of the lesions. Inferior ureterocalicostomy was performed after lower pole nephrectomy in all cases. The mean follow-up was 21 months (range: 20 to 27 months). Three patients had an uneventful postoperative course and satisfactory radiological follow-up. One patient rapidly developed stenosis that was treated successfully by endoscopy and another patient obtained a poor result requiring nephrectomy. Ureterocalicostomy requires laborious surgical dissection and meticulous ureterocaliceal anastomosis, but it is a useful technique in some cases of severe and extensive iatrogenic stenosis of the ureteropelvic junction.