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Transcolonic retrograde ureteric catheterization assisted by 3-D computed tomography.
1Department of Radiology, Gold Coast Hospital, Southport, Queensland, Australia. tom_snow@yahoo.com
Australasian Radiology
|July 21, 2000
Summary
This case study explores managing recurrent hyperammonaemia in a bladder exstrophy patient. Urine diversion via transcolonic catheterization successfully reduced ammonia levels.
Area of Science:
- Urology
- Nephrology
- Metabolic Disorders
Background:
- Bladder exstrophy is a rare congenital condition requiring complex surgical management.
- Ureterocolic anastomosis for urine diversion can lead to metabolic complications like hyperammonaemia.
- Recurrent hyperammonaemia poses significant risks, including coma, necessitating effective management strategies.
Observation:
- A 42-year-old female with a history of bladder exstrophy presented with recurrent hyperammonaemia and comas.
- The patient had previously undergone ureterocolic anastomosis for urine diversion and refused an ileal conduit.
- Computed tomography ureterography was crucial for visualizing the ureterocolic anastomosis.
Findings:
- Transcolonic retrograde catheterization of the ureter was successfully performed for urine diversion.
- This novel approach was only feasible after detailed anatomical visualization via CT ureterography.
- The urine diversion procedure was implemented to assess its efficacy in reducing hyperammonaemia.
Implications:
- This case demonstrates a potential alternative urine diversion technique in complex urological cases.
- Successful urine diversion may offer a strategy to manage hyperammonaemia in select patients with bladder exstrophy.
- Further research is warranted to evaluate the long-term outcomes and applicability of this method.