[Trans-ureteral pyelostomy: 5 cases]

The authors report 5 cases of extensive loss of substance of the distal ureter due to radiation fibrosis, operative trauma or tumour invasion; these lesions occurred during the course of a genital tumour in 4 cases and rectal prolapse in one case. The lesion was bilateral and radiation-induced in 2 cases and unilateral in 3 cases. The patients presented with renal colic in 2 cases, renal failure in 1 case and infection in 2 cases (pyelonephritis, septic shock). All patients presented with secondary hydronephrosis. The extent of the lesions made vesical anastomosis impossible, especially as the bladder was irradiated and/or absent in 3 cases. Anastomosis of the proximal ureteric stump onto the contralateral ureter was impossible in the presence of bilateral lesions requiring diversion of the contralateral ureter or due to the short donor ureter, or because of the discordant diameter of the two ureters. Transureteropyelostomy was therefore performed in these 5 cases. The postoperative course was uneventful 4 cases, with a transient anastomotic fistula in only one case. Four of the 5 patients achieved long-term survival with an excellent clinical and radiological result.