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Related Experiment Videos

Renal function in the setting of urinary diversion.

Axel Kristjansson1, Wiking Mansson

  • 1Department of Urology, Landspitali University Hospital, Reykjavik, Iceland.

World Journal of Urology
|September 2, 2004
PubMed
Summary

Urinary tract reconstruction using bowel carries risks to the upper urinary tract, including kidney damage. Lifelong monitoring is essential for patients with continent or non-continent urinary diversion.

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Area of Science:

  • Urology
  • Nephrology
  • Surgical Innovation

Background:

  • Urinary tract reconstruction incorporating bowel segments can lead to upper tract complications like obstruction, reflux, and chronic bacteriuria.
  • Previous assessments of renal function often relied on inadequate methods such as intravenous pyelography (IVP) and serum creatinine.
  • Long-term studies of ileal conduit diversion show a high rate of kidney damage, often associated with refluxing ureteric implantation techniques.

Purpose of the Study:

  • To evaluate the impact of different ureteric implantation techniques (refluxing vs. antirefluxing) on upper urinary tract health in patients undergoing continent urinary diversion.
  • To highlight the need for improved methods for assessing renal function in these patients.
  • To emphasize the importance of long-term surveillance for upper tract integrity.

Main Methods:

  • Review of existing literature on renal function following various urinary diversion techniques, including ileal conduit, continent cutaneous diversion, and orthotopic bladder substitution.
  • Analysis of reported outcomes related to ureteric implantation techniques (refluxing vs. antirefluxing) and their association with upper tract complications.
  • Discussion of the limitations of traditional renal function assessment methods.

Main Results:

  • While some recent studies suggest preserved glomerular filtration rates with refluxing techniques in specific continent diversions, high pouch pressures and common bacteriuria remain concerns.
  • Traditional antirefluxing techniques have been standard, but a trend towards refluxing anastomosis is emerging.
  • The long-term consequences of refluxing anastomosis in continent urinary reconstruction are largely unknown, necessitating caution.

Conclusions:

  • The potential for upper urinary tract damage necessitates careful consideration of ureteric implantation techniques in urinary reconstruction.
  • Prospective randomized controlled trials are crucial to definitively compare refluxing versus antirefluxing anastomosis in continent urinary reconstruction.
  • Lifelong follow-up of the upper urinary tract is imperative for all patients with continent or non-continent urinary diversion.

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