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Ureterosigmoidostomy and obstructive uropathy.

Ofer Yossepowitch1, Jack Baniel

  • 1Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. oferyoss@netvision.net.il

Nature Clinical Practice. Urology
|February 14, 2006
PubMed
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This study details a complex case of a young man with a history of bladder exstrophy repair and ureterosigmoidostomy who developed severe pyelonephritis. Management involved antibiotics, metabolic correction, and surgical rediversion to an ileal conduit.

Area of Science:

  • Urology
  • Pediatric Surgery
  • Nephrology

Background:

  • A 19-year-old male with a history of bladder exstrophy repair and ureterosigmoidostomy presented with symptoms of acute infection.
  • The patient had a prior left nephrectomy for a staghorn calculus in a compromised kidney.

Observation:

  • The patient presented with high fever, vomiting, and right flank pain, indicating acute pyelonephritis.
  • Physical examination revealed fever and tenderness in the right flank.

Findings:

  • Investigations included renal function tests, cultures, CT scan, and pyeloureterography.
  • The ureterosigmoidostomy was complicated by acute pyelonephritis, obstructive uropathy, recurrent urinary tract infections, renal impairment, renal stones, and metabolic acidosis.

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Implications:

  • Prompt diagnosis and management are crucial for patients with complex urinary diversions.
  • Surgical rediversion to an ileal conduit may be necessary to manage complications like pyelonephritis and obstructive uropathy.
  • This case highlights the long-term challenges associated with ureterosigmoidostomy and the importance of vigilant monitoring.