[Reconstructive surgery of obstructive disease of the upper urinary tract]

Efficacy of reconstructive surgery for the obstructive disease of the upper urinary tract was evaluated. Reconstructive surgery was performed in 75 units of the urinary drainage system of 72 patients between July, 1977 and December, 1987. 44 patients were male and 28 were female. The patients ranged in age 1 to 71, mean +/- S.D. being 43 +/- 14 years old. Original diseases were postoperative scar, scar due to the calculi, injury, retroperitoneal fibrosis, ureteritis, tuberculosis, amyloidosis and multiple ureteral diverticulum. The surgery consisted of ureterocalicostomy, renal descensus, descent of right renal vein, uretero-ureterostomy, ureteroneocystostomy (to the dome of the bladder), psoas bladder hitch and renal autotransplantation. Renal autotransplantation was chosen instead of ileal substitution to preserve the continuity of the urinary drainage system, when the upper urinary tract was extensively damaged. The obstructive change of the upper urinary tract improved or disappeared in 66 of 75 units. However, it persisted in 9 units, which were treated with ureterocalicostomy (wrong technics; in 4 units), ureteroureterostomy (wrong choice of the procedure; in 4 units) and autotransplantation (cessation of anti tbc drugs; in 1 unit). In 3 of these 9 units, additional reconstructive surgery was necessary. One patient who was treated with autotransplantation, died of massive bleeding from rupture of arterial anastomosis on 14th postoperative day. No other life-threatening complications were observed. Deterioration of the renal function was observed in two severely damaged kidneys which were performed autotransplantation, although the obstructive change of their urinary tract completely disappeared.(ABSTRACT TRUNCATED AT 250 WORDS)