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[Urological problems related to aorto-bifemoral surgery (author's transl)]
Insights
Aorto-bifemoral bypass surgery can lead to significant urological complications, including infections and ureteric issues. Early visualization of the urinary tract and postoperative intravenous urography are crucial for patient management.
Area of Science:
- Urology
- Vascular Surgery
Context:
- Review of 400 patients undergoing aorto-bifemoral bypass between 1967 and 1980.
- Analysis focused on urological outcomes and complications.
Purpose:
- To assess the urological sequelae of aorto-bifemoral bypass surgery.
- To identify risk factors and recommend preventative measures for urological complications.
Summary:
- Renal artery lesions were found in 26.5% of patients.
- Postoperative urological morbidity was 24.9%, dominated by infectious (16%) and ureteric lesions (5%).
- Indwelling urethral catheter use was a key factor in infections; intravenous urography is vital for surveillance.
Impact:
- Highlights the importance of pre-operative urinary tract visualization during aortoiliac disease angiography.
- Emphasizes the necessity of intravenous urography for postoperative monitoring to detect conditions like hydronephrosis.
Abstract:
The authors reviewed, from a urological standpoint, the records of 400 patients undergoing aorto-bifemoral bypass between 1967 and 1980. Stenosing or aneurysmal lesions of the renal arteries were present in 106 patients, i.e. 26.5% of cases. 7% of the patients had previous pathology (2 lithiasis, 4 hydronephrosis and one non-functioning kidney). All the operations consisted of a bypass inserted posterior to the peritoneum and ureters. 39 patients (9.7%) underwent simultaneous surgery on the renal artery or vein, or the kidney, Amongst a total of 12% deaths, 1.5% were of renal causes. The postoperative urological morbidity was 24.9% being dominated by infectious lesions (16%) and ureteric lesions (5%). The majority of ureteric lesions took the form of progressive distension of the excretory apparatus. The presence of an indwelling urethral catheter was considered to be the most important factor in infection. The authors feel that it is essential to visualise the urinary tract at the time of angiographic investigation of aortoiliac disease. Amongst 18 cases of progressive dilatation of the upper urinary tract after such vascular surgery, only 3 underwent operation. Nevertheless, intravenous urography is an essential part of postoperative surveillance after surgery of this sort. Only 15% of their patients had undergone IVU and amongst them 18 were found to have a hydronephrosis.