[Extrasinusal ureterocaliceal anastomoses. Review of 27 cases (author's transl)]

Extrasinusal ureterocaliceal anastomoses have been conducted in 27 patients, 21 adults and 6 children, in the Urological Clinic of the Hôpital Necker over the last 10 years. Principal indications, of much greater importance than tuberculosis, are pyelocaliceal lithiasis and certain anomalies of the pyeloureteral junction. In 15 cases, the operation was first choice therapy, while in the other 12 patients it was employed to treat a postoperative cicatriceal stenosis of the subpyelic portion of the ureter. "Peripheral" ureterocaliceal anastomosis (the ureter is sutured to a section of a calyx opened by partial nephrectomy) was carried out in 21 cases, and a "central" anastomosis, suturing the ureter to the base of a calyx after partial nephrectomy, in the 6 others. The most effective drainage method, employed in 14 patients without secretion leak, was nephrostomy at the side of a ureteral sound intubating the anastomosis. The two main postoperative complications were early anastomosis stenosis (6 cases), requiring a repeat operation, and fistulae necessitating prolonged ureteral drainage. Results have remained constant, and of the 25 cases followed up for an average of 2 years, 19 are still perfectly satisfactory (3 of these patients had had repeated ureterocaliceal anastomoses). Results were better after first than second choice ureterocaliceal anastomoses. It should logically be performed as the initial operation, therefore, when required because of the existing pathological condition: destroyed or inaccessible renal pelvis, inability to use the subpyelic portion of the ureter, or very marked pyelocaliceal distension requiring dependent drainage.