B. Reisch

[Ureteric reconstruction with reconfigured ileal segments according to Yang-Monti. A 4-year prospective report].

BACKGROUND We report on 4 years experience with ileal ureteric replacement using the Yang-Monti procedure. PATIENTS AND METHODS From April 2001 to January 2009 reconfigured ileal segments were used for total (in 16) or partial (in 2) substitution of the ureter in 18 patients (mean age 47.4 years) with functional ureteric loss secondary to radiogenic or iatrogenic conditions. An antireflux implantation into the native bladder was done in 16 patients. All patients were followed prospectively according to a standardized protocol. RESULTS The mean follow-up was 4.2 years (0.5-8 years). There were no perioperative deaths. Ultrasound controls showed an improvement of the upper tract dilatation in 11, a constant finding in 5 and a worsening in 2 cases. All of the treated renal units had evidence of improved renal function in ten and stabilization in eight patients. Neither a metabolic complication nor mucous obstruction was observed. Minor short-term complications, mainly febrile urinary tract infection and paralytic ileus, occurred in 50% and long-term complications, infections and hernia in 22%. CONCLUSIONS The ileal ureteral substitute with reconfigured segments offers distinct advantages. A short bowel segment is used with the consequent absence of metabolic complications and excessive mucous production. It allows construction of an ileal ureter with a suitable cross-sectional diameter without any need for tailoring and makes it possible to use an antireflux technique. The intermediate results are encouraging.

Harnleiterrekonstruktion mit rekonfigurierten Ileumsegmenten nach Yang-Monti

BACKGROUND We report on 4 years experience with ileal ureteric replacement using the Yang-Monti procedure. PATIENTS AND METHODS From April 2001 to January 2009 reconfigured ileal segments were used for total (in 16) or partial (in 2) substitution of the ureter in 18 patients (mean age 47.4 years) with functional ureteric loss secondary to radiogenic or iatrogenic conditions. An antireflux implantation into the native bladder was done in 16 patients. All patients were followed prospectively according to a standardized protocol. RESULTS The mean follow-up was 4.2 years (0.5-8 years). There were no perioperative deaths. Ultrasound controls showed an improvement of the upper tract dilatation in 11, a constant finding in 5 and a worsening in 2 cases. All of the treated renal units had evidence of improved renal function in ten and stabilization in eight patients. Neither a metabolic complication nor mucous obstruction was observed. Minor short-term complications, mainly febrile urinary tract infection and paralytic ileus, occurred in 50% and long-term complications, infections and hernia in 22%. CONCLUSIONS The ileal ureteral substitute with reconfigured segments offers distinct advantages. A short bowel segment is used with the consequent absence of metabolic complications and excessive mucous production. It allows construction of an ileal ureter with a suitable cross-sectional diameter without any need for tailoring and makes it possible to use an antireflux technique. The intermediate results are encouraging.

Lichen sclerosus mit Meatusstenose

A novel technique is reported to relieve stenosis of the external urinary meatus in men and boys with lichen sclerosus. A total of 21 patients underwent the new operation of Malone in a 4-year period. The mean patient age was 41.7 years (range: 7-75 years) and mean follow-up was 3.4 years (6 months to 4.1 years). The procedure combines a small ventral with an extensive dorsal meatotomy and ends with an inverted V-shaped relieving incision to correct puckering caused by dorsal meatotomy. Patients were mailed a questionnaire asking if they were pleased with the functional and cosmetic results There were no complications or recurrences. A total of 18 patients replied to the questionnaires. All patients were pleased with the functional and 15 were satisfied with the cosmetic results. The technique relieves stenosis of the external urinary meatus in the short term.It is rapid and easy to perform, avoids a hypospadiac meatus and provides good results.

Rekonstruktion des Harntraktes nach intestinaler Fistel

Bei der oben genannten Patientin erfolgte aufgrund eines 1985 diagnostizierten linksseitigen Ovarialkarzinoms eine explorative Längslaparotomie mit anschließenderadjuvanterRadiatio. ImDezember 2016 wurde die Patientin notfallmäßig in einer auswärtigen chirurgischen Abteilung wegen einer spontanen Perforation des terminalen Ileums mit begleitender Peritonitis behandelt. Hierbei wurde das betroffene Darmsegment reseziert, die histologische Begutachtung ergab den Nachweis einer floriden Entzündung. Ein erneuter KrankenhausaufenthalterfolgteeinJahrspätermit zunehmenden Flankenschmerzen rechts und undulierendem Fieber. Bei sonographisch nachgewiesener zweitgradiger Nierenbeckenkelchektasiewurdenotfallmäßig eine innereHarnleiterschiene eingelegt. In der weiterführenden Diagnostik zeigte sich ein 7× 2cm großer retroperitonealer Abszess (. Abb. 2). Der Versuch einer radiologischen Punktion mit Entlastung gestaltete sich jedoch frustran. Eine weitere operative Sanierung wurde auswärts nicht angestrebt.

Harnleiterrekonstruktion mit rekonfigurierten Ileumsegmenten nach Yang-Monti@@@Ureteric reconstruction with reconfigured ileal segments according to Yang-Monti: Prospektiver 4-Jahres-Bericht@@@A 4-year prospective report

BACKGROUND We report on 4 years experience with ileal ureteric replacement using the Yang-Monti procedure. PATIENTS AND METHODS From April 2001 to January 2009 reconfigured ileal segments were used for total (in 16) or partial (in 2) substitution of the ureter in 18 patients (mean age 47.4 years) with functional ureteric loss secondary to radiogenic or iatrogenic conditions. An antireflux implantation into the native bladder was done in 16 patients. All patients were followed prospectively according to a standardized protocol. RESULTS The mean follow-up was 4.2 years (0.5-8 years). There were no perioperative deaths. Ultrasound controls showed an improvement of the upper tract dilatation in 11, a constant finding in 5 and a worsening in 2 cases. All of the treated renal units had evidence of improved renal function in ten and stabilization in eight patients. Neither a metabolic complication nor mucous obstruction was observed. Minor short-term complications, mainly febrile urinary tract infection and paralytic ileus, occurred in 50% and long-term complications, infections and hernia in 22%. CONCLUSIONS The ileal ureteral substitute with reconfigured segments offers distinct advantages. A short bowel segment is used with the consequent absence of metabolic complications and excessive mucous production. It allows construction of an ileal ureter with a suitable cross-sectional diameter without any need for tailoring and makes it possible to use an antireflux technique. The intermediate results are encouraging.

[Lichen sclerosus in conjunction with meatal stenosis. Prospective 4-year report on meatotomy according to Malone].

A novel technique is reported to relieve stenosis of the external urinary meatus in men and boys with lichen sclerosus. A total of 21 patients underwent the new operation of Malone in a 4-year period. The mean patient age was 41.7 years (range: 7-75 years) and mean follow-up was 3.4 years (6 months to 4.1 years). The procedure combines a small ventral with an extensive dorsal meatotomy and ends with an inverted V-shaped relieving incision to correct puckering caused by dorsal meatotomy. Patients were mailed a questionnaire asking if they were pleased with the functional and cosmetic results There were no complications or recurrences. A total of 18 patients replied to the questionnaires. All patients were pleased with the functional and 15 were satisfied with the cosmetic results. The technique relieves stenosis of the external urinary meatus in the short term.It is rapid and easy to perform, avoids a hypospadiac meatus and provides good results.

Lichen sclerosus mit Meatusstenose@@@Lichen sclerosus in conjunction with meatal stenosis: Prospektiver 4-Jahres-Bericht über die plastische Meatotomie nach Malone@@@Prospective 4-year report on meatotomy according to Malone

A novel technique is reported to relieve stenosis of the external urinary meatus in men and boys with lichen sclerosus. A total of 21 patients underwent the new operation of Malone in a 4-year period. The mean patient age was 41.7 years (range: 7-75 years) and mean follow-up was 3.4 years (6 months to 4.1 years). The procedure combines a small ventral with an extensive dorsal meatotomy and ends with an inverted V-shaped relieving incision to correct puckering caused by dorsal meatotomy. Patients were mailed a questionnaire asking if they were pleased with the functional and cosmetic results There were no complications or recurrences. A total of 18 patients replied to the questionnaires. All patients were pleased with the functional and 15 were satisfied with the cosmetic results. The technique relieves stenosis of the external urinary meatus in the short term.It is rapid and easy to perform, avoids a hypospadiac meatus and provides good results.