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Urological Emergencies in Clinical Practice - part 5

Nước tiểu thoát nước tạm thời có thể đạt được vị trí của một nephrostomy qua da, và nếu có một urinoma ý nghĩa thể hiện bởi CT hoặc siêu âm, điều này có thể được lấy dưới da bởi một bác sĩ quang tuyến. | 72 J. REYNARD iatrogenic ureteric injuries in 43 patients 28 65 of whom underwent definitive repair within 6 weeks of injury. Delayed Treatment Temporizing Procedures Temporary urine drainage may be achieved by placement of a percutaneous nephrostomy and if there is a significant urinoma demonstrated by CT or ultrasound this can be drained percuta-neously by a radiologist. If the patient is too unstable for definitive repair you may insert a nephrostomy on the operating table by opening the renal pelvis and inserting it from inside out . However this can take a considerable amount of time which you may not have in a shocked patient. In such cases tie the ureter off at the site of the leakage with a long nonabsorbable suture. This allows dilatation of the ureter so your interventional radiologist can subsequently place a nephrostomy tube under x-ray control a day or so later. The nonabsorbable suture allows easier identification of the ureter when you later come back for definitive repair. Definitive Treatment The options include JJ stenting Primary closure of partial transection of the ureter Direct ureter to ureter anastomosis primary ureteroureterostomy Reimplantation of the ureter into the bladder ureteroneocys-tostomy either using a psoas hitch or a Boari flap Transureteroureterostomy Autotransplantation of the kidney into the pelvis Replacement of the ureter with ileum Permanent cutaneous ureterostomy Nephrectomy JJ Stenting For some injuries JJ stenting may be adequate for definitive treatment particularly where the injury does not involve the entire circumference of the ureter and continuity therefore is maintained across the region of the ureteric injury. In situations where a ligature has been applied around the ureter and this has been immediately recognised such that viability of the ureter has probably not been compromised the ligature should be removed and a JJ stent should be placed cystoscopically if this is feasible or if not by opening the bladder