[Circumvallate nephro-cystostomy].

Abstract

Circumvallate nephro-cystostomy (CNC) provides a subcutaneous connection of a nephrostomy and a cystostomy catheter thus allowing spontaneous micturition. This procedure is suitable for those patients affected by an obstructive nephropathy where it was not possible to insert a double "J" stent or where surgical treatment was not allowed. Patients affected by debilitating disease benefit from these procedure by avoiding problems connected with daily handling of catheter, examples are medications at the insertion site or possible dislodgement of a nephrostomy catheter added to the psychological problems related to carry the urine collection bag. A number of 13 patients have been treated with this method, 5 had monolateral CNC, 8 had bilateral CNC for a total of 21 procedures. All but one cause of ureteral obstruction were neoplastic, the exception being a patient with necrosis of the ureter subsequent to major vascular surgery. CNC had a residence time ranging from 1, 5 to 25 months with an average of 9.8 months. Only in 2 cases it was necessary to remove CNC due to recurrent cystitis and orchitis due to bladder irritation by a cystostomy catheter and for an obstruction which could not be remedied in a patient with necrosis of the ureter. The most important complication, i.e. obstruction, occurred in 4 cases. In the above mentioned case CNC was removed after 9 months of proper performance. In the other 3 cases obstruction occurred after 2, 3, 18 months and in all this cases obstruction was easily removed. Besides obstruction only minor malfunctions were experienced and the procedure was very well tolerated by all patients.(ABSTRACT TRUNCATED AT 250 WORDS)