Hydronephrosis complicating aortic reconstruction

Abstract

Prompted by an encounter with a symptomatic case, a study has been made of hydronephrosis complicating operations for aortic reconstruction. Twenty patients operated upon consecutively for occlusive vascular disease and undergoing reconstructions involving the use of synthetic material in the vicintiy of the ureter have been investigated by intravenous pyelography. The incidence of hydronephrosis in pyelograms after a year or more was 10 per cent of the patients and 5-7 per cent of the ureters at risk. Dilatation, when it arose, was always apparent in the immediate postoperative period, but half of the dilatations evident at that time resolved within a year.

Urologische Komplikationen nach aortofemoraler Gefäßprothesenimplantation

“…In prospektiven Studien variiert die Inzidenz der Frü hobstruktionen (< 12 Monate) zwischen 10 und 20 % [3][4][5]. In den Untersuchungen mit Frü hkontrollen waren nach 3 Mona-ten alle Harnstauungsnieren nachweisbar, wobei es sich meist um asymptomatische Obstruktionen handelte.…”

Obstructive Uropathy following Aortofemoral Graft Surgery

“…The incidence of hydronephrosis after aortic reconstructive surgery varies from 2% [4] to 10% [3], 13% [5] and 20% [6]. Such variation probably reflects differences in the type of surgery, rate of postop erative complications and length of follow-up in the dif ferent series.…”

“…It seems, therefore, that obstruc tive uropathy following vascular surgery may be early and transient, early and persistent or delayed at onset. The latter, nonetheless, seems to be very rare [3,18].…”

“…If a mild hydronephrosis is detected during the first postoperative year, an expectant policy seems to be justified, since in a high proportion of patients spontaneous resolution may occur [3,7], Ste roids may be useful at an early stage, before retroperito neal fibrosis develops [16].…”

“…Recently, systematic urographie [3][4][5] or sonographic [6,7] evaluation of patients after vascular surgery suggests that the incidence of this com plication has been underestimated, since many cases are asymptomatic.…”