Tramoyeres Celma A, Alonso Gorrea M, Pastor Sempere F, Rodríguez Hernández J, Santolaya García J I
Arch Esp Urol. 1980 Jan-Feb;33(1):19-50.
These operations, in which the risk is essentially ureteral, must be carried out in a urological rather than gynaecological way; the said ureter must be sought after a permanent, ureteral probe has been placed before the operation. We feel that a vaginography is more useful than a retrograde pyelography for diagnosing ureterovaginal fistulae. Another important indication is the need for an intravenous urography to be systematically carried out in the postoperative period of all pelvis operations. Only I.V.U. enables the discovery in time of ureteral lesions which would otherwise remain undiscovered too long. We feel that nephrostomy is an emergency therapy in cases of anuria and septic shock with a urinary focus. It is a safety measure for preventing kidney deterioration in ureter lesions which have remained undiscovered for a long time. In pelvic ureter lesions and providing that there is no vesical retraction, we perform a vesical psoization along with the ureterocystoneostomy (1). When the ureteral lesion is bilateral and the elasticity of the bladder enables us to do so, we perform a ureterocystoneostomy with vesical bipartition and psoization of both vesical wings. In cases of extensive, bilateral ureteral lesions associated with vesical damage such as: vesico-vaginal fistulae and retracted bladder, we perform a ureteroileocystoplasty and vesical stretching.
这些手术的风险主要在于输尿管，必须以泌尿外科而非妇科的方式进行；在手术前放置永久性输尿管探子后，必须寻找上述输尿管。我们认为，阴道造影术在诊断输尿管阴道瘘方面比逆行肾盂造影术更有用。另一个重要的指征是，在所有盆腔手术的术后阶段都需要系统地进行静脉尿路造影。只有静脉尿路造影能够及时发现输尿管病变，否则这些病变可能会长期未被发现。我们认为，肾造瘘术是无尿和伴有泌尿病灶的感染性休克病例的紧急治疗方法。它是一种安全措施，可防止在长期未被发现的输尿管病变中肾脏恶化。在盆腔输尿管病变且膀胱无回缩的情况下，我们在进行输尿管膀胱吻合术的同时进行膀胱腰大肌固定术（1）。当输尿管病变为双侧且膀胱弹性允许时，我们进行输尿管膀胱吻合术，同时将膀胱二分并对膀胱两翼进行腰大肌固定术。在广泛的双侧输尿管病变伴有膀胱损伤（如膀胱阴道瘘和膀胱回缩）的情况下，我们进行输尿管回肠膀胱成形术和膀胱扩张术。
