LOWER POLE CALICOSTOMY FOR THE MANAGEMENT OF IATROGENIC URETEROPELVICJUNCTION OBSTRUCTION

It is often possible to use endoscopic techniques for the management o f iatrogenic upper ureteral or ureteropelvic junction obstruction. How ever, in some cases with severe stricture disease or significant ische mic injury open surgical reconstruction is necessary. We report our ex perience with ileal ureter-lower pole calicostomy for the management o f these complex urological injuries. During the last 3 years we treate d 3 patients with severe ureteral/ureteropelvic junction obstruction s econdary to iatrogenic injuries, including ureteral avulsion during ur eteroscopic stone extraction, ureteral laceration during dilation for diagnostic ureteropyeloscopy, and ureteral ligation with ureteropelvic junction disruption and large peri-pelvic urinoma. In all cases unsuc cessful attempts at endoscopic management necessitated open repair. Lo wer pole heminephrectomy was performed in all patients to expose the l ower pole calix and ileal ureter-lower pole calicostomy was created du e to the injury of large segments of the ureter. Satisfactory results were demonstrated on postoperative excretory urography and by a lack o f symptoms. Followup averaged 23 months (range 20 to 26) with stable r enal function in all patients. We believe that ileal ureter-lower pole calicostomy represents an attractive alternative for the management o f severe ischemic, iatrogenic upper ureteral or ureteropelvic junction obstruction when endoscopic maneuvers are not possible or ineffective .