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Medline ® Abstract for Reference 4

of 'Renal complications following ureteral diversion'

Ureterosigmoidostomy and obstructive uropathy.
Yossepowitch O, Baniel J
Nat Clin Pract Urol. 2005 Oct;2(10):511-5; quiz 516.
BACKGROUND: A 19-year-old mentally retarded man with failed exstrophy repair and ureterosigmoidostomy urinary diversion presented with high fever, vomiting and right-flank pain of 2 days' duration. Past medical history was notable for a left nephrectomy to treat an infected staghorn calculus in a poorly functioning kidney. Physical examination revealed pyrexia and right-flank tenderness.
INVESTIGATIONS: Physical examination, renal function tests, electrolyte and metabolic assessment, urine and blood cultures, abdominal CT, ANTEGRADE PYELOURETEROGRAPHY, sigmoidoscopy and histopathology.
DIAGNOSIS: Ureterosigmoidostomy complicated by acute pyelonephritis, obstructive uropathy, recurrent urinary tract infections, renal impairment and the development of renal stones and metabolic acidosis.
MANAGEMENT: Fluids, intravenous antibiotics, bicarbonate and potassium supplementation, and rediversion of ureterosigmoidostomy to an ileal conduit.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. oferyoss@netvision.net.il