[Causes of the functional disorder of the kidneys in patients with bladder cancer after cystectomy with ureterosigmoid anastomosis].

Cystectomy with ureterosigmoid anastomosis by modified Goodwin's technique was performed in 47 patients with local vesical cancer. Pre- and postoperative functional status of the kidneys was assessed by means of renography, excretory urography and laboratory tests. Unilateral or bilateral renal dysfunction developed within 12 to 18 months after surgery in 22.2% of patients with good pretreatment renal status. In cases of preoperative renal impairment, it improved postoperatively in just 35% of the patients. Rectoromanoscopy, contrast sigmoidography and excretory urography demonstrated pathological conditions in the area of ureterointestinal anastomoses (strictures, gaping or anastomositis) or sigmoid changes (sigmoiditis, kinking or stenosis in the perianastomosis area) in 83.3% of patients with impaired postoperative renal function. These conditions lead to hydroureteronephrosis, intestinoureteral refluxes and progress or development of pyelonephritis as a result. It is concluded that the state of ureterointestinal anastomoses and the sigmoid should be assessed specifically in postureterosigmoid anastomosis patients with impaired renal function. The surgical techniques and the degree of ureteral dilatation can make an important contribution to pathologic conditions developing around the anastomoses. Good functional activity of the kidneys and the absence of upper urinary dilatation are the principal prerequisite for ureterosigmoid anastomosis.