A 39-year-old woman with a history of pulmonary tuberculosis, recurrent nephritic colic and stress urinary incontinence.
She came to the emergency room for low back pain and pollakiuria.
An abdominal ultrasound performed revealed left urolithiasis, bilateral nephronephrosis preserved left renal parenchyma, and right kidney of cortex and kidney dysfunction. The patient also had renal function with a creatinine level of 1.98 mg.
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She was diagnosed with genitourinary tuberculosis by positive Lowestein culture in the urine evacuated by the nephrostomy. Medical treatment was established with Rifampicin, Isoniazid and Pirazinamide for 2 months.
During follow-up in outpatient clinics, a renal scintigraphy showed a right kidney without function and the left kidney with preserved morphology and mild ectasia of the upper lime system.
Abdominal ultrasound is also obtained, which corroborates the findings of renal scintigraphy.
The patient abandons antibiotic treatment and the follow-up at 6 months due to social problems, despite the persistence of disease in the cultures.
One year after diagnosis, medical treatment was restarted and maintained for one year with adequate clinical follow-up.
An intravenous urography was performed, with a diagnosis of right massive kidney and stenosis of the last cms of the left ureter.
Right nephrectomy was performed and an attempt was made to reinstate the left bladder neck during which there was left disinsertion to 1 below the left junction ureter, which was decided by permanent urethrotomy.
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For three years, the patient remained with good renal function and regular changes in the size of the nephrostomy with evident limitation and impairment of quality of life.
After this time and given the good physical condition and the age of the patient, the excretory pathway reconstruction was proposed with an ileum.
Preoperative evaluation confirmed complete bladder retraction so simultaneous replacement of this organ was proposed.
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The surgical technique consisted in releasing and defunctionalizing 60 cm of ileum with opening of left mesocolon to allow anastomosis of the proximal end of the ileum jejunum modified jejunum jejunum jejunum 20 cm making double anastomosis jejunal anastomosis jejunum with jejunum modified jejunum and jejunal anastomosis posterior jejunum jejunal anastomosis jejunum jejunum jejunum jejunum jejunum jejun
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The postoperative course was uneventful and the ureteral stent was removed 21 days after surgery.
A cystogram was performed to check the tightness of the bladder suture, although there was vesicoureteral reflux with high pressure.
After removal of the nephrostomy and catheter, the patient was discharged home with voiding and leakage between voiding, requiring a Credé bladder compress and bladder augmentation maneuver.
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At six months cystography with bladder more capacity and low reflux, persisting nocturnal incontinence.
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During periodic reviews every 6 months, the patient shows her satisfaction with the results obtained after surgery and her improvement in quality of life, since she has no urinary diversion and nocturnal urine leakage are scarce.
Currently, four years after the last surgical intervention, the patient has adequate voiding every two to three hours with diurnal continence and a later nocturnal bicarbonate compress, without needing a diary for metabolic control Credétin Val7.
