At the current stage of development of urology, selection of the surgical method for cases of severe obstructive diseases of the upper urinary system remains a challenge. This study aimed to explore the results of application of a buccal graft (BG) to remedy extended recurrent strictures and obliterations of the distal ureter. Seven patients with the mentioned diseases had undergone surgery: for six of them, the method of choice was complete BG ureteroplasty, one had onlay ureteroplasty. One intervention was laparoscopic, the remaining surgeries were open. The length of the replaced ureteral defect was 5–8 cm. In five cases, the flap was additionally vascularized with the iliac muscle, in one we used omentum tissue, in another — both the iliac muscle and the omentum. There were no fatalities registered, nor severe complications as per the Clavien–Dindo classification. The patients were followed-up for 4–18 months; as of today, no recurrence cases were identified. Control examinations showed complete patency of the neoureter and good vascularization of the BG. Thus, this method can be an option in cases disallowing distal ureter restoration with tissues of the patient's own urinary tract or segments of the gastrointestinal tract.
ГБУЗ «Московский городской научно-практический центр борьбы с туберкулезом Департамента здравоохранения города Москвы», Москва, РФ 2 ГБУ «Госпиталь ветеранов войн», г. Ростов-на-Дону, РФ Цель исследования: анализ эффективности хирургического лечения пациентов с посттуберкулезными стриктурами/облитерациями мочеточника при использовании для реконструкции слизистой оболочки ротовой области.Материалы и методы. Оперировано 5 человек с последствиями специфического поражения мочеточника в виде протяженных стриктур или облитераций. Всем пациентам выполнена уретеропластика с использованием буккального графта (БГ). В 4 случаях применяли тубуляризированный БГ, в 1 случае -onlay.Результаты. Период наблюдения пациентов составил 3-55 мес. Рецидива заболевания, а также тяжелых осложнений за этот срок не было.Заключение. Метод буккальной уретеропластики является перспективным для лечения посттуберкулезных стриктур/облитераций мочеточника при высоком риске проведения других реконструктивных операций.
Purpose of the study. Surgical treatment of extended strictures and obliterations of the ureter is still a complicated problem of modern urology. The aim of the study was to analyze our own experience of ureteral replacement plastic surgery with buccal graft, i.e buccal ureteroplasty (BU) with its extended strictures/obliterations.Patients and methods. We’ve observed 25 patients who underwent BU. The lower third of the ureter was affected in 3 (12.0 %) cases, the lower third and the mouth of the ureter was affected in 7 people (28.0 %), the middle third in 2 (8.0 %), the upper third in 5 patients (20.0 %), the combined lesion of the upper third of the ureter and the pelvic‑ureteral segment (PUS) was in 8 (32.0 %) patients. All patients underwent repeated operations on a ureter, all revealed a significant comorbid background. The surgery was performed with a tubularized buccal graft in 13 (52.0 %), the onlay technique was applied in 12 (48.0 %). Laparoscopic surgery was performed in 10 (40.0 %) patients, surgical aid was carried out in an open way in 15 (60 %).Results. Severe complications according to the Clavien‑Dindo classification, requiring hospitalization of patients in the intensive care unit with organ dysfunction, as well as lethal outcomes were absent. The follow‑up period of patients ranged from 1 to 57 months (an average of 14.7 months). One patient after laparoscopic BU with a tubular graft had a short (1 mm) stenosis in the anastomosis area for 6 months of follow‑up, which was successfully eliminated by laser endoureterotomy. During the entire follow‑up period, residual hydronephrosis was recorded in 4 patients (16.0 %) against the background of complete patency of the anastomosis. A control flexible ureteroscopy performed in 16 (64.0 %) patients did not reveal rejection of the buccal graft. There are still 20 patients under our supervision.Conclusion. Our experience shows that the implementation of BU is possible on any part of the VMP using various techniques. This operation can be regarded as the "second" line of surgical treatment of strictures and obliterations of the ureter, especially after unsuccessful attempts of other reconstructions in a group of patients with severe concomitant pathology.
Introduction. Reconstruction of the distal ureter after exposure to radiation energy on the pelvic organs remains an important problem in modern urology. The use of tissues of the own urinary tract in these cases is not always possible due to their deficiency in this category of patients, and the formation of an anastomosis by intestinal segments is often unjustified due to the high degree of trauma of enteroplastics. Materials and methods. To improve the immediate and long-term results of surgical treatment of extended strictures and obliterations of the distal ureter, we have developed a new method of its reconstruction – laparoscopic ureteroplasty of the distal ureter with tubularized buccal graft. This surgary was performed on a 36-year-old patient after extirpation of the uterus with appendages and the upper third of the vagina due to malignant neoplasm and several courses of radiation therapy. The length of the replaced ureteral defect was 6 cm. Results. The use of a tubularized buccal graft is an affordable alternative to these operations, and the laparoscopic technique allows one to achieve better anastomosis and reduce the number of postoperative complications. The immediate results of this operation are encouraging in terms of the possibility of its use in this category of patients. Conclusion. Laparoscopic ureteroplasty with tubularized buccal graft may be one of the promising options for the reconstruction of the distal ureter in case of its extended obliteration. The possibilities of this operation will be studied as experience is gained and as long-term postoperative observation of patients is observed.
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