Buccal Mucosal Grafts in Surgery of Urethral Tuberculosis

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.

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Buccal ureteroplasty options, techniques, long-term results

Волков¹,

Будник²,

Зубань³

et al. 2022

Issled. prakt. med. (Print)

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Evaluation of the effectiveness of buccal ureteroplasty in the late postoperative period

Волков¹

2022

Surgeon

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Surgical treatment of organic obstruction of the upper urinary tract is a complex problem in modern urology. The aim of the study was to analyze the assessment of the late postoperative period after ureteral replacement with a buccal graft. We followed up 32 patients who underwent buccal ureteroplasty (BU). The effectiveness of this surgical intervention was assessed by the absence of recurrence of the disease and the need to reuse ureteral stenting or percutaneous nephrostomy. Recurrence of urinary tract obstruction was later detected in 3 (9.4 %) patients. Also, after removal of the stent in 18 patients, the following indicators were evaluated: glomerular filtration rate, maximum systolic blood flow velocity in the interlobar arteries of the kidney, thickness of the kidney parenchyma, ureteroscopy, and pain in the lumbar region. After 6 months, the established parameters were re-determined, and in case of improvement or unchanged primary indicators, each of the parameters was scored 1 point, in case of deterioration of the primary indicators, each of the parameters was scored 0 points. If the total score is 3 or more, then the course of the postoperative period after reconstructive surgery on the upper urinary tract using a buccal graft is considered favorable and conservative therapy is continued. Two of the 18 patients had a score of 2, which led to a change in the tactics of postoperative follow-up. Thus, this method for assessing parameters in operated patients allows timely correction of renal dysfunction.

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Buccal Mucosal Grafts in Surgery of Urethral Tuberculosis

Cited by 2 publications

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Buccal ureteroplasty options, techniques, long-term results

Buccal ureteroplasty options, techniques, long-term results

Evaluation of the effectiveness of buccal ureteroplasty in the late postoperative period

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