Buccal ureteroplasty for recurrent extended strictures and obliterations of distal ureter

Innovacionnaâ medicina Kubani

Mustapaev³

2021

Self Cite

Buccal ureteroplasty is considered a rare operation in urology and the indications for its implementation are still not clearly defined. We have described a clinical case of successful replacement of a part of the proximal ureter with a buccal graft in a patient with a single kidney, which was drained for a long time with a nitinol stent, which was subsequently incrustated, which led to the installation of a permanent nephrostomy drainage. The patient had no postoperative complications, the patency of the urinary tract was fully restored.

Section: Introductionunclassified

Buccal ureteroplasty in a patient with an extended stricture of the proximal ureter of a solitary kidney

Innovacionnaâ medicina Kubani

Mustapaev³

2021

Self Cite

Optimization of laparoscopic ureteral repair with a buccal graft in case of its extended strictures and obliterations

Issled. prakt. med. (Print)

Зубань³

2021

Purpose of the study. Currently, laparoscopic technique has become widely used in the treatment of extended strictures and obliterations of the ureter. The use of minimally invasive approaches will also be relevant for such a relatively new operation as buccal ureteroplasty. In the literature, there are isolated publications devoted to this technique. The aim of this study was to study the results of our own experience of laparoscopic ureteral reconstruction using a buccal graft.Patients and methods. We observed 5 patients – 2 men and 3 women, at the age of 30–62 years. All patients have already been operated on the urinary tract, of these, in four patients, the urinary tract was drained with a nephrostomy or internal ureteral stent. Two patients underwent replacement ureteroplasty with tubularized buccal graft, and three patients underwent augmentation ureteroplasty with buccal graft using the onlay method.Results. All operations in this group were carried out without conversions. The average length of the ureteral defect was 4.9 cm (4.0–6.0 cm). The patients did not have severe complications in the postoperative period according to the ClavienDindo classification. One patient underwent treatment for exacerbation of chronic pancreatitis; one man experienced ureteral stent migration, which required restentation. The follow-up period was 1–15 months; one woman developed unextended ureteral restenosis, which was eliminated by endoureterotomy and ureteral stenting. At the moment, all patients are spared from permanent urinary drains, they do not have upper urinary tract obstruction. Conclusion. All operations in this group were carried out without conversions. The average length of the ureteral defect was 4.9 cm (4.0–6.0 cm). The patients did not have severe complications in the postoperative period according to the Clavien-Dindo classification. One patient underwent treatment for exacerbation of chronic pancreatitis; one man experienced ureteral stent migration, which required restentation. The observation period for the patients was 1–15 months, one woman developed short ureteral restenosis, which was eliminated by endoureterotomy and ureteral stenting. At the moment, all patients do not have permanent urinary drains, violations of the urodynamics of the upper urinary tract were not revealed in them.

Buccal ureteroplasty options, techniques, long-term results

Issled. prakt. med. (Print)

Зубань³

et al. 2022

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.