Русский
Results of intestinal ureteral plastic surgery
DOI: https://dx.doi.org/10.18565/urology.2024.5.5-11
Komyakov B.K., Al-Attar T.H., Kirichenko O.A., Pirozhok Y.S., Mhanna H.M.
1) Department of Urology (Head of the Department – prof. B.K. Komyakov) of the North-Western State Medical University named after I.I. Mechnikov, St. Petersburg, Russia; 2) Saint-Petersburg State Budgetary Healthcare Institution Multi-field Hospital №2, St. Petersburg, Russia
The aim of the research is to present the features of the technique and results of intestinal reconstruction surgery of ureters.
Materials and methods. From 2001 to 2024 ileoureteroplasty was performed in 217 patients. The average age was 51±3.2 years. The ileum was used in 213 (98.2%) and the colon in 4 (1.8%) patients. The panel consisted of 85 men (39.2%), 132 women (60.8%). Unilateral ileoureteroplasty was performed 174 (80.2%), bilateral – 43 (19.8%). 41,8% of the operations were performed laparoscopically. The total number of operated ureters was 262, taking into account the doubled ones.
Results. The early complications occurred in 18 (8.4%) patients. There were no fatal outcomes. Late complications were observed in 165 people between 3 and 254 months (average 66 ± 2 months) after surgery. They developed in 16 (9.7%). The functional state of the upper urinary tract improved in 143 (86.7%), remained at the same level in 18 (10.9%) and worsened in 4 (2.4%) patients. On average, positive results of operations were obtained in 97.6% of cases.
Discussion. The ureteral reconstraction surgery with its indicated in cases of extended constrictions and obliterations, when impossible to restore urine passage, remains one challenge of reconstructive urology today. The isolated segment of the ileum is the best and universal substitution plastic material for the replacement of ureteral defects of any localization and extent, including including bilateral cases. The isolated segment of the ileum was applied in 98.2% of patients. Most of these operations can be performed in laparoscopic manner.
Conclusion. Reconstruction of the ureters by intestinal sites is an effective method of treating their extended constrictions. We have obtained good long-term results, a minimal number of postoperative complications and no fatal outcomes, which allows us to recommend the use of this operation in clinical practice.
Materials and methods. From 2001 to 2024 ileoureteroplasty was performed in 217 patients. The average age was 51±3.2 years. The ileum was used in 213 (98.2%) and the colon in 4 (1.8%) patients. The panel consisted of 85 men (39.2%), 132 women (60.8%). Unilateral ileoureteroplasty was performed 174 (80.2%), bilateral – 43 (19.8%). 41,8% of the operations were performed laparoscopically. The total number of operated ureters was 262, taking into account the doubled ones.
Results. The early complications occurred in 18 (8.4%) patients. There were no fatal outcomes. Late complications were observed in 165 people between 3 and 254 months (average 66 ± 2 months) after surgery. They developed in 16 (9.7%). The functional state of the upper urinary tract improved in 143 (86.7%), remained at the same level in 18 (10.9%) and worsened in 4 (2.4%) patients. On average, positive results of operations were obtained in 97.6% of cases.
Discussion. The ureteral reconstraction surgery with its indicated in cases of extended constrictions and obliterations, when impossible to restore urine passage, remains one challenge of reconstructive urology today. The isolated segment of the ileum is the best and universal substitution plastic material for the replacement of ureteral defects of any localization and extent, including including bilateral cases. The isolated segment of the ileum was applied in 98.2% of patients. Most of these operations can be performed in laparoscopic manner.
Conclusion. Reconstruction of the ureters by intestinal sites is an effective method of treating their extended constrictions. We have obtained good long-term results, a minimal number of postoperative complications and no fatal outcomes, which allows us to recommend the use of this operation in clinical practice.
About the Autors
Corresponding author: B.K. Komyakov – Doctor of Medical Science (DMSc), professor, Head of the Department of Urology of the North-Western State Medical University named after I.I. Mechnikov, Honoured Physician of the Russian Federation; St. Petersburg, Russia; e-mail: komyakovbk@mail.ru
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