Лапароскопическая уретеропластика тубуляризированным буккальным графтом при протяженной облитерации дистального отдела мочеточника

Abstract

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.