Abstract
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.
Highlights
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 efficacy or using a buccal graft (BG) to treat extended recurrent strictures and obliterations of the distal ureter
Patients of the analyzed group had undergone extensive surgical procedures: three (42.9%) had malignant cervical cancer removed through extended extirpation of the uterus with appendages, which was followed by radiotherapy; three (42.9%) had abdominal surgery, one (14.3%) in the form of hemicolectomy targeting a malignant tumor and followed by radiotherapy, two (28.6%) — as traditional appendectomy for destructive forms of acute appendicitis
Summary
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. Control examinations showed complete patency of the neoureter and good vascularization of the BG 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. Данный способ может служить одной из дополнительных методик при невозможности восстановления дистального отдела мочеточника с использованием тканей собственных мочевых путей или сегментов желудочно-кишечного тракта. Obstruction of the lower third of the ureter caused by its strictures and obliterations is a result of endourological interventions aimed at urolithiasis [3,4,5] Such obstruction may be a delayed complication of pelvic radiotherapy [6] most commonly aimed at bladder, cervix or uterine body cancer. The irradiation degrades vascularization and regeneration capabilities of the subject
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