Применение уретероуретеростомии при удвоении почки. Обзор литературы.

Abstract

Introduction. Kidney duplication is one of the most common urological developmental anomalies, the incidence of which is 0.8%. At the same time, various types of obstructive uropathy can be a concomitant pathology in such a situation. There are various methods for correcting obstructive uropathy. Currently, more and more often in the treatment of obstructive uropathy of one of the segments of the doubled kidney, a method such as ureteroureterostomy is used. However, there is still no consensus on which treatment tactics in this case is the most optimal. The aim of our work was to analyze literature about using ureteroureterostomy in patients with obstructive uropathies of a duplicated kidney, as well as to compare this technique with others. Materials and methods. Search results were analyzed in the scientific databases e-Library, PubMed, Medline, Web of Science, Embase, Cochrane Library and PEDro according to the following. keywords: «renal duplication», «heminephrectomy», «ureteroureterostomy», «obstructive uropathies». In total it was found 157 publications, after analyzing the literature, 33 papers were selected for review, most fully reflecting the topic. Results. Heminephrectomy is still popular for severely reduced or absent duplex kidney function, but it has complications such as decreased function of the remaining segment, pseudocyst formation, stump, urinoma, segmental hematoma, ureteral stricture, and vesicoureteral reflux into the remaining segment. Ureteroureterostomy, as an alternative method for correcting obstructive uropathies of a double kidney, has been recognized as effective and safe in many studies. Data are presented to prove that ureteroureterostomy is applicable for any function of the affected segment. In this article, various techniques for ureteroureterostomy are consecrated, from open intervention to robotic one. In addition, research data on the safety of ureteroureteroanastomosis in case of a pronounced discrepancy between the diameters of the ureters are presented. Among the complications of ureteroureteroanastomosis, cultitis, urine leakage in the anastomosis zone, urinoma, and stenosis of the anastomosis can be noted. The predictors of an unfavorable outcome of the proposed method were identified. These include ectopic ureterocele, hydronephrosis of both segments of the duplex kidney, as well as simultaneous ureteroureterostomy and reimplantation of the recipient ureter. Conclusions. Ureteroureterostomy in patients with various pathologies inherent in duplication of the kidney is an effective and safe technique that allows preserving the function of the segment and adequately draining it. The use of this technique does not depend on the presence of a decrease or lack of function of one of the segments.