Experience of the 193 small intestine reconstructions of ureters

Abstract

BACKGROUND: The ureteral plastic surgery with their extended constrictions and obliterations remains one of the most difficult problems of reconstructive urology. This is especially true in cases where it is impossible to repair the patency of the ureter due to unchanged urinary tract sections. In such cases, various segments of the gastrointestinal tract and, above all, the ileum proved to be the best plastic material. However, the number of such operations in the world is not enough, which requires further accumulation of experience and study of long-term results of ileoureteroplasty.
 AIM: The aim of the research is to present the technical features and results of intestinal plastic surgery of ureters.
 MATERIALS AND METHODS: From 2001 to 2023 ileoureteroplasty was performed in 193 patients of the Clinic of the North-Western State Medical University named after I.I. Mechnikov on the basis of the urological department of City Multidisciplinary Hospital No. 2. The panel consisted of 71 men (36.8%), 122 women (63.2%). The average age was 51 ± 3.2 years. Indications for these operations were extensive defects of the ureters as a result of complications of surgical intervention on the upper urinary tract in 69 (35.8%) of patients, radiation therapy — in 54 (28.0%) and the consequences of iatrogenic damage to the ureters — in 40 (20.7%). Megaureter (6.2%), Ormond’s disease (7.3%) and neoplasms of the ureters (2.0%) were observed less frequently.
 RESULTS: Unilateral ileoureteroplasty was performed 153 (79.3%), bilateral — 40 (20.7%). The total number of ureteralsurgeries is 235. Since 2013 ileureteroplasty has also been performed with laparoscopic method, and the share of such operations for this period was 35.9%. The early postoperative complications occurred in 18 (9.3%) patients. There were no fatal outcomes. Late complications developed in 16 (11.2%) of 143 examined patients.
 CONCLUSIONS: This surgical tactics may be recommended in the clinical practice of large urological hospital due to our 22-year experience in using small intestine segments to replace extended ureteral constrictions with a minimum number of postoperative complications, no deaths and good long-term results allows us to recommend.