MP9-14 THE LONG-TERM RESULTS OF URETERAL RECONSTRUCTION IN PATIENTS WITH DEFECTS OF PELVIC URETER

Abstract

You have accessJournal of UrologyTrauma/Reconstruction: Trauma & Reconstructive Surgery III1 Apr 2014MP9-14 THE LONG-TERM RESULTS OF URETERAL RECONSTRUCTION IN PATIENTS WITH DEFECTS OF PELVIC URETER Boris Komyakov and Viktor Ochelenko Boris KomyakovBoris Komyakov More articles by this author and Viktor OchelenkoViktor Ochelenko More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.502AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Ureteral reconstruction is one of the most difficult procedures in urology. The aim of this study is to compare the long-term results of reconstructive operations in patients with long strictures of pelvic ureter. METHODS From 1998 to 2013 168 patients with long strictures of pelvic ureter underwent ureteral reconstruction at our clinic. There were 125 (74.4%) women and 43 (25.6%) men with a median age of 48.3±14.3 years. All patients were divided by 3 groups. The first group included 98 patients underwent Boari operation, the second group - 52 patients to whom intestinal ureteral reconstruction was made and the third group - 19 patients underwent ureteral substitution with appendix. All patients underwent long-term follow-up including routine laboratory analysis and urinary tract imaging. Outpatient visits occurred at 3 and 6 months postoperatively and at least annually thereafter. RESULTS The period of postoperative supervision was from 3 months up to 15 years (mean 8.9±0.6 years). In the first group of patients early postoperative complications developed in 5 (5.1%) cases. Late complications, including urine reflux and bladder dysfunction took place at 17 (17.4%) patients that was higher, than in groups of comparison (p<0.05). In the second group postoperative complications developed in 7 (13.5%) cases. Short-term complications occurred in 6 (11.5%) patients and included: intestinal obstruction,-2 (3.9%), ileal graft mesentery thrombosis -1 (1.9%) and acute pyelonephritis – 3 (5.8%). Late complication – stricture of ileal graft anastomosis developed in 1 patient (1.9%) in 3 months after operation. In the group of patients underwent ureteral substitution with appendix no complications in the early postoperative period were revealed. Late complications developed in 2 (10.5%) cases. The stricture of ureteroappendicoanastomosis was developed in 3 months in two patients. The average operation time was higher at intestinal and appendicular ureteral substitution. On the other hand, according to the early and remote complications, ureteral substitutions with gastrointestinal segments were more preferable than Boari operation. CONCLUSIONS The ileal and appendix ureteral substitution is an effective technique for partial and complete ureteral reconstruction. The advantage of ureteral substitution with appendix is that the bladder which has been already affected in previous operations is affected minimally. The risk of a bladder dysfunction as a result of formation of surrounding fibrosis and scars, deformation of its walls, or neurovascular disturbances is minimal. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e127 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Boris Komyakov More articles by this author Viktor Ochelenko More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...