Abstract
Objective: Open or laparoscopic dismembered pyeloplasty has been the gold standard for the correction of ureteropelvic junction obstruction (UPJO) with a success rate of about 90%. Main insufficient feature of dismembered pyeloureteroplasty is interfering ureteral blood supply, which creates the prerequisites for the deterioration of the regeneration of the ureter and the possibility of developing restenosis. Methods: We offered and applied the new method – subadventitial resection of ureteropelvic junction (UPJ) to prevent damage to vessels of the distal part of pelvis and proximal part of the ureter. The protection of blood supply in this area should improve anastomosis regeneration and prevent fibrotic changes for long time, simultaneously providing better condition for the kinetic ability of the ureter. Results: Retrospective analysis of 106 patients with hydronephrosis, whom performed 108 open dismembered pyeloplasty (two patients were operated bilaterally) with subadventitial resection of UPJ from 1998-2020 years with a mean follow-up of 36 month shows that this technique has advantages over analogues. Conclusion: Our 22 years of experience shows that the technique of subadventitial resection of the ureter, allows us to save the ureteral blood circulation and thus creates conditions for better regeneration of the anastomosis and prevent later complications of dismembered pyelouretereroplasty.
Highlights
Open or laparoscopic dismembered pyeloplasty has been the gold standard for the correction of ureteropelvic junction obstruction (UPJO) with a success rate of about 90%
Dismembered pyeloureteroplasty is accompanied by resection of the ureteral artery, which leads to a deterioration in the blood supply to the ureter [5]
Clinical manifestations as periodic pains in the lumbar region were observed in half of the patients (55 patients), in one patient (63 years old women) the examination was conducted for nephrogenic hypertension, in two infants hydronephrosis was detected during prenatal examination, in the remaining cases with ultrasound testing not related to this pathology
Summary
Open or laparoscopic dismembered pyeloplasty has been the gold standard for the correction of ureteropelvic junction obstruction (UPJO) with a success rate of about 90%. Main insufficient feature of dismembered pyeloureteroplasty is interfering ureteral blood supply, which creates the prerequisites for the deterioration of the regeneration of the ureter and the possibility of developing restenosis. Material and methods: We offered and applied the new method – subadventitial resection of ureteropelvic junction (UPJ) to prevent damage to vessels of the distal part of pelvis and proximal part of the ureter. Conclusion: Our 22 years of experience shows that the technique of subadventitial resection of the ureter, allows us to save the ureteral blood circulation and creates conditions for better regeneration of the anastomosis and prevent later complications of dismembered pyelouretereroplasty. Dismembered pyeloureteroplasty is accompanied by resection of the ureteral artery, which leads to a deterioration in the blood supply to the ureter [5]
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