Reconstructive surgery in patients with extended defects of the pelvic ureter

A comparison of long-term results of various reconstructive procedures in patients with extended strictures of the pelvic ureter was performed. The study included 175 patients with extended strictures of the pelvic ureter who underwent surgery and were observed in urological clinic of the NWSMU n.a. I.I. Mechnikov in a period from 1998 to 2014. Age of patients ranged from 18 to 69 years. There were 79 (45.2%) men and 96 (54.8%) women. All patients were divided into three groups. The group 1 consisted of 102 (58.3%) patients who underwent ureteroplasty by Boari procedure, the group 2 - 54 (30.1%) patients who underwent intestinoplasty of ureters, and the group 3 - 19 (10.9%) patients who underwent appendicourethroplasty. In the immediate and late postoperative periods, assessment of renal function and function of upper urinary tract was performed according to the results of laboratory, X-ray, radioisotope and endourological methods. Follow-up period ranged from 3 months to 16 years (mean 7.3 ± 0.8 years). It was found that in the group operated by Boari method, early postoperative complications occurred in 5 (4.9%) patients. Late postoperative complications occurred in 13 (12.8%) patients, which was significantly higher than in the comparison groups (P<0.05). Among patients who underwent intestinoplasty of ureters, early postoperative complications occurred in 7 (12.9%) patients. In the late postoperative period, complication rate was 5.6%. Among the 19 patients who underwent appendicourethroplasty, early postoperative complications were not observed. At long-term follow, they occurred in 2 (10.5%) patients, which was significantly lower than in the group of patients who underwent Boari procedure (P<0.05). Intestinoplasty, and in some cases, appendicourethroplasty, allow to replace defects of one or both ureters of any location and extent, and to get good long-term functional results; they are often considered as a safe and effective alternative to replacement surgery of ureter by own tissues of the urinary system.

appendix, intestinoplasty, ureter, Boari procedure