INTESTINAL AND APPENDICULAR URETERAL SUBSTITUTION
- Authors: Komyakov B.K1,2, Al-Attar T.K.1,2, Guliev B.G1
-
Affiliations:
- FGBOU VO North-Western State Medical University named after I.I. Mechnikov
- Saint Petersburg GBUZ City clinical multidisciplinary hospital No 2
- Issue: No 2 (2021)
- Pages: 14-20
- Section: Articles
- URL: https://journals.eco-vector.com/1728-2985/article/view/312550
- DOI: https://doi.org/10.18565/urology.2021.2.14-20
- ID: 312550
Cite item
Open Access
Access granted
Abstract
Aim. To present the technical features and results of intestinal and appendicular ureteral replacement. Material and methods. From 1998 to 2020, a total of 196 patients aged 18 to 77 years (mean age 49.5 ± 1.2 years) were undergone to intestinal and appendicular ureteral reconstruction in our clinic. There were 123 women (62.8%). The most frequent indications for surgery were complications of open and endoscopic ureteral procedures, radiation-induced ureteral stricture, and iatrogenic injuries of the ureters during gynecological and surgical interventions (81.6%). In 165 (84.2%) patients, for ureteral replacement the ileal segment was used, while in 4 (2.0%) and 27 (13.8%) cases the colon segment and the appendix were chosen, respectively. Unilateral ileal ureteral replacement was performed in 131 (79.4%) cases, while in 34 (26.6%) patients a bilateral procedure was done. Partial and complete ureteral replacement was performed in 107 (81.7%) and 24 (18.3%) cases, respectively. Laparoscopic intestinal and appendicular ureteral replacement was performed in 44 (22.4%) patients, while two patients were undergone to robot-assisted procedure (1.0%). Results. Early postoperative complications were noted in 17 (8.7%) cases. The most severe included acute bowel obstruction, leakage of entero-ureteral anastomoses, necrosis of the ileal graft and bleeding in 10 (5.1%) patients. In all cases, repeat intervention was performed. There were no lethal complications. Late postoperative complications developed in 24 (14.3%) patients. Conclusion. Today our clinic has the world’s largest experience in intestinal and appendicular ureteral reconstruction, including original procedures, confirmed by 5 patents for inventions. The minimum number of postoperative complications, the absence of deaths and good long-term results provide the basis for the introduction of ileal and appendicular ureteral replacement into clinical practice.
Full Text
About the authors
B. K Komyakov
FGBOU VO North-Western State Medical University named after I.I. Mechnikov; Saint Petersburg GBUZ City clinical multidisciplinary hospital No 2
Email: komyakovbk@mail.ru
Ph.D., MD, professor, Head of the Department of Urology of FGBOU VO North-Western State Medical University named after I.I. Mechnikov, Chief of Saint Petersburg Scientific and Practical Center of GBUZ City clinical multidisciplinary hospital No 2 Saint Petersburg, Russia
T. Kh Al-Attar
FGBOU VO North-Western State Medical University named after I.I. Mechnikov; Saint Petersburg GBUZ City clinical multidisciplinary hospital No 2
Email: dr-talat@mail.ru
Ph.D., assistant at the Department of Urology Saint Petersburg, Russia
B. G Guliev
FGBOU VO North-Western State Medical University named after I.I. Mechnikov
Email: gulievbg@mail.ru
Ph.D., MD, professor at the Department of Urology of FGBOU VO North-Western State Medical University named after I.I. Mechnikov, Head of Center of Urology with robot-assisted surgery of City Mariinsky hospital Saint Petersburg, Russia
References
- Komyakov B.K. Intestinal and appendicular ureteroplasty. M.: GEOTAR-Media, 2015. 416 p.
- Лоран О.Б., Синякова Л.А., Серегин А.В. и др. Использование изолированных сегментов кишечника в оперативном лечении лучевых повреждений мочевыводящих путей. Урология. 2012;2:20-24.
- Зубань О.Н., Скорняков С.Н., Арканов Л.В. и др. Энтеропластика протяженных стриктур мочеточника туберкулезного и другого генеза. Урология. 2014;4:10-15.
- Komyakov B., Ochelenko V., Mhanna H. Ureteral substitution with intestinal segments. The Journal Of Urology. 2020;203(4S, Suppl):e597-598.
- Комяков Б.К., Фадеев В.А., Гулиев Б.Г., Очеленко В.А., Ал-Аттар Т.Х., Сергеев А.В., Тарасов В.А. Желудочнокишечная реконструкция мочевых путей: опыт 502 операций. Урологические ведомости. 2019;9(1S):47-48.
- Okumura Y., Akamatsu S., Okada Y., et al. Clinical Utility of Upper Urinary Tract Reconstruction by Ileal-Ureter Substitution. Hinyokika Kiyo. 2018;64(3):87-94.
- Zhong W., Hong P., Ding G., et al. Technical considerations and outcomes for ileal ureter replacement: a retrospective study in China. BMC Surg. 2019;19(1):9.
- Komyakov B., Ochelenko V., Guliev B. Shevnin M. Ureteral substitution with appendix. International Journal of Urology. 2020;27(8):663-669.
- Комяков Б.К., Гулиев Б.Г., Очеленко В.А. Технические особенности кишечной пластики мочеточников. Часть 3: лапароскопическая илео- и аппендикулярная уретеропластика. Урология. 2016;4:4-9.
- Кочкин А.Д., Галлямов Э.А., Попов С.В., Биктимиров Р.Г., Санжаров А.Е., Сергеев В.П., Севрюков Ф.А., Орлов И.Н., Новиков А.Б. Лапароскопическая заместительная кишечная пластика мочеточников. Результаты первых 40 операций. Урология. 2018;5:5-12.
- Карпенко B.С. Кишечная пластика мочеточников в лечении приобретенных обструктивных уретерогидронефрозов. Урология. 2001;2:3-6.
- Monn M.F., Roth J.D, Bihrle R., Mellon J.M. Long term outcomes in the use of ileal ureter for radiation-induced ureteral strictures. Int. Urol. Nephrol. 2018;50(8):1375-1380.
- Esmat M., Abdelaal A., Mostafa D. Application of Yang-Monti principle in ileal ureter substitution: is it a beneficial modification? Int Braz J Urol. 2012;38(6):779-785.
- Ordorica R., Wiegand L., Webster J. Ureteral replacement and only repair with reconfigured intestinal segments. J Urol. 2014;191(5):1301-1306.
Supplementary files
