Results of intestinal ureteral plastic surgery

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Abstract

The aim of the research is to present the features of the technique and results of intestinal reconstruction surgery of ureters.

Materials and methods. From 2001 to 2024 ileoureteroplasty was performed in 217 patients. The average age was 51±3.2 years. The ileum was used in 213 (98.2%) and the colon in 4 (1.8%) patients. The panel consisted of 85 men (39.2%), 132 women (60.8%). Unilateral ileoureteroplasty was performed 174 (80.2%), bilateral – 43 (19.8%). 41,8% of the operations were performed laparoscopically. The total number of operated ureters was 262, taking into account the doubled ones.

Results. The early complications occurred in 18 (8.4%) patients. There were no fatal outcomes. Late complications were observed in 165 people between 3 and 254 months (average 66 ± 2 months) after surgery. They developed in 16 (9.7%). The functional state of the upper urinary tract improved in 143 (86.7%), remained at the same level in 18 (10.9%) and worsened in 4 (2.4%) patients. On average, positive results of operations were obtained in 97.6% of cases.

Discussion. The ureteral reconstraction surgery with its indicated in cases of extended constrictions and obliterations, when impossible to restore urine passage, remains one challenge of reconstructive urology today. The isolated segment of the ileum is the best and universal substitution plastic material for the replacement of ureteral defects of any localization and extent, including including bilateral cases. The isolated segment of the ileum was applied in 98.2% of patients. Most of these operations can be performed in laparoscopic manner.

Conclusion. Reconstruction of the ureters by intestinal sites is an effective method of treating their extended constrictions. We have obtained good long-term results, a minimal number of postoperative complications and no fatal outcomes, which allows us to recommend the use of this operation in clinical practice.

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About the authors

B. K. Komyakov

North-Western State Medical University named after I.I. Mechnikov; Saint-Petersburg State Budgetary Healthcare Institution Multi-field Hospital №2

Author for correspondence.
Email: komyakovbk@mail.ru
ORCID iD: 0000-0002-8606-9791

Doctor of Medical Science (DMSc), professor, Head of the Department of Urology of the North-Western State Medical University named after I.I. Mechnikov, Honoured Physician of the Russian Federation

Russian Federation, St. Petersburg; St. Petersburg

T. H. Al-Attar

North-Western State Medical University named after I.I. Mechnikov; Saint-Petersburg State Budgetary Healthcare Institution Multi-field Hospital №2

Email: dr-talat@mail.ru
ORCID iD: 0000-0002-2080-5637

Doctor of Medical Science (DMSc), Professor of the Department of Urology of the North-Western State Medical University named after I.I. Mechnikov

Russian Federation, St. Petersburg; St. Petersburg

O. A. Kirichenko

Saint-Petersburg State Budgetary Healthcare Institution Multi-field Hospital №2

Email: a.kir@mail.ru
ORCID iD: 0009-0000-4681-1755

candidate of Medical Sciences, urologist

Russian Federation, St. Petersburg

Y. S Pirozhok

Saint-Petersburg State Budgetary Healthcare Institution Multi-field Hospital №2

Email: ulia_pirozhok@mail.ru
ORCID iD: 0009-0004-6225-6228

urologist

Russian Federation, St. Petersburg

H. M. Mhanna

North-Western State Medical University named after I.I. Mechnikov

Email: viphussam@mail.ru
ORCID iD: 0009-0006-3168-518X

aspirant of the Department of Urology 

Russian Federation, St. Petersburg

References

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Supplementary files

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2. Fig. 1. Bending and corrugation in the anastomosis zone when suturing two reconfigured intestinal segments into a single ileograft using the generally accepted technique

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3. Fig. 2. Stage of resection of the central part of the intestinal segment in order to free up space for two lateral ileografts with their subsequent reconfiguration

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4. Fig. 3. The stage of dissection of two short ileografts along the antimesenteric edges and their rotation by 90° towards each other. The removed central segment of the graft is on the upper right.

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5. Fig. 4. The stage of detubularization and suturing of the two remaining unfolded intestinal sections together

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6. Fig. 5. Stage of formation of a single tubular ileograft from two detubularized intestinal sections

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7. Fig. 6. The final appearance of the operation of ureteroileoureteroanastomosis with two reconfigured intestinal grafts according to Yang-Monti in our modification

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8. Fig. 7. Data of MSCT with contrast of the patient 2 years after right-sided ileoureteroplasty with two intestinal transplants according to Yang-Monti in our modification. Good function of the right kidney, patency

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9. Fig. 8. Data from MSCT with contrast of a patient 5 years after bilateral isoperistaltic figure-7 ileoureteroplasty.

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10. Fig. 9. Data of MSCT with contrast of the patient 6 months after laparoscopic bilateral total ileoureteroplasty. Good function of newly created ureters from straightened intestinal segments

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