INTESTINAL AND APPENDICULAR URETERAL SUBSTITUTION


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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.

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作者简介

B. 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. 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. 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

参考

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