Reconstructive procedures in women with irradiation injuries of urinary tract: change of a paradigm

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Introduction. Radiation therapy is one of the main methods of treating pelvic malignant tumors, which provides good oncological results. Specific features of the pelvic anatomy may result in various radiation injuries of adjacent organs, which are complicated by genitourinary fistulas, post-radiation fibrosis with the formation of hydronephrosis, microcyst, reducing the quality of life.

Aim. To describe the relevance and importance of the correct choice of surgical treatment in patients with post-radiation urinary tract injuries.

Materials and methods. The group of irradiation injuries of the urinary tract included 60 patients aged 39–65 years. 19 (31.7%) women with various post-radiation ureteral injurie, who underwent reconstructive surgery using isolated bowel segments, were included in the study group.

Results. Substitution of the ureter by intestinal segment in patients with extensive post-radiation ureteral strictures provides good functional results. During follow-up computed tomography, an absence of urinary tract obstruction was confirmed in 16 (84.2%) patients, while in 3 (15.8%) cases an obstruction was diagnosed, followed by nephrectomy due to loss of function in 1 woman (5.3%). When assessing renal function using the dynamic nuclear scintigraphy, improvement in function was revealed in 14 (73.7%) patients, stabilization in 2 (10.5%), deterioration in 3 (15.8%). Histological examination revealed that inflammatory infiltration and the absence of a clear margins of the stricture area were more pronounced in patients who had had internal ureteral stent prior to reconstruction. A number of clinical cases demonstrating the treatment tactics of this group of patients is presented in the article.

Conclusion. Based on the extensive experience of two centers and long follow-up, we suggest scientifically proven approach to surgical treatment of radiation injuries of the urinary tract, the implementation of which will significantly improve medical and social rehabilitation.

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作者简介

O. Loran

Russian Medical Academy of Continuous Professional Education (RMACPE); S.P. Botkin’s State Clinical Hospital

Email: olegloran@gmail.com
ORCID iD: 0000-0002-7531-1511

Academician of RAS, Ph.D., MD, professor, Chief of Department of Urology and Surgical Andrology

俄罗斯联邦, Moscow; Moscow

R. Guspanov

FGAOU VO Pirogov Russian National Research University; GBUZ MMKC “Kommunarka”

编辑信件的主要联系方式.
Email: uroguspanov@yandex.ru
ORCID iD: 0000-0002-2944-2668

Ph.D., associate professor at the Department of Urology and Andrology of Pirogov Russian National Research Medical University

俄罗斯联邦, Moscow; Moscow

S. Kotov

FGAOU VO Pirogov Russian National Research University; GBUZ MMKC “Kommunarka”

Email: urokotov@mail.ru
ORCID iD: 0000-0003-3764-6131

Ph.D., MD, professor, Head of the Department of Urology and Andrology 

俄罗斯联邦, Moscow; Moscow

A. Seregin

Russian Medical Academy of Continuous Professional Education (RMACPE); S.P. Botkin’s State Clinical Hospital

Email: av_seregin@mail.ru
ORCID iD: 0000-0002-5842-7344

Ph.D., MD, professor, Head of the Urologic Department No 41 of S.P. Botkin city clinical hospital

俄罗斯联邦, Moscow; Moscow

A. Morozov

S.P. Botkin’s State Clinical Hospital

Email: renat@guspanov.ru

Ph.D., urologist of the Urologic Department No 41 

俄罗斯联邦, Moscow

D. Bogdanov

FGAOU VO Pirogov Russian National Research University; GBUZ MMKC “Kommunarka”

Email: renat@guspanov.ru
ORCID iD: 0000-0001-6847-5684

Ph.D. student at the Department of Urology and Andrology of Pirogov Russian National Research Medical University

俄罗斯联邦, Moscow; Moscow

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2. Fig. 1. Histological study of a ureteral fragment after previously placed nephrostomy drainage. Haematoxylin-eosin staining, magnification - x56

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3. Fig. 2. Histological study of a ureteral fragment after a previously placed internal stent. Haematoxylin-eosin staining, magnification - x56

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4. Fig. 3. Immunohistochemical study of the ureter fragment

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5. Fig 4. Intraoperative picture. Stages of the operation performed on patient M.

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6. Fig. 5. Control CT scan

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7. Fig 6. CT scan after 1 year. No urodynamic disturbance in the upper urinary tract was detected

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8. Fig. 7. Antegrade pyeloureterography. Recurrence of ureteral stricture (indicated by arrow)

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9. Fig. 8. Intraoperative picture. Boari operation. Dedicated narrow ureter on the holder

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10. Fig 9. CT scan with IV contrast. Bladder defect. Urinary leakage into the retroperitoneal space

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11. Fig. 10. Overview radiography. Ureteral stents are placed

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12. Fig. 11. Control CT scan - no retention of upper urinary tract changes

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