PLASTIC SURGERY OF THE PROXIMAL URETER WITH A BUCCAL MUCOSA GRAFT
Abstract
Introduction. With recurrent extended strictures of the pyeloureteral segment (PUS) and the proximal ureter, when standard operations are ineffective or technically impossible, the narrowed area can be replaced with a buccal mucosa graft. The purpose of the study: to study the results of laparoscopic plastic surgery of the PUS and proximal ureter with buccal graft. Materials and methods. Minimally invasive plastic surgery of the extended stricture of the PUS, upper and middle third of the ureter with a flap from the cheek mucosa was performed in 30 patients. Of these, there were men 18 (60.0%), women — 12 (40.0%)., the average age was 51 (19–77) years. The cause of narrowing in 18 patients was previously performed pyeloplasty. Laparoscopic access was used in 27 patients, and robot-assisted access was used in 3 patients. In 18 of them, the narrowed area was replaced by the onlay technique, in 12 patients, anastomosis augmentation was performed with a buccal graft. Results. There were no intraoperative complications. The duration of operations ranged from 115 to 340 minutes. There were no cases of urine leaking through the drainage. Fever up to 38.0 °C was observed in 5 (18.5%) patients, 3 (11.1%) of them underwent antibacterial therapy (grade II according to Clavien), and 2 (7.4%) without nephrostomy drainage, puncture nephrostomy (grade IIIa according to Clavien) was performed. There were no complications according to Clavien ≥IIIb degree. On excretory urograms and computed tomography, the area of the ureter replaced by a buccal flap is wide and well passable. In patients with PUS strictures, a decrease in the size of expanded cups and pelvis was observed in dynamics. Clinically, all operations were successful, as it was possible to relieve patients from nephrostomy drainage and symptoms of upper urinary tract obstruction. Conclusion. Buccal ureteroplasty may be the method of choice in patients with extensive narrowing of the PUS and proximal ureter. It is a relatively simple operation and does not require extensive mobilization of the ureter and provides good functional results.
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