Laparoscopic technique
Under magnification, the surgeon identifies the ureter, cuts off the narrowed section, opens the bladder and passes the ureter into the submucosal tunnel, performing an anastomosis with thin threads on a stent; if there is a lack of length, the bladder is fixed to the psoas muscle. The absence of a large incision and minimal blood loss allows you to get up the next day. The catheter is removed after 5–7 days, the stent after 4–6 weeks. The method is not used for severe scars after radiation therapy and repeated operations - then open access is preferable.
Indications for ureteral reimplantation
- stricture or obliteration of the lower third of the ureter after pelvic surgery, radiation therapy, stones;
- damage to the ureter during gynecological and surgical operations;
- high-grade vesicoureteral reflux with infections and scarring of the kidney;
- ureterocele and ectopic ureter with duplication;
- megaureter with outflow disturbance;
- tumor of the lower third of the ureter after resection.
How the ureter is restored
The essence of the operation is to re-sew a healthy ureter to the bladder so that urine flows freely downwards, but is not thrown back: the ureter is passed through a submucosal tunnel of the bladder wall 2-3 cm long (anti-reflux protection). If, after excision, there is not enough ureteral stricture, the bladder is mobilized and fixed to the psoas muscle (psoas hitch) or a flap-tube is cut out of its wall (Boari operation) - this way the defect is replaced up to 10-12 cm. The anastomosis is formed on a stent, which is removed after 4-6 weeks. Efficiency 90–95%.
