Bilateral laparoscopy
One set of punctures gives access to both ureters; the surgeon sequentially forms two antireflux anastomoses on stents, if necessary, with bilateral fixation of the bladder. The operation is longer than one-sided, but avoids repeated hospitalization. After the operation, the outflow from both kidneys is monitored by ultrasound and drainage; stents are removed after 4–6 weeks, cystography is performed after 3 months. The indications and results are the same as for open bilateral reimplantation, with less trauma and faster recovery.
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%.
