Open reimplantation
Through an incision above the pubis, the bladder is opened, the ureter is exposed to a healthy area, and the affected section is cut off. A submucosal tunnel is formed in the wall of the bladder, through which the ureter is passed and sutured from the inside to the mucosa (Politano-Leadbetter or Cohen technique). If there is insufficient length, the bladder is pulled towards the psoas muscle. A stent, urethral catheter and drainage are installed. An open approach is preferred for reoperations, radial strictures, extensive lesions, and when another open operation is simultaneously needed.
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%.
