Features of bilateral surgery
Bilateral high-grade reflux and megaureter are more common in children and young patients; reimplantation of both ureters in one operation eliminates the need for repeated anesthesia and hospital stay. Through the opened bladder, both ureters are passed into new submucosal tunnels (in children, often using the Cohen technique - with a cross), stents are installed for 4-6 weeks. Careful monitoring of urine flow from both kidneys in the first days is an essential part of postoperative management. Control cystography after 3 months confirms the disappearance of reflux.
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%.
