Open plastic surgery: when is it preferable?
Through a 6–10 cm lumbotomy, the surgeon exposes the pelvis and ureter, excises the stricture and excess distended pelvis, spatulates the ureter and forms a wide anastomosis with thin absorbable sutures on an internal stent; with an accessory vessel, the ureter is transferred in front of it. Direct tactile control is useful for scars from previous operations and severe inflammation. The drainage is removed on the 2-3rd day, the sutures - on the 10th, the stent - after 4-6 weeks. Recovery takes 4–6 weeks.
Hydronephrosis and stricture of the lumbar spine
Hydronephrosis is an enlargement of the pelvis and calyces due to an obstruction to the outflow of urine at the junction of the pelvis and the ureter (ureteropelvic segment, LMS). Causes: congenital narrowing, accessory vessel, compressive ureter, high ureteral discharge, scars after stones and operations. Without treatment, the kidney gradually loses function. Indications for plastic surgery: decreased kidney function according to scintigraphy, pain, infections, stones, progression of dilation.
Results and recovery
Pyeloplasty is the most effective operation for hydronephrosis: outflow is restored in 90–95% of patients, and kidney function stabilizes or improves. After laparoscopic surgery, the patient spends 3-4 days in the hospital, after open surgery - 5-7; the stent is removed after 4–6 weeks on an outpatient basis. Ultrasound monitoring and scintigraphy confirm the result within a year.
