Repeated reconstruction
Recurrence of stricture after pyeloplasty occurs in 5–10% of cases: due to ischemia of the anastomosis, infection, urinary leakage or missed accessory vessel. Before re-operation, MSCT and retrograde ureteropyelography are performed to assess the extent of the scar. The surgeon excises the scar anastomosis to healthy tissue; with a short defect, a new anastomosis is formed, with a long one, a flap of the pelvis, buccal mucosa, or relocation of the kidney is used. The stent is left in place for 6–8 weeks. The effectiveness of re-plasty is 80–90%; If the kidney is not functioning, nephrectomy becomes an alternative.
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.
