| Popis: |
222 patients with obstructive ureterohydronephrosis aged 14 to 65 years were treated surgically. They have undergone nephroureteroectomy (n = 7), direct ureterocystoneostomy (n = 84). In 134 patients 156 ureters were replaced by an iliac segment (unilaterally in 102 cases, bilaterally in 50 cases, in 4 cases of ureterohydronephrosis of a single kidney). In addition to routine diagnostic methods for ureterohydronephrosis, intraoperative electroureteromyography was used. By intensity of ureteral biopotentials, the borders of nonfunctioning zone of the ureter were estimated. Normal bioelectricity was found 40 to 60 mm down and up from the pathological focus, respectively. The presence of structural changes in the ureters' wall within this zone was proved by morphological investigations. Indications for intestinal plastic surgery of the ureter were the following: recurrent ureteral strictures, ureteral fistula, long strictures of the ureter, prepelvic strictures of the ureter, multiple strictures (36, 21, 69, 16 and 7 cases, respectively). All the operations were performed in one stage through the abdominal cavity with a single intestinal transplant. The above plastic surgery restores both patency of the urinary tracts and transportation of uric bolus to the bladder. Postoperative course depends mostly on the initial condition of the patient and function of the kidneys. Postoperative lethality was 0.45%. Intestinal plastic surgery of the ureter is a valuable alternative to nephroureteroectomy in bilateral pathology of the kidney and in ureterohydronephrosis of a single kidney. |
