Ureteroplasty has become widespread in recent years.
It is often the only option for a person who suffers from severe urinary problems to return to a normal lifestyle.
Surgical intervention is used in medical practice to treat various human diseases. Thanks to operations, it becomes possible to restore the lost functions of various internal organs, their integrity. One of these interventions is ureteroplasty. This intervention has several varieties, is used for pathological changes in the organs of the urinary system, strictures, duplication of the ureter, tumors, hydronephrosis and other diseases.
Indications
The main indications for ureteroplasty are as followspathological conditions in the patient:
- Tumor formations in the urinary system.
- Hydronephrosis (ICD 10 13.0-13.3).
- Removal of fibroids.
- Complicated childbirth in women, as a result of which the outflow of urine is disturbed.
- Restoration of the ureter damaged as a result of surgery.
- Obstructive changes in the ureter (the appearance of an obstruction to the outflow of urine).
Contraindications
Ureteroplasty is contraindicated if the patient has the following diseases and physiological conditions:
- Mental disorders.
- Pathological changes in the heart, blood vessels.
- Diabetes mellitus.
- Pregnancy.
- Presence in the body of diseases of infectious etiology in the acute or chronic period.
- Reduced blood clotting.
It is important to note that the success of the operation largely depends on a preliminary complete examination of the patient. This will identify possible contraindications and prevent the development of complications.
The essence of the surgical intervention, preparation for the conduction
Ureteroplasty means the replacement of a certain part of the organ with a special implant. Intervention is carried out only if the patient has serious indications for this and conservative therapy has not given the expected result. The method of operation is chosen based on the individual characteristics of the patient's body, the course of the disease, and its type.
An important stage of treatment is the process of preparing the patient for the upcoming surgical intervention. At this stage, a complete diagnosis of the patient's he alth status is carried out. If infectious lesions are detected in the genitourinary system, appropriate therapy is indicated. In addition, it is imperative to conduct a laboratory study of blood and urine samples. The next stage of preparation is the identification of allergic reactions to certain drugs. In the absence of serious contraindications, the doctor determines the date of the operation.
Varieties of surgery
The operation on the ureter is performed exclusively under general anesthesia. The type of anesthesia and the required dosage of the drug for each patient are determined in advance. Immediately before the operation, the patient is placed a catheter (stent) in the ureter. It will allow you to urinate during the operation and for several days after.
Intestinal plasty
Under such plastic means partial or complete replacement of a fragment of the urinary tract. During the operation, the formation of the ureter in the part where it is damaged is carried out using an isolated segment of the intestine. As a rule, tissues of the small intestine are used for such purposes. During the surgical intervention, the surgeon performs the formation of a part of the urinary canal, suturing in the area of the bladder and kidney. This method is often used when a total ureter replacement is required.
In case of partial plasticity, a part is replacedurinary tract. The method is similar to the previous one. The catheter is brought out - it temporarily performs the functions of the ureter. Once the sutures have healed, the ureteral stent must be removed. Partial replacement of the urinary canal is indicated for patients if removal of oncological tumors, adhesions in the ureter is required. Often this technique is used in case of significant damage to the organ.
Mouth Endoplasty
Ureteral orifice endoplasty is indicated for patients diagnosed with vesicoureteral reflux. This type of intervention has several advantages, is characterized by minor trauma to the organs, and a low likelihood of complications. In addition, such an operation does not last long.
During surgery, a needle is inserted into the mouth of the ureter, which is attached to a syringe with a volume-forming substance. This substance is slowly injected to a depth of 5-7 mm under the mucous membranes. Due to this action, the mouth of the ureter expands at the injection site of the gel. Then the needle is removed. After such manipulation, it is necessary to use a catheter for up to 12 hours.
Ureteroureteroanastomosis
Ureteroureteroanastamosis refers to a type of surgical intervention in which the ends of the urinary canal are connected. Such an intervention is indicated in case of damage to the organ during the operation, strictures of the ureter. Such ureteroplasty in hydronephrosis can also be used. During the operation, the surgeon exciseddamaged tissues that are replaced by implants. This is followed by suturing. The main contraindications for this manipulation are:
- Chronic form of pyelonephritis.
- Fibrosis.
- Rejection of urine into the contralateral kidney.
- Urotelial cancer.
- Hydronephrosis (ICD 10 13.0-13.3).
It is important to note that ureteroureteroanastamosis is not used if radiation therapy of organs located in the small pelvis was performed, with diagnosed oncological neoplasms in the bladder, and some other pathological changes.
Boari Method
Surgical intervention according to the Boari method means plastic surgery of the urinary tract using the tissues of the bladder of the operated patient. During the operation, a special plastic tube is inserted into the ureter, which is then fixed. The surgeon excised a flap of tissue from the bladder. Then a part of the ureter is formed from the resulting tissue. Such an intervention is carried out in open access. An access incision is made over the damaged area of the urinary tract.
Boari surgery is usually indicated for bilateral ureteral lesions. At the same time, several flaps are cut out from the tissues of the bladder at once. Excised tissues of the bladder heal with blind sutures. The catheter is removed after the wound has completely healed.
Probable complications, rehabilitation period
Like other surgical interventions, ureteroplasty canprovoke negative consequences. Among them:
- The appearance of hernias.
- Tissue damage to nearby organs.
- Development of the inflammation process.
- Accession of infection.
- Pain.
- Bleeding.
To prevent the above complications and other serious consequences, the patient must be properly rehabilitated after surgery. After the end of the operation, the patient should be transferred under the close supervision of a specialist. Condition control should be carried out with the help of special devices, by measuring temperature, based on the complaints of the operated patient. Be sure to evaluate the quality as well as the amount of urine excreted. After 3-4 days, removal of the catheter is indicated. The length of the patient's stay in hospital depends on the success of the operation and the speed with which the activity of the urinary system is restored. If the manipulations were performed by laparoscopy, the patient can stay in the hospital for only a few days. After an open intervention, the patient's rehabilitation period is longer and takes up to 3 weeks.
Recommendations
After returning home to the patient, in order to speed up recovery, it is extremely important to follow certain medical recommendations:
- Establish a diet that will reduce urine acidity. This is necessary in order to prevent irritation justoperated tissues of the ureter.
- Within a month after surgery, you should refrain from intense physical activity, sports. Such a measure will eliminate the possibility of divergence of the seams, the occurrence of complications.
- If pain occurs, changes in the visual characteristics of urine (color, smell, quantity), the patient must visit the doctor without fail and inform him of the negative changes.
- It is important to bandage the wound in time and visit a doctor to examine the stitches. With the development of purulent inflammation, you must immediately contact a medical facility.
Ureteroplasty is a fairly common surgical intervention that allows you to save the patient from many pathologies. With the right technique, the exclusion of contraindications, and strict adherence to medical recommendations during the recovery period, the patient can quickly return to a normal and fulfilling life.
It must be remembered that surgical operations are quite serious interventions, so the success of the cure largely depends on the recovery period. It is important to monitor your own he alth, and at the slightest suspicion of developing a complication or other violation, you should seek the advice of a doctor.
