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Reconstruction of the Ureter

Reconstruction of the Ureter
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This article is written by our team of reconstructive urological surgeonsfor patients with narrowing or complete loss of the ureter. Perhaps only patients with ureteral damage and doctors dealing with this complex branch of medicine are able to fully appreciate the expression "ureteral invalid."

In our bodies, there are many seemingly inconspicuous organs, the failure of which can cause a sudden deterioration in the quality of life or even a threat to life itself. Just think of the appendix, a tiny appendage of the intestine, inflammation of which, without immediate surgical intervention, can almost inevitably lead to death.

While appendicitis can quickly be fatal, damage to or removal of the ureter turns a person into a so-called "ureteral invalid." Since narrowing or compression of the ureter leads to the inability of urine to flow from the kidney, patients are forced to constantly wear a nephrostomy tube. The nephrostomy tube is a catheter that drains urine from the kidney into a special bag, which also has to be carried at all times. In such cases, one can simply forget about a normal social life or any kind of activity.

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Nephrostomy

Nephrostomy(also known as nephrostomic catheter or drainage, CPNS, renal catheter) is a hollow tube that is inserted at one end into the renal pelvis for collecting and draining urine, while the other end is attached to a urine collection bag. The nephrostomy tube passes through the skin, so it may also be referred to as a percutaneous drainage. In addition to the natural household and hygienic inconveniences, a nephrostomy requires regular replacement and maintenance.

The exit site of the tube from the skin needs to be regularly treated with antiseptics, and so on. Besides the obvious drawbacks, wearing this drainage entails two major dangers

Issues with having a nephrostomy

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Tube dislodgement
Firstly, the tube from the kidney can accidentally be dislodged, simply by sitting awkwardly on the urine collection bag. In such a case, immediate medical attention would be required, hoping that help arrives promptly.
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Infection
Secondly, and perhaps the main concern for those who are forced to wear a nephrostomy for an extended period, is that the tube serves as a direct channel for infection, which almost inevitably affects the kidney.
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Renal insufficiency
Various inflammations and acute pyelonephritis attacks will sooner or later lead to chronic renal insufficiency, which unfortunately ends in dialysis or the death of the patient.

Prolonged wearing of a nephrostomy is a necessary measure that leads to kidney inflammations, radical deterioration in the quality of life, and unfortunately, the death of the patient withina few years due to chronic renal insufficiency.

Ureter Reconstruction Surgeries at Our Center

Before we delve into describing various methods of reconstructive-plastic surgery of the ureter, it is worth noting that such operations are carried out only in specialized centers. Reconstructive surgeries in general, and ureter reconstruction in particular, are considered the "pinnacle" of urological surgery. Simply because restoring is always more challenging than, for example, removing a kidney. Such operations require not only the personal skill of the surgeon but also the cohesive teamwork of specialists, state-of-the-art equipment, and a responsible approach to choosing the methodology.

In our clinic, all types of ureter reconstructions are performed, from standard Boari flap procedures to simultaneous reconstruction of both ureters and the urinary bladder.

What types of ureter surgeries are performed?

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Boari Operation
This procedure is performed when the urinary bladder is intact, but the ureter is damaged in the lower part. A flap is detached from the bladder, and a portion of the ureter is formed from it. This operation is indicated for patients with damage to the lower third of the ureter.
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Intestinal Plastic Surgery
If the ureter is completely damaged or removed, intestinal plastic surgery of the ureter is performed. For this operation, an isolated segment of the ileum is taken, and it is used to replace the ureter.
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Appendiceal Plastic Surgery
This is an excellent option, provided that the appendix has not been removed. Replacement of a portion of the lower and sometimes middle part of the ureter can be performed using the appendix in cases of strictures of the right ureter.
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Mucosal Cheek Reconstruction
A relatively new method, especially suitable for patients after recurrences of strictures, such as in the pelvicalyceal-ureteric segment. This method also demonstrates good results in cases of moderately extensive strictures.
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Reconstruction of Both Ureters
This is a highly complex surgery performed in severe cases of pathology affecting both ureters. An isolated segment of the small intestine is used as a substitute tube, creating a connection between the kidneys, the segment, and the urinary bladder.
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Bladder and Ureters Plastic Surgery
A rare operation conducted for patients who have lost the function of their ureters and urinary bladder due to oncological or traumatic reasons. The urinary bladder and ureters are specially sutured.

How is treatment carried out in our clinic

DAY 1
CONSULTATION AND MEDICAL CONSILIUM
DAY 2
PREPARATION FOR SURGERY, HOSPITALIZATION
DAY 3
URETER RECONSTRUCTION SURGERY
DAYS 4-10
HOSPITAL OBSERVATION, TREATMENT, AND DISCHARGE
1-5 YEARS
PATIENT HEALTH MONITORING AND CONTROL

During the initial consultation, we evaluate the results of previous examinations and surgeries, perform preliminary analyses, and assess the patient's overall condition. The most suitable method for ureter reconstruction is chosen during the consilium.

Preparation for surgery is strictly individualized for each patient: it is necessary to assess too many factors to standardize this examination. Bowel preparation is conducted using modern methods as part of the preoperative process.

Day of the operation. In the morning of this day, we recommend not eating or drinking. On the night before the surgery, we provide the patient with a sedative to alleviate anxiety and allow for a good night's sleep. Additionally, preliminary antibiotic therapy is administered before the surgery.

Inpatient observation and treatment involve careful monitoring of the patient's health, allowing us to adjust the treatment accordingly. The most important aspect at this stage is early patient mobilization, which facilitates rapid recovery.

It is important to understand that reconstructive surgeries require careful patient monitoring. During the first year after the operation, we invite the patient for follow-up appointments every three months, and afterward, every six months. This allows for prompt and effective treatment in case of recurrence.

Our Center's Experience

COUNTRIES
27
Residents from 27 countries around the world have turned to us for surgical treatment.
PATIENTS
334
Operated in our clinic up to 2021 for ureteral strictures or pathologies.
COMPLICATIONS
1,3%
The laparoscopic approach allows us to avoid frequent complications
DAYS
5-6
Hospitalization for ureteral reconstructive surgery typically lasts an average of 5-6 days.
FAST TRACK
93%
The majority of our patients undergo postoperative recovery according to the Fast Track protocol.
TYPES OF PLASTIC SURGERY
All
We have experience performing all possible types of ureteral reconstruction surgeries
Ask your question
What is and how does ureteral stricture manifest?
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What are the causes of ureteral stricture?
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In such cases, ureteroplasty is usually recommended. Please tell me, what is ureteroplasty and what types of surgeries are available for treating ureteral stricture?
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What is special about treating ureteral stricture?
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author
Dr. Oganes E. Dilanyan
Urology-oncology surgeon, Ph.D. of Medical Sciences
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