ABSTRACT
The article presents the operation results of 380 patients (170 (44,7%) men and 210 (55,3%) women) with obstruction of pyeloureteral segment at the period from 1996 to 2014. The middle age was 43,2±7,6 years old. Primary strictures took place in 302 (79,5%) patients and recurrent strictures - in 78 (20,5%). Open and laparoscopic plastic operations were performed in 248 (65,2%), endoscopic surgery - in 112 (29,5%), organo-removal surgery - in 20 (5,3%) cases out of 380 patients with obstruction of pyeloureteral segment. The hines Andersen open pyeloplasty was carried out in 142 (37,4%) patients with primary hydro- nephrosis out of 152. In addition, an antevasal pyeloureteral anastomosis was formed in 65 (17,1%) cases. Neivert operation was used in 8 (2,1%) cases because of extensive stricture of pyeloureteral segment. Kalp-De Vird pathwise pyeloplasty was fulfilled in 2 (0,5%) patients. Laparoscopic pyeloplasty was performed on 96 (16,7%) patients. These surgeries were carried out by transperitoneal approach using lateral position and 3 or 4 trocars. Endoscopic treatment of pyeloureteral segment was completed in 112 (29,5%) patients. Percutaneous endopyelotomy was used in 42 (11,0%) and retrograde - in 64 (16,8%) cases. Endoplasty of pyeloureteral segment was applied in 6 (1,6%). The efficacy of open pyeloplasty consisted of 93,7% and laparoscopic pyeloplasty - 94,6%. Good results after endopyelotomy were noted in recurrent strictures of pyelouretal segment.
Subject(s)
Kidney/surgery , Laparoscopy/methods , Plastic Surgery Procedures/methods , Ureter/surgery , Ureteral Obstruction/surgery , Urologic Surgical Procedures/methods , Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Retrospective Studies , Treatment Outcome , Young AdultABSTRACT
The article presents the results of laparoscopic pyeloplasty in 72 patients with primary stricture of pyeloureteral segment (PUS). The study included 34 men, 38 women; mean age was 32 +/- 4,6 years. The operation was performed by transperitoneal approach in side position of patients. 4 trocars were used. There were no conversions to open surgery. Urinary leak after surgery was observed in 4 patients; in 3 patients it has discontinued independently, and in one patient it has required a repeat laparoscopy and suturing of anastomotic defect. Due to recurrent narrowing of the PUS, two patients underwent retrograde endopyelotomy, and one patient--open pyeloplasty. The effectiveness of laparoscopic pyeloplasty in these series was 94.4%. Impediments for performing laparoscopic pyeloplasty included small pelvis size, the presence of inferior polar vessels, and frequent exacerbations of chronic pyelonephritis, which led to the development of adhesive process in the PUS. Thus, laparoscopic pyeloplasty is the treatment of choice in patients with primary constrictions of PUS and is as effective as open plasty of PUS.
