[Subcutaneous nephrovesical bypass in ureteral obstruction].

We performed subcutaneous bypass draining (SBD) of the upper urinary tract (UUT) in 12 patients (3 males, 9 females, mean age 64 years) in 2006-2008. Ureteral obstruction was caused by a tumor in 11 patients, one patient had extended obliteration of the left ureter after resection of the abdominal aorta aneurysm and two plastic operations on the UUT. All the patients with ureteral tumor obstruction had only one functional kidney. For SBD of the kidney we used Detoure stent in 2 cases, the nephrovesical bypass - in the rest cases. Surgery was made in the lateroposition of the patient which provided sumaltenous establishment of the renal and vesical ends of the stent. The kidney was also drained by the nephrostoma in 8 patients. The nephrostoma was removed after antegrade pyelography and pyelomanometry. Intraoperative complications were not registered. Suprapubic urine leak in 3 patients previously given radiotherapy was stopped by a long drain of the bladder. Obstruction of the distal stent part by a progressive tumor was diagnosed in 1 patient 3 months later. The bypass was removed and a nephrostomic drainage was made. The nephrovesical stent was changed in one case 5 months after SBD. Upon 6-32 month follow-up 3 patients died of cancer progression, the rest are still alive. Thus, SBD is indicated if stenting, ureteral endoprosthesis, constant nephrostomic drainage are impossible. In some cancer patients with ureteral obstruction in UUT drainage SBD is a method of choice with promising short- and long-term results.

[Treatment of epithelial tumors of the upper urinary tracts]. / Operativnoe lechenie épitelial'nykh opukholei verkhnikh mochevyvodiashchikh putei.

The authors present the results of different operative treatments of tumors of the upper urinary tracts (UUT). A total of 116 patients with UUT tumors were examined and treated from 1990 to 2002 (age 19-80 years, mean age 61.3+/- 1.3 years; males 82, females 34). Tumors of the renal pelvis and the ureter were detected in 76 (65.5%) and 40 (34.5%) patients, respectively (8.0 and 4.3% of a total number of patients with tumors of the kidneys and UUT). 107 (92.2%) patients were operated. Nephroureterectomy and ureterectomy with resection of the urinary bladder were performed in 73 (68.2%) patients, TUR of the urinary bladder wall, ureteral ostium with pelvic part of the ureter and nephroureterectomy (including endovideosurgery) in 22 (20.6%), nephroureterocystectomy in 4 (3.7%), resection of the pelvic ureter with Boari's operation in 5 (4.7%), nephroscopy, ureteroscopy with removal of urothelial tumor in 3 (2.8%) patients. Postoperative complications (most of them infectious-inflammatory) developed in 10 (9.3%) patients. Lethality was 0.9%. Tumor recurrences occurred in 27 (25.2%) patients within 5-year follow-up. 15 (14.0%) patients were reoperated. 5-year survival reached 67.0%. Conventional and radical method of treating patients with tumors of the renal pelvis and ureter is nephroureterectomy with urinary bladder resection and its modification. In invasion of the tumor in the muscular layer of the bladder wall surgery should be extended and supplemented with cystectomy. Conservative surgical interventions are indicated in tumors of the sole kidney, bilateral process, benign or surface tumor of the urothelium.

[Short-term results of radical cystectomy]. / Blizhaishie rezul'taty radikal'nykh tsistéktomii.

The paper presents the results of 114 radical cystectomies made in 1996-2002. The age of 114 patients (103 males, 11 females) ranged from 37 to 78 years (mean age 57.5 years). Transient cell carcinoma was diagnosed in 81.5% patients. Supravesical urine derivation was conducted by means of ureterocutaneostomy and transureteroureteronephrostomy in 9 (7.9%) patients, ureterosygmoanastomosis--in 43 (37.7%) patients, artificial orthotopic urinary bladder was created in 7 (6.1%) patients of a gastric segment and in 55 (48.2%) patients of the ileum. Postoperative complications were observed in 28 (24.6%) patients, intestinal obstruction being a prevailing complication. Five patients died: 2 of pulmonary artery thromboembolism, 1 of acute cardiac failure, 1 of sepsis and 1 of gastric bleeding. Continent methods of urine derivation were preferred, such as ureterosygmoanastomosis by Mainz-Pouch II and creation of orthotopic urinary bladder of the stomach or of the ileum.