[Laparoscopic antevasal uretero-ureteral anastomosis for treating retrocaval ureter].

The article presents a case of laparoscopic antevasal correction of the retrocaval ureter in a 16 year old patient, who was admitted to the hospital with complaints of aching pain in the right lower back. His history was noteworthy of early age onset of intermittent fever accompanied by abdominal and lumbar pain. Blood count and urinalysis were within normal limits, and he was treated symptomatically. However, no renal ultrasound scan was done. Intravenous urography and MSCT showed a retrocaval ureter. The diagnosis was confirmed by retrograde ureteropyelography. With the patient placed in the lateral position, the right ureter was mobilized by transperitoneal access, transected and mobilized from under the inferior vena cava. Anterior uretero-ureteral anastomosis on the stent was performed, drainage was established. The operating time was 90 minutes, blood loss was 60 ml. There were no postoperative complications. Drainage was removed 2 days after surgery and the patient was discharged for outpatient treatment. The stent was removed 6 weeks postoperatively. Control urography showed normal function of both kidneys, no urodynamic abnormality of the upper urinary tract was identified.

[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.

[Short-term outcomes of radical surgery for bladder cancer]. / Blizhaishie rezul'taty radikal'noi operatsii pri rake mochevogo puzyria.

A total of 102 radical cystectomies have been conducted for 1996-2001 (94 males, 8 females, age 37-78 years, mean age 57.5 years). Most of the patients (81.4%) were diagnosed to have transitional cell carcinoma. Supravesical urine derivation was made by means of ureterocutaneostomy and transureteroureteronephrostomy in 7(6.9) patients, ureterosigmoanastomosis--in 41(40.2%), Sigma-rectumpouch--in 1(0.9%) patients, ileocystoplasty, largely by Hautmann and Studer was carried out in 52(51%) patients. Postoperative complications developed in 25(24.5%) patients who often had adhesive ileus. Four patients died: 2 of pulmonary artery thromboembolism, 1 of acute cardiac failure and 1 of sepsis. Methods of continence urine derivation were preferred, such as ureterosigmoanastomosis by Mainz-Pouch II and creation of orthotopic bladder of the ileum.