In recent years, the plastic walls of the ureter has become widespread.
Often this is the only option for a person who suffers from serious diseases of the urinary system to return to a normal lifestyle.
In order to treat various human diseases in medical practice, surgical intervention is used. 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, it is used for pathological changes in the organs of the urinary system, strictures, doubling of the ureter, tumors, hydronephrosis and other diseases.
Indications
The main indications for ureteroplasty are the following pathological conditions in the patient:
- Tumor masses in the urinary system.
- Hydronephrosis (according to ICD 10 13.0-13.3).
- Removal of fibroids.
- Complicated labor in women, as a result of which the outflow of urine is disrupted.
- Recovery of a ureter damaged by surgery.
- Obstructive changes in the ureter (the appearance of an obstacle to the outflow of urine).
Contraindications
Ureter plastic is contraindicated if the patient has the following diseases and physiological conditions:
- Mental disorders.
- Pathological changes in the heart, blood vessels.
- Diabetes.
- Pregnancy.
- The presence in the body of diseases of infectious etiology in the acute or chronic period.
- Decreased blood coagulation.
It is important to note that the success of the operation largely depends on a preliminary full examination of the patient. This will allow you to identify likely contraindications and prevent the development of complications.
The essence of surgery, preparation for
Ureteroplasty means the replacement of a certain part of an organ with a special implant. An intervention is carried out only if the patient has serious indications and conservative therapy did not give the expected result. The operating method is selected based on the individual characteristics of the patient’s body, the course of the disease, 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 health status is performed. If infectious lesions are found 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.
Types of surgery
An operation on the ureter is performed exclusively under general anesthesia. The type of anesthesia and the necessary dosage of the drug for each patient are determined in advance. Immediately before the operation, a catheter (stent) is inserted into the ureter. It will allow urine to be excreted during surgery and for several days after it.
Intestinal plastic
Under such plastic surgery is meant partial or complete replacement of a fragment of the urinary tract. During surgery, 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, tissue of the small intestine is used for such purposes. During the surgical intervention, the surgeon forms part of the urinary canal, suturing the area of the bladder and kidney. This method is often used if a complete replacement of the ureter is required.
With partial plastic, part of the urinary tract is replaced. The method is similar to the previous one. The catheter is brought out - it temporarily performs the functions of the ureter. After the sutures heal, the stent from the ureter must be removed. Partial replacement of the urinary canal is indicated for patients if removal of oncological tumors or adhesions in the ureter is required. Often, this technique is used in case of significant organ damage.
Endoplasty of the mouth
Endoplasty of the ureteral orifice is indicated for patients diagnosed with vesicoureteral reflux. This type of intervention has several advantages, it is characterized by insignificant organ trauma, and a low probability of complications. Moreover, such an operation does not last long.
During surgery, a needle is inserted into the mouth of the ureter, which is attached to the syringe with a volume-forming substance. This substance is slowly introduced 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, the use of a catheter for up to 12 hours is necessary.
Ureteroureteroanastamosis
Ureteroureteroanastamosis refers to a type of surgical intervention in which the ends of the urinary canal are connected. Such an intervention is indicated for organ damage during surgery, ureteral strictures. Such a plastic ureter with hydronephrosis can also be used. During the operation, the surgeon excised the damaged tissue, which is replaced by implants. This is followed by suturing. The main contraindications to this manipulation are:
- Chronic form of pyelonephritis.
- Fibrosis.
- Throwing urine into the contralateral kidney.
- Urothelial 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 cancerous tumors in the bladder, and some other pathological changes.
Boari technique
Surgery according to the Boari method means plasty 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 part of the ureter is formed from the resulting tissue. Such an intervention is carried out by open access. The incision for access is performed over the damaged area of the urinary tract.
Boari surgery, as a rule, is indicated for bilateral lesions of the ureters. At the same time, several flaps are cut from the bladder tissue at the same time. Excised bladder tissue is healed with blind sutures. The removal of the catheter occurs after complete healing of the wounds.
Possible complications, rehabilitation period
Like other surgical interventions, plastic surgery of the ureter can provoke negative consequences. Among them:
- The appearance of hernias.
- Damage to nearby organs.
- The development of inflammation.
- Joining an infection.
- Pain
- Bleeding.
To prevent the above complications and other serious consequences, the patient must be properly rehabilitated after surgery. After the operation, the patient should be transferred under the close supervision of a specialist. Condition monitoring should be carried out using special devices, by measuring temperature, based on complaints of the operated patient. Be sure to perform an assessment of the quality, as well as the amount of urine excreted. After 3-4 days, catheter removal is indicated. The duration of the patient’s stay in stationary conditions 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 remain 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 accelerate recovery, it is extremely important to adhere to certain medical recommendations:
- Adhere to a diet that will reduce the level of acidity of urine. This is necessary in order to prevent irritation of the newly operated tissues of the ureter.
- Within a month after surgery, you should refrain from intense physical activity, sports. Such a measure will eliminate the likelihood of divergence of seams, the occurrence of complications.
- In case of pain, a change in the visual characteristics of urine (color, smell, quantity), the patient must visit a doctor and inform him about negative changes.
- It is important to timely perform wound dressings and visit a doctor for examination of sutures. With the development of purulent inflammation, it is necessary to immediately contact a medical institution.
Urethral grafting is a fairly common surgical intervention, allowing you to save the patient from many pathologies. With the right methodology, exclusion of contraindications, strict adherence to medical recommendations during the recovery period, the patient can quickly return to a familiar and full 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 health, and at the slightest suspicion of developing a complication or other disorder, you must consult a doctor.