[Laparoscopic substitution of the right ureter by appendix onlay]
B G Guliev1,2, B K Komyakov1,2, J P Avazkhanov1,2
1Department of Urology of FGBOU VO North-Western State Medical University named after I.I. Mechnikov, Saint Petersburg, Russia.
Introduction:
In highly-selected patients with long narrowing of the middle and upper third of the right ureter, ureteroplasty with an appendix can be performed. In the literature, publications on the possibility of ureteroplasty onlay with a detubularized appendix have been appeared.
Aim:
To study the results of laparoscopic ureteroplasty of the right ureter using appendix as onlay flap.
Materials And Methods:
In the Center of Urology of Mariinsky hospital, 5 patients (2 men and 3 women) with a long stricture of the middle or upper third of the right ureter underwent right-side ureteroplasty using appendix as onlay flap. The mean age of the patients was 42.5 years. In 4 cases, the stricture developed after ureteroscopy with lithotripsy, while in 1 patient, laparoscopic ureterolysis was previously performed. Three patients were admitted with nephrostomy tube, two with a ureteral stent. The average length of the stricture was 3.5 (2.8-5.2) cm. The ureteral stricture was visualized by laparoscopic access, dissected along its length and replaced with a detubularized appendix as onlay flap.
Results:
The average procedure time was 225 (180-260) min, the volume of blood loss was 160 (70-245) ml, and the hospital stay was 3.6 (3-7) days. There were no intraoperative complications. In the postoperative period, fever was observed in one patient, and ileus, which resolved spontaneously, developed in another patient. With an average follow-up period of 13.5 (6.2-24.4) months, the procedure was effective in all cases. The urodynamics of the upper urinary tract recovered completely in 3 patients and improved in 2 cases. Pain disappeared in all patients. It was possible to remove external and internal drainage in all cases.
Conclusion:
In patients with long strictures of the middle and proximal parts of the right ureter, laparoscopic ureteroplasty using the appendix as onlay flap may be the method of choice. This procedure is less traumatic and has a low complication rate.
