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Technical options in complex ureteral lesions: 'ureter-sparing' surgery
G Passerini-Glazel1, A Meneghini, F Aragona
1Department of Urology, University of Padua, Italy.
European Urology
|January 1, 1994
Summary
Major ureteral reconstructive surgery effectively restores urothelial continuity for extensive ureteral lesions. These advanced techniques offer satisfactory outcomes, preserving kidney function and avoiding nephrectomy.
Area of Science:
- Urology
- Surgical Innovation
Background:
- Ureteral lesions often result from instrumentation, surgery, or trauma.
- Extensive ureteral defects pose significant reconstructive challenges, potentially leading to kidney loss.
Purpose of the Study:
- To evaluate the efficacy of major ureteral reconstructive surgery for extensive ureteral lesions.
- To compare outcomes of various reconstructive techniques aimed at restoring urothelial continuity.
Main Methods:
- Retrospective analysis of 74 patients with ureteral lesions from 1979-1992.
- Focus on 22 patients with extensive (5-7 cm) ureteral lesions undergoing major reconstructive surgery.
- Procedures included psoas hitch variations, transureterouretero-anastomosis, and renal autotransplantation.
Main Results:
- Satisfactory results were achieved in all but one patient, with a follow-up of 6-84 months.
- Only 5 minor postoperative complications were reported.
- Successful restoration of urothelial continuity was observed in complex cases, including solitary kidneys and bilateral injuries.
Conclusions:
- Restoring urothelial continuity is the preferred approach for extensive ureteral lesions.
- Major ureteral reconstructive surgery offers a viable alternative to diversion or nephrectomy.
- Renal autotransplantation is reserved for highly selected, rare cases.