Bağirov Akif Memmedoglu
Department of Urology, Azerbaijan Medical University, Azerbaijan, Baku, Azerbaijan.
Asian J Urol. 2023 Apr;10(2):195-200. doi: 10.1016/j.ajur.2021.08.009. Epub 2021 Sep 10.
The aim of our study was to examine results of pyeloplasty using the new method-subadventitial resection of the ureter with preservation of the ureteral artery proposed by us and the possibility of using this method in one-stage surgery with ureteropelvic junction (UPJ) and ureterovesical junction (UVJ) obstructions or vesicoureteral reflux.
A retrospective analysis of 108 patients with hydronephrosis (including two patients with hydroureteronephrosis) who received treatment from March 1998 to March 2020 was carried out, with an average follow-up period of 36 months. Dismembered pyeloplasty using a subadventitial technique with preservation of ureteral blood supply was performed in 108 patients (including bilateral in two cases). In one patient with UPJ and UVJ obstructions and in one patient with UPJ obstruction and vesicoureteral reflux subadventitial resection of the ureter were performed in both segments.
All patients managed to preserve the integrity of the ureteral artery during dismembered pyeloplasty, and two patients simultaneously underwent ureterocystostomy by subadventitial resection of the ureter. The method of pyeloureteroplasty with subadventitial resection of the ureter makes it possible to improve long-term results in patients with hydronephrosis, including those with lesions of the UPJ and UVJ segments. In all cases, it was feasible to achieve a decrease in the degree of hydronephrosis. Postoperative complications were observed in five cases (4.6%), in none of which there were complications associated with the surgical technique, and were eliminated without loss of renal function.
Our 22 years of experience shows that the technique of subadventitial resection of the ureter allows us to preserve the ureteral blood circulation during dismembered pyeloplasty and thus creates conditions for prevention of restenosis of UPJ and for single-stage ureteroplasty on the upper and lower ureteral segments.
本研究旨在探讨采用我们提出的新方法——保留输尿管动脉的输尿管外膜下切除术进行肾盂成形术的效果，以及该方法用于输尿管肾盂连接部（UPJ）和输尿管膀胱连接部（UVJ）梗阻或膀胱输尿管反流一期手术的可能性。
对1998年3月至2020年3月接受治疗的108例肾积水患者（包括2例输尿管肾积水患者）进行回顾性分析，平均随访期为36个月。108例患者（包括2例双侧手术）采用保留输尿管血供的外膜下技术进行离断性肾盂成形术。1例UPJ和UVJ梗阻患者以及1例UPJ梗阻合并膀胱输尿管反流患者的输尿管两个节段均行外膜下切除术。
所有患者在离断性肾盂成形术中均成功保留了输尿管动脉的完整性，2例患者同时通过输尿管外膜下切除术进行了输尿管膀胱吻合术。输尿管外膜下切除术的肾盂输尿管成形术方法能够改善肾积水患者的长期治疗效果，包括那些UPJ和UVJ节段有病变的患者。在所有病例中，均可行地实现了肾积水程度的减轻。观察到5例（4.6%）术后并发症，其中无一例与手术技术相关，且均在未丧失肾功能的情况下得以消除。
我们22年的经验表明，输尿管外膜下切除术技术使我们能够在离断性肾盂成形术中保留输尿管血液循环，并因此为预防UPJ再狭窄以及输尿管上下段一期输尿管成形术创造了条件。
