RECONSTRUCTION OF THE UPPER THIRD OF THE URETER
WITH A TUBULARIZED PELVIS FLAP IN DIFFICULT CLINICAL SITUATIONS
Demchenko V., Shchukin D., Strakhovetskyi V., Slobodyanyuk Ye., Safonov R.
Kharkiv National Medical University; Municipal Noncommercial Enterprise of Kharkiv Regional Council; “V. I. Shapoval Regional Medical
Clinical Center of Urology and Nephrology”, Kharkiv; Kharkiv Medical Academy of Postgraduate Education, Ukraine
Ureteroplasty with a tubularized pelvis ap is a very rare option for urethral reconstruction. This surgical approach allows replacing extended defects of the upper third of the ureter, and in some cases the entire ureter. Pelvic tubuloplasty can also be used to correct hydronephrosis associated with additional vessels to the lower pole of the kidney. Nowadays there are only a few reports onusing tubular pyeloplasty in literary sources. Not all indications forthis type of reconstruction have been studied yet. Thus, not all possible methods for the pelvis aps formation have been developed. This article presents the experience of using this surgical technique in two patients with complex clinical situations.
Our experience shows that displacement the anastomosis below the lower polar arteries or veins by using tubular pyeloplasty can exclude the pathological e ect of these vessels on it. Therefore, this reconstruction can be considered a standard
technique for the surgical treatment of hydronephrosis caused by uretero-vasal conflict. However, this requires practical con-firmation, because there is no experience of using such surgical tactics presented in the world literature now.
The second clinical observation showed the possibility ofreconstruction of an extended defect in the upper and middlethird of the ureter by the tubular ap of the pelvis. The proposed technique for the formation of the ap allowed extending it by 2 cm and successfully performing an anastomosis between the ap and the ureter. The main advantage of this approach is the possibility of extending the ap not by reducing the width of its base, but by means of small transverse incisions at various points. This let us to save the blood supply to the flap.
Dismembered Tubularized Flap Pyeloplasty