Retrograde ureteropyeloscopy in patients after buccal onlay ureteroplasty

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Дәйексөз келтіру

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Аннотация

Introduction. After buccal ureteroplasty of long stricture of ureteropelvic junction and proximal ureter, there is a risk of recurrent stricture and urinary stone formation, requiring endoscopic procedure.

Aim. To evaluate the possibility of performing ureteroscopy (URS) in patients after onlay ureteroplasty, as well as to study its results and efficiency.

Materials and methods. Buccal ureteroplasty was performed in 30 patients who had previously undergone endoscopic and reconstructive procedures on the upper urinary tract. In 18 (60.0%) of them, stricture developed after pyeloplasty, in 10 (33.4%) after retrograde lithotripsy for the upper ureteral stone, in 1 (3.3%) after laparoscopic excision of a parapelvic cyst complicated by an injury of UJO. In addition, in 1 (3.3%) patient, stenosis of the upper third of the right ureter was caused by retroperitoneal fibrosis. The indication for URS in 7 (23.3%) cases was urolithiasis. Three patients had a dense stone measuring 1.0 cm in the lower calyx, three more had a recurrent stone after previous procedures, and one had encrusted nephrostomy. Rigid URS with laser fragmentation was performed in 3 (10.0%) cases. In two patients, the indication for endoscopic procedure was a dense stone in the upper third of the ipsilateral ureter. The patient with encrusted nephrostomy pigtail underwent lithotripsy with drainage removal. Retrograde laser lithotripsy using flexible ureteroscope was performed in 4 patients (13.3%). Rigid URS with buccal graft mucosa biopsy was done in 5 cases (16.7%) 12 and 24 months after reconstruction.

Results. Endoscopic procedures for urolithiasis were effective in all patients. The average time was 45.0±28 min. During URS, hematuria developed in 1 of 14 patients at a late stage, but visibility allowed completing an intervention. High fever was observed in 2 patients (14.3%) postoperatively. One of them underwent rigid URS with lithotripsy of incrusted pigtail of nephrostomy tube, and he also had bleeding. Laser lithotripsy using flexible ureteroscope was performed in another case. Both patients had stage II complications according to Clavien, requiring conservative therapy.

Conclusion. After buccal ureteroplasty, URS should not be a routine study, except for patients with recurrent urolithiasis or ureteral strictures.

Толық мәтін

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Авторлар туралы

B. Guliev

Center of Urology with Robot-Assisted Surgery of Mariinsky City Hospital

Хат алмасуға жауапты Автор.
Email: gulievbg@mail.ru
ORCID iD: 0000-0002-2359-6973

PhD, MD, Professor, Head

Ресей, Saint Petersburg

Zh. Avazkhanov

Center of Urology with Robot-Assisted Surgery of Mariinsky City Hospital

Email: professor-can@mail.ru
ORCID iD: 0000-0003-1551-0284

Urologist

Ресей, Saint Petersburg

M. Agagyulov

Center of Urology with Robot-Assisted Surgery of Mariinsky City Hospital

Email: murad1311@bk.ru
ORCID iD: 0000-0001-9647-9690

Urologist

Ресей, Saint Petersburg

M. Shevnin

Center of Urology with Robot-Assisted Surgery of Mariinsky City Hospital

Email: gulievbg@mail.ru
ORCID iD: 0000-0002-5788-464X

Urologist

Ресей, Saint Petersburg

O. Abdurakhmanov

Center of Urology with Robot-Assisted Surgery of Mariinsky City Hospital

Email: ovshen_19@mail.ru
ORCID iD: 0009-0002-0350-3538

Urologist

Ресей, Saint Petersburg

Әдебиет тізімі

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2. Fig. 1. Endoscopic picture at ureteroscopy at 3 months (A), 12 months (B) and 24 months (C) after buccal ureteroplasty

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3. Fig. 2. Simultaneous transurethral ureteroscopy in a 48-year-old patient after buccal ureteroplasty on the right A) computed tomography after buccal onlay plasty of the upper third of the right ureter - stent and lower cup stone are visualised on the right side; B) postoperative review radiograph - ureteral stent on the right side and X-ray contrast shadow in the projection of the right kidney are visible, on the left side no shadow of the nodule is visible; C) computed tomography of this patient - shadow of a stone in the projection of the middle third of the left ureter, the buccal plasty zone is marked with arrows on the right side; D) review radiograph after simultaneous bilateral retrograde ureterolithotripsy - ureteral stents are visualised on both sides, no shadow of concrements in the projection of the TMJ

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