Non-Standard Approaches to Upper Urinary Tract Reconstruction

Abstract

The main alternatives to a standard ureteral reconstruction at the expense of urothelial−containing tissues are an autotransplantation of the kidney, replacement of the ureter, and interposition of autologous tissues that do not contain urothelium. This compares the tissues that have a similar histological structure, system of blood supply and innervation. Although the general trend in the assessment of the role of renal autological transplantation in the correction of ureteral defects is quite optimistic, there is a likelihood of severe complications, including severe transplant infection and its loss, complications from vascular anastomoses. At the same time the tissues having similar histological structure, system of blood supply and innervation have been compared. However, in some clinical situations it is not possible to replace the upper urinary tract with such a surgical approach, which forces the surgeon to use alternative and non−standard methods of ureteral reconstruction. Among the various types of ureteral reconstruction with enteral tissues, the leading role is the interposition of segments of the small intestine. Most authors point to the favorable results of this technique in terms of minimal lethality, low incidence of complications and stabilization of renal function after surgery. However, the problem of intestinal interposition is complications associated with enterotomy, electrolyte balance disorders, reabsorption into the blood of metabolism products and active secretion of mucus into the lumen of the urinary tract. The published reports have mostly described the positive results after ureteral plasticity of the buccal mucosa flap, but the length of the stricture in the implementation of such a treatment method should not exceed 5−6 cm ureter. Key words: ureteral reconstruction, kidney autotransplantation, intestinal ureteroplasty, ureteral reconstruction with buccal mucosa flap.