ISSN 2415-3060 (print), ISSN 2522-4972 (online)
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УЖМБС 2020, 5(3): 187–193
Clinical Medicine

Technical Features of Conducting Ureterocalicostomy

Demchenko V. N., Schukin D. V.

In reconstructive surgery of the upper urinary tract, there are many clinical situations where it is impossible to carry out radical resection of the ureteropelvic junction, to apply an adequate anastomosis between unchanged tissues or to perform it without significant tension. First, this concerns cases of hydronephrosis with the intrarenal pelvis, as well as with extended strictures of the ureteropelvic junction and the upper third of the ureter. Even more problematic are situations of secondary hydronephrosis, complicated by severe inflammatory and cicatricial changes in the pelvis and ureter, especially in patients with an imperative indication for preserving the kidney. The complexity of the surgical task increases with the frequency of ineffective operations performed at the preliminary stage. Ureterocalicostomy refers to complex surgical interventions, which is due not only to the need for extensive kidney resection and reconstruction of the lower cup, frequent surgery in conditions of thermal ischemia, but also severe inflammatory and scarring in the retroperitoneal space after previous operations. Although the technical features of this surgical procedure are described in detail, it requires further modernization, since the level of poor results in the long term can reach 30%. From our point of view, ureterocalicostomy consists of three main technical stages: suturing the wounds of the renal pelvis after cutting the ureter, resection of the kidney and the actual anastomosis between the lower cup and ureter. The renal pelvis wounds suturing is paid little attention in the literature, but it must be borne in mind that the functional results of the entire treatment may depend on it. It also influences the level of early postoperative complications. Moreover, the defects in the tightness of the pelvic wound are the most common causes of the urinary fistulae formation in the postoperative period. The main condition for the correct completion of ureterocalicostomy is the adequacy of the second stage concerning resection of the kidney lower pole. This technique allows you to access unmodified tissue covered with urothelium and to have good blood supply. We are active supporters of using thermal kidney ischemia in case of ureterocalicostomy in patients with preserved renal parenchyma, since only in the conditions of a completely dry surgical field and good visibility it is possible to correctly compare the mucous membranes of the renal cup and ureter. One of the most responsible stages of the operation is the third one which comprises preparation of the lower cup and the application of an anastomosis. Anastomosis between the ureter and the lower kidney cup is much easier and faster when there is a possibility to cross the cup 3-5 mm distal to the parenchyma resection zone. However, it is rarely possible to save this part of the renal cup, especially in patients with a renal parenchyma thickness less than 10 mm. Results and discussion. In our study we presented an original technical modification of this operation, which consists in guillotine resection of the lower pole of the kidney at an angle of 450, in the intersection of the lower cup 4-5 mm distal to the parenchyma resection zone, in the application of an anastomosis only between the ureter and the lower cup without trapping the renal parenchyma in the suture and a fibrous capsule of the kidney, as well as using only separate z-shaped hemostatic sutures without using p-shaped or twisting sutures on the renal parenchyma. Conclusion. This technique is more physiological, since it only compares tissues containing urothelium, reduces the likelihood of developing ischemic and cicatricial changes in the anastomotic zone.

Keywords: anastomosis of the ureter, ureterocalicostomy, ureteral reconstruction

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  1. Neuwirt K. Implantation of the lower ureter into the lower calyx of the renal pelvis. VII Congress de le Societe Internationale d'Urologie. 1947; 253-5.
  2. Manetti S. Les anastomoses urétéro-calicielles. Chir Path Sper. 1956; 4: 929.
  3. Couvelaire R, Auvert J, Moulonguet A, Cukier J, Leger P. Implantations et anastomoses urétérocalicielles. Techniques et indicatios. J Urol Néphrol. 1964; 70: 437.
  4. Hawthorne NJ, Zincke H, Kelalis PP. Ureterocalicostomy: an alternative to nephrectomy. J Urol. 1976; 115(5): 583-6.
  5. Shah TP, Vishana K, Joshi RN, Kadam G, Dhawan M. Ureterocalycostomy: A salvage procedure for complex ureteropelvic junction strictures. Indian J Urol. 2004; 20: 144-7.
  6. Osman T, Eltahawy I, Fawaz Kh, Shoeib M, Elshawaf H, El Halaby R. Ureterocalicostomy for treatment of complex cases ofureteropelvic junction obstruction in adults. Urology. 2011; 78: 202-7.
  7. Srivastava D, Sureka SK, Yadav P, Bansal A, Gupta S, Kapoor R, et al. Ureterocalicostomy for Reconstruction of Complicated Ureteropelvic Junction Obstruction in Adults: Long - Term Outcome and Factors Predicting Failure in a Contemporary Cohort. J Urol. 2017; 198(6): 1374-8.
  8. Casale P, Mucksavage P, Resnick M, Kim S. Robotic Ureterocalicostomy in the pediatric population. J Urol. 2008; 180: 2643-8.
  9. Arap MA, Andrade H, Torricelli FC, Denes FT, Mitre AI, Duarte RJ, et al. Laparoscopic ureterocalicostomy for complicated upper urinary tract obstruction: mid - term follow - up. Int Urol Nephrol. 2014; 46(5): 865-9.
  10. Komyakov BK, Gulyev BG, Al Attar TKh. Laparoskopichnyy ureterokalykoanastomoz pry protyazhniy retsydyvniy strykturi pyeloureteralnogo segmentu sprava [Laparoscopic ureterocalicoanastomosis with long recurrent stricture of the pyeloureteral segment on the right]. Visnyk urologiyi Urology Herald. 2017; 5(3): 87-94. [Ukrainian]
  11. Steffens J, Humke U, Haben B, Stark E, Breitling P, Treiyer A. Open ureterocalycostomy. Surgical Atlas. BJU International. 2008; 101: 397-407.
  12. Patent 2467702 RU, A61B17/00. Sposob nalozhenyya ureterokalykoanastomoza [The method of applying ureterocalikoanastomosis] /Popkov VM, Ponukalyn AN, Potapov DYu. (RU); zayavitel' i vladelets patenta Potapov DYu (RU). № 2467702; zayavl 20.12.2011 ; opubl 27.11.2012. [Russian]