Laparoscopic buccal plasty of the pyeloureteral segment and proximal ureter

Abstract

BACKGROUND: With recurrent extended strictures of the pyeloureteral segment and the proximal ureter, when standard operations are ineffective or technically impossible, the narrowed area can be replaced with a flap from the cheek mucosa. AIM: The aim of the study is the results of laparoscopic plastic surgery of the pyeloureteral segment and proximal ureter with buccal graft. MATERIALS AND METHODS: Minimally invasive plastic surgery of the extended stricture of the pyeloureteral segment, upper and middle third of the ureter with a flap from the cheek mucosa was performed in 27 patients. There were 16 men, 11 women, and the average age was 51 years. The cause of narrowing in 16 patients was previously performed pyeloplasty, in 10 contact ureterolithotripsy in the proximal ureter, in 1 his injury during laparoscopic excision of a parapelvical kidney cyst. Laparoscopic access was used in 24 patients, and robot-assisted access was used in 3 patients. In 17 of them, the narrowed area was replaced by the onlay technique, in 10 patients, anastomosis augmentation was performed with a buccal graft. RESULTS: There were no intraoperative complications. The duration of operations ranged from 115 to 340 minutes. There were no cases of urine leaking through the drainage. Fever up to 38.0 C was observed in 5 (18.5%) patients, 3 (11.1%) of them underwent antibacterial therapy (grade II according to Clavien), and 2 (7.4%) without nephrostomy drainage, puncture nephrostomy (grade IIIa according to Clavien) was performed. There were no complications according to Clavien IIIb degree. On excretory urograms and computed tomography, the area of the ureter replaced by a buccal flap is wide and well passable. In patients with pyeloureteral segment strictures, a decrease in the size of expanded cups and pelvis was observed in dynamics. Clinically, all operations were successful, as it was possible to relieve patients from nephrostomy drainage and symptoms of upper urinary tract obstruction. CONCLUSIONS: Buccal ureteroplasty may be the method of choice in patients with extensive narrowing of the pyeloureteral segment and proximal ureter. It is a relatively simple operation and does not require extensive mobilization of the ureter and provides good functional results.