METHOD FOR SURGICAL MANAGEMENT OF RECURRENT AND POSTRADIAL LONG STRICTURES AND OBLITERATIONS OF URETERAL LOWER ONE-THIRD Russian patent published in 2019 - IPC A61B17/00 

FIELD: medicine.

SUBSTANCE: invention relates to medicine, specifically to urology. Method for surgical management of recurrent and postradial long strictures and obliterations of the lower one-third of the ureter, involving resection of the involved ureter, excision of cicatrical-stenosed part of it and fixation of ureter to bladder mucosa. In the patients with intramural involvement, the affected portion of the ureter is removed with surrounding cicatricial pulp. Bladder side wall is mobilized, a buccal-labial flap with width of 2.0 cm is taken from the oral cavity; the flap is fixed by a buccal end to a distal end of a pre-dissected ureter. Transplant is then fixed on 1/3 of the width with single monocrylous 4/0 suturing the epithelium to the outside on the ventral surface of the iliac muscle. Stent for internal drainage No. 6 is inserted, the flap is closed above the stent with continuous external monocrylous 4/0 sutures, not reaching the distal end of flap by 0.5 cm. Transverse incision of the bladder wall is performed above the former mouth by 2 cm; a neoureter is implanted in the bladder by a separate puncture without tension on 5 mm and fixed to the mucous membrane by six interrupted sutures with monocryl 5/0 along the circumference to form a mouth from the labial portion of the flap. Bladder is closed, outside the neoureter is fixed to the bladder wall and vesicopexy is performed by fixing the bladder to the iliac muscle without tension with additional sutures from the long-absorbable material.

EFFECT: method enables reducing intraoperative injuries and reducing the risk of the number of postoperative recurrences in the patients with recurrent strictures after previously unsuccessful ureter reconstruction, post-radial and iatrogenic strictures and oblitrations.

1 cl, 2 ex