OPTIMIZATION OF THE SURGICAL TECHNIQUE OF EXTRAVESICAL URETERAL REIMPLANTATION
1Department of Pediatric Surgery, Institute of Postgraduate Education in Healthcare of the Republic Tajikistan, Dushanbe, Republic of Tajikistan
2Health Complex «Istiklol», Dushanbe, Republic of Tajikistan
3Central Research Laboratory, Avicenna Tajik State Medical University, Dushanbe, Republic of Tajikistan
Objective: To optimize the technique of extravesical ureteral reimplantation in experimental animals.
Methods: Experiments were carried out on 21 Flanders rabbits. Initially, ureterohydronephrosis (UHN) was modeled by alcoholization of the ureter in its vesical part according to the method of Ya.V. Gudynsky. After 21 days, the animals underwent extravesical ureteral reimplantation using the technique optimized by the team of urologists.
Results: The stents were removed endoscopically on the 20th day. In order to exclude vesicoureteral reflux, contrast cystography was performed, in which reflux was not detected. To exclude obstruction, on the 30th, 60th, and 90th days after the operation, an ultrasound scanning of the urinary system was performed, in which the presence of UHN was not noted. On the 90th day, the experimental animals underwent resection of the anastomotic zone for histological examination. It was found that the diameter of the transplanted segment corresponded to the normal size of the rabbit ureter, there was a slight thickening of the ureteric wall, its hypertrophy, and intracellular hyperplasia.
Conclusion: The effectiveness and safety of the proposed method of extravesical ureteral reimplantation with antireflux protection has been experimentally proven.
Keywords: Ureter, urodynamics, obstruction, ureterohydronephrosis, megaureter.
- Vrublyovskiy SG, Vrublyovskaya EN. Gidronefroz u detey (vzglyad skvoz prizmu vremeni [Hydronephrosis in children (a look through the prism of time]. Detskaya khirurgiya. 2018;22(1):4-8.
- Dubrov VI, Kachantsov IM. Sravneniya rezul’tatov vnutripuzyrnoy i vnepuzyrnoy reimplantatsii mochetochnika pri dvukhstoronem refleksiriyushchem megauretere u detey [Comparison of the results of intravesical and extravesical reimplantation of the ureter with bilateral reflexive megaureter in children]. Vestnik urologii. 2020;8(2):21-8.
- Dubrov VI, Bandarenko SG, Kachantsov IM, Sizanov VI. Endoskopicheskaya korektsiya puzyrno-mochetochnikovogo reflyuksa posle reimplantatsii mochetochnika u detey [Endoscopic correction of vesicoureteral reflux after ureter reimplantation in children]. Detskaya khirurgiya. 2020;24(4):229-33.
- Pishaev EV, Krotin VA, Osipov VV, Obukhov NS. Optimal’nyy ureterotsistoanastomoz u detey [Optimal ureterocystoanastomosis in children]. Zdravookhranenie Yugry: opyt i inovatsii. 2022;2:13-7.
- Salnikov VYu, Zorkin SN. Pervyy opyt primineniya refleksiruyushchey reimplantatsii mochetochnika v etapnom lechenii pervichnogo obstruktivnogo megauretera u detey pervogo goda zhizni [The first experience of using reflexive ureteral reimplantation in the staged treatment of primary obstructive megaureter in children of the first year of life]. Detskaya khirurgiya. 2017;21(5):244-8.
- Salnikov VYu, Gubarev VI, Zorkin SN, Filinov IV, Petrov EI. Endoskopicheskaya balonnaya dilatatsiya vysokogo davleniya kak metod lecheniya pervichnogo obstruktivnogo megauretera u detey [Endoscopic high-pressure balloon dilatation as a treatment for primary obstructive megaureter in children]. Pediatriya. 2016;95(5):48-52.
- Santhalia PK, Mittal D, Gupta AK, Jana M. Utility of ureteric jet: A simple yet useful tool for the evaluation of complex urogenital anomaly. Indian J Radiol Imaging. 2018;28(1):45-8.
- Casal Beloy I, Somoza Argibay I, García González M, García Novoa MA, Míguez Fortes LM, Dargallo Carbonell T. Endoscopic balloon dilatation in primary obstructive megaureter: Long-term results. J Pediatr Urol. 2018;14(2):167.
- Gundeti MS, Boysen WR, Shah A. Robot-assisted laparoscopic extravesical ureteral reimplantation: Technique modifications contribute to optimized outcomes. Eur Urol. 2016;70(5):818-23.
- Doudt AD, Pusateri CR, Christman M. Endoscopic management of primary obstructive megaureter: A systematic review. J Endourol. 2018;32(6):482-7.
- Kassite I, Braïk K, Morel B, Villemagne T, Szwarc C, Maakaroun Z, et al. High-pressure balloon dilatation of the ureterovesical junction in primary obstructive megaureter: Infectious morbidity. Prog Urol. 2017;27(10):507-11.
- Komasara L, Bryks-Laszkowska A, Sroka M, Gołębiewski A, Czauderna P. A unique defect-persistent posterior cloaca: An example of staged genitourinary and digestive tract reconstruction with an alternative vaginal creation using the urinary bladder wall. Int J Urol. 2017;24(6):468-71.
- Liu W, Du G, Guo F, Ma R, Wu R. Modified ureteral orthotopic reimplantation method for managing infant primary obstructive megaureter: A preliminary study. Int Urol Nephrol. 2016;48(12):1937-41.
- Sultanov ShR, Azizov AA, Sattorov AM, Sharapov ShK. Otsenka metodov khirurgicheskogo lecheniya vrozhdyonnogo gidronefroza, obuslovlennogo aberrantnym sosudom [Evaluation methods of surgical treatment of congenital hydronephrosis caused by aberrant vessel]. Zdravookhranenie Tadzhikistana. 2015;4:52-7.
- Nazarov TKh, Stetsik OV, Rychkov IV, Agagyulov MYu, Trubnikova KE. Netipichnyy gidronefroz pri obstruktivnom kamne mochetochnika [Atypical hydronephrosis during obstructive urinary stones]. Vestnik poslediplomnogo obrazovaniya v sfere zdravookhraneniya. 2017;2:99-102.
- Pogonchenkova IV, Khan MA, Novikova EV, Mikitchenko NA. Meditsinskaya reabilitatsiya detey, operirovannykh po povodu gidronefroza [Medical rehabilitation after hydronephrosis surgical treatment in children]. Problemy sotsial'noy gigieny, zdravookhraneniya i istorii meditsiny. 2019;27(S):667-70. https://doi. org/10.32687/0869-866X-2019-27-si1-667-670
- Lopez M, Gander R, Royo G, Varlet F, Asensio M. Laparoscopic-assisted extravesical ureteral reimplantation and extracorporeal ureteral tapering repair for primary obstructive megaureter in children. J Laparoendosc Adv Surg Tech A. 2017;27(8):851-7
- Zhong W, Yao L, Cui H, Yang K, Wang G, Xu T, et al. Laparoscopic ureteral reimplantation with extracorporeal tailoring and direct nipple ureteroneocystostomy for adult obstructive megaureter: Long-term outcomes and comparison to open procedure. Int Urol Nephrol. 2017;49(11):1973-8.
Mirakov Khurshed Makhmadovich Applicant, Department of Pediatric Surgery, Institute of Postgraduate Education in Healthcare of the Republic Tajikistan ORCID ID: 0000-0002-5431-713Х E-mail: email@example.com
Ibodov Khabibullo Doctor of Medical Sciences, Professor of the Department of Pediatric Surgery, Institute of Postgraduate Education in Healthcare of the Republic Tajikistan Researcher ID: AAF-4599-2019 ORCID ID: 0000-0002-2449-1241 SPIN: 6016-1732 Author ID: 845362 E-mail: firstname.lastname@example.org
Rofiev Rauf Candidate of Medical Sciences, Associate Professor of the Department of Pediatric Surgery, Institute of Postgraduate Education in Healthcare of the Republic Tajikistan ORCID ID: 0000-0002-7394-8893 E-mail: email@example.com
Davlatov Afzaldzhon Rakhmonalievich Head of the Department of Surgery of Newborns and Hereditary Pathologies, Health Complex «Istiklol» ORCID ID: 0000-0002-8976-4706 E-mail: firstname.lastname@example.org
Abdulloev Zikriyo Rakhimboevich Candidate of Medical Sciences, Associate Professor, Researcher of Central Research Laboratory, Avicenna Tajik State Medical University ORCID ID: 0000-0001-5308-7654 E-mail: email@example.com
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The research was carried out in accordance with the research plan of the Institute of Postgraduate Education in Healthcare of the Republic Tajikistan (state registration number – 0116TJ00525). The authors did not receive financial support from manufacturers of medicines and medical equipment
Conflicts of interest: No conflict
Address for correspondence:
Mirakov Khurshed Makhmadovich
Applicant, Department of Pediatric Surgery, Institute of Postgraduate Education in Healthcare of the Republic Tajikistan
734026, Republic of Tajikistan, Dushanbe, Somoni Ave., 59a
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