Efficiency of Laparoscopic Treatment of the Stricture of the Bowl-ureter Segment in Combination with Urolithiasis

Abstract

Stricture of the bowl-ureter segment (BUS) is one of the common pathologies in urology. Quite often in urological practice narrowing of BUS is accompanied by urolithiasis. In adults, according to various authors, the combination of these two serious pathologies occurs in 16-25 % of observations. For a long period, reconstructive-plastic surgery on BUS was a category of complex surgical interventions, required long-term intubation anesthesia, accompanied by a wide opening of the retroperitoneal space with careful allocation of the BUS area. Patients were in the hospital for a long time. Progress in the development of endoscopic equipment has contributed to the active introduction into clinical practice of minimally invasive techniques. Today, an increasing number of urologists are favoring different methods of laparoscopic plastics of BUS structures. But, both in the domestic and in the foreign literature, there are few works that would present advantages, complications, disadvantages of laparoscopic BUS plastic in combination with laparoscopic pyelolithotomy in patients with BUS complicated. This paper presents an analysis of our treatment of patients with BUS strictures in combination with urolithiasis. The objective: analysis and evaluation of the effectiveness of laparoscopic MCC plastics in combination with laparoscopic pyelolithotomy in patients with MCC obstruction complicated by SCC. Materials and methods. For the period from 2013 to 2019 41 patients with the above pathology were laparoscopically operated in the clinic of theInstitute ofUrology of the National Academy of Medical Sciences ofUkraine, including 25 men and 16 women. Their age ranged from 18 to 66 years. The length of the strictures – from 0.3 to1 cm. The size of the concretions varied from 0.5 to1.5 cm. One patient was found to be a coral stone of8.6 cm in size. There were no complications. The average length of stay in the hospital was 5.4 days. Results. In the distant postoperative period, there was no recurrence of BUS stricture and stone formation, stabilization or improvement of the secretory function of the kidney on the side of the plastic was noted. The effectiveness of our use of this method was 90.2 %, which allows us to consider it as the «gold» standard in the treatment of the above pathology.Conclusion. The use of laparoscopic plastics in combination with laparoscopic pyelolithotomy has made it possible to achieve good clinical results both in the immediate and long-term postoperative period. Timely surgery allowed us to achieve positive results in all patients with hydronephrotic transformation due to BUS stricture and complicated urolithiasis.