Reconstruction of the upper third of the ureter with a tubularized pelvis flap in difficult clinical situations

Abstract

Ureteroplasty with a tubularized pelvis flap is a very rare option for urethral reconstruction. This surgical approach allows replacing extended defects of the upper third of the ureter, and in some cases the entire ureter. Pelvic tubuloplasty can also be used to correct hydronephrosis associated with additional vessels to the lower pole of the kidney. Nowadays there are only a few reports on using tubular pyeloplasty in literary sources. Not all indications for this type of reconstruction have been studied yet. Thus, not all possible methods for the pelvis flaps formation have been developed. This article presents the experience of using this surgical technique in two patients with complex clinical situations. Our experience shows that displacement the anastomosis below the lower polar arteries or veins by using tubular pyeloplasty can exclude the pathological effect of these vessels on it. Therefore, this reconstruction can be considered a standard technique for the surgical treatment of hydronephrosis caused by uretero-vasal conflict. However, this requires practical confirmation, because there is no experience of using such surgical tactics presented in the world literature now. The second clinical observation showed the possibility of reconstruction of an extended defect in the upper and middle third of the ureter by the tubular flap of the pelvis. The proposed technique for the formation of the flap allowed extending it by 2 cm and successfully performing an anastomosis between the flap and the ureter. The main advantage of this approach is the possibility of extending the flap not by reducing the width of its base, but by means of small transverse incisions at various points. This let us to save the blood supply to the flap.