URETEROCYSTONEOSTOMY

From Big Medical Encyclopedia

URETEROCYSTONEOSTOMY (Greek ureter ureter + kystis bladder + neos new + stoma of companies, opening, pass; synonym: ureterotsis-toanastomoz, ureters-mochepu-zyrny an anastomosis) — operation of change of an ureter in a bladder with creation of a new anastomosis.

At the end of 19 century this operation applied in case of damage of a pelvic part of an ureter in time a gine-stake. operations. In Russia the first At. A. G. Podrez in 1897 made. In the subsequent its steel widely to use at obstruction of okoloiuzyr-ny department of ureters (the inborn and acquired strictures, beam damages of ureters, etc.). At. is method of the choice at the dynamic obstruction arising owing to various anomalies of the lower third of an ureter (see) and its mouths (an ostium ureteris, T.), followed by a vesicoureteral reflux (see). At. carry out at a resection of paravesical department of an ureter concerning a tumor of a bladder and a prostate with defeat of mouths of ureters; renal transplantation also comes to an end with imposing of an anastomosis between an ureter of a donor kidney and a bladder of the recipient (ShM. Renal transplantation).

Contraindications to performance At. extensive tumoral damage of a bladder, inflammatory process, and also infra-vesical obstruction are. Relative contraindications — too big capacity of a bladder with its atony or its too small capacity. At such patients At. often is complicated puzyrno - mo che by t about chn and to about - by a reflux through a neoostomy.

Preoperative preparation, in addition to the general actions (see. The preoperative period), consists in careful sanitation of uric system. Operation is made under anesthetic (see); use transabdominal or extra peritoneal accesses through a front abdominal wall (the last is more preferable in connection with smaller risk of development of peritonitis).

There are many options U., but all of them represent modifications of three essentially various ways of formation of an anastomosis of an ureter with a bladder: an anastomosis a side sideways, reimplantation of an ureter, plastic of an ureter with substitution of its defect tissues of a bladder (see the Ureter, operations). The replaced ureter is intubated, entering a catheter to a renal pelvis; other end of a catheter is spent through an ureteric and vesical anastomosis and removed on an urethra outside. In a bladder leave other drainage tube, to-ruyu also remove on an urethra outside. Tubes delete in 10 — 15 days after operation. If At. carry out after a cystectomy at its tumoral defeat, finish operation with the epicystostomy (see Cystostomy) preventing emergence of a vesicoureteral reflux because of the small capacity of a stump of a bubble. In 2 — 3 months after such operation the capacity of a bladder increases and need for its drainage disappears.

From complications At. the greatest value have bleeding from a wall of a bladder, insolvency of an anastomosis, uric flowed; in later terms — a stenosis of an anastomosis, a vesicoureteral reflux.

In the absence of complications the forecast favorable. In cases of a postoperative stenosis and a puzyrnomochetochnikovy reflux At. carry out repeatedly.

Bibliogrderevyanko I. M. Obstruction of ureters, Stavropol, 1979; A. G. O Undercut connection of an ureter with a bladder (uretero-cystoneo-stomia), Chronicle Russian hir., t. 3, book 4, page 644, 1898; H at x r and e N to about D. P. and Lyulko A. V. The atlas of operations on bodies of urinogenital system, M., 1972;

Chukhriyenkod. The item, L yu l to about A. V. and Romanenko H. T. Atlas of urogi-nekologichesky operations, Kiev, 1981; Seppelt U., Rath eke J. u. Ber-termann H. Komplikationen nach direkter Ureterocystoneostomie (UCN) of bei Erwachsenen, Urologe, Bd 18, S. 19, 1979.

I. M. Derevyanko.

Яндекс.Метрика