RU2408297C1 - Method of ureterocutaneostomy - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method relates to medicine, namely to oncourology, and can be used as method of urine diversion in treatment of patients with complications of cancer of urinary bladder, prostate and other diseases, accompanied by disturbance of urine passage into urinary bladder. Mobilisation is carried out. Mobilised section is submerged into mesh endoprosthesis made in form of tube, which is fixed to ureter and aponeurosis of abdominal wall muscles.

EFFECT: method allows formed frame to strengthen ureter walls, as well as to reduce risk of ureter wall perforation during replacement of ureter catheter.

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Description

The invention relates to medicine, namely to oncourology, and can be used as a method for urine diversion in the treatment of patients with complications of cancer of the bladder, prostate gland and other diseases accompanied by impaired passage of urine into the bladder.

Closest to the proposed method is a method of ureterocutaneostomy (Chukhrienko D.P., Lyulko A.V., Romanenko N.T. Atlas of urogynecological operations. Kiev: Vishche school. Head publishing house, 1981. - S.187-188.).

The disadvantage of this method is the possibility of perforation of the mobilized portion of the ureter and the formation of false passages when changing the urethral catheter due to the development of weakness of the wall after devascularization and denervation when excreted from surrounding tissues.

Object of the invention: to strengthen the wall of the mobilized portion of the ureter when performing ureterocutaneostomy by creating a frame around it.

The task is achieved by the fact that the mobilized portion of the ureter is immersed in a mesh endoprosthesis made in the form of a tube, which is fixed to the ureter and aponeurosis of the muscles of the abdominal wall. This creates a mesh frame that grows with connective tissue and strengthens the walls of the ureter throughout the entire mobilized area. Formed frame gives the walls of the ureter strength, preventing their perforation when changing the urethral catheter.

The invention is illustrated by drawings:

Figure 1 - mesh endoprosthesis made in the form of a tube.

Figure 2 - the mobilized portion of the ureter is immersed in a mesh endoprosthesis fixed to the aponeurosis of the muscles of the abdominal wall.

The method is carried out as follows.

An oblique incision is made of the skin, subcutaneous fat in the iliac region parallel to the inguinal fold 8-10 cm long. The fibers of the external oblique, internal oblique and transverse muscles of the abdominal wall are dissected or separated in layers. The peritoneal sac is retracted medially. In the retroperitoneal space, there is a ureter site at the border of its lower and middle third. Under the ureter is a turnstile. The ureter is bluntly and sharply secreted from the surrounding tissues from its upper third to the ureter-cystic anastomosis. In the area of the anastomosis, a ligature is applied to the ureter, proximal to which the ureter intersects. Further, throughout the entire mobilized area, with the exception of the distal 5-6 cm, the ureter is immersed in a mesh endoprosthesis made in the form of a tube (Fig. 1, Fig. 2), with a diameter exceeding the diameter of the ureter by 1 mm. The mesh endoprosthesis is fixed to the ureter wall in 2-3 places with separate interrupted sutures. The muscles of the abdominal wall are sutured in layers to the ureter removed through the wound with an endoprosthesis. The distal end of the mesh endoprosthesis with several interrupted sutures is sutured to the aponeurosis of the muscles of the abdominal wall (figure 2). Subcutaneous fat and skin are sutured. The distal end of the ureter is sutured to the skin so that it protrudes 1.5-2.5 cm above its surface. A ureteral vinyl chloride catheter is inserted into the ureter, the end of which is immersed in the urine. A similar operation is performed on the opposite side.

EXAMPLE OF SPECIFIC APPLICATION

Patient P., 65 years old, medical history No. 2137, was admitted to the Oncology Center of Belgorod on 04.24.07, with a diagnosis of bladder cancer st II, T2NxMO, clinical group II, bilateral ureterohydronephrosis, chronic renal failure, art. After preoperative preparation on 04/26/07, the patient underwent surgery: bilateral ureterocutaneostomy using a mesh endoprosthesis.

An oblique incision was made in the skin, subcutaneous fat in the iliac region parallel to the inguinal fold 10 cm long. The external oblique, internal oblique and transverse muscles of the abdominal wall were dissected in layers. The peritoneal sac was mobilized in the medial direction. In the retroperitoneal space, a section of the ureter was found and isolated at the border of its lower and middle third. A turnstile was placed under the ureter. Stupidly and sharply, the ureter was isolated from the surrounding tissues from its upper third to the ureter-cystic anastomosis. In the area of the anastomosis, a ligature is placed on the ureter, proximal to which the ureter was crossed. Throughout the entire mobilized area, with the exception of the distal 6 cm, the ureter was immersed in a mesh endoprosthesis made in the form of a tube with a diameter of 9 mm. The mesh endoprosthesis was fixed to the ureter wall in 3 places with separate interrupted sutures. The muscles of the abdominal wall were sutured in layers to the ureter removed through the wound with an endoprosthesis. The distal end of the mesh endoprosthesis with three interrupted sutures was sutured to the aponeurosis of the muscles of the abdominal wall. When suturing subcutaneous fat and skin, the distal end of the ureter was sutured to the skin so that it protruded 2 cm above its surface. A ureteral vinyl chloride catheter was inserted into the ureter, the end of which was immersed in the urine. A similar operation was carried out from the opposite side.

There were no complications in the postoperative period. The wounds healed by primary intention. 05/08/07, the patient was discharged in satisfactory condition.

When observed on an outpatient basis for 1.5 years, the passage of urine is preserved from 2 sides. Urethral catheters are replaced without technical difficulties and without complications in the form of perforations of the ureter wall and the formation of false passages.

Thus, the task was achieved in that the mobilized portion of the ureter was immersed in a mesh endoprosthesis made in the form of a tube that was fixed to the ureter and to the aponeurosis of the muscles of the abdominal wall. At the same time, a mesh frame was created around the ureter, which grows with connective tissue and strengthens the walls along the entire mobilized area. Formed frame gave the walls of the ureter strength, preventing their perforation when changing the urethral catheter.

Claims (1)

A method of ureterocutaneostomy, including mobilization of the ureter and suturing of the distal end of the ureter to the skin so that it protrudes 1.5-2.5 cm above its surface, characterized in that the mobilized portion of the ureter is immersed in a mesh endoprosthesis made in the form of a tube , which is then fixed to the ureter and aponeurosis of the muscles of the abdominal wall.

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