SU1725843A1 - Method for treating the vesicoureteral reflux - Google Patents

Abstract

The invention relates to medicine, more specifically to pediatric surgery and urology. The goal is to prevent dislocation of the intramural ureter during surgical treatment of the vesicoureteral reflux. The bladder is opened, the mouth is localized and incubated, the ureter wall is fixed to the detrusor. The ureter is isolated by a bordering incision around the mouth with a radius of about 0.5 cm of the bladder mucosa. The intravesical compartment of the ureter (I) is mobilized. Having retreated 3–3.5 cm above the mouth, they fix its wall along the posterior semicircle with nodal nonabsorbable sutures to the detrusor from the inner side at the place where the ureter enters the bladder (II). Then, the free intravesical part of the ureter is placed in its bed and the mouth is fixed to the mucous membrane of the bladder (III) in the same place by 3-4 catgut sutures. The defect of the mucous membrane over the intra uterine part of the ureter is sutured with interrupted catgut sutures (IV). 1 il. t

Description

This invention relates to medicine, in particular to pediatric surgery.

The purpose of the invention is the prevention of dislocation (extravasation) of the intramural ureter.

The goal is achieved by fixing the wall of the intravesical allocated distal ureteral section before creating the ureter bed, fixed to the detrusor wall by separate nonabsorbable sutures in the posterior semicircle at the distance of the anatomical length of its intravesical department from the mouth.

The drawing shows a diagram of the implementation of the method.

The method of treating vesicoureteral reflux by vesicization of the intravesical ureter is performed as follows.

Vezikalizatsi intravesical separated la ureteral dissection bladder includes a longitudinal cut along the front wall, the determination of localization ust ureter intubating last drainage tubes, ureter fixing thereto catgut ligature (taped) selection ureter bordered yuschim ust cut around with a radius of about 0.5 cm bladder mucosa and then the release of an incorrectly fixed intravesical ureter from connective tissue adhesions to the detrusor Obstruction of the mouth of the ureter (I). Having retreated 3–3.5 cm above the mouth of the latter to eliminate the excessive mobility of the ureter and stabilize its intravesical department, its wall is fixed along the semicircle by interrupted sutures from a nonabsorbable material to the detrusor from the inner side at the place of ureter entry into the bladder (II ), eliminate the failure of the intravesical fixation of the ureter in the detrusor mechanism. Then the free intravesical part of the ureter is placed in its bed and the mouth is fixed to the mucous membrane of the bladder (III) at the same place with 3-4 catgut sutures. The defect of the mucous membrane above the intravesical ureter is sutured with interrupted catgut sutures (IV).

Ureteric drains are discharged through separate contraceptive openings, departing from a longitudinal incision of the bladder. The wall of the bladder is sutured with a double-sided catgut suture over the urethral catheter. After formation, the mouth at the same place, the length of the vesical ureter segment corresponds to the normal length

intravesical ureter healthy child.

Example. Medical history of patient K: 4 years before admission to the treatment by the proposed method, leukocyturia was detected. treated for pyelonephritis; a year later, X-ray examination diagnosed left-sided vesicoureteral reflux, was treated with paraffin baths; another 3 years later he was diagnosed with a left-sided vesicoureteral reflux, grade III, hypertensive hyperreflex bladder, chronic pyelonephritis. The survey results: blood and urine tests without pathology, uroflowmetry - norms, urine velocity, retrograde cystometry - hypertonic hyperreflex bladder. Profilometry of the ureterovesicular junction on the left: when the bladder is filled, the length of the intravesical ureter is 2.3 cm, the pressure gradient is 64 cm H20; with an empty bladder: the length of the intravesical ureter is 1.3 cm, the pressure gradient is 6 cm H20. On the basis of profilometric data, the violation of the locking function of the left ureterovesical junction with an empty bladder was revealed - a dynamic variant of extravascularization. Conservative treatment was conducted by electrostimulation of the ureterovesical junction on the left, but without effect.

An antireflux operation was performed - vesicization of the intravesical part of the left ureter. After intubation anesthesia, after mobilization of the anterior wall of the bladder a longitudinal incision opened the bladder, the mouth of the ureter was found, the latter was intubated by drainage tubes fixing them to the edge of the ureter with catgut ligatures (holders). Departing from the estuaries at a distance of 0.5 cm by a bordering incision of the mucous membrane of the bladder around the mouth of the discharge and mobilized the intravesical ureter at a distance of about 4-5 cm to its free mobility within the bladder-ureteral junction, supported by the handles. Having retreated 3–3.5 cm above the ureteral orifice to eliminate its excessive mobility and stabilize the intravesical department, the ureter wall was fixed along the semicircle by interrupted sutures (capron) to the detrusor from the inner side of the ureter entering the bladder, eliminating the failure of the mechanism that fixes the intravesical department ureter in detrusor. The free part of the intravesical ureter was placed in its former bed, the mouth was fixed to the mucous membrane of the bladder in the same place by 3-4 catgut sutures. Defect of the mucous membrane over the intravesical ureter department was stitched with 2-3 nodal catgut sutures. The ureteral catheter is pulled out through a separate contra-coupling hole. With a double-stranded catgut stitch, the front wall of the bladder was stitched over the urethral catheter. The postoperative course is smooth, dizuri was not disturbed, pyelonephritis was not exacerbated. The ureteric catheter was removed on the 5th day, the cystostomy tube was removed on the 9th day, after which the urinalis was restored. Wound healing by primary tension. Discharged home on the 12th day after the operation in a satisfactory condition.

The proposed method of antireflux surgery was applied in 14 children on 15 ureters (in one case simultaneously on both sides). Reflux eliminated in 13 ureters.

Claims (1)

The invention of the method of treating vesicoureteral reflux, including intravesical secretion of the distal ureter, creating a bed for the ureter with preservation of normal topography, drawing on the mucosal defect of individual catgut sutures to create the anterior wall of the bed, characterized in that dislocation of the intramural division, the wall of the ureter is fixed to the wall of the detrusor by separate nonabsorbable sutures along the posterior semicircle at the distance of the anatomical length of its intravesical wow department from ust.