SU787012A1 - Method of treative vesicoureteral-pyelorenal reflux - Google Patents

Description

The invention relates to medicine, namely to surgery in urology.

There is a method of treating vesicoureteral-pelvic reflux, which includes an incision of the muscular wall of the bladder, the formation of an antireflux valve by placing the ureteral juxtavesical segment in the incision and stitching a wound over the ureter 1.

However, this method does not provide an antireflux effect with significant inflammatory changes in its wall and a decrease in the contractility of the bladder, i.e., under conditions that occur in most patients.

The aim of the invention is the treatment of patients with ureters greater than 1 cm in diameter.

For this, the incision of the muscular membrane of the bladder is continued to the ureter and the antireflux valve is formed by laying the mucosa of the ureter on the mucosa of the bladder, the muscular edges of the wound of the bladder and the ureter are stitched in pairs and the ends of the threads of opposite sides are tied over the ureter.

2

The method of treating vesicoureteral uterine reflux is performed as follows.

On the muscular wall of the bladder and from the justavical angle upwards 5 by 1.5-2.5 cm, an incision is made to the bladder mucosa. The incision is continued on the muscle wall of the ureter 1.5 to 2.5 cm to the mucous membrane of the ureter. The resulting wound is divorced. The bottom of the diluted wound is formed by the mucous membranes of the urinary tract and ureter. On the edges of the wound impose individual nylon seams. The yukstavesical segment of the ureter of its naked mucous is placed on the mucosa of the bladder, thus forming an anti-reflux valve consisting of a duplicatory mucous membrane of the bladder and ureter. The stitches of the unilateral margins of the wound are tied.

An example is Sick Hunters Igor, 9 years old. Sick from early childhood, but was examined in a hospital only at the age of 5 years. Diagnosed pyelonephritis. Treatment is ineffective. Transferred to the city children's hospital number 1 for further examination. In November 1973, a diagnosis was established: bilateral mega-ureterohydronephrosis of stage 2–3, caused by primary vesicoureteral urethral reflux, complicated by secondary pyelonephritis. The patient is treated with an antireflux plastic with the proposed method of treating vesicoureteral-pelvic reflux on February 3, 1977. Under intratracheal anesthesia with muscle relaxants, the anterior and left lateral walls of the bladder are exposed to an extraperitoneal incision above the pubis. The transitional fold of peritoneum is shifted upward. The left ureter is isolated and taped on the taped in the lower third. The ureter Illuet thickened hypertrophied walls, its diameter in the juxtavesical segment is 12 mm, it is actively reduced. Valdeyerovo vagina is missing. Fix the absence of a submucosal ureter segment, t. e. lack of antireflux protection. The bladder mucosa and the lower third of the ureter in the area of the juxta of the vesicular angle are separated from the muscles by hydraulic preparation of a 0.25% novocaine solution. An incision is made in the muscular wall of the bladder from the Yustavesical angle, in the direction, to its top, 2.0 cm long to the mucosa. The incision is continued on the ureter at the same length. The resulting wound is divorced. The bottom of the wound is the mucous membranes of the bladder and ureter, its yuxtaseical segment. The like edges of the wound of the bladder and ureter are sutured with individual nylon joints so that the mucous membranes of the ureter and bladder overlap to form duplicatory. Strands of suture on opposite sides of the ureter. Higher than the schvov, the ureter is fixed to the wall of the bladder by separate sutures. The operation is performed on a polyethylene perforated drainage inserted through the mouth of the ureter to a height of 12-14 cm. The wounds of the bladder and the anterior peritoneal wall are tightly sutured in layers. Drainage is introduced through a section; ny puncture tissue above the pubis.

The postoperative period runs smoothly. Drainage is removed on day 8, the wound heals by primary tension. The patient is discharged in satisfactory condition 20 days after surgery. The boy is examined after 3 and 10 months. Pyelonephritis attacks are not observed. Urine and blood tests are normal. The function of the kidney and its macromorphologists have improved significantly, there is no vesicoureteral-pelvic reflex.

Since 1974, the proposed method. M operated on 10 patients. The lumen of the ureter in 4 patients was more than 1 cm (from 1 cm to 2.4 cm). Results of operations studied

in 8 children. The postoperative period was uneventful, no complications were observed. In all cases, a complete anti-reflux effect was obtained, since a more malleable anti-reflux valve wall is created from duplicatory mucous membranes of the urinary bladder and juxtavesicular ureter segment. The formation of a powerful wall of the urinary tract, which is subject to a valve, from the duplicatory muscles of the ureter and, additionally, the wall of the bladder, effectively provides antireflux protection while weakening the contractility of the bladder. A change in the lumen of the ureter during an antireflux valve in a slit-semilunar one allows using this method also with a ureter diameter of more than 1 cm.

Claims (1)

1. Gregoir et al. Urologia internat, 1964 V, 18.2, p. 122-136.