Ureteral laparoscopic surgery in cancer patients

Objective: to improve the results of treatment of cancer patients with strictures and obliteration of the ureters after surgery and/or remote radiation therapy.

Materials and methods. The study included 6 men and 12 women. The average age of men was 67 + 8.5 years (53—79years) and 46 + 15.8 years (28—74years) among women. According to the results of X-ray examinations, the average length of cicatricial narrowing of the ureter was determined, after which the tactics of surgical treatment were determined.

Results. The duration of surgical treatment rangedfrom 97 to 380 minutes. Intraoperative blood loss in all groups was approximately the same and ranged from 20 to 160 ml. Intraoperative complications occurred in one patient (5.5 %), injury of the intestine. The described damage was repaired by the intracorporeal manual suture. All operations were completed laparoscopically. A generalized indicator of postoperative complications reached 16.7 %. All the complications that occurred had a slight effect on the the rehabilitation period.

Conclusion. The results of this work indicate that ureteroplasty in patients after cancer treatment can be performed by laparoscopic access, which significantly reduces the invasiveness of surgery, reduces the length of hospital stay and rehabilitation of patients. Also, the possibilities of laparoscopic surgery allow you to achieve better visualization, to form more precise sutures.

1. Dovlatyan A.A. Tactics and results of reconstructive operations in urinary tract injury in obstetric and gynecological practice. Akusherstvo i gi-nekologiya = Obstetrics and Gynecology 1994;(1):51—4. (In Russ.).

2. Billmeyer B.R., Nygard I.E., Kreder K.J. Uretero-uterine and vesicoureterovaginal fistulas as complication of cesarean section. J Urol 2001;165(4):1212—3.

3. Blandy I.P., Badenoch D.F., Fowler D.S. et al. Early repair of iatrogenic injury to ureter or bladder after gynecological surgery. J Urol 1991;146(4):761—5. DOI: 10.1016/s0022-5347(17)37915-6.

4. Knysh V.I. Treatment and prevention of urinary tract injuries during radical surgery for colorectal cancer. Voprisy onkologii = Oncology Issues 1982;28(9):84—90. (In Russ.).

5. Komyakov B.K., Guliev B.G., Dorofeev S.Ya. et al. Appendicoureteroplasty. Urologiya = Urology 2006;(5):19—24. (In Russ.).

6. Loran O.B., Sinyakova L.A., Seregin A.V. et al. Use of isolated intestinal segments in surgical treatment of radiation-induced lesions of the urinary tract. Urologiya = Urology 2012;(2):20-4. (In Russ.).

7. Giannakopoulos X., Lolis D., Grammeniatis E., Kotoulas K. Iatrogenic injuries to the distal ureter during gynecologic interventions. J Urol 1995;101(2):69—76.

8. Kochkin A.D., Gallyamov E.A., Popov S.V. et al. Laparoscopic ileal ureteral substitution. Results of the first 40 operations. Urologiya = Urology 2018;(5):5—12. (In Russ.).

9. Gill I.S., Savage S.J., Senagore A.J., Sung G.T. Laparoscopic ileal ureter. J Urol 2000;163(4):1199—202.

10. Wagner J.R., Schimpf M.O., Cohen J.L. Robot-assisted laparoscopic ileal ureter. JSLS 2008;12(3):306—9.

11. Brandao L.F., Autorino R., Zargar H. et al. Robotic ileal ureter: a completely intracorporeal technique. Urology 2014;83(4):951—4. DOI: 10.1016/j.urology.2013.11.035.

12. Lutsevich O.E., Gallyamov E.A., Zabrodina N.B. et al. Experience of laparoscopic ileouretero-plasty. Endokhirurgiya segodnya = Endosurgery Today 2013;(4):26—32. (In Russ.).

13. Sanzharov A.E., Frank M.A., Panshin S.V. et al. Laparoscopic urethroplasty using a segment of the small intestine. Materials of the XIV Congress of the Russian Society of Urology. Saratov, 2014. Pp. 533—534. (In Russ.).

14. Khat’kov I.E., Kasaikin A.V., Rodin D.B. et al. Totally laparoscopic substitutive plasty of the right ureter with ileal loop. Endoskopicheskaya khirurgiya = Endoscopic Surgery 2011;17(1):41 —3. (In Russ.).

15. Stein R.J., Turna B., Patel N.S. et al. Laparoscopic assisted ileal ureter: technique, outcomes and comparison to the open procedure. J Urol 2009;182(3):1032-9. DOI: 10.1016/j.juro.2009.05.013.

16. Ochelenko V.A. Surgical treatment of patients with extensively narrowed ureters. Thesis for a doctor of medical sciences. 01.14.23. Saint Petersburg, 2018. Pp. 66-67. (In Russ.).

17. Karam G., Hetet J., Maillet F. et al. Late ureteral stenosis following renal transplantation: risk factors and impact on patient and graft survival. Am J Transplant 2006;6(2):352—6. DOI: 10.1111/j.1600-6143.2005.01181.x.

18. Polyakov N.V., Keshishev N.G., Kachmazov A.A. et al. Surgical treatment of the stricture of the lower third of ureter after radiation therapy of pelvic organs. Onkourologiya = Cancer Urology 2016;12(3):68—73. (In Russ.).

19. Komyakov B.K., Guliev B.G. Laparoscopic bowel ureteroplasty. Endo-skopicheskaya khirurgiya = Endoscopic Surgery 2015;21(3):8—12. (In Russ.).

20. Chung B.I., Hamawy K.J., Zinman L.N., Libertino J.A. The use of bowel for ureteral replacement for complex ureteral reconstruction: long-term results. J Urol 2006;175(1):179—83. DOI: 10.1016/S0022-5347(05)00061-3.

21. Armatys S.A., Mellon M.J., Beck S.D. et al. Use of ileum as ureteral replacement in urological reconstruction. J Urol 2009;181(1):177—81. DOI: 10.1016/j.juro.2008.09.019.

22. Wolff B., Chartier-Kastler E., Mozer P. et al. Long-term functional outcomes after ileal ureter substitution: a single-center experience. Urology 2011;78(3):692—5. DOI: 10.1016/j.urology.2011.04.054.

23. Kocot A., Kalogirou C., Vergho D., Riedmiller H. Long-term results of ileal ureteric replacement: a 25-year singlecentre experience. BJU Int 2017;120(2): 273-9. DOI: 10.1111/bju.13825.

24. Комяков Б.К., Очеленко В.А. Результаты кишечной пластики мочеточников. Урология 2013;(3):5—9. [Komyakov B.K., Ochelenko V.A. The results of intestinal plastic surgery of the ureters. Urologiya = Urology 2013;(3):5—9. (In Russ.)].

25. Baba S., Oya M., Miyahara M. et al. Laparoscopic correction of circumcaval ureter. Urology 1994;44(1):122—6. DOI: 10.1016/s0090-4295(94)80023-5.

26. Simmons M.N., Gill I.S., Fergany A.F. et al. Laparoscopic ureteral reconstruction for benign stricture disease. Urology 2007;69(2):280—4. DOI: 10.1016/j.urology.2006.09.067.

27. Baranov A.V., Biktimirov R.G., Parkhonin D.I. Laparoscopic transperitoneal and extraperitoneal reconstructive plastic surgery on the ureter. Urologiya = Urology 2013;(5):80—3. (In Russ.).

28. Gozen A.S., Cresswell J., Canda A.E. et al Laparoscopic ureteral reimplantation: prospective evaluation of mediumterm results and current developments. World J Urol 2010;28(2):221—6. DOI: 10.1007/s00345-009-0443-8.

29. Permpongkosol S., Bella A.J., Tantara-wongsa U., Stoller M.L. Laparoscopic extravesical ureteral reimplantation for iatrogenic distal ureteral stricture. J Med Assoc Thai 2009;92(10):1380—6.

30. [Komyakov B.K., Ochelenko V.A., Stetsik O.V., Nikolaev N.M. The results of ureteral replacement with appendix and boari-flap in patients with ureteral strictures. Meditsinskij vestnik Bashkortostana = Medical Bulletin of Bashkortostan 2013;8(2):100—3. (In Russ.).