Feature of ureterocystoanastomosis

Operation according to N.A. Lopatkin-L.N. Lopatkina. An arcuate incision is made in the groin area. The upper corner of the cut may extend as far as the costal arch. The dilated part of the ureter is mobilized. A feature of this stage is the extremely careful attitude to the vessels of the ureter. The most affected area, which has lost contractility (usually the lower cystoid), is resected not along the border of the intercystoid narrowing, but retreating by 1 cm, that is, along the lower cystoid. A duplication of the ureter is formed along the remaining dilated cystoids (with complete preservation of its vessels) on the tire with a continuous suture with chrome-plated catgut, starting from the intercystoid narrowing. The seams should be close together. A feature of ureterocystoanastomosis is the formation of an antireflux roller from the flap of the lower cystoid of the ureter (in front of its opening). The opening of the ureter resembles a cochlea-like formation. Thus, the duplication of the ureter narrows its lumen, and the formed blind canal serves as an anatomical valve: at the time of urination or when the intravesical pressure rises, the urine stream rushes to the ureter and fills both of its canals. The blind canal, overflowing with urine, comes into contact with the through channel with its walls and blocks the flow of urine from the bladder to the pelvis.

The operation proposed by N.A. Lopatkin and L.N. Lopatkina (1978), qualitatively differs from interventions based on resection of the ureter in width. The authors achieve a narrowing of the lumen of the ureter not by cutting out a strip of one width or another, but by creating a duplication of the ureter. This technique has several advantages. Resection in width over a considerable extent disrupts the blood supply to the abnormal ureter. When a long wound surface is scarred, the ureter turns into a rigid tube with sharply impaired contractility. The formation of a duplication of the ureter does not disturb its blood supply, and due to the “doubling” of the wall, the peristaltic activity of the ureter is somewhat enhanced. During neoimplantation, the “doubled” wall of the ureter, forming a roller around the artificial opening, prevents reflux.