Nephroureterectomy is used only in case of irreversible destructive changes in the kidney, a sharp decrease in its function and the presence of a healthy contralateral kidney.
AND I. Pytel, A.G. Pugachev (1977) believe that the main tasks of reconstructive plastic surgeries for neuromuscular dysplasia of the ureter are excision of the ureteral area that creates an obstacle, modeling the diameter of the ureter to a normal caliber, neoimplantation into the bladder and antireflux surgery.
Experience shows that simple reimplantation of the ureter fails to create a satisfactory functioning opening, since the entire complex anti-reflux mechanism is damaged during resection of the distal ureter. Surgical intervention should be aimed at normalizing urodynamics and eliminating VUR. Direct or indirect ureterocystoneostomy without antireflux correction in most patients is complicated by VUR, which contributes to the progression of irreversible destructive processes in the renal parenchyma. Antireflux surgery can be successful if a long submucosal canal is created. The diameter of the reimplanted ureter should be close to normal. Therefore, during the reconstruction of the ureter, it is not enough to perform resection of the excessive length of the ureter.
The following operations are most widespread.
BischotT operation. The corresponding half of the bladder and the pelvic part of the ureter are mobilized. The ureter is dissected, preserving the pelvic region. The widened part of the distal ureter is resected. A tube is formed from the remaining part of the ureter and sutured with the preserved segment of the intramural ureter. With a bilateral anomaly, the operation is performed on both sides.
J. Williams after resection of the megaloureter implants the ureter into the wall of the bladder in an oblique direction, creating a “cuff” from the wall of the ureter.