Narrowing of the ureteral opening

Operation according to V. Gregor. An inferior pararectal incision is performed. The peritoneal sac is peeled off in a blunt way and retracted in the opposite direction. The ureter is exposed and excreted extraperitoneally from the opening in the bladder. Then the posterior wall of the bladder is isolated and dissected to the mucous membrane from the confluence of the ureter towards the apex at a distance of 3 cm. The ureter is placed in the wound, and the wall of the bladder is sutured over it with knotty sutures. The wound is sewn up tightly.

V. Politano, V. Leadbetter, the reimplanted ureter is first carried out for 1-2 cm under the mucous membrane of the bladder and only then brought to the surface and fixed.

Some authors excise the narrowing of the ureteral opening and suture its end in the formed opening of the bladder wall.

Operation according to N.A. Lopatkin A.Yu. Svidler. After the formation of the ureter according to the method of M. Bishov, it is immersed under the serous membrane of the descending colon, that is, ureteroenteropexy is performed. According to the authors, the ureter “gets used” well into the surrounding tissues, and a vascular network is formed between the intestine and the ureter, providing additional blood supply to the ureter. The disadvantage of this operation is that it can only be performed on the left side. On the right, diving can only be anti-peristaltic, which disrupts the passage of urine. In addition, this operation does not eliminate the expansion of the lower cystoid of the ureter. A significant drawback of this method is the need for complete mobilization of the lower cystoid of the ureter, which leads to complete avascularization and denervation.

Given these shortcomings, N.A. Lopatkin, L.N. Lopatkina (1978) developed a new method of surgery, which consists in the formation of an intramural valve while maintaining vascularization and innervation of the ureter, its muscle layer, as well as narrowing the lumen of the expanded part to a slit-like one by duplicating the ureter.