The next stage of modeling is transverse resection of the ureter in order to provide the required length for the correct application of the ureterocyst-anastomosis. The resected tissue of the ureteral wall is sent for histological examination, which is essential in determining the timing of postoperative splinting of the anastomosis and predicting the restoration of ureteral contractility.
At the next stage of the operation, a longitudinal oblique resection of the distal part of the ureter is performed. Depending on the patient’s age, the length of the longitudinal resection may vary, however, as a rule, it corresponds to the lower third of the ureter. ON THE. Lopatkin performs a duplication of the ureter, and not its resection in order to minimize trauma to the ureter and maximize the preservation of its neuromuscular elements. When performing duplication of the ureter, it is recommended to use interrupted sutures, and apply the ureterocystoanastomosis according to the principle of “non-spill inkwells”.
Suturing of the ureter along the lateral wall is performed using absorbable suture material in a continuous manner. The lumen of the ureter after modeling should ensure unimpeded passage of urine under conditions of reduced evacuation function, and its diameter should correspond to the size of the antireflux tunnel of the bladder wall. The further course of the operation does not differ from that of the standard technique for performing ureterocystoanastomosis. Immediately before the imposition of the anastomosis, the ureter is splinted with an intubating drainage tube of the required diameter (10-12 CH). Depending on the severity of sclerotic changes in the wall of the ureter, which is determined by histological examination, splinting of the ureter is carried out for a period of 7 to 14 days.
As a rule, histological examination reveals a sharp decrease in nerve and elastic fibers, pronounced sclerosis of the muscle layer with almost complete atrophy of muscle bundles, fibrosis of the submucosal layer, segmental ureteritis.