Treatment plan for patients with bilateral neuromuscular dysplasia of the ureter

A.V. Lyulko (1981) performs this operation as follows. With a club-shaped incision, the ureter is exposed extraperitoneally and mobilized along the dilated part. Then, retreating 2 cm from the wall of the bladder, the lower cystoid of the ureter is resected and its distal end is invaginated through the opening into the bladder. Throughout the remaining dilated cystoids of the central segment of the ureter, while preserving its mesentery and vessels, a duplication is formed by imposing a continuous catgut suture on the bus. After that, the central end of the ureter is guided into the bladder through its invaginated distal end using a specially created clamp. Both ends are sewn with knotty catgut sutures. If the distal end of the invaginated ureter is very narrow and it is not possible to draw the end, it is dissected along its length and additionally with separate catgut sutures is fixed to the duplication of the ureter.

A.V. Lyulko, T.A. Chernenko (1981) conducted experimental studies, which showed that the formed “papilla” does not atrophy, but flattens and becomes covered by the epithelium of the bladder. Even with the creation of high intravesical pressure, the formed anastomosis in most cases prevents the occurrence of VUR.

It is extremely difficult to draw up a treatment plan for patients with bilateral neuromuscular dysplasia of the ureter in stage III of the disease with symptoms of chronic renal failure. Such patients can be operated on in two stages. First, nephrostomy is applied, and then radical surgery is performed on the distal ureters. In recent years, this tactic has been abandoned. First, intensive detoxification therapy, antibacterial treatment, and forced frequent urination are performed.