Semaniv O. The choice of methods of operative treatment of patients with the damage and obstruction of ureter's pelvic department.

The dissertation is theoretical generalization and new decision of actual scientific task of urology is an increase of efficiency of treatment of patients with one-sided and by bilateral damages and primary and secondary obstruction of pelvic departments of ureters by the rational choice of surgical interference and perfection of the known operative methods taking into account certain new nosotropic factors that influence on development of postoperative complications.The renewal of integrity of pelvic departments of ureters in the early terms by ureteroureteroanastomosis or removal of squeezing ligature resulted to development of postoperative complications in 45,5% of cases and is inadvisable. This is predefined by a previous operating trauma, often, considerable bleeding and morphological changes of ureters in the zones of damage. The videoendoscopic ureteroscopy allowed to extensive the zone of bandaging(compression) under visual control, to set the internal stent and renew the arcade of urine in 31,8% of patients with the damages of pelvic departments of ureters, that allowed to avoid for these patients of stage reconstructive operative treatment.The use of the modified method of surgical treatment of primary and secondary obstruction of pelvic department of ureters in adults with ureterohydronephrosis by removing of extended lower third of ureters and creation of high ureterocystoanastomosis allowed to attain the positive result of treatment in 85,7% of patients in comparison with 42,9% (?2=0,20 p<0,01) of patients with the correction of pathological changes of ureter by the traditional methods - its resection and narrowing. Application of the improved method of surgical treatment of patients with the bilateral obstruction of pelvic departments of ureters in the stage of bilateral ureterohydronephrosis by the replacement of pelvic departments of ureters by the loop of ileac bowel allowed to attain the positive result of treatment in 75,0% of cases. Distribution of sclerotic process to 2 - 5 cm outside of trauma's location of ureter and largenesses of defect between the cicatrical-changed distal and proximal departments of ureters are reason of development of urinary fistula and secondary postoperative stenosis at the correction in communicating of ureters by traditional operative methods - by ureteroureteroanastomosis or operation by Boari. Application of the modified method of vesicopsoas - hitch at the sizes of defect a from 3 to 10 cm between the distal and proximal departments of the damaged pelvic departments of ureters allowed to decrease development of urinary fistula and secondary postoperative stenosis and to attain the positive result of treatment in 94,1% of patients (in comparison group 40,8%, ?2=0,20 p<0,01). Autotransplantation of kidney with implementation of ureterocystoanastomosis is expedient for restoring of urine flow at the size of defect between the proximal and distal departments of ureters more than 10 cm