Demchenko V. Substantiation of the strategy of surgical reconstruction of the ureter by urothelium-containing autologous tissues.

The dissertation work is devoted to the actual question of modern urology, namely to increase of quality of treatment of patients with pathology of an ureter by development of optimum tactics of surgical reconstruction and formation of effective algorithms.The author has developed original modifications of existing surgical techniques for the reconstruction of the upper urinary tract due to urothelial tissues, including ureterocalicoanastomosis, tubularized flaps of the bladder and renal pelvis.Based on the analysis of images obtained by multispiral computed tomography, a new classification of the anatomical structure of the lower renal calyxes in relation to the problems of ureterocalicoanastomosis has been developed. An algorithm for selecting the type of kidney resection in patients who are scheduled for ureterocalicoanastomosis is presented.Using discriminant analysis, the factors predicting the complications of ureterocalicoanastomosis were demonstrated, namely, the secondary nature of the operation, the presence of urinoma before reconstructive intervention and the operation time of more than 170 minutes. It is confirmed that the main negative parameter of the prognosis of long-term results of this operation is the thickness of the renal parenchyma less than 10 mm. We analyzed the frequency of angular deformation of the ureterocalicoanastomosis and presented its dependence on the type of kidney resection.The effectiveness of reconstruction of the upper third of the ureter with a tubularized pelvic flap in patients with prolonged ureteral strictures and hydronephrosis due to ureterovascular conflict was proved on a large clinical material. We also determined the factors predicting complications and long-term results. The obtained results showed that the main negative prognostic factors were prolonged strictures of the upper third of the ureter and the duration of the operation more than 120 minutes.We conducted a comparative analysis of the results of pelvic tubuloplasty and antevasal pyeloureteral anastomosis in patients with hydronephrosis caused by additional vessels to the lower pole of the kidney. The analysis demonstrated the priorities of the tubular pelvis in this category of patients.Based on statistically confirmed results, the effectiveness of ureteral reconstruction with a tubularized bladder flap was demonstrated and negative factors for the prognosis of complications and long-term results were presented, namely the presence of uretero-vaginal fistula and bladder volume less than 350 ml. The research results allowed clarifying the data on the results of using bladder flaps of different lengths, and on the bladder functioning after performing its tubular plasticity. We studied the results of using tubularized bladder flaps in doubling of the ureters, in the restoration of defects of both ureters and in the reconstruction after unsuccessful Boari surgeries. It is proved that two-stage operations have priorities over synchronous bilateral reconstruction due to a higher level of positive long-term results.