Evaluation of the results of minimally invasive treatment of iatrogenic strictures and detrusor function after the distal ureter reconstructions.

Introduction. Injuries to the ureter occur in 1-2,5% of cases of all lesions of the genitourinary organs. Iatrogenic injuries account for more than 80% of cases. Their number is associated with the active application of minimally invasive treatment methods into practice. The choice of reconstructive surgery in these patients depends on the functional state of the kidneys and ureters, the extent and level of stricture. Of particular importance is theBoari technique, which is associated with the general embryogenesis of the lower urinary tract. If there is tension in the anastomosis ar ea, it is preferable to use the psoas-hitch technique. Materials and methods. The work was based on the results of the treatment of 42 patients undergoing inpatient treatment at the MC «Medassist» clinic from 2019 to 2024. All patients underwent laparoscopic ureteral plastic surgery using the Boari and psoas-hitch techniques. Results. According to MSCT of the urinary system, no relapse was detected in any of the subjects during the follow-up period. With dynamic nephroscintigraphy after surgical treatment, an improvement in the functional parameters of kidney function was recorded in most patients (n=39; 92,9). According to ultrasound data, passive reflux was noted in 15 (35,7%) patients. Pyelonephritis occurred in 3 (7,1%) patients, all of whom had a urological history. According to the cystometric study, there was no reliable relationship between the volume of the flap used and the development of dysfunctional urination; detrusor hyperactivity of the detrusor before surgery was detected in 7,1% of cases (n=3); after surgery – 9,5% of cases (n=4); no clinically significant change in the maximum cystometric capacity after such a benefit was recorded. Conclusions. Reconstructive surgery for iatrogenic injuries of the lower third of the ureter using Boari and psoas-hitch techniques is effective in 92,9% of patients. 35,7% of patients in the postoperative period had clinically insignificant passive vesicoureteral reflux. Patients with a history of infravesical obstruction, bladder surgery or repeated plasty using flap techniques, and external radiation therapy to the pelvic organs have a high risk of recurrent urinary infection due to active and passive reflux. Cystometry revealed no significant relationship between the length of the bladder flap used and the development of dysfunctional urination.