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Aktuelle Urol 2017; 48(06): 550-560
DOI: 10.1055/s-0043-120806
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Rekonstruktive Chirurgie des Ureters

Reconstructive surgery of ureteral stricture disease
Axel Heidenreich
Klinik für Urologie, Uro-Onkologie, Roboter-assistierte und spezielle urologische Chirurgie Universitätsklinik Köln
,
Markus Grabbert
Klinik für Urologie, Uro-Onkologie, Roboter-assistierte und spezielle urologische Chirurgie Universitätsklinik Köln
,
Tobias Kohl
Klinik für Urologie, Uro-Onkologie, Roboter-assistierte und spezielle urologische Chirurgie Universitätsklinik Köln
,
David Pfister
Klinik für Urologie, Uro-Onkologie, Roboter-assistierte und spezielle urologische Chirurgie Universitätsklinik Köln
› Author Affiliations
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Publication History

Publication Date:
07 December 2017 (online)

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Zusammenfassung

Ureterstrikturen mit konsekutiver Hydronephrose können sich als Folge endourologischer oder operativer Manipulationen, nach intra- oder extraluminalen entzündlichen Prozessen, als Folge einer Radiotherapie der Nachbarorgane oder auch nach Steinabgängen entwickeln. Anatomische Lage, Längenausdehnung, zugrundeliegende Ursache, Alter und Komorbiditäten des Patienten sowie die bereits durchgeführten Voroperationen im Peritonealraum, Retroperitoneum oder kleinem Becken müssen im Rahmen der Planung einer operativen Korrektur berücksichtigt werden. An Therapieoptionen stehen von der End-zu-End Anastomose über die Ureterolyse und die Ureterneoimplantation bis hin zum Ureter-Ileum-Interponat oder der renalen Autotransplantation eine Vielzahl chirurgischer Techniken zur Verfügung, die individuell abgewogen werden müssen und von dem Chirurgen eine große operative Erfahrung erfordern. Neben den operativ-rekonstruktiven Verfahren müssen auch minimal-invasive Therapieverfahren wie die Implantation selbst-expandierender Stents oder eines pyelovesikalen Bypass in das Therapiespektrum mit einbezogen werden. Bei geeigneter Indikation und entsprechender operativer Erfahrung sind die einzelnen Verfahren mit einer hohen Erfolgsrate von über 90 % und einer signifikanten Komplikationsrate von < 5 % vergesellschaftet. Es ist die Zielsetzung dieses Artikels die verschiedenen Therapieverfahren kritisch darzustellen und Empfehlungen für eine individuelle, differenzialtherapeutische Entscheidung aufzuzeigen.

Abstract

Ureteral strictures with consecutive hydronephrosis may result from endourological or surgical intraperitoneal and intrapelvic procedures, intra- or extraluminal inflammatory processes, radiation therapy to adjacent organs, and spontaneous passage of ureteral calculi. Anatomical location, stricture length, age and comorbidities of the patient as well as previous surgeries in the peritoneal cavity and the retroperitoneum or pelvis minor have to be considered when planning surgical correction. Treatment options include various surgical techniques ranging from simple stricture excision and end-to-end anastomosis to ureterolysis with omental wrapping, ureteroneoimplantation, renal autotransplantation and ureter-ileum replacement. Besides surgical reconstruction, minimally-invasive procedures such as the placement of self-expandable thermostents or a pyelovesical bypass prosthesis must be integrated in the process of differential therapy. If the indication for surgery is adequate, all procedures have a long-term success rate of more than 90 % and a rate of significant complications < 5 %. This article aims to highlight the various therapeutic options and to give some recommendations on how to select individual treatment options.

Schlüsselwörter

Ureterrekonstruktion - Ureter Ileum Interponat - Psoas Hitch - Boari Plastik - Ureterolyse - memokath - pyelovesical bypass - Detour System

Keywords

ureteral reconstruction - ureteral ileal replacement - psoas hitch - Boari flap - ureterolysis - ureteral reimplantation - Memokath - pyelovesical bypass - detour system
 

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