Solutions for ureteral obstructions between UPJ and UVJ in adult patients

Abstract

The ureter is a small muscular tube (25-30 cm long and 5 mm in outer diameter) that transports urine from the kidney to the bladder. Given this long trajectory, the ureter can be affected by many pathological processes. The general public is aware of the extremely painful condition of ureteral colic caused by stones, but there are numerous other reasons for ureteral obstruction. Unfortunately, approximately one-third of obstructions are caused by interventions performed by gynecologists, vascular surgeons, and urologists. The challenge in addressing these ureteral issues is to minimize patient harm. This thesis describes the results of using locally anesthetized insertion of metal stents to relieve obstructions (similar to stents in coronary arteries) and compares it with open surgery. Additionally, a technique (psoas hitch procedure) is evaluated to bridge obstructions in the lower part of the ureter by lifting and fixing the bladder on one side, allowing the healthy ureter to be re-implanted into the bladder wall. The long-term results of this procedure are very favorable. A connection between an artery and ureter can be fatal. Before 2000, 1 in 5 patients with this diagnosis died; nowadays, due to the use of new techniques, this rate has decreased to 7%. This dangerous condition predominantly occurs in individuals who have undergone abdominal surgery, sometimes combined with external radiation. In 80% of cases, a stent has been present in the ureter for an extended period.