Laparoscopic contractattachments with the formation of ilocandia in pelvic dystopia of the kidneys in muscle invasive bladder cancer


DOI: 10.29188/2222-8543-2020-13-4-24-29

A.Yu. Pavlov, A.G. Dzidzaria, I.B. Kravtsov, A.D. Tsybulsky, S.V. Fastovets
№4 2020

Introduction. According to autopsies, the frequency of unilateral kidney dystopia ranges from 1:660 to 1: 1000, with an average of 1:800 newborns, and lumbar dystopia is more common, mainly in boys. The left kidney is dystopian more often than the right. Bilateral dystopia is rare. In the structure of cancer incidence in the Russian population, bladder cancer ranks 9th among men and 17th among women. When analyzing the literature data, we did not find any recommendations for methods of urine derivation in patients with diagnosed bladder cancer in pelvic kidney dystopia.

Materials and methods. Clinical case. A patient with a diagnosis of bladder cancer сT3bN0M0G1 associated with concomitant abnormality of the kidneys and urinary tract (pelvic kidney dystopia with shortening of the ureters) was admitted to the Department of oncourology of the Federal state budgetary institution RSCRR. The decision was made on the implementation of laparoscopic radical contractattachments, with an attempt of derivation of urine (formation ureteroileostomy) by Bricker. Intraoperatively: given the short length of the ureters, the location of the kidneys, it was decided to impose an end-to-end anastomosis of the ileoconduit with the pelvis of the right kidney, ureteroileoanastomosis end-to-side on the left. Based on the results of histological examination, the final clinical diagnosis was made: рТ2bN1М0G1R-.

Results. 3 months after surgical treatment, no complications were observed, according to control studies, both anastomoses are passable. The planned adjuvant pоlichemotherapy (PCT) has been completed. There are no data for disease progression in the control examination.

Conclusion. The method of urine removal is determined intraoperatively. In this patient, the condition and length of the right ureter did not allow performing classical ureteroileoanastomosis (end-to-end), and therefore pyeloileoanastomosis was performed on the right. On the left, the length of the ureter made it possible to perform end-to-side ureteroileoanastomosis, but only if the ileoconduit was removed to the left side.

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