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Rekonstruktionsmöglichkeiten des Harnleiters

Surgical reconstruction of the ureter

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Zusammenfassung

Funktionsstörungen des Harnleiters sind im urologischen Alltag ein häufig gesehenes Krankheitsbild mit vielfältigen Ursachen und einem breiten Spektrum an operativen Therapieoptionen. In vielen Fällen ist eine Harnleiterstriktur Folge einer Harnleiterverletzung im Rahmen einer Operation im Becken bzw. einer endoskopischen Stein- oder Tumorsanierung des Harnleiters, einer Radiatio im Bereich des Beckens oder Retroperitoneums oder einer Endometriosis extragenitalis. Das operative Ziel der Therapie von Harnleiterfunktionsstörungen ist die Wiederherstellung eines nicht refluxiven sowie nicht obstruktiven Urinflusses mit einer stabilen Nierenfunktion. Hierfür stehen zahlreiche offene als auch laparoskopische und roboterassistierte Operationsmethoden – von einer Harnleiterneuimplantation mit ggf. Psoas-hitch- oder Boari-Plastik bis hin zum Ileuminterponat zur Verfügung. Diese Arbeit soll einen Überblick über die möglichen operativen Verfahren in der Rekonstruktion des Harnleiters geben mit einem Ausblick für Zukunftsprojekte mittels beispielsweise Gewebetransplantation nach Regenerierung von Urothel aus Zellkulturen.

Abstract

Defects in ureteral continuity and function can originate from various etiologies such as stricture, radiotherapy, tuberculosis, tumor, trauma or perforation due to iatrogenic injury. The surgical options for the management of ureteral defects are complex and depend on the location of the defect. The aim of the surgical management of ureteral stricture is the reconstruction of an anti-refluxive and nonobstructive flow of urine to preserve kidney function. There are numerous possibilities for the reconstruction of ureteral defects ranging from ureteroneocystostomy with or without psoas-hitch- or Boari-flap to ileal ureteral replacement. Nearly all these techniques can either be done in open surgery or in a laparoscopically or robotic-assisted manner. The technique of robotic-assisted reconstruction of ureteral defects is challenging but offers a great opportunity. The aim of this article is to provide an overview of current surgical procedures in ureteric reconstruction.

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Authors and Affiliations

  1. Klinik für Urologie, Universitätsklinikum Tübingen, Eberhard Karls Universität Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Deutschland

    V. Stühler, J. Bedke &  A. Stenzl

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  1. V. Stühler
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  2. J. Bedke
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  3. A. Stenzl
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Correspondence to A. Stenzl.

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Interessenkonflikt

A. Stenzl Ad Board: Ipsen Pharma, Roche, Janssen, Alere, Bristol-Myers Squibb, Stebabiotech, Synergo, Ferring. Speaker, Janssen, Ipsen Pharma, Sanofi Aventis, CureVac, Astellas, Amgen. Clinical study: Johnson & Johnson, Roche, Cepheid, Roche, Research grant: Amgen Inc., Bayer AG, CureVac, immatics biotechnologies GmbH, GemeDx Biosciences. Research grant: immatics biotechnologies GmbH, Novartis AG, Karl Storz AG. V. Stühler und J. Bedke geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Stühler, V., Bedke, J. & Stenzl, A. Rekonstruktionsmöglichkeiten des Harnleiters. Urologe 58, 651–657 (2019). https://doi.org/10.1007/s00120-019-0944-z

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  • DOI: https://doi.org/10.1007/s00120-019-0944-z

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