Minimally invasive treatments for ureteral injuries

Introduction. Application of endourological interventions is the first step for treatment number of diseases of urinary tract. However, experience has shown, to date short-term and long-term results occasionally are worse for patients pretreated with minimally invasive methods, then open surgery. Still it is open to discuss about choice between methods of treatment for primary and second application of patients with damages of urinary tract. Materials and methods. In literature review used data about using minimally invasive methods for treatment of ureteral strictures, published in PubMed’s base (https://www.ncbi.nlm.nih.gov/pubmed/), scientific electronic library of RF - Elibrary.ru (https://elibrary.ru/) and also professional endourological association websites. Results. Overall, ureteral trauma accounts for 1 - 2,5% of urinary tract trauma. In origin all ureteral strictures can be divided into three main groups: post-traumatic, post-inflammatory, post - radiation. Method of treatment of injuries (open surgery or minimally invasive methods) and strictures of ureter depends from etiology, location of injury, spread of defect and also time from moment of damage or forming stricture or obliteration. Open surgery let recovery spreading strictures of ureter (to 15 cm) in the middle and distal thirds by means of uretherocystoneostomy (with or without antireflux protection) with maneuver Psoas - hitch, both of methods shown promising longterm results in 97% of cases with postoperative supervision for 4,5 year. As opposed to open surgery in accordance to last european clinical recommendations, efficacy of minimally invasive methods of manage account for about 90%, however in the literature insufficient data to suggest so high methods efficacy. The review contains information about different methods, applied for managed of ureteral strictures, eligibility criteria patients for endourological treatment, their short-term and long-term outcomes, and also provides an update on the possibilities in ureteral tissue engineering for regenerative medicine, as alternative to open and minimally - invasive surgery. Conclusion. Most of the urological procedures were to adopt endoscopical and minimally invasive techniques. Still there is no standardized and optimized method of treatment. The modern methods include: stenting, nephrostomy, balloon - dilatation, Acucise - endotomy, endouretherotomy with cold-knife, Ho-L and electro-string. It is impossible to compare effectiveness of this methods, due to absence of multicentral, randomized trials. Failure in applying endourological methods can be explained with incorrect selection of patients for this treatment.