Abstract: Aim: was to assess the possibility of x-ray surgical recovering of the integrity of the upper urinary tract in the absence of dilatation of kidney collecting system. Material and methods: for the period of 2018-2020, under our supervision there were 9 patients with an unexpanded kidney collecting system against the background of the existing external or internal urinary fistula. In 6 patients after cystoprostatectomy and ureteroenterocutaneostomy (Bricker surgery), a migration of urethral drainage occurred. In 3 cases, after gynecological operations, patients were diagnosed with iatrogenic complete transverse ureter damage with the formation of retroperitoneal (intrapelvic) uroma. At the first stage in all 9 patients we performed percutaneous nephrostomy on unexpanded kidneys’ collecting system under ultrasound guidance using special techniques. To restore patency of the damaged ureter, a combined ante-retrograde approach was used. The antegrade flexible guidewire was moved through damaged (cut off) ureter, and retrograde through the entrance of damaged ureter or enterostomy with a capturing device, under x-ray control, the guidewire was brought out. Then, pyeloureteral drainage was placed in an adequate position of the enterocutaneostomy retrograde or antegrade, splinting the ureter damage zone. Results: in 6 patients, after Bricker surgery, the lost ureteral drainage was adequately restored. In patients with a cut off ureter, it was possible to restore the course of the damaged ureter on the external-internal pyelo-urethral drainage by closing the internal urinary fistula and eliminating retroperitoneal urine by percutaneous drainage under radiation control. There were no complications associated with the technique of x-ray surgery. Conclusion: percutaneous nephrostomy on an unexpanded kidney collecting system using special techniques for the verification of kidney collecting system is a potentially replicable safe technique that allows to perform in stages adequate external derivation of urine. Percutaneous nephrostomy can be used as a «bridge» technique for subsequent x-ray surgical interventions on the ureter, including with its complete iatrogenic damage.
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