Trauma

Injury to the ureter is most commonly the result of surgical intervention. Damage during ureteroscopy, bowel or gynaecological surgery is well recognized. End-to-end re-anastomosis of the ureter is possible if little or no length has been lost. If the ureter is damaged close to the bladder, re-implantation is usually preferred. If the damage is higher with significant loss or ureter, a Boari flap, using a flap of bladder or direct anastomosis to the normal ureter on the other side (a transuretero-ureterostomy) will deal with the problem. The anastomosis should be stented with a ureteric stent until it has healed (Fig. 19.8).

Figure 19.8. Transuretero-ureterostomy with an indwelling double J® ureteric stent across the anastomosis from the bladder to the pelvis of the affected kidney.

Figure 19.9. Anderson-Hynes dismembered pyeloplasty: (a) PUJ obstruction with hydronephrosis and (b) a contractile segment of ureter is excised and the ureter spatulated to anastomose to the trimmed renal pelvis.

Figure 19.9. Anderson-Hynes dismembered pyeloplasty: (a) PUJ obstruction with hydronephrosis and (b) a contractile segment of ureter is excised and the ureter spatulated to anastomose to the trimmed renal pelvis.

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