Ureteroureterostomy

If the defect is short (<3cm), then primary end-to-end anastomosis can be considered. Success of primary repair depends almost exclusively on obtaining a watertight tension-free anastomosis. After debridement of all nonvi-able tissue, the ends should be spatulated and the anastomosis performed using fine absorbable suture over an appropriately sized stent. If possible, retroperitoneal fat or omentum, if available, should be placed over the anastomosis. We use closed suction drainage for 24 to 48 hours or until drainage is minimal. A Foley catheter should be left in place for a few days because urine will reflux with a stent in place and impair wound healing. Most literature supports leaving the stent in place after ureteral reconstruction for 4 to 6 weeks and this can easily be removed in the office. High success rates are expected. Most failures and recurrent strictures are the result of excessive tension on the anastomosis, injudicious devascularization, or prolonged urinary leak.

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