Dr. med. Dirk Manski



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Ureteroureterostomy: End-to-End Anastomosis of the Ureter

Indication for Ureteroureterostomy

Contraindications

Surgical Technique of Ureteroureterostomy

Preoperative Patient Preparation

Surgical Approach:

Surgical Approach

The surgical approach to the proximal ureter is via a flank incision. The mid-ureter and distal ureter is reached with retroperitoneal or transperitoneal lower abdomen incisions: e.g. paramedian laparotomy or Gibson incision. After identification of the ureter with stricture or injury, the ureter is carefully exposed. Atraumatic treatment and protection of the vascular supply is important.

Anastomosis of the Ureter:



fig. ureteroureterostomy: end-to-end ureter anastomosis Ureteroureterostomy: both ends of the ureter are spatulated. After placement of corner sutures, the anastomosis is done in a running or interrupted fashion.

Care after Ureterureterostomy

General measures:

Early mobilization. Respiratory therapy. Thrombosis prophylaxis. Laboratory controls (Hb). Wound inspections.

Analgesia:

In adults, a flank approach is painful and an epidural catheter is an option. In addition, analgesics according to the ladder of WHO pain management are given, e.g. metamizol and tramadol.

Drains and catheters:

Complications of Ureteroureterostomy

Bleeding. Infection. Urinoma. Recurrence of the ureteral stricture. Injury to adjacent organs (e.g. bowel).







Index: 1–9 A B C D E F G H I J K L M N O P Q R S T U V W X Y Z



References

Elliott, S. P. & McAninch, J. W.
Ureteral injuries: external and iatrogenic
Urol Clin North Am, 2006, 33, 55-66, vi


  Deutsche Version: Ureteroureterostomie