Dr. med. Dirk Manski

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Transureteroureterostomy: Surgical Technique and Complications

Transureteroureterostomy is used to bypass a diseased distal ureter with an end-to-side anastomosis of the donor (diseased) ureter with the recipient (healthy) ureter on the opposite side. Transureteroureterostomy is rarely used for the following indications (Barry, 2005):

Indication for Transureteroureterostomy

fig. Transureteroureterostomy: the diseased ureter is anastomosed end-to-side with the healthy ureter on the opposite side.
Transureteroureterostomy: the diseased ureter is anastomosed end-to-side with the healthy ureter on the opposite side.

Contraindications

Surgical Technique of Transureteroureterostomy

Preoperative Patient Preparation

Surgical Approach

Median laparotomy is the standard approach, incise the white line of Toldt on both sides and identify both ureters. Depending on the underlying disease, mobilize and resect the distal ureter on the diseased side. Carefully mobilize the proximal end of the diseased ureter with attention to the vascular supply. Dilate a tunnel from the left to the right retroperitoneum with finger dissection under the mesentery and above the large vessels. Alternatively, incise the posterior peritoneum and mobilize the bowel's meso comparable to retroperitoneal lymphadenectomy. Guide the diseased proximal ureter to the opposite side without kinking. 

Transureteroureterostomy:

fig. Transureteroureterostomy: the posterior wall of the anastomosis is sutured in a running fashion from the inside and the anterior wall of the anastomosis is sutured from the outside.
Transureteroureterostomy: suture the posterior wall of the anastomosis in a running fashion from the inside and the anterior wall of the anastomosis from the outside.

Postoperative Care after Transureteroureterostomy

General measures:

Early mobilization, thrombosis prophylaxis, respiratory therapy, laboratory tests (hemoglobin, creatinine), regular physical examination of the abdomen and incision wound.

Analgesia:

Analgesics with a combination of NSAIDs and opioids. Peridural anesthesia facilitates postoperative pain management.

Drains and catheters:

Remove the retroperitoneal drainage if the daily drainage is well below 50 ml. The bladder catheter stays additional 1–2 days or 3–5 days in total, and the ureteral stent for 2–4 weeks.

Complications of Transureteroureterostomy

Bleeding, infection, urinoma, recurrent ureteral stricture, loss of kidney function, injury to adjacent organs (bowel, liver, spleen, pancreas).






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

J. M. Barry, “Surgical atlas transureteroureterostomy.,” BJU Int., vol. 96, no. 1, pp. 195–201, 2005, doi: 10.1111/j.1464-410X.2005.05552.x.



  Deutsche Version: Transureteroureterostomie