Dr. med. Dirk Manski

 You are here: Urology Textbook > Surgery (procedures) > Ureteroureterostomy

Ureteroureterostomy: Surgical Technique and Complications

reteroureterostomy is the end-to-end anastomosis of the ureter, which can be performed with open surgery, laparoscopy, or robotic-assisted laparoscopy for the following indications: (Elliot and McAninch, 2006).

Indication for Ureteroureterostomy

fig. ureteroureterostomy: end-to-end ureter anastomosis
Ureteroureterostomy: spatulate both ends of the ureter about 7--10 mm at 180 degrees apart. Place corner sutures and finish the anastomosis in a running or interrupted fashion with PDS 5-0.


Surgical Technique of Ureteroureterostomy

Preoperative Patient Preparation

Surgical Approach

The surgical approach to the proximal ureter is via a flank incision. The mid-ureter and distal ureter are reached with a retroperitoneal or transperitoneal lower abdomen incision, e.g., paramedian laparotomy or Gibson incision. A laparoscopic (robotic-assisted) approach is also possible. After identification, mark the ureter with a vessel loop and continue to mobilize the ureter cranial and caudal to the stricture. It is essential to treat the ureter atraumatically and to spare its vascular supply. 

Anastomosis of the Ureter:

Postoperative Care after Ureterureterostomy

General measures:

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


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 Ureteroureterostomy

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


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

  Deutsche Version: Ureteroureterostomie