Dr. med. Dirk Manski

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Ureteroureterostomy: End-to-End Anastomosis of the Ureter

Indication for Ureteroureterostomy


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. Depending on previous operations, a laparoscopic approach is also possible. After identification the ureter is marked with a vessel loop, followed by mobilization cranial and caudal to the stricture. It is important to treat the ureter atraumatically and to spare its vascular supply.

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.


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:

The retroperitoneal drainage is removed if daily volume of drainage is well below 50 ml, Bladder catheter additional 1–2 days, ureteral stent 2–4 weeks.

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


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

  Deutsche Version: Ureteroureterostomie