A novel reconstructive option for long upper ureter obliteration.
BACKGROUND
Injuries of the upper (lumbar) portion of the ureter are rare; however, their reconstruction may pose considerable challenges. We describe a novel technique of surgical reconstruction in case of a long upper ureteral obliteration that may be a viable treatment option in select patients.


METHODS
Reconstruction of a iatrogenic 5 cm injury to the upper ureter, consisting of 2 cm obliteration and 1.5 cm stenotic segments on its sides, unsuitable for an end-to-end reanastomosis, was performed using a novel technique of augmented pelvic flap anastomotic ureteroplasty. The injured ureteral segment was excised, the ureteral stump was spatulated on the medial aspect and the lateral tissue defect was replaced by a flap from the posterior surface of the renal pelvis.


RESULTS
The procedure was successfully performed avoiding more aggressive and morbid management choices. To date, patient's renal function is stable and there is no clinical or radiographic evidence of obstruction.


CONCLUSIONS
The described augmented anastomotic ureteroplasty using a pelvic flap is a useful surgical solution for select patients with long upper ureteral obliteration that cannot be managed by a direct reanastomosis. This technique may represent a valid addition to the urologic surgical armamentarium.
Department of Urologic Surgery, The E. Wolfson Medical Center, Holon, Israel.
Alexander
A
Tsivian
Matvey
M
Tsivian
A Ami
AA
Sidi
D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods*; D005260:Female; D006801:Humans; D007682:Kidney Pelvis / Q000601:surgery*; D013524:Surgical Flaps; D014513:Ureter / Q000293:injuries* / Q000601:surgery*; D014517:Ureteral Obstruction / Q000601:surgery