title: [The Importance of De- /Vascularisation of the Ureter during Reconstruction after Trauma].
abstract: BACKGROUND
  Serious errors may occur in the reconstruction of injured ureters if the degree of -devascularisation is not taken in account.
  
  
  METHODS
  The problems involved in ureter reconstruction after traumatic reconstruction are presented by means of two case -studies reviewed by the Expert Committee for Re-viewing Errors in Medical Treatment of the Ärztekammer Nordrhein.
  
  
  RESULTS
  In a 55-year-old man there was a persistent drainage disorder of the left kidney following implantation of a Y-prosthesis with "lateralisation of the ureter". Following renewed splint-ing of the ureter and percutaneous nephrostomy, operative ureterolysis with partial resection of the ureter and end-to-end anastomosis resulted in anastomostic necrosis with a ureter-skin fistula. Fol-lowing a renewed nephrostomy, the left kidney had to be removed because of considerable loss in function. In a 66-year-old woman with right-sided salpingo-oophorectomy and right-sided -colonectomy there was extensive devascularisation of the right ureter with complete -severance in the lower third. An emergency uretero-uretero anastomosis led to scar-induced stenosis of the anastomosed segment of the ureter. Following unsuccessful attemps at splinting, the ureter was reimplanted using the psoas hitch procedure. Because of a fistula to the small intestine, relaparotomy with segmental resection of the small intestine and opening of an abscess -because of wound infection were necessary. A satisfactory final result was obtained after about nine months.
  
  
  CONCLUSIONS
  When reconstructing damaged -ureters, numerous factors must be taken into account, e. g., the type, extent and location of the -damage to the ureter(s), the time of detection, the duration and severity of the sequelae for the kidney(s), the patient's concomitant condition and the suitability of the reconstruction procedure. Further-more, the degree of de- / vascularisation is of decisive impor-tance.
authors: ehem. Abteilung für Urologie, St. Nikolaus Stiftshospital, Andernach, Gutachterkommission für ärztliche Behandlungsfehler bei der Ärztekammer Nordrhein, Düsseldorf.
authors: V
authors: V
authors: Lent
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation; D003082:Colectomy; D005104:Expert Testimony / Q000331:legislation & jurisprudence; D005187:Fallopian Tubes / Q000601:surgery; D005260:Female; D005858:Germany; D019983:Guideline Adherence / Q000331:legislation & jurisprudence; D006801:Humans; D008297:Male; D019300:Medical Errors / Q000331:legislation & jurisprudence; D008875:Middle Aged; D009392:Nephrectomy; D009403:Nephrostomy, Percutaneous; D010052:Ovariectomy; D011183:Postoperative Complications / Q000209:etiology* / Q000601:surgery*; D019919:Prosthesis Implantation; D019651:Plastic Surgery Procedures; D012086:Reoperation; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000209:etiology / Q000601:surgery; D014513:Ureter / Q000098:blood supply* / Q000293:injuries* / Q000601:surgery