title: How to manage total avulsion of the ureter from both ends: our experience and literature review.
abstract: OBJECTIVE
  To evaluate the treatment alternatives of total avulsion of the ureter from both ends including ureteropelvic junction (UPJ) and ureterovesical junction (UVJ).
  
  
  METHODS
  Total ureteral avulsion on both ends of the ureter was examined in 4 cases performing ureteroscopy. In two male patients of the four cases, avulsion was noticed intraoperatively and ureteral re-anastomosis at UPJ and re-implantation at UVJ were performed immediately. Boari flap was performed for one female patient immediately and for the other female patient who was referred from another hospital after the ureteroscopy, 4 days later.
  
  
  RESULTS
  One patient who had ureteral re-implantation was followed with 3-month intervals by ultrasonography and abdominal X-ray. At the end of 1 year, it was determined that kidney parenchyma was normal and the patient had kidney and upper ureteral stones. Percutaneous nephrolithotomy was performed, and the patient was stone-free at the end of the operation. Two years after the surgery, both kidneys were normal. This is the only case who had a successful ureteral re-implantation in literature. The other patient turned up a year later for routine checks after the ureteral stent was removed. Then, hydronephrosis and renal atrophy were detected. The patient did not accept nephrectomy or any other intervention and he was lost to follow-up. Boari flap procedure was performed after UPJ repair for the other two female patients. Their kidneys were both normal 3 months after the operation.
  
  
  CONCLUSIONS
  In case of ureteral avulsion from both ends of the ureter in the male patients, as bladder capacity is not enough for a Boari flap, proximal anastomosis and distal re-implantation could be a good choice for the management of this untoward event. This new approach also saves time for reconstructive treatments if necessary. If bladder capacity is enough to reach UPJ, Boari flap could be a good choice in female patients.
authors.affiliation: Department of Urology, Kecioren Training and Research Hospital, Şenlik mah. Bukut sok. 100. yıl sitesi 38/A No:8 Kecioren, Ankara, Turkey.
authors.forename: Ali
authors.initials: A
authors.lastname: Unsal
authors.forename: Ural
authors.initials: U
authors.lastname: Oguz
authors.forename: Altug
authors.initials: A
authors.lastname: Tuncel
authors.forename: Omer Faruk
authors.initials: OF
authors.lastname: Bozkurt
authors.forename: Yilmaz
authors.initials: Y
authors.lastname: Aslan
authors.forename: Asir
authors.initials: A
authors.lastname: Eraslan
authors.forename: Çagri
authors.initials: Ç
authors.lastname: Senocak
authors.forename: Ali
authors.initials: A
authors.lastname: Atan
mesh_terms: D000007:Abdominal Injuries / Q000209:etiology / Q000601:surgery; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D005260:Female; D006801:Humans; D007682:Kidney Pelvis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012092:Replantation; D012189:Retrospective Studies; D013524:Surgical Flaps; D014513:Ureter / Q000293:injuries* / Q000601:surgery*; D014514:Ureteral Calculi / Q000628:therapy; D018666:Ureteroscopy / Q000009:adverse effects*; D001743:Urinary Bladder / Q000601:surgery*