title: The management of total avulsion of the ureter from both ends: Our experience and literature review.
abstract: OBJECTIVE
  To evaluate the treatment modalities of total ureteral avulsion and to clarify the risk factors of this serious complication.
  
  
  METHODS
  This study retrospectively analyzed the data of 3 patients with complete ureteral avulsion during ureteroscopy. Of the three patients, two had distal ureteral complete avulsion, and one total ureteral avulsion on both ends. Ureteroneocystostomy (UNC) was immediately performed after distal ureteral avulsion cases. Ileal ureter substition was performed on the same session after the total ureteral avulsion in both ends. Two of the patients were under chronic use of corticosteroid treatment due to diagnosis of idiopathic trombocytopenic purpura and myastenia gravis and all patients had unsuccesful shockwave litotripsy (SWL) treatment history with at least 1 month period before surgery.
  
  
  RESULTS
  The patient who had ileal ureter substitution was followed at 3-month intervals by ultrasonography and renal function tests and she was uneventful after a 2 year follow-up period. The patients treated with UNC were followed up at 3 month interval by ultrasonography and renal function tests. They had normal renal function 1 year after the operation
  
  
  CONCLUSIONS
  Complete ureteral avulsion is a rare but severe complication. Treatment modality can vary and ileal ureter can be applied succesfully in the total ureter avulsion in both ends when bladder capacity is not enough for a Boari flap. Failed SWL and/or corticosteroid treatment history of patients seems to increase the risk of the ureteral avulsion.
authors.affiliation: Medicana International Istanbul Hospital, Urology Clinic, Istanbul. cuneydsevinc@yahoo.com.
authors.forename: Cuneyd
authors.initials: C
authors.lastname: Sevinc
authors.forename: Muhsin
authors.initials: M
authors.lastname: Balaban
authors.forename: Orkunt
authors.initials: O
authors.lastname: Ozkaptan
authors.forename: Ugur
authors.initials: U
authors.lastname: Yucetas
authors.forename: Tahir
authors.initials: T
authors.lastname: Karadeniz
mesh_terms: D000328:Adult; D000368:Aged; D003559:Cystostomy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D014513:Ureter / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D014515:Ureteral Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D018666:Ureteroscopy / Q000009:adverse effects*; D013520:Urologic Surgical Procedures / Q000379:methods