Transureteroureterostomy

INJURY to the distal third of the ureter is not uncommon. It usually follows surgery of pelvic organs. If recognized at the time of surgery the primary repair can usually be done with good results. The late complications of ureteral stricture, ureterovaginal fistula, or ureteral necrosis and the leakage of urine either into the retroperitoneal or peritoneal spaces present more difficult problems. Numerous techniques for restoration of ureterovesical continuity have met with success. Primary ureteral anastomosis, primary reimplantation of the ureter into the bladder, bladder tube flaps, and interposition of isolated ileal segments have all been done and are accepted procedures. However, the amount of destroyed ureter sometimes does not allow one of these primary techniques, and ileal segment construction is a formidable procedure. The new technique presented here for management of injury to the distal portion of the ureter can be used as a primary means of repair at