Ureteroureterostomy is a surgical procedure that involves removing a damaged or obstructed segment of the ureter and directly connecting the two healthy ends. This approach is most commonly used to address localized issues within the mid-to-upper ureter, such as strictures, injuries, tumors, or complications from previous surgeries. It preserves the function of the native ureter and is typically considered when less invasive interventions are not appropriate or have failed.
Causes of Ureteral Damage
A variety of conditions can lead to the need for ureteroureterostomy. These include:
- Ureteral Strictures: Narrowing of the ureter due to scar tissue, infection, or inflammation
- Ureteral Injury: Often caused by prior surgeries involving the abdomen or pelvis
- Ureteral Tumors: Benign or malignant growths confined to a specific ureteral segment
- Congenital Anomalies: Structural abnormalities diagnosed later in life
- Impacted Stones or Recurrent Stone Disease: That result in long-term damage
When these conditions interfere with urine flow or compromise kidney function, surgical reconstruction may be necessary.
Diagnosis
Before recommending ureteroureterostomy, a thorough evaluation is conducted to determine the location, severity, and cause of ureteral dysfunction:
- CT Urography: Provides detailed images of the urinary tract and identifies obstruction
- Retrograde or Antegrade Pyelography: Used during endoscopy to define the exact anatomy of the ureter
- Renal Scan: Assesses kidney function and the effect of obstruction on urine drainage
The choice of treatment depends on the length of the affected segment and the overall condition of the kidney and ureter.
Treatment Options
- Open or Robotic-Assisted Surgery: A small incision is made to access the ureter. The diseased portion is carefully removed, and the two healthy ends are precisely sutured together to restore continuity.
- Tension-Free Anastomosis: Ensures optimal healing and minimizes the risk of leakage or re-stricture.
- Temporary Ureteral Stenting: A stent is often placed to support the ureter during healing and is removed weeks later.
Robotic-assisted ureteroureterostomy is increasingly used due to its precision, minimal invasiveness, and quicker recovery.
Next Steps
Patients typically stay in the hospital for 1–2 days after the procedure. A follow-up appointment is scheduled within a few weeks to remove the stent and confirm healing through imaging. Most patients can return to normal activities within a few weeks. Long-term monitoring may be recommended to ensure sustained ureteral patency and kidney health.