End-to-end Anastomosis

This treatment is used for short segment ureteral stricture of the middle and proximal ureter and less than 3 cm in length and for retrocaval ureter which is the medial deviation of the ureter through the back before entering the pelvic region. Longer ureteral stirctures can be treated with reimplantation. Also in case of abnormal functioning of kidneys, and underlying diseases etc this is not the preferred method.

Prior to the surgery, stents are placed. The ureter is approached through an incision via a lumbar flank incision which is made near the twelfth rib. The ureter is carefully exposed after locating the stricture. The diseased apart is removed and both ends of the ureter are made free from the scarred tissue. With good vascular supply, the both ends of the ureter are brought together without tension. The ends are spatulated 180 degrees apart to obtain a homogenous ureter. Stents are placed if not installed before surgery. Corner sutures are placed in a running manner to complete the procedure. The incisions are closed just like any other surgical procedure. The wounds are dressed and left untouched to heal.

A transurethral catheter and a DJ stent are placed to ensure proper drainage of urine while the wound heals. The complications of the surgery involve bleeding, infection, urinoma etc. However, injury to adjacent organs is the major concern while surgery. There is also possibility for the stricture to recur again.