Ureteroureterostomy (UU) usually refers to an end-to-end anastomosis of the segments of the same ureter, with removal of the intervening injured or scarred ureter. However, in the pediatric population, UU may also be done in the setting of obstruction of an upper pole ureter linked with a functioning upper pole; thereby the UU is done in an end-to-side fashion in between the upper pole and the lower pole ureter.
The fundamental concept of transperitoneal ureteroureterostomy (TUU) is to get the injured ureter from one side across the peritoneal cavity beneath the mesentery of the intestine to the healthy ureter on the other side and to anastomose it.
PROCEDURE:
Ureteroureterostomies are usually performed because of injured or scarred ureters, particularly when the ureter is damaged in its upper 3rd section. Usually if the patient have distal uretral strictures (narrowing of the ureter), a ureteroureterostomy is not suggested but in this cases a ureter reimplantation would be a good option.
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The surgical treatment to the proximal ureter is by a flank incision or cut. The mid-ureter and distal ureter was reached with transperitoneal lower abdomen or retroperitoneal incisions: e.g. Gibson incision or paramedian laparotomy.
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After recognition of the ureter with stricture or injury, the ureter is cautiously exposed. A traumatic treatment and safety of the vascular supply is main.
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After discovery of the stricture or injury, the diseased part of the ureter need to be removed. 2 ends of the ureter should be free of scarred tissue, with fine vascular supply and must be brought together without tension.
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The distal and proximal ends are spatulated about 7–10 mm at 180 degrees apart.
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Placement of a ureteral stent, if it was not done preoperatively.
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Corner sutures (e.g. PDS 5-0) are positioned. Afterwards, the ureter anastomosis is finished by using the corner sutures (running suture) or in a interrupted fashion.
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Insert wound drainage.
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Wound closure is done.
