Upper urinary tract reconstruction

This chapter addresses the problem of dealing with a ruptured, ligated or transected ureter, or a ureteric defect caused accidentally or intentionally by surgery. Ureteric strictures may occur as a result of tuberculosis or schistosomiasis. Tuberculous strictures may occur at either end of the ureter; schistosomal strictures occur primarily in the distal ureter. Ureteric stones are another cause of stricture formation and these tend to occur at the common sites of impaction of a stone; therefore, particularly just above the pelvic brim and just outside the bladder. It also develops the theme known as ‘bridging the gap’ and describes the techniques of ureteroureterostomy; the psoas hitch and Boari flap with ureteric reimplantation; transureteroureterostomy (TUU); and the ileal ureter; and briefly refers to renal autotransplantation. Finally, we introduce the concept of ‘complexity’ by reference to the problems of the patient with ureteric obstruction because of, or otherwise associated with radiotherapy.