include malignancy, cystitis, stricture, trauma, or congenital malformations such as
ureteral reflux. Pelvic malignancy or an anomaly requiring removal of the bladder
necessitates urinary diversion.
b. Definitions and Purposes.
(1) Ureterostomy (ureterotomy). The opening of the ureter for continued
(2) Cutaneou-sureterostomy (anastomosis or transplant). The diversion of
the flow of urine from the kidney via the ureter away from the bladder onto the skin,
usually on the abdomen.
(3) Ureterectomy. The complete removal of the ureter. This procedure
includes hephrectomy, as well as the excision of a cuff of the bladder.
Uretero-lithotomy. An incision into the ureter and removal of a stone.
(5) Ureterou-reterostomy. The division of the ureter and reconstruction in
continuity with another ureteral segment (see figure 3-7).
(6) Ureteroileostomy (ileal conduit) or ureterosigmoidostomy (anastomosis).
The diversion of the ureter into a segment of the ileum or into the sigmoid colon.
(7) Ureteroneocystostomy (ureterovesical anastomosis). The division of the
ureter from the urinary bladder and reimplantation of the ureter into the bladder at
c. Patient Preparation. The site of incision and position of the patient will
depend on the indications for surgery and the nature of the proposed reconstruction or
anastomosis. The patient may be placed in a supine position for an abdominal
approach or in a modified Trendelenburg position for a low abdominal or pelvic incision.
The patient may also be placed in a lateral position for high ureteral stones.
d. Operative Procedure for Ureteral Anastomosis.
(1) The ureter is exposed through the desired incision. A ureteral catheter,
passed retrograde, may be used to facilitate identification and isolation of the ureter.
The ureter is identified and dissected free, using long forceps and scissors.
(2) The ureter is picked up with fine traction sutures, freed from the
surrounding tissues, and severed at the desired level.
(3) The distal end of the ureter is ligated, and the proximal stoma is
transferred to the site of anastomosis. The anastomosis is accomplished with fine
dissection instruments and fine swaged-on sutures.