What is the role of ureteroureterostomy of in the treatment of iatrogenic ureteral injury?

Updated: Nov 12, 2020
  • Author: Sandip P Vasavada, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Answer

If the ureteral injury occurred below the pelvic brim, where visualization of the ureter is difficult and where the vesical pedicles overlie the ureter, ureteroureterostomy is often too difficult to perform. In these cases, 2 types of ureteroneocystostomy procedures are indicated, either a psoas hitch or a Boari flap, in which the bladder is mobilized to reach the easily identifiable ureter proximal to the injury. Boari flaps are contraindicated in patients with prior pelvic radiation, a history of bladder cancer, or any condition with a thick, hypertrophied bladder wall.


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