What causes obstruction or reflux iatrogenic ureteral injury repair and how is it treated?

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

The most common complications of tunneled ureteroneocystostomy are ureteral obstruction or reflux.

Immediately postoperative obstruction can be a result of either edema of the ureter or technical errors (eg, constricting ureteral tunnel, ureteral angulation during fixation of the bladder). If obstruction occurs later in the postoperative course, a ureteral stricture must be considered. Ureteral strictures typically occur at the distal segment of the ureter and are most often due to ischemia. These strictures can be refractory to endoscopic management; when this is the case, repeat ureteroneocystostomy may be considered.

If the ureteral tunnel is too short, reflux can occur. Unless systemic adverse effects from the reflux occur (eg, recurrent bouts of pyelonephritis, worsening renal function), reflux is typically managed conservatively with observation.


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