How is ureterotomy performed for iatrogenic ureteral injury repair?

Updated: Nov 12, 2020
  • Author: Sandip P Vasavada, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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If an endoscopic ureterotomy is to be made, prior to placing the stent, retrograde pyelography is performed (as discussed above) to delineate the ureteral anatomy, and a Teflon-coated guidewire, acting as a safety wire, is positioned into the renal pelvis and out through the urethra.

With ureteroscopic endoureterotomy, a rigid ureteroscope is then placed through the ureteral orifice and into the ureter lumen until the ureteral lesion can be visualized. The ureteral stricture is then cut with a probe. A number of cutting modalities may be used, including Holmium laser or electrocautery. A full-thickness incision through the ureteral wall is made until periureteral fat is visualized. Retrograde pyelography is performed; extravasation of contrast outside the ureter should be seen. A wide-caliber ureteral stent (usually 8F) is then placed, in the fashion described above.

If Acucise endoureterotomy is performed, the Acucise device is placed over the safety wire. Once position is confirmed via fluoroscopic guidance and the orientation of the cut is set, the Acucise balloon is inflated and electrocautery is instituted. The Acucise device is withdrawn, retrograde pyelography is performed to confirm extravasation, and a wide-caliber ureteral stent is placed in the fashion described above.

The formal Davis intubated ureterotomy is typically performed intraoperatively only when consultation with a urologist is called for while the patient is open. In this case, the injured ureter is cut sharply in a longitudinal fashion. A stent then can be placed to the kidney and bladder through the ureteral incision.

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