A novel reconstructive option for long upper ureter obliteration

Introduction: Injuries of the upper (lumbar) portion of the ureter are rare; however, their reconstruction may pose considerable challenges. We describe a novel technique of surgical reconstruction in case of a long upper ureteral obliteration that may be a viable treatment option in select patients. Materials and methods: Reconstruction of a iatrogenic 5 cm injury to the upper ureter, consisting of 2 cm obliteration and 1.5 cm stenotic segments on its sides, unsuitable for an end-to-end reanastomosis, was performed using a novel technique of augmented pelvic flap anastomotic ureteroplasty. The injured ureteral segment was excised, the ureteral stump was spatulated on the medial aspect and the lateral tissue defect was replaced by a flap from the posterior surface of the renal pelvis. Results: The procedure was successfully performed avoiding more aggressive and morbid management choices. To date, patient's renal function is stable and there is no clinical or radiographic evidence of obstruction. Conclusions: The described augmented anastomotic ureteroplasty using a pelvic flap is a useful surgical solution for select patients with long upper ureteral obliteration that cannot be managed by a direct reanastomosis. This technique may represent a valid addition to the urologic surgical armamentarium.