Editing Management of Upper Urinary Tract Obstruction (section)

===== Ureteroneocystotomy =====
* '''<span style="color:#ff0000">Appropriate for injury or obstruction affecting 3-4 cm the distal of the ureter</span>'''
* '''<span style="color:#ff0000">Bridges ureteral defect of 4-5cm</span>'''
** '''After adequate proximal ureteral mobilization, direct ureteroneocystostomy is performed only if a tension-free anastomosis is possible. Otherwise, a psoas hitch or Boari flap should be used as an adjunct.'''
*'''Technique:'''
**'''Approaches: intravesical, extravesical, or through a combination of the two'''
**Anastomosis can be tunneled or non-tunneled
***A direct, non-tunneled anastomosis may be performed if postoperative reflux is acceptable
**** In a retrospective review, '''no significant difference in the preservation of renal function or risk of stenosis was found between refluxing versus anti-refluxing procedures.''' '''However, it is unclear if a non-refluxing anastomosis increases the risk of pyelonephritis in an adult patient'''
**'''Extravesical ureteroneocystomy[https://pubmed.ncbi.nlm.nih.gov/20620446/]'''
***'''Cystotomy:''' Use cautery to make 1-1.5 cm vertical incision on anterior surface of bladder. Use 4-0 chromic to take inside out bites at 4 quadrants of the cystotomy. Apply snaps to these.
***'''Spatulate ureter'''. Use scissors to spatulate the ureter for 1-1.5 cm at 6 o'clock.
***'''Cephalad vesicoureteric anastomosis'''. Use 3-0 absorbable monofilament suture (e.g. monocryl or PDS) to take an outside-in bite on the bladder at the cephalad aspect of the cystotomy and then inside-out on one side of 6 o'clock apex of distal ureter. Use another 3-0 absorbable monofilament suture (e.g. monocryl or PDS) and repeat on contralateral side of cephalad aspect of cystotomy. Tie these down, cut end without needle, place needle end on shod.
***'''Insert double J stent'''. Advance guidewire through ureter into renal pelvis. Advance double J stent over this, remove guidewire , and allow distal curl to fall into bladder. 
***'''Caudal vesicoureteric anastomosis'''. Use 3-0 absorbable monofilament suture (e.g. monocryl or PDS) and place a U stitch at 12 o'clock of ureter to caudal aspect of cystotomy: take an outside-in bite at 12 o'clock on the ureter followed by inside-out bite on caudal aspect of the cystotomy, then outside-in bite on caudal aspect of the cystotomy just opposite to previous bite, then inside-out on the opposite side at 12 o'clock on the ureter. Tie this down, cut needle off, and leave suture side long.
***'''Complete vesicoureteric anastomosis'''. Use previous 3-0 absorbable monofilament sutures at apex and run each stitch distally. First bite is outside-in on ureter, second bite is backhand inside-out on bladder. Then subsequent bites are forehand outside-in on ureter, inside out on bladder. Once at the caudal end of anastomosis, tie to previous long 3-0 vicryl U sutures. Cut sutures.
***'''Insert surgical drain'''