Editing Ureteric Stricture Disease (section)

====== 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'''