Editing Management of Upper Urinary Tract Obstruction (section)

===== Transureterostomy =====
* Transposing the injured ureter across the midline and anastomosing it end-to-side into the uninjured ureter
* '''Most often performed as a secondary or delayed procedure'''
* '''<span style="color:#ff0000">Absolute contraindications (1):</span>'''
*# '''<span style="color:#ff0000">Insufficient length</span> of the donor ureter to reach the contralateral recipient ureter'''
* '''<span style="color:#ff0000">Relative contraindications (5):'''
*# '''<span style="color:#ff0000">History of nephrolithiasis</span>'''
*# '''<span style="color:#ff0000">Urothelial malignancy</span>'''
*# '''<span style="color:#ff0000">Retroperitoneal fibrosis</span>'''
*# '''<span style="color:#ff0000">Chronic pyelonephritis</span>'''
*# '''<span style="color:#ff0000">Abdominopelvic radiation</span>'''
*#* '''Any disease process that may affect both ureters represents a relative contraindication'''
* '''<span style="color:#ff0000">Reflux to the recipient ureter, if present, needs to be identified and corrected simultaneously. Therefore, a voiding cystogram should be performed preoperatively, in addition to any other imaging</span>'''
* '''A tunnel under the sigmoid colon mesentery is created proximal to the inferior mesenteric artery''' to avoid ureteral tethering by this vessel; the donor ureter is then brought through the tunnel to the recipient side.
* The injured ureter becomes subsequently difficult to intubate or image with ureteroscopy through the bladder; ureteral access needs to be provided by a nephrostomy placed on the injured side.
* Caution is required while performing this procedure because it involves surgery on the uninjured, contralateral ureter with the theoretical risk for converting unilateral ureteral injury into bilateral ureteral injury. '''<span style="color:#ff0000">Instead of transureteroureterostomy, ileal interposition or ureteroureterostomy with renal mobilization, if necessary, are preferred.</span>'''