Ureteric Reconstruction and Replacement

The best tissue with which to repair the ureter is the ureter itself. If that is not feasible, tubularised bladder is the next choice. Reconstruction and replacement of the ureter is an exercise in imaginative use of the available techniques. For a damaged lower ureter, direct re-implantation into the bladder using a subepithelial tunnel is the procedure of choice. For longer sections of missing ureter it is necessary to raise a flap of bladder known as a Boari. The Boari flap is a most useful means of salvaging the ureter using urothelial lined tissue. The reconstructions using anastomosis of ureter to renal pelvis, ureter to ureter and ureteric re-implantation with or without a Boari flap are remarkably successful. Their follow-up and long-term outcomes are almost identical. The function and appearance of the kidneys after obstruction has been most studied in patients after repair of pelvi-ureteric obstruction.