Ureterovesical anastomosis

The type of ureterovesical anastomosis chosen depends on the initial radiological images, the condition of the graft s ureter and intra-operative observations (quality of exposure, the healthy appearance of the bladder, compliance during filling via a catheter). 

Fig. 3.7a,b. Urinary leak secondary to failure of ureterovesical anastomosis. Retrograde (a) and voiding cystography (b) show extravasation of contrast agent from the bladder... 

This complication develops somewhat later (several months) and its frequency tends to increase with time, 5% at 1 year and 10% at 5 years. In 80% of the cases, it is the consequence of progressive fibrosis of the ureterovesical anastomosis (probably secondary to sequelae after ureteral ischemia) but it can also result from inflammatory infiltration of the ureter... 

In the rare cases of extended and/or multiple stenoses, surgical reimplantation is required and the rules given above for fistula treatment should be followed. Most of the time, the stenosis is short and located in the ureterovesical anastomosis zone, and endoscopic repair, which is more successful the earlier it is undertaken, should be attempted. For the highly unusual immediate postoperative stenoses, the simple insertion of a double-J stent for 4 weeks... 

Fig. 3.1a,b. Vascular and ureterovesical anastomoses. The renal vein is attached to the external iliac vein. The arterial anastomosis is variable a end-to-side to the primary iliac artery, or b to the external iliac artery, most often above the venous implantation... 

---