Ureteral surgery

Complete ureteral duplication anomalies can present with obstruction of, mostly, the upper pole moiety. Although multiple surgical approaches are available, ipsilateral ureteroureterostomy (U‐U) can be performed with minimal morbidity and excellent outcomes. In addition, transureteroureterostomy (TUU) has been successfully used for salvage cases after failed ureteral reimplantation, or for diversion/undiversion procedures. For ipsilateral U‐U, a small lower abdominal incision is used to access the retroperitoneum, and the end of the donor ureter is anastomosed to the side of the normal ureter. A stent and drain should be placed, and ipsilateral ureterocele excision or recipient ureteral reimplantation can be performed concomitantly if necessary. TUU is a more extensive operation, where the donor ureter is brought across the midline after bowel mobilization and opening of the posterior peritoneum, and the anastomosis is performed in a similar fashion. Complications reported include: de novo vesico‐ureteral reflux (VUR), prolonged drain output, VUR into the distal stump, urinoma, febrile illnesses and the need for anastomotic revision. Despite these, the overall outcomes are quite good and success rates are high. Preoperative knowledge of the relevant anatomy, following basic surgical tissue handling and tension‐free anastomosis principles, and placement of a ureteral stent and/or externalized drain can all potentially mitigate complications. Although traditionally performed with an open surgical technique, laparoscopic and robotic approaches have been reported, and are becoming more popular, with long‐term data still lacking.