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A version of this article appears in print onSection C, Page 5 of the National edition with the headline:In these instances, the ureter should be generously debrided before repair.
Care is taken Yhaoo preserve ureteral adventitia to avoid damage to ureteral blood supply.
If there is still tension, the surgeon should be prepared to perform a psoas hitch or a bladder flap or both to relieve tension. Ureteroscopy is performed proximally and distally to confirm there are no remaining sites of pathology.
Each end of the ureter is widely spatulated 1. Before beginning the anastomosis, the break is taken out of the table to reduce tension.
The authors prefer braided polyglactin or an equivalent suture because of its easy handling and relatively quick dissolution.
The specific details of the repair are less important than the basic principle of wide spatulation and anastomosis of the unspatulated end of one ureter to the spatulated end of the other ureter.
The anastomosis may be performed in a running or an interrupted fashion If the tissue quality is tenuous, an interrupted anastomosis allows a more precise closure and ensures that the entire repair is not in jeopardy if a single area becomes compromised because of poor tissue quality, delayed ischemia, or an inadequate bite during the suturing.
Knots may be placed intraluminally or extraluminally at the preference of the surgeon.
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After the posterior anastomosis is complete, a ureteral stent is placed, and then the anterior anastomosis is chxt. Tissue sealant is applied, and tissue wrap omental or peritoneal is used if readily available.
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