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Uretero-Ureterostomy Explained

Uretero-Ureterostomy Explained

📖 6 min read Written/reviewed by Dr. Alhad Naragude, MBBS, MS, DrNB Urology Last updated: September 4, 2026

Uretero-ureterostomy is a reconstructive operation in which a short diseased or injured segment of ureter is removed and the two healthy ends are joined directly. It is most useful for selected short defects of the upper or middle ureter when both ends have good blood supply and can meet without tension. A temporary DJ stent is usually placed across the join. Longer defects should not be forced together; another reconstruction such as reimplantation, psoas hitch, Boari flap, buccal graft ureteroplasty or ileal ureter may be safer.

When is it considered?

  • Short proximal or mid-ureter stricture.
  • Short traumatic or surgical transection.
  • Focal scar after stone or ureteroscopic injury when healthy ends remain.
  • Selected redo situations with adequate length and blood supply.

Key surgical principles

  • Remove clearly scarred or non-viable tissue when excision is planned.
  • Preserve ureteric blood supply by avoiding unnecessary stripping.
  • Spatulate the ends to create a wider connection.
  • Create a watertight tension-free anastomosis.
  • Avoid twisting the ureter.
  • Use internal stenting according to the reconstruction.

Why tension matters

If a long segment is removed and the ends are pulled together, blood supply and healing can suffer. Reconstruction should bridge the gap safely rather than accept tension for the sake of a shorter operation.

How is it performed?

The operation may be open, laparoscopic or robotic. The scar is identified, healthy ends are prepared and sutured together around a stent. A drain may be used temporarily to monitor for urine leak.

Risks

  • Urine leak.
  • Recurrent stricture.
  • UTI.
  • Stent discomfort.
  • Bleeding.
  • Further loss of ureteric length if recurrence requires redo surgery.

Follow-up

After stent removal, ultrasound and kidney-function assessment are commonly used. CT urography or renography may be obtained when drainage is uncertain.

Emergency warning signs

  • Fever, chills or shivering with flank pain or known urinary obstruction.
  • Severe worsening flank or abdominal pain with repeated vomiting.
  • Markedly reduced urine output, especially with a solitary functioning kidney or bilateral obstruction.
  • New confusion, weakness or feeling very unwell.
  • A nephrostomy or stent-dependent patient with fever or failure of the drainage tube.

When another operation is preferable

Uretero-ureterostomy is attractive because it preserves the normal bladder and uses native ureter, but it should not be forced onto a long defect. Distal injuries are often better served by ureteric reimplantation because the bladder can be mobilised to meet healthy ureter. Longer proximal defects may need buccal-mucosa grafting, transureteroureterostomy, ileal ureter or renal autotransplantation in highly selected cases.

The choice also changes after radiation or repeated surgery, where the apparent ureteric ends may not have reliable blood supply. Joining two unhealthy ends creates a technically neat anastomosis with a high biological risk of restricture.

A good reconstruction therefore sacrifices the minimum healthy tissue while refusing a tensioned or poorly vascularised join.

What to bring for consultation

  • Ultrasound, CT urography/CT abdomen or MR urography reports and images if available.
  • Renogram report (DTPA/MAG3) if performed.
  • Serum creatinine and recent kidney-function reports.
  • Urine routine and culture reports.
  • Previous operative notes, discharge summaries and pathology reports if the problem followed surgery.
  • Details of any DJ stent or nephrostomy: side, date placed and last change.
  • A list of current medicines and any history of radiation, stones, endoscopy or pelvic surgery.

When uretero-ureterostomy is suitable

Uretero-ureterostomy removes a short diseased segment and joins healthy ureter to healthy ureter. It works best when enough mobile, well-vascularised ureter remains on both sides to create a spatulated, tension-free anastomosis. This makes it particularly useful for selected proximal or mid-ureteric injuries/strictures.

The operation is less suitable when the defect is long, when the ureter is extensively devascularised or when previous radiation/retroperitoneal fibrosis limits mobility. In those settings, forcing the ends together risks ischaemia and recurrent narrowing. Distal ureteric injuries are often better managed by reimplantation because the damaged distal blood supply can be unreliable.

A temporary internal stent supports drainage during healing and an external drain may be used. The surgeon’s technical priorities are removal of unhealthy tissue, generous spatulation, mucosa-to-mucosa apposition and preservation of blood supply. Open, laparoscopic and robotic approaches can all follow these same principles.

How the anastomosis is constructed

After the damaged segment is removed, the two healthy ureteric ends are gently mobilised while preserving their surrounding blood supply. Both ends are spatulated to create a broad lumen and then sutured together without tension over a DJ stent. The nearby peritoneum or other tissue may be used to keep the repair separated from inflamed structures.

The operation is best suited to a short defect where the ends reach naturally. Excessive mobilisation to force a longer gap together can devascularise the ureter and recreate the very problem being treated. If reach is doubtful, another reconstructive technique is safer.

A drain may be left near the repair to detect urinary leak. The DJ stent remains temporarily and is later removed. Follow-up imaging checks both hydronephrosis and drainage; persistent dilation alone does not necessarily equal recurrent obstruction, so functional assessment may be needed when the picture is unclear.

Recovery and possible failure

After uretero-ureterostomy, a DJ stent usually remains across the join while it heals and a drain may be left near the repair. Hospital stay and return to activity depend on whether the operation is open, laparoscopic or robotic and whether it was performed during another major surgery.

The important early complications are urinary leak, infection and obstruction. Later, scar can recur at the anastomosis. Follow-up ultrasound assesses hydronephrosis; CT urography or functional imaging may be used if drainage is uncertain.

If the repair narrows again, options depend on the reason. A tiny anastomotic recurrence may occasionally be managed endoscopically, while a longer ischaemic failure may need a different reconstruction such as graft augmentation or reimplantation rather than simply repeating the same join.

FAQs

Is this the same as ureteric reimplantation?

No. Uretero-ureterostomy joins ureter to ureter; reimplantation connects ureter to bladder.

How long a stricture can be treated this way?

There is no universal centimetre cutoff; the defining principle is a healthy tension-free join.

Will a DJ stent be required?

It is commonly used temporarily.

What if the ends do not reach?

A different reconstruction is selected rather than creating a tight anastomosis.

Can it be performed after gynecological injury?

Yes for selected short proximal or mid-ureter defects; distal injuries more often use reimplantation.

Related reading

References

Note: This information is for educational purposes only and is not a substitute for medical advice. Please consult your doctor for any symptoms.