Uretero-ureteral Anastomosis.

Abstract

The accidental division or crushing of ureters during difficult gynecological operations has occurred occasionally, even with the most experienced surgeons. Suture of the divided ureter when the level of division has been too high to allow implantation in the bladder has resulted in a low percentage of permanently functioning ureters. This failure has resulted most often from progressive cicatricial stenosis due to leakage of urine. In this study the method used by McArthur 1 for the plastic repair of a traumaticaly ruptured ureter is applied to end to end suture of the ureter in dogs and in one woman. Through a slit in the side of the proximal portion of the ureter a catheter is inserted distally toward the bladder and over it the ureteral ends are joined by 2 fine catgut sutures. Through the same slit in the ureter a snugly fitting rubber catheter is inserted toward the kidney to divert the urine from the site of suture for 8 days or more until healing occurs. The free ends of both catheters are brought outside the body in the lumbar region. The ureters of 6 dogs examined at intervals of 19 to 270 days after such an operation healed without narrowing or appreciable dilation of the lumens, with a minimum scar, without changes in the renal pelves, and without evidence of any considerable damage to the kidneys. Five months after a similar operation in a woman the ureter is slightly dilated but is not constricted at any point. The renal pelvis and calyces are not appreciably altered.