Ureterovesical Anastomosis

Abstract

Due to the formation of strictures in the ureter when transplanted into a tube constructed from the bladder, 1 studies were directed toward finding a satisfactory method of anastomosing the normal ureter with the normal bladder. Several modifications of the Coffey type of implanting the ureter into the sigmoid were employed. 2

Our most satisfactory anastomosis was obtained by the following technic. The ureter was cut across near the bladder between 2 silk ligatures. The bladder was opened anteriorly. The proximal portion of the ureter was led through the posterior bladder wall at about the same level and slightly medial to the normal entrance of the incised ureter. This was easily done by using a large curved, non-cutting needle which carried through the loose ends of the ligature previously tied around the proximal end of the cut ureter and which then could be used to pull the ureter into the bladder cavity for the desired distance (usually about 1.5 cm.). To accomplish this no incision or dilatation with instruments was needed. The mucous membrane of the bladder was incised downward for a distance of about 1 cm. from the hole made by the artificial entrance of the ureter. The corresponding portion of the ureter within the bladder was next placed in the defect created by the incision of the mucous membrane which was then sutured over the ureter. This left about 1 cm. of the ureter lying between the muscle and the mucous membrane. Subsequently the ureter projecting into the bladder cavity was cut squarely across just proximal to the silk ligature, and usually the end was split into 2 equal parts, each of which was turned back and sutured to the mucosa of the bladder.