TREATMENT

If intervention is needed, the ureter can be reconstructed by performing an open or laparoscopic ureteroureterostomy. Regardless of the modality, the basic steps of the procedure are the same. The renal pelvis and proximal ureter are dissected to the point where the ureter passes behind the IVC. The ureter is then divided adjacent to the lateral IVC wall, and the distal end of the ureter is removed from behind the IVC. (Some surgeons divide the ureter both lateral and medial to the IVC, effectively excluding the segment located behind the IVC.) The ureteral ends are repositioned such that the ureter takes a course lateral to the IVC. The proximal end of the ureter is typically long enough to make a tension-free, spatulated, end-to-end anastomosis without difficulty, which restores continuity to the ureter. A ureteral stent is deployed and left in position for several weeks after the procedure to ensure proper healing of the anastomosis.