Article

Reimplantation of the Ureter into the Bladder

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Abstract

THE operation of reimplantation of the ureter into the bladder has undergone a stormy course of criticism before being accepted as a sound surgical procedure. It may not have been frequently advocated, primarily because there was no satisfactory method of evaluating the status of the upper urinary tract and the end results without subjecting the patient to retrograde pyelography which might be unsatisfactory. However, with the advent of intravenous urography, a simple yet relatively innocuous procedure may be used to evaluate with accuracy those cases that can be submitted to this type of operation. Because of the increased number of cases amenable for this type of surgical procedure observed recently by one of us (C. C. H.) at the Cleveland Clinic, a review of the results seems indicated.

Indications

Gynecological surgery has frequently been followed by complications necessitating reimplantation of the ureter. In recent years the increased use of combined abdominoperineal resection of the colon has also brought numerous cases to the urologist for which this surgical procedure was indicated.

A summary of indications for implantation is as follows:

  1. Traumatic injuries to the lower ureter, e.g.

    1. Complicating hysterectomy.

    2. Complicating abdominoperineal resections.

    3. Complicating manipulation of ureteral stones.

    4. Complicating ureterolithotomy.

    5. Complicating ruptured bladder.

    6. Gunshot wounds.

  2. Embryologic malformation of the lower ureter

    1. Ectopic ureter.

    2. Congenital ureteral valves.

    3. Stricture of the ureter.

    4. Certain ureteroceles.

    5. Ureteral diverticula.

  3. Neoplastic involvement of the lower ureter

    1. Bladder neoplasms in close proximity to the. . .


 

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