Management of iatrogenic ureteral injury and techniques for ureteral reconstruction

PURPOSE OF REVIEW: Ureteral reconstruction is still a sophisticated approach. Because of an increase in endoscopic procedures for kidney and ureteral stone treatment, radiation therapy and pelvic surgery, ureteral strictures are more frequently observed. Short proximal and distal strictures can be reconstructed by using the renal pelvis or urinary bladder. New techniques are needed for reconstruction of long strictures as well as those located in the middle ureter.

RECENT FINDINGS: This article summarizes very recent studies from 2014, investigating new techniques and their functional outcome of procedures for ureteral reconstruction. In an open reconstruction, some new techniques to reconstruct full-length ureter defects using bladder flaps or by intestinal onlay techniques were described. In addition, laparoscopic and robotic reconstruction methods as well as single site procedures demonstrated feasibility. Visualizing the ureter using near-infrared fluorescence techniques for prevention of ureteral injuries is also a new aspect. Future targets focus on the development of artificial transplants by tissue engineering for ureteral reconstruction.

SUMMARY: Novel open and minimally invasive techniques for reconstruction of full-length and middle ureter strictures demonstrated feasibility in the past year. Although reasonable outcomes were reported, current results are significantly compromised by short-term follow-up. To date, artificial transplants remain experimental.