Transureteroureterostomy Workup

  • Author: Bradley Fields Schwartz, DO, FACS; Chief Editor: Edward David Kim, MD, FACS   more...
 
Updated: Jun 20, 2011
 

Laboratory Studies

Obtain baseline renal function tests, including BUN and creatinine, CBC counts, and electrolytes. Generally, patients with normal or slightly low hemoglobin levels do not require transfusion, and physicians do not routinely type and screen or type and crossmatch patients. Urine cultures identify urinary pathogens preoperatively, so directed therapy can be administered.

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Imaging Studies

The necessary evaluation prior to a transureteroureterostomy (TUU) should ensure overall patient stability. The surgery ranges from 2-6 hours, depending on the tissue encountered in the retroperitoneum, the health of the ureters, and the experience of the surgeon.

Obtain a thorough cardiopulmonary history to ascertain whether preoperative pulmonary function tests, graded exercise stress test, Persantine thallium stress test, or angiography needs to be performed. Consultation with a cardiologist or internist is recommended if the perioperative risk is significant.

Imaging studies of the ureters and renal pelvis bilaterally are important. They characterize the ureters and potentially define the distal limits of dissection necessary to obtain adequate ureteral length. Multiple modalities are available to opacify the urothelium. The quality, character, and useable length of the ureters can be defined using any of the following modalities:

  • Intravenous pyelography (IVP)
  • Retrograde pyelography (RPG)
  • Antegrade nephrostography
  • CT scan with reformatting and 3-dimensional reconstruction
  • MRI with intravenous gadolinium
  • Pouch-o-gram or loop-o-gram if reflux is present
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Histologic Findings

Histology may play a role in patients with malignancy or in patients with idiopathic ureteral obstruction. Recurrence of a malignant process requires involvement with multiple specialists, including a medical oncologist and radiation oncologist. Frozen section at the time of TUU may be used to diagnose rare or uncommon disease such as retroperitoneal fibrosis, amyloidosis, or malakoplakia.

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Contributor Information and Disclosures
Author

Bradley Fields Schwartz, DO, FACS  Professor of Urology, Director, Center for Laparoscopy and Endourology, Department of Surgery, Southern Illinois University School of Medicine

Bradley Fields Schwartz, DO, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Association of Military Osteopathic Physicians and Surgeons, Endourological Society, Society of Laparoendoscopic Surgeons, and Society of University Urologists

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael Grasso III, MD  Director of Endourology, Lenox Hill Hospital; Professor and Vice Chairman, Department of Urology, New York Medical College

Michael Grasso III, MD is a member of the following medical societies: American Medical Association, American Urological Association, Endourological Society, Medical Society of the State of New York, National Kidney Foundation, Société Internationale d'Urologie (International Society of Urology), and Society of Laparoendoscopic Surgeons

Disclosure: Karl Storz Endoscopy Consulting fee Consulting; Boston Scientific Consulting fee Consulting; Cook Urologic Consulting fee Consulting

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Shlomo Raz, MD  Professor, Department of Surgery, Division of Urology, University of California at Los Angeles School of Medicine

Shlomo Raz, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Urological Association, and California Medical Association

Disclosure: Nothing to disclose.

J Stuart Wolf Jr, MD, FACS  The David A Bloom Professor of Urology, Director, Division of Endourology and Stone Disease, Department of Urology, University of Michigan Medical School

J Stuart Wolf Jr, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Catholic Medical Association, Endourological Society, Society for Urology and Engineering, Society of Laparoendoscopic Surgeons, Society of University Urologists, and Society of Urologic Oncology

Disclosure: Nothing to disclose.

Chief Editor

Edward David Kim, MD, FACS  Professor of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine; Consulting Staff, University of Tennessee Medical Center

Edward David Kim, MD, FACS is a member of the following medical societies: American College of Surgeons, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association, and Tennessee Medical Association

Disclosure: Lilly Consulting fee Advisor; Astellas Consulting fee Speaking and teaching; Watson Consulting fee Speaking and teaching; Allergan Consulting fee Speaking and teaching

References

  1. Sharpe NW. VIII. Trans-Uretero-Ureteral Anastomosis. I. Intraperitoneal. II. Retroperitoneal: (a) Anterior to Aorta and Vena Cava; (b) Posterior to Aorta and Vena Cava. Ann Surg. Nov 1906;44(5):687-707. [Medline].

  2. Higgins C. Transuretero-ureteral anastomosis. Report of a clinical case. J Urol. 1935;34:349.

  3. Noble IG, Lee KT, Mundy AR. Transuretero-ureterostomy: a review of 253 cases. Br J Urol. Jan 1997;79(1):20-3. [Medline].

  4. Iwaszko MR, Krambeck AE, Chow GK, Gettman MT. Transureteroureterostomy revisited: long-term surgical outcomes. J Urol. Mar 2010;183(3):1055-9. [Medline].

  5. Mure PY, Mollard P, Mouriquand P. Transureteroureterostomy in childhood and adolescence: long-term results in 69 cases. J Urol. Mar 2000;163(3):946-8. [Medline].

  6. Kilciler M, Bedir S, Erdemir F, et sl. Comparison of ileal conduit and transureteroureterostomy with ureterocutaneostomy urinary diversion. Urol Int. 2006;77(3):245-50. [Medline].

  7. Strup SE, Sindelar WF, Walther MM. The use of transureteroureterostomy in the management of complex ureteral problems. J Urol. May 1996;155(5):1572-4. [Medline].

  8. Dechet CB, Young MM, Segura JW. Laparoscopic transureteroureterostomy: demonstration of its feasibility in swine. J Endourol. Sep 1999;13(7):487-93. [Medline].

  9. Ehrlich RM, Skinner DG. Complications of transureteroureterostomy. J Urol. Apr 1975;113(4):467-73. [Medline].

  10. Elliott SP, McAninch JW. Ureteral injuries from external violence: the 25-year experience at San Francisco General Hospital. J Urol. Oct 2003;170(4 Pt 1):1213-6. [Medline].

  11. Hendren WH, Hensle TW. Transureteroureterostomy: experience with 75 cases. J Urol. Jun 1980;123(6):826-33. [Medline].

  12. Hodges CV, Barry JM, Fuchs EF, et al. Transureteroureterostomy: 25-year experience with 100 patients. J Urol. Jun 1980;123(6):834-8. [Medline].

  13. Maxwell KL, McDougall EM, Shalhav AL, et al. Laparoscopic ureteroureterostomy using vascular closure staples in porcine model. J Endourol. Jun 1998;12(3):265-8. [Medline].

  14. Rushton HG, Parrott TS, Woodard JR. The expanded role of transureteroureterostomy in pediatric urology. J Urol. Aug 1987;138(2):357-63. [Medline].

  15. Sandoz IL, Paull DP, MacFarlane CA. Complications with transureteroureterostomy. J Urol. Jan 1977;117(1):39-42. [Medline].

  16. Schwartz BF, Stoller ML. Endourologic management of urinary fistulae. Tech Urol. Sep 2000;6(3):193-5. [Medline].

  17. Sugarbaker PH, Gutman M, Verghese M. Transureteroureterostomy: an adjunct to the management of advanced primary and recurrent pelvic malignancy. Int J Colorectal Dis. Jan 2003;18(1):40-4. [Medline].

 
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