Transureteroureterostomy Workup

Updated: Jun 04, 2013
  • Author: Bradley Fields Schwartz, DO, FACS; Chief Editor: Edward David Kim, MD, FACS  more...
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Workup

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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