PMC10085642_01
Upper ureteral reconstruction with a tapered segment of descending colon. (
A
) Preoperative retrograde pyelography revealed a 5-cm-long stenosis of the ureter (
white arrowheads
). (
B
) An 8-cm-long descending colon (
A
) was isolated, tapered (
red dotted line
), sutured in a funnel shape, and then anastomosed to reconstruct the upper ureter. The photograph shows the colon segment being grasped before being tapered and sutured using a catheter as a temporary stent. (
C
) The final outcome with a double J stent, percutaneous nephrostomy tube, and retroperitoneal drain.
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At presentation when he was almost 13 years old, the RP identified a 5-cm-long stenosis at the UPA and hypoperistalsis of the UPJ and upper ureter ( Fig. 1A ). Some 3 cm of the inflamed lower ureter was also resected ( Fig. 1A ) until the ureter appeared healthier. Because the upper cut end of the old UPA was no more than a fine opening ( Fig. 1B ), it was incised and the incision extended to the renal parenchyma. An 8-cm segment of the mobilized colon with intact blood vessels was isolated, tapered, and sutured into a funnel shape with an upper diameter of 2 cm and a lower diameter of 1 cm ( Fig. 1A, B ) around a 14-Fr catheter as a temporary stent. A 9-Fr percutaneous nephrostomy tube and a 15-Fr retroperitoneal drain were placed ( Fig. 1C ).
Postoperative urography. Smooth urine flow through the (
A
) calyx-tapered segment of descending colon (TDC) anastomosis 13 days postoperatively and through the (
B,C
) ureter-TDC anastomosis 49 days postoperatively.
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Contrast pyelography via the percutaneous nephrostomy tube the next day showed passage through the calyx-TDC anastomosis but not through the ureter-TDC anastomosis ( Fig. 2A ).