PMC6469001_01
Antegrade and retrograde pyelography.
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After resolution of the acute episode, a thorough workup was undertaken, demonstrating a long proximal ureteral obliteration with an intrarenal pelvis as shown by the antegrade and retrograde urography (Figure 1).
A. Long upper ureteral obliteration; B. Excision of the obliterated segment with spatulation of the lateral aspect of the ureter; C. Partial transection of the hilar lower lip of renal parenchyma; D. Anastomosis end-to-side of the upper ureter with the lower calyx.
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Given the patient's intrarenal pelvis and lack of severe hydronephrosis and thus no available redundant tissue for a possible flap with healthy appearing parenchyma (Figure 2A), ureterocalycostomy was considered. After complete mobilization of the ureter and the intrarenal pelvis, we continued to dissect the neck of the lower pole calyx and decided to perform an ureterocalycostomy not in standard fashion intraparenchymally, but through the hilar portion of the lower calyx neck (Figure 2B). The obliterated segment was then excised and the healthy ureter spatulated for roughly 1 cm (Figure 2C). This was then anastomosed to the intrarenal lower calyx with interrupted 4-0 absorbable sutures (Figure 2D).