Upper-tract and ureteric reconstruction
PUJ, ureteric, bladder and fistula reconstruction across the reconstructive ladder.
Distal ureteric reimplantation and reconstruction
Urine leak or pelvic urinoma
Anastomotic or bladder-closure failure can cause pelvic leakage, collection and infection.
Applies to: Direct ureteroneocystostomy · Psoas-hitch ureteric reimplantation · Boari-flap ureteric reconstruction · Extravesical anti-reflux reimplantation · Cross-trigonal intravesical reimplantation · Redo ureteric reimplantationAnastomotic stricture and recurrent obstruction
Ischaemia, tension, kinking or scar can impair upper-tract drainage.
Applies to: Direct ureteroneocystostomy · Psoas-hitch ureteric reimplantation · Boari-flap ureteric reconstruction · Extravesical anti-reflux reimplantation · Cross-trigonal intravesical reimplantation · Redo ureteric reimplantationVesicoureteric reflux or recurrent infection
A refluxing or ineffective tunnel may allow retrograde flow, though the clinical importance varies with indication and bladder function.
Applies to: Direct ureteroneocystostomy · Psoas-hitch ureteric reimplantation · Boari-flap ureteric reconstruction · Extravesical anti-reflux reimplantation · Cross-trigonal intravesical reimplantation · Redo ureteric reimplantationContralateral ureteric-orifice injury
Bladder incision, mobilisation or tunnel creation can compromise the opposite ureter.
Applies to: Psoas-hitch ureteric reimplantation · Boari-flap ureteric reconstruction · Cross-trigonal intravesical reimplantation · Redo ureteric reimplantationGenitofemoral nerve or psoas-related injury
Fixation too deep or lateral can trap the genitofemoral nerve or injure psoas and adjacent vessels.
Applies to: Psoas-hitch ureteric reimplantationFlap ischaemia, necrosis or reduced bladder capacity
A narrow, scarred or over-tensioned flap may fail, while extensive tubularisation can worsen storage function.
Applies to: Boari-flap ureteric reconstructionUrinary retention or bladder dysfunction
Bladder dissection, bilateral extravesical work, altered capacity or pre-existing dysfunction can impair emptying.
Applies to: Psoas-hitch ureteric reimplantation · Boari-flap ureteric reconstruction · Extravesical anti-reflux reimplantation · Cross-trigonal intravesical reimplantation · Redo ureteric reimplantationUrinary or wound infection
Stents, catheters, obstruction and urine leakage create infection risk.
Applies to: Direct ureteroneocystostomy · Psoas-hitch ureteric reimplantation · Boari-flap ureteric reconstruction · Extravesical anti-reflux reimplantation · Cross-trigonal intravesical reimplantation · Redo ureteric reimplantationStent migration, blockage or retention
A drainage device may fail, cause symptoms or be left beyond the intended removal date.
Applies to: Direct ureteroneocystostomy · Psoas-hitch ureteric reimplantation · Boari-flap ureteric reconstruction · Extravesical anti-reflux reimplantation · Cross-trigonal intravesical reimplantation · Redo ureteric reimplantationPyeloplasty and pelvi-ureteric junction reconstruction
Urine leak or urinoma
Anastomotic failure, collecting-system injury or inadequate drainage can cause persistent extravasation and collection.
Applies to: Open dismembered pyeloplasty · Laparoscopic dismembered pyeloplasty · Robot-assisted dismembered pyeloplasty · Non-dismembered flap pyeloplasty · Endopyelotomy · Redo pyeloplastyRecurrent PUJ obstruction
Ischaemia, tension, missed crossing anatomy, inadequate incision or scar can lead to recurrent symptoms and impaired drainage.
Applies to: Open dismembered pyeloplasty · Laparoscopic dismembered pyeloplasty · Robot-assisted dismembered pyeloplasty · Non-dismembered flap pyeloplasty · Endopyelotomy · Redo pyeloplastyVascular injury or haemorrhage
Crossing and hilar vessels are close to the junction; internal incision has a specific risk when vascular anatomy is unfavourable.
Applies to: Open dismembered pyeloplasty · Laparoscopic dismembered pyeloplasty · Robot-assisted dismembered pyeloplasty · Non-dismembered flap pyeloplasty · Endopyelotomy · Redo pyeloplastyUreteric or collecting-system injury
Incorrect orientation, devascularisation or instrumentation can create a longer defect or compromise the remaining lumen.
Applies to: Open dismembered pyeloplasty · Laparoscopic dismembered pyeloplasty · Robot-assisted dismembered pyeloplasty · Non-dismembered flap pyeloplasty · Endopyelotomy · Redo pyeloplastyStent migration, blockage or retained stent
Internal drainage can fail, cause symptoms or remain beyond its planned removal date.
Applies to: Open dismembered pyeloplasty · Laparoscopic dismembered pyeloplasty · Robot-assisted dismembered pyeloplasty · Non-dismembered flap pyeloplasty · Endopyelotomy · Redo pyeloplastyUrinary or wound infection
Obstruction, urine leak, foreign material and access wounds can support infection.
Applies to: Open dismembered pyeloplasty · Laparoscopic dismembered pyeloplasty · Robot-assisted dismembered pyeloplasty · Non-dismembered flap pyeloplasty · Endopyelotomy · Redo pyeloplastyAdjacent-organ injury
Renal exposure and adhesiolysis may injure bowel, spleen, pancreas, liver or pleura.
Applies to: Open dismembered pyeloplasty · Laparoscopic dismembered pyeloplasty · Robot-assisted dismembered pyeloplasty · Non-dismembered flap pyeloplasty · Redo pyeloplastyPersistent pain despite patent drainage
Symptoms may persist even when postoperative imaging suggests an unobstructed repair, requiring reassessment of the original pain mechanism.
Applies to: Open dismembered pyeloplasty · Laparoscopic dismembered pyeloplasty · Robot-assisted dismembered pyeloplasty · Non-dismembered flap pyeloplasty · Endopyelotomy · Redo pyeloplastyUreteroureterostomy and short-segment ureteric reconstruction
Urine leak or urinoma
Tension, ischaemia or an imperfect anastomosis can leak and cause collection or infection.
Applies to: Open ipsilateral ureteroureterostomy · Laparoscopic ureteroureterostomy · Robot-assisted ureteroureterostomy · Transureteroureterostomy · Ureteroureterostomy in duplex systemAnastomotic stricture or recurrent obstruction
Ischaemia, inadequate spatulation, residual disease or scar can narrow the repair.
Applies to: Open ipsilateral ureteroureterostomy · Laparoscopic ureteroureterostomy · Robot-assisted ureteroureterostomy · Transureteroureterostomy · Ureteroureterostomy in duplex systemUreteric devascularisation or extended defect
Over-mobilisation or thermal dissection can compromise segmental blood supply and make a direct repair fail.
Applies to: Open ipsilateral ureteroureterostomy · Laparoscopic ureteroureterostomy · Robot-assisted ureteroureterostomy · Transureteroureterostomy · Ureteroureterostomy in duplex systemInjury or obstruction of the healthy ureter
A shared drainage reconstruction can expose an otherwise healthy ureter or moiety to injury, reflux or bilateral/combined obstruction.
Applies to: Transureteroureterostomy · Ureteroureterostomy in duplex systemBleeding or vascular injury
Iliac, gonadal, mesenteric or small segmental vessels may be injured during exposure and tunnelling.
Applies to: Open ipsilateral ureteroureterostomy · Laparoscopic ureteroureterostomy · Robot-assisted ureteroureterostomy · Transureteroureterostomy · Ureteroureterostomy in duplex systemUrinary or wound infection
Obstruction, urine leak, stents and incisions create infection risk.
Applies to: Open ipsilateral ureteroureterostomy · Laparoscopic ureteroureterostomy · Robot-assisted ureteroureterostomy · Transureteroureterostomy · Ureteroureterostomy in duplex systemStent migration, blockage or retention
Internal drainage may fail or become a source of symptoms, infection or encrustation.
Applies to: Open ipsilateral ureteroureterostomy · Laparoscopic ureteroureterostomy · Robot-assisted ureteroureterostomy · Transureteroureterostomy · Ureteroureterostomy in duplex systemVesicovaginal fistula repair
Persistent or recurrent fistula
Ischaemia, tension, infection, missed additional tracts or poor tissue quality can prevent durable closure.
Applies to: Transvaginal layered repair · Transvaginal repair with interposition flap · Open transabdominal repair · Laparoscopic fistula repair · Robot-assisted fistula repair · Radiation-associated or redo fistula repairUreteric injury or obstruction
Trigonal fistulae and deep sutures can injure, ligate or kink a distal ureter.
Applies to: Transvaginal layered repair · Transvaginal repair with interposition flap · Open transabdominal repair · Laparoscopic fistula repair · Robot-assisted fistula repair · Radiation-associated or redo fistula repairBladder leak, pelvic collection or infection
Failure of bladder closure or contaminated dead space may cause collection, wound infection or systemic illness.
Applies to: Transvaginal layered repair · Transvaginal repair with interposition flap · Open transabdominal repair · Laparoscopic fistula repair · Robot-assisted fistula repair · Radiation-associated or redo fistula repairBleeding or adjacent-organ injury
Scarred planes may involve pelvic vessels, bowel, urethra or surrounding organs.
Applies to: Transvaginal layered repair · Transvaginal repair with interposition flap · Open transabdominal repair · Laparoscopic fistula repair · Robot-assisted fistula repair · Radiation-associated or redo fistula repairReduced bladder capacity, urgency or voiding dysfunction
Underlying bladder injury, radiation, tissue excision and reconstruction may leave persistent storage or emptying symptoms after closure.
Applies to: Transvaginal layered repair · Transvaginal repair with interposition flap · Open transabdominal repair · Laparoscopic fistula repair · Robot-assisted fistula repair · Radiation-associated or redo fistula repairStress urinary incontinence
Fistula leakage may mask sphincter weakness, and repair near the bladder neck or urethra may affect continence.
Applies to: Transvaginal layered repair · Transvaginal repair with interposition flap · Open transabdominal repair · Laparoscopic fistula repair · Robot-assisted fistula repair · Radiation-associated or redo fistula repairVaginal shortening, stenosis, pain or sexual dysfunction
Vaginal incision, scarring and interposition can affect length, calibre, sensation and sexual function.
Applies to: Transvaginal layered repair · Transvaginal repair with interposition flap · Open transabdominal repair · Laparoscopic fistula repair · Robot-assisted fistula repair · Radiation-associated or redo fistula repairInterposition-flap morbidity
Harvesting vascularised tissue adds donor-site pain, weakness, ischaemia or hernia risk depending on the selected flap.
Applies to: Transvaginal repair with interposition flap · Open transabdominal repair · Laparoscopic fistula repair · Robot-assisted fistula repair · Radiation-associated or redo fistula repair