Ureterocalicostomy was a reconstructive option in rare patient with surgically failed or difficult ureteropelvic junction (UPJ) obstruction along with fibrosis and considerably hydronephrosis. Ureterocalicostomy (UCO) was a method used to anastomose nondilated healthy ureter proximal to lower calyceal system, which was exposed from amputation of the most needy portion of the lower pole of the kidney, to bypass severe peripelvic fibrosis along with ureteropelvic junction (UPJ) obstruction or a long proximal ureteral stricture if the renal pelvis was scarred or intrarenal in the location.
PROCEDURE OF URETEROCALICOSTOMY:
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A ureteral stent is advisable because it will serve dual function of facilitating dissection of the ureter throughout surgery.
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Even though, if the obstruction was such severity the passage of the stent won’t be possible, percutaneous nephrostomy placement will be necessary.
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If the degree of renal function was low enough that nephrectomy was considered, measurements of differential renal function by using 24-hours urine collection or nuclear renal scan need be repeated for many weeks after the temporary drainage was established to conclude whether any recovery of the function has taken place that could render the kidney salvageable.
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Intraoperative details Preliminary cystoscopic or antegrade placement of a ureteral catheter will be aid in the dissection of ureter and renal pelvis.
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The ureter was isolated in the retroperitoneum & dissected proximally as far as possible, by taking care to protect a large amount of periureteral tissue.
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The proximal ureteral stump was ligated, even if the complete obstruction was present radiologically, to prevent the potential leakage into retroperitoneum.
The major common sign for ureterocalicostomy was proximal ureteral stricture into combination with pelvic fibrosis or intrarenal pelvis those will occurs after multiple failed pyeloplasty attempts. Luckily, this was extremely rare. Less than 0.5% of the patients who have been undergone pyeloplasty afterward require salvage along with ureterocalicostomy. Even more scarce are cases are requiring ureterocalicostomy for the horseshoe kidney, ischemic fibrosis of renal pelvis/ureter in the renal transplants, traumatic avulsion of proximal ureter and renal pelvis, extensive fibrosis subsequent surgery for the upper urinary tract stone disease, or followed by ablative procedures like cryotherapy and radiofrequency ablation of the lower pole renal masses.
