Appendicular Ureteroplasty for a Firearm Related Rupture of the Right Ureter

Abstract

One of the most challenging aspects of urology is restoring patency to ureters with long defects. In certain cases, it may not be feasible to perform plastic surgery on the ureter with its own tissue or bladder. In such instances, alternative solution like appendicular ureteroplasty may be promising solution. Ureteral injuries have several etiologies, some of them are secondary to unintentional ureteral trauma during surgery. More than half of these injuries are unrecognized during the first laparotomy. Extensive ureteral injuries are difficult to repair, even with application of several types of surgical techniques. The advantage of appendicular ureteroplasty is the simplicity of the ureteral replacement technique without compromising other substitution options in case of failure. This is a case report of a young adult with abdominal gunshot injuries, with significant loss of tissues located to distal third of the right ureter. The appendicular urethroplasty was successfully performed. The patient remained stable after one year of out follow-up as an outpatient.

Keywords: appendix; firearm; ureteroplasty.

Figure 1

(A and B) Intravenous urography showing collection of contrast in the right pelvic region, draining to the gluteal region.

Figure 2

Adherences in the abdominal cavity.

Figure 3

Important fibrosis in the right pelvic region with normal vermicular appendix.

Figure 4

(A and B) Appendiceal ureteroplasty of the third distal ureter on a double J catheter.

Figure 5

Cystoscopic view of the implanted ureteral meatus.

Figure 6

(A–C) Postoperative Uroscanner confirming viability and permeability of appendicular graft.