Management of complete ureteral avulsion and literature review: a report on four cases.

Objective: The aim of this study was to investigate the treatment modality of complete ureteral avulsion.

Patients And Methods: This study retrospectively analyzed the data of four patients with complete ureteral avulsion who were treated between November 2003 and March 2008 in our hospital. Of the four patients, one had ureteropelvic junction avulsion, one had proximal ureteral avulsion, and the other two had distal ureteral avulsion. One patient underwent autotransplantation of kidney for treatment of severe proximal ureteral avulsion. Pyeloureterostomy plus greater omentum investment outside the native distal ipsilateral ureter was performed in the patient with ureteropelvic junction avulsion. The other two patients underwent ureterovesical anastomosis. All four patients were followed up for an average time of 29 months (16-45 months).

Results: Renal function recovered well in the patient who underwent autotransplantation of kidney and ureterovesical anastomosis and the two patients who underwent ureterovesical anastomosis. The other patient who underwent pyeloureterostomy developed hydronephrosis and nonfunctioning kidney. The patient then underwent nephrectomy.

Conclusions: Complete ureteral avulsion is a rare but severe complication. Autotransplantation of kidney and ureterovesical anastomosis may result in positive outcomes in patients with proximal ureteral avulsion.