Reconstructing Full-length Ureteral Defects Using a Spiral Bladder Muscle Flap With Vascular Pedicles

IntroductionThis study investigates the efficacy of ureteral reconstruction using a spiral bladder muscle flap with vascular pedicles (ie, the superior vesical arteries) to repair full-length ureteral defects and explores a surgical approach for repairing long ureteral defects (>20 cm) using a bladder muscle flap.Technical ConsiderationsThe characteristics of the ureteral reconstruction surgery include the following: (1) Surgeons fully expose the bladder in the retroperitoneal space. (2) While dissecting the superior vesical arteries, the integrities of the blood vessel trunk and the primary branches are maintained as much as possible. (3) While preparing the bladder muscle flap, the surgeons make an S-shaped cut along the route of the superior vesical arteries along the bladder. In general, the basal width of the muscle flap is approximately 2-3 cm in length, and the total length is approximately 1-2 cm longer than the defective ureter. (4) During the surgery, kidney descent and fixation and psoas hitch are performed to reduce end-to-end anastomotic tension. (5) The addition of a submucosal tunnel to prevent postoperative ureteral reflux is unnecessary. (6) A pedicled greater omentum graft is transferred to cover the reconstructed ureter to enhance blood supply when necessary.ConclusionUreteroplasty using a spiral bladder muscle flap with vascular pedicles (ie, the superior vesical arteries) is an ideal treatment to repair full-length ureteral defects. Moreover, this technique is particularly useful for ureteral defects longer than 20 cm. This procedure should be strongly promoted.