Clinically reviewed by
Honorary Associate Professor Jeremy Ockrim
Consultant Urological Surgeon · Reviewed August 2026 · Review due August 2027
What is Ureteric Reconstruction?
Ureteric reconstruction is the specialist surgical repair or replacement of a damaged, blocked or diseased ureter — the thin muscular tube that carries urine from the kidney to the bladder. It is a high-complexity area of urology, performed by a small number of experienced reconstructive teams because the choice of technique, the risk of damaging surrounding structures, and the need to preserve kidney function all demand very careful planning.
Depending on the length, location and cause of the problem, the ureter may be rejoined end-to-end, reimplanted into the bladder, bridged with a flap of bladder wall, patched with a graft, replaced with a segment of small bowel, or — in the most complex cases — the kidney itself may be moved to shorten the distance to the bladder.
Who It's For
Ureteric reconstruction is used to treat a range of conditions in which the ureter has been narrowed, injured or diseased. Referrals often come from other urologists, gynaecologists and colorectal surgeons after less invasive treatments have not resolved the problem.
Ureteric Strictures
Narrowing of the ureter from inflammation, stones, previous surgery, radiation, or idiopathic causes.
Iatrogenic Ureteric Injury
Accidental damage during gynaecological, colorectal or other pelvic surgery, or after hysterectomy or caesarean section — sometimes presenting later as a urinary fistula.
Endometriosis
Endometriosis ureteric obstruction occurs when deep infiltrating endometrial tissue or dense scar tissue presses on or grows into the ureters.
Retroperitoneal Fibrosis
A fibrous plaque forming behind the abdominal cavity that encases and obstructs one or both ureters.
Malignant Obstruction
Selected cases where a surgical bypass is preferable to long-term ureteric stenting.
Failed Endoscopic Management
Strictures that have recurred after balloon dilatation or laser endoureterotomy.
Congenital Abnormalities
Including pelvi-ureteric junction (PUJ) obstruction presenting in adulthood.
Ureteric Fistulae
Abnormal communications between the ureter and adjacent structures such as the vagina or bowel — see urinary fistula.
The Surgical Techniques
There is no single operation for a damaged ureter. The right technique depends on where the problem is, how long the affected segment is, what caused it, how much healthy ureter remains, and factors specific to each patient. Below are the main techniques your consultant will consider.
Ureteroureterostomy
Best for: short mid-ureteric strictures
The diseased segment is excised and the healthy ends of the ureter are rejoined directly (end-to-end reanastomosis). This is the simplest reconstructive option and works well when only a short section of ureter needs replacing.
Reimplantation with Psoas Hitch
Best for: lower ureteric strictures up to 4–5 cm
The bladder is mobilised and hitched upwards to the psoas tendon, so the remaining healthy ureter can be reimplanted into the bladder with a tension-free join. This is a robust and reliable technique for damage to the lowest part of the ureter.
Boari Flap
Best for: longer lower ureteric defects (8–12 cm)
A tubed flap of bladder wall is created and extended upwards to bridge a longer defect in the lower ureter. The Boari flap effectively "lengthens" the urinary tract using the patient's own bladder, avoiding the need for a bowel segment.
Buccal Mucosa Graft Ureteroplasty
Best for: moderate mid-ureteric strictures
A small patch of tissue is taken from the inside of the cheek (buccal mucosa) and used as an onlay graft to widen the narrowed segment of ureter without excising it. Cheek lining heals rapidly and provides excellent, durable tissue for ureteric reconstruction.
Ileal Ureter Replacement
Best for: very long strictures (>10–12 cm) or after failed reconstructions
A segment of small bowel (ileum) is isolated from the intestinal tract and used to replace a long section of ureter. This is a well-established technique for extensive disease, but requires tertiary surgical expertise to perform.
Renal Autotransplantation
Best for: very long or complex strictures where other techniques would fail
The kidney is removed, prepared on the back table, and reimplanted into the pelvis to shorten the distance the urine has to travel to the bladder. This is a technically demanding operation reserved for the most complex reconstructive challenges, and is performed only at specialist centres.
Minimally invasive access. Wherever the anatomy allows, ureteroureterostomy, psoas hitch, Boari flap and buccal mucosa graft ureteroplasty can be performed robotically. Ileal ureter replacement and renal autotransplantation are more often open, but robotic approaches are increasingly available for selected patients.
Your Pathway
Ureteric reconstruction is planned carefully around detailed imaging and, where relevant, prior operative records. Each patient's pathway is individualised, but most journeys through our service follow the steps below.
1. Consultation & Assessment
Review of your symptoms, previous imaging, treatment history and any previous operative notes with one of our reconstructive urology consultants.
2. Diagnostic Workup
CT urogram, MRI abdomen/pelvis, MAG3 renogram to assess relative kidney function and drainage, retrograde or antegrade ureterography to map the position and length of the stricture.
3. MDT Planning
The reconstructive approach is chosen at multidisciplinary planning based on the location and length of the stricture, its cause, kidney function, and any patient-specific factors.
4. Surgery
Open or robotic, depending on the technique. Most reconstructions take 3–5 hours and are carried out under general anaesthetic.
5. Post-operative Care
Hospital stay of 3–7 days is usual. A JJ ureteric stent is left in place for 4–6 weeks to protect the repair while it heals.
6. Follow-up Imaging
MAG3 renogram at 3 and 12 months to confirm patency and preserved kidney function, with long-term imaging to detect any recurrent stricturing.
Recovery & Aftercare
Most patients recover well from ureteric reconstruction, but this is major surgery and pacing yourself in the first few weeks is important to protect the repair.
- ✓Hospital stay: Typically 3–7 days depending on the technique used.
- ✓Urethral catheter: In place for 2–4 weeks, depending on whether the bladder has been opened.
- ✓JJ ureteric stent: Left in for 4–6 weeks and removed as a short day-case procedure.
- ✓Return to sedentary work: Usually possible at 4–6 weeks.
- ✓Heavy activity: Best avoided for 8–12 weeks to give the reconstruction time to heal fully.
- ✓Long-term follow-up: Regular imaging to confirm the repair remains open and kidney function is preserved.
Benefits & Risks
Published series from specialist centres report high long-term patency for most reconstructive techniques when performed by experienced teams. Every operation carries risks, and your consultant will discuss the balance of benefits and risks specific to the technique planned for you.
Benefits
- ✓High long-term patency at specialist centres
- ✓Preservation of kidney function on the affected side
- ✓Avoids the need for long-term ureteric stenting and stent changes
- ✓Range of techniques — the operation is tailored to your problem
- ✓Reconstruction remains possible even after previous failed surgery
Risks
- !Bleeding, infection and urinary leak from the anastomosis
- !Recurrent stricture in a small proportion of cases
- !Bowel-related complications with ileal ureter (mucus in urine, metabolic changes)
- !Higher morbidity with ileal ureter and renal autotransplantation than simpler techniques
- !Loss of kidney function on the affected side if the surgery is unsuccessful
- !General surgical risks including anaesthetic risk and thromboembolism
Meet your Specialists
Assessment and treatment for ureteric reconstruction is led by our experienced consultant urologists. Your care will be personally overseen by one of our senior specialists. The London Urology Specialists are all part of the specialist reconstructive urology team at University College London Hospital.
Key Takeaways
Ureteric Reconstruction — What You Need to Know
- ✓ A high-complexity procedure performed by a small number of specialist reconstructive urology teams in the UK
- ✓ The right technique depends on the location, length and cause of the problem — options range from a simple end-to-end join to replacing the ureter with bowel or moving the kidney
- ✓ High long-term patency is reported in specialist published series
- ✓ A JJ stent is left in place for 4–6 weeks after surgery to protect healing; follow-up scans check both patency and kidney function