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A combined antegrade and retrograde technique for reestablishing ureteral continuity.

Ureteral injuries are not uncommon and may lead to ureteral stricture, complete obliteration, or urinary fistula. Traditionally, open surgical repair was required to reestablish ureteral continuity. With the development of improved instrumentation and technique, it is now possible to treat these injuries endoscopically. Endoscopic ureteroureterostomy has been demonstrated to be an effective means of treating ureteral strictures and obliterated segments of the ureter. We describe a combined ureteroscopic and fluoroscopic technique to reestablish ureteral integrity. Using this technique we have successfully treated two patients with ureteral injuries. The first patient had a ureterovaginal fistula that occurred after a hysterectomy. The second patient had a completely obstructed distal ureter. These cases and the techniques used to successfully manage them are described.