The Blood Supply of the Human Ureter in Relation to Ureterocolic Anastomosis1

Abstract

4s yet no method of ureterocolic anastomosis has proved its superiority in a large series of cases, and the operation still carries a not inconsiderable morbidity and mortality rate. The evolution of an improved technique is hindered by difficulty in investigating the causes of failure as the clinical manifestations of failure due to all causes are those of local or spreading inflammation and ureteral obstruction. Post-mortem examination is often not possible until a time when precise evidence of the cause of failure is lost in suppuration.Most methods of ureterocolic anastomosis involve the isolation of 5 to 6 cm. of ureter, and although the risk of ischsmic necrosis of this portion of ureter has been widely recognised (Nitch, 1932 ; Flocks, 1947 ;Cordonnier, 1949), there have been few assessments of the importance of this danger. Harper (1942) concluded that division of the lower ureteral twigs from the inferior vesical and middle rectal arteries would not produce ischlemia and impaired vitality of the duct,

Anterior retroperitoneal rami: Until now unnamed direct branches of the abdominal aorta

“…Owing to the nonuniformity of the terminology in the clinical literature and missing term in the anatomical nomenclature, we propose a simple and clear anatomical term, the “ rami retroperitoneales anteriores aortae abdominalis ” in Latin and the “ anterior retroperitoneal branches of abdominal aorta ” in English (with corresponding translations in other languages). Following the results of our study and the study performed by Daniel and Shackman () we can conclude that there is a constant branch (present in at least 90% of cases) supplying the right ureter, which can be denominated as the “ ramus uretericus aortae abdominalis ” in Latin and the “ ureteric branch of abdominal aorta ” in English (with corresponding translations in other languages). Both new terms should be (after appropriate discussion) incorporated into the next issue of the official anatomical nomenclature.…”

“…Direct branches of abdominal aorta and their contribution to the arterial supply of human ureter. Freely readapted after Daniel (Daniel and Shackman, ).…”

Hydronephrosis in mouse, rat, and man.

“…To appreciate the cause of constriction, it is necessary to consider the ureteric vascular system. This is well known in man (Daniel and Shackman, 1952), but no comparable study has been made in the mouse. Cook (1965) mentions that the junction of the internal spermatic veins and the inferior vena cava varies between individuals of a random-bred strain of mice, but she shows only the most usual position of the ureteric vein (Cook's Plate III).…”

Getting out of a tight spot: an overview of ureteroenteric anastomotic strictures

“…• Avoid excessive mobilization and handling of the ureter 3,9,13,78 • Minimize or completely avoid the use of thermal energy 1 • Divide the ureter 2 cm below a pulsating ureteric artery 78 • Excise redundant ureteric length 1 • Fashion the stoma first and then anastomose the ureters to the conduit • Excise a wedge of bowel to achieve a wider anastomosis • Use a single-J stent or nasogastric tube anchored to the ileal conduit to protect the anastomosis 3 • Test the anastomosis using saline for leaks 3 • Leave a sump drain in the conduit to prevent pressure on the anastomosis and allow healing of suture lines 3,41 Meticulous surgical technique is required to prevent tissue ischaemia and create a durable anastomosis; these recommendations are based on our personal experience and review of the literature. 37 evaluated the effect of running versus interrupted sutures on stricture formation in a consecutive single-surgeon series of 266 patients undergoing radical cystectomy and urinary diversion.…”