[Therapy of bilateral lesions of the ureter during or after surgery for gynecologic carcinoma].

Special conditions for plastic surgery on the upper urinary tract in cases of gynaecological radical hysterectomy are discussed in conjunction with one case of bilateral ureteral injury inflicted during the operation and one case of postoperative bilateral ureterovaginal fistulas. Today, Boari grafting is preferred rather than direct implantation. Oblique submucous canalisation (antireflux effect) in unnecessary in most cases. Two-stage operations would provide a better protection of the bladder than one-stage restorative treatment. In emergency cases unilateral nephrostomy or ureterostomy in situ may be considered as interim solution. Transperitoneal access is necessary only in cases of injury during operation or when a one-stage plastic operation has to be carried out. For subsequent reconstructive operations performed in two stages we would prefer the extraperitoneal approach.