Transposition of Left Ureter

The ureters are dissected for a distance sufficient to reach the proximal end of the loop. Care is taken to preserve periureteral tissue and thus the ureteral vascular supply. The sigmoid colon is retracted superiorly and anteriorly. Blunt dissection is used to develop a tunnel posterior to the sigmoid mesocolon and anterior to the sacrum. The left ureter is passed under the sigmoid colon using the previously placed holding suture. Ureteral length is once again confirmed to assure that both ureters reach the proximal portion of the ileal segment in order to avoid undue tension on the anastomoses. Proximal dissection of the left ureter will provide the further length needed to reach the urinary diversion.

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