Complete excision of the affected distal ureter with a cuff of bladder, followed by reimplantation of ureter in a tension free manner to the bladder.
Lower midline incision – allows mobilisation of contralateral bladder for reimplant if needed.
Expose ureter over iliac vessels. Early proximal ligation to avoid refluxing of tumour cells. Consider PLND if high grade disease.
Sling ureter and dissect circumferentially as low as possible.
Open bladder obliquely perpendicular to ureter (a la psoas hitch/Boari) between stays and identify UO. Figure of 8 suture to close UO and also use as traction. Circumferentially diathermy UO and excise with cuff of bladder, pulling ureter through.
Close posterior cystotomy (trying to bury knots outside mucosa) with 3-0 PDS in one or two layers.
Mobilise bladder contralateral side and assess mobility re: direct reimplant or psoas hitch. Hitch if necessary.
Intravesical non tunnelled refluxing reimplant over a stent with absorbable interrupted 4-0 monocryl sutures.
Close bladder in 2 layers over a catheter, leave an external drain.
Can also be done robotically or laparoscopically.