Figure 5.

A 55-year-old woman after surgery for excision of a small tumor over the left ureter with subsequent complete ureteral transection and continuous urinary leak into the peritoneum. The patient has a double-J stent on the left side. (A) Snaring of the double-J stent through the urinary bladder was performed, which revealed a transection of the double-J stent. (B) The cephalad end of the double-J stent was used as a target for accessing the pelvocaliceal system. (C,D) Complete transection of the ureter (arrowhead) with a large urinoma (arrows). (E) Multiple attempts to cross the lesion were unsuccessful and the wire repeatedly entered the urinoma. (F) A hydrophilic wire was used to make a loop and was advanced while maintaining the loop into the distal end of the ureter and finally into the bladder. (G,H) Final images shows the percutaneous internal/external nephroureteral (PCNU) stent in good position (no side holes were created at the level of the ureteric injury).