Transperitoneal conversion of the ureter after Wertheim's operation with lymphadenectomy

The incidence of ureteral fistula occurring after Wertheim's operation with lymphadenectomy, performed at our Department since 1953, has been high. Therefore, in 1970, a new procedure (a modification of the technique proposed by Novak) was attempted: the peritoneal flaps were used to cover the pelvic wall, which was previously completely cleaned to assure total lymphadenectomy. Thus a new bed is provided for the isolated ureter, which is prevented from falling into the retroperitoneal space. One hundred and thirty-three cases were operated on according to this technique and the incidence of ureteral fistulas fell from 10 to 0.75 per cent. Intravenous urographies taken two, six and ten months after the operation showed good results. All patients in this series who underwent this operation had previously had irradiation.