Nephrocystanastomosis: Surgical Creation of Kidney-to-Bladder Communication

Nephrocystanastomosis (also ureteroneocystostomy or pyelovesical anastomosis) is a surgical procedure that establishes a direct connection between the renal pelvis (or ureter) and the urinary bladder to divert urine when the native ureter is obstructed, absent, or non-functional.

Indications

• Ureteral loss from trauma, tumor resection, or radiation fibrosis
• Congenital ureteral atresia or ectopic ureter
• Complex ureteral stricture unresponsive to endoscopic management
• Renal transplantation (ureteroneocystostomy is the standard implant technique)

Technique Overview

1. Mobilize bladder and renal pelvis/ureter with adequate vascular supply.
2. Create a submucosal tunnel in the bladder wall (anti-reflux mechanism).
3. Anastomose ureter/renal pelvis to bladder mucosa with absorbable sutures.
4. Stent the anastomosis (double-J stent) for 4–6 weeks.

Complications

• Urine leak, stricture at anastomosis, vesicoureteral reflux, infection.

Success rates exceed 90% in experienced hands; robotic/laparoscopic approaches are increasingly used.