First, attach great importance to prevention Ideology: remember! Ureteroscopic surgery has risks, into the mirror must be careful! If the ureter is torn off, both the doctor and patient will suffer! Focus on prevention! High-risk groups: women are prone to avulsion; middle-aged and elderly women are relatively thin ureteric wall, it is very easy to avulsion after perforation holding the mirror; these years, the rate of cesarean section is very high in married women giving birth, in the cesarean section patients after delivery of the fetus, due to the problem of suturing the uterus, we have encountered a few cases of anatomical changes in the position of the ureter, especially in the second or more than two cesarean section patients, the ureter is tortuous and serious; previous history of ureteroscopic lithotripsy may also be increase the risk of injury. Surgical strategy: For stones above the level of the third lumbar vertebra, consider percutaneous nephrolithotripsy as much as possible; for stones that do not respond to repeated lithotripsy, especially those in the middle and upper segments, consider ureteral stenosis and inflammatory stimulation of the staghorn segment of the ureter by the stone. Do not risk into the mirror: endoscopic surgery, keep the peace of mind, caution is not adventurous is very important; surgery is not reluctant to enter or exit the mirror, the operation must pay attention to the return of water, surgery if the mood is not good, immediately stop the operation; do not go up don’t force it, with a fine mirror, the operation time can not be long, exit the mirror, pay attention to the mucous membrane situation …… …; so ureteroscopy operation mainly depends on the condition of the ureteral lumen, if too fine, can stay stent tube, second stage surgery, must not force on the mirror. Retreat mirror: do not do not go up do not force, with a fine mirror, the operation time can not be long, retreat mirror pay attention to the mucous membrane condition ………; focus on prevention, retreat mirror must be hand feeling + close observation of the lumen situation, such as the discovery of ureteral rupture, immediately change the open surgery, take the mirror and repair as appropriate. Do not cause long segment injury even if the ureter is broken. If it has been stuck: If the mirror is held during the operation, change to general anesthesia, you can relax the wall of the ureter, first release the pyelon urine from the working channel, then inject 5ml of lidocaine and 5mg of dexamethasone, observe for a few minutes, and then gently shake the mirror, and the whole process must not be impatient, calm and collected. If it is ineffective, communicate with the patient’s family and change to open surgery. This injury can not be hidden, to face the reality, do a good job of follow-up remedial measures, and the results must be good, otherwise the patient down the ward on the renal colic, abdominal distension and abdominal pain, do not pay attention to the loss of the kidney, and in severe cases, will lose their lives. Second, if the ureteral avulsion has occurred Avoid further injury: because of the lack of bowel preparation at that time, a phase of bowel generation if postoperative complications will increase the handle of medical disputes. Therefore, once it is impossible to deal with one stage, decisive nephrostomy and appropriate fixation of the upper and lower stumps of the ureter. Save the kidney and be prepared to lose money. This may be the best option. Don’t try to bury anything. There are probably more cases like this in primary care, and it’s pretty important to keep the ureter moist enough to go back to the bladder to soak up the urine during the waiting time for an expert to save the day. Ureteral reimplantation with bladder wall flap: the main difficulty is for long segmental defects. The prerequisite for bladder flap repair is that the person has adequate bladder capacity; with a spiral bladder flap it is basically possible to reach the level of the renal pelvis, but if the bladder has been operated on and bladder flap removal is very difficult, a bowel substitute may be a more appropriate choice. The base of the bladder flap should be wider when the spiral flap is taken, and there is no problem with the blood supply, in addition, the bladder can be suspended properly to shorten the distance: we have also done spiral bladder flap, and the blood supply is basically not a problem because of the condition of the bladder blood supply, and the results of postoperative review are good, and the bladder flap can be achieved to the ureteropelvic junction, and can be fixed in the psoas muscle if the tension is high: there is a ureteral reflux, but there are some specialists who believe that there is a reflux but there is no need to be re-treated. Mild hydronephrosis with no progression over years of follow-up; those who have had laparoscopic uretero-bladder flap reimplantation have no significant hydronephrosis on current follow-up. Bowel substitute ureter surgery: there is a view that recurrent urinary tract infections after bowel substitute ureter surgery should be considered, it is better not to move! Some experts also mentioned a case of intestinal replacement done by Prof. Ye Min, ileal reduction, the latest follow-up is six months after surgery, no hydronephrosis, occasional urinary sensation, that the effect is good. Director Li Xuesong of the Peking University study mentioned experience with 17 cases of bowel substitution, with a median follow-up of two years and no serious urinary tract infections. However, it is technically challenging and it is indeed recommended that it should be done sparingly and not at all. Technical question: in this case on the right, how do you take the bowel, how much is taken, and does it need to be trimmed? How do you keep the bowel smooth peristalsis on the right side of the bowel substitute, does the bowel need to be trimmed, which section of bowel is taken, and how long is it taken? Whether it needs to be narrowed Autologous renal transplantation: If the upper ureter near the renal hilum is broken and damaged in a long section, there are those who perform one-stage autologous renal transplantation + bladder wall flap, but it is easy to reflux and infections after the operation. Original ureter restoration: there was a case of similar ureteral avulsion, the plasma membrane layer is intact, retrograde return and anastomosis with the renal pelvis, and free large omentum cover, retained nephrostomy and dj tube 9 months after soft microscopic examination of the ureteral blood supply is good, there is no anastomotic stenosis, pulling out the dj tube, clamped nephrostomy after the ctu show that the ureteral excretion of the fluids, after the withdrawal of the fistula. The treatment was successful.