Stuck between a rock and a hard place is how a surgeon feels when faced with a ureteral defect that cannot be primarily repaired. If possible, first line therapy when reconstructing the ureter is to bridge the defect with the ureter. The use of this approach depends on the site of the injury (near the kidney, the mid ureter or below the pelvic brim). When the injury is below the pelvic brim, mobilization of the bladder with fixation via psoas hitch may allow for primary ureteral reimplantation, and if not possible a Boari flap can be used to bridge the gap.
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