After implantation of the ureters into the colon, serious sequelae, such as hydronephrosis and pyelonephrosis, are possible. The pathologic physiology of the ureters is significant. At least six factors are interrelated.
After direct implantation the incidence of peritonitis is high. In animals this condition occurs rarely after submucous implantation. Coffey's1 method of constructing a ureterointestinal valve aided in preventing peritonitis. Hyperperistalsis in the colon, especially after bilateral implantation, contributes to the tendency toward leakage, particularly if specialized instruments are used in the ureters or in the rectum.
INFECTION OF THE URETER AND KIDNEY
Bacterial invasion of the ureter occurs through the hiatus in the ureteral mucosa. David and Mattill2 have shown that it is improbable that infection of the renal pelvis occurs through involvement of the periureteral lymphatics. Rather, extension of infection is via the lumen of the ureter. Vermooten3 has shown that ureteral elasticity is