Ureteral reconstruction is an evolving field in endourology, with all efforts directed towards maintaining ureteral continuity, patency and function. Ureteral defects can originate from various etiologies including congenital problems, tumors causing intrinsic and extrinsic obstruction, trauma and iatrogenic, complications of radiation therapy and various infectious processes such as tuberculosis. Over the last three decades with the introduction of laparoscopic and subsequently robotic surgery, ureteral reconstructive techniques have evolved significantly with several possibilities available for ureteral reconstruction, ranging from dismembered pyeloplasty for ureteropelvic junction obstruction, ureteroneocystostomy with or without psoas hitch and Boari flap, to ileal ureteral replacement. The techniques of robotic assisted reconstruction of ureteral defects are challenging but offer a great opportunity to maintain and preserve adequate renal function (Nakada SY. Management of upper urinary tract obstruction. In: Wein AJKL, Partin AW et al. Campbell-Walsh urology. 11th edn, Elsevier, Philadelphia, pp 1104–1147, 2016). The aim of this chapter is to provide an overview of the diagnostic and therapeutic management strategies for patients with upper urinary tract obstruction and highlight the current surgical procedures for ureteral reconstruction in the adult population. In a detailed fashion, the chapter is organized by diagnosis, pre-operative preparation, required surgical instruments, principles of surgery, stenting, post-operative care and follow up.