V1856: Laparoscopic ureteral reimplantation in Hautmann’s neobladder
VideoIntroduction and Objectives
Ureteroileal stricture formation following orthotopic urinary diversion is a challenging complication. Surgical management is technically demanding but often necessary due to the low long-patency rates of endourologic approaches. Herein we present step by step a transperitoneal laparoscopic ureteral reimplantation in a patient with a Hautmann’s neobladder presenting with ureteroileal anastomosis stricture.
64 years-old male with previous radical cystoprostatectomy and Hautmann’s neobladder (pT2a N1 high grade urothelial carcinoma), treated with adjuvant chemotherapy and pelvic radiotherapy. The patient had also been submitted to a laparotomy due to an abdominal abscess and an open right ureteral reimplantation. A laparoscopic approach was decided following diagnosis of left ureterointestinal anastomosis stricture. Preoperatively, a nephrostomy tube was replaced by a straight stent that was passed downwards to the level of the stricture. In supine position, a transperitoneal laparoscopic access was performed. Following liberation of intestinal adhesions, left ureter and adjoining neobladder were carefully isolated. A double 5/0 Monocryl running suture followed excision of the ureteroileal anastomosis and the ureteral stent placed intravesical. Watertightness was confirmed by introducing 200mL of saline into the neobladder.
Operative time was 130 minutes and blood loss was negligible. Patient was discharged on the postoperative day 5 and ureteral stent removed at postoperative week 4 after confirmation of ureteral patency and watertightness through anterograde pyelography. Pathological examination reported chronic inflammation and no malignancy.
The present technique, although demanding, is a feasible minimally invasive option for the definitive treatment of the ureteroenteric anastomosis in Hautmann’s neobladder.