V910: A standardized technique for laparoscopic repair of ureteroileal anastomosis stricture
VideoIntroduction and Objectives
Ureteroileal anastomotic stricture after radical cystectomy (RC) and urinary diversion is a late complication and sometimes can have a difficult surgical management.
The aim of this video is to present a standardized technique to repair this complication using a laparoscopic approach.
We present a 73 years old man who underwent a radical cystectomy and ileal conduit because of muscle invasive bladder cancer, with no carcinoma in situ in the distal ureters. Nine months after surgery, the patient developed a bilateral ureteroileal anastomotic stricture with unsuccessful endourological management.
Based in our initial experience we describe a standardized technique for laparoscopic repair of ureteroileal anastomotic strictures after RC and ileal conduit urinary diversion.
-Firstly, the patient must be positioned as a laparoscopic left nephrectomy. After colon has been reflected a wide dissection of left ureter is necessary before its section. We recommend previous surgery the placement of a left ureteral tutor stent through the nephrostomy.
-Secondly, the patient must be placed in a dorsal decubitus position for the left ureteral translocation under mesosigmoid. In this position we perform the right ureteral dissection.
-After we do and end-to-side ureteroileal right anastomosis and an end-to-end left ureteral anastomosis to the ileal conduit, leaving bilateral ureteral stents.
Surgical time was 180 minutes. Estimated blood loss was 200cc and patient was discharged by the fifth postoperative day. Pielography evidenced a normal filling of the ileal conduit, with no leaks and changes at 6 months follow-up.
Laparoscopic approach can be a useful tool for reconstructive surgery in uro-oncology as has demonstrated before in the management of ureteral strictures in kidney transplant.