V912: Laparoscopic ureteroneocystostomy: modification of current techniques
VideoIntroduction and Objectives
To review the feasibility of laparoscopic ureteroneocystostomy with extracorporeal eversion of ureteral end in various distal ureteral lesion.
We conducted a retrospective review of 5 laparoscopic ureteroneocystostomy with extracorporeal eversion of ureteral end. Of these, 4 patients (median 49.8 years; range, 45 to 54 years) had distal ureter stricture or obstruction after gynecological surgeries for endometriosis or large uterine myoma. One patient (male, 67 years) had low-grade distal ureter cancer. The laparoscopic procedure was combined with cystoscopic insertion of ureteral stent and extracorporeal eversion of ureter through the affected side 10 mm port.
The technique laparoscopic ureteral re-implantations with and without a psoas hitch in patients with distal ureteral lesion was successful in all patients. Mean operation time was 137 minutes (range, 104 to 228 minutes). Two patients underwent additional dissection of the contralateral perivesical plane and psoas hitch. In all patients, a short-term success was confirmed by voiding cystourethrography and intravenous pyelography 3 months after operation. Mean follow-up of the entire group is 12 months (range, 3 to 30 months). We noted no major or minor complications over the follow up period.
The technique of laparoscopic ureteroneocystostomy for benign or malignant ureteral strictures continues to be in evolution. Surgeon should be versatile with various options and technical nuances while dealing with these cases. Simple modifications for laparoscopic ureteroneocystostomy with extracorporeal eversion of ureteral end, non-reflux extravesical anastomosis, and simultaneous cystoscopy will be crucial to the ease of performance and a successful outcome.