Laparoscopic Extravesical Lich-Gregoir Ureteroneocystostomy with Psoas Hitch for the Management of Ureterovaginal Fistula in Post-Hysterectomy Patients

Abstract

Introduction: Most commonly ureterovaginal fistula occurs due to surgical injury inflicted to the distal ureter and because of gynaecological procedures. Open surgical repair is a standard procedure and commonly involves ureteroneocystostomy. Methods: We retrospectively reviewed data of 9 patients, who underwent laparoscopic extravesical Lich-Gregoir ureteroneocystostomy using the psoas hitch procedure for ureterovaginal fistulas following hysterectomy during the period December 2012-August 2014. Transperitoneal laparoscopic ureteroneocystostomy was performed in all cases. Results: The mean operative time was 212 min (range 170-310) and estimated blood loss was 108 ml (range 70-150). Average hospital stay was 5.7 days. Follow-up time was from 6 to 26 months. Postoperative intravenous urography was done after 3 months, which showed patent anastomosis in 8 patients except for 1 patient who had nonvisualization of the ipsilateral renal moiety. Voiding cystogram done at 3 months showed no leakage in all patients. In the postoperative period, 1 patient had recurrent ipsilateral pyelonephritis 2 weeks after surgery, while another patient had febrile UTI. Apart from these no major complications were observed. Conclusion: Laparoscopic ureteroneocystostomy with psoas hitch can be performed safely with a success rate compared to that of open surgery but with less morbidity and quick convalescence.

Long‐term results of laparoscopic Lich–Gregoir technique for ureteral reimplantation: Saint Augustin Clinic experience

“…This technique in adults is more challenging than in pediatric patients, as in the latter it is used to treat vesicoureteral reflux, whereas most adult cases are carried out for iatrogenic injuries. The present results and complication rate are in line with open and laparoscopic series, with minor operative time . However, early reported success can be misleading, because recurrent strictures typically develop up to 1 year after surgery .…”

Our Experience with Iatrogenic Ureteric Injuries among Women Presenting to University College Hospital, Ibadan: A Call to Action on Trigger Factors

“…Laparoscopic ureteroneocystostomy has an advantage of reducing blood loss, early recovery, less postoperative pain, and successful outcome [22]. Boari's flap and psoas hitch are recommended to reduce tension at the anastomosis for ureters in which a long segment have been lost due to devascularization or transection [23]. Some authors have successfully used the appendix or ileum as the interposition graft and transureteroureterostomy [24].…”

Laparoscopic Extravesical Submucosal Tunneling Ureteroneocystostomy Combined with Psoas Hitch for Medium-Length Distal Ureteral Defects in Adults

“…The laparoscopic approach is gaining popularity for its comparable result with the open approach. The results of this procedure have been reported to be 90-100% effective in antirefluxing and avoiding obstruction without any additional morbidity [5,19] . Several variations of this type of extravesical procedure have been described with improved success rates [9,19] .…”

“…In the past decade, however, laparoscopic and robot-assisted laparoscopic procedures have become popular in urology and resulted in improved outcomes compared with open surgery, even in lower urinary tract reconstruction procedures that are likely hindered by the narrow pelvic space [1,[4][5][6][7] . Robot-assisted reconstruction may overcome the drawbacks of laparoscopy to some extent.…”