Laparoscopic ureteroureteral anastomosis for repair of ureteral injury involving stricture

Abstract

We describe an approach to laparoscopic ureteroureteral anastomosis for surgical management of ureteral stricture, and review four cases in which this method was used. In these four cases, we observed no intraoperative complications. Patients' length of hospital stay was 1-2 days. Follow-up ranged from 12 to 14 months. All four patients have been asymptomatic, and their follow-up intravenous pyelograms (IVPs) have been normal. This surgical approach warrants further study with larger series and long-term follow-up.

Laparoscopic management of ureteral lesions in gynecology

“…An overall 1.5% of ureteral lesions in deep endometriosis surgery without hydronephrosis is similar to the overall reported incidences of ureteral lesions between 0.5 and 4% (1)(2)(3)(4)12). As can be expected, but to the best of our knowledge not yet reported, the incidence increases when hydroureteronephrosis is present.…”

“…Gynecologic surgery is associated with ureteral lesions, with an incidence ranging from 0.1 to 1.5% for benign procedures and up to 5% for oncologic procedures (1)(2)(3)(4). Whether laparoscopic procedures increase the risk of ureteral lesion is unclear, although a higher risk of ureteral and other complications can be expected during the learning curve (5).…”

“…Ureteral reanastomosis, although reported to have an overall success rate of 94%, never gained widespread popularity (1). Over the last decade, laparoscopically aided treatment of ureteral injuries, such as the removal of a suture or stricture, the laparoscopically guided stent insertion and suturing for ureteral laceration, the laparoscopic reanastomosis over a stent, and, very recently, ureter reimplantations have become feasible (2,(8)(9)(10)(11). The numbers, however, are still small and do not permit solid conclusions.…”

The diagnosis and management of ureteric injury after laparoscopy

“…30-45% are diagnose intraoperatively, and 55-70% are postoperatively [2,3]. Pelvic surgery is one of the most common cause of iatrogenic ureteral injury [4,5]. The estimated incidence is 0.5% to 3%, and one third of these cases were not identified or corrected during surgery [6].…”

“…Symptoms of ureter injury may detect by hematuria, cystoscopy or explore the ureter directly. Over the last decade, laparoscopically aided treatment of ureteral injuries, such as the removal of a suture or stricture, the laparoscopically guided stent insertion and suturing for ureteral laceration, the laparoscopic reanastomosis over a stent, and, very recently, ureter reimplantations have become feasible (4,(7)(8)(9)(10).…”