Laparoscopic Extravesical Ureteroneocystostomy by a New “Y” Flap Technique

Abstract

Laparoscopic ureteral implantation can be a challenging procedure. We describe a simple "Y" flap technique to facilitate laparoscopic ureteral implantation. Three patients with distal ureteral strictures underwent laparoscopic ureteral reimplantation by a modified technique. Blunt dissection is used to mobilize 4 cm of the ureter. A neocystostomy is performed in the bladder and, after isolation of the ureter, it is bivalved for a length of 1.5 cm, creating a Y flap. A 6 by 24 Double-J stent is placed intraoperatively, feeding it through the distal end of the ureter. The cut ends of the bivalved Y flaps of the ureter are anastomosed into the bladder by two simple pexic sutures. The ureter is advanced 1 cm from the neocystostomy to lay the Y flap into the bladder. After laparoscopic reimplantation using this new technique, all patients were studied postoperatively. None revealed any obstruction, as confirmed by intravenous urography at 1 month and diuretic renography at 3 months after removal of the stent. Laparoscopic ureteral reimplantation is feasible using a new Y flap technique with excellent functional and anatomic results.