Laparoscopic Transureteroureterostomy: A Novel Approach

Abstract

We describe the feasibility and short-term results of laparoscopic transureteroureterostomy in children. We performed transperitoneal laparoscopic transureteroureterostomy with a 4-trocar technique in 3 children with a mean age of 63 months (range 18 to 105). Diagnoses were unilateral ureteral obstruction after cross-trigonal reimplantation for vesicoureteral reflux (1 patient), unilateral refluxing megaureter (1) and ureteral injury after bladder diverticulectomy (1). Cystoscopy, retrograde pyelogram and stent placement in the recipient ureter were performed at the beginning of each case. The anastomoses were carried out with running 6-zero reabsorbable sutures at the level of the pelvic bream. An abdominal drain and Foley catheter were left indwelling for 1 to 3 days. All cases were performed successfully. Postoperative course was uneventful except for a transient urinary leak, and patients were discharged home on postoperative day 2 to 4. At a mean followup of 6 months all patients were clinically well, with normal kidney function and blood pressure, and no significant hydronephrosis. Based on our initial experience, laparoscopic transureteroureterostomy is safe and effective, and is associated with little blood loss, minimal analgesia requirements, fast recovery and excellent cosmetic results. We believe that in selected cases in which transureteroureterostomy is the chosen technique a laparoscopic approach is advantageous.