Laparoscopic Ureteral Reimplantation: A Single Center Experience and Literature Review

Abstract

Laparoscopic Boari flap, psoas hitch, and direct ureteral reimplantation have all been described in the management of benign distal ureteral strictures. A retrospective review of a single center experience of laparoscopic reconstructive surgery for benign distal ureteral strictures was undertaken. The results of this initial series were compared with the published literature. To date, six patients with benign distal ureteral strictures have undergone laparoscopic reconstructive surgery at our center. Stricture etiology was stone disease in two patients, postvaginal hysterectomy in one patient, and unknown in the remaining two. In all cases, the operative procedure was undertaken with five-port transperitoneal access. Depending on healthy ureteral length, a decision for direct reimplantation was made in two patients, and Boari flap reconstruction was undertaken in the remaining three patients. Mean operative time was 322 minutes (range 240-360 min), which is longer than in the published literature, reflecting our initial learning curve in reconstructive laparoscopy. The mean drop in hemoglobin, however, was only 0.5 g/dL, which is comparable to that in other series. Further, there were no complications, and patients were discharged at a mean of 6.6 days postoperatively (range 5-9 days). All patients had satisfactory follow-up intravenous urograms with a mean follow-up period of 4 months. Laparoscopic reconstructive surgery for managing benign distal ureteral strictures is both safe and effective. Although open surgery currently remains the gold standard for these patients, all operative steps can be replicated laparoscopically, and this may become the future standard treatment.