Laparoscopic ureteroneocystostomy in iatrogenic injuries of ureter after gynecoloc operations

Abstract

The Objective. To evaluate outcomes of laparoscopic ureteroneocystostomy in patients with iatrogenic strictures of distal part of ureter, caused by gynecologic interventions. Materials and methods. From 2010 to 2014, 10 female patients with iatrogenic injuries of distal part of ureter underwent laparoscopic ureteroneocystostomy. Seven had previous open or laparoscopic hysterectomy, two - removal of endometrioid nodes and 1 - ovarial resection. Surgery was performed using transperitoneal approach with inserting of 4 trocars. Ureter was mobilized and transected above the stricture with subsequent extravesical implantation to the bladder. Results. We had no conversion cases and in all patients ureteroneocystostomy didn’t fail. In 3 cases intervention included ureteroneocystostomy with psoas-hitch, in 2 - Boari flap and in 5 - direct anastomosis of ureter with bladder. Average surgery time was 140 min (ranged between 110 and 215min), average blood loss was estimated as 160 ml (125-240 ml). Cystoureteral reflux was noted in 2 patients. Conclusion. Laparoscopic ureteroneocystostomy is less invasive and reliable surgical treatment modality efficient in cases of iatrogenic ureteral injuries due to gynecological interventions.