Non-Oral Poster 49

Abstract

OBJECTIVES: Ureteral injury is one of the most common complications of pelvic surgery. It is estimated that ureteral injury occurs in 0.4% of gynecologic cases and in two thirds of these patients the initial procedure is abdominal hysterectomy. Treatment of this injury consists of ureteral stenting, and in cases in which a stent cannot be placed, nephrostomy tube with subsequent implantation of the ureter is required. Current advances in robotic assisted laparoscopic surgery have made it an ideal tool for performing ureteral reimplantation. MATERIALS AND METHODS: In the past 24 months four patients in our institution incurred ureteral injury during pelvic surgery; one during cesarean section, two patients after total abdominal hysterectomy and one after total robotic hysterectomy. In the first case ureteral injury was recognized two days after surgery; in three cases of hysterectomy patients developed ureterovaginal fistulas within two weeks of surgery. All patients had attempted stenting of the affected ureter, and, after failed stenting, nephrostomy tube was placed. Six weeks after placement of nephrostomy, all patients underwent robotic assisted extravesical ureteroneocystostomy with stent placement and psoas hitch. All patients were discharged with foley catheter for two weeks. Ureteral stent was removed six weeks after surgery and retrograde ureterogram done. RESULTS: Robotic ureteral reimplantation was successful in all cases as demonstrated by ureteral patency on retrograde ureterogram. All patients were discharged from the hospital within 24 hours of surgery. There were no complications noted during any of the procedures. CONCLUSION: Robotic assisted laparoscopic ureteral neocystostomy offers excellent surgical outcomes. When compared to traditional open procedure it offers shortened hospital stay and quicker recovery.