Transperitoneal Intravesical Technique for Laparoscopic Ureteral Reimplantation to Treat Terminal Ureteral Stenosis.

Abstract

To describe a newly developed transperitoneal intravesical technique for laparoscopic ureteral reimplantation in patients with terminal ureteral stenosis. Between July 2009 and May 2015, laparoscopic transperitoneal intravesical ureteral reimplantation was performed in 16 patients with terminal ureteral stenosis without vesicoureteral reflux (VUR). An incision was made in the superior bladder wall of the affected side with an electric hook. The bladder mucosa was then circumferentially cut away from the ureteral orifice to a distance of 0.5 cm, and the intramural portion of the ureter was freed from the bladder wall and dissected until 4 to 5 cm of terminal ureter was mobilized. The stenotic segment was resected, and a longitudinal cut was made in the mobilized ureter. The terminal ureter was then evaginated and sutured to the bladder wall to form a papilla. All patients underwent standard postoperative examinations. All of the 16 operations were successful, and none required conversion to an extravesical approach or open surgery. The operation time ranged from 85 to 135 minutes (mean 98 minutes), and the estimated blood loss was ∼30-60 mL (mean 42 mL). There were no obvious intraoperative or postoperative complications. Resolution of hydronephrosis was achieved in all 16 patients, and VUR of the operated ureter was not detected at postoperative follow-up. The transperitoneal intravesical technique of laparoscopic ureteral reimplantation that we describe was safe and feasible in our 16 patients and may be an alternative surgical treatment for terminal ureteral stenosis in patients without VUR.