URETERAL REIMPLANTATION DURING ROBOT ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY

Abstract

Ureteral injury during radical prostatectomy is a well described complication. Reports describing ureteral reimplantation exist in the open surgical literature.1 In the laparoscopic literature recognition of this injury intraoperatively has allowed for primary end-to-end ureterorrhaphy.2 Too ur knowledge laparoscopic ureteral reimplantation during radical prostatectomy has not previously been described. CASE REPORT A 62-year-old man with Gleason sum 7 prostate adenocarcinoma presented for robot assisted laparoscopic radical prostatectomy. The Montsouris technique was used. After extirpation of the prostate the bladder neck was inspected. Indigo carmine was infused intravenously and was seen effluxing from only the left ureteral orifice. A 0.038-inch guidewire was used to cannulate the right ureteral orifice, confirming ureteral transection at the level of the seminal vesical. Investigation posteriorly in the area of the initial seminal vesical dissection revealed the proximal end of the ureter effluxing blue urine. Our standard vesicourethral anastomosis was used, with 8 interrupted 2-zero polyglactin absorbable suture. The bladder was distended and the mobilized distal ureter was positioned toward the right lateral dome without tension. A cystotomy was made at the corresponding site. The distal 5 mm section of ureter was resected and spatulated. Through the lateral accessory port a 6Fr 26 cm double pigtail ureteral stent was passed over a wire up to the kidney. The distal end of the stent was placed in the cystotomy. Using 4, 4-zero absorbable sutures in an interrupted fashion, the ureter was securely implanted with mucosal apposition. To augment this anastomosis, a layer of detrusor was used to buttress the anastomosis. A self-suctioning drain was left in the pelvis for 48 hours. The patient had no other perioperative complications and was discharged home on postoperative day 2. The urinary catheter was removed at 8 days postoperatively. Five weeks later the stent was removed cystoscopically. At 3 months postoperatively excretory urography demonstrated normal upper tract architecture and drainage (see figure). DISCUSSION