Ureteroneocistostomía con psoas Hitch laparoscópico como tratamiento de fístula ureterovaginal: experiencia inicial

Abstract

BackgroundNumerous approaches have been described for the surgical repair of ureterovaginal fistulas, including the psoas hitch and Boari flap. With the continual refinement of laparoscopic techniques, reconstructive approaches have gone from being practically experimental, to becoming common practice. AimsWe present herein our preliminary experience in ureteroneocystostomy with laparoscopic psoas hitch in referred patients presenting with ureterovaginal fistula. MethodsFive cases of ureterovaginal fistula were retrospectively identified that were treated with LichGregoir ureteral reimplantation and psoas hitch within the time frame of September 2010 to July 2012 at our institution. Indication for surgery was: ureterovaginal fistula with or without stricture in the distal third of the ureter. ResultsThe 5 patients presented with fistula secondary to hysterectomy for benign disease. Mean age was 37.2 (range: 34–43) years. Percutaneous nephrostomy was placed in 2 patients prior to surgery and double-J catheter placement was achieved in 3 patients. The fistula invol-ved the right ureter in 2 patients and the left ureter in 3. Mean stricture length was 1.9 (range: 1.4–2.2)cm, mean surgery duration was 174 (range: 160–180) min, and estimated blood loss was 130 (range: 50–200)mL. DiscussionThe first laparoscopic ureteral reimplantation was performed in 1994 by Erlich et al. in a pediatric patient. Also in 1994, Reddy and Evans published a report on the first ureteroneocystostomy in the adult population. ConclusionsLaparoscopic ureteroneocystostomy is a safe procedure with the advantages of minimally invasive surgery: rapid recovery and short convalescence, with similar results to those of open surgery.