Laparoscopic extravesical ureteral reimplantation for iatrogenic distal ureteral stricture

Abstract

Objective: The authors describe their experience with laparoscopic extravesical neoureterocystostomy for iatrogenic distal ureteral stricture using a transperitoneal intracorporeal freehand suturing technique. Material and Method: Three patients with distal ureteral strictures underwent laparoscopic transperitoneal extravesical ureteral reimplantation. A 77 year old male underwent a Lich-Gregoir antireflux ureteral reimplantation following complications arising from transurethral resection of the prostate, and two females, aged 28 and 34 years, underwent refluxing ureteral reimplantation with concurrent psoas hitch after gynecologic surgery. The authors reviewed patient records to assess peri- and postoperative outcomes following definitive laparoscopic management of stricture segments. Results: All procedures were completed entirely using a laparoscopic approach. No intra- or post-operative complications were reported. Operative times ranged between 180-250 minutes and mean blood loss was 50-150 ml. The mean time to restarting oral intake was 12 hours. Pathological evaluation confirmed benign lesions in each case and follow-up imaging confirmed satisfactory functional results. Conclusion: Laparoscopic extravesical neoureterocystostomy for iatrogenic distal ureteral strictures is a safe and efficacious procedure. Larger cohorts and longer-term results are required before this technique is considered first-line therapy in this patient group.