Category: Laparoscopy: Upper Tract - Benign
Introduction & Objective :
Currently many treatment options are available for treatment of upper ureteric stricture. However, the ideal
treatment for recurrent stricture is open ureteroureterostomy. We present a video of endoscopic assisted laparoscopic ureteroureterostomy as an alternative of
open surgery for recurrent upper ureteric stricture.
We present a female who is 26 years old with a body mass index of 26 kg/m2. The patient presented with recurrent right flank pain with a
history of laser endoureterotomy for right upper ureteric stricture and insertion of two 6-Fr. JJ for 6 weeks 3 months ago. Intravenous urography of the patient showed recurrent upper ureteric stricture with secondary right hydronephrosis. The patient was placed in the Gladako-modified Valdivia position where transperitoneal laparoscopic repair of stricture was done. A long segment of the right upper ureter was surrounded with extensive fibrosis where adhesolysis was done laparoscopically. However, the exact site of the stricture was specified through simultaneous retrograde ureteroscoscopy where a 6 Fr. JJ was inserted under
ureteroscopic guidance. The exact segment of stricture was excised and both ends of the ureter were spatulated and re-anastomosed in a water-tight tension-free
manner using 4/0 vicryl sutures. A tube drain was left through one of port sites.
Only 3 ports were used for ureteroureterostomy; two 5-mm and one 3-mm port. Operative time was 146 minutes. Blood loss was 80 c.c.
There were no intraoperative or postoperative complications. Drain was removed after 48 hours as there was no leakage. Hospital stay was 2 days. Visual analog
at discharge was 2. Follow-up CT urography showed patent right ureter with marked reduction of the hydronephrosis.
Endoscopic assisted laparoscopic ureteroureterostomy of recurrent upper ureteric stricture is a feasible, safe and effective treatment
option. The procedure has low morbidity and high patient satisfaction
Aly Abdel-Karim– Professor of Urology, Alexandria University, Alexanderia, Al Iskandariyah, Egypt
Mohamed Yehia– Consultant Urological Surgeon, Wrexham Maelor Hospital NHS Wales, Betsi Cadwaladr University Health Board, Wrexham, Wales, United Kingdom, Wrexham, Wales, United Kingdom
Ahmed Abulkhair– Alexandria, Al Iskandariyah, Egypt
Ahmed Aboelfotoh– Alexandria, Al Iskandariyah, Egypt
Salah Elsalmy– Alexandria, Al Iskandariyah, Egypt
Professor of Urology
Alexanderia, Al Iskandariyah, Egypt
Consultant Urological Surgeon
Wrexham Maelor Hospital NHS Wales, Betsi Cadwaladr University Health Board, Wrexham, Wales, United Kingdom
Wrexham, Wales, United Kingdom