Category: Reconstruction: Benign

MP14-2 - Laparoscopic ureteroneostomy for ureteral injuries after gynecologic procedures

Sat, Sep 22
10:00 AM - 12:00 PM

Introduction & Objective :

To evaluate outcomes of laparoscopic ureteroneocystostomy in patients with iatrogenic strictures of distal part of ureter, caused by gynecologic procedures

Methods :

From 2010 to 2017, 26 female patients with iatrogenic injuries of distal part of ureter underwent laparoscopic ureteroneocystostomy. Nine had previous open or laparoscopic hysterectomy, five– removal of endometrioid nodes and one – ovarial resection. Surgery was performed using transperitoneal approach with inserting of 4 trocars. Ureter was mobilized and transected above the stricture with subsequent extravesical implantation to the bladder. All procedures were performed at a single institution. A retrospective review of perioperative and clinical data was performed assessing the operative time, estimated blood loss, length of hospital admission. Success of operations as indicated by the absence of obstruction on follow-up imaging.

Results :

We had no conversion cases and in all patients ureteroneocystostomy didn’t fail. In 12 cases intervention included ureteroneocystostomy with psoas-hitch, in 8 – Boari flap and in 6 – direct anastomosis of ureter with bladder. Average surgery time was 160 min (ranged between 110 and 215min), average blood loss was estimated as 120 ml (80 - 240 ml). Average of hospital admission was 3,7 days. Cystoureteral reflux was noted in 2 patients. 

Conclusions :

Laparoscopic ureteroneocystostomy is less invasive and reliable surgical treatment modality efficient in cases of iatrogenic ureteral injuries due to gynecological interventions 

Bakhman Guliev

Urology department, ass. of prof
North West medical university by Mechnikov
St Petersburg, Saint Petersburg City, Russia

Boris Komyakov

St Petersburg, Saint Petersburg City, Russia