Korean J Urol.  2013 Jan;54(1):26-30.

Laparoscopic Ureteroneocystostomy: Modification of Current Techniques

• Ahn JH
• Han JY
• Nam JK
• Park SW
• Lee SD
• Chung MK

Abstract

PURPOSE
To review the feasibility of laparoscopic ureteroneocystostomy with extracorporeal eversion of the ureteral end in various distal ureteral lesions.
MATERIALS AND METHODS
We conducted a retrospective review of 5 laparoscopic procedures of ureteroneocystostomy with extracorporeal eversion of the ureteral end. Of these, 4 patients (range, 45 to 54 years) had distal ureter stricture or obstruction after gynecological surgeries for endometriosis or a large uterine myoma. One patient (male, 67 years) had low-grade distal ureter cancer. The laparoscopic procedure was combined with cystoscopic insertion of a ureteral stent and extracorporeal eversion of the ureter through the 10-mm port on the affected side.
RESULTS
The laparoscopic ureteral reimplantations with and without a psoas hitch in patients with distal ureteral lesions was successful in all patients. The mean operation time was 137 minutes (range, 104 to 228 minutes). Two patients underwent additional psoas hitch. In all patients, short-term success was confirmed by voiding cystourethrography and intravenous pyelography conducted 3 months after the operation. The mean follow-up of the entire group was 12 months (range, 3 to 30 months). We noted no major or minor complications over the follow-up period.
CONCLUSIONS
The technique of laparoscopic ureteroneocystostomy for benign or malignant ureteral strictures continues to evolve. Surgeons should be versatile with various options and technical nuances when dealing with these cases. Simple modifications of laparoscopic ureteroneocystostomy with extracorporeal eversion of the ureteral end, nonreflux extravesical anastomosis, and simultaneous cystoscopy will be crucial to the ease of performance and a successful outcome.

Keyword

Gynecologic surgical procedures; Laparoscopy; Ureter; Wounds and injuries

MeSH Terms

Constriction, Pathologic
Cystoscopy
Endometriosis
Female
Follow-Up Studies
Gynecologic Surgical Procedures
Humans
Laparoscopy
Myoma
Replantation
Retrospective Studies
Stents
Ureter
Ureteral Neoplasms
Urography

Figure

• 

  FIG. 1 Preparation of the distal ureter and vesicoureteral anastomosis. (A) Antegrade ureterography showing a 3-cm stricture in the right distal ureter. (B) The obstructed ureteral segment was dissected to the lower end. (C) Ureteral intussusception to produce a nipple was performed outside the abdomen. (D) A double-J ureteral stent was passed with the aid of a guidewire simultaneously through the cystoscope in a retrograde manner. (E) Normal saline was instilled to confirm that the anastomosis was watertight after the remaining mucosa-to-mucosa anastomosis. (F) Detrusorrhaphy created a second plane for antireflux.

Reference

1. Simmons MN, Gill IS, Fergany AF, Kaouk JH, Desai MM. Technical modifications to laparoscopic Boari flap. Urology. 2007. 69:175–180.

2. Roupret M, Harmon JD, Sanderson KM, Barret E, Cathelineau X, Vallancien G, et al. Laparoscopic distal ureterectomy and anastomosis for management of low-risk upper urinary tract transitional cell carcinoma: preliminary results. BJU Int. 2007. 99:623–627.

3. Gerber E, Dinlenc CZ, Wagner JR. Laparoscopic distal ureterectomy for low grade transitional cell carcinoma. J Urol. 2003. 169:2295.

4. Park JH, Park JW, Song K, Jo MK. Ureteral injury in gynecologic surgery: a 5-year review in a community hospital. Korean J Urol. 2012. 53:120–125.

5. Azioni G, Bracale U, Scala A, Capobianco F, Barone M, Rosati M, et al. Laparoscopic ureteroneocystostomy and vesicopsoas hitch for infiltrative ureteral endometriosis. Minim Invasive Ther Allied Technol. 2010. 19:292–297.

6. Rassweiler JJ, Gozen AS, Erdogru T, Sugiono M, Teber D. Ureteral reimplantation for management of ureteral strictures: a retrospective comparison of laparoscopic and open techniques. Eur Urol. 2007. 51:512–522.

7. Stengel JN, Felderman ES, Zamora D. Ureteral injury complication of laparoscopic sterilization. Urology. 1974. 4:341–342.

8. Ghali AM, El Malik EM, Ibrahim AI, Ismail G, Rashid M. Ureteric injuries: diagnosis, management, and outcome. J Trauma. 1999. 46:150–158.

9. Dowling RA, Corriere JN Jr, Sandler CM. Iatrogenic ureteral injury. J Urol. 1986. 135:912–915.

10. Modi P, Goel R, Dodiya S. Laparoscopic ureteroneocystostomy for distal ureteral injuries. Urology. 2005. 66:751–753.

11. Hemal AK, Nayyar R, Gupta NP, Dorairajan LN. Experience with robot assisted laparoscopic surgery for upper and lower benign and malignant ureteral pathologies. Urology. 2010. 76:1387–1393.

12. Gao J, Dong J, Xu A, Wang W, Shi L, Guo G, et al. A simplified technique for laparoscopic ureteroneocystostomy without ureteral nipple or submucosal tunneling. J Endourol. 2007. 21:1505–1508.

13. Nerli RB, Reddy MR, Ravish IR, Amarkhed SS. Laparoscopic bladder (Boari) flap ureteroneocystostomy. J Multidiscip Healthc. 2008. 1:15–16.

14. Modi P, Gupta R, Rizvi SJ. Laparoscopic ureteroneocystostomy and psoas hitch for post-hysterectomy ureterovaginal fistula. J Urol. 2008. 180:615–617.

15. Chung H, Jeong BC, Kim HH. Laparoscopic ureteroneocystostomy with vesicopsoas hitch: nonrefluxing ureteral reimplantation using cystoscopy-assisted submucosal tunneling. J Endourol. 2006. 20:632–638.

16. Lakshmanan Y, Fung LC. Laparoscopic extravesicular ureteral reimplantation for vesicoureteral reflux: recent technical advances. J Endourol. 2000. 14:589–593.

17. Hill JE, Dodson AI Jr, Hooper JW Jr. Experimental ureteroneocystostomy using nipple anastomosis technique. J Urol. 1955. 74:596–599.

18. Urquhart-Hay D, McIlwaine J, Stephenson CB. The use of a ureteric nipple alone for reflux prevention. Br J Urol. 1977. 49:375–377.

19. Elem B. Use of a ureteric nipple in the surgical management of bilharzial ureteric strictures. Br J Urol. 1985. 57:137–140.

20. Abou-Elela A, Torky M, Salah E, Morsy A, Elsherbiny M. Inverted ureteral nipple as antireflux technique in surgical management of bilharzial ureteral strictures. Urology. 2010. 76:983–987.

21. Fergany A, Gill IS, Abdel-Samee A, Kaouk J, Meraney A, Sung G. Laparoscopic bladder flap ureteral reimplantation: survival porcine study. J Urol. 2001. 166:1920–1923.

22. Schimpf MO, Wagner JR. Robot-assisted laparoscopic Boari flap ureteral reimplantation. J Endourol. 2008. 22:2691–2694.

23. Fugita OE, Dinlenc C, Kavoussi L. The laparoscopic Boari flap. J Urol. 2001. 166:51–53.

24. Basiri A, Karami H, Mehrabi S, Javaherforooshzadeh A. Laparoscopic distal ureterectomy and Boari flap ureteroneocystostomy for a low-grade distal ureteral tumor. Urol J. 2008. 5:120–122.

25. Mitre AI, Lestingi JF, Arap MA, Lucon AM, Srougi M. Totally laparoscopic ureteroneocystostomy with intracorporeal tailoring for primary obstructive megaureter. Clinics (Sao Paulo). 2011. 66:177–179.