Introduction and Objectives
Laparoscopic technique successfully replaces classic open surgical methods in urology. Ablation surgery is a method of special interest for laparoscopy. Reconstructive urology less frequently applies laparoscopic techniques that mainly depend on the center's experience. The aim of the study is to evaluate the course and outcome of laparoscopic treatment of the strictured distal ureter.
Material and Methods
Two males aged 41 and 73 years with the diagnosis of strictured left distal ureter with subsequent symptomatic hydronephrosis underwent surgery. The stricture of the distal ureter was caused in both cases by scars resulting from transurethral resection of the superficial cancer of urinary bladder located nearby the ureter's orifice. The diagnosis was confirmed by urography and pyelography performed after implantation of the nephrostomy catheter. The length of the stricture was 2 cm. Both patients did not achieve patency of the ureter despite preoperative deep resection of the scar. No features of the malignant relapse were found. Laparoscopic procedure was performed using 3 working ports and camera port. Mobilization of the colon was followed by identification and preparation of the distal ureter. Then the distal ureter was excised from the urinary bladder, spatulated and after ureteric stenting a new ureterovesical anastomosis was created. Intermittent sutures were applied through the full thickness of the urinary bladder wall. Ureteric stent was removed 4 weeks after surgery.
Results
Mean surgery time was 145 minutes, blood loss −25 ml and postoperative hospitalization 5 days. No intraoperative or postoperative complications were noted. The efficacy of the treatment was evaluated basing on patient interview and intravenous urography performed 1–2 days following the removal of the ureteric stent. In each case normal urinary flow from the kidney to the urinary bladder was noted. Cystoscopy performed 3 months post-surgery revealed normal picture of the urinary bladder and orifice of the reimplanted ureter in the treated males.
Conclusions
Laparoscopic reimplantation of the ureter is an efficacious and safe alternative to open surgery in the chosen patients treated in the centers experienced in reconstructive laparoscopic surgery.
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Copyright
© 2009 European Association of Urology. Published by Elsevier Inc. All rights reserved.
