Laparoscopic Ureteral Reimplantation: Technique and Outcomes

North Shore-Long Island Jewish Health System, New Hyde Park, New York, USA.
The Journal of urology (Impact Factor: 4.47). 03/2009; 181(4):1742-6. DOI: 10.1016/j.juro.2008.11.102
Source: PubMed


We describe our experience with laparoscopic ureteral reimplantation in 45 adults, and report success rates and complications at intermediate term followup.
We performed a retrospective chart review of 45 patients who underwent laparoscopic ureteral reimplantation between 1997 and 2007. Demographics, clinicopathological parameters, perioperative course, complications and followup studies were analyzed.
Elective laparoscopic ureteral reimplantation was performed in 35 female and 10 male patients with a mean followup of 24.1 months (range 1 to 76). All patients presented with distal ureteral stricture with a mean stricture length of 3 cm and a mean +/- SD preoperative serum creatinine of 0.91 +/- 0.04 mg/dl. Mean patient age was 47.8 +/- 2.2 years (range 17 to 87). Mean American Society of Anesthesiologists score was 2 (range 1 to 3). Median estimated blood loss was 150 ml. The overall success rate, defined as radiographic evidence of no residual obstruction, symptoms, renal deterioration or need for subsequent procedures, was 96%. Two patients had recurrent strictures and 1 underwent nephrectomy for flank pain and preexisting chronic pyelonephritis.
According to intermediate followup data laparoscopic ureteral reimplantation can be performed with an excellent success rate and low morbidity. Our data substantiate this technique as an effective method for managing distal ureteral stricture.

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Available from: Mohammad Nadjafi-Semnani, Feb 06, 2015
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    • "Following the success in ablative procedures, laparoscopic approach has been increasingly employed for reconstruction of urological pathologies and for reconstruction of lower ureteral strictures, albeit sparingly.[3] Although the projected outcome following laparoscopic reconstruction is promising,[4] citations till date have not focussed on the feasibility of conducting this approach primarily after the inciting event. This paper aims to compare the immediate and long term outcomes following early and delayed laparoscopic repair of lower ureteric strictures. "
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    ABSTRACT: Influence of timing of repair on outcome following laparoscopic reconstruction of lower ureteric strictures To assess the influence of timing of repair on outcome following laparoscopic reconstruction of lower ureteric strictures in our adult patient population. Single surgeon operative experience in two institutes. Retrospective analysis. All patients were worked up in detail. All patients underwent cystoscopy and retrograde pyelography prior to laparoscopic approach. Patients were categorised into two groups: early repair (within seven days of inciting event) and delayed repair (after two weeks). Operative parameters and postoperative events were recorded. Postprocedure all patients were evaluated three monthly. Follow-up imaging was ordered at six months postoperatively. Improvement in renal function, resolution of hydronephrosis and unhindered drainage of contrast through the reconstructed unit on follow-up imaging was interpreted as a satisfactory outcome. Mean, standard deviation, equal variance t test, Mann Whitney Z test, Aspin-Welch unequal variance t test. Thirty-six patients (37 units, 36 unilateral and 1 simultaneous bilateral) underwent laparoscopic ureteral reconstruction of lower ureteric stricture following iatrogenic injury - 21 early repair (Group I) and 15 delayed repair (Group II). All patients were hemodynamically stable at presentation. Early repair was more technically demanding with increased operation duration. There was no difference in blood loss, operative complications, postoperative parameters, or longterm outcome. In hemodynamically stable patients, laparoscopic repair of iatrogenically induced lower ureteric strictures can be conveniently undertaken without undue delay from the inciting event. Compared to delayed repairs, the procedure is technically more demanding but morbidity incurred and outcome is at par.
    Indian Journal of Urology 10/2011; 27(4):465-9. DOI:10.4103/0970-1591.91433
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    ABSTRACT: Over the past two decades, technological innovations have remarkably improved the delivery of urologic care. The management of ureteral diseases has undergone a tremendous evolution in the range of available options. Various minimally invasive surgical options have become available, for instance, in treating ureteropelvic junction obstruction (UPJO) including antegrade and retrograde endopyelotomy, Acucise™ incisional endopyelotomy, and percutaneous endopyeloplasty. More recently, the introduction of laparoscopic and robotic surgery has opened new doors for diverse application of these techniques in minimally invasive urologic surgery. In particular, laparoscopic pyeloplasty has evolved into the standard of care for UPJO [1, 2]. KeywordsRobotics-Reimplantation-Ureter-Laparoscopy-Complications
    12/2009: pages 187-196;
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    ABSTRACT: To present our experience of laparoscopic ureteral reimplantation using intracorporeal ureteral tapering for management of distal ureteral stricture. Between April 2005 and October 2008, six patients, including 3 children and 3 adults, underwent laparoscopic modified Lich-Gregoir type extravesical ureteral reimplantation for distal ureteral stricture. Significant dilatations of proximal segment in these patients were repaired with intracorporeal ureteral tapering. Stricture etiologies were congenital ureterovesical megaureter and iatrogenic gynecologic injury in 4 and 2 patients, respectively. Mean age of the patients was 29.3 years (range, 2 to 62 years). Mean operation time and hospital stay was 185 minutes (range, 150 to 240 minutes) and 4 days (range, 2 to 6 days), respectively. No significant complications were noted intra-operatively. Surgical procedure was performed in all the subjects laparoscopically and no conversion to open surgery happened. Postoperatively, 2 patients were complicated with febrile urinary tract infection that were managed medically. No urinary leakage occurred in early postoperative period. All the patients had patent ureterovesical junction anastomosis in follow-up imaging and recurrence of obstruction was noted in no cases. Two patients (33.3%) developed grade II vesicoureteral reflux. Laparoscopic ureteral reimplantation with intracorporeal tapering of distal segment may be performed safely in management of patients with distal ureteral stricture and severe dilatation of proximal segment.
    Urology journal 01/2010; 7(4):238-42. · 0.57 Impact Factor
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