Transperitoneal laparoscopic ureteric reimplantation for lower ureteric strictures and ureterovaginal fistulas: A study from north India

Abstract

Introduction: Incidence of lower ureteric injuries has increased due to proliferation of complex pelvic laparoscopic and ureteroscopic procedures.

Objective: To describe our experience of laparoscopic ureteric reimplantation for lower ureteric strictures and ureterovaginal fistulas due to different aetiologies.

Patients and methods: A total of 42 patients underwent laparoscopic ureteric reimplantation from January 2007 to December 2013 after preoperative evaluation by intravenous urography or CT urogram to delineate the site and length of stricture or ureterovaginal fistula. All the patients were followed up with ultrasonography and micturating cystourethrogram at 3 months. Out of the total 42 patients, 22 patients (group 1) underwent laparoscopic ureteric reimplant for lower ureteric stricture and 20 patients (group 2) underwent laparoscopic ureteric reimplant for ureterovaginal fistula.

Results: There were 5 male and 37 female patients. The mean patient age was 43.5 ± 12 (range 24–62 yrs), mean operating time was 129 ± 11 (range 110–160) minutes, mean hospital stay was 2.8 (range 2–6) days and mean follow up period of 16 months (range 6–70). Two procedures had to be converted to open (one each in both groups). There were no major (Clavien grade III and above) intra-operative or post-operative complications. One of the failures in lower ureteric stricture group was managed by open reconstruction with boari flap.

Conclusion: Laparoscopic ureteric reimplantation is an excellent modality for both lower ureteric strictures and ureterovaginal fistulas with long term good outcomes in addition to the advantage of lesser hospital stay and lesser comorbidities.

Keywords: Laparoscopic; Ureteric reimplantation; Lower ureteric strictures; Ureterovaginal fistulas