Laparoscopic ureteroneocystostomy with psoas hitch.
OBJECTIVE
Laparoscopic extravesical ureteroneocystostomy is an infrequently described technique. Our aim is to describe five cases where we used the intracorporeal freehand suturing technique successfully for performing laparoscopic extravesical transperitoneal ureteral reimplantation with psoas hitch. We describe the preliminary results of these cases.


METHODS
We performed this surgery in five female patients. Two patients had a low ureterovaginal fistula after total laparoscopic hysterectomy. The other three patients had undergone laparoscopic radical hysterectomy.


RESULTS
The average surgical time was 220 minutes. The average blood loss was 150 mL. The average stay was 3 days, and the average time to starting oral intake was 12 hours. No intraoperative or postoperative complications occurred. The urinary catheter was removed after 3 weeks and the double j stent after 6 weeks. Follow-up urography showed good clearance of the kidney and ureter. There was no reflux on the postoperative cystogram.


CONCLUSIONS
Laparoscopic extravesical ureteroneocystostomy with intracorporeal freehand suturing technique and psoas hitch is a feasible procedure in females for managing ureterovaginal fistulas after laparoscopic gynecologic surgeries. The patients need not be subjected to open surgery because this complication can be repaired laparoscopically, thus minimizing the morbidity.
Puntambekar
Shailesh
S
Galaxy Laparoscopy Institute Pune, Maharahstra, India.
Palep
Reshma J
RJ
Gurjar
Ajit M
AM
Sathe
Ravindra M
RM
Talaulikar
Amol G
AG
Agarwal
Geetanjali A
GA
Kashyap
Madhuri
M
D000714:Anastomosis, Surgical; D003559:Cystostomy / Q000379:methods*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects; D010535:Laparoscopy; D008875:Middle Aged; D013536:Suture Techniques; D014513:Ureter / Q000601:surgery*; D014515:Ureteral Diseases / Q000209:etiology / Q000601:surgery*; D014548:Urinary Fistula / Q000209:etiology / Q000601:surgery*; D014624:Vaginal Fistula / Q000209:etiology / Q000601:surgery*