title: Prevention and management of ureteral injuries occurring during laparoscopic radical prostatectomy: the Heilbronn experience and a review of the literature.
abstract: OBJECTIVE
  There is a small risk of ureteral injury during laparoscopic radical prostatectomy (LRP). It is important to recognise and repair such ureteral injuries immediately. Laparoscopic reconstructive surgery has proven to be feasible for the treatment of ureteral injury. We report our experience of ureteral injuries during LRP including the incidence, mechanism of injury, management, prevention and outcome.
  
  
  METHODS
  During a 9-year period, 2,164 LRP's were performed at our clinic. Three cases were complicated by lower ureteral injuries including two complete and one partial transection. The complete transections occurred during posterior dissection of the bladder neck and seminal vesicles, and the partial transection during an extended lymph node dissection. All were recognised and managed intraoperatively. We performed Lich-Gregoir (LG) extravesical ureteral reimplantation for complete transections, and primary repair for the partial ureteral transection.
  
  
  RESULTS
  Overall, the incidence of ureteral injuries was 0.13%. Laparoscopic reconstructive surgery was performed successfully in all cases without complication. This added 71, 46 and 59 min, respectively, to LRP operative time. The postoperative course was uneventful in all patients. Hospital stay was 8 days. After 30, 17 and 14 months of follow-up, intravenous urography (IVU) demonstrated good drainage.
  
  
  CONCLUSIONS
  Recognition and repair of ureteral injuries during LRP requires a high index of suspicion, and expertise in laparoscopic technique. Laparoscopic reimplantation or primary repair of these injuries during LRP is, in experienced hands, a safe, feasible and minimally invasive procedure with the benefits of laparoscopic surgery maintained for the patient.
authors.affiliation: Department of Urology, SLK-Kliniken Heilbronn, Heidelberg University, Am Gesundbrunnen 20, 74078 Heilbronn, Germany.
authors.forename: Dogu
authors.initials: D
authors.lastname: Teber
authors.forename: Ali Serdar
authors.initials: AS
authors.lastname: Gözen
authors.forename: Joanne
authors.initials: J
authors.lastname: Cresswell
authors.forename: Abdullah Erdem
authors.initials: AE
authors.lastname: Canda
authors.forename: Faruk
authors.initials: F
authors.lastname: Yencilek
authors.forename: Jens
authors.initials: J
authors.lastname: Rassweiler
mesh_terms: D000368:Aged; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000453:epidemiology / Q000517:prevention & control* / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000379:methods*; D014513:Ureter / Q000293:injuries*