title: Laparoscopic ureteroneocystostomy for ureteral injuries after hysterectomy.
abstract: OBJECTIVE
  To examine the feasibility of early laparoscopic ureteroneocystostomy for ureteral obstruction due to hysterectomy injury.
  
  
  METHODS
  We retrospectively reviewed a 10-y experience from 2 institutions in patients who underwent early (<30 d) or late (>30 d) laparoscopic ureteroneocystostomy for ureteral injury after hysterectomy. Evaluation of the surgery included the cause of the stricture and intraoperative and postoperative outcomes.
  
  
  RESULTS
  A total of 9 patients with distal ureteral injury after hysterectomy were identified. All injuries were identified and treated as early as 21 d after hysterectomy. Seven of 9 patients underwent open hysterectomy, and the remaining patients had vaginal and laparoscopic radical hysterectomy. All ureteroneocystostomy cases were managed laparoscopically without conversion to open surgery and without any intraoperative complications. The Lich-Gregoir reimplantation technique was applied in all patients, and 2 patients required a psoas hitch. The mean operative time was 206.6 min (range, 120-280 min), the mean estimated blood loss was 122.2 cc (range, 25-350 cc), and the mean admission time was 3.3 d (range, 1-7 d). Cystography showed no urine leak when the ureteral stent was removed at 4 to 6 wk after the procedure. Ureteroneocystostomy patency was followed up with cystography at 6 mo and at least 10 y after ureteroneocystostomy.
  
  
  CONCLUSIONS
  Early laparoscopic ureteral reimplantation may offer an alternative surgical approach to open surgery for the management of distal ureteral injuries, with favorable cosmetic results and recovery time from ureteral obstruction due to hysterectomy injury.
authors.affiliation: Department of Surgery, University of Colorado Health Sciences Center, Denver, CO, USA.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Pompeo
authors.forename: Wilson R
authors.initials: WR
authors.lastname: Molina
authors.forename: David
authors.initials: D
authors.lastname: Sehrt
authors.forename: Marcos
authors.initials: M
authors.lastname: Tobias-Machado
authors.forename: Renato M
authors.initials: RM
authors.lastname: Mariano Costa
authors.forename: Antonio Carlos Lima
authors.initials: AC
authors.lastname: Pompeo
authors.forename: Fernando J
authors.initials: FJ
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D003251:Constriction, Pathologic; D003559:Cystostomy / Q000379:methods*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D007431:Intraoperative Complications / Q000601:surgery*; D010535:Laparoscopy; D008875:Middle Aged; D012189:Retrospective Studies; D014513:Ureter / Q000293:injuries* / Q000473:pathology; D014519:Ureterostomy / Q000379:methods*