Laparoscopic Psoas Hitch Double Ureteral Re-implantation in the Duplex Urinary System for Treatment of Ureterovaginal Fistula.
BACKGROUND
Although laparoscopy is widely established for ablative urologic procedures, pelvic reconstructive procedures are still mostly performed by open-surgery. As urologists continue to introduce advanced laparoscopic skills to reconstructive urologic procedures, we present our experience with a laparoscopic psoas hitch double ureteral re-implantation in a patient with an ureterovaginal fistula and an ipsilateral duplex urinary system.


METHODS
A 42-year-old patient presented with continuous involuntary urine loss from the vagina after an abdominal hysterectomy. A double modified Lich-Gregoir ureteral re-implantation with a psoas hitch was performed, using a 4-port laparoscopic approach.


RESULTS
There were no post-operative complications and the cystography at post-operative day 14 revealed good positioning of the psoas hitch, with no leak or reflux. At three-months follow-up, the patient is completely dry and asymptomatic.


CONCLUSIONS
Laparoscopic ureteroneocystostomy with psoas hitch for the treatment of lesions of the distal ureter is a possible, safe, and effective way to resolve a complex urologic situation with minimally invasive surgery. Laparoscopy is becoming the standard approach to urologic pelvic reconstructive procedures, even in the most complex cases.
Urology Department, Centro Hospitalar Lisboa Norte, Faculdade de Medicina de Lisboa, CAML, Centro Académico de Medicina de Lisboa, Lisboa, Portugal.
Tito Palmela
TP
Leitão
Urology Department, Centro Hospitalar Lisboa Norte, Lisboa, Portugal.
Ricardo Pereira
RP
E Silva
Obstetrics and Gynecology Department, Centro Hospitalar Lisboa Norte, Hospital Santa Maria, Lisboa, Portugal.
Sónia
S
Barata
Radiology Department, Hospital da Luz, Lisboa, Portugal.
Adalgisa
A
Guerra
Head of Minimally Invasive Surgery Unit, Obstetrics and Gynecology Department, Hospital da Luz, Faculdade de Medicina de Lisboa, CAML, Centro Académico de Medicina de Lisboa, Lisboa, Portugal.
Filipa
F
Osório
D000328:Adult; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects; D010535:Laparoscopy / Q000295:instrumentation / Q000379:methods*; D016658:Psoas Muscles / Q000601:surgery; D012086:Reoperation; D015607:Stents; D016896:Treatment Outcome; D014513:Ureter / Q000002:abnormalities* / Q000601:surgery; D014515:Ureteral Diseases / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery*; D014548:Urinary Fistula / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*