title: Laparoscopic ureteroureterostomy with an intraoperative retrograde ureteroscopy-assisted technique for distal ureteral injury secondary to gynecological surgery: a retrospective comparison with laparoscopic ureteroneocystostomy.
abstract: OBJECTIVE
  The aim of this study was to compare the operative and postoperative outcomes of laparoscopic ureteroureterostomy (LAP-UU) using a retrograde ureteroscopy-assisted technique with laparoscopic ureteroneocystostomy (LAP-UNC) in treating ureteral injury after gynecological surgery.
  
  
  METHODS
  The study analyzed 60 ureteral injury repairs performed between May 2010 and February 2016 in patients who underwent either LAP-UU using the retrograde ureteroscopy-assisted technique (n = 26) or LAP-UNC (n = 34). Demographic parameters, operative variables and perioperative outcomes were retrospectively analyzed. The chi-squared test, Fisher's exact test and Student's t test were used for statistical analyses.
  
  
  RESULTS
  Demographic and clinical data revealed no significant differences between patients in each group in terms of age, body mass index, length of obstruction, incidence of postoperative urinary leakage, incidence of urinary tract infection during hospitalization, oral antibiotics, mean hospital stay, incidence of recurrent obstruction, rate of conversion to open surgery and mean operative time. The LAP-UU group had significantly less estimated blood loss (85 ± 40 vs 120 ± 35 ml, p = .0006) and a significantly lower incidence of vesicoureteral reflux (grade I) on cystography (0/26 vs 6/34, p = .031) during a mean follow-up of 36.5 months (range 7-71 months).
  
  
  CONCLUSIONS
  Compared with LAP-UNC, LAP-UU is also a technically feasible and safe option for repairing distal ureteral injury secondary to gynecological surgery. The intraoperative retrograde ureteroscopy-assisted technique during LAP-UU contributes to precise localization of the lesion, reduces intraoperative bleeding, enables sufficient dissection of the intramural ureter and preserves its natural antireflux mechanism.
authors.affiliation: a Department of Urology , Xiangya Hospital, Central South University , Changsha , Hunan , PR China.
authors.forename: Zhaohui
authors.initials: Z
authors.lastname: Wang
authors.affiliation: a Department of Urology , Xiangya Hospital, Central South University , Changsha , Hunan , PR China.
authors.forename: Zhi
authors.initials: Z
authors.lastname: Chen
authors.affiliation: a Department of Urology , Xiangya Hospital, Central South University , Changsha , Hunan , PR China.
authors.forename: Yao
authors.initials: Y
authors.lastname: He
authors.affiliation: a Department of Urology , Xiangya Hospital, Central South University , Changsha , Hunan , PR China.
authors.forename: Bingsheng
authors.initials: B
authors.lastname: Li
authors.affiliation: a Department of Urology , Xiangya Hospital, Central South University , Changsha , Hunan , PR China.
authors.forename: Zhiqiang
authors.initials: Z
authors.lastname: Wen
authors.affiliation: a Department of Urology , Xiangya Hospital, Central South University , Changsha , Hunan , PR China.
authors.forename: Xiang
authors.initials: X
authors.lastname: Chen
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D016063:Blood Loss, Surgical; D061887:Conversion to Open Surgery; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D000072836:Surgical Wound / Q000209:etiology / Q000601:surgery*; D014513:Ureter / Q000293:injuries* / Q000601:surgery*; D018666:Ureteroscopy / Q000009:adverse effects / Q000379:methods*; D001743:Urinary Bladder / Q000601:surgery*; D014718:Vesico-Ureteral Reflux / Q000209:etiology
keywords: Gynecological surgery; laparoscopy; reimplantation; ureteral obstruction; ureteroscopy; ureterovaginal fistula