Laparoscopic ureteroureterostomy: a prospective follow-up of 9 patients

Objective: To report the technique and long-term outcome of laparoscopic ureteroureterostomy of injured ureter.Design: A prospective follow-up study.Materials and Methods: Follow-up of nine patients, aged 30-43 years, who acquired intentional ureteral injury during operative laparoscopy for treatment of endometriosis. They were treated between September 1991 and September 1997 by ureteral transection or resection with primary laparoscopic repair by ureteroureterostomy (8 procedures) and ureteroneocystostomy (2 procedures).Results: All operations were successfully completed by operative laparoscopy without need to convert to laparotomy. Estimated blood loss related to the ureteral portion of the procedure was less than 100 mL. Duration of follow-up was between 2 months and 6 years. Follow-up intravenous pyelogram revealed complete healing in seven patients. One patient had mild ureteral stricture, which resolved with transvesical ureteral dilatation, and she is doing well 4 years postoperatively. Another patient with severe endometriosis had recurrent ureteral stricture due to fibrosis distal to the anastomosis site. She underwent laparoscopic ureteroneocystostomy psoas hitch and is doing well 3 months postoperatively.Conclusions: This is the first series of laparoscopic ureter reanastomosis reported to date. The outcome was excellent with low postoperative morbidity typically associated with laparoscopy.