[LAPAROSCOPIC URETERO-CYSTO-ANASTOMOSIS IN TREATMENT OF PELVIC URETERAL STRICTURES]

The aim of the paper was to evaluate the efficacy of laparoscopic uretero-cysto-anastomosis (UCA) in patients with lower ureteral strictures of various etiologies. Over the period from 2010 to 2014, 12 patients (8 females and 4 males) aged 19 to 64 years (mean age 35.6 ± 8.5 years) underwent laparoscopic UCA. In all females, iatrogenic ureteral injury occurred during gynecological surgery. Types of gynecological surgeries were an open or laparoscopic hysterectomy (5), excision of endometriosis nodules (2), and resection of the ovaries (1). In men indications for surgery were ureteral strictures after ureteroscopy (3) and neuromuscular dysplasia (1). The operation was performed in lithotomy position by transperitoneal access using 4 trocars. In all cases, extravesical ureteral reimplantation into the bladder was performed. The stent was removed after week four, excretory urography and cystography were conducted. The operation was thought to be successful in all patients. There were no cases of conversion and no need in blood transfusion. In 4 patients we performed psoas-hitch + UCA, in 2--Boari operation, in 5--direct UCA. The patient with neuromuscular dysplasia longitudinal resection of the lower third of the ureter was carried out. Then it was sutured on the stent by interrupted sutures, and extravesical implantation into the bladder was performed. Mean duration of surgery was 145 minutes (110 to 230 minutes), mean blood loss--180 ml (from 120 to 245 ml). Passive asymptomatic vesicoureteral reflux was observed in 3 patients. Laparoscopic UCA is a highly effective intervention with the functional results similar to those of open surgery.