Laparoscopic Ureteroneocystostomy: Be Prepared!

STUDY OBJECTIVE: To assess the outcomes and complications of laparoscopic ureteroneocystotomy in gynecologic surgery. DESIGN: We retrospectively reviewed all medical records of patients who underwent ureteroneocystostomy between April 2008 and May 2012. DESIGN CLASSIFICATION: Retrospective case series study. SETTING: A university tertiary care hospital. PATIENTS: Nine patients underwent ureteroneocystostomy: 3 patients had ureteral endometriosis stenoses; and 6 patients had iatrogenic ureter injuries. INTERVENTIONS: All procedures were performed laparoscopically. The ureterovesical re-implantation was unilateral in 8 cases and bilateral for 1 patient. MEASUREMENTS AND MAIN RESULTS: The mean operating time was 226.7 min (range, 120-480). Average blood loss was 114.4 mL (range, 30-400). The mean duration of the in-dwelling catheter was 10.4 days (range, 7-21); the average hospital stay was 12.6 days (range, 6-26). The mean duration of the ureteral double J stent was 7.8 weeks (range, 6-16). One patient was re-operated for vaginal and laparoscopic drainage of a pelvic abscess on the sixth postoperative day. The median follow-up time was 20.8 months (range, 9-36), No patient had stenosis or breakdown of a suture line. CONCLUSIONS: Our series confirms the feasibility and the effectiveness of laparoscopic ureteroneocystostomy. This minimally invasive approach, which avoids laparotomy, requires a multidisciplinary team.