Ureteral reimplantation for management of ureteral strictures: a retrospective comparison of laparoscopic and open techniques.

Abstract:

OBJECTIVES:To compare the results of laparoscopic ureteral reimplantation with a previous series of open surgery. MATERIALS AND METHODS:We compared ten patients who underwent laparoscopic vesicopsoas-hitch with (n=4) or without Boari-flap (n=6) technique for ureteral obstructions with ten patients treated by open ureteroneocystostomy for similar pathologies. Patient demographics, preoperative symptoms, radiologic imaging, and postoperative outcomes were analyzed. Postoperative observation time averaged 17 mo (range: 9-23) in the laparoscopic and 65 mo (range: 18-108) in the open group. Success was defined as relief of obstruction in postoperative imaging studies and relief of pain. RESULTS:Mean length of stricture (28.5 vs. 25 mm) was comparable in both groups. In laparoscopy versus open surgery, mean operative time (228 vs. 187 min) was longer, blood loss (370 vs. 610 ml) and analgesic requirement (4.9 vs. 21.5mg) were significantly lower, and mean time to oral intake (1.5 vs. 2.9 d), hospital stay (9.2 vs. 19.1 d), and convalescence time (2.3 vs. 4.2 wk) were significantly shorter. Success rates yielded 10 of 10 after laparoscopy and 8 of 10 after open surgery. No intra- or postoperative major complications occurred in the laparoscopic series. After open surgery, two patients had major postoperative complications, including urinary extravasation with abdominal haematoma and anastomostic stricture, respectively. CONCLUSIONS:Laparoscopic ureteroneocystostomy is feasible, providing functional outcomes comparable to open surgery while offering the advantages of a minimal invasive technique (e.g., less postoperative analgesics, and shorter hospitalization and convalescence). Nevertheless, it requires a high level of laparoscopic expertise and should be carried out only in specialist centers.

journal_name

Eur Urol

journal_title

European urology

authors

Rassweiler JJ,Gözen AS,Erdogru T,Sugiono M,Teber D

doi

10.1016/j.eururo.2006.08.004

subject

Has Abstract

pub_date

2007-02-01 00:00:00

pages

512-22; discussion 522-3

issue

2

eissn

0302-2838

issn

1873-7560

pii

S0302-2838(06)00909-2

journal_volume

51

pub_type

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