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Artículo Tomo 70, Número. 4, Mayo 2017

Archivos Españoles de Urología

Laparoscopic uretero-ureterostomy for iatrogenic lesions of the distal uréter.

Authors: Álvaro Juárez Soto, Rubén Campanario Pérez, Rocío Sáiz Marenco, Javier Amores Bermúdez, Manuel Soto Delgado, Jose Miguel Arroyo Maestre y Margarita De Paz Suárez.

Arch. Esp. Urol. 2017; 70 (4): 429-435

Vol. 70, Number. 4, May 2017

OBJECTIVES: The most frequent ureteral lesions are iatrogenic, mainly due to gynecologic and urologic procedures. The resolution and repair of these lesions, when they require surgery, is often the performance of ureteroneocystostomy.

We describe the technique for the repair of distal ureter lesions that preserves both anatomy and function of the urinary tract (1). The operation consists in dissection and extraction of the distal ureteral stump from its intramural tract to get at least 1 cm of free ureter, percutaneous insertion of a ureteral stent, checking the absence of tension between proximal ureter and distal dissected stump, end to end anastomosis and reinsertion of the distal ureter in the previously dissected bladder muscle layer.

We present 4 cases of ureteral injury after laparoscopic simple total hysterectomy for uterine myomas with complete section of the distal ureter, that were operated 3-5 days after injury, performing laparoscopic repair surgery. We performed clinical and radiological control with intravenous urography demonstrating ureteral continuity normalization and good renal function. We believe that repair of the urinary tract with anatomical and physiological preservation must be the first option in the laparoscopic treatment of complete distal ureteral injuries, and intramural ureter dissection when needed avoids the performance of ureteroneocystostomy. It is necessary to keep progressing in the technique improvement, and to increase the number of cases and experience.

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