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Artículo Tomo 70, Número. 4, Mayo 2017

Archivos Españoles de Urología

Laparoscopic ureteral reimplantation

Authors: Iván González Rodríguez, Rodrigo Gil Ugarteburu, Sergio Fernández-Pello Montes, Begońa Díaz Méndez, Rebeca Blanco Fernández y Javier Mosquera Madera.

Arch. Esp. Urol. 2017; 70 (4): 412-421

Vol. 70, Number. 4, May 2017

Although the laparoscopic ureteral reimplantation (LUR) has a history of over 20 years, its presence in the literature is relatively sparse, almost always in the form of small case series with low statistical power, which has prevented consistent results. It has proven to be a safe and effective technique, improving the safety profile and perioperative complications compared to open ureteral reimplantation (OUR). The few long-term results suggest a similar success rate between the open and laparoscopic approaches. Although we do not found in the literature a strong evidence of the benefits of anti-reflux reimplantation techniques in adults, most of the published series include these procedures.

Ureteral reimplantation is considered the treatment of choice in ureteral injuries below the iliac vessels. This is its main indication now. Intraoperative recognition of the injury and immediate LUR avoid other complications, but most of ureteral injuries are diagnosed in the early postoperative period. Although the classical recommendations advise urinary diversion and delayed treatment, the immediate approach is feasible, and indeed seems to improve results in complications, stay and long-term renal function. In situations of postoperative peritonitis secondary to a ureteral fistula, immediate LUR offers specific advantages, at least theoretically, for the protective effect of pneumoperitoneum in abdominal sepsis.

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