Difficulties in laparoscopic ureteral and bladder reconstruction

Rakesh V. Khanna, Ricardo Brandina, Andre Berger, Robert J. Stein, Inderbir S. Gill

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

Ureteral reconstruction may be required in the setting of iatrogenic injury to the ureter, infectious strictures from tuberculosis, or schistosomiasis, endometriosis, trauma, or malignancy. Injury to the ureter is most commonly iatrogenic in nature. These occur most commonly in gynecological, colorectal, or urological procedures. Mechanism of injury may include transection, ligation, cautery injury, or devascularization. If not recognized and repaired intraoperatively, patients may present postoperatively with a urine leak or fistula. A number of techniques exist for ureteral reconstruction. These include ureteroureterostomy, ureteroneocystostomy, psoas hitch, Boari flap, ileal ureter, and transureteroureterostomy (TUU). The choice of technique is dependent on the length and location of injury. These should be assessed by either intravenous urogram, computed tomography (CT) urogram, retrograde pyelography, ureteroscopy, or a combination of these techniques. In patients with a nephrostomy tube preoperatively, antegrade nephrostogram is often used in evaluating the proximal extent of injury. Additional preoperative investigations include a measurement of both total and ipsilateral renal function, especially when nephrectomy, ileal substitution or TUU is considered, and in cases of ureteroneocystostomy, an estimate of bladder capacity can be obtained. Augmentation cystoplasty remains the most widely accepted technique for patients requiring surgical augmentation of bladder capacity for protection of the upper urinary tract and provides urinary continence in patients with bladder dysfunction secondary to reduced functional capacity or poor compliance.1,2 With increasing experience in minimally invasive urology, a laparoscopic approach for each of these reconstructive techniques has been described. In general, the laparoscopic approach aims to duplicate the principles of open surgery. In the appropriate patient, laparoscopy offers the advantages of decreased pain and shorter convalescence.

Original languageEnglish (US)
Title of host publicationDifficult Conditions in Laparoscopic Urologic Surgery
PublisherSpringer London
Pages321-342
Number of pages22
ISBN (Print)9781848821040
DOIs
StatePublished - Dec 1 2011

ASJC Scopus subject areas

  • Medicine(all)

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    Khanna, R. V., Brandina, R., Berger, A., Stein, R. J., & Gill, I. S. (2011). Difficulties in laparoscopic ureteral and bladder reconstruction. In Difficult Conditions in Laparoscopic Urologic Surgery (pp. 321-342). Springer London. https://doi.org/10.1007/978-1-84882-105-7_23