Laparoendoscopic Management of Midureteral Strictures

Abstract

The incidence of ureteral strictures has increased worldwide owing to the widespread use of laparoscopic and endourologic procedures. Midureteral strictures can be managed by either an endoscopic approach or surgical reconstruction, including open or minimally invasive (laparoscopic/robotic) techniques. Minimally invasive surgical ureteral reconstruction is gaining in popularity in the management of midureteral strictures. However, only a few studies have been published so far regarding the safety and efficacy of laparoscopic and robotic ureteral reconstruction procedures. Nevertheless, most of the studies have reported at least equivalent outcomes with the open approach. In general, strictures more than 2 cm, injury strictures, and strictures associated either with radiation or with reduced renal function of less than 25% may be managed more appropriately by minimally invasive surgical reconstruction, although the evidence to establish these recommendations is not yet adequate. Defects of 2 to 3 cm in length may be treated with laparoscopic or robot-assisted uretero-ureterostomy, whereas defects of 12 to 15 cm may be managed either via ureteral reimplantation with a Boari flap or via transuretero-ureterostomy in case of low bladder capacity. Cases with more extended defects can be reconstructed with the incorporation of the ileum in ureteral repair.

Boari flap reconstruction in a male infant with solitary kidney and associated megaureter

“…Renal autotransplantation6 is also described in the literature, but we felt that it was not a good option in our patient as this procedure requires ureteroneocystostomy; moreover, effective renal plasma flow of the solitary kidney was suboptimal.…”

Transumbilical laparoendoscopic single-site ureteral reimplantation

“…There are few series comparing open and laparoscopic surgery, among which are that of Rassweiler et al, 13 Data on outcomes in single-site laparoscopic reconstructive surgery are even more scarce. 15 The broadest multicenter casuistry of patients treated with LESS approach in urological surgery is the one presented by Kaouk et al, 16 in which 1076 consecutive cases performed between 2007 and 2010 in 18 institutions are analyzed. Among them, the vast majority of cases were excisional surgery with only a total of 98 cases (8.4%) of reconstructive surgery for obstruction of the upper urinary tract, including UPJ obstruction, ureteral stenosis, and retrocaval ureter.…”

Reimplantación ureteral laparoendoscópica por puerto único transumbilical

“…Los datos sobre resultados en cirugía reconstructiva laparoscópica por puerto único son todavía mucho más 15 . La casuística multicéntrica más amplia de pacientes tratados con abordaje LESS en cirugía urológica es la presentada por Kaouk et al 16 , en la que se analizan 1.076 casos consecutivos realizados entre 2007 y 2010 en 18 instituciones.…”