Laparoscopic Extravesical Submucosal Tunneling Ureteroneocystostomy Combined with Psoas Hitch for Medium-Length Distal Ureteral Defects in Adults

Abstract

Objective: This study aims to describe the technique and feasibility of laparoscopic submucosal tunneling ureteroneocystostomy in combination with psoas hitch to restore urinary tract continuity in patients showing medium-length distal ureteral defects. Materials and Methods: From January 2012 to April 2016, a total of 13 patients (4 males and 9 females) with a mean age of 37 years were performed with the laparoscopic operation of ureteral submucosal tunneling reimplantation combined with psoas hitch. The mean defective length was 5.5 cm (range 4-8 cm). The etiologies included ureteral strictures secondary to endoscopic laser lithotripsy in 2 patients, previous gynecological surgeries in 4, infiltrative ureteral endometriosis in 3, as well as ureteral strictures without obvious causes in the remaining 4. Results: The operations were successfully performed in all patients. The mean operating time was 179 min (range 150-230 min). The mean estimated blood loss was 32 mL (range 15-80 mL). The mean drainage time was 5.8 days (range 4-8 days). No major complications occurred during the perioperative period. The mean follow-up time was 25 months. All patients experienced symptomatic relief and showed good urine drainage. Conclusion: Extravesical submucosal tunneling ureteroneocystostomy combined with psoas hitch under laparoscopy is a feasible and effective option for medium-length distal ureteral defects in selected patients.

Psoas hitch procedure in 166 adult patients: The largest cohort study before the laparoscopic era

“…The psoas hitch procedure has so far been performed predominantly with an open approach. However, case series ranging from 9 to 18 patients, 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 and one prospective cohort study of endometriosis patients (psoas hitch n = 94), 30 reported on the feasibility of laparoscopic and robot‐assisted psoas hitch procedures with outcomes comparable to open surgery. For future research on psoas hitch procedures performed with a laparoscopic or robotic approach, our advice is to carry out effective follow‐up and documentation of patients in whom a psoas hitch is performed, in order to be better able to assess the long‐term results of the psoas hitch procedure.…”

Metallic Ureteric Stents a cost-effective alternative in the management of Obstructed Distal Ureters

“…Surgical interventions, such as reimplantation of the ureter with psoas hitch, Boari lap or ureteroneocystostomy will re-establish drainage of urine from the kidney [1][2][3]. Creation of an orthotopic sigmoid neobladder will likewise effectively correct the obstruction and prevent permanent damage to renal function [4].…”

A Modified Transurethral Stenting Technique for (Robot-Assisted) Laparoscopic Ureteral Reimplantation

“…Recently, with the wide adoption of minimally invasive techniques in urology, ureteral reimplantation (UR) has experienced a transition from open to laparoscopic and robotic approach. Compared to OUR, minimally invasive approach is associated with less blood loss, reduced postoperative analgesic consumption, and shorter hospital stay while yielding similar clinical outcomes [3][4][5][6].…”