Laparoscopic reconstruction of iatrogenic-induced lower ureteric strictures: Does timing of repair influence the outcome?

Abstract

Context:Influence of timing of repair on outcome following laparoscopic reconstruction of lower ureteric stricturesAims:To assess the influence of timing of repair on outcome following laparoscopic reconstruction of lower ureteric strictures in our adult patient population.Settings and Design:Single surgeon operative experience in two institutes. Retrospective analysis.Materials and Methods:All patients were worked up in detail. All patients underwent cystoscopy and retrograde pyelography prior to laparoscopic approach. Patients were categorised into two groups: early repair (within seven days of inciting event) and delayed repair (after two weeks). Operative parameters and postoperative events were recorded. Postprocedure all patients were evaluated three monthly. Follow-up imaging was ordered at six months postoperatively. Improvement in renal function, resolution of hydronephrosis and unhindered drainage of contrast through the reconstructed unit on follow-up imaging was interpreted as a satisfactory outcome.Statistical Analysis Used:Mean, standard deviation, equal variance t test, Mann Whitney Z test, Aspin-Welch unequal variance t test.Results:Thirty-six patients (37 units, 36 unilateral and 1 simultaneous bilateral) underwent laparoscopic ureteral reconstruction of lower ureteric stricture following iatrogenic injury - 21 early repair (Group I) and 15 delayed repair (Group II). All patients were hemodynamically stable at presentation. Early repair was more technically demanding with increased operation duration. There was no difference in blood loss, operative complications, postoperative parameters, or longterm outcome.Conclusions:In hemodynamically stable patients, laparoscopic repair of iatrogenically induced lower ureteric strictures can be conveniently undertaken without undue delay from the inciting event. Compared to delayed repairs, the procedure is technically more demanding but morbidity incurred and outcome is at par.

Laparoscopic ureteroneocystostomy for mid and lower ureteric strictures: Experience from a tertiary center

“…Recently, several reported studies on robotic ureteroneocystostomy have been published showing successful results similar to those obtained with the laparoscopic technique. [ 20 22 23 24 25 26 27 28 29 ] The present study results are in similar lines with the previous conducted studies as depicted in Table 3 . Uberoi et al .…”

“…Abraham et al . [ 20 ] concluded that in hemodynamically stable patients, laparoscopic repair of iatrogenically induced lower ureteric strictures can be conveniently undertaken without undue delay from the inciting event. Compared to delayed repairs, the procedure is technically more demanding but morbidity incurred and outcome is at par.…”

A retrospective comparison between laparoscopic and open ureteroneocystostomy for management of benign lower ureteral strictures: An experience in tertiary care centre of Eastern India

“…Previous literature also suggests the similar findings and concluded that laparoscopic ureteroneocystostomy is a safe and feasible option for lower ureteric stricture (Tables 3 and 4). [8][9][10][11][12][13][14][15][16][17][18][19] limitation of this study are, it is a single centre nonrandomised study with a small sample size.…”

“…22 Since then many studies had been published favouring the role of laparoscopy in ureteroneocystostomy. [9][10][11][12][13][14][15][16][17][18][19] Ureteroneocystostomy with or without Psoas hitch and Boari flap can be done using laparoscopic approach with a good success rate and having all advantage of minimal access surgery. 11 We were able to complete 93% of our laparoscopic surgery without need of conversion to open procedure.…”

“…22 Since then many studies had been published favouring the role of laparoscopy in ureteroneocystostomy. 9 –19…”