UroToday- Urologic laparoscopy has evolved from an experimental technique to an efficacious surgical modality. Although many ablative procedures have become standard indications, reconstructive laparoscopic procedures are still at an early stage.

Long, obstructed ureteral segments are often managed by complex reconstructive procedures such as reimplantation with a psoas hitch or a Boari flap. In a recent study by J. Rassweiler and colleagues from Heidelberg, Germany, the role of laparoscopy in the management of ureteral obstruction is evaluated by comparison with a previous open series of open ureteroneocystotomies performed for similar ureteral pathologies, focusing on feasibility, safety, and short-term outcome. The study is published in the February 2007 issue of European Urology.

Over a two-year period,10 patients with a mean age of 52.2 years suffering from endoscopic refractory or primary ureteral strictures underwent laparoscopic ureteral reimplantation with a psoas hitch (n = 6) or with a hitch and a Boari flap (n = 4). Obstruction site was distal ureter in eight and mid ureter in two patients with a mean stricture length of 28.5 mm. This group was compared with ten patients who had undergone traditional open ureteroneocystotomy with a hitch (n = 8) or a Boari flap (n = 2) for similar indications. The laparoscopic group had a mean follow-up of 17 months while the open group had a mean follow-up of 65 months.

Analysis of the results showed that the mean operative time was longer in the laparoscopic group (228 minutes) versus 187 minutes for the open group. Blood loss (370 vs. 610 ml) and analgesic requirement (4.9 vs. 21.5 mg of piritramide) were significantly lower in the laparoscopic group. Mean time to oral intake (1.5 vs. 2.9 days), hospital stay (9.2 vs. 19.1 days), and convalescence time (2.3 vs. 4.2 weeks) were also significantly shorter in the laparoscopic group. Success rates were 100 % after laparoscopic surgery and 80 % after open surgery. No intra- or post-operative major complications occurred in the laparoscopic series while two complications occurred in the open series. One had an anastomotic stricture and one had urinary extravasation with abdominal hematoma formation.

The authors do point out that this reconstruction operation does require a high degree of laparoscopic skill and probably should be carried out only in centers of excellence. This laparoscopic procedure has shown great outcomes and provides the typical advantages of laparoscopy including less post-operative analgesics, shorter hospital stay, and faster convalescence. Rassweiler JJ, Gözen AS, Erdogru T, Sugiono M, Teber D, Deger S, Goddard J

Eur Urol. 2007 Feb; 51(2):512-23
Reviewed by UroToday Contributing Editor Michael J. Metro, MD

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