Laparoscopic ureteral reimplantation with extracorporeal tailoring for megaureter: a simple technical nuance

Abstract

Purpose: We describe a novel technique of extracorporeal tailoring for megaureter to perform laparoscopic extravesical transperitoneal ureteral reimplantation. We present our initial results with this procedure.

Materials and methods: Three cases of megaureter were operated on laparoscopically. The 3-port technique was used (all 5 mm in 2 cases, and 2, 5 mm and 1, 10 mm in 1). The colon was reflected medially to expose the retroperitoneal course of the ureter. The ureter was gently dissected circumferentially down to the bladder. It was ligated close to the bladder and divided proximal to it. The free ureteral end was delivered out through the ipsilateral 5 mm port. The lower end was tailored over an 8Fr feeding tube. A 6Fr Double-J stent was placed. Later the whole assembly was carefully replaced in the abdomen. A Lich-Gregoir type extravesical reimplantation was done.

Results: Mean operating time was 220 minutes (range 210 to 240), which included 15 to 20 minutes to exteriorize the ureter, complete extracorporeal tailoring and replace the stented ureter in the abdomen. Mean blood loss was 40 ml. Cystourethrogram at 3 months did not demonstrate any reflux. Renal scan showed preserved renal function in all 3 cases, with prompt drainage in 2 and delayed drainage in 1. At a mean followup of 12 months all 3 patients were asymptomatic.

Conclusions: Extracorporeal tailoring for obstructing megaureter is an easy and safe procedure that makes laparoscopic ureteral reimplantation simpler and quicker to perform.