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Review
. 2019 May;72(4):428-435.

[Post-hysterectomy uretero-vaginal fistula: Laparoscopic management with ureteroneocystostomy and psoas hitch]

[Article in Spanish]
Miguel Efrén Jiménez-Romero  1 , Inés Saucedo-Giménez  1 , Cristina Gimeno-Cerezo  2 , Sara Díez-Farto  1
Affiliations
  • PMID: 31070140
Review

[Post-hysterectomy uretero-vaginal fistula: Laparoscopic management with ureteroneocystostomy and psoas hitch]

[Article in Spanish]
Miguel Efrén Jiménez-Romero et al. Arch Esp Urol. 2019 May.

Abstract
in English, Spanish

This paper describes our initial experience with laparoscopic ureteroneocystostomy in two patients with distal ureter lesions following gynaecological surgery (hysterectomy). Furthermore, we review the evidence on the incidence, prevention, and management of urinary tract injuries that occur during laparoscopic gynaecological surgery. METHOD: Two patients with iatrogenic lower ureteral injuries during hysterectomy leading to ureterovaginal fistula underwent laparoscopic ureteroneocystostomy with a psoas hitch. RESULTS: The procedures were successfully performed without any conversion. No intraoperative or postoperative complications were noted. Our minimally invasive approach has yielded successful results, similar to those achieved through open surgical repair. CONCLUSION: Laparoscopic ureteroneocystostomy with a psoas hitch for ureterovaginal fistula secondary to hysterectomy is a safe and feasible option for patients with gynecologic distal ureteral injury, with excellent results and low morbidity.

Presentamos nuestra experiencia inicial mediante ureteroneocistostomía laparoscópica en dos pacientes con lesión del uréter distal tras cirugía ginecológica (histerectomía). A su vez, se lleva a cabo una revisión de la literatura acerca de la incidencia, prevención y manejo de las lesiones urinarias secundarias a cirugía laparoscópica ginecológica.MÉTODO: Presentamos dos pacientes con fístula ureterovaginal tras lesión ureteral distal post-histerectomía, que son sometidos a ureteroneocistostomía por vía laparoscópica aplicando la técnica de vejiga psóica. RESULTADOS: Ambos procedimientos se realizaron con éxito sin necesidad de reconversión a cirugía abierta. No se objetivaron complicaciones intra ni postoperatorias. Nuestro enfoque mínimamente invasivo ofrece excelentes resultados, similares a los obtenidos en la reparación quirúrgica por vía abierta. CONCLUSIÓN: El tratamiento de la fístula ureterovaginal secundaria a lesión ureteral distal post-histerectomía, mediante ureteroneocistostomía laparoscópica aplicando técnica de vejiga psóica, es una técnica factible y segura, con buenos resultados y bajas tasas de morbilidad asociada.

Keywords: Complicaciones postoperatorias; Fistula genitourinaria; Genitourinary fistula; Laparoscopia; Laparoscopy; Lesión ureteral; Postoperative complications; Psoas hitch; Reimplante ureteral; Ureteral reimplantation; Ureteric injury; Vejiga psoica.

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