Abstract:

Introduction: Although laparoscopy is widely established for ablative urologic procedures, pelvic reconstructive procedures are still mostly performed by open-surgery. As urologists continue to introduce advanced laparoscopic skills to reconstructive urologic procedures, we present our experience with a laparoscopic psoas hitch double ureteral re-implantation in a patient with an ureterovaginal fistula and an ipsilateral duplex urinary system.
Materials and Methods: A 42-year-old patient presented with continuous involuntary urine loss from the vagina after an abdominal hysterectomy. A double modified Lich-Gregoir ureteral re-implantation with a psoas hitch was performed, using a 4-port laparoscopic approach.
Results: There were no post-operative complications and the cystography at post-operative day 14 revealed good positioning of the psoas hitch, with no leak or reflux. At three-months follow-up, the patient is completely dry and asymptomatic.
Conclusion: Laparoscopic ureteroneocystostomy with psoas hitch for the treatment of lesions of the distal ureter is a possible, safe, and effective way to resolve a complex urologic situation with minimally invasive surgery. Laparoscopy is becoming the standard approach to urologic pelvic reconstructive procedures, even in the most complex cases.

Authors:

Tito Palmela Leitão, MD, FEBU, Head of Minimally Invasive Surgery Unit, Urology Department, Centro Hospitalar Lisboa Norte , Faculdade de Medicina de Lisboa, CAML, Centro Académico de Medicina de Lisboa, Lisboa, Portugal, Ricardo Pereira e Silva, MD, Chief Resident, Urology Department, Centro Hospitalar Lisboa Norte, Lisboa, Portugal, Sónia Barata, MD, Clinical Assistant, Obstetrics and Gynecology Department, Centro Hospitalar Lisboa Norte, Hospital Santa Maria, Lisboa, Portugal, Adalgisa Guerra, MD, Head of Unit, Radiology Department, Hospital da Luz, Lisboa, Portugal, Filipa Osório, MD, Head of Minimally Invasive Surgery Unit, Obstetrics and Gynecology Department , Hospital da Luz, Faculdade de Medicina de Lisboa, CAML, Centro Académico de Medicina de Lisboa, Lisboa, Portugal

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