Document Detail


Laparoscopic ureteroneocystostomy and psoas hitch for post-hysterectomy ureterovaginal fistula.
MedLine Citation:
PMID:  18554656     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: We assessed the results of laparoscopic ureteroneocystostomy with a psoas hitch for iatrogenic lower ureteral injuries leading to a ureterovaginal fistula. MATERIALS AND METHODS: Between July 2003 and November 2007, 18 patients with iatrogenic lower ureteral injuries during hysterectomy leading to ureterovaginal fistula underwent laparoscopic ureteroneocystostomy with a psoas hitch. Of the patients 17 underwent abdominal or vaginal hysterectomy, while in 1 with a ruptured gravid uterus emergency hysterectomy was done for uncontrolled bleeding. Mean patient age was 35.5 years (range 23 to 45) and mean time to surgery since the injury was 2.2 months (range 1.5 to 3.5). Transperitoneal 3 or 4 port laparoscopic ureteroneocystostomy with a psoas hitch was performed. RESULTS: Of the procedures 17 were completed successfully. Intraoperative cardiac arrhythmia occurred in 1 patient due to pneumoperitoneum and hypercarbia, requiring open conversion. Mean operative time was 2.5 hours (range 1.9 to 2.8) hours, mean blood loss was 90 ml (range 45 to 150) and total hospital stay was 5.3 days (range 2.9 to 8). The nephrostomy tube was blocked on the table in all patients and it was removed on day 7. At an average followup of 26.4 months (range 3 to 52) postoperative excretory urography did not reveal obstruction in any patient. One patient had vesicoureteral reflux on voiding cystogram. CONCLUSIONS: Laparoscopic ureteroneocystostomy with a psoas hitch for ureterovaginal fistula secondary to hysterectomy is safe and effective, and associated with a low incidence of postoperative reflux and obstruction.
Authors:
Pranjal Modi; Rahul Gupta; S J Rizvi
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Publication Detail:
Type:  Journal Article     Date:  2008-06-12
Journal Detail:
Title:  The Journal of urology     Volume:  180     ISSN:  1527-3792     ISO Abbreviation:  J. Urol.     Publication Date:  2008 Aug 
Date Detail:
Created Date:  2008-07-14     Completed Date:  2008-09-02     Revised Date:  2009-02-04    
Medline Journal Info:
Nlm Unique ID:  0376374     Medline TA:  J Urol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  615-7     Citation Subset:  AIM; IM    
Affiliation:
Department of Urology and Transplantation Surgery, Institute of Kidney Diseases and Research Centre, Institute of Transplantation Sciences, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat, India.
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MeSH Terms
Descriptor/Qualifier:
Adult
Cohort Studies
Cystostomy / methods*
Female
Follow-Up Studies
Humans
Hysterectomy / adverse effects*,  methods
Iatrogenic Disease
Laparoscopy / methods*
Middle Aged
Recovery of Function
Retrospective Studies
Risk Assessment
Surgical Procedures, Minimally Invasive / methods
Treatment Outcome
Ureter / injuries*
Ureteral Diseases / etiology,  surgery
Urinary Fistula / etiology,  surgery*
Urodynamics
Uterine Diseases / pathology,  surgery
Vaginal Fistula / etiology,  surgery*
Comments/Corrections
Comment In:
J Urol. 2009 Feb;181(2):920; author reply 920   [PMID:  19110283 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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