Transperitoneal unstented ureteral reimplantation for injuries postgynecological surgery

Pelvic ureteral injuries represent a serious surgical accident due to the potential damage they may cause to renal function. We report here the results of 19 years of experience with reconstruction of distal ureteral injuries by transperitoneal unstented reimplantation. This was a prospective cohort study undertaken at Barão de Lucena and University Hospitals, Recife (Brazil). Forty-seven patients with ureteral obstruction postgynecological surgery were routinely operated using the initial incision. The ureter was identified, dissected, and reimplanted through the peritoneal cavity. No stent was necessary. The average surgical time was 70 min (45-180 min). A psoas hitch or a Boari-Ockenblad bladder flap was required in six (12.8%) and four (8.5%) patients, respectively. Among 32 patients without fistula, 28 (87.5%) had complete and four (12.5%) had partial hydronephrosis regression without clinical repercussions. The cure rate was 100%. There were no complications. Routine primary unstented distal ureteral reimplantation using the transperitoneal approach is an effective and safe treatment strategy for injuries following benign gynecological surgery.