Laparoscopic ureteral repair in gynaecological surgery

To review laparoscopic surgery in the treatment options for ureteral lesions in gynaecological surgery.

Laparoscopic treatment of ureteral injuries has been increasingly reported over the past years. Treatment has progressively shifted from ureteroneocystostomy performed by laparotomy to less invasive treatment options such as ureteral stenting or dilatation in case of stricture, stenting under laparoscopic guidance and laparoscopic stitching of lacerations, laparoscopic ureteral reanastomosis or laparoscopic ureteroneocystostomy for transections. Deep endometriosis surgery of an associated hydronephrosis is associated with a high incidence of ureteral lesions making preoperative stenting desirable in order to facilitate the eventual repair, while avoiding the more problematic insertion of a stent after a lesion is made.The available data confirm the excellent outcome of stenting obstructive lesions. When stenting proves difficult or in case of a ureteral leakage, laparoscopic aided stenting is strongly suggested, in order to avoid further damage while permitting simultaneous repair if necessary. Laparoscopic suturing of a laceration over a stent is clearly superior to stenting only. Results of ureteral reanastomosis of a transected ureter vary from 88 to 100%; an occasional subsequent stenosis can be treated with dilatation. Bladder reimplantation has become feasible by laparoscopy and results seem promising. Laparoscopic bladder reimplantation is suggested as the method of choice in case of failure of a previous laparoscopic treatment.

Data strongly support laparoscopy as the method of choice for the management of ureteral lesions.