[Laparoscopic ileal ureteral replacement for ureteral avulsion]

Ureteral avulsion is a serious complication of ureteroscopy and may require reconstructive procedures on the upper urinary tract. This study presents the outcomes of ileal ureteral replacement for ureteral avulsion.

We observed 6 patients with ureteral avulsion who underwent ileal ureteral replacement. There were 4 men and 2 women; the mean age was 42 years (range 36-65). In all cases, ureteral injury occurred during ureteroscopy with lithotripsy. Avulsion was diagnosed at the junction of the upper and middle thirds in 4 patients and below the ureteropelvic junction in 2 patients. In 4 patients, ureteral avulsion occurred in other clinics: three underwent exploration of retroperitoneal space with insertion of nephrostomy tube, and in one case the avulsed ureter was repositioned and anastomosed to its proximal end. In our institution, ureteral avulsion occurred in two patients; both underwent emergency ileal ureteroplasty, whereas the remaining 4 patients were operated on elective indications.

All procedures were successfully completed laparoscopically. Mean operative time was 190+/-45 min (range 170-260), and mean blood loss was 130+/-25 mL. Length of hospital stay ranged from 6 to 9 days. The ureteral stent was removed after 6-8 weeks; if a nephrostomy tube was present, antegrade pyelography was performed. In all patients, urinary drainage was removed and ureteral patency was restored.

Ureteral avulsion is a rare complication of ureteroscopy with lithotripsy and more often develops during removal of large proximal stones. In experienced centers performing bowel-segment reconstruction, emergency ileal ureteral replacement can be considered for ureteral avulsion.