Treatment of symptomatic primary obstructive megaureter by laparoscopic intracorporeal or extracorporeal ureteral tapering and ureteroneocystostomy: experience on 11 patients.

Purpose: To present our experience and the feasibility with laparoscopic ureteral reimplantation using ureteral tapering (intracorporeal or extracorporeal) for symptomatic primary obstructive megaureter.

Patients And Methods: Between June 2005 and September 2010, 11 patients (mean age: 33.2 years) with symptomatic congenital primary obstructive megaureter underwent laparoscopic reconstruction. All patients underwent laparoscopic intracorporeal or extracorporeal ureteral tailoring and ureteroneocystostomy by the same surgical team. The relevant perioperative details and complications were recorded.

Results: No open conversions or blood transfusions were necessary. Total mean operative time was 142 minutes (range 109-227 min). The mean operative time for the five patients with intracorporeal tailoring was 154 minutes (range 121-227 min), compared with 125 minutes (range 109-165 min) for the six patients with extracorporeal tailoring. The mean blood loss was 45 mL (range 30-85 mL) for all cases. Mean postoperative hospital stay was 6.4 days (range 5-8 days). In one patient, urinary leakage was noted immediately postoperatively; it disappeared spontaneously with conservative treatment by postoperative day 7. Average follow-up was 18 months (range 13-24 mos). Follow-up renal ultrasonography and intravenous urography confirmed decreased hydronephrosis with good drainage. Nonobstructed clearance was also demonstrated using diuretic renography in all cases.

Conclusions: Laparoscopic intracorporeal or extracorporeal ureteral tailoring and ureteroneocystostomy is a feasible and reproducible procedure. Follow-up revealed satisfactory objective and subjective outcomes.