Robotic-assisted ureteral reimplantation and psoas hitch after ureteral injury during cesarean section.

Int Urogynecol J

Department of Urology, Wake Forest Baptist Health, One Medical Center Boulevard, Winston-Salem, NC, 27101, USA.

Published: October 2021

AI Article Synopsis

  • Ureteral injuries during gynecological surgeries can be treated using various methods, including endoscopic stents and more complex reconstructions like ureteroneocystotomy.
  • Many of these injuries occur during hysterectomies, making repair less familiar for gynecological surgeons dealing with intact uteri.
  • The presented technique highlights a delayed robotic-assisted ureteral repair in a woman who suffered an injury during a cesarean section, emphasizing modifications needed for surgery while the uterus is intact.

Article Abstract

Introduction And Hypothesis: Ureteral injury during gynecological surgery can be managed in a variety of ways, from endoscopic stent placement to ureteroneocystotomy with accompanying psoas hitch and/or Boari flap. The majority of these occur during hysterectomy; therefore, gynecologic surgeons may not be as familiar with repair in women with intact uteri. Herein we present our technique for delayed robotic-assisted ureteral reimplant and psoas hitch in a woman with a ureteral injury sustained during cesarean section, which initially presented as a uretero-cervical fistula.

Methods: In this video, we describe the evaluation and surgical management of a patient with delayed recognition of a left distal ureteral injury sustained during cesarean section. We present necessary modifications to robotic-assisted laparoscopic ureteroneocystostomy and psoas hitch to accommodate an intact uterus including the need for uterine manipulation, division of the round ligament, bladder mobilization from the lower uterine segment and development of the retropubic space, reimplantation steps, and psoas hitch.

Conclusions: Simple modifications to a traditional technique of robotic-assisted ureteroneocystotomy effectively compensate for the presence of a uterus. Obstetricians should maintain a high index of suspicion for ureteral injury in women with new-onset severe urinary leakage post-cesarean section.

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Source
http://dx.doi.org/10.1007/s00192-020-04627-4DOI Listing

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