Laparoscopic submucosal tunneling ureteroneocystostomy with psoas hitch: 22 cases report
WU Zhenqi1,2, GONG Huijie2, SHI Jing2, FENG Yingying2, GAO Wenfeng2, LI Yanfeng2, WU Yabing2, MA Xuetao2, LIU Jingbo2, DAI Linfeng2, DUAN Junyao2, YAN Yongji2
1Beijing Miyun District Hospital of Traditional Chinese Medicine; 2Dongzhimen Hospital, Beijing University of Chinese Medicine ,Beijing 100700, China
Abstract：Objective： To investigate the surgery indications and describe the techniques and results of laparoscopic submucosal tunneling ureteroneocystostomy in combination with psoas hitch to restore urinary tract continuity in patients with medium-length distal ureteral defects. Methods： From January 2012 to March 2019, a total of 22 patients (10 males and 12 females) with age ranged from 21 to 55 years, (mean, 40.6±7.2 years), suffering from distal ureteral diseases, were given the laparoscopic operation of ureteral submucosal tunneling reimplantation combined with psoas hitch. The perioperative data were retrospectively collected. The etiologies included ureteral strictures secondary to endoscopic laser lithotripsy in 7patients, previous gynecological surgeries in 6 patients, infiltrative ureteral endometriosis in 3 patients, and ureteral strictures without obvious causes in the remaining 6 patients. The defective length ranged from 4 to 8 cm (mean, 5±1.6 cm) and the diameter of upper ureter ranged from 0.7 to 2.5 cm (mean, 1.3±0.7 cm). The anterior-posterior pelvic diameter ranged from 1.5 to 4.1 cm (mean, 2.6±0.8 cm). During the operation, the distal ureter and the bladder were adequately mobilized. After the bladder was hitched to the musculus psoas major or psoas minor tendon, submucosal tunneling ureteroneocystostomy was performed. Results： In all patients, the laparoscopic procedure was successfully performed without conversion to open. The operating time ranged from 130 to 230 min (mean, 168±30.2 min), the estimated blood loss ranged from 15 to 120 mL (mean, 60±30.2 mL) and the drainage time ranged from 4 to 8 days (mean, 6±0.5 days). The Foley catheter was removed on postoperative day 7. The length of postoperative hospital stay ranged from 8 to 11 days (mean, 9±1.2 days). The double J ureteral stent was removed at 2nd-3rd month after the operation. All patients experienced symptomatic relief within a follow-up of 5 to 80 months (mean, 48.4±25.3 months). No major complications defined as urine leak, fistula or ureteral stenosis, occurred during the follow-up period. Ultrasonography and IVU showed mild hydronephrosis in 8 cases and no obvious hydronephrosis in 14 cases. Voiding cystogram revealed mild reflux in 1 of the 22 cases. Conclusion： Extravesical submucosal tunneling ureteroneocystostomy combined with psoas hitch under laparoscopy is a feasible and effective option with little damage and quick recovery for medium-length distal ureteral defects in selected patients. Tension free anastomosis was achieved owing to the psoas hitch procedure. The submucosal tunneling ureteroneocystostomy efficiently improved the antireflux mechanism, reducing the chances of retrograde infection and chronic impairment to the kidney.
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