Clinical Application Of Laparoscopic Free Ureteral Reimplantation

Objective:To introduce the new technique of laparoscopic free ureteral reimplantation and to evaluate its feasibility and clinical significance.Methods:From June 2002 to January 2008,36 cases(21 man and 15women) of ureterovesical Obstruction were operated with transperitoneal laparoscopic free ureteral reimplantation.They were retrospectively studied in this research,in order to sum up the process,subsequent complications,aftertreatment and follow-up of transperitoneal laparoscopic free ureteral reimplantation and evaluate clinical values. Among the cases(left in 20,right in 14 and bilateral in 2),26 cases had been diagnosed to have ureter orifice stricture,in which 6 combined with ureter calculi and 2 with terminational ureteral tumor,1 case had left renal tuberculosis combining with bilateral ureter orifice stricture,and 10 cases were diagnosed to have the congenital megaureter.Results:The operations were all successful in 36 cases with operating time of 60～180 min(mean 100 min)and blood loss of 30～120 ml(mean 60 ml).The patients were discharged 3～14 days(mean 7d)after surgery without urine leakage or hydronephrosis aggravating.During 1～60 months' follow-up,ultrasound B and IVU showed moderate or mild hydronephrosis in 21 cases and no obvious hydronephrosis in 15 cases.1～ 60 months after surgery cystography showed no urine reflux in all cases. Cystoscope in 5 cases showed papillary ureteral termination(1.5～2.0cm) and urine spurting.Conclusions:Transperitoneal laparoscopic free ureteral reimplantation,in possession of the advantages of both laparoscopic surgery and free ureteral reimplantation,has minimal invasion,clear view, less suffering and complications,excellent anti-urine reflux effect and quicker recovery.It plays an important role in the treatment of ureterovesical junction obstruction.