Intracorporeal Tapering of the Ureter for Distal Ureteral Stricture Before Laparoscopic Ureteral Reimplantation

Purpose: To present our experience of laparoscopic ureteral reimplantation using intracorporeal ureteral tapering for management of distal ureteral stricture. Materials and Methods: Between April 2005 and October 2008, six patients, including 3 children and 3 adults, underwent laparoscopic modified Lich-Gregoir type extravesical ureteral reimplantation for distal ureteral stricture. Significant dilatations of proximal segment in these patients were repaired with intracorporeal ureteral tapering. Stricture etiologies were congenital ureterovesical megaureter and iatrogenic gynecologic injury in 4 and 2 patients, respectively. Results: Mean age of the patients was 29.3 years (range, 2 to 62 years). Mean operation time and hospital stay was 185 minutes (range, 150 to 240 minutes) and 4 days (range, 2 to 6 days), respectively. No significant complications were noted intra-operatively. Surgical procedure was performed in all the subjects laparoscopically and no conversion to open surgery happened. Postoperatively, 2 patients were complicated with febrile urinary tract infection that were managed medically. No urinary leakage occurred in early postoperative period. All the patients had patent ureterovesical junction anastomosis in follow-up imaging and recurrence of obstruction was noted in no cases. Two patients (33.3%) developed grade II vesicoureteral reflux. Conclusion: Laparoscopic ureteral reimplantation with intracorporeal tapering of distal segment may be performed safely in management of patients with distal ureteral stricture and severe dilatation of proximal segment.