Laparoscopic ureteral reimplantation for a distal ureteral injury detected after laparoscopic radical prostatectomy

ABSTRACT

@#Distal ureteral injury is a rare complication of laparoscopic radical prostatectomy (LRP). The authorsreport such a case which was repaired successfully with an exclusively laparoscopic approach. Theyalso describe the advantages of the flank position when performing this minimally invasive approach.@*THE CASE@# 61-year-old Filipino male, with a PSA of 10 ng/cc, diagnosed with localized prostatecancer undergoes LRP, utilizing a posterior approach to the seminal vesicles. Intraoperatively, alarge intravesical median lobe was noted which was dissected meticulously after the division of thebladder neck. The excision of the 60gm prostate was completed in the conventional manner followedby a urethrovesical anastomosis. Blood loss was minimal with no apparent intraoperative events.Histopathology confirmed prostate cancer, Gleason score (4+3) with negative margins. Postoperatively,he had progressively high pelvic drain output and noticeably a relatively low urethral catheter output.CT urogram done on POD 8 showed a distal left ureteral disruption with intraabdominal extravasation.The authors performed a laparoscopic left ureteroneocystostomy on POD 9. The patient did wellafter the repair. After removing the indwelling catheter on postoperative day 14, he was dischargedin a good clinical condition. The ureteral stent was removed one month after the reimplantation.Follow-up CT urogram showed unobstructed flow through the reimplanted left ureter. Follow-upPSA at this time was 0.01ng/cc.@*CONCLUSION@#Ureteral injury following LRP is a devastating complication which may go undiagnosedintraoperatively. Prompt recognition, followed by a timely minimally invasive repair through alaparoscopic approach is needed to correct this problem.