Laparoscopic Ureterovaginal Fistula Repair-Ureteric re-implantation|Dr Kiran Shetty|Urologist|Mysore скачать в хорошем качестве

Laparoscopic Ureterovaginal Fistula Repair-Ureteric re-implantation|Dr Kiran Shetty|Urologist|Mysore

Here’s a step-by-step outline of Laparoscopic Ureterovaginal Fistula Repair, commonly performed after iatrogenic injury during hysterectomy or pelvic surgery Indication • Persistent urinary leakage per vagina following surgery. • Confirmed diagnosis of ureterovaginal fistula on imaging CT urography, cystoscopy. Preoperative Preparation • IV antibiotics. • Ureteral stent (DJ stent) sometimes pre-placed to aid identification. • Bowel preparation in selected cases. • Lithotomy with Trendelenburg position (to expose pelvis). Procedure Steps 1. Port Placement • Standard 3–4 port laparoscopic configuration. • Camera port infra-umbilical, working ports in lower quadrants. 2. Access & Exposure • Pneumoperitoneum created. • Pelvic adhesions released. • Ureter identified at pelvic brim and traced downwards. 3. Identification of Fistula • Dissect ureter to site of fistula. • Fistulous communication between ureter and vagina identified. • Vaginal end separated carefully from surrounding tissue. 4. Excision & Mobilization • Fistulous tract excised. • Ureter mobilized proximally to achieve a tension-free anastomosis. • Adequate spatulation of ureteric end performed. 5. Ureteric Reimplantation • Two main options depending on fistula site: • Ureteroneocystostomy (direct bladder implantation) if length is sufficient. • Psoas hitch or Boari flap if additional length required. • Ureter implanted into bladder mucosa laparoscopically. • 4-0/5-0 absorbable interrupted sutures used. • DJ stent placed across anastomosis. 6. Closure • Watertight anastomosis confirmed. • Peritoneum closed over repair to separate from vagina. • Suction drain may be placed. Postoperative Care • Foley catheter maintained for 10–14 days. • Ureteral stent left for 4–6 weeks. • Antibiotics and analgesics. • Follow-up imaging. Outcomes • Laparoscopic repair offers shorter hospital stay, less morbidity, and good long-term success. • Recurrence rare if meticulous dissection and tension-free reimplantation.