Long-Term Outcomes of Laparoscopic Repair of Complex Ureteral Injuries: A Single-Center Experience

Abstract

Ureteral injuries, often iatrogenic during gynecological or endo-urological procedures, can severely impact quality of life and renal function, potentially causing sepsis or renal failure. The distal ureter is most vulnerable, and resulting strictures require management based on their cause, location, and length. Short distal strictures are treated with ureteroureterostomy or ureteroneocystostomy, while longer ones may require a Boari flap with psoas hitch or ileal ureter replacement. This study evaluates postoperative renal function and symptoms recurrence in patients treated with these techniques for complex ureteral injuries. A retrospective review of 14 patients treated between 2007 and 2017 was conducted. Nine underwent laparoscopic Boari flap and five ileal loop interposition, with at least five years of follow-up. Intraoperative and postoperative outcomes were analyzed. Indications included endoscopic surgery strictures (3), radiation-induced strictures (2), and non-urological iatrogenic injuries (7). Two patients had primary ureteral cancer. Mean operative time was 158 minutes, and hospital stay averaged 2.1 days. Preoperative creatinine was 1.3 mg/dL, increasing to 1.4 mg/dL and 1.5 mg/dL at one and three months postoperatively. CT cystogram showed vesicoureteral reflux in all Boari flap patients. At five years, all patients were symptom-free with unobstructed ureters. Complications included one ileus and one anastomotic stricture. Boari flap and ileal ureter replacement are effective alternatives for complex ureteral strictures, preserving renal function. Larger studies are needed to validate these findings against standard open techniques.