Laparoscopic repair of iatrogenic long ureteral injury

Introduction: Transection of the ureter in laparoscopic retroperitoneal lymph node dissection (RPLND) is a rare iatrogenic complication. Its repair is possible by end-to-end anastomosis when the defect is short, but if there is a long defect, laparoscopic repair is a challenge. Methods: A 30-year-old man underwent modified RPLND of a clinically stage-A mixed germ cell of the left testis. While cutting the gonadal vein, 1.5 cm of the ureter was transected 2 cm below the renal pelvis and clipped by one of our residents. The injury was diagnosed immediately. After the completion of the modified RPLND, the clips were removed and a 20-mm defect of the ureter was seen precluding anastomosis. The kidney was dissected and pulled down 35 mm. The lower pole of the kidney was then fixed to the psoas muscle by a 2-0 vicryl, making anastomosis possible after an 8-mm spatulation of both sides. Anastomosis was done over a stent by interrupted sutures using 4-0 vicryl. Results: Leakage was 400 mL at the first postoperative day and ceased at the 4th day. On the control excretion urography, the kidney function was normal and a fullness of the caliceal system was seen. Conclusion: Long defect of the ureter that may occur in laparoscopic urological surgeries could be manageable laparoscopically using methods for shortening of the interval such as relocation of the kidney. Thus, a same approach as open surgeries can yield acceptable results in laparoscopic surgeries