Laparoscopic urinary tract reconstruction for iatrogenic ureteral injuries: a retrospective observational study from a single high-volume referral center.

BACKGROUND

Iatrogenic ureteral injuries are challenging complications that may require complex urinary tract reconstruction. Although laparoscopic approaches have been increasingly adopted, detailed clinical outcomes of laparoscopic reconstruction for iatrogenic ureteral injuries remain limited. This study aimed to evaluate the surgical outcomes of laparoscopic urinary tract reconstruction for iatrogenic ureteral injuries at a single high-volume referral center.

METHODS

We conducted a retrospective single-center observational cohort study of consecutive patients who underwent laparoscopic ureteral reconstruction for iatrogenic ureteral injuries at Kameda Medical Center, Japan, between January 2012 and December 2024. Patients who underwent reconstruction for non-iatrogenic ureteral injuries or open surgery were excluded. The reconstructive procedures included ureteroneocystostomy (n=14), ureteroneocystostomy with a Boari flap (n=7), and ileal interposition using an isolated ileal segment (n=4). The perioperative outcomes, including operative time, blood loss, complications, and hospital stay, were analyzed. The long-term outcomes were assessed with respect to surgical success, which was defined as the absence of recurrent obstruction or the need for further intervention.

RESULTS

Twenty-five consecutive patients were included. The median patient age was 51 years, and 92% of the patients were female. Gynecological procedures, most commonly hysterectomies, accounted for 80% of all injuries. The median interval between injury and repair was 261 days. The median operative time was 291 min, and the median blood loss was 20 mL. None of the procedures required conversion to open surgery. Five patients experienced Clavien-Dindo grade ≥III complications. Reoperation was required in three cases (two after ileal interposition and one after Boari flap), all of which ultimately achieved successful reconstruction.

CONCLUSIONS

Laparoscopic ureteral reconstruction is feasible and effective for iatrogenic ureteral injuries, with acceptable morbidity and high success rates. These results highlight the value of minimally invasive reconstructive strategies and may inform surgical decision-making in similar high-volume settings.