Laparoscopic ureteral anastomosis to a bladder diverticulum for the treatment of postoperative ureteral fistula: a case report.

OBJECTIVE

To investigate the feasibility and potential indications of laparoscopic ureteral anastomosis to a bladder diverticulum for the treatment of ureteral fistula in the setting of complex reoperative pelvic surgery.

CASE PRESENTATION: A 75-year-old man with a 7-year history of progressive dysuria underwent transabdominal laparoscopic bladder diverticulectomy and cystolithotomy combined with transurethral holmium laser enucleation of the prostate for benign prostatic hyperplasia-related bladder outlet obstruction, bladder stones, and bladder diverticula. Twelve days after surgery, the patient developed increased pelvic drainage output. Elevated drainage-fluid creatinine levels and computed tomography urography showing contrast extravasation from the left ureter with hydronephrosis confirmed a left ureteral fistula. During reoperation, severe adhesions around the left ureter and bladder precluded conventional reconstruction. A bladder diverticulum adjacent to the distal ureter was therefore used as an alternative implantation site, and laparoscopic ureteral reimplantation into the diverticulum was performed. At 4 months of follow-up, no progression of hydronephrosis, recurrent urinary leakage, or urinary tract infection was observed.

CONCLUSION

In selected patients with postoperative ureteral fistula, severe perivesical adhesions, and limited feasibility of conventional reconstruction during complex reoperative surgery, ureteral anastomosis to a bladder diverticulum may serve as an individualized salvage option for urinary tract reconstruction.