Videosurgery
Transvesical laparoendoscopic single-port reimplantation for primary obstructive megaureter in an adult: first clinical experience
Marek Roslan1-2, Maciej Przudzik1-2, Michał Borowik1-2
1Department of Urology, Faculty of Medicine, University of Warmia and Mazury, Olsztyn, Poland
2Department of Urology and Oncological Urology, Regional Hospital of the Ministry of the Interior and Administration, Olsztyn, Poland
Citation: Roslan M, Przudzik M, Borowik M Transvesical laparoendoscopic single-port reimplantation for primary obstructive megaureter in an adult: first clinical experience. www.ceju.online/journal/2022/megaureter-reimplantation-minimally-invasive-surgery-2201.php
Key Words: reimplantation • laparoendoscopic single-site surgery • minimally invasive surgery • megaureter

An incidence of megaureter is 1 per 10,000 population. Megaureters found in older patients with pain or infection are likely to need surgery. Although various minimally invasive procedures have been reported, there is no universally accepted endoscopic technique for megaureter repair. We describe our first clinical experience of using the transvesical laparoendoscopic single-site surgery (T-LESS) for megaureter reimplantation.
In September 2019, we carried out the T-LESS reimplantation of a symptomatic left megaureter on a 68-year-old woman. The procedure was performed with a single-port device (TriPort+, Olympus, Germany) via a 1.5-cm incision made 2 cm above the pubic symphysis. A standard 10-mm optic and straight laparoscopic instruments were used. The left ureteral orifice was identified and separated from the bladder mucosa by a circular cut using a hook electrode. A 6-cm long distal segment of the ureter was dissected and pulled into the bladder. The submucosal tunnel was made. The orifice and 2.5-cm intramural ureter were resected, and the remaining ureter was implanted according to the Glenn-Anderson technique with running absorbable V-Loc™ suture. A double-J catheter and a Foley catheter were left for 10 weeks and 7 days, respectively. The oral intake of cephalosporine was administered for ten days.
The operative time was 200 minutes. No extra port was inserted except for a grasper introduced via the urethra to facilitate some steps of the procedure. No significant bleeding or other complications were observed. The postoperative hospital stay was 42 hours. During a one-year follow-up the left hydronephrosis was decreased significantly, and ultrasound, scintigraphy and computed tomography examinations revealed complete resolution of left hydronephrosis and normal function of both kidneys.
The T-LESS technique for reimplantation of megaureter appeared to be safe and effective. Nevertheless, further experience and observations are necessary.

Article history
Submitted: 11 February, 2022
Accepted: 17 March, 2022
Published online: 20 March, 2022
doi: 10.5173/ceju.2022.0016
Corresponding author
Marek Roslan
email: mroslan@gumed.edu.pl
Conflicts of interest:  The authors declare no conflicts of interest.
This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0). License (http://creativecommons.org/licenses/by-nc-sa/4.0/).
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