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.