Robotic Assisted Lower Ureteric Reimplantation with Psoas Hitch repair following an Iatrogenic Injury

Background The risk of injury to the ureter during an abdominal hysterectomy is estimated at 1.3% [1] . This injury often occurs following ligation of the uterine vessels as the ureter crosses under the artery. Objective To illustrate a minimally-invasive approach in the surgical management of a distal ureteric injury. Method A 45 year old female was reviewed in an outpatient setting with a left nephrostomy insitu following an intraoperative injury to her left distal ureter during a hysterectomy for a large fibroid. An initial attempted endoscopic realignment procedure was unsuccessful. Operative Method The ureter was mobilised proximal to healthy tissue with preservation of the adventitia. The bladder was mobilised and a psoas hitch performed to ensure a tension free anastomosis. The ureter was then spatulated and anastomosed into the bladder over a JJ stent. Results The patient had an uneventful post-operative course and was discharged home on day 4 with the JJ stent and urinary catheter insitu. At post-operative day 14, the patient returned for a urinary catheter removal, cystoscopy and JJ stent removal, the ureteric reimplantation was found to be successful. Conclusion A robotic assisted technique is a safe and effective approach for distal ureteric reimplantation.