Laparoscopic extravesical ureteral reimplantation (LEVUR): a systematic review

Clinical indications for ureteral reconstruction include strictures, trauma (often iatrogenic), vesicoureteral reflux (VUR), fistulas, and malignancy (1-3). Short ureteral defects can be managed by ureteroureterostomy, or ureteroneocystostomy. Longer defects require complex procedures such as psoas-hitch ureteral reimplantation often combined with a Boari flap. Traditionally, open ureteral reimplantation has been the gold standard for ureteral reconstruction (1,2,4-6). Laparoscopy provides patients the advantages of quicker recovery, low post-operative morbidity, less postoperative pain, less blood loss and better cosmesis (7,8). Successful results using laparoscopic ureteral reimplantations have been reported in the literature to treat ureteral strictures, iatrogenic injuries, VUR, and ureterovaginal fistulas (8,9). It demonstrates that laparoscopic ureteral reimplantation has comparable functional outcomes to open surgery (8). However, in reconstructive surgery early reported success rates can be misleading and the long-term outcomes are important in assessing the efficacy of the procedure. In this study, we review medium-term outcomes of laparoscopic ureteral reimplantation and discuss current developments of this procedure