Advancing Ureterovesical Trauma Management: The Role of Laparoscopy in Precision Repair

At WALS 2025, Dr. Javed Iqbal delivered an insightful lecture on the Role of Laparoscopy in Ureterovesical Trauma, emphasizing how minimally invasive techniques are revolutionizing the management of complex urinary tract injuries. Ureterovesical trauma, often resulting from iatrogenic injuries, pelvic surgeries, or blunt trauma, poses significant challenges in diagnosis and treatment. Traditionally managed through open surgery, laparoscopic approaches now offer better visualization, precise repair, reduced morbidity, and faster recovery.

Dr. Iqbal highlighted key laparoscopic techniques such as primary ureteral reimplantation, Boari flap reconstruction, and psoas hitch procedures, which ensure optimal functional outcomes while minimizing complications. He also discussed advancements in robotic-assisted laparoscopic repairs, which further enhance dexterity and surgical precision. The talk covered critical intraoperative considerations, including early identification of injury, careful ureteral mobilization, tension-free anastomosis, and the importance of ureteral stenting for post-repair healing.

In addition, he emphasized the role of laparoscopy in delayed ureteral injury management, where minimally invasive approaches help reconstruct strictures and improve long-term ureteral function. With increasing experience and technological advancements, laparoscopy is now a preferred alternative to open surgery, offering excellent outcomes with reduced hospital stay and minimal postoperative discomfort.

Dr. Iqbal concluded that early diagnosis, meticulous surgical planning, and expertise in laparoscopic suturing are key to successful ureterovesical trauma management, paving the way for better patient care in the era of minimally invasive surgery.

A ureterovesical fistula is an abnormal connection between the ureter and the bladder, often resulting from iatrogenic injury, radiation therapy, pelvic surgery, or prolonged ureteral obstruction. Management depends on the size, location, and duration of the fistula, as well as the patient’s overall condition.

1. Conservative Management (For Small, Early-Detected Fistulas)
• Ureteral Stenting (Double-J Stent): Helps bypass urine flow, allowing spontaneous closure in minor fistulas.
• Bladder Catheterization (Foley’s Catheter): Reduces bladder pressure and promotes healing.
• Antibiotics and Supportive Care: Prevents secondary infections.
• Observation: Small fistulas (≤5mm) may heal within 4-6 weeks.

2. Minimally Invasive Surgical Management
• Laparoscopic or Robotic Ureteral Reimplantation: Ideal for distal fistulas, involving excision of the affected ureteral segment and reimplantation into the bladder.
• Boari Flap or Psoas Hitch Procedure: Used if a large defect or ureteral shortening occurs, mobilizing the bladder for tension-free anastomosis.
• Ureteroureterostomy: Performed for mid-ureteral fistulas where direct anastomosis is possible.
• Endoscopic Approaches: Fulguration of the fistula tract or fibrin glue application in select cases.

3. Open Surgical Repair (For Complex or Recurrent Cases)
• Open ureteroneocystostomy remains an option when laparoscopic or robotic repair is not feasible.
• Ileal Ureter Interposition: Considered in cases of extensive ureteral loss.
• Nephrectomy (Last Resort): Only in nonfunctional kidneys with severe damage.

4. Postoperative Care & Follow-Up
• Ensure adequate urinary drainage with a stent for 4-6 weeks.
• Monitor renal function with imaging (IVU, CT Urography) and renal function tests.
• Early mobilization and hydration to prevent complications.

Laparoscopic and robotic-assisted approaches have significantly reduced morbidity, hospital stay, and recovery time, making them the preferred techniques for ureterovesical fistula repair in modern urology.