ABSTRACT
Department of Pediatric Urology, The University of Pittsburgh School of Medicine, Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
History 82
Transperitoneal vs. Retroperitoneal Approach 82
Laparoscopic Tools Specific to Ureteral Surgery 83
Illuminated Stents 83
Alternative Anastomotic Techniques 83
Procedures 84
Laparoscopic Pyeloplasty 84
Ureterolithotomy 88
Ureterolysis 88
Ureteral Reimplantation 89
Cystectomy 91
Laparoscopic Management of Urinary Incontinence 92
Laparoscopic Bladder Reconstruction 93
Complications of Laparoscopic Bladder and Ureteral Surgery 97
Summary 98
References 98
HISTORY
Laparoscopy in urology began largely as a diagnostic tool for the nonpalpable
testis (1). Urological possibilities for laparoscopy became apparent when the
first laparoscopic nephrectomies were performed (2). Since that time, the indi-
cations for and techniques of urologic laparoscopic surgery have expanded as
rapidly as imagination and instrumentation have allowed. Laparoscopy for the
ureter and bladder has been performed for extirpative procedures, but the exciting
future is in reconstruction. Pediatric laparoscopic pyeloplasty was published as
early as 1995 (3), but remains a procedure that is performed in only a handful
of centers due to the technical complexity of suturing. The first laparoscopic
bladder augmentation was performed in 1994 (4), but the technique is comp-
licated enough so that very few have been performed, and almost all of these
have been in adults (5). At about the same time, bladder autoaugmentation was
performed laparoscopically (6). This is an ideal operation for adaptation to
laparoscopic techniques, but its long-term outcomes have been controversial.
Reconstructive procedures of the lower urinary tract can be performed in a
laparoscopic-assisted manner (7). All this represents a step forward, especially
for pediatric patients who require bladder augmentation and/or continent stomas. Laparoscopic-assisted reconstruction hopefully represents a way station
as the techniques and instruments for complex laparoscopic procedures continue
to develop.
