Extravesical robotic ureteral reimplantation for ureterovaginal fistula

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We present a video describing the technical considerations for performing an extravesical robotic ureteral reimplantation.


A 55-year old woman presented with urinary incontinence secondary to a ureterovaginal fistula after robotic-assisted hysterectomy. After failure of more conservative measures, she proceeded to a robotic ureteral reimplantation. Following port placement, the ureter is identified at the level of the iliac vessels and dissected circumferentially. The ureter is dissected free to the level of the ureterovaginal fistula, transected, and the distal remnant ligated. The ureter is spatulated, a cystotomy created, and a running anastomosis with mucosa-to-mucosa apposition performed over a stent. Care is taken to ensure it is tension free. The integrity of the anastomosis is tested with retrograde filling of the bladder. Postoperatively, a drainage catheter is left to allow for adequate healing. Follow-up imaging is performed to ensure a patent anastomosis.


The patient had an uncomplicated postoperative course. A cystogram showed adequate healing at 10 days, and the stent was removed at 6 weeks. A follow-up renal ultrasound 6 weeks later showed no hydronephrosis.


Extravesical robotic ureteral reimplantation is a useful technique for managing ureterovaginal fistula; here we highlight pertinent technical considerations.

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  1. 1.

    Morey AF, Brandes S, Dugi DD 3rd, Armstrong JH, Breyer BN, Broghammer JA, et al., American Urological A. Urotrauma: AUA guideline. J Urol. 2014;192(2):327–35.

  2. 2.

    Burks FN, Santucci RA. Management of iatrogenic ureteral injury. Ther Adv Urol. 2014;6(3):115–24.

  3. 3.

    Warwick RT, Worth PH. The psoas bladder-hitch procedure for the replacement of the lower third of the ureter. Br J Urol. 1969;41(6):701–9.

  4. 4.

    Gellhaus PT, Bhandari A, Monn MF, Gardner TA, Kanagarajah P, Reilly CE, et al. Robotic management of genitourinary injuries from obstetric and gynaecological operations: a multi-institutional report of outcomes. BJU Int. 2015;115(3):430–6.

  5. 5.

    Musch M, Hohenhorst L, Pailliart A, Loewen H, Davoudi Y, Kroepfl D. Robot-assisted reconstructive surgery of the distal ureter: single institution experience in 16 patients. BJU Int. 2013;111(5):773–83.

  6. 6.

    Hemal AK, Nayyar R, Gupta NP, Dorairajan LN. Experience with robot assisted laparoscopic surgery for upper and lower benign and malignant ureteral pathologies. Urology. 2010;76(6):1387–93.

  7. 7.

    McClung C, Gorbonos A. Ureteral reimplantation in adults: open versus robotic. J Urol. 2014;192(4):1023–5.

  8. 8.

    Patil NN, Mottrie A, Sundaram B, Patel VR. Robotic-assisted laparoscopic ureteral reimplantation with psoas hitch: a multi-institutional, multinational evaluation. Urology. 2008;72(1):47–50. discussion 50

  9. 9.

    Packiam VT, Cohen AJ, Nottingham CU, Pariser JJ, Faris SF, Bales GT. Open Vs minimally invasive adult Ureteral Reimplantation: analysis of 30-day outcomes in the National Surgical Quality Improvement Program (NSQIP) database. Urology. 2016;94:123–8.

  10. 10.

    Pantuck AJ, Han KR, Perrotti M, Weiss RE, Cummings KB. Ureteroenteric anastomosis in continent urinary diversion: long-term results and complications of direct versus nonrefluxing techniques. J Urol. 2000;163(2):450–5.

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Correspondence to Brian J. Linder.

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Written informed consent was obtained from the patient for publication of this case report and any accompanying images.

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Linder, B.J., Frank, I. & Occhino, J.A. Extravesical robotic ureteral reimplantation for ureterovaginal fistula. Int Urogynecol J 29, 595–597 (2018) doi:10.1007/s00192-017-3459-4

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  • Fistula
  • Robot
  • Ureteroneocystostomy
  • Ureter
  • Urinary incontinence
  • Iatrogenic injury