Laparoscopic ureteral anastomosis to a bladder diverticulum for the treatment of postoperative ureteral fistula: a case report.

OBJECTIVE: To investigate the feasibility and potential indications of laparoscopic ureteral anastomosis to a bladder diverticulum for the treatment of ureteral fistula in the setting of complex reoperative pelvic surgery. CASE PRESENTATION: A 75-year-old man with a 7-year history of progressive dysuria underwent transabdominal laparoscopic bladder diverticulectomy and cystolithotomy combined with transurethral holmium laser enucleation of the prostate for benign prostatic hyperplasia-related bladder outlet obstruction, bladder stones, and bladder diverticula. Twelve days after surgery, the patient developed increased pelvic drainage output. Elevated drainage-fluid creatinine levels and computed tomography urography showing contrast extravasation from the left ureter with hydronephrosis confirmed a left ureteral fistula. During reoperation, severe adhesions around the left ureter and bladder precluded conventional reconstruction. A bladder diverticulum adjacent to the distal ureter was therefore used as an alternative implantation site, and laparoscopic ureteral reimplantation into the diverticulum was performed. At 4 months of follow-up, no progression of hydronephrosis, recurrent urinary leakage, or urinary tract infection was observed. CONCLUSION: In selected patients with postoperative ureteral fistula, severe perivesical adhesions, and limited feasibility of conventional reconstruction during complex reoperative surgery, ureteral anastomosis to a bladder diverticulum may serve as an individualized salvage option for urinary tract reconstruction.