To show the safety and efficacy of the mucosa to mucosa anastomosis in ureteroneocystostomy without anti-reflux technique, and to compare the therapeutic outcome between laparoscopic repair and open surgery using same procedure principles for iatrogenic ureterovaginal fistula.

A retrospective cohort study was conducted at a high-volume referral hospital. 87 female patients, previously diagnosed with ureterovaginal fistula, underwent ureter reimplantation between 2008 and 2018. Those patients were contacted and underwent a follow-up examination. The modified ureteroneocystostomy (mucosa to mucosa anastomosis without anti-reflux technique) was conducted to restore urinary continuity. Vesicoureteric reflux was assessed by voiding cystogram, and effectiveness and safety in the laparoscopic repair group and open surgery group were compared.

No vesicoureteric reflux occurred in postoperative follow-up. Women whose ureterovaginal fistula treated by open surgery underwent a longer follow-up time (12-126 months) than the laparoscopic group (7-39 months). The successful repair of the ureterovaginal fistula was achieved similarly in the open surgery group (96.67%) and laparoscopic group (95.00%). There was no immediate or delayed complication in the laparoscopic group. No significant difference was found between the laparoscopic repair group and the open surgery group in postoperative complications.

The 80 iatrogenic ureteral injuries consisted of 75 ureterovaginal fistula patients and 5 ureteral obstruction patients (all from the open group). Three patients (2 in the open group and 1 in the laparoscopic group) underwent a failed ureteral reimplantation in other centers. Only 1 patient received nephrostomy before open ureteroneocystostomy. The mean ages at the surgery of two groups had no statistical difference (p = 0.94) with 45.57 (26-60) yrs in the open group and 45.70 (34-63) yrs in the laparoscopic group. No statistical differences were also found between two groups in height, body mass index, parity, education background, and comorbidity. In the open group, 57 ureteral injuries arose after hysterectomy, among which 36 were pathologically confirmed to be benign and 21 were malignant. Similarly, 18 ureteral injuries presented as a complication of previous hysterectomy (9 benign tumors and 9 malignant tumors) in the laparoscopic group. Women whose ureterovaginal fistula treated by open surgery had longer follow-up time (47 months vs 16.5 months, p < 0.001). The successful repair of the ureterovaginal fistula was achieved similarly in the open surgery group (96.67%) and laparoscopic group (95.00%). Initial failure was observed in 3 procedures, in which 1 patient repaired by laparoscopy received nephrectomy and the remaining 2 patients with severe hydronephrosis after open surgery underwent regular ureteral stent replacement.  Patients whose ureterovaginal fistula repaired by laparoscopic technique recovered faster with shorter hospital stay (6 days vs 8 days, p < 0.001). Postoperative complications, which only arose in the open group, were not serious: only 2 wound infections occurred and 7 women underwent incision pain. Overall, no vesicoureteric reflux was found in both groups according to the postoperative VCUG.

Our study preliminarily indicates that mucosa to mucosa anastomosis ureteroneocystostomy without anti-reflux technique is feasible, effective and offers durable results without apparent complications, and laparoscopic ureteroneocystostomy with can be performed safely with a success rate compared to that of open surgery but with less morbidity and quick convalescence.