Laparoscopic lower urinary tract reconstruction

In the past decade laparoscopy has been successfully utilized for both the obliterative and reconstructive management of urologic disease. We have see n not only an advance in the technology available to perform these procedur es, but also an effort on the part of laparoscopic urologists to refine the ir techniques to allow them to perform more complicated procedures. In the lower urinary tract, the development of reconstructive procedures has been slow. While early interest in laparoscopy promoted several pioneers to perf orm the initial reconstructive procedures, the difficulties associated with these procedures at that time largely precluded their wide spread applicat ion or adoption. Recently, improvements in the skills of laparoscopic urolo gists and the advent of instruments to facilitate suturing (e.g. EndoStich semi-automatic suturing device, Lapra-Ty clips to replace intracorporeal kn otting, and advances in staple and clip technology ) have facilitated a ren ewed interest in laparoscopic reconstructive surgery of lower urinary tract . At present, almost all types of urologic open reconstructive procedures h ave been accomplished laparoscopically: urinary diversion (e.g. ureteroilea l loop urinary diversion and continent diversion), bladder reconstruction ( e.g. ureterovesicostomy, bladder augmentation, bladder diverticulectomy, pa rtial cystectomy), ureteral reimplantation, and, most recently, urethrovesi cal anastomosis following radical prostatectomy. This article well review t he development of these procedures.