Over the last ten years, 27 usable patient files of patients who had benefited from ureterovesical reimplantation according to Nesbit or Leadbetter Politano in the two study hospitals were found, with a frequency of 2.7 cases/per year and a sex ratio of 4.4 in favor of women. The average age was 42.5 ± 7.54 years with extremes ranging from 8 to 77 years. Specifically, the average age of men was 40.5 ± 20.5 years with extremes ranging from 8 to 77 years, while that of women was 43.25 ± 7.25 years with extremes ranging from 30 to 63 years. The oldest age group represented was the 40 to 50year age group. Delay to consultation in this study was on average 30 (7 - 150) days with extremes ranging from 1 day to 6 years ( Figure 2 ).

Urinary tract infections were recurrent in 51.9% of patients and 63% had undergone a hysterectomy. We equally recorded 3.7% of patients who had ligated pelvic ureters secondary to laparoscopic varicocelectomies ( Table 1 ).

Chronic low back pain was found in 12 (44.4%) of our patients. Continuous intravaginal urine leakage was found in 10 (37.0%) patients and was associated with urinary tract infections in 5 patients ( Table 2 ).

The vast majority of our patients, a percentage of 85.2 had an ultrasound scan of the urinary tract. A CT urogram was performed in 44.4% of patients. Grade III uretero-hydronephrosis was found in 56.5% of patients and grade IV in 21.7%. The damage to the ureter concerned the right side in 51.5% of patients and the left in 33.3% ( Figure 3 ).

Once the diagnosis was made, the time to surgical treatment was an average of 90 (14 - 150) days with extremes ranging from 1 day to 6 years. Iatrogenic injury was the most represented lesion 20 (74.1%), 63% was secondary to hysterectomy and 11.1% due to C section. The initial intraoperative lesion found was ligation of the pelvic ureter with suture material in 13 (48.1%) patients. Furthermore, we had 14.7% of our patients in whom ureteral stones were found in the intramural part of the pelvic ureter. Ureterocele, primary vesicoureteral reflux and punctal diverticulum were found with a frequency of 3.7% each ( Table 3 ).

We noticed in this study by using patient files that, several surgical techniques had been used. However, the technique of direct ureterovesical reimplantation according to Nesbit had been the most regular, in 55.6% of patients, followed by that of Leadbetter Politano seen in 14,8% of cases ( Figure 4 ).

The type of sutures used for the ureterovesical anastomosis had been specified in the operative reports of only 17 patients. These were resorbable polyglactin910 sizes 3/0, 4/0 or 5/0 all with round bodied needles. Braided sutures were used in 12 patients (44.5%) and monofilaments in 5 (18.5%) ( Table 4 ).

Intraoperative bleeding around the point of fibrosis was the most common complication. Average blood loss was estimated at 145 ± 55 ml per intervention with extremes ranging from 80 to 500 ml. 33.3% of patients required whole blood transfusions. A ureteral stent across the anastomotic area was systematically placed in all patients (100%). This was externalized through a counter skin incision in 12 (44.4%) patients. For the internal stents, the DJ stent was the most used type, used in 15 (55.6%) patients ( Table 5 ).

The average duration of interventions was 172.5 ± 7.5 min with extremes ranging from 90 to 300 min ( Table 6 ).

The trans-vesico-parietal ureterostomy was removed on the 12th day (8 - 14).

Post operation and the double J stent removed on the 49th (42 - 180) day. Removal of the drainage tube in the space of Retzius was done on the 9th post operation day (6.7 - 13) with extremes ranging from 5 to 17 days and that of the urinary catheter was made at the 10.5th (8 - 15) day with extremes ranging from 2 to 32 days. The postoperative period was unremarkable in 15 patients. 12 developed surgical site infections, 7 (25.9%) of whom benefitted from appropriate wound care. Unfortunately, one death was recorded in this study, it occurred on post operation day 21 in a context of chemical peritonitis.

The hospital stay was an average of 15 (13 - 19) days with extremes ranging from 7 to 30 days. After an average follow-up of 48 (34.5 - 85.5) months, 26 patients were re-evaluated and none presented clinical signs of a failed anastomosis. Serum creatinine was normal in all patients, urine microscopy and culture was negative in 23 (88.5%) patients. Sterile pyuria was noted in 3 (11.5%) other patients. Control ultrasound scanning was the only paraclinical examination requested in the postoperative period for all 26 patients. No case of uretero-hydronephrosis was seen post op. The clinical success rate of the surgery was therefore evaluated at 96.29%.

All age groups were represented in our study, the age group the most represented was that from 40 - 50 years. Our figures show that this Intervention is mainly practiced on adult subjects, with a female predominance and sex ratio of 4.4. This contradicts the series by Jellal et al. in Togo which reported an equal sex distribution [7] .

Hysterectomy was the most common surgical past history in our study population with a percentage of 63%, followed by cesarean section with 11.1%. Fouda et al. at the YCH reported that 94% of patients who had undergone a hysterectomy complicated by a ureteral injury benefited from Uretero-vesical reimplantation surgery [6] . The techniques of hysterectomy should therefore be revisited or further mastered in future to reduce the incidents of these ureteral accidents

Low back pain was the most frequent reason for consultation, seen in 59.3% of the cases. Chronicity of this pain was the indication for surgery in 44.4% of our patients. This indication was same in the study by Adama and al in Mali and that of Amri et al in Morocco [5] [8] . Recurrent urinary tract infection was found in 5 patients and persistent intravaginal urine leak in 40.7% of cases of patients who had a history of gynecologic surgery. This figure is higher than that of Amri et al. who had a value of just 20%. These symptoms were found in similar proportions by Amri et al. in Morocco [8] and by Adama Seydou et al. in Mali [5] .

The majority of our patients (85.2%) had an ultrasound scan of the urinary tract. This is the first-line examination mentioned in the diagnosis of ureteral lesions. IVU was only performed in 25.9% here, explained by the fact that IVU has gradually lost in value over the years with the advent of CT scanning. CT Urogram was performed in 44.4% of the cases. None had done renal scintigraphy. Renal differential function was therefore assessed based on the excretory phases of the CT urogram and/or IVU. We equally relied on the thickness of the renal parenchyma. The realities of our third world study settings did not permit us have renal scintigraphy done for direct renal function assessment. Any future study on this subject with use renal scintigraphy will definitely be of better quality.

A uretero-hydronephrosis grade 3 or 4 was present in 85.2% of patients. This result is comparable to that of Amri et al. who found 87% of uretero-hydronephrosis on ultrasound in his study population [8] .

Iatrogenic injury was the most prevalent lesion, seen in 20 (74.1%) patients ,63% of which were secondary to hysterectomy and 11.1% to cesarean section. The initial intraoperative lesion found was ligation of the pelvic ureter, found in 13 (48.1%) patients. In the studies of Gambachidze et al. and those of Amri et al., both reported iatrogenic lesions to the pelvic ureter (section, ligation, perforation, devascularization) of gynecological origin in 54% of cases and approximately 25% of these lesions were secondary to hysterectomy. These lesions either caused an obstruction in more than two thirds the time, an immediate or a late fistula [7] [8] . Amri et al. in a study in Morocco reported stenosis of the pelvic ureter in 45.83% of cases and 25% of these were secondary to urogenital tuberculosis. Ureterovaginal fistulas was equally reported in 20.83% of cases in the same study [8] . Adama et al. in their study in Mali found stenosis of the pelvic ureter in 75.56% of cases and the etiology here had been parasitic (urogenital schistosomiasis) in 69.48% of cases.

Furthermore, we found 14.7% of patients with lithiasis in the intramural part of the pelvic ureter. Ureterocele, primary vesicoureteral reflux and punctal diverticulum were equally found with a frequency of 3.7% for each. These results are similar to those of Adama et al. in Mali, who had same position lithiasis in 17.78%, ureterocele and primary vesicoureteral reflux each in 4.17% of cases [5] . The intraoperative lesions here are similarly encountered in other studies across the globe. This gives further value to our study and to its potential to be exploited by the scientific community across the world.

The Nesbit direct ureterovesical reimplantation technique without an anti-reflux system was the most used in 55.6% of cases followed by that of Leadbetter Politano, in 14.8% of cases. This is contrary to standard literature information where the most used techniques are those of Leadbetter Politano, Lich Gregoir and Cohen [8] . Although this is contrary to standard literature, the techniques is mastered by surgeons here and still guarantees good results post op.

The type of suture material most used was Polyglactin 910 with sizes 3/0, 4/0 or 5/0. Braided suture was used in 12 patients and monofilament suture No. 4/0 in 5 patients. This is contrary to standard literature where resorbable monofilament suture is the recommended material to perform ureteral reimplantations.

Intraoperative bleeding around the fibrosis site was the intraoperative incident the most recorded, in 16 (59.3%) patients. Gambachidze et al. in a review of the literature published blood loss which varied from 163 to 610 ml in open surgery, 86 to 466 ml in laparoscopic surgery and from 44 to 104 ml in robot-assisted laparoscopy. These are contrary to the result of our study where the mean estimated blood loss was 145 ± 55 ml with extremes ranging from 80 to 500 ml. 33.3% of patients in this study received whole blood transfusions intraoperatively or during the immediate postoperative period. A ureteral stent, across the anastomotic site was systematically used in all patients (100%). This stent was exteriorized via a separate stab incision in 12 patients (44.4%), and an internal DJ stent used 55.6% of the time.

The average duration of these surgical interventions varies depending on the approach. Here It was 172.5 ± 7.5 minutes with extremes ranging from 90 to 300 mins. This time is close to that reported by Gambachidze et al. in a review of the literature where it varied between 176 and 235 minutes in open surgery, from 118 to 228 minutes in laparoscopic surgery and finally from 162.5 to 262.5 minutes in robot-assisted laparoscopic surgery [9] . In case of repeat surgery, estimated blood loss will depend on the experience of the surgeon and also on the degree of inflammatory fibrosis around the lesion.

Removal of the DJ probe via endoscopy was carried out on average on the 49th (42 - 180) post-operative day. Other series offer removal around the 42nd day, a deadline close to ours [5] [7] [8] . We extended this time by a week further out of extra caution. Removal of the transurethral urine catheter was done on 10.5 (8 - 15) days post-operation, that of the drain located in the Retzius space on the 9^th day (6.7 - 13) post-operation and from the external drain on the 12th (8 - 14) post-operative day.

The postoperative course was unremarkable in 15 patients. Twelve patients had postoperative complications. Surgical site infections were found in 7 (25.9%). These complications were found in several other series [5] [7] and classified grade I according to the Clavien-Dindo system, therefore not requiring surgical interventions. Adama et al. in Mali found the same grade of complications [5] . Surgical site infections are quite common, nonetheless we should be relentless in our efforts to control them in future.