In modern gynaecological and urogynaecological surgery, the value of experience is most visible in moments when a patient presents with a complex postoperative condition, pain and the need for a fast, precise and well-planned surgical decision.

A month ago, a successful and complex laparoscopic ureteroneocystostomy was performed at Plodnost Hospital in a patient with suspected ureteral injury following a previously performed hysterectomy.

On the fourth postoperative day, surgical revision was performed. During the operative assessment, a thermal lesion of the right ureter was confirmed. This is a condition that can disrupt the normal flow of urine and lead to urinary extravasation, meaning leakage of urine outside the normal urinary tract.

A ureterocystostomy with psoas hitch technique and ureteral reimplantation was performed laparoscopically, successfully restoring normal urinary system function.

The operation was performed by Hristijan Trpchevski, MD, Specialist in Gynaecology and Obstetrics.

This is a rare and highly complex surgical procedure, requiring exceptional laparoscopic experience, precision and surgical maturity.

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What is a ureteral injury?

The ureter is the tube that carries urine from the kidney to the bladder. During complex pelvic operations, especially near the uterus, ovaries, blood vessels and pelvic structures, the ureter may be at risk of injury.

A ureteral injury can be mechanical, thermal or combined. In this specific case, a thermal lesion of the right ureter was confirmed, meaning that the damage was related to heat effect on the tissue.

This is a serious condition because it can lead to urine leakage, inflammatory reaction, pain, impaired urinary system function and potential risk to the kidney if it is not recognised and treated in time.

What does urinary extravasation mean?

Urinary extravasation means leakage of urine outside the normal urinary tract. When the ureter is injured, urine may not pass normally from the kidney to the bladder, but may leak into surrounding tissues or into the abdominal cavity.

This condition can cause severe pain, inflammation, discomfort, deterioration of the general condition and the need for surgical revision.

For this reason, patients who experience severe pain, fever, weakness, flank pain or worsening condition after previous gynaecological surgery should receive timely medical assessment.

Laparoscopic approach to a complex postoperative condition

At Plodnost Hospital, a laparoscopic approach was selected, meaning a minimally invasive surgical technique that allows surgery through small incisions, with clear visualisation of the pelvic structures and precise surgical control.

Laparoscopy in such cases requires significant experience. The surgeon works in an anatomically complex area, where previous surgery, inflammatory changes and altered anatomical relationships can further increase the complexity of the procedure.

The aim is not only to resolve the immediate problem, but to restore normal urine flow, preserve urinary system function and enable safe recovery for the patient.

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What is laparoscopic ureteroneocystostomy?

Laparoscopic ureteroneocystostomy is a reconstructive surgical procedure in which the ureter is reconnected to the bladder. This technique is used when the lower part of the ureter is damaged or when the normal connection between the ureter and the bladder can no longer function properly.

In this case, ureterocystostomy, meaning reconnection of the ureter to the bladder, was performed together with ureteral reimplantation.

This creates a new functional pathway for urine to pass correctly from the kidney to the bladder.

Psoas hitch technique: why is it important?

During the operation, the psoas hitch technique was also applied.

This technique involves mobilisation of the bladder and its attachment to the psoas muscle, in order to bring the bladder closer to the ureter and allow a safe, stable and functional connection.

The psoas hitch technique is particularly important when it is necessary to reduce tension on the connection between the ureter and the bladder. For a successful outcome, the connection must be stable, well positioned and functionally appropriate.

In this patient, the operation went very well. Normal urinary system function was successfully restored, and the patient recovered well and is in good general condition.

Whatch the full youtube video here: https://www.youtube.com/watch?v=kAMpvbYX8gg 

Why is this surgical procedure highly complex?

Laparoscopic ureteroneocystostomy with psoas hitch technique belongs to the group of complex reconstructive urogynaecological procedures.

The operation requires advanced knowledge of pelvic anatomy, experience in minimally invasive surgery and the ability to make calm surgical decisions in a situation where every detail matters.

In such cases, the surgeon must carefully identify the ureter, assess the condition of the damaged segment, mobilise the bladder, create the new connection and ensure normal urine flow.

This is especially challenging when the patient has already undergone previous surgery, when the tissues have changed and when there is a risk of additional complications.

The importance of timely surgical revision

In patients with suspected ureteral injury after gynaecological surgery, timely response is essential.

Symptoms may include severe pain, fever, weakness, abdominal or flank pain, changes in urination, discomfort and general deterioration of the condition.

In this case, surgical revision was performed on the fourth postoperative day. This allowed timely confirmation of the condition, the correct choice of operative technique and successful restoration of normal urinary system function.

Plodnost Hospital and advanced laparoscopic surgery

At Plodnost Hospital, laparoscopic surgery has an important role in the treatment of complex gynaecological and urogynaecological conditions. The minimally invasive approach enables precise work, improved visualisation and treatment focused on resolving the problem with less operative trauma for the patient, always depending on the individual condition.

This case shows how important the combination of timely diagnostics, surgical experience and team readiness can be.

When it comes to ureteral injury, every step matters: from recognising symptoms, to surgical revision, the choice of technique, the performance of the operation and postoperative follow-up.

The patient’s successful recovery is the most important indicator that the treatment was properly planned and performed.

When should medical help be sought after gynaecological surgery?

After any major gynaecological or abdominal operation, the patient should seek medical help if she experiences severe pain, fever, deterioration of the general condition, flank pain, urinary problems or a feeling that recovery is not progressing as expected.

Early assessment can make a significant difference. Complex conditions such as ureteral injury require timely response, accurate assessment and appropriate treatment.

Booking an appointment at Plodnost Hospital

If you have pain, urinary symptoms, complications after previous gynaecological surgery or need a professional opinion regarding laparoscopic treatment, you can book an appointment at Plodnost Hospital.

For information and appointments:

+389 47 208 880
Viber: +389 75 472 503

Plodnost Hospital continues to apply contemporary surgical approaches, with a focus on precise diagnostics, minimally invasive treatment and safe recovery for patients.

FAQ: Common questions about ureteral injury and laparoscopic ureteroneocystostomy

What is a ureteral injury?

A ureteral injury is damage to the tube that carries urine from the kidney to the bladder. It may occur during complex pelvic surgery and requires timely diagnosis and appropriate treatment.

What is a thermal lesion of the ureter?

A thermal lesion of the ureter is damage to the ureter caused by heat effect on the tissue. This type of injury can disrupt the normal function of the ureter and lead to leakage of urine outside the normal urinary tract.

What does ureteral reimplantation mean?

Ureteral reimplantation is a surgical procedure in which the ureter is reconnected to the bladder, with the aim of restoring normal urine flow from the kidney to the bladder.

What is the psoas hitch technique?

The psoas hitch technique is a surgical technique in which the bladder is mobilised and attached to the psoas muscle to allow a stable and functional connection with the ureter.

Can ureteroneocystostomy be performed laparoscopically?

Yes, in selected cases, ureteroneocystostomy can be performed laparoscopically. The decision depends on the patient’s condition, the type and extent of the injury, previous operations and the assessment of the surgical team.

The post Laparoscopic Ureteroneocystostomy at Plodnost appeared first on Hospital Plodnost.

As part of the scientific urogynaecology section, which will take place at Hotel “Tsar Samoil” in Strumica on 24 April 2026, Dr Hristijan Trpchevski will deliver a lecture on the topic:

“Laparoscopic Burch Colposuspension and ‘Burch-like TOT’ Modification in the Surgical Treatment of Stress Urinary Incontinence”

The lecture is focused on contemporary surgical approaches in urogynaecology, with emphasis on precision, minimally invasive treatment and the sharing of practical clinical experience.

What is stress urinary incontinence?

Stress urinary incontinence is a condition in which involuntary urine leakage occurs during coughing, sneezing, laughing, lifting, physical activity or other situations that increase pressure inside the abdomen.

Although this condition is common, many women accept it as something “normal” after childbirth, with age or after certain gynaecological changes. However, stress urinary incontinence should not be a subject patients feel they must remain silent about. With proper assessment and appropriate treatment, many patients can experience significant improvement in control, comfort and everyday functioning.

Why is urogynaecology important in modern gynaecology?

Urogynaecology is a field that connects gynaecology, surgery and the functional anatomy of the pelvic floor. It deals with conditions such as stress urinary incontinence, uterine or vaginal prolapse, impaired pelvic organ support and other problems that affect women’s health.

These conditions are not only medical diagnoses. They influence how a woman moves, works, exercises, travels, sleeps and feels in her own body. This is why the modern approach does not focus only on anatomical correction, but also on restoring function and improving quality of life.

Laparoscopic Burch colposuspension: a precise minimally invasive approach

Laparoscopic Burch colposuspension is a surgical technique used in the treatment of stress urinary incontinence. The aim of the procedure is to improve support of the urethra and the anterior vaginal wall, reducing involuntary urine leakage during physical effort.

The laparoscopic approach allows treatment through small incisions, with improved visualisation of anatomical structures and greater surgical precision. For patients, minimally invasive surgery often means less operative trauma, faster recovery and a shorter period before returning to daily activities, depending on individual condition and medical assessment.

In these procedures, the surgeon’s experience, knowledge of pelvic anatomy and appropriate patient selection are essential.

“Burch-like TOT” modification: clinical reasoning and surgical adaptation

The topic of Dr Hristijan Trpchevski’s lecture also includes the “Burch-like TOT” modification in the surgical treatment of stress urinary incontinence. This part is particularly important because it reflects surgical thinking that is not only technical, but also clinically adapted.

In urogynaecological surgery, there is no single identical approach for every patient. Differences in anatomy, previous childbirths, previous operations, degree of incontinence and pelvic floor condition require individual assessment.

This is why such lectures have real value: they do not only present theory, but also practical experience from the operating theatre, analysis of approach, selection of technique and the clinical reasoning behind each surgical decision.

The importance of sharing clinical experience

Scientific sections and professional meetings play an important role in the development of medicine. They create space for doctors to exchange experience, discuss contemporary approaches and compare different methods of treatment.

The lecture by Dr Hristijan Trpchevski at the urogynaecology section is an opportunity to present a practical surgical approach to a condition that is significant for many patients. The focus is not only on the technique, but also on the purpose of treatment: better function, greater confidence and improved quality of life for women.

Plodnost Hospital and the development of minimally invasive gynaecological surgery

At Plodnost Hospital, minimally invasive gynaecological surgery has an important role in the treatment of different gynaecological conditions. Laparoscopic procedures allow a contemporary approach, precise surgical work and treatment that is directed towards the patient, not only the diagnosis.

The participation of doctors from Plodnost Hospital in scientific sections, lectures and professional gatherings is an important part of continuous development, knowledge exchange and following contemporary medical standards.

The lecture by Dr Hristijan Trpchevski is another example of how clinical experience, surgical practice and scientific discussion connect in the interest of better treatment for patients.

Booking an appointment at Plodnost Hospital

Women who experience involuntary urine leakage when coughing, sneezing, laughing, exercising or during everyday activities should not accept this condition as something that must simply be tolerated.

With timely assessment, gynaecological examination and an individual approach, the most appropriate treatment options can be discussed.

For information and appointments at Plodnost Hospital, please call:

Telephone: +389 47 208 880
Viber/WhatsApp: +389 75 472 503

Plodnost Hospital remains committed to contemporary gynaecological care, professional assessment and treatment guided by the needs of each patient.

The post Dr Hristijan Trpchevski Lecture on Urogynaecology appeared first on Hospital Plodnost.

The post Endometriosis and infertility – laparoscopic treatment | Plodnost Bitola appeared first on Hospital Plodnost.

The delivery was conducted under continuous medical supervision by Dr Pajakovska, Dr Mishik, midwife Diana, and nurse Natasha. This successful case reflects the growing demand for private maternity care in Europe, where natural birthing approaches are combined with strict medical protocols.

What Is a Water Birth?
A water birth is a modern obstetric method in which labour and delivery take place in a specially designed birthing pool filled with warm, temperature-controlled water. Unlike alternative home births, a hospital water birth is carried out in a fully equipped clinical environment with continuous monitoring.

At Plodnost Hospital Bitola, water births are offered to carefully selected low-risk pregnancies, ensuring safety for both mother and baby. Vital signs, foetal heart rate, and labour progression are continuously assessed throughout the process.

Benefits of Water Birth in a Private Hospital Setting

1. Gentler Transition for the Newborn
Moving from the amniotic fluid to warm water may allow a smoother physiological adaptation compared to conventional delivery.
2. Reduced Labour Discomfort
Warm water promotes muscle relaxation, improves circulation, and may help reduce perceived pain levels during contractions.
3. Increased Mobility for the Mother
The buoyancy of water allows easier movement and positioning, potentially supporting a more efficient labour process.
4. Controlled & Safe Clinical Environment
Choosing a private hospital water birth in Europe ensures immediate access to medical intervention if required. At Plodnost Hospital, emergency protocols are in place, and the medical team remains present at all times.

Safety Protocols & European Medical Standards

Water birth at Plodnost Hospital follows internationally recognised obstetric guidelines. Each patient undergoes detailed prenatal evaluation before approval for water delivery.

Safety measures include:

• Continuous foetal monitoring
• Maternal vital sign monitoring
• Strict hygiene and sterilisation procedures
• Immediate transfer capability if complications arise

This approach aligns with European best practices for safe childbirth in private maternity hospitals.

Who Is a Candidate for Water Birth?

Water birth may be considered in cases of:

• Singleton pregnancy
• Full-term gestation
• Low-risk obstetric profile
• No significant maternal or foetal complications

Final eligibility is determined by a specialist in obstetrics and gynaecology after comprehensive assessment.

Why Choose Private Childbirth in North Macedonia?

Plodnost Hospital – Bitola is recognised for:

• Advanced obstetrics and gynaecology services
• Modern delivery techniques including water birth
• Personalised maternity care
• Neonatal support and monitoring
• International patient experience

Increasingly, families from across the Balkans and Europe are choosing private childbirth in North Macedonia due to the combination of high medical standards, experienced specialists, and competitive healthcare costs.

Water Birth at Plodnost Hospital – Bitola

The birth of baby Matej is another example of how water birth in Bitola, North Macedonia can provide both a natural and medically supervised start to life. The hospital’s multidisciplinary team ensures that each delivery meets strict safety and quality standards.

For expectant parents exploring water birth in Europe, Plodnost Hospital offers a structured, safe, and professionally managed approach within a fully equipped private maternity facility.

The post Water Birth in North Macedonia – Safe & Modern Delivery at Plodnost Hospital Bitola appeared first on Hospital Plodnost.

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What Is Emotional Intelligence in Healthcare?

• Doctor–patient communication
• Treatment adherence
• Patient satisfaction
• Reduction of pre-procedural anxiety
• Institutional trust

Psychological Immunity and Resilience in Medical Treatment

• IVF treatment in North Macedonia
• Obstetrics and gynaecology
• High-risk pregnancy monitoring
• Surgical procedures
• Long-term diagnostic processes

 Empathic Communication as a Measurable Clinical Standard

• Reduces patient stress
• Improves clarity of medical explanations
• Enhances shared decision-making
• Strengthens long-term institutional credibility

Interdisciplinary Healthcare in North Macedonia – A Forward-Looking Model

• Strategic integration of psychology into clinical medicine
• Support for patient resilience during complex treatments
• Development of emotionally intelligent medical teams
• Alignment with European private healthcare standards

The Future of Holistic Private Healthcare in Europe

• Transparent communication
• Emotional understanding
• Psychological support during treatment
• Evidence-based medical expertise

The post Plodnost Hospital Introduces an Interdisciplinary Model with Prof. Dr Ljupcho Kebereski appeared first on Hospital Plodnost.

• Inflammation of the urinary or reproductive system
• Fertility problems in both men and women
• Complications during pregnancy, including preterm birth or infection of the fetus
• Increased risk of recurrent infections

• Burning or pain during urination
• Discomfort or pain in the lower abdomen
• Unusual discharge from the urogenital tract

The post Ureaplasma – why timely diagnosis and treatment matter appeared first on Hospital Plodnost.

• Dr. Kristinka Pajakovska, obstetrician-gynaecologist
• Prim. Dr. Anica Apchevska Vasileva, neonatologist
• Nurses Frosina, Natasha, and Biljana
• Midwives Irena, Zaneta, and Fiona

The post The 500th baby born in 2025 appeared first on Hospital Plodnost.

• Couples facing infertility – whether primary or secondary
• Patients with recurrent miscarriages – three or more pregnancy losses
• Individuals with a family history of genetic abnormalities
• Patients with clinical symptoms that suggest potential chromosomal issues

The post Karyotyping: the key to answers in infertility and recurrent miscarriages appeared first on Hospital Plodnost.

• Patients experiencing chest pain or pressure
• Individuals with suspected arrhythmias
• Monitoring therapy effectiveness for patients with diagnosed heart conditions
• People at higher risk of cardiovascular diseases, such as smokers, diabetics, individuals with high blood pressure, or those with a family history of heart disease

• Early detection of coronary artery disease
• Accurate assessment of heart rhythm and function
• Monitoring the effectiveness of cardiac therapy
• Reducing the risk of complications through timely intervention

The post Stress test – the most reliable check-up for your heart appeared first on Hospital Plodnost.

• Australia remains one of the global leaders, with consistently rising numbers of successful IVF treatments.
• In the United Kingdom, success rates have improved dramatically in recent decades, thanks to technological innovations and improved medical protocols.
• Across Europe and the United States, IVF has become a trusted and standard procedure for couples struggling with infertility.

The post How Many Children Have Been Born Through IVF Worldwide? appeared first on Hospital Plodnost.