Objective:To explore the safety and efficacy of ureteroscopy-assisted laparoscopic ureteroplasty in the healthy side-lying running position for the treatment of ureteral stenosis after pelvic surgery.Methods:The data of 92 patients with ureteral stenosis after surgery admitted to Ganzhou People’s Hospital from June 2017 to February 2023 were retrospectively analysed. There were 31 male patients and 61 female patients, with an average age of (46.4±23.3) years. Of the 92 patients, 53 patients had previously undergone stone fragmentation or stone retrieval surgery for urinary system stones, 35 patients had undergone gynecologic laparoscopic surgery for gynecologic diseases, 2 patients had previous intestinal surgery, and 2 patients had undergone laparoscopic ureteral reconstruction surgery. The mean preoperative serum creatinine was (120.33±16.52) μmol/L, the mean blood urea nitrogen was (14.28 ± 2.47) mmol/L, and the mean renal pelvis dilation was (3.23±2.47) cm. All patients were placed in healthy side-lying running position with general anesthesia. The patient's lower limbs were in the oblique supine position, and the angle of the lower limbs was 60-80°. By using a transabdominal approach, the narrow section of the ureter was mobilized and excised under the guidance of ureteroscopy. The posterior wall of the ureter was sutured and a zebra guidewire was placed into the renal pelvis. An F7 double-J stent was then retrogradely advanced over the guidewire. Then the anterior wall of the ureter was anastomosed to complete the surgery. The operation time, average length of hospital stay, perioperative complications, preoperative and postoperative pyelectasis and renal function changes were recorded, and the clinical efficacy were evaluated by comparative analysis.Results:Of the 92 patients, 90 patients were successfully treated with ureterovesical anastomosis. Two patients underwent ureterovesical reimplantation because of the low position and heavy adhesion of the stenosis segment. There were no cases of conversion to open surgery or intraoperative death. The mean surgery duration was (121.52±22.35) min, the mean drainage tube indwelling time was (3.16±1.23) d, and the mean hospital stay was (6.46±2.37) d. A patient with moderate hydronephrosis exhibited postoperative urinary leakage. Two patients developed symptoms of hematuria after ambulation. Following treatment with bed rest, adequate drainage, and appropriate hemostatic medication, all patients recovered smoothly and were discharged. The double J tube was removed 3 months after operation, and the CT reexamination after extubation showed that the degree of pyelectasis was (2.52±1.54) cm, the average serum creatinine was (89.64±15.21) μmol/L, and urea nitrogen was (9.42±1.36) mmol/L, which was all significantly different from that before operation ( P<0.05). The patients were followed up for 6 to 12 months, and there was no ureteral restenosis. Conclusions:Ureteroscopic-assisted laparoscopic ureteroplasty in the healthy side-lying running position is a safe and effective surgical method for the treatment of short segment (narrow segment <3 cm) ureteral cicatrix stenosis after surgery. And this surgical method has the advantages of accurate positioning of the narrow segment, safe and convenient ureteral free, exact ureteral anastomosis, and easy placement of double J tube.

Objective To study the relationship between serum urine regulator protein and cystatin C levels and pathological characteristics and prognosis in patients with hypertensive nephropathy.Methods A total of 100 patients admitted in the hospital from August 2021 to October 2022 were selected as the study group,and 40 healthy persons who underwent the physical examination in the hospital were selected as the control group,complete data of all patients were collected and analyzed,the levels of serum urinary regulatory protein and cystatin C in each group were tested,and the relationship between serum urinary regulatory protein and cysta-tin C levels,pathological characteristics,and prognosis was analyzed.Results The urine regulatory protein and glomerular filtration rate in the study group were lower than those in the control group,but cystatin C,u-rea nitrogen,and blood creatinine were all higher than those in the control group,and the differences were sta-tistically significant(P＜0.05).Urinary regulatory protein was negatively correlated with urea nitrogen and blood creatinine,but positively correlated with glomerular filtration rate(P＜0.05).Cystatin C was positively correlated with urea nitrogen and blood creatinine,but negatively correlated with glomerular filtration rate(P＜0.05).Urinary regulatory protein level was related to crescent formation,renal tubular atrophy/intersti-tial fibrosis(P＜0.05),while level the expression of cystatin C was related to glomerular segmental sclerosis,glomerular glomerular sclerosis,and glomerular ischemic shrinkage(P＜0.05).The survival rate of the high urinary regulatory protein level group(≥126.49 ng/mL)was higher than that of the low urinary regulatory protein level group(＜126.49 ng/mL),while the survival rate of the high cystatin C level group(≥2.43 mg/L)was lower than that of the low cystatin C level group(＜2.43 mg/L)(P＜0.05).Urinary regulatory protein,cystatin C,renal tubular atrophy/interstitial fibrosis were factors that affected the occurrence of end-stage renal disease in hypertensive nephropathy(P＜0.05).Conclusion Hypertensive kidney disease patients u-sually have higher levels of cystatin C and lower levels of urinary regulatory protein,among which cystatin C is closely related to pathological features of glomerular segmental sclerosis,glomerular glomerular sclerosis,and glomerular is-chemic shrinkage,and urinary regulatory protein is closely related to crescent formation,renal tubular atrophy/intersti-tial fibrosis.In addition,urinary regulatory protein and cystatin C have a significant impact on the development of hy-pertensive nephropathy into end-stage renal disease,and could become important indicators for evaluating patient prognosis.