Efficacy analysis of laparoscopy combined with flexible ureteroscope in the treatment of complex ureteral stricture
10.19723/j.issn.1671-167X.2025.04.025
- VernacularTitle:腹腔镜与输尿管软镜联合定位治疗复杂输尿管狭窄的疗效分析
- Author:
Huanrui WANG
1
;
Shicong LAI
1
;
Haopu HU
1
;
Zehua DING
1
;
Tao XU
1
;
Hao HU
1
Author Information
1. 北京大学人民医院泌尿外科,北京大学应用碎石技术研究所,北京 100044
- Publication Type:Journal Article
- Keywords:
Ureteral stricture;
Ureteroplasty;
Ureteroscopes;
Laparoscopy;
Robotic surgical proce-dures
- From:
Journal of Peking University(Health Sciences)
2025;57(4):784-788
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the safety and efficacy of a dual-endoscopic technique combining laparoscopy/robot-assisted laparoscopy with disposable flexible ureteroscopy for intraoperative localization and reconstruction in complex ureteral strictures.Methods:A retrospective analysis was conducted on 21 patients with complex ureteral strictures(stenosis length ≥2 cm,multiple strictures,or iatrogenic stric-tures,or radiation-induced strictures)treated at Peking University People's Hospital between January 2023 and November 2024.All the patients underwent dual-endoscopic procedures using laparoscopy(n=17)or da Vinci robotic-assisted laparoscopy(n=4)combined with disposable flexible ureterosco-py.Preoperative evaluation included contrast-enhanced CT urography and diuretic renography.Intra-operatively,stricture localization was achieved by synchronizing laparoscopic light sources with uretero-scopic visualization.Surgical positions were optimized:non-split-leg oblique supine position for mid-upper strictures and lithotomy position for mid-lower strictures.Reconstruction strategies(lingual mucosa graft,bladder flap augmentation,or primary anastomosis)were selected based on stricture length and tension.Postoperative outcomes were assessed via symptom resolution,hydronephrosis improvement(ultrasono-graphic renal pelvis diameter),and stent-free patency.Results:The cohort included 10 males and 11 females[mean age(44.1±13.3)years].Etiologies included lithogenic strictures(71.4％,15/21),post-gynecologic surgery injury(4.8％),radiation-induced fibrosis(4.8％),and congenital factors(19.0％).Intraoperative findings revealed discrepancies in stricture localization compared with pre-operative imaging in 52.4％(11/21)of cases,necessitating extended resection or modified reconstruc-tion.Mean stricture length was(4.81±4.33)cm.Postoperative complications included transient urina-ry leakage(1 case)and secondary ureteral obstruction due to stone migration(1 case),both resolved without sequelae.At a mean follow-up of(10.76±6.81)months(range 2-21),hydronephrosis sig-nificantly improved in all the patients(100％efficacy),with no recurrence of strictures or symptom re-currence.Conclusion:The dual-endoscopic technique enhances intraoperative precision in complex ure-teral stricture management by integrating real-time luminal visualization with extraluminal anatomical guidance.This approach minimizes excessive resection of healthy ureter,optimizes reconstruction strate-gies,and reduces postoperative recurrence.The modified positioning protocol further improves ergonomic efficiency,making it a reliable and adaptable option for challenging ureteral pathologies.
