Surgical techniques and clinical outcomes of upper urinary tract reconstruction for stone-related ureteral strictures
10.19723/j.issn.1671-167X.2025.04.007
- VernacularTitle:结石相关输尿管狭窄的上尿路修复手术技术与临床结局
- Author:
Xiaoteng YU
1
;
Yixuan HUANG
1
;
Xinfei LI
1
;
Changfu CHEN
1
;
Fangzhou ZHAO
1
;
Honggang YING
1
;
Zihao TAO
1
;
Yiming ZHANG
1
;
Liqing XU
1
;
Zhihua LI
1
;
Kunlin YANG
1
;
Liqun ZHOU
1
;
Xuesong LI
1
;
Zheng ZHAO
1
Author Information
1. 北京大学第一医院泌尿外科,北京大学泌尿外科研究所,国家泌尿男生殖系研究肿瘤中心,北京 100034
- Publication Type:Journal Article
- Keywords:
Hydronephrosis;
Ureteral stenosis;
Reconstruction surgery;
Ureteroscopy;
Lithotripsy
- From:
Journal of Peking University(Health Sciences)
2025;57(4):670-675
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To summarize the surgical strategies and to evaluate the clinical outcomes of up-per urinary tract reconstruction in patients with stone-related ureteral strictures.Methods:This retro-spective study included 71 patients diagnosed with ureteral strictures secondary to urinary stones who un-derwent upper urinary tract reconstructive surgery at Peking University First Hospital between March 2014 and November 2023.Patient data were collected,including demographic characteristics,clinical presen-tation,laboratory results,imaging findings,surgical procedures,and follow-up outcomes.Ureteral stric-tures were classified according to anatomical location into upper,middle,lower,or multiple segments.Surgical procedures were carried out depending on the stricture characteristics.Surgical success was de-fined as resolution or improvement of clinical symptoms,radiographic improvement or stabilization of hy-dronephrosis,and maintenance of normal and stable renal function.Results:Among the 71 patients,36(50.7％)had strictures in the upper ureter,9(12.7％)in the middle ureter,15(21.1％)in the lower ureter,and 11(15.5％)had multifocal ureteral strictures.The median stricture length was 5.0 cm(interquartile range:3.0-15.0 cm).Surgical approach selection was individualized based on the location and extent of the stricture.For upper ureteral strictures,the most frequently employed techniques were oral mucosal graft ureteroplasty(13/36,36.1％)and appendiceal flap ureteroplasty(8/36,22.2％).Other options included ureteroureterostomy and ileal ureter replacement for longer or more complex strictures.In middle ureteral strictures,treatment was stratified by length:balloon dilation(1/9,11.1％)and ureteroureterostomy(1/9,11.1％)were applied in shorter strictures,while oral mucosal graft ureteroplasty(3/9,33.3％)and ileal ureter replacement(4/9,44.4％)were reserved for longer segments.For lower ureteral strictures,ureteral reimplantation into the bladder was the most common approach(10/15,66.7％),often combined with a psoas hitch or Boari flap when necessary.All the patients with multiple segmental strictures underwent ileal ureter replacement due to the extensive nature of the disease.The median follow-up period was 14.2 months(range:6.1-107.1 months).During follow-up,69 of 71 patients(97.2％)achieved surgical success.Conclusion:Stone-related ure-teral strictures present with considerable heterogeneity in terms of anatomical location,length,and com-plexity.Careful preoperative evaluation and individualized surgical planning are critical to successful re-construction.With appropriate selection of surgical methods,favorable long-term clinical outcomes can be achieved in the majority of patients.
