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.

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.

Objective:To assess health related quality of life(HRQOL)in patients with kidney stones and to predict risk factors for reduced HRQOL in the patients by the Chinese version of Wisconsin stone quality of life questionnaire(C-WISQOL).Methods:The patients with renal stones admitted to Peking University People's Hospital from July 2020 to June 2021 were prospectively enrolled.The inclusion cri-teria included the patients with renal stones aged 18-80 years and sufficient Chinese language founda-tion,and the exclusion criteria included the patients with internal ureteral stents,malignant tumors,sep-sis,etc.Demographic data and clinical data related to kidney stones were collected,and the C-WISQOL and the short form 36 health survey(SF-36)questionnaire completed by the patients was recorded.C-WISQOL included four domains(D):emotional impact(D1),social impact(D2),stone-related im-pact(D3)and vitality impact(D4).Cronbach's α coefficient was used to verify the internal consistency of C-WISQOL,Spearman's rho coefficient was used to verify the criterion validity between C-WISQOL and SF-36 questionnaire,confirmatory factor analysis was used to verify the structural validity,conver-gent validity and discrimination validity of C-WISQOL,and univariate and multivariate analyses were used to explore the risk factors leading to the decline of HRQOL in the patients with kidney stones.Re-sults:The study included 307 patients with kidney stones,of whom 212(69.1％)were male,with a mean age of(51.9±13.5)years,and a mean body mass index(BMI)of(25.4±3.6)kg/m2.160(52.1％)patients were complicated with metabolic syndrome(MS),202(65.8％)had history of cal-culi,217(70.7％)had calculi related symptoms,53(17.3％)had bilateral renal calculi,82(26.7％)had ureteral calculi,199(64.8％)had hydronephrosis,78(25.4％)had renal insufficien-cy,and urinary tract infection(UTI)was found in 168 patients(54.7％)with an average diameter of(15.6±5.9)mm.The mean total score of C-WISQOL questionnaire for all the patients was(94.9±13.7)points,D1 was(27.2±4.2)points,D2 was(23.8±3.7)points,D3 was(27.0±3.6)points,and D4 was(10.1±1.9)points.The Cronbach's α coefficient of the total score of C-WISQOL questionnaire was 0.968 and the four dimensions ranged from 0.860 to 0.898.The Spearman's rho co-efficient between C-WISQOL and SF-36 total score was 0.564,and the Spearman's rho coefficient between dimensions was 0.684-0.901,indicating that C-WISQOL had good internal consistency and criterion validity.Confirmatory factor analysis showed that C-WISQOL had good structural validity,convergent va-lidity and discrimination validity.Univariate analysis showed that the patients with MS(OR=1.607,P＜0.001),calculi related symptoms(OR=1.268,P＜0.001),bilateral kidney stones(OR=1.900,P＜0.001),combined with ureteral calculi(OR=1.018,P＜0.001),accompanied by hydronephrosis(OR=1.685,P＜0.001),and UTI(OR=1.275,P＜0.001)were risk factors for decreased HRQOL in the patients with kidney stones,and multivariate analysis showed that the patients with MS(OR=1.475,P＜0.001),calculi related symptoms(OR=1.546,P=0.043)and UTI(OR=1.646,P=0.005)were independent risk factors for HRQOL decline in the patients with renal calculi.The t-test re-sults showed that C-WISQOL scores were significantly higher in the patients without MS,stone-related symptoms and UTI than those in the patients with associated risk factors(P＜0.001).Conclusion:C-WISQOL the questionnaire can be used to evaluate the HRQOL of patients with kidney stones with good reliability.The combination of MS,stone-related symptoms and UTI were independent risk factors for HRQOL reduction in the patients with renal stones.