Enhancing surgical outcomes in ureteral stricture treatment: a combined approach using flexible ureteroscopy and laparoscopy
Year: 2025
Type: article
Abstract: BACKGROUND: Ureteral strictures pose significant challenges in urological surgery, requiring precise localization of stenotic segments for effective resection. Traditional rigid ureteroscopy-assisted techniques involve positioning limitations and procedural inefficiencies. This study evaluates the safety and efficacy of a novel approach combining flexible ureteroscopy and laparoscopy for ureteroureterostomy, focusing on improved intraoperative navigation and reduced procedural complexity. METHODS: A retrospective analysis was conducted in 12 patients (7 males, 5 females; median age 50 years) undergoing laparoscopic ureteroureterostomy with flexible ureteroscopy between July 2023 and August 2024. All strictures were located in the upper ureter (length: 8-23 mm). Key innovations included lateral positioning, a flexible ureteroscope sheath (external/internal diameter: 12 Fr /10 Fr), and real-time ureteral light guidance. Surgical parameters (operative time, blood loss), perioperative outcomes, and follow-up data (median 10 months) were analyzed. Biochemical recovery (serum creatinine normalization) and radiological recovery (urography patency) were primary endpoints. RESULTS: All procedures were completed without conversion to open surgery. Median operative time was 175 min (range: 130-225), with intraoperative bleeding of 22.5 mL (range: 20-50). Flexible ureteroscopy enabled repeated lumen verification (median 6 insertions) without ureteral trauma. Postoperatively, hydronephrosis resolved in all patients, with no anastomotic leaks or restenosis. Median hospital stay was 5.5 days (range: 3-9); one patient experienced transient fever. Biochemical and radiological recovery was achieved in all cases. Follow-up imaging (median 10 months) confirmed sustained ureteral patency and improved renal function. CONCLUSIONS: The integrated flexible ureteroscopy-laparoscopy approach enhances surgical precision and efficiency for upper ureteral strictures, mitigating positioning limitations and reducing iatrogenic injury. While initial outcomes demonstrate safety and efficacy, long-term follow-up and prospective multicenter trials are warranted to validate durability. This technique represents a promising advancement in minimally invasive ureteral reconstruction.
Source: BMC Urology
Authors: Xuhong Zhang, Rongchang Guo, Bin Xu, Yiwei Wang
Language: English
Subfield: Obstetrics and Gynecology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,990
OpenAlex ID: W4416392230