Efficacy of laparoscopic ureteroureterostomy with intraoperative retrograde ureteroscopy-assisted technique for ureteral strictures secondary to Holmium laser lithotripsy

Abstract

Objective To investigate the safety and efficacy of laparoscopic ureteroureterostomy with intraoperative retrograde ureteroscopy-assisted technique in the treatment of ureteral strictures secondary to Holmium laser lithotripsy. Methods The clinical data of 26 cases of ureteral strictures secondary to Holmium laser lithotripsy performed by laparoscopic ureteroureterostomy from December 2013 to January 2016 in our hospital were analyzed retrospectively. The patients included 15 men and 11 women, with an average age of 39.5 years (range 24-71 years). The ureteral strictures secondary to holmium laser lithotripsy were found on average follow-up of 5.2 months (range 1-22 months). There were 12 cases of mild hydronephrosis before surgery, moderate hydronephrosis in 11 cases, severe hydronephrosis in 3 cases. Preoperative serum creatinine was 102.0 μmol/L on average ( range 53.3-201.4 μmol/L), and ureteral stenosis length was 15.0 mm on average (range 8.0-26.0 mm) .The upper ureteral strictures in 6 cases, the middle strictures in 13 cases, and the lower strictures in 7 cases. Results All the operations were completed successfully without conversion to open and no intraoperative death .The average operation time was 121.4 min(range 90-155 min); the estimated blood loss was 92.3 ml(range 30-200 ml); the mean recovery time of gastrointestinal function after operation was 1.4 d(range 0.5-2.5 d); the mean hospital stay was 6.2 d(range 4-9 d)with indwelling double J; the Foley catheter was removed 14.5 d(range 12-16 d)postoperatively; the mean time of double J withdrawal was 76.3 d(range 61-86 d ). Postoperative fever occurred in two patients and were successfully treated by re-indwelling catheter and antibiotic administration. Urine leakage occurred in 1 patient postoperatively and was successfully treated by conservative management 5 days later. After a period of 11 to 22 months of follow-up, no patient had ureteric re-stenosis. Conclusions Laparoscopic ureteroureterostomy with intraoperative retrograde ureteroscopy-assisted technique could accurately locate and cure the ureteral strictures. It might be safe and effective with short operation time, less injury and quick recovery. Key words: Laparoscope; Ureteroscope; Holmium laser lithotripsy; Ureteral strictures