Enhancing surgical outcomes in ureteral stricture treatment: a combined approach using flexible ureteroscopy and...

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.

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.

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.

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.