Ileal ureteral replacement for tuberculous ureteral strictures: 11 cases of experience

To evaluate the feasibility and safety of ileal ureteral replacement (IUR) for long-segment ureteral strictures secondary to urogenital tuberculosis (UGTB).

11 patients with complex tuberculous ureteral strictures underwent IUR across three tertiary centers between March 2015 and January 2024. Surgical approaches included open (n = 2), laparoscopic (n = 4), and robotic-assisted (n = 5). Demographic characteristics, perioperative data and follow-up outcomes were prospectively collected.

11 patients (8 males, 3 females) with a mean age of 38.3 ± 13.1 years were included. Two patients had bilateral involvement, and nine patients had unilateral involvement. Four patients underwent concomitant ileocystoplasty. The mean stricture length was 19.0 ± 6.3 cm, and the median length of ileum harvested was 25 cm. The mean operative time was 283.9 ± 28.1 min. The median estimated blood loss was 150 mL. The median postoperative hospital stay was 15 days, with the robotic approach significantly reducing hospitalization time (p = 0.015). During the median follow-up of 36 months, all patients achieved ureteral patency. The mean preoperative and latest estimated glomerular filtration rate were 82.0 ± 24.1 and 74.7 ± 22.9 mL/min/1.73 m² (p = 0.062), respectively. Complications were reported in 8 patients, primarily metabolic acidosis (6/11) and urinary tract infections (4/11). Metabolic acidosis was associated with renal function decline (p = 0.015). Two patients experienced major complications, consisting of ileus and incision infection respectively.

IUR is a safe and effective last resort for patients with complex ureteral strictures secondary to UGTB. High complication rates and long-term metabolic risks limit its application, necessitating strict patient selection and rigorous lifelong management.