[Surgical techniques and clinical outcomes of upper urinary tract reconstruction for stone-related ureteral strictures].

Abstract

Objective: To summarize the surgical strategies and to evaluate the clinical outcomes of upper urinary tract reconstruction in patients with stone-related ureteral strictures.

Methods: This retrospective study included 71 patients diagnosed with ureteral strictures secondary to urinary stones who underwent upper urinary tract reconstructive surgery at Peking University First Hospital between March 2014 and November 2023. Patient data were collected, including demographic characteristics, clinical presentation, laboratory results, imaging findings, surgical procedures, and follow-up outcomes. Ureteral strictures were classified according to anatomical location into upper, middle, lower, or multiple segments. Surgical procedures were carried out depending on the stricture characteristics. Surgical success was defined as resolution or improvement of clinical symptoms, radiographic improvement or stabilization of hydronephrosis, and maintenance of normal and stable renal function.

Results: Among the 71 patients, 36 (50.7%) had strictures in the upper ureter, 9 (12.7%) in the middle ureter, 15 (21.1%) in the lower ureter, and 11 (15.5%) had multifocal ureteral strictures. The median stricture length was 5.0 cm (interquartile range: 3.0-15.0 cm). Surgical approach selection was individualized based on the location and extent of the stricture. For upper ureteral strictures, the most frequently employed techniques were oral mucosal graft ureteroplasty (13/36, 36.1%) and appendiceal flap ureteroplasty (8/36, 22.2%). Other options included ureteroureterostomy and ileal ureter replacement for longer or more complex strictures. In middle ureteral strictures, treatment was stratified by length: balloon dilation (1/9, 11.1%) and ureteroureterostomy (1/9, 11.1%) were applied in shorter strictures, while oral mucosal graft ureteroplasty (3/9, 33.3%) and ileal ureter replacement (4/9, 44.4%) were reserved for longer segments. For lower ureteral strictures, ureteral reimplantation into the bladder was the most common approach (10/15, 66.7%), often combined with a psoas hitch or Boari flap when necessary. All the patients with multiple segmental strictures underwent ileal ureter replacement due to the extensive nature of the disease. The median follow-up period was 14.2 months (range: 6.1-107.1 months). During follow-up, 69 of 71 patients (97.2%) achieved surgical success.

Conclusion: Stone-related ureteral strictures present with considerable heterogeneity in terms of anatomical location, length, and complexity. Careful preoperative evaluation and individualized surgical planning are critical to successful reconstruction. With appropriate selection of surgical methods, favorable long-term clinical outcomes can be achieved in the majority of patients.