Flexible Ureteroscopic Guided Laparoscopic Ureteroplasty For The Treatment Of Ureteral Stricture

ABSTRACT

Introduction

Ureteral stricture is often a consequence of urolithiasis or previous endourological procedures (¹-³). Precisely delineating the stricture zone intraoperatively is crucial to minimize ureter shortening and target only the affected tissue (⁴, ⁵). Flexible ureteroscopy offers a significant advantage in this regard.

Objective

This video aims to demonstrate the step-by-step technique of flexible ureteroscopic guided laparoscopic ureteroplasty for treating ureteral stricture caused by urolithiasis and prior endourological interventions.

Patient and Methods

We present a case of a 36-year-old male with a history of urolithiasis and unsuccessful endourological treatments, including endoureterotomy and balloon dilation, diagnosed with re-stenosis of the proximal ureter of 1 cm through ureteroscopy and pyelography. He underwent a successful laparoscopic ureteroplasty. While the lead surgeon performed the laparoscopy, an assistant conducted the flexible ureteroscopy. Intraoperatively, using transillumination facilitated by the flexible ureteroscope, we can precisely identify the narrowed area, allowing for resection of only the damaged segment. Subsequently, we perform the end-to-end ureteroplasty, confirming its patency through the seamless passage of the ureteroscope. Upon completion, we employ a fat patch to safeguard the anastomosis.

Results

The patient was discharged on the third postoperative day. Double J stent was removed six weeks after surgery. Symptoms resolved. Renal function improved: eGFR 49 to 67 ml/min. Furthermore, improvement was observed in the DTPA scan, and a decrease in hydronephrosis was noted on the follow-up tomography.

Conclusion

Flexible ureteroscopy effectively identifies the stricture zone in laparoscopic ureteroplasty, enhancing surgical precision and outcomes. This approach is safe, effective, and reproducible, offering a valuable technique in the surgical treatment of ureteral strictures.

Available at: http://www.intbrazjurol.com.br/video-section/20240250_Danilovic_et_al

REFERENCES

• ¹
  Skolarikos A, Jung H, Neisius A, Petřík A, Somani B, et al. EAU Guidelines on urolithiasis. European Association of Urology. 2024. [Internet]. Available at. <https://uroweb.org/guidelines/urolithiasis Accessed 10 Apr 2024.
  » https://uroweb.org/guidelines/urolithiasis
• ²
  Andrade HS, Kaouk JH, Zargar H, Caputo PA, Akca O, Ramirez D, et al. Robotic Ureteroureterostomy for Treatment of a Proximal Ureteric Stricture. Int Braz J Urol. 2016;42:1041-2. doi: 10.1590/S1677-5538.IBJU.2015.0249.
  » https://doi.org/10.1590/S1677-5538.IBJU.2015.0249
• ³
  Menegola C, Tavares PM, Batezini NS, Gorgen ARH, Rosito TE. Laparoscopic ureteroplasty with buccal mucosa graft for long proximal ureteral stenosis: A step by step video. Int Braz J Urol. 2020;46:141-2. doi: 10.1590/S1677-5538.IBJU.2018.0830.
  » https://doi.org/10.1590/S1677-5538.IBJU.2018.0830
• ⁴
  Chow PM, Hsu JS, Su YR, Chen YS. Intraoperative retrograde ureteroscopy during laparoscopic ureteroureterostomy: Precise localization of the lesion. Asian J Surg. 2016;39:253-4. doi: 10.1016/j.asjsur.2013.04.005.
  » https://doi.org/10.1016/j.asjsur.2013.04.005
• ⁵
  Yang W, Tang W, Zheng X, Zhang M, Lu X, Chen Z, et al. Combination of robot-assisted laparoscopy and ureteroscopy for the management of complex ureteral strictures. BMC Urol. 2023;23:161. doi: 10.1186/s12894-023-01333-3.
  » https://doi.org/10.1186/s12894-023-01333-3

Publication Dates

• Publication in this collection
  02 Aug 2024
• Date of issue
  Jul-Aug 2024

History

• Received
  28 Apr 2024
• Accepted
  30 Apr 2024
• Published
  20 May 2024