The Clinical Analysis Of Transurethral Internal Ureterotomy For Ureteral End Stricture

Background:The ureter is a pair of flat and slender muscular conduit located in the retroperitoneal space.It starts at the end of the renal pelvis and ends at the bladder.The ureter can be divided into three parts:ventral segment,pelvic segment and intermural segment which is about 1.5cm.The causes of ureteral stricture include:congenital ureteral stenosis,ectopic ureter-bladder orifice,ureteral cyst,congenital megaureter and inflammation or calculus.Ureteral end stricture was treated by laparoscopic ureterovesical reimplantation in our department previously,but the procedure destroys the original anatomic structures of ureter and bladder and results in relatively high incidence of postoperative complications.Objective:Comparing with the traditional laparoscopic ureterovesical reimplantation,to evaluate the clinical effects of transurethral internal ureterotomy for the ureteral end stricture.Methods:Fifty-four cases of ureteral end stricture were included from January 2010 to January 2016 in our hospital.Preoperative urinary B-mode ultrasound,CT urography(CTU),magnetic resonance urography(MRU),or intravenous urography(IVU)were performed in all patients to confirm the diagnosis of ureterovesical junction stricture and the degree of hydronephrosis.54 cases were divided into two groups:26 cases(group A)underwent the transurethral internal ureterotomy;28 cases(group B)underwent the laparoscopic ureterovesical reimplantation.Data on the general information,operation time,the hospital stay,oral intake time after operation and postoperative complications were compared between the two groups.Ureteral stents were removed in all patients 2 to 3 months after the the operation.The mean follow-up time was(16.7 ± 4.4)months,(15.4± 4.2)months in group A and group B.The symptoms improvement of the two groups was observed and statistically compared by independent-samples t test,chi-square test and Fisher exact test.Statistical significance was defined as P<0.05.Results:Obstruction have been releaved in all the 54 with no changing surgery approach.There was no significant difference in general information between the two groups(P>0.05).Comparisons between group A and group B also included the following:the operation time was[(13.42±3.91)min vs.(88.68±10.22)min,t=-35.221,P=0.000],the hospital stay after operation was[(2.77±0.76)d vs.(6.36±1.47)d,t=-11.115,P=0.000],oral intake time after operation was[(15.31±3.95)h vs.(20.04 ±3.64)h,t=-4.582,P=0.000].The difference between the two groups was statistically significant(P<0.05).The postoperative complication was 0 vs 3.57%(1/28)between the group A and the group B.The difference was not statistically significant(P>0.05).Conclusion:Internal ureterotomy and laparoscopic ureterovesical reimplantation were safe and effective for ureteral end stricture.Internal ureterotomy does not destroy the normal anatomy of the ureter and bladder,does not interfere the other intraabdominal organ and minimize the damage to normal function ureter,with advantages of shorter operation time,shorter postoperative hospital stay,faster postoperative recovery,and simpler surgical operation.In the selected cases,the transurethral internal ureterotomy can be an alternative surgery for ureteral end stricture and be worth promoting widely.