Laparoscopic Treatment Of Iatrogenic Recurrent Middle And Upper Ureteral Stricture

Objective To summarize the technical points and efficacy of laparoscopic ureterostenosis resection plus anastomosis with planes surgical technique for curing iatrogenic recurrent middle and upper ureterostenosis..Methods A retrospective analysis was performed on 31 patients with iatrogenic recurrent middle and upper ureterostenosis treated by laparoscopic ureterostenosis resection plus anastomosis with planes surgical technique from June 2014 to January 2020,the upper strictures in 26 cases,the middle strictures in 5 cases.All patients had undergone 1-4 times of endoscopic ureterectasia or internal incision before surgery,and preoperative conventional methods such as color Doppler ultrasound,CTU,retrograde pyelography,or ureteroscopy were used to evaluate the location,degree and length of ureterostenosis,and ECT was used to evaluate renal function of some;During the operation,the planes surgical technique was used for separation and exposure,the ureter was partially cut with cold knife and the non-clamping suture technique is applied to the whole process,so as to protect the blood supply of the broken end of the ureter.Postoperative routine indwelling of double J ureteral stent and follow-up visit were conducted.Results The length of stricture ranges from 0.5 to 4cm,with an average of 1.5cm.The operation was successfully completed in 30 cases,among which 1 case was transferred to laparotomy anastomosis,and one patient underwent anastomosis after laparoscopic renal moved down.The operation time was 90?360min,with an average of 247.8min.Intraoperative blood loss was 20-300ml,with an average of 83.5ml.The perirenal drainage tube was indwelled for3-13 days,with an average of 5.4 days.The postoperative hospital stay was 7?16 days,8.7 days on average.Postoperative double J ureteral stent was indwelled for 1?3months.Two patients who had undergone twice opening ureteral surgery had postoperative urinary leakage,and two patients had recurrent obstruction during follow-up visit.The remaining 29 patients were followed up for 3?67 months after the double J ureteral stent was removed,with an average follow-up of 20.7 months,and their lumbar pain disappeared,and imaging showed that hydronephrosis was significantly reduced or disappeared.Conclusion1.Laparoscopic ureterostenosis resection plus anastomosis with planes surgical technique for curing iatrogenic recurrent middle and upper ureterostenosis is minimally invasive and has obvious curative effect,which should be the first choice for curing iatrogenic recurrent middle and upper ureterostenosis.2.In this study,there were no significant differences in operative time,blood loss,degree of surgical inflammation,postoperative complications,and postoperative hospital stay between the two groups which adopted transabdominal approach and trans-retroperitoneal approach respectively.