Hook S, Gross A J, Netsch C, Becker B, Filmar S, Vetterlein M W, Kluth L A, Rosenbaum C M
Abteilung für Urologie, Asklepios Klinik Barmbek, Rübenkamp 220, 22307, Hamburg, Deutschland.
Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland.
Urologie. 2024 Jan;63(1):25-33. doi: 10.1007/s00120-023-02232-z. Epub 2023 Nov 21.
Ureteral strictures can occur along the entire course of the ureter and have many different causes. Factors involved in the development include, among other things, congenital anomalies, iatrogenic injuries during endoscopic as well as open or minimally invasive visceral surgical, gynecological, and urological procedures as well as prior radiation therapy. Planning treatment for ureteral strictures requires a detailed assessment of stricture and patient characteristics. Given the various options for ureteral reconstruction, various methods must be considered for each patient. Short-segment proximal strictures and strictures at the pyeloureteral junction are typically surgically managed with Anderson-Hynes pyeloplasty. End-to-end anastomosis can be performed for short-segment proximal and middle ureteral strictures. Distal strictures are treated with ureteroneocystostomy and are often combined with a Boari and/or Psoas Hitch flap. Particularly, the treatment of long-segment strictures in the proximal and middle ureter remain a surgical challenge. The use of bowel interposition is an established treatment option for this, offering good functional results but also potential associated complications. Robot-assisted surgery is increasingly becoming a minimally invasive treatment alternative to reduce hospital stays and optimize postoperative recovery. However, open surgical ureteral reconstruction remains an established procedure, especially after multiple previous abdominal operations.
输尿管狭窄可发生于输尿管全程，病因多样。其发病相关因素包括先天性异常、内镜检查以及开放或微创的内脏手术、妇科手术和泌尿外科手术过程中的医源性损伤，以及既往放疗史等。输尿管狭窄的治疗规划需要对狭窄情况和患者特征进行详细评估。鉴于输尿管重建有多种选择，必须针对每位患者考虑不同的方法。短节段近端狭窄和肾盂输尿管连接处狭窄通常采用安德森 - 海因斯肾盂成形术进行手术治疗。短节段近端和中段输尿管狭窄可进行端端吻合术。远端狭窄采用输尿管膀胱再植术治疗，常联合鲍里氏瓣和/或腰大肌悬吊瓣。特别是，近端和中段输尿管长节段狭窄的治疗仍然是一项手术挑战。肠代输尿管术是针对此情况的一种成熟治疗选择，功能效果良好，但也存在潜在相关并发症。机器人辅助手术正日益成为一种微创治疗选择，以减少住院时间并优化术后恢复。然而，开放性输尿管重建仍是一种成熟的手术方式，尤其是在既往有多次腹部手术史的情况下。
