Tang Haibin, Luo Shengjun, Yuan Heng, Jin Xiaosong, Xu Rutong, Zhao Jialei, Chen Gang
Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Transl Androl Urol. 2024 Sep 30;13(9):1922-1931. doi: 10.21037/tau-24-266. Epub 2024 Sep 25.
The treatment of complex ureteral stricture has always been a hot and difficult topic in urology. The aim of our study is to investigate the feasibility and clinical efficacy of labial mucosal graft (LMG) onlay ureteroplasty without omental wrap for ureteral stricture with occlusion and present our initial experience.
We retrospectively reviewed perioperative and follow-up data of 12 patients admitted to The First Affiliated Hospital of Chongqing Medical University who underwent the LMG ureteroplasty with ureteral occlusion from April 2022 to September 2023. After stricture and occluded segments were incised longitudinally, the LMG was used to expand the ureteral lumen without omental wrap.
All patients had successful surgery with no intraoperative complications. The median length of ureteral stricture was 3.5 cm (range, 3-5 cm), the median length of the occlusion was 1.5 cm (range, 1-2 cm), the median length of the LMGs is 4.5 cm (range, 4-6 cm). Ureteroscopy confirmed that the reconstructed ureteral lumen was unobstructed except for one patient with thin film-like ureteral stricture. Only one patient had slight contracture at the graft site, which did not affect movement of lip and appearance. No persistent and obvious discomfort was observed at the graft site in the remaining patients.
Our experience suggests that LMG onlay ureteroplasty without omentum wrap appears to be a feasible and safe option for reconstruction of ureteral occlusion.
复杂性输尿管狭窄的治疗一直是泌尿外科领域的热点和难点问题。本研究旨在探讨唇黏膜移植(LMG)覆盖输尿管成形术在无网膜包裹情况下治疗输尿管狭窄伴梗阻的可行性及临床疗效,并分享我们的初步经验。
我们回顾性分析了2022年4月至2023年9月在重庆医科大学附属第一医院接受LMG输尿管成形术治疗输尿管梗阻的12例患者的围手术期及随访数据。纵行切开狭窄及梗阻段后,使用LMG在无网膜包裹的情况下扩张输尿管管腔。
所有患者手术均成功,术中无并发症。输尿管狭窄的中位长度为3.5cm(范围3 - 5cm),梗阻的中位长度为1.5cm(范围1 - 2cm),LMG的中位长度为4.5cm(范围4 - 6cm)。输尿管镜检查证实,除1例薄膜样输尿管狭窄患者外,重建后的输尿管管腔通畅。仅1例患者移植部位有轻微挛缩,但不影响唇部活动及外观。其余患者移植部位未观察到持续且明显的不适。
我们的经验表明,无网膜包裹的LMG覆盖输尿管成形术似乎是重建输尿管梗阻的一种可行且安全的选择。