Wang H, Lai S, Hu H, Ding Z, Xu T, Hu H
Department of Urology, Peking University People' s Hospital; Institute of Applied Lithotripsy Technology, Peking University, Beijing 100044, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2025 Aug 18;57(4):784-788. doi: 10.19723/j.issn.1671-167X.2025.04.025.
To evaluate the safety and efficacy of a dual-endoscopic technique combining laparoscopy/robot-assisted laparoscopy with disposable flexible ureteroscopy for intraoperative localization and reconstruction in complex ureteral strictures.
A retrospective analysis was conducted on 21 patients with complex ureteral strictures (stenosis length ≥2 cm, multiple strictures, or iatrogenic strictures, or radiation-induced strictures) treated at Peking University People' s Hospital between January 2023 and November 2024. All the patients underwent dual-endoscopic procedures using laparoscopy (=17) or da Vinci robotic-assisted laparoscopy (=4) combined with disposable flexible ureteroscopy. Preoperative evaluation included contrast-enhanced CT urography and diuretic renography. Intra-operatively, stricture localization was achieved by synchronizing laparoscopic light sources with ureteroscopic visualization. Surgical positions were optimized: non-split-leg oblique supine position for mid-upper strictures and lithotomy position for mid-lower strictures. Reconstruction strategies (lingual mucosa graft, bladder flap augmentation, or primary anastomosis) were selected based on stricture length and tension. Postoperative outcomes were assessed via symptom resolution, hydronephrosis improvement (ultrasonographic renal pelvis diameter), and stent-free patency.
The cohort included 10 males and 11 females [mean age (44.1±13.3) years]. Etiologies included lithogenic strictures (71.4%, 15/21), post-gynecologic surgery injury (4.8%), radiation-induced fibrosis (4.8%), and congenital factors (19.0%). Intraoperative findings revealed discrepancies in stricture localization compared with pre-operative imaging in 52.4% (11/21) of cases, necessitating extended resection or modified reconstruction. Mean stricture length was (4.81±4.33) cm. Postoperative complications included transient urinary leakage (1 case) and secondary ureteral obstruction due to stone migration (1 case), both resolved without sequelae. At a mean follow-up of (10.76±6.81) months (range 2-21), hydronephrosis significantly improved in all the patients (100% efficacy), with no recurrence of strictures or symptom recurrence.
The dual-endoscopic technique enhances intraoperative precision in complex ureteral stricture management by integrating real-time luminal visualization with extraluminal anatomical guidance. This approach minimizes excessive resection of healthy ureter, optimizes reconstruction strategies, and reduces postoperative recurrence. The modified positioning protocol further improves ergonomic efficiency, making it a reliable and adaptable option for challenging ureteral pathologies.
评估一种双内镜技术的安全性和有效性，该技术将腹腔镜/机器人辅助腹腔镜与一次性软性输尿管镜相结合，用于复杂输尿管狭窄的术中定位和重建。
对2023年1月至2024年11月在北京大学人民医院接受治疗的21例复杂输尿管狭窄（狭窄长度≥2 cm、多处狭窄、医源性狭窄或放射性狭窄）患者进行回顾性分析。所有患者均接受了使用腹腔镜（=17）或达芬奇机器人辅助腹腔镜（=4）联合一次性软性输尿管镜的双内镜手术。术前评估包括增强CT尿路造影和利尿肾图。术中，通过将腹腔镜光源与输尿管镜视野同步实现狭窄定位。优化手术体位：中上段狭窄采用非分腿斜仰卧位，中下段狭窄采用截石位。根据狭窄长度和张力选择重建策略（舌黏膜移植、膀胱瓣扩大或一期吻合）。通过症状缓解、肾积水改善（超声测量肾盂直径）和无支架通畅情况评估术后结果。
该队列包括10名男性和11名女性[平均年龄（44.1±13.3）岁]。病因包括结石性狭窄（71.4%，15/21）、妇科手术后损伤（4.8%）、放射性纤维化（4.8%）和先天性因素（19.0%）。术中发现52.4%（11/21）的病例狭窄定位与术前影像学检查存在差异，需要扩大切除或改良重建。平均狭窄长度为（4.81±4.33）cm。术后并发症包括短暂性尿漏（1例）和结石移位导致的继发性输尿管梗阻（1例），均无后遗症而缓解。平均随访（10.76±6.81）个月（范围2 - 21个月），所有患者肾积水均显著改善（有效率100%），无狭窄复发或症状复发。
双内镜技术通过将实时管腔可视化与腔外解剖学引导相结合，提高了复杂输尿管狭窄治疗中的术中精准度。这种方法最大限度地减少了对健康输尿管的过度切除，优化了重建策略，并降低了术后复发率。改良的体位方案进一步提高了人体工程学效率，使其成为处理具有挑战性的输尿管病变的可靠且适应性强的选择。
