Laparoscopic surgery for complicated ureteral strictures after Holmium laser lithotripsy / 中华泌尿外科杂志

ABSTRACT

Objective To explore the therapeutic effect of laparoscopic surgery for complicated ureteral strictures after Holmium laser lithotripsy.Methods There were 67 patients with ureteral stenosis after ureteroscopic lithotripsy or percutaneous nephrolithotomy Holmium laser lithotripsy from January 2009 to September 2017.There were 38 males and 29 females.The average age of patients was 37 years old(rang 21-62 years).47 cases were hospitalized because of osphyalgia,among whom 8 cases had fever.There were 19 cases of upper ureteral calculi postoperative stenosis,18 cases of middle ureteral calculi postoperative stenosis and 30 cases of lower ureteral calculi postoperative stenosis,17 cases of whom had complete atresia.6 patients had received twice Holmium laser lithotripsy.Two patients had received triple Holmium laser lithotripsy.In 67 cases,11 cases had received a ureteral stent placement to dilate the affected ureter.2 cases had received twice ureteral stent placements,two double-J tubes were placed in the two stage surgery.2 cases had received treatment of incision inside the ureteral stricture by ureteroscope,but symptoms recurred after removal of the double-J tube.There were 15 cases of mild hydronephrosis before surgery,moderate hydronephrosis in 27 cases,severe hydronephrosis in 25 cases.The depth of separation of the renal collecting system was (3.85 ± 0.58) cm,preoperative serum creatinine was 115μmol/L on average (range 46-258 μmol/L).The surgery was done by the abdominal pathway or posterior abdominal pathway.52 patients had ureteral stenosis resection plus ureter end anastomosis,15 patients had ureteral bladder replantation.Results All the patients had successful surgery.The operation time was 65-160 min,and the average operation time was 82 min;the intraoperative blood loss was about 20-300 ml,and the average blood loss was about 56 ml;Postoperative fever occurred in two patients and were successfully treated by re-indwelling catheter and antibiotic.The stent was removed after 2-3 months and patients were followed up for 5-24 months after removing the double-J tube,with an average of 12 months.The patients with osphyalgia were significantly relieved.The separation of the renal collecting system was reduced to(3.85 ± 0.58)cm,postoperative serum creatinine was 75.8 μmol/L on average (range 47-165 μmol/L).Renal function stop deterioration in 67 patients.Conclusion The operation of laparoscopic ureteral strictures resection plus ureter end anastomosis or ureteral bladder replantation after ureteral strictures due to the use of Holmium laser lithotripsy is the minimally invasive,safe and effective treatment.