Laparoscopic and Robot-Assisted Laparoscopic Management of Iatrogenic Ureteral Strictures: Preliminary Experience

TL;DR

This paper reports on the successful use of laparoscopic and robotic techniques to treat ureteral strictures caused by medical procedures, showing promising results with minimal complications.

Contribution

The study presents preliminary clinical experience with minimally invasive techniques for managing iatrogenic ureteral strictures.

Findings

All procedures were technically feasible with a median operating time of 105 minutes and no major complications.

At a median follow-up of 38 months, 88.88% of patients remained asymptomatic with preserved renal function.

One recurrence was observed in a laparoscopic case, requiring a permanent stent.

Abstract

Iatrogenic ureteral strictures are uncommon but challenging to manage. We present our expertise in laparoscopic and robot-assisted laparoscopic ureteroureterostomy (LUU and RAUU) for lumbar and iliac strictures and laparoscopic ureteral reimplantation for pelvic strictures. A descriptive study was conducted on nine adult patients who underwent minimally invasive procedures. Six had lumbar or iliac ureteral strictures—five due to ureterorenoscopy and one following pancreaticoduodenectomy for pancreatic cancer. Three developed pelvic strictures after ureterorenoscopy. Preoperative evaluation included a medical history review, abdominal ultrasound, and CT scan. Success was characterized by the absence of symptoms and the lack of obstruction on follow-up imaging at one year. All procedures were technically feasible, with a median operating time of 105 min and a median hospital stay of four days. No major complications occurred. One patient experienced ureteral stricture recurrence following a laparoscopic approach for a lumbar stricture, and required a permanent double-J stent. At a median follow-up of 38 months, 88.88% of patients remained asymptomatic with preserved renal function. Our findings suggest that robotic and laparoscopic ureteral reconstruction performed by experienced surgeons at a tertiary center is a safe and effective option with a low complication rate.

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