# Clinical outcomes and quality of life assessment of fully laparoscopic appendiceal flap and tongue mucosa ureteroplasty for complex ureteral strictures

## TL;DR

This study shows that two fully laparoscopic surgeries for complex ureteral strictures are safe and improve patients' quality of life.

## Contribution

Demonstrates the safety and effectiveness of fully laparoscopic AFU and LMGU for complex ureteral strictures with HRQoL improvements.

## Key findings

- Both AFU and LMGU achieved 100% technical success in treating complex ureteral strictures.
- Health-related quality of life scores improved significantly at 6 and 12 months post-surgery.
- Surgical procedures had low blood loss and short hospital stays with no conversion to open surgery.

## Abstract

The main goal of this study is to evaluate the clinical effectiveness of two fully laparoscopic methods. These two methods are appendiceal flap ureteroplasty (AFU) and lingual mucosal graft ureteroplasty (LMGU). They are used to treat complex ureteral strictures (US). This study also analyzes how these methods affect the health-related quality of life (HRQoL) of patients.

We did a single-center, retrospective cohort study. This study included 22 patients who had complex US. All these patients received fully laparoscopic AFU or LMGU in our hospital. The time of the surgery was from January 2022 to October 2024. We assessed surgical results. We based the assessment on radiographic imaging, renal function tests and patient-reported outcomes. Patient-reported outcomes were longitudinally evaluated using the internationally validated 36-Item Short Form Health Survey (SF-36) at one day before surgery, 6 months, and 12 months postoperatively.

All 22 patients successfully underwent the fully laparoscopic procedures without conversion to open surgery. The cohort comprised 14 patients who received AFU and 8 who received LMGU. The average length of US in the patients was 4.14 ± 0.68 cm. The average time spent on surgery was 198.86 ± 44.88 min. The median estimated blood loss during surgery was 67.5 ml. The median number of days patients stayed in the hospital after surgery was 8 days. The median follow-up period for the patients was 12 months. Every surgery was successful in terms of technique, so the success rate reached 100%. Patient-reported outcome scores showed obvious improvement. This improvement happened from the baseline to 6 months after surgery, and it also happened at the 12-month postoperative evaluation. Most domains of the scores had this improvement, and the difference was statistically significant (p < 0.05).

Both fully laparoscopic AFU and LMGU are safe and effective for the reconstructive treatment of complex US. We also found that HRQoL improved significantly after the operation.