擬雙鏡聯合手術：半硬式輸尿管鏡導引下腹腔鏡輸尿管成形術治療嚴重輸尿管狹窄洪健哲、王世鋒

國泰綜合醫院 外科部 泌尿科
Advanced Collaborative Surgical Techniques: Semi-rigid Ureteroscopic-Guided Laparoscopic Ureteroplasty For The Case of Severe Ureteral Stricture

Chien-Che Hung, Shih-Feng Wang

Division of Urology, Department of Surgery, Cathay General Hospital, Taipei, Taiwan

Ureteral stricture often results from urolithiasis or previous endourological procedures. Ureteroplasty or even uretero-ureterostomy may be the treatment of choice. In order to minimize ureter shortening and target only the affected tissue, it is crucial to precisely delineate the stricture zone intraoperatively. However, the most challenging point is to identify the stricture site precisely. Ureteroscopy offers a significant advantage in this regard.

We present a case of a 70-year-old male with a medical history of hypertension and Diabetes mellitus. He suffered from recurrent right ureteral stones and ever received ESWL, URSL, and PCNL 5 years ago.
However, due to intermittent right flank soreness, he came to our hospital for help. Renal Echo was performed and demonstrated right severe hydronephrosis with decreased kidney size and cortical thickness. Right ureterorenoscopy was further conducted, and the right middle ureteral stricture was identified with a near pinhole feature. The stricture point is about 12-13cm from the right ureteral orifice. A double-J stent was inserted and prescribed as a temporary dilator for the stricture site. Nonetheless, the patient suffered from intolerable right flank pain with severe hydronephrosis after the Double-J stent was removed. After discussing with the patient, he decides to receive laparoscopy ureteroplasty. A successful surgery was performed afterward. While the lead surgeon performed the laparoscopy, an assistant conducted the semi-rigid ureteroscopy. Intraoperatively, we simultaneously use the transillumination facilitated by the ureteroscope, which allows us to precisely identify the narrowed area, allowing for the incision of the stricture segment. Subsequently, we performed the ureteroplasty and inserted the double-J stent, confirming through laparoscopy direct vision. Double-J stent was removed 3 months later with a subsequent renal echo follow-up, which indicated improving right hydronephrosis.

The transillumination facilitated by ureteroscopy effectively identifies the stricture zone in laparoscopic ureteroplasty, significantly enhancing surgical precision and outcomes. Besides, this approach is safe, effective, and reproducible, offering a valuable technique in the surgical treatment of ureteral strictures. Thus, we herein report this case to share our experience in collaborative surgical methods.