Application of laparoscopic ureterocalicostomy in proximal ureteral stricture: a single- center 5-year experience

Background To evaluate the current indications and outcomes of laparoscopic ureterocalicostomy. Methods Nine patients with complex proximal ureteral obstruction underwent laparoscopic ureterocalicostomy. Seven patients with previous upper ureteral calculi underwent intracavitary stone surgery (antegrade or retrograde ureteroscopic holmium laser lithotripsy). One patient had previously undergone open pyelolithotomy, while two patients underwent primary UPJ obstruction with complete renal pelvis. Seven patients underwent laparoscopic surgery and 2 patients underwent robotic-assisted laparoscopic surgery. Postoperative outcomes were observed and followed up. Outcome indicators included operation time, hospital stay and blood loss, and blood loss. Ultrasound examination was performed after surgery, and patients were followed up at 6 and 12 months with hypotonic intravenous pyelography imaging to check for obstruction. Results All patients underwent successful surgery. One patient had previously undergone open pyelolithotomy. Adhesion around the renal pelvis was evident, dissociation was difficult, and intraoperative bleeding was evident. Open surgery was successful. The mean was 192 min (80 ~ 310 min), blood loss was 77 mL (10 ~ 300 mL), and postoperative hospital stay was 8.3 days (6 ~ 13 days). The colour Doppler ultrasound three months after surgery showed that the hydronephrosis was relieved or stable. Hypotonic intravenous pyelography was performed after surgery and no evidence of ureteral obstruction was found. The median (range) follow-up was 35 (4–59) months. One patient had Clavien-Dindo IIIa complications and required regular stent replacement. Conclusion Laparoscopic ureterocalicostomy is essential in modern urology. However, its primary indications have changed. It is a safe and feasible choice for patients with complex proximal ureteral obstructions.