Ureteroscopy-assisted techniques in laparoscopic repair of middle and lower ureteral stenosis: A retrospective comparative study

Background: Intraoperative localization of ureteral strictures and safe placement of double-J stents are pivotal steps during laparoscopic reconstruction, yet practical guidance on these steps is limited. Objective: To introduce a simple and feasible new method of using ureteroscopy-assisted localization and indwelling double-J tubes in laparoscopic repair of middle and lower ureteral stenosis, and to confirm its safety and effectiveness. Methods: We conducted a single-center, two-period retrospective comparison of patients undergoing laparoscopic reconstruction for middle or lower ureteral stricture. The control cohort (2010–2017) used conventional laparoscopic localization with trocar-assisted guidewire/stent placement, whereas the experimental cohort (2018–2023) used ureteroscopy-assisted localization with transureteral guidewire/stent placement under simultaneous laparoscopic visualization. Primary outcomes were time to localize the stricture and time to place the double-J stent. Results: A total of 49 patients were included in the experimental cohort and 56 in the control cohort. Ureteroscopy assistance shortened stricture localization time (138 ± 24 versus 174 ± 12 min; mean difference [MD] −36; 95% CI −43.5 to −28.5; p=0.02) and double-J stent placement time (5.2 ± 0.6 versus 9.8 ± 2.4 min; MD −4.6; 95% CI −5.26 to −3.94; p=0.01). Estimated blood loss, drain duration, time to first flatus, and stent malposition rates were similar between groups. Conclusions: Ureteroscopy-assisted localization and transureteral stent placement may streamline laparoscopic reconstruction for middle and lower ureteral strictures by reducing operative time without compromising safety. Prospective studies with longer follow-up are warranted. Ureteroscopy-assisted double-J stent.