Is membrane-guided total intracorporeal laparoscopic reconstruction a viable therapeutic alternative for ureteral avulsion following ureteroscopic lithotripsy?

OBJECTIVE

To evaluate the feasibility and outcomes of membrane-guided total intracorporeal laparoscopic reconstruction for ureteral avulsion (UA) following ureteroscopic lithotripsy.

MATERIALS AND

METHODS

From January 2021July 2025, eight patients with UA secondary to ureteroscopic lithotripsy underwent membrane-guided total intracorporeal laparoscopic reconstruction. Five patients were treated with the Boari flap technique (BFT), and three underwent ileal ureter replacement combined with Boari flap-psoas hitch (IURBFPH). Preoperative evaluations to assess the ureteral defects included anterograde urography and computed tomography urography (CTU). For all procedures, the membranes were considered during gastrointestinal mobilization and ureteral defect preparation. The postoperative follow-up examinations included urological ultrasound, CTU, and clinical symptom assessment.

RESULTS

All eight reconstructions were successfully completed intracorporeally without conversion to open surgery. The median length of the UA was 6.50 cm (range: 3.00-18.00 cm). The mean operative time was 362.00 min (range: 240.00-515.00 min), with an estimated blood loss volume of 75.00 ml (range: 20.00-400.00 ml). The mean postoperative length of hospital stay was 12.88 days (range: 7.00-18.00 days). No serious complications or progressive hydronephrosis were observed during a mean follow-up of 9.39 months (range: 1.00-35.00 months), and the success rate was 100%.

CONCLUSIONS

The preliminary findings from this case series demonstrate that membrane-guided total intracorporeal laparoscopic reconstruction may be a feasible alternative approach for managing UA secondary to ureteroscopic lithotripsy. However, longer-term functional assessments are warranted.