[Total 3D laparoscopic ileal ureters replacement for bilateral ureters combined with bladder augmentation in the management of post-radiotherapy bilateral ureteral strictures and contracted bladder].

OBJECTIVE

To retrospectively evaluate the clinical efficacy and safety of total 3D laparoscopic ileal ureters replacement for bilateral ureters combined with bladder augmentation in patients with post-radiotherapy long-segment bilateral ureteral strictures and contracted bladder.

METHODS

Clinical data of two patients (aged 72 and 54 years) with radiation-induced long-segment bilateral ureteral strictures and reduced bladder capacity, treated at the Sixth Affiliated Hospital of Jinan University from October 2023 to June 2024, were analyzed. Both presented with bilateral flank pain, recurrent chills/fever, urinary frequency, and urgency. Preoperative ureteral stricture lengths were measured as follows: left 10.4 cm and right 8.7 cm in the first case; left 10.6 cm and right 11.7 cm in the second case. Bladder capacity assessed by nephrostomy-assisted antegrade urography was 90 mL and 130 mL respectively. Both underwent single-position, one-stage totally 3D laparoscopic bilateral ileal ureteral replacement and bladder augmentation based on membrane anatomy principles, with regular postoperative follow-up.

RESULTS

Procedures were completed by the same experienced urologist. Operative times were 420 min and 355 min, with intraoperative blood loss of 50 mL (no transfusion required). Postoperative bowel function resumed at the end of 4.5 and 3 days. No major perioperative complications occurred. Ureteral stents were removed at 2 months postoperatively, with imaging showing improved hydronephrosis, unobstructed ureteral drainage, symmetrical bladder morphology, and smooth walls. Postoperative bladder capacities were 230 mL and 250 mL. Follow-up durations were 10 and 8 months. Both patients experienced significant relief of flank pain and lower urinary tract symptoms. No complications (enteric fistula, urinary fistula, or metabolic acidosis) were observed. At the final follow-up, one patient had mildly elevated serum creatinine, while the other showed reduced levels compared with preoperative values; both remained stable.

CONCLUSION

Membrane anatomy-based dissection facilitates safe mobilization of fibrotic ureters with minimal bleeding and collateral damage. Total intracorporeal 3D laparoscopic ileal ureters replacement for bilateral ureters combined with bladder augmentation effectively addresses long-segment ureteral obstruction and improves bladder capacity. This approach is technically safe and feasible, though further validation with larger clinical cohorts is warranted.