Simultaneous management of kidney stones and ureteral strictures using tip-bendable ureteral access sheath assisted transabdominal approach combined with laparoscopic upper urinary tract reconstruction.

PURPOSE: The treatment of ureteral strictures combined with kidney stones often necessitates staged surgical intervention, increasing the patient burden and leading to the inefficient use of medical resources. This study aimed to evaluate the efficacy of simultaneous treatment of ureteral strictures and kidney stones using tip-bendable ureteral access sheath (UAS)-assisted transabdominal flexible ureteroscopic lithotripsy (FUL) combined with laparoscopic upper urinary tract reconstruction, potentially providing a safer and more effective therapeutic option.

METHODS

We retrospectively reviewed data from 21 patients with ureteral strictures and kidney stones who underwent tip-bendable UAS-assisted transabdominal FUL combined with laparoscopic upper urinary tract reconstruction between January 2023 and June 2024. We analyzed the stone-free rate (SFR), operative time, postoperative hospital stay, complications, changes in laboratory parameters, and hydronephrosis.

RESULTS

Complete stone clearance was achieved in 19 (90.5%) patients. The mean stone size was 20.0 ± 4.7 mm, and the mean operative time was 136.9 ± 23.8 min. Postoperative renal function significantly improved with reduced serum creatinine levels (P = 0.024) and an increased estimated glomerular filtration rate (P < 0.001). Hydronephrosis was notably reduced, with only two patients exhibiting mild dilation. Furthermore, only minor Grade I complications occurred, including fever and nausea.

CONCLUSIONS

Tip-bendable UAS-assisted transabdominal FUL combined with laparoscopic upper urinary tract reconstruction via the transabdominal approach is an effective and safe strategy for simultaneously managing ureteral strictures and kidney stones. This approach resulted in a high SFR, improved renal function, and minimal complications.