To compare the efficacy and safety between balloon dilation and robot-assisted laparoscopic ureter reconstruction in treating short (≤ 2 cm) ureter stricture following holmium laser: a single-center retrospective study.

Ureteral stricture is an important complication following holmium laser lithotripsy. Although robot-assisted laparoscopic ureteral reconstruction (RALUR) may provide durable anatomical repair, balloon dilation (BD) is frequently used for short strictures because of its minimally invasive nature and shorter recovery time. This retrospective single-center study compared the efficacy and safety of RALUR and BD for short (≤2 cm) ureteral strictures following holmium laser lithotripsy. Patients treated with RALUR or BD between February 2016 and October 2021 were reviewed. Eligible patients had a solitary ureteral stricture measuring ≤2 cm, no history of ureteral laceration or prior ureteral surgery, and at least 2 years of follow-up after double-J stent removal. The primary outcome was surgical success. A total of 104 patients were initially included, and 69 remained after propensity score matching, including 46 in the RALUR group and 23 in the BD group. Before matching, patients in the RALUR group had longer strictures and a higher prevalence of diabetes; after matching, baseline characteristics were well balanced. The overall complication rate did not differ significantly between the groups, and no patient required blood transfusion. The postoperative hospital stay was longer in the RALUR group [5 (5-6) days vs. 1 (1-3) day, P < 0.001], and surgical costs were also higher. During follow-up, success rates decreased in both groups, with a more pronounced decline in the BD group. At 24 months, the success rate was significantly higher after RALUR than after BD (82.61% vs. 26.09%, P < 0.001). Multivariable logistic regression showed that BD and higher BMI were independently associated with reoperation. RALUR provided significantly higher and more durable success rates than BD for holmium laser-related short ureteral strictures, although it was associated with longer hospitalization and higher costs.