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Surgical Management of Multi-Segment Ureteral Strictures

Yongqiang You, Xingyuan Xiao

Ureteral stricture commonly is associated with hydronephrosis and impaired renal function. In recent years, iatrogenic injury such as endoscopic management, pelvic surgery and radiotherapy of malignant tumors, contributes to the increasing incidence of ureteral strictures. Endoscopic dilation or end to end ureteroureterostomy are widely used in short ureteral stenosis. But, the management of multi-segment ureteral strictures is a more difficult task. Dual transections of the ureter at multiple points would lead to devascularization of the ureteric segment which should be avoided at all costs. Then the traditional operations for multi-segment ureteral strictures are Ileal Replacement of the Ureter surgery (IRU) and Autologous Kidney Transplantation (AKT). Both IRU and AKT are unsatisfactory solutions because of the complex surgical procedure, large trauma and serious postoperative complications, including ileus, metabolic acidosis, anastomotic leakage, vascular stenosis and thrombosis. Therefore, it is urgent to explore innovative minimally invasive surgery for multisegment ureteral strictures