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Journal of Peking University (Health Sciences) ›› 2025, Vol. 57 ›› Issue (4): 789-795. doi: 10.19723/j.issn.1671-167X.2025.04.026

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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

Wanwei HUANG1, Xianshen SHA1, Yibao ZHANG1, Guohao WU2, Feng LUO2, Zhihui CHEN2, Dongming YE2, Xuesong LI3,*(), Caiyong LAI1,2,*()   

  1. 1. Department of Urology, The First Affiliated Hospital of Jinan University, Guangzhou 510630, China
    2. Department of Urology, The Sixth Affiliated Hospital of Jinan University, Dongguan 523570, Guangdong, China
    3. Department of Urology, Peking University First Hospital, Beijing 100034, China
  • Received:2025-02-12 Online:2025-08-18 Published:2025-08-02
  • Contact: Xuesong LI, Caiyong LAI
  • Supported by:
    the Guangzhou Science and Technology Plan Project(2023A03J0569); the Jinan University Medical Joint Fund Project(YXZY2022032); the Dongguan City Social Development Science and Technology Project(20231800940732)

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Abstract:

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.

Key words: Ureteral obstruction, Urinary bladder, Radiotherapy, Radiation-induced extensive ureteral strictures, Ileal ureteral replacement, Totally laparoscopic surgery

CLC Number: 

  • R699

Table 1

Patient baseline characteristics"

Items Case 1 Case 2
Age/years 72 54
Gender Female Female
Affected side Bilateral Bilateral
Etiology Radiotherapy for cervical high-grade squamous intraepithelial lesion Radiotherapy after cervical cancer surgery

Symptom manifestation		 Low back pain, intermittent fever, urinary frequency and urgency Low back pain, intermittent fever,
urinary frequency and urgency
Length of ureteral stricture/cm Left 10.4, right 8.7 Left 10.6, right 11.7
Preoperative hydronephrosis degree Bilateral moderate to severe hydronephrosis Bilateral moderate to severe hydronephrosis
Past surgical history Open pyelolithotomy on the left side Hysterectomy and bilateral adnexectomy
Preoperative management Nephrostomy for 2 months Nephrostomy for 2 months

Figure 1

Surgical position and trocar layout"

Figure 2

Surgical and schematic diagrams of total 3D laparoscopic ileal replacement of bilateral ureters with cystoplasty A, dissection into the plane between the retromesenteric leaf and prerenal fascia; B, incising the continuation of renal fascia followed by dissection and ligation of right gonadal vein; C, dissection of right ureter along the extra-mesenteric plane; D, mobilization and tagging of right ureter; E, performing precise measurement for ileal segment required for ureteral replacement; F, intracorporeal suturing of ileal bladder flap; G, clamp-free end-to-end anastomosis between right ureter and ileal conduit; H, transverse incision (4 cm) on bladder dome; I, continuous suture of ileal bladder flap to native bladder; J, schematic diagram of surgical procedure."

Figure 3

Preoperative and postoperative imaging examinations A and B, preoperative nephrostogram and 3D CT reconstruction demonstrated bilateral long-segment ureteral strictures, contracted bladder with reduced capacity, and rigid, thickened bladder walls; C and D, two-month follow-up 3D CT reconstruction revealed good peristalsis in the ileal ureteral substitute segment. The bladder exhibited symmetrical morphology with smooth wall contour."

Table 2

Perioperative and postoperative follow-up conditions of patients"

Items Case 1 Case 2
Surgical method Total 3D laparoscopy Total 3D laparoscopy
Surgical duration/min 420 355
Intraoperative blood loss/mL 50 50
Length of bowel resection/cm 40 38
Perioperative complications None None
Time to flatus passage after surgery/d 4.5 3
Hospital stay duration/d 10 8
Residual urine volume (preoperative/2 months postoperative)/mL 45/50 60/55
Bladder capacity (preoperative/2 months postoperative)/mL 90/230 130/250
24-hour urination frequency (preoperative/2 months postoperative) (16-18)/(9-10) (12-14)/(8-9)
Nocturia frequency (preoperative/2 months postoperative) (3-5)/(1-2) (2-3)/(1-2)
Clean intermittent self-catheterization No No
Base excess/(mmol/L)
  Preoperative +0.8 -1.2
  2 months postoperative -1.8 -2.6
  6 months postoperative -2.2 -2.4
Serum creatinine/(μmol/L)
  Preoperative 118.11 179.63
  1 day postoperative 131.77 180.41
  2 months postoperative 125.31 100.03
  6 months postoperative 136.83 110.67
  8 months postoperative 138.40 107.89
  10 months postoperative 126.65 -
Follow-up duration/months 10 8
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