Comparative efficacy of flexible ureteroscopy and laparoscopic surgery in the treatment of impacted ureteral stones with ureteral stenosis of different lengths

LIU Guang; HU Yougen; WU Yunbing; SHAN Weiyuan; WANG Sujuan; TANG Yuanjie

doi:10.3969/j.issn.1004-3594.2026.09.007

PDF(1007 KB)

Medical Journal of the Chinese People Armed Police Forces ›› 2026, Vol. 37 ›› Issue (9) : 766-770. DOI: 10.3969/j.issn.1004-3594.2026.09.007

ORIGINAL ARTICLES

Comparative efficacy of flexible ureteroscopy and laparoscopic surgery in the treatment of impacted ureteral stones with ureteral stenosis of different lengths

LIU Guang, HU Yougen, WU Yunbing, SHAN Weiyuan, WANG Sujuan, TANG Yuanjie^*

Author information +

History +

Abstract

Objective To compare the efficacy of flexible ureteroscopic holmium laser lithotripsy combined with endoureterotomy versus laparoscopic ureterolithotomy combined with resection of the stenotic ureteral segment and end-to-end anastomosis in the treatment of proximal impacted ureteral stones with ureteral stenosis of different lengths (<10 mm vs. 10-20 mm). Methods A retrospective analysis was conducted on the data of 105 patients with proximal impacted ureteral stones complicated by ureteral stenosis who were treated at Jiangsu Provincial Corps Hospital of Chinese People's Armed Police Force between January 2020 and December 2024. According to the length of the stenosis, the patients were divided into group A (<10 mm, n=60) and group B (10-20 mm, n=45). Each group was further subdivided into a flexible ureteroscopy subgroup and a laparoscopy subgroup based on the surgical approach. The operation time, postoperative length of hospital stay, intraoperative blood loss, postoperative complication rate, stone-free rate at 1 month, and ureteral patency rate at 6 months were statistically analyzed and compared between the subgroups. Results In group A, both the flexible ureteroscopy and laparoscopy subgroups achieved high stone-free rates(91.4% vs. 96.0%) and ureteral patency rates (94.3% vs. 100%), with no statistically significant differences between the two approaches. The flexible ureteroscopy subgroup demonstrated significant advantages over the laparoscopy subgroup in terms of shorter operation time[(63.1±9.5) min vs. (91.1±6.5) min], less intraoperative blood loss[(39.6±7.8) ml vs. (57.0±6.3) ml], shorter postoperative hospital stay[(3.7±0.6) d vs. (6.8±0.5) d], and a lower postoperative complication rate (8.6% vs. 28.0%). In group B, the laparoscopy subgroup achieved significantly higher stone-free rates (96.3% vs.72.2%) and ureteral patency rates (92.6% vs. 66.7%) than the flexible ureteroscopy subgroup. However, laparoscopy was associated with a longer operation time [(92.6±5.4) min vs. (62.7±10.4) min], greater intraoperative blood loss[(57.9±6.4) ml vs. (34.3±4.4) ml], and a longer postoperative hospital stay[(6.9±0.6) d vs. (3.7±0.8) d]. Conclusions For impacted ureteral stones complicated by short-segment ureteral stenosis (<10 mm), flexible ureteroscopic holmium laser lithotripsy combined with endoureterotomy can be considered the preferred treatment option. In contrast, for impacted ureteral stones associated with longer ureteral stenosis (10-20 mm), laparoscopic ureterolithotomy combined with resection of the stenotic segment and end-to-end anastomosis provides superior stone clearance and ureteral patency, representing a more reliable therapeutic strategy.

Key words

impacted ureteral stones / ureteral stenosis / flexible ureteroscopy / endoureterotomy / laparoscopic ureterolithotomy

Cite this article

EndNote

Ris (Procite)

Bibtex

Download Citations

LIU Guang, HU Yougen, WU Yunbing, SHAN Weiyuan, WANG Sujuan, TANG Yuanjie. Comparative efficacy of flexible ureteroscopy and laparoscopic surgery in the treatment of impacted ureteral stones with ureteral stenosis of different lengths[J]. Medical Journal of the Chinese People Armed Police Forces. 2026, 37(9): 766-770 https://doi.org/10.3969/j.issn.1004-3594.2026.09.007

References

[1] Ulvik Ø, Harneshaug J R, Gjengstø P.Ureteral strictures following ureteroscopic stone treatment[J].J Endourol, 2021,35(7):985-990.
[2] Lucas J W,Ghiraldi E,Ellis J,et al.Endoscopic management of ureteral strictures: an update[J].Curr Urol Rep, 2018,19(4):24-27.
[3] Yamashita S,Inoue T,Kohjimoto Y,et al.Comprehensive endoscopic management of impacted ureteral stones: literature review and expert opinions[J].Int J Urol,2022,29(8):799-806.
[4] 欧阳洁,张国庆,邹忠林,等.良性输尿管狭窄的诊疗进展[J].局解手术学杂志,2023,32(12):1095-1099.
[5] Zhang Y,Ouyang W,Xu H,et al.A comparison of robot-assisted laparoscopic ureteral reimplantation and conventional laparoscopic ureteral reimplantation for the management of benign distal ureteral stricture[J].Urol J, 2020,17(3):252-256.
[6] 陶军跃,梁朝朝,郝宗耀,等.机器人辅助腹腔镜治疗内镜术后继发输尿管狭窄的疗效(附27 例报告)[J].微创泌尿外科杂志,2021,10(6):385-389.
[7] 陈松,唐宇哲,付猛,等.良性输尿管狭窄的治疗:90 例单中心回顾分析[J].中华腔镜泌尿外科杂志(电子版),2021,15(4):313-316.
[8] 徐涛,唐鑫伟,胡浩.输尿管狭窄的内镜治疗:现状与未来[J].中华腔镜泌尿外科杂志(电子版),2021, 15(3):177-181.
[9] Zhu W,Zhu Z,Li Z,et al.A ureteral stricture disease score and classification system: correlation with upper urinary tract reconstructive surgery complexity[J].Transl Androl Urol,2021,10(10):3745-3755.
[10] 储传敏,张鹤,王磊,等.2019年泌尿系统结石诊治进展[J].上海医学,2020,43(6):341-346.
[11] 周宇林,王娟婷,郑秋平,等.CT检测对结石梗阻性肾盂积脓术前的诊断价值[J].中国实用医药,2023,18(3):81-83.
[12] 彭泳涵,李超,董浩,等.低功率钬激光瞬时切割对输尿管狭窄及组织纤维化的影响[J].中华泌尿外科杂志,2024,45(7):539-543.
[13] 张立进,赵虎,吴斌.后腹腔镜输尿管切开取石术与输尿管镜碎石术在治疗输尿管上段嵌顿性结石的临床对比研究[J].临床泌尿外科杂志,2024,39(3):212-216.
[14] 王坤杰,周亮,李虹.输尿管狭窄治疗中几个关键问题的探讨[J].中华泌尿外科杂志,2020,41 (12):881-883.
[15] 陈宦君,李丽云,赵晋齐,等.输尿管狭窄的介入治疗(附10例报告)[J].中国医学影像技术,2001,17(10):937-938.
[16] Xiong M,Zhu X,Chen D,et al.Post ureteroscopic stone surgery ureteral strictures management: a retrospective study[J].Int Urol Nephrol,2020,52(5):841-849.
[17] Henry T,Olga A,Paterson R F,et al.Evaluation of risk factors and treatment options in patients with ureteral stricture disease at a single institution[J].Can Urol Assoc,2015,9(11-12):E921-E924.
[18] 谢超群,吴泰山,谢国红,等.腹腔镜和输尿管镜联合治疗15例医源性输尿管狭窄[J].中国内镜杂志,2021,27(9):75-80.
[19] 王磊,韩天栋,江卫星,等.主动迁移技术与原位碎石技术在输尿管软镜治疗1~2cm输尿管上段结石中的安全性和有效性比较[J].北京大学学报(医学版),2023,55(3):553-557.
[20] 刘雨杭,陈湘,何垚,等.双镜种联合技术治疗复杂输尿管狭窄的疗效[J].中南大学学报(医学版), 2019,44(7):795-800.
[21] Sahin C,Sinanoglu O,Sobay R,et al.Predictive role of ureteral wall thickness and patient characteristics in endoscopic treatment outcomes for ureteral stricture disease following stone surgery[J].World J Urol,2024, 42(1):258-261.
[22] 祝宏斌,王进峰,舒文云,等.腹膜外腹腔镜下输尿管膀胱再植术治疗输尿管狭窄疗效观察[J].浙江临床医学,2022,24(5):675-677.
[23] 刘广,汤元杰,胡有根,等.输尿管镜钬激光与冷刀内切开治疗输尿管狭窄的疗效比较[J].医学研究生学报,2019,32(3):273-277.
[24] 廖文彪,杨嗣星,宋超,等.输尿管镜钬激光碎石术后输尿管狭窄的处理方法:5年单中心回顾性研究[J].中华泌尿外科杂志,2021,42(12):910-914.
[25] Shiozaki K,Izaki H,Fukuta K,et al.Laser endoureterotomy with cut-to-the-light technique for complete ureteral obstruction-a case report[J].Urol Case Rep,2022,42:102036.
[26] Mohyelden K,Hussein H A,Helaly H A E,et al.Long-term outcomes of two ipsilateral versus single Double-J stent after laser endoureterotomy for bilharzial ureteral strictures[J].J Endourol,2020,35(6):775-780.
[27] 赵永录,张兴盛,宋广智,等.多根双J管置入在输尿管狭窄腔内钬激光切开中的应用体会[J].中国微创外科杂志,2022,22(6):467-471.
[28] 顾炜,徐耀庭,顾伟平,等.首次输尿管镜无法通过的良性输尿管狭窄的治疗方案探讨[J].临床泌尿外科杂志,2016,31(7):625-627.
[29] 杨钧显,艾倩,施文秀,等.输尿管结石经输尿管镜下钬激光碎石术治疗后输尿管狭窄的影响因素[J].中华保健医学杂志,2024,26(6):818-821.
[30] 蒋武阳,谭靖.腔镜下输尿管结石术后输尿管狭窄的原因及预防[J].国际泌尿系统杂志,2024,44(6):1161-1163.
[31] 徐磊,鲁继东,梁亮,等.CT平扫及冠状位重建对泌尿系结石的诊断价值[J].中国临床医学,2019, 26(4):611-614.
[32] Khizir L,Kaldany A,Patel H V,et al.Mp42-06 assessing the accuracy of preoperative radiographic imaging in determining ureteral stricture length at time of robotic ureteral reconstruction[J].J Urol,2023,209(Sup4):1-9.