Comparative analysis of the outcomes of laparoscopic buccal ureteroplasty and renal descensus with ureteral resection for extensive strictures of the proximal ureter and ureteropelvic junction

BACKGROUND: Recurrent and extensive strictures of the ureteropelvic junction and proximal ureter pose a significant challenge in modern reconstructive urology, as standard surgical procedures are not always effective or technically feasible. Such cases require complex upper urinary tract surgeries, such as renal descensus with ureteral resection and end-to-end anastomosis, or substitution of the stenotic segment with a buccal mucosa graft.

AIM: To conduct a comparative analysis of the outcomes of laparoscopic buccal ureteroplasty and renal descensus with ureteral resection and end-to-end anastomosis.

MATERIALS AND METHODS: Surgical reconstruction of extensive recurrent strictures of the ureteropelvic junction and the upper and middle thirds of the ureter was performed in 72 patients: 35 men (48.6%) and 37 women (51.4%), aged 19 to 77 years. The patients were divided into two groups: group 1 included 30 patients (41.6%) who underwent buccal mucosa ureteroplasty, and group 2 included 42 patients (58.4%) who underwent renal descensus with resection of the stenotic ureteral segment and end-to-end anastomosis. The causes of stenosis included previous pyeloplasty (n = 54), contact ureterolithotripsy in the proximal ureter (n = 12), impacted stones (n = 4), ureteropelvic junction injury during laparoscopic excision of a parapelvic cyst of the left kidney (n = 1), and retroperitoneal fibrosis due to acute cholecystopancreatitis (n = 1). Laparoscopic access was used in 69 patients, and robot-assisted access was used in 3 cases.

RESULTS: A major intraoperative complication occurred in one patient from group 2, who developed bleeding from a lower pole vessel, requiring conversion. Group 1 demonstrated significantly shorter operative time (197.1 ± 52.9 vs. 227.6 ± 30.6 min, p = 0.003), lower blood loss (93.0 ± 21.0 vs. 176.6 ± 44.6 mL, p < 0.001), fewer postoperative complications (23.3% vs. 47.5%, p = 0.039), and a lower reoperation rate (6.6% vs. 30.8%, p = 0.043). The surgical success rate was 93.4% in group 1 and 71.5% in group 2 (p = 0.0009).

CONCLUSIONS: Compared with renal descensus, ureteral resection, and end-to-end anastomosis, buccal ureteroplasty is a highly effective procedure with a lower incidence of postoperative complications.