Laparoscopic Ureteral Reconstruction for Benign Stricture Disease

Objectives: To describe our experience with laparoscopic ureteral reconstruction in the adult patient with benign ureteral stricture disease. Methods: We retrospectively compared laparoscopic (n = 12) and open (n = 34) ureteroureterostomy, ureteroneocystostomy, and Boari flap procedures conducted from January 1999 to November 2005 for benign stricture disease. The demographic, operative, complication, and outcome data were analyzed and compared. Results: The patient demographics and ureteral stricture etiology, location, and length were equivalent between the open and laparoscopic groups. The open surgical group had greater operative blood loss (258 versus 86 mL; P = 0.002) and a longer hospital stay (median 5 days versus 3 days; P <0.001) compared with the laparoscopic group. The overall complication rate in the open and laparoscopic groups was 15% and 8%, respectively (P = 0.225). Ureteral patency had been successfully reestablished in all 12 patients (100%) in the laparoscopic group at a mean follow-up of 23 months. In the open group, patency had been achieved in 30 patients (96%) at a mean follow-up of 43 months. No significant difference was found in patency success (P = 0.544) or the duration of follow-up (P = 0.098) between the two groups. Conclusions: Laparoscopic ureteral reconstructive surgery is technically feasible and efficacious in treating benign ureteral stricture disease in adults.