Minimally invasive ureteroplasty with lingual mucosal graft for complex ureteral stricture: analysis of surgical and patient-reported outcomes

Wang, Xiang; Meng, Chang; Li, Derun; Ying, Yicen; Ma, Yunke; Fan, Shubo; Li, Xinfei; Yang, Kunlin; Wang, Bing; Guan, Hua; Zhang, Peng; Liu, Jing; Huang, Chen; Zhu, Hongjian; Zhang, Kai; Zhou, Liqun; Li, Zhihua; Li, Xuesong

doi:10.1590/S1677-5538.IBJU.2023.0393

Xiang Wang

Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China

http://orcid.org/0000-0002-2923-1828

Chang Meng

Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China

Derun Li

Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China

Yicen Ying

Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China

Yunke Ma

Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China

Shubo Fan

Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China

Xinfei Li

Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China

Kunlin Yang

Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China

Bing Wang

Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China

Hua Guan

Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China

Department of Nursing, Peking University First Hospital, Peking University, Beijing, China

Peng Zhang

Department of Urology, Emergency General Hospital, Beijing, China

Jing Liu

Department of Urology, Beijing Jiangong Hospital, Beijing, China

Chen Huang

Department of Urology, Beijing Jiangong Hospital, Beijing, China

Hongjian Zhu

Department of Urology, Beijing Jiangong Hospital, Beijing, China

Kai Zhang

Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China

Liqun Zhou

Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China

Zhihua Li Correspondence address: Zhihua Li, MD Department of Nursing, Peking University First Hospital, Peking University, No. 8 Xishiku St, Xicheng District, Beijing 100034, China. E-mail: niuniu51233@163.com

Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China

Department of Nursing, Peking University First Hospital, Peking University, Beijing, China

Xuesong Li

Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China

Correspondence address: Zhihua Li, MD Department of Nursing, Peking University First Hospital, Peking University, No. 8 Xishiku St, Xicheng District, Beijing 100034, China. E-mail: niuniu51233@163.com

CONFLICT OF INTEREST

None declared.

Variables		Value
Patients		41
Gender, n (%)
	Male	32 (78.00)
	Female	9 (22.00)
Age, years, median (range)		33 (21-67)
BMI, kg/m², mean (SD)		24.73 ± 3.70
Etiology associated with stricture, n (%)
	UPJO	15 (36.58)
	Ureteral calculi	23 (56.09)
	Ureteral polyps	1 (2.43)
	Laparoscopic renal cyst decortication	1 (2.43)
	Laparoscopic adrenalectomy	1 (2.43)
Affected side, n (%)
	Left	38 (92.68)
	Right	3 (7.32)
Presenting symptoms, n (%)
	Symptomatic	20 (48.78)
	Incidental	21 (51.22)
Stricture location, n (%)
	UPJ	14 (34.15)
	Proximal	21 (51.22)
	Middle	6 (14.63)
Stricture length, cm, mean (SD)		3.50 ± 1.56
Prior ureteral reconstruction, n (%)		21 (51.22)
Type of surgical procedure, n (%)
Laparoscopic		9 (22.00)
Robotic assisted		32 (78.00)
Surgical technique, n (%)
	Only ventral onlay	19 (46.34)
	Posteriorly augmented anastomosis with ventral onlay	22 (53.66)
Length of LMG, cm, median (range)		3.5 (2-7)
Width of LMG, cm, median (range)		1.5 (1-2)
Operative time, min, median (range)		189 (130-346)
EBL, mL, median (range)		50 (5-200)
Length of hospital, day, median (range)		6 (4-14)
Follow-up time, mo, median (range)		29 (15-41)
Clinical success, n (%)		40 (97.56)
Complication rate, CD grade, n (%)		7 (17.07)
	Tongue numbness (Grade I)	4 (9.75)
	Urinary tract infection (Grade II)	3 (7.32)

Variable	Baseline	6 mo	12 mo	p^# p value# = p value was determined by the Friedman test comparing changes in scores along the follow-up.
PF	80 (62.5-95)	95 (90-97.5)	100 (95-100)	<0.001
p ^* p value* = p value was determined by the Wilcoxon signed-rank test comparing the 6-mo scores and 12-mo scores to the baseline values.	-	0.001	<0.001	-
RP	0 (0-25)	100 (62.5-100)	100 (100-100)	<0.001
p ^* p value* = p value was determined by the Wilcoxon signed-rank test comparing the 6-mo scores and 12-mo scores to the baseline values.	-	<0.001	<0.001	-
BP	64 (53-74)	84 (79-100)	84 (84-100)	<0.001
p ^* p value* = p value was determined by the Wilcoxon signed-rank test comparing the 6-mo scores and 12-mo scores to the baseline values.	-	<0.001	<0.001	-
GH	57 (45-72)	72 (55-92)	72 (57-91)	<0.001
p ^* p value* = p value was determined by the Wilcoxon signed-rank test comparing the 6-mo scores and 12-mo scores to the baseline values.	-	<0.001	<0.001	-
VT	60 (42.5-70)	70 (55-80)	80 (57.5-82.5)	<0.001
p ^* p value* = p value was determined by the Wilcoxon signed-rank test comparing the 6-mo scores and 12-mo scores to the baseline values.	-	0.033	<0.001	-
SF	50 (37.5-75)	87.5 (75-100)	100 (75-100)	<0.001
p ^* p value* = p value was determined by the Wilcoxon signed-rank test comparing the 6-mo scores and 12-mo scores to the baseline values.	-	<0.001	<0.001	-
RE	33.3 (0-100)	100 (83.3-100)	100 (100-100)	<0.001
p ^* p value* = p value was determined by the Wilcoxon signed-rank test comparing the 6-mo scores and 12-mo scores to the baseline values.	-	0.010	0.004	-
MH	60 (48-76)	72 (56-80)	76 (56-86)	0.009
p ^* p value* = p value was determined by the Wilcoxon signed-rank test comparing the 6-mo scores and 12-mo scores to the baseline values.	-	0.366	0.010	-
PCS	38.6 (32.8-44.8)	53.8 (47.7-57.3)	56.1 (51.9-59.1)	<0.001
p ^* p value* = p value was determined by the Wilcoxon signed-rank test comparing the 6-mo scores and 12-mo scores to the baseline values.	-	<0.001	<0.001	-
MCS	40 (29.5-51.1)	54 (47.7-56.9)	53 (45.5-59)	0.001
p ^* p value* = p value was determined by the Wilcoxon signed-rank test comparing the 6-mo scores and 12-mo scores to the baseline values.	-	0.009	0.001	-

Dimension	Mean study population ± SD	Mean general population ± SD	p value (t test)
PF	74.15 ± 18.16	94.02±12.44	<0.001
RP	21.95 ± 34.55	88.79±28.49	<0.001
BP	64.85 ± 16.36	88.18±19.02	<0.001
GH	56.10 ± 19.39	69.74±20.95	<0.001
VT	57.80 ± 17.64	68.92±18.78	<0.001
SF	56.40 ± 24.39	88.03±16.00	<0.001
RE	46.34 ± 42.74	89.57±27.95	<0.001
MH	62.63 ± 16.80	77.61±15.85	<0.001

Variable	Baseline	6 mo	12 mo	p ^# p value# = p value was determined by the Friedman test comparing changes in scores along the follow-up.
OHIP-14	2.95, 1 (0-4)	4.73, 1 (0-5)	3.73, 1 (0-3)	0.013
p ^* p value* = p value was determined by the Wilcoxon signed-rank test comparing the 6-mo scores and 12-mo scores to the baseline values.	-	0.181	1.000
Functional limitation	0.49, 0 (0-1)	1.02, 0 (0-2)	0.85, 0 (0-1.5)	0.035
p value^* p value* = p value was determined by the Wilcoxon signed-rank test comparing the 6-mo scores and 12-mo scores to the baseline values.	-	0.408	0.739
Physical pain	0.98, 0 (0-2)	1.17, 1 (0-2)	1.02, 1 (0-1)	0.322
p value^* p value* = p value was determined by the Wilcoxon signed-rank test comparing the 6-mo scores and 12-mo scores to the baseline values.	-	-	-
Psychological discomfort	0.32, 0 (0-0)	0.68, 0 (0-0.5)	0.46, 0 (0-0)	0.099
p value^* p value* = p value was determined by the Wilcoxon signed-rank test comparing the 6-mo scores and 12-mo scores to the baseline values.	-	-	-
Physical disability	0.51, 0 (0-0.5)	0.54, 0 (0-0.5)	0.51, 0 (0-0)	0.879
p value^* p value* = p value was determined by the Wilcoxon signed-rank test comparing the 6-mo scores and 12-mo scores to the baseline values.	-	-	-
Psychological disability	0.34, 0 (0-0)	0.56, 0 (0-0)	0.34, 0 (0-0)	0.086
p value^* p value* = p value was determined by the Wilcoxon signed-rank test comparing the 6-mo scores and 12-mo scores to the baseline values.	-	-	-
Social disability	0.29, 0 (0-0)	0.37, 0 (0-0)	0.27, 0 (0-0)	0.738
p value^* p value* = p value was determined by the Wilcoxon signed-rank test comparing the 6-mo scores and 12-mo scores to the baseline values.	-	-	-
Handicap	0.15, 0 (0-0)	0.39, 0 (0-0)	0.27, 0 (0-0)	0.069
p value^* p value* = p value was determined by the Wilcoxon signed-rank test comparing the 6-mo scores and 12-mo scores to the baseline values.	-	-	-

[1] Correspondence address: Zhihua Li, MD Department of Nursing, Peking University First Hospital, Peking University, No. 8 Xishiku St, Xicheng District, Beijing 100034, China. E-mail: niuniu51233@163.com

Brasil

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Minimally invasive ureteroplasty with lingual mucosal graft for complex ureteral stricture: analysis of surgical and patient-reported outcomes

ABSTRACT

Objective:

Materials and Methods:

Results:

Conclusions: