Ureteral strictures remain a formidable reconstructive challenge, particularly in patients with a solitary kidney, where preserving renal function is critical. Long-segment distal ureteral strictures often preclude primary repair, necessitating alternative grafting techniques. Appendiceal interposition has been recognized as a feasible option for reconstructing distal ureteral defects. We present a case of laparoscopic ureteroneocystostomy with appendiceal interposition in a patient who had an obliterative distal ureteral stricture and a solitary functioning kidney.

A 68-year-old Asian female with a history of recurrent urolithiasis and previous left nephrectomy developed a complete right distal ureteral stricture following multiple stone-related endourological interventions. Consequently, she became dependent on a nephrostomy tube. Antegrade pyelography confirmed a distal ureteral obstruction. In September 2024, she underwent laparoscopic right ureteroneocystostomy with appendiceal graft interposition. Intraoperative ureteroscopy was performed to precisely localize the stricture.

The operative time was 6 hours and 2 minutes, with minimal blood loss. No intraoperative or postoperative complications occurred. The patient was discharged on postoperative day 14. One month after discharge, the double-J stent was removed. Follow-up antegrade pyelography demonstrated a patent, unobstructed ureter.

This case illustrates the technical feasibility and safety of laparoscopic ureteroneocystostomy with appendiceal interposition in a patient with a solitary kidney. As a minimally invasive technique, it offers a valuable alternative to open surgical repair for complex distal ureteral strictures, providing ureteral continuity while preserving renal function.