Reconstruction of ureteral stricture is a complex surgical procedure that requires thorough consideration of multiple factors. The most important factors, such as anastomotic tension and adequate blood supply of anastomotic cut-end, are critical to minimize the recurrence. Although the average success rate for ureteral reconstruction is approximately 70 to 80%, a significant portion of patients may continue to experience persistent postoperative hydronephrosis. This study aims to provide an effective treatment and management protocol for these cases.

From August 2020 to October 2024, a single urologist performed ureteral reconstruction on 70 patients diagnosed with ureteral strictures at a single medical center. Of these, 39 patients had strictures located in the upper or mid-ureter, while 31 patients had strictures in the lower ureter. We collected and analyzed patients' preoperative and postoperative data. Ultrasonography was performed after the removal of ureteral double-J stents to evaluate postoperative outcomes. If there was still hydronephrosis, diuretic renal scan (DRS) and ureteroscopy (URS) or retrograde pyelography (RP) will be arranged for further evaluation.

Among these patients, 48 received da Vinci robotic-assisted reconstruction, 8 underwent laparoscopic reconstruction, and 14 had traditional open surgery. In patients with upper ureteral strictures (n=39), 31 received robotic-assisted reconstruction, 13 required buccal mucosal grafts for reconstruction, 14 underwent primary end-to-end anastomosis, and 11 underwent pyeloplasty. For lower ureteral strictures (n=31), 17 patients received robot-assisted reconstruction, 4 required a Boari flap for reconstruction, 10 had end-to-end anastomosis, and 22 underwent ureteroneocystostomy with psoas hitch reconstruction. Postoperative follow-up revealed persistent hydronephrosis in 23 patients (23/70), with 18 cases involving upper ureter and 5 involving lower ureter. Patients with persistent hydronephrosis after upper ureteral reconstruction, they underwent a DRS and URS or RP, revealing surgical failure in 3 cases. For lower ureteral reconstruction, 4 cases were surgical failure.

After careful evaluation, ureteral reconstruction surgery demonstrates a high success rate, reaching up to 90%. However, persistent postoperative hydronephrosis is about 32.85% (23/70) in this study. They may need additional diagnostic assessments, such as DRS, URS, or RP, to confirm surgical success.