Two years ago, Anh Trung underwent retrograde endoscopic lithotripsy with a rigid scope for a ureteral stone. Following the procedure, he developed a ureteral stricture, a common complication. He then had reconstructive surgery and a ureteral stent (DJ stent) placed to maintain urine flow during healing. Despite repeated follow-ups, the stricture persisted, necessitating continuous stent usage and replacement every 6 months.

The persistent stricture and discomfort culminated in severe back pain recently, leading Anh Trung to Tam Anh General Hospital, Ho Chi Minh City. Doctor Nguyen Hoang Duc, Head of Urology at the Center for Urology - Nephrology - Andrology, diagnosed extensive scar tissue around the ureter, a consequence of the initial surgery. He noted that ureteral stents are typically removed 1-3 months after reconstructive surgery, once natural urine flow is restored. Anh Trung's two-year reliance on a stent due to the ongoing stricture had caused significant inconvenience.

To address the long-standing issue, doctors opted for a second surgery utilizing the Da Vinci Xi robot. Doctor Duc precisely controlled four robotic arms, guided by 3D camera images magnified 10-15 times. This advanced approach allowed him to meticulously excise the fibrotic, strictured segment and successfully restore normal urine flow in the ureter.

Just three days after the robotic procedure, Anh Trung's urine flow returned to normal, and his kidney function was preserved. He was discharged and is scheduled for a follow-up appointment in approximately 1-2 months for stent removal.

Doctor Duc (center) places trocars, preparing for Da Vinci Xi robotic surgery. Photo: Tam Anh General Hospital

Doctor Duc highlighted that ureteral stricture can affect 5% of patients following retrograde endoscopic lithotripsy, particularly when rigid scopes are used. This complication often arises from mucosal injury that leads to fibrous scarring. Untreated, this obstruction can result in hydronephrosis (swelling of the kidney due to urine buildup) and eventual loss of kidney function.

Treatment for ureteral stricture varies based on its location and severity. Options include ureteral dilation with stent placement or reconstructive surgery. Post-treatment, patients must adhere to follow-up schedules, maintain adequate hydration, avoid holding urine, and vigilantly monitor for symptoms such as back pain, fever, painful urination, hematuria, or decreased urine output, which may indicate a need for prompt medical attention.

Dinh Lam

*Patient's name has been changed