Clinical Outcomes and Health-Related Quality of Life Assessment Following Minimally Invasive Reconstructive Surgery for Benign Ureteral Strictures

Clinical Outcomes and Health-Related Quality of Life Assessment Following Minimally Invasive Reconstructive Surgery for Benign Ureteral Strictures | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Clinical Outcomes and Health-Related Quality of Life Assessment Following Minimally Invasive Reconstructive Surgery for Benign Ureteral Strictures Quan Zhang, Hanqing Wang, Xuemeng Zhang, Zhenhua Gao, Hao Li, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6795942/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 17 Sep, 2025 Read the published version in World Journal of Urology → Version 1 posted 18 You are reading this latest preprint version Abstract Background To evaluate the clinical efficacy of minimally invasive ureteral reconstruction for benign strictures and analyze its impact on health-related quality of life (HRQoL) and psychological status. Methods This retrospective study included 29 patients undergoing robotic/laparoscopic ureteral reconstruction at our institution. Surgical outcomes were assessed through imaging, laboratory parameters, and patient-reported outcomes using SF-36 and HADS. Results With a median follow-up of 12 months, the surgical success rate was 96.6%, accompanied by a significant reduction in postoperative serum creatinine levels (p < 0.05). The perioperative complication rate was 6.90% (2 cases of transient high fever), with no severe adverse events observed. Preoperative SF-36 scores in PF and BP domains were significantly lower than those of the general population (p 0.05). Notably, all SF-36 domains (except RE) demonstrated significant improvement from baseline (p < 0.05). Additionally, both anxiety and depression scores assessed by HADS decreased markedly after surgery (p < 0.05). Conclusion Minimally invasive ureteral repair and reconstruction effectively relieves obstruction, improves renal function, and significantly enhances health-related quality of life and psychological well-being, representing a safe therapeutic option for benign ureteral strictures. Early surgical intervention reduces the need for long-term stent or nephrostomy placement, thereby alleviating physical and psychological burdens. Further studies with expanded cohorts and extended follow-up durations are warranted to validate long-term outcomes. Quality of life Anxiety Depression Ureteral stricture reconstruction Figures Figure 1 Figure 2 Figure 3 1 Introduction Benign ureteral stricture is a common pathological condition of the urinary system, typically caused by iatrogenic injury, trauma, urolithiasis, radiation therapy, or ischemia[ 1 ]. It manifests as upper urinary tract obstruction, renal impairment, and even renal failure, underscoring the necessity of timely and effective intervention to improve patient prognosis[ 2 ]. Current therapeutic strategies for ureteral strictures are diverse. Ureteral repair and reconstruction surgery may be indicated when endoscopic dilation is unsuitable due to excessive stricture length or when patients decline long-term nephrostomy or ureteral stenting [ 3 ]. Ureteral strictureplasty represents a classic and well-established surgical approach, widely employed to relieve obstruction and restore physiological urinary tract function, thereby alleviating symptoms and preserving renal integrity. For complex or recurrent strictures, techniques such as end-to-end anastomosis or reconstruction with grafts (e.g., lingual/buccal mucosal grafts) have gained increasing attention, demonstrating enhanced postoperative efficacy and reduced recurrence rates [ 4 – 6 ]. When surgical management is indicated, one of the primary objectives of intervention is to optimize patient quality of life. Health-related quality of life (HRQoL) plays a pivotal role in postoperative evaluation. Assessing pre- versus postoperative HRQoL changes provides an additional dimension for evaluating surgical outcomes. Multidimensional HRQoL assessment encompasses not only physical function but also emotional, psychological, and social adaptation [ 7 ]. For patients undergoing ureteral stricture repair, longitudinal HRQoL evaluation offers critical insights into therapeutic effectiveness; however, evidence in this domain remains limited. This study aims to investigate the clinical efficacy of ureteral strictureplasty and analyze its impact on HRQoL, anxiety, and depressive symptoms, thereby providing evidence-based guidance for optimizing treatment strategies. 2 Materials and Methods 2.1 Study Population This retrospective study included 29 patients who underwent surgical treatment for ureteral strictures at the First Affiliated Hospital of Kunming Medical University from January 2019 to November 2024. Surgical approaches comprised laparoscopic or robot-assisted techniques, including pyeloureteroplasty, end-to-end anastomosis, and lingual mucosal graft augmentation. Inclusion criteria were: (1) age 18–75 years; (2) preoperative confirmation of ureteral stricture via ultrasonography, contrast-enhanced CT, magnetic resonance urography (MRU), or antegrade/retrograde urography; (3) benign stricture etiology; (4) voluntary participation with signed informed consent. Exclusion criteria included: (1) contraindications to anesthesia/surgery; (2) uncontrolled systemic diseases or active infections; (3) severe coagulation disorders; (4) pregnancy; (5) cognitive/psychiatric impairments affecting informed consent or follow-up compliance; (6) malignant ureteral obstruction. Informed consent was obtained from all patients and this study was approved by the Ethics Committee of the First Affiliated Hospital of Kunming Medical University (approval number: 2024L127). 2.2 Data Collection Preoperative parameters: Demographic data (age, sex, BMI), medical history, stricture etiology, laboratory tests (serum creatinine), and imaging findings. Perioperative parameters: Surgical approach (laparoscopic/robot-assisted), anastomotic technique, stricture location, operative time (minutes), intraoperative blood loss (mL), postoperative hospital stay (days), and complications (graded by Clavien-Dindo classification). Postoperative follow-up: Subjective symptoms (flank pain, fever, nausea/vomiting), imaging outcomes, and long-term complications. Surgical success was defined as: (a) symptomatic relief; (b) imaging-confirmed hydronephrosis improvement and stable/improved renal function. 2.3 HRQoL and Psychological Assessment SF-36 Health Survey (Chinese version 2.0) [ 8 ]: A validated 36-item tool assessing eight HRQoL domains: Physical Functioning (PF), Role-Physical (RP), Bodily Pain (BP), General Health (GH), Vitality (VT), Social Functioning (SF), Role-Emotional (RE), and Mental Health (MH). Scores range 0–100 (higher = better status).Patients' anxiety and depressive states were assessed using the Hospital Anxiety and Depression Scale (HADS) [ 9 ]. This instrument comprises 14 items, divided into two subscales:Anxiety (HADS-A) and Depression (HADS-D). Each subscale contains 7 items rated on a 4-point Likert scale. The total score for each dimension ranges from 0 to 21 points, with higher scores indicating more severe anxiety/depressive symptoms. 2.4 Statistical Analysis Normally distributed continuous variables are expressed as mean ± standard deviation (SD); non-normal variables as median (interquartile range). Categorical variables are presented as frequencies (percentages). Pre- versus postoperative HRQoL scores were compared to Chinese population norms using Student’s t-test. Statistical significance was set at two-tailed p < 0.05. Analyses were performed using IBM SPSS Statistics 22.0 (IBM Corp, Armonk, NY, USA). 3 Results 3.1 Demographic and Baseline Characteristics Preoperative patient characteristics are summarized in Table 1 . None of the patients had undergone prior ureteral reconstruction. Among the 29 patients, 18 (62.1%) presented with strictures involving the ureteropelvic junction (UPJ) or proximal ureter. Preoperatively, 7 patients (24.1%) had indwelling ureteral stents, and 11 (37.9%) required nephrostomy tubes. Surgical interventions included pyeloureteroplasty (11 cases, 37.9%), ureteroneocystostomy (3 cases, 10.3%), end-to-end anastomosis (5 cases, 17.2%), lingual mucosal graft augmentation (6 cases, 20.7%), and bladder flap ureteroplasty (4 cases, 13.8%). Table 1 .Characteristics of patients Outcomes Age (years), mean±SD 43.6±14.6 BMI,mean± D 23.0±4.3 Gender,n(%) Male 18（63.1） Female 11（37.9） Laterality,n(%) Left 22（75.9） Right 7（24.1） Location,n(%) UPJ 12（41.40） Proximal 6（20.7） Middle 5（17.2） Distal 6（20.7） flank pain,n（%） 24（82.8） Etiology,n(%) UPJO 13（44.8） Ureteral calculi 3（10.3） Iatrogenic injury 12（41.4） Unknown 1（3.4） Preoperative indwelling ureteral stent，n(%) 7（24.1） Preoperative indwelling nephrostomy tube，n(%) 11（37.9） Follow-up time, mo, median(range) 21.7（1,70） 3.2 Safety All 29 patients successfully underwent laparoscopic or robot-assisted ureteroplasty without conversion to open surgery. Perioperative parameters are summarized in Table 2 . The mean stricture length was 3.1±2.1 cm. Mean operative time was 154.3±54.4 minutes, with an estimated blood loss of 37.9±13.4 mL. The average postoperative hospital stay was 5.4±2.6 days. Two patients who underwent ureteroneocystostomy developed high-grade fever with chills postoperatively, diagnosed as acute pyelonephritis; both resolved with intravenous antibiotic therapy. For patients receiving lingual mucosal graft augmentation, all harvest sites healed uneventfully. Two cases reported intermittent numbness at the lingual mucosal harvest sites, though without impairment in phonation or swallowing, and were managed conservatively. Table 2. Summary of perioperative data Parameters Outcomes Type of surgical procedure Laparoscopic surgery，n 28 Robotic-assisted surgery，n 1 Type of surgical technique Pyeloureteroplasty，n(%) 11（37.9） Ureteroneocystostomy，n(%) 3（10.3） Ureteroureterostomy，n(%) 5（17.2） Lingual mucosal graft augmentation，n(%) 6（20.7） Bladder flap ureteroplasty，n(%) 4（13.8） Operative time (min), mean±SD 154.3±54.4 Intraoperative blood loss (ml), mean±SD 37.9±13.4 Duration of postoperative drainage (days), mean±SD 3.9±1.2 Postoperative hospital stay (days), mean±SD 5.4±2.6 Postoperative complications (Clavien-Dindo) No I II III IV 27 2 0 0 0 3.3 Effectiveness At a median follow-up of 12 months, only 1 out of 29 patients reported persistent postoperative lumbar pain requiring long-term indwelling ureteral stent placement for pain management and hydronephrosis. Symptoms resolved in the remaining 28 patients, who required neither ureteral stents nor nephrostomy. Both clinical and radiological success was achieved, resulting in a surgical success rate of 96.6% (28/29). During postoperative follow-up, 20 patients had their serum creatinine levels reassessed at our hospital. As shown in Figure 1 , compared to the preoperative baseline creatinine level (113.98 ± 70.28 μmol/L), the postoperative creatinine level in these 20 patients was significantly lower (104.91 ± 10.23 μmol/L). Comparison of HRQoL, anxiety and depression Figure 2A compares preoperative SF-36 scores of ureteral stricture patients with Chinese population norms. Prior to surgery, patients exhibited significantly lower scores in all SF-36 domains except Vitality (VT), Role-Emotional (RE), and Mental Health (MH) (all p< 0.001). Figure 2B demonstrates postoperative SF-36 scores versus population norms. After surgical repair, patients achieved significantly superior scores in VT and MH domains compared to the general population (p 0.05). Figure 2C illustrates longitudinal changes in SF-36 scores pre- versus postoperatively. Significant improvements (p< 0.05) were observed across all domains except Role-Emotional (RE). As shown in Figure 3 , postoperative anxiety and depression scores (3.48 ± 3.00, 3.24 ± 2.44) in ureteral stricture patients from our study were significantly reduced compared to preoperative scores (4.72 ± 3.29, 4.67 ± 2.52). 4 Discussion Ureteral stricture, as a chronic urological condition, not only causes physiological complications such as recurrent infections, flank pain, hydronephrosis, and renal impairment [ 10 ], but interventions like nephrostomy or ureteral stenting—aimed at symptom relief and renal preservation—may trigger urinary tract infections and pain [ 11 ]. These factors collectively disrupt daily activities and significantly compromise patients' psychological well-being and quality of life. Patients with ureteral strictures frequently exhibit substantial anxiety and depressive symptoms. In line with a prior study of 275 ureteral stricture patients [ 2 ], our findings demonstrate that those seeking urological care have significantly lower quality of life compared to the general Chinese population. For these patients, we performed minimally invasive ureteral reconstruction based on stricture location and length: Lingual mucosal graft ureteroplasty for proximal long-segment strictures [ 6 ]; Pyeloureteroplasty for ureteropelvic junction (UPJ) obstruction [ 12 ];Ureteroureterostomy for mid-ureteral short-segment strictures [ 13 ];Ureteroneocystostomy or bladder flap ureteroplasty for distal strictures [ 14 , 15 ].Surgical principles included tension-free anastomosis, blood supply preservation, watertight closure, and routine stenting. At a median follow-up of 12 months, the success rate reached 96.6% without major complications (Clavien-Dindo grade III-IV). Only two patients (6.90%) experienced minor complications (grade I). Imaging confirmed reduced hydronephrosis, and among 20 patients with serial creatinine measurements, postoperative levels decreased significantly without requiring reintervention. Preoperatively, 7 patients had ureteral stents and 11 required nephrostomy tubes. Postoperatively, only one patient needed long-term stenting for persistent flank pain and hydronephrosis; all others avoided permanent drainage devices. This exceptional case had a history of percutaneous nephrolithotomy with failed stent placement due to obliterated ureteral lumen. After our reconstruction, external drainage was eliminated, improving his quality of life. Although lingual graft harvest inevitably causes oral mucosal injury, no severe complications (e.g., severe tongue pain, trismus, sialadenitis, or taste loss) occurred [ 6 , 16 , 17 ]. All harvest sites healed well, with only two cases reporting transient lingual numbness. This confirms the technique's long-term safety and efficacy. A paramount objective of any surgical intervention is to enhance patients' daily quality of life. While existing literature extensively details technical nuances, postoperative management, and complications of ureteral reconstruction [ 3 , 18 ], data on health-related quality of life (HRQoL) changes following repair remain scarce. Consistent with prior reports [ 17 ], our patients demonstrated significant postoperative HRQoL improvements, achieving parity with Chinese population norms. Notably, Vitality (VT) and Mental Health (MH) scores surpassed population standards, likely attributable to regained energy from symptom resolution and alleviated psychological distress after eliminating disease-related threats. This favorable outcome likely stems from resolution of flank pain and recurrent infections, along with elimination of indwelling devices requiring frequent exchanges. These findings indicate that HRQoL assessment serves dual roles: preoperatively identifying surgical candidates who would benefit most from reconstruction, and postoperatively evaluating therapeutic efficacy as an objective outcome metric. Notably, our findings demonstrate significant alleviation of anxiety and depression post-repair, indicating that successful ureteral reconstruction mitigates negative illness perceptions and fears regarding renal deterioration while improving physical function scores and enhancing psychological well-being through restored social role participation [ 19 ], owing to symptom resolution, elimination of frequent device exchanges, and reduced financial burden, consistent with reports documenting quality-of-life impairments from indwelling devices—particularly marked self-care difficulties in nephrostomy-dependent patients [ 20 , 21 ]—thus necessitating early surgical candidate identification to preserve renal function, alleviate symptoms, lessen economic strain, and elevate both quality of life and psychological well-being. This study has several limitations. First, the relatively small sample size may compromise the reliability of our conclusions. Second, the questionnaire-based assessments relied on self-reported data, introducing potential response biases. Finally, the mean follow-up duration of 12 months is insufficient to evaluate long-term disease and treatment impacts on HRQoL. Our research team is currently collecting extended follow-up data from this cohort for future publication. 5 Conclusion Minimally invasive ureteral repair and reconstruction effectively relieves obstruction and improves renal function, while significantly enhancing health-related quality of life and psychological well-being, establishing itself as a safe therapeutic option for benign ureteral strictures. Early surgical intervention reduces the need for long-term stent or nephrostomy placement, thereby alleviating physical and psychological burdens. Future studies should expand sample sizes and prolong follow-up durations to validate long-term efficacy. Declarations Author contributions statement BYZ, HL and ZHG were involved in the project development. HQW, QZ and XMZ contributed to the data collection. QZ and HQW assisted in the data analysis. HL, QZ and HQW helped in the manuscript writing. HL, BYZ, ZHG, XMZ and HQW were involved in the supervision. QZ contributed to the ethics. Conflict of interest None Funding This study was supported by grants from the Project of Yunnan Applied Basic Research Project-Kunming Medical University Union Foundation(No.202301AY070001-198), Yunnan Province Clinical Research Center for Chronic Kidney Disease (No. 202102AA100060) and Youth Project of Yunnan Provincial Basic Research Program(No. 202301AU070170). Author Contribution BYZ, HL and ZHG were involved in the project development. HQW, QZ and XMZ contributed to the data collection. QZ and HQW assisted in the data analysis. HL, QZ and HQW helped in the manuscript writing. HL, BYZ, ZHG, XMZ and HQW were involved in the supervision. QZ contributed to the ethics. Data availability The data that support the findings of this study are available from the corresponding author, upon reasonable request. References Yang K, Pang KH, Fan S, Li X, Osman NI, Chapple CR, Zhou L, Li X: Robotic ureteral reconstruction for benign ureteral strictures: a systematic review of surgical techniques, complications and outcomes : Robotic Ureteral Reconstruction for Ureteral Strictures . BMC Urol 2023, 23 (1):160. Li Z, Wang X, Ying Y, Li X, Zhu W, Meng C, Han G, Liu J, Wang J, Huang Y et al : Health-related quality of life (HRQoL), anxiety and depression in patients with ureteral stricture: a multi-institutional study . World J Urol 2023, 41 (1):275-281. Bilotta A, Wiegand LR, Heinsimer KR: Ureteral reconstruction for complex strictures: a review of the current literature . Int Urol Nephrol 2021, 53 (11):2211-2219. Elbers JR, Rodriguez Socarras M, Rivas JG, Autran AM, Esperto F, Tortolero L, Carrion DM, Sancha FG: Robotic Repair of Ureteral Strictures: Techniques and Review . Curr Urol Rep 2021, 22 (8):39. Drain A, Jun MS, Zhao LC: Robotic Ureteral Reconstruction . Urol Clin North Am 2021, 48 (1):91-101. Liang C, Wang J, Hai B, Xu Y, Zeng J, Chai S, Chen J, Zhang H, Gao X, Cheng G et al : Lingual Mucosal Graft Ureteroplasty for Long Proximal Ureteral Stricture: 6 Years of Experience with 41 Cases . Eur Urol 2022, 82 (2):193-200. Alonso J, Ferrer M, Gandek B, Ware JE, Jr., Aaronson NK, Mosconi P, Rasmussen NK, Bullinger M, Fukuhara S, Kaasa S et al : Health-related quality of life associated with chronic conditions in eight countries: results from the International Quality of Life Assessment (IQOLA) Project . Qual Life Res 2004, 13 (2):283-298. Li L, Wang HM, Shen Y: Chinese SF-36 Health Survey: translation, cultural adaptation, validation, and normalisation . J Epidemiol Community Health 2003, 57 (4):259-263. Mykletun A, Stordal E, Dahl AA: Hospital Anxiety and Depression (HAD) scale: factor structure, item analyses and internal consistency in a large population . Br J Psychiatry 2001, 179 :540-544. Paffenholz P, Heidenreich A: Modern surgical strategies in the management of complex ureteral strictures . Curr Opin Urol 2021, 31 (2):170-176. Qi Y, Kong H, Xing H, Zhang Z, Chen Y, Qi S: A randomized controlled study of ureteral stent extraction string on patient's quality of life and stent-related complications after percutaneous nephrolithotomy in the prone position . Urolithiasis 2023, 51 (1):79. Song P, Shu M, Peng Z, Yang L, Zhou M, Wang Z, Lu N, Pei C, Dong Q: Transperitoneal versus retroperitoneal approaches of pyeloplasty in management of ureteropelvic junction obstruction: A meta-analysis . Asian J Surg 2022, 45 (1):1-7. Lu L, Bi Y, Wang X, Ruan S: Laparoscopic Resection and End-to-End Ureteroureterostomy for Midureteral Obstruction in Children . J Laparoendosc Adv Surg Tech A 2017, 27 (2):197-202. Engel O, Rink M, Fisch M: Management of iatrogenic ureteral injury and techniques for ureteral reconstruction . Curr Opin Urol 2015, 25 (4):331-335. White C, Stifelman M: Ureteral Reimplantation, Psoas Hitch, and Boari Flap . J Endourol 2020, 34 (S1):S25-S30. Kumar A, Das SK, Trivedi S, Dwivedi US, Singh PB: Substitution urethroplasty for anterior urethral strictures: buccal versus lingual mucosal graft . Urol Int 2010, 84 (1):78-83. Wang X, Meng C, Li D, Ying Y, Ma Y, Fan S, Li X, Yang K, Wang B, Guan H et al : Minimally invasive ureteroplasty with lingual mucosal graft for complex ureteral stricture: analysis of surgical and patient-reported outcomes . Int Braz J Urol 2024, 50 (1):46-57. Kapogiannis F, Spartalis E, Fasoulakis K, Tsourouflis G, Dimitroulis D, Nikiteas NI: Laparoscopic and Robotic Management of Ureteral Stricture in Adults . In Vivo 2020, 34 (3):965-972. Ito K, Takahashi T, Koterazawa S, Somiya S, Haitani T, Kanno T, Higashi Y, Yamada H: Determinants of health-related quality of life in patients undergoing medical expulsion therapy for acute renal colic . Urologia 2025, 92 (2):209-215. Cardoso A, Coutinho A, Neto G, Anacleto S, Tinoco CL, Morais N, Cerqueira-Alves M, Lima E, Mota P: Percutaneous nephrostomy versus ureteral stent in hydronephrosis secondary to obstructive urolithiasis: A systematic review and meta-analysis . Asian J Urol 2024, 11 (2):261-270. Zhang KP, Zhang Y, Chao M: Which is the best way for patients with ureteral obstruction? Percutaneous nephrostomy versus double J stenting . Medicine (Baltimore) 2022, 101 (45):e31194. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 17 Sep, 2025 Read the published version in World Journal of Urology → Version 1 posted Editorial decision: Revision requested 07 Aug, 2025 Reviews received at journal 04 Aug, 2025 Reviews received at journal 01 Aug, 2025 Reviews received at journal 31 Jul, 2025 Reviews received at journal 27 Jul, 2025 Reviews received at journal 25 Jul, 2025 Reviews received at journal 22 Jul, 2025 Reviewers agreed at journal 22 Jul, 2025 Reviewers agreed at journal 21 Jul, 2025 Reviewers agreed at journal 20 Jul, 2025 Reviewers agreed at journal 18 Jul, 2025 Reviewers agreed at journal 17 Jul, 2025 Reviewers agreed at journal 16 Jul, 2025 Reviewers agreed at journal 16 Jul, 2025 Reviewers invited by journal 16 Jul, 2025 Editor assigned by journal 12 Jun, 2025 Submission checks completed at journal 12 Jun, 2025 First submitted to journal 01 Jun, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6795942","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":488057084,"identity":"d398ff6f-4460-4464-a900-59fa9d60eec3","order_by":0,"name":"Quan Zhang","email":"","orcid":"","institution":"First Affiliated Hospital of Kunming Medical University","correspondingAuthor":false,"prefix":"","firstName":"Quan","middleName":"","lastName":"Zhang","suffix":""},{"id":488057085,"identity":"5fa7bc85-7451-4a55-9f2a-b9d9c8b033f0","order_by":1,"name":"Hanqing Wang","email":"","orcid":"","institution":"First Affiliated Hospital of Kunming Medical University","correspondingAuthor":false,"prefix":"","firstName":"Hanqing","middleName":"","lastName":"Wang","suffix":""},{"id":488057086,"identity":"7f9fc501-84d1-4e71-b2e5-aa5e521408db","order_by":2,"name":"Xuemeng Zhang","email":"","orcid":"","institution":"First Affiliated Hospital of Kunming Medical University","correspondingAuthor":false,"prefix":"","firstName":"Xuemeng","middleName":"","lastName":"Zhang","suffix":""},{"id":488057087,"identity":"3f5e3ec3-a8fc-40ff-b390-3fffde6124c3","order_by":3,"name":"Zhenhua Gao","email":"","orcid":"","institution":"First Affiliated Hospital of Kunming Medical University","correspondingAuthor":false,"prefix":"","firstName":"Zhenhua","middleName":"","lastName":"Gao","suffix":""},{"id":488057088,"identity":"c8e710bc-854f-41c1-a598-8c4d4a7fa75e","order_by":4,"name":"Hao Li","email":"","orcid":"","institution":"First Affiliated Hospital of Kunming Medical University","correspondingAuthor":false,"prefix":"","firstName":"Hao","middleName":"","lastName":"Li","suffix":""},{"id":488057089,"identity":"3edd10c7-acba-4ab1-9e56-272202ada2ad","order_by":5,"name":"Baiyu Zhang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA20lEQVRIiWNgGAWjYDACCSBmbGDgYWBgPgAiSdLClkCaFiDgMSBOi/zs5mcPv+6wkzG4kfNN4m3bYQb+2Q34tTDOOWZuLHsmmcfgRu42yblALRJ3DuDXwiyRYCYt2cYM1iLNC9RiIJGAXwubRPo3oJZ6oJacZ8Rp4ZHIMZP82HYYpIWNOC0SEjll0oxnjvNInnlmbDnnXDqPxA0CWuRnpG+T/Lmj2p7vePLDG2/KrOX4ZxDQAgLMoOhQOMDAIsHI1kxcbDL+AFnXwMD8geFPHVE6RsEoGAWjYGQBAP1TQuh+t4lIAAAAAElFTkSuQmCC","orcid":"","institution":"First Affiliated Hospital of Kunming Medical University","correspondingAuthor":true,"prefix":"","firstName":"Baiyu","middleName":"","lastName":"Zhang","suffix":""}],"badges":[],"createdAt":"2025-06-01 13:38:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6795942/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6795942/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s00345-025-05926-5","type":"published","date":"2025-09-17T15:56:52+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":87380957,"identity":"527f3a63-2ee9-47d6-9e17-fe0a2cfec1a8","added_by":"auto","created_at":"2025-07-23 08:35:59","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":23098,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eChanges in serum creatinine levels before and after surgery.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6795942/v1/f3ef12a2b52881d33487ad3a.png"},{"id":87380965,"identity":"0b7f52a0-7e1d-46d4-b4d3-587e83640a3c","added_by":"auto","created_at":"2025-07-23 08:36:00","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":47353,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSF-36 Scores in Ureteral Stricture Patients (n = 29) from This Study\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e(A) Comparison of SF-36 scores between preoperative ureteral stricture patients in our study (n=29) and the general Chinese population (n=3214).\u003c/p\u003e\n\u003cp\u003e(B) Comparison of SF-36 scores between postoperative ureteral stricture patients in our study (n=29) and the general Chinese population (n=3214).\u003c/p\u003e\n\u003cp\u003e(C) Comparison of SF-36 scores in ureteral stricture patients pre versus post operative in our study (n=29).\u003c/p\u003e\n\u003cp\u003eError bars indicate significant variables (p ≤0.05, **p ≤0.01, ***p≤ 0.001; n.s.= not significant).\u003c/p\u003e\n\u003cp\u003ePF: Physical Functioning, RP: Role-Physical, BP: Bodily Pain, GH: General Health, VT: Vitality, SF: Social Functioning, RE: Role-Emotional, MH: Mental Health.*\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6795942/v1/d61ecdd7d4435c3ed39271b7.png"},{"id":87380951,"identity":"274f5acd-47bf-45e5-a8e7-a52651541d09","added_by":"auto","created_at":"2025-07-23 08:35:59","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":38996,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eComparison of anxiety and depression scores in ureteral stricture patients pre versus post operative in our study\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eError bars indicate standard deviations. Significance variables: *p ≤ 0.05, **p ≤ 0.01, ***p ≤ 0.001; n.s. = not significant. HADS-Score: Hospital Anxiety and Depression Scale Score.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-6795942/v1/81e7ad0e8d31df6049a9ecc8.png"},{"id":91889776,"identity":"74e615db-fb4f-4fde-b1da-5e5af9cc941a","added_by":"auto","created_at":"2025-09-22 16:01:32","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1750913,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6795942/v1/7b60eed3-d3da-4d61-8380-2af57d22c94b.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Clinical Outcomes and Health-Related Quality of Life Assessment Following Minimally Invasive Reconstructive Surgery for Benign Ureteral Strictures","fulltext":[{"header":"1 Introduction","content":"\u003cp\u003eBenign ureteral stricture is a common pathological condition of the urinary system, typically caused by iatrogenic injury, trauma, urolithiasis, radiation therapy, or ischemia[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. It manifests as upper urinary tract obstruction, renal impairment, and even renal failure, underscoring the necessity of timely and effective intervention to improve patient prognosis[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Current therapeutic strategies for ureteral strictures are diverse. Ureteral repair and reconstruction surgery may be indicated when endoscopic dilation is unsuitable due to excessive stricture length or when patients decline long-term nephrostomy or ureteral stenting [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eUreteral strictureplasty represents a classic and well-established surgical approach, widely employed to relieve obstruction and restore physiological urinary tract function, thereby alleviating symptoms and preserving renal integrity. For complex or recurrent strictures, techniques such as end-to-end anastomosis or reconstruction with grafts (e.g., lingual/buccal mucosal grafts) have gained increasing attention, demonstrating enhanced postoperative efficacy and reduced recurrence rates [\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eWhen surgical management is indicated, one of the primary objectives of intervention is to optimize patient quality of life. Health-related quality of life (HRQoL) plays a pivotal role in postoperative evaluation. Assessing pre- versus postoperative HRQoL changes provides an additional dimension for evaluating surgical outcomes. Multidimensional HRQoL assessment encompasses not only physical function but also emotional, psychological, and social adaptation [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. For patients undergoing ureteral stricture repair, longitudinal HRQoL evaluation offers critical insights into therapeutic effectiveness; however, evidence in this domain remains limited.\u003c/p\u003e\u003cp\u003eThis study aims to investigate the clinical efficacy of ureteral strictureplasty and analyze its impact on HRQoL, anxiety, and depressive symptoms, thereby providing evidence-based guidance for optimizing treatment strategies.\u003c/p\u003e"},{"header":"2 Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e2.1 Study Population\u003c/h2\u003e\u003cp\u003eThis retrospective study included 29 patients who underwent surgical treatment for ureteral strictures at the First Affiliated Hospital of Kunming Medical University from January 2019 to November 2024. Surgical approaches comprised laparoscopic or robot-assisted techniques, including pyeloureteroplasty, end-to-end anastomosis, and lingual mucosal graft augmentation. Inclusion criteria were: (1) age 18\u0026ndash;75 years; (2) preoperative confirmation of ureteral stricture via ultrasonography, contrast-enhanced CT, magnetic resonance urography (MRU), or antegrade/retrograde urography; (3) benign stricture etiology; (4) voluntary participation with signed informed consent. Exclusion criteria included: (1) contraindications to anesthesia/surgery; (2) uncontrolled systemic diseases or active infections; (3) severe coagulation disorders; (4) pregnancy; (5) cognitive/psychiatric impairments affecting informed consent or follow-up compliance; (6) malignant ureteral obstruction. Informed consent was obtained from all patients and this study was approved by the Ethics Committee of the First Affiliated Hospital of Kunming Medical University (approval number: 2024L127).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e2.2 Data Collection\u003c/h2\u003e\u003cp\u003ePreoperative parameters: Demographic data (age, sex, BMI), medical history, stricture etiology, laboratory tests (serum creatinine), and imaging findings. Perioperative parameters: Surgical approach (laparoscopic/robot-assisted), anastomotic technique, stricture location, operative time (minutes), intraoperative blood loss (mL), postoperative hospital stay (days), and complications (graded by Clavien-Dindo classification). Postoperative follow-up: Subjective symptoms (flank pain, fever, nausea/vomiting), imaging outcomes, and long-term complications. Surgical success was defined as: (a) symptomatic relief; (b) imaging-confirmed hydronephrosis improvement and stable/improved renal function.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003e2.3 HRQoL and Psychological Assessment\u003c/h2\u003e\u003cp\u003eSF-36 Health Survey (Chinese version 2.0) [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]: A validated 36-item tool assessing eight HRQoL domains: Physical Functioning (PF), Role-Physical (RP), Bodily Pain (BP), General Health (GH), Vitality (VT), Social Functioning (SF), Role-Emotional (RE), and Mental Health (MH). Scores range 0\u0026ndash;100 (higher\u0026thinsp;=\u0026thinsp;better status).Patients' anxiety and depressive states were assessed using the Hospital Anxiety and Depression Scale (HADS) [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. This instrument comprises 14 items, divided into two subscales:Anxiety (HADS-A) and Depression (HADS-D). Each subscale contains 7 items rated on a 4-point Likert scale. The total score for each dimension ranges from 0 to 21 points, with higher scores indicating more severe anxiety/depressive symptoms.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003e2.4 Statistical Analysis\u003c/h2\u003e\u003cp\u003eNormally distributed continuous variables are expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD); non-normal variables as median (interquartile range). Categorical variables are presented as frequencies (percentages). Pre- versus postoperative HRQoL scores were compared to Chinese population norms using Student\u0026rsquo;s t-test. Statistical significance was set at two-tailed p\u0026thinsp;\u0026lt;\u0026thinsp;0.05. Analyses were performed using IBM SPSS Statistics 22.0 (IBM Corp, Armonk, NY, USA).\u003c/p\u003e\u003c/div\u003e"},{"header":"3 Results","content":"\u003cp\u003e\u003cstrong\u003e3.1 Demographic and Baseline Characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePreoperative patient characteristics are summarized in \u003cstrong\u003eTable 1\u003c/strong\u003e. None of the patients had undergone prior ureteral reconstruction. Among the 29 patients, 18 (62.1%) presented with strictures involving the ureteropelvic junction (UPJ) or proximal ureter. Preoperatively, 7 patients (24.1%) had indwelling ureteral stents, and 11 (37.9%) required nephrostomy tubes. Surgical interventions included pyeloureteroplasty (11 cases, 37.9%), ureteroneocystostomy (3 cases, 10.3%), end-to-end anastomosis (5 cases, 17.2%), lingual mucosal graft augmentation (6 cases, 20.7%), and bladder flap ureteroplasty (4 cases, 13.8%).\u003c/p\u003e\n\u003cp\u003eTable 1 .Characteristics of patients\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"491\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 365px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003eOutcomes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 365px;\"\u003e\n \u003cp\u003eAge (years), mean\u0026plusmn;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e43.6\u0026plusmn;14.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 365px;\"\u003e\n \u003cp\u003eBMI,mean\u0026plusmn; D\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e23.0\u0026plusmn;4.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 365px;\"\u003e\n \u003cp\u003eGender,n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 365px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Male\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e18（63.1）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 365px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Female\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e11（37.9）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 365px;\"\u003e\n \u003cp\u003eLaterality,n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 365px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Left\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e22（75.9）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 365px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Right\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e7（24.1）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 365px;\"\u003e\n \u003cp\u003eLocation,n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 365px;\"\u003e\n \u003cp\u003eUPJ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e12（41.40）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 365px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Proximal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e6（20.7）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 365px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Middle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e5（17.2）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 365px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Distal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e6（20.7）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 365px;\"\u003e\n \u003cp\u003eflank pain,n（%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e24（82.8）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 365px;\"\u003e\n \u003cp\u003eEtiology,n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 365px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;UPJO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e13（44.8）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 365px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Ureteral calculi\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e3（10.3）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 365px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Iatrogenic injury\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e12（41.4）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 365px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Unknown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e1（3.4）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 365px;\"\u003e\n \u003cp\u003ePreoperative indwelling ureteral stent，n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e7（24.1）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 365px;\"\u003e\n \u003cp\u003ePreoperative indwelling nephrostomy tube，n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e11（37.9）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 365px;\"\u003e\n \u003cp\u003eFollow-up time, mo, median(range)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e21.7（1,70）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e3.2 Safety\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll 29 patients successfully underwent laparoscopic or robot-assisted ureteroplasty without conversion to open surgery. Perioperative parameters are summarized in \u003cstrong\u003eTable 2\u003c/strong\u003e. The mean stricture length was 3.1\u0026plusmn;2.1 cm. Mean operative time was 154.3\u0026plusmn;54.4 minutes, with an estimated blood loss of 37.9\u0026plusmn;13.4 mL. The average postoperative hospital stay was 5.4\u0026plusmn;2.6 days.\u003c/p\u003e\n\u003cp\u003eTwo patients who underwent ureteroneocystostomy developed high-grade fever with chills postoperatively, diagnosed as acute pyelonephritis; both resolved with intravenous antibiotic therapy. For patients receiving lingual mucosal graft augmentation, all harvest sites healed uneventfully. Two cases reported intermittent numbness at the lingual mucosal harvest sites, though without impairment in phonation or swallowing, and were managed conservatively.\u003c/p\u003e\n\u003cp\u003eTable 2. Summary of perioperative data\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"759\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 376px;\"\u003e\n \u003cp\u003eParameters\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003eOutcomes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 376px;\"\u003e\n \u003cp\u003eType of surgical procedure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 376px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Laparoscopic surgery，n\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 376px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Robotic-assisted surgery，n\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 376px;\"\u003e\n \u003cp\u003eType of surgical technique\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 376px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Pyeloureteroplasty，n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e11（37.9）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 376px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Ureteroneocystostomy，n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e3（10.3）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 376px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Ureteroureterostomy，n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e5（17.2）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 376px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Lingual mucosal graft augmentation，n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e6（20.7）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 376px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Bladder flap ureteroplasty，n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e4（13.8）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 376px;\"\u003e\n \u003cp\u003eOperative time (min), mean\u0026plusmn;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e154.3\u0026plusmn;54.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 376px;\"\u003e\n \u003cp\u003eIntraoperative blood loss (ml), mean\u0026plusmn;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e37.9\u0026plusmn;13.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 376px;\"\u003e\n \u003cp\u003eDuration of postoperative drainage (days), mean\u0026plusmn;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e3.9\u0026plusmn;1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 376px;\"\u003e\n \u003cp\u003ePostoperative hospital stay (days), mean\u0026plusmn;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e5.4\u0026plusmn;2.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 376px;\"\u003e\n \u003cp\u003ePostoperative complications (Clavien-Dindo)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003eI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003eII\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003eIII\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003eIV\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 376px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e3.3 Effectiveness\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAt a median follow-up of 12 months, only 1 out of 29 patients reported persistent postoperative lumbar pain requiring long-term indwelling ureteral stent placement for pain management and hydronephrosis. Symptoms resolved in the remaining 28 patients, who required neither ureteral stents nor nephrostomy. Both clinical and radiological success was achieved, resulting in a surgical success rate of 96.6% (28/29). During postoperative follow-up, 20 patients had their serum creatinine levels reassessed at our hospital. As shown in \u003cstrong\u003eFigure 1\u003c/strong\u003e, compared to the preoperative baseline creatinine level (113.98\u0026nbsp;\u0026plusmn;\u0026nbsp;70.28\u0026nbsp;\u0026mu;mol/L), the postoperative creatinine level in these 20 patients was significantly lower (104.91\u0026nbsp;\u0026plusmn;\u0026nbsp;10.23\u0026nbsp;\u0026mu;mol/L).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eComparison of\u0026nbsp;HRQoL, anxiety and\u0026nbsp;depression\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFigure 2A\u003c/strong\u003e compares preoperative SF-36 scores of ureteral stricture patients with Chinese population norms. Prior to surgery, patients exhibited significantly lower scores in all SF-36 domains except Vitality (VT), Role-Emotional (RE), and Mental Health (MH) (all p\u0026lt; 0.001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFigure 2B\u003c/strong\u003e demonstrates postoperative SF-36 scores versus population norms. After surgical repair, patients achieved significantly superior scores in VT and MH domains compared to the general population (p\u0026lt; 0.05), while scores in all other domains showed no significant differences (p\u0026gt; 0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFigure 2C\u003c/strong\u003e illustrates longitudinal changes in SF-36 scores pre- versus postoperatively. Significant improvements (p\u0026lt; 0.05) were observed across all domains except Role-Emotional (RE).\u003c/p\u003e\n\u003cp\u003eAs shown in \u003cstrong\u003eFigure 3\u003c/strong\u003e, postoperative anxiety and depression scores (3.48 \u0026plusmn; 3.00, 3.24 \u0026plusmn; 2.44) in ureteral stricture patients from our study were significantly reduced compared to preoperative scores (4.72 \u0026plusmn; 3.29, 4.67 \u0026plusmn; 2.52).\u003c/p\u003e"},{"header":"4 Discussion","content":"\u003cp\u003eUreteral stricture, as a chronic urological condition, not only causes physiological complications such as recurrent infections, flank pain, hydronephrosis, and renal impairment [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], but interventions like nephrostomy or ureteral stenting\u0026mdash;aimed at symptom relief and renal preservation\u0026mdash;may trigger urinary tract infections and pain [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. These factors collectively disrupt daily activities and significantly compromise patients' psychological well-being and quality of life. Patients with ureteral strictures frequently exhibit substantial anxiety and depressive symptoms. In line with a prior study of 275 ureteral stricture patients [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], our findings demonstrate that those seeking urological care have significantly lower quality of life compared to the general Chinese population.\u003c/p\u003e\u003cp\u003eFor these patients, we performed minimally invasive ureteral reconstruction based on stricture location and length: Lingual mucosal graft ureteroplasty for proximal long-segment strictures [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]; Pyeloureteroplasty for ureteropelvic junction (UPJ) obstruction [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e];Ureteroureterostomy for mid-ureteral short-segment strictures [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e];Ureteroneocystostomy or bladder flap ureteroplasty for distal strictures [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].Surgical principles included tension-free anastomosis, blood supply preservation, watertight closure, and routine stenting.\u003c/p\u003e\u003cp\u003eAt a median follow-up of 12 months, the success rate reached 96.6% without major complications (Clavien-Dindo grade III-IV). Only two patients (6.90%) experienced minor complications (grade I). Imaging confirmed reduced hydronephrosis, and among 20 patients with serial creatinine measurements, postoperative levels decreased significantly without requiring reintervention. Preoperatively, 7 patients had ureteral stents and 11 required nephrostomy tubes. Postoperatively, only one patient needed long-term stenting for persistent flank pain and hydronephrosis; all others avoided permanent drainage devices. This exceptional case had a history of percutaneous nephrolithotomy with failed stent placement due to obliterated ureteral lumen. After our reconstruction, external drainage was eliminated, improving his quality of life. Although lingual graft harvest inevitably causes oral mucosal injury, no severe complications (e.g., severe tongue pain, trismus, sialadenitis, or taste loss) occurred [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. All harvest sites healed well, with only two cases reporting transient lingual numbness. This confirms the technique's long-term safety and efficacy.\u003c/p\u003e\u003cp\u003eA paramount objective of any surgical intervention is to enhance patients' daily quality of life. While existing literature extensively details technical nuances, postoperative management, and complications of ureteral reconstruction [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], data on health-related quality of life (HRQoL) changes following repair remain scarce. Consistent with prior reports [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], our patients demonstrated significant postoperative HRQoL improvements, achieving parity with Chinese population norms. Notably, Vitality (VT) and Mental Health (MH) scores surpassed population standards, likely attributable to regained energy from symptom resolution and alleviated psychological distress after eliminating disease-related threats. This favorable outcome likely stems from resolution of flank pain and recurrent infections, along with elimination of indwelling devices requiring frequent exchanges. These findings indicate that HRQoL assessment serves dual roles: preoperatively identifying surgical candidates who would benefit most from reconstruction, and postoperatively evaluating therapeutic efficacy as an objective outcome metric.\u003c/p\u003e\u003cp\u003eNotably, our findings demonstrate significant alleviation of anxiety and depression post-repair, indicating that successful ureteral reconstruction mitigates negative illness perceptions and fears regarding renal deterioration while improving physical function scores and enhancing psychological well-being through restored social role participation [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], owing to symptom resolution, elimination of frequent device exchanges, and reduced financial burden, consistent with reports documenting quality-of-life impairments from indwelling devices\u0026mdash;particularly marked self-care difficulties in nephrostomy-dependent patients [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u0026mdash;thus necessitating early surgical candidate identification to preserve renal function, alleviate symptoms, lessen economic strain, and elevate both quality of life and psychological well-being.\u003c/p\u003e\u003cp\u003eThis study has several limitations. First, the relatively small sample size may compromise the reliability of our conclusions. Second, the questionnaire-based assessments relied on self-reported data, introducing potential response biases. Finally, the mean follow-up duration of 12 months is insufficient to evaluate long-term disease and treatment impacts on HRQoL. Our research team is currently collecting extended follow-up data from this cohort for future publication.\u003c/p\u003e"},{"header":"5 Conclusion","content":"\u003cp\u003eMinimally invasive ureteral repair and reconstruction effectively relieves obstruction and improves renal function, while significantly enhancing health-related quality of life and psychological well-being, establishing itself as a safe therapeutic option for benign ureteral strictures. Early surgical intervention reduces the need for long-term stent or nephrostomy placement, thereby alleviating physical and psychological burdens. Future studies should expand sample sizes and prolong follow-up durations to validate long-term efficacy.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor contributions statement\u003c/h2\u003e\n\u003cp\u003eBYZ, HL and ZHG were involved in the project development. HQW, QZ and XMZ contributed to the data collection. QZ and HQW assisted in the data analysis. HL, QZ and HQW helped in the manuscript writing. HL, BYZ, ZHG, XMZ and HQW were involved in the supervision. QZ contributed to the ethics.\u003c/p\u003e\n\u003ch2\u003eConflict of interest\u003c/h2\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eThis study was supported by grants from the Project of Yunnan Applied Basic Research Project-Kunming Medical University Union Foundation(No.202301AY070001-198), Yunnan Province Clinical Research Center for Chronic Kidney Disease (No. 202102AA100060) and Youth Project of Yunnan Provincial Basic Research Program(No. 202301AU070170).\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eBYZ, HL and ZHG were involved in the project development. HQW, QZ and XMZ contributed to the data collection. QZ and HQW assisted in the data analysis. HL, QZ and HQW helped in the manuscript writing. HL, BYZ, ZHG, XMZ and HQW were involved in the supervision. QZ contributed to the ethics.\u003c/p\u003e\n\u003ch2\u003eData availability\u003c/h2\u003e\n\u003cp\u003eThe data that support the findings of this study are available from the corresponding author, upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eYang K, Pang KH, Fan S, Li X, Osman NI, Chapple CR, Zhou L, Li X: \u003cstrong\u003eRobotic ureteral reconstruction for benign ureteral strictures: a systematic review of surgical techniques, complications and outcomes : Robotic Ureteral Reconstruction for Ureteral Strictures\u003c/strong\u003e. \u003cem\u003eBMC Urol \u003c/em\u003e2023, \u003cstrong\u003e23\u003c/strong\u003e(1):160.\u003c/li\u003e\n\u003cli\u003eLi Z, Wang X, Ying Y, Li X, Zhu W, Meng C, Han G, Liu J, Wang J, Huang Y\u003cem\u003e et al\u003c/em\u003e: \u003cstrong\u003eHealth-related quality of life (HRQoL), anxiety and depression in patients with ureteral stricture: a multi-institutional study\u003c/strong\u003e. \u003cem\u003eWorld J Urol \u003c/em\u003e2023, \u003cstrong\u003e41\u003c/strong\u003e(1):275-281.\u003c/li\u003e\n\u003cli\u003eBilotta A, Wiegand LR, Heinsimer KR: \u003cstrong\u003eUreteral reconstruction for complex strictures: a review of the current literature\u003c/strong\u003e. \u003cem\u003eInt Urol Nephrol \u003c/em\u003e2021, \u003cstrong\u003e53\u003c/strong\u003e(11):2211-2219.\u003c/li\u003e\n\u003cli\u003eElbers JR, Rodriguez Socarras M, Rivas JG, Autran AM, Esperto F, Tortolero L, Carrion DM, Sancha FG: \u003cstrong\u003eRobotic Repair of Ureteral Strictures: Techniques and Review\u003c/strong\u003e. \u003cem\u003eCurr Urol Rep \u003c/em\u003e2021, \u003cstrong\u003e22\u003c/strong\u003e(8):39.\u003c/li\u003e\n\u003cli\u003eDrain A, Jun MS, Zhao LC: \u003cstrong\u003eRobotic Ureteral Reconstruction\u003c/strong\u003e. \u003cem\u003eUrol Clin North Am \u003c/em\u003e2021, \u003cstrong\u003e48\u003c/strong\u003e(1):91-101.\u003c/li\u003e\n\u003cli\u003eLiang C, Wang J, Hai B, Xu Y, Zeng J, Chai S, Chen J, Zhang H, Gao X, Cheng G\u003cem\u003e et al\u003c/em\u003e: \u003cstrong\u003eLingual Mucosal Graft Ureteroplasty for Long Proximal Ureteral Stricture: 6 Years of Experience with 41 Cases\u003c/strong\u003e. \u003cem\u003eEur Urol \u003c/em\u003e2022, \u003cstrong\u003e82\u003c/strong\u003e(2):193-200.\u003c/li\u003e\n\u003cli\u003eAlonso J, Ferrer M, Gandek B, Ware JE, Jr., Aaronson NK, Mosconi P, Rasmussen NK, Bullinger M, Fukuhara S, Kaasa S\u003cem\u003e et al\u003c/em\u003e: \u003cstrong\u003eHealth-related quality of life associated with chronic conditions in eight countries: results from the International Quality of Life Assessment (IQOLA) Project\u003c/strong\u003e. \u003cem\u003eQual Life Res \u003c/em\u003e2004, \u003cstrong\u003e13\u003c/strong\u003e(2):283-298.\u003c/li\u003e\n\u003cli\u003eLi L, Wang HM, Shen Y: \u003cstrong\u003eChinese SF-36 Health Survey: translation, cultural adaptation, validation, and normalisation\u003c/strong\u003e. \u003cem\u003eJ Epidemiol Community Health \u003c/em\u003e2003, \u003cstrong\u003e57\u003c/strong\u003e(4):259-263.\u003c/li\u003e\n\u003cli\u003eMykletun A, Stordal E, Dahl AA: \u003cstrong\u003eHospital Anxiety and Depression (HAD) scale: factor structure, item analyses and internal consistency in a large population\u003c/strong\u003e. \u003cem\u003eBr J Psychiatry \u003c/em\u003e2001, \u003cstrong\u003e179\u003c/strong\u003e:540-544.\u003c/li\u003e\n\u003cli\u003ePaffenholz P, Heidenreich A: \u003cstrong\u003eModern surgical strategies in the management of complex ureteral strictures\u003c/strong\u003e. \u003cem\u003eCurr Opin Urol \u003c/em\u003e2021, \u003cstrong\u003e31\u003c/strong\u003e(2):170-176.\u003c/li\u003e\n\u003cli\u003eQi Y, Kong H, Xing H, Zhang Z, Chen Y, Qi S: \u003cstrong\u003eA randomized controlled study of ureteral stent extraction string on patient\u0026apos;s quality of life and stent-related complications after percutaneous nephrolithotomy in the prone position\u003c/strong\u003e. \u003cem\u003eUrolithiasis \u003c/em\u003e2023, \u003cstrong\u003e51\u003c/strong\u003e(1):79.\u003c/li\u003e\n\u003cli\u003eSong P, Shu M, Peng Z, Yang L, Zhou M, Wang Z, Lu N, Pei C, Dong Q: \u003cstrong\u003eTransperitoneal versus retroperitoneal approaches of pyeloplasty in management of ureteropelvic junction obstruction: A meta-analysis\u003c/strong\u003e. \u003cem\u003eAsian J Surg \u003c/em\u003e2022, \u003cstrong\u003e45\u003c/strong\u003e(1):1-7.\u003c/li\u003e\n\u003cli\u003eLu L, Bi Y, Wang X, Ruan S: \u003cstrong\u003eLaparoscopic Resection and End-to-End Ureteroureterostomy for Midureteral Obstruction in Children\u003c/strong\u003e. \u003cem\u003eJ Laparoendosc Adv Surg Tech A \u003c/em\u003e2017, \u003cstrong\u003e27\u003c/strong\u003e(2):197-202.\u003c/li\u003e\n\u003cli\u003eEngel O, Rink M, Fisch M: \u003cstrong\u003eManagement of iatrogenic ureteral injury and techniques for ureteral reconstruction\u003c/strong\u003e. \u003cem\u003eCurr Opin Urol \u003c/em\u003e2015, \u003cstrong\u003e25\u003c/strong\u003e(4):331-335.\u003c/li\u003e\n\u003cli\u003eWhite C, Stifelman M: \u003cstrong\u003eUreteral Reimplantation, Psoas Hitch, and Boari Flap\u003c/strong\u003e. \u003cem\u003eJ Endourol \u003c/em\u003e2020, \u003cstrong\u003e34\u003c/strong\u003e(S1):S25-S30.\u003c/li\u003e\n\u003cli\u003eKumar A, Das SK, Trivedi S, Dwivedi US, Singh PB: \u003cstrong\u003eSubstitution urethroplasty for anterior urethral strictures: buccal versus lingual mucosal graft\u003c/strong\u003e. \u003cem\u003eUrol Int \u003c/em\u003e2010, \u003cstrong\u003e84\u003c/strong\u003e(1):78-83.\u003c/li\u003e\n\u003cli\u003eWang X, Meng C, Li D, Ying Y, Ma Y, Fan S, Li X, Yang K, Wang B, Guan H\u003cem\u003e et al\u003c/em\u003e: \u003cstrong\u003eMinimally invasive ureteroplasty with lingual mucosal graft for complex ureteral stricture: analysis of surgical and patient-reported outcomes\u003c/strong\u003e. \u003cem\u003eInt Braz J Urol \u003c/em\u003e2024, \u003cstrong\u003e50\u003c/strong\u003e(1):46-57.\u003c/li\u003e\n\u003cli\u003eKapogiannis F, Spartalis E, Fasoulakis K, Tsourouflis G, Dimitroulis D, Nikiteas NI: \u003cstrong\u003eLaparoscopic and Robotic Management of Ureteral Stricture in Adults\u003c/strong\u003e. \u003cem\u003eIn Vivo \u003c/em\u003e2020, \u003cstrong\u003e34\u003c/strong\u003e(3):965-972.\u003c/li\u003e\n\u003cli\u003eIto K, Takahashi T, Koterazawa S, Somiya S, Haitani T, Kanno T, Higashi Y, Yamada H: \u003cstrong\u003eDeterminants of health-related quality of life in patients undergoing medical expulsion therapy for acute renal colic\u003c/strong\u003e. \u003cem\u003eUrologia \u003c/em\u003e2025, \u003cstrong\u003e92\u003c/strong\u003e(2):209-215.\u003c/li\u003e\n\u003cli\u003eCardoso A, Coutinho A, Neto G, Anacleto S, Tinoco CL, Morais N, Cerqueira-Alves M, Lima E, Mota P: \u003cstrong\u003ePercutaneous nephrostomy versus ureteral stent in hydronephrosis secondary to obstructive urolithiasis: A systematic review and meta-analysis\u003c/strong\u003e. \u003cem\u003eAsian J Urol \u003c/em\u003e2024, \u003cstrong\u003e11\u003c/strong\u003e(2):261-270.\u003c/li\u003e\n\u003cli\u003eZhang KP, Zhang Y, Chao M: \u003cstrong\u003eWhich is the best way for patients with ureteral obstruction? Percutaneous nephrostomy versus double J stenting\u003c/strong\u003e. \u003cem\u003eMedicine (Baltimore) \u003c/em\u003e2022, \u003cstrong\u003e101\u003c/strong\u003e(45):e31194.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"world-journal-of-urology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"wjur","sideBox":"Learn more about [World Journal of Urology](https://link.springer.com/journal/345)","snPcode":"345","submissionUrl":"https://submission.nature.com/new-submission/345/3","title":"World Journal of Urology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Quality of life, Anxiety, Depression, Ureteral stricture reconstruction","lastPublishedDoi":"10.21203/rs.3.rs-6795942/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6795942/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground\u003c/b\u003e To evaluate the clinical efficacy of minimally invasive ureteral reconstruction for benign strictures and analyze its impact on health-related quality of life (HRQoL) and psychological status.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e This retrospective study included 29 patients undergoing robotic/laparoscopic ureteral reconstruction at our institution. Surgical outcomes were assessed through imaging, laboratory parameters, and patient-reported outcomes using SF-36 and HADS.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e With a median follow-up of 12 months, the surgical success rate was 96.6%, accompanied by a significant reduction in postoperative serum creatinine levels (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The perioperative complication rate was 6.90% (2 cases of transient high fever), with no severe adverse events observed. Preoperative SF-36 scores in PF and BP domains were significantly lower than those of the general population (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Postoperatively, except for VT and MH domains which surpassed population norms, scores in other dimensions showed no significant differences compared to the general population (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Notably, all SF-36 domains (except RE) demonstrated significant improvement from baseline (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Additionally, both anxiety and depression scores assessed by HADS decreased markedly after surgery (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e Minimally invasive ureteral repair and reconstruction effectively relieves obstruction, improves renal function, and significantly enhances health-related quality of life and psychological well-being, representing a safe therapeutic option for benign ureteral strictures. Early surgical intervention reduces the need for long-term stent or nephrostomy placement, thereby alleviating physical and psychological burdens. Further studies with expanded cohorts and extended follow-up durations are warranted to validate long-term outcomes.\u003c/p\u003e","manuscriptTitle":"Clinical Outcomes and Health-Related Quality of Life Assessment Following Minimally Invasive Reconstructive Surgery for Benign Ureteral Strictures","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-23 08:35:54","doi":"10.21203/rs.3.rs-6795942/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-08-07T07:05:41+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-04T16:08:33+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-01T06:38:39+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-31T21:04:04+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-27T18:14:44+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-25T10:32:09+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-22T22:15:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"308388423092277175626786001824718873486","date":"2025-07-22T06:28:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"237399002728932720513945583841833126967","date":"2025-07-21T04:36:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"4005094878331755024967015085556782070","date":"2025-07-20T12:29:34+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"80483858946115621036624752485241530202","date":"2025-07-18T07:54:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"49776530374144957702782018965203339283","date":"2025-07-17T09:24:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"301483252588462260701684292152102434511","date":"2025-07-16T21:47:23+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"269603455244118310346008568994090838763","date":"2025-07-16T21:31:47+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-07-16T21:30:04+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-06-12T12:53:48+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-06-12T09:17:11+00:00","index":"","fulltext":""},{"type":"submitted","content":"World Journal of Urology","date":"2025-06-01T13:27:56+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"world-journal-of-urology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"wjur","sideBox":"Learn more about [World Journal of Urology](https://link.springer.com/journal/345)","snPcode":"345","submissionUrl":"https://submission.nature.com/new-submission/345/3","title":"World Journal of Urology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"70f2b143-18df-4438-bcb7-97c2270d1314","owner":[],"postedDate":"July 23rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-09-22T15:58:42+00:00","versionOfRecord":{"articleIdentity":"rs-6795942","link":"https://doi.org/10.1007/s00345-025-05926-5","journal":{"identity":"world-journal-of-urology","isVorOnly":false,"title":"World Journal of Urology"},"publishedOn":"2025-09-17 15:56:52","publishedOnDateReadable":"September 17th, 2025"},"versionCreatedAt":"2025-07-23 08:35:54","video":"","vorDoi":"10.1007/s00345-025-05926-5","vorDoiUrl":"https://doi.org/10.1007/s00345-025-05926-5","workflowStages":[]},"version":"v1","identity":"rs-6795942","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6795942","identity":"rs-6795942","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}