A 72-year-old man in Taichung suffered from fibrotic ureteral stenosis and underwent Da Vinci robotic arm surgery to reconstruct the urinary tract.

2026/09/23 11:33

Dr. Zheng Jiawei reminds that not all stone patients require reconstruction. If the ureteral stricture has caused repeated obstruction, infection, or even requires long-term dependence on the catheter, further evaluation of reconstruction surgery is required; the picture is a situational photo. (Picture taken from freepik)

[Reporter Zhang Xuanzhe/Taichung Report] Mr. Li, 72 years old in Taichung City, has been troubled by stones in his right kidney and ureter for many years. In his early years, he underwent traditional open ureterotomy for stone removal due to large stone obstruction. After the operation, the ureter gradually became fibrotic and severely narrowed. Since then, even small stones have repeatedly become stuck. The doctor discovered that the ureteral stenosis caused by fibrosis and adhesion after previous surgeries resulted in the gradual accumulation of crystals and the inability to remove the tube. The double J catheter could not be replaced after two endoscopic treatments. After discussion with the patient and family, the doctor decided to remove the severely fibrotic ureter and rebuild a smooth urinary tract.

Mr. Li recently had a stone blockage again and went to the outpatient clinic of urologist Zheng Jiawei of Guangtian General Hospital for treatment. Zheng Jiawei said that he first inserted a ureteroscope with a diameter of only 0.25 cm and thinner than bamboo chopsticks through the urethra, but still could not reach the stricture. A channel is then established through the kidney, and a flexible ureteroscope is inserted antegrade to explore downward. However, it is also blocked by polyps and strictures, making it impossible to reach the lesion. The upper and lower paths are blocked, and the catheter cannot be left in for a long time.

Please read on...

Since the stricture was deep in the pelvic cavity and close to the bladder, Mr. Li underwent a "Da Vinci robotic arm surgery" at his own expense. The doctor first removed the fibrotic ureter, took out the crystallized catheter, and then used a "psoas major suspension" to fix the bladder upward and reconnect the healthy ureter back to the bladder. Finally, a new double-J catheter was inserted, and indocyanine green (ICG) fluorescence imaging was used to confirm that the blood flow at the anastomosis was well perfused.

Zheng Jiawei described ureteral reconstruction as "suturing two Yakult-drinking straws back together while keeping the middle open." It not only tests fine suturing skills, but also takes into account blood flow supply and joint tension.

After the operation, the edema in Mr. Li's right kidney was significantly improved, and the double J catheter was successfully removed. There is no need to return to the hospital for replacement every 3 to 6 months. Dr. Zheng Jiawei reminded that not all stone patients need reconstruction. If the ureteral stenosis has caused repeated obstruction, infection, or even long-term dependence on the catheter, further evaluation of reconstruction surgery is needed.