To summarize the safety and clinical efficacy of 3D laparoscopic lingual mucosa graft ureteroplasty for the treatment of mid-to-long-segment ureteral strictures based on membrane anatomy.

The clinical data of 8 patients who underwent 3D laparoscopic lingual mucosal ureteroplasty for the treatment of mid-to-long-segment ureteral strictures at the Sixth Affiliated Hospital of Jinan University between July 2021 and February 2025 were retrospectively analyzed. The cohort comprised 5 males and 3 females, with a median age of 47.5 (range: 19-55) years. The median ureteral stricture length was 4.25 (range: 3.0-7.0) cm. The median preoperative serum creatinine level was 84.7(range: 56.2-141.1) μmol/L. All 8 patients underwent membrane anatomy-based 3D laparoscopic lingual mucosal ureteroplasty in a single surgical position. Regular follow-up was conducted postoperatively.

All procedures were performed by the same urologist with 20 years of clinical experience, achieving a success rate of 100%. The median operative time was 240 (range: 227-410) min, the median estimated blood loss was 20 (range: 5-30) mL. The harvested lingual mucosal graft had a median length of 4.5 (range: 4.0-7.0) cm and width of 1.5 cm. The median postoperative hospital stay was 8 (range: 7-15) d. No high-grade complications (Clavien-Dindo Ⅲ-IV) occurred during or after surgery. The median follow-up time was 9 (range: 6-30) months. The median serum creatinine level at 6 months postoperation was 76.9 (range: 53.3-121.3) μmol/L; at the last follow-up, it was 73.4 (range: 52.4-128.7) μmol/L. Among the 7 patients with preoperative flank pain, 5 experienced complete resolution and 2 reported significant improvement. Two patients developed urinary tract infections (Clavien-Dindo Ⅱ), which resolved after targeted antibiotic therapy. Seven patients experienced transient mild numbness at the lingual donor site (Clavien-Dindo I), with only 1 case persisting at the final follow-up. Five patients developed mild tongue movement impairment, all of which resolved after rehabilitation training. One patient had a grade B wound healing at the drainage site (Clavien-Dindo Ⅱ), which healed completely after local debridement and dressing changes. At the final follow-up, only 1 patient showed a mild increase in serum creatinine (an increase of 7.9 μmol/L, <15.0%). In the remaining 7 patients, renal function improved compared to preoperative levels (mean decrease in serum creatinine range 2.2-64.5 μmol/L). During follow-up, the fluctuation in renal function was <10% in all patients (except for 1 patient with a decrease of approximately 55%). No patient required dialysis or developed acute kidney injury.

The use of 3D laparoscopy combined with membrane anatomy-based dissection facilitates the mobilization and exposure of the strictured ureter, reducing bleeding and collateral injury. Lingual mucosal graft ureteroplasty based on membrane anatomy effectively relieves mid-to-long-segment ureteral obstruction without serious complications, demonstrating good feasibility and safety. However, further clinical data is needed to validate its efficacy and safety.