ArticleTranslational andrology and urology2026
Advancing urological practice: the value of combined antegrade and retrograde ureterography for the management of complex ureteral strictures.
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Abstract
Background: Complex proximal and mid-ureteral strictures, caused by calculi, inflammation, fibrosis, or iatrogenic injury, can result in hydronephrosis and renal function loss. Traditional ureterography, when used alone, has limitations in accurately assessing stricture length and detecting multiple segments. We evaluated the diagnostic value of the combined antegrade and retrograde ureterography (CARU) technique in complex strictures, focusing on stricture length, location, and severity. Methods: This retrospective study collected data from 110 patients diagnosed with proximal and mid-ureteral strictures at our center between January 2023 and November 2025. All patients were evaluated with CARU 4 weeks prior to surgery and subsequently underwent lingual mucosal graft (LMG) ureteroplasty. A comparative analysis was performed to assess the correlation between the preoperative CARU assessment of stricture data and the intraoperative findings. Subgroup analyses were conducted according to stricture etiology and severity. Results: CARU demonstrated excellent agreement with intraoperative findings for stricture location (κ=0.93, P<0.001) and substantial agreement for stricture severity (κ=0.69, P<0.001). CARU tended to underestimate the true length of ureteral strictures and, consequently, the graft length required for reconstruction. The stricture length measured by CARU (2.89±2.29 cm) was, on average, 0.74 cm shorter than the intraoperative stricture length (3.63±1.88 cm; P<0.001) and 0.93 cm shorter than the intraoperative LMG length (3.82±1.80 cm; P<0.001). In subgroup analyses, CARU-measured stricture length was broadly comparable with both intraoperative stricture length and graft length in congenital or idiopathic cases, but underestimated these lengths in patients with acquired etiologies and severe strictures. Nevertheless, ICC analysis demonstrated good agreement between CARU-based and intraoperative measurements. Conclusions: CARU is a valuable tool for evaluating complex proximal and mid-ureteral strictures, with high accuracy in assessing stricture location and severity. It provides valuable reference for estimating stricture and graft lengths. It could serve as a useful preoperative imaging modality for patients with proximal and mid-ureteral strictures.
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