Login to Access Video or Poster Abstract: MP24-10
Sources of Funding: none

Introduction

The purpose of this study was to analyze and compare upper to lower ureteral reconstruction (UR) for ureteral stricture in a large cohort of patients.

Methods

A retrospective analysis was performed in patients undergoing upper and lower UR for iatrogenic injury, complications of cancer surgery, and radiation, or retroperitoneal fibrosis. Distinction between upper and lower US was above and bellow the iliac vessels, respectively. Success was defined as ureteral patency on CTIVP, Mag-3 studies, symptoms resolution, and stabilization in renal function. A descriptive and a linear regression analysis were conducted to evaluate variables associated with recurrent stricture.

Results

A total of 128 patients were included of which 18 underwent bilateral UR. Iatrogenic injury following pelvic surgery was the most common etiology of US, followed by radiation (26.3%) and idiopathic retroperitoneal fibrosis. There was no significant difference between groups for age (p=0.23), gender (p=0.36), length of stricture (p=0.14), prior radiation exposure (p=0.52) and estimated glomerular filtration rate (p= 0.10). Time to surgery, number of prior attempts at reconstruction and number of patients diverted prior to final reconstruction were significantly higher for patient with upper US (p value = 0.02, 0.01 and 0.004, respectively). A total of 51% (74/146) of strictures treated were in the upper ureter and required complex reconstruction procedures. Median hospital stay was 7 days (range 1-56) and length of follow-up was 120 days (32 – 2824). Short-term complications developed in 52 (34.4%). With respect to lower UR (n=72), the procedures performed were reimplant (33/72), VPH (22/72), ureterolysis (9/72), ileal ureter (IU - 5/72), transureteroureterostomy (TUU - 2/72) and ureteroureterostomy (UU - 1/72). Success rates were 100%, 100%, 100%, 80%, 50% and 100%, respectively. With respect to upper UR (n=74), the procedures performed were IU (42/74), ureterolysis (12/74), UU (8/74), vertical flap pyeloplasty (5/74), VPH (4/74), Boari flap (2/74), and TUU (1/74). Success rates were 95%, 83.3%, 100%, 80%, 50%, 50%, 0%, respectively. The overall success rate was 88%. Boari Flap, TUU and radiation exposure were associated with inferior outcomes after UR, with p values of 0.03, 0.006 and 0.01, respectively.

Conclusions

Upper US required more complex procedures, associated with higher incidence of complications and a lower success rate when compared to lower US. Excellent anatomical and function outcomes are expected after the treatment of both upper and lower ureteral strictures.

Funding

none