Urothelial-based reconstructive surgery for upper- and mid-ureteral defects: Long-term results

Abstract

Introduction: Ureteral strictures can result in obstructive nephropathy and renal function deterioration. Surgical management of ureteral defects, especially in the proximal-and mid-ureter, is particularly challenging. Our purpose was to analyze the long-term outcomes of urothelial-based reconstructive surgery for upper-and mid-ureteral defects. Methods:We conducted a retrospective analysis of a single tertiary centre's database, including 149 patients treated for ureteral defects between 2001 and 2011. Thirty-one patients (21%) underwent complex urothelial-based surgical repairs for upper-and mid-ureter defects. Patients' median age was 61 years. The mean length of the ureteral strictures was 2.5 cm, located in upper-, mid-ureter, or in between in 19 (61%), 10 (32%), and two (6%) patients, respectively. All patients were treated with a primary urothelial-based repair. Median followup time was 26 months. The primary outcome of the study was the long-term preservation of renal function and lack of clinical obstruction. The secondary endpoint of the study was the assessment of the intra-and postoperative complication rates. Results: Most of the lesions were benign (22, 71%), while nine strictures (29%) were malignant. Seven patients (23%) suffered from postoperative complications, five of which were infectious. The median pre-and postoperative calculated glomerular filtration rates were 66 ml/min/1.72m 2 and 64ml/min/1.72m 2 , respectively. Success rate was 84%, defined as lack of need for re-operation or kidney drainage at the last followup. Conclusions: Upper-and mid-ureteral defects present a complex pathology necessitating experienced reconstructive surgical skills. Our data suggest good long-term results for primary urothelialbased reconstructions for these pathologies.

Treatment of long ureteric strictures with a free peritoneal graft: long-term results

“…Several factors like stones, infections, fibrosis, malignancy, radiotherapy, or iatrogenic surgical trauma during gynecological, colorectal, and vascular surgery or after endourological surgery can cause a ureteric stenosis [18,19]. If the stricture is too long, a treatment with end-to-end anastomosis, Boari-flap or Psoas Hitch technique may not be feasible and it may be necessary to perform an uretero-ureterostomy, an ileal ureter, an autotransplantation or a nephrectomy [18,20]. These procedures are technically difficult to perform and are associated with high morbidity, especially in unprepared patients in emergency situations [1,2,3,4].…”