Long-term Follow Up of Ileal Ureteral Replacement for Complex Ureteral Strictures: Single Institution Study

Bryn M Launer,Kirk D Redger,David S Koslov,Anessa N Sax-Bolder,Ty T Higuchi,Andrew P Windsperger,Brian J Flynn

doi:10.1016/j.urology.2021.07.012

Abstract

ObjectiveTo report our 16-year experience with ileal ureter interposition for complex ureteral stricture. Ureteral reconstruction continues to evolve to include less invasive techniques to successfully manage ureteral stricture. However, long, complex, obliterative and especially radiated ureteral strictures are not amenable to less invasive techniques and may require Ileal ureter interposition. Materials and MethodsRetrospective review of a single institution's ureteral reconstruction database was performed. Demographics, operative details, success rate, complication rate, and length of follow-up were noted. Unilateral replacements utilized ileal ureteral interposition. Success rate was defined as no need for further open intervention. ResultsBetween 2003 and 2019, 188 ureteral reconstructions were performed, of which 46 required ileal ureter interposition. Of these 46 patients, 10 required bilateral reconstruction. Average age was 53 years, 26 (57%) were female. The average stricture length was 9.1 cm (2-20 cm). Stricture etiology included iatrogenic causes (n = 24, 52%), radiation causes (n = 12; 26%), vascular disease (n = 3; 7%), and idiopathic retroperitoneal fibrosis (n = 3; 7%). Forty-three surgeries were performed by open abdominal approach; 3 were performed robotically. The average length of operation was 412 minutes, blood loss 417 mL and LOS was 10 days. At mean follow up of 4.4 years (1-16 years), overall success rate was 83%, with 17% (n = 8) patients requiring subsequent major surgery (5 successful ureteral revision, 3 nephrectomy) and 11 (24%) patients experiencing a major complication. ConclusionIn our long-term follow up of over 4 years, ileal ureteral interposition remains a successful option for complex ureteral strictures in properly selected patients.

Highlights

This study aims to evaluate the 16 years of experience performing ileal ureter interventions at a single tertiary academic center
Patients Between 2003 and 2019, 188 ureteral reconstructions were performed at our institution, of which 46 required ileal ureter interposition
Ileal ureteral interposition was performed by 2 surgeons (TTH and BJF) at the University of Colorado

Summary

Methods

Patients Between 2003 and 2019, 188 ureteral reconstructions were performed at our institution, of which 46 required ileal ureter interposition. Ileal ureteral interposition was performed by 2 surgeons (TTH and BJF) at the University of Colorado. Patients were excluded from surgery if creatinine was ≥2.5 or the ureteral stricture was related to malignancy. Outcomes, and Data Analysis Retrospective data included in the analysis were demographics, preoperative, surgical, and long-term complication variables. Preoperative variables included etiology, prior interventions, and history of GU malignancy, stone disease, and/or radiation exposure. The intraoperative stricture length is typically longer than what is predicted on preoperative imaging. Longterm follow up data included length of follow up, complications, and need for readmission. Success rate was defined as no need for subsequent open surgical intervention, including stricture ureteral revision or nephrectomy

Results

Discussion

Conclusion