MP41-20 ILEAL URETER REPLACEMENT FOR COMPLEX URETERAL RECONSTRUCTION HAS A HIGH SUCCESS RATE AT 3 YEAR FOLLOW UP

Abstract

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Ureter (including Pyeloplasty) and Bladder Reconstruction (including fistula), Augmentation, Substitution, Diversion I (MP41)1 Apr 2020MP41-20 ILEAL URETER REPLACEMENT FOR COMPLEX URETERAL RECONSTRUCTION HAS A HIGH SUCCESS RATE AT 3 YEAR FOLLOW UP Bryn Launer*, David Koslov, Kirk Redger, Anessa Sax-Bolder, Ty Higuchi, and Brian Flynn Bryn Launer*Bryn Launer* More articles by this author , David KoslovDavid Koslov More articles by this author , Kirk RedgerKirk Redger More articles by this author , Anessa Sax-BolderAnessa Sax-Bolder More articles by this author , Ty HiguchiTy Higuchi More articles by this author , and Brian FlynnBrian Flynn More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000890.020AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Complex or lengthy ureteral strictures may require ileal ureter interposition, which remains an important option for ureteral reconstruction. Reported long term success rate is 75-85%. We report on our 16 year institutional experience with ileal ureter interposition. METHODS: Retrospective review of a single institution’s ureteral reconstruction database was performed. Three urologic surgeons performed all surgeries. Unilateral replacements utilized ureteral interposition when possible. Bilateral ileal ureters were performed using the “reverse 7” approach. Preoperative patient demographics, ureteral stricture characteristics, intraoperative variables, complications, and secondary procedures were recorded. Success rate was defined as no need for further intervention. RESULTS: Between 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 at the time of surgery was 53 years, and 20 (44%) of the cohort were male. The average stricture length was 9.1 cm. Stricture etiology included iatrogenic causes (n=24, 52%), radiation (n=12; 26%), vascular disease (n=3; 7%), idiopathic retroperitoneal fibrosis (n=3; 7%), and other causes including congenital and trauma (n=4; 9%). Half (n=23) of the cohort received prior intervention for the strictures, and all required prior stent or nephrostomy tube. Forty-three surgeries were performed by open abdominal approach and 3 were performed robotically. The average length of operation was 412 minutes, blood loss=417 mLs, LOS=10 days. Although 23 (50%) patients had a complication, with only 11 (24%) patients experiencing a major (Clavien Dindo ≥ 3a) complication. At a mean follow up of 3.3 years, the overall success rate was 83%, with only 17% (n=8) patients requiring subsequent procedures. Three of the 8 patients required a nephrectomy due to persistent UTIs and pain, while the remaining 5 underwent successful ileal ureteral revision. CONCLUSIONS: In our long-term follow up of over 3 years, ileal ureter interposition is a highly successful option for complex ureteral strictures in properly selected patients. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e602-e602 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Bryn Launer* More articles by this author David Koslov More articles by this author Kirk Redger More articles by this author Anessa Sax-Bolder More articles by this author Ty Higuchi More articles by this author Brian Flynn More articles by this author Expand All Advertisement Loading ...