MP51-10 URETERAL STRICTURES AFTER URETEROSCOPY FOR NEPHROLITHIASIS: MULTI-INSTITUTIONAL OUTCOMES

Abstract

You have accessJournal of UrologyStone Disease: Surgical Therapy V1 Apr 2016MP51-10 URETERAL STRICTURES AFTER URETEROSCOPY FOR NEPHROLITHIASIS: MULTI-INSTITUTIONAL OUTCOMES Philip May, Ryan Hsi, Henry Tran, Marshall Stoller, Ben Chew, Thomas Chi, Manint Usawachintachit, Brian Duty, John Gore, and Jonathan Harper Philip MayPhilip May More articles by this author , Ryan HsiRyan Hsi More articles by this author , Henry TranHenry Tran More articles by this author , Marshall StollerMarshall Stoller More articles by this author , Ben ChewBen Chew More articles by this author , Thomas ChiThomas Chi More articles by this author , Manint UsawachintachitManint Usawachintachit More articles by this author , Brian DutyBrian Duty More articles by this author , John GoreJohn Gore More articles by this author , and Jonathan HarperJonathan Harper More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.465AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Ureteroscopy (URS) is a common surgical intervention for the management of nephrolithiasis. While ureteral stricture after URS is a relatively rare complication (<1%), it is associated with significant morbidity. Our objective was to evaluate the procedural burden and outcomes for ureteral strictures related to URS performed for nephrolithiasis. METHODS Records for patients managed at 4 academic tertiary care centers between December 2006 and October 2015 with the diagnosis of ureteral stricture following URS for nephrolithiasis were reviewed. Ureteral stricture was defined as the presence of hydronephrosis, evidence of luminal narrowing, and elevated t1/2 on renal scintigraphy. Patients were excluded if their stricture could not be determined to have occurred after URS as verified by three independent physician reviewers. Type of stricture treatment and clinical outcomes were examined as primary endpoints. RESULTS Among 38 patients with 40 ureteral strictures identified, 55% were female and mean BMI was 31.3 kg/m2. Overall, 73% of strictures were left sided; 50% were proximal ureteral, 42.5% distal ureteral, 5% pan-ureteral, and 2.5% mid-ureteral. The mean number of known URS procedures prior to stricture diagnosis was 2.5 ± 2.5 (range 1-10). At least 35% of cases had hydronephrosis or stone impaction at the time of URS, and 20% had known ureteral perforation. After stricture diagnosis, the mean number of procedures performed for stricture treatment was 3.3 ± 1.8 (range 1-10) with a mean follow-up time of 17.2 months. 30% of strictures were successfully managed with endoscopic techniques alone. 35% were successfully managed with complex open, laparoscopic, or robotic-assisted reconstruction (e.g. ureteroureterostomy, ureteroneocystostomy, ileal ureter, or autotransplant), 10% were managed with chronic ureteral stenting or nephrostomy drainage, and 25% with nephrectomy. CONCLUSIONS Ureteral strictures that occurred following URS for nephrolithiasis were associated with high morbidity. Less than one-third of patients in this series could be managed with endoscopic techniques alone, and the majority of patients required complex ureteral reconstruction or nephrectomy. Strategies for stricture prevention should be emphasized in future studies. © 2016FiguresReferencesRelatedDetailsCited byAhn J, Holt S, May P and Harper J (2018) National Imaging Trends after Ureteroscopic or Shock Wave Lithotripsy for NephrolithiasisJournal of Urology, VOL. 199, NO. 2, (500-507), Online publication date: 1-Feb-2018. Volume 195Issue 4SApril 2016Page: e684 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Philip May More articles by this author Ryan Hsi More articles by this author Henry Tran More articles by this author Marshall Stoller More articles by this author Ben Chew More articles by this author Thomas Chi More articles by this author Manint Usawachintachit More articles by this author Brian Duty More articles by this author John Gore More articles by this author Jonathan Harper More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...