MP53-02 RECONSTRUCTION OF OBLITERATED URETERAL STRICTURES IS ASSOCIATED WITH INCREASED DIFFICULTY

Abstract

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Ureter (including Pyeloplasty) and Bladder Reconstruction (including fistula), Augmentation, Substitution, Diversion II (MP53)1 Sep 2021MP53-02 RECONSTRUCTION OF OBLITERATED URETERAL STRICTURES IS ASSOCIATED WITH INCREASED DIFFICULTY Randall Lee, Ziho Lee, Aeen Asghar, David Strauss, Robert Harrison, Nathan Cheng, Lee Zhao, Michael Stifelman, and Daniel Eun Randall LeeRandall Lee More articles by this author , Ziho LeeZiho Lee More articles by this author , Aeen AsgharAeen Asghar More articles by this author , David StraussDavid Strauss More articles by this author , Robert HarrisonRobert Harrison More articles by this author , Nathan ChengNathan Cheng More articles by this author , Lee ZhaoLee Zhao More articles by this author , Michael StifelmanMichael Stifelman More articles by this author , and Daniel EunDaniel Eun More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002083.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There is currently a paucity of literature evaluating predictors of increased difficulty for ureteral reconstruction. Herein, we evaluate whether stricture patency (ie. obliterated versus narrowed) affect the difficulty of ureteral reconstruction. METHODS: The multi-institutional Collaborative of Reconstructive Robotic Ureteral Surgery (CORRUS) database was queried for patients who underwent ureteral reconstruction from June 2012 to February 2019. Strictures were identified as obliterated versus narrowed. Patients with obliterated strictures were defined as those unable to be traversed with contrast or an endoscopic guidewire. We utilized operating time (OT), estimated blood loss (EBL), and frequency of utilization of adjunctive mobility procedures (downward nephropexy, psoas hitch) as surrogates for procedure difficulty. Surgical success was defined as the absence of flank pain and the improvement or absence of obstruction on renal scan. RESULTS: A total of 361 patients presented for surgical management. A total of 55 obliterated strictures and 206 narrowed strictures were identified. There was no difference in stricture length between two subsets (P=0.162). Obliterated strictures had significantly longer OT when located in the proximal/mid ureter (239 vs 160 min, P=0.002 and 278 vs 190 min, P=0.05, respectively). The EBL was slightly higher with proximal/mid ureteral reconstruction (100 vs 50 cc, P=0.005). Reconstruction of obliterated strictures at the proximal/mid ureter required significantly more adjunct mobilization procedures, 32% vs 14.7% (P=0.029). Obliterated strictures at the proximal/mid ureter had significantly increased major complications (24% vs 7.9%, P=0.01), but the clinical and radiographic success rates remained similar regardless of location (P=0.3 and P=0.94). CONCLUSIONS: We demonstrate that reconstruction of obliterated proximal and mid ureteral strictures are associated with increased complexity and likelihood to utilize adjunct mobilization procedures. Despite the increased complexity, success rates of obliterated strictures are similar to narrowed strictures. Defining stricture patency aids in preoperative planning and managing intraoperative expectations. No differences were seen when managing distal ureteral strictures. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e939-e939 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Randall Lee More articles by this author Ziho Lee More articles by this author Aeen Asghar More articles by this author David Strauss More articles by this author Robert Harrison More articles by this author Nathan Cheng More articles by this author Lee Zhao More articles by this author Michael Stifelman More articles by this author Daniel Eun More articles by this author Expand All Advertisement Loading ...