MP65-18 LONG-TERM RENAL PRESERVATION WITH ILEAL URETER CREATION

Abstract

You have accessJournal of UrologyCME1 Apr 2023MP65-18 LONG-TERM RENAL PRESERVATION WITH ILEAL URETER CREATION Mary E Soyster, Ramzy T Burns, Jason L Zappia, Peter Arnold, Joshua Roth, Maria Francesca Roth, and Matthew Mellon Mary E SoysterMary E Soyster More articles by this author , Ramzy T BurnsRamzy T Burns More articles by this author , Jason L ZappiaJason L Zappia More articles by this author , Peter ArnoldPeter Arnold More articles by this author , Joshua RothJoshua Roth More articles by this author , Maria Francesca RothMaria Francesca Roth More articles by this author , and Matthew MellonMatthew Mellon More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003323.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Long segment or proximal ureteral defects can often pose a challenging reconstructive problem. Ureteroureterostomy, psoas hitch, boari flap, buccal ureteroplasty and autotransplantation are common reconstructive techniques for ureteral injuries, however, in cases where these are not viable options, ileal replacement is considered. We present our long term results of ureteral replacement with ileum with over 32 years of experience. To the best of our knowledge, this is the longest follow up series on ileal ureter creation. METHODS: We performed a retrospective review of patients greater than 18 years old undergoing ileal ureter creation at Indiana University from 1989 to 2021. Patient demographics, etiology, renal function, and complications were examined. All patients were followed pre and post-operatively for change in renal function. . Deterioration was defined as an increase in the chronic kidney disease (CKD) stage. RESULTS: Of the 159 patients with ileal ureter creation, 80.5% had unilateral ileal ureter creation, 19.5% had bilateral reconstruction. 50.3% of these were female. Average age at operation was 52.8 (SD 14.9). Average follow up was 41 months, ranging from 6-179 months. 26.4% of patients had radiation induced strictures. Pre-operatively, 57.9% of patients were in CKD stage 1-2 by MDRD criteria, and 42.1% were in stage 3-5 CKD. Post-operative, 54.7% were in stage 1-2 and 45.3% were in stage 3-5. Logistic regression examining outcomes of worsening renal function demonstrated no significant correlation between worsening renal function and stricture cause (p=.09), bilateral repair (p=.103), post-operative complications (p=.130), or sex (p=.42). 76.7% had no short-term (within 30 day) complications. Identified Clavien complications included grade 1 (18[11.3%]), grade 2 (4[2.5%]), grade 3 (9[5.7%]0, grade 4 (5[3.1%]) and grade 5 (1[.6%]. Long term complications included worsening renal function (34.6%), incisional hernia (8.2%), small bowel obstruction (6.9%). 5 patients (3.1%) on long term follow up had renal failure requiring dialysis, and 5 (3.1%) patients suffered from metabolic acidosis. CONCLUSIONS: Ileal ureteral reconstruction is often a last resort for patients with ureteral injuries. However, our long-term follow up confirms that this is a safe approach with good preservation of renal function and low risk of hemodialysis and metabolic acidosis. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e898 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mary E Soyster More articles by this author Ramzy T Burns More articles by this author Jason L Zappia More articles by this author Peter Arnold More articles by this author Joshua Roth More articles by this author Maria Francesca Roth More articles by this author Matthew Mellon More articles by this author Expand All Advertisement PDF downloadLoading ...