輸尿管重建失敗結果的預測因素：一項真實世界的回顧性研究

陳正哲、林敬祥、李建儀、程千里、裘坤元、王賢祥、陳卷書、楊晨洸、

台中榮民總醫院 外科部 泌尿科

Predictors for the failed result of ureteral reconstruction: A Real-World Retrospective Study

Chen-Cheng Che, Jing-Siang Lin, Jian-Ri Lee, Chen-Li Cheng, Kun-Yuan Chiu, Shian-Shiang Wang, Chuan-Shu Chen , Cheng-Kuang Yang

Divisions of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung Taiwan

Purpose: Ureteral reconstruction is a complex surgery to maintain ureter patency, restore renal function, and prevent long-term catheter placement. Different surgical strategies could be adopted according to individualized factors, such as etiology, location of injury, the length of the defect, and the severity of the injury. However, various complications and failed results were associated with different situations of ureteral injuries. We aim to analyze the parameters to predict those who cannot be free from further catheterization after reconstruction

Materials and Methods: Between January 2007 and December 2021, patients who received urinary reconstruction were included. Surgeries for ureteral reconstruction included bench surgery, ureteroneocystostomy, Boari flap, transuretero-ureterostomy and ureterostomy. Peri-operative laboratory data and images were collected. Success of the ureteral reconstruction was defined as free from further catheterization after operation.

Results: A total of 184 patients underwent ureteral reconstruction in our institution between January 2007 and December 2021. Median age was 57.6 years (range 22 to 86).  There were 62 male patients (34.1%) and 122 female patients (65.9%). Malignant disease with ureter invasion and iatrogenic injuries during operation is 79.9%. Injury of lower third ureter is 89.1%. In addition, perioperative radiotherapy for their primary malignancy is 23.4%. Most of the patients (79.3%) were free from subsequent interventions. A total of 59 patients (32.1%) presented a radiographic improvement, while 20 patients (10.9%) presented with stable status. Patients in the success group had a significantly higher hemoglobin before and 1 year after surgery (12.10 g/dL vs 11.10 g/ dL, p=0.007; 12.20 g/dL vs 10.0 g/ dL, p<0.001). The predictors for failed result of ureteral reconstruction were history of radiotherapy (OR = 2.75, p=0.01) and chronic kidney disease (CKD) (OR = 3.42, p<0.001). In multivariate analysis, the location of upper ureter injury (OR=5.68, p=0.042) is the risk factor for failed result. There was no significant difference among surgical strategies.

Conclusions: We conclude that, history of radiation therapy, upper third ureter injury and CKD were predictors for failed result of ureteral reconstruction. Malignant diseases, surgical methods and repair techniques do not affect the outcome of an operation.