#0558
Assessment of Persistent Hydronephrosis Following Ureteral Reconstruction
C. Chen1, J. Li1, C. Chen1, S. Wang1, C. Yang1, C. Cheng1
1Taichung Veterans General Hospital, Urology, Taichung, Taiwan
Introduction:
Reconstruction of ureteral stricture is a complex surgical procedure that requires thorough consideration of multiple factors. The most important factors, such as anastomotic tension and adequate blood supply of anastomotic cut-end, are critical to minimize the recurrence. Although the average success rate for ureteral reconstruction is approximately 70 to 80%, a significant portion of patients may continue to experience persistent postoperative hydronephrosis. This study aims to provide an effective treatment and management protocol for these cases.
Material and methods:
From August 2020 to October 2024, a single urologist performed ureteral reconstruction on 70 patients diagnosed with ureteral strictures at a single medical center. Of these, 39 patients had strictures located in the upper or mid-ureter, while 31 patients had strictures in the lower ureter. We collected and analyzed patients' preoperative and postoperative data. Ultrasonography was performed after the removal of ureteral double-J stents to evaluate postoperative outcomes. If there was still hydronephrosis, diuretic renal scan (DRS) and ureteroscopy (URS) or retrograde pyelography (RP) will be arranged for further evaluation.
Results:
Among these patients, 48 received da Vinci robotic-assisted reconstruction, 8 underwent laparoscopic reconstruction, and 14 had traditional open surgery. In patients with upper ureteral strictures (n=39), 31 received robotic-assisted reconstruction, 13 required buccal mucosal grafts for reconstruction, 14 underwent primary end-to-end anastomosis, and 11 underwent pyeloplasty. For lower ureteral strictures (n=31), 17 patients received robot-assisted reconstruction, 4 required a Boari flap for reconstruction, 10 had end-to-end anastomosis, and 22 underwent ureteroneocystostomy with psoas hitch reconstruction. Postoperative follow-up revealed persistent hydronephrosis in 23 patients (23/70), with 18 cases involving upper ureter and 5 involving lower ureter. Patients with persistent hydronephrosis after upper ureteral reconstruction, they underwent a DRS and URS or RP, revealing surgical failure in 3 cases. For lower ureteral reconstruction, 4 cases were surgical failure.