Ureteral Rest is Associated With Improved Outcomes in Patients Undergoing Robotic Ureteral Reconstruction of Proximal and Middle Ureteral Strictures - 08/06/21

Doi : 10.1016/j.urology.2021.01.058

Ziho Lee ^a,^⁎ , Matthew Lee ^a, Randall Lee ^a, Helaine Koster ^b, Nathan Cheng ^b, Michael Siev ^c, Min Jun ^c, Ravi Munver ^b, Mutahar Ahmed ^b, Lee C. Zhao ^c, Michael D. Stifelman ^b, Daniel D. Eun ^a
Collaborative of Reconstructive Robotic Ureteral Surgery (CORRUS)
^a Lewis Katz School of Medicine at Temple University, Philadelphia, PA
^b Hackensack Meridian School of Medicine at Seton Hall University, Hackensack, NJ
^c New York University Grossman School of Medicine at New York University Langone Medical Center, New York, NY

^⁎Address correspondence to: Ziho Lee, M.D., Department of Urology at Lewis Katz School of Medicine at Temple University, Parkinson Pavilion (Zone C), 3rd Floor, 3401 N. Broad Street, Philadelphia, PA 19140.Department of Urology at Lewis Katz School of Medicine at Temple UniversityParkinson Pavilion (Zone C)3rd Floor, 3401 N. Broad StreetPhiladelphiaPA19140

Resumen

Objectives

To evaluate the effect of ureteral rest on outcomes of robotic ureteral reconstruction.

Methods

We retrospectively reviewed all patients who underwent robotic ureteral reconstruction of proximal and/or middle ureteral strictures in our multi-institutional database between 2/2012—03/2019 with ≥12 months follow-up. All patients were recommended to undergo ureteral rest, which we defined as the absence of hardware (ie. double-J stent or percutaneous nephroureteral tube) across a ureteral stricture ≥4 weeks prior to reconstruction. However, patients who refused percutaneous nephrostomy tube placement did not undergo ureteral rest. Perioperative outcomes were compared after grouping patients according to whether or not they underwent ureteral rest. Continuous and categorical variables were compared using Mann-Whitney U and 2-tailed chi-squared tests, respectively; P <.05 was considered significant.

Results

Of 234 total patients, 194 (82.9%) underwent ureteral rest and 40 (17.1%) did not undergo ureteral rest prior to ureteral reconstruction. Patients undergoing ureteral rest were associated with a higher success rate compared to those not undergoing ureteral rest (90.7% versus 77.5%, respectively; P = .027). Also, patients undergoing ureteral rest were associated with lower estimated blood loss (50 versus 75 milliliters, respectively; p<0.001) and less likely to undergo buccal mucosa graft ureteroplasty (20.1% versus 37.5%, respectively; p=0.023).

Conclusions

Implementing ureteral rest prior to ureteral reconstruction may allow for stricture maturation and is associated higher surgical success rates, lower estimated blood loss, and decreased utilization of buccal mucosa graft ureteroplasty.

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