Urothelial-based reconstructive surgery for upper- and mid-ureteral defects: Long-term results

Authors

  • Barak Rosenzweig Department of Urology The Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel Affiliated to Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel The Dr. Pinchas Borenstein Talpiot Medical Leadership Program 2013 The Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
  • Yoram Mor Department of Urology The Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel Affiliated to Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
  • Tomer Erlich Department of Urology The Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel Affiliated to Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
  • Menachem Laufer Department of Urology The Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel Affiliated to Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
  • Harry Winkler Department of Urology The Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel Affiliated to Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
  • Issac Kaver Department of Urology The Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel Affiliated to Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
  • Jacob Ramon Department of Urology The Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel Affiliated to Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
  • Zohar A. Dotan Department of Urology The Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel Affiliated to Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel

DOI:

https://doi.org/10.5489/cuaj.3659

Abstract

Introduction: Ureteral strictures can result in obstructive nephropathy and renal function deterioration. Surgical management of ureteral defects, especially in the proximal- and mid-ureter, is particularly challenging. Our purpose was to analyze the long-term outcomes of urothelial-based reconstructive surgery for upper- and mid-ureteral defects.

Methods: We conducted a retrospective analysis of a single tertiary centre’s database, including 149 patients treated for ureteral defects between 2001 and 2011. Thirty-one patients (21%) underwent complex urothelial-based surgical repairs for upper- and mid-ureter defects. Patients’ median age was 61 years. The mean length of the ureteral strictures was 2.5 cm, located in upper-, mid-ureter, or in between in 19 (61%), 10 (32%), and two (6%) patients, respectively. All patients were treated with a primary urothelial-based repair. Median followup time was 26 months. The primary outcome of the study was the long-term preservation of renal function and lack of clinical obstruction. The secondary endpoint of the study was the assessment of the intra- and postoperative complication rates.

Results: Most of the lesions were benign (22, 71%), while nine strictures (29%) were malignant. Seven patients (23%) suffered from postoperative complications, five of which were infectious. The median pre- and postoperative calculated glomerular filtration rates were 66 ml/min/1.72m2 and 64ml/min/1.72m2, respectively. Success rate was 84%, defined as lack of need for re-operation or kidney drainage at the last followup.

Conclusions: Upper- and mid-ureteral defects present a complex pathology necessitating experienced reconstructive surgical skills. Our data suggest good long-term results for primary urothelialbased reconstructions for these pathologies.

Downloads

Download data is not yet available.

Author Biography

Barak Rosenzweig, Department of Urology The Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel Affiliated to Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel The Dr. Pinchas Borenstein Talpiot Medical Leadership Program 2013 The Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel

Urology resident

Downloads

Published

2016-09-13

How to Cite

Rosenzweig, B., Mor, Y., Erlich, T., Laufer, M., Winkler, H., Kaver, I., Ramon, J., & Dotan, Z. A. (2016). Urothelial-based reconstructive surgery for upper- and mid-ureteral defects: Long-term results. Canadian Urological Association Journal, 10(9-10), E290–5. https://doi.org/10.5489/cuaj.3659

Issue

Section

Original Research