Mp48-01 Comparison of Long-Term Outcomes of Endoscopic Management vs Minimally Invasive Ureteral Reimplantation for Adult Primary Obstructive Megaureter

You have accessJournal of UrologyReconstruction: Ureteral Reconstruction (Including Pyeloplasty) and Bladder Reconstruction (Including Trauma-Related Fistula) I (MP48)1 May 2024MP48-01 COMPARISON OF LONG-TERM OUTCOMES OF ENDOSCOPIC MANAGEMENT VS MINIMALLY INVASIVE URETERAL REIMPLANTATION FOR ADULT PRIMARY OBSTRUCTIVE MEGAURETER Zhenyu Li, Kunlin Yang, Yicong Du, Xinfei Li, Zhihua Li, Bing Wang, Chen Huang, Silu Chen, Hongjian Zhu, Peng Zhang, Liqun Zhou, Gang Wang, and Xuesong Li Zhenyu LiZhenyu Li , Kunlin YangKunlin Yang , Yicong DuYicong Du , Xinfei LiXinfei Li , Zhihua LiZhihua Li , Bing WangBing Wang , Chen HuangChen Huang , Silu ChenSilu Chen , Hongjian ZhuHongjian Zhu , Peng ZhangPeng Zhang , Liqun ZhouLiqun Zhou , Gang WangGang Wang , and Xuesong LiXuesong Li View All Author Informationhttps://doi.org/10.1097/01.JU.0001009512.15743.d7.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Minimally invasive ureteral reimplantation (MIUR), including laparoscopic ureteral reimplantation (LUR) and robot-assisted laparoscopic ureteral reimplantation (RALUR), has been a standard treatment for symptomatic primary obstructive megaureter (POM). Endoscopic management (EM) including endoscopic balloon dilatation (EBD) and endoureterotomy may be simpler and less invasive than ureteral reimplantation. EBD has been recognized as a definitive treatment for pediatric POM. To determine whether EM for adult POM is as effective as MIUR in the long-term follow-up, we made a comparison between EM and MIUR. METHODS: Eighty-seven patients were included from our prospectively maintained database between August 2010 and May 2023. The diagnosis was based on clinical findings, diuresis renal scintigraphy and radiographic images. The surgery indications were recurrent symptoms, renal function deterioration, and progressive obstruction. Sixty-three patients in the EM group underwent EBD without X-ray. The narrow vesicoureteral junction (VUJ) was dilated with a balloon pressure of 20-30 atm for 3 minutes. Twenty-nine of them with tough stenotic rings received additional endoureterotomy. The MIUR group consisted of 14 patients undergoing our modified LUR with extracorporeal tailoring and laparoscopic direct nipple ureteroneocystostomy, and 10 patients undergoing intracoroporeal RALUR. Ten patients of MIUR added psoas hitch or/and Boari flap techniques to achieve a tension-free anastomosis. Postoperative follow-ups were conducted routinely. The success criteria were the absence of reflux or obstruction, the relief of symptoms and hydronephrosis, and stable renal function. RESULTS: No intraoperative complications occurred in both groups. The median operative time, estimated blood loss and postoperative hospitalization period showed significant differences between EM and MIUR (45 minutes vs 164.5 minutes, p<0.001; 5 ml vs 10 ml, p<0.001; 3 days vs 5 days, p<0.001). The median follow-up time was 39 and 65.5 months for EM and MIUR, respectively. Five (7.9%) patients in the EM group and 1 (4.2%) patient in the MIUR group developed restenosis of VUJ, and 1 (1.6%) patient in the EM group developed high-grade vesicoureteral reflux, who were treated with EM and/or RALUR again. The success rate of EM and MIUR was 90.5% (57/63) and 95.8% (23/24), respectively (p=0.668). CONCLUSIONS: EM seems as safe and effective as MIUR for treating adult POM. EM may be less invasive with shorter operative time, less blood loss, and shorter postoperative hospitalization than MIUR. However, more prospective and large trials are further required to validate these findings. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e772 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Zhenyu Li More articles by this author Kunlin Yang More articles by this author Yicong Du More articles by this author Xinfei Li More articles by this author Zhihua Li More articles by this author Bing Wang More articles by this author Chen Huang More articles by this author Silu Chen More articles by this author Hongjian Zhu More articles by this author Peng Zhang More articles by this author Liqun Zhou More articles by this author Gang Wang More articles by this author Xuesong Li More articles by this author Expand All Advertisement PDF downloadLoading ...