Mp45-19 Ureteral Strictures Following Ureteroscopic Ureteral Wall Injury: A Previously Unidentified Concern

You have accessJournal of UrologyStone Disease: Epidemiology & Evaluation II (MP45)1 May 2024MP45-19 URETERAL STRICTURES FOLLOWING URETEROSCOPIC URETERAL WALL INJURY: A PREVIOUSLY UNIDENTIFIED CONCERN Andrei D. Cumpanas, Seyed Amiryaghoub Lavasani, Seyedamirvala Saadat, Jacob C. Tsai, Brandon Camp, Candice M. Tran, Bruce Gao, Zachary E. Tano, Pengbo Jiang, Roshan M. Patel, Jaime Landman, and Ralph V. Clayman Andrei D. CumpanasAndrei D. Cumpanas , Seyed Amiryaghoub LavasaniSeyed Amiryaghoub Lavasani , Seyedamirvala SaadatSeyedamirvala Saadat , Jacob C. TsaiJacob C. Tsai , Brandon CampBrandon Camp , Candice M. TranCandice M. Tran , Bruce GaoBruce Gao , Zachary E. TanoZachary E. Tano , Pengbo JiangPengbo Jiang , Roshan M. PatelRoshan M. Patel , Jaime LandmanJaime Landman , and Ralph V. ClaymanRalph V. Clayman View All Author Informationhttps://doi.org/10.1097/01.JU.0001008764.86460.8e.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Although the reported incidence of ureteral stricture following ureteroscopy (URS) is low (0.3-3%), limited knowledge exists on the association between ureteral stricture formation and graded ureteral injury severity. Accordingly, we sought to determine the risk of developing a ureteral stricture based on the post-ureteroscopic lesion scale (PULS) score (Figure 1). METHODS: At our institution, 543 patients who underwent flexible URS for upper tract calculi between 2018–2022, were retrospectively reviewed. Ureteral stricture formation was defined on follow-up imaging 3-6 months after surgery based on: the presence of new hydronephrosis (either on CT or US), a T1/2>20 minutes on nuclear split renal function or endoscopic evidence of ureteral stricture on a subsequent ipsilateral procedure without an obstructing stone. Patients were excluded if they had a pre-existing stricture or the stricture formed at the site of an impacted ureteral stone. To ensure that the coefficient estimates were not biased by the low-event rate, a penalized logistic regression model was employed to assess the different factors that increase the likelihood of developing a ureteral stricture. RESULTS: De novo stricture rates for PULS 0, 1, and 2 patients were 0% (0/235), 0.48% (1/208), and 2% (1/92) respectively, while PULS 3 injuries had a higher rate of 13.33% (2/15); there were no PULS 4 or 5 injuries. Compared to the PULS 0 and PULS 1 groups, the PULS 2 and PULS 3 groups had a significantly higher stricture rate (p=0.0364 and p<0.0001, respectively). Upon a penalized logistic regression analysis, we found that when urothelial splitting (i.e., PULS 2 or higher) is present, the odds of developing a ureteral stricture are 13 times higher (p=0.028) (Table 1). Furthermore, visualization of periureteral fat (i.e., PULS grade 3 or higher) increased the odds of developing a ureteral stricture by 40 times (p=0.0002) (Table 1) CONCLUSIONS: Stricture rates surge whenever the integrity of the urothelial wall is disrupted. A full thickness tear may lead to a stricture in up 13.33% of patients. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e750 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Andrei D. Cumpanas More articles by this author Seyed Amiryaghoub Lavasani More articles by this author Seyedamirvala Saadat More articles by this author Jacob C. Tsai More articles by this author Brandon Camp More articles by this author Candice M. Tran More articles by this author Bruce Gao More articles by this author Zachary E. Tano More articles by this author Pengbo Jiang More articles by this author Roshan M. Patel More articles by this author Jaime Landman More articles by this author Ralph V. Clayman More articles by this author Expand All Advertisement PDF downloadLoading ...