Pd44-10 Ureteral Rest Is Unnecessary for Ureteral Reimplantation

You have accessJournal of UrologyReconstruction: Ureteral Reconstruction (Including Pyeloplasty) and Bladder Reconstruction (Including Trauma-Related Fistula) II (PD44)1 May 2024PD44-10 URETERAL REST IS UNNECESSARY FOR URETERAL REIMPLANTATION Kendrick Campbell, Fernandino L. Vilson, Sajya Singh, Alethea Paradis, Joel Vetter, and Gregory Murphy Kendrick CampbellKendrick Campbell , Fernandino L. VilsonFernandino L. Vilson , Sajya SinghSajya Singh , Alethea ParadisAlethea Paradis , Joel VetterJoel Vetter , and Gregory MurphyGregory Murphy View All Author Informationhttps://doi.org/10.1097/01.JU.0001008800.83683.92.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The principles of urethral rest prior to urethroplasty have often been applied to ureteral reconstruction. Ureteral rest has been shown to be advantageous for proximal and mid ureteral strictures but has not been studied in distal ureteral reconstruction. We posited that ureteral rest may not be necessary for patients undergoing ureteral reimplant with or without psoas hitch/Boari flap reconstruction. METHODS: We retrospectively reviewed all patients who underwent ureteral reimplantation from 12/19/2016 to 4/11/2023. We included reimplants that required psoas hitch/Boari flap reconstruction. Median follow up was 8.6 months. Peri-operative outcomes were compared between ureteral rest and no ureteral rest where rest was defined as the absence of ureteral stent for at least 4 weeks prior to surgery. Patients were not recommended into either group but were taken as they presented with either a stent (no rest) or nephrostomy tube (rest). Patients were followed after surgery for recurrence with renal ultrasounds at 3 and 12 months. Renal scintigraphy was used if significant or worsening hydronephrosis was seen. Continuous and categorical variables were compared using Mann-Whitney U-test and chi-square test respectively; p<0.05 was considered significant. RESULTS: Our cohort consisted of 50 patients, 29 (58%) of whom underwent ureteral rest and 21 (42%) who did not. Age, sex, pre-operative kidney function, history of UTI, and stricture length, laterality, and location (middle versus distal) were comparable between the two groups. Use of psoas hitch and Boari flap were also comparable. Significantly more patients with iatrogenic ureteral injury had ureteral rest (75.9%), while most patients with radiation induced stricture did not (47.6%). Other/idiopathic causes were split relatively evenly. Post-operatively, there were no significant differences in 30-day complication rate, post-operative hydronephrosis, or stricture recurrence (Table 1). CONCLUSIONS: Although ureteral rest is popular prior to ureteral reconstruction for proximal ureteral strictures, our data demonstrate that it does not confer an advantage for more distal ureteral reconstruction. Thus, surgery should not be delayed to achieve ureteral rest when reimplantation with or without psoas hitch/Boari flap is expected. Source of Funding: N/A © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e909 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Kendrick Campbell More articles by this author Fernandino L. Vilson More articles by this author Sajya Singh More articles by this author Alethea Paradis More articles by this author Joel Vetter More articles by this author Gregory Murphy More articles by this author Expand All Advertisement PDF downloadLoading ...