Pd44-03 Comparative Effectiveness of Surgical Treatments for Recurrent Obstruction Following Pyeloplasty: A Multicenter, Prospective Study

You have accessJournal of UrologyReconstruction: Ureteral Reconstruction (Including Pyeloplasty) and Bladder Reconstruction (Including Trauma-Related Fistula) II (PD44)1 May 2024PD44-03 COMPARATIVE EFFECTIVENESS OF SURGICAL TREATMENTS FOR RECURRENT OBSTRUCTION FOLLOWING PYELOPLASTY: A MULTICENTER, PROSPECTIVE STUDY Shengwei Xiong, Hongjian Zhu, Peng Zhang, Bing Wang, Liqun Zhou, and Xuesong Li Shengwei XiongShengwei Xiong , Hongjian ZhuHongjian Zhu , Peng ZhangPeng Zhang , Bing WangBing Wang , Liqun ZhouLiqun Zhou , and Xuesong LiXuesong Li View All Author Informationhttps://doi.org/10.1097/01.JU.0001008800.83683.92.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Recurrent ureteropelvic junction obstruction (UPJO) is a relatively rare but challenging condition in clinical practice. This study aims to prospectively compare the effectiveness of different surgical treatments in patients with recurrent UPJO following failed pyeloplasty. METHODS: Patients who underwent subsequent surgical treatments for recurrent UPJO following failed pyeloplasty at four centers were prospectively enrolled starting from May 2020. The patients were grouped based on the type of secondary surgical treatment, including balloon dilation, and robot-assisted dismembered pyeloplasty, flap pyeloplasty, graft ureteroplasty, and ileal ureteral substitution. The choice of surgical treatment was based on factors such as the length of ureteral stricture, and regular follow-up examinations were conducted postoperatively. Surgical outcomes were assessed at 1 year postoperatively. Surgical success was defined as resolution of both clinical symptoms and obstruction on radiographic evaluation. This is a multicenter prospective cohort study that utilized a registry-based research design. Clinical and follow-up data for all enrolled patients were registered in the RECUTTER multicenter database. RESULTS: A total of 255 patients were prospectively enrolled, including 85 balloon dilation, 63 dismembered pyeloplasty, 47 flap pyeloplasty, 27 lingual mucosal graft ureteroplasty, 18 appendiceal onlay flap ureteroplasty, and 5 ileal ureteral substitution. All surgeries were successfully completed without intraoperative complications. The median length of ureteral stricture for the balloon dilation, dismembered pyeloplasty, flap pyeloplasty, lingual mucosal graft ureteroplasty, appendiceal onlay flap ureteroplasty and ileal ureteral substitution were 1 cm, 1.5 cm, 3 cm, 3.5 cm, 3 cm and 5.5 cm, respectively. The median operative time was 75 min, 168 min, 194 min, 200 min, 210 min, and 213.5 min, respectively. The median intraoperative blood loss was 6 mL, 20 mL, 45 mL, 30 mL, 40 mL and 50 mL, respectively. All patients have currently undergone follow-up for more than one year for surgical outcome evaluation. No high-grade complications occurred during the follow-up period. In the balloon dilation group, ten cases (11.8%) were classified as surgical failure; while in the dismembered pyeloplasty group, six cases (9.5%) were classified as surgical failure. For the flap pyeloplasty group, two cases (4.3%) were classified as surgical failure, while no surgical failure was observed in the other groups. CONCLUSIONS: Flap pyeloplasty and graft ureteroplasty demonstrate higher surgical success rates due to their minimal disruption of the ureteral blood supply. Balloon dilation demonstrates favorable early treatment outcomes in patients with shorter ureteral strictures; however, it is associated with a higher recurrence rate. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e905 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Shengwei Xiong More articles by this author Hongjian Zhu More articles by this author Peng Zhang More articles by this author Bing Wang More articles by this author Liqun Zhou More articles by this author Xuesong Li More articles by this author Expand All Advertisement PDF downloadLoading ...