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Delayed proximal ureteric stricture formation after complex partial nephrectomy
Author(s) -
Reyes Jose M.,
Canter Daniel J.,
Sirohi Mohit,
Simhan Jay,
Smaldone Marc C.,
Teper Ervin,
Kutikov Alexander,
Chen David Y.T.,
Uzzo Robert G.
Publication year - 2012
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2011.10395.x
Subject(s) - medicine , nephrectomy , surgery , ureter , complication , incidence (geometry) , ureterostomy , urinary system , kidney , leak , urology , cancer , bladder cancer , cystectomy , physics , optics , environmental engineering , engineering
Study Type – Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? As the indications for nephron sparing surgery continue to evolve, so do the potential complications. This study examines a rare but likely underreported complication of nephron sparing surgery in order to better counsel and treat patients with complex renal tumours. OBJECTIVE• To report and review our incidence of delayed ureteric stricture (US) after complex nephron‐sparing surgery (NSS).PATIENTS AND METHODS• Using our institutional kidney cancer database, we identified 720 patients who underwent NSS from 1 January 2000 until 31 December 2010 and identified eleven (1.5%) patients with a delayed US. • Patient and tumour characteristics were reviewed.RESULTS• Median (range) tumour size and RENAL nephrometry score was 4.1 (2–7.2) cm and 10p (4–11p), respectively. • There were eight of 10 solitary tumours (80%) located in the lower or mid‐pole of the kidney. • There were eight of 11 patients with delayed US (72.7%) who experienced a postoperative urinary leak. • There were two of 11 (18.2%) patients who experienced a postoperative retroperitoneal haemorrhage, with one of these patients requiring selective embolization. • All US were in the upper third of the ureter and were diagnosed at a minimum of 10 weeks postoperatively (median 154 days, range 70–400 days).CONCLUSIONS• US formation is an uncommon and under‐reported event after complex NSS. • Risk factors appear to include tumour complexity, imperative indications, mid‐ or lower pole location, postoperative urinary leak and haemorrhage. • Although uncommon, postoperative US can occur after NSS for complex renal masses, necessitating patient counselling and diligent postoperative surveillance.