Transureteroureterostomy Revisited: Long-Term Surgical Outcomes

Markian R. Iwaszko, Amy Krambeck, George K. Chow, Matthew T. Gettman

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Purpose: Transureteroureterostomy is a treatment alternative for ureteral obstruction when more conventionally reconstructive techniques are not feasible. We report on long-term outcomes of patients treated with transureteroureterostomy. Materials and Methods: A retrospective chart review of all patients treated with transureteroureterostomy from January of 1985 to February of 2007 was performed. Results: We identified 63 patients who underwent transureteroureterostomy at our institution. Average treatment age was 31.5 years (range 1 to 83). Transureteroureterostomy was performed for 21 (33%) malignant and 42 (67%) benign indications. Reconstructions were 30 right-to-left (47.6%) and 33 left-to-right (52.4%) with 21 concurrent urinary diversions. There were 16 patients (25.4%) who received radiation before transureteroureterostomy. Postoperative complications occurred in 15 (23.8%) patients and were more common in those undergoing diversion for malignancy. Mean followup was 5.8 years (range 0.1 to 22.2) and 5 patients were lost to followup. Of the 56 patients with followup imaging the transureteroureterostomy was patent in 54 (96.4%) and obstructed in 2 (3.6%). Mean preoperative and recent calculated glomerular filtration rate for this cohort were 62.8 (range 13 to 154) and 71.8 (range 22 to 141) ml per minute, respectively (p = 0.04). Stone disease developed in 8 patients, and was treated with percutaneous nephrolithotomy (2), spontaneous passage (2), ureteroscopy (1) and surveillance (3). Subsequent urological intervention was required for obstruction or revision in 6 (10.3%) patients. Conclusions: We demonstrated the long-term safety and effectiveness of transureteroureterostomy with sustained improvement of renal function compared to preoperative status. Recurrent stricture, distal obstruction and stone disease occur in a small percentage of patients, and can be treated in most with minimal intervention.

Original languageEnglish (US)
Pages (from-to)1055-1059
Number of pages5
JournalJournal of Urology
Volume183
Issue number3
DOIs
StatePublished - Mar 2010
Externally publishedYes

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Ureteroscopy
Percutaneous Nephrostomy
Ureteral Obstruction
Urinary Diversion
Glomerular Filtration Rate
Pathologic Constriction
Radiation
Kidney
Safety
Therapeutics
Neoplasms

Keywords

  • reconstructive surgical procedures
  • ureter
  • ureteral obstruction

ASJC Scopus subject areas

  • Urology

Cite this

Transureteroureterostomy Revisited : Long-Term Surgical Outcomes. / Iwaszko, Markian R.; Krambeck, Amy; Chow, George K.; Gettman, Matthew T.

In: Journal of Urology, Vol. 183, No. 3, 03.2010, p. 1055-1059.

Research output: Contribution to journalArticle

Iwaszko, Markian R. ; Krambeck, Amy ; Chow, George K. ; Gettman, Matthew T. / Transureteroureterostomy Revisited : Long-Term Surgical Outcomes. In: Journal of Urology. 2010 ; Vol. 183, No. 3. pp. 1055-1059.
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abstract = "Purpose: Transureteroureterostomy is a treatment alternative for ureteral obstruction when more conventionally reconstructive techniques are not feasible. We report on long-term outcomes of patients treated with transureteroureterostomy. Materials and Methods: A retrospective chart review of all patients treated with transureteroureterostomy from January of 1985 to February of 2007 was performed. Results: We identified 63 patients who underwent transureteroureterostomy at our institution. Average treatment age was 31.5 years (range 1 to 83). Transureteroureterostomy was performed for 21 (33{\%}) malignant and 42 (67{\%}) benign indications. Reconstructions were 30 right-to-left (47.6{\%}) and 33 left-to-right (52.4{\%}) with 21 concurrent urinary diversions. There were 16 patients (25.4{\%}) who received radiation before transureteroureterostomy. Postoperative complications occurred in 15 (23.8{\%}) patients and were more common in those undergoing diversion for malignancy. Mean followup was 5.8 years (range 0.1 to 22.2) and 5 patients were lost to followup. Of the 56 patients with followup imaging the transureteroureterostomy was patent in 54 (96.4{\%}) and obstructed in 2 (3.6{\%}). Mean preoperative and recent calculated glomerular filtration rate for this cohort were 62.8 (range 13 to 154) and 71.8 (range 22 to 141) ml per minute, respectively (p = 0.04). Stone disease developed in 8 patients, and was treated with percutaneous nephrolithotomy (2), spontaneous passage (2), ureteroscopy (1) and surveillance (3). Subsequent urological intervention was required for obstruction or revision in 6 (10.3{\%}) patients. Conclusions: We demonstrated the long-term safety and effectiveness of transureteroureterostomy with sustained improvement of renal function compared to preoperative status. Recurrent stricture, distal obstruction and stone disease occur in a small percentage of patients, and can be treated in most with minimal intervention.",
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