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Long term outcomes in the use of ileal ureter for radiation-induced ureteral strictures

  • Urology - Original Paper
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Abstract

Purpose

Radiation-induced ureteral stricture disease poses significant surgical challenges. Ureteral substitution with ileum has long been a versatile option for reconstruction. We evaluated outcomes in patients undergoing ileal ureter replacement for ureteral reconstruction due to radiation-induced ureteral stricture versus other causes.

Methods

Between July 1989 and June 2013, 155 patients underwent consecutive ileal ureter creation. The study cohort included 104 patients with complete data sets and at least 7 months of follow up. Records were retrospectively reviewed with regard to demographics, indications, complications, and renal deterioration.

Results

Surgical indications included radiation-induced stricture in 23 (22%) and non-radiation-induced stricture in 81 (78%). Comparing ileal ureter substitution due to radiation versus other stricture etiologies, no statistical significance was observed in regard to age (45.6 vs. 51.2, p = 0.141), hospital length of stay in days (8.8 vs. 7.7, p = 0.216), percent GFR loss (MDRD-4 vs. -5%, p = 0.670 and CKD-EPI-7 vs. -6%, p = 0.914), 30-day surgical complications (26.1 vs. 30.1%, p = 0.658), metabolic acidosis (8.7 vs. 1.2%, p = 0.059), and renal failure requiring dialysis (4.3 vs. 1.2%, p = 0.337). Fistula formation (13.0 vs. 3.7%, p = 0.095), partial small bowel obstructions (21.7 vs. 7.4%, p = 0.063), and small bowel obstructions requiring reoperation (13.0 vs. 1.2%, p = 0.033) approached or reached statistical significance. Using Kaplan–Meier methodology, there was no difference in time to worsening renal outcome between the radiation and non-radiation groups (p > 0.05).

Conclusion

Ureteral substitution with ileum is an effective reconstructive option for radiation-induced ureteral strictures in carefully selected patients.

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Author notes

  1. M. Francesca Monn and Joshua D. Roth have shared equally in contribution to the project and manuscript.

Authors and Affiliations

  1. Department of Urology, Indiana University School of Medicine, 1801 Senate St. Suite 220, Indianapolis, IN, 46202, USA

    M. Francesca Monn, Joshua D. Roth, Richard Bihrle & Matthew J. Mellon

Authors
  1. M. Francesca Monn
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  2. Joshua D. Roth
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  3. Richard Bihrle
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  4. Matthew J. Mellon
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Corresponding author

Correspondence to Matthew J. Mellon.

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Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

IRB exempt status for the conduct of the study was obtained from Indiana University. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Monn, M.F., Roth, J.D., Bihrle, R. et al. Long term outcomes in the use of ileal ureter for radiation-induced ureteral strictures. Int Urol Nephrol 50, 1375–1380 (2018). https://doi.org/10.1007/s11255-018-1904-z

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  • DOI: https://doi.org/10.1007/s11255-018-1904-z

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