Laparoscopic reconstruction of ureteral strictures involving solitary renal units-1 year and 5 year outcomes

• Main Authors: George P Abraham, Krishanu Das, Avinash T Siddiaiah, Krishnamohan Ramaswami, P Datson George, Jisha J Abraham
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2015-01-01
• Series: Journal of Minimal Access Surgery
• Subjects: Kidney; laparoscopy; reconstruction; ureteral obstruction
• Online Access: http://www.journalofmas.com/article.asp?issn=0972-9941;year=2015;volume=11;issue=4;spage=236;epage=240;aulast=Abraham

Context: Long-term outcome following a laparoscopic reconstruction of ureteral strictures (US) involving solitary renal units (SRU) are scarcely reported. Aims: The aim was to report short-term (1 year) and long-term (5 years) outcomes following a laparoscopic reconstruction of US in a solitary kidney. Settings and Design: Retrospective. Materials and Methods: Records of patients operated for similar scenarios between January 2004 and January 2014 were evaluated. Clinical, biochemical and radiological profile were noted. Operative and post-operative profile were recorded. Follow-ups were scheduled at regular intervals (3 months post-procedure, 6 monthly for 2 years and yearly thereafter. Imaging was repeated at yearly intervals). Outcome was assessed by comparing pre-operative and post-operative clinical, biochemical, and radiological parameters. Statistical Analysis Used: SAS software 9.2 version. A P < 0.05 was inferred as statistically significant. Results: Seven patients underwent a laparoscopic reconstruction. Stricture location was upper ureter (n = 1), mid ureter (n = 2), lower ureter (n = 4). Surgeries performed were ureteroureterostomy, Boari flap ureteroneocystostomy and ureteroneocystostomy with psoas hitch. Four patients reported prior contralateral nephrectomy. Three patients underwent prior endoscopic correction. Four patients presented with elevated serum creatinine (>1.4 mg/dl). Till last follow-up, improvement in symptomatology and improvement or stabilisation of serum creatinine was perceived in all. Ureteral patency with resolution of hydronephrosis was observed in five patients at 1 year follow-up. Two patients revealed ureteral patency with persistence of hydronephrosis. Clinical, biochemical and radiological outcomes were maintained till long-term follow-up. Conclusion: Laparoscopic reconstruction of US in SRU offers impressive short- and long-term outcome.