Radiographical Changes after Ureteral Rest for Robotic Ureteral Reconstruction.

Introduction

We evaluate radiographical changes involved with the implementation of ureteral rest before robotic ureteral reconstruction (RUR) for the management of ureteral strictures. Materials and

Methods

We retrospectively reviewed our single-institutional robotic ureteral surgery database to identify all consecutive patients who underwent ureteral rest before RUR for the surgical management of ureteral strictures between 1/2018 and 12/2022. Ureteral rest was defined as having the absence of hardware across a strictured segment before definitive surgical repair. All patients who obtained both pre- and post-ureteral rest retrograde and/or antegrade pyelograms were included for analysis. An experienced genitourinary radiologist reviewed all pre- and post-retrograde and/or antegrade pyelograms to determine stricture quality and length. Primary outcomes included the change in stricture quality and the difference in ureteral stricture length after ureteral rest.

Results

Overall, 50 patients met the inclusion criteria. Preoperative stricture quality was determined to be narrowed in 86.0% and obliterative in 14.0% of patients. The median duration of ureteral rest was 11.1 (interquartile range [IQR] 5.7-22.8) weeks. Of those with narrowed strictures, 12.0% progressed to obliterative strictures after ureteral rest. There were 37 (74.0%) patients who had an increase in stricture length after ureteral rest. The median growth in stricture length after ureteral rest was 0.2 (IQR: -0.2-0.4) centimeters. At a median follow-up of 6.2 (IQR: 2.9-10.0) months, 88.0% of patients were surgically successful.

Conclusions

Ureteral rest can lead to changes in stricture quality, which may be valuable in surgical decision-making.