EAU 2018: Laparoscopic Ureteroureterostomy – International Multicenter Experience
Dr. Macek from the General University Hospital and First Medical Faculty of Charles University Department of Urology presented a retrospective analysis of 21 patients managed with endourologic treatment of ureteric strictures at 3 institutions (12 of which had distal ureteric strictures, and 9 of which had proximal ureteric strictures).
Of these 21 patients, all procedures were completed with no intraoperative complications and had a median one-stage procedure time of 171 minutes. Median blood loss in all procedures was 250ml, but was noted to be significantly higher for those with distal strictures (300ml versus 40 ml). Regardless, no blood transfusions were required, no conversions were necessary, and all stents were removed after a median of 8 weeks. At one month follow-up, four patients experienced Clavien-Dindo grade 2 complications and there have been no stricture recurrences at a median follow-up of 33 months.
In discussion, Dr. Macek notes that the retrospective nature of the current study was the largest limitations. Regardless, this study represents the largest cohort of patients with ureteric strictures and treated by endoscopic techniques. While laparoscopic UUS appears to be a safe and feasible procedure for these patients, it also appears to come with lower comorbidity in patients presenting with proximal strictures (I.e. with lower blood loss and a shorter surgery). Benefit to this particular subset of patients should be further explored in larger and more diverse patient populations.
In practice, the results of this study can also be applied to patients with distal ureteric strictures, given that a multidiscliplinary approach is utilized. Despite a longer surgery and greater blood loss, the technical success of the procedure is clear and it is with hope that increased experience in patients with distal ureteric strictures can decrease associated morbidity.
Presented by: Macek P., MD General University Hospital and First Medical Faculty of Charles University, Dept. of Urology, Prague, Czech Republic
Co-Authors: Abdel-Karim A.2 , Hora M.3 , Fanta M.4 , Elsalmy S.2 , Dytrych P.5 , Hanus T.1
Author Information:
1. General University Hospital and First Medical Faculty of Charles University, Dept. of Urology, Prague, Czech Republic
2. Alexandria University, Dept. of Urology, Alexandria, Egypt
3. Faculty Hospital Pilsen, Dept. of Urology, Pilsen, Czech Republic
4. General University Hospital and First Medical Faculty of Charles University, Dept. of Gynecology and Obstetrics, Prague, Czech Republic
5. General University Hospital and First Medical Faculty of Charles University, Dept. of Surgery, Prague, Czech Republic
Written by: Linda M. Huynh, BS, Department of Urology, University of California-Irvine at the 2018 European Association of Urology Meeting EAU18, 16-20 March, 2018 Copenhagen, Denmark