Ureteral Rest is Unnecessary Prior to Ureteral Reimplantation

Abstract

Purpose:

We aim to determine if ureteral rest is necessary prior to distal ureteral reconstruction with reimplantation with or without psoas hitch and/or Boari flap.

Methods:

We retrospectively reviewed all patients who underwent ureteral reimplantation at a single institution from December 2016 to April 2023. We included all reimplantation techniques, including psoas hitch and Boari flap. Patients were stratified based on if they had ureteral rest, defined as the absence of a ureteral stent for at least 4 weeks prior to the operation. Patient demographics, stricture characteristics, and perioperative outcomes were compared between the two groups. Patients were scheduled for 3 and 12 month postoperative ultrasounds to assess for stricture recurrence. Renal scintigraphy was used if significant or worsening hydronephrosis was seen.

Results:

Our cohort consisted of 50 patients, among whom 29 (58%) underwent ureteral rest before reimplantation. Demographics, stricture characteristics, and use of psoas hitch and/or Boari flap were comparable between the two groups. Stricture etiology was significantly different in patients with and without ureteral rest (p = 0.002). The cohort without ureteral rest had a higher percentage of radiation-induced ureteral injury (47.6%), while the cohort with ureteral rest had a higher percentage of iatrogenic ureteral injury (75.9%). Other/idiopathic causes were split relatively evenly. Median follow-up for the cohort was 8.6 months (interquartile range: 4.6–17.4 months). Postoperatively, there were no significant differences in 30-day complication rate, postoperative hydronephrosis, or stricture recurrence rate.

Conclusions:

Our data suggest that ureteral rest does not confer an advantage for distal ureteral reconstruction. Thus, operation should not be delayed in order to achieve ureteral rest when reimplantation is expected.