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Abstract：
BACKGROUND: Successful ureteral reconstruction is challenging, particularly in radiated fields. We characterize and directly compare surgical outcomes in modern cohorts of radiated and non-radiated patients undergoing ureteral reconstruction utilizing a systematic approach to pre-operative assessment. We hypothesize that radiated patients will undergo more complex ureteral reconstructions and experience higher rates of surgical failure and complications compared to nonradiated patients.
METHODS: Consecutive cases of ureteral reconstruction for acquired ureteral injury performed by a single surgeon from 2010-2018 were retrospectively reviewed. Clinical data were collected including pre-operative bladder capacity, ureteral injury characteristics, and surgical technique. Ileal ureter and autotransplantation were classified as \"complex\" ureteral repairs, and surgical success was defined as freedom from surgical revision of the ureteral anastomosis and/or ureteral stenting.
RESULTS: There were 47 ureteral reconstructions performed including 17 (36%) radiated patients. Radiated patients had lower pre-operative bladder capacity and were more likely to undergo complex repairs compared to non-radiated patients (35% vs. 7%, P=0.01). Overall surgical success was high (98%) and similar between radiated (94%) and non-radiated groups (100%) at median follow up of 30 months. Clavien grade 3-4 complications occurred in 18% of radiated and 10% of non-radiated patients (P=0.48).
CONCLUSIONS: Careful pre-operative evaluation and appropriate selection of surgical technique facilitates high and similar success of ureteral reconstruction in radiated and non-radiated patients. Complex ureteral repairs were more common in radiated patients, however the majority of radiated ureteral injuries (65%) were reconstructed without tissue transfer. Radiated patients had lower pre-operative bladder capacities, but similar surgical morbidity, renal function, and persistent urge incontinence compared to non-radiated patients.
METHODS: Consecutive cases of ureteral reconstruction for acquired ureteral injury performed by a single surgeon from 2010-2018 were retrospectively reviewed. Clinical data were collected including pre-operative bladder capacity, ureteral injury characteristics, and surgical technique. Ileal ureter and autotransplantation were classified as \"complex\" ureteral repairs, and surgical success was defined as freedom from surgical revision of the ureteral anastomosis and/or ureteral stenting.
RESULTS: There were 47 ureteral reconstructions performed including 17 (36%) radiated patients. Radiated patients had lower pre-operative bladder capacity and were more likely to undergo complex repairs compared to non-radiated patients (35% vs. 7%, P=0.01). Overall surgical success was high (98%) and similar between radiated (94%) and non-radiated groups (100%) at median follow up of 30 months. Clavien grade 3-4 complications occurred in 18% of radiated and 10% of non-radiated patients (P=0.48).
CONCLUSIONS: Careful pre-operative evaluation and appropriate selection of surgical technique facilitates high and similar success of ureteral reconstruction in radiated and non-radiated patients. Complex ureteral repairs were more common in radiated patients, however the majority of radiated ureteral injuries (65%) were reconstructed without tissue transfer. Radiated patients had lower pre-operative bladder capacities, but similar surgical morbidity, renal function, and persistent urge incontinence compared to non-radiated patients.
摘要：
背景：成功的输尿管重建具有挑战性，特别是在辐射领域。我们利用系统的术前评估方法，对接受输尿管重建的现代放射和非放射患者进行表征并直接比较手术结果。我们假设，与非辐射患者相比，辐射患者将进行更复杂的输尿管重建，并且手术失败和并发症的发生率更高。
方法：回顾性分析了2010年至2018年由一名外科医生进行的输尿管重建治疗后天性输尿管损伤的连续病例。收集临床数据，包括术前膀胱容量，输尿管损伤特征，和手术技术。回肠输尿管和自体移植被归类为“复杂”输尿管修复，手术成功被定义为免于输尿管吻合和/或输尿管支架置入术的手术翻修。
结果：进行了47例输尿管重建，包括17例（36%）放射患者。与未辐射患者相比，辐射患者的术前膀胱容量较低，并且更有可能进行复杂的修复（35％vs.7%,P=0.01）。在中位随访30个月时，放疗组（94％）和非放疗组（100％）的总体手术成功率很高（98％），相似。18％的放疗患者和10％的非放疗患者发生了Clavien3-4级并发症（P=0.48）。
结论：仔细的术前评估和适当的手术技术选择有利于放射和非放射患者输尿管重建的高成功率和相似成功率。复杂的输尿管修复在辐射患者中更为常见，然而，大多数放射性输尿管损伤（65％）在没有组织转移的情况下进行了重建。放射患者术前膀胱容量较低，但是手术发病率相似，肾功能,与未辐射患者相比，持续性急迫性尿失禁。
方法：回顾性分析了2010年至2018年由一名外科医生进行的输尿管重建治疗后天性输尿管损伤的连续病例。收集临床数据，包括术前膀胱容量，输尿管损伤特征，和手术技术。回肠输尿管和自体移植被归类为“复杂”输尿管修复，手术成功被定义为免于输尿管吻合和/或输尿管支架置入术的手术翻修。
结果：进行了47例输尿管重建，包括17例（36%）放射患者。与未辐射患者相比，辐射患者的术前膀胱容量较低，并且更有可能进行复杂的修复（35％vs.7%,P=0.01）。在中位随访30个月时，放疗组（94％）和非放疗组（100％）的总体手术成功率很高（98％），相似。18％的放疗患者和10％的非放疗患者发生了Clavien3-4级并发症（P=0.48）。
结论：仔细的术前评估和适当的手术技术选择有利于放射和非放射患者输尿管重建的高成功率和相似成功率。复杂的输尿管修复在辐射患者中更为常见，然而，大多数放射性输尿管损伤（65％）在没有组织转移的情况下进行了重建。放射患者术前膀胱容量较低，但是手术发病率相似，肾功能,与未辐射患者相比，持续性急迫性尿失禁。
