Grimaud Logan W, Sury Kiran, Salvino Matthew, Livingston Austin, Lentz Aaron C, Peterson Andrew C
Department of Urology, Duke University School of Medicine, Durham, NC, United States.
Front Urol. 2025 Sep 9;5:1593307. doi: 10.3389/fruro.2025.1593307. eCollection 2025.
Patients with a poorly functioning kidney, defined as less than 20% differential renal function, have historically been considered poor candidates for ipsilateral ureteral reconstruction for stricture. To determine if renal function can be safely preserved in poorly functioning kidneys with ureteral stricture, we evaluated patient outcomes following ureteral reconstruction.
We conducted a review of 114 adult patients who underwent ureteral reconstructive surgery at our institution between 2013 and 2023. Patients with poorly functioning ipsilateral kidneys were identified by a preoperative renal scan (MAG3 renogram). Variables of interest included patient characteristics, peri/postoperative outcomes, resolution of hydronephrosis, pre/postoperative renal function, and preservation of renal parenchyma.
Of the 8 patients meeting inclusion criteria, 5 underwent bladder elongation psoas hitch (BEPH), 1 ileal ureter, 1 ileal ureter with BEPH, and 1 ureteroureterostomy. Median preoperative differential renal function was 16.0% with a median preoperative serum creatinine (sCr) of 1.70 mg/dL before decompression and 1.35mg/dL after percutaneous nephrostomy tube (PCN) placement. Preoperative median average renal parenchyma thickness (RPT) was 14.5mm. At 6-month follow-up, median sCr and RPT were preserved at 1.25mg/dL (p= 0.084) and 14.3 mm (p=0.41), respectively. At median follow-up of 49.2 months, all patients had a successful repair, defined as no reinsertion of stent/PCN, resolution of hydronephrosis, and no return to the operating room for revision or nephrectomy. Median sCr at last follow-up showed sustained improvement at 1.22 (p=0.0097).
Reconstruction can be successful for obstructed kidneys with less than 20% differential function and may be considered prior to nephrectomy.
肾功能不佳（定义为患侧肾功能差异小于20%）的患者，历来被认为不是同侧输尿管狭窄重建术的理想候选者。为了确定输尿管狭窄且肾功能不佳的患者的肾功能能否得到安全保留，我们评估了输尿管重建术后的患者结局。
我们回顾了2013年至2023年间在本机构接受输尿管重建手术的114例成年患者。术前肾脏扫描（MAG3肾图）确定患侧肾功能不佳的患者。感兴趣的变量包括患者特征、围手术期/术后结局、肾积水的缓解情况、术前/术后肾功能以及肾实质的保留情况。
在符合纳入标准的8例患者中，5例行膀胱延长腰大肌悬吊术（BEPH），1例行回肠代输尿管术，1例行回肠代输尿管术联合BEPH，1例行输尿管输尿管吻合术。术前患侧肾功能差异的中位数为16.0%，减压前术前血清肌酐（sCr）中位数为1.70mg/dL，放置经皮肾造瘘管（PCN）后为1.35mg/dL。术前肾实质平均厚度（RPT）中位数为14.5mm。在6个月的随访中，sCr中位数和RPT分别维持在1.25mg/dL（p = 0.084）和14.3mm（p = 0.41）。在中位随访49.2个月时，所有患者均成功修复，定义为无需再次置入支架/PCN、肾积水缓解且无需返回手术室进行翻修或肾切除术。末次随访时sCr中位数持续改善至1.22（p = 0.0097）。
对于功能差异小于20%的梗阻性肾脏，重建术可能成功，在肾切除术之前可考虑进行重建术。
