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Reyes JM , Canter DJ , Sirohi M , Simhan J , Smaldone MC , Teper E , Kutikov A , Chen DYT , Uzzo RG
Delayed proximal ureteric stricture formation after complex partial nephrectomy
Bju International. 2012 Feb;109(4) :539-543
PMID: WOS:000299945100014   
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OBJECTIVE To report and review our incidence of delayed ureteric stricture (US) after complex nephron-sparing surgery (NSS). PATIENTS AND METHODS Using our institutional kidney cancer database, we identified 720 patients who underwent NSS from 1 January 2000 until 31 December 2010 and identified eleven (1.5%) patients with a delayed US. Patient and tumour characteristics were reviewed. RESULTS Median (range) tumour size and RENAL nephrometry score was 4.1 (2-7.2) cm and 10p (4-11p), respectively. There were eight of 10 solitary tumours (80%) located in the lower or mid-pole of the kidney. There were eight of 11 patients with delayed US (72.7%) who experienced a postoperative urinary leak. There were two of 11 (18.2%) patients who experienced a postoperative retroperitoneal haemorrhage, with one of these patients requiring selective embolization. All US were in the upper third of the ureter and were diagnosed at a minimum of 10 weeks postoperatively (median 154 days, range 70-400 days). CONCLUSIONS US formation is an uncommon and under-reported event after complex NSS. Risk factors appear to include tumour complexity, imperative indications, mid-or lower pole location, postoperative urinary leak and haemorrhage. Although uncommon, postoperative US can occur after NSS for complex renal masses, necessitating patient counselling and diligent postoperative surveillance.
Reyes, Jose M. Canter, Daniel J. Sirohi, Mohit Simhan, Jay Smaldone, Marc C. Teper, Ervin Kutikov, Alexander Chen, David Y. T. Uzzo, Robert G. National Cancer Institute[P30 CA006927]; Fox Chase Cancer This publication was supported in part by grant number P30 CA006927 from the National Cancer Institute. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Cancer Institute or the National Institutes of Health. Additional funds were provided by the Fox Chase Cancer via institutional support of the Kidney Cancer Keystone Program. 21 Wiley-blackwell Malden 887qy