Radiographical Changes after Ureteral Rest for Robotic Ureteral Reconstruction

Introduction: We evaluate radiographical changes involved with the implementation of ureteral rest before robotic ureteral reconstruction (RUR) for the management of ureteral strictures. Materials and Methods: We retrospectively reviewed our single-institutional robotic ureteral surgery database to identify all consecutive patients who underwent ureteral rest before RUR for the surgical management of ureteral strictures between 1/2018 and 12/2022. Ureteral rest was defined as having the absence of hardware across a strictured segment before definitive surgical repair. All patients who obtained both pre- and post-ureteral rest retrograde and/or antegrade pyelograms were included for analysis. An experienced genitourinary radiologist reviewed all pre- and post-retrograde and/or antegrade pyelograms to determine stricture quality and length. Primary outcomes included the change in stricture quality and the difference in ureteral stricture length after ureteral rest. Results: Overall, 50 patients met the inclusion criteria. Preoperative stricture quality was determined to be narrowed in 86.0% and obliterative in 14.0% of patients. The median duration of ureteral rest was 11.1 (interquartile range [IQR] 5.7-22.8) weeks. Of those with narrowed strictures, 12.0% progressed to obliterative strictures after ureteral rest. There were 37 (74.0%) patients who had an increase in stricture length after ureteral rest. The median growth in stricture length after ureteral rest was 0.2 (IQR: -0.2-0.4) centimeters. At a median follow-up of 6.2 (IQR: 2.9-10.0) months, 88.0% of patients were surgically successful. Conclusions: Ureteral rest can lead to changes in stricture quality, which may be valuable in surgical decision-making.