Ureteral reconstruction is safe and successful in poorly functioning kidneys

Area of Science:

• Urology
• Nephrology
• Surgical Innovation

Background:

• Historically, kidneys with <20% differential renal function were poor candidates for ureteral reconstruction.
• Ureteral strictures can lead to significant kidney dysfunction and hydronephrosis.

Purpose of the Study:

• To evaluate the safety and efficacy of ureteral reconstruction in patients with poorly functioning kidneys.
• To determine if renal function can be preserved in kidneys with <20% differential function undergoing ureteral repair.

Main Methods:

• Retrospective review of 114 adult patients undergoing ureteral reconstructive surgery (2013-2023).
• Identified 8 patients with poorly functioning ipsilateral kidneys (<20% differential function) via MAG3 renogram.
• Analyzed patient characteristics, surgical outcomes, hydronephrosis resolution, and renal function/parenchyma preservation.

Main Results:

• Eight patients with median preoperative differential renal function of 16% underwent various reconstructive procedures.
• Post-operatively, serum creatinine and renal parenchyma thickness were preserved at 6 months and long-term follow-up.
• Successful repair (no re-intervention, hydronephrosis resolution) was achieved in all patients at a median follow-up of 49.2 months.

Conclusions:

• Ureteral reconstruction is a successful option for obstructed kidneys with poor function (<20% differential function).
• This surgical approach can preserve renal function and may be considered before nephrectomy.