Urinary Quality of Life Outcomes Following Bladder Flap Reconstruction for Ureteral Strictures

To evaluate the impact of radiation and sex differences on urinary quality of life outcomes following ureteral reimplant with bladder flap, including lower urinary tract symptoms requiring medications and postoperative flank pain from reflux.

Of the 95 patients who underwent bladder flap reconstruction at our institution (2018-2024), 81 were included for analysis. Patients were surveyed postoperatively to assess urinary outcomes (Urinary Distress Inventory Short Form, UDI-6), development of symptomatic reflux, and need for persistent use of medications to manage bladder symptoms. Survey response rate was 69% (56/81).

Of the 81 patients, 62% (n = 50) were female and 38% (n = 31) had prior radiation. Overall reconstructive success was 97% at a median follow-up of 2.3 years. Median flap length was 5 cm (IQR 4-8). Median UDI-6 score was 42 (IQR 33-58). Females had higher scores compared to males (42 vs 33; P = .04), and both females and radiated patients reported more urinary incontinence postoperatively. New persistent medication use was identified in 12 (15%) patients, with higher proportions in females compared to males (22% vs 1%; P = .03). Of the 9/81 (11%) patients with flank pain related to reflux, only 1 radiated patient with a solitary kidney required intervention with a nephrostomy tube due to development of poor bladder compliance.

Bladder flap ureteral reconstruction is well tolerated with mildly bothersome urinary symptoms postoperatively, even in select patients with history of radiation. Female patients should be counseled on the potential for new persistent use of medications to manage irritative voiding symptoms postoperatively.