Delayed proximal ureteric stricture formation after complex partial nephrectomy

Authors


Daniel Canter, Department of Surgical Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111, USA. e-mail: danieljcanter@gmail.com

Abstract

Study Type – Therapy (case series)

Level of Evidence 4

What's known on the subject? and What does the study add?

As the indications for nephron sparing surgery continue to evolve, so do the potential complications.

This study examines a rare but likely underreported complication of nephron sparing surgery in order to better counsel and treat patients with complex renal tumours.

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.

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