ORIGINAL RESEARCH article
Front. Urol.
Sec. Neurourology, Behavioural Urology, and Urodynamics
Volume 5 - 2025 | doi: 10.3389/fruro.2025.1593307
This article is part of the Research TopicInnovations in Treating Ureteral Strictures and Upper Urinary Tract IssuesView all articles
Ureteral Reconstruction is Safe and Successful in Poorly Functioning Kidneys
Provisionally accepted
- Department of Urology, Duke University School of Medicine, Durham, NC, United States
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Objectives: Patients with a poorly functioning kidney, defined as less than 20% differential renal function, have historically been considered poor candidates for ipsilateral ureteral reconstruction for stricture. To determine if renal function can be safely preserved in poorly functioning kidneys with ureteral stricture, we evaluated patient outcomes following ureteral reconstruction. Methods: We conducted a review of 114 adult patients who underwent ureteral reconstructive surgery at our institution between 2013 and 2023. Patients with poorly functioning ipsilateral kidneys were identified by a preoperative renal scan (MAG3 renogram). Variables of interest included patient characteristics, peri/postoperative outcomes, resolution of hydronephrosis, pre/postoperative renal function, and preservation of renal parenchyma. Results: Of the 8 patients meeting inclusion criteria, 5 underwent bladder elongation psoas hitch (BEPH), 1 ileal ureter, 1 ileal ureter with BEPH, and 1 ureteroureterostomy. Median preoperative differential renal function was 16.0% with a median preoperative serum creatinine (sCr) of 1.70 mg/dL before decompression and 1.35mg/dL after percutaneous nephrostomy tube (PCN) placement. Preoperative median average renal parenchyma thickness (RPT) was 14.5mm. At 6-month follow-up, median sCr and RPT were preserved at 1.25mg/dL (p= 0.084) and 14.3 mm (p=0.41), respectively. At median follow-up of 49.2 months, all patients had a successful repair, defined as no reinsertion of stent/PCN, resolution of hydronephrosis, and no return to the operating room for revision or nephrectomy. Median sCr at last follow-up showed sustained improvement at 1.22 (p=0.0097). Conclusions: Reconstruction can be successful for obstructed kidneys with less than 20% differential function and may be considered prior to nephrectomy.
Keywords: ureteral stricture, reconstruction, renal function Article Type: Original research, Renal function, Dogma
Received: 13 Mar 2025; Accepted: 07 Aug 2025.
Copyright: © 2025 Grimaud, Sury, Salvino, Livingston, Lentz and Peterson. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Logan Wilson Grimaud, Department of Urology, Duke University School of Medicine, Durham, NC, United States
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