Long-term renal functional outcomes following ureteroureterostomy performed during multi-organ resection for non-urothelial cancers.

Objectives: To evaluate the long-term renal function outcomes after ureteroureterostomy (UU) in patients undergoing multi-organ resection for non-urothelial cancers. The secondary aim was to examine the length of ureteric defect that can be successfully bridged with UU. Patients and methods: We retrospectively reviewed the charts of patients who underwent UU between 1995 and 2012 at our institution. Renal imaging studies performed before and after UU were used to determine whether hydronephrosis was present. Renal function was assessed by comparing estimated glomerular filtration rate (eGFR) before and at the last follow-up after UU. Results: Nineteen patients underwent UU during multi-organ resection for non-urothelial cancers. Median follow-up time was 62 months. Overall, UU had a high success rate, with one patient (5.2%) developing progressive hydronephrosis with a >20% drop in eGFR from baseline due to UU failure. Four additional patients developed progressive hydronephrosis due to cancer recurrence involving the UU. There were no statistically significant differences between pre- and post-UU eGFR in these patient cohort. All patients with a ureteric defect of ≤5 cm underwent successful reconstruction. Conclusions: UU maintains long-term renal function in the majority of patients undergoing multi-organ resection for non-urothelial cancers and can be successfully utilized if the resected ureteric length is ≤5 cm.

Is transureteroureterostomy performed during multi-organ resection for non-urothelial malignancy safe and effective?

BACKGROUND: Multi-organ resection in patients with non-urothelial cancer may include segmental ureteral resection. The resulting ureteral defect can be reconstructed with a transureteroureterostomy (TUU); however, whether TUU is safe and effective in this patient group remains unclear. OBJECTIVES: In the current retrospective analysis, we evaluated renal function before and after complex multi-organ resection that included TUU to determine whether TUU is safe and effective. METHODS: We retrospectively reviewed the charts of patients who underwent TUU between 1995 and 2011. Renal imaging studies performed before and after TUU were used to determine whether hydronephrosis was present in either kidney. Kidney function was assessed by measuring serum creatinine levels and calculating the estimated glomerular filtration rate (eGFR) before and after TUU. RESULTS: Twelve patients underwent TUU during multiorgan resection. Median follow-up time was 15 months. Three patients with cancer recurrence involving the TUU developed progressive hydronephrosis. Serum creatinine levels did not increase more than 0.5 mg/dl in any patient. Kidney function as assessed by eGFR was maintained in all patients (until the time of recurrence in the three patients with recurrence affecting the TUU). CONCLUSIONS: TUU during multi-organ resection for non-urothelial malignancy is safe and effective. Long-term renal function is maintained in the majority of patients.