title: Delayed proximal ureteric stricture formation after complex partial nephrectomy.
abstract: OBJECTIVE
  •  To report and review our incidence of delayed ureteric stricture (US) after complex nephron-sparing surgery (NSS).
  
  
  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.
authors: Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA.
authors: Jose M
authors: JM
authors: Reyes
authors: Daniel J
authors: DJ
authors: Canter
authors: Mohit
authors: M
authors: Sirohi
authors: Jay
authors: J
authors: Simhan
authors: Marc C
authors: MC
authors: Smaldone
authors: Ervin
authors: E
authors: Teper
authors: Alexander
authors: A
authors: Kutikov
authors: David Y T
authors: DY
authors: Chen
authors: Robert G
authors: RG
authors: Uzzo
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects* / Q000379:methods; D009399:Nephrons / Q000601:surgery; D059351:Organ Sparing Treatments / Q000009:adverse effects*; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D014517:Ureteral Obstruction / Q000209:etiology*; D014548:Urinary Fistula / Q000209:etiology