title: Delayed relief of ureteral obstruction is implicated in the long-term development of renal damage and arterial hypertension in patients with unilateral ureteral injury.
abstract: OBJECTIVE
  A delay in the diagnosis and treatment of iatrogenic obstructive ureteral injury is the most important prognostic factor for worse results in terms of lesion repair and renal function recovery. The role of the time of relief in determining the onset of renal failure and arterial hypertension in patients with obstructive ureteral injury was evaluated. In addition, we analyzed the prognostic value of the ratio of urinary epidermal growth factor-to-monocyte chemotactic peptide-1 in predicting long-term renal function deterioration.
  
  
  METHODS
  A total of 76 patients with obstructive ureteral injury and treated with reconstructive procedures were prospectively enrolled in the study. The ratio of epidermal growth factor-to-monocyte chemotactic peptide-1 was evaluated 4 weeks after the relief of obstruction. After a median followup of 60.8 months, estimated creatinine clearance and (99m)technetium-mercaptoacetyltriglycine scan were evaluated.
  
  
  RESULTS
  Within 2 weeks of the obstructive ureteral injury 36 patients underwent surgery for relief of obstruction while in the remaining 40 patients the surgery was performed after more than 2 weeks. Significant differences between the 2 groups were observed regarding mean mercaptoacetyltriglycine clearance of the obstructed kidney (p <0.0001), estimated creatinine clearance (p <0.001) and ratio of epidermal growth factor-to-monocyte chemotactic peptide-1 (p <0.0001). There was a direct correlation between mercaptoacetyltriglycine clearance and epidermal growth factor-to-monocyte chemotactic peptide-1 (rs = 0.78, p <0.0001). Patients with a time of relief greater than 2 weeks had a higher incidence of postoperative hypertension. On logistic regression the time of relief was the only significant variable predicting renal function deterioration (OR 1.49, p = 0.01).
  
  
  CONCLUSIONS
  Patients who experience delayed relief of obstructive ureteral injury have decreased long-term renal function as suggested by the lower values of estimated creatinine clearance and mercaptoacetyltriglycine clearance, and are at risk for hypertension or exacerbation of preexisting hypertension.
authors.affiliation: Urology, Andrology and Kidney Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy. giuseppe.lucarelli@inwind.it
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Lucarelli
authors.forename: Pasquale
authors.initials: P
authors.lastname: Ditonno
authors.forename: Carlo
authors.initials: C
authors.lastname: Bettocchi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Grandaliano
authors.forename: Loreto
authors.initials: L
authors.lastname: Gesualdo
authors.forename: Francesco Paolo
authors.initials: FP
authors.lastname: Selvaggi
authors.forename: Michele
authors.initials: M
authors.lastname: Battaglia
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure; D018932:Chemokine CCL2 / Q000097:blood; D002648:Child; D002675:Child, Preschool; D003401:Creatine / Q000097:blood; D018450:Disease Progression; D004815:Epidermal Growth Factor / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000379:methods*; D051437:Renal Insufficiency / Q000097:blood / Q000209:etiology* / Q000503:physiopathology; D013997:Time Factors; D014513:Ureter / Q000601:surgery*; D014517:Ureteral Obstruction / Q000097:blood / Q000150:complications* / Q000601:surgery; D013520:Urologic Surgical Procedures / Q000379:methods*; D055815:Young Adult
chemical_list: D015415:Biomarkers; D018932:Chemokine CCL2; D004815:Epidermal Growth Factor; D003401:Creatine