title: Outcomes of distal ureteral reconstruction through reimplantation with psoas hitch, Boari flap, or ureteroneocystostomy for benign or malignant ureteral obstruction or injury.
abstract: OBJECTIVE
  To assess functional outcomes and complications of ureteroneocystotomies (UNCs) with or without psoas hitch or Boari flap in the reconstruction and repair of the ureter.
  
  
  METHODS
  We reviewed a consecutive series of patients that underwent open ureteral reconstruction for ureteral obstruction or injury. Underlying ureteral disorder, preoperative and postoperative estimated glomerular filtration rate (eGFR), and imaging studies regarding resolution of hydronephrosis were assessed.
  
  
  RESULTS
  A total of 100 ureteral reimplantations performed at our institution from November 1986 to August 2012 were identified: 24 primary ureteroneocystotomies, 58 with psoas hitch, and 18 with Boari flap. Median follow-up was 48.7 months (range 12.3-253 months). The most common underlying disorder was ureteral transitional cell cancer (TCC). Men were found to have more frequent underlying chronic ureteral disorders with chronic renal failure when compared to women. Ureteral stents were placed in 81% and were removed after a median of 33 days (range 2-161 days). Resolution of hydronephrosis was noted in 81% of the patients. The eGFR deteriorated significantly over time only in male patients (P = .001). Postoperative complications included stent-related dysuria, urinary tract infection, and contrast-extravasation on cystogram necessitating prolonged urethral and ureteral catheter drainage.
  
  
  CONCLUSIONS
  Excellent functional outcome without significant morbidity associated with ureteral reimplantation/reconstruction was achieved. Despite resolution of hydronephrosis in the vast majority of patients, those with chronic underlying ureteral disorder and renal failure did not show improvement of their eGFR.
authors: Department of Urology, Columbia University Medical Center, New York Presbyterian Hospital, New York, NY, USA. sw2510@columbia.edu
authors: Sven
authors: S
authors: Wenske
authors: Carl A
authors: CA
authors: Olsson
authors: Mitchell C
authors: MC
authors: Benson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000150:complications*; D003251:Constriction, Pathologic / Q000150:complications; D003559:Cystostomy; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D006869:Hydronephrosis / Q000209:etiology; D008297:Male; D008875:Middle Aged; D016658:Psoas Muscles / Q000601:surgery; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000503:physiopathology; D012092:Replantation / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D012737:Sex Factors; D015607:Stents / Q000009:adverse effects; D013524:Surgical Flaps; D014513:Ureter / Q000293:injuries / Q000473:pathology / Q000601:surgery*; D014516:Ureteral Neoplasms / Q000150:complications*; D014517:Ureteral Obstruction / Q000150:complications* / Q000209:etiology / Q000601:surgery*; D014519:Ureterostomy