Objectives. A radiation-induced ureteral stricture (RIUS) is a challenging condition in urologic surgery, and the optimal surgical strategy is still a matter of debate. The aim of this study was to report post-operative outcomes of minimally invasive management of this condition from a multi-institutional cohort. Methods. Data of patients with diagnoses of RIUS at five referral robotic centers between January 2017 and December 2022 were retrospectively analyzed. Pre-, intra- and post-operative variables were collected. Recurrence was defined as the presence of flank pain combined with imaging findings for obstruction, and requiring further management. Univariate and multivariate logistic regression models were built to identify predictors of ureteral stricture recurrence. Results. Fifty-three patients with a diagnosis of an RIUS were included. Primary pelvic malignancy was mostly cervical (42%). In 72% of cases (mostly mid-proximal and short strictures) endourological management was attempted, which was deemed successful in 74% of patients at stent removal. The endourology success rate at a median follow-up of 12 months was 59%. Twenty-five patients (47%) were scheduled for robotic surgery. The reconstructive techniques most often performed were end-to-end anastomosis (44%) and ureteral reimplantation (52%). Three low-grade Clavien-Dindo post-operative complications (12%) occurred. Robotic surgery was successful in all cases except one. Considering the entire cohort, eight patients (15%) developed recurrence at a median follow-up of 5 months. All patients with recurrence were managed by permanent drainage. A statistically significant improvement in eGFR with respect to baseline was found at a median follow-up of 12 months (p= 0.007). The univariate logistic regression model identified ureteral stricture length >2 cm (OR 6.4, 95% C.I. 1.1–36.9,p= 0.04) and concomitant chemotherapy (OR 8.9, 95% C.I. 1.6–49.9,p= 0.01) as predictors of recurrence. At multivariate analysis concomitant chemotherapy was confirmed as an independent predictor of recurrence (OR 7.8, 95% C.I. 1.3–49.0,p= 0.03). Conclusions. Endourological management of an RIUS is reasonable for short and mid-proximal ureteral strictures, while robotics is required in almost all the remaining cases. Up to 15% of recurrence develops within 6 months. Re-do reconstructive surgery is rarely performed, even in referral centers.
目的：放射性输尿管狭窄（RIUS）是泌尿外科手术中的一项棘手病症，其最佳手术策略目前仍存争议。本研究旨在通过多中心队列数据，报告该病症微创治疗的术后效果。方法：回顾性分析2017年1月至2022年12月期间五家机器人手术转诊中心诊断为RIUS的患者资料，收集术前、术中和术后相关变量。复发定义为出现腰痛合并影像学梗阻证据，且需进一步干预治疗。通过构建单因素及多因素逻辑回归模型，分析输尿管狭窄复发的预测因素。结果：共纳入53例RIUS患者。原发盆腔恶性肿瘤以宫颈癌为主（42%）。72%的病例（主要为中近段及短段狭窄）尝试了腔内泌尿外科治疗，其中74%患者在拔除支架时被视为治疗成功。中位随访12个月时腔内治疗成功率为59%。25例患者（47%）接受了机器人手术，最常用的重建技术为端端吻合术（44%）和输尿管再植术（52%）。术后发生3例低级别Clavien-Dindo并发症（12%）。除1例外，所有机器人手术均获成功。整体队列中，8例患者（15%）在中位随访5个月时出现复发，所有复发患者均采用永久性引流处理。中位随访12个月时，估算肾小球滤过率较基线值有统计学意义的改善（p=0.007）。单因素逻辑回归分析显示，输尿管狭窄长度>2 cm（OR 6.4，95% CI 1.1-36.9，p=0.04）及联合化疗（OR 8.9，95% CI 1.6-49.9，p=0.01）是复发的预测因素。多因素分析证实联合化疗是复发的独立预测因素（OR 7.8，95% CI 1.3-49.0，p=0.03）。结论：对于短段及中近段输尿管狭窄，RIUS的腔内治疗具有合理性，而其余绝大多数病例需采用机器人手术。约15%的复发发生在6个月内。即使在转诊中心，再次重建手术也较少实施。
肿瘤(癌症)患者之家