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Delayed Ureteral Complications following Complex Partial Nephrectomy
Jose Reyes, Daniel Canter, Jay Simhan, Marc Smaldone, Ervin Teper, Alexander Kutikov, David Y.T. Chen, Robert G Uzzo
Fox Chase Cancer Center, Philadelphia, PA

The recent AUA guidelines for management of the clinical T1 renal mass highlight the role of nephron sparing surgery (NSS). As detailed in the recent guidelines, nephron preservation is associated with a higher risk of major urologic complications. Ureteral complications including delayed ureteral stricture (DUS) formation after NSS is an uncommonly reported event. Here we report the incidence of DUS after complex NSS in order to identify the potential risk factors.
Materials & Methods:
Using our institutional kidney cancer database, we identified 720 patients who underwent NSS from January 1, 2000 through December 31, 2010 and identified eleven (1.5%) patients with a DUS. Patient and tumor characteristics were reviewed.
Median tumor size and R.E.N.A.L. Nephrometry score was 4.1 (2-7.2) cm and 10p (4p-11p), respectively. Eighty percent of tumors were located in the mid or lower pole of the kidney. Eight (72.7%) patients with DUS experienced a postoperative urinary leak. Two (18.2%) patients experienced a postoperative retroperitoneal hemorrhage with one of these patients requiring selective embolization. All ureteral strictures were in the upper third of the ureter and were diagnosed at a minimum of 10 weeks postoperatively (median 154 days, range 70-400).

Ureteral stricture formation is an uncommon and under reported event following complex NSS. Risk factors include tumor complexity, imperative indications, mid or lower pole location, postoperative urinary leak and hemorrhage. Although uncommon, postoperative DUS can occur after NSS for complex renal masses, necessitating patient counseling and diligent postoperative surveillance.

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