Effect of ureteral rest on surgical outcomes in adults with ureteral stricture undergoing reconstruction: a propensity score matching study.

Abstract

Purpose: To investigate the effect of ureteral rest on outcomes of ureteral reconstruction (UR) and analyse the risk factors for postoperative recurrence of ureteral stricture.

Methods: A retrospective study was conducted on patients with ureteral strictures who underwent ureteral rest or did not undergo ureteral rest prior to UR using propensity score matching (PSM). Furthermore, univariate, and multivariate regression models were used to analyse the risk factors for the recurrence of ureteral stricture.

Results: A total of 261 patients were grouped according to whether they underwent ureteral rest. After PSM, two groups of 82 patients were selected for the comparative study. The ureteral rest group had a higher surgical success rate (96.34% vs 86.59%; P = 0.025) and a lower proportion of patients with estimated blood loss (EBL) > 100 ml (9.76% vs 23.17%; P = 0.021). Subgroup analysis showed that the patients with the history of ureteroscopy in ureteral rest group had a lower proportion of patients with EBL > 100 ml (6.98% vs 22.22%, P = 0.044) and higher surgical success rate (100.00% vs 86.67%, P = 0.040) compared to those with no ureteral rest. Multivariate logistic regression identified high BMI (OR = 1.19, P = 0.018), no ureteral rest (OR = 3.90, P = 0.019), a history of UR (OR = 4.59, P = 0.012), and American Society of Anesthesiologists (ASA) grade III (OR = 3.56, P = 0.031) as independent risk factors for stricture recurrence.

Conclusion: Preoperative ureteral rest facilitates stricture maturation, improving surgical success rate and reducing blood loss, particularly in patients with prior ureteral surgery. Furthermore, high BMI, no ureteral rest, history of UR, and ASA grade III are independent risk factors for stricture recurrence. Therefore, ureteral rest is recommended to enhance surgical outcomes.