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IP45-25 IMPACT OF PATIENT COMORBIDITIES AND RENAL FUNCTION ON FUNCTIONAL AND SURGICAL OUTCOMES AFTER URETERAL RECONSTRUCTION: A MULTI-INSTITUTIONAL ANALYSIS FROM THE TRAUMA AND UROLOGIC RECONSTRUCTION NETWORK OF SURGEONS
Abstract   Peer reviewed

IP45-25 IMPACT OF PATIENT COMORBIDITIES AND RENAL FUNCTION ON FUNCTIONAL AND SURGICAL OUTCOMES AFTER URETERAL RECONSTRUCTION: A MULTI-INSTITUTIONAL ANALYSIS FROM THE TRAUMA AND UROLOGIC RECONSTRUCTION NETWORK OF SURGEONS

Dhruv Puri, Nishant Garg, Shawn Grove, Sweta Parija, Kshitij Pandit, Anh Nguyen, Alex J. Vanni, Anna Saltman, Nejd Alsikafi, Bryan Voelzke, …
The Journal of urology, Vol.215(5S), p.e925
05/2026
DOI: 10.1097/01.JU.0001191548.79667.9d.25

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Abstract

INTRODUCTION AND OBJECTIVES: We evaluated the effect of common comorbidities, smoking, and CKD stage on renal recovery, drainage, or recurrence after ureteral reconstruction. METHODS: We retrospectively analyzed a multi-institutional cohort of 777 patients who underwent ureteral reconstruction. Demographic, clinical, and operative variables were extracted, including smoking status and comorbidities such as hypertension, diabetes, CAD, CKD, and history of malignancy. eGFR was recorded preop and at 3 months postop to calculate ΔGFR. Hydronephrosis improvement was defined as a decrease in SFU grade between baseline and 3-month imaging. Recurrence-free survival was assessed up to 12 months, defined by absence of radiographic or clinical evidence of obstruction requiring intervention. RESULTS: A total of 777 patients underwent ureteral reconstruction (mean age 52.3 ± 16.5 years, BMI 28.9 ± 7.1), of whom 51.9% were female. Mean follow-up was 13.5 months. Comorbidities included hypertension (37%), diabetes (non-insulin 10%, insulin-dependent 6.1%), CAD (8.1%), CKD ≥ stage 3 (19.6%), and history of malignancy (28%). Active smoking was reported in 12.2%, prior smoking in 23.6%, and never smoking in 63.5%. Renal function preservation and hydronephrosis improved across all patients, irrespective of comorbidities. Specifically postoperative improvement in hydronephrosis was substantial across all CKD stages (p<0.05). Active smokers demonstrated a higher 12-month recurrence rate (6.8%) compared to prior (2.1%) and never smokers (2.6%), with univariate cox regression showing increased recurrence (HR 3.85, 95% CI 1.33–11.11, p = 0.013). However, given the low overall recurrence rate (3.7%), this association did not remain statistically significant on multivariable analysis. CONCLUSIONS: Ureteral reconstruction resulted in improved drainage and preserved renal function across comorbidity and CKD groups. Despite significant medical comorbidities, patients did not experience higher failure rates, supporting reconstruction as a viable option in medically complex patients. Active smoking was associated with higher odds of recurrence on univariate analysis.

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