Bilateral Ileal Ureter Substitution For Patients With Ureteral Strictures Secondary To Gynecological Tumors Radiotherapy: A Multi-Center Retrospective Study

Background: The selection of treatment for bilateral ureteral strictures caused by radiotherapy in patients with gynecological tumors often brings great challenges to urologists. This study was designed to analyze the characteristics of radiation-induced ureteral strictures and summarize the surgical experience of bilateral ileal ureter substitution.Methods: We retrospectively collected the medical records of 18 patients between June 2010 and June 2019 who had a radiation-induced bilateral ureteral strictures. Time interval from radiotherapy to the discovery of ureteral stricture was categorized into short-term (less than 12 months) and long-term (over 12 months) groups. All patients received reverse "7" bilateral ileal ureteral substitution. Surgical success was defined as no restenosis, relief of symptoms, and improved/stabilized hydronephrosis.Results: The patients had been suffered from ureteral stricture for a median of 12 [2-106] months. The mean length of the left and right ureteral stricture was 9.6 +/- 2.6 and 8.8 +/- 3.2 cm, respectively. The mean length of the ileal graft was 29.1 +/- 7.4 cm. The mean operative time was 308.4 +/- 70.2 min, and the mean estimated blood loss was 254.7 +/- 166.2 mL. The postoperative hospital stays in the short-term group was significantly shorter than that in the long-term group (14.0 vs. 20.6 days, P=0.049). During a median follow-up time of 24.1 (4.5-71.9) months, the success rate was 94.4%. Eight minor complications and two major complications occurred in 7 patients.Conclusions: Bilateral ileal ureter substitution can be an effective strategy for radiation-induced ureteral stricture in patients with gynecological tumors.