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- W1976898160 abstract "Evaluate kidney autotransplantation (KAT) and ileal ureter substitution (IUS) practice and outcome as alternatives to indwelling ureteral stents for the management of long ureteral stenosis (US).We included all patients treated for US with KAT or IUS in 5 French university urology centers between 2010 and 2018. We excluded US due to urothelial carcinoma. Primary endpoint was the preservation of ipsilateral kidney and renal function without any urinary diversion.22 patients were treated with KAT (n = 8, 36.4%) and IUS (n = 14, 63.6%). Mean US length was 4.6 cm and 6 cm (P = 0.52) in KAT and IUS groups respectively. US etiologies were lithiasis, iatrogenic, retroperitoneal fibrosis or extrinsic compression. US level was varied. The surgery was described as difficult because of peritoneal adhesions or major peri-ureteral fibrosis. Mean operating time and hospital stay were 336 and 346 minutes (P = 0.87) and 8 and 15 days respectively (P = 0.001). Postoperative complications were mostly Clavien ≤ 2 (n = 17, 77.3%). Revision surgery was required in the KAT group in 3 cases (37.5%), for textiles, renal vein thrombosis and anastomotic leak, none in the IUS group. The mean follow-up was 15.7 months. All but one (in the KAT group) ipsilateral kidneys were preserved, without renal function impairment (Δcreat +2.1 vs. +2.4 μmol/l respectively, P = 0.67), nor urinary diversion.KAT and IUS are safe alternatives whose indication depends on surgeons expertise. Our study pointed out the scarcity of this practice suggesting the need to refer patients to expert centers.3.Évaluer la pratique et les résultats de l’autotransplantation rénale (ATR) et de l’urétéro-iléoplastie (UIP) dans la prise en charge des longues sténoses urétérales (SU) comme alternatives à la sonde JJ.Les patients traités pour SU par ATR ou UIP étaient inclus dans 5 centres d’urologie français entre 2010 et 2018. Les cancers urothéliaux étaient exclus. Le critère de jugement principal était la préservation du rein homolatéral et de la fonction rénale sans dérivation urinaire.22 patients étaient traités par ATR (n = 8, 36,4 %) et UIP (n = 14, 63,6 %). La longueur médiane de SU était de 4,6 cm et 6 cm (p = 0,52) respectivement. Les causes de SU étaient lithiasiques, iatrogéniques, la fibrose rétropéritonéale et la compression extrinsèque. La durée opératoire médiane et d’hospitalisation étaient respectivement de 336 et 346 minutes (p = 0,87) et 8 et 15 jours (p = 0,001). Les complications post-opératoires étaient principalement Clavien ≤ 2 (n = 17, 77,3 %). Nous avions 3 cas de reprise chirurgicale dans le groupe ATR (37,5 %) pour textile oublié, thrombose de la veine rénale et lâchage anastomotique, aucun dans le groupe UIP. Le suivi médian était de 15,7 mois. Tous les reins homolatéraux excepté un (dans le groupe ATR) ont été préservés, sans altération de la fonction rénale (Δcreat +2,1 vs +2,4 μmol/l respectivement, p = 0,67), ni dérivation urinaire.ATR et UIP sont des alternatives sûres dont l’indication dépend de l’expertise du chirurgien. Notre étude souligne la disparité de cette pratique et ainsi l’importance d’adresser les patients à un centre expert.3." @default.
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