MP42-05: Preoperative Imaging Does Not Predict Postoperative Outcomes in Patients Undergoing Robotic Reconstructive Surgery for Ureteral Stricture Disease
Introduction: The benefit of preoperative imaging prior to upper tract reconstruction is not well established. We sought to determine whether preoperative imaging affected the choice of procedure performed for ureteral stricture disease, its correlation to intraoperative stricture length, and postoperative outcomes. Methods: The Collaborative of Reconstructive Robotic Ureteral Surgery (CORRUS) database was queried for patients undergoing robotic ureteral reconstructive surgery from 2013-2021. Outcomes measured included intraoperative complications, 30-day complications, hardware-free status, and need for additional procedures. Chi-square testing and post-hoc testing with Bonferroni correction were used to determine if presence of preoperative radiographic stricture length estimate differed for procedure type. Mann-Whitney U testing was used to analyze time from diagnosis to reconstructive surgery. Binary logistic regression was performed for each measurement in patients with both measurements to see which was more predictive of outcomes. Chi-square testing was also used to detect differences in postoperative outcomes between surgery types and patients with and without preoperative imaging. Results: Of 395 patients with surgical estimates of stricture length, 216 (54.7%) had preoperative radiographic assessment of stricture length. Buccal ureteroplasty patients were more likely (73.3%) to have prior imaging, while pyeloplasty patients were less likely (38.0%, p<0.0001). The average surgical observation was 0.39 cm (±1.23) longer than radiographic assessment, and the Pearson correlation coefficient between intraoperative and radiographic stricture length measurements was +0.83. Those with prior imaging waited 2.5 months longer for surgery (p=0.044). The only significant predictive factor was preoperative stricture length on 30-day postoperative complications greater than Clavien-Dindo II, and this difference remained significant when controlling for procedure type (p=0.035, B=1.35). Patients with preoperative imaging were more likely to have intraoperative complications (2.8 vs 0%, p=0.034). Conclusions: There are few measures if any where preoperative radiographic imaging offers clinically meaningful diagnostic intervention, and it may lead to delay in offering definitive therapy. SOURCE OF Funding: None
