Health-related Quality of Life in Patients Undergoing Ileal Ureter Replacement for Extensive Ureteral Stricture: A Prospective Multi-institutional Study

We present the first longitudinal evaluation of health-related quality of life (HRQoL) following ileal ureter replacement (IUR). The results demonstrate significant improvements across multiple HRQoL domains within 12 mo after surgery. These findings confirm that IUR is an effective reconstructive option for complex ureteral strictures and support its role in restoring patient QoL, while highlighting the value of routine HRQoL assessment in clinical practice. Ileal ureter replacement (IUR) is the definitive management approach for extensive ureteral strictures (UrSs). Patients with UrS exhibit poor health-related quality of life (HRQoL). We conducted a long-term, multi-institutional evaluation of patients who underwent IUR to assess its durable safety and efficacy, as well as postoperative recovery of HRQoL. A prospective multicenter study (January 2020–July 2022) enrolled patients with an extensive UrS scheduled for IUR. Participants completed the 36-item Short Form Survey (SF-36) before and at 6 mo and 12 mo after surgery. A significant HRQoL improvement was defined as an increase of ≥10 points from baseline. Overall, 82 consecutive patients who underwent IUR were evaluated. The mean age of the cohort was 44.6 yr, and 52/82 (63.4%) were female. During median follow-up of 48 mo, one patient experienced radiographic reobstruction, and eight patients had Clavien-Dindo grade III–IV complications. There was a significant decrease in serum creatinine after surgery ( p < 0.001), with a minor increase observed at long-term follow-up ( p = 0.001). Some 45.5–79.2% of patients with poor HRQoL at baseline experienced significant improvements in different domains within 12 mo after surgery. Specifically, in comparison to baseline, 77 patients (93.9%) reported improvements at 6 mo (median improvements: physical function [PF] +15; role limitation due to physical health [RP] +87.5; bodily pain [BP] +10; general health perception [GH] +16; vitality [VT] +20; social function [SF] +25; role limitation due to emotional problems [RE] +100; mental health [MH] +12), and 79 (96.3%) reported improvements at 12 mo (PF +20; RP +100; BP +20; GH +18.5; VT +20; SF +25; RE +100; MH +12). The main limitations are the lack of a disease-specific questionnaire and the relatively short-term follow-up for HRQoL. Our study confirms the safety and efficacy of IUR for complex ureteral reconstruction. IUR was associated with favorable HRQoL improvements within 12 mo in most domains. We looked at changes in quality of life for patients who had surgery that used a piece of bowel tissue to repair a complex urinary blockage. Most patients reported a substantial improvement in their quality of life within 12 months. Our findings support use of this surgical procedure as an effective option when simpler treatments fail.