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Conference Coverage AUA 2004 - Selected Abstracts AUA 2004 - Adrenal, Kidney, Ureteral Surgery Selected Abstracts
Conference Coverage AUA 2004 - Selected Abstracts AUA 2004 - Adrenal, Kidney, Ureteral Surgery Selected Abstracts |
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| AUA 2004 - Adrenal, Kidney, Ureteral Surgery Selected Abstracts |
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| Saturday, 08 May 2004 | |||||||||||||||||||||||||||||||||||||||||||||||
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ANTHROPOMETRIC CORRELATION OF URETERAL LENGTH WITH SURFACE BODY HABITUS PARAMETERS Saturday, May 08, 2004 Jaime Landman*, Caroline D Ames, David Lieber, Ramakrishna Venkatesh, St. Louis, MO; Richard Vanlangendock, New Orleans, LA; Sara Best, Stephen Lukasewycz, Manoj Monga, Minneapolis, MN. INTRODUCTION AND OBJECTIVE: The proper choice of ureteral stent length may help prevent stent deployment complications, and may increase stent tolerance by reducing stent associated pain and irritative voiding symptoms. Clinically, surgeon choice of stent length has been dependent on patient height. To date, there is no data correlating height or other body habitus parameters with ureteral length. As such we attempted to correlate body habitus parameters with ureteral length. METHODS: We prospectively measured UPJ to UVJ length in 42 patients by placement of a ruled 5Fr ureteral catheter. Ureteral length was correlated with patient height, weight, body mass index (BMI), and the length from shoulder to wrist (S-W), elbow to wrist (E-W), xyphoid to umbilicus (X-U), xyphoid to pubis (X-P), umbilicus to pubis (U-P), and anterior iliac spine to anterior iliac spine (AIS-AIS). Patients with pathology affecting ureteral length were excluded from study. Statistical analysis was performed with a multiple linear regression model with a stepwise selection of variables as well as paired t test. RESULTS: The mean right ureteral length (25.5 cm) was significantly shorter than the mean left ureteral length (26.3 cm) (p=0.03). Both the U-P (p<0.01) and the height (p=0.02) significantly correlated with the length of the right ureter. Both height and U-P were equally important in correlating to the length of the right ureter. Right ureteral length can be predicted from the model: length=9.1+(0.7)(height)+(0.25)(UP distance). For the left ureter, height (p=0.04) correlated significantly with length and U-P trended towards significance (p=0.10). CONCLUSIONS: Our preliminary data demonstrates laterality should be considered when considering stent length. Additionally, ureteral length is correlated with height and U-P distance. U-P distance may be an easier parameter to measure at the time of surgery. ENDOPYELOTOMY FOR URETEROPELVIC JUNCTION OBSTRUCTION: WHAT SUCCESS RATE CAN THE PATIENT EXPECT? Saturday, May 08, 2004 Hansjoerg Danuser*, Eduard Dobry, Fiona C Burkhard, Werner W Hochreiter, Urs E Studer, Bern, Switzerland. INTRODUCTION AND OBJECTIVE: Ureteropelvic junction obstruction (UPJO) can be corrected by open pyeloplasty, laparoscopy or various endopyelotomy techniques. It is important to know the outcome and risk factors of the different techniques in order to recommend the optimal procedure in relation to its invasiveness. Therefore we performed a logistic regression analysis to search for factors influencing the success of antegrade endopyelotomy. METHODS: 193 patients with 1° and 2° UPJO were treated with antegrade endopyelotomy. This series was now investigated using multivariate logistic regression analysis in an effort to define risk factors for success. The following parameter were implemented in the analysis: Age, sex, side, 1° or 2° etiology of UPJO, symptoms leading to the diagnosis (acute, permanent or intermittent pain, pyelonephritis, asymptomatic), volume of calyces, renal pelvis and both, total, as well as absolute and relative (%) split renal function, grade of obstruction, concomitant stones, stent size and stenting duration. Volume of the collecting system was measured using the PICA_88 computer software. Renal function was measured by diuretic renography with 131Iodine-hippuran. The size of the stent was either 14 or 27 french. RESULTS: Of all the factors considered only the volume of the collecting system p=0.0002) and the size of the stent (p=0.02) had a significant influence on the success rate. The function of the affected kidney showed a strong trend influencing the outcome but did not reach statistical significance (p=0.1). Based on the logistic regression analysis and provided the endopyelotomy is stented with a 27 instead a traditional 14 french stent the expected chance of success depending on collecting system volume and kidney function can be found in the following table: (Table1) CONCLUSIONS: The chance of endopyelotomy success depends mostly on the volume of the collecting system, the size of the stent and possibly the function of the affected kidney. The knowledge of the expected success rate makes it easier to discuss the different treatment options and to find the individually optimal procedure together with the patient.
COLD KNIFE RETROGRADE ENDOPYELOTOMY:18 YEARS EXPERIENCE AND FOLLOW- UP Saturday, May 08, 2004 Srinivas Rajamahanty*, Albert A Samadi, Majid Eshghi, Valhalla, NY. INTRODUCTION AND OBJECTIVE: In the management of ureteropelvic junction (UPJ) obstruction, treatment modalities range from open and laparoscopic pyeloplasty to retrograde and antegrade endoscopic techniques. Retrograde manipulation includes utilization of hot or cold knife, holmium laser, and rarely, balloon dilation. We report our 18 year experience and follow-up results with retrograde endopyelotomy with cold knife for the treatment of UPJ obstruction. METHODS: From January 1989 to October 2003, 155 patients (age range 20 months to 82 years) underwent cold knife retrograde endopyelotomy at our institution for primary and secondary UPJ obstruction. Fifteen patients had bilateral UPJ obstruction and 35 presented with simultaneous ipsilateral ureteral stricture. Other associated co-morbidities included stones, solitary kidneys, renal transplant. A13 French (Fr) Olympus endoureterotome or a11.5Fr Storz ureteroscope with a straight cold knife was used to perform retrograde endopyelotomy in the initial 31 cases. For the remainder (n = 124), a 11Fr Wolf dedicated endoureterotome with a semilunar blade was utilized. After endoscopic visualization of the stricture, a full thickness posterolateral incision was made at the UPJ. A 14/7 or 10/7 Fr endopyelotomy stent was placed at the conclusion and removed 4-6 weeks later. The follow-up protocol consisted of renal ultrasound at the first post-op visit, diuretic renal scan in 8-12 weeks, intravenous urogram (IVP) in 6 months, and repeat renal scan every 6 months for 2 years. RESULTS: All patients were discharged within 48 hours unless immediate lithotripsy were to be performed. In one case, guide wire access was lost and a temporary nephrostomy was placed. Post-operatively, one patient underwent percutaneous removal of the stent. Five patients required a second endopyelotomy for inadequate incision/recurrent scar. Four patients subsequently underwent open pyeloplasty: 2 for continuing chronic pain and 2 for massive redundancy of renal pelvis. One patient had urinary extravasation and needed foley drainage for 1 week. Another patient had migration of the ureteric stent and needed ureteroscopy for removal. There were no instances of post-op sepsis, bleeding, or deterioration of renal function. CONCLUSIONS: Cold knife retrograde endopyelotomy is a safe and effective therapeutic option for primary and secondary UPJ obstruction. With a success rate of 96.1% and its associated negligible long term complications, this procedure is durable and should be the initial step in treating UPJ obstruction.
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