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MP54-01 DYNAMIC CONTRAST ENHANCED MRI (DCE-MRI) FOR EVALUATION OF THE EFFECTS OF RENO-PROTECTIVE DRUGS ON RENAL PERFUSION AFTER SWL
THE JOURNAL OF UROLOGYâ
e726
Vol. 195, No. 4S, Supplement, Sunday, May 8, 2016
V7-12 ROBOT-ASSISTED LAPAROSCOPIC PYELOURETEROSTOMY IN INFANTS WITH DUPLEX SYSTEMS WITH UPPER POLE URETERAL OBSTRUCTION: VARIATIONS IN DOUBLE J URETERAL STENTING TECHNIQUES Minki Baek*, Jason Au, Chester Koh, Houston, TX INTRODUCTION AND OBJECTIVES: Duplex systems can be associated with upper pole ureteral obstruction. When severe loss of function has occurred, extirpative treatment is often performed. However, if functioning renal tissue is present, urinary tract reconstruction is recommended. The expanded use of robot-assisted laparoscopic surgery has allowed the option of minimally invasive surgery for many reconstructive procedures. We describe our technique for robot-assisted laparoscopic pyeloureterostomy in infants with duplex systems with upper pole ureteral obstruction. METHODS: We applied our robot-assisted laparoscopic pyeloureterostomy technique in two female infants with right duplex systems with upper pole ureteral obstruction. Both patients were 6 - 7 months old. After the tortuous dilated upper pole ureter was dissected, the lower pole ureter was identified and the upper pole distal ureter was ligated and transected when vesicoureteral reflux was present. A Hitch stitch on the upper pole ureter or the lower pole renal pelvis allowed for better visualization for the renal pelvis incision or the pyeloureterostomy anastomosis. For the 1st case, we introduced the double J stent during the robotic operation and placed it in the recipient lower pole ureter. For the 2nd case, we inserted the double J stent during retrograde pyelography prior to the robotic procedure, and the proximal portion of the stent was placed across the anastomosis into the upper pole renal pelvis. RESULTS: Postoperatively, each of the patients were discharged on postoperative day 1 without any perioperative complications. The double J stent was removed on postoperative 1 month in both patients. The postoperative renal ultrasound at 3 months demonstrated marked improvement of the right upper pole hydronephrosis in both patients. CONCLUSIONS: Robotic-assisted laparoscopic pyeloureterostomy represents a minimally invasive option for upper tract reconstruction of duplex systems with upper pole ureteral obstruction even in infants. The double J ureteral stent can be placed at the beginning of or during the procedure. The ureteral stent can be placed in the lower pole ureter or across the anastomosis into the upper pole ureter.
2-4 hours and 1 week post-SWL to estimate renal perfusion and postSWL obstruction. The ratio between the intensity of the kidney and that of the aorta was used to evaluate renal perfusion changes. RESULTS: Between August 2012 and February 2015, DCEMRI studies were completed in 135 cases (66% were males) and mean age was 38+10 years. As shown in table 1, there were no significant changes after 2-4 hours but there was a significant decrease of renal perfusion at one week post-SWL in comparison to pre-SWL (P¼0.04). Temporary obstruction of the treated renal unit was observed in 44 patients (33%) one week post-SWL. On stratification of results in relation to obstruction at one week post-SWL, there was a significant decrease of the renal perfusion in patients with obstructed kidneys in comparison to pre-SWL (P¼0.003). These significant changes in renal perfusion were present in patients who received placebo or antioxidants, while there were no significant changes in patients who received losartan and verapamil. CONCLUSIONS: Losartan and verapamil could protect the kidney from the deleterious effects of post-SWL renal obstruction by maintaining adequate levels of renal perfusion during obstruction.
Source of Funding: None
Stone Disease: Shock Wave Lithotripsy
Source of Funding: This study was funded by Science and Technology Development Fund (#4228), Egypt
Moderated Poster Sunday, May 8, 2016
3:30 PM-5:30 PM
MP54-01 DYNAMIC CONTRAST ENHANCED MRI (DCE-MRI) FOR EVALUATION OF THE EFFECTS OF RENO-PROTECTIVE DRUGS ON RENAL PERFUSION AFTER SWL Ahmed EL-Nahas*, Mohamed Abo EL-Ghar, Diaa-Eldin Taha, Mohamed Elsaadany, Ahmed Elshal, Khaled Sheir, Mansoura, Egypt INTRODUCTION AND OBJECTIVES: This study was conducted for evaluation of the protective effects of antioxidants, verapamil and losartan on renal perfusion after SWL. METHODS: A randomized controlled trial was conducted for 160 patients with single renal stone. Patients were randomly allocated to one of 4 groups (control, antioxidants, losartan and verapamil). Dynamic contrast enhanced MRI (DCE-MRI) was performed before SWL,
MP54-02 DEVELOPMENT OF A NOVEL MAGNETIC RESONANCE IMAGING (MRI) ACQUISITION AND ANALYSIS WORKFLOW FOR THE QUANTIFICATION OF RENAL HEMORRHAGIC INJURY. Paul Territo, Rajash Handa*, Philip Blomgren, Lin Chen, Cynthia Johnson, Lie Jiang, Bret Connors, Gary Hutchins, Indianapolis, IN INTRODUCTION AND OBJECTIVES: Shock wave lithotripsy (SWL) has been used as an effective noninvasive treatment for nephrolithiasis; however, SWL can produce undesirable side effects in the target tissue resulting in renal hemorrhagic injury. The current gold standard for quantifying SWL-induced tissue damage is based on morphometric detection of renal hemorrhage in serial tissue sections from fixed kidneys. This methodology is time/labor intensive; requires expert knowledge of renal anatomy and image processing to generate accurate results and is tissue destructive. We sought to develop a nondestructive method that would permit rapid assessment of whole kidney
e726
Vol. 195, No. 4S, Supplement, Sunday, May 8, 2016
V7-12 ROBOT-ASSISTED LAPAROSCOPIC PYELOURETEROSTOMY IN INFANTS WITH DUPLEX SYSTEMS WITH UPPER POLE URETERAL OBSTRUCTION: VARIATIONS IN DOUBLE J URETERAL STENTING TECHNIQUES Minki Baek*, Jason Au, Chester Koh, Houston, TX INTRODUCTION AND OBJECTIVES: Duplex systems can be associated with upper pole ureteral obstruction. When severe loss of function has occurred, extirpative treatment is often performed. However, if functioning renal tissue is present, urinary tract reconstruction is recommended. The expanded use of robot-assisted laparoscopic surgery has allowed the option of minimally invasive surgery for many reconstructive procedures. We describe our technique for robot-assisted laparoscopic pyeloureterostomy in infants with duplex systems with upper pole ureteral obstruction. METHODS: We applied our robot-assisted laparoscopic pyeloureterostomy technique in two female infants with right duplex systems with upper pole ureteral obstruction. Both patients were 6 - 7 months old. After the tortuous dilated upper pole ureter was dissected, the lower pole ureter was identified and the upper pole distal ureter was ligated and transected when vesicoureteral reflux was present. A Hitch stitch on the upper pole ureter or the lower pole renal pelvis allowed for better visualization for the renal pelvis incision or the pyeloureterostomy anastomosis. For the 1st case, we introduced the double J stent during the robotic operation and placed it in the recipient lower pole ureter. For the 2nd case, we inserted the double J stent during retrograde pyelography prior to the robotic procedure, and the proximal portion of the stent was placed across the anastomosis into the upper pole renal pelvis. RESULTS: Postoperatively, each of the patients were discharged on postoperative day 1 without any perioperative complications. The double J stent was removed on postoperative 1 month in both patients. The postoperative renal ultrasound at 3 months demonstrated marked improvement of the right upper pole hydronephrosis in both patients. CONCLUSIONS: Robotic-assisted laparoscopic pyeloureterostomy represents a minimally invasive option for upper tract reconstruction of duplex systems with upper pole ureteral obstruction even in infants. The double J ureteral stent can be placed at the beginning of or during the procedure. The ureteral stent can be placed in the lower pole ureter or across the anastomosis into the upper pole ureter.
2-4 hours and 1 week post-SWL to estimate renal perfusion and postSWL obstruction. The ratio between the intensity of the kidney and that of the aorta was used to evaluate renal perfusion changes. RESULTS: Between August 2012 and February 2015, DCEMRI studies were completed in 135 cases (66% were males) and mean age was 38+10 years. As shown in table 1, there were no significant changes after 2-4 hours but there was a significant decrease of renal perfusion at one week post-SWL in comparison to pre-SWL (P¼0.04). Temporary obstruction of the treated renal unit was observed in 44 patients (33%) one week post-SWL. On stratification of results in relation to obstruction at one week post-SWL, there was a significant decrease of the renal perfusion in patients with obstructed kidneys in comparison to pre-SWL (P¼0.003). These significant changes in renal perfusion were present in patients who received placebo or antioxidants, while there were no significant changes in patients who received losartan and verapamil. CONCLUSIONS: Losartan and verapamil could protect the kidney from the deleterious effects of post-SWL renal obstruction by maintaining adequate levels of renal perfusion during obstruction.
Source of Funding: None
Stone Disease: Shock Wave Lithotripsy
Source of Funding: This study was funded by Science and Technology Development Fund (#4228), Egypt
Moderated Poster Sunday, May 8, 2016
3:30 PM-5:30 PM
MP54-01 DYNAMIC CONTRAST ENHANCED MRI (DCE-MRI) FOR EVALUATION OF THE EFFECTS OF RENO-PROTECTIVE DRUGS ON RENAL PERFUSION AFTER SWL Ahmed EL-Nahas*, Mohamed Abo EL-Ghar, Diaa-Eldin Taha, Mohamed Elsaadany, Ahmed Elshal, Khaled Sheir, Mansoura, Egypt INTRODUCTION AND OBJECTIVES: This study was conducted for evaluation of the protective effects of antioxidants, verapamil and losartan on renal perfusion after SWL. METHODS: A randomized controlled trial was conducted for 160 patients with single renal stone. Patients were randomly allocated to one of 4 groups (control, antioxidants, losartan and verapamil). Dynamic contrast enhanced MRI (DCE-MRI) was performed before SWL,
MP54-02 DEVELOPMENT OF A NOVEL MAGNETIC RESONANCE IMAGING (MRI) ACQUISITION AND ANALYSIS WORKFLOW FOR THE QUANTIFICATION OF RENAL HEMORRHAGIC INJURY. Paul Territo, Rajash Handa*, Philip Blomgren, Lin Chen, Cynthia Johnson, Lie Jiang, Bret Connors, Gary Hutchins, Indianapolis, IN INTRODUCTION AND OBJECTIVES: Shock wave lithotripsy (SWL) has been used as an effective noninvasive treatment for nephrolithiasis; however, SWL can produce undesirable side effects in the target tissue resulting in renal hemorrhagic injury. The current gold standard for quantifying SWL-induced tissue damage is based on morphometric detection of renal hemorrhage in serial tissue sections from fixed kidneys. This methodology is time/labor intensive; requires expert knowledge of renal anatomy and image processing to generate accurate results and is tissue destructive. We sought to develop a nondestructive method that would permit rapid assessment of whole kidney