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Ureteroscopic manipulation in the reimplanted bilharzial ureter
577 URETEROSCOPIC BILHARZIAL
MANIPULATION
IN
THE
REIMPLANTED
URETER
Tawtiek E., Bassiuney El-Minia University,
M., Ezz-Eldin K., Hussein A., Abel-Hassan
H.
Jain,
& OBJECTIVES:
Evaluation
of
the
efficacy
of
to extract lower ureteral stones and migrated stents in the patients
having re-implanted
bilharrial
MATERIAL
& METHODS:
implantation
documented
ureters. Twenty-one
patients with prior ureterovesical
to be direct in (6) and anti-reflux
re-
(15)
nipple cuff in
patient. Seventeen patients had unilateral lower third ureteral stones and four had retained migrated stents. Ureteroscopic RESULTS:
Cystoscopy
manipulation
was done for all patients.
revealed different locations for neo-ureteral
relation to the original ureteral orifice (postero-medial lateral
with termination
in the two cases with posterolateral
of the procedure.
Stone migration
location of the occurred
in one
patient. Extraction of foreign body was successful in all patients. Reimplantation in the postero-medial
location was the easiest to manipulate
side. Those
posterolaterally
nifftcult
located
manipulation
orifices
was encountered
were
especially
difftcult
on right
to manipulate.
when ureters have been re-implanted
in
a direct method. CONCLUSIONS:
Ureteroscopy
has its role in reimplanted
ureters
being difficult. It is a time saving and a less traumatic procedure. neo-ureteral
orifice
greatly
influences
despite
The site of the
More studies are required
the success.
INTRODUCTION & OBJECTIVES: When standard diuresis renography is used in the investigation of upper urinary tract obstruction up to 15% of cases will show an equivocal response. These patients then require further investigation, traditionally with F-l 5 renography. The aim of this study was to investigate the usefulness of measuring renal output efficiency (OE) in the routine diagnosis of upper tract obstruction. MATERIAL & METHODS: In an initial validation study 100 adult renograms from archive were re-analysed using computer software to calculate OE, which is defined for an individual kidney as the total output up to time, expressed as a percentage of the total input up to that time. Objective criteria used for interpretation of OE were as follows: >78% no obstruction, 70-78% equivocal, ~70% obstructed. On completion of the validation study OE was incorporated mto routine clinical practice and a prospective analysis was performed.
in 11 patients
those with multiple stones (73%). Failure to negotiate the guide wire
up the ureter was encountered orifices
orifices in
in 13 patients, postero-
in 6). Stones were extracted
in 2, and antero-lateral
including
Cosgriff P.S.‘, Turner D.T.‘, Aslam M.‘, Morrish 0.’
‘Pilgrim Hospital, Urology, Leicester, United Kingdom, ‘Pilgrim Hospital, Medical Physics, Boston, United Kingdom, ‘Pilgrim Hospital, Radiology, Boston, United Kingdom
Urology, El-Minia, Egypt
INTRODUCTION ureteroscopy
578 CALCULATING THE RENAL OUTPUT EFFICIENCY REDUCES THE NEED FOR REPEAT RENOGRAPHY IN ADULTS WITH EQUIVOCAL UPPER URINARY TRACT OBSTRUCTION
to
confirm its role.
RESULTS: In the initial validation study 15 frusemide responses were deemed equivocal. OE converted 8 to negative, 5 to positive and 2 remained equivocal. Based on clinical information 7 of the 8 ‘equivocal to negative’ studies were judged true negative and 4 of the 5 ‘equivocal to positive’ studies were deemed true positive. Hence I l/l 5 (73%) of equivocal renogram results were correctly classified by the use of OE. The prospective study included 62 patients. Thirteen of these had equivocal standard renography and the use of OE provided a clear diagnosis in six (46%) of these cases. Four patients were deemed obstructed and these patients underwent pyeloplasty. CONCLUSIONS: This study has demonstrated that the use of OE can reduce the equivocal rate of standard F+15 renography. This should translate into a decreased need for confirmatory F-15 renograms and hence reduced cost, patient inconvenience, and radiation dose. It is the largest reported experience with this technique in adults and the second part of the study demonstrates applicability in routine clinical practice. We feel it should be routinely calculated in all patients referred for diuresis renography.
580
579 CONSERVATIVE
MANAGEMENT
OF
UPPER
URINARY
TRACT
TUMOURS
PROGNOSTIC FACTORS FOR SURVIVAL IN THE TRANSITIONAL CELL CARCINOMA OF THE UPPER URINARY TRACT Park SC., Kim Y J., Ahn H.J.
Cherasse A..Colombel M.. Dcligne E.. Badet L., Dubernard J.. Cielet A., Martin
.,
Asan Medical Center. Urology, Seoul, South Korea
n
Herriot
Univ.
Urology & Transplantation,
Hospttal.
INTRODUCTION
& OBJECTIVES:
term results of endoscopic
MATERIAL
of upper tract transitional
and preservation
& METHODS:
From January
Of the patients
resected
in a one time
percutaneous necessary
ncphroscopy
Immediate
insufficient
management
of upper tract cell
kidney. Tumours
by ureteroscopy
only
nephrectomy
local control
nephrostomy
were
in 31.5%,
in 29% or both in 8%; multiple
in 3 1.5% of cases using percutaneous
RESULTS: patients)
procedure
MATERIAL & METHODS: A retrospective study was conducted on 79 patients (69 men and IO women; mean age 59.6 years) with TCC of the upper urinary tract who
1990 to July 2001, 78 patients
26 (33%) had a solitary
treatment
by were
only.
was done in 6 cases for high-grade
(2 cases)
or patient’s
(3
choices (1 case). There
were 7 cases of benign tumours excluded from survival Kaplan Meier analysis. With a median recurrence
follow
up of 49.9 months,
the rate of kidney
preservation,
free rate, global survival and specific survival rates were respectively
Xl%, 68%, 17X0, and 84%.
CONCLUSIONS: cell carcinoma
Nephron is applicable
sparing percutaneous in a significant
defect
of upper urinary
tract TCC. In carefully
least
comparable
other
preservation
to
of renal function.
forms
of
management
of upper tract
number of patients with a filling selected
management
patients of
INTRODUCTION & OBJECTIVES: In transitional cell carcinoma (TCC‘) of the upper urinary tract, the number of reported series with greater than 50 cases has been limited. Pathologic stage and grade are well-known prognostic factors in TCC of the upper urinary tract. However the significance of the tumour location as a prognostic factor is controversial. We evaluated whether the tumour location had impact on the survival and the progression.
cell in regard
of renal function.
(mean age 64.2 years old) underwent endoscopic carcinoma.
France
We determined the immediate and long-
management
to rates of tumour recurrence
Lyon,
the results
tumour
control
are at and
underwent surgical treatment in Asan Medical Center from 1991 to 2001. Seventy-four patients underwent nephroureterectomy with bladder cuff excision, 3 patients nephroureterectomy with partial cystectomy, 2 patients ureterectomy with Psoas hitch procedure. The sites of involvement were: renal pelvis (n=44), ureter (n-35). The median follow-up period was 41. I months. Prognostic factors including age, sex, tumour stage, nodal status, grade and tumour location were analysed with response to patient survival and progression-free survival.
RESULTS: Overall five year survival and progression-free survival rates were 81% and 68% (n-79). According to the pathological stage, five year survival and progression-free survival rates were both 100% (n=l6) in pTaNOM0 group, 86% and 77% (n=18) in pTINOM0, 86% and 75% (n=lO) in pT2NOMO group, 73% and 71% (n=22) in pT3NOMO group, 75% and 20% (n=lO) in pTa4N+MO group, and both 33% (n=3) in pTa-4NO-IMl group, respectively. According to the location, 5 year survival and progression-free survival rates were 94% and 82% (n=44) in renal pelvis tumour, 61% and 31% (n=35) in ureter tumour (p=O.O04, p=O.OOO, respectively). According to the grade system, 5 year survival and progression-free survival rates were both 100% (n=6) in grade I disease, 85% and 77% (n=40) in grade 2 disease, 70% and 48% (n=31) in grade 3 disease (p=O.O40, p=O.O16, respectively). In the univariate analysis, TNM stage, grade and tumour location had significant impact on survivaland progression-free survival of the patients while age and sex had no influence on survival and progressionfree survival of them in the univariate analysis. Tumour location was the only significant predictor of overall survival and progression-free survival in the multivariate analysis (p=O.O30. p=O.OOl, respectively). CONCLUSIONS: Tumour location was the most significant factor in umvariate analysis and was the only significant factor in multivariate analysis. The presence of the turnour in the ureter was significantly associated with a poorer prognosis compared to the tumour m the renal pelvis.
European
Urology
Supplements
2 (2003) No. 1, pp. 147
MANIPULATION
IN
THE
REIMPLANTED
URETER
Tawtiek E., Bassiuney El-Minia University,
M., Ezz-Eldin K., Hussein A., Abel-Hassan
H.
Jain,
& OBJECTIVES:
Evaluation
of
the
efficacy
of
to extract lower ureteral stones and migrated stents in the patients
having re-implanted
bilharrial
MATERIAL
& METHODS:
implantation
documented
ureters. Twenty-one
patients with prior ureterovesical
to be direct in (6) and anti-reflux
re-
(15)
nipple cuff in
patient. Seventeen patients had unilateral lower third ureteral stones and four had retained migrated stents. Ureteroscopic RESULTS:
Cystoscopy
manipulation
was done for all patients.
revealed different locations for neo-ureteral
relation to the original ureteral orifice (postero-medial lateral
with termination
in the two cases with posterolateral
of the procedure.
Stone migration
location of the occurred
in one
patient. Extraction of foreign body was successful in all patients. Reimplantation in the postero-medial
location was the easiest to manipulate
side. Those
posterolaterally
nifftcult
located
manipulation
orifices
was encountered
were
especially
difftcult
on right
to manipulate.
when ureters have been re-implanted
in
a direct method. CONCLUSIONS:
Ureteroscopy
has its role in reimplanted
ureters
being difficult. It is a time saving and a less traumatic procedure. neo-ureteral
orifice
greatly
influences
despite
The site of the
More studies are required
the success.
INTRODUCTION & OBJECTIVES: When standard diuresis renography is used in the investigation of upper urinary tract obstruction up to 15% of cases will show an equivocal response. These patients then require further investigation, traditionally with F-l 5 renography. The aim of this study was to investigate the usefulness of measuring renal output efficiency (OE) in the routine diagnosis of upper tract obstruction. MATERIAL & METHODS: In an initial validation study 100 adult renograms from archive were re-analysed using computer software to calculate OE, which is defined for an individual kidney as the total output up to time, expressed as a percentage of the total input up to that time. Objective criteria used for interpretation of OE were as follows: >78% no obstruction, 70-78% equivocal, ~70% obstructed. On completion of the validation study OE was incorporated mto routine clinical practice and a prospective analysis was performed.
in 11 patients
those with multiple stones (73%). Failure to negotiate the guide wire
up the ureter was encountered orifices
orifices in
in 13 patients, postero-
in 6). Stones were extracted
in 2, and antero-lateral
including
Cosgriff P.S.‘, Turner D.T.‘, Aslam M.‘, Morrish 0.’
‘Pilgrim Hospital, Urology, Leicester, United Kingdom, ‘Pilgrim Hospital, Medical Physics, Boston, United Kingdom, ‘Pilgrim Hospital, Radiology, Boston, United Kingdom
Urology, El-Minia, Egypt
INTRODUCTION ureteroscopy
578 CALCULATING THE RENAL OUTPUT EFFICIENCY REDUCES THE NEED FOR REPEAT RENOGRAPHY IN ADULTS WITH EQUIVOCAL UPPER URINARY TRACT OBSTRUCTION
to
confirm its role.
RESULTS: In the initial validation study 15 frusemide responses were deemed equivocal. OE converted 8 to negative, 5 to positive and 2 remained equivocal. Based on clinical information 7 of the 8 ‘equivocal to negative’ studies were judged true negative and 4 of the 5 ‘equivocal to positive’ studies were deemed true positive. Hence I l/l 5 (73%) of equivocal renogram results were correctly classified by the use of OE. The prospective study included 62 patients. Thirteen of these had equivocal standard renography and the use of OE provided a clear diagnosis in six (46%) of these cases. Four patients were deemed obstructed and these patients underwent pyeloplasty. CONCLUSIONS: This study has demonstrated that the use of OE can reduce the equivocal rate of standard F+15 renography. This should translate into a decreased need for confirmatory F-15 renograms and hence reduced cost, patient inconvenience, and radiation dose. It is the largest reported experience with this technique in adults and the second part of the study demonstrates applicability in routine clinical practice. We feel it should be routinely calculated in all patients referred for diuresis renography.
580
579 CONSERVATIVE
MANAGEMENT
OF
UPPER
URINARY
TRACT
TUMOURS
PROGNOSTIC FACTORS FOR SURVIVAL IN THE TRANSITIONAL CELL CARCINOMA OF THE UPPER URINARY TRACT Park SC., Kim Y J., Ahn H.J.
Cherasse A..Colombel M.. Dcligne E.. Badet L., Dubernard J.. Cielet A., Martin
.,
Asan Medical Center. Urology, Seoul, South Korea
n
Herriot
Univ.
Urology & Transplantation,
Hospttal.
INTRODUCTION
& OBJECTIVES:
term results of endoscopic
MATERIAL
of upper tract transitional
and preservation
& METHODS:
From January
Of the patients
resected
in a one time
percutaneous necessary
ncphroscopy
Immediate
insufficient
management
of upper tract cell
kidney. Tumours
by ureteroscopy
only
nephrectomy
local control
nephrostomy
were
in 31.5%,
in 29% or both in 8%; multiple
in 3 1.5% of cases using percutaneous
RESULTS: patients)
procedure
MATERIAL & METHODS: A retrospective study was conducted on 79 patients (69 men and IO women; mean age 59.6 years) with TCC of the upper urinary tract who
1990 to July 2001, 78 patients
26 (33%) had a solitary
treatment
by were
only.
was done in 6 cases for high-grade
(2 cases)
or patient’s
(3
choices (1 case). There
were 7 cases of benign tumours excluded from survival Kaplan Meier analysis. With a median recurrence
follow
up of 49.9 months,
the rate of kidney
preservation,
free rate, global survival and specific survival rates were respectively
Xl%, 68%, 17X0, and 84%.
CONCLUSIONS: cell carcinoma
Nephron is applicable
sparing percutaneous in a significant
defect
of upper urinary
tract TCC. In carefully
least
comparable
other
preservation
to
of renal function.
forms
of
management
of upper tract
number of patients with a filling selected
management
patients of
INTRODUCTION & OBJECTIVES: In transitional cell carcinoma (TCC‘) of the upper urinary tract, the number of reported series with greater than 50 cases has been limited. Pathologic stage and grade are well-known prognostic factors in TCC of the upper urinary tract. However the significance of the tumour location as a prognostic factor is controversial. We evaluated whether the tumour location had impact on the survival and the progression.
cell in regard
of renal function.
(mean age 64.2 years old) underwent endoscopic carcinoma.
France
We determined the immediate and long-
management
to rates of tumour recurrence
Lyon,
the results
tumour
control
are at and
underwent surgical treatment in Asan Medical Center from 1991 to 2001. Seventy-four patients underwent nephroureterectomy with bladder cuff excision, 3 patients nephroureterectomy with partial cystectomy, 2 patients ureterectomy with Psoas hitch procedure. The sites of involvement were: renal pelvis (n=44), ureter (n-35). The median follow-up period was 41. I months. Prognostic factors including age, sex, tumour stage, nodal status, grade and tumour location were analysed with response to patient survival and progression-free survival.
RESULTS: Overall five year survival and progression-free survival rates were 81% and 68% (n-79). According to the pathological stage, five year survival and progression-free survival rates were both 100% (n=l6) in pTaNOM0 group, 86% and 77% (n=18) in pTINOM0, 86% and 75% (n=lO) in pT2NOMO group, 73% and 71% (n=22) in pT3NOMO group, 75% and 20% (n=lO) in pTa4N+MO group, and both 33% (n=3) in pTa-4NO-IMl group, respectively. According to the location, 5 year survival and progression-free survival rates were 94% and 82% (n=44) in renal pelvis tumour, 61% and 31% (n=35) in ureter tumour (p=O.O04, p=O.OOO, respectively). According to the grade system, 5 year survival and progression-free survival rates were both 100% (n=6) in grade I disease, 85% and 77% (n=40) in grade 2 disease, 70% and 48% (n=31) in grade 3 disease (p=O.O40, p=O.O16, respectively). In the univariate analysis, TNM stage, grade and tumour location had significant impact on survivaland progression-free survival of the patients while age and sex had no influence on survival and progressionfree survival of them in the univariate analysis. Tumour location was the only significant predictor of overall survival and progression-free survival in the multivariate analysis (p=O.O30. p=O.OOl, respectively). CONCLUSIONS: Tumour location was the most significant factor in umvariate analysis and was the only significant factor in multivariate analysis. The presence of the turnour in the ureter was significantly associated with a poorer prognosis compared to the tumour m the renal pelvis.
European
Urology
Supplements
2 (2003) No. 1, pp. 147