H.J. Chung

Retroperitoneoscopy-assisted nephroureterectomy for the management of upper urinary urothelial cancer

SummaryTraditionally, transitional cell carcinoma of the upper urinary tract needs a flank incision to remove the kidney and a lower abdominal incision to remove the ureter and bladder cuff. We report the surgical techniques and the initial clinical experience of retroperitoneoscopy-assisted nephroureterectomy for the treatment of this disease. Seven patients (6 males and 1 female; mean age 64.3 years, range 47-75 years) with the pre-operative diagnosis of upper urinary tract tumour underwent retroperitoneoscopy-assisted nephroureterectomy. The operation was performed first by retroperito-neoscopic nephrectomy, dissection of the lower third ureter and bladder cuff excision were performed with the traditional open method. The whole specimen with intact urothelium was removed through the lower abdominal incisional wound. We have successfully applied this technique for six patients with urothelial tumours. In one case, this technique had to be converted to open nephroureterectomy due to severe perirenal adhe...

Is Renal Function at the Tumor Side a Prognostic Factor in Ureteral Transitional Cell Carcinoma

OBJECTIVES To evaluate whether the ipsilateral renal function on the tumor side is a prognostic factor in transitional cell carcinoma (TCC) of the ureter. PATIENTS AND METHODS We retrospectively reviewed 129 consecutive patients with ureteral TCC between September 1973 and July 1993 at our hospital. There were 98 males and 31 females aged from 31 to 84 years (mean 64.9). Of them, 126 patients who received intravenous pyelography (IVP) were divided into 3 groups according to their radiological findings (group 1: nonvisualization of kidney at tumor side; group 2: hydronephrosis or hydroureter; group 3: no obstruction). Eighty patients receiving radionuclide (131I-hippuran) renal function test (RRFT) with available effective renal plasma flow (ERPF) were divided into 2 groups using ipsilateral ERPF 50 ml/min as a cutoff value (group 1: < 50 ml/min; group 2: > or = 50 ml/min). The mean survival of each group was estimated by the Kaplan-Meier method. RESULTS For patients receiving IVP, the mean survivals were 61.7, 99.7 and 83.8 months for groups 1, 2, and 3, respectively, and the differences between each 2 of the 3 groups were statistically significant (p < 0.05). For patients having RRFT, the mean survivals were 65.8 months for group 1 and 89.2 months for group 2 patients, and the difference between them was statistically significant (p < 0.05). When renal function, tumor number, grade, stage and type of treatment were analyzed using a multivariate method, only tumor stage was statistically significant as a prognostic factor. CONCLUSION Ipsilateral renal function at the tumor side is not a good prognostic factor for patients with ureteral TCC. However, when the stage of tumor is not available, renal function at the tumor side may provide an implication of the patients prognosis.

1033 Is preoperative UTI associated with increased risks of UTI after ureteroscopic lithotripsy? A nationwide population-based study

INTRODUCTION AND OBJECTIVES: The AUA offers Best Practice recommendations for antimicrobial prophylaxis for urologic surgeries. Despite these recommendations, the duration and class of antibiotics administered by urologists varies considerably. Improper administration of antibiotics may lead to increased costs, antibiotic resistance, predispose to hospital-acquired infections, and induce adverse drug reactions. We examined index urologic procedures and assessed compliance with AUA guidelines for antibiotic class and duration. METHODS: From the Premier Perspectives Database, we identified 53,450 patients undergoing radical prostatectomy (RP), 4,732 undergoing radical cystectomy (RC), 44,133 undergoing partial or radical nephrectomy (Nephx), 202,740 undergoing ureteroscopy/shock wave lithotripsy (SWL), 91,279 undergoing transurethral resection of the prostate (TURP), 21,469 undergoing percutaneous nephrostolithotomy (PCNL), 54,908 undergoing transvaginal surgery, 8,612 undergoing penile prosthesis (IPP), 11,487 patients undergoing brachytherapy, and 114,132 undergoing transurethral resection of bladder tumors (TURBT), based on ICD-9 procedure codes, from 2007-2012. Antibiotic class and duration were abstracted from patient billing data. Overall compliance with the AUA Best Practice Policy Statement was defined as receiving the appropriate antibiotic class (or antibiotic class combination) in conjunction with duration not extending beyond 24 hours post-surgery as detailed in the AUA Best Practice Policy Statement. RESULTS: Surgery-specific rates of compliance with AUA guidelines for selected procedures are listed in the Table. Correct antibiotic class was ordered in 67% of cases (range 34-80% for the different procedures). The correct duration (<24 hours post-surgery) was observed in 78% of cases overall (range 1.2-98%). Average length of antibiotic prophylaxis ranged from 1.1 days after brachytherapy to 10.3 days following RC. Overall compliance was 53.4%, ranging from 0.6% in RC to 68.3% in ESWL. Over time, compliance increased, ranging from a low of 46.2% overall compliance in 2007 to 58.9% overall compliance in 2012. CONCLUSIONS: The administration of antibiotic prophylaxis after surgery is subject to considerable variation. Increased compliance in recent years may relate to better dissemination of AUA guidelines. Efforts are needed to further improve standardization of antibiotic administration for common urologic procedures.