Yuval Bar-Yosef

Does information provided to men before a urodynamic study affect their expectation of pain

To evaluate the effect of a routine explanation provided to men on their expectation of pain associated with a urodynamic study (UDS).

Can Classic Bladder Exstrophy be Safely and Successfully Reconstructed at a Low Volume Center

PURPOSE Exstrophy reconstruction is challenging and requires expertise and experience. However, many patients are treated at low volume centers. We evaluated whether classic bladder exstrophy could be safely and successfully reconstructed at a low volume center. MATERIALS AND METHODS A total of 31 patients with classic bladder exstrophy were primarily treated at our low volume center during a 17-year period. A total of 22 patients underwent primary closure within 5 days of birth and 9 underwent delayed closure with osteotomy. Of the patients 29 underwent planned modern staged repair and 2 underwent attempted complete primary repair. RESULTS The bladder was successfully closed in all 31 children. All 22 newborns underwent primary bladder closure without osteotomy, including 4 with extremely small bladder plates. Bladder neck obstruction developed in 3 patients (10%), of whom 2 were treated successfully with transurethral dilation and 1 underwent open repair. Epispadias repair was successful in 12 of 15 patients undergoing the Cantwell-Ransley technique and in 2 of 4 undergoing complete primary repair. A total of 16 patients underwent bladder neck reconstruction, of whom 9 are awaiting appropriate age or capacity, 4 were lost to followup, 1 is continent after bladder closure alone and 2 underwent continent diversion (1 after failed bladder neck reconstruction). Of the 15 patients with at least 1 year of followup after bladder neck reconstruction 9 are continent day and night, 2 are continent only during the daytime and 4 are incontinent, for a 73% post-bladder neck reconstruction continence rate (11 of 15 patients). CONCLUSIONS Successful exstrophy reconstruction is achievable at a low volume center, with results comparable to those of high volume centers.

Endourological procedures and sexual dysfunction: a prospective multivariate analysis

Study Type – Therapy (case series)

A Novel Method for Re-Positioning Suboptimally Preoperatively Placed Nephrostomy Tubes for PCNL without Renal Re-Puncture

OBJECTIVE Nephrostomy tubes (NTs) inserted in emergency settings by interventional radiologists are frequently unsuitable for subsequent percutaneous nephrolithotomy (PCNL). We report a novel method of adjusting these NTs to be used as PCNL tracts and avoid renal repuncture. PATIENTS AND METHODS A retrospective search of 981 consecutive PCNLs performed in our institution between 2002 and 2017 identified all patients with preoperatively inserted NTs. The NTs unsuitable for PCNL were adjusted by a novel approach in which a 5-mm incision was made at the ideal puncture location (IPL) as indicated under fluoroscopic guidance. The preinserted NT was removed after passing a guidewire into the kidney. A dissector clamp was introduced through the entry wound of the removed NTs to bluntly dissect a retroperitoneal tunnel and pull out the distal tip of guidewire through the IPL, while its proximal segment was maintained in the kidney. The newly positioned guidewire was used for PCNL tract preparation without repuncturing the kidney. RESULTS The NTs were located in the mid calix, lower calix, and renal pelvis in 6 (26%), 13 (57%), and 4 (17%) cases, respectively. The NT was suitable for PCNL in 5 (22%) cases, a new renal access was performed in 3 (13%), and the novel adjustment approach was used in 15 (65%), all successfully. The place of entry was moved an average of 6 cm (range 47) and the angle between the tract axis and the calix axis was reduced by 65° in average. The procedure was done uneventfully in an average of 4 minutes. CONCLUSIONS The novel method of adjusting preoperatively inserted NTs for PCNL by repositioning their original entry location to the IPL offers the possibility of avoiding kidney repuncture. It is feasible, safe, and easy to implement, and it spares potential morbidity related to additional puncturing of the kidney.

MP78-11 POSITIVE PREDICTIVE VALUE OF CT UROGRAPHY FOR UPPER TRACT UROTHELIAL CARCINOMA DIAGNOSIS USING DIAGNOSTIC URETEROSCOPY AS THE REFERENCE STANDARD

INTRODUCTION AND OBJECTIVES: We reported the lack of therapeutic effect of lymphadenectomy on lower ureteral cancer (LUC). We further examined this mechanism by analyzing the recurrence pattern and factors influencing the outcome of LUC. METHODS: From January 1988 to September 2016, we performed radical nephroureterectomy for 83 patients with non-metastatic (clinically N0 M0) LUC at two Japanese institutes. The lower ureter was designated as located below the crossing of the common iliac artery. Metastatic sites were identified with radiological imaging studies or resected specimens. Regional nodes of LUC were identified as ipsilateral pelvic nodes below the aortic bifurcation, according to the description in our previous study. RESULTS: The mean age of the 83 patients was 71.2 years (range: 38e90 years), and the mean follow-up period was 48 months (range: 2e225 months). Radical nephroureterectomy was performed for 41 patients with right LUC and for 42 patients with left LUC. No significant difference was found in the patients who underwent templatebased lymphadenectomy (34% in the right and 36% in the left LUC, p1⁄40.88). The 5-year recurrence-free and cancer-specific survival rates were respectively 71.9% and 80.1% in the right LUC, and 50.6% and 62.7% in the left LUC. The difference was statistically significant (p1⁄40.02 and 0.03, respectively; Figure 1). The incidence of lymph node recurrence was even higher in the patients with left LUC (24%) than in those with right LUC (2%), and 60% of the lymph node recurrences occurred at the extraregional nodes in the left LUC. The multivariate analysis revealed that the factors that influenced cancer-specific survival were left ureteral tumors (hazard ratio [HR], 3.38; p1⁄40.02) and pathological stage T3 or higher (HR, 28.9; p1⁄40.002). Template-based lymphadenectomy or adjuvant chemotherapy was not a significant factor. CONCLUSIONS: This multi-institutional study shows a higher risk of extraregional nodes recurrence after nephroureterectomy in patients with left LUC, which is likely to be associated with worse oncological outcome of left LUC than right LUC. Template-based lymphadenectomy alone appears inadequate to improve patient survival in left LUC.