The Experts below are selected from a list of 42180 Experts worldwide ranked by ideXlab platform
Jay D Raman - One of the best experts on this subject based on the ideXlab platform.
-
does the presence of Hydronephrosis on preoperative axial ct imaging predict worse outcomes for patients undergoing nephroureterectomy for upper tract urothelial carcinoma
Urologic Oncology-seminars and Original Investigations, 2011Co-Authors: Casey K Ng, Shahrokh F Shariat, Steven M Lucas, Aditya Bagrodia, Yair Lotan, Douglas S Scherr, Jay D RamanAbstract:Abstract Objectives Hydronephrosis at the time of diagnosis of bladder cancer is associated with advanced disease and is a predictor of poorer outcomes. There is, however, limited information addressing whether a similar relationship exists for upper-tract urothelial carcinoma (UTUC). We investigate the prognostic impact of Hydronephrosis on preoperative axial imaging on clinical outcomes after radical nephroureterectomy. Materials and Methods The records for 106 patients with UTUC who underwent radical nephroureterectomy at 2 medical centers were reviewed. Preoperative computed tomography (CT) images were evaluated for ipsilateral Hydronephrosis by radiologists blinded to clinical outcomes. Association of Hydronephrosis with pathologic features and oncologic outcomes after surgery was assessed. Results Sixty-seven men and 39 women with a median age of 69 years (range, 36 to 90) were evaluated. One-third of these patients had muscle invasive disease or greater (≥T2), 44% had high grade tumors, and 3% had lymph node (LN) metastases. At a median follow-up of 47 months (range, 1 to 164), 43% of patients experienced disease recurrence, 18% developed metastasis, and 12% died of their cancer. Thirty-nine patients (37%) had Hydronephrosis on preoperative axial imaging; 35% of these patients had ureteral tumors, and 27% had multifocal disease. The presence of Hydronephrosis was associated with advanced pathologic stage ( P = 0.03) and disease in the ureter (vs. renal pelvis) ( P = 0.007). Hydronephrosis was a predictor of non-organ confined disease on final pathology (hazard ratio [HR] 3.7, P = 0.01). On preoperative multivariable analysis controlling for age, gender, tumor location, ureteroscopic biopsy grade, and urinary cytology, Hydronephrosis was independently associated with cancer metastasis (HR 8.2, P = 0.02) and cancer-specific death (HR 12.1, P = 0.03). Conclusions Preoperative Hydronephrosis on axial imaging is associated with features of aggressive disease and predicts advanced pathologic stage for UTUC. Hydronephrosis can be a valuable prognostic tool for preoperative planning and counseling regarding disease outcomes.
Sheau-fang Yang - One of the best experts on this subject based on the ideXlab platform.
-
Concurrent Preoperative Presence of Hydronephrosis and Flank Pain Independently Predicts Worse Outcome of Upper Tract Urothelial Carcinoma
PloS one, 2015Co-Authors: Hsin-chih Yeh, Hau-chern Jan, Shu-pin Huang, Chia-chu Liu, Yung-chin Lee, Sheau-fang YangAbstract:Objectives To investigate the impact of preoperative Hydronephrosis and flank pain on prognosis of patients with upper tract urothelial carcinoma. Methods In total, 472 patients with upper tract urothelial carcinoma managed by radical nephroureterectomy were included from Kaohsiung Medical University Hospital Healthcare System. Clinicopathological data were collected retrospectively for analysis. The significance of Hydronephrosis, especially when combined with flank pain, and other relevant factors on overall and cancer-specific survival were evaluated. Results Of the 472 patients, 292 (62%) had preoperative Hydronephrosis and 121 (26%) presented with flank pain. Preoperative Hydronephrosis was significantly associated with age, hematuria, flank pain, tumor location, and pathological tumor stage. Concurrent presence of Hydronephrosis and flank pain was a significant predictor of non-organ-confined disease (multivariate-adjusted hazard ratio = 2.10, P = 0.025). Kaplan-Meier analysis showed significantly poorer overall and cancer-specific survival in patients with preoperative Hydronephrosis (P = 0.005 and P = 0.026, respectively) and in patients with flank pain (P < 0.001 and P = 0.001, respectively) than those without. However, only simultaneous Hydronephrosis and flank pain independently predicted adverse outcome (hazard ratio = 1.98, P = 0.016 for overall survival and hazard ratio = 1.87, P = 0.036 for and cancer-specific survival, respectively) in multivariate Cox proportional hazards models. In addition, concurrent presence of Hydronephrosis and flank pain was also significantly predictive of worse survival in patient with high grade or muscle-invasive disease. Notably, there was no difference in survival between patients with Hydronephrosis but devoid of flank pain and those without Hydronephrosis. Conclusion Concurrent preoperative presence of Hydronephrosis and flank pain predicted non-organ-confined status of upper tract urothelial carcinoma. When accompanied with flank pain, Hydronephrosis represented an independent predictor for worse outcome in patients with upper tract urothelial carcinoma.
Masahiro Jinzaki - One of the best experts on this subject based on the ideXlab platform.
-
preoperative Hydronephrosis grade independently predicts worse pathological outcomes in patients undergoing nephroureterectomy for upper tract urothelial carcinoma
The Journal of Urology, 2011Co-Authors: Eiji Kikuchi, Nobuyuki Tanaka, Akira Miyajima, Shuji Mikami, Masahiro JinzakiAbstract:Purpose: We analyzed the prognostic impact of Hydronephrosis grade on disease specific survival and evaluated whether Hydronephrosis grade could preoperatively predict worse pathological outcomes in cases of upper tract urothelial carcinoma treated surgically.Materials and Methods: We identified and retrospectively reviewed the records of 91 patients who were evaluated by multidetector computerized tomography and/or magnetic resonance imaging preoperatively, and treated with nephroureterectomy at our institution from 2000 to 2009. Ipsilateral Hydronephrosis was graded 0 to 4 by 2 urological radiologists blinded to clinical outcomes. We analyzed the associations between Hydronephrosis grade, and pathological findings and patient outcomes.Results: Preoperatively 67 patients (73.6%) had ipsilateral Hydronephrosis. Grade was 1 to 4 in 3 (3.3%), 17 (18.7%), 23 (25.3%) and 24 cases (26.4%), respectively. Higher Hydronephrosis grade was significantly associated with a ureteral tumor (p = 0.0307), higher pT stage...
Young Deuk Choi - One of the best experts on this subject based on the ideXlab platform.
-
grade of Hydronephrosis and tumor diameter as preoperative prognostic factors in ureteral transitional cell carcinoma
Urology, 2007Co-Authors: Kang Su Cho, Sung Joon Hong, Nam Hoon Cho, Young Deuk ChoiAbstract:OBJECTIVES To evaluate the clinical significance of the grade of Hydronephrosis and the tumor diameter in ureteral transitional cell carcinoma. METHODS From 1986 to 2004, the medical records of 104 patients who were treated with nephroureterectomy and diagnosed with ureteral transitional cell carcinoma were retrospectively reviewed. The correlation of the grade of Hydronephrosis and tumor diameter with the pathologic T stage was investigated. Also evaluated were the effects of the grade of Hydronephrosis and tumor diameter on the prognosis. RESULTS The grade of Hydronephrosis was grade 0 in 11 patients, grade 1 to 2 in 36, and grade 3 to 4 in 57. The tumor diameter measured on the transverse section of the computed tomography scan was less than 1.5 cm in 40 patients, 1.5 cm or greater but less than 2.5 cm in 37, and 2.5 cm or greater in 27 patients. Of the 57 patients with grade 3 to 4 Hydronephrosis, invasive tumor was found in 49 (86.0%). Of the 64 patients with a tumor diameter of 1.5 cm or greater, invasive tumor was found in 51 (79.7%). The grade of Hydronephrosis and the tumor diameter correlated with the T stage (P <0.001). In addition, the grade of Hydronephrosis (P = 0.022) and the tumor diameter (P = 0.008) had a significant influence on disease-specific survival. CONCLUSIONS The results of our study have demonstrated that the grade of Hydronephrosis and the tumor diameter correlate with the pathologic T stage and have a significant influence on prognosis. Thus, radical surgery is required for patients with severe Hydronephrosis or a large tumor diameter, rather than conservative surgery.
Kevin Campbell - One of the best experts on this subject based on the ideXlab platform.
-
Nonoperative Management of Unilateral Neonatal Hydronephrosis
The Journal of Urology, 1992Co-Authors: Stephen A. Koff, Kevin CampbellAbstract:AbstractWe followed nonoperatively 45 neonates with unilateral Hydronephrosis and suspected uretero-pelvic junction obstruction for 30 months, regardless of the degree of Hydronephrosis, shape of diuretic renogram washout curve or initial degree of functional impairment. Of the patients 30 had mild Hydronephrosis and no renal deterioration, while 15 had severe Hydronephrosis, an obstructed diuretic renogram and markedly decreased hydronephrotic kidney function. During followup percentage and absolute renal function rapidly increased in all patients, Hydronephrosis improved in 7 and contralateral compensatory hypertrophy did not develop in any. These findings help to define the natural history of untreated Hydronephrosis, suggest that many newborn kidneys with severe Hydronephrosis are not obstructed despite even profound initial decreases in renal function and demonstrate that traditional tests for diagnosing obstruction are inaccurate in this age group. Therefore, the methods for assessing obstruction an...
-
Nonoperative management of unilateral neonatal Hydronephrosis.
The Journal of urology, 1992Co-Authors: S A Koff, Kevin CampbellAbstract:We followed nonoperatively 45 neonates with unilateral Hydronephrosis and suspected ureteropelvic junction obstruction for 30 months, regardless of the degree of Hydronephrosis, shape of diuretic renogram washout curve or initial degree of functional impairment. Of the patients 30 had mild Hydronephrosis and no renal deterioration, while 15 had severe Hydronephrosis, an obstructed diuretic renogram and markedly decreased hydronephrotic kidney function. During followup percentage and absolute renal function rapidly increased in all patients, Hydronephrosis improved in 7 and contralateral compensatory hypertrophy did not develop in any. These findings help to define the natural history of untreated Hydronephrosis, suggest that many newborn kidneys with severe Hydronephrosis are not obstructed despite even profound initial decreases in renal function and demonstrate that traditional tests for diagnosing obstruction are inaccurate in this age group. Therefore, the methods for assessing obstruction and the indications for surgical intervention in these patients require reexamination.
