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Anil Kapoor - One of the best experts on this subject based on the ideXlab platform.
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TERMINAL LOOP CUTANEOUS Ureterostomy IN RENAL TRANSPLANTATION: AN UNDER UTILIZED URINARY DIVERSION TECHNIQUE
The Journal of urology, 2005Co-Authors: Shian Yiu Tsai, Chiu Yen M Chang, Kevin Piercey, Anil KapoorAbstract:ABSTRACT Purpose: We evaluated the effectiveness of terminal loop cutaneous Ureterostomy as a means of urinary drainage in kidney transplant recipients during a 20-year period. Materials and Methods: Five cadaveric and 2 living related patients underwent kidney transplantation with terminal loop cutaneous Ureterostomy between 1984 and 2004. These patients had no usable bladder or they were not suitable candidates for intermittent catheterization. Results: Followup was 20 months to 17 years. One patient underwent stomal revision 5 months after renal transplantation. Current serum creatinine 4 years later was 166 μmol/l. The remaining 6 patients had no evidence of ureteral obstruction and rarely had bacteriuria or urinary tract infections. Four patients had a functioning allograft with normal serum creatinine. One patient died with a normally functioning allograft and the remaining patient lost his graft due to chronic rejection. No patient in this series lost the graft due to a urological cause. Overall outcomes included excellent allograft function with minimal infection or stomal stenotic complications. Conclusions: Terminal loop cutaneous Ureterostomy is a simple, safe and alternative means of urinary diversion in patients with renal transplant and a defunctionalized lower urinary tract.
John N. Wettlaufer - One of the best experts on this subject based on the ideXlab platform.
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TransureteroUreterostomy and Terminal Loop Cutaneous Ureterostomy in Advanced Pelvic Malignancies
The Journal of urology, 1991Co-Authors: J. Brantley Thrasher, John N. WettlauferAbstract:AbstractTransureteroUreterostomy was combined with terminal loop cutaneous Ureterostomy, without complications, in 8 patients with advanced pelvic malignancy and a poor prognosis. Urinary diversion was palliative in all patients and followed pelvic exenteration in 4, debulking of pelvic tumor in 2 and radical cystectomy in 1, while 1 had inoperable bladder cancer. All patients had at least unilateral hydroureteronephrosis preoperatively. In each case a postoperative excretory urogram revealed significant improvement of the hydroureteronephrosis and the serum creatinine improved or stabilized. No patient had ureteral stomal stenosis or retraction. Mean survival was 5 months, with the longest survival being 1 year. TransureteroUreterostomy in conjunction with terminal loop cutaneous Ureterostomy is an effective technique of urinary diversion in selected patients with a poor prognosis and advanced pelvic malignancy, decreasing operative time while avoiding the morbidity associated with a ureterointestinal op...
Shian Yiu Tsai - One of the best experts on this subject based on the ideXlab platform.
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TERMINAL LOOP CUTANEOUS Ureterostomy IN RENAL TRANSPLANTATION: AN UNDER UTILIZED URINARY DIVERSION TECHNIQUE
The Journal of urology, 2005Co-Authors: Shian Yiu Tsai, Chiu Yen M Chang, Kevin Piercey, Anil KapoorAbstract:ABSTRACT Purpose: We evaluated the effectiveness of terminal loop cutaneous Ureterostomy as a means of urinary drainage in kidney transplant recipients during a 20-year period. Materials and Methods: Five cadaveric and 2 living related patients underwent kidney transplantation with terminal loop cutaneous Ureterostomy between 1984 and 2004. These patients had no usable bladder or they were not suitable candidates for intermittent catheterization. Results: Followup was 20 months to 17 years. One patient underwent stomal revision 5 months after renal transplantation. Current serum creatinine 4 years later was 166 μmol/l. The remaining 6 patients had no evidence of ureteral obstruction and rarely had bacteriuria or urinary tract infections. Four patients had a functioning allograft with normal serum creatinine. One patient died with a normally functioning allograft and the remaining patient lost his graft due to chronic rejection. No patient in this series lost the graft due to a urological cause. Overall outcomes included excellent allograft function with minimal infection or stomal stenotic complications. Conclusions: Terminal loop cutaneous Ureterostomy is a simple, safe and alternative means of urinary diversion in patients with renal transplant and a defunctionalized lower urinary tract.
Chul Jang Kim - One of the best experts on this subject based on the ideXlab platform.
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Diagnostic Criteria for Stomal Obstruction of Tubeless Cutaneous Ureterostomy by Use of 99mTc-Mercaptoacetyltriglycine Diuretic
2016Co-Authors: Reconstructive Urology, Chul Jang Kim, Shigehisa Kubota, Ryosuke MuraiAbstract:Purpose: To evaluate 99mTc-mercaptoacetyltriglycine diuretic renograms for diagnos-ing stomal obstruction in tubeless cutaneous Ureterostomy. Materials and Methods: Cutaneous Ureterostomy was performed in 29 patients (56 re-nal units) with a minimum follow-up period of 12 months. Stomal obstruction was eval-uated with 99mTc-mercaptoacetyltriglycine diuretic renography 3 months after surgery. Regions of interest were drawn that completely encircled and snugly fit the kidney, renal pelvis, and ureter. The data analyses were performed with half-times to tracer clearance following furosemide (0.5 mg/kg) administration. Results: The mean half-times to tracer clearance were 6.90±6.30, 5.25±4.29, and 8.75±7.63 minutes in the total, ipsilateral, and contralateral kidneys, respectively, in side relationships between the ureter and the stoma. There were significant differences between the ipsilateral and contralateral kidneys in the mean half-time to tracer clear-ance (p=0.038). Forty-eight renal units (85.7%) had a half-time to tracer clearance of less than 15 minutes, and all 48 renal units had no hydronephrosis. On the other hand, 5 renal units (8.9%) had a half-time to tracer clearance of more than 20 minutes, and these 5 renal units required the insertion of stent catheters or became atrophic. Conclusions: 99mTc-mercaptoacetyltriglycine diuretic renography was very useful for diagnosing stomal obstruction of tubeless cutaneous Ureterostomy. The upper limit of the half-time to tracer clearance for unobstructed systems was 15 minutes, which al-lowed for the confident exclusion of stomal obstruction in tubeless cutaneous Ureterostomy
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Diagnostic Criteria for Stomal Obstruction of Tubeless Cutaneous Ureterostomy by Use of 99mTc-Mercaptoacetyltriglycine Diuretic Renography
Korean journal of urology, 2013Co-Authors: Chul Jang Kim, Shigehisa Kubota, Ryosuke MuraiAbstract:Purpose To evaluate 99mTc-mercaptoacetyltriglycine diuretic renograms for diagnosing stomal obstruction in tubeless cutaneous Ureterostomy.
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Evaluations for Hydronephrosis After the Establishment of Tubeless Cutaneous Ureterostomy
Korean journal of urology, 2013Co-Authors: Chul Jang Kim, Taichi Sano, Ryosuke MuraiAbstract:Purpose: To investigate hydronephrosis after the establishment of tubeless cutaneous Ureterostomy by using our definition of the tubeless condition and our indications for catheter insertion. Materials and Methods: Twenty-eight (54 renal units) patients with both establishment of tubeless cutaneous Ureterostomy 3 months after surgery and at least 12 months of follow-up were investigated in this study. The 4-grade system was used to evaluate the hydronephrosis. The definition of the tubeless condition in cutaneous Ureterostomy was as follows: 1) the catheter stent is not placed in the renal pelvis through the stoma, 2) the grade of hydronephrosis is less than 3, and 3) the kidney is functioning. Indications for catheter insertion after the establishment of tubeless cutaneous Ureterostomy were as follows: 1) difficulty in curing acute pyelonephritis by drug treatments, 2) flank pain due to hydronephrosis, or 3) increase in the grade of hydronephrosis. Results: The follow-up period was 12 to 78 months (average, 40.5±22.1 months). After the establishment of tubeless cutaneous Ureterostomy, 6 of 54 renal units (11.1%) were eligible for catheter insertion. The catheter insertion was performed in 4 renal units. Another 2 renal units were followed up without intervention, and they gradually became atrophic. The renal functions were preserved in the other 52 renal units. Conclusions: Our results suggest that our definition of the tubeless condition and our indications for catheter insertion would be useful for the evaluation and management of hydronephrosis after establishment of tubeless cutaneous Ureterostomy.
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Evaluation of hydronephrosis with tubeless cutaneous Ureterostomy using Tc-99m MAG3 diuretic renography.
Clinical nuclear medicine, 2009Co-Authors: Chul Jang Kim, Kazuyoshi Johnin, Keita Takimoto, Keiji Tomita, Takashi Osafune, Nobuyuki Nishikawa, Yusaku OkadaAbstract:PURPOSE To assess hydronephrosis of tubeless cutaneous Ureterostomy using Tc-99m mercaptoacetyltriglycine (MAG3) diuretic renogram. MATERIALS AND METHODS Cutaneous Ureterostomy with a unilateral stomal creation was performed in 15 patients (27 renal units) with a minimum follow-up period of 6 months. Stomal obstruction was evaluated with Tc-99m MAG3 diuretic renography 3 months after the surgery. The data analyses were performed with half-times to tracer clearance (T1/2) after furosemide (0.5 mg/kg) administration. RESULTS T1/2 means were 7.27 +/- 7.11, 5.69 +/- 4.63, and 8.96 +/- 8.37 minutes for total, ipsilateral, and contralateral kidneys, respectively, in side relationships between ureter and stoma. There were no statistical differences among the groups. Six months after the surgery, of 26 renal units (96.3%) that had achieved a tubeless condition, and 25 renal units (92.6%) had no hydronephrosis. T1/2 was within 20 minutes in these 25 renal units, and of 25 renal units 23 (92%) revealed less than 15 minutes in T1/2, suggesting that the upper limit of T1/2 for nonobstructed systems after construction of a cutaneous Ureterostomy might be 15 minutes. Mild hydronephrosis without the need for intervention was present in 1 renal unit (T1/2, 31.70 minutes). Catheterization was performed in one renal unit (T1/2, 21.04 minutes) due to acute pyelonephritis and persistence of grade 2 hydronephrosis 5 months after the surgery. Only these 2 renal units showed more than 20 minutes in T1/2, resulting in an obstructive pattern on diuretic renography. CONCLUSION Tc-99m MAG3 diuretic renography with T1/2 assessment is useful to evaluate stomal stenosis in tubeless cutaneous Ureterostomy.
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Simple technique for improving tubeless cutaneous Ureterostomy.
Urology, 2005Co-Authors: Chul Jang Kim, Yoshihiko Wakabayashi, Yuji Sakano, Kazuyoshi Johnin, Tatsuhiro Yoshiki, Yusaku OkadaAbstract:Abstract Introduction Cutaneous Ureterostomy is the simplest and safest method of all permanent urinary diversions. However, the procedure does carry a risk of stomal stenosis. We describe a simple technique for improving tubeless cutaneous Ureterostomy. Technical Considerations Between June 1991 and June 2003, the Toyoda cutaneous Ureterostomy was performed in 54 patients (102 renal units) with a minimum of 6 months of follow-up. Since 1998, we introduced a new technique, consisting of fixation between the anterior and posterior rectus sheath by four interrupted sutures to maintain the stability of the abdominal wall tunnel for the ureters. The ureteral patency rate was reviewed. Of the 79 renal units (77.5%) that achieved a tubeless condition, 70 (68.6%) had no hydronephrosis. The catheter-free rate improved from 60.5% (26 of 43 renal units) to 89.8% (53 of 59 renal units) with the introduction of the new surgical stabilization step for the abdominal wall tunnel. Conclusions This surgical modification is an effective and simple procedure that improves tubeless cutaneous Ureterostomy performed with the Toyoda method.
Yusaku Okada - One of the best experts on this subject based on the ideXlab platform.
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Evaluation of hydronephrosis with tubeless cutaneous Ureterostomy using Tc-99m MAG3 diuretic renography.
Clinical nuclear medicine, 2009Co-Authors: Chul Jang Kim, Kazuyoshi Johnin, Keita Takimoto, Keiji Tomita, Takashi Osafune, Nobuyuki Nishikawa, Yusaku OkadaAbstract:PURPOSE To assess hydronephrosis of tubeless cutaneous Ureterostomy using Tc-99m mercaptoacetyltriglycine (MAG3) diuretic renogram. MATERIALS AND METHODS Cutaneous Ureterostomy with a unilateral stomal creation was performed in 15 patients (27 renal units) with a minimum follow-up period of 6 months. Stomal obstruction was evaluated with Tc-99m MAG3 diuretic renography 3 months after the surgery. The data analyses were performed with half-times to tracer clearance (T1/2) after furosemide (0.5 mg/kg) administration. RESULTS T1/2 means were 7.27 +/- 7.11, 5.69 +/- 4.63, and 8.96 +/- 8.37 minutes for total, ipsilateral, and contralateral kidneys, respectively, in side relationships between ureter and stoma. There were no statistical differences among the groups. Six months after the surgery, of 26 renal units (96.3%) that had achieved a tubeless condition, and 25 renal units (92.6%) had no hydronephrosis. T1/2 was within 20 minutes in these 25 renal units, and of 25 renal units 23 (92%) revealed less than 15 minutes in T1/2, suggesting that the upper limit of T1/2 for nonobstructed systems after construction of a cutaneous Ureterostomy might be 15 minutes. Mild hydronephrosis without the need for intervention was present in 1 renal unit (T1/2, 31.70 minutes). Catheterization was performed in one renal unit (T1/2, 21.04 minutes) due to acute pyelonephritis and persistence of grade 2 hydronephrosis 5 months after the surgery. Only these 2 renal units showed more than 20 minutes in T1/2, resulting in an obstructive pattern on diuretic renography. CONCLUSION Tc-99m MAG3 diuretic renography with T1/2 assessment is useful to evaluate stomal stenosis in tubeless cutaneous Ureterostomy.
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Simple technique for improving tubeless cutaneous Ureterostomy.
Urology, 2005Co-Authors: Chul Jang Kim, Yoshihiko Wakabayashi, Yuji Sakano, Kazuyoshi Johnin, Tatsuhiro Yoshiki, Yusaku OkadaAbstract:Abstract Introduction Cutaneous Ureterostomy is the simplest and safest method of all permanent urinary diversions. However, the procedure does carry a risk of stomal stenosis. We describe a simple technique for improving tubeless cutaneous Ureterostomy. Technical Considerations Between June 1991 and June 2003, the Toyoda cutaneous Ureterostomy was performed in 54 patients (102 renal units) with a minimum of 6 months of follow-up. Since 1998, we introduced a new technique, consisting of fixation between the anterior and posterior rectus sheath by four interrupted sutures to maintain the stability of the abdominal wall tunnel for the ureters. The ureteral patency rate was reviewed. Of the 79 renal units (77.5%) that achieved a tubeless condition, 70 (68.6%) had no hydronephrosis. The catheter-free rate improved from 60.5% (26 of 43 renal units) to 89.8% (53 of 59 renal units) with the introduction of the new surgical stabilization step for the abdominal wall tunnel. Conclusions This surgical modification is an effective and simple procedure that improves tubeless cutaneous Ureterostomy performed with the Toyoda method.
