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Poster 3: Oncology – Kidney/Ureter

UP-3.2. Table 1. Clinical characteristics UP-3.3
TA PN p Ureteral reconstruction during posterior and or lateral pelvic
exenteration for locally advanced and recurrent malignancy
Patients, n 157 112 Alexander Combes , Brayden J. March , Catalina A. Palma , Alexander
1
1
1
2
1
1
RFA 104 Robotic 86 S.E. McCarthy , David R. Eisinger , Scott Leslie , Christopher Byrne 2,3,4 ,
2,3,4
2,3,4
2,3,4
(66.2%) (76.8%) Kirk K.S. Austin , Peter J. Lee , Michael Solomon
1 Department of Urology, Royal Prince Alfred Hospital, Camperdown,
CA 46 (29.3%) Open 26 Australia; Department of Colorectal Surgery, Royal Prince Alfred Hospital,
2
(23.2%) Camperdown, Australia; Surgical Outcomes Research Centre, Royal
3
4
MWA 7 (4.5%) Prince Alfred Hospital, Camperdown, Australia; Institute of Academic
Surgery, Royal Prince Alfred Hospital, Camperdown, Australia
Age (years), mean (±SD) 68 (±10.44) 58.6 (±11.34) 0.0001
Introduction: Pelvic exenteration (PE) is an established treatment modal-
CCI, mean (±SD) 5.42 (±1.99) 3.82 (±1.38) 0.0001 ity for locally advanced and recurrent malignancy. Concurrent resec-
Preop eGFR (mL/min/ 86.0 (±41.7) 107.9 (±38.5) 0.0001 tion and reconstruction of the urinary tract are often required. Urinary
2
1.73m ), mean (±SD) diversion with ileal conduit is typically indicated in complete soft tissue
PE. In less extensive disease, posterior and/or lateral exenteration (PLE)
Tumor size (cm), mean 2.51 (±0.77) 2.6 (±0.81) 0.324 may only require segmental ureterectomy and reconstruction. This study
(±SD) evaluated postoperative outcomes of ureteral reconstruction in patients
RENAL score, mean (±SD) 6.03 (±1.69) 6.45 (±1.73) 0.055 who underwent PLE.
Histology, n (%) 0.21 Methods: We conducted a retrospective review of our prospective data-
base of 920 PE patients; 491 patients were managed with PLE between
Clear-cell RCC 78 (49.7) 6 (59.8) 1994 and 2021 at Royal Prince Alfred Hospital, Sydney, Australia. Of
Papillary RCC 30 (19.9) 14 (12.5) these 491, 158 patients required urological intervention (UI). Twenty-six
Chromophobe RCC 9 (5.7) 6 (5.4) patients required total cystectomy and three patients underwent concur-
rent nephrectomy for synchronous renal cell carcinoma. Both of these
Oncocytoma 7 (4.5) 12 (10.7) groups were excluded from the study.
AML - 7 (6.3) Results: Of the 129 patients requiring UI, the mean age of patients was
Not done 17 (10.8) - 60.9 years. PLE was predominately performed for colorectal malignancies
(77%); 86 of the 129 patients required partial cystectomies, 26 required
Not diagnostic 16 (10.2) - ureteral resection and reconstruction, and 17 patients had prophylactic
Other benign - 6 (5.4) ureteral stenting for extensive ureterolysis. Ten patients had a urine leak
AML: angiomyolipoma; CA: cryo ablation; CCI: Charlson comorbidity index; MWA: after ureteral reconstruction (Table 1). Urine leaks were associated with
microwave ablation; PN: partial nephrectomy; RCC: renal cell carcinoma; RFA; radiofre- preoperative hydronephrosis, ureteral resection proximal to common iliac
quency ablation; TA: tumor ablation. vessels, and postoperative urinary tract infection (UTI). Prior radiother-
apy, type of reconstruction performed, or medical comorbidities did not
increase the risk of urine leak. UI was associated with an increased risk of
complications (Clavian Dindo III or higher) compared to all PLE (21.4%
UP-3.2. Table 2. Functional and oncological outcome vs. 14.3%, p=0.063).
TA (n=157) PN (n=112) p Conclusions: The extent of ureteral resection and postoperative UTI may
be associated with higher rates of urine leaks in ureteral reconstruction.
Preop Cr (μmol/L), mean 100.3 (±68.3) 74.3 (±17.2) 0.0001 Ureteral reconstruction may also increase postoperative morbidity in PLE.
(±SD)
Preop eGFR (mL/ 86.0 (±41.7) 107.9 (±38.5) 0.0001 UP-3.6
2
min/1.73m ), mean (±SD) The historical origins and contemporary role of endoluminal
eGFR change pre-postop, 8.7 (±12.6) 18.7 (±19.2) <0.0001 treatment for urethral stricture disease
mean (±SD) Kunal Jain , Thomas Southall , Umesh Jain 2
1
1
Complication, n (%) <0.0001 1 Section of Urology, Department of Surgery, University of Manitoba,
2
Winnipeg, MB, Canada; Division of Urology, St. Joseph’s Health Centre,
Any 11 (7) 35 (31.25)
Toronto, ON, Canada
Clavien grade I-II 9 (5.7) 28 (25) Introduction: We explored the historical origins of and developments in
Clavien grade ≥ III 2 (1.3) 7 (6.25) dilation and urethrotomy for the treatment of urethral stricture disease
(USD).
Repeat ablation for 19 (12.1) - Methods: Primary and secondary source documents relating to USD were
persistent disease, n reviewed and put into perspective within current practices.
Requiring nephrectomy, 2 (1.3) 2 (1.8) NS Results: The earliest known treatment for USD is from the Ayurveda, when
n (%) in 600 BC, Sushruta of India used metal and wooden dilators lubricated
with ghee. By 200 BC, Erasistratus of Greece had developed S-shaped
Renal replacement 8 (5.1) 1 (0.9) 0.059 metal catheters. This was adapted and modernized by the Romans, who
therapy, n (%)
used lead and bronze dilators. It was not until the first recorded epidemic
Recurrence at > 3 14 (8.9) 3 (2.7) 0.038 of gonorrhea in 1520 AD that a renewed focus on USD arose and a primi-
months, n (%) tive form of internal urethrotomy was developed. By 1730 AD, Ledran
Death any cause, n (%) 18 (11.5) 7 (6.25) 0.146 of France performed the first recorded successful external urethrotomy,
lending credence to the role of diversion in USD. Near the end of the
PN: partial nephrectomy; TA: tumor ablation.
1700s AD, Desault of France first described using a fine guide with a
larger following instrument. The development of the lancellated catheter
in 1795 AD successfully allowed for internal urethrotomy and paved the
future for the development of later internal urethrotomes. It was only in
CUAJ • June 2022 • Volume 16, Issue 6(Suppl1) S49