Real-time indocyanine green angiography with the SPY fluorescence imaging platform decreases benign ureteroenteric strictures in urinary diversions performed during radical cystectomy
Background: Ischemia is thought to contribute to benign ureteroenteric stricture (UES) after radical cystectomy with urinary diversion (RCUD). Our institution adopted the use of ureteral perfusion assessment during all RCUDs using real-time indocyanine green angiography using the SPY fluorescence im...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
SAGE Publishing
2019-04-01
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| Series: | Therapeutic Advances in Urology |
| Online Access: | https://doi.org/10.1177/1756287219839631 |
| _version_ | 1811274269639835648 |
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| author | Jim K. Shen Juzar Jamnagerwalla Bertram E. Yuh Mitchell R. Bassett Avinash Chenam Jonathan N. Warner Ali Zhumkhawala Jonathan L. Yamzon Christopher Whelan Nora H. Ruel Clayton S. Lau Kevin G. Chan |
| author_facet | Jim K. Shen Juzar Jamnagerwalla Bertram E. Yuh Mitchell R. Bassett Avinash Chenam Jonathan N. Warner Ali Zhumkhawala Jonathan L. Yamzon Christopher Whelan Nora H. Ruel Clayton S. Lau Kevin G. Chan |
| author_sort | Jim K. Shen |
| collection | DOAJ |
| description | Background: Ischemia is thought to contribute to benign ureteroenteric stricture (UES) after radical cystectomy with urinary diversion (RCUD). Our institution adopted the use of ureteral perfusion assessment during all RCUDs using real-time indocyanine green angiography using the SPY fluorescence imaging platform (Stryker Corp., Kalamazoo, MI, USA). This guides the location of ureteral transection prior to ureteroenteric anastomosis. We sought to compare UES rates before and after adoption of SPY. Methods: A retrospective chart review was undertaken for the first 47 consecutive cases of RCUD using SPY as well as the previous 47 consecutive cases, which were performed without SPY. Fisher’s exact and Wilcoxon rank-sum tests were used to compare benign UES rates and the length of ureter excised during anastomosis. A p < 0.05 indicated statistical significance. Results: Median follow up was 12.0 months for SPY cases and 24.3 months for non-SPY cases. The UES rate for SPY RCUDs was 0% (0/93 ureters) compared with 7.5% (7/93 ureters) for non-SPY RCUDs ( p = 0.01). Amongst SPY RCUDs, 86 ureters had no hydronephrosis and 7 had mild hydronephrosis with reflux on loopogram. A total of 34.4% of ureters (32/93) had poor distal perfusion, requiring a more proximal anastomosis. The median length excised for ureters with poor distal perfusion was 3.8 cm, compared with 2.2 cm for ureters with good distal perfusion ( p < 0.0001). No complications attributable to the use of SPY were noted. Conclusion: Use of SPY to assess ureteral perfusion was associated with a decrease in the UES rate after RCUD. A total of 34.4% of ureters demonstrated poor distal perfusion, requiring a significantly more proximal ureteroenteric anastomosis. |
| first_indexed | 2024-04-12T23:15:57Z |
| format | Article |
| id | doaj.art-44579d51a13a4861884da4b186f27b43 |
| institution | Directory Open Access Journal |
| issn | 1756-2880 |
| language | English |
| last_indexed | 2024-04-12T23:15:57Z |
| publishDate | 2019-04-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Therapeutic Advances in Urology |
| spelling | doaj.art-44579d51a13a4861884da4b186f27b432022-12-22T03:12:41ZengSAGE PublishingTherapeutic Advances in Urology1756-28802019-04-011110.1177/1756287219839631Real-time indocyanine green angiography with the SPY fluorescence imaging platform decreases benign ureteroenteric strictures in urinary diversions performed during radical cystectomyJim K. ShenJuzar JamnagerwallaBertram E. YuhMitchell R. BassettAvinash ChenamJonathan N. WarnerAli ZhumkhawalaJonathan L. YamzonChristopher WhelanNora H. RuelClayton S. LauKevin G. ChanBackground: Ischemia is thought to contribute to benign ureteroenteric stricture (UES) after radical cystectomy with urinary diversion (RCUD). Our institution adopted the use of ureteral perfusion assessment during all RCUDs using real-time indocyanine green angiography using the SPY fluorescence imaging platform (Stryker Corp., Kalamazoo, MI, USA). This guides the location of ureteral transection prior to ureteroenteric anastomosis. We sought to compare UES rates before and after adoption of SPY. Methods: A retrospective chart review was undertaken for the first 47 consecutive cases of RCUD using SPY as well as the previous 47 consecutive cases, which were performed without SPY. Fisher’s exact and Wilcoxon rank-sum tests were used to compare benign UES rates and the length of ureter excised during anastomosis. A p < 0.05 indicated statistical significance. Results: Median follow up was 12.0 months for SPY cases and 24.3 months for non-SPY cases. The UES rate for SPY RCUDs was 0% (0/93 ureters) compared with 7.5% (7/93 ureters) for non-SPY RCUDs ( p = 0.01). Amongst SPY RCUDs, 86 ureters had no hydronephrosis and 7 had mild hydronephrosis with reflux on loopogram. A total of 34.4% of ureters (32/93) had poor distal perfusion, requiring a more proximal anastomosis. The median length excised for ureters with poor distal perfusion was 3.8 cm, compared with 2.2 cm for ureters with good distal perfusion ( p < 0.0001). No complications attributable to the use of SPY were noted. Conclusion: Use of SPY to assess ureteral perfusion was associated with a decrease in the UES rate after RCUD. A total of 34.4% of ureters demonstrated poor distal perfusion, requiring a significantly more proximal ureteroenteric anastomosis.https://doi.org/10.1177/1756287219839631 |
| spellingShingle | Jim K. Shen Juzar Jamnagerwalla Bertram E. Yuh Mitchell R. Bassett Avinash Chenam Jonathan N. Warner Ali Zhumkhawala Jonathan L. Yamzon Christopher Whelan Nora H. Ruel Clayton S. Lau Kevin G. Chan Real-time indocyanine green angiography with the SPY fluorescence imaging platform decreases benign ureteroenteric strictures in urinary diversions performed during radical cystectomy Therapeutic Advances in Urology |
| title | Real-time indocyanine green angiography with the SPY fluorescence imaging platform decreases benign ureteroenteric strictures in urinary diversions performed during radical cystectomy |
| title_full | Real-time indocyanine green angiography with the SPY fluorescence imaging platform decreases benign ureteroenteric strictures in urinary diversions performed during radical cystectomy |
| title_fullStr | Real-time indocyanine green angiography with the SPY fluorescence imaging platform decreases benign ureteroenteric strictures in urinary diversions performed during radical cystectomy |
| title_full_unstemmed | Real-time indocyanine green angiography with the SPY fluorescence imaging platform decreases benign ureteroenteric strictures in urinary diversions performed during radical cystectomy |
| title_short | Real-time indocyanine green angiography with the SPY fluorescence imaging platform decreases benign ureteroenteric strictures in urinary diversions performed during radical cystectomy |
| title_sort | real time indocyanine green angiography with the spy fluorescence imaging platform decreases benign ureteroenteric strictures in urinary diversions performed during radical cystectomy |
| url | https://doi.org/10.1177/1756287219839631 |
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