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Type 2 modified Whitaker test. (A) Type 2: With peristalsis of the ureter, relative renal pelvis pressure decreased to near baseline. (B) In the phrase 1, the pelvic morphology was unnormal. (C&D) Showing a peristalsis of the ureter.
Source publication
Background:
To evaluate the feasibility and effect of upper urinary tract videourodynamics in complex reconstructed upper urinary tract.
Methods:
From January 2016 to December 2018, patients who underwent complex upper urinary tract reconstruction and received upper urinary tract videourodynamics were included in the study. The modified Whitaker...
Citations
... Moreover, some patients still carry nephrostomy tubes for a long time after surgery in order to prevent postoperative urine leakage and other reasons. For these patients with nephrostomy tube, the Whitaker test has been transformed from an invasive test to a non-invasive test and is gradually being used in patients after upper urinary tract reconstruction surgery [16,18,19,24]. To our knowledge, the Whitaker test is useful in the diagnosis of upper urinary tract obstruction, while its usefulness in follow up after upper urinary tract reconstruction has been poorly explored [18,24,25]. ...
... For these patients with nephrostomy tube, the Whitaker test has been transformed from an invasive test to a non-invasive test and is gradually being used in patients after upper urinary tract reconstruction surgery [16,18,19,24]. To our knowledge, the Whitaker test is useful in the diagnosis of upper urinary tract obstruction, while its usefulness in follow up after upper urinary tract reconstruction has been poorly explored [18,24,25]. Gotoh et al. reported 10 patients who underwent the Whitaker test before and after percutaneous endopyelotomy, and this study found that the Whitaker test was more sensitive for evaluating the results of surgery than diuresis renography and excretory urography [7]. ...
... Gotoh et al. reported 10 patients who underwent the Whitaker test before and after percutaneous endopyelotomy, and this study found that the Whitaker test was more sensitive for evaluating the results of surgery than diuresis renography and excretory urography [7]. In recent years, these were two studies (19 and 12 patients) found that the Whitaker test can help judge whether nephrostomy could be removed safely after complex upper urinary tract reconstruction [18,24]. These studies included only a small number of patients with upper urinary tract reconstruction and only evaluated short-term surgical outcomes after upper urinary tract reconstruction. ...
Purpose
To explore the role of the Whitaker test in evaluating the postoperative outcome of upper urinary tract reconstruction surgery in patients carrying a nephrostomy tube after surgery.
Patients and methods
This was a prospective observational study performed in 42 patients with nephrostomy tube undergoing the Whitaker test after upper urinary tract reconstruction surgery between January 2020 and December 2021. Data on clinical information, the Whitaker test and surgical procedure were collected prospectively, and the long-term follow-up results were analysed retrospectively.
Results
The 46 ureters of 42 patients (right 16, left 22, bilateral 4) underwent six common upper urinary tract surgical reconstruction procedures and one combined procedure, including pyeloplasty, ureteroureterostomy, lingual mucosal onlay graft, appendiceal onlay flap, ureteral reimplantation, Boari flap, and ipsilateral lingual mucosal onlay graft combined ureteral reimplantation. All patients underwent the Whitaker test successfully without any discomfort after examination. The postoperative Whitaker test showed 43 kidneys without obstruction and 3 kidneys with obstruction. At a median follow-up of 18 months (range 13–31), the follow-up results showed that the overall success rate of the surgery was 100% (46/46). Concerning the concordance Whitaker test and follow-up results, the observed proportion of agreement was 93.5% (43/46).
Conclusion
The Whitaker test can achieve similar consistency with the long-term follow-up results after upper urinary tract reconstruction surgery and can be used as a tool to evaluate the surgical efficacy of upper urinary tract reconstruction surgery, which can provide a prognostic efficacy evaluation for patients carrying a nephrostomy tube after surgery.
... The Whitaker test was performed before removing a nephrostomy catheter at 3 months after the surgery with reference to previous research (10). Nephrostomy tubes and preliminarily retained urinary catheters were connected to the pressure transducer respectively. ...
Background:
To assess the feasibility and usefulness of cine magnetic resonance urography (MRU) and Whitaker test as postoperative evaluation tools of ileal ureter replacement.
Methods:
We retrospectively collected the medical records of 42 patients who underwent ileal ureter replacement between August 2015 and August 2020. The morphology, luminal diameter, amplitude, contraction ratio, peristaltic frequency, ureteral jets and peristalsis efficiency were recorded in cine MRU. Under different perfusion loads, image and pressure changes of the reconstructed upper urinary tract were recorded in the Whitaker test. Patients were categorized into normal pressure and elevated pressure groups.
Results:
A total of 42 patients underwent cine MRU, and 20 of them finished the Whitaker test successfully. The mean amplitude was 9.29±3.51 mm, and the contraction ratio was 0.607 (0.247-0.790). The median peristaltic efficiency was 0.75 (0.29-1). Three patients presented an unusual rise in renal pelvis pressure, which was 54, 26, 57 cmH2O respectively. The amplitude of the ileal graft in the elevated pressure group was larger (13.80±5.73 vs. 8.09±3.38 mm, P=0.024), the contraction ratio was higher [0.68 (0.59-0.79) vs. 0.59 (0.25-0.79), P=0.028], the peristaltic frequency was more active [7 (6-8) vs. 4 (3-8), P=0.025], but the peristaltic efficiency was lower [0.50 (0.29-0.50) vs. 0.75 (0.33-1), P=0.029] compared to the normal pressure group. There were no significant differences in the ureteral jets [3 (2-4) vs. 3 (1-7), P=0.840), creatinine (97.3±7.3 vs. 103.2±30.7 µmol/L, P=0.753), and estimated glomerular filtration rate (eGFR) (76.4±14.1 vs. 68.5±28.7 mL/min·1.73 m2, P=0.663).
Conclusions:
Cine MRU provides morphological and peristaltic motility of the ileal graft, cine MRU after ileal ureter replacement was recommended as a routine examination. The Whitaker test represents a complementary investigation to evaluate pressure changes to reveal the ability to transport urine, and it can be used as a supplementary examination to clarify equivocal cases.
... The clinical data of patients were collected prospectively: demographic characteristics, presenting symptoms, preoperative imaging, ureteral stricture aetiology, site, and lengths, previous management, operative details and postoperative complications (according to the Clavien-Dindo classification), postoperative hospital stay and follow-up data. The outcomes of patients were evaluated through two aspects, including their postoperative symptoms and imaging examinations, such as upper urinary tract imaging urodynamics examination (IUE) which has been described in our previous studies (18,19), functional cine magnetic resonance urography (cine MRU), and computed tomography urography (CTU). According to our experience, the following conditions are considered to be complex ureteral stricture diseases. ...
Background:
To describe our technical experience of robotic appendiceal onlay flap ureteroplasty (RAUP) for complex ureteral stricture disease and report the updated analysis of 18-month follow-up outcomes.
Methods:
Since May 2019, nine patients with right ureteral strictures have undergone RAUP in our medical centre. Patients' perioperative data and follow-up information were collected prospectively. Patients were excluded in present study if the postoperative follow-up time was less than 6 months.
Results:
Eight patients were recruited. Proximal ureteric strictures were present in 5 patients, and 3 patients had middle ureteric strictures. The mean stricture length was 4.3 cm (range, 3.0-6.0 cm). Nephrostomy was performed in 4 patients, and 4 patients had indwelling double-J ureteral stents before they were admitted to our hospital. All operations were implemented successfully without intraoperative complications. The mean operation time was 162 minutes (range, 135-211 minutes), and the mean estimated blood loss was 78 mL (range, 30-200 mL). The mean postoperative hospital stay was 8 days (range, 4-12 days). No patients had high-grade postoperative complications (Clavien-Dindo III and IV) 30 days after surgery. At a mean follow-up of 18 months (range, 6-28 months), all patients were not needed further surgical intervention and could be considered successful. But 2 cases still have stable mild hydronephrosis without symptoms such as flank pain or fever.
Conclusions:
RAUP is a workable option for managing long-segment (3-6 cm) proximal and middle ureteral strictures of the right side. The outcomes of 18-month follow-up are satisfactory.
Purpose
To present the experience of ileal ureter with ileocystoplasty (IUC), and compare the outcomes of IUC in minimally invasive procedures to open procedures.
Patients and methods
From December 2017 to April 2023, twenty patients underwent IUC in open or minimally invasive (including laparoscopic and robotic) procedures. The baseline characteristics, perioperative data and follow-up outcomes were collected. Success was defined as relief of clinical symptoms, stable postoperative serum creatine and absence of radiographic obstruction. The perioperative and follow-up outcomes of open procedures and minimally invasive procedures were compared.
Results
The etiology included pelvic irradiation (14/20), urinary tuberculosis (3/20) and surgical injury (3/20). Bilateral ureter strictures were repaired in 15 cases. The surgeries conducted consisted of open procedures in 9 patients and minimally invasive procedures in 11 patients. Compared to open procedures, minimally invasive surgeries had less median estimated blood loss (EBL) (100 ml vs. 300 min, p = 0.010) and shorter postoperative hospitalization (27 d vs. 13 d, p = 0.004). Two patients in the open group experienced grade 3 complications (sigmoid fistula and acute cholecystitis in one patient, and pulmonary embolism in another patient). Over a median follow-up period of 20.1 months, the median bladder functional capacity was 300 ml, with a 100% success rate of IUC.
Conclusion
IUC is feasible in both open and minimally invasive procedures, with acceptable complications and a high success rate. Minimally invasive procedures can have less EBL and shorter postoperative hospitalization than open procedure. However, prospective studies with larger groups and longer follow-up are needed.
