Utilizing computed tomography-based renal parenchymal volumes to calculate split renal function in patients with ureteral stricture disease.

PURPOSE: Evaluation of split renal function (SRF) is critical for guiding surgical treatment decisions for patients with ureteral stricture disease (USD). We aimed to determine whether computed tomography (CT)-based renal parenchymal volumes may be used to predict SRF in patients with USD. METHODS: We retrospectively reviewed all patients undergoing surgical management for USD at a single institution from October 2021 to January 2024. Patients who had preoperative nuclear medicine scan (NMS) and CT scan with intravenous contrast that were obtained within six weeks of each other were included. Interval between NMS and CT could be longer if the affected renal unit was drained with ureteral stent and/or percutaneous nephrostomy. Volume measurements were obtained using the 3D Region of Interest (ROI) Tool on Visage®7 Enterprise Imaging Platform (Visage Inc., San Diego, USA) by two investigators that were blinded to NMS derived SRF. Intraclass correlation coefficient (ICC) was used to assess consistency between investigators. Predictive accuracy was assessed using Pearson correlation coefficient (r) and linear regression. RESULTS: 40 of 160 patients met inclusion criteria. There was excellent reliability in calculating renal parenchymal volume between raters (ICC = 0.990). There was a strong linear correlation between estimated CT SRF and NMS SRF (r = 0.912, p < 0.00001). A linear regression model found RObservedSRF = -0.013 + 1.015(REstimatedSRF), with r2 = 0.832. CONCLUSION: CT-derived parenchymal volume analysis may be used to estimate SRF in patients with USD. This may obviate the need to obtain preoperative renal scans for SRF measurement in selected patients when assessing surgical management options.

Development of a Patient-Reported Outcome Measure for Patients with Ureteral Stricture Disease.

OBJECTIVES: To develop a patient-reported outcome measure using qualitative patient-centered methods and expert opinion to quantify the impact of ureteral stricture disease and its management. METHODS: Patients undergoing robotic ureteral reconstruction for ureteral stricture disease between 9/2021-4/2023 were enrolled. A novel patient-reported outcome was developed in four steps: 1) Semi-structured concept elicitation interviews to evaluate the physical, mental, and social effects of ureteral stricture disease; 2) Item generation based on themes identified in the interview transcripts, existing patient-reported outcomes on health-related QOL, and expert opinion; 3) Feedback on the generated items from a panel of external clinicians with high surgical volume for ureteral stricture disease; and 4) Cognitive interviews assessing patient comprehension and relevance. RESULTS: We conducted 14 semi-structured concept-elicitation interviews. After qualitative analysis of these interviews, we generated a 13-item instrument: 8 items assessed symptoms, 4 items assessed QOL, and 1 item assessed patient-perceived treatment success. Expert input supported the content of the patient-reported outcome measure and guided minor adjustments. Two rounds of cognitive interviews were conducted. The first round included 6 patients, and the patient-reported outcome measure was revised according to patient feedback. The second round included 4 patients, and no additional revisions were made based on the second round. CONCLUSIONS: We utilized qualitative patient-centered methods and expert opinion to develop a patient reported outcome measure to assess outcomes in patients undergoing surgery for ureteral stricture disease.

A review of complications after ureteral reconstruction.

Objective: This study aimed to provide a comprehensive overview of the complications unique to ureteral reconstruction in adults, emphasizing their presentation, diagnosis, and management in the treatment of ureteral structure disease. Methods: This review involves an in-depth analysis of existing literature and case studies pertaining to ureteral reconstruction, with a focus on examining the range of complications that can arise post-surgery. Special attention is given to the presentation of each complication, the diagnostic process involved, and the subsequent management strategies. Results: Ureteral reconstruction can treat ureteral stricture disease with low morbidity; however, complications, although uncommon, can have severe consequences. The most notable complications include urinary extravasation, stricture recurrence, urinary tract infections, compartment syndrome, symptomatic vesicoureteral reflux, and Boari flap necrosis. Each complication presents unique diagnostic challenges and requires specific management approaches. Conclusion: Ureteral reconstruction is a highly effective treatment for ureteral stricture disease. Having a strong understanding of the potential complications that patients may experience following ureteral reconstruction is not only critical to adequately counsel patients but also facilitate prompt diagnosis and management of complications when they arise.

History and design considerations for arthroplasty around the wrist.

The history and evolution of both soft tissue and implant arthroplasty about the wrist are discussed, including carpometacarpal, radiocarpal, and distal radioulnar joints. Technical considerations for arthroplasty are reviewed, including factors affecting implant osseointegration, implant articulation/constraint, and management of complications.

Emotional and psychiatric issues in hypertrophic cardiomyopathy and other cardiac patients.

Hypertrophic cardiomyopathy (HCM) exposes young patients to the risk of sudden death. The risk of sudden death separates the young patient from his peers, but connects him more closely to his physician. The physician may have a powerful effect replacing uninformed fears with accurate knowledge, restoring hope, and helping the patient shift focus from the fear of dying to engaging in life and living with a medical illness. Depression and panic disorder are two psychiatric illnesses that are common in cardiac practices, cause significant morbidity and mortality, and may be overlooked and undertreated. Depression is a significant cardiac risk factor. Panic disorder may be confused with cardiac illness and complicate cardiac treatment. The cardiologist should recognize these illnesses and help patients who have them receive treatment for the psychiatric as well as the cardiac causes of their distress. There is a possibility that treating these psychiatric illnesses may actually improve cardiac outcome. Cardiac and psychotropic medications may have additive side effects or interact by altering drug metabolism. Many psychotropic medications cause orthostatic hypotension that may worsen obstructive HCM.

Biomechanical investigation of optimal fixation of isolated talonavicular joint fusion.

Despite reports of high nonunion rates for isolated talonavicular fusion, this procedure may be indicated for some patients, including those for whom increased stability of the talonavicular joint in triple arthrodesis is needed. In the biomechanical cadaveric study reported here, we evaluated fixation methods used to provide optimal stability of talonavicular arthrodesis. A physiologic 3-point loading model was used to measure dorsal displacement of the navicular on the talus with 1 or 2 cannulated 4.5-mm screws across the talonavicular joint both with and without one 7.3-mm cannulated screw across the subtalar joint. Statistically significant differences in displacement under cyclic loading to one-half body weight were found. Use of 2 talonavicular screws and no subtalar screw or 1 talonavicular screw plus 1 subtalar screw decreased the motion, as compared with use of 1 talonavicular screw and no subtalar screw.