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Janssen KM, Cho JY, Stone K, Kirsch AJ, Linam LE. Decreased percent change in renal pelvis diameter on diuretic functional magnetic resonance urography following administration of furosemide may help characterize unilateral uretero-pelvic junction obstruction. J Pediatr Urol 2023; 19:779.e1-779.e5. [PMID: 37704530 DOI: 10.1016/j.jpurol.2023.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 06/21/2023] [Accepted: 08/12/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND A well-established definition of obstruction in the setting of congenital hydronephrosis is lacking. Multiple imaging modalities and radiographic characteristics or parameters have been described to help confirm the diagnosis of ureteropelvic junction obstruction (UPJO). We sought to evaluate the change in anterior-posterior renal pelvic diameter (APRPD) following furosemide administration in patients with unilateral hydronephrosis and confirmed UPJO on functional magnetic resonance urography (fMRU) who underwent pyeloplasty. MATERIALS AND METHODS There were 49 patients who met inclusion criteria (11 females, 38 males; average age 2.2 years, SD 3.4 years) from February 2006 to September 2020, diagnosed with unilateral hydronephrosis (SFU Grade 3-4) who underwent fMRU prior to pyeloplasty for confirmed UPJO. 29 of the included patients also underwent a post-pyeloplasty fMRU. A weight-adjusted dose of 1 mg/kg of furosemide (max 20 mg/kg) was administered intravenously. Two board-certified pediatric radiologists measured the APRPD of the obstructed and non-dilated kidneys prior to pyeloplasty and APRPD of the hydronephrotic kidneys on the post-pyeloplasty follow up fMRUs. Measurements were performed on images prior to and approximately 30 min following furosemide injection. RESULTS The average APRPD before furosemide injection in the obstructed kidney prior to pyeloplasty was 26.3 mm (SD 9.0 mm) compared to the non-dilated (not obstructed) kidney measurement of 5.1 mm (SD 3.6 mm) (p < 0.001). Following administration of furosemide, the average APRPD was 31.4 mm (SD 8.8 mm) in the obstructed kidney, and 7.8 mm (SD 4.1 mm) in the non-dilated kidney (p < 0.001). After pyeloplasty, the pre-furosemide APRPD measurement was 17.8 mm (SD 11 mm), which was significantly less compared to the pre-pyeloplasty APRPD (p < 0.001). The post-pyeloplasty, post-furosemide APRPD measurement was 25.8 mm (SD 12 mm), also significantly less compared to the pre-pyeloplasty measurement (p = 0.02). The changes in APRPD in the obstructed kidney prior to pyeloplasty was 5.1 mm (SD 3.5 mm) and after pyeloplasty was 8 mm (SD 4.6 mm) (p = 0.002). Change in APRPD in the non-dilated kidney was 2.7 mm (SD 2.3 mm). Percent APRPD change in the obstructed kidney was 22.9% (SD 18.5%), which was significantly less than 33.3% (SD 22.1%) in the post-pyeloplasty kidney (p = 0.028) and 82.8% (SD 87.9%) in the non-dilated kidney (p < 0.001). CONCLUSIONS A relatively smaller change in APRPD on fMRU following administration of furosemide in the setting of UPJO may serve as another predictive characteristic of obstructed kidneys.
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Affiliation(s)
- Karmon M Janssen
- Department of Urology, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Joo Y Cho
- Department of Radiology, Emory University and Children's Healthcare of Atlanta, Atlanta, GA, USA
| | | | | | - Leann E Linam
- Department of Radiology, Emory University and Children's Healthcare of Atlanta, Atlanta, GA, USA.
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Janssen KM, Kirsch AJ. Outcomes of complex robot-assisted laparoscopic ureteral reimplantation after failed ipsilateral endoscopic treatment of vesicoureteral reflux. J Pediatr Urol 2021; 17:547.e1-547.e6. [PMID: 34274237 DOI: 10.1016/j.jpurol.2021.05.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 05/26/2021] [Accepted: 05/31/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Endoscopic injection (EI) has been considered a minimally invasive option with high success rates. However, in clinical settings where EI has failed, and after repeat injections or worsening clinical presentation, different treatment modalities may be offered. Open ureteral reimplantation has emerged as a safe option in patients who have failed EI for VUR treatment. Currently there is limited literature describing success of complex robot-assisted laparoscopic ureteral reimplantation (RALUR) following primary EI for vesicoureteral reflux (VUR). OBJECTIVE We aim to describe our surgical technique and outcomes using RALUR approach following failed EI for VUR. We hypothesize RALUR can be a safe, salvage option in patients who have failed EI for VUR in the setting of recurrent VUR or ureterovesical junction obstruction (UVJO). METHODS A single site, retrospective study using electronic medical records of all patients who underwent RALUR between 2013 and 2019 following history of previous ipsilateral EI using dextranomer/hyaluronic acid (DHA) for diagnosis of vesicoureteral reflux (VUR) was conducted. Primary outcomes were radiographic resolution and/or clinical resolution. RESULTS A total of 17 RALUR procedures were reviewed in 16 patients. There were 14 females (87.5%) and 2 males (12.5%). Seven patients had two prior EI. Median (range) age at time of RALUR was 10.1 (5.7-17.9) years, and the average time between EI and RALUR was 5.9 years [1-13]. The average VUR recurrence grade after failed EI was 3 (ranges 2-4) on preoperative VCUG. History of bilateral EI using dextranomer/hyaluronic acid (DHA), was observed in 14 patients. Surgical diagnosis at time of RALUR included persistent VUR (N = 10) or symptomatic ureterovesical junction obstruction (UVJO, N = 6). Mean console times were 102 min (range 70-240 min) for RALUR vs 128 min (range 70-180 min) for cases requiring ureteral tailoring. Six complications occurred in 16 patients (37.6%): Using the Clavien-Dindo classification scale, four patients (25%) were grade I, one (6.3%) grade II, and one (6.3%) was grade IIIb, which required additional procedures for ureteral obstruction. CONCLUSION RALUR after failed EI should be considered a reasonably safe and effective surgical approach in older children with persistent VUR or acquired UVJO.
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Affiliation(s)
- Karmon M Janssen
- From Emory University and Children's Healthcare of Atlanta, Atlanta, GA, USA.
| | - Andrew J Kirsch
- From Emory University and Children's Healthcare of Atlanta, Atlanta, GA, USA
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Abstract
OBJECTIVES To determine if boys with acute testicular torsion, a surgical emergency requiring prompt diagnosis and treatment to optimize salvage of the testicle, delayed presentation to a medical facility and experienced an extended duration of symptoms (DoS), and secondarily, a higher rate of orchiectomy, during the coronavirus disease 2019 (COVID-19) pandemic. METHODS Single-center, descriptive retrospective chart review of boys presenting with acute testicular torsion from March 15, to May 4, 2020 ("during COVID-19" or group 2), as well as for the same time window in the 5-year period from 2015 to 2019 ("pre-COVID-19" or group 1). RESULTS A total of 78 boys met inclusion criteria, group 1 (n = 57) and group 2 (n = 21). The mean age was 12.86 ± 2.63 (group 1) and 12.86 ± 2.13 (group 2). Mean DoS before presentation at a medical facility was 23.2 ± 35.0 hours in group 1 compared with 21.3 ± 29.7 hours in group 2 (P < 0.37). When DoS was broken down into acute (<24 hours) versus delayed (≥24 hours), 41 (71.9%) of 57 boys in group 1 and 16 (76.2%) of 21 boys in group 2 presented within less than 24 hours of symptom onset (P < 0.78). There was no difference in rate of orchiectomy between group 1 and group 2 (44.7% vs 25%, P < 0.17), respectively. CONCLUSIONS Boys with acute testicular torsion in our catchment area did not delay presentation to a medical facility from March 15, to May 4, 2020, and did not subsequently undergo a higher rate of orchiectomy.
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Affiliation(s)
- Annalise R. Littman
- From the Department of Urology, Emory University and Children's Healthcare of Atlanta
| | - Karmon M. Janssen
- From the Department of Urology, Emory University and Children's Healthcare of Atlanta
| | - Li Tong
- Department of Biomedical Engineering
| | - Hang Wu
- Department of Biomedical Engineering
| | - May D. Wang
- Department of Biomedical Engineering, School of Electric and Computer Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA
| | - Emily Blum
- From the Department of Urology, Emory University and Children's Healthcare of Atlanta
| | - Andrew J. Kirsch
- From the Department of Urology, Emory University and Children's Healthcare of Atlanta
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Janssen KM, Nieves-Robbins NM, Echelmeier TB, Nguyen DK, Baker KC. Could Nonenhanced Computer Tomography Suffice as the Imaging Study of Choice for the Screening of Asymptomatic Microscopic Hematuria? Urology 2018; 120:36-41. [PMID: 30099126 DOI: 10.1016/j.urology.2018.07.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 07/02/2018] [Accepted: 07/06/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare the diagnostic accuracy of the noncontrast and contrast-enhanced phases of computed tomographic urography for detection of upper urinary tract findings in adults undergoing initial evaluation of newly diagnosed asymptomatic microscopic hematuria to determine if less-intensive noncontrast imaging has the potential to become a suitable imaging alternative in the work-up of this common condition. MATERIALS AND METHODS Retrospective review from 2010-2015 for adults who underwent computed tomographic urography for initial evaluation of asymptomatic microscopic hematuria. Three nonblinded physicians independently categorized the upper urinary tract findings described in the computed tomography reports into one of three groups: normal, benign, or suspicious for malignancy. The noncontrast images of a randomized portion of the studies categorized as normal and all studies categorized as suspicious and benign were submitted to two blinded radiologists who independently classified each study into one of the aforementioned categories. RESULTS The noncontrast images for 475 subjects were blindly reviewed. When compared to the computed tomographic urography reports, the negative predictive values of noncontrast images were 97.25% and 94.92% for radiologist 1 and radiologist 2, respectively, with an associated specificity of 88.6% and 97.95%. Of the 5 true upper tract malignancies, both blinded radiologists correctly identified 4 of the 5. CONCLUSION Contrast imaging added little diagnostic value when compared with noncontrast imaging for most subjects undergoing initial evaluation for asymptomatic microscopic hematuria. Less-intensive imaging with nonenhanced computed tomography could reduce the nontrivial risks associated with multiphasic contrast imaging but further work is necessary to identify risk-stratifying criteria.
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Affiliation(s)
| | - Neris M Nieves-Robbins
- Deputy Chief Medical Informatics Officer, Headquarters, Department of the Army (Office of the Surgeon General) Falls, Church, VA; General Diagnostic and Pediatric Radiologist, Fort Belvoir Community Hospital, Fort Belvoir, VA
| | - Trevor B Echelmeier
- General Diagnostic and Pediatric Radiologist, Fort Belvoir Community Hospital, Fort Belvoir, VA
| | - David K Nguyen
- General Diagnostic and Pediatric Radiologist, Fort Belvoir Community Hospital, Fort Belvoir, VA
| | - Karen C Baker
- Madigan Army Medical Center, Urology Department, Tacoma WA; Department of Surgery, Division of Urology, Duke University Medical Center, Durham NC
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Janssen KM, Brand TC, Bailey MR, Cunitz BW, Harper JD, Sorensen MD, Dunmire B. Effect of Stone Size and Composition on Ultrasonic Propulsion Ex Vivo. Urology 2017; 111:225-229. [PMID: 28964820 DOI: 10.1016/j.urology.2017.09.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 09/12/2017] [Accepted: 09/19/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate in more detail the effectiveness of a new designed more efficient ultrasonic propulsion for large stones and specific stone compositions in a tissue phantom model. In the first clinical trial of noninvasive ultrasonic propulsion, urinary stones of unknown compositions and sizes up to 10 mm were successfully repositioned. MATERIALS AND METHODS The study included 8- to 12-mm stones of 4 different primary compositions (calcium oxalate monohydrate, ammonium acid urate, calcium phosphate, and struvite) and a renal calyx phantom consisting of a 12 mm × 30 mm well in a 10-cm block of tissue-mimicking material. Primary outcome was the number of times a stone was expelled over 10 attempts, with ultrasonic propulsion burst duration varying from 0.5 seconds to 5 seconds. RESULTS Overall success rate at expelling stones was 95%. All calcium oxalate monohydrate and ammonium acid urate stones were expelled 100% of the time. The largest stone (12 mm) became lodged within the 12-mm phantom calyx 25% of the time regardless of the burst duration. With the 0.5-second burst, there was insufficient energy to expel the heaviest stone (0.88 g), but there was sufficient energy at the longer burst durations. CONCLUSION With a single burst, ultrasonic propulsion successfully moved most stones at least 3 cm and, regardless of size or composition, expelled them from the calyx. Ultrasonic propulsion is limited to the stones smaller than the calyceal space, and for each burst duration, related to maximum stone mass.
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Affiliation(s)
| | | | - Michael R Bailey
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, WA; Department of Urology, University of Washington School of Medicine, Seattle, WA
| | - Bryan W Cunitz
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, WA
| | - Jonathan D Harper
- Department of Urology, University of Washington School of Medicine, Seattle, WA
| | - Mathew D Sorensen
- Department of Urology, University of Washington School of Medicine, Seattle, WA; Division of Urology, Department of Veteran Affairs Medical Center, Seattle, WA
| | - Barbrina Dunmire
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, WA
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Janssen KM, Brand TC, Cunitz BW, Wang YN, Simon JC, Starr F, Liggitt HD, Thiel J, Sorensen MD, Harper JD, Bailey MR, Dunmire B. Safety and Effectiveness of a Longer Focal Beam and Burst Duration in Ultrasonic Propulsion for Repositioning Urinary Stones and Fragments. J Endourol 2017; 31:793-799. [PMID: 28537452 DOI: 10.1089/end.2017.0167] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE In the first-in-human trial of ultrasonic propulsion, subjects passed collections of residual stone fragments repositioned with a C5-2 probe. Here, effectiveness and safety in moving multiple fragments are compared between the C5-2 and a custom (SC-50) probe that produces a longer focal beam and burst duration. MATERIALS AND METHODS Effectiveness was quantified by the number of stones expelled from a calyx phantom consisting of a 30-mm deep, water-filled well in a block of tissue mimicking material. Each probe was positioned below the phantom to move stones against gravity. Single propulsion bursts of 50 ms or 3 s duration were applied to three separate targets: 10 fragments of 2 different sizes (1-2 and 2-3 mm) and a single 4 × 7 mm human stone. Safety studies consisted of porcine kidneys exposed to an extreme dose of 10-minute burst duration, including a 7-day survival study and acute studies with surgically implanted stones. RESULTS Although successful in the clinical trial, the shorter focal beam and maximum 50 ms burst duration of the C5-2 probe moved stones, but did not expel any stones from the phantom's 30-mm deep calyx. The results were similar with the SC-50 probe under the same 50 ms burst duration. Longer (3 s) bursts available with the SC-50 probe expelled all stones at both 4.5 and 9.5 cm "skin-to-stone" depths with lower probe heating compared to the C5-2. No abnormal behavior, urine chemistry, serum chemistry, or histological findings were observed within the kidney or surrounding tissues for the 10 min burst duration used in the animal studies. CONCLUSIONS A longer focal beam and burst duration improved expulsion of a stone and multiple stone fragments from a phantom over a broad range of clinically relevant penetration depths and did not cause kidney injury in animal studies.
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Affiliation(s)
- Karmon M Janssen
- 1 Department of Urology, Madigan Army Medical Center , Tacoma, Washington
| | - Timothy C Brand
- 1 Department of Urology, Madigan Army Medical Center , Tacoma, Washington
| | - Bryan W Cunitz
- 2 Applied Physics Laboratory, Center for Industrial and Medical Ultrasound, University of Washington , Seattle, Washington
| | - Yak-Nam Wang
- 2 Applied Physics Laboratory, Center for Industrial and Medical Ultrasound, University of Washington , Seattle, Washington
| | - Julianna C Simon
- 2 Applied Physics Laboratory, Center for Industrial and Medical Ultrasound, University of Washington , Seattle, Washington
| | - Frank Starr
- 2 Applied Physics Laboratory, Center for Industrial and Medical Ultrasound, University of Washington , Seattle, Washington
| | - H Denny Liggitt
- 3 Department of Comparative Medicine, University of Washington , Seattle, Washington
| | - Jeff Thiel
- 4 Department of Radiology, University of Washington , Seattle, Washington
| | - Mathew D Sorensen
- 5 Department of Urology, University of Washington School of Medicine , Seattle, Washington.,6 Division of Urology, Department of Veteran Affairs Medical Center , Seattle, Washington
| | - Jonathan D Harper
- 5 Department of Urology, University of Washington School of Medicine , Seattle, Washington
| | - Michael R Bailey
- 2 Applied Physics Laboratory, Center for Industrial and Medical Ultrasound, University of Washington , Seattle, Washington
| | - Barbrina Dunmire
- 2 Applied Physics Laboratory, Center for Industrial and Medical Ultrasound, University of Washington , Seattle, Washington
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Janssen KM, Willis CJ, Anderson M, Gelnett MS, Wickersham EL, Brand TC. Filariasis Orchitis-Differential for Acute Scrotum Pathology. Urol Case Rep 2017; 13:117-119. [PMID: 28507911 PMCID: PMC5426035 DOI: 10.1016/j.eucr.2017.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 04/11/2017] [Indexed: 12/05/2022] Open
Abstract
Granulomatous Orchitis secondary to lymphatic filiarisis is a rare diagnosis within the United States. We report a case of a 22yo Male from Sri Lanka, with a new onset scrotal swelling and palpable right testicular mass. Ultrasound identified a 1 cm right testicular mass with signs of tunica albuginea invasion. A right inguinal radical orchiectomy was performed and pathology showed Filarial orchitis. This report describes the detailed history, physical exam, and diagnostic workup and treatment options for a rare entity for acute scrotal pathology.
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Affiliation(s)
- Karmon M Janssen
- Madigan Army Medical Center, Urology Department, Tacoma, WA 98431, USA
| | - Cornelia J Willis
- Madigan Army Medical Center, Urology Department, Tacoma, WA 98431, USA
| | - Mark Anderson
- Madigan Army Medical Center, Urology Department, Tacoma, WA 98431, USA
| | - Mary S Gelnett
- Madigan Army Medical Center, Pathology Department, Tacoma, WA 98431, USA
| | - Emily L Wickersham
- Madigan Army Medical Center, Pathology Department, Tacoma, WA 98431, USA
| | - Timothy C Brand
- Madigan Army Medical Center, Urology Department, Tacoma, WA 98431, USA
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Janssen KM, Knoblich PR. The increase in renal sodium excretion in response to Angiotensin II infusion in exercised female rats is dependent on a rise in renal perfusion pressure. FASEB J 2009. [DOI: 10.1096/fasebj.23.1_supplement.969.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Russel MG, Pastoor CJ, Janssen KM, van Deursen CT, Muris JW, van Wijlick EH, Stockbrügger RW. Familial aggregation of inflammatory bowel disease: a population-based study in South Limburg, The Netherlands. The South Limburg IBD Study Group. Scand J Gastroenterol Suppl 1997; 223:88-91. [PMID: 9200312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
BACKGROUND The aim of our study was to investigate the prevalence of Crohn's disease (CD) and ulcerative colitis (UC) in first-degree relatives of IBD patients living in a well-defined area. METHODS IBD patients known at the IBD Registration South Limburg as well as population controls were asked about the occurrence of IBD in their first-degree relatives. RESULTS IBD was reported and confirmed in 16 (out of 1554) relatives by 11 (out of 245) patients. Prevalence of IBD was highest for siblings (1.5%) and children (1.3%), while only 0.2% of the parents were affected with IBD. Among relatives of the control subjects, IBD was observed in 0.8% (versus 4.5% in IBD patients), resulting in an odds ratio of 5.7 (95% CI: 2.0-16.7). CONCLUSIONS The observed risk of IBD for first-degree relatives of IBD patients was higher than in controls. However, the risk in our population is lower than has been reported by other centres, possibly because of the population-based character of our study.
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Affiliation(s)
- M G Russel
- Dept. of Gastroenterology, University Hospital Maastricht, The Netherlands
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Janssen KM, Mazee HA, Ruers TJ, Baeten CG. [Transanal resection of large sessile rectal polyps]. Ned Tijdschr Geneeskd 1996; 140:1646-9. [PMID: 8815406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess the safety and effectiveness of transanal resection of large rectal adenomas. DESIGN Retrospective. SETTING Department of Surgery, University Hospital Maastricht, the Netherlands. METHOD 35 patients underwent transanal resection of large rectal polyps. These cases were analysed as to the accuracy of preoperative biopsies, complication rate, recurrence rate and value of endoscopic follow-up. RESULTS Preoperative biopsies proved to be unreliable: in 49% of the cases histology of the whole specimen matched with the result of the biopsy. Five patients showed adenocarcinoma in the definite specimen, they were treated successfully by low anterior resection or rectum extirpation following the transanal resection. Six patients developed complications. In 1 patient this resulted in a colostomy. The average follow-up was 45 months. Sixty per cent of the patients in whom an adenoma or a carcinoma in situ was removed developed a recurrent adenoma. Recurrent adenomas were all treated by endoscopic polypectomy. CONCLUSION Transanal resection of large rectal adenomas is a safe and effective method of treatment. However, the high recurrence requires frequent endoscopy.
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Affiliation(s)
- K M Janssen
- Academisch Ziekenhuis, Afd. Chirurgie, Maastricht
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