MP53-09 INDIA INK TATTOOING OF URETEROENTERIC ANASTOMOSES

Abstract

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Ureter (including Pyeloplasty) and Bladder Reconstruction (including fistula), Augmentation, Substitution, Diversion II (MP53)1 Sep 2021MP53-09 INDIA INK TATTOOING OF URETEROENTERIC ANASTOMOSES Mei Tuong, and Tracey Krupski Mei TuongMei Tuong More articles by this author , and Tracey KrupskiTracey Krupski More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002083.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Upper tract access is necessary to treat diseases in the ureter or kidney after urinary diversion. Access through the insensate conduit is more cost-effective versus percutaneous kidney access. However, endoscopic ureteroenteric anastomoses (UEA) identification can be difficult. We injected India Ink (ink) into bowel mucosa near UEA during ileal conduit diversion (IC) to determine the safety and feasibility of ink tattooing and ability to facilitate retrograde upper tract access. METHODS: After IRB approval, patients undergoing IC were prospectively randomized to receive ink or normal saline (NS) injections, a control group to assess safety of ink. Injections were placed 1 cm from UEA in a triangular configuration with a 19-gauge needle. Follow-up minimized cost and radiation exposure to assess patency and location of UEA. 1-month loopogram assessed for ureteral reflux (UR). If there was any absent UR, looposcopy was performed to assess for occult UEA stricture (UEAS). Ability to visualize UEA and/or ink tattooing was recorded at time of looposcopy. RESULTS: 42 renal units (21 patients) undergoing IC were randomized to ink (20 renal units) or NS (22 renal units). Overall median age was 65 (IQR 60, 73) years with ink patients being older (72 vs 61 years old, p=0.04). Ink patients also had a higher Charlson Comorbidity Index (5 vs 2, p=0.01). Loopogram and looposcopy protocol data are shown in Figure 1. 20 renal units had no UR on loopogram (12/16 ink vs 8/20 NS). Of patients who returned for looposcopy, 14 non-UR renal units were assessed (6/12 ink vs 8/8 NS). Visualization of UEA was achieved in 6 (100%) and 4 (50%) in ink versus NS patients, respectively (p=0.26). Follow up of the cohort revealed a higher than expected UEAS rate in the ink group (N=3, 30%) compared to NS (N=1, 9%). The ink vs NS cohorts underwent 6 vs 1 surgeries respectively for UEAS (p=0.28). 2 ink and 1 NS patients were managed with either endoscopic dilation, percutaneous nephrostomy tube, or ureteral stent. 1 ink patient required open reimplantation of UEA. CONCLUSIONS: Our pilot study demonstrates ink is well-visualized following injection near UEA during IC. However, the ink cohort had more UEAS than our prior rates of UEAS (6%) and in the literature. While this study sample is small, the higher development of UEAS after ink leads to question the utility and safety of ink injection following IC. Source of Funding: none © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e942-e942 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mei Tuong More articles by this author Tracey Krupski More articles by this author Expand All Advertisement Loading ...