PD04-05 CLINICAL CURE VS A NOVEL TRIFECTA SYSTEM FOR EVALUATING LONG-TERM OUTCOMES OF MINIMALLY-INVASIVE PARTIAL OR TOTAL ADRENALECTOMY FOR UNILATERAL PRIMARY ALDOSTERONISM: RESULTS OF A MULTICENTRIC SERIES

Abstract

You have accessJournal of UrologyCME1 May 2022PD04-05 CLINICAL CURE VS A NOVEL TRIFECTA SYSTEM FOR EVALUATING LONG-TERM OUTCOMES OF MINIMALLY-INVASIVE PARTIAL OR TOTAL ADRENALECTOMY FOR UNILATERAL PRIMARY ALDOSTERONISM: RESULTS OF A MULTICENTRIC SERIES Umberto Anceschi, Riccardo Mastroianni, Gabriele Tuderti, Alfredo Maria Bove, Aldo Brassetti, Mariaconsiglia Ferriero, Marilda Mormando, Alessandro Carrara, Bernardino De Concilio, Leonardo Misuraca, Orazio Zappalà, Cristian Fiori, Marialuisa Appetecchia, Antonio Celia, Francesco Porpiglia, Giuseppe Tirone, Michele Gallucci, and Giuseppe Simone Umberto AnceschiUmberto Anceschi More articles by this author , Riccardo MastroianniRiccardo Mastroianni More articles by this author , Gabriele TudertiGabriele Tuderti More articles by this author , Alfredo Maria BoveAlfredo Maria Bove More articles by this author , Aldo BrassettiAldo Brassetti More articles by this author , Mariaconsiglia FerrieroMariaconsiglia Ferriero More articles by this author , Marilda MormandoMarilda Mormando More articles by this author , Alessandro CarraraAlessandro Carrara More articles by this author , Bernardino De ConcilioBernardino De Concilio More articles by this author , Leonardo MisuracaLeonardo Misuraca More articles by this author , Orazio ZappalàOrazio Zappalà More articles by this author , Cristian FioriCristian Fiori More articles by this author , Marialuisa AppetecchiaMarialuisa Appetecchia More articles by this author , Antonio CeliaAntonio Celia More articles by this author , Francesco PorpigliaFrancesco Porpiglia More articles by this author , Giuseppe TironeGiuseppe Tirone More articles by this author , Michele GallucciMichele Gallucci More articles by this author , and Giuseppe SimoneGiuseppe Simone More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002519.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In order to critically evaluate long-term functional outcomes of adrenal surgery for primary aldosteronism (PA), several predictive scores have been recently conceived. We compared a novel trifecta system that summarizes outcomes of adrenal surgery for Conn’ syndrome regardless the surgical technique with the standard clinical cure criteria proposed by Vorselaars. METHODS: A multicenter minimally-invasive adrenalectomy dataset was queried for “unilateral adrenal mass” and “primary aldosteronism (PA)” at 4 participating institutions between 2011-2021. Clinical and biochemical complete, partial and absent success rates according to PASO criteria were assessed for the overall cohort. Trifecta was defined as the coexistence of ≥50% antihypertensive therapeutic intensity score (TIS) reduction (∆TIS) and no electrolyte impairment at 3-months after surgery, no Clavien-Dindo (2-5) complications. Probability of absent clinical success according to non-achievement of trifecta and clinical failure were estimated by Kaplan-Meier method, respectively. Cox regression analyses were used to identify predictors of long-term clinical success. For all analyses, a two-sided p <0.05 was considered significant. RESULTS: Out of 90 patients, at a median follow-up of 42 months (IQR 27-54) a complete, partial, and absent clinical success was observed in 60%, 17.7%, 22.3% of cases while a complete, partial and absent biochemical success was achieved in 83.3%, 12.3%, 4.4% respectively. Overall trifecta and clinical cure rates were 21.1% and 58.9%, respectively (Tab.1). On Kaplan-Meier analysis, both trifecta and clinical failure predicted higher absent clinical success rates (each p <0.001; Fig. 1,2). On multivariable Cox regression analysis, trifecta achievement (HR 2.10; 95% CI 1.13-3.90; p=0.018) was the only independent predictor of complete clinical success at long-term follow-up. CONCLUSIONS: Compared to clinical cure, trifecta can be used to differentiate patients who are likely to achieve a stable and complete clinical success after partial and total adrenalectomy from those who will need continuous surveillance after treatment due to persistent or refractory hypertension on the long run. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e50 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Umberto Anceschi More articles by this author Riccardo Mastroianni More articles by this author Gabriele Tuderti More articles by this author Alfredo Maria Bove More articles by this author Aldo Brassetti More articles by this author Mariaconsiglia Ferriero More articles by this author Marilda Mormando More articles by this author Alessandro Carrara More articles by this author Bernardino De Concilio More articles by this author Leonardo Misuraca More articles by this author Orazio Zappalà More articles by this author Cristian Fiori More articles by this author Marialuisa Appetecchia More articles by this author Antonio Celia More articles by this author Francesco Porpiglia More articles by this author Giuseppe Tirone More articles by this author Michele Gallucci More articles by this author Giuseppe Simone More articles by this author Expand All Advertisement PDF DownloadLoading ...