PD43-07 PARENCHYMAL VOLUME IS KING, BUT WHO ARE THE JESTERS?

Abstract

You have accessJournal of UrologyCME1 Apr 2023PD43-07 PARENCHYMAL VOLUME IS KING, BUT WHO ARE THE JESTERS? Carlos Munoz-Lopez, Kieran Lewis, Worapat Attawettayanon, João Pedro Emrich Accioly, Nityam Rathi, Zaeem Lone, Rebecca Campbell, Jihad Kaouk, Georges-Pascal Haber, Mohamad Eltemamy, Venkatesh Krishnamurthi, Robert Abouassaly, Samuel Haywood, Christopher Weight, and Steven Campbell Carlos Munoz-LopezCarlos Munoz-Lopez More articles by this author , Kieran LewisKieran Lewis More articles by this author , Worapat AttawettayanonWorapat Attawettayanon More articles by this author , João Pedro Emrich AcciolyJoão Pedro Emrich Accioly More articles by this author , Nityam RathiNityam Rathi More articles by this author , Zaeem LoneZaeem Lone More articles by this author , Rebecca CampbellRebecca Campbell More articles by this author , Jihad KaoukJihad Kaouk More articles by this author , Georges-Pascal HaberGeorges-Pascal Haber More articles by this author , Mohamad EltemamyMohamad Eltemamy More articles by this author , Venkatesh KrishnamurthiVenkatesh Krishnamurthi More articles by this author , Robert AbouassalyRobert Abouassaly More articles by this author , Samuel HaywoodSamuel Haywood More articles by this author , Christopher WeightChristopher Weight More articles by this author , and Steven CampbellSteven Campbell More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003353.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Previous studies on functional outcomes after PN have been limited in size and potentially influenced by selection bias, as they were restricted to a minority (≈10%) of patients with both preop./postop. nuclear scans available for estimation of split-renal-function (SRF). Software now allows for parenchymal volume analysis (PVA), which provides a more accurate estimate of SRF, and also facilitates inclusion of a greater proportion of patients. The software also provides more accurate estimation of parenchymal volume loss and thereby improves evaluation of secondary factors affecting functional recovery. Our objective is to provide a more rigorous assessment of factors affecting functional recovery after PN. METHODS: 1192 patients were managed with PN (2012-14) at our center and 670 (56%) had imaging and SCr before/after PN necessary for inclusion. Baseline demographics/comorbidities were assessed. The primary endpoint was recovery from ischemia (Rec-ischemia), defined as ipsilateral GFR saved normalized by parenchymal volume saved. Multivariable regression models were constructed to identify predictors of Rec-ischemia. RESULTS: 261 and 409 patients had cold/zero or warm ischemia, with median ischemia times of 30/22 minutes, respectively. Median preop. global GFR and new-baseline GFR (NB-GFR) were 78/69*, respectively. Median ipsilateral preop. GFR and NB-GFR were 40/31*, respectively. Functional recovery correlated strongly with parenchymal volume preserved (r=0.83, p<0.001). Median decline in ipsilateral GFR associated with PN was 7.8*, with loss of parenchyma accounting for 81% of the loss. Median Rec-ischemia was 96% overall, and 96/95% in the cold/zero and warm ischemia groups, respectively. Insulin-dependent diabetes (coefficient=-6.2, p<0.001), treatment resistant hypertension (coefficient=-10.1, p<0.001), warm ischemia (coefficient=-1.6, p=0.03) and baseline GFR (coefficient=-0.05, p=0.01) independently associated with reduced Rec-ischemia. *ml/min/1.73m2 CONCLUSIONS: Our data confirms that the main determinant of functional recovery after PN is parenchymal volume preservation. A more rigorous evaluation allowed us to identify secondary factors that independently associated with impaired recovery. However, these secondary factors were altogether less impactful. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1120 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Carlos Munoz-Lopez More articles by this author Kieran Lewis More articles by this author Worapat Attawettayanon More articles by this author João Pedro Emrich Accioly More articles by this author Nityam Rathi More articles by this author Zaeem Lone More articles by this author Rebecca Campbell More articles by this author Jihad Kaouk More articles by this author Georges-Pascal Haber More articles by this author Mohamad Eltemamy More articles by this author Venkatesh Krishnamurthi More articles by this author Robert Abouassaly More articles by this author Samuel Haywood More articles by this author Christopher Weight More articles by this author Steven Campbell More articles by this author Expand All Advertisement PDF downloadLoading ...