Split Function Research Articles

V09-10 ROBOTIC-ASSISTED AUGMENTED ROOF URETEROPLASTY WITH APPENDICEAL ONLAY FLAP

You have accessJournal of UrologyCME1 Apr 2023V09-10 ROBOTIC-ASSISTED AUGMENTED ROOF URETEROPLASTY WITH APPENDICEAL ONLAY FLAP Andrew Gabrielson, Oscar Li, and Andrew Cohen Andrew GabrielsonAndrew Gabrielson More articles by this author , Oscar LiOscar Li More articles by this author , and Andrew CohenAndrew Cohen More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003317.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Mid-to-proximal ureteral strictures pose a surgical challenge that historically required ileal ureter substitution, downward nephropexy, or renal autotransplantation. Ureteral reconstruction techniques involving buccal mucosa or appendix have gained traction with success rates approaching 90%. In this video we describe surgical technique for a robotic-assisted augmented roof ureteroplasty using an appendiceal onlay flap. METHODS: Our patient is a 45 year old male with recurrent impacted ureteral stones requiring multiple right-sided interventions including ureteroscopy with laser lithotripsy, ureteral dilation, and laser incision of ureteral stricture. Despite adequate treatment of his stone disease, he had deterioration of his renal split function with worsening right hydroureteronephrosis to the level of the mid-to-proximal ureter consistent with failed endoscopic management of his stricture. We proceeded with simultaneous endoscopic evaluation and robotic repair with plan for either ureteroureterostomy or augmented roof ureteroplasty using buccal mucosa or an appendiceal flap. RESULTS: Ureteroscopy and retrograde pyelogram revealed a 2-3cm near-obliterative stricture in the mid-to-proximal ureter. The ureteroscope was left in situ and the patient was placed in the modified flank position to allow concurrent endoscopic access during reconstruction. The right colon was reflected revealing significant scar tissue overlying the ureter. With the ureteroscope in situ, we utilized firefly imaging to aid in our dissection. The ureter was spatulated and mucosa of the diseased segment of ureter excised in a non-transecting manner. The mucosal edges of the posterior ureter were re-approximated with the ureteral backing left in place. The appendix was harvested on its mesentery, spatulated, and interposed in a pro-peristaltic fashion. A tension-free anastomosis was performed between ureteral mucosa and the open appendix flap. A JJ stent was placed under direct vision and ICG green was used to evaluate blood supply to the margins of the ureter and the appendix flap. The stent was removed 6 weeks postoperatively, and on 3-month follow-up imaging he had resolution of his right hydroureteronephrosis and has had no further episodes of stone formation, infections, or flank pain with 8-month followup. CONCLUSIONS: Augmented roof ureteroplasty with appendiceal onlay is a valuable tool in the urologists arsenal of reconstructive techniques. Use of intraoperative ureteroscopy with firefly imaging can aid in delineating anatomy during difficult ureteral dissections. Source of Funding: NA © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e840 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Andrew Gabrielson More articles by this author Oscar Li More articles by this author Andrew Cohen More articles by this author Expand All Advertisement PDF downloadLoading ...

MP47-01 LIMITATIONS OF PARENCHYMAL VOLUME ANALYSIS (PVA) FOR ESTIMATING SPLIT RENAL FUNCTION (SRF) & NEW BASELINE GFR (NBGFR) AFTER RADICAL NEPHRECTOMY (RN)

You have accessJournal of UrologyCME1 Apr 2023MP47-01 LIMITATIONS OF PARENCHYMAL VOLUME ANALYSIS (PVA) FOR ESTIMATING SPLIT RENAL FUNCTION (SRF) & NEW BASELINE GFR (NBGFR) AFTER RADICAL NEPHRECTOMY (RN) Kieran Lewis, Carlos Munoz-Lopez, Worapat Attawettayanon, João Pedro Emrich Accioly, Nityam Rathi, Zaeem Lone, Rebecca Campbell, Jihad Kaouk, Georges-Pascal Haber, Mohamad Eltemamy, Venkatesh Krishnamurthi, Robert Abouassaly, Christopher Weight, and Steven Campbell Kieran LewisKieran Lewis More articles by this author , Carlos Munoz-LopezCarlos Munoz-Lopez 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 , 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.0000000000003293.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Accurate prediction of NBGFR after RN can be important for counseling about RN vs. partial nephrectomy in some patients. SRF-based models have been shown to be most accurate for predicting NBGFR after RN, and PVA appears to be superior to nuclear renal scans (NRS) for this purpose. However, data regarding the potential limitations of PVA remain sparse. Our objective was to identify factors associated with PVA inaccuracy. METHODS: 241 RCC patients who underwent RN (2006-2021) with preop. CT/MRI and NRS were included for analysis. Our SRF-based model was: Predicted NBGFR=1.25(Global GFRPre-RN)(SRFContra), with SRF determined by PVA or NRS. Patients were grouped by PVA accuracy: PVAO (PVA over predicted NBGFR by >20%), PVAU (PVA under predicted NBGFR by >20%) and PVAA (PVA accurately predicted NBGFR). Accuracy of NRS was also studied in a similar manner. RESULTS: Six patients (2.5%) were excluded from PVA due to severely altered renal architecture (e.g. PCKD). PVA accurately predicted NBGFR for 83% (196/235) of patients and over/underpredicted NBGFR in 7% and 9%, respectively. NRS only accurately predicted NBGFR for 66% of patients and over/under predicted NBGFR in 22% and 13% of patients, respectively. PVAO had more patients with active/recent hydronephrosis compared to both PVAU /PVAA (29% vs 14% vs 10%, p=0.05). Prior renal infarct (p=0.01) and infiltrative renal mass (IRM) (p=0.002) were associated with PVA inaccuracy in both directions. In contrast, NRS inaccuracy was random and did not associate with hydronephrosis, prior renal infarct, or IRM (all p>0.3). Overall, 30% of patients fell into cohorts where accuracy of PVA was less reliable, but even in these situations PVA was non-inferior to NRS. CONCLUSIONS: PVA accuracy is reduced for IRMs likely due to difficulty distinguishing the true margins of the tumor and, in about 3% of patients, severe disruption of the architecture rendered PVA impossible (e.g. PCKD). Disease processes that distort the volume/function relationship, such as active/recent hydronephrosis, can lead to PVAO, because measured mass may not function optimally. Awareness of cohorts where PVA can be less accurate has clinical utility. However, even in these cohorts, PVA was still non-inferior to NRS, and it remains a cost effective tool for determining SRF/NBGFR. Further study of other processes that can affect the volume/function relationship, such as active or chronic pyelonephritis, or that can affect the degree of renal functional compensation, such as extremes of age, will be required. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e642 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kieran Lewis More articles by this author Carlos Munoz-Lopez 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 Christopher Weight More articles by this author Steven Campbell More articles by this author Expand All Advertisement PDF downloadLoading ...

PD43-12 NEW 3D VIRTUAL MODELS WITH RENAL PERFUSION VOLUMES: OPTIMIZING THE CLAMPING STRATEGY DURING ROBOT-ASSISTED PARTIAL NEPHRECTOMY TO MINIMIZE THE POSTOPERATIVE RENAL INJURY

You have accessJournal of UrologyCME1 Apr 2023PD43-12 NEW 3D VIRTUAL MODELS WITH RENAL PERFUSION VOLUMES: OPTIMIZING THE CLAMPING STRATEGY DURING ROBOT-ASSISTED PARTIAL NEPHRECTOMY TO MINIMIZE THE POSTOPERATIVE RENAL INJURY Daniele Amparore, Federico Piramide, Alberto Piana, Sabrina DE Cillis, Paolo Verri, Giovanni Busacca, Marco Colombo, Martina Mandaletti, Enrico Checcucci, Cristian Fiori, and Francesco Porpiglia Daniele AmparoreDaniele Amparore More articles by this author , Federico PiramideFederico Piramide More articles by this author , Alberto PianaAlberto Piana More articles by this author , Sabrina DE CillisSabrina DE Cillis More articles by this author , Paolo VerriPaolo Verri More articles by this author , Giovanni BusaccaGiovanni Busacca More articles by this author , Marco ColomboMarco Colombo More articles by this author , Martina MandalettiMartina Mandaletti More articles by this author , Enrico CheccucciEnrico Checcucci More articles by this author , Cristian FioriCristian Fiori More articles by this author , and Francesco PorpigliaFrancesco Porpiglia More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003353.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The aim of this study was to develop and test new 3D virtual models (3DVM) considering their different perfusion volumes instead of vascular regions empirically estimated, to evaluate their intraoperative accuracy in guiding selective clampings and to assess their impact on the renal function of the operated kidney. METHODS: We implemented our 3DVMs together with the Voronoi diagram, a Euclidean distance-based mathematical tool used to calculate vascular dominant regions in other organs. A perfusion volume-based 3DVM was built for all the renal masses scheduled for robot-assisted partial nephrectomy (RAPN) from 12/2019 to 09/2022. On its basis a selective or superselective clamping, limited to the peritumoral area, was planned and performed intraoperatively when feasible. To assess the functional impact of the clamping strategy on the operated kidney a sub-cohort of patients underwent baseline and 3 months postoperative renal scintigraphy (RS), evaluating the split renal function (SRF) and estimated renal plasmatic flow (ERPF). RESULTS: 103 patients were prospectively enrolled in the study. The median (IQR) number of kidney and tumor perfusion volumes were 8 (7-10) and 3 (2-3), respectively. In 79 patients (76.6%) a selective clamping was performed, for 16 (15.5%) patients the main artery was clamped, and 8 (7.8%) patients underwent clampless procedure. The median (IQR) ischemia time for global and selective clamping were 17 (15-25) and 16 (12-20) minutes, respectively. In the 51 patients underwent RS (Table 1), mean change in SRF rate decreased from 11.3% to 7.7% and 1.7% for global, selective (I order artery) and super-selective (II order artery) clamping, respectively (p=0.004). Similarly, mean change in ERPF rate diminished from 18.9% to 9.9% and 6.0% for the same category groups (0.02). CONCLUSIONS: The implementation of mathematical algorithms to 3DVMs allows a precise estimation of the kidney perfusion volumes, minimizing the extension of the ischemic region with the selective clamping and leading to reduce the postoperative renal function impairment. Source of Funding: None. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1123 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniele Amparore More articles by this author Federico Piramide More articles by this author Alberto Piana More articles by this author Sabrina DE Cillis More articles by this author Paolo Verri More articles by this author Giovanni Busacca More articles by this author Marco Colombo More articles by this author Martina Mandaletti More articles by this author Enrico Checcucci More articles by this author Cristian Fiori More articles by this author Francesco Porpiglia More articles by this author Expand All Advertisement PDF downloadLoading ...

PD43-06 FULLY AUTOMATED AI-GENERATED MODELS PREDICT POST-OPERATIVE GLOMERULAR FILTRATION RATE AFTER RENAL SURGERY WITH SIMILAR ACCURACY TO A VALIDATED CLINICAL MODEL.

You have accessJournal of UrologyCME1 Apr 2023PD43-06 FULLY AUTOMATED AI-GENERATED MODELS PREDICT POST-OPERATIVE GLOMERULAR FILTRATION RATE AFTER RENAL SURGERY WITH SIMILAR ACCURACY TO A VALIDATED CLINICAL MODEL. Nour Abdallah, Tarik Benidir, Nicholas Heller, Andrew Wood, Fabian Isensee, Resha Tejpaul, Chalairat Suk-Ouichai, Nityam Rathi, Diego Aguilar Palacios, Alex You, Erick Remer, Jihad Kaouk, Samuel Haywood, Venkatesh Kirshnamurthi, Steven Campbell, Nikolaos Papanikolopoulos, and Christopher Weight Nour AbdallahNour Abdallah More articles by this author , Tarik BenidirTarik Benidir More articles by this author , Nicholas HellerNicholas Heller More articles by this author , Andrew WoodAndrew Wood More articles by this author , Fabian IsenseeFabian Isensee More articles by this author , Resha TejpaulResha Tejpaul More articles by this author , Chalairat Suk-OuichaiChalairat Suk-Ouichai More articles by this author , Nityam RathiNityam Rathi More articles by this author , Diego Aguilar PalaciosDiego Aguilar Palacios More articles by this author , Alex YouAlex You More articles by this author , Erick RemerErick Remer More articles by this author , Jihad KaoukJihad Kaouk More articles by this author , Samuel HaywoodSamuel Haywood More articles by this author , Venkatesh KirshnamurthiVenkatesh Kirshnamurthi More articles by this author , Steven CampbellSteven Campbell More articles by this author , Nikolaos PapanikolopoulosNikolaos Papanikolopoulos More articles by this author , and Christopher WeightChristopher Weight More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003353.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The American Urologic Association recommends estimating postoperative (postop) glomerular filtration rate (GFR) in patients with renal mass to prioritize partial (PN) over radical nephrectomy (RN) when postop GFR<45 mL/min/1.73m2. Validated models based on clinical equations or renal volumes from hand or semi-automated segmentations are quite accurate but have limited uptake in clinical practice. We aimed to develop an artificial intelligence (AI)-GFR prediction calculated automatically on a preoperative (preop) computed tomography (CT) scan to predict a postop GFR as accurately as a validated clinical model. METHODS: Three hundred patients having PN or RN for renal tumor from the KiTS21 challenge were analyzed. We excluded 7 patients having bilateral tumors. Preop GFR was the closest recorded value, and postop GFR was ≥90 days. Split-renal function (SRF) was determined in a fully automated way from preop CT and our deep learning segmentation model. We programmed the algorithm to estimate postop GFR as 1.24×preop GFR×contralateral SRF for RN and 89% of preop GFR for PN. We compared AI-predicted GFR to a validated clinical model (GFR=35+preop GFR (x0.65)-18 (if RN) -age (x0.25)+3 (if tumor size>7 cm)-2 (if diabetes)). We compared AI and clinical model estimations of GFR to the measured postop GFR using correlation coefficients (R) and compared their ability to predict postop GFR<45 using logistic regression and areas under the curves (AUC). RESULTS: In 293 patients, median age was 60 years ((IQR) 51-68), 40.6% were female, and 62.1% had PN. Median tumor size was 4.2 (2.6-6.1), and 91.8% of the tumors were malignant, of which 35.1% were high-grade, 25.6% high-stage, and 21.8% had necrosis. When comparing measured postop GFR, the correlation coefficients were 0.75 and 0.77 for AI and clinical models, respectively. For the prediction of postop GFR<45, the AI and clinical models performed similarly (AUC 0.89 and 0.9, respectively). CONCLUSIONS: Our study introduces a fully automated prediction of postop GFR based on CT and baseline GFR with comparable predictive accuracy to validated clinical prediction models. These AI-based predictions can be implemented for decision-making without clinical details, clinician time, or measurements needed. 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 Nour Abdallah More articles by this author Tarik Benidir More articles by this author Nicholas Heller More articles by this author Andrew Wood More articles by this author Fabian Isensee More articles by this author Resha Tejpaul More articles by this author Chalairat Suk-Ouichai More articles by this author Nityam Rathi More articles by this author Diego Aguilar Palacios More articles by this author Alex You More articles by this author Erick Remer More articles by this author Jihad Kaouk More articles by this author Samuel Haywood More articles by this author Venkatesh Kirshnamurthi More articles by this author Steven Campbell More articles by this author Nikolaos Papanikolopoulos More articles by this author Christopher Weight More articles by this author Expand All Advertisement PDF downloadLoading ...

V01-03 SINGLE-PORT MINI PFANNENSTIEL ROBOTIC EXTRAPERITONEAL PEDIATRIC PYELOPLASTY: INITIAL EXPERIENCE

You have accessJournal of UrologyCME1 Apr 2023V01-03 SINGLE-PORT MINI PFANNENSTIEL ROBOTIC EXTRAPERITONEAL PEDIATRIC PYELOPLASTY: INITIAL EXPERIENCE Jaya Sai Chavali, Brendan Frainey, Albert Geskin, Ethan Ferguson, Roxana Ramos, Audrey Rhee, and Jihad Kaouk Jaya Sai ChavaliJaya Sai Chavali More articles by this author , Brendan FraineyBrendan Frainey More articles by this author , Albert GeskinAlbert Geskin More articles by this author , Ethan FergusonEthan Ferguson More articles by this author , Roxana RamosRoxana Ramos More articles by this author , Audrey RheeAudrey Rhee More articles by this author , and Jihad KaoukJihad Kaouk More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003221.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We aim to report our technique and functional and radiological outcomes of extra peritoneal robotic pediatric pyeloplasty through a mini-pfannenstiel (3 cm) incision using da-Vinci single-port (SP) robotic surgical system in pediatric population. METHODS: We present our initial series of 8 pediatric patients that underwent robotic SP pyeloplasty between 2020 - 2022. The case presented in current video is 1 year old male with known history antenatal hydronephrosis that presented with worsening postnatal hydronephrosis and renal function on split function and renal ultrasound imaging studies. The patient underwent cystoscopy, stent placement that confirmed severe ureteropelvic junction (UPJ) obstruction prior to proceeding with robotic surgery. He was placed in relaxed lateral position, extra peritoneal space was developed through mini pfannenstiel incision before docking the SP surgical system. The following robotic surgical steps were described: (1) development of extra peritoneal space, (2) identification of ureter and ureteropelvic junction, (3) dismemberment and reduction of redundant renal pelvis, (4) ureteropelvic junction anastomosis using running 5-0 Vicryl sutures. RESULTS: Overall operative time was 120 minutes and associated with minimal blood loss. No complications and patient discharged on POD1 and stent removed in 4 weeks as outpatient. The attached tables describe our study patient demographics, indications (Table 1) and outcomes among our study population (Table 2). All patients tolerated the surgery with minimal postsurgical pain and no narcotic requirement. CONCLUSIONS: Single port extra peritoneal pyeloplasty is a safe and feasible option for upper tract reconstruction in pediatric patients. All patients had complete resolution of symptoms both clinically and based on imaging upon follow up. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e79 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jaya Sai Chavali More articles by this author Brendan Frainey More articles by this author Albert Geskin More articles by this author Ethan Ferguson More articles by this author Roxana Ramos More articles by this author Audrey Rhee More articles by this author Jihad Kaouk More articles by this author Expand All Advertisement PDF downloadLoading ...

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

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 ...

Simultaneous Antegrade and Retrograde Endoscopic Management of Complete Short-Segment Ureteroileal Anastomotic Stricture: Technique and Early Outcome

Background: Ureteroileal anastomotic strictures have a prevalence of up to 10%. Although open surgical revision remains the gold standard treatment, endoscopic and robotic approaches are described to reduce morbidity.1 Patients with complete occlusive strictures are usually not considered candidates for endoscopic management. There are limited publications with small number of patients who employed endoscopic management for complete occlusive ureteroileal anastomotic stricture. Objective: The aim of this video is to describe surgical approach in a stepwise manner for endoscopic management of a complete short-segment (<1 cm) ureteroileal anastomotic stricture.2–6 Methods: A 51-year-old woman underwent an anterior pelvic exenteration and ileal conduit followed by adjuvant chemoradiotherapy for cervical cancer management. After 1 year, she underwent nephrostomy tube placement for pyelonephritis associated with a left hydroureteronephrosis. Subsequent antegrade nephrostogram demonstrated a complete ureteroileal anastomotic stricture. The patient was counseled regarding various management options, and she opted for endoscopic management. Under general anesthesia we initially performed a flexible cystoscopy through the ileal conduit and were unable to identify the left ureteroileal anastomotic site. We then dilated percutaneous renal access and placed 13F ultra-mini percutaneous nephrolithotomy sheath in kidney under fluoroscopic guidance. Antegrade simultaneous ureteroscopy and nephrostogram confirmed a short-segment complete stenosis of ureteroileal anastomosis. Using 200 micron holmium laser fiber at 1 J × 10 Hz, we incised the distal blind end of ureter near conduit allowing passage of the ureteroscope in periureteral tissue. We then incised the ileal conduit, allowing antegrade advancement of a guidewire into the conduit. This wire was retrieved cystoscopically through an ileal conduit and secured at the level of stoma. Finally, a 7F/14F endoureterotomy stent was placed followed by nephrostomy tube placement. Results: The patient had an uneventful postoperative recovery and was discharged home the next day with an open nephrostomy tube. After 10 days, we confirmed free drainage of contrast into the conduit without extravasation on antegrade nephrostogram and clamped the nephrostomy tube. We later removed nephrostomy tube at 2 weeks and endoureterotomy stent by office cystoscopy at 6 weeks. At 3-month and 1-year follow-up, the patient remained asymptomatic. A renal ultrasonography revealed residual mild left hydronephrosis and a renal scan showed stable split left renal function of 25% with adequate drainage. Conclusion: Our video provides detailed technical nuisances to novice endourologist for a safe and effective treatment of a complete short-segment ureteroileal anastomotic occlusion with simultaneous antegrade and retrograde endoscopic management. No competing financial interests exist. Authors have received and archived patient consent for video recording/publication in advance of video recording of procedure. Runtime of video: 4 mins 58 secs

V03-01 SINGLE-PORT KIDNEY AUTO-TRANSPLANTATION (SP-KAT) WITH BOARI FLAP URETERAL REIMPLANT: DESCRIPTION OF OUR NOVEL APPROACH

You have accessJournal of UrologyCME1 Apr 2023V03-01 SINGLE-PORT KIDNEY AUTO-TRANSPLANTATION (SP-KAT) WITH BOARI FLAP URETERAL REIMPLANT: DESCRIPTION OF OUR NOVEL APPROACH Jaya Sai Chavali, Jihad Kaouk, Ethan Ferguson, Roxana Ramos, Albert Geskin, Alvin Wee, and Mohamed Eltemamy Jaya Sai ChavaliJaya Sai Chavali More articles by this author , Jihad KaoukJihad Kaouk More articles by this author , Ethan FergusonEthan Ferguson More articles by this author , Roxana RamosRoxana Ramos More articles by this author , Albert GeskinAlbert Geskin More articles by this author , Alvin WeeAlvin Wee More articles by this author , and Mohamed EltemamyMohamed Eltemamy More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003241.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We aim to demonstrate the feasibility and safety of the novel minimally invasive technique for efficient, multiquadrant robotic kidney transplantation using da Vinci single-port robot platform (SP-KAT). The study patient had a good split renal function and complete ureter avulsion. METHODS: Eight consecutive patients underwent SP KAT using the DaVinci SP platform. Overall patient clinicopathologic variables were recorded in Table 1. We demonstrate our technique in 58 year old male that presented after complete avulsion of the ureter during ureteroscopy. He had good split renal function on imaging. Technical steps of the surgery included (1). Robotic nephrectomy; (2) Kidney benching; (3) Dissection of Iliac vessels and Kidney placement; (4) Vascular anastomosis; (5) Ureteral reimplant. Extra corporeal kidney benching performed at the same time while the iliac vessels are being exposed robotically for subsequent transplant. This patient in addition required Boari flap ureteroneocystostomy due to insufficient length of ureter. RESULTS: All SP KAT cases were successfully performed without repositioning or conversion to open. Total operative time was 701 minutes. Estimated blood loss was 500cc. The Foley and stent removed at 2 and 6 weeks postoperatively. Patient had complete preservation of renal function. No documented postoperative complications up to latest follow up at 1 year. CONCLUSIONS: We demonstrate our single-port efficient, multiquadrant robotic kidney transplantation technique performed though a single incision further reducing surgical morbidity. All the cases were completed successfully without conversion or loss of graft function. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e246 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jaya Sai Chavali More articles by this author Jihad Kaouk More articles by this author Ethan Ferguson More articles by this author Roxana Ramos More articles by this author Albert Geskin More articles by this author Alvin Wee More articles by this author Mohamed Eltemamy More articles by this author Expand All Advertisement PDF downloadLoading ...

PD45-02 THE IDEAL TIME INTERVAL BETWEEN REPEATED SHOCK WAVES LITHOTRIPSY SESSIONS FOR RENAL STONES: A RANDOMIZED CONTROLLED TRIAL

You have accessJournal of UrologyCME1 Apr 2023PD45-02 THE IDEAL TIME INTERVAL BETWEEN REPEATED SHOCK WAVES LITHOTRIPSY SESSIONS FOR RENAL STONES: A RANDOMIZED CONTROLLED TRIAL Mohamed Fadallah, Ahmed R. EL-Nahas, Ahmed Abdelhalim, Wael I. Mortada, Abdelwahab Hashem, Hadeer A.M. Ibrahim, Khaled Z. Sheir, and Mahmoud R. EL-Kenawy Mohamed FadallahMohamed Fadallah More articles by this author , Ahmed R. EL-NahasAhmed R. EL-Nahas More articles by this author , Ahmed AbdelhalimAhmed Abdelhalim More articles by this author , Wael I. MortadaWael I. Mortada More articles by this author , Abdelwahab HashemAbdelwahab Hashem More articles by this author , Hadeer A.M. IbrahimHadeer A.M. Ibrahim More articles by this author , Khaled Z. SheirKhaled Z. Sheir More articles by this author , and Mahmoud R. EL-KenawyMahmoud R. EL-Kenawy More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003358.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There is no consensus about the optimal time intervals between SWL repeated sessions. The study was conducted to assess the ideal interval between repeated SWL for renal stones. METHODS: The study protocol was approved by local ethical committee (ID: MD.20.05.327) and was registered to clinicaltrial.gov (NCT04575480). A randomized controlled trial was conducted between July 2020 and March 2022. Eligible patients with single renal stone<2 cm who required multiple SWL sessions were randomly assigned to one of three groups. Patients underwent 2nd session after (3,7 and 14 days) for groups (1,2 and 3) respectively. Tubular damage was assessed through estimation of changes in urinary execration of KIM-1, N-GAL and IL-18. While glomerular damage was assessed by the protein/ creatinine ratio and changes in renal DTPA isotope scan. Treatment success were assessed by NCCT after 3 months. RESULTS: The study included 166 patients. All patient's demographics were comparable between groups. There was significant elevation of protein /creatinine ratio and all tubular biomarkers post 1st and 2nd SWL when compared with pre-SWL values (p<0.0001 in all). All tubular damage biomarkers' values returned to pre-SWL at the planned day for the 3rd session in group 2 and 3 only (table 1). At 3 month follow up all urinary biomarkers and protein /creatine ratio were less than pre-SWL values in all groups. However, a significant decrease in ipsilateral renal split function was observed in group 1 only (p. value=0.005,0.887 and0.337 for group 1, 2 and 3 respectively . SWL treatment succeeded in 73.6% in group 1, 83.7% in group 2 and 81% in group 3. CONCLUSIONS: At least 7 days' interval is required between repeated session for treatment of renal stones to allow for complete recoverability of kidney glomerular and tubular functions. Source of Funding: we received funding from Urology and Nephrology Center - Mansoura University, Egypt © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1162 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mohamed Fadallah More articles by this author Ahmed R. EL-Nahas More articles by this author Ahmed Abdelhalim More articles by this author Wael I. Mortada More articles by this author Abdelwahab Hashem More articles by this author Hadeer A.M. Ibrahim More articles by this author Khaled Z. Sheir More articles by this author Mahmoud R. EL-Kenawy More articles by this author Expand All Advertisement PDF downloadLoading ...

V09-11 ROBOT-ASSISTED LAPAROSCOPIC PYELOLITHOTOMY AND SIDE-TO-SIDE PYELOPYELOSTOMY

You have accessJournal of UrologyCME1 Apr 2023V09-11 ROBOT-ASSISTED LAPAROSCOPIC PYELOLITHOTOMY AND SIDE-TO-SIDE PYELOPYELOSTOMY Mario Basulto-Martínez, Eduardo González-Cuenca, and Stephen Pautler Mario Basulto-MartínezMario Basulto-Martínez More articles by this author , Eduardo González-CuencaEduardo González-Cuenca More articles by this author , and Stephen PautlerStephen Pautler More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003317.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Duplication of the collecting system is the most common congenital ureteral abnormality. We aimed to describe a robot-assisted laparoscopic pyelolithotomy and a side-to-side pyelopyelosotmy in a patient with a duplex system and a stricture. METHODS: A 55 years-old man was referred to our center for right flank pain and proximal stones in the context of an incomplete duplex system. The endourology team tried a retrograde and antegrade approach and were both unsuccessful due to an unpassable stricture distal to the stone. Baseline imaging found an obstructed upper moiety with a cluster of stones in its ureter following by and obstructive stricture, and a renogram showed a split function of 39%. A standard 5 port approach was performed, and both ureters were identified. The, the ureter draining the upper moiety was incised and the stones were extracted. The stricture was identified and excised. The pelvis and ureter draining the lower moiety were also incised longitudinally and the posterior aspect of both ureters was sutured. A stent was advanced, and the anterior aspect of both ureters was closed. RESULTS: The estimated blood loss was 100 mL and the patient was discharged the next day. The stent was removed 4 weeks after and the patients is currently pain-free. A follow up imaging showed resolution of the upper moiety hydronephrosis and excretion of contrast in both ureters through the pyelopyelostomy. CONCLUSIONS: A side-to-side pyelopyelostomy is a feasible and safe technique in patients with a a duplex system and obstruction. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e840 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mario Basulto-Martínez More articles by this author Eduardo González-Cuenca More articles by this author Stephen Pautler More articles by this author Expand All Advertisement PDF downloadLoading ...

Redo Robotic Ureteroplasty After Prior Failed Ureterocalicostomy

Clinical History: Surgical management of patients with recurrent strictures after prior ureterocalicostomy for complex ureteropelvic junction obstruction is challenging because of extensive periureteral fibrosis and scarring that is present in this setting. Physical Examination: The patient presented with left flank pain. Diagnosis: We report the case of a 37-year-old male patient with a recurrent symptomatic stricture after undergoing a laparoscopic converted to open left ureterocalicostomy 12 years prior. Retrograde pyelogram showed a small filling defect and 1 cm narrowed segment at the ureter's insertion point into the lower pole calix. Intervention: We describe our approach for robotic ureteral reconstruction for patients with recurrent strictures after prior ureterocalicostomy. We highlight the utilization of intravenous indocyanine green (ICG) to facilitate identification of the strictured aspect of the ureter. A longitudinal incision was made along the strictured segment and a buccal mucosa graft was anastomosed to the defect in onlay manner. Follow-Up/Outcomes: Intraoperatively, operative time was 213 minutes and estimated blood loss was 100 mL. There were no intraoperative complications and the patient was discharged on the same day. At follow-up of 20 months, the patient had no flank pain and his postoperative renal scan showed normal split function and half washout time of 12 minutes bilaterally. Robotic ureteral reconstruction may be utilized for management of patients with recurrent ureteral strictures after prior ureterocalicostomy. Near infrared fluorescence with ICG may assist with identification of the strictured ureter in these complex settings. This surgical approach may reduce damage to the fragile periureteral blood supply and minimize the risk of stricture recurrence. Patient Consent Statement: Authors have received and archived patient consent for video recording/publication in advance of video recording of procedure. The study was approved by the institutional review board at Temple University (protocol number 20793). M.L. and J.J. have no conflicts of interest to disclose. D.E. is founder of Melzi corp and a consultant for Intuitive Surgical and Johnson and Johnson. Runtime of video: 4 mins 45 secs

All-order celestial OPE in the MHV sector

On-shell kinematics for gluon scattering can be parametrized with points on the celestial sphere; in the limit where these points collide, it is known that tree-level gluon scattering amplitudes exhibit an operator product expansion (OPE)-like structure. While it is possible to obtain singular contributions to this celestial OPE, getting regular contributions from both holomorphic and anti-holomorphic sectors is more difficult. In this paper, we use twistor string theory to describe the maximal helicity violating (MHV) sector of tree-level, four-dimensional gluon scattering as an effective 2d conformal field theory on the celestial sphere. By organizing the OPE between vertex operators in this theory in terms of soft gluon descendants, we obtain all-order expressions for the celestial OPE which include all regular contributions in the collinear expansion. This gives new, all-order formulae for the collinear splitting function (in momentum space) and celestial OPE coefficients (in the conformal primary basis) of tree-level MHV gluon scattering. We obtain these results for both positive and negative helicity gluons, and for any incoming/outgoing kinematic configuration within the MHV sector.

Dipole formalism for massive initial-state particles and its application to dark matter calculations

The dark matter abundance plays a crucial role in the determination of the valid parameter space of models both in the case of a discovery of dark matter and in the context of exclusion limits. Reliable theoretical predictions of the dark matter relic density require technically demanding precision calculations, which were so far limited in their automation due to challenges in the treatment of infrared divergences appearing in higher order calculations. In particular, massive initial states need to be considered in early Universe computations, so that the known dipole subtraction methods could not be directly exploited. We therefore provide a full generalization of the dipole subtraction method by Catani and Seymour to supersymmetric (SUSY) QCD with massive initial states. All dipole splitting functions and their integrated counterparts are given explicitly for four different dimensional schemes. To showcase their application, we apply our results to dark matter (co)annihilation processes in the context of the minimal supersymmetric Standard Model. We also demonstrate the accuracy of the dipole method by comparing our numerical results with those obtained with the phase space slicing method. Our analytical results will facilitate future automation of dark matter abundance calculations at next-to-leading order for both SUSY and non-SUSY models.

Function-Versatile Thermo-Optic Switch Using Silicon Nitride Waveguide in Polymer

A function-versatile thermo-optic switch is proposed and experimentally demonstrated using silicon nitride waveguides embedded in polymer cladding. The device consists of a 1 × 2 input splitter, 2 single-mode waveguides for phase shifting, and a thermally controlled 2 × 2 output coupler to give another degree of freedom in achieving phase-matching conditions. Combining the high waveguide birefringence of the thin silicon nitride waveguide and the excellent thermo-optic property of the polymer material, this device can realize multiple functions by applying different micro-heater powers, i.e., polarization-independent path switching, beam splitting, and polarization beam splitting. For the polarization-independent path switching, the fabricated device has shown a crosstalk suppression better than 10 dB for the TE mode and over 20 dB for the TM mode in the wavelength range from 1500 nm to 1620 nm. For the polarization beam splitting function, the device can reach a polarization extinction ratio greater than 10 dB at selected bands. This simple yet scalable device may find applications in polarization-multiplexed optical communication technology and complex photonic computing networks.

Reproducibility of Computed Tomography Volumetry for Predicting Post-Donation Remnant Renal Function: A Retrospective Analysis

Recent studies indicate that split renal function calculated by computed tomography (CT) volumetry is equally or more useful than that calculated by nuclear renography for donated kidney side selection. However, it remains unclear if CT volumetry accurately reflects split renal function as measured by nuclear renography. Therefore, this study aimed to evaluate the reproducibility of CT volumetry. Data from 141 donors who underwent living donor nephrectomy at Nara Medical University from March 2007 to June 2021 were reviewed. The correlation and agreement between the predicted postdonation estimated glomerular filtration rate (eGFR) by 99mTc-diethylenetriamine penta-acetic acid (DTPA) scintigraphy and by CT volumetry were evaluated by the Pearson's correlation coefficient and Bland-Altman analysis, respectively. Moreover, a comparison in split renal function categorization between 99mTc-DTPA scan and CT volumetry was performed. A total of 133 donors were included in the analysis. There was high correlation between the predicted postdonation eGFR by 99mTc-DTPA scintigraphy and by CT. Moreover, there was agreement in the predicted postdonation eGFR between 99mTc-DTPA scintigraphy and CT volumetry (Bland-Altman analysis [bias, 95% limits of agreement]; 0.83%, -5.6% to 7.3%). However, in one of 17 donors with absolute split renal function greater than 10% by 99mTc-DTPA scintigraphy, this clinically significant difference was missed by CT volumetry. There are donors for whom a clinically significant split renal function is not accurately reflected in CT volumetry. Future studies need to amend this discrepancy.

Variation in the Expression of Interstitial Cell of Cajal-like Cell (CD117) Across Congenital Pelvic-ureteric Junction Obstruction and its Renal Sonological and Functional Correlation: A Prospective Observational Study.

This study aims to study the variation in the expression of CD117-positive interstitial cells of Cajal-like cells (ICC-LC) across the upper urinary tract region in children presenting with pelvic-ureteric junction obstruction (PUJO) and its association with renal functional and sonological parameters of patients. A prospective observational study was done on 20 children with congenital PUJO who underwent dismembered pyeloplasty. All children underwent renal sonography (anteroposterior pelvic diameter [APPD], pelvicalyceal ratio [P/C ratio], Mid polar renal parenchymal diameter [MPPD]) and functional imaging scan (LLEC scan or DTPA scan). Three specimens were taken intraoperatively from above PUJ, at the level of PUJ, and below PUJ. Those were examined immunohistochemically using CD117 to count ICC-LC using standard criteria. Variation in the expression of CD117-positive ICC-LC was correlated with the abovestated parameters. The number of CD117-positive ICC-LC showed a continuous decreasing trend above downward. P/C ratio and APPD showed a parallel trend with ICC-LC distribution, whereas split renal function (SRF) showed an inverse relationship with the expression of ICC-LC. Children with lesser severity of obstruction (APPD <30 mm and SRF >40%) showed a uniform decreasing trend in the number of CD117-positive ICC-LC across PUJ. Children with more severe obstruction (APPD >30 mm and SRF <40%) showed a decrease in the expression of ICC-LC up to the level of PUJO followed by a sudden relatively increased expression of ICC-LC below the obstruction. The expression of ICC-LC shows a uniformly decreasing trend across obstruction when the severity of obstruction is less. Resurgence in the number of ICC-LC below PUJ in subjects with severe obstruction hints at the emergence of a new pacemaker area below severely blocked PUJ akin to that seen in complete heart block patients and deserves early attention.

Robot-Assisted Laparoscopic Ureteroureterostomy of an Obstructive Retrocaval Ureter

Clinical History: A 32-year-old woman without significant medical history presented with incidentally found right severe hydronephrosis from a computed tomography scan after car accident. Her symptoms include only intermittent right flank pain. She has no dysuria or hematuria. Physical Examination: Examination was notable for right-sided costovertebral angle tenderness. Diagnosis: A computed tomography urogram scan was performed, which revealed severe right hydronephrosis with abrupt transition point at proximal ureter. The transition point was located posterior to the inferior vena cava, consistent with retrocaval ureter anatomy. Renal nucleotide scan showed 40% right kidney split function as well as a t1/2 of 35 minutes in right kidney, suggesting obstruction. Intervention: Given symptomatic pain, radiologic evidence of ureteral obstruction, good residual right renal function, and performance status, decision was made to perform a right robot-assisted laparoscopic ureteroureterostomy. Follow-up/Outcomes: Patient tolerated the procedure well and was discharged home the morning after surgery with drain removed. She had prompt return of daily activities and complete resolution of flank pain. Her ureteral stent was removed in clinic 6 weeks after the surgery. Repeat renal nucleotide scan 3 months after the surgery demonstrated resolution of obstruction with new t1/2 of 8.7 minutes. Patient Consent Statement: The author(s) have received and archived patient consent for video recording/publication in advance of video recording of procedure. The authors have no conflicts of interest that may alter the results of this study. Runtime of video: 4 mins 28 secs

Approximate N^{3}LO parton distribution functions with theoretical uncertainties: MSHT20aN^3LO PDFs

We present the first global analysis of parton distribution functions (PDFs) at approximate N^{3}LO in the strong coupling constant alpha _{s}, extending beyond the current highest NNLO achieved in PDF fits. To achieve this, we present a general formalism for the inclusion of theoretical uncertainties associated with the perturbative expansion in the strong coupling. We demonstrate how using the currently available knowledge surrounding the next highest order (N^{3}LO) in alpha _{s} can provide consistent, justifiable and explainable approximate N^{3}LO (aN^{3}LO) PDFs. This includes estimates for uncertainties due the currently unknown N^{3}LO ingredients, but also implicitly some missing higher order uncertainties (MHOUs) beyond these. Specifically, we approximate the splitting functions, transition matrix elements, coefficient functions and K-factors for multiple processes to N^{3}LO. Crucially, these are constrained to be consistent with the wide range of already available information about N^{3}LO to match the complete result at this order as accurately as possible. Using this approach we perform a fully consistent approximate N^{3}LO global fit within the MSHT framework. This relies on an expansion of the Hessian procedure used in previous MSHT fits to allow for sources of theoretical uncertainties. These are included as nuisance parameters in a global fit, controlled by knowledge and intuition based prior distributions. We analyse the differences between our aN^{3}LO PDFs and the standard NNLO PDF set, and study the impact of using aN^{3}LO PDFs on the LHC production of a Higgs boson at this order. Finally, we provide guidelines on how these PDFs should be used in phenomenological investigations.

Analytical Solution to DGLAP Integro-Differential Equation in a Simple Toy-Model with a Fixed Gauge Coupling

We consider a simple model for QCD dynamics in which DGLAP integro-differential equation may be solved analytically. This is a gauge model which possesses dominant evolution of gauge boson (gluon) distribution and in which the gauge coupling does not run. This may be N=4 supersymmetric gauge theory with softly broken supersymmetry, other finite supersymmetric gauge theory with a lower level of supersymmetry, or topological Chern–Simons field theories. We maintain only one term in the splitting function of unintegrated gluon distribution and solve DGLAP analytically for this simplified splitting function. The solution is found using the Cauchy integral formula. The solution restricts the form of the unintegrated gluon distribution as a function of momentum transfer and of Bjorken x. Then, we consider an almost realistic splitting function of unintegrated gluon distribution as an input to DGLAP equation and solve it by the same method which we have developed to solve DGLAP equation for the toy-model. We study a result obtained for the realistic gluon distribution and find a singular Bessel-like behavior in the vicinity of the point x=0 and a smooth behavior in the vicinity of the point x=1.

Hypergraphs with edge-dependent vertex weights: p-Laplacians and spectral clustering.

We study p-Laplacians and spectral clustering for a recently proposed hypergraph model that incorporates edge-dependent vertex weights (EDVW). These weights can reflect different importance of vertices within a hyperedge, thus conferring the hypergraph model higher expressivity and flexibility. By constructing submodular EDVW-based splitting functions, we convert hypergraphs with EDVW into submodular hypergraphs for which the spectral theory is better developed. In this way, existing concepts and theorems such as p-Laplacians and Cheeger inequalities proposed under the submodular hypergraph setting can be directly extended to hypergraphs with EDVW. For submodular hypergraphs with EDVW-based splitting functions, we propose an efficient algorithm to compute the eigenvector associated with the second smallest eigenvalue of the hypergraph 1-Laplacian. We then utilize this eigenvector to cluster the vertices, achieving higher clustering accuracy than traditional spectral clustering based on the 2-Laplacian. More broadly, the proposed algorithm works for all submodular hypergraphs that are graph reducible. Numerical experiments using real-world data demonstrate the effectiveness of combining spectral clustering based on the 1-Laplacian and EDVW.