A Novel Method of Evaluating Ureteropelvic Junction Obstruction: Dynamic Near Infrared Fluorescence Imaging Compared to Standard Modalities to Assess Urinary Obstruction in a Swine Model

Rowe, Courtney K.; Franco, Felipe; Barbosa, João Arthur Brunhara Alves; Minnillo, Brian J.; Chow, Jeanne S.; Treves, Ted; Retik, Alan B.; Nguyen, Hiep T.

doi:10.1016/j.juro.2012.07.002

Cited by 14 publications

(12 citation statements)

References 16 publications

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“…20 Moreover, NIR imaging has recently shown feasibility in diagnosing ureteropelvic junction obstruction in a swine model. 21 However, to date, no clinical data are available. The aim of the current study was to assess feasibility of this technique for detection of the ureters in patients undergoing lower abdominal surgery.…”

Section: Introductionmentioning

confidence: 99%

Intraoperative Near Infrared Fluorescence Guided Identification of the Ureters Using Low Dose Methylene Blue: A First in Human Experience

et al. 2013

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Purpose Near-infrared (NIR) fluorescence imaging is a promising technique that offers, real-time, visual information during surgery. The current study reports the first clinical results of ureter imaging using NIR fluorescence after a simple peripheral infusion of methylene blue (MB). Furthermore, optimal timing and dose of MB were assessed. Materials and Methods A total of 12 patients that underwent lower abdominal surgery were included in this prospective feasibility study. NIR fluorescence imaging was performed using the Mini-FLARE™ imaging system. To determine optimal timing and dose, MB was injected intravenously at doses of 0.25, 0.5 or 1 mg/kg, after exposure of the ureters. Subsequently imaging was performed for up to 60 min following injection. Results In all patients both ureters could be clearly visualized within 10 minutes after infusion of MB. Signal lasted at least up to 60 minutes after injection. The mean signal-to-background ratio (SBR) of the ureter was 2.27 ± 1.22 (N = 4), 2.61 ± 1.88 (N = 4) and 3.58 ± 3.36 (N = 4) for the 0.25, 0.5 and 1 mg/kg groups, respectively. A mixed model analysis was used to compare SBRs between dose groups and time points and to assess the relation between dose and time. A significant difference between time points (P < 0.001) was found. However no difference between dose groups was observed (P = 0.811). Conclusions This study demonstrates the first successful use of NIR fluorescence using low-dose MB for the identification of the ureters during lower abdominal surgery.

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Section: Introductionmentioning

confidence: 99%

Intraoperative Near Infrared Fluorescence Guided Identification of the Ureters Using Low Dose Methylene Blue: A First in Human Experience

et al. 2013

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“…Rowe et al described the use of Genhance 750 as a novel method to evaluate ureteropelvic junction obstruction [ 36 ]. In this study, the ureteral obstruction was visualized in swine.…”

Section: Resultsmentioning

confidence: 99%

Currently available and experimental dyes for intraoperative near-infrared fluorescence imaging of the ureters: a systematic review

et al. 2019

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Background Iatrogenic ureteral injury (IUI) following abdominal surgery has a relatively low incidence, but is associated with high risks of morbidity and mortality. Conventional assessment of IUI includes visual inspection and palpation. This is especially challenging during laparoscopic procedures and has translated into an increased risk of IUI. The use of near-infrared fluorescent (NIRF) imaging is currently being considered as a novel method to identify the ureters intraoperatively. The aim of this review is to describe the currently available and experimental dyes for ureter visualization and to evaluate their feasibility of using them and their effectiveness. Methods This article adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standard for systematic reviews. A systematic literature search was performed in the PubMed database. All included articles were screened for eligibility by two authors. Three clinical trial databases were consulted to identify ongoing or completed unpublished trials. Risk of bias was assessed for all articles. Results The search yielded 20 articles on ureter visualization. Two clinically available dyes, indocyanine green (ICG) and methylene blue (MB), and eight experimental dyes were described and assessed for their feasibility to identify the ureter. Two ongoing clinical trials on CW800-BK and one trial on ZW800-1 for ureter visualization were identified. Conclusions Currently available dyes, ICG and MB, are safe, but suboptimal for ureter visualization based on the route of administration and optical properties, respectively. Currently, MB has potential to be routinely used for ureter visualization in most patients, but (cRGD-)ZW800-1 holds potential for this role in the future, owing to its exclusive renal clearance and the near absence of background. To assess the benefit of NIRF imaging for reducing the incidence of IUI, larger patient cohorts need to be examined. Electronic supplementary material The online version of this article (10.1007/s10151-019-01973-4) contains supplementary material, which is available to authorized users.

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“…10SP could differentiate between a normal and nonobstructive dilated ureter in adults, but not in children. In addition, Rowe et al [6] developed fluorescence imaging to obtain dynamic images of the urine flow and ureteral peristalsis; they concluded that fluorescence imaging would be a potential modality for the diagnosis of UPJO, but its ability in differentiating obstructive from nonobstructive hydroureter was not indicated. MRU and computed tomography urography (CTU) possess a diagnostic superiority over conventional modalities [15].…”

Section: Discussionmentioning

confidence: 99%

“…Nonetheless, an optimal modality remains to be unveiled [5]. Because US does not provide objective, reproducible parameters of function and obstruction, other diagnostic modalities, including diuretic renal scintigraphy (diuretic renography), are mandatory to evaluate for obstruction in hydroureter [6].…”

Section: Introductionmentioning

confidence: 99%

Drainage-related ultrasonography (DRUS): a novel technique for discriminating obstructive and nonobstructive hydroureters in children

et al. 2014

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Background Despite advances in urologic imaging, the paucity of an optimal technique that accurately clarifies obstructive and nonobstructive hydroureter exists. Objective This study was conducted to introduce a novel and modified ultrasonographic technique, known as drainage-related ultrasonography (DRUS), discriminating obstructive and nonobstructive, nonrefluxing hydroureter. Materials and methods A total of 358 children (mean age, 3.7 years) with 418 nonrefluxing hydroureter were included. These children were composed of two groups of obstructive nonrefluxing (141 children with 157 dilated ureters) and nonobstructive, nonrefluxing (217 children with 261 hydroureter). The definite diagnosis regarding the subtype of hydroureter was derived from appropriate investigation. The maximum diameter of the dilated ureter, which was observed on ultrasonography, was recorded before and after 3 h of catheterization, as D1 and D2, respectively. To assess the D ratio, a formula was developed, that is, [(|D1 -D2|)/D1] 9 100. Values were recorded and cutoff points were set to discriminate between subtypes. Results Obstructive versus nonobstructive subtypes of nonrefluxing hydroureter were clarified with 78.5 % sensitivity and 83.4 % specificity, by setting a cutoff point of 22 % for the D ratio. Regardless of the cutoff point assigned to the reduction in D (D2 compared with D1), DRUS revealed 93.9 % sensitivity, 80.6 % specificity, 63.2 % positive predictive value, and 97.4 % negative predictive value in discriminating upper from lower obstruction. Conclusion DRUS affords favorable results in terms of differentiating between obstructive and nonobstructive, nonrefluxing hydroureter, as well as between upper and lower obstruction in obstructive cases. It has the potential to become an efficient imaging modality in the diagnostic algorithm of hydroureter.Keywords Urinary tract obstruction Á Hydroureter Á Technetium-99 m DTPA Á Radioisotope renography Á Urinary bladder Á Drainage Sommario Background Nonostante i progressi nella diagnostica per immagini urologica, vi è la mancanza di una tecnica ottimale che definisca con precisione l'idrouretere ostruttivo e non-ostruttivo. Obiettivi Questo studio è stato condotto per introdurre una nuova e modificata tecnica ecografica (US), conosciuta (2015) 18:117-125 DOI 10.1007/s40477-014-0128-z come drenaggio correlato all'ecografia (DRUS), per discriminare l'idrourete ostruttivo da quello non-ostruttivo. Materiali e metodi Un totale di 358 bambini (età media: 3,7 anni) con 418 idroureteri senza reflussi sono stati inclusi nello studio. Questi bambini sono stati divisi in due gruppi, con forme ostruttive, senza reflusso (141 bambini con 157 ureteri dilatati) e con forme non-ostruttive, senza reflusso (217 bambini con 261 idroureteri). La diagnosi definitiva riguardo il sottotipo di idrouretere è stata fatta con indagini appropriate. Il diametro massimo dell'uretere dilatato misurato con ecografia, è stato registrato prima e tre ore dopo la cateterizzazione, rispettivamente come D1...

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A Novel Method of Evaluating Ureteropelvic Junction Obstruction: Dynamic Near Infrared Fluorescence Imaging Compared to Standard Modalities to Assess Urinary Obstruction in a Swine Model

Cited by 14 publications

References 16 publications

Intraoperative Near Infrared Fluorescence Guided Identification of the Ureters Using Low Dose Methylene Blue: A First in Human Experience

Intraoperative Near Infrared Fluorescence Guided Identification of the Ureters Using Low Dose Methylene Blue: A First in Human Experience

Currently available and experimental dyes for intraoperative near-infrared fluorescence imaging of the ureters: a systematic review

Drainage-related ultrasonography (DRUS): a novel technique for discriminating obstructive and nonobstructive hydroureters in children

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