The modified Whitaker test in evaluating the surgical effect after ileal ureter replacement

Area of Science:

• Urology
• Surgical innovation
• Postoperative assessment

Background:

• Ileal ureter replacement (IUR) is a complex reconstructive procedure.
• Assessing the functional outcomes and safety of IUR requires reliable postoperative evaluation methods.
• Current methods may not fully capture the dynamic function of the ileal segment.

Purpose of the Study:

• To develop and evaluate a modified Whitaker test for assessing surgical outcomes after ileal ureter replacement (IUR).
• To determine the feasibility and effectiveness of this adapted test in postoperative patient evaluation.
• To provide evidence supporting the safety of nephrostomy tube removal based on test results.

Main Methods:

• Prospective enrollment of patients undergoing the modified Whitaker test post-IUR (November 2021 - September 2023).
• Measurement of relative pressure (pelvis pressure minus bladder pressure) during the test.
• Classification of results into three types based on pressure changes and ureteral peristalsis.

Main Results:

• The modified Whitaker test was successfully performed on 51 ureters in 39 patients without discomfort.
• 47 ureters (Type I) showed steady pressure (<15 cmH2O) and normal peristalsis, allowing prompt nephrostomy removal.
• 2 ureters (Type II) had moderate pressure increase (15-22 cmH2O) with good peristalsis, also permitting early removal; 2 ureters (Type III) showed high pressure (>22 cmH2O) or leakage, requiring delayed removal.

Conclusions:

• The modified Whitaker test is a safe and effective tool for evaluating the surgical results of ileal ureter replacement.
• This method provides valuable data for assessing the functional integrity of the ileal ureter.
• The test aids in making informed decisions regarding the timing of nephrostomy tube removal.