The Whitaker Test in the Follow-up of Complex Upper Urinary Tract Reconstruction: Is It Clinical Useful or Not
Vol. 19 No. 01 (2022),
18 March 2022
Purpose: To evaluate the feasibility and guiding significance in postoperative management of the Whitaker test after complex reconstruction of the upper urinary tract.
Materials and Methods: Patients who underwent complex ureteral reconstruction and received the Whitaker test after surgery between December 2018 and December 2019 were included. We judged it abnormal that the renal pelvis pressure was higher than 22 cmH2O or the pressure difference was greater than 15 cmH2O. The results were used as a reference for removing the nephrostomy tube. Based on whether the renal pelvic pressure was higher than 22 cmH2O, the patients were divided into the elevated pelvis pressure group and the normal group. Follow ups at 1 month and every 3 months were collected.
Results: A total of 19 patients were included. Fifteen patients did not present obvious abnormalities. One patient suffered from contrast infiltrating into the renal parenchyma, and the pressure was higher than 15 cmH2O. Ureteral stent implantation was performed. The other 3 patients had either elevated pelvis pressure or insufficient image, 2 of which prolonged the duration of nephrostomy tubes. The median follow-up time was 12.6 months. CTU/MRU after removing nephrostomy tubes indicated improved/stable hydronephrosis in all patients. The creatinine in the elevated pelvis pressure group was higher than that in the normal group (91.4 ± 27.6 vs 86.7 ± 16.5 μmol/L, P = .782), and the eGFR was lower (76.0 ± 14.0 vs 81.8 ± 24.1 mL/min/1.73m2, P = .695), but without significant difference. The change in creatinine during follow-up in the elevated renal pelvic pressure group was significantly different from that in the normal group (-13.6 ± 1.0 vs -0.2 ± 10.6 umol/L, P = .047).
Conclusion: Postoperative Whitaker test can help judge whether nephrostomy could be removed. Elevated pressure in upper urinary tract after reconstruction suggests the need to prolong the time of the nephrostomy tube or even re-intervene. Proper management for patients with elevated renal pelvis pressure can help restore the renal function.
- ureteral reconstruction
- diagnostic techniques
- urodynamic study
- renal function
- the Whitaker test
How to Cite
Jayanthi VR. Reconstructive surgery of the upper urinary tract. Curr Opin Urol. 1998;8:215-20.
Wang J, Xiong S, Fan S, et al. Appendiceal Onlay Flap Ureteroplasty for the Treatment of Complex Ureteral Strictures: Initial Experience of Nine Patients. J Endourol. 2020;34:874-81.
Fan S, Yin L, Yang K, et al. Posteriorly augmented anastomotic ureteroplasty with lingual mucosal onlay grafts for long proximal ureteral strictures: Ten cases of experience. J Endourol. Epub ahead of print. doi: 10.1089/end.2020.0686.
Gu H, Chen S, Wu Y, et al. Improved Long Ureteral Reconstruction With Ileum By Longitudinal Clipping And Mucosal Stripping: An Animal Study. Urol J. 2020;17:198-203.
Vignoli G. Urodynamics of the Upper Urinary Tract. In: Vignoli G, editor. Urodynamics. Switzerland: Springer Cham; 2017. p. 175-84.
Farrugia MK, Whitaker RH. The search for the definition, etiology, and effective diagnosis of upper urinary tract obstruction: the Whitaker test then and now. J Pediatr Urol. 2019;15:18-26.
Whitaker RH, BuxtonThomas MS. A comparison of pressure flow studies and renography in equivocal upper urinary tract obstruction. J Urol. 1984;132:1209-10.
Whitaker RH. Methods of assessing obstruction in dilated ureters. Br J Urol. 1973;45:15-22.
Lupton EW, George NJ. The Whitaker test: 35 years on. BJU Int. 2010;105:94-100.
George NJ, O'Reilly PH, Barnard RJ, Blacklock NJ. High pressure chronic retention. Br Med J. 1983;286:1780-3.
Djurhuus JC, Jorgensen TM, Norgaard JP, Nerstrom B, Hvid-Hansen H. Constant perfusion provocation in idiopathic hydronephrosis. Urology. 1982;19: 611-6.
Wahlin N, Magnusson A, Persson AE, Lackgren G, Stenberg A. Pressure flow measurement of hydronephrosis in children: a new approach to definition and quantification of obstruction. J Urol. 2001;166:1842-7.
Johnston RB, Porter C. The Whitaker test. Urol J. 2014;11:1727-30.
Amling CL, O'Hara SM, Wiener JS, et al. Renal ultrasound changes after pyeloplasty in children with ureteropelvic junction obstruction: long-term outcome in 47 renal units. J Urol. 1996;156:2020-4.
Fernandez-Ibieta M, Nortes-Cano L, Guirao-Pinera MJ, et al. Radiation-free monitoring in the long-term follow-up of pyeloplasty: Are ultrasound new parameters good enough to evaluate a successful procedure? J Pediatr Urol. 2016;12:230-1.
Marshall V, Whitaker RH. Ureteral pressure flow studies in difficult diagnostic problems. J Urol. 1975;114:204-7.
Weiss RM. Clinical implications of ureteral physiology. J Urol. 1979;121:401-13.
Djurhuus JC, Sorensen SS, Jorgensen TM, et al. Predictive value of pressure flow studies for the functional outcome of reconstructive surgery for hydronephrosis. Br J Urol. 1985;57:6-9.
Koff SA. Determinants of progression and equilibrium in hydronephrosis. Urology. 1983;21:496-500.
- Abstract Viewed: 60 times
- 6277/pdf Downloaded: 59 times