MP18-09 COMPARISON OF INTRAOPERATIVE TO LAB-BASED STONE COMPOSITION ANALYSIS AND IMPACT ON MEDICAL MANAGEMENT

Abstract

You have accessJournal of UrologyStone Disease: Surgical Therapy II (MP18)1 Sep 2021MP18-09 COMPARISON OF INTRAOPERATIVE TO LAB-BASED STONE COMPOSITION ANALYSIS AND IMPACT ON MEDICAL MANAGEMENT Nilang Shah, Sriniwasan Mani, and Noah Canvasser Nilang ShahNilang Shah More articles by this author , Sriniwasan ManiSriniwasan Mani More articles by this author , and Noah CanvasserNoah Canvasser More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002003.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Appropriate medical management of recurrent kidney stone formers is reliant on both a stone analysis and a 24-hour urine collection. However, the accuracy of lab-based compositional stone analysis can be variable due to the amount of stone sample provided and differences in analytic methods. During ureteroscopy, given the ability to assess the entire stone for color, durility, how it fragments, and homogeneity or heterogeneity, a unique opportunity exists to predict stone composition. The present study focused on comparing the intraoperative stone composition to lab-based assessment and its subsequent effect on medical management. METHODS: Data was collected on all patients undergoing ureteroscopy from July 2019 until July 2020 for the treatment of renal and/or ureteral stones. During ureteroscopy we extract all stone fragments and submit all for stone analysis. Patient demographics, stone sizes, intraoperative assessment, lab-based stone analysis, initial post-operative 24-hour urinalyses and medical management were recorded. Primary outcome was the accuracy of the intraoperative assessment for dominant (≥50%) stone type and all constituents. Secondary outcome was the accuracy of the intraoperative assessment to guide management of the 24-hour urine abnormality. RESULTS: A total of 187 patients underwent ureteroscopy. Table 1 lists patient demographics and stone details (include age, race, % gender, target stone size, % bilateral, etc.). Intraoperative assessment matched the lab analysis in 97 patients (overall 51%). In the non-matching cases, the intraoperative assessment matched the majority composition of the stone in 64 cases (overall 34%), but not all constituents were identified. The most common inaccuracy was not identifying a calcium phosphate component in a calcium oxalate dominant stone (20%). Overall, intraoperative assessment guided medical management accurately in 88% of cases. CONCLUSIONS: Intraoperative stone assessment serves as a useful adjunct during ureteroscopy. Although accuracy for the dominant stone type and all stone constituents was only 51%, the assessment accurately guides medical management in most cases. This can be helpful in cases where obtaining a complete stone sample is not possible. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e321-e321 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nilang Shah More articles by this author Sriniwasan Mani More articles by this author Noah Canvasser More articles by this author Expand All Advertisement Loading ...