MP80-10 URETEROSCOPIC GRADING SYSTEM FOR RENAL PAPILLAE: IMPLICATIONS ON ETIOLOGY OF STONE FORMATION AND RECURRENCE

Abstract

You have accessJournal of UrologyStone Disease: Evaluation II1 Apr 2015MP80-10 URETEROSCOPIC GRADING SYSTEM FOR RENAL PAPILLAE: IMPLICATIONS ON ETIOLOGY OF STONE FORMATION AND RECURRENCE Blake Anderson, Shane Pearce, Anna Zisman, Elaine Worcester, Fredric Coe, and Glenn Gerber Blake AndersonBlake Anderson More articles by this author , Shane PearceShane Pearce More articles by this author , Anna ZismanAnna Zisman More articles by this author , Elaine WorcesterElaine Worcester More articles by this author , Fredric CoeFredric Coe More articles by this author , and Glenn GerberGlenn Gerber More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2846AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Several theories for the etiology of kidney stone formation persist. Digital ureteroscopy allows high resolution depiction of renal papillae. The purpose of this study is to determine if renal papillary appearance at time of stone removal offers insight to stone etiology or recurrence. METHODS This is an IRB-approved, single surgeon, single center prospective study of patients undergoing ureteroscopic stone removal, initial results from 2013 to 2014. Demographics and baseline characteristics were collected. Ureteroscopy was performed with a flexible, digital ureteroscope, and images of papillae were recorded in a systematic fashion. Papillae were graded (0=absent, 1=mild, 2=moderate, 3=severe) for presence of Randall's plaques (RP) and Bellini duct plugging (BD) by 3 nephrologists blinded to patient characteristics. Per papillae scores were calculated and compared between recurrent (n=9) and first-time (n=5) stone formers. Likelihood of total, RP, and BD score per papillae greater than mean was correlated with recurrent status. Statistical tests performed were Chi-square and two sample t-tests. RESULTS Subjects to date include 14 patients with 74 renal papillae from 14 kidneys, majority female (79%). Age was higher in first-time stone formers (p<0.01), who also had a trend to higher serum Cr (p=0.055), but there were no significant differences in sex, race, BMI, Charlson Comorbidity Index or family history of stones (Table). Preoperatively, there were no differences in urine pH, rate of multiple stones, laterality, rate of positive urine cultures or stone size. Total score > 1.7 was marginally correlated with recurrent status (78% vs. 25%, p=0.071) and BD score > 0.6 approached significance (55% vs. 0%, p=0.057). RP score > 1.1 was not associated with recurrent status (p=0.85). CONCLUSIONS This standardized grading system suggests Bellini duct plugging on ureteroscopy may be associated with recurrent stones. Future studies with larger numbers of patients will help further determine the utility of this grading system. Demographics, Baseline Characteristics, and Papillae Grading Outcomes Parameter First-time Stone Formers (n=5) Recurrent Stone Formers (n=9) p value Total Papillae (%) 23 (31%) 51 (69%) Age 65.2 ± 12 45.1 ± 11 0.0073 Sex (%): 0.207 Female 60 89 Male 40 11 Race (%): 0.337 Caucasian 60 44 African American 40 22 Hispanic 0 33 BMI (kg/m2) 34.2 ± 8.9 28.0 ± 5.4 0.128 Charlson Comorbidity Index 3.4 ± 0.9 1.9 ± 1.6 0.08 History of (%): Smoking 60 22 0.158 Diuretics 40 44 0.872 Prior UTI 20 33 0.597 (+) Family History of Stones 20 33 0.597 Preoperative: Serum Cr (mg/dL) 1.3 ± 0.5 0.8 ± 0.2 0.0551 Urine pH 6 ± 0.5 6.6 ± 1.1 0.389 Laterality (%): 0.5 Bilateral 0 22 Left 60 44 Right 40 33 Presented with: Multiple stones (%) 20% 67% 0.094 (+) Urine Culture (%) 20% 11% 0.649 Stone Size (cm) 1.36 ± 0.6 0.99 ± 0.4 0.201 Grading Outcomes: Mean Total Score 1.51 ± 0.3 1.84 ± 0.8 0.4 % Total Score > 1.7 25 78 0.071 % RP Score > 1.1 50 56 0.853 % BD Score > 0.6 0 56 0.057 © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e1022-e1023 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Blake Anderson More articles by this author Shane Pearce More articles by this author Anna Zisman More articles by this author Elaine Worcester More articles by this author Fredric Coe More articles by this author Glenn Gerber More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...