Cases Of Stones Research Articles

Analysis of Liver Function Test in Common Bile Duct Stone: A Descriptive Cross sectional study

Introduction: Liver function test (LFT) is a useful tool to differentiate between the obstructive and hepatocellular cause for biliary obstruction. Therefore this study was done to see the accuracy of LFT in predicting common bile duct (CBD) stones. Methods: A descriptive cross sectional study was carried out on patient undergoing endoscopic retrograde cholangiopancreatography for CBD stones at Bharatpur Hospital and Dev Hospital from 2021 June 15 to 2022 October 15. Ethical clearance was taken from Institutional Review Committee Bharatpur Hospital reference number 079/80-013. The convenient sampling method was applied. Data were collected and analyzed in statistical package for the social sciences version 22. Results: Out of 95 patients higher aged female predominance was seen. The overall incidence of abnormal LFT in CBD stones was 85.3%. All the parameters of LFT were raised in majority of the cases of CBD stones and among these, SGOT was mostly increased (75.6%). In patients with ERCP findings of sludge in bile duct have increased total, direct and indirect bilirubin than in patient with CBD stone and this finding was found to be statistically significant. However, other liver parameters were comparable.Similarly, total, direct and indirect bilirubin, serum glutamic oxaloacetic transaminase (SGOT), serum glutamic pyruvic transaminase (SGPT) and alkaline phosphatase (ALP) were equally raised with both group of CBD stones with and without cholecystitis. Conclusion: Liver function test was equally raised in both case of CBD stone with and without cholecystitis. Although ALP and total bilirubin represented the most reliable predictors in obstructive jaundice, SGOT might also be added tool to exclude choledocholithiasis.

Mini Percutaneous Nephrolithotomy in Ectopic Lumber Kidney: A Case Report

The chance of the development of hydronephrosis and the formation of stones is more in the ectopic kidney. Treatment of stones in ectopic kidneys is challenging for urologists due to abnormal location and rotation of the kidney and unfavourable local anatomy. We herein report a case of stone in a lumber kidney successfully managed by mini percutaneous nephrolithotomy (PCNL) in a prone position. A 55-year-old male presented with right lower abdominal pain. His CT scan of the KUB reveals the right kidney is in an ectopic location and has a hyperdense structure measuring about 15 mm in length, seen in the right renal pelvis with mild dilatation of the pelvicalyceal system. The patient underwent right-sided prone mini PCNL under the subarachnoid block (SAB), and complete stone clearance was achieved. There was no adverse event during or after surgery or post-operative blood transfusion. Bangladesh J. Urol. 2022; 25(2): 122-125

Predictors of success of conventional ERCP for bile duct stones and need for single-operator cholangioscopy.

Background and study aims The characteristics of difficult stones requiring cholangioscopy-assisted lithotripsy are poorly defined. We sought to determine clinician perception of these characteristics and decision-making in biliary endoscopy. Methods One hundred twenty-four delegates attending an online course were invited to assess 20 clinical stone cases. Each image was graded on a 4-point Likert for: grading of stone difficulty, confidence of clearance with conventional endoscopic retrograde cholangiopancreatography (ERCP) methods, likelihood of needing cholangioscopy-assisted lithotripsy, and confidence of clearance with one session of lithotripsy. An independent reviewer rated each case on largest stone size, stone number, presence of stricture distal to stone, size of stone relative to distal duct size, and acute common bile duct (CBD) angulation < 135°. Multilevel (mixed) statistical methods with a two-level model were utilized with multilevel ordinal logistic regression. Results Stone size and location, stricture and stone diameter:duct ratio impacted perceived procedural difficulty P < 0.01). Stone:duct ratio (< 50% odds ratio [OR] 0.22, P < 0.001), stricture (OR 7.26, P < 0.001) and stone location impacted confidence of clearance with conventional ERCP. Intrahepatic and cystic duct stones were least likely to engender confidence ( P < 0.01). The same factors plus CBD angulation < 135° predicted cholangioscopy requirement ( P < 0.01). Stone number did not influence procedure difficulty or cholangioscopy requirement. Strictures (OR 0.29, P < 0.001) and location, especially intrahepatic (OR 0.42, P < 0.001) impaired confidence in clearance with one cholangioscopy session. Conclusions Ductal anatomy, the presence of a stricture distal to a stone, cystic and intrahepatic stones and stones larger than the distal duct are considered by endoscopists to be significant predictors of requiring cholangioscopy-assisted lithotripsy.

Outcome of the Endoscopic Biliary Stenting for Irretrievable Common Bile Duct Stones in an Academic Hospital – A Prospective Study

Background: Choledocholithiasis is characterized by the existence of a stone in the common bile duct. Based on findings published in the Medical Clinics of North America, around 10-15% of individuals with gallstones experience the development of choledocholithiasis. Presently, the established approach for addressing common bile duct stones involves the implementation of endoscopic papillotomy and stone extraction. The combined utilization of Dormia basket, balloon catheter, and lithotripsy achieves a success rate of approximately 90%. In cases where traditional endoscopic removal methods prove ineffective, biliary stenting plays a crucial role in the conservative management of CBD stones. Objectives: The main goal of the study was to evaluate the outcome of biliary stenting in irretrievable common bile duct stones. Materials and Methods: This observational study took place at the Department of Gastroenterology, Dhaka Medical College and Hospital, Dhaka, from January 2018 to December 2018. The study included consecutive patients who were 18 years or older and diagnosed with common bile duct stones. These patients underwent endoscopic retrograde cholangiopancreatography (ERCP) for stone extraction. The study specifically focused on patients who received biliary stenting for irretrievable common bile duct stones, and they were enrolled as participants in the study. Results: Out of the 83 patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) for stone extraction, 29 patients (35%) were deemed as having irretrievable stones, necessitating the implementation of stenting. Among these irretrievable stone cases, the average age was 46.69, and there was a predominance of females with 17 patients (58.6%). Of the 29 cases, 22 patients completed the follow-up. During the follow-up ERCP, a significant reduction was observed in both the average number of stones (3.14 vs. 1.9; P=0.002) and their size (16.32 vs. 12.4; P=0.005). Successful stone extraction was achieved in 14 patients (63.64%) during the second ERCP. In one patient (4.55%), spontaneous clearance of the stone occurred, while in 7 patients (31.81%), stone extraction was not possible during the second ERCP. The reduction in mean stone size was the only significant factor affecting the success of the second ERCP. However, there was no correlation found between the duration of stenting and the reduction in stone size (r=-0.193, p=0.401). Conclusion: Our study shows that repeat ERCP can successfully extract stones regardless of stenting duration. Unlike Western data, we emphasize the effectiveness of endoscopic biliary stenting in a context with limited access to advanced techniques, where initial stone extraction rates are lower. This approach is particularly beneficial for patients with stone sizes over 15 mm, avoiding the need for complex surgical procedures.

Evaluation of the efficacy of ureteroscopic lithotripsy for proximal impacted ureter stones based on a new scoring standard: a bicentric matched-pair analysis.

To evaluate the clinical efficacy of ureteroscopic lithotripsy (URSL) in the treatment of proximal impacted ureter stones (PIUS) based on a new scoring standard in two medical centers. The data of 45 patients with Complicated PIUS (total stone score ≥ 3) and 350 with Simple PIUS (total stone score < 3) who underwent URSL were collected in this retrospective study between January 2015 and June 2022. The definition and scoring standards for preoperative high-risk factors associated with stones included whether the diameter of the stone was > 2cm, stone density was > 1000 HU, there was a history of lithotripsy, the degree of hydronephrosis was greater than moderate, and there was an infection. Scores for stones were then assigned (yes = 1, no = 0), and the Complicated stone case was defined as a total stone score ≥ 3; the Simple stone case was defined as a total stone score < 3. During the same period, 45 patients were selected from the patients with Simple stone cases as the control group, matched at a 1:1 ratio to index Complicated stone cases with regard to age, sex, and BMI. Perioperative data were compared between the two groups. All 90 operations were successfully completed. Compared to the Simple cases group, the surgical duration of the Complicated group was significantly longer (59.69 ± 28.06min vs. 73.46 ± 27.12min, p < 0.05), and stone-free rate (SFR) was significantly lower (88.89 vs. 68.9%, p < 0.05). There was a significant difference in complication rate between the two groups regarding Clavien grade I, II, or III complications (20.0% in Complicated cases group vs. 8.9% in Simple cases group, p = 0.037). As for the length of the hospital stay and the total treatment cost, the two groups have no difference. For Simple stone cases, URSL had a better SFR and higher surgical efficacy, whereas complicated stone cases had a high complication rate and long operation time. Thus, we suggest that URSL is the preferred choice for Simple stone cases rather than complicated stone cases.

Calcium Reduction Using Variations of Thickness and Retention Time of Cocoa Shell Activated Carbon

High levels of hardness can lead to increased cases of kidney stones. Hardness levels can be reduced by using activated carbon from the cocoa rind as an adsorbent. The purpose of this research was to determine the variation of activated carbon thickness and optimum retention time in reducing the calcium content of dug well water, to determine the percent decrease in calcium ion levels at the optimum variation, and to determine the significance of the difference in the decreased in calcium levels between the treatment groups. The research method used the principle of adsorption of activated carbon from cocoa shells to calcium ions, which are activated by KOH. There were ten treatment samples with different variations of activated carbon thickness and retention time. The results showed that the thickness of activated carbon of 60 cm with a retention time of 50 minutes had the optimum ability to reduce the calcium content of dug well water. The percentage decrease in calcium levels reached 89,041 % with a decreased concentration of 234 ppm. The result of the statistical test showed a significance value of 0,05. The conclusion of the research is that activated carbon of cocoa shells can reduce calcium levels to the levels of soft water hardness, with variations in activated carbon thickness and retention time having a significant effect.

Case report: Crossed fused renal ectopia with stones: Asurgical challenge overcome by robotic surgery.

Crossed fused renal ectopia (CFRE) is an extremely rare congenital anomaly of the urinary tract that is prone to stone formation. The surgical treatment of CFRE with stones is challenging due to anatomical abnormalities. Right kidney stones were treated by flexible ureteroscopic lithotripsy (FURSL) and left kidney stones were treated by robotic surgery. The authors present an unreported case of bilateral renal stones in a patient with CFRE, which was successfully treated by robotic pyelolithotomy combined with FURSL. The procedure was manoeuverable, and the stone-free rate was satisfactory. CFRE with stones (S-shaped kidney) present a surgical challenge due to anatomical abnormalities and a high stone burden. The authors recommend robotic pyelolithotomy with or without FURSL as a viable treatment option for stones with similar anatomical abnormalities.

Pure uric acid stone prediction model using the variant coefficient of stone density measured by thresholding 3D segmentation-based methods: A multicenter study

Urinary stones are common urological diseases with increasing prevalence and incidence worldwide. Among the various types of stones, uric acid stones can be dissolved by oral chemolysis without any surgical procedure. Therefore, our study demonstrates that variant coefficient of stone density measured by thresholding a three-dimensional segmentation-based method from noncontrast computed tomography images can be used to identify pure uric acid stones from non-pure uric acid stones. This study provides a preoperative pure uric acid stone prediction model that could reduce invasive procedural treatments. The pure uric acid stone prediction model may offer optimized clinical decision-making for patients with urinary stones. Background and objectivesWhile most urinary stones are managed with interventional therapy, uric acid (UA) stones can be dissolved by oral chemolysis without invasive procedures. This study aimed to develop and validate a pure UA (pUA) stone prediction model using a variant coefficient of stone density (VCSD) measured by thresholding a three-dimensional (3D) segmentation-based method. MethodsPatients with urolithiasis treated at Keimyung University Dongsan Hospital between January 2017 and December 2020 were divided into training and internal validation sets, and patients from Kyungpook National University Hospital between January 2017 and December 2018 were used as an external validation set. Each stone was segmented by a thresholding 3D segmentation-based method using an attenuation threshold of 130 Hounsfield units. VCSD was calculated as the stone heterogeneity index divided by the mean stone density. ResultsA total of 1175 urinary stone cases in 1023 patients were enrolled in this study. Of these, 224 (19.1%) were pUA stone cases. Among the potential predictors, thresholding 3D segmentation-based VCSD, age, sex, radio-opacity, hypertension, diabetes, and urine pH were identified as independent pUA stone predictors, and VCSD was the most powerful indicator. The pUA stone prediction model showed good discrimination, yielding area under the receiver operating characteristic curve of 0.960 (95% confidence interval (CI): 0.940–0.979, P < 0.001), 0.931 (95% CI: 0.875–0.987, P < 0.001), and 0.938 (95% CI: 0.912–0.965, P < 0.001) in the training, internal validation, and external validation sets, respectively. ConclusionsVCSD measured using 3D segmentation was a decisive independent predictive factor for pUA stones. Furthermore, the established prediction model with VCSD can serve as a noninvasive preoperative tool to identify pUA stones.

Evaluation of the Role of MSCT in the Diagnosis of Ureteral Kidney Stones

A study of 100 patients with ureteral kidney stones, in which 66 cases of kidney stones and 68 cases of ureteral stones were taken with 128 slices of computerized tomography at Hanoi Medical University Hospital from September 2019 to the end of January 2020. Results: male/female ratio was 1.7/1. The mean age was 51.2 ± 11.7. The rate of renal function decline (creatinine increase) was 18%. The supersonic, X-ray, and Multi-slice Computer Tomography (MSCT) detected stones in 89%, 84%, and 100% of cases, respectively, including 32% of kidney stones, 34% of ureteral stones, 34% of stones in both kidneys and ureters, 63.6% kidney stones in many positions. Patients with two or more stones accounted for 78.8% and the average kidney stone size was 15.5 ± 10.9 mm. Ureteral stones in the upper third accounted for 54.4%, one stone accounted for 77.9%, and the average size of ureteral stones was 9.1 ± 3.6 mm. Complications of nephrolithiasis caused by stones account for 82%, and grades II and III are the most common. Complications of ureteral dilatation due to stones accounted for 51%, perirenal fat infiltration accounted for 24% and 32% of cases of drug excretion lasted more than 1 hour. Conclusion: MSCT plays an important role in diagnosing urinary stones and assessing renal function before treatment.

Giant staghorn stone causing inferior vena cava compression: a novel case report.

We report a case of a 63-year-old male who presented with chronic abdominal pain, hepatosplenomegaly, and normal renal function. He was later diagnosed with polycythemia vera. Computed tomography of the abdomen revealed massive, bilateral staghorn stones measuring 7.3×5.5cm and 1.8×4.5cm on the right and left, respectively. Additionally, the right stone was found to be compressing the inferior vena cava (IVC). The patient was promptly scheduled for right-sided PCNL and the target of 80% stone fragmentation was successfully attained. We present the first case of a stone of such size in the Middle East, as well as the first known case of a renal stone compressing the IVC. Unlike previous reports, the stone was successfully fragmented via PCNL - a procedure that has not been described for stones of such size. This report highlights that ultrasound-guided PNCL without any other intervention is sufficient for the successful treatment of giant SC. Greater research is needed on the potential utility of using ultrasound-guided PCNL for the fragmentation of stones sized over 5cm.

A Giant Urethral Stone With Urethrocutaneous Fistula: A Case Report

Urethral stones are commonly associated with urinary tract calculi and underlying diverticulum or stricture urethra. Urethral calculus represent less then 1% of all urinary stones diseases. Giant urethral calculi frequently may occur in male and rarely in female. This purpose of reporting this case is to describe a way to diagnose urethral stone cases and so that patients can be treated by urologists. CASE PRESENTATION: A 48-year-old man patient with a giant urethral stone with urethrocutaneous fistula for the past 1 year and a diventral penile meatotomy was performed. With physical examination found on the penis palpable stone +/- 4cm anterior to the penis, the tip of the stone can be seen from Eksternum Urethra Orifice. There was also a urethrocutaneous fistula on the ventral penis, about a stone, measuring +/- 0.1 cm so a diventral penis meatotomy was performed, a stone measuring 4x1 cm was found, with unhealthy tissue in the urethra along the stone. DISCUSSION: The incidence of penile urethral stones is increasing which may due to various factors especially climate change and genetic factors. The gradual formation of this long penile urethral stone could take approximately around 5-10 years which indicates the patient’s persistent ignorance of pain and discomfort in the urinary tract. In our case, 3 months after the first operation, urethrocutaneous fistula repair was performed. Evaluation after 2 months after fistula repair, Urination is smooth, no pain, good wound, no fistula, was performed in our report. CONCLUSION: From our experience some predisposing factors of urethral stone with a Urethrocutaneous fistula. The complications seriously affect the quality of life and even cause more serious consequences, so physicians and patients should be aware. Keywords: giant urethral stone, urethrocutaneous fistula, meatotomi ventral penis

Mask Laws to study Texture Features of the Kidney Infection

This paper aims to early study of detection and diagnosis of kidney tumors and kidney stones using Computed Tomography Scanning CT scan images by digital image processing. Computerized Axial Tomography (CAT) is a special medical imaging technique that provides images with 3D, including much information about the body's construction consisting of bones and organs. A C.T scan uses X-rays to create cross-sectional images of the body and gives the doctor a full explanation of the diagnosis of the situation through the examination. It has been used in five cases of kidney images, including healthy, stones, tumors (cancer), cystic and renal fibrosis. The masking procedure is used to separate the required C.T. images from undesirable ones. The segmentation processes which was used in this study is a thresholding algorithm, applied on C.T. images, used to detect unhealthy tissues (tumor and stone). The results showed that the system is able to distinguish between different tumors of the kidney of cases mentioned above. It's important for the instructor to determine the area of the tumor and stone to avoid damaging the healthy tissue during the treatment. The histogram which was used to study the differences between the healthy and unhealthy depending on the intensity of the image

Successful Healing Treatment of Renal Calculi (Kidney Stones) using Yoga Prana Vidya System Protocols: A Case Series Study

Introduction: A kidney stone is a cluster of crystals formed together to create a hard mass in one or both kidneys, bladder and the urinary tract, varying in size from a few millimetres to several centimetres causing severe pain. The majority of stones less than 10 mm in size will pass out of the body in the urine using various remedies, but some medical help is preferable. This paper presents 7 patient cases of kidney stones dissolved and patients relieved of pain, anxiety and worry and associated symptoms successfully using Yoga Prana Vidya healing protocols. Method: This paper uses the case study method, analysing patient medical records, and healers’ records with patient feedback. Results: The kidney stones of patients were fully dissolved within 45 days in respect of cases 1 and 2. In respect of cases 3 and 4, the kidney stones were dissolved within 10 to 14 days of healing. The patients correspondingly experienced complete relief of all symptoms within the same period. In respect of cases 5, 6 and 7, the kidney stones were dissolved within 5 days of healing in an in-house healing camp in a controlled Group environment. Conclusion: YPV healing protocols effectively healed and eliminated kidney stones (renal calculi). Documented and published evidence shows that integrated YPV system of healing protocols have been successfully applied in the treatment of a variety of illnesses holistically both as Complementary Medicine and as Alternative Medicine (CAM). Further research using appropriate samples and methodology is recommended. It is also worthwhile to train frontline health workers such as doctors and nurses in using YPV techniques to complement their respective specialties for the holistic healing of patients.

Vesicolithotomy in 64 Year-Old Male with Giant Bladder Stone at Leona Hospital, Kupang, East Nusa Tenggara, Indonesia

Giant bladder stone is a rare case of urinary tract stones. These cases are strongly related to social economy status. The patient was a 64 year old male with bladder stone with the size of 10,5 cm x 7,5 cm. The patient presented to emergency department with pain on lower abdomen due to severe lower urinary tract symptoms. A hard mass was palpable in suprapubic area. Cystoscopy was performed, followed by vesicolithotomy. Conclusion : Giant bladder stone can be treated by vesicolithotomy preferably following cystoscopy procedure to eliminate the possibility of bladder mass.

Results of laparoscopic choledocholithoextraction and choledochoscopy for difficult choledocholithiasis: a single centre experience

The management of difficult choledocholithiasis, which accounts for 10—15% of all cases of bile duct stones, has not yet been definitively defined. One of the treatment options for difficult choledocholithiasis is laparoscopic choledocholithoextraction combined with choledochoscopy.&#x0D; Objective — to evaluate the experience of a single centre in the treatment of difficult choledocholithiasis using laparoscopic choledocholithoextraction and choledochoscopy.&#x0D; Materials and methods. A total of 47 patients, including 16 (34%) men and 31 (66%) women with difficult choledocholithiasis, were enrolled in the study and received treatment at our centre. All patients were operated on using laparoscopic choledocholithoextraction combined with choledochoscopy. Thereafter, the results of treatment were analysed for the cohort of patients. In the study, we identified the causes of difficult choledocholithiasis and evaluated the achievement of complete bile duct clearance, the surgery duration, total and postoperative bed days, complications, and mortality.&#x0D; Results. All patients underwent laparoscopic choledocholithoextraction combined with choledochoscopy. The causes of difficult choledocholithiasis were as follows: characteristics of bile duct stones — 27 (57.4%), altered anatomy of the organs of the hepatopancreatobiliary zone — 11 (23.6%), specific location of bile duct stones — 9 (19.1%). After laparoscopic choledocholitoextraction combined with choledochoscopy, complete bile duct clearance was achieved in 95.7% of cases. The average duration of the operation was 130.0±14.7 min. The length of hospital stay after surgery was, on average, 14.3±1.7 days. 4 (8.5%) patients had complications corresponding to classes II (2 (4.2%)) and III (2 (4.2%)) according to the standardized Clavien‑Dindo classification (2009).&#x0D; Conclusions. Laparoscopic choledocholithoextraction combined with choledochoscopy can be used as one of the technologies for the treatment of difficult choledocholithiasis.&#x0D;

Feasibility of Biliary Drainage Using a Novel Integrated Biliary Stent and Nasobiliary Drainage Catheter System for Acute Cholangitis.

Background Acute cholangitis is caused by cholestasis and bacterial infection, and if exacerbated, sepsis may occur and be fatal. Biliary drainage is recommended for acute cholangitis regardless of severity, except in some cases of mild acute cholangitis, in which antibiotics are effective. A novel integrated device comprising a biliary drainage stent and a nasobiliary drainage tube, called the UMIDAS NB stent (UMIDAS Inc., Kanagawa, Japan), was developed. In this study, we evaluated the efficacy and safety of biliary drainage using the UMIDAS NB stent outside type for acute cholangitis in clinical practice. Methods Patients with acute cholangitis with common bile duct stones or distal biliary strictures who underwent biliary drainage with the UMIDAS NB stent outside type at our institution between January 2022 and December 2022were examined retrospectively. The UMIDAS NB stent outside type was placed transpapillary using endoscopic retrograde cholangiopancreatography (ERCP). Patients with biliary drainage stent placement other than the UMIDAS NB stent outside type on the same ERCP session and patients with acute cholecystitis were excluded. Results A total of 13 patients were included in this study. The severity of cholangitis was mild in four cases, moderate in five, and severe in four. There were eight cases of common bile duct stones and five cases of pancreatic cancer. The stent diameter was 7 French scale (Fr) in five cases and 8.5 Fr in eight cases. The median procedure time was 20 minutes. Clinical success was achieved in all 13 patients (100%). No treatment-related adverse events were observed. Unintended removal of the nasobiliary drainage tube was not observed. There were no cases of biliary drainage stent dislocation with nasobiliary drainage tube removal. Conclusions Although the sample size was small, our studydemonstrated that biliary drainage with the UMIDAS NB stent outside type was effective and safe for patients with acute cholangitis who had common bile duct stones or distal biliary strictures, regardless of the severity of cholangitis.

Renal stone disease

Renal stone disease (urolithiasis, nephrolithiasis) covers many conditions causing kidney, ureteric or bladder stones. These include metabolic and inherited disorders, anatomical defects of the upper or lower urinary tract, and chronic urinary infection. However, most cases of renal stones are idiopathic. They present with loin or abdominal pain, and visible or non-visible haematuria; this is followed by the eventual passage of a stone and resolution, or the need for further investigation and intervention. Renal stones often recur, and it is important to identify the underlying cause, particularly because the risk can be related to diet and lifestyle, and is often associated with hypertension and/or diabetes mellitus. Although clinical management is largely surgical and can seem straightforward, the increasing prevalence of renal stone disease in developed countries is becoming a significant health and economic burden.

A Study of Factors Affecting Febrile Urinary Tract Infection Following Ureterorenoscopic Lithotripsy

Febrile urinary tract infection (f-UTI) is a common complication after ureterorenoscopic lithotripsy (URSL) but is sometimes lethal. In this article, we analyzed the factors of post URSL f-UTI. We retrospectively evaluated the association between the development of f-UTI and patients, stones, and perioperative factors in 695 cases in which URSL was performed at our institution from September 2015 to 2018. Seventy-six of the 695 patients (10.9%) had postoperative f-UTI. Elderly (p＝0.013), female (p＝0.02), and hypertension (p＝0.001) patients had significantly higher rates of f-UTI. Renal stone (p＝0.001) cases showed significantly higher rates of f-UTI. Preoperative urine positive culture (p＝0.045), preoperative f-UTI (p＜0.001), URSL procedure using flexible ureteroscopy (p＝0.048), non-stone-free (p＝0.006), long operation time (p＝0.011), preoperative urinary stent insertion due to preoperative f-UTI (p＜0.001), were factors associated with post-operative f-UTI. Multivariate analysis revealed that hypertension (OR＝2.08, p＝0.008) and preoperative f-UTI (OR＝3.739, p＝0.033) were independent factors of postoperative f-UTI. Patients with hypertension or preoperative f-UTI should be managed more carefully during the perioperative period, suspecting that they are more likely to develop postoperative f-UTI.

A78 BILIARY STENT USE IN ERCP: A QUALITY ASSURANCE STUDY ASSESSING ADHERENCE TO CLINICAL GUIDELINES AND COST OUTCOMES

Abstract Background A perceived increase in the use of biliary stents during endoscopic retrograde cholangiopancreatography (ERCP) was observed by our nursing team leader and brought to the attention of the Director of Endoscopy. Purpose To assess a) biliary stent utilization during ERCP, b) the adherence for stent placement based on published guidelines, and c) the associated cost. Method A chart review of all consecutive patients that underwent ERCP for one year (January 2020 to 2021) at the University of Alberta Hospital (UAH) was performed. The need for biliary stent placement was assessed independently by two blinded reviewers and compared with published guidelines. Costs were calculated using Alberta Health Services fee codes. Result(s) A total of 598 patients (316 F) with mean age of 60±19 years (range 3-99 years) underwent 842 ERCPs. Clinical indications for the initial ERCP were common bile duct (CBD) stones (376, 63%), malignant stricture (84, 14%), benign stricture (49, 8%), bile leak (27, 5%), stent removal (15, 3%), and others (47, 8%). Of the 244 patients that had a follow-up ERCP, the most common indications were stent removal (126, 52%), stent replacement (61, 25%), stent placement (28, 11%), and stone extraction (8, 3%). A total of 296 biliary stents were inserted, of which 223 stents (114 plastic, 109 metal) were inserted during the first ERCP (223/598, 37%) and 73 stents (43 plastic, 30 metal) during follow-up ERCP (73/244, 30%). Of the 296 stents, 79 (27%) were inserted for indications not in accordance with published guidelines (63/223 initial ERCP, and 16/73 follow-up ERCP, kappa=0.62). Most of these were placed in CBD stone cases (61/63 initial ERCP, 6/16 follow-up ERCP). In the subgroup of 376 patients with CBD stones, 61 (16%) underwent stent placement not in accordance with published guidelines. The added cost of such stent insertions and follow-up ERCPs for stent removal was $130,000. Conclusion(s) Stent insertion not in accordance with published guidelines was identified in some patients with CBD stones presenting for ERCP. To reduce unnecessary follow-up procedures and healthcare resource utilization, ERCP stent insertion education based on published guidelines, as well as regular practice audit and feedback are required. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared

Carbon Dioxide Pyelography: A Convenient and Safe Alternative to Both Room Air and Iodinated Contrast Pyelography During Endourologic Procedures.

Introduction/Background: There are increasing reports of serious complications related to the air pyelography technique, which raise concerns about the safety of room air (RA) injection into the renal collecting system. Carbon dioxide (CO2) is much more soluble in blood than nitrogen and oxygen and thus considerably less likely to cause gas emboli. Iodinated contrast medium (ICM) is expensive, and supplies may not be as reliable as previously assumed. CO2 pyelography (CO2-P) techniques using standard fluoroscopy and digital subtraction fluoroscopy (CO2 digital subtraction pyelography [CO2-DSP]) are described. Materials and Methods: During the endourologic stone cases, 15 to 20 mL of CO2 gas was typically injected into the renal pelvis through a catheter or sheath. Imaging was usually obtained with endovascular CO2 digital subtraction angiography settings using either a traditional fluoroscopy system (TFS) or robotic arm multiplanar fluoroscopy system (RMPFS) (Artis Zeego Care+Clear®; Siemens). Results: CO2-P was performed in 22 endoscopic stone treatment cases between March 2021 and August 2022, primarily using digital subtraction settings in 20 cases. CO2-DSP overall provided higher quality images of the renal pelvis and collecting system than CO2-P, but with a relatively higher radiation dose. Following a quality intervention, fluoroscopy doses for CO2-DSP cases were decreased by 81% overall. The use of CO2-P avoided fluoroscopic or intraoperative CT (ICT) artifacts seen with intraluminal ICM. Conclusions: CO2-P allows the urologist to obtain imaging of the renal collecting system without ICM and with much lower risk of air embolism compared with RA pyelography. CO2 is a nearly cost-free alternative to ICM. Because CO2 is widely available and the technique is easy to perform, we propose that CO2-P should be favored over traditional air pyelography to improve patient safety.