Nephrostomy Insertion Research Articles

Comparative Feasibility Analysis of Retrograde Double J Stenting, Antegrade Double J Stenting, and Percutaneous Nephrostomy Tube Placement for Ureteric Obstruction Secondary to Pelvic Malignancies

Background: The management of ureteric obstruction secondary to pelvic malignancies (UOPM) presents a significant challenge. Objectives: Our study aimed to assess the factors affecting the feasibility of interventions for patients with UOPM - including retrograde and antegrade double J (DJ) stenting, and percutaneous nephrostomy (PCN) insertion. Methods: We conducted a retrospective analysis of patients who underwent intervention for UOPM over two years, from January 2022 to December 2023. Patients were categorized into groups based on intervention type: Group 1: Retrograde DJ stenting, group 2: Antegrade DJ stenting, and group 3: PCN insertion. Demographic, clinical, radiological, cystoscopic, and laboratory data were compared between the three groups. Analysis of Variance (ANOVA), logistic regression, and marginal mean plots were utilized for statistical analysis. Results: Fifty–nine patients were included in the study, consisting of 14 males and 45 females, and the mean age of the study population was 60.1 ± 10.8 years. Retrograde DJ stenting was successfully achieved in 59.3% of patients, with 10.2% undergoing antegrade DJ stenting and 30.5% needing PCN insertion. Serum albumin (P = 0.04), serum creatinine (P = 0.02), albumin creatinine ratio (P < 0.001), and severity of hydroureteronephrosis (HDUN) (P = 0.02) were significantly associated with intervention outcomes. There was an increased likelihood of PCN insertion in higher serum creatinine and lower serum albumin levels. Multinomial logistic regression with univariate and multivariate analysis revealed significance among the above-mentioned variables. Conclusions: Even though DJ stenting remains common, a significant proportion of patients require PCN insertion. Serum albumin, serum creatinine, albumin creatinine ratio, and HDUN severity are significant predictors of intervention success. Further research is warranted to validate these findings and enhance management strategies for UOPM.

Gross hydronephrosis secondary to pelviureteric junction structure, complicated with caliceal rupture

A 23-year-old Myanmar male with previous history of percutaneous nephrolithotomy was presented with acute abdominal pain for 2 days. The pain was pricking in nature and started at left lumbar region and later became generalized. There was no fever, vomiting or history of trauma. The bowel and urinary output were normal. On examination, he was alert and mildly dehydrated. The vital signs were stable. Per abdomen revealed generalized guarding and tender mostly over the left lumbar region. Abdomen radiograph showed left abdominal homogenous opacity with bowel displacement to the right. A round calculus was appreciated at the left lumbar region (Figure 1a). Urgent contrast enhanced CT abdomen revealed gross hydronephrosis with stricture at the left pelviureteric junction (Figure 1b). There was caliceal wall defect at the upper pole calyx (Figure 2a) with perirenal free fluid (Figure 2b). Patient underwent urgent ultrasound-guided left nephrostomy insertion and was discharged well.

Assessing the Impact of Percutaneous Nephrostomy Presence on Neoadjuvant Treatment Quality in Patients With Muscle Invasive Bladder Cancer

IntroductionSymptomatic hydronephrosis associated with muscle invasive bladder cancer (MIBC) necessitates percutaneous nephrostomy (PCN) insertion before neoadjuvant chemotherapy (NAC). This study assesses the impact of PCN presence on standard intended NAC quality, its related complications and outcome after radical cystectomy (RC). Materials and MethodsThe study comprises a retrospective, multicenter cohort of 193 consecutive RCs performed between 2016 and 2019. Eighty (42%) of these patients received NAC and were divided in 2 comparison groups by presence (n = 26; 33%) or absence (n = 54; 67%) of PCN. Endpoints included completion of adequate NAC treatment (cisplatin-based chemotherapy for at least 4 courses), complications during NAC, post-RC complications and hospital stay. ResultsOverall, patients with PCN (45/193; 23%) featured a higher referral rate to NAC (58% vs. 36%, P = .01), worse glomerular filtration rates (P < .001) and more adverse events (P = .04), in comparison to non-PCN patients. In the NAC cohort, PCN patients had less adequate treatment rates (54% vs. 85%, P = .005), and more infections (35% vs, 7%; P = .008) and hospitalizations (58% vs. 13%; P < .001) during chemotherapy. Post-RC outcome was similar for both comparison groups. PCN was an independent risk factor for inadequate NAC (OR = 3.9, P = .04), and infections (OR = 11.3, P = .01) and hospitalizations (OR = 7.5, P = .004) during NAC. ConclusionsPCN in MIBC patients is a significant risk factor for inadequate NAC and adverse events during treatment. This finding may quire the rationale of NAC, potentially leading to consideration of NAC avoidance and upfront RC in PCN patients. Further survival studies with long follow-up are needed for elucidating this issue.

Changing trends in the management of posttransplant ureteric stricture

Abstract Introduction: Chronic kidney disease (CKD) is a common disease now. Diabetes and hypertension are the main cause. Renal transplant is a gold standard treatment. Posttransplant stricture is also common, and changing trends in management are emerging. Materials and Methods: It is a retrospective observational study in a tertiary care hospital in East India. The study duration was from January 2019 to December 2021. In total, 140 patients were studied, including both live and cadaveric transplants. A patient who developed posttransplant hydronephrosis or presented with acute kidney injury was evaluated with ultrasonography, intravenous urography, contrast-enhanced computerized tomography, and magnetic resonance imaging. Management was done with double J (DJ) stenting, percutaneous nephrostomy (PCN) insertion, or surgical intervention. Results and Analysis: Twelve (8.6%) patients out of 140 developed posttransplant ureteric stricture. Five (41.7%) out of 12 patients were managed with long dura DJ stenting, and five (41.7%) were managed with PCN insertion and serial follow-up. Only two (16.7%) required ureteric reimplantation. Discussion: Posttransplant ureteric stricture is a common complication following renal transplantation. Common causes are increased cold ischemia time, ureteral edema, clots, tumors, calculi, lymphocele, abscess, and hematoma. Other causes include kinking of the ureter and previously unrecognized pelviureteric junction obstruction. In the literature, the incidence of posttransplant ureteric stricture ranges from 2% to 10% in one study; and in another study, it is 1% to 9%. In our study, it is 8.6%. Conclusion: Diagnosis of the posttransplant ureteric stricture should be prompt, and management should be given as early as possible for better graft survival.

Has the COVID-19 pandemic affected ureteral stone management in pregnant women? A retrospective single-center study.

This study aimed to evaluate the effect of coronavirus disease (COVID-19) on the patients' referral in the pregnant population and also investigate each treatment approach's advantages and disadvantages for acute renal colic in pregnancy. In this retrospective study, we included all pregnant women with ureteral stones referred to a referral center between January 2019 and March 2021. Among 53 pregnant women, 18 (33.9%) were on conservative therapy, which passed the stone without any complications. Double J stent or nephrostomy tube insertion was done for 24 patients (45.2%). Seventeen of these patients (70.8%) presented post-surgical complications, including hematuria (29.2%), pyelonephritis (20.8%), and lower urinary tract symptoms (20.8%). Transurethral lithotripsy (TUL) was done in 11 patients (20.7%). Only one of these patients developed hematuria following TUL. Thus, in our population study, double J stent or nephrostomy insertion was associated with a higher chance of postoperative complications than TUL (p-value = 0.001). Thirty-six patients were referred within 13 months before the entry of COVID-19, while 17 were referred during a similar approximate duration after the COVID-19 entry into the country. Only the initial presentation had a significant difference between these two periods (p-value = 0.034). When conservative treatment fails, we recommend TUL as the second-line treatment over temporary procedures, such as double J stent or nephrostomy insertion. Of note, in a group of patients with an emergent clinical setting, including active infection, deteriorating renal function, signs of preterm labor, solitary kidney, etc., double J or nephrostomy tube insertion remains the preferred management method for its fast resolution of obstruction and infection. Besides, a decrease in visits with an increase in complicated cases after COVID-19 was observed, maybe due to a delay in referring.

Pelvic lipomatosis: A rare case

Abstract Pelvic lipomatosis (PL) is a benign condition characterized by excessive intrapelvic deposition of mature fatty tissue, resulting in compression of pelvic structures and causing a broad range of symptoms. As this condition is rare with limited cases, there are no standardized guidelines for its management. This case of PL was associated with bilateral hydroureteronephrosis and was managed with bilateral percutaneous nephrostomy insertion with long-term follow-up.

937 Investigation and Management of Symptomatic Hydronephrosis in Pregnancy, a Retrospective Study

Abstract Aim Although hydronephrosis in pregnancy can be a common physiological phenomenon, if symptomatic, it may represent a pathological process requiring further investigation and management. The purpose of the study was to determine how symptomatic hydronephrosis in pregnancy presents, and the proportion of cases requiring further investigation and management. Method A retrospective study was carried out at a District General Hospital. A search was conducted on PACS for all ultrasound abdomen/kidneys/urinary tract performed between August 2019 and August 2022, where requests/reports had the terms ‘pregnant’, ‘pregnancy’ or ‘gestation’. Results Of the 261 ultrasound scans performed, 39 had reported hydronephrosis (mean age 28.6, range 19-39; laterality: 22 right, 6 left, 11 bilateral), of which 31 were symptomatic of pain, dysuria and/or pyrexia. Seven patients warranted further acute imaging (4 MRI, 2 low-dose CTKUB, 1 had both following inconclusive MRI). A majority of patients (33/39, 92%) with hydronephrosis were conservatively managed and had resolution of symptoms. Only 3 patients (8%) required eventual emergency management – two had nephrostomy insertion (without any further imaging other than ultrasound) and one had retrograde stenting (after management was planned using CT). Conclusions A majority of women with symptomatic hydronephrosis in pregnancy are successfully managed conservatively and will rarely require further investigation with radiation. Limited radiation may be indicated where this will impact upon treatment. There is need for a consensus to guide management of these patients, weighing up risks vs benefits of further investigation and intervention.

140 Five Year Single-Unit Experience and Outcomes of Renal Decompression for Ureteral Obstruction: A Retrospective Analysis of 102 Kidney Units

Abstract Aim Renal decompression following ureteral obstruction is a common urological emergency. Malignant obstruction patients often have poor life-expectancy, and the impact of decompression on survival is questionable [1]. We herein review outcomes of ureteral obstruction management in a single unit. Method Records of nephrostomy requests in Ysbyty Gwynedd between January 2017 and December 2021 were retrospectively reviewed. Information on patient demographics, primary pathology, performance status (PS), change in renal function and outcomes were recorded. Results Over 60 months, 102 nephrostomies were performed. Benign obstructions constituted 30.4% (n = 31) of cases. Of 71 cancer cases, 9 were re-insertions due to complications. Cancer group was associated with high and early deaths (11.3%, 64.5% and 85.5% at 3, 12 and 60 months, respectively) with only 1 in 5 kidney units illustrating improvement in renal function following decompression. All cancer patients were frail, with performance status of 2 (63%) and 3 (37%). Following nephrostomy insertion, 69.3% of kidney units developed urinary infection and/or sepsis requiring treatment. Only about 1 in 2 (53%) cancer patients received further oncological treatment (chemo- and /or radiotherapy). Though ante grade ureteric stenting was attempted in 23 kidney units following nephrostomy insertion for cancer, only 21 were successful and 2 of those blocked within 14 days. Conclusions Decompression of malignant ureteral obstruction may not improve survival and can involve multiple interventions with quality-of-life implication. Hence, the decision to decompress should not be the default and would therefore need to be individualized, adopting a multidisciplinary approach.

Ketamine uropathy: Clinical experience in a high prevalence center.

Ketamine uropathy causes inflammatory changes to the urothelium, manifesting as significant lower urinary tract symptoms, small bladder capacity, and pelvic pain. Upper tract involvement and hydronephrosis can occur. Data from UK centers are limited, and no formal treatment guidelines exist. All patients with ketamine uropathy presenting to our unit over an 11-year period were identified through operative and clinic lists, emergency presentations, and a prospectively collected local database. Demographic data, biochemical findings, imaging techniques, and both medical and surgical management were recorded. A total of 81 patients with ketamine uropathy were identified from 2011 to 2022; however, a large proportion presented from 2018 onwards. The average age at presentation was 26 years (interquartile range [IQR]: 27-34), 72.8% were male, and average follow-up time was 34 months (IQR: 8-46). Therapeutic interventions included anticholinergic medication, cystodistension, and intravesical sodium hyaluronate. Hydronephrosis was present in 20 (24.7%) patients and nephrostomy insertion was required in six. One patient underwent bladder augmentation surgery. Serum gamma-glutamyl transferase and length of follow-up were significantly higher in patients with hydronephrosis. Adherence to follow-up was poor. We present a large cohort of patients with ketamine uropathy from a small town in the UK which is unusual. The incidence appears to be rising, in-keeping with increasing recreational ketamine use and should be of concern to urologists. Abstinence is a key aspect of management, and a multi-disciplinary approach works best particularly as many patients are lost to follow-up. The development of formal guidance would be helpful.

MP16-03 THE IMPACT OF TIMING OF DEFINITIVE INTERVENTION FOR PATIENTS WITH ACUTE RENAL COLIC: A POPULATION-BASED STUDY

You have accessJournal of UrologyCME1 Apr 2023MP16-03 THE IMPACT OF TIMING OF DEFINITIVE INTERVENTION FOR PATIENTS WITH ACUTE RENAL COLIC: A POPULATION-BASED STUDY Michael Ordon, Sarah Bota, Yuguang Kang, and Blayne Welk Michael OrdonMichael Ordon More articles by this author , Sarah BotaSarah Bota More articles by this author , Yuguang KangYuguang Kang More articles by this author , and Blayne WelkBlayne Welk More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003236.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Little data exists on the optimal timing for intervention for symptomatic kidney stones, as such, our objective was to determine the impact of early intervention versus delayed intervention/expectant management for patients presenting to the emergency department (ED) with renal colic. METHODS: We conducted a population-based cohort study in the province of Ontario, utilizing linked administrative health data. Patients who presented to an ED with renal colic between April 1, 2010 to June 30, 2020 were included. Patients were divided into two groups. The early intervention (EI) group underwent shockwave lithotripsy (SWL), ureteroscopy (URS) or percutaneous nephrolithotomy (PCNL) within 2-weeks of presentation. The delayed intervention/expectant management (non-EI) group represented all other patients. Patients were followed forward in time for 3 months in the EI group and for 4 weeks post-intervention or 3 months (whichever was longer) in the non-EI group to assess for our outcomes. The outcomes included additional ED visits, hospitalizations or imaging studies, stent or nephrostomy insertion and urologist/primary care visits. These outcomes were compared across the two groups using matched propensity score modelling. RESULTS: There were 397,185 index renal colic events (EI=28,910, non-EI=368,275). The EI group was slightly older and more likely to have a history for stones, hypertension and diabetes (Table 1). The EI group had a lower risk for additional ED visits (RR 0.70 95% CI 0.68-0.72, p<0.001) and hospital admissions (RR 0.52, 95% CI 0.50-0.55, p<0.001) compared to the non-EI group. Similarly, the EI group had a lower risk for stent (RR 0.62, 95% CI 0.54-0.71, p<0.001) or nephrostomy insertion (RR 0.49, 95% CI 0.42-0.57, p<0.001), however there was no difference for additional imaging. The EI group had a slightly increased risk for urologist/primary care visit (RR 1.02, 95% CI 1.02-1.03, p<0.001). In the non-EI group, 17% underwent eventual intervention. CONCLUSIONS: Our population-based study suggests a benefit to EI for those presenting with renal colic to the ED, but potentially with the risk of exposing some patients to unneeded treatment. These findings could influence practice patterns and guideline recommendations moving forward. Source of Funding: Northeastern Section of the AUA © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e202 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael Ordon More articles by this author Sarah Bota More articles by this author Yuguang Kang More articles by this author Blayne Welk More articles by this author Expand All Advertisement PDF downloadLoading ...

MP23-04 IMPACT OF THE TIMING OF PERCUTANEOUS NEPHROSTOMY ON THE PROGNOSIS IN PATIENTS WITH OBSTRUCTIVE UROLITHIASIS WITH SEPSIS

You have accessJournal of UrologyCME1 Apr 2023MP23-04 IMPACT OF THE TIMING OF PERCUTANEOUS NEPHROSTOMY ON THE PROGNOSIS IN PATIENTS WITH OBSTRUCTIVE UROLITHIASIS WITH SEPSIS Ji Eun Yu, Ye Chan Joo, Young Seop Chang, Jin Bum Kim, Hong Wook Kim, Hyung Joon Kim, and Dong Hoon Koh Ji Eun YuJi Eun Yu More articles by this author , Ye Chan JooYe Chan Joo More articles by this author , Young Seop ChangYoung Seop Chang More articles by this author , Jin Bum KimJin Bum Kim More articles by this author , Hong Wook KimHong Wook Kim More articles by this author , Hyung Joon KimHyung Joon Kim More articles by this author , and Dong Hoon KohDong Hoon Koh More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003248.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To investigate how time to percutaneous nephrostomy insertion impacts on prognosis of patients with obstructing ureteral stones with sepsis. METHODS: Using a database from 2017 to 2021, we evaluated patients who visited emergency department with obstructive uropathy due to urinary stones and underwent percutaneous nephrostomy insertion. We classified patients in two groups, whom met quick sequential organ failure assessment (qSOFA) score of lesser than two, and qSOFA score of two or more, and retrospectively investigated patients. The aim of this study is to understand how time to percutaneous nephrostomy insertion affects the prognosis, including total length of stay, need for intensive care unit. RESULTS: Total 96 patients met the criteria. 70 patients had qSOFA score of lesser than two, and 26 patients had qSOFA score of two or more. Overall, 37 patients have positive urine culture. Mean time to percutaneous nephrostomy insertion was 229 minutes, and mean length of stay was 18.11 days. There was no difference between groups in clinical values. In group of qSOFA score of lesser than two, there was no correlation between the time to procedure and length of stay, but in group of qSOFA score of two or more, hospitalization days was significantly shorter in patients of percutaneous nephrostomy before 4 hours than patients whom underwent procedure after 4 hours. CONCLUSIONS: In patients with obstructive uropathy with high risk of sepsis, length of stay would be decreased as time to percutaneous nephrostomy insertion shortened. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e307 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ji Eun Yu More articles by this author Ye Chan Joo More articles by this author Young Seop Chang More articles by this author Jin Bum Kim More articles by this author Hong Wook Kim More articles by this author Hyung Joon Kim More articles by this author Dong Hoon Koh More articles by this author Expand All Advertisement PDF downloadLoading ...

Management of urolithiasis in pregnancy.

Urolithiasis is the most common cause of nonobstetric abdominal pain, resulting in 1.7 admissions per 1000 deliveries. Urolithiasis most commonly occurs in the second and third trimesters, with an incidence between 1:125 and 1:2000. Acute urinary system obstructions are challenging to manage in obstetric patients because they contribute to physiological and anatomical changes that result in pathological outcomes. The restricted use of computed tomography in diagnosing and managing urolithiasis is particularly challenging. In addition, a prompt diagnosis is required because the presence of renal calculi during pregnancy increases the risk of fulminating sepsis and preterm delivery. Affected pregnancies are conservatively managed; however, 1 in 4 requires surgical intervention. Indications for surgical interventions are complex and range from nephrostomy insertion to empirical stent placement or ureteroscopy. Therefore, a multidisciplinary approach is required to optimize patient care. The diagnosis and management of urolithiasis in pregnancy are complex. We reviewed the role, safety, advantages and disadvantages of diagnostic tests and treatment used to manage acute urinary obstructions in pregnancy.

OUTCOME OF RENAL TRAUMA IN A TERTIARY CARE CENTER OF NEPAL: A RETROSPECTIVE STUDY

Background: Management of renal trauma has evolved over past decades from surgical exploration to renal preservation. Conservative management of high-grade renal trauma is possible due to advancement in imaging modality, dedicated critical care and availability of selective embolization. The objective to this research was to analyze the demographics, characteristics and management of renal trauma in our institution. Methods: All patient who were admitted to College of Medical Sciences Teaching Hospital with diagnosis of renal trauma from 2017 to 2022 were retrospectively analyzed. Ethical approval was taken from institutional review committee of college of Medical Sciences. Data was collected from hospital medical records. Data was analyzed using descriptive statistical tools. For the categorical variable frequency and percentage was calculated while for continuous variables mean and standard deviation was calculated. Results: Sixty-three patients were included in this study and Median age of patient admitted with renal trauma was 31 years with male to female ratio of 7:3. Blunt renal trauma was the most common type (96.8 %) with Road traffic accidents responsible for the majority of mechanisms of injury 66.7% (42) followed by fall 11(17.5%). Majority of Renal trauma was in AAST Grade III 26(41.3%). Right sided renal injury was common 33 (52.4%) than left sided renal injury 30 (47.6%). Intervention was required in 9 patients. Conclusions: High-grade renal trauma can be managed conservatively in selected cases with close monitoring in critical care unit and with use of minimally invasive technique such as Selective angioembolization, Double J Ureteric stenting or Nephrostomy Insertion. But hemodynamically unstable patient after resuscitation warrants immediate surgical exploration.

Feasibility and safety of laparoscopic nephrectomy in emphysematous pyelonephritic kidneys

Background: Emphysematous pyelonephritis (EPN) is a serious suppurative infection of renal and extrarenal tissues. Most of them end up in nephrectomy, either in an emergency setting or delayed, which is increasingly favored. Laparoscopic nephrectomy is difficult in the post-EPN state due to dense adhesion around the kidney. Aims and Objectives: In this study, we want to check the feasibility of laparoscopic nephrectomy in EPN kidneys. To the best of our knowledge, our series is the single largest series as of today with 10 cases of laparoscopic nephrectomies in EPN kidneys. Materials and Methods: All patients of EPN who underwent laparoscopic nephrectomy at Institute of Kidney Diseases and Research Centre, Ahmedabad, between December 2017 and October 2019 were taken as study subjects and retrospectively reviewed. Patients in whom conservative management was successful were excluded from the study. All patients were diverted initially, either ultrasound/computed tomography-guided percutaneous nephrostomy (PCN) insertion or double J stenting, with or without PCN along with antibiotics and supportive therapy. Delayed transperitoneal laparoscopic nephrectomies were performed for poorly functioning EPN kidneys in follow-up renal scans. Results: A total of 10 patients underwent nephrectomy in this period. The male-to-female ratio was 3:7. As per Huang and Tseng’s EPN classification, one patient had Class 2, four patients had Class 3a, and five patients had Class 3b EPN disease. Mean operative time was 192 min and mean blood loss was 206 ml. Two cases had intraoperative complications managed laparoscopically. No conversion to open nephrectomy or mortality was seen. The drain was placed for a mean period of 3.1 days. The mean hospital stay was 4.8 days. Conclusion: Laparoscopy is safe and feasible for nephrectomy in EPN kidneys. Experience with laparoscopy and operating on pyelonephritis cases is important to reduce complications and extend the advantages of laparoscopy in these groups of patients. An increase in class does not increase the degree of difficulty during laparoscopy.

Choosing the best way for urinary decompression and developing a novel predictive model for septic shock using SOFA in these patients.

To identify predictive factors for the development of sepsis/septic shock postdecompression of calculi-related ureteric obstruction using the Sequential Organ Failure Assessment (SOFA) score and to compare clinical outcomes and odd risk ratios of patients developing sepsis/septic shock following the insertion of percutaneous nephrostomy (PCN) versus insertion of retrograde ureteral stenting (RUS). Clinico-epidemiological data of patients who underwent PCN and/or RUS in two institutions for calculi-related ureteric obstruction were retrospectively collected from January 2014 to December 2020. 537 patients (244 patients in PCN group, 293 patients in RUS group) from both institutions were eligible for analysis based on inclusion and exclusion criteria. Patients with PCN were generally older, had poorer Eastern Cooperative Oncology Group status, and larger obstructive ureteral calculi compared to patients with RUS. Patients with PCN had longer durations of fever, the persistence of elevated total white cell and creatinine, and longer hospitalization stays compared with patients who had undergone RUS. RUS up-front has more unsuccessful interventions compared with PCN. There were no significant differences in the change in SOFA score postintervention between the two interventions. In multivariate analysis, the higher temperature just prior to the intervention (adjusted odds ratio [OR]: 2.039, p = 0.003) and Cardiovascular SOFA score of 1 (adjusted OR:4.037, p = 0.012) were significant independent prognostic factors for the development of septic shock postdecompression of ureteral obstruction. Our study reveals that both interventions have similar overall risk of urosepsis, septic shock and mortality rate. Despite a marginally higher risk of failure, RUS should be considered in patients with lower procedural risk. Patients going for PCN should be counseled for a longer stay. Post-HDU/-ICU monitoring, inotrope support postdecompression should be considered for patients with elevated temperature within 1 h preintervention and cardiovascular SOFA score of 1.

Risk Factors for Intra-operative Bleeding in Percutaneous Nephrolithotomy in an Academic Center: A Retrospective Study.

Percutaneous nephrolithotomy (PNL) is the treatment of choice for renal stones as a safe, effective, and minimally invasive method. However, bleeding remains a major concern in the procedure. This study aimed to investigate the risk factors of bleeding in PNL. This retrospective descriptive cross-sectional study was conducted in the Urology department of Razi hospital. The data of patients with urinary calculi staghorn type who underwent PNL in a prone position under general anesthesia were recorded. A checklist including patients' demographics, surgical characteristics, and outcomes was filled out for each patient. The data from 151 complete files were gathered. The mean age of the cases was 47.89 ± 12.41 years. The mean hemoglobin (Hb) drop was 1.92 ± 1.56 mg/dL. At least 1 mg/dL Hb drop was observed in all cases. The highest Hb drop was 3 mg/dL.). There was no significant relationship between stone bulk, age, BMI, GFR, surgery duration, and the number of tracts, and Hb drop during PNL (P > 0.05). But there was a positive correlation between Urinary Tract Infection (UTI) history (P = 0.01) and transfusion (P = 0.0001) and Hb drop during PNL. Also, the history of open kidney surgery (P = 0.031), nephrostomy insertion (P = 0.003), and extracorporeal shock wave lithotripsy therapy (ESWL) (P = 0.041) were correlated with the increased risk of Hb drop. Urinary tract infection, history of open surgery, nephrostomy implantation, and ESWL were significantly associated with more bleeding in PNL.

Comparison complications rate between double-J ureteral stent and percutaneous nephrostomy in obstructive uropathy due to stone disease:A randomized controlled trial

BackgroundObstructive uropathy due to stone disease is seen every day in urological practice. Percutaneous nephrostomy and double j ureteral stent procedures are used. MethodologyA randomized controlled trial was conducted in one center from January 2021 to January 2022. A total of 104 patients of age ≥18 years who had unilateral or bilateral obstructive uropathy due to stone disease were divided into two groups. In Group A, 50 patients underwent to double j stent while in Group B, 54 patients who underwent percutaneous nephrostomy insertion tube. Under local anesthesia, the stent was inserted by cystoscopy. While the percutaneous nephrostomy was done under ultrasound guidance by using local anesthetic agent. Complications were noted in immediate postoperative period and on follow up. ResultsMean age of Group A was 35 ± 12.7 years whereas mean age in Group B was 36.7 ± 12.5 years and 49 out of patients were male. The most common complication in double j group and nephrostomy group was hematuria (16% and 5.5% respectively). Post DJ stent, complications like septicemia, painful trigon irritation, and stent encrustation were seen in 8.0%, 10.0%, 10.0% and 4.0% patients respectively. On the other hand, post-PCN septicemia, tube dislodgment or blockage, and injury to adjacent organs were seen in 3.7%, 5.5% and 1.8% respectively. In our trial, overall success rate for double j stenting was up to 84.0% and for percutaneous nephrostomy (PCN) was 96.29% (p < 0.0001). ConclusionWe found percutaneous nephrostomy is better and had overall higher success rate with less complications post procedure.

191 The Effect of Covid-19 on the Management of Acute Ureteric Colic in a Tertiary Hospital

Abstract Introduction The Covid-19 pandemic forced changes to care pathways. We have analysed the difference in provision of care to patients presenting with ureteric colic during the pandemic (PC) compared to a pre-pandemic cohort (PPC). Method A list was generated of all CT KUB scans requested in the emergency department. Imaging and notes were reviewed to identify acute ureteric colic presentations in September to December 2019 and 2020. Statistical significance was calculated using either the Student T-test or Chi-squared test. Results There were 92 patients in the PC, and 107 in the PPC. Primary treatment was provided for more patients during the pandemic (25% vs 10%, p&amp;lt;0.05), mainly by extracorporeal shockwave therapy (ESWL, 21% vs 7%, p&amp;lt;0.05). The rate of conservative management (64% vs 76%, p&amp;gt;0.05), temporising stent (11% vs 14%, p&amp;gt;0.05), and nephrostomy insertion (1% vs 1%, p&amp;gt;0.05) was similar in PC and PPC. The PC had a shorter time to intervention (17 vs 39 days, p&amp;lt;0.05), to ESWL (4 vs 12 days, p&amp;gt;0.05), to ureteroscopy (35 vs 45 days, p&amp;gt;0.05), and to stone passage confirmation (44 vs 91 days, p&amp;lt;0.05) respectively. There was no follow up for 15% and 30% respectively (p&amp;lt;0.05). Conclusion During the pandemic, a reduction in electives created capacity for urgent interventions, (21% vs 7% ESWL, 4 vs 12 waiting days). Accordingly, the stone passage confirmation time was more than halved (44 vs 91 days). In accordance with recommendations from NICE, TISU and GIRFT, this demonstrates the importance of ringfencing ESWL, particularly as we emerge from the pandemic.

Gynecological malignancy with obstructive uropathy patient profile in Cipto Mangunkusumo Hospital: Our 2-year experience

Introduction: Gynecological malignancies are one of the most common causes of death from cancer in women. Hydronephrosis or obstructive uropathy is the most common finding in patients with gynecological malignancy. This study aimed to describe the profile of obstructive uropathy patients causes of gynecology malignancies treated in our center from 2019 to 2021. Method: From January 2019 to January 2021, obstructive uropathy patients with gynecological malignancies who underwent DJ stent or nephrostomy insertion procedures at Cipto Mangunkusumo Hospital were included in this prospective study. Patients with a history of urinary diversion or other diseases that may cause urinary tract obstruction were excluded. Result: One hundred and twenty-one patients with gynecological malignancies with obstructive uropathy were included. Cervical carcinoma was the most common cause, followed by ovarian carcinoma and endometrial carcinoma. The percentages of bilateral, right-, and left-sided stenting were 72%, 18%, and 10%, respectively. Most of them were grade 3 or grade 4 hydronephrosis. Percutaneous nephrostomy was mainly used for 69,4%, and only 17% of patients experienced a polyuria episode. Conclusion: Most cases of obstructive uropathy were caused by cervical malignancies, with bilateral obstruction due to cervical cancer occurring in most cases. Nephrostomy is the method of choice for urinary drainage in our center.

The Impact of Early COVID-19 Pandemic on the Presentation and Management of Urinary Calculi Across the Globe: A Systematic Review.

Introduction: It is acknowledged that the COVID-19 pandemic has had a major impact on health care services around the globe with possible worse outcomes. It has resulted in stretch of resources with canceled or delayed procedures. Patients with urinary calculi have also suffered the negative impact. This systematic review aims to assess the impact of the early COVID-19 pandemic on the presentation and management of urinary calculi around the globe. Methods: We reviewed the impact of early COVID-19 on the clinically important aspects of stone disease using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. We searched Medline, Embase, and Central databases using themes of COVID-19 OR Sars-Cov-2 OR pandemic OR coronavirus AND kidney stone, urinary calculi, urolithiasis, and similar allied terms. Inclusion criteria were studies with data on both pre- and COVID-19 period covering one or more of eight clinical domains. Results: Our search returned 231 studies, after removal of duplicates, of which 18 studies were included for analysis. The number of patients presenting to hospital declined by 21%-70% at the beginning of the pandemic, whereas majority of studies reported increased associated complications. There are mixed reports in terms of delay to presentation and use of conservative management. There was a consistent trend toward reduction in elective procedures with wide variations (shockwave lithotripsy 38%-98%, percutaneous nephrolithotomy 94%-100%, and ureteroscopy 8%-98%). There was a trend toward increased nephrostomy insertion with the onset of the pandemic. Conclusion: This review demonstrated the differences in the number of patients presenting to hospital, complication rates, and management of urinary calculi, including surgical interventions, with the onset of the COVID-19 pandemic. It offers baseline global information that would help understand the impact of early pandemic, variations in practices, and be useful for future comparisons.