Percutaneous Nephrostomy Insertion Research Articles

Emergency Placed Percutaneous Nephrostomy Catheter Provides Safe and Effective Access for Future Percutaneous Nephrolithotomy Operation

Objective: It was aimed to investigate the feasibility of the percutaneous nephrostomy (PCN) catheter placed in an emergency in the future percutaneous nephrolithotomy (PNL) operation. Material and Methods: Patients who underwent PCN catheter insertion by an interventional radiologist under emergency situations prior to PNL surgery between January 2013 and December 2018 were included in the study. Demographic characteristics, indication for PCN insertion, stone characteristics, pre- and post-operative laboratory values, intra-operative data, usability/non-usability of PCN catheter for renal access, post-operative data and complications were recorded. Results: A total of 32 patients were included in the study. (PCN usable: 21, unusable: 11). Indications for catheter insertion were obstruction in 26 (81.25%) patients and urinary tract infection in 6 (18.75%) patients. Renal access was achieved in 21 (65.62%) patients by using the PCN catheter tract during PNL. The most common PCN access was used in the inferior pole. In 11 (34.37 %) patients, the PCN tract was not usable for access. In patients in whom PCN was unusable due to an unsuitable calyx for access, the most common new access site was the inferior calyx in 6 patients, the superior calyx in 3 patients and the middle calyx in 2 patients. There was no statistically significant difference between the two groups in which the PCN catheter was usable and unusable for PNL access (p>0.05), except for the mean length of hospital stay (p=0.039). Conclusions: PCN catheters inserted prior to PNL surgery can be used effectively and safely for renal access during surgery. However, in emergency cases, it is important that the PCN catheter is inserted through the appropriate calyx in patients undergoing future surgery.

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.

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 ...

The implications when offering percutaneous nephrostomy for the management of malignant obstructive uropathy secondary to urological malignancy: can we be more selective?

Percutaneous nephrostomy (PN) for malignant ureteric obstruction (MUO) is increasingly accessible with high success rates. However, it is not without associated risks and morbidity, impacting quality of life, while not improving overall survival. In two UK hospitals, we investigated the outcomes of undergoing PN for MUO, to inform future patient counselling and selection for this intervention. A retrospective audit of electronic records identified patients that received PN for bladder, and prostate cancer (PCa) between January 2015 and December 2018. Hospital 1 had a 24-h nephrostomy service, while Hospital 2 had a limited service; Group A: recurrent or treatment-resistant PCa, Group B: primary PCa, Group C: Bladder cancer. A total of 261 patients (Hospital 1 = 186, Hospital 2 = 75), had PN insertion. Seventy-eight had prostate or bladder cancer. Group A n = 30, Group B n = 12, Group C n = 36. Median age = 79 [interquartile range (IQR) = 72-86]. Following PN insertion, 12-month mortality was significantly greater in Hospital 1 at 82%, versus 52% in Hospital 2 (p = 0.015). Median survival: Group A: 177 days (IQR = 80-266), Group B: 209 days (IQR = 77-352), Group C: 145 days (IQR = 97-362). There was no significant difference in same-admission mortality, although group A had the greatest same-admission mortality at 17%. A total of 69% of all patients received bilateral nephrostomies. Patients with bilateral versus unilateral PN had no difference in mortality or nadir creatinine. Most patients with malignant obstruction secondary to prostate or bladder cancer lived less than 12 months after PN insertion. When offering PN, careful consideration of disease prognosis should be made, and frank discussion of the implications of a life-long nephrostomy with patients and relatives.

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.

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.

Percutaneous Nephrostomy Insertion Training: An Overview

Percutaneous nephrostomy insertion is a technique performed by an interventional radiologist or a urologist for an acutely or long-standing obstructed urinary tract. Mastering the technique involves overcoming a steep learning curve. Various methods of training have been developed over the years to facilitate learning. These vary from simple physical models, such as biological or non-biological practice phantoms, to more sophisticated virtual reality sets, which allow for a more lifelike learning environment by replicating factors such as kidney movement caused by breathing. The authors discuss the pros and cons of different practice models and the challenges that trainees face on their journey to becoming competent at performing nephrostomies. They also propose their recommendations based on the experience of trainees in their institution.

Comparison of Percutaneous Nephrostomy and Ureteral DJ Stent in Patients with Obstructive Pyelonephritis: A Retrospective Cohort Study

Purpose Comparing the two different drainage methods of percutaneous nephrostomy (PCN) versus retrograde ureteral double – J (DJ) stent insertion in patients with obstructive pyelonephritis cases. Material and methods In this retrospective study, patients with obstructive pyelonephritis secondary to urolithiasis who underwent PCN or DJ insertion were included in the study. Patients were divided into two groups according to drainage method. After exclusion criteria, the study included 105 patients. The groups were compared for intraoperative outcomes, duration of fluoroscopy usage, the time needed for normalization of infection parameters (white blood cells (WBC), C – reactive protein (CRP), procalcitonin), and complications were observed. Results From 105 patients, 56 patients were in DJ stent group and 49 patients were in PCN group. According to intraoperative data, operative time and fluoroscopy duration were significantly shorter in the DJ ureteral stent group (P < .001). WBC returned to normal range in mean 3.5 ± 1.3 days in the DJ stent group and 3.2 ± 1.1 days in the PCN group (95% CI: −0.76–0.21, P = .268). There were no statistically significant differences identified for the duration for CRP, PCT and fever to return to normal range between the drainage methods. The complication rates was 51.8% for DJ stent group and, 30.6% in PCN group (P = .028). Conclusion Both methods are effective and safe in obstructive pyelonephritis. Despite the higher complication rate in DJ stent group, these complications were minor.

Nephrectomy – A study of recent trends in a high-volume tertiary care center, exploring the need for screening and preventive strategies

Background: Nephrectomy being one of the most commonly performed procedures, a retrospective study and analysis was done to evaluate, the scope for screening and timely preventive measures that could help to reduce the need for nephrectomy. Aims and Objectives: The aim of the study was to study indications, demographic-details, clinical-presentations, time delay, comorbidities, operative procedures, and complications of patients undergoing nephrectomies. The study was to identify the high risk groups, assess for feasibility for screening measures, and formulate strategies for nephrectomy prevention for benign etiologies. Materials and Methods: A retrospective study was done on medical records of 220 consecutive nephrectomies from June 2018 to June 2020. Results: Out of 220 nephrectomies, 68% were performed for benign conditions, 17% for malignant etiology, and 15% were donor nephrectomies. In the benign group, the most common etiology was renal stones (44.54%), followed by pelvic ureteric junction obstruction (12.72 %), and renal tuberculosis (6.81%). The most common clinical presentations were flank pain (80%), followed by lower urinary tract symptoms (22%), dysuria (25%), hematuria (15%), and fever (7%). In the malignant group, the most common etiology was renal cell carcinoma (14.09%). The most common clinical presentations were flank pain (90%) followed by hematuria (67%). Overall, 24% of the patients presented with acute kidney injury. A pre-operative intervention such as DJ stenting and percutaneous nephrostomy insertion was performed in 13% and 9% of patients, respectively. A laparoscopic approach was used in 76% of the patients out of which 10% were converted to open procedures. Partial nephrectomy was performed in 3% of patients. Conclusion: There is a difference in nephrectomy indications between Western countries and India, where 68% of nephrectomies are performed for benign conditions especially calculus disease. Nephrectomy for calculus disease is potentially preventable and public education in the form of posters, media and the involvement of the community medicine department could be helpful.

A new porcine training phantom for percutaneous nephrostomy insertion

A new porcine training phantom for percutaneous nephrostomy insertion

Tumor Stent for Chronic Ureteral Obstruction: Which Are Predictors of Stent Failure?

Purpose: To identify predictors of UROSOFT® tumor stent failure. According to the manufacturer, this reinforced ureteral stent has a maximal dwell time of 6 months. Nonetheless, stent failure may reduce this maximal dwell time. Methods: All patients undergoing first-time UROSOFT tumor stent insertion in our institution between 2010 and 2018 were considered for this retrospective analysis. Primary endpoint was stent failure and defined as premature stent exchange or percutaneous nephrostomy insertion. The local ethics committee approved the study protocol (study ID: BASEC 2020-00175). Results: In total, 182 patients were available for analysis. Median age was 68 years. Causes for tumor stent placement were extrinsic ureteral obstruction in 144 patients (79%) and intrinsic obstruction in 38 patients (21%). Tumor stent failure-free survival estimates at 1, 2, 3, 4, and 5 months were 89%, 83%, 76%, 65%, and 52%, respectively. Patients with stent failure had significantly higher grade of hydronephrosis, higher urinary culture bacterial growth, higher serum white blood cell count, higher C-reactive protein, and lower estimated glomerular filtration rate at the time of reintervention, compared with patients who underwent regular stent exchange. Of all baseline and perioperative parameters, we found bilateral insertion, intrinsic ureteral obstruction, and urinary tract infection (UTI) at time of tumor stent insertion to be significant and independent predictors of stent failure (all p < 0.05). Conclusion: Despite a theoretical maximal dwell time of 6 months, ∼50% of all cases are subject to premature stent failure. Predictors of stent failure are bilateral insertion, intrinsic ureteral obstruction, and UTI at the time of tumor stent insertion. Preoperative antibiotic therapy may impact on stent failure rate.

Clinical factors predicting ureteral stent failure in patients with external ureteral compression.

Double-J stent (DJ) placement is usually the treatment of choice for relieving external compression of the ureter. However, in some cases DJ function may become impaired and a percutaneous nephrostomy (PCN) may be required. Previous studies have reported different predictive factors for choosing PCN or DJ insertion as the initial treatment. In this study, we analyzed the risk factors for DJ failure in patients with external ureteral compression. Our results showed that the patients with moderate and severe hydronephrosis (p-value = 0.0171 and 0.0249, respectively), preexisting pyuria (p-value = 0.0128), or lower ureter obstruction (p-value = 0.0305) were more prone to DJ laterality. Age was also an important predictor. Urologists should pay more attention to these patients and consider PCN as the initial treatment.

Predictors for Retrograde Ureteral Stenting Failure as an Initial Drainage Method for Emergent Complicated Acute Calculus Obstructive Uropathy

Objective: To define predictors for initial retrograde ureteral stenting (RUS) failure with the need for the percutaneous nephrostomy (PCN) insertion as a drainage method in patients with complicated acute calculus obstructive uropathy. Methods: We undertook a retrospective evaluation of patients who presented with complicated obstructive calculus uropathy (acute renal failure or obstructive pyelonephritis) between January 2016 and January 2020. Patients in whom there was failure to visualize ipsilateral ureteric orifice and those with extrinsic ureteral obstruction were excluded. Patient demographics and radiological data including stone site, hydronephrosis grade, maximum transverse stone diameter, periureteral density (PUD) and pericalcular ureteric thickness (P-CUT) at the maximum transverse stone diameter were assessed using non-contrast computed tomography at the time of admission. Results: The study included 256 patients who were managed initially by RUS trial. Of them, 48 (18.8 %) had RUS failure. The presence of acute pyelonephritis, increased maximum transverse stone diameter ≥ 9.5 mm, P-CUT ≥ 7.5 mm, and PUD at stone level ≥ 17.5 HU were risk factors associated with RUS failure (P = 0.007, 0.002, &lt; 0.001, and &lt; 0.001, respectively). Conclusion: Initial radiological stone and ureteric characteristics, in addition to the clinical diagnosis of obstructive pyelonephritis, can be used to determine PCN insertion as the preferred option over RUS for urinary drainage.

Risk factors for hospital readmission following complicated urinary tract infection

Hospital readmissions following severe infections are a major economic burden on the health care system and have a negative influence on patients' quality of life. Understanding the risk factors for readmission, particularly the extent to which they could be prevented, is of a great importance. In this study we evaluated potentially preventable risk factors for 60-day readmission in patients surviving hospitalization for complicated urinary tract infection (cUTI). This was a multinational, multicentre retrospective cohort study conducted in Europe and the Middle East. Our cohort included survivors of hospitalization due to cUTI during the years 2013–2014. The primary outcome was 60-day readmission following index hospitalization. Patient characteristics that could have influenced readmission: demographics, infection presentation and management, microbiological and clinical data; were collected via computerized medical records from infection onset up to 60 days after hospital discharge. Overall, 742 patients were included. The cohort median age was 68 years (interquartile range, (IQR) 55–80) and 43.3% (321/742) of patients were males. The all-cause 60-day readmission rate was 20.1% (149/742) and more than half were readmitted for infection [57.1%, (80/140)]. Recurrent cUTI was the most frequent cause for readmission [46.4% (65/140)]. Statistically significant risk factors associated with 60-day readmission in multivariable analysis were: older age (odds ratio (OR) 1.02 for an one-year increment, confidence interval (CI) 1.005–1.03), diabetes mellitus (OR 1.63, 95% CI 1.04–2.55), cancer (OR 1.7, 95% CI 1.05–2.77), previous urinary tract infection (UTI) in the last year (OR 1.8, 95% CI: 1.14–2.83), insertion of an indwelling bladder catheter (OR 1.62, 95% CI 1.07–2.45) and insertion of percutaneous nephrostomy (OR 3.68, 95% CI 1.67–8.13). In conclusion, patients surviving hospitalization for cUTI are frequently re-hospitalized, mostly for recurrent urinary infections associated with a medical condition that necessitated urinary interventions. Interventions to avoid re-admissions should target these patients.

Gender differences in acute stone admissions - should we have a lower threshold for treatment in female patients?

To examine the gender-related differences in the presentation, management and outcomes of patients admitted with acute renal colic at our institution. A retrospective analysis of 231 consecutive patients requiring inpatient admission for acute renal colic between October 2015 and March 2018. For each admission, data on demographics, admission blood results, stone characteristics, management and outcomes were collected. Differences between genders were compared using the chi-squared and Student's t-test. Gender distribution was 35% female: 65% male. There was no significant difference in age, American Society of Anesthesiologists Physical Status Classification grade or history of diabetes. Women had a higher admission C-reactive protein level (89.3 vs 32.9mg/L, P < 0.001) and neutrophil count (10.0 vs 8.8×109 /L, P = 0.04) than men. They also had more positive cultures (34.1% vs 6.0%, P < 0.001) and were more likely to require percutaneous nephrostomy insertion (9.8% vs 0.7%, P = 0.005). Women had more intensive therapy unit (ITU) admissions (12.2% vs 0.6%, P < 0.001) and longer lengths of stay (4.4 vs 1.8days, P < 0.001) than men. There was no mortality in our series. In the present study, women admitted with acute renal colic were more likely to have an associated infection than men and require rapid decompression. Although there was no difference in mortality, women experienced greater morbidity as evidenced by the higher rate of ITU admissions and longer length of stay. These differences are important to consider when assessing the suitability of conservative management for female patients.

Local prostate radiotherapy in metastatic prostate cancer and symptomatic local events.

111 Background: Local prostate radiotherapy (LPRT) is associated with improved overall survival in patients with low metastatic burden (MB) and is now standard of care. However, the role of LPRT in reducing symptomatic local events (SLE) in metastatic prostate cancer (MPC) remains unclear and requires long-term follow-up. The purpose of this study was two-fold: i) identify the risk factors associated with SLE, and ii) evaluate the association between LPRT and SLE in MPC. Methods: We conducted a retrospective, population-based cohort study of patients diagnosed with initial MPC between 2005 and 2016. Patients were identified through the Alberta Cancer Registry and patient, tumour, and treatment characteristics were collected by chart review. Data were linked to physician billing claims between 2004 and 2017 for diagnostic or therapeutic procedures potentially related to genitourinary (GU) and gastrointestinal (GI) SLE including percutaneous nephrostomy (PCN) and ureteric stent insertion (USI), cystoscopy, TURP, TURBT, colonoscopy and proctosigmoidoscopy. Both Andersen-Gill recurrent event and multivariable Cox regression time to first event analyses were conducted to evaluate the effect of LPRT on the occurrence of these procedures. Patients who underwent radical prostatectomy were excluded. LPRT was defined as 40 Gy or higher total dose to the prostate within one year of diagnosis. Patients with a SLE occurring after diagnosis but prior to LPRT were allocated to the control group. MB was defined as per STAMPEDE. Covariates for both models included MB, age at diagnosis, PSA at diagnosis, clinical T- and N-stage, and Gleason score (GS). Results: Of a total cohort of 1363 patients, 745 (54.7%) had high MB and 450 (33%) had low MB. Fifty-four (4%) received LPRT, of which 14.8% had high MB. Of those receiving LPRT, median PSA was 9.4, 79.6% had GS of 8-10, and 59.3% had T3-T4 disease. One or more SLE were observed in 43.5% and 37% of the control and LPRT groups, respectively. Among those with SLE, the median SLE frequency was 2 (interquartile range [IQR], 2-5) and 1 (IQR, 1-2.3) for the control and LPRT groups, respectively. On recurrent event analysis, LPRT was associated with lower risk of composite GU SLE (HR 0.34, 95% CI 0.17-0.67; p = 0.002), PCN and USI (HR 0.20, 95% CI 0.05-0.84; p = 0.027) and cystoscopy (HR 0.38, 95% CI 0.15-0.96; p = 0.041). Risk factors for GU SLE were T4 disease, GS of 8-10 and unknown GS. Risk factors for PCN and USI were T3, TX and N1 disease, GS of 8-10 and unknown GS. On time to first event analysis, there were no statistically significant differences for all outcomes between the control and LPRT groups. MB was not a risk factor for SLE in both analyses. Conclusions: LPRT was associated with lower risk for recurrent GU SLE, PCN and USI, and cystoscopy. The associated benefit in SLE reduction with LPRT warrants further study to determine if this effect is modified by MB and whether there may be a role for LPRT in patients with high MB.

Stenting the ureteroneocystostomy reduces urological complications in kidney transplantation: a noninferiority randomized controlled trial, SPLINT trial.

The role of ureteral stents in living-donor kidney transplantation remains uncertain. In this randomized controlled trial (SPLINT), we compared urological complications in living-donor kidney transplantations performed with or without stents. We included 200 consecutive patients that received living-donor kidney transplantations at the Erasmus MC, University Medical Center, Rotterdam. Patients (124 males, 76 females, mean age 54±13) were randomized for suprapubic externalized single J stents (N=100) or no stent (N=100). The primary outcome was the probability of a percutaneous nephrostomy insertion (PCN) during a 12-month follow-up. To assess whether no stenting is noninferior to stenting, we allowed the probability of a PCN to increase by at most 5% (this is the noninferiority margin). Baseline characteristics were comparable between groups. In the no-stent group, there were more PCN insertions, 14% (95% CI 4.3-23.7%); urinary leakages, 12% (95% CI 5.4-21.3%); and surgical re-interventions because of urological complications, 8% (95% CI 1.5-14.5%). The stent group had more hematuria, 26% (95% CI 13.1-38.9%); and graft rejections, 15% (95% CI 2.7-27.3%). Patients in both groups had similar mean GFRs at several time points. Besides a better Euro-Qol-5D in the no-stent group at 2 and 6weeks postoperative, similar quality of life was reported based on SF-36 and Euro-Qol-5D scores. In this trial, noninferiority has not been demonstrated for no-stent placement in relation to the number urological complications.

Percutaneous Nephrostomy in the Neonatal Period: Indications, Complications, and Outcome-A Single Centre Experience.

The purpose of this study was to evaluate the indications, technique for percutaneous nephrostomy (PCN) insertion, the complications related to PCN, duration of PCN, and outcome following PCN removal regarding the kidney function. Medical charts of 31 neonates (22 boys and 9 girls, mean age 13.9days) treated with 43 PCN were reviewed. Collected data included indications for PCN, PCN complications, duration of PCN, and outcome of these patients by analysing the kidney function. The indications for PCN insertion were obstructive urinary tract dilation in 24 neonates (four with associated infection), and non-obstructive urinary tract dilation with urosepsis or pyonephrosis in seven cases. Primary technical success of PCN placement using Seldinger technique was 97.7%. The following complications were reported: self-limited post-procedural bleeding into the pelvicalyceal system in two, chronic microscopic haematuria in five, and clinically manifested urinary tract infection in five children. Four PCN were dislocated. Cellulitis was present at the skin entry of 5 PCN, urinary leak in 5 PCN, and mechanical damage of 5 PCN. Eight PCN had to be replaced. Mean duration of PCN was 5months. Kidney insufficiency was detected in 5/29 children with the mean follow-up of 3.9years. PCN is a safe, effective transient solution in neonates with pyonephrosis or when surgery of obstructed urinary system has to be postponed. The rate of minor complications increased with PCN duration. If kidney insufficiency is present after PCN removal, it is related to the complexity of kidney anomalies.