Percutaneous Nephrostomy Tube Placement Research Articles

189 Reversal of Severe Metabolic Abnormalities of a Ureterosigmoidostomy After Percutaneous Nephrostomy Tube Placement

189 Reversal of Severe Metabolic Abnormalities of a Ureterosigmoidostomy After Percutaneous Nephrostomy Tube Placement

Rare Complication of Percutaneous Nephrolithotomy: Nephrostomy Tube in Renal Vein and Inferior Vena Cava

Percutaneous nephrolithotomy (PCNL) is considered as the gold standard treatment for renal stones > 2cm. We encountered a patient who underwent PCNL and inadvertently placement ofpercutaneous nephrostomy tube in the inferior vena cava through the left renal vein from the left Kidney.There was profuse bleeding during the procedure (PCNL), and the procedure was abandoned by placing a nephrostomy tube. PNT was removed after 04 days in two steps without any bleeding.

Urine Leak After Partial Nephrectomy: A Rare Complication After Robot-Assisted Partial Nephrectomy

In this systematic review, we looked at the rate of urine leakage from the kidney after surgical removal of kidney tumors. Urine leak (UL) is a common post-operative complication of partial nephrectomy (PN). The reported incidence varies in the literature, and there are no well-established guidelines for management of UL after PN. The goal of this study is to report the incidence and most common management strategies for UL after PN. For our quantitative synthesis, a systematic review of articles related to UL after PN from April 2010 to April 2020 was performed using PubMed and EMBASE. 475 total records were found, of which 40 reported on post-operative UL. A total of 19,904 cases were included. The overall incidence of UL was 2.8% (554/20,140). UL was most common in open cases (5.01%), followed by laparoscopic (4.40%) and robotic (1.18%) PN. Thirty-one of the included studies reported on management technique for a total of 343 interventions. UL was most frequently managed non-operatively (46.6%). Other management strategies included cystoscopy with ureteral stent placement (39.4%), percutaneous drain placement (8.7%), and percutaneous nephrostomy tube placement (2.3%). Use of nephrectomy, open reconstruction, angioembolization, or ureteroscopic techniques was uncommon (3.1%). Our study revealed that UL is rare after robotic approach to PN. Many reported cases have been managed conservatively. A stepwise management strategy is recommended. Most of these leaks heal with time or with placement of a stent into the ureter after surgery. We found that urine leak is less common with robotic surgery versus open or laparoscopic surgery.

V08-03 INDIANA POUCH CONTINENT CUTANEOUS URINARY DIVERSION AFTER ROBOTIC-ASSISTED RADICAL CYSTECTOMY: A 16-YEAR EXPERIENCE

You have accessJournal of UrologyCME1 Apr 2023V08-03 INDIANA POUCH CONTINENT CUTANEOUS URINARY DIVERSION AFTER ROBOTIC-ASSISTED RADICAL CYSTECTOMY: A 16-YEAR EXPERIENCE Albert Kim and Kevin Chan Albert KimAlbert Kim More articles by this author and Kevin ChanKevin Chan More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003306.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Continent urinary diversion after radical cystectomy is an underutilized option even at high-volume centers with studies demonstrating socio-economic, geographical, and gender disparities. Efforts to optimize utilization of continent diversion must concentrate on changing perceptions regarding feasibility and accurate reporting of complications.The objective of this study is to report long-term clinical outcomes in bladder cancer patients receiving an Indiana pouch continent cutaneous urinary diversion (CCUD) after robot-assisted radical cystectomy. METHODS: After Institutional Review Board approval, a prospectively maintained bladder cancer database was queried for patients with T1-T4, N0-N1, M0 bladder cancer undergoing radical cystectomy with CCUD at a tertiary referral center from 2004 to 2020. Complications at 30- and 90-days were recorded according to the Clavien-Dindo classification. Continence rates were recorded by manual chart review. RESULTS: A total of 97 patients were included with a median follow-up of 93 months. Clinically, 91.8% had £T2 disease and 29.9 % received neoadjuvant chemotherapy. The median length of surgery was 8.0 hours, length of hospital stay was 8.3 days, and urinary continence rate was 99.0%. The overall complication rate was 73.2% and 76.5% at 30- and 90-days respectively. Most complications were low grade (Clavien I or II). Acute blood loss anemia and symptomatic urinary tract infection were the most common low grade complications. The major complication rate was 17.5% at 30-days and 22.7% at 90-days. The most common major complications were abdominal infection requiring percutaneous drain placement, Clavien Grade III, and uretero-colonic stricture requiring percutaneous nephrostomy tube placement and surgical revision, Clavien Grade III. The readmission rate was 21.4% and median overall survival was 108 months. CONCLUSIONS: CCUD provides exceptional functional outcomes with acceptable complication rates compared to other diversion types. Source of Funding: NONE Disclosures: NONE © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e749 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Albert Kim More articles by this author Kevin Chan More articles by this author Expand All Advertisement PDF downloadLoading ...

Holmium Laser Removal of Antegrade-Placed Ureteral Stent Suture via Ureteroscopy

Antegrade conversion to nephroureteral stent is common after percutaneous nephrostomy tube placement for obstruction when retrograde alternatives fail. Nephroureteral stents often have a nylon retaining suture attached to aid in placement and removal. If the nephroureteral suture is not removed, it can become embedded in the renal parenchyma as nylon is unabsorbable, preventing stent removal and potentially leading to adverse outcomes. This case report describes a complication of antegrade nephroureteral stenting and shows that retrograde ureteroscopy with holmium lasering of the retained suture was an effective treatment for the removal of retained stents. Furthermore, after a difficult extraction of the nephroureteral stent, the patient displayed minimal post-operative sequelae, and no visible defects on follow-up renoscopy.

Long-Term Management of Post-Transplant Ureteral Stricture with Surgical Reconstruction: A Case Series and Literature Review

Introduction: Ureteral stricture is the most common complication after kidney transplant and is largely responsible for graft dysfunction. Surgical intervention is the definitive treatment if conservative management with stenting and percutaneous nephrostomy tube placement fails and has been shown to have comparable long-term survival rates and limited post-operative complications. Methods: This is a single-center retrospective study following seven patients who received a kidney or a kidney and pancreas transplant between August 2012 and January 2021. These patients underwent surgical ureteral reconstruction after failed conservative management of a ureteral stricture. The reconstruction procedures performed were native ureter to transplanted kidney ureteropyelostomy, native bladder to transplanted renal pelvis vesicopyelostomy, non-transecting side-to-side ureteroneocystostomy, and a Boari flap creation. Data collected from electronic medical records included recipient age, gender, delayed post-transplant complications, ureteral reconstruction technique, and post-reconstruction outcomes. Renal ultrasound (RUS), renogram, nephrostogram, serum creatinine (Cr), and graft biopsy were used to assess for severity of hydronephrosis, ureteral stricture, and graft dysfunction. Serum Cr and RUS were used to assess renal function after the ureteral reconstruction. Results: Six out of seven cases resulted in reduced or resolved hydronephrosis and preserved graft function without future nephrostomy or ureteral stenting. One case required immediate revision due to persistent obstruction, and this patient had concomitant rejection leading to intrarenal stricture requiring ureterocalycostomy. Conclusions: Formal ureteral reconstruction is the definitive treatment for many cases of ureteral strictures after transplant. The surgical technique chosen for these procedures must consider the physical and functional state of the bladder, ureter, and kidney. Our series outlines multiple surgical approaches that should be considered early in the management of post-transplant ureteral strictures to limit graft dysfunction.

Which objective emergency department parameters leads to expedited intervention in patients with acute urinary tract calculi.

Objectives:To retrospectively determine which objective measurements had an increased likelihood of requiring immediate surgical intervention in patients presenting to the emergency department (ED) with acute ureteral calculi.Materials and methods:Employing our institution's electronic medical record system, we conducted a retrospective cohort study of 4366 patients who presented to the ED with an acute ureteral calculus over an 8-year period. Data consisting of relevant demographic information, vital signs, laboratory parameters, and interventional history was obtained and analyzed.Results:This study consisted of 4366 patients presenting to the ED with acute ureteral calculi, of whom 312 (7%) required a procedure prior to being discharged. Of these 312 patients, 290 (6.6%) underwent cystoscopy with ureteral stent placement and 22 (0.5%) were sent to interventional radiology for percutaneous nephrostomy tube placement. Patients who tested positive for nitrites in their urine had a relative risk of 3.48 of receiving intervention when compared to the nitrite negative group.Conclusions:Through this retrospective cohort study, we were able to find what objective measurements were associated with an increased need for immediate surgical intervention in patients who presented to the ED with acute ureteral calculi. With this data, urologists can be better equipped to identify the patients that present in the emergency setting that will require urgent intervention.

Ultrasound guided direct puncture percutaneous nephrostomy: a single tertiary centre observational study

Background: Percutaneous nephrostomy (PCN) is indicated to drain the upper urinary tract collecting system in cases of obstruction. Objective of our study is to evaluate the safety and efficacy of Ultrasound guided direct puncture PCN in our populations.Methods: This observational study was conducted from May 2020 to April 2021in department of urology and renal transplant. The total 65 patients with upper urinary tract obstruction requiring PCN were enrolled. All parameters were recorded and statistical analysis was performed using the Statistical package for the social sciences (SPSS 16.0) for windows.Results: In our study Ca Cervix with ureteric infiltration (35%) was the most common indication for PCN tube placement. Majority of patients (83%) had Grade IV and Grade III hydroneprosis. Single attempt for tube placement was sufficient most of the time in (86% cases). Direct Puncture PCN tube placement was successful in 62 (95.4%) cases. The mean duration of procedure was 12.4 minutes. Loin pain was the most common procedure related complication observed in 58 patients. There was no evidence of visceral injury, no need of blood transfusion in post procedural duration in our study.Conclusions: USG guided direct puncture PCN technique is simple, low cost, less time consuming, less chance of loss of tract and effective procedure for drainage of urine in case of upper urinary tract obstruction. We recommended this procedure in grade III and IV hydronephrosis and this procedure suitable for developing countries like India because of procedure related low cost.

Determining Variable Costs in the Acute Urolithiasis Cycle of Care Through Time-Driven Activity-Based Costing

ObjectiveTo characterize full cycle of care costs for managing an acute ureteral stone using time-driven activity-based costing. MethodsWe defined all phases of care for patients presenting with an acute ureteral stone and built an overarching process map. Maps for sub-processes were constructed through interviews with providers and direct observation of clinical spaces. This facilitated calculation of cost per minute for all aspects of care delivery, which were multiplied by associated process times. These were added to consumable costs to determine cost for each specific step and later aggregated to determine total cost for each sub-process. We compared costs of eight common clinical pathways for acute stone management, defining total cycle of care cost as the sum of all sub-processes that comprised each pathway. ResultsCost per sub-process included $920 for emergency department (ED) care, $1665 for operative stent placement, $2368 for percutaneous nephrostomy tube placement, $106 for urology clinic consultation, $238 for preoperative center visit, $4057 for ureteroscopy with laser lithotripsy (URS), $2923 for extracorporeal shock wave lithotripsy, $169 for clinic stent removal, $197 for abdominal x-ray, and $166 for ultrasound. The lowest cost pathway ($1388) was for medical expulsive therapy, whereas the most expensive pathway ($8002) entailed a repeat ED visit prompting temporizing stent placement and interval URS. ConclusionWe found a high degree of cost variation between care pathways common to management of acute ureteral stone episodes. Reliable cost accounting data and an understanding of variability in clinical pathway costs can inform value-based care redesign as payors move away from pure fee-for-service reimbursement.

Rethinking Time-to-Exchange: Outcomes of Nephrostomy Tube Placement in Pregnancy

This study evaluated outcomes for percutaneous nephrostomy tube placement in pregnant patients, including potential complications that required early, unplanned tube exchange. A retrospective review was conducted for 51 pregnant patients and a nonpregnant cohort matched 1:1 who received percutaneous nephrostomy tube placement between 2012 and 2020. Factors potentially contributing to unplanned tube exchanges were analyzed, including gestational age, prevalence and severity of hydronephrosis, presence of renal calculi, and serum calcium level. The mean tube exchange interval was significantly shorter in the pregnant group (3.4 weeks ± 1.8 [standard deviation] vs 5.7 weeks ± 0.7, P < .0001), and pregnant subjects were significantly more likely to require reintervention before the 6-week scheduled exchange (80.4% vs 21.6%, P < .0001). The serum calcium level was lower in pregnant subjects (8.4 mg/dL ± 0.4 vs 8.9 mg/dL ± 0.7, P = .002). A shorter interval schedule (every 3 weeks) of routine percutaneous nephrostomy tube exchange in pregnant patients may be necessary to avoid complications.

Health Education Intervention for Patients Undergoing Placement of Percutaneous Nephrostomy Tube: A Randomized Controlled Trial.

The purpose of this study was to compare the economic impact (cost) of percutaneous nephrostomy (PCN) tube care in patients following an educational intervention to no intervention. A randomized controlled trial. The sample comprised 178 patients recruited between May 2017 and April 2019. The study setting was the Marqués de Valdecilla University Hospital located in Cantabria on the northern coast of Spain. Data were collected in the hospital's radiology department. Participants were randomly allocated to 2 groups: an intervention group received an educational intervention that specifically addressed living with a PCN tube and a control group that received standard instruction. The intervention group received the educational intervention twice, before placement of the nephrostomy and at first tube change (6 weeks later). The main outcome variable was economic impact of the PCN, operationally defined as unscheduled or urgent visits and health care costs related to PCN tube placement. When compared to control group subjects, participants who received the educational intervention had fewer urgent (unscheduled) visits (1.9 vs 4.0; P = .004) and lower direct and indirect health care costs reflecting a savings of €5277 (approximately US $6257). The health education intervention reduced costs associated with these additional visits when compared to patients receiving standard postprocedural education.

Acute Dyspnea in a Young Woman Following Percutaneous Nephrostomy Tube Placement.

Acute Dyspnea in a Young Woman Following Percutaneous Nephrostomy Tube Placement.

Ureteral Rest is Associated With Improved Outcomes in Patients Undergoing Robotic Ureteral Reconstruction of Proximal and Middle Ureteral Strictures

To evaluate the effect of ureteral rest on outcomes of robotic ureteral reconstruction. We retrospectively reviewed all patients who underwent robotic ureteral reconstruction of proximal and/or middle ureteral strictures in our multi-institutional database between 2/2012-03/2019 with ≥12 months follow-up. All patients were recommended to undergo ureteral rest, which we defined as the absence of hardware (ie. double-J stent or percutaneous nephroureteral tube) across a ureteral stricture ≥4 weeks prior to reconstruction. However, patients who refused percutaneous nephrostomy tube placement did not undergo ureteral rest. Perioperative outcomes were compared after grouping patients according to whether or not they underwent ureteral rest. Continuous and categorical variables were compared using Mann-Whitney U and 2-tailed chi-squared tests, respectively; P <.05 was considered significant. Of 234 total patients, 194 (82.9%) underwent ureteral rest and 40 (17.1%) did not undergo ureteral rest prior to ureteral reconstruction. Patients undergoing ureteral rest were associated with a higher success rate compared to those not undergoing ureteral rest (90.7% versus 77.5%, respectively; P = .027). Also, patients undergoing ureteral rest were associated with lower estimated blood loss (50 versus 75 milliliters, respectively; p<0.001) and less likely to undergo buccal mucosa graft ureteroplasty (20.1% versus 37.5%, respectively; p=0.023). Implementing ureteral rest prior to ureteral reconstruction may allow for stricture maturation and is associated higher surgical success rates, lower estimated blood loss, and decreased utilization of buccal mucosa graft ureteroplasty.

Predictive value of ureteral wall thickness (UWT) assessment on the success of internal ureteral stent insertion in cases with obstructing ureteral calculi.

To evaluate the possible role of ureteral wall thickness (UWT) assessment in the prediction of the success for stent placement in cases with obstructing ureteric stones. 227 adult patients with a single unilateral obstructing ureteral stone requiring internal ureteral stent placement were included. In addition to stone size, the ureteric wall thickness at the impacted stone site and the degree of hydronephrosis were also assigned on CT images. Patients were divided into two subgroups: Group 1: patients in whom internal ureteral stent could not be passed beyond the stone and Group 2: patients in whom an internal ureteral stent was passed successfully. The possible relationship between the UWT values and the success of stent placement, degree of hydronephrosis were comparatively evaluated. The majority of the stones were located in the proximal ureter in Group 1 and the degree of hydronephrosis was also higher in these cases. Moreover, while the mean value of UWT calculated on CT images was 4.3 ± 0.9mm in Group 1, this value was noted to be 2.5 ± 0.8mm in cases of group 2. A cutoff UWT value of 3.35mm was highly predictive for the stent insertion and cases with higher values required additional procedures or percutaneous nephrostomy tube placement. UWT value calculated at the obstructing stone site was found to be predictive enough for the likelihood of internal ureteral stent passage with high sensitivity and specificity. This evaluation may enable the urologist to make the best decision for urinary diversion in such cases.

NEPHROPLEURAL FISTULA AND URINOTHORAX AFTER PERCUTANEOUS NEPHROLITHOTOMY

SESSION TITLE: Fellows Disorders of the Pleura Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: October 18-21, 2020 INTRODUCTION: Urinothorax is a rare diagnosis caused by urinary tract obstruction or trauma resulting in leakage of urine from the retroperitoneum into the pleural space. These effusions are typically large, unilateral, and nearly always associated with a ratio of pleural fluid creatinine to serum creatinine greater than one. Definitive treatment requires correction of the uropathy, as thoracentesis or chest tube insertion alone is invariably ineffective. Here we describe a case of urinothorax due to nephropleural fistula which formed after percutaneous nephrolithotomy for staghorn calculi. CASE PRESENTATION: A 54 year-old female with morbid obesity and bilateral staghorn calculi was admitted to the hospital for elective bilateral percutaneous nephrolithotomy (PCNL) for progressive renal dysfunction. A left sided PCNL was performed and a percutaneous nephrostomy (PCN) tube was left in place. Four days post procedure, the PCN tube was removed. Six days post procedure, the patient developed severe left-sided pleuritic chest pain, orthopnea, and dyspnea at rest. She required two liters of oxygen by nasal cannula to maintain her oxygen saturation above 90%. Exam was notable for super morbid obesity (BMI of 60), mild respiratory distress, and absent left sided breath sounds with dullness to percussion. Chest x-ray showed a large left pleural effusion. Urgent bedside thoracentesis was performed, and 1.8 liters of clear, pink-tinged fluid was removed. Pleural fluid analysis revealed a transudate by Light’s criteria with a pH of 7.8, creatinine of 6.69 mg/dL, and a pleural fluid to serum creatinine ratio of 2.9. CT scan of her chest, abdomen, and pelvis revealed bilateral staghorn calculi, a large left pleural effusion, and a fistulous tract between the kidney and the posteroinferior pleural space. A chest tube was placed, and the patient underwent double J-stent placement within the urinary tract which relieved the obstruction and halted the accumulation of pleural fluid. The chest tube was removed, and the patient was discharged with plans to undergo right sided PCNL in the future. DISCUSSION: Urinothoraces can be caused by urinary tract obstruction or trauma. PCN tube placement above the 12th rib can lead to pleural transgression and injury, as in this case. Traumatic urinothoraces are typically symptomatic, unilateral, and large. In most cases, pleural fluid analysis shows an acidic transudate with a pleural fluid to serum creatinine ratio of greater than one. Diagnosis can be made on the basis of pleural fluid analysis or imaging with either CT or radionucleotide scans. Treatment with thoracentesis or chest tube drainage alone leads to unfavorable outcomes in nearly all cases; therefore, management should focus on correction of the uropathy which provides definitive treatment. CONCLUSIONS: See Discussion Reference #1: Toubes, M. E et al. Urinothorax: a systematic review. J Thorac Dis. 2017 May; 9(5): 1209-1218. Reference #2: Chandra A, Pathak A, Kapur A, Russia N, Bhasin N. Urinothorax: A rare cause of severe respiratory distress. Indian J Crit Care Med. 2014;18(5):320-2. Reference #3: Dagli M, Ramchandani P. Percutaneous nephrostomy: technical aspects and indications. Semin Intervent Radiol. 2011;28(4):424–437. DISCLOSURES: No relevant relationships by Traci Adams, source=Web Response No relevant relationships by Carlos Cardenas, source=Web Response No relevant relationships by Dylan Lovin, source=Web Response no disclosure on file for Arthi Satyanarayan

Urologic Complications Requiring Intervention Following High-dose Pelvic Radiation for Cervical Cancer

ObjectiveTo identify the incidence of radiation-induced urologic complication requiring procedural intervention following high-dose radiotherapy for cervical carcinoma, and to identify predictors of complication occurrence. Materials and MethodsWe performed a retrospective chart review of cervical cancer patients undergoing radiotherapy with primary focus on procedural complications (Clavien-Dindo ≥ III). Clinical data were collected including radiation dose, procedure performed, timing of complication, and need for additional procedures. Univariate and multivariate logistic regression modeling was performed to assess predictive value of demographic and clinical variables. ResultsA total of 126 patients with FIGO stage 1A2-4B cervical cancer were included in study analysis, with 18 patients experiencing procedural complication (14.3%). A total of 22 complications were identified, representing an average of 1.2 complications per patient with complication. The most common complications were ureteral stricture and radiation cystitis. The most common nononcologic procedures performed in the treatment of these complications were ureteral stenting, percutaneous nephrostomy tube placement, and cystoscopy. Notably, a total of 259 procedures were performed in the treatment of urologic complications, representing 14.4 procedures per patient and 24.6 procedures per patient with ureteral stricture. Logistic regression demonstrated active smoking at the time of diagnosis to be a predictor of procedural complication. ConclusionRadiotherapy in the treatment of cervical cancer is associated with a high rate of urologic procedural complication. These complications often require numerous procedures and long-term management given their complexity. These findings suggest a need for awareness and plans for multidisciplinary management of urologic complications in this patient population.

Renal artery angiography in pediatric trauma using a national data set

With limited pediatric renal trauma management literature, treatment pathways for children have been extrapolated from the adult population. A shift to non-operative management has led to higher renal preservation rates; however, characterization of endovascular intervention in the pediatric trauma population is lacking. This study uses the National Trauma Data Bank (NTDB), to evaluate renal outcomes after use of renal artery angiography. We hypothesized that patients undergoing renal artery angiography for renal trauma are unlikely to require additional surgical interventions. All children ≤18 years old treated for traumatic renal injuries from 2012 to 2015 were identified by the Abbreviated Injury Scaled Score (AISS) codes in the NTDB. AISS codes were converted to American Association for Surgery of Trauma (AAST) grades. ICD-9 codes were used to identify patients that had renal artery angiography, and additional renal interventions such as nephrectomy, partial nephrectomy, percutaneous nephrostomy tube or ureteral stent placement. 536,379 pediatric trauma cases were in the NTDB from 2012 to 2015, with 4506 renal injury cases identified. A total of 88 patients had renal artery angiography (ICD-9 88.45). Only 10% (n=9) of patients who received renal artery angiography underwent an additional urological intervention. Of those nine, two patients were excluded due to renal angiography taking place after nephrectomy was performed. The remaining seven patients had high grade laceration (AAST grade 4-5). Overall, two patients underwent post angiography nephrectomies, two patients had partial nephrectomies, one percutaneous nephrostomy tube was placed (prior to partial nephrectomy), one aspiration of a kidney (prior to ureteral stent placement), and three had ureteral stent placements. The limitations of this study include: the NTDB is a national dataset that is not population based, inclusion is limited to the first hospitalization, inaccuracies exist in encounter coding, and the database is lacking laterality of the renal injury. Based on nonspecific nature of ICD-9 coding for angioembolization, we are unable to discern the number of cases that subsequently had angioembolization after or at the time of angiography. Renal artery angiography in children remains a rare procedure, 88/4,506, in children with renal trauma. In pediatric trauma cases that undergo renal artery angiography additional procedures are more common with higher grade injuries. Further studies are needed to create pediatric specific trauma management algorithms.

Metastatic Breast Cancer to the Bladder

Metastatic breast cancer to the bladder is extraordinarily rare, with only 66 cases reported in the literature to date. Occasionally, metastatic breast cancer can first present itself with obstructive uropathy from a proposed retroperitoneal spread. We present a case of in which a 77 year old Caucasian female was found to have acute urinary obstruction from metastatic breast cancer to the bladder. Her breast biopsy came back invasive carcinoma with lobular features (Estrogen Receptor negative, Progesterone Receptor negative, and HER2 negative). She has symptoms of spontaneous urinary incontinence, but no gross hematuria. She had elevated Chromogranin A, Cancer Antigen (CA) 19-9, and CEA. She had a bladder biopsy which demonstrated metastatic breast carcinoma that stained GATA3, GCDFP15, BerEp4 positive and CK20 negative. 0% of tumor cells were positive for PD-L1 expression. The patient had renal deterioration despite bilateral ureteral stent placement, and thus required percutaneous nephrostomy tube placement. She died 4 months after her initial diagnosis.

Personal Protective Equipment for Common Urologic Procedures Before and During the United States COVID-19 Pandemic: A Single Institution Study

OBJECTIVETo evaluate the personal protective equipment (PPE) utilized in common urologic procedures before and during the COVID-19 outbreak in the United States. As elective urologic procedures are being reduced to conserve resources, we sought to quantify the PPE used per case to determine the impact on potentially limited resources needed for protecting healthcare providers treating COVID-19 patients.METHODSAn IRB approved retrospective analysis of all urologic procedures in March 2019 and March 2020 was performed. Additionally, all urologic procedures performed by vascular interventional radiology (VIR) in May 2019 and March 2020 were included in the analysis. Case length, surgical and operating room staff present and number of articles of PPE were quantified. Articles of PPE were defined as surgical bonnet/hat and mask, and disposable or reusable gown with 1 pair of surgical gloves.RESULTSFour hundred and thirty-seven urologic and VIR procedures were included in the analysis. The mean PPE per case varied significantly between endoscopic and robotic categories. Robotic assisted laparoscopic cystectomy required the most hats and masks (14.5 per case in March 2019) whereas percutaneous nephrostomy tube placement by VIR required the fewest (3.1 in May 2019 and March 2020).CONCLUSIONPPE consumption varied significantly across urologic procedures. Robotic-assisted cases require the most PPE and percutaneous nephrostomy placement by VIR requires the fewest. While PPE shortages are currently being addressed national and internationally, our results provide a baseline benchmark for articles of PPE required should another pandemic or global disaster requiring careful attention to resource allocation occur in the future.

Pregnancy Outcomes in Women With Percutaneous Nephrostomy Tube Placement for Renal Colic [32N

INTRODUCTION: Maternal and fetal outcomes in pregnant patients undergoing treatment of renal colic with percutaneous nephrostomy tubes (PCN) have not previously been described. We undertook this study to evaluate pregnancy outcomes in patients who had nephrostomy tubes placement during pregnancy. METHODS: Following IRB approval, we retrospectively identified women who had nephrostomy tubes placed during pregnancy at a single tertiary care center. Data were collected from maternal and newborn charts. Descriptive statistics were utilized to characterize pregnancy outcomes. RESULTS: During the study period (2014–2018), 41 patients underwent placement of nephrostomy tubes during pregnancy, however maternal and neonatal outcomes were available for only 13 patients. Median gestational age at PCN placement was 28.2 weeks. Prior to PCN placement, renal stones were identified on imaging in 53% of patients and median creatinine was 0.6 (range 0.44–1.06). Urinary tract infection (positive urine culture) was identified in 46% of patients. Median number of hospital days during pregnancy was 9 (range 3–19 days). 31% of patients delivered prior to 37 weeks (median 37, range 32w6d-40w4d). A total of 5 (38%) infants required NICU admission and 2 (15%) were diagnosed with neonatal abstinence syndrome (NAS). CONCLUSION: Although limited by follow up data, this is the largest case series to date describing PCN in pregnancy. The underlying renal disease necessitating PCN is associated with prolonged hospital stays, NICU admission, and treatment for NAS. Given these findings, our group is planning to conduct prospective studies to characterize pregnancy outcomes in women with symptomatic renal colic during pregnancy.