Stent Removal Research Articles

MP32-06 EARLY STENT REMOVAL AFTER RADICAL CYSTECTOMY

You have accessJournal of UrologyCME1 Apr 2023MP32-06 EARLY STENT REMOVAL AFTER RADICAL CYSTECTOMY Jessica Wenzel, Solange Bassale, Paul Jones, Eric Robinson, Sudhir Isharwal, Christopher Amling, Kamran Sajadi, and Jen Jane Liu Jessica WenzelJessica Wenzel More articles by this author , Solange BassaleSolange Bassale More articles by this author , Paul JonesPaul Jones More articles by this author , Eric RobinsonEric Robinson More articles by this author , Sudhir IsharwalSudhir Isharwal More articles by this author , Christopher AmlingChristopher Amling More articles by this author , Kamran SajadiKamran Sajadi More articles by this author , and Jen Jane LiuJen Jane Liu More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003265.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Extended antibiotic prophylaxis after radical cystectomy (RC) reduces urinary tract infections (UTI) and urosepsis. Optimal duration of prophylaxis remains unknown as ureteral stents are associated with an increased risk of UTI. Similarly, the optimal duration and benefit of ureteral stents is unknown, with trends toward removing stents earlier or foregoing them altogether. Our protocol after RC previously consisted of ureteral stent duration of at least 14 days and 30 days of antibiotic prophylaxis postoperatively. To reduce stent duration and antibiotic exposure, we changed our protocol in 2020 to remove stents prior to discharge and stop antibiotic prophylaxis earlier (14d). We assessed rates of UTI and urine leak in our cohort of patients undergoing RC during this change. METHODS: We performed a retrospective chart review of all patients who underwent radical cystectomy for bladder cancer at our institution between 2016-2022(OHSU IRB approved). Patients were stratified into early or late stent removal ( <14 or >14 days post-operatively). The primary outcomes were incidence of UTI (defined as positive urine culture requiring antibiotic treatment) and urine leak, as measured by postoperative drain creatinine measurement greater than twice serum creatinine Statisical analysis was performed using Wilcoxon test and chi-square analysis. RESULTS: Of 221 patients with evaluable data, 33% of patients had early and 67% had late stent removal. Mean day of stent removal was 8.0 versus 19.9 in the early versus late group. Antibiotic exposure was lower in the early stent removal group (10 vs 21 days, p≤0.05). There was no difference in rate of postoperative UTI when comparing early versus late stent removal (10.8% vs 10.2%, p=0.9). Similarly, there was no difference in rate of urine leak when comparing early versus late stent removal (0% vs 1.3%, p=0.31). Readmission rates were similar for early versus late stent removal (7 vs 12%, p=0.3). CONCLUSIONS: Earlier stent removal and reduced duration of antibiotic prophylaxis after RC does not result in an increased rate of UTI or urine leak. Decreasing ureteral stent duration reduces postoperative antibiotic exposure without increasing adverse outcomes in patients undergoing RC. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e442 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jessica Wenzel More articles by this author Solange Bassale More articles by this author Paul Jones More articles by this author Eric Robinson More articles by this author Sudhir Isharwal More articles by this author Christopher Amling More articles by this author Kamran Sajadi More articles by this author Jen Jane Liu More articles by this author Expand All Advertisement PDF downloadLoading ...

MP42-10 SELF-EXPANDING LARGE CALIBER URETERAL STENTS FOR TREATMENT OF IDIOPATHIC URETERAL STRICTURE

You have accessJournal of UrologyCME1 Apr 2023MP42-10 SELF-EXPANDING LARGE CALIBER URETERAL STENTS FOR TREATMENT OF IDIOPATHIC URETERAL STRICTURE Hyun Soo Lee, Sun Tae Ahn, Wonku Hwang, Seon Beom Jo, Jong Wook Kim, Mi Mi Oh, Hong Seok Park, and Du Geon Moon Hyun Soo LeeHyun Soo Lee More articles by this author , Sun Tae AhnSun Tae Ahn More articles by this author , Wonku HwangWonku Hwang More articles by this author , Seon Beom JoSeon Beom Jo More articles by this author , Jong Wook KimJong Wook Kim More articles by this author , Mi Mi OhMi Mi Oh More articles by this author , Hong Seok ParkHong Seok Park More articles by this author , and Du Geon MoonDu Geon Moon More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003280.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Treatment for the idiopathic ureteral stricture has not yet been established. Recently, efficacy of self-expanding large caliber stent (Allium, Allium LTD, Israel) for ureteral stricture related to surgery, radiation or malignancy was reported. This study aims to investigate the effect of Allium stent on idiopathic ureteral stricture. METHODS: From July 2018 and January 2022, 54 patients with 58 renal units were underwent ureteroscopic balloon dilation and placement of Allium stent. All the patients showed hydronephrosis before the stenotic lesion and pain. In all the patients, we used, 12 cm or 20cm length of self-expanding Allium ureteral stent and inserted retrogradely with intraoperative x-ray guidance after dilation of the stricture (Figure 1). The primary outcome was immediate improvement in pain and improvement in hydronephrosis through ultrasound examination at 1 month after the procedure. And the secondary outcome was stricture resolution rates following stent removal. RESULTS: Patients and ureteral stricture characteristics were summarized in Table 1. Of 54 patients, 20cm stent was inserted in 47 patients and 12cm stent was inserted in 7 patients. After median follow-up period of 16.5 months, 39.7 % (23/58) of stents were kept in situ. Median indwelling time was 10months (range 1-37) and stent migration was observed in 8 cases (13.8%). All the patients were immediately free of pain after the procedure, and through ultrasound examination, improvement of hydronephrosis was confirmed in 53 out of 58 renal units. Among the 42 renal units which stent removal was performed, 13 renal units (31.0%) recurred stricture. Logistic analysis showed that stricture length was a significant predicting factor for stent failure (HR 2.75, 95% CI 1.58, 4.79, p<0.01) CONCLUSIONS: Self-expanding allium ureteral stenting showed efficacy in relieving pain and improving hydronephrosis in idiopathic ureter stricture with minimal risk of complication. Overall success rate after stent removal was associated with preoperative stricture lengths. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e570 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hyun Soo Lee More articles by this author Sun Tae Ahn More articles by this author Wonku Hwang More articles by this author Seon Beom Jo More articles by this author Jong Wook Kim More articles by this author Mi Mi Oh More articles by this author Hong Seok Park More articles by this author Du Geon Moon More articles by this author Expand All Advertisement PDF downloadLoading ...

MP49-10 AN AUTOMATED WHATSAPP ASSISTED-WEB BASED STENT TRACKING REGISTRY IN PREVENTING MISSED APPOINTMENT FOR URETERAL DOUBLE-J STENTS REMOVAL IN A DEVELOPING COUNTRY

You have accessJournal of UrologyCME1 Apr 2023MP49-10 AN AUTOMATED WHATSAPP ASSISTED-WEB BASED STENT TRACKING REGISTRY IN PREVENTING MISSED APPOINTMENT FOR URETERAL DOUBLE-J STENTS REMOVAL IN A DEVELOPING COUNTRY Shanky Singh and Girdhar Bora Shanky SinghShanky Singh More articles by this author and Girdhar BoraGirdhar Bora More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003297.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Missed double-J (DJ) stents removal appointment can lead to various complications. Here, we detail a novel model designed to minimize the incidence of missed appointment of ureteral stents removal in a resource challenged environments. METHODS: We designed a tool i.e Web based stent tracking registry- consisting of Web Whatsapp, Microsoft excel workbook and Python software.The tool works on the URL based functionality of Web Whatsapp, where we add the details. As a GUI (Graphical User Interface) an excel workbook serve as a place. A message template is sent based on the patient’s appointment date. A button is provided which when clicked by the user does the following steps (Figure 1): 1.Takes the information from the excel workbook and saves in a CSV (comma separated values) file. 2.Open a batch file which in turn runs the python script housing the Whatsapp messaging code. 3.The python script opens the base CSV for reference and sends messages to patients one at a time. 4.One messages takes few seconds to send to account for the lag in opening and sending of messages through Web Whatsapp. 5.The tool then overwrites the CSV with information of which messages have been sent, and the time of sending messages. 6.Then the Python script gets closed. 7.The saved CSV is then auto loaded whenever the user opens the Excel Interface. RESULTS: Based on early feasibility study we found the tool to be useful to send bulk messages to both patients and doctors. Pending extensive data collection, effect on appointment attendance shows a positive trend towards Whatsapp based reminders. CONCLUSIONS: Today, smartphones and computers are an integral part of our daily lives. For tracking patients with indwelling DJ stents, our automated Whatsapp-assisted web based stent tracking registry may help in preventing missed appointment of stents removal and its associated complications in an underserved environments. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e681 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Shanky Singh More articles by this author Girdhar Bora More articles by this author Expand All Advertisement PDF downloadLoading ...

MP26-20 RANDOMIZED TRIAL OF SINGLE-USE VERSUS REUSABLE CYSTOSCOPE FOR URETERAL STENT REMOVAL

You have accessJournal of UrologyCME1 Apr 2023MP26-20 RANDOMIZED TRIAL OF SINGLE-USE VERSUS REUSABLE CYSTOSCOPE FOR URETERAL STENT REMOVAL Brett Johnson, Jay Raman, Best Sara, and Yair Lotan Brett JohnsonBrett Johnson More articles by this author , Jay RamanJay Raman More articles by this author , Best SaraBest Sara More articles by this author , and Yair LotanYair Lotan More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003254.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Reusable cystoscopes are associated with risks of cross-contamination, need for chemical reprocessing, mechanical breakdown, manpower for cleaning and maintenance costs. A sterile, single use cystoscope may reduce or eliminate the source of these infections, while also decreasing exposure to reprocessing chemical agents. This multicenter, prospective randomized trial compared single-use vs. reusable endoscope for removal of ureteral stents. METHODS: The evaluation of a single-use cystoscope (Ambu A/S) was completed in a prospective, randomized, dual-arm post-market clinical trial to directly compare its performance to standard of care (SOC) flexible reusable cystoscopes in the removal of ureteral stents in an outpatient setting. 102 patients were evaluated from baseline through day 10 post-procedure at three investigative sites. The primary endpoint was the success rate of the stent removal procedures, delineated by single-use or reusable cystoscope. Secondary endpoints included time from preparation to disposal or reprocessing preparation, urologic adverse events 0-10 days, and a post-procedure clinician satisfaction survey. RESULTS: There were 102 subjects, randomized 1:1 between the single-use scope and SOC reusable scope. The successful stent removal rate was 51/51 for SOC group and 50/51 for single-use group (p=1.00). One patient required the conversion to a reusable scope due to a grasper passage issue with the index scope. There was no statistical difference in the time from scope insertion to procedure completion between the study arms. Median time from prep for the procedure to disposal/prep for reprocessing was 611 sec. for the single-use and 1105 sec. for the reusable (p=0.00). Reprocessing time was not evaluated in study. The 5-point survey demonstrated no difference in clinician satisfaction between both arms across all parameters addressed, as seen in the Clinician Satisfaction Table. There was no difference in adverse events between arms and no device causal attribution for any adverse events reports. One serious adverse event required hospitalization for infection in the SOC arm. CONCLUSIONS: The RCT of single-use cystoscopes vs. reusables showed comparable device success with significant time savings for single-use and equal clinician satisfaction. Source of Funding: Ambu USA sponsored this trial. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e361 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Brett Johnson More articles by this author Jay Raman More articles by this author Best Sara More articles by this author Yair Lotan More articles by this author Expand All Advertisement PDF downloadLoading ...

Over-the-scope Technique for Partially Covered Self-expandable Metal Stent Placement to Treat Duodenal Perforation during EUS

Although endoscopic ultrasound (EUS) is generally safe, duodenal perforation may occur during the procedure. When the iatrogenic break is wide, endoscopic positioning of a covered self- expandable metal stent is indicated to avoid a more invasive surgical approach. We evaluated the efficacy of the 'over-the-scope stenting' (OTSS) technique to treat iatrogenic duodenal perforations occurred during EUS. Data of patients with large iatrogenic duodenal perforations treated with OTSS procedure were collected in 5 centers. Technical success was defined as a correct stent placement on the perforation site, and clinical success as complete healing of the duodenal leak at stent removal 3 weeks later. A total of 15 (7 males; median age: 78 years, range 47-91) patients were included in this series. A correct stent positioning was achieved in all cases (technical success: 100%), and the perforation was healed in all, apart from one patient at stent removal (clinical success: 93%). This patient was successfully treated with a novel stent placement. No immediate post-procedural adverse events occurred, and no need for emergency surgery was recorded. In one (6.7%) patient, stent migration occurred 10 days after positioning, and it was spontaneously expulsed with stool movement without complications two days later. Our data showed that the OTTS technique for partially covered self-expandable metal stent placement is feasible, safe and effective to tread large iatrogenic duodenal perforation occuring during EUS.

MP35-01 A SINGLE CENTRE PROSPECTIVE RANDOMIZED CONTROLLED STUDY TO ASSESS OUTCOMES AND COMPLICATIONS OF CONVENTIONAL STENT PLACEMENT VERSUS NO STENT PLACEMENT AFTER URETEROSCOPY FOR DISTAL URETERIC CALCULUS OF SIZE &lt; 1 CMS

You have accessJournal of UrologyCME1 Apr 2023MP35-01 A SINGLE CENTRE PROSPECTIVE RANDOMIZED CONTROLLED STUDY TO ASSESS OUTCOMES AND COMPLICATIONS OF CONVENTIONAL STENT PLACEMENT VERSUS NO STENT PLACEMENT AFTER URETEROSCOPY FOR DISTAL URETERIC CALCULUS OF SIZE <1 CMS Arun Chawla, Suraj Jaidev Reddy, and Jean de la Rosette Arun ChawlaArun Chawla More articles by this author , Suraj Jaidev ReddySuraj Jaidev Reddy More articles by this author , and Jean de la RosetteJean de la Rosette More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003269.01AboutAbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Abstract INTRODUCTION AND OBJECTIVE: Most Endo-urologists routinely insert ureteric stents, justified by the hypothetical fact that stent placement promotes the passage of residual stone fragments and clots, presumably lowers the risk of stricture formation, and prevents ureteric obstruction and renal colic induced by ureteric oedema We aimed to compare the efficacy, safety and morbidity of No stent placement with the conventional stent placement after uncomplicated retrograde semi rigid URSL for distal ureteric calculus of size <1 cm pertaining to Lower Urinary tract symptoms and Sexual function using validated questionnaires. In addition, to compare complication rate, emergency visits, secondary interventions and pain at the time of follow up using visual analog scale (VAS) between the two groups. METHODS: 104 patients were randomized following an uncomplicated ureteroscopic lithotripsy into Conventional stented Group (CSG) and non-stented group (NSG). Lower urinary tract symptoms and sexual function were evaluated using validated questionnaires (IPSS+IIEF-5+MSHQ-EjD/FSFI) preoperatively and at 4 weeks during follow up/ stent removal based on the group. Pain scores at follow up/ stent removal were recorded using a visual analogue scale (VAS). Patients who had emergency room visits, need for secondary interventions before the recommended time of follow up were noted. Generalized Estimating Equations method was used to explore the difference in change in the domains of IPSS, IIEF-5, MSHQ-EjD and FSFI between the two groups over time. RESULTS: Significant difference was noted in the following IPSS domains: Frequency, Urgency, Nocturia, Storage symptoms, Total IPSS Score (p=<0.001) and QoL (p=0.002), IIEF-5 domains: Overall Score (p=0.004), MSHQ-EjD domains, Ejaculation Bother/ Satisfaction (p=<0.001) and FSFI domains: Lubrication (p=<0.001), Satisfaction (p=0.006) and Overall Score (p=0.004). There was no significant difference between the various groups in terms of distribution of Emergency Visits, Readmission and Secondary Interventions, pain at follow-up (VAS) and long-term analgesia. CONCLUSIONS: Non placement of stents after uncomplicated URS decreases stent related symptoms, improves QoL without jeopardizing for an increased postoperative risk. Header Variable CSG Group (n=49) NSG Group (n=43) p-Value χ2 Header Emergency visits 7(14.3%) 5 (11.6%) 0.706 0.143 Header Readmissions 4 (8.2%) 1 (2.3%) 0.367 1.519 Secondary Interventions Conservative Management 0 (0.0%) 1 (2.3%) 0.467 1.152 Early stent removal 3 (6.1%) NA - - PCN Insertion 0 (0.0%) 0 (0.0%) - - Relook URS 1 (2.0%) 0 (0.0%) 1.000 0.887 Analgesia requirement (> 5 days) 11 (22.4%) 5 (11.6%) 0.172 1.867 Variable CSG Group (n=49) NSG Group (n=43) p-Value χ2 Emergency visits 7(14.3%) 5 (11.6%) 0.706 0.143 Readmissions 4 (8.2%) 1 (2.3%) 0.367 1.519 Secondary Interventions Conservative Management 0 (0.0%) 1 (2.3%) 0.467 1.152 Early stent removal 3 (6.1%) NA - - PCN Insertion 0 (0.0%) 0 (0.0%) - - Relook URS 1 (2.0%) 0 (0.0%) 1.000 0.887 Analgesia requirement (> 5 days) 11 (22.4%) 5 (11.6%) 0.172 1.867 Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e468 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Arun Chawla More articles by this author Suraj Jaidev Reddy More articles by this author Jean de la Rosette More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP42-03 ASSESSMENT OF PATIENT-REPORTED OUTCOMES OF URETERAL STRICTURE DISEASE AND ROBOTIC URETERAL RECONSTRUCTION

You have accessJournal of UrologyCME1 Apr 2023MP42-03 ASSESSMENT OF PATIENT-REPORTED OUTCOMES OF URETERAL STRICTURE DISEASE AND ROBOTIC URETERAL RECONSTRUCTION Devin Boehm, Kyle Nolla, Jonathan Rosenfeld, Emily Ji, James Griffith, and Ziho Lee Devin BoehmDevin Boehm More articles by this author , Kyle NollaKyle Nolla More articles by this author , Jonathan RosenfeldJonathan Rosenfeld More articles by this author , Emily JiEmily Ji More articles by this author , James GriffithJames Griffith More articles by this author , and Ziho LeeZiho Lee More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003280.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Patient perspectives regarding clinical conditions and the influence of treatments are essential to patient-centered care. We aimed to evaluate patient-reported outcomes regarding experiences, symptoms, and impacts of ureteral stricture disease (USD) and robotic ureteral reconstruction (RUR). METHODS: Patients undergoing RUR for USD between 9/2021 and 9/2022 were eligible for enrollment. Semi-structured concept elicitation interviews were conducted to evaluate the physical, mental, and social effects of USD at three stages: 1. Preoperative, 2. Postoperative recovery (with ureteral stent), 3. Postoperative recovery (after stent removal). Concerning symptoms related to USD, patients rated symptom bother from 0 (none) to 10 (extreme). We conducted interviews until concept saturation was achieved and no new information was gained. Interviews were transcribed, coded, and qualitatively analyzed. RESULTS: Concept saturation was reached after 14 interviews. In the preoperative phase, flank pain (10/14 [71%]) and urinary urgency (6/14 [42%]) were the most common symptoms. All patients with urinary urgency had a ureteral stent during the preoperative phase. The median (IQR) preoperative bother scores of flank pain and urinary urgency were 8.5 (6.6-10) and 9.0 (5.8-10), respectively. The most common themes were emotional distress to symptoms (10/14 [71]%) and social/occupational impairment (9/14 [64]%). The most common factors that influenced a patient’s decision to undergo RUR were renal function preservation (8/14 [57]%), and the desire to remove hardware (i.e., nephrostomy tubes and ureteral stents) (8/8 [100]% who had presurgical hardware). During postoperative recovery, urinary urgency (8/14 [57%]) and flank pain (5/14 [35%]) were the most common symptoms. The median (IQR) postoperative recovery phase bother scores of flank pain and urinary urgency were 8.0 (4.0-8.0) and 6.0 (5.8-9.0), respectively. In the postoperative recovery phase, 1/14 (7%) reported intermittent flank pain (bother=4). All patients reported a “successful surgery.” Patients most commonly described surgical success as complete symptom relief (8/14 [57%]). CONCLUSIONS: Flank pain and urinary urgency (related to ureteral stent) were the most bothersome symptoms in the preoperative phase. Renal function preservation and the desire to remove hardware were the most common factors that influenced patients to undergo RUR. Symptom relief was the most commonly described determinant of patient-perceived surgical success. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e567 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Devin Boehm More articles by this author Kyle Nolla More articles by this author Jonathan Rosenfeld More articles by this author Emily Ji More articles by this author James Griffith More articles by this author Ziho Lee More articles by this author Expand All Advertisement PDF downloadLoading ...

V01-11 ROBOT-ASSISTED BILATERAL URETERAL RE-IMPLANTATION AFTER CYSTECTOMY AND ORTHOTOPIC NEOBLADDER FOR DISTAL URETERAL FIBROSIS

You have accessJournal of UrologyCME1 Apr 2023V01-11 ROBOT-ASSISTED BILATERAL URETERAL RE-IMPLANTATION AFTER CYSTECTOMY AND ORTHOTOPIC NEOBLADDER FOR DISTAL URETERAL FIBROSIS Gabriel Frölicher, Christoph Schregel, Yasmin Trachsel, Tutal Mustafa, and Hubert John Gabriel FrölicherGabriel Frölicher More articles by this author , Christoph SchregelChristoph Schregel More articles by this author , Yasmin TrachselYasmin Trachsel More articles by this author , Tutal MustafaTutal Mustafa More articles by this author , and Hubert JohnHubert John More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003221.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: This video presents the surgical technique of robot-assisted ureteral re-implantation for distal ureteral fibrosis after open cystectomy and reconstruction with Studer orthotopic neobladder. A 59-year-old patient underwent open radical cystectomy and orthotopic urinary diversion for muscle-invasive bladder cancer. Postoperatively, left hydronephrosis and pyelonephritis occurred. Antegrade attempts to place an ureteral stent were unsuccessful. A nephrostomy drain was placed in the left side. The patient was then referred for laparoscopic robotic reconstruction. METHODS: The ports were placed in analogy to robot-assisted cystectomy. First an extended adhesiolysis was necessary. The intestinal loops were dissected guided by concomitant cystoscopy which revealed the borders between intestine and bladder wall. Finally, right ureter was identified in the proximity of the afferent loop of the Studer neobladder. After preparing and freeing, the right ureter was intubated with a Ch.8 mono-J catheter. The search for the left ureter continued. The left ureter was localised using Methylene blue applied antegrade by the nephrostomy tube. Several attempts to intubate the left ureter Ch.8 mono-J were frustrane due to the considerable long stricture. Further dissection into the retroperitoneal space was necessary. The ureter seemed totally fibrotic over several centimetres. Finally antegrade left ureteral catheterization and retrograde insertion of a Ch.8 mono-J catheter was successful. Accidental lesions of the afferent loop were closed with a 4-0 PDS suture. The ureters were re-implanted end-to-side with 4-0 Stratafix® running sutures. RESULTS: The patient was discharged on the 7th postoperative day after testing the uretero-neobladder anastomosis through a pouchography and a retrograde ureteropyelography and after removal of both mono-J stents. No perioperative complications were observed. Furthermore, the left renal function showed an increasing function 1 year postoperatively in the renal scintigraphy. CONCLUSIONS: This demanding robotic reconstructive ureteral re-implantation so far shows the feasibility and the clinical value of robotic minimal invasive approaches even in complex reconstructive surgeries after open urinary diversion. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e83 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Gabriel Frölicher More articles by this author Christoph Schregel More articles by this author Yasmin Trachsel More articles by this author Tutal Mustafa More articles by this author Hubert John More articles by this author Expand All Advertisement PDF downloadLoading ...

MP42-08 THE MODIFIED UPPER URINARY TRACT VIDEOURODYNAMICS IN PATIENTS WITH REFRACTORY HYDRONEPHROSIS AFTER URETERAL RECONSTRUCTION

You have accessJournal of UrologyCME1 Apr 2023MP42-08 THE MODIFIED UPPER URINARY TRACT VIDEOURODYNAMICS IN PATIENTS WITH REFRACTORY HYDRONEPHROSIS AFTER URETERAL RECONSTRUCTION Xinfei Li, Zhihua Li, Yuke Chen, Yang Yang, Chen Huang, Hongjian Zhu, Liqun Zhou, and Xuesong Li Xinfei LiXinfei Li More articles by this author , Zhihua LiZhihua Li More articles by this author , Yuke ChenYuke Chen More articles by this author , Yang YangYang Yang More articles by this author , Chen HuangChen Huang More articles by this author , Hongjian ZhuHongjian Zhu More articles by this author , Liqun ZhouLiqun Zhou More articles by this author , and Xuesong LiXuesong Li More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003280.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To validate the modified upper urinary tract videourodynamics in reconstructed ureter with still dilation and hydronephrosis, and to explore the significance in guiding subsequent management. METHODS: From December 2018 to November 2021, a total of 137 patients underwent upper urinary tract video urodynamics at the time of nephrostomy removal 3 months after the reconstruction. The urodynamic result was classified into 3 types. Type 1: the pressure remains stable near the baseline throughout the perfusion process, and the reconstructed ureter is well visualized. Type 2: The renal pelvic pressure increases with perfusion, while urography shows the ureteral peristalsis still exists. At the end of the examination, the pressure difference is lower than 15 cmH2O, and the renal pelvis pressure is lower than 22 cmH2O. Type 3: The renal pelvic pressure and pressure difference increase with perfusion and exceed the normal level. At the same time, ureteral peristalsis is weak or absent (Figure 1). RESULTS: The patients were classified as type I in 124 cases, type II in 7 cases, and type III in 6 cases. All patients in type III received further treatment, including regular DJ stent replacement (2 cases), Allium stent (1 case), ureteroscopic balloon dilation (1 case), ureteroneocystostomy (1 case), and ileal ureter (1 case). Patients in type Ⅱ were instructed to avoid holding urine after the removal of nephrostomy and DJ stents. In 124 patients with type I, there was also 1 case receiving balloon dilatation and 4 cases replacing DJ tube. The sensitivity and specificity of the modified upper urinary tract videourodynamics in predicting the need for further treatment were 54.5% and 100% , and the area under curve was 0.747 (p=0.007) (Figure 2). CONCLUSIONS: The modified upper urinary tract videourodynamics can be used to evaluate the dilated upper urinary tract after reconstruction, and the classification has certain guiding significance for further treatment. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e569 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Xinfei Li More articles by this author Zhihua Li More articles by this author Yuke Chen More articles by this author Yang Yang More articles by this author Chen Huang More articles by this author Hongjian Zhu More articles by this author Liqun Zhou More articles by this author Xuesong Li More articles by this author Expand All Advertisement PDF downloadLoading ...

V04-11 THE CHALLENGING CASE OF A STAG HORN CYSTINE STONE AND A DISLOCATED URETERAL STENT IN A 18-MONTH-OLD PATIENT: VACUUM-ASSISTED MINI-PCNL AND ROBOTIC SURGERY TO THE RESCUE

You have accessJournal of UrologyCME1 Apr 2023V04-11 THE CHALLENGING CASE OF A STAG HORN CYSTINE STONE AND A DISLOCATED URETERAL STENT IN A 18-MONTH-OLD PATIENT: VACUUM-ASSISTED MINI-PCNL AND ROBOTIC SURGERY TO THE RESCUE Dario Guido Minoli, Carolina Bebi, Michele Gnech, Erika Adalgisa De Marco, Irene Paraboschi, Stefano Paolo Zanetti, Giancarlo Albo, Filippo Molinari, Emanuele Montanari, Gianantonio Manzoni, and Alfredo Berrettini Dario Guido MinoliDario Guido Minoli More articles by this author , Carolina BebiCarolina Bebi More articles by this author , Michele GnechMichele Gnech More articles by this author , Erika Adalgisa De MarcoErika Adalgisa De Marco More articles by this author , Irene ParaboschiIrene Paraboschi More articles by this author , Stefano Paolo ZanettiStefano Paolo Zanetti More articles by this author , Giancarlo AlboGiancarlo Albo More articles by this author , Filippo MolinariFilippo Molinari More articles by this author , Emanuele MontanariEmanuele Montanari More articles by this author , Gianantonio ManzoniGianantonio Manzoni More articles by this author , and Alfredo BerrettiniAlfredo Berrettini More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003252.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We present the case of an 18-month-old female patient brought to the emergency department of a foreign hospital due to anuria. She was diagnosed with bilateral staghorn kidney stones and Acute Kidney Injury (AKI) (Creatinine 5.47 mg/dL) and underwent bilateral ureteral JJ stent placement. METHODS: The patient was then referred to our centre where we performed a low-dose CT scan, documenting bilateral staghorn stones and dislocation of the proximal end of the right stent in the retroperitoneum. We planned a vacuum-assisted right-sided mini-PCNL (16 Ch ClearPetra set, 12 Ch MIP Storz endoscope and 550 um Ho:YAG laser fiber) and endoscopic JJ stent removal. RESULTS: We achieved complete clearance of the urolithiasis and visualised the site of exit of the JJ stent from the ureter, 1-2 cm below the ureteropelvic junction. Unfortunately, we were unable to safely remove the device endoscopically as the proximal pigtail appeared to be stuck and very close to major vessels when pulling the distal end with endoscopic graspers under fluoroscopic vision. We reported no post-operative complications. The stone composition was cystine 100%. A week later we performed a robot-assisted procedure with a transperitoneal approach to remove the dislocated JJ stent. Removal under direct vision was possible. Few weeks later, a left mini-PCNL was performed to obtain complete stone removal. CONCLUSIONS: The use of miniaturised vacuum-assisted technologies and robotic-assisted surgery greatly aids in the management of complex cases, especially in very young children affected by cystine stones, for whom reducing invasiveness is paramount. Source of Funding: no © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e341 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Dario Guido Minoli More articles by this author Carolina Bebi More articles by this author Michele Gnech More articles by this author Erika Adalgisa De Marco More articles by this author Irene Paraboschi More articles by this author Stefano Paolo Zanetti More articles by this author Giancarlo Albo More articles by this author Filippo Molinari More articles by this author Emanuele Montanari More articles by this author Gianantonio Manzoni More articles by this author Alfredo Berrettini More articles by this author Expand All Advertisement PDF downloadLoading ...

MP19-05 DAILY ECOLOGICAL MOMENTARY ASSESSMENTS OF PAIN AND ABILITY TO WORK AFTER URETEROSCOPY AND STENTING

You have accessJournal of UrologyCME1 Apr 2023MP19-05 DAILY ECOLOGICAL MOMENTARY ASSESSMENTS OF PAIN AND ABILITY TO WORK AFTER URETEROSCOPY AND STENTING Russell E. N. Becker, John Michael Dibianco, Andrew M. Higgins, Eduardo Kleer, David Leavitt, Andre King, Naveen Kachroo, Sami E. Majdalany, David Gandham, Golena Fernandez Moncaleano, Bronson Conrado, Stephanie Daignault-Newton, Casey A. Dauw, Khurshid R. Ghani, and for the Michigan Urological Surgery Improvement Collaborative Russell E. N. BeckerRussell E. N. Becker More articles by this author , John Michael DibiancoJohn Michael Dibianco More articles by this author , Andrew M. HigginsAndrew M. Higgins More articles by this author , Eduardo KleerEduardo Kleer More articles by this author , David LeavittDavid Leavitt More articles by this author , Andre KingAndre King More articles by this author , Naveen KachrooNaveen Kachroo More articles by this author , Sami E. MajdalanySami E. Majdalany More articles by this author , David GandhamDavid Gandham More articles by this author , Golena Fernandez MoncaleanoGolena Fernandez Moncaleano More articles by this author , Bronson ConradoBronson Conrado More articles by this author , Stephanie Daignault-NewtonStephanie Daignault-Newton More articles by this author , Casey A. DauwCasey A. Dauw More articles by this author , Khurshid R. GhaniKhurshid R. Ghani More articles by this author , and for the Michigan Urological Surgery Improvement Collaborative More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003244.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Ureteral stents can cause significant patient discomfort, yet the temporal dynamics of symptoms and impact on social activities remain poorly characterized. We employed an automated text message tool to collect daily ecological momentary assessments (EMA) following ureteroscopy with stenting regarding pain and ability to work. Our aim was to assess the feasibility of capturing EMA data, and better characterize the postoperative patient experience. METHODS: As an exploratory endpoint within an ongoing pragmatic clinical trial (NCT05026710), patients undergoing ureteroscopy and stone intervention with stenting (without a tether) were asked to complete daily EMAs for 10 days postoperatively, or until the stent was removed, whichever was longer. Stents were removed in the office. Questionnaires were distributed via text message and included a numeric pain scale (0-10) and a single item from the validated PROMIS Ability to Participate in Social Roles and Activities instrument, as well as days missed from work or school. Responses from postoperative day (POD) 1 through the day of stent removal (up to POD10) were analyzed for the first 35 participants in EMAs. RESULTS: Median patient age was 56.1 years (IQR 46.6-62.8), 51% were female. Stones were 66% renal and 34% ureteric, with median stone diameter 8.5mm (IQR 6-10). Daily EMA response rates were >90% for all days through POD10. Median stent dwell time was 7 days (IQR 6-9). Pain scores were highest on POD1 (median score 4) and declined with each day, reaching median score 2 on POD5 (Figure 1, panel A). 65% of patients on POD1 reported they had trouble performing their usual work at least sometimes, but by POD5 this was <50% of patients (Figure 1, panel B). Patients who work or attend school reported a median of 1 day missed (IQR 0-3). CONCLUSIONS: An automated daily text message EMA system for capturing patient reported outcomes was demonstrated to be feasible with sustained excellent response rates. Patients with stents reported the worst pain and interference with work on POD1 with steady improvements thereafter, and by POD5 the majority of patients had minimal pain or trouble performing their usual work. Source of Funding: Coloplast & Blue Cross Blue Shield of Michigan © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e266 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Russell E. N. Becker More articles by this author John Michael Dibianco More articles by this author Andrew M. Higgins More articles by this author Eduardo Kleer More articles by this author David Leavitt More articles by this author Andre King More articles by this author Naveen Kachroo More articles by this author Sami E. Majdalany More articles by this author David Gandham More articles by this author Golena Fernandez Moncaleano More articles by this author Bronson Conrado More articles by this author Stephanie Daignault-Newton More articles by this author Casey A. Dauw More articles by this author Khurshid R. Ghani More articles by this author for the Michigan Urological Surgery Improvement Collaborative More articles by this author Expand All Advertisement PDF downloadLoading ...

Robot-assisted Laparoscopic Pyeloplasty: Experience of a Single Pediatric Institution, Including Long-term and Safety Outcomes

To evaluate the efficacy and safety of robot-assisted laparoscopic pyeloplasty (RALP) and describe the short and long-term outcomes of pediatric RALP. We retrospectively reviewed all patients ..±21 years old who underwent primary RALP from 7/2007 through 12/2019. Patients were excluded from postoperative analysis if follow-up data after stent removal was not available. The primary outcome was surgical success, defined as radiographic improvement of hydronephrosis without need for reoperation. Secondary outcomes were time to reoperation and 90-day complication rate. A total of 356 patients underwent primary repair of ureteropelvic junction obstruction during the study period; 29.ßpatients were limited to intraoperative data due to lack of follow-up imaging. Radiographic improvement at latest follow-up was seen in 308/327 (94.2%). Ten of 327 patients (3.1%) underwent reoperation: 7 were identified within 1 year of RALP and 3 were identified over 1 year after RALP. The median time to reoperation was 13.0 months (IQR 9.3-21.7). We defined long-term as>3 years after pyeloplasty. Over one-third (122/327, 37.3%) of the cohort had>3 years of follow-up, none of whom developed evidence of recurrent obstruction requiring reoperation beyond 3 years. Complications occurred within 90 days of surgery in 20/327 (6.1%). This largest single-institution series confirms short- and long-term surgical effectiveness and safety of RALP. Our data also indicate that most patients who needed reoperation were identified within 1 year, and reoperation more than 3 years after RALP is rare.

Evaluate the optimal stent duration following endourology procedures: 5 days versus 14 days

Background: Most urologists prefer not to place a stent in an uncomplicated URS (ureterorenoscopy) in the post-op period. Even if they do so, they place it with an extraction string that can be removed in post-op day 3-5 based on the patient’s compliance. Here we sought to determine the optimal duration of stenting following endo-urology procedures (URSL, RIRS, PCNL) for stone disease (5 days vs 14 days). Methods: It was a prospective randomised study where 1547 patients were evaluated over a span of 1.5 years, 671 of whom stent was removed on day 5 and 876 of whom stent was removed on day 14. Results: Of all the patients, 32% experienced post-procedure-related events within 30 days (15% of 5-day stent removal compared to 44.9% of 14-day patients). Conclusions: Removal of the stent on the 5th day does not warrant re-procedure and is associated with fewer post-procedure-related symptoms.

Successful re-intervention using endoscopic ultrasound-guided drainage via an endoscopic tapered sheath for recurrent walled-off necrosis with fibrosis.

Patients with disconnected pancreatic duct syndrome recur with pancreatic fluid collection in 17–38 % of cases after transmural stent removal [1] [2]. Symptomatic patients require endoscopic re-intervention; however, an approach via the same puncture route is often complicated by fibrosis caused by previous treatment. Long-term placement of a plastic stent is recommended for endoscopic ultrasound-guided drainage of a recurrent walled-off necrosis (WON). However, commonly used pigtail stents are difficult to pass through a fistula even post-dilation, especially in fibrotic cases. Lumen-apposing metal stents can be easily employed in such cases, albeit with an increased risk of serious adverse events in long-term placements [3] [4]. We report a successful re-intervention using endoscopic ultrasound-guided drainage via an endoscopic tapered sheath (EndoSheather; Piolax, Inc., Kanagawa, Japan) ([Fig. 1]) for a recurrent WON with fibrosis.

Reply to van Malenstein et al.

See also: Plastic stent replacement after metal stent removal – what about patients with residual walled-off necrosis collections?Endoscopy 2023; 55(04): 395-395DOI: 10.1055/a-1949-0607

Plastic stent replacement after metal stent removal - what about patients with residual walled-off necrosis collections?

See also: Impact of transmural plastic stent on recurrence of pancreatic fluid collection after metal stent removal in disconnected pancreatic duct: a randomized controlled trialEndoscopy 2022; 54(09): 861-868DOI: 10.1055/a-1747-3283 See also: Reply to van Malenstein et al.Endoscopy 2023; 55(04): 396-396DOI: 10.1055/a-1975-0158

Retrospective Analysis of Characteristics, Indications and Outcomes of Endoscopic Retrograde Cholangiopancreatography (ERCP) in a Tertiary Referral Center in Saudi Arabia.

Endoscopic retrograde cholangiopancreatography (ERCP) is an advanced endoscopic procedure that is an essential tool in the management of pancreaticobiliary diseases. There is limited data available on the indications and outcomes of ERCP from this region. Therefore, we aim to report the characteristics of patients, indications and outcomes of ERCP in Saudi Arabia. Methods: We retrospectively looked at ERCP procedures done at a tertiary referral center covering the western region of Saudi Arabia from August 2018 until July 2020. Data were collected from the hospital's electronic patient record and endoscopy database. Of 1001 ERCPs performed, full data was available on 712 procedures on 581 patients that were included in the final analysis. Mean age was 53.1 years. Four hundred four (56.7%) were female. Board-certified consultants performed all ERCPs. The most common intervention was sphincterotomy, which was performed in 563(96.9%) patients who underwent first-ever ERCP, followed by dilatation and stenting. The commonest indication of ERCP was confirmed or suspected choledocholithiasis (52.6%), followed by replacement or removal of a biliary stent (15.7%), 55 (7.7%) for suspected ascending cholangitis, 54 (7.5%) for acute biliary pancreatitis and 15 (2%) for suspected sphincter of Oddi dysfunction. The commonest finding among all patients was choledocholithiasis in 57.9%, debris in 15.2% and biliary stricture in 14.8%. The commonest complication was pancreatitis in 22(3.1%) followed by post-sphincterotomy bleeding in 16(2.2%) and perforation in nine (1.2%). Bleeding was controlled by endoscopic intervention in four (25%) and one (6.2%) patient underwent surgery. One (0.14%) patienthad procedure-related mortalitysecondary to post-procedure pulmonary embolism and one had significant morbidity and prolonged hospitalization because of complicated perforation. The deeper common bile duct (CBD) cannulation rate was 97.3%. Our study results revealed that ERCP performed in the western region of Saudi Arabia has similar indications and findings as reported in theinternational literature. ERCP is successful in achieving the therapeutic objectives with complication rates consistent with published data.

Medical disputes related to advanced endoscopic procedures with endoscopic retrograde cholangiopancreatography or endoscopic ultrasonography for the management of pancreas and biliary tract diseases.

This study aimed to evaluate the characteristics of endoscopic retrograde cholangiopancreatography (ERCP) or endoscopic ultrasonography (EUS)-related adverse events (AEs) that eventually lead to medical disputes or claims on medical professional liability. Medical disputes for ERCP/EUS-related AEs filed in the Korea Medical Dispute Mediation and Arbitration Agency between April 2012 and August 2020 were evaluated using corresponding medical records. AEs were categorized into three sections: procedure-related, sedation-related, and safety-related AEs. Among a total of 34 cases, procedure-related AEs were 26 (76.5%; 12 duodenal perforations, 7 post-ERCP pancreatitis, 5 bleedings, 2 perforations combined with post-ERCP pancreatitis); sedation-related AEs were 5 (14.7%; 4 cardiac arrests, 1 desaturation), and safety-related AEs were 5 (8.8%; 1 follow-up loss for stent removal, 1 asphyxia, 1 fall). Regarding clinical outcomes, 20 (58.8%) were fatal and eventually succumbed to AEs. For the types of medical institutions, 21 cases (61.8%) occurred at tertiary or academic hospitals, and 13 (38.2%) occurred at community hospitals. The ERCP/EUS-related AEs filed in Korea Medical Dispute Mediation and Arbitration Agency showed distinct features: duodenal perforation was the most frequent AE, and clinical outcomes were fatal, resulting in at least more than permanent physical impairment.

Comparison of carotid endarterectomy and repeated carotid angioplasty and stenting for in-stent restenosis (CERCAS trial): a randomised study

Background and aimIn-stent restenosis (ISR) belongs to an infrequent but potentially serious complication after carotid angioplasty and stenting in patients with severe carotid stenosis. Some of these patients might be...

Extracorporeal membrane oxygenation in critical airway interventional therapy: A review.

Extracorporeal membrane oxygenation (ECMO) is widely used during refractory cardiac or respiratory failure, and some case reports described ECMO utilization in critical airway interventional therapy. Eligible reports about patients receiving airway interventional therapy under ECMO were retrieved from Web of Science, Embase, Medline, and Cochrane databases up to 1 August 2022. Forty-eight publications including 107 patients who underwent ECMO for critical airway problems met the inclusion criteria. The critical airway problem that was reported the most was tumor-associated airway obstruction (n = 66, 61.7%). The second most reported etiology was postoperative airway collapse or stenosis (n = 19, 17.8%). The main interventional therapies applied were airway stent placement or removal (n = 61, 57.0%), mass removal (n = 22, 20.6%), and endotracheal intubation (n = 12, 11.2%) by bronchoscopy. The median ECMO duration was 39.5 hours. Eleven patients had ECMO-associated complications, including seven cases of airway hemorrhage, one case of arteriovenous fistula, one case of vein rupture and hematoma, one case of foot ischemia, and one case of neuropraxia of the cannulation site. In total, 91.6% of the patients survived and were discharged from the hospital. ECMO appears to be a viable form of life support for patients undergoing interventional therapy for critical airway problems.