Upper-tract Stone Research Articles

PCNL in neurogenic bladder: A challenging population for both clinical management and analysis.

To review the management of patients with neurogenic bladder undergoing percutaneous nephrolithotomy (PCNL) at our institution with the aim of assessing peri-operative morbidity. We conducted a retrospective review of all neurogenic bladder patients who underwent PCNL at our hospital in the last decade with the aim of assessing peri-operative morbidity. A total of 298 PCNL were performed during the study period of which 58 were in patients with a neurogenic bladder or urinary diversion, 33 of which were in SCI patients. Preoperative demographic and stone characteristics, intraoperative data and postoperative length of stay and complications are summarised in table form. PCNL remains an acceptably safe and efficacious treatment for upper tract stone disease in patients with neurogenic bladders and will continue to have a valuable role where SCI prevents alternative approaches such as ureteroscopy.

Optimising pre-operative imaging-surgery intervals for stones.

The NICE guidelines for acute ureteric colic recommend diagnostic imaging, definitive management and definitive care within 24 and 48 h of symptoms and 4weeks of temporisation, respectively. However, the NHS reality is fraught with long waiting times to definitive treatment, further compounded by a progressively increasing stone burden, paucity of on-site lithotripters and a decrease in non-cancer elective theatre sessions during the COVID-19 pandemic. By the time patients attended the elective surgeries, their reference images (RIs) were often significantly out of date. Scant direction exists on what interval between imaging and surgery invalidates the usefulness of the RIs in providing surgical guidance.This study aimed to evaluate the role of imaging-surgery intervals (ISIs) on upper tract stone negative surgery outcomes and derive a cut-off ISI warranting updated images, with a view to improving efficiency and patient safety. Upper tract stone surgeries were retrospectively assessed. Each renal unit was considered independently in bilateral stones. Cases were grouped into renal/pelvic (referred to as 'RENAL') and URETERIC stones. Data retrieved included the ISI, intra-operative disparity (IOD) between stone-related features on RIs and the surgical findings. Receiver operating curves (ROCs) were used to determine ISI cut-offs more predictive of IODs. Four hundred and twenty-seven surgeries on 174 (40.7%) RENAL and 253 (59.3%) URETERIC stones were appraised. No stones were found intraoperatively in 52 (12.1%) patients. Longer ISIs were associated with IODs, especially with URETERIC stones (p = 0.011, CI95 0.63; 4.84). The derived ROC ISI cut-offs beyond which IODs, including negative surgeries, were more likely were 9weeks for URETERIC (AUC: 63%, CI95 0.56; 0.70) and 19 weeks (AUC: 58.6%, CI95 0.50; 0.68) for RENAL stones, respectively. There is a need to update reference imaging done more than 9 or 19 weeks before surgery for URETERIC and RENAL stones, respectively.

MP54-07 STENTS AND SHOCKWAVE LITHOTRIPSY - THE WHO AND THE WHY: RESULTS FROM A STATEWIDE COLLABORATIVE

You have accessJournal of UrologyCME1 Apr 2023MP54-07 STENTS AND SHOCKWAVE LITHOTRIPSY - THE WHO AND THE WHY: RESULTS FROM A STATEWIDE COLLABORATIVE Sami E. Majdalany, Monica van Til, Stephanie Daignault-Newton, David Leavitt, Khurshid Ghani, Casey Dauw, Naveen Kachroo, and Michigan Urological Surgery Improvement Collaborative Sami E. MajdalanySami E. Majdalany More articles by this author , Monica van TilMonica van Til More articles by this author , Stephanie Daignault-NewtonStephanie Daignault-Newton More articles by this author , David LeavittDavid Leavitt More articles by this author , Khurshid GhaniKhurshid Ghani More articles by this author , Casey DauwCasey Dauw More articles by this author , Naveen KachrooNaveen Kachroo More articles by this author , and Michigan Urological Surgery Improvement Collaborative More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003307.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Shockwave lithotripsy (SWL) is a commonly performed stone procedure in the US. AUA guidelines do not recommend routine stent placement for SWL patients. We evaluated statewide practice patterns and predictors for stent placement at the time of SWL and whether stent placement affected stone free rates (SFR) and 30-day complication rates. METHODS: Adult patients undergoing SWL between 2016-2022 were identified using the MUSIC Reducing Operative Complications from Kidney Stones prospectively collected registry. We determined stent usage prior and during SWL across practices and collected demographic, clinical, stone and procedural factors. Outcomes included peri-operative management, complications and SFR. Multivariable logistic regression was used to identify predictors of stent placement at time of SWL. RESULTS: Among 13,063 cases identified from 35 practices (222 urologists), wide practice variation in stent placement patterns were noted ranging from 0-17% (Figure 1). Overall, 2.3% cases were stented at the time of SWL and 15.5% had a prior stent. Stent on a string was performed in 26 cases (9%) by 11 urologists (54% by 1 provider). Stented SWL patients (prior/time of SWL) were more likely to be older, have a higher Charlson comorbidity index, solitary kidney, 1st upper tract stone, ureteral stone, larger stone, hydronephrosis and positive urinalysis/urine culture (all p<0.01). Stented patients were more likely to have peri-op and post-op antibiotics and anticholinergics (p<0.001). Predictors of stent placement at time of SWL included ureteral stones (OR1.6, 95%CI 1.1-2.3, p=0.01), larger stones (OR1.2, 95%CI 1.216-1.23, p<0.001), African-American race (OR1.8, 95%CI 1.03-3.0, p=0.039) and hydronephrosis (OR1.8, 95%CI 1.3-2.6, p<0.001). There were no differences in emergency department (ED) visits between stented and unstented patients (5.3% vs 3.9%, p=0.21) or 60-day SFR (34% vs 40%, p=0.10). Stented patients had significantly higher infectious complications (3% vs 0.6%, p<0.001). CONCLUSIONS: Variation exists amongst urologists regarding stent usage with SWL, influenced by specific patient and stone factors as well as provider preference. Although ED visits and SFR did not differ, stented patients had a significantly increased post operative infection rate. Source of Funding: Blue Cross Blue Shield of Michigan © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e756 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sami E. Majdalany More articles by this author Monica van Til More articles by this author Stephanie Daignault-Newton More articles by this author David Leavitt More articles by this author Khurshid Ghani More articles by this author Casey Dauw More articles by this author Naveen Kachroo More articles by this author Michigan Urological Surgery Improvement Collaborative More articles by this author Expand All Advertisement PDF downloadLoading ...

The feasibility of endourological surgery in low-resource settings.

One of the widest variations in contemporary surgical practice between high and low, or low-middle, income countries is the utilisation of endoscopy as a means of treating urological pathology. The endoscopic management of lower urinary tract problems such as benign prostatic hypertrophy, bladder cancer and urethral strictures was established in the UK in the late 1970s, whilst its adoption into everyday practice in sub-Saharan Africa (SSA) has been significantly retarded. It is still neither a major feature of urological training in those countries nor widely available to the patients that established consultants treat. Likewise, the explosion of less invasive technologies for treating upper tract stone disease in the 1980s, particularly the management of renal stone disease, has also lagged behind practice established in the UK over the last 40 years. This is not due to a lack of patients who could be treated endoscopically or restricted by the abilities of the surgeons in SSA. The restraint in assumption of these less-invasive management options is rather due to the physical availability of trained specialist surgeons, their access to basic infrastructure such as electricity and water, access to endoscopes and the peripheral equipment necessary to successfully deploy them, and the ability of patients to afford the disposable items required for less-invasive forms of management. Some endoscopic procedures are viable in resource-poor settings. However, they are largely dependent upon the supply of equipment from non-governmental organisations in high-income countries, frugal innovation to reduce individual procedure costs, adequately skilled mentors, and maintenance and supply chains to make them a durable option in patient management. Urolink and the Medi Tech Trust present their experience of how endoscopic surgery can be taught, and used sustainably, in a resource-poor healthcare environment.

This Month in Pediatric Urology

You have accessJournal of UrologyThis Month in Pediatric Urology1 Aug 2022This Month in Pediatric Urology Stacy T. Tanaka Stacy T. TanakaStacy T. Tanaka More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002760AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Pediatric Ureteroscopy Laser Outcomes The application of new medical technology in children commonly lags innovation in adult patients. Jaeger et al (page 426) at Boston Children’s Hospital in Boston, Massachusetts describe their early-adopter experience using a superpulse thulium fiber laser (SPTF) to treat upper tract stones in children.1 The group started using SPTF in September 2020. In a retrospective analysis, the authors compared stone-free rates in patients less than 21 years of age treated with either SPTF (23) or low-power Ho:YAG (holmium:yttrium-aluminum-garnet) laser (69). Stone-free rate, measured by primarily renal ultrasound within 90 days of the procedure, was higher in patients treated with SPTF (70% vs 59%). Because of concern about SPTF generating higher temperatures, the authors were careful to use continuous irrigation and low power settings. The SPTF was not associated with higher postoperative complications or an increase in operative time. The authors’ careful analysis addresses some of the limitations of the retrospective nature of this study. Nevertheless, their success with SPTF without increase in complication rate or operative time is very promising. Salvage Surgery Rates for Pediatric Testicular Torsion Hospital rating systems have weaknesses, but are there any strengths? Mandated reporting of hospital metrics can be a motivator to focus attention on specific aspects of care quality. In 2015, the US News & World Report introduced the quality metric of “time from ED/clinic to operating room” for testicular torsion in their Best Children’s Hospital Rankings. Using the Pediatric Health Information System database, which includes 52 children’s hospitals across the United States, Chun et al (page 441) from Children’s Hospital of Pittsburgh in Pittsburgh, Pennsylvania compared testicular salvage rate before and after this metric was introduced.2 The authors found that the salvage rate improved. Of course, temporal association does not prove causation. However, it is suggestive that salvage rates did not change at hospitals that were receiving full score when the metric was introduced but did increase at hospitals not initially receiving the full score. From 2015 to 2019, the number of hospitals that received a full score for this question increased from 62% to 98%. Hospital rating systems are here to stay. Although it will take work, there is the potential for the pediatric urology community to replace flawed measures with meaningful ones that can nudge care quality. Dietary Risk Factors for Pediatric Kidney Stones Dietary counseling for children with stone disease is primarily based on adult data. Wang et al (page 434) from Boston Children’s Hospital in Boston, Massachusetts present one of the only studies to investigate the relationship between dietary nutrient intake and urolithiasis occurrence in children.3 At Boston Children’s, the primary care clinic was administering the Harvard Service Food Frequency Questionnaire at well child visits while the pediatric stone clinic was administering the Youth Adolescent Food Frequency Questionnaire to first-time stone formers within 6 months of diagnosis. The Harvard School of Public Health Nutrition Department has an analysis mechanism to translate data from both these validated surveys to standardized daily nutrition intake. The authors elegantly used this information to perform a case-control study in 57 stone patients and 228 controls. Unsurprisingly, they found that stone formers had higher sodium intake and lower potassium intake. Unexpectedly, they also found an association with increased calcium intake and increased beta-carotene intake. Although carrots are the most well-known dietary source of beta-carotene, high oxalate foods like spinach and kale also have beta-carotene; however, there did not appear to be an association with dietary oxalate intake. Unfortunately, the dietary surveys did not include data on water intake or specific diets (eg ketogenic diet). However, this novel exploratory study generates intriguing questions for future pediatric stone research.

MP23-20 THIRTY-YEAR TRENDS IN THE MANAGEMENT OF UROLITHIASIS IN THE UNITED STATES

You have accessJournal of UrologyHealth Services Research: Practice Patterns, Quality of Life and Shared Decision Making III (MP23)1 Sep 2021MP23-20 THIRTY-YEAR TRENDS IN THE MANAGEMENT OF UROLITHIASIS IN THE UNITED STATES Ridwan Alam, Jared Winoker, Ayman Alam, and Brian Matlaga Ridwan AlamRidwan Alam More articles by this author , Jared WinokerJared Winoker More articles by this author , Ayman AlamAyman Alam More articles by this author , and Brian MatlagaBrian Matlaga More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002014.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Over the past 30 years, the field of endourology has seen an explosion of technological advancements that has significantly changed the management of stone disease. We sought to determine if the constant refinement and increased familiarity with endoscopic procedures has led to a concomitant shift in treatment practices for both upper and lower urinary tract calculi. METHODS: In this population-based cohort study, we used data from TriNetX, a large health research network with real-time updates of electronic medical records (EMR) from 49 health care organizations in the United States. Due to the dependence on EMR, data from participating institutions prior to the implementation of an electronic record system are not included. Patients with upper tract stones who underwent shock wave lithotripsy (SWL), ureteroscopy (URS), percutaneous nephrolithotomy (PCNL), or open surgery were identified based on Current Procedural Terminology (CPT) codes. Similarly, patients with lower tract stones who underwent cystolitholapaxy or cystolithotomy were separately identified and analyzed. RESULTS: SWL was the primary mode of treatment for patients with upper tract stones until 2000, after which URS saw a dramatic increase that has persisted through 2020 (Figure 1). During this time, PCNL has remained relatively stable, representing about 10% of upper tract stone procedures. For patients with lower tract stones, cystolitholapaxy has always been favored over cystolithotomy, and the gap continues to increase over time (Figure 2). CONCLUSIONS: URS has gained considerable popularity at the expense of SWL for the management of upper tract calculi. However, the use of PCNL has been largely unaffected by this shift in practice patterns. The relative stability of PCNL may be a reflection of its surgical invasiveness when compared to SWL and URS, or may be due to less overlap in clinical indication with its less invasive counterparts, among other reasons. Minimally invasive approaches have always been and continue to be favored for the treatment of lower tract calculi. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e410-e410 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ridwan Alam More articles by this author Jared Winoker More articles by this author Ayman Alam More articles by this author Brian Matlaga More articles by this author Expand All Advertisement Loading ...

MP10-16 DOES THE USE OF MOSES TECHNOLOGY INCREASE EFFICIENCY DURING FLEXIBLE URETEROSCOPY FOR STONE DISEASE? SINGLE CENTER EXPERIENCE

You have accessJournal of UrologySurgical Technology & Simulation: Instrumentation & Technology I (MP10)1 Sep 2021MP10-16 DOES THE USE OF MOSES TECHNOLOGY INCREASE EFFICIENCY DURING FLEXIBLE URETEROSCOPY FOR STONE DISEASE? SINGLE CENTER EXPERIENCE Margaret Knoedler, Shuang Li, Sara Best, Sean Hedican, Kristina Penniston, and Stephen Nakada Margaret Knoedler Margaret Knoedler More articles by this author , Shuang LiShuang Li More articles by this author , Sara BestSara Best More articles by this author , Sean HedicanSean Hedican More articles by this author , Kristina PennistonKristina Penniston More articles by this author , and Stephen NakadaStephen Nakada More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001983.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The objective of this study was to evaluate the efficiency of Moses technology compared to the regular mode during flexible ureteroscopy for stone disease. Moses technology has been shown to improve stone fragmentation both in vitro and in vivo, but it is unclear if this translates into improved efficiency in the operating room. METHODS: An IRB approved database of patients with upper tract stones was analyzed for ureteroscopies from January 1, 2020 to December 31, 2020. Patients who underwent flexible ureteroscopy with the Lumenis Pulse P120H holmium laser system with the regular or Moses mode were included. Patient characteristics including age, gender, BMI, diabetes, hypertension, gout, chronic urinary tract infection, chronic kidney disease, bowel disease and cumulative stone size were evaluated. Outcome measures included procedural time, laser time, total energy used, laser efficiency (laser time per stone size), complication rate and stone free rate. Univariate analysis with chi squared and MANCOVA controlling for cumulative stone size and comorbidities were performed. Patients were excluded if they had a staged procedure. RESULTS: Of the 200 surgical cases, 184 met the inclusion criteria. Moses was utilized in 114 cases and the regular mode in 70 cases. There was no difference in the cumulative stone size between the Moses and regular mode (11.6±7.4 vs 10.5±8.4 mm, p=0.314). Procedural time (44.5±33.6 vs 38.5±23.8 min, p=0.282), laser time (7.3±11 vs 6.6±8.2 min, p=0.927), total energy used (4.9±6.7 vs 3.7±4.9 kJ, p=0.373), and laser efficiency (4.7±6.5 vs 5.5±9.8 mm/min, p=0.501) were also similar between the two groups. Complications (6.1% vs 5.7%, p=0.906) and stone free rates (67.4% vs 70.4%, p=0.712) did not differ between the two. CONCLUSIONS: At our institution, Moses technology did not demonstrate a significant change in procedural time, laser time, total energy used or laser efficiency. Moreover, there was no difference in complications or stone free rate. There may be other technical benefits to Moses technology not captured in this analysis. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e174-e174 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Margaret Knoedler More articles by this author Shuang Li More articles by this author Sara Best More articles by this author Sean Hedican More articles by this author Kristina Penniston More articles by this author Stephen Nakada More articles by this author Expand All Advertisement Loading ...

V05-04 STONE DISSOLUTION: CURRENT SAFE AND EFFECTIVE USE OF RENACIDIN

You have accessJournal of UrologyUrolithiasis & Endourology (V05)1 Sep 2021V05-04 STONE DISSOLUTION: CURRENT SAFE AND EFFECTIVE USE OF RENACIDIN Egor Parkhomenko, Vivian Williams, and Michael Kurtz Egor ParkhomenkoEgor Parkhomenko More articles by this author , Vivian WilliamsVivian Williams More articles by this author , and Michael KurtzMichael Kurtz More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002012.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Struvite stones cause significant morbidity in urologic congenitalism. Though stone-free rates have improved with advanced endoscopic equipment, some anatomic circumstances make complete stone clearance impossible. Renacidin (Citric Acid, Glucono Delta-Lactone, and Magnesium Carbonate solution) to treat upper tract stones was popular in the 1960s, but after 6 deaths it was banned by the FDA and not re-approved until the 1990s. We wished to treat a patient in an extraordinary circumstance, which presented challenges as Renacidin therapy had not been used at our institution in 30 years. We present our experience and a step-by-step guide to infusion. METHODS: We conducted a literature review and collected national expert opinion. Key stakeholders from nursing, pharmacy, nephrology, infectious diseases, intensive care unit (ICU), and biomedical engineering developed a safe protocol for renacidin infusion. The patient was monitored on a 1:1 staff to patient ratio in the ICU initially. As the medication is in vials with non-sterile exteriors, pharmacy cleaned the vials and pooled it under a sterile hood. The biomedical engineering team recommended a gravity drip, elevated to 30 cm H2O above PCN tube entry site infused at 120 ml/hour (20 drips/minute) or 60 ml/hr (drop factor 10 drips/minute). A mock infusion was completed with a multidisciplinary team prior to the patient’s admission. A 27yF with severe scoliosis, reconstructed bladder, and tortuous ureter from prior ureterostomies leading to limited options for renal access had struvite stone recurrence after bilateral percutaneous nephrolithotomy. Bilateral nephrostomy tubes, an antegrade ureteral catheter, and a urethral catheter were placed. Daily electrolytes and urine cultures were drawn, and weekly CT scans performed to assess stone burden. Renacidin was infused unilaterally at full or half rate, depending on patient tolerance, during the day; nocturnal infusions were with normal saline. Continuous culture-directed IV antibiotics were administered throughout the infusion. RESULTS: Infusion was carried out for 60 days, initially on the left for 30 days (larger stone burden), and 30 days on the right. Total hospital stay was 71 days. The patient has been stone-free since end of Renacidin therapy for ∼150 days. There were no episodes of mucosal hemorrhage or sepsis. CONCLUSIONS: Renacidin infusion can be performed safely and effectively and may eliminate upper tract recurrent struvite stones in patients who have failed endoscopic therapy. An inpatient monitoring program and multidisciplinary collaboration is required for safe infusion. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e387-e387 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Egor Parkhomenko More articles by this author Vivian Williams More articles by this author Michael Kurtz More articles by this author Expand All Advertisement Loading ...

Composition chimique des calculs urinaires et caractéristiques épidémiologiques associées en République Démocratique du Congo

To compare the chemical composition of the upper and lower urinary tract stones in Congolese patients, and to identify factors associated with the different types of stones. Stones from 119 patients originating from the upper tract and 75 from the lower tract were analyzed by infrared spectrophotometry. Among 119 patients with upper tract stones, age ranged from 10 to 81 years with a mean (SD) of 45.8 (13.6) years; males were the majority (55.5%). The main types of stones identified were whewellite (79%). For the 75 patients with lower apparatus stones, age ranged from 4 to 87 years with a mean (SD) of 51.6 (21.6) years; the majority were males (89.3%). The main types of stones were whewellite (44%) and anhydrous uric acid (22.7%). Overall, the factors associated with calcium oxalate included: site [4.95 (95% CI 2.35-10.44)] and diameter [3.03 (95% CI 1.45–6.25)]; patient's place of residence [0.05 (95% CI 0.01–0.29)] was associated with calcium phosphate. Infection stones were associated with; site [0.19 (95% CI 0.06–0.63)] and diameter [0.10 (95% CI 0.03–0.38)]. Finally, age 0.26 (95% CI 0.09–0.71) and stone site [0.23 (95% CI 0.07–0.68)] were associated with uric stones. The epidemiological and chemical profile of upper and lower tract stones were different. Several factors were associated with the chemical and crystalline composition of stones in the Democratic Republic of Congo.

Commentary to ‘Mini PCNL: A viable single stage treatment for pediatric nephrolthiasis in lower socioecnomic countries’

Rehman and colleagues [1] report on a series of patients undergoing mini-PCNL in developing nations, concluding that the procedure is safe and effective for a single-setting treatment of upper tract stones. To be sure, this study has its weaknesses: the follow-up period was short, and over one-third (63/176; 35.8%) had insufficient records for inclusion, so the true proportion of patients rendered stone-free by this procedure (though the authors cite stone clearance proportions in excess of 90%), and the true incidence of early postoperative complications, cannot be known.

Urolithiasis: Presentation and Surgical Outcome at a Tertiary Care Hospital in Ethiopia.

BackgroundThe prevalence of urolithiasis is on a rising trend in tropical and sub-Saharan African countries. The treatment options and data on the surgical outcome are limited in our country. This study was designed to assess the clinical presentation, surgical management and outcome of patients operated on for urolithiasis.Patients and MaterialsA retrospective study of all patients admitted and operated for urolithiasis at St. Paul’s hospital millennium medical college (SPHMMC) from July, 2016 to December, 2017 was conducted. Factors associated with surgical outcome were identified with binary logistic regression.ResultsUrolithiasis constituted 247 (30.0%) of 824 urologic admissions. Of these, 202 (Male:Female = 2:1) patients were investigated. The mean age was 37.1 ± 14.4 years (range, 10–85 years). The mean duration of illness was 16.7 ± 18.7 months and the commonest presenting symptom was isolated flank pain (97, 48.0%). A majority of the patients (186, 92.1%) had upper tract stones of which 96 (51.6%) were renal stones. More than two-thirds (164, 81.2%) of the patients had complications at presentation, and hydronephrosis (148, 73.3%) was the major one. Half of the patients (104, 51.5%) were treated with endoscopic procedures, 88 (43.6%) with open stone surgery and in 10 (4.9%) patients both were performed. Nephrectomy was done to 15 (7.4%) patients. Intraoperative and postoperative complications were noted in 16 (7.9%) and 26 (12.9%) patients, respectively. These complications were higher in patients with comorbid illness (AOR = 2.44; 95% CI 1.12–5.31; p = 0.024). Complete stone clearance was achieved in more than half of the clients (114, 61.0%). Multiple stones (AOR = 8.33; 95% CI 2.53–27.43; p < 0.0001) and endoscopic procedures (AOR = 4.17; 95% CI 1.57–10.71; p = 0.003) had significant association with incomplete stone clearance.ConclusionPatients’ presentation in this review was not different from studies elsewhere. Endoscopic procedures are emerging in our set up; however, it was significantly associated with incomplete stone clearance. Strategies to improve outcome (stone clearance) need to be implemented accordingly.

MP03-11 PREDICTORS OF STONE FREE RATE FOLLOWING AGGRESSIVE URETEROSCOPY

INTRODUCTION AND OBJECTIVE:Ureteroscopy (URS) and aggressive stone basketing for upper tract stones yields stone free rates (SFR) of only ∼50% by computed tomography (CT). We used a prospective coh...

MP69-18 IMPACT OF HEALTH LITERACY ON URETEROSCOPY OUTCOMES AMONG KIDNEY STONE PATIENTS

You have accessJournal of UrologyStone Disease: Surgical Therapy VII (MP69)1 Apr 2020MP69-18 IMPACT OF HEALTH LITERACY ON URETEROSCOPY OUTCOMES AMONG KIDNEY STONE PATIENTS Naren Nimmagadda*, Caroline Kang, Nicole Miller, S Duke Herrell, and Ryan Hsi Naren Nimmagadda*Naren Nimmagadda* More articles by this author , Caroline KangCaroline Kang More articles by this author , Nicole MillerNicole Miller More articles by this author , S Duke HerrellS Duke Herrell More articles by this author , and Ryan HsiRyan Hsi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000949.018AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Nephrolithiasis is a disease dependent on patients’ self-management; however, little is known on the effect of health literacy on treatment outcomes. We sought to understand the impact of health literacy in this population using the validated Brief Health Literacy Screen (BHLS). METHODS: A retrospective review was conducted of all patients who underwent ureteroscopy for upper tract stones between January and June 2017. Of the 244 patients, BHLS data was available for 105 patients. Demographic, surgical, and postoperative data were collected using the electronic medical record. Opiate usage was obtained from the local controlled substance monitoring database. Univariate and multivariable logistic regression analysis were performed to assess the association of BHLS scores with postoperative complications, stone outcomes, adherence to follow-up and treatment, and opiate use. RESULTS: Mean BHLS score was 13.37 (range 4.09-15.0). 81% of patients attended their initial postoperative visit of which 87.6% maintained subsequent follow-up. On univariate analysis, health literacy did not associate with 30-day complications, ipsilateral stone recurrence or progression, ipsilateral stone events, rates of postoperative follow-up, 24-hour urine collection prescription at initial follow-up, 24-hour urine collection completion by subsequent follow-up, or additional requests for opiates within 30 days. Lower BHLS scores were significantly associated with new chronic opiate usage, defined as obtaining an opiate prescription > 60 days postoperatively without a prior history of chronic usage (OR 0.75, 95% CI 0.59-0.96, p = 0.02). Preoperative opiate prescription patterns were also associated with new chronic opiate usage including increased number of preoperative prescriptions, days supplied, and number of prescribing providers. On multivariable logistic regression, lower health literacy remained a significant predictor of postoperative opiate usage > 60 days (Table 1). CONCLUSIONS: An assessment of health literacy can further screen individuals at risk of postoperative opiate dependence after ureteroscopy. These data identify a need to develop decision-making and counseling tools that account for varying levels of health literacy among kidney stone patients. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1052-e1053 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Naren Nimmagadda* More articles by this author Caroline Kang More articles by this author Nicole Miller More articles by this author S Duke Herrell More articles by this author Ryan Hsi More articles by this author Expand All Advertisement PDF downloadLoading ...

MP69-20 ASSOCIATION BETWEEN URETERIC STENT DWELL TIME AND URINARY TRACT INFECTION

You have accessJournal of UrologyStone Disease: Surgical Therapy VII (MP69)1 Apr 2020MP69-20 ASSOCIATION BETWEEN URETERIC STENT DWELL TIME AND URINARY TRACT INFECTION Kevin Zhuo*, Nelson Wang, Vaux Kenneth, Enzo Lazzaro, Vass Justin, Kris Rasiah, Michael Wines, Venu Chalasani, and Amanda Chung Kevin Zhuo*Kevin Zhuo* More articles by this author , Nelson WangNelson Wang More articles by this author , Vaux KennethVaux Kenneth More articles by this author , Enzo LazzaroEnzo Lazzaro More articles by this author , Vass JustinVass Justin More articles by this author , Kris RasiahKris Rasiah More articles by this author , Michael WinesMichael Wines More articles by this author , Venu ChalasaniVenu Chalasani More articles by this author , and Amanda ChungAmanda Chung More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000949.020AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urosepsis following ureteropyeloscopy laser lithotripsy can be associated with significant morbidity and sometimes even death. Urinary foreign bodies can be a risk factor for urinary tract infection (UTI). A number of patients undergoing ureteropyeloscopy laser lithotripsy have ureteric stents in situ. This study aims to investigate possible association between ureteric stent dwell time and the presence of UTI between staged procedures of endoscopic ureteric stone treatment (ureteropyeloscopy). METHODS: A retrospective review of all adult patients who were treated under 7 urologists at a single institution (Royal North Shore Hospital) by ureteropyeloscopy laser lithotripsy or basket removal of upper tract urolithiasis, who already had been presented, was conducted from 01 January 2018 – 30 June 2019. Patient demographic data, pre-operative urine culture results, ureteric stent dwell time, intra-operative complications and post-operative complications were recorded. Data was analysed using IBM SPSS V24. Descriptive analyses were performed. Normally distributed data was analysed using independent t-tests and ANOVA; categorical variables were analysed using Chi-square and Fisher’s exact tests. P-values < 0.05 were considered statistically significant. RESULTS: 172 patients (mean age 56.1 years, range 24.1-93.9) were identified for this study. Of these patients, 23 patients (13.4%) underwent their secondary procedure with a stent dwell time of 1 month or less (Group A); whilst 149 patients (86.6%) underwent ureteropyeloscopy stone treatment with a stent dwell time greater than 1 month (Group B). Overall, 23.3% (40/172) patients booked for ureteropyeloscopy stone treatment had positive pre-operative urine culture results. Among Group A 4.3% patients had positive preoperative urine culture results whereas among Group B 26.2% patients had positive preoperative urine culture results. There was a statistically significant preoperative infection rate between the two groups (p < 0.05). CONCLUSIONS: In conclusion, longer duration of stent dwell time prior to secondary ureteroscopic treatment for upper tract stones is significantly associated with increased rate of positive pre-operative urine culture. Preoperative UTIs are a known risk factor for serious peri-operative complications such as urosepsis and can lead to subsequent morbidity and even mortality. Therefore, patients who have been prestented and are waitlisted for subsequent ureteropyeloscopy laser lithotripsy should be appropriately triaged to schedule their secondary procedure within an appropriate timeframe to help avoid possible serious negative outcomes. Source of Funding: Nil © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1053-e1054 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kevin Zhuo* More articles by this author Nelson Wang More articles by this author Vaux Kenneth More articles by this author Enzo Lazzaro More articles by this author Vass Justin More articles by this author Kris Rasiah More articles by this author Michael Wines More articles by this author Venu Chalasani More articles by this author Amanda Chung More articles by this author Expand All Advertisement PDF downloadLoading ...

Robot-assisted laparoscopic augmentation ileocystoplasty and Mitrofanoff appendicovesicostomy in children: Step-by-step and modifications to UChicago technique.

ObjectiveTo describe the step‐by‐step techniques and modifications for robot‐assisted augmentation ileocystoplasty and Mitrofanoff appendicovesicostomy in a pediatric population with updated institutional results.IntroductionRobot‐assisted laparoscopic augmentation ileocystoplasty with Mitrofanoff appendicovesicostomy (RALIMA) protects the upper urinary tract and reestablishes continence in patients with refractory neurogenic bladder. Robotic assistance could provide the benefits of minimally invasive surgery without the challenges of pure laparoscopy. Here, we focus on the outcomes of RALIMA with salient tips and modifications of the technique.MethodsWe performed a retrospective review of our robotic database and identified 24 patients who underwent attempted robot‐assisted laparoscopic augmentation ileocystoplasty (RALI) between 2008 and 2017 by a single surgeon at an academic center. Outcomes of interest included operative time, hospitalization time, postoperative complications, and change in bladder capacity. RALI and all concomitant procedures were performed using the da Vinci® surgical system (Intuitive Surgical, Sunnyvale, CA, USA).ResultsOf 24 patients, 20 successfully underwent RALI. Eighty percent underwent concomitant appendicovesicostomy (APV), 40% underwent antegrade continence enema channel formation (ACE), and 30% underwent a bladder neck procedure. Mean operative time was 573 minutes and the most recent RALIMA was 360 minutes. The average return to regular diet was 3.9 days and length of stay was 6.9 days. Mean change in bladder capacity was 244% postoperatively. Thirty‐day complications were noted in 35% of patients; one Clavian grade I (5%) complication, five grade II (25%) complications, and one grade IIIb (5%) complication. With a median follow‐up of 83.1 months we note a 25% incidence of bladder stones, 15% upper tract stones, 5% incidence of bladder rupture, and 5% small bowel obstruction. No patients required re‐augmentation in the follow‐up period.ConclusionsRALI has similar functional outcomes and complications when compared with the open augmentation ileocystoplasty literature. RALI is desirable due to favorable pain control with decreased length of stay. Long‐term outcomes after RALI are similar to the open approach. As the operative time is currently the largest point of criticism with the robotic approach, we discuss modifications to decrease the operative time.

Complications in Patients With Autosomal Dominant Polycystic Kidney Disease Undergoing Ureteroscopy: A Cohort Study.

Background:Ureteroscopy is a minimally invasive treatment option for upper tract stones. The distorted kidney anatomy in patients with autosomal dominant polycystic kidney disease (ADPKD) may place them at higher risk for ureteroscopic complications.Objective:To compare the 30-day risk of ureteroscopic complications between patients with and without ADPKD.Design:Retrospective cohort study.Setting:Ontario, CanadaPatients:Seventy three patients with ADPKD and 81 445 patients without ADPKD who underwent ureteroscopy for upper urinary tract stones between April 1, 2002, and March 1, 2018.Measurements:A 30-day risk of (1) hospital presentation with ureteroscopic complications (which was a composite outcome of either emergency department visit or hospital admission with acute kidney injury, urinary tract infection, or sepsis); (2) all-cause hospital presentation; (3) all-cause hospital admission; and (4) all-cause emergency department visit.Methods:We regressed outcomes on demographic variables, health care use in the prior 1-year, various procedures and comorbidities related to the outcome in the prior 5 years, and prescribed medications filled in the past 120 days using modified Poisson regression to compare the risk ratio (RR) of each outcome between patients with and without ADPKD.Results:The median (interquartile, IQR) age was 44 (38-60 years) in the ADPKD group and 53 (42-64) in the control group. About 40% were women in both groups. The risk of ureteroscopic complications was not significantly different in patients with versus without ADPKD (8.2% vs 4.3%; adjusted RR = 1.5, 95% confidence interval [CI] = 0.7-3.2). Patients with versus without ADPKD were more likely to present to hospital after their procedure (35.6% vs. 20.0%; adjusted RR = 1.6, 95% CI = 1.2-2.2), which included a statistically significant increase in the risk of presenting to the emergency department (32.9% vs. 19.0%; adjusted RR = 1.6, 95% CI = 1.1-2.2) but not hospital admissions (10.9% vs. 5.0%; adjusted RR = 1.8, 95% CI = 0.9-3.4).Limitations:The low numbers of events led to imprecision around the estimates.Conclusion:Patients with ADPKD have a higher risk of return to the hospital within 30 days of ureteroscopy for stone disease.Trial registration:We did not register this study.

Risk factors of calculi in upper urinary tract after radical cystectomy with urinary diversion

Introduction and objectivesThe study was conducted to identify the risk factors of upper tract stone formation in patients with diversions after radical cystectomy (RC). Materials and methodsAll patients with diversion after RC were collected in our center from January 2005 to December 2013. Three different common diversions were included: Orthotopic neobladder (ON: 168 patients), Ileal Conduit (IC: 93 patients) or Ureterocutaneostomy (UC: 104 patients). Univariable and multivariable logistic regression analysis were conducted to identify the independent predictors of stone formation in the upper tract. ResultsA total of 365 consecutive patients (316 males, 49 females) were included. At a median follow-up of 48 months (range 12–65 months), 36 patients (9.9%) developed upper tract stone. Among them, 26 (72.2%), 5 (13.9%) and 5 (13.9%) patients underwent ON, IC and UC, respectively. 25 patients had renal stone and 11 ureter stone. Minimally invasive operations (endoscopic laser lithotripsy via the anterograde or retrograde approach in 24 cases, percutaneous nephrolithotomy in 9 cases and shock wave lithotripsy in 3 cases) were carried out successfully in all stone cases. On univariable and multivariable logistic regression analysis, diabetes mellitus, hypertension, urinary tract infection (UTI), anastomotic stenosis and types of diversions (P<0.05) were positively associated with upper tract stone formation. ConclusionsThe variable predictors of upper tract stone may contain diabetes mellitus, hypertension, UTI, anastomotic stenosis and types of diversion.

New Persistent Opioid Use After Outpatient Ureteroscopy for Upper Tract Stone Treatment

ObjectiveTo measure the incidence of persistent opioid use following ureteroscopy (URS). Over 100 Americans die every day from opioid overdose. Recent studies suggest that many opioid addictions surface after surgery. MethodsUsing claims data, we identified adults who underwent outpatient URS for treatment of upper tract stones between January 2008 and December 2016 and filled an opioid prescription attributable to URS. We then measured the rate of new persistent opioid use—defined as continued use of opioids 91-180 days after URS among those who were previously opioid-naive. Finally, we fit multivariable models to assess whether new persistent opioid use was associated with the amount of opioid prescribed at the time of URS. ResultsIn total, 27,740 patients underwent outpatient URS, 51.2% of whom were opioid-naïve. Nearly 1 in 16 (6.2%) opioid-naïve patients developed new persistent opioid use after URS. Six months following surgery, beneficiaries with new persistent opioid use continued to fill prescriptions with daily doses of 4.2 oral morphine equivalents. Adjusting for measured sociodemographic and clinical differences, patients in the highest tercile of opioids prescribed at the time of URS had 69% higher odds of new persistent opioid use compared to those in the lowest tercile (odds ratio, 1.69; 95% CI, 1.41-2.03). ConclusionNearly 1 in 16 opioid-naive patients develop new persistent opioid use after URS. New persistent opioid use is associated with the amount of opioid prescribed at the time of URS. Given these findings, urologists should re-evaluate their post-URS opioid prescribing patterns.

Epidemiology of Upper Tract Urolithiasis and ESWL Treatment in Kumasi, Ghana

Background: The incidence of upper tract urolithiasis is rising worldwide and treatment options have improved to include extracorporeal shock-wave lithotripsy (ESWL), percutaneous nephrolitothomy (PCNL) and ureterorenoscopy (URS) but sub- Saharan Africa has lagged behind the rest of the world. Open stone surgery was the main surgical treatment for upper tract stones in Kumasi until the introduction of ESWL five years ago. This study was conducted to evaluate ESWL in the management of upper tract urolithiasis in Kumasi, Ghana.&#x0D; Materials and methods: We prospectively analyzed all patients treated for upper tract urolithiasis at the Bomso Specialist Hospital in Kumasi from January 1, 2014, to December 31, 2017. Patients with upper tract stone of 2cm or less underwent ESWL. Data was obtained on patient demographics, stone characteristics, outcome of ESWL and analyzed with PASW Statistics for Windows, Version 18.0. Chicago: SPSS Inc.&#x0D; Results: There were 170 patients with upper tract urinary stones over the study period with a male: female ratio of 2:1. The mean age was 46.5 years. Inadequate fluid intake (&lt;3L/day) was the most common predisposing factor, seen in 45.3% of the patients and the commonest symptom was flank pain, seen in 134 (78.8%) patients. There were 149 (87.6%) patients with solitary stones, mostly in the kidney 115 (67.6%). A total of 142 (83.5%) patients underwent ESWL with successful stone clearance in 120 patients. The most common complication of ESWL was flank pain 36 (25.4%).&#x0D; Conclusions:ESWL is effective for treatment of upper tract urolithiasis and should be available to selected patients in sub- Saharan Africa.

Factores de riesgo de formación cálculos en el tracto urinario superior tras cistectomía radical con derivación urinaria

Introduction and objectivesThe study was conducted to identify the risk factors of upper tract stone formation in patients with diversions after radical cystectomy (RC). Materials and methodsAll patients with diversion after RC were collected in our center from January 2005 to December 2013. Three different common diversions were included: Orthotopic neobladder (ON: 168 patients), Ileal Conduit (IC: 93 patients) or Ureterocutaneostomy (UC: 104 patients). Univariable and multivariable logistic regression analysis were conducted to identify the independent predictors of stone formation in the upper tract. ResultsA total of 365 consecutive patients (316 males, 49 females) were included. At a median follow-up of 48 months (range 12-65 months), 36 patients (9.9%) developed upper tract stone. Among them, 26 (72.2%), 5 (13.9%) and 5 (13.9%) patients underwent ON, IC and UC, respectively. 25 patients had renal stone and 11 ureter stone. Minimally invasive operations (endoscopic laser lithotripsy via the anterograde or retrograde approach in 24 cases, percutaneous nephrolithotomy in 9 cases and shock wave lithotripsy in 3 cases) were carried out successfully in all stone cases. On univariable and multivariable logistic regression analysis, diabetes mellitus, hypertension, urinary tract infection (UTI), anastomotic stenosis and types of diversions (P<.05) were positively associated with upper tract stone formation. ConclusionsThe variable predictors of upper tract stone may contain diabetes mellitus, hypertension, UTI, anastomotic stenosis and types of diversion.