Upper-tract Stone Research Articles

Contemporary Analysis of Calculous Nephrectomy Utilization and Outcomes in the United States.

Introduction: Calculous nephrectomy was a mainstay of treatment of complex upper tract stone disease up until the 1970s, but data on its contemporary utilization in the current era of rising rates of stone disease are lacking. We characterized the nationwide utilization and outcomes for calculous nephrectomy in the United States. Patients and Methods: The National/Nationwide Inpatient Sample databases for 2001 to 2014 were queried for adults with a principal diagnosis of upper urinary tract calculi (UUTCs), who underwent nephrectomy as well as other inpatient surgeries for UUTCs. Per-population trend in utilization of calculous nephrectomy was analyzed using negative binomial regression. The proportion of calculous nephrectomy as a fraction of all inpatient surgical procedures for UUTCs was analyzed using the Cochran-Armitage test. Patient demographics, hospital characteristics, perioperative outcomes, and complications were analyzed using appropriate statistical tests. Results: Of almost 1.42 million inpatient UUTC procedures performed over the study period, 9232 (0.65%) were calculous nephrectomies. Per-population utilization rate for calculous nephrectomy decreased significantly over time (incidence rate ratio = 0.82; 95% confidence interval = 0.73-0.91, p < 0.001). The proportion of calculous nephrectomy as a fraction of all inpatient surgical procedures for UUTC also decreased significantly over time (p < 0.0001). Majority of the procedures were performed in females, in urban teaching hospitals, and in the Southern United States. The overall complication rate was 38.3%, most commonly hemorrhage requiring transfusion (15.6%). Older age, female gender, and nonprivate insurance or lack of insurance were significant predictors of increased risk of complications, whereas hospitalization in urban hospitals was a predictor of lower risk. Conclusions: Despite increasing prevalence of stone disease in the United States in the contemporary era, utilization of calculous nephrectomy is low and is declining. Inpatient complication rates are moderately high and influenced by patient sociodemographic and hospital characteristics.

MP23-07 NATURAL HISTORY OF RESIDUAL FRAGMENTS AFTER URETEROSCOPY

INTRODUCTION AND OBJECTIVES:Even with aggressive fragment retrieval, ureteroscopy (URS) for upper tract stones yields stone free rates of only approximately 50% when assessed by computed tomography...

Opiate Exposure and Predictors of Increased Opiate Use After Ureteroscopy.

Objective: Kidney stone formers are at risk for opioid dependence. The aim of this study is to describe opiate exposure and determine predictors of prolonged opiate use among kidney stone formers after surgery. Materials and Methods: A retrospective review was performed among patients who underwent ureteroscopy for upper tract stone disease. Prescription data were ascertained from a statewide prescribing database. Demographic data and surgical factors were collected from the electronic medical record. Predictors of additional postsurgery prescriptions filled within 30 days and persistent opiate use 60 days after ureteroscopy were determined. Results: Among 208 patients, 127 (61%) had received preoperative opiate prescriptions within 30 days before surgery. Overall, 12% (n = 25) of patients required an additional opiate prescription within 30 days after ureteroscopy, and 7% (n = 14) of patients continued to use opiate medications more than 60 days postoperatively. Patients continuing to use opiates long-term were not chronic opiate users. For both outcomes, preoperative opiate exposure, including number of prescriptions, days prescribed, and unique providers had significant associations (all p < 0.05). Additionally, younger age (p = 0.049) was associated with obtaining an additional opiate prescription within 30 days. Lower BMI (p = 0.02) and higher ASA score (p = 0.03) were predictors of continued opiate use more than 60 days after ureteroscopy. Conclusions: The majority of stone formers have had opiate exposure before surgery, often from multiple providers. Approximately 1 in 8 stone formers who undergo ureteroscopy require additional opiate prescriptions within 30 days. A small but significant population receive opiates beyond the immediate postoperative period.

Current role of single-use flexible ureteroscopes in the management of upper tract stone disease.

Current role of single-use flexible ureteroscopes in the management of upper tract stone disease.

Flexible ureterorenoscopy to treat upper urinary tract stones in children.

Development of surgical expertise and technology has affected the way renal tract stones are treated. Our hypothesis was that flexible ureteroscopy (FURS) for upper tract stones in children produces good results. Our outcomes were reviewed. A retrospective case note review was performed for children with upper tract calculi who were treated by FURS. There were 56 stone episodes in 36 patients. Median age was 10.6years. Stones were 3-23mm (median 8mm); 64.3% had multiple calculi. Median follow-up was for 17.1months. After the first FURS there was stone clearance in 42/56 (75%). Although there were no immediate complications, two required re-admission; one with stent symptoms, the other with urinary infection. A second FURS was performed in 11, bringing the cumulative clearance to 89%, although this was often done as "another look" before stent removal. There was no statistically significant difference in stone clearance after first FURS for those with single stones (81.0%) compared to those with multiple stones (72.2%). Clearance rates of more than 70% after first FURS were achieved with stones of up to 17mm. Unexpected disease was found and treated during FURS in 9 (16.1%) children. FURS is safe in children and good clearance rates are achieved. Multiple stones at different sites may be treated during the same treatment. In addition, FURS allows diagnosis and treatment of unexpected problems.

Metabolic Syndrome Increases Risk of Postoperative Myocardial Infarction Following Percutaneous Nephrolithotomy.

Percutaneous nephrolithotomy (PCNL) is the gold standard treatment for upper tract stone burdens greater than 2 cm. Metabolic syndrome (MetS) is a constellation of conditions (diabetes mellitus, hypertension, dyslipidemia, and obesity) and is a risk factor for nephrolithiasis. Our objective was to investigate adverse cardiovascular outcomes of PCNL in patients with comorbid MetS diagnoses. Data from the Healthcare Cost and Utilization Project State Inpatient Database for Florida and California were used to identify PCNL patients (ICD9: 55.03, 55.04) between 2007 and 2011. Patients were categorized having 0, 1-2, or 3-4 components of MetS. Postoperative myocardial infarction (MI) and inhospital mortality rate outcomes were identified. Multivariate logistic regression was used to control for patient characteristics (age, race, and primary insurance provider) and medical comorbidities. PCNL was performed on 39,868 patients, of whom 17,932 (45.0%) had no MetS conditions, 19,268 (48.3%) had 1-2 MetS conditions, and 2668 (6.7%) had 3-4 MetS conditions. With increasing MetS conditions, patients had increased incidence of postoperative MI (0: 0.6%; 1-2: 1.0%; 3-4: 1.8%, p < 0.001). On multivariate analysis, the presence of 3-4 MetS comorbidities increased the odds of a postoperative MI (1-2: odds ratio [OR] 1.2, 95% confidence interval [CI] 0.94-1.53, p = 0.147; 3-4: OR 2.2, 95% CI 1.54-3.15, p < 0.001). MetS patients have an increased risk of MI following PCNL given their pre-existing comorbidities. Routine preoperative cardiac testing may benefit this population before PCNL.

The Morbidity of Ureteral Strictures in Patients with Prior Ureteroscopic Stone Surgery: Multi-Institutional Outcomes.

Nephrolithiasis is an increasingly common ailment in the United States. Ureteroscopic management has supplanted shockwave lithotripsy as the most common treatment of upper tract stone disease. Ureteral stricture is a rare but serious complication of stone disease and its management. The impact of new technologies and more widespread ureteroscopic management on stricture rates is unknown. We describe our experience in managing strictures incurred following ureteroscopy for upper tract stone disease. Records for patients managed at four tertiary care centers between December 2006 and October 2015 with the diagnosis of ureteral stricture following ureteroscopy for upper tract stone disease were retrospectively reviewed. Study outcomes included number and type (endoscopic, reconstructive, or nephrectomy) of procedures required to manage stricture. Thirty-eight patients with 40 ureteral strictures following URS for upper tract stone disease were identified. Thirty-five percent of patients had hydronephrosis or known stone impaction at the time of initial URS, and 20% of cases had known ureteral perforation at the time of initial URS. After stricture diagnosis, the mean number of procedures requiring sedation or general anesthesia performed for stricture management was 3.3 ± 1.8 (range 1-10). Eleven strictures (27.5%) were successfully managed with endoscopic techniques alone, 37.5% underwent reconstruction, 10% had a chronic stent/nephrostomy, and 10 (25%) required nephrectomy. The surgical morbidity of ureteral strictures incurred following ureteroscopy for stone disease can be severe, with a low success rate of endoscopic management and a high procedural burden that may lead to nephrectomy. Further studies that assess specific technical risk factors for ureteral stricture following URS are needed.

Correlative Analysis Between Severity of Urolithiasis and Laboratory Parameters and Its Implication in Evaluation of the Probable Risk Profile

Background: Urolithiasis presents serious hazard which significantly elevates the cost of national health expenditure in almost every part of both the hemispheres. There is high risk of hospitalization with loss of valuable human resource and decreased productivity along with it. Risk factors still evade the exact etiology and search for optimal serum panel is still in its infancy. Urolithiasis incidence has gradually increased in last 3 decades which suggests that some constant metabolic and urinary parameters are implicated in the risk of occurrence of urinary stone. The present study is intended to identify a panel of serum parameters, urinary parameters, radiological characteristics and correlating it with the clinical severity of stone disease. Methods: The present study was conducted at the Department of Urology at GMCH Guwahati. The authors retrospectively analyzed 151 patients undergoing stone surgery from a period of January 2016 to August 2017. Data comprised of all serum and urinary examinations done 1 week preoperatively and radiological scans within 1 month before surgery. Spearman test was used to determine correlation and analysis of variance (ANOVA) was applied for comparison between more than two categories. Results: Stone multiplicity was positively correlated with upper tract stone sides (r = 0.530, P < 0.01), large stone volume (r = 0.172, P < 0.02), stone recurrence, urinary infection and urine protein. Upper tract stone sides number was positively correlated with upper tract obstruction sides (r = 0.542, P < 0.03), large stone volume (r = -0.321, P < 0.01). Upper tract obstruction sides number was positively correlated with large stone volume (r = -0.848, P < 0.01). Conclusions: Results demonstrated that urinary tract obstruction and total stone volume significantly correlated with abnormal serum panel, urinary profile and were harbinger of complex stone pattern. World J Nephrol Urol. 2018;7(1):25-31 doi: https://doi.org/10.14740/wjnu332w

Is retrograde intrarenal surgery the game changer in the management of upper tract calculi? A single-center single-surgeon experience of 131 cases.

Introduction:Success of any modality for stone disease needs to be evaluated in terms of Stone Free Rates (SFR), auxiliary procedures needed; complications and follow up. SFR in RIRS is subject to parameters like stone burden, location, number, hardness, composition; calyceal and ureter anatomy; use of ureteric access sheath (UAS); surgeon experience etc.Methods:The aim of this study is to evaluate the efficacy and safety of RIRS for managing upper tract stones. The objectives include evaluating SFR in RIRS in relation to stone burden, location and number. Other objectives include evaluating SFR after re RIRS in relation to stone burden, necessity of pre DJ stenting, use of UAS and post operative complication rate. 131 patients operated by single surgeon for single/multiple renal and/or upper ureteric stones were evaluated. Stone size > 3 mm on follow up CT KUB was considered as residual. Re RIRS was required for residual stones.Results:The overall SFR was 76%. SFR were statistically lower with stone burden > 1.5 cm, lower calyceal stones and single stones with stone burden > 1.5 cm. SFR was 90% after 2nd RIRS and 98.5% after 3rd RIRS procedure. No significant difference in SFR was noted between single v/s multiple stones, single calyx v/s multiple calyx stones and renal v/s upper ureteric stones. No major complication was noted.Conclusion:Larger stone burden and lower calyceal location are important factors deciding SFR in RIRS. With auxiliary procedure, RIRS is safe and effective compared to PCNL.

Ureteroscopic Stone Treatment

Renal and ureteral stone treatment has evolved from an open operation to being entirely endoscopic. Since the inception of the natural orifice treatment of stones, there have been many more advancements in multiple aspects of the case, including smaller scopes, higher-resolution imaging, and more powerful lasers. This technological evolution in ureteroscopic stone treatment has broadened its indication as a first-line therapy by helping to attenuate the learning curve and expedite stone fragmentation and extraction. This overview includes the evolution of ureteroscopic stone treatment; however, the majority is dedicated to reviewing equipment and operative techniques pertaining to ureteroscopic stone treatment of upper tract stones. This review contains 10 highly rendered figures, 5 tables, and 43 references Key words: holmium laser, kidney, lithotripsy, nephrolithiasis, ureter, ureteral stent, ureteroscopy

Percutaneous endoscopic treatment for urinary stones in pediatric patients: where we are now.

Percutaneous nephrolithotomy (PCNL) has been adopted for pyelo-calyceal stones treatment in pediatric patients, starting from the 90's. Very recently, miniaturization of endoscopic instruments allowed less invasive procedures with low complication rate. We reviewed our experience on upper tract stone treatment utilizing two different percutaneous accesses, focusing on the recent new miniaturized devices offered for pediatric renal stones. Patients presenting upper tract urinary stones observed from January 2011 to December 2015 and treated by percutaneous renal access were prospectively evaluated: age, sex, metabolic issues, associated abnormalities, treatment modalities, hospital stay and complication rate were recorded in a specific database. Two different endourological percutaneous modalities were adopted, depending to the stone size and position. PCNL was performed through a direct calyceal puncture under ultrasonographic and fluoroscopic guidance and Amplatz access dilatation till 24 Fr. Ballistic energy was used for fragmentation. Micropercutaneous (Microperc) procedure was recently offered utilizing a 4.85 Fr metallic needle and Holmium:YAG laser lithotripsy under direct vision through a 0.9 mm high resolution optic flexible wire connected with a telescope. Thirty-eight percutaneous access to pyelo-calyceal renal stones were performed on a total of 108 children treated for upper tract stones, aged 4 to 18 years (mean age 7.5 years). The overall number of procedures was 144 (36 repeated procedures). Cystinuria was diagnosed in 5 patients. PCNL was adopted in 28 patients, Microperc was utilized in 8 patients. Hemoglobin dropdown was limited to 1.20±0.80 mg% in PCNL and was not significant in Microperc. No blood transfusion was needed. No significant complications were observed. Stone free rate or minimal not significant residuals were achieved in 82% of PCNL and in 87.5% of Microperc, after a single procedure. Percutaneous endoscopic treatment of renal calculi is feasible in pediatric age, with high success rate in a single step. Advanced miniaturized endoscopic devices as Microperc guarantee high efficacy and reduced complication rate, but endo-urological experience and adequate learning curve are required, especially in small body weight children. Centralization of these patients in Pediatric Stone Centers is welcomed to optimize results and reduce risks.

Clinical efficacy of percutaneous nephrolithotomy versus retrograde intrarenal surgery for pediatric kidney urolithiasis

Percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS) are widely used for pediatric upper tract stones; however, comparisons of their clinical efficacies are needed. Literature searches for relevant articles were performed using PubMed, the Cochrane Central Register of Controlled Trials, Embase and the China CNKI database. Study quality was assessed by Jadad and Newcastle-Ottawa Scales. Standard mean differences (SMDs) or odds ratios (OR), and 95% confidential intervals (95% CIs) were pooled for meta-analysis. In addition, data was evaluated the quality of the body of evidence by means of grading of recommendations assessment, development, and evaluation (GRADE). Data from 4 studies (231 PCNL, 212 RIRS cases) were analyzed. There was no significant difference in operation time (SMD: 1.39; 95% CIs: -0.049 to 2.82; P = .058), overall stone-free rate (OR: 3.72; 95% CIs: 0.55-25.22; P = .18), or complication rate (OR: 1.92; 95% CIs: 0.90-4.07; P = .091). PCNL cases had longer hospital stays (SMD: 1.22; 95% CIs: 0.95-1.50; P < .001), but showed a higher stone-free rate for stones greater than 20 mm (OR: 6.38; 95% CIs: 1.83-22.22; P = .004). For stones less than 20 mm, however, no significant difference between PCNL and RIRS was found (OR: 0.92; 95% CIs: 0.33-2.55; P = .87). The quality of evidence based on the GRADE system was low. Results of our systematic review and meta-analysis suggest that, for the treatment of larger kidney stones (>20 mm) in pediatric patients, PCNL is a better option due to its higher stone-free rate, although RIRS may be associated with shorter hospital stays. A large-scale clinical trial is necessary to validate our findings.

The "Acute" Stone Clinic Effect: Improving Healthcare Delivery by Reorganizing Clinical Resources.

To determine the time to specialist urologic consultation and definitive management after establishing a subspecialist administered acute stone clinic (ASC) for adults with symptomatic upper tract stones in a publically funded universal healthcare system. We retrospectively reviewed 337 adult referrals for stone management. Three distinct 9-week periods were assessed. Group 1 patients were seen/treated by their individual urologist before inception of a general urology emergency clinic (pre-EC). Group 2 patients were seen in a pooled EC and Group 3 patients were seen in the ASC. A total of 337 patients (75, pre-EC; 91, EC; 171, ASC) were reviewed. Mean time to consultation for pre-EC, EC, and ASC cohorts was 29, 7, and 7 days, respectively (p < 0.05), whereas loss to follow-up decreased from 13% to 5% (p < 0.05). On average, the number of patients seen per week increased from 9 to 20. Mean time to stone surgery from date of referral was 75 days pre-EC, 43 days EC, and 25 days ASC (p < 0.05). The percentage of patients undergoing surgery was between 59% and 63% per cohort; however, the number of patients increased from 5 to 11 per week. By reorganizing clinical resources, a dedicated ASC was able to increase patient capacity, reduce time to urologist consultation and reduce surgical wait times.

PD42-06 ASSESSMENT OF NEW TECHNOLOGY IN URETEROSCOPY: A COMPARISON OF DIGITAL, FIBEROPTIC, AND DISPOSABLE DIGITAL URETEROSCOPES USING A NOVEL EVALUATION INSTRUMENT

You have accessJournal of UrologySurgical Technology & Simulation: Instrumentation & Technology II1 Apr 2017PD42-06 ASSESSMENT OF NEW TECHNOLOGY IN URETEROSCOPY: A COMPARISON OF DIGITAL, FIBEROPTIC, AND DISPOSABLE DIGITAL URETEROSCOPES USING A NOVEL EVALUATION INSTRUMENT John Roger Bell, Sara L Best, Kristina L Penniston, and Stephen Y Nakada John Roger BellJohn Roger Bell More articles by this author , Sara L BestSara L Best More articles by this author , Kristina L PennistonKristina L Penniston More articles by this author , and Stephen Y NakadaStephen Y Nakada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1898AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Currently there is no standardized evaluation instrument for evaluation and comparing flexible ureteroscopes for clinical or research purposes. Our goals were to test a novel evaluation instrument in order to assess the performance of flexible ureteroscopes including a new disposable digital flexible ureteroscope during clinical use. METHODS We designed a novel evaluation instrument comprised of 9 questions designed to provide a comprehensive assessment of a flexible ureteroscope. Response options were presented as an interval scale ranging from 0 to 5 with 5 being the best response possible. We tested the instrument at our institution by administering it after routine upper tract stone cases utilizing a flexible ureteroscope. Three flexible ureteroscope categories were evaluated including: fiberoptic (Olympus URF-P5/P6), reusable digital (Storz Flex Xc), and the LithoVue disposable digital (Boston Scientific). Any urologist or trainee who used the ureteroscope during the procedure was allowed to evaluate the ureteroscope. The instrument was completed independently of each other and opinions about the ureteroscope were not discussed during the procedure. Internal consistency was assessed with Cronbach's alpha and Pearson correlation coefficients were calculated to describe the linear relationship between items. Multivariate analyses were done to assess responses. RESULTS A total of 34 upper tract stone cases were performed resulting in 79 evaluations. The Storz digital scored the highest of the three ureteroscopes. The image quality was very good on the LithoVue outside the patient, but we did notice some distortion when performing laser lithotripsy that impaired vision. We found no difference in the ease of ureteral access between the ureteroscopes. The instrument demonstrated internal consistency (Cronbach's alpha = 0.85). The mean inter-item Pearson correlation coefficient was 0.46 (0.10 to 0.88), the highest of which related maneuverability to overall satisfaction (0.88). Respondents who had completed residency scored the ureteroscopes significantly lower in the areas of maneuverability, intuitiveness and overall satisfaction (P = 0.019, 0.003, and 0.046 respectively). CONCLUSIONS We report our results from a pilot study evaluating a novel flexible ureteroscope evaluation instrument during clinical use. All ureteroscopes performed well on our evaluation instrument during clinical use. Further validation is needed to assess the quality of this evaluation instrument. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e814-e815 Advertisement Copyright & Permissions© 2017MetricsAuthor Information John Roger Bell More articles by this author Sara L Best More articles by this author Kristina L Penniston More articles by this author Stephen Y Nakada More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Defining the Rate of Negative Ureteroscopy in the General Population Treated for Upper Tract Urinary Stone Disease.

Ureteroscopy is increasingly used to treat upper tract urinary stone disease. A negative ureteroscopy is a ureteroscopy performed with the intent of removing a kidney or ureteral stone, but in which ultimately no stone is removed. Negative ureteroscopy may occur when the stone is found to have already passed, or the presumed stone is found to be outside of the collecting system. We sought to determine the rate of negative ureteroscopy in a large population-based sample as well as factors associated with its use. We examined nonpublic data from the Office of Statewide Health Planning and Development (OSHPD) Database for all patients in California undergoing outpatient surgery from 2010 to 2012. We identified all patients with an International Classification of Diseases, Ninth Revision (ICD-9) diagnosis code for upper tract urinary stone disease, who underwent a ureteroscopic procedure. After excluding patients undergoing second look procedures or who had diagnosis codes for separate urologic pathology, the negative ureteroscopy rate was defined as the proportion of those ureteroscopy cases coded as a diagnostic ureteroscopy. We fit logistic regression models to evaluate patient factors associated with negative ureteroscopy. During the years 2010 to 2012, 20,236 eligible patients underwent ureteroscopic procedures for upper tract stone disease. Of these, 1287 patients underwent diagnostic ureteroscopy and 19,039 underwent ureteroscopy with stone removal accounting for a negative ureteroscopy rate of 6.3%. The odds of receipt of a negative ureteroscopy rate were higher in females compared to males (odds ratio [OR] 1.41, 95% confidence interval [CI] 1.25, 1.58) and lower in self-pay patients compared with insured patients (OR = 0.55, 95% CI 0.33, 0.91). Negative ureteroscopy is common, occurring in nearly 1 in 16 procedures to treat urinary stone disease.

Percutaneous nephrolithotomy versus extracorporeal shock wave lithotripsy for moderate-sized kidney stones

Objective The aim of this study was to evaluate the effectiveness of extracorporeal shock wave lithotripsy (ESWL) with that of percutaneous nephrolithotomy (PCNL) for managing moderate-sized kidney stones measuring between 100 and 300 mm2 in area. Background Shock wave lithotripsy (SWL) is considered a standard treatment for patients with upper-tract stones that are less than 10 mm in diameter, whereas stones that are larger than 20 mm are best managed with PCNL. The management of stones between these sizes remains controversial. Our purpose was to review our contemporary series of SWL, ureteroscopy, and PCNL outcomes for intermediate-sized upper-tract calculi (100–300 mm2). Patients and methods This study was conducted at the Urology Department, Menoufia Teaching Hospital, Menoufia University, between December 2013 and February 2015. It study included all patients with moderate-sized renal calculi (range: 1–3 cm) who were planned for management of renal calculi either with PCNL or with ESWL. Patient data were taken as follows: (a) preoperatively, clinical assessment and laboratory investigations; (b) during surgery; and (c) postoperatively, complications and residual stone. Results This study included 70 patients with nonstaghorn calculi with an area between 100 and 300 mm. Thirty patients underwent PCNL and 40 underwent ESWL; 49 (70%) patients were male and 21 (30%) were female; 29 (41.4%) patients had right-sided stones and 41 (58.5%) had left sided stones. The mean age of the patients was 34.1 years and the average BMI was 29.0 kg/m2. The mean operative time in our study was 2.36 ± 0.8 h. Conclusion This study demonstrates that PCNL and up to two SWL treatments are safe and comparably effective in treating patients with intermediate-sized upper-urinary-tract stones between 100 and 300 mm2 in area.

Safety and Efficacy of Spinal Anaesthesia in Percutaneous Nephrolithotomy

Renal stone is one of the common entities occurring in our population. There are different treatment modalities of stones; out of those percutaneous nephrolithotomy is one of the most popular and effective for the renal and upper tract stones. This study is based to compare the safety and efficacy of spinal anaesthesia and general anaesthesia in PCNL. In a randomized prospective study 60 patients were divided in two groups; group 1 (n=30) underwent PCNL in general anaesthesia and group 2 (n=30) underwent PCNL in spinal anaesthesia in prone position with the conventional technique. Demographic, operative data, post operative complications, patients' satisfaction rate and follow up complications were recorded and analyzed between two groups. Mean age in group 1 was 39.10±12.45years and 36.10±14.18 in group 2 (P=0.100). Mean stone size in group 1 was 3.75±1.27cm and 3.23±1.36cm in group 2 (P=0.129).Similarly the operative time was 89.10 ± 49.38 min and 62.53±35.91 min in group 1 and group 2 respectively (P=0.042). There was no significant difference between the complications regarding the anaesthesia. Post operative nausea and vomiting were significantly higher in group 1 and headache in group 2 (p=<0.001). Overall patient satisfaction rate was higher in group 2 then in group 1 (p=0.01). Hospital stay in group 1 was 5.27±1.87 days and 4.53±1.88 days in group 2 (p = 0.07). Stone success rate was similar in each group (p =0.50). Spinal anaesthesia is a safe and effective method in performing PCNL.

Characterization of Urolithiasis in Patients Following Lower Urinary Tract Reconstruction with Intestinal Segments.

Urinary diversion and augmentation cystoplasty are associated with long-term complications, including metabolic derangements, infectious complications, and urolithiasis. The aim of this series was to characterize upper and lower urinary tract (LUT) calculi in this population. A retrospective chart review was performed on all patients with a history of urinary diversion or augmentation cystoplasty who subsequently underwent treatment for urolithiasis between January 1998 and May 2015. Data collected included demographics, perioperative characteristics, type of reconstructive procedure, urine culture, stone analysis, and metabolic evaluation. A statistical analysis was performed. Ninety-nine patients were identified with a history of urolithiasis and incontinent urinary diversion (28), neobladder (21), continent cutaneous diversion (12), and augmentation cystoplasty (38). LUT stones were more common than upper tract stones in all except for incontinent diversions, which only had one lower tract stone (p = 0.0001). Twenty-three percent of stones were metabolic. Several metabolic derangements were noted, including hypocitraturia (100%), elevated urine pH (100%), low urine volume (70%), and hyperoxaluria (35%). There was a 44% rate of recurrent urolithiasis. Given the high rate of stone recurrence among patients with a history of urinary diversion and augmentation cystoplasty, all measures should be taken to prevent recurrent stones. In addition to actions aimed to prevent infectious stones such as bladder and pouch irrigation, we recommend these patients undergo a full metabolic workup with targeted dietary changes and medical therapies.

PD10-08 COMPLIANCE AND METABOLIC STONE DISEASE. DOES DISTANCE TO CARE MATTER?

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Quality Improvement & Patient Safety III1 Apr 2016PD10-08 COMPLIANCE AND METABOLIC STONE DISEASE. DOES DISTANCE TO CARE MATTER? Maxx Gallegos and Julie Riley Maxx GallegosMaxx Gallegos More articles by this author and Julie RileyJulie Riley More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2916AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Due to a dry climate and unique patient demographic, metabolic stone disease is prevalent in New Mexico. University of New Mexico Hospital is the only tertiary referral center for urologic disease in the state, therefore, comprehensive stone surveillance and treatment is crucial. It has been anecdotally suggested that distance from a care center is a factor in patient noncompliance. Our study aims to show this phenomenon. METHODS All upper tract stone diagnoses of the last 5 years were reviewed, including patients who received medical expulsive therapy, ureteroscopy or percutaneous nephrolithotomy. Of those, only patients who submitted a 24-hour urine for metabolic stone surveillance were analyzed. This yielded 225 unique patients for final review. Compliance with follow up was determined by chart review. Patients were stratified into groups based on their distance from UNMH. Fisher tests and odds ratios were used to compare groups. RESULTS One hundred fifty seven were compliant with follow up while 68 were not. Patients were more likely to be compliant who lived within 40 miles (OR: 4.45, CI: 2.03 – 9.61, P = 0.0002), 30 miles (OR: 3.83, CI: 2.05 – 7.16, P < 0.0001), and 20 miles (OR: 3.83 CI: 2.09 – 7.02, P < 0.0001) of our institution. In contrast, those living within 15 miles of UNMH were not statistically different than all other patients living farther away (OR: 0.66, CI: 0.37-1.19, P=0.17). CONCLUSIONS Urolithiasis is a common problem in the southwest United States, and the need for comprehensive follow up care is crucial for treatment. To our knowledge, this is the first study of its kind to show how distance from point of care relates to compliance in stone disease. Patients living greater than 20 miles from our center demonstrated significantly decreased compliance. Stone disease is distressing to patients and economically costly, and our study highlights the need for further research in strategies to improve compliance. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e241-e242 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Maxx Gallegos More articles by this author Julie Riley More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Quality of Acute Care for Patients With Urinary Stones in the United States

To describe guideline adherence for patients with suspected upper tract stones. We performed a cross-sectional analysis of visits recorded by the National Hospital Ambulatory Medical Care Survey (emergency department [ED] component) in 2007-2010 (most recent data). We assessed adherence to clinical guidelines for diagnostic laboratory testing, imaging, and pharmacologic therapy. Multivariable regression models controlled for important covariates. An estimated 4,956,444 ED visits for patients with suspected kidney stones occurred during the study period. Guideline adherence was highest for diagnostic imaging, with 3,122,229 (63%) visits providing optimal imaging. Complete guideline-based laboratory testing occurred in only 2 of every 5 visits. Pharmacologic therapy to facilitate stone passage was prescribed during only 17% of eligible visits. In multivariable analysis of guideline adherence, we found little variation by patient, provider, or facility characteristics. Guideline-recommended care was absent from a substantial proportion of acute care visits for patients with suspected kidney stones. These failures of care delivery likely increase costs and temporary disability. Targeted interventions to improve guideline adherence should be designed and evaluated to improve care for patients with symptomatic kidney stones.