Page 4 - CUA2018 Abstracts - Endourology

2018 CUA AbstrACts

Poster Session 4: Endourology

June 25, 2018; 0800–0930

MP–4.1 point Likert scale was defined as acceptable based on review of litera-
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Effects of a changing patient population on percutaneous ture. Participants were classified as expert or novice based on a cutoff
nephrolithotomy outcomes of 50 real procedures performed.
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Jennifer Bjazevic , Linda Nott , John Denstedt , Hassan Razvi 1 Results: Eight experts (including one resident) and nine novices com-
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1 Urology, Western University, London, ON, Canada pleted the training. Face validity was acceptable among experts (mean
Introduction: The incidence of nephrolithiasis and the use of percutaneous realism 4.00±0.93 standard deviation [SD]; 4.13±0.641), but not novices
nephrolithotomy (PCNL) has risen significantly over the years. Along with (3.22±0.667; 3.33±1.12). Overall simulation of key steps (content validity)
this, patient populations are becoming increasingly complex. The objective was acceptable among experts (mean 4.00±0.93). Individual elements were
of our study was to determine the impact of changes in patient demograph- acceptable in 4/8 domains. Lowest scores were for fluid management and
ics over a 25–year time period on PCNL outcomes. depth of resection. There was no significant difference between groups
Methods: A retrospective analysis on a prospectively maintained database on any performance metrics (resection %, visualization, safety, economy,
was carried out from July 1990 to 2015, including 2554 consecutive PCNL resection time, rate of perforation, or total score). Overall, 94.1% of all
treatments in 2486 patients. Patients were divided into equal terciles of participants (100% of experts) agreed the simulator should be in the official
852 consecutive procedures ordered chronologically. Patient demographics, urology curriculum.
comorbidities, and stone and procedure characteristics were analyzed. A Conclusions: Based on expert assessment, the TURBT Mentor achieved
multivariate logistic regression was used to evaluate differences in opera- face and content validity. The simulator did not demonstrate construct
tive duration, adverse events, stone–free rate, and hospital length of stay. validity, as novices and experts showed no difference in performance.
Results: A total of 2486 patients with a mean age of 54±15 years, body mass Participants endorsed its use in urology training. Our study suggests there
index (BMI) of 31±8, and stone surface area of 895±602 mm were ana- is a role for using the device as an introduction to TURBT for trainees.
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lyzed. Almost half of patients (46.9%) had medical comorbidities, including Improvements could be made in fluid management, depth of resection,
hypertension (22%), diabetes (14%), and cardiac disease (13%). Overall and scoring of performance.
complication rate was 15.6%, including a 2.5% rate of major complications Reference:
(Clavien grade 3–5). There was a statistically significant increase in patient 1. Schout B, Bemelmans B, Martens E, et al. How useful and realis-
age, BMI, comorbidities, and American Society of Anesthesiologists (ASA) tic is the uro trainer for training transurethral prostate and bladder
score over time, which was correlated with an increased complication rate tumour resection procedures? J Urol 2009;181:1297–1303. https://
(odds ratio [OR] 1.15; p=0.010). The overall transfusion rate was 1.0%, doi.org/10.1016/j.juro.2008.10.169
and remained stable (p=0.131). With time, both operating rom duration
(mean ∆ 16 minutes; p<0.001) and hospital length of stay (mean ∆ 3 days; MP–4.3
p<0.001) decreased significantly. Stone–free rate of 1873 patients with To stent or not to stent: A Cochrane review and meta–analysis
available three–month followup was 86.7% and decreased significantly Shreyas Gandhi , Maria Ordonez , Michael Borofsky , Caitlin Bakker ,
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over time (OR 1.09; p<0.001), but was correlated with an increased use Philipp Dahm 4
of computed tomography scans for followup imaging. 1 Department of Urology, Dalhousie University, Halifax, NS, Canada;
Conclusions: Despite an increasing complex patient population, PCNL 2 Department of Urology, University of Minnesota, Minneapolis, MN, United
remains a safe and effective procedure with a high stone–free rate and States; Health Sciences Library, University of Minnesota, Minneapolis,
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low risk of complications. MN, United States; Department of Urology & Minneapolis VA Health
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Care System, University of Minnesota, Minneapolis, MN, United States
MP–4.2 Introduction: The role of ureteral stent placement following uncomplicated
A high–fidelity transurethral resection of bladder tumour ureteroscopy for ureteral and renal calculi remains controversial. We per-
simulator: Validation as a tool for training formed this review to better understand the tradeoffs of stenting vs. not
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Jonathan Moore , Jason Lee , Michael Ordon , Neal Rowe , Gregory Bailly , stenting to inform clinical decision–making.
Andrea Lantz 1 Methods: We conducted a Cochrane review based on published a priori
1 Department of Urology, Dalhousie University, Halifax, NS, Canada; protocol. We searched multiple data sources for published and unpublished
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Division of Urology, Department of Surgery, Toronto General Hospital, randomized controlled trials (RCTs) in any language. Review outcomes
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University of Toronto, Toronto, ON, Canada; Division of Urology, were included unplanned return visits, need for secondary interventions,
Department of Surgery, St. Michael’s Hospital, University of Toronto, operating room (OR) time, urinary tract infections (UTIs), and ureteral stric-
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Toronto, ON, Canada; Division of Urology, Department of Surgery, The ture rates. We completed title/abstract and full–text screening in dupli-
Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada cate using Covidence software. Based on a priori published protocol, we
Introduction: Simulation–based training is used in urology to help trainees performed meta–analysis using RevMan 5.3 software using random effect
learn challenging procedures safely. To date, there has been no publica- models and rated the quality of evidence using GRADE.
tion of a successfully validated transurethral resection of bladder tumour Results: We screened the titles/abstracts of 3459 references and subse-
(TURBT) simulator. We aim to test the face, content, and construct validity quently 32 full–text studies, of which ultimately 24 met our inclusion crite-
of the Simbionix TURBT Mentor (Simbionix LTD, Airport City, Israel). ria. We found that stenting may not change the rate of secondary interven-
Methods: Urologists and urology residents performed five rounds of stan- tions with a risk ratio (RR) of 0.65 (95% confidence interval [CI] 0.24–1.77;
dardized training on the simulator. Participant performance was assessed low–quality evidence); this corresponds to six fewer (14 fewer to 14 more)
by the simulator’s built–in metrics. Pre– and post–simulation question- per 1000 patients. Stenting may also not change the rate of return to the
naires were completed by participants. A level of 4.0 or higher on five– hospital, with a RR of 0.77 (95% CI 0.48–1.24; low–quality evidence); this
S84 CUAJ • June 2018 • Volume 12(6Suppl2)
© 2018 Canadian Urological Association