Page 5 - CUA2018 Abstracts - Endourology

Poster session 4: Endourology

corresponds to 14 fewer (95% CI 33 fewer to 15 more) per 1000 patients. Results: Results are shown in Table 1 (available at https://cua.guide/). In
Based on moderate–quality evidence, OR time is likely longer by a mean summary, minimum fetal dose is obtained when the beam is collimated
difference of 4.0 minutes (95% CI 2.2–5.9). Stenting may also not impact such that the fetus is completely outside of the irradiated field of view,
strictures rates (RR 0.88; 95% CI 0.30–2.59; low–quality evidence); this with a reduction in fetal dose of almost 90% relative to the situation
corresponds to one fewer (6 fewer to 13 more) per 1000. where the fetus is within the field of view. Shielding the fetus with 0.5
Conclusions: Findings of this systematic review failed to demonstrate the mm lead equivalent thyroid shields reduced fetal dose by roughly 70%,
merits of routine postoperative stent in patients undergoing uncomplicated while increasing kidney dose by roughly 40%. Using low–dose instead
ureteroscopy for stone disease. of normal fluoroscopy, and pulsed instead of continuous fluoroscopy,
provides significant dose–sparing to both the mother and the fetus.
Conclusions: Using pulsed low–dose fluoroscopy with culmination is the
MP–4.4 most effective fluoroscopy setting to minimize radiation exposure to the
Medical expulsive therapy in pregnancy: A retrospective study fetus. Shielding with thyroid collars while reducing dose to the shielded
Benoît Thériault , Fannie Morin , Jonathan Cloutier 1 area increases exposure to the surrounding tissues .
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1 Department of Surgery, Division of Urology, CHU de Québec, Quebec References:
City, QC, Canada 1. Blanco LT, Socarras MR, Montero RF, et al. Renal colic during preg-
Introduction: The use of medical expulsive therapy (MET) is common nancy: Diagnostic and therapeutic aspects. Literature review. Central
practice in urology for the treatment of symptomatic urolithiasis, despite Eur J Urol 2017;70:93–100.
debates over its efficacy. Its use in pregnancy is even more controversial 2. McAleer SJ, Loughlin KR. Nephrolithiasis and pregnancy. Curr
because of poor safety data. Our objective is to evaluate the safety and O Urol 2004;14:123–7. https://doi.org/10.1097/00042307–
efficacy of tamsulosin 0.4 mg once a day as a MET in pregnant women. 200403000–00013
Methods: We retrospectively identified pregnant patients who presented 3. Alan J, Wein AJ, Kavoussi LR, et al. Campell–Walsh Urology. 11th
with renal colic at the CHU de Québec from 2000–2015. We compared Edition. 2015. ISBN 978–1455775675.
patients who received tamsulosin as MET to a control group without MET.
We evaluated efficacy as passage rate of lithiasis and necessity of interven-
tion or additional treatment. We evaluated safety of the treatment accord- MP–4.6
ing to fetal outcomes (fetal weight at birth, APGAR, gestational age, etc.) Metabolic evaluation guidelines in patients with nephrolithiasis:
Results: We evaluated 207 pregnant patients presenting renal colic; 69 Are they being followed? Results of a national, multi–institutional
patients in the MET group were compared to 138 patients in the control quality assessment study
group. Of these, 48 (70%) in the tamsulosin therapy group and 76 (55%) Sabrina Harmouch , Hiba Abou–Haidar , Hassan Elhawary , Thomas
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in the control group had proven urolithiasis. No significant difference Grgic , Andrea Lantz , Ben Chew , Jason Lee , Sero Andonian , Naeem
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was found for mean gestational age, birthweight at term, and APGAR. Bhojani 1
No sudden death infant syndrome was encountered in neither group. 1 Urology, Université de Montréal, Montreal, QC, Canada; Urology,
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There was no significant difference for length of hospitalization stay and McGill University, Montreal, QC, Canada; Urology, University of British
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need for surgical intervention. The spontaneous passage rate was 52% Columbia, Vancouver, BC, Canada; Urology, Dalhousie University,
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(25/48) in the MET group compared to 38% (29/76) in the control group, Halifax, NS, Canada; Urology, University of Toronto, Toronto, ON, Canada
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but this difference was not statistically significant (p=0.13). Tamsulosin Introduction: The significant cost burden of kidney stones underscores
therapy was associated with longer time to spontaneous passage (mean the importance of best clinical practice in kidney stone management. We
34 vs. 17 days; p=0.01). evaluated adherence to kidney stone metabolic evaluation guidelines in
Conclusions: Short–term use of tamsulosin as MET in pregnancy is not a Canadian population and the interest of patients with regard to kidney
associated with adverse maternal or infant outcomes. Moreover, there stone prevention.
was no significant adjunct for the rate of stone passage. Conservative Methods: A questionnaire based on Canadian Urological Association best
management of renal colic in pregnancy remains a safe treatment option. practice guidelines was designed. Patients presenting for shockwave litho-
Further studies are needed in the evaluation of MET as adjunctive therapy tripsy treatment (SWL) were administered this questionnaire to evaluate
for symptomatic urolithiasis during pregnancy. risk factors of stone disease and assess the use of metabolic evaluations.
Patients were asked if they received explanations about their results and
MP–4.5 understood them and if they were interested in kidney stone prevention.
Results: We identified 530 patients at five academic institutions (Table 1;
Minimizing ionizing radiation exposure during retrograde available at https://cua.guide/); 79.4% had at least one strict indication to
fluoroscopic–guided ureteral stent insertion in the pregnant receive a metabolic evaluation (high–risk stone formers) and 96.6% if first–
patient time stone formers that reported an interest in metabolic evaluation were
Mohammad Mohaghegh , Harry Ingleby , Brian Peters 1 included. However, only 41.1% of these patients had a metabolic evalu-
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1 Section of Urology, University of Manitoba, Winnipeg, MB, Canada;
2 Medical Physics, University of Manitoba, Winnipeg, MB, Canada ation. Endourologists ordered metabolic evaluation more often than other
referring urologists (63.6% vs. 36.5%; p<0.001). Furthermore, urologists
Introduction: Of pregnant women who develop symptomatic renal stone ordered metabolic evaluations more often than other prescribing physi-
disease, 20–30% will require intervention. 1–3 One treatment that continues cians. (68.9% vs. 31.1%; p<0.001) (Fig. 1; available at https://cua.guide/).
to be used is retrograde ureteric stent insertion under fluoroscopic guid- Sixty–two percent of patients received explanations and 77.5% understood
ance. Unfortunately, X–ray is a known teratogen. Protecting the fetus with them. Regarding prevention, 84.1% and 83.8% were interested in more
lead aprons has been recommended, but not well–studied. We devised explanations and in following a diet or a medication, respectively.
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an experiment to investigate this. Conclusions: Adherence to metabolic evaluation guidelines is suboptimal
Methods: A phantom was assembled using methyl methacrylate to mimic and could be improved by general urologists referring patients for SWL.
a pregnant patient undergoing a fluoroscopic procedure. A standard 20 Communication between physicians and patients may not be adequate.
cc syringe containing 15 cc of omnipaque contrast agent at 50% con- The majority of stone formers are interested in kidney stone prevention.
centration, was used to mimic the renal collecting system. A dosimeter
was positioned at the approximate position of the fetus and adjacent to
the kidney. The experimental setup in shown in Fig. 1 (available at https://
cua.guide/). Dose measurements were carried out at the fetal location
with no shielding used, fetal location shielded, beam collimated to avoid
fetal location and adjacent to the kidney with fetal location shielded.
Measurements were taken for all four combinations with normal or low–
dose fluoroscopy modes, and continuous or pulsed fluoroscopy.
CUAJ • June 2018 • Volume 12(6Suppl2) S85