Page 7 - CUA2018 Abstracts - Endourology

Poster session 4: Endourology

MP–4.10 to DAP (B=0.034; p<0.001), which was only partially (B=0.812; p=0.048)
Initial clinical testing of ureteral access sheath force sensor to a determinant of ocular dose.
prevent ureteral injuries Conclusions: Ocular radiation dose was only 9% of the revised annual
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Kamaljot Kaler , Mitchell O’Leary , Zachary Valley , Vinay Cooper , Renai safe limit. The association between dose delivered to the patient (DAP) and
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Yoon , Roshan Patel , Jaime Landman , Ralph Clayman 1 ocular dose was unexpectedly weak. Minimizing exposure is prudent, but
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1 Urology, University of California Irvine, Orange, CA, United States excepting very high numbers of interventional procedures (greater than
Introduction: Ureteral injury is a major concern with regard to deploy- 400 PCNLs yearly), it is unlikely that urologists would exceed safe radia-
ment of an ureteral access sheath (UAS). The force that results in ureteral tion limits. Wearing lead protective glasses is optional, but not required.
injury in humans has not been defined. In a previous study, using a novel Reference:
UAS Force Sensor (UAS–FS) (Fig. 1; available at https://cua.guide/), we 1. International Commission on Radiological Protection, Statement on
noted that a peak force of 8 Newtons (N) resulted in splitting of the ureter tissue reactions 4825–3093–1464. 2011, ICRP
in a porcine model. Herein, we present our initial clinical findings using
UAS–FS during routine ureteroscopy. MP–4.12
Methods: Among 24 patients, tamsulosin was given for up to a week prior Characterizing renal colic management and outcomes in
to UAS deployment in 88% in an attempt to induce a state of ureteral Western Canada
relaxation. UAS deployment force was measured using UAS–FS under Navraj Dhaliwal , Bruce Gao , Bryce Weber , Ravneet Dhaliwal , Joel
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fluoroscopic control by four different surgeons. Continuous measurements Teichman , Kevin Carlson , Eric Grafstein , Heidi Boyda , Mike Law ,
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began when the tip of the UAS was inserted into the urethra and ceased Grant Innes 5
when the tip of the UAS reached the ureteropelvic junction. If the force 1 Undergraduate Medical Education, University of Calgary, Calgary, AB,
approached/began to exceed 8 N (audible sound), passage was stopped, Canada; Urology, University of Calgary, Vancouver, AB, Canada; Urology,
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progress of the UAS was recorded fluoroscopically, and the UAS was University of British Columbia, Vancouver, AB, Canada; Emergency
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withdrawn and a smaller UAS selected. Ureteroscopic evaluation of the Medicine, University of British Columbia, Vancouver, AB, Canada;
entire ureter was performed at the end of each case to assess for potential 5 Emergency Medicine, University of Calgary, Calgary, AB, Canada
ureteral injuries using the post–ureteroscopic lesions scale (PULS). Introduction: Renal colic affects 10% of the population and is often
Results: There were 24 patients among whom there were 32 UAS deploy- managed with medical expulsive therapy or early urological interven-
ments (Table 1; available at https://cua.guide/). The 16 French (F) UAS tion. Calgary and Vancouver are two large stone centres with differing
could be passed at <8 N in 72% of patients; in the remainder the 16 F UAS approaches to acute renal colic, but comparable patient demographics.
was withdrawn and a smaller UAS was deployed (14 F in six cases and We evaluated rates of urological intervention and admission, as well as
11.5 F in one case) being careful to not exceed 8 N (Table 1; available at the need for rescue intervention or readmission at each site.
https://cua.guide/). The mid–ureter location was where the maximum peak Methods: We retrospectively reviewed all 2014 Calgary and Vancouver
pressure (24%) was most commonly recorded. No patient experienced a patients with an index visit for renal colic. Emergency department (ED)
significant ureteral injury (i.e., PULS ≥3) The mean PULS grade was 0.79. databases were used to collect arrival mode, triage category, and patient
Conclusions: The UAS–FS was able to measure UAS insertion force in a demographics. Regional hospital databases were used to collect ED visits,
reproducible fashion. By limiting the force exerted on the UAS to <8 N, admissions, and urological intervention. The primary outcome was uro-
no significant urothelial injury occurred. logical intervention or admission within 60 days of the first visit.
Results: A total of 3283 patients with computed tomography–confirmed
MP–4.11 stones were characterized. Calgary and Vancouver had similar stone and
Are lead glasses necessary? A prospective, multicentre cohort patient demographics. Calgary patients were more likely to undergo uro-
study on radiation exposure to the operator’s eyes during logical intervention or admission than Vancouver patients (60.9% vs.
urological surgery 31.3%; p<0.001). Calgary patients also had higher intervention rates on
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Marcus Handmer 1,2,3 , Venu Chalasani 1,2,4 , Prem Rashid , Maxwell Dias 1,2,4 their first presentation (52.1% vs. 7.5%; p<0.001). For stones less than
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1 Department of Urology, Hornsby Hospital, Sydney, Australia; Department 5 mm, readmission or rescue intervention occurred significantly less in
of Urology, Sydney Adventist Hospital, Sydney, Australia; Department Vancouver (Table 1; available at https://cua.guide/). Conversely, for stones
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of Urology, Port Macquarie Base Hospital, Port Macquarie, Australia; greater than 5mm, readmission or rescue intervention occurred signifi-
4 Sydney Medical School, Sydney University, Sydney, Australia cantly less in Calgary (Table 1; available at https://cua.guide/).
Introduction: Urologists use ionising radiation during surgery. Scattered Conclusions: Calgary patients were more likely to undergo urological
radiation may expose the surgeon. Few urologists use radiation protection intervention or admission than Vancouver patients. Furthermore, our data
eyewear. Lens radiation causes cataracts, and in 2012, the ICRP lowered suggest that medical expulsive therapy for smaller stones (<5 mm) and
the recommended annual eye dose limit by more than 80% to 20000 µSv. 1 early urological intervention for large stones (>5 mm) reduces the need
Methods: For all operations using fluoroscopy, commencing in June 2016, for readmission or rescue intervention. We are currently launching a
the first author wore a Geiger–Müller tube–based digital dosimeter on prospective trial between Calgary and Vancouver to better evaluate renal
his forehead. Procedure, consultant, operating table, intensifier model, colic, management, and the effect on patient quality of life.
screening time, dose delivered, and ocular scatter dose received were
recorded. Analysis was performed with SPSS version 17. Required UP–4.1
TM
sample size was 138 cases. Ethical approval was obtained from NSLHD Holmium laser–assisted endoscopic–guided retrograde
HREC. Reporting followed the STROBE statement for cohort studies. nephrostomy access for percutaneous nephrolithotomy in prone
Results: Dosimetry data were available for 245 of 264 (93%) possible split–leg position
procedures during a one–year study period, amounting to 1638 µSv of Kamaljot Kaler , Egor Parkhomenko , Zachary Valley , Zhamshid Okhunov ,
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measured exposure, and 1827 µSv total exposure when extrapolated for Roshan Patel , Jaime Landman , Ralph Clayman 1
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unmeasured cases. There were 84 insertion of ureteric stent procedures, 1 Urology, University of California Irvine, Orange, CA, United States
25 retrograde pyelogram only procedures, 129 ureteroscopic procedures, Introduction: Obtaining nephrostomy access remains the most challeng-
four percutaneous nephrolithotomy (PCNL) procedures, and three others. ing aspect of a percutaneous nephrolithotomy. Herein, we report a novel
Mean eye dose with 95% confidence intervals for ureteric stenting were “inside–out” approach using the holmium laser to establish access in a
5.4±0.8 µSv, for retrograde pyelography were 5.4±0.7 µSv, for uretero- retrograde fashion.
scopic procedures were 7.8±1.5 µSv, for PCNL were 56.8±9.0 µSv, and Methods: After one week of pre–treatment with tamsulosin and following
other procedures were 20.8±3.1 µSv. For the 153 cases with available a documented sterile urine, seven patients underwent retrograde, hol-
data, screening times ranged from 2–496 seconds, with dose area products mium laser–assisted, endoscopic–guided nephrostomy access in a prone,
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(DAP) of 0.07 to 22.48 Gy/cm , respectively. Screening time was related split–leg position (Figs. 1, 2; available at https://cua.guide/) (Table 1; avail-
CUAJ • June 2018 • Volume 12(6Suppl2) S87