Page 8 - CUA2019 Abstracts - BPH

2019 CUA Abstracts

tomography (CT) scan or ureteroscopy. Radiographic stone passage was 3. Ljunghall S. Incidence of upper urinary tract stones. Miner Electrolyte
compared to patient survey responses to calculate sensitivity and specificity. Metab 1987;13:220-7.
Results: A total of 136 patients met inclusion criteria with an average
followup of 16.9±8.0 days from diagnosis; 69.5% were male, 50% POD-1.5
were distal stones, average stone size was 6.8±3.2 mm, and 43.3% of
patients had imaging-confirmed stone passage at first visit. Fifty-eight Surgical performance as a predictor of functional and oncological
percent of patients who reported cessation of pain had passed their stone. outcomes in robotic prostatectomy 1 1
1
Furthermore, only 77.7% of patients who believed they had passed their Mitchell G. Goldenberg , Alaina Garbens , Hossein Sadaat , Antonio
1
2
1
1
stone had actually passed it. Cessation of pain at the time of assessment Finelli , Rajiv K. Singal , Jason Lee , Teodor P. Grantcharov
1
demonstrated a sensitivity of 79.7% (95% confidence interval [CI] 67.1– Division of Urology, Department of Surgery, University of Toronto,
2
89.0) and a specificity of 55.8% (95%CI 44.0–67.1%) for true ureteric Toronto, ON, Canada; Division of General Surgery, Department of
stone expulsion. Patient-reported stone passage had a sensitivity of 59.3% Surgery, University of Toronto, Toronto, ON, Canada
(95% CI 45.7–71.9) and a specificity of 87.0% (95% CI 77.4–93.5) for Royal College of Physicians and Surgeons and Canada (RCPSC), Canadian
true ureteric stone expulsion. Urologic Oncology Group (CUOG)
Conclusions: This is the largest prospective cohort study to assess patient- Introduction: Objective assessments of surgical technical performance
reported outcomes on ureteric stone expulsion. Cessation of pain dis- have been identified as a novel measure of surgical quality across multiple
1
played a high sensitivity for predicting ureteric stone expulsion, while procedures. This study aimed to investigate the ability of such assessments
patient-reported stone passage had a high specificity. Both assessments to predict clinically significant patient outcomes following robotic-assisted
may incorrectly assess ureteric stone expulsion, which raises concern for radical prostatectomy (RARP) in a multicentre, prospective cohort.
their validity as a clinical endpoint. Methods: Surgical video from patients undergoing RARP at three insti-
tutions was collected over a nine-month period. Blinded surgical ana-
lysts completed assessments of surgeon technical skill using the Global
POD-1.4 Evaluative Assessment of Robotic Skills (GEARS), and the Prostatectomy
2
“Stone-free,” now what? A retrospective review of patients Assessment Competency Evaluation (PACE). Postoperative urinary conti-
3
following stone-free status nence at three months, sexual function at 12 months, and positive surgical
Betty Wang , Mark Assmus , Nick Dean , Shubha De , Trevor D. Schuler , margins were selected as primary outcomes. Binary logistic regression was
2
1
2
2
2
Tim Wollin 2 used to control for patient factors and a sensitivity analysis was carried
1 Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, out to account for surgeon and hospital fixed effects. Cross-validation
Canada; Department of Surgery, Division of Urology, University of was carried out to further test the predictive models.
2
Alberta, Edmonton, AB, Canada Results: Thirty-one surgeons, including staff and trainees, and 92 patients
The Data Integration and Management Repository (DIMR) were eligible for the final analysis. On multivariable analysis, GEARS
Introduction: There remains a paucity of clinically relevant long-term score was an independent predictor of continence (p<0.05) and PACE
stone event rate data for varying stone burdens. Previous literature quotes score was predictive of continence (p<0.01), potency (p<0.05), and posi-
30–50% recurrence rates at 8–10 years for all first-time stone-formers tive surgical margin (p<0.05). Adjusting for surgeon experience and hos-
irrespective of stone burden. We sought contemporary, long-term event pital volume, only PACE remained a significant predictor of continence
1-3
rates for a subset of “low stone burden” patients presenting with single (p<0.01) and positive surgical margin (p=0.02). Cross-validation reduced
symptomatic urinary tract calculi who achieved stone-free status. the area under the curve for the continence model from 0.742 to 0.740,
Methods: To date, 119 adults with a solitary symptomatic urinary tract and the positive surgical margin model from 0.725 to 0.521.
stone on computed tomography (CT) seen by one of four urologists in Conclusions: Surgical technical skill is a predictor of oncological and
Edmonton, Alberta, from April to September 2009, who later achieved functional outcomes following RARP. These findings have implications
stone-free status, have been added to a REDCap database. Province-wide for training, credentialing, and quality improvement in the field of uro-
data was extracted with Data Integration and Management Repository logic oncology.
(DIMR) for demographics, stone burden, and eight-year outcomes (emer- References
gency room [ER] renal colic, urology visit, stone surgeries). T-test, Fisher’s 1. Fecso AB, Szasz P, Kerezov G, et al. The effect of techni-
exact two-tailed test, and Kaplan-Meier time to event curves were used cal performance on patient outcomes in surgery: A systematic
(significance p<0.05). review. Ann Surg 2017;265:492-501. https://doi.org/10.1097/
Results: A total of 119 patients with solitary symptomatic urinary tract SLA.0000000000001959
calculi achieved stone-free state. Mean age was 55 years (18–94) with 2. Goh AC, Goldfarb DW, Sander JC, et al Global evaluative assess-
41% female. Thirteen percent (15/119) had spontaneous passage, while ment of robotic skills: Validation of a clinical assessment tool to
the remainder required surgery. Once stone-free (asymptomatic and imag- measure robotic surgical skills. J Urol 2012;187:247-52. https://doi.
ing-confirmed), 29% (34/119) had a subsequent stone event within eight org/10.1016/j.juro.2011.09.032
years, with 20% (24/119) requiring surgery. Nineteen percent (23/119) 3. Hussein AA, Ghani KR, Peabody J, et al. Development and valida-
re-presented to the ER with renal colic. Four patients required >2 surger- tion of an objective scoring tool for robot-assisted radical prosta-
ies and only two patients experienced a septic stone event at eight years. tectomy: Prostatectomy assessment and competency evaluation. J
The eight-year stone event rate for this “low stone burden” population Urol 2017;197:1237-44. https://doi.org/10.1016/j.juro.2016.11.100
differed between first-time stone-formers and recurrent (FTSF 21% vs.
RS 44%, p<0.05). POD-1.6
Conclusions: Eight-year followup of patients achieving stone-free status
after a solitary symptomatic urinary tract calculi revealed an overall symp- A population-based comparison of healthcare utilization
tomatic recurrence rate of 29%. Overall, achieving stone-free status led and retreatment after electrode and laser transurethral
to a low rate of subsequent ER visits, urology consultations, and need for prostatectomies 2 2,3 1
1,2
surgery, especially for first-time stone-formers. Blayne K. Welk , Jennifer Reid , Michael Ordon , Hassan Razvi , Jeffrey
1
References B. Campbell 2
1
1. Uribarri J, Oh MS, Carroll HJ. The first kidney stone. Ann Intern Med Surgery, Western University, London, ON, Canada; Institute for Clinical
3
1989;111:1006-9. https://doi.org/10.7326/0003-4819-111-12-1006 Evaluative Sciences, London, ON, Canada; Surgery, University of Toronto,
2. Ljunghall S, Danielson BG. A prospective study of renal stone recur- Toronto, ON, Canada
rences. Br J Urol 1984;56:122–4. https://doi.org/10.1111/j.1464- Funded by the St Joseph’s Hospital Foundation
410X.1984.tb05346.x Introduction: To our knowledge, the real-world implementation of laser-
based transurethral resection of prostate (TURP) has not been studied. Our
S78 CUAJ • June 2019 • Volume 13, Issue 6(Suppl5)