Page 1 - CUA2019 Abstracts - Endourology

2019 CUA Abstr
2019 CUA AbstrACtsACts

Poster Session 3: Endourology

June 30, 2019; 0730–0900

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Comparison of early vs. delayed ureteroscopy following obstructive What is the relationship of stress to patients’ stone-related quality
pyelonephritis treated with urinary diversion of life?
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Steven Lagace , Jonathan Cloutier , Ioana Fugaru , David Simonyan , Colin Lundeen , Jonathan Lim , Kymora Scotland , Reza Safaee Ardekani ,
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Nathalie Laflamme 2 Kristina Penniston , Necole Streeper , Thomas Chi , Jaime Landman , Davis
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1 Department of Urology, CHUQ-Université Laval, Québec City, QC, Viprakasit , Ben H. Chew 1
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Canada; Centre de Recherche (PRCE), CHUQ-Université Laval, Québec 1 Department of Urologic Sciences, University of British Columbia,
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City, QC, Canada Vancouver, BC, Canada; Department of Urology, University of Wisconsin
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Introduction: Urolithiasis is a common disease affecting approximately - Madison, Madison, WI, United States; Penn State Health, Hershey,
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8.8% of Americans. Obstructive urolithiasis and sepsis call for emer- PA, United States; Department of Urology, University of California San
gent decompression and antibiotic therapy. After treatment, definitive Francisco, San Francisco, CA, United States; Department of Urology,
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management can be achieved with ureteroscopy (URS) or percutaneous University of California Irvine, Irvine, CA, United States; Department of
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nephrolithotomy. There are no guidelines identifying the best moment to Urology, University of North Carolina, Chapel Hill, NC, United States
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perform elective URS after urosepsis. Thus, our objective was to compare Introduction: Patients with kidney stones have lower health-related quality
the outcomes, especially post-URS sepsis, of patients who underwent early of life (HRQOL) not only when they have a stone, but also between stone
vs. delayed URS for obstructive pyelonephritis following decompression. events and even when their stone(s) are asymptomatic. Higher stress has
Methods: In this retrospective, non-inferiority, single-centre study, data were been reported as a potential factor in HRQOL, yet there have been few
collected from patients who underwent elective URS following decompres- investigations into the effect of stress on stone-related quality of life (QOL).
sion for obstructive pyelonephritis between 2012 and 2017. Patients with The Wisconsin Stone Quality Of Life questionnaire (WISQOL) is a recently
the following criteria were excluded: obstruction unrelated to urolithiasis, developed tool to assess patients’ HRQOL. In this study, we evaluated the
other procedures performed during URS, and unclear diagnosis. Early URS relationship of stress to stone-related QOL and determined the extent to
was defined as URS performed within 14 days after decompression while which the stress affects HRQOL in patients with a history of kidney stones.
the patient was still on antibiotics. Methods: Patients enrolled in the WISQOL Research Consortium who con-
Results: A total of 164 patients were included in the study. Of those patients, temporaneously completed both the WISQOL and the PSS-10, a validated
61 of them had early URS, while 103 had delayed URS. There were 10 cases general stress questionnaire, were included. Patients were stratified into
of post-URS sepsis, including one in the early URS group and the other those with stones at the time of the questionnaires (further subdivided into
nine in the delayed URS group. The adjusted odds ratio after multivariate those with and without symptoms) and those without stones. Statistical com-
analysis was 7.3 (p=0.0661) for post-URS sepsis when comparing delayed parisons were made between groups and correlations between responses
URS to early URS. The complication-free survival at 30 days was 98.4% on the two instruments.
for early URS and 91.3% for delayed URS (p=0.0665). Results: Patients (n=704) from six centres were included. There was no
Conclusions: Our study clearly shows the non-inferiority of early URS overall correlation (R=-0.05; Pearson correlation coefficient) between the
for post-URS sepsis when compared to delayed URS. Furthermore, our questionnaires. Moreover, while the WISQOL identified patients who cur-
data show a tendency that early URS might be better than delayed URS rently had a stone, the PSS-10 did not (p<0.0001). These factors suggest
regarding post-URS sepsis, although it is not statistically significant. Further that stress is not a significant driver of stone-related QOL. However, stress
studies will be needed to evaluate the superiority of early URS. However, was higher in patients with symptomatic stones.
our results showed that it is safe to perform early URS for treatment of uro- Conclusions: General stress does not appear to drive overall stone-related
lithiasis following emergent decompression for obstructive pyelonephritis. QOL, including in patients with a current kidney stone. However, patients
References with current symptoms related to stones did have higher stress, suggesting
1. Scales CD Jr, Smith AC, Hanley JM, et al. Prevalence of kidney stones that stone symptoms affect stress. The lack of correlation between QOL
in the United States. Eur Urol 2012;62:160-5. https://doi.org/10.1016/j. and stress indicates that patients with stone disease have factors other than
eururo.2012.03.052 stress that affect QOL. The WISQOL is a highly sensitive tool capable of
2. Sammon JD, Ghani KR, Karakiewicz, et al. Temporal trends, prac- measuring patients’ stone-related QOL.
tice patterns, and treatment outcomes for infected upper urinary
tract stones in the United States. Eur Urol 2013;64:85-92. https://doi. MP-3.3
org/10.1016/j.eururo.2012.09.035 Augmenting the predictive criteria for successful medical expulsive
3. Borofsky MS, Walter D, Shah O, et al. Surgical decompression is therapy
associated with decreased mortality in patients with sepsis and 1 2 1 1
ureteral calculi. J Urol 2013;189:946-51. https://doi.org/10.1016/j. Naveen Kachroo , Rajat Jain , Luay Alshara , Sherif Armanyous , Sara
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juro.2012.09.088 1 Maskal , Manoj Monga , Sri Sivalingam
Department of Urology, Cleveland Clinic, Cleveland, OH, United States;
2 Department of Urology, University of Rochester, Rochester, NY, United States
Introduction: A number of clinical and radiological predictors of either
stone impaction or ureteral stone passage have been proposed. We aimed
to identify the key predictors of successful stone passage during medical
expulsive therapy (MET) using readily available computed tomography (CT)-
based tools/measurements.
S96 CUAJ • June 2019 • Volume 13, Issue 6(Suppl5)
© 2019 Canadian Urological Association