Page 2 - CUA2019 Abstracts - Endourology

Poster session 3: Endourology

Methods: Patients presenting to the emergency room from February 2017 This paper has a figure, which may be viewed online at:
to February 2018 with an acute unilateral ureteral stone confirmed on https://2019.cua.events/webapp/lecture/92
non-contrast CT and managed by MET were prospectively followed for References
stone passage. Patients with renal impairment, sepsis, or requiring emergent 1. Peterli R, Wölnerhanssen BK, Peters T, et al. Effect of laparoscopic
intervention were excluded. Patients were followed at one month to con- sleeve gastrectomy vs. laparoscopic Roux-en-Y gastric bypass on
firm stone passage (stone collection/repeat imaging) or failure of passage. weight loss in patients with morbid obesity. JAMA 2018;319:255-65.
CT variables analyzed: stone factors (location, size, volume, Hounsfield https://doi.org/10.1001/jama.2017.20897
unit density [HUD]), ureteral HUD above and below the stone, maximal 2. Valezi AC, Fuganti PE, Junior JM, et al. Urinary evaluation after
ureteral wall thickness (UWT) at the stone site, contralateral UWT and RYGBP: A lithogenic profile with early postoperative increase in
ureteral diameter above and below the stone. Binary logistic regression the incidence of urolithiasis. Obes Surg 2013;23:1575-80. https://
analysis was performed to identify predictors of stone passage. doi.org/10.1007/s11695-013-0916-0
Results: Forty-nine patients met study inclusion criteria, of whom 32
(65.3%) passed the stone without further intervention. The HUD above/ MP-3.5
below stone, ureteral diameter, or any stone factor did not have a significant
predictive value. Only maximal UWT at the stone site was significantly Tubeless ambulatory percutaneous nephrolithotomy: Initial
associated with stone passage, with the odds of stone passage decreasing by 15-year experience from a single institution 1
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97.5% for each 1 mm increase in UWT above 2 mm at the stone impaction Kash Visram , Michael A. Di Lena , Michael Kim , Andrea Kokorovic,
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site (odds ratio 0.0149; p=0.02) (Table 1). Youden’s criterion identified 2.3 Darren T. Beiko
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mm as the optimal UWT cutoff point, below which will accurately predict Department of Urology, Queen’s University, Kingston, ON, Canada
stone passage with an 87.5% sensitivity and 82.4% specificity. Introduction: Percutaneous nephrolithotomy (PCNL) is the gold standard
Conclusions: Maximal UWT at the stone site was the most significant treatment for large renal calculi, and is typically regarded as an inpatient
predictor of successful MET in acute unilateral ureteral stones, with an procedure. Tubeless ambulatory PCNL (aPCNL) has been shown to be
optimal cutoff point of 2.3 mm. Further prospective studies are needed a safe and effective procedure when adhering to strict discharge criteria
to accurately predict spontaneous stone passage. in carefully selected patients. We report the outcomes over our initial
This paper has a figure, which may be viewed online at: 15-year experience with aPCNL to better define the safety and efficacy
https://2019.cua.events/webapp/lecture/91 of this approach.
Methods: A retrospective chart review was conducted of all consecutive
unilateral and bilateral ambulatory PCNL cases done at Kingston Health
MP-3.4 Sciences Centre from January 1, 2004 to December 31, 2018. Preoperative,
Bariatric surgery in patients with a history of nephrolithiasis: intraoperative, and postoperative data were collected, including gender,
24-hour urine profiles and radiographic changes after Roux-en-Y age, body mass index (BMI), American Society of Anesthesiologists (ASA)
gastric bypass vs. sleeve gastrectomy score, stone type, number, size, and location based on imaging. Safety
Richard Di Lena , Michael Uy , Jen Hoogenes , Badr Al-Harbi , Scott of aPCNL was determined by assessing postoperative complications,
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Gmora , Bobby Shayegan , Edward D. Matsumoto emergency department (ED) visits, and hospital readmissions. Efficacy of
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1 Department of Surgery, Division of Urology, McMaster University, aPCNL was determined by assessing radiographic stone-free rate.
Hamilton, ON, Canada; Department of Surgery, Division of General Results: The mean patient age was 55.7 years, 54% were male and 46%
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Surgery, McMaster University, Hamilton, ON, Canada were female. The average BMI was 34.3 kg/m , and 46% of patients
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Introduction: Roux-en-Y gastric bypass (RNYGB) and sleeve gastrectomy were ASA 3. The average stone size was 16.1 mm, and 59% of patients
(SG) are the most common bariatric surgeries, yet it is not clear which is had multiple stones. At the time of abstract submission, we did not have
superior. Considering the propensity for the development of lithogenic complete followup data available on all patients. The preliminary stone-
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urinary profiles and nephrolithiasis, post-bariatric surgery is important. To free rate was 88%, with 17% and 5% of patients requiring ED visits and
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our knowledge, no studies have evaluated these changes in post-bariatric hospital readmission, respectively.
surgery patients with a history of nephrolithiasis. We evaluated the dif- Conclusions: aPCNL is a safe and effective treatment and patient selection
ferences in 24-hour urine (24HU) values and radiographic imaging post- and strict discharge criteria are still imperative for success. However, our
RNYGB and SG in patients with a history of nephrolithiasis. data shows that despite performing aPCNL in more comorbid patients with
Methods: We reviewed the records of 92 patients with a history of more complex stones, a high stone-free rate and low hospital readmission
nephrolithiasis and who underwent either RNYGB or GS at our centre. rate can be achieved.
Computed tomography of the kidney-ureter- bladder (CT KUB) imaging and
24HU profiles were performed preoperatively and at one-year followup. MP-3.6
The Wilcoxon rank sum test compared pre- and postoperative values, while
multivariate regression analysis determined predictors of stones. Incidence of hydronephrosis and stricture with the use of ureteral
Results: Fifty-five patients underwent RNYGB and 37 had SG. No base- access sheaths in the treatment of nephrolithiasis 2
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line differences were found between groups. For 24HU profiles (Table Luke F. Reynolds , Daniela Ghiculete , Abdulaziz M. Althunayan , Jason
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1), both groups had similar findings, although the RNYGB group had a Lee , Michael Ordon , Kenneth T. Pace
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significant increase in oxalate and a decrease in citrate, while the SG 2 Division of Urology, St. Michael’s Hospital, Toronto, ON, Canada;
group had a significant decrease in oxalate and stable citrate. A history 3 Division of Urology, King Khalid University, Riyadh, Saudi Arabia;
of stone procedures (odds ratio [OR] 4.4; 95% confidence interval [CI] Division of Urology, Toronto General Hospital, Toronto, ON, Canada
1.2–16.5; p=0.03) and RNYGB (OR 4.2; 95% CI 1.2–14.9; p=0.03) were Introduction: The ureteral access sheath (UAS) is an effective adjunct
predictors of postoperative hyperoxaluria. Radiographically, 20.4% of the for ureteroscopic management of stone disease. While there are many
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RNYGB group and 24.3% of the SG developed new stones. Postoperative benefits, there is a risk of ureteric injury with UAS use. A clear causative
stone procedure rate for each group was 9.3% and 8.1%, respectively. link between UAS use and ureteral stricture disease has not been dem-
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Conclusions: Patients with a history of nephrolithiasis who underwent onstrated, but is possible. Our objective was to assess the incidence of
RNYGB had exacerbated lithogenic 24HU profiles, while those in SG hydronephrosis and ureteric strictures following ureteroscopy (URS) for
patients improved. There were no differences in stone event rate, although urolithiaisis with and without the use of a UAS.
this may be due to limited followup. The postoperative stone formation Methods: Consecutive patients undergoing URS for urolithiasis with
rate is higher than previously reported in similar studies. These findings and without ureteral access sheaths were compared. A control group of
support close urinary monitoring in patients with a history of nephroli- patients undergoing semi-rigid and flexible URS without a UAS was used
thiasis who undergo RNYGB. to compare outcomes of patients undergoing flexible URS with either
a 9.5/11 Fr or 12/14 Fr UAS for ureteric and renal stones. The primary
CUAJ • June 2019 • Volume 13, Issue 6(Suppl5) S97