Page 4 - CUA2019 Abstracts - Endourology

Poster session 3: Endourology

MP-3.9 March 2018 with billing codes signifying “diagnostic ureteroscopy.” These
Radiation exposure in prone vs. modified supine position during patients were then individually queried and those with failed access were
percutaneous nephrolithotomy: Results with an anthropomorphic included in our patient cohort. Patients declining interval ureteroscopy
model or those with known strictures were excluded. The outcome measures
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Marie-Pier St-Laurent , Maéva Rosec , Jean-Baptiste Terrasa , Lucca Villa , were mean/median time to salvage ureteroscopy (days) and the rate of
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Olivier Traxer , Jonathan Cloutier 1,2 successful renal access of the repeat procedure.
1 Department of Urology, University Hospital of Québec – Université Laval, Results: A total of 119 patients were identified as having a failed ureteros-
Québec City, QC, Canada; Department of Urology, Tenon University copy during our study period. Average and median age were 55.85 and
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Hospital, APHP, Paris, France 56.99 years, respectively. Median stent duration to second procedure was
Introduction: Radiation exposure during urological procedures is still of 17 days (mean 20.46, range 10–84). Twenty-two (18.49%) patients had
concern in the urology community. It has been reported that percutane- their repeat ureteroscopy between 10 and 13 days. No patients underwent
ous nephrolithotomy (PCNL) in supine position has less irradiation, as repeat ureteroscopy in less than 10 days. The overall success rate of renal
the puncture is mostly done under ultrasound guidance. However, it can access during a second ureteroscopy after stenting was 99.16% (118/119).
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also be done under fluoroscopy guidance. Unfortunately, data on radia- Conclusions: Ureteric stenting following failed ureteroscopy leads
tion exposure during PCNL is lacking since they are often drawn form to exceedingly high rates of successful access at interval procedure
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generalization and extrapolation, or are not evaluating new procedures (99.16%). Of the patients that underwent an accelerated second proce-
or different positions. The aim of our study was to compare the radiation dure (between 10 and 13 days of stenting), all had successful access at
dose depending on the position of the surgeon. their interval procedure.
Methods: A portable C-arm was used in standard mode (32 impulsions/
seconde; 98 kV, 3.8 mA). Specific dosimeters were placed for lens, extrem- MP-3.11
ity, and torso. Anthropomorphic models and hand phantom models were Perioperative opiate use for transurethral surgery patients with
used to reproduce the position of surgeon and patient (with same bone catheter-related bladder discomfort
density than real human) during PCNL in prone and modified supine posi- Samir Sami , Haider Abed , Alina Abbasi , Hassan Razvi
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tion. Fluoroscopy time (FT) was six minutes to obtain higher exploitable 1 Urology, London Health Sciences Centre, London, ON, Canada;
signal and the results are given for a FT of three minutes (more realistic). 2 Medicine, Western University, London, ON, Canada
Ten percent of the FT is done with an angulation of 15 degrees and the Introduction: Catheter-related bladder discomfort (CRBD) is common in
rest in anteroposterior position. the postoperative period following transurethral surgery. CRBD can cause
Results: The equivalent doses (ED) are given in uSV (uncertainty k=2). significant pain and often requires multimodal analgesia. Over-prescription
During the modified supine position: neck, lens, right index finger, left of narcotics is prevalent during this period and has been implicated in
thumb, and index finger received ED of 99 (20%), 62 (18%), 437 (10%), potential long-term misuse after low-risk surgery. We sought to improve
112 (12%), and 204 (10%), respectively. In a prone position, the phantom understanding of CRBD management at our centre by identifying analgesic
received ED on the neck, lens, right thumb and index finger, and left use incidence and assessing potential contributory perioperative factors.
thumb and index finger of 85 (20%), 92 (12%), 401 (10%), 585 (10%), Methods: We retrospectively reviewed all patients undergoing a trans-
295 (10%), and 567 (10%), respectively. In both positions, the right hand urethral resection of prostate (TURP) or bladder tumour (TURBT) at our
seems more exposed than the left hand. center from 2016–2018. Descriptive statistics were used to evaluate gen-
Conclusions: The effective dose is 1.5- and 1.3-fold higher for lens and eral trends, and assessment of potential factors that could be predictive of
extremities, respectively, in a prone position PCNL compared to a modi- opioid-specific analgesia requirement, including preoperative analgesic
fied supine position. Both positions are still well below the recommended use, catheter size, previous indwelling catheter, anesthetic type, trial of
limit for professional exposure. 3 void (ToV) success, and use of anticholinergics postoperatively, was done
References by multivariate logistical and linear regression.
1. Breda A, Territo A, Scoffone C, et al. The evaluation of radiologic Results: A total of 310 patients with a mean age of 71.7 years, including
methods for access guidance in percutaneous nephrolithotomy: 174 and 126 patients who underwent TURP and TURBT, respectively,
A systematic review of the literature. Scand J Urol 2018;52:81-6. were analyzed. Of these, 173 patients did not use any preoperative anal-
https://doi.org/10.1080/21681805.2017.1394910 gesia regularly, 86 patients used non-steroidal anti-inflammatories, and 23
2. Hellawell GO, Mutch SJ, Thevendran G, et al. Radiation exposure used opiates. In the early postoperative period, 75% of patients required
and the urologist: What are the risks? J Urol 2005;174:948-52; dis- analgesics, including 61% who required mild opioids, 22% who required
cussion 952. https://doi.org/10.1097/01.ju.0000170232.58930.8f an additional strong opioid, and 40% who required anticholinergic use
3. Governor General in Council, Radiation Protection Regulations, for CRBD. Among TURP patients, spinal anesthetic showed an associa-
in (SOR/2000-203), Minister of Natural Resources, Editor. 2000: tion with mild opiate use (p<0.05), while lack of anticholinergic use and
Official Gazette, Statutory Instruments, 2000;134:1171-83. day 1 ToV failure showed an association with strong opiate use (p<0.05).
Conclusions: Opioid analgesics are commonly used for CRBD following
MP-3.10 transurethral surgery. Adjunctive non-opiate treatment modalities need
Success rate of repeat flexible ureteroscopy following previous to be further explored in order to better control CRBD and minimize
failed access from ureteral spasm opiate use.
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Dylan Hoare , Tim Wollin , Shubha De , Michael G. Hobart 1
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1 Division of Urology, Department of Surgery, University of Alberta, MP-3.12
Edmonton, AB, Canada Pulmonary complications following percutaneous
Introduction: Approximately 8% of patients that undergo therapeutic or nephrolithotomy in the tubed vs. tubeless eras
diagnostic ureteroscopy will have the procedure aborted due to failed Monica Farcas , Thomas Canil , Daniela Ghiculete , R. John D. Honey 1
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access. These patients are usually stented to allow for passive dilation of 1 Urology, St. Michael’s Hospital, Toronto, ON, Canada
the ureter. There is currently no evidence-based duration for indwelling Introduction: Pulmonary complications, although rare, can be a significant
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ureteric stents after which interval ureteroscopy should be attempted. The cause of morbidity to patients undergoing percutaneous nephrolithotomy
primary objective of this study was to assess the average time to salvage/ (PCNL). The routine use of nephrostomy tubes following PCNL (tubed
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staged ureteroscopy and the associated rate of successful renal access. approach) may pose an increased risk of clinically significant pulmonary
Methods: This retrospective descriptive study evaluated all patients under- injury by potentiating a transpleural tract. Our objective in this study was to
going interval ureteroscopy following a failed procedure by urologic assess whether the cessation of routine nephrostomy tube insertion following
surgeons participating in the stone treatment group at the University of PCNL (tubeless approach) has reduced the incidence of pulmonary injuries.
Alberta affiliated hospitals. Patients were identified from January 2016 to
CUAJ • June 2019 • Volume 13, Issue 6(Suppl5) S99