Page 5 - CUA2019 Abstracts - Endourology

2019 CUA Abstracts

Methods: We performed a retrospective chart review of all consecu- improved non-exposed residents significantly. Residents scored higher
tive PCNLs performed at our centre from 2007–2010 (‘tubed era’) and in both bullseye and triangulation techniques after one session using the
2012–2014 (‘tubeless era’). For each case, we documented the exit strat- simulator. There is a role for simulation to complement clinical training
egy (tubed vs. tubeless), presence of pulmonary complications and inter- in centres with low PCNL volume.
vention undertaken, as well as access site location. Our primary outcome
was the rate of pulmonary complications between the tubed vs. tubeless MP-3.14
approach to PCNL.
Results: A total of 544 PCNLs were performed over this span of time. All Bilateral percutaneous nephrolithotomy on the same procedure:
160 cases during the tubed era were confirmed to have a nephrostomy A retrospective analysis of its safety and efficiency 1
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tube left at the end of the case, while of the 384 PCNLs performed dur- Joanie Pelletier , Ioana Fugaru , Frédéric Soucy , Bruno Laroche , Jonathan
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ing the tubeless era, 357 (93%) were left with only a stent. During the 1 Cloutier
tubed era, seven patients (4.4%) developed pulmonary complications. Urology, CHU de Québec, Québec City, QC, Canada
Of these, two patients were treated conservatively, with the remaining Introduction: Percutaneous nephrolithotomy (PCNL) has become the gold
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five patients requiring external drainage. During the tubeless era, four standard for more complex nephrolithiasis. When patients present with
patients (1.1%) developed pulmonary complications from PCNL access, bilateral kidney stones, there is no consensus as to whether to proceed to
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with three requiring percutaneous intervention. The tubed era had a lower a synchronous bilateral PCNL (sBPCNL) or do a staged surgery. To assess
rate of supra-11 punctures during this period (4.4%) compared to the the safety and efficacy of sBPCNL, we performed a review of the periop-
tubeless era (6.6%). The overall pulmonary complication rate during the erative outcomes of our sBPCNL. The second endpoint was to evaluate
study periods was 2.1%. the validity of the nephrolithometry nomogram (CROES) with sBPCNL.
Conclusions: There appears to be a trend towards increased risk of pul- Methods: Using hospital coding data, we identified 802 patients who
monary complications following PCNL with a tubed vs. tubeless approach underwent a PCNL between January 2006 and June 2016. Thirty of them
despite access site location. Overall, the risk of pulmonary injury follow- underwent a sBPCNL. The Charlson comorbidity index (CCI) was used to
ing PCNL remained low in our study cohort. compare comorbidities. The stone characteristics and prediction of stone-
References free rate (SFR) were analyzed using the CROES nephrolithometry scoring
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1. Tyson MD, Humphreys MR. Postoperative complications after per- system. The SFR was analyzed with an X-ray or a computed tomography.
cutaneous nephrolithotomy: A contemporary analysis by insurance Treatment success was defined as residual fragments of 4 mm or less.
status in the United States. J Endourol 2014;28:291-7. https://doi. Postoperative outcomes were evaluated with the modified Clavien Dindo
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org/10.1089/end.2013.0624 score. Bivariate analyses were used to identify variables affecting SFR.
2. Palnizky G, Halachmi S, Barak M. Pulmonary complications follow- Results: The median CCI was 3 (0–9) for the sBPCNL. The total mean
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ing percutaneous nephrolithotomy: A prospective study. Curr Urol stone burden was 416.9 mm (65.9–1479). The mean operating time
2014;7: 113-6. https://doi.org/10.1159/000356260 was 168 minutes (121–183). Fifteen (57.7%) patients had no postopera-
tive complications (Clavien 0). There was no Clavien score higher than
2. The SFR for the first side operated was achieved in 20 patients (68%)
MP-3.13 compared to 17 patients (61.5%) for the second side. Overall, the first side
Percutaneous nephrolithotomy (PCNL) training in Québec: operated had a better SFR than the second side in about 10% (p=0.37).
Patterns among residents and comparison of pre- and post- CROES scores predicted a SFR of 80% for both renal units compared to
simulation training scores 45% according to postoperative imaging.
Ahmad Almarzouq , Jason Hu , Julien Letendre , Naeem Bhojani , Jundi Conclusions: From our data, sBPCNL manipulation is feasible and safe.
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Mazen , Mohamed El-Sherbiny , Nader Fahmy 1 It can be offered to selected patients with medium-sized bilateral renal
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1 Urology Division, Department of Surgery, McGill University, Montréal, stones in high-volume centres by experienced surgeons. The CROES neph-
QC, Canada; Urology Division, Deptartment of Surgery, Université de rolithometry scoring system seems to be a valid tool to predict the SFR
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Montréal, Montréal, QC, Canada but for renal unit separately.
Introduction: Percutaneous nephrolithotomy (PCNL) is one of the cor- References
nerstone procedures in urology and gaining access to the pelvi-calyceal 1. Kadlec AO, Greco KA, Fridirici ZC, et al. Comparison of com-
system is a critical step. The evidence shows improvement of outcomes plication rates for unilateral and bilateral percutaneous nephroli-
and lower complications after the 15th case and plateaus after the 60th thotomy (PCNL) using a modified Clavien grading system. BJU Int
case. This number may not be attainable with a reduction in working 2013;11:E243-8. https://doi.org/10.1111/j.1464-410X.2012.11589.x
hours and the introduction of competency by design training model. The 2. Desai M, Grover R, Manohar T, et al. Simultaneous bilateral percu-
primary objective of this study was to establish trends of PCNL perfor- taneous nephrolithotomy: A single-centre experience. J Endourol
mances among urology residents in Québec. The secondary objective 2007;21:508-14. https://doi.org/10.1089/end.2006.0401
was to assess the impact of simulation training on PCNL access in a 3. Williams SK, Hoeing DM. Synchronous bilateral percutaneous
simulated (OSCE) setting. nephrostolithotomy. J Endourol 2009;10:1707-12. https://doi.
Methods: We conducted a retrospective review of the results from an org/10.1089/end.2009.1538
OSCE that included all senior urology residents from all Québec pro- 4. Smith A, Averch TD, Shahrour K, et al. A nephrolithometric normo-
grams. Bullseye and triangulation access by PGY3–5 were tested on the gram to predict treatment success of percutaneous nephrolithotomy.
PERC Mentor . Following the findings of the station, a session was given J Urol 2013;190:149-56. https://doi.org/10.1016/j.juro.2013.01.047
TM
to the residents in one program, where access using both techniques 5. Tefekli A, Karadag MA, Tepeler K, et al. Classification of percuta-
was taught on the simulator. In the second OSCE, one of the groups neous nephrolithotomy complications using the modified Clavien
was used as a control to compare the impact of one session of teaching grading system: Looking for a standard. Eur Urol 2008;53:184-90.
both techniques on the success of gaining access on the PERC Mentor . https://doi.org/10.1016/j.eururo.2007.06.049
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Results: A total of 33 residents were included. Fifty-one percent of the
residents had no prior experience with PCNL. Table 1 breaks down the
self-declared experience with PCNL prior to OSCE 1, stratified by resi-
dency year and program. The majority of residents had no prior case expe-
rience with either technique. Simulation training significantly improved
performances of previously non-exposed residents (Table 2).
Conclusions: There is a clear deficiency in PCNL access among a signifi-
cant portion of senior urology residents in Québec. Simulation training
S100 CUAJ • June 2019 • Volume 13, Issue 6(Suppl5)