Page 7 - CUA2019 Abstracts - Endourology

2019 CUA Abstracts

UP-3.2 10. Brown J. Diagnostic and treatment patterns for renal colic in US
Outcomes of surgical vs. medical management in emergency emergency departments. Int Urol Nephrol 2006;38:87-92. https://
departments for acute ureteral colic doi.org/10.1007/s11255-005-3622-6
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Grant Innes , Kevin Carlson , James Andruchow , Alec Mitchell , Andrew 11. Sfoungaristos S, Kavouras A, Kanatas P, et al. Early hospital admission
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McRae , Eric Grafstein , Frank Scheuermeyer , Michael Law , Joel and treatment onset may positively affect spontaneous passage of
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Teichman , Bryce A. Weber 1 ureteral stones in patients with renal colic. Urology 2014;84:16-21.
1 University of Calgary, Calgary, AB, Canada; University of British https://doi.org/10.1016/j.urology.2014.01.005
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Columbia, Vancouver, BC, Canada 12. Lindqvist K, Hellström M, Holmberg G, et al. Immediate versus
Introduction: Ureteric colic is a common condition that causes severe deferred radiological investigation after acute renal colic: A pro-
pain and generates substantial health system utilization. 1-5 Management spective randomized study. Scand J Urol Nephrol 2006;40:119-24.
includes analgesia and a trial of spontaneous passage, which succeeds https://doi.org/10.1080/00365590600688203
in most cases, 5-9 but causes severe morbidity. 10-14 Stone removal rapidly 13. Schoenfeld EM, Pekow PS, Shieh MS, et al. The diagnosis and man-
improves patient outcomes by relieving obstruction and pain, 15-17 but to agement of patients with renal colic across a sample of us hospitals:
date, there has not been a study comparing early intervention with spon- High CT utilization despite low rates of admission and inpatient uro-
taneous passage. 18 logic intervention. PLoS One 2017;12:1-15. https://doi.org/10.1371/
Methods: We looked at two health regions, Calgary Health Region and journal.pone.0169160
Vancouver Coastal Health region. Using regional administrative data- 14. Turk C, Petrik A, Sarica K, et al. EAU guidelines on interventional
bases, we identified all emergency department (ED) patients with a diag- treatment for urolithiasis. Eur Urol 2015;69:475-82. https://doi.
nosis of renal colic. Eligible patients required computed tomography (CT) org/10.1016/j.eururo.2015.07.041
to confirm a stone 2.0–9.9 mm in size. Two cohorts were studied: an early 15. Picozzi SCM, Ricci C, Gaeta M, et al. Urgent ureteroscopy as first-
intervention group, which had surgical intervention within three days line treatment for ureteral stones: A meta-analysis of 681 patients.
from ED presentation, and a trial of spontaneous passage group, which Urol Res 2012;40:581-6. https://doi.org/10.1007/s00240-012-
did not receive surgical intervention for at least five days. 0469-z
Results: We studied 3081 ED patients. Of these, 1168 (37.9%) underwent 16. Youn JH, Kim SS, Yu JH, et al. Efficacy and safety of emergency
early surgical intervention and 1913 (62.0%) had a trial of spontane- ureteroscopic management of ureteral calculi. Korean J Urol
ous passage. Patients that underwent spontaneous passage saw adverse 2012;53:632-5. https://doi.org/10.4111/kju.2012.53.9.632
outcomes increase in a linear fashion, with increasing stone width and 17. Sarica K, Tanriverdi O, Aydin M, et al. Emergency ureteroscopic
proximal location. In early intervention patients, outcomes are relatively removal of ureteral calculi after first colic attack: Is there any
constant regardless of stone size, but worse with proximal location. advantage? Urology 2011;78:516-20. https://doi.org/10.1016/j.
Conclusions: This study provides strong evidence for specific stone param- urology.2011.01.070
eters to guide early intervention in patients presenting with ureteral colic. 18. Canadian Agency for Drugs and Technologies in Health. Treatment
This data suggests that patients having low-risk stones (width <5 mm) strategies for patients with renal colic: A review of the compara-
undergo a trial of spontaneous passage, that patients having high-risk tive clinical and cost-effectiveness. CADTH Rapid Response Serv
stones (width >7.0 mm or proximal-middle >5 mm) be offered early 2014;November:1-6.
surgical intervention, and that those with medium-risk stones (distal >5.0
mm) be managed on a case-by-case basis. These recommendations are UP-3.3
more aggressive than current American guidelines, which recommend a Role of attenuation histogram analysis in the prediction of
trial of spontaneous passage at <10 mm. extracorporeal shockwave lithotripsy efficacy for renal and
This paper has a figure, which may be viewed online at: ureteric calculi
https://2019.cua.events/webapp/lecture/106 Benjamin Shiff , Mark Nassar , Premal Patel , Signy Holmes , Taylor
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References Kohn , Brian Peters , Mohammad Mohaghegh , Iain Kirkpatrick 2
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1. Scales CD, Smith AC, Hanley JM, et al. Prevalence of kidney 1 Urology, University of Manitoba, Winnipeg, MB, Canada; Radiology,
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stones in the United States. Eur Urol 2012;62:160-5. https://doi. University of Manitoba, Winnipeg, MB, Canada; Urology, University
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org/10.1016/j.eururo.2012.03.052 of Miami, Miami, FL, United States; Surgery, Johns Hopkins University,
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2. Bensalah K, Tuncel A, Gupta A, et al. Determinants of quality of life Baltimore, MD, United States; Surgery, University of Manitoba, Winnipeg,
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for patients with kidney stones. J Urol 2008;179:2238-43; discussion MB, Canada
2243. https://doi.org/10.1016/j.juro.2008.01.116 Introduction: Extracorporeal shockwave lithotripsy (ESWL) is a frequent
3. Saigal CS, Joyce G, Timilsina AR. Direct and indirect costs of neph- first-line treatment of renal and ureteric calculi. However, the efficacy
rolithiasis in an employed population: Opportunity for disease of this treatment modality is variable. Recently, novel computed tomog-
management? Kidney Int 2005;68:1808-14. https://doi.org/10.1111/ raphy (CT) parameters describing stone heterogeneity have been shown
j.1523-1755.2005.00599.x to correlate with treatment outcome. Stone heterogeneity studies have
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4. Bryant M, Angell J, Tu H, et al. Health-related quality of life for been limited to analysis of standard deviation of stone density and its
stone formers. J Urol 2012;188:436-40. https://doi.org/10.1016/j. derivatives. More detailed heterogeneity evaluation using density histo-
juro.2012.04.015 gram analysis may provide more accurate prediction of ESWL success.
5. Teichman JM. Acute renal colic from ureteral calculus. N Engl J Med Methods: A historical cohort of 57 patients who had undergone ESWL
2004;350:684-93. https://doi.org/10.1056/NEJMcp030813 at our institution between January and June 2017 was identified. Stones
6. Ordon M, Andonian S, Blew B, et al. Canadian Urological <5 mm or >20 mm in diameter were excluded. Pre-procedure CT scans
Association guideline: Management of ureteral calculi. Can Urol were reviewed for stone parameters and post-procedure x-rays were used
Assoc J 2015;9:E837-51. https://doi.org/10.5489/cuaj.3483 to determine ESWL success, defined as absence of residual stone frag-
7. Preminger GM, Tiselius HG, Assimos DG, et al. 2007 guideline ments >4 mm after up to three treatments within a three-month period.
for the management of ureteral calculi. J Urol 2007;178:2418-34. Stone parameters were compared between the success and failure groups.
https://doi.org/10.1016/j.juro.2007.09.107 Results: Of 57 ESWL patients, 36 (63.2%), had treatment success and
8. Coll DM, Varanelli MJ, Smith RC. Relationship of spontaneous pas- 21 (36.8%) had treatment failure. Successful stones were of higher mean
sage of ureteral calculi to stone size and location as revealed by axial density (1133.8 vs. 933.5 HU; p=0.006) and of smaller volume
unenhanced helical CT. Am J Roentgenol 2002;178:101-3. https:// (0.32 vs. 0.43 cm ; p=0.13) than the unsuccessful ones, though the latter
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doi.org/10.2214/ajr.178.1.1780101 difference was not significant. In ordinal regression, controlling for stone
9. oursey C, Casalino D, Remer E, et al. ACR appropriateness criteria: volume, laterality, location, and number of ESWL attempts, percent of
Acute onset flank pain suspicion of stone disease. Ultrasound Q Hounsfield unit per stone was not predictive of ESWL success (p>0.05).
2012;28:227-33. https://doi.org/10.1097/RUQ.0b013e3182625974
S102 CUAJ • June 2019 • Volume 13, Issue 6(Suppl5)