Page 19 - CUA 2020_Endourology

2020 CUA ABSTRACTS

Moderated Poster Session 1: Endourology I

MP-1.2
Safety and efficacy of synchronous bilateral percutaneous MP-1.3. Table 1. Demographic and preoperative information
nephrolithotomy: A matched retrospective cohort study of all patients included in the study
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Colin Lundeen , Victor KF Wong , Kymora Scotland , Ben H. Chew 1 Variable Outpatient Standard p
1 Department of Urologic Sciences, University of British Columbia, PCNL PCNL
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Vancouver, BC, Canada; Department of Urology, University of California
Los Angeles, Los Angeles, CA, United States Number of patients 20 20 -
Introduction: Percutaneous nephrolithotomy (PCNL) is the gold standard Number of males 15 10 0.11
treatment for renal stones greater than 2 cm. For patients with substantial Mean age 52.0 56.0 0.29
bilateral nephrolithiasis requiring stone treatment, there is debate regarding
the safety and efficacy of synchronous vs. staged bilateral procedures. At Mean BMI 32.6 31.0 0.61
our tertiary hospital, nearly all bilateral PCNL procedures are performed Total bilateral PCNL 2 5 0.22
in a synchronous fashion. In this study, we investigated synchronous PCNL Total unilateral PCNL and 4 0 0.01*
for the treatment of bilateral renal stones. Contralateral Ureteroscopy
Methods: Using the institutional review board-approved PCNL database
from our hospital, patients who underwent bilateral synchronous PCNL Mean sum diameter of all 40.8 27.0 0.002*
were retrospectively matched by age, gender, and American Society of stones (mm)
Anesthesiologists physical status classification to patients with unilateral Mean Guy’s score 2.4 2.0 0.10
stones undergoing PCNL. Procedures were performed in the prone position Standard PCNL patients were match paired with outpatient PCNL patients. *Statistical
using balloon dilation up to 30 F, ultrasonic lithotripsy followed by flexible significance.
nephroscopy ± laser lithotripsy. Non-contrast computed tomography (CT)
was performed on postoperative day one to assess for residual fragments.
Results: A total of 90 subjects were included with 45 in each group. Subjects sPCNL (fluoroscopic with nephrostomy tube with postoperative nephrosto-
undergoing bilateral synchronous PCNL had longer operating room (OR) gram) were retrospectively compared with the oPCNL (endoscopic-guided
times (249.5 vs. 179.2 minuyes; p<0.001) and hospital stay (3.60 vs. 2.56 with stent and tripe hemostasis with same-day computed tomography [CT]
days; p=0.020), as well as more residual fragments (1.63 vs. 1.28; p=0.001). scan) cohort based on age, body mass index (BMI), and stone burden (Table
No differences were seen in complications, narcotic use, readmission rates, 1). Student’s t-tests were used to determine statistical significance.
or postoperative hemoglobin change (p>0.05). Results: Twenty patients underwent oPCNL and 20 underwent sPCNL. The
Conclusions: Bilateral synchronous PCNL is safe in stone patients but may oPCNL technique at a single center demonstrates a reduction in patient
lead to longer OR times and hospital stay, in addition to more residual frag- cost. Postoperative complications were not different (Table 2). There was
ments compared to unilateral PCNL. Further prospective data is required no significant difference in postoperative emergency department visits or
to determine the optimal treatment timing for patients with substantial hospital readmission. Median time to discharge was 12.4 hours for oPCNL
bilateral stone burden. and 55.7 hours for sPCNL. For oPCNL, 64% of accesses were via the upper
pole, while 84% of sPCNL was accessed via the lower pole.
Conclusions: The oPCNL group in this early cohort shows a total cost
MP-1.3 savings of $53 420 despite higher operative case cost with majority of
Early assessment and outcomes of tubeless outpatient percutaneous patients discharged same day. This represents a large percentage of upper
nephrolithotomy: A retrospective, contemporaneous analysis to pole oPCNL patients with no difference in complications. Long-term data
standard percutaneous nephrolithotomy at a single center is required to see if costs change with a larger patient population.
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Zachary Valley , John W. Dushinski , Richard E. Barr , Patricia A. Dere ,
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Derek Bley , Charles B. Metcalfe , Kamaljot S. Kaler 1 MP-1.4
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1 Department of Surgery, Section of Urology, University of Calgary, Calgary,
AB, Canada Outcome of miniaturized percutaneous nephrolithotomy using
hemostatic plug vs. standard percutaneous nephrolithotomy
Introduction: Standard percutaneous nephrolithotomy (sPCNL) is the gold 1 1 1 1
standard surgical treatment for large renal calculi. Traditionally, the patient Fabiola Oquendo , Amr Hodhod , Loay Abbas , Brianna Beaudry , Amer
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is admitted postoperatively with an indwelling nephrostomy tube, which Alaref , Yasser Labib , Scott Bonneville , Ahmed Kotb , Owen Prowse , Walid
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is typically removed within 1–2 days. However, use of nephrostomy tubes Shahrour , Hazem Elmansy
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has its downsides, including discomfort, urine leakage, and prolonged dis- Urology, Northern Ontario School of Medicine, Thunder Bay, ON,
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charge. Recently, outpatient tubeless PCNL (oPCNL) has been described Canada; Radiology, Northern Ontario School of Medicine, Thunder Bay,
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where patients are discharged on the same day as surgery without the ON, Canada; Anesthesia, Northern Ontario School of Medicine, Thunder
use of a nephrostomy tube but instead with a stent. We hypothesize that Bay, ON, Canada
oPCNL will result in lower healthcare costs when compared to sPCNL Introduction: We assessed perioperative morbidity and stone-free rate (SFR)
with similar outcomes. after mini percutaneous nephrolithotomy (mPCNL) using hemostatic plug
Methods: A retrospective chart review was conducted of patients who under- vs. standard percutaneous nephrolithotomy (sPCNL) for managing single
went PCNL at the Rockyview General Hospital from June to September medium-sized renal stones (1–3 cm)
2019 by three fellowship-trained endourologists. Patients who underwent Methods: We conducted a retrospective study of prospectively collected
data from 2018 to 2019. All patients underwent a preoperative non-contrast
CUAJ • June 2020 • Volume 14, Issue 6(Suppl2) S79
© 2020 Canadian Urological Association