Page 20 - CUA 2020_Endourology

2020 CUA Abstracts

MP-1.3. Table 2. Perioperative data MP-1.4. Table 1. Patient characteristics and preoperative
Variable Outpatient Standard p data
PCNL PCNL mPCNL sPCNL
Parameter p
Mean operating time (min) 85.5 42.7 <0.001* 25 patients 39 patients
Mean fluoroscopy time (sec) 46.3 249.2 <0.001* Age median (range), years 58.5 (34–72) 61 (23–85) 0.42
Nephrostomy tract access Side Right, n (%) 11 (44) 15 (38.5) 0.66
location Left, n (%) 14 (56) 24 (61.5)
Lower pole 2 21 - Male, n (%) 15 (60) 23 (59)
Interpolar 4 2 - Gender Female, n 10 (40) 16 (41) 0.94
Upper pole 14 0 - (%)
Renal pelvis 0 1 - Nil or mild, 16 (64) 31 (79.5)
n (%)
Unknown 2 1 -
Hydronephrosis Moderate 0.17
Mean number of punctures 1.2 1.1 0.51
or severe, 9 (36) 8 (20.5)
Mean number of dilated tracts 1.1 1.0 0.33 n (%)
Mean hospital stay (hours) 21.2 58.7 <0.001* 19 mm 21 mm
Stone burden median (range) 0.08
Mean hospital stay 0.8 2.1 <0.001* (10–24) (11–29)
(postoperative days) Pelvic, n (%) 5 (20) 11 (28.2)
Mean operative cost/patient $2504.00 $1752.50 <0.001* Lower
(CAD) calyx, n (%) 16 (64) 19 (48.8)
Mean total hospital stay/patient $3054.95 $8473.25 <0.001* Stone location Middle
(CAD) calyx, n (%) 3 (12) 7 (17.9)
Total SIRS 1 1 1.0 Upper
Total UTI 2 2 0.96 calyx, n (%) 1 (4) 2 (5.1)
Total postoperative 3 1 0.31
complications MP-1.5
Total emergency department 4 3 0.63 Single-center experience: Miniaturized percutaneous
visits nephrolithotomy vs. flexible ureteroscopy in management of
Total hospital readmission 3 4 0.74 lower calyceal renal stones ≤2 cm 1 1
1
1
Mean cost of readmission $11 995.18 $2016.25 0.15 Fabiola Oquendo , Amr Hodhod , Loay Abbas , Brianna Beaudry , Yasser
Labib , Scott Bonneville , Ahmed Kotb , Owen Prowse , Walid Shahrour ,
1
2
1
1
2
(CAD) Hazem Elmansy 1
*Statistical significance. 1 Urology, Northern Ontario School of Medicine, Thunder Bay, ON,
Canada; Anesthesia, Northern Ontario School of Medicine, Thunder
2
computed tomography (CT) to determine hydronephrosis grade, stone Bay, ON, Canada
burden, and location. A 16.5/17.5 F system (Karl Storz, Germany) was Introduction: The aim of this study is to compare outcomes of miniatur-
used for mPCNL and a 30 F sheath with a 26 F nephroscope (Karl Storz, ized percutaneous nephrolithotomy (mPCNL) and flexible ureteroscopy
Germany) was used for sPCNL. A nephrostomy tube remained after (fURS) at our tertiary institution. We assessed the safety of discharging
sPCNL, while a Floseal hemostatic plug was used after mPCNL. Operative patients undergoing mPCNL for the management of lower calyceal renal
data were collected. Patients undergoing mPCNL were discharged the stones ≤2 cm on the same operative day.
same day and sPCNL patients were discharged two days after surgery. A Methods: We conducted a retrospective study of prospectively collected
non-contrast CT was done on postoperative day 1 to evaluate the pres- data from September 2018 to September 2019. Demographic data were
ence of hematoma. Postoperative complications were assessed using the collected. All patients underwent a preoperative evaluation using non-
Clavien-Dindo system. Hematomas were graded based on size: <10 mm contrast helical computed tomography (CT) to determine hydronephrosis
(trace): small; 10–30 mm: moderate; and >30 mm: large. At one month grade, stone burden, and location. mPCNL was performed using either
followup, a non-contrast CT was done to detect residual stones. Stone-free a Storz (Germany) 16.5/17.5 Fr nephroscope or fURS. Operative data
was defined as residual stone fragments ≤3 mm. included operative time, fluoroscopy time, intraoperative complications,
Results: Twenty-five patients underwent mPCNL with hemostatic plug and and the need for JJ stenting. Patients were postoperatively discharged on
39 patients had sPCNL. Patients’ characteristics are presented in Table 1. the same day. Postoperative complications were collected and assessed
None of the patients had intraoperative complications. The mPCNL arm using the Clavien-Dindo system. A non-contrast helical CT was ordered at
had less operative time (70 vs. 93 minutes) and fluoroscopic time (102 vs. one month to detect residual stones. A patient was defined as stone-free
143 seconds) (p=0.013 and p<0.001, respectively) (Table 2). Perioperative if residual stone fragments were ≤3 mm.
morbidity and hemoglobin loss percentages were similar in both groups Results: Thirty-seven patients underwent mPCNL and 54 patients had
(p=0.4 and p=0.29, respectively). Sixteen percent of mPCNL were com- fURS. Patient demographics are presented in Table 1. There was no sig-
plicated with hematomas compared to 7.7% after sPCNL (p=0.3) (Table nificant difference between the treatment modalities in terms of gender,
2). SFR and residual stone size were comparable among the groups. affected kidney side, and stone burden. mPCNL was associated with
Conclusions: We found mPCNL with hemostatic plug to be a safe and shorter operating room time but longer fluoroscopy time than fURS
effective procedure that reduced hospital stays. (p=0.03 and p<0.001, respectively) (Table 2). No intraoperative compli-
cations were reported for either group. fURS was associated with a higher
S80 CUAJ • June 2020 • Volume 14, Issue 6(Suppl2)