Page 8 - CUA 2020_Endourology

2020 CUA Abstracts

UP-1.9 UP-1.10
Robotic-assisted laparoscopic technique for repair of iatrogenic Urological use of nephrostomy tubes for ureteric obstruction
ureteric injuries from gynecologic surgeries – the Edmonton Nick Dean , Gillian Shiau , Shubhadip (Shubha) K. De , Tim Wollin 1
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2
1
experience 1 Urology, University of Alberta, Edmonton, AB, Canada; Interventional
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Alexandra Bain , Blair A. St Martin , Michael G. Hobart 1 Radiology, University of Alberta, Edmonton, AB, Canada
1
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1 Urology, University of Alberta, Edmonton, AB, Canada Introduction: We aimed to assess the use of nephrostomy tube drain-
Introduction: The incidence of iatrogenic genitourinary injuries occur- age with and without antegrade stenting over a six-year period. The pri-
ring at the time of gynecologic surgery for benign disease is estimated mary objective was to identify if there was a change in the volume of
at 1%, with approximately 70% of injuries involving the bladder and nephrostomy tubes placed over time and to describe the indication for
30% involving the ureters. Recently, centers performing high volumes of placement for both benign and malignant causes of ureteric obstruction.
1
robotic-assisted laparoscopic surgery have converted to using a robotic- The secondary objective of our study was to better delineate the role of
assisted approach to repair these injuries, but only a handful of series have the urologist in the setting of patients with both benign and malignant
been published on this novel approach. Edmonton has one of the high- ureteric obstruction.
est volumes of robotic-assisted laparoscopic surgery in Canada and has Methods: We performed a retrospective analysis of percutaneous neph-
been using a robotic approach for repair of these injuries. We performed rostomy requisition data provided by the Interventional Radiology depart-
a review of the indications, technique, and postoperative outcomes of ment in Edmonton, Alberta from 2013–2019. Using patient identifiers,
these repairs at our center. long-term outcome data was tracked from 2013 to present using the
Methods: A case study of patients from January 2018 to September 2019 electronic medical record at the Kipnes Urology Center and compiled
who underwent robotic assisted laparoscopic repair of iatrogenic ureteric in our database.
injuries from gynecologic surgery for benign disease were reviewed. Results: From 2013 to present, a total of 1247 nephrostomy tubes were
Results: Six patients were identified that had iatrogenic ureteric injuries inserted in Edmonton. The incidence of nephrostomy tube insertion
from gynecologic surgery that were repaired with a robotic-assisted lapa- increased linearly from 156 in 2013 to 246 in 2018. The main indication
roscopic approach. Five of six cases were a delayed repair with an average for new nephrostomy tube placement was malignancy in 45% and stone
of three months (94 days) between time of injury and time of repair. All disease in 22% in 2018; 50% (18/36) of patients who had a nephrostomy
injuries were in the distal ureter requiring ureteroneocystostomy. Followup tube placed for non-prostate cancer malignant hydronephrosis were dead
for all patients included a cystogram two weeks postoperatively, cystoscopy, within one year and 35% (12/34) of patients receiving a nephrostomy
stent removal 4–8 weeks postoperatively, and renal scan at 3–4 months. tube for an obstructing ureteric stone had a previous failed cystoscopic
All patients had complete resolution of ureteric obstruction by six months, placement of a retrograde stent. For other services that initiated a nephros-
with no evidence of leak, stricture, or persistent obstruction (Table 1). tomy tube insertion, urology became involved in 95% of cases last year.
Conclusions: Robotic-assisted laparoscopic repair of iatrogenic injuries Conclusions: Our system’s use of nephrostomy tubes is increasing. Using
post-gynecologic surgery is an effective technique, with all patients hav- this database, we will attempt to discover predictors of failed retrograde
ing successful resolution of obstruction. In the era of minimally invasive stent placement by cystoscopy in the setting of obstructing ureteric stones,
surgery and patient expectations, this technique offers patients an option failed indwelling stents in the setting of malignant hydronephrosis, evaluate
to resolve a surgical complication with potentially less morbidity than a one- vs. two-stage nephrostomy tubes and antegrade stents, and shed light
traditional open repair. on the optimal treatment strategy for treating causes of ureteric obstruction.
Reference
1. Gellhaus PT, Bhandari A, Monn MF, et al. Robotic management of UP-1.11
genitourinary injuries from obstetric and gynecological operations: Effect of 2012 and 2017 United States Preventive Services Task Force
A multi-institutional report of outcomes. BJU Int 2015;115:430-6. prostate-specific antigen screening guidelines on prostate cancer
https://doi.org/10.1111/bju.12785
grade and age of diagnosis: A single-center, retrospective study
1
Samantha McGirr , Luke Wang , Jinfeng Jiang , Bryant Van Leeuwen , Chad
1
1
1
A. LaGrange , Shawna L. Boyle 1
1
1 Department of Urology, University of Nebraska Medical Center, Omaha,
NE, United States
UP-1.9. Table 1. Intraoperative and postoperative results of Introduction: In 2017, the United States Preventive Services Task Force
robotic-assisted laparoscopic repair of iatrogenic ureteric (USPSTF) updated its prostate-specific antigen (PSA) testing guidelines,
injuries from gynecological surgery issuing a grade “C” recommendation for men 55–69 years old, making
1
whether to undergo routine testing a personal decision. This changed from
Number of patients
the USPSTF’s 2012 Grade “D” recommendation, which recommended
Location of ureteric injury against routine testing. After the 2012 recommendation, a 3–10% decline
Proximal 0/6 in PSA screening was seen in all age groups. The effects of the 2012 and
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Mid 0/6 2017 guideline on age and cancer severity at initial diagnosis is unclear.
Distal 6/6 Methods: This study analyzed all patients with biopsy-confirmed prostate
cancer at the University of Nebraska Medical Center from 2005–2019
Operative technique used for repair 6/6 (n=647). Patients were split into those diagnosed prior to the 2012 recom-
Ureteroneocystostomy
mendation (group 1; n=179), between the 2012 and 2017 recommenda-
Postoperative followup tions (group 2; n=276), and after the 2017 recommendation (group 3;
Cystogram 2 weeks 6/6 n=192). Age of diagnosis and biopsy Gleason were obtained for each
Cystoscopy and stent removal 4–6 weeks 6/6 group and compared against each other. A Bonferroni correction was
Renal scan 3 months 6/6 employed, with statistically significant p-value set at 0.017.
Results: Mean age at diagnosis was 61.7±6.6 years. Group 1’s mean age
Resolution of obstruction (60.3±6.4) did not significantly differ from group 2 (61.6±6.6; p=0.046)
Yes 6/6 but was less than group 3 (63.3±6.5; p<0.001). Group 2’s mean age was
No 0/6 less than group 3 (p=0.007).
Clavien Dindo complications >grade II 1/6 Conclusions: The USPSTF updates have been associated with significant
rise in age of cancer diagnosis and a decrease in the diagnosis of GGG1
Average length of hospital stay post-repair 2 days
cancer, as expected. However, with each update, there is a significant
increase in the rates of both GGG4 and GGG5. Furthermore, GGG3 rates
S46 CUAJ • June 2020 • Volume 14, Issue 6(Suppl2)