Page 10 - CUA Absracts 2022_Fulldraft

2022 CUA ABSTRACTS

CUA 2022 Annual Meeting Abstracts – Podium Session 2: Endourology

Saturday, June 25, 2022 • 08:00–09:00

Cite as: Can Urol Assoc J 2022;16(6Suppl1):S8-12. http://dx.doi.org/10.5489/cuaj.7920

POD-2.1 Methods: This is a population-based study of patients who presented with
Characterizing symptomatic patients with small non-obstructing renal colic in Ontario between 2003 and 2019 using administrative data.
renal calculi (SNORC): A primary prospective cohort study analysis Patients were assessed according to the imaging modality obtained during
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David Chapman , Suhyeon Park , Saifee Rashiq , Bruce Dick , Stacey their index visit. Descriptive statistics and the Chi-squared test were used
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Broomfield , Timothy Wollin 1,3,4 , Trevor Schuler 1,3,4 , Shubhadip De 1,2,3 to examine differences between the groups. The primary outcome was the
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1 Faculty of Medicine, University of Alberta, Edmonton, AB, Canada; need for subsequent imaging. Secondary outcomes included length of renal
2 Department of Anesthesiology and Pain Medicine, University of Alberta, colic episode, days to surgery, and the number of emergency department
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Edmonton, AB, Canada; Alberta Center for Urologic Research and and primary care visits during the renal colic episode.
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Excellence, Edmonton, AB, Canada; Division of Urology, Department of Results: A total of 429 060 patients were included in the analysis. Of
Surgery, University of Alberta, Edmonton, AB, Canada those, 50.5% had a CT scan as their initial imaging modality, 19.7% had
Introduction: As little data exists on the nature and causes of pain in non- an US, and 3.2% had both a CT and an US on the same day. Rates of
obstructing renal stones, our objective was to assess how disease-specific any subsequent imaging were similar accross these groups. Of those who
factors, global patient characteristics, and personality traits influence per- initially had an US, 38.0% went on to have at least one CT scan during
ceived symptoms. their renal colic episode, including those who had a CT on the same day
Methods: After consent was obtained, patients completed a standardized as the initial US, while 62.0% were able to avoid a CT scan altogether. In
history, physical exam, and questionnaire sets. Enrollment was 2:1 asymp- contrast, 16.8% had a repeat CT after an initial CT at the time of presenta-
tomatic patients (AP) to symptomatic patients (SP) with computed tomog- tion. Fewer emergency department and family physician visits were seen
raphy-confirmed calyceal stones ≤5 mm, without focal signs of obstruction. in those who had an initial CT.
Descriptive statistics and Student’s t-tests were used to characterize and Conclusions: In patients presenting with renal colic in Ontario, approxi-
compare groups. mately half have a CT as initial imaging despite US being recommended
Results: Our primary analysis included 28 patients (8 SP, 20 AP). There in uncomplicated renal colic patients. Those who have an US done first
were no significant differences in age, gender, household income, or are often able to avoid subsequent CT scans. Efforts should be made to
prevalence of functional pain syndromes (i.e., 25% vs. 27% IBS, FM, IC, encourage the use of US in those presenting with renal colic rather than
etc.). All (100%) SP had prior stone events (vs. 55% of AP). More AP CT when clinically indicated.
endorsed chronic neck or back pain (25% vs. 12.5%), whereas SP reported
worsened pain with physical activity (50% vs. 30%) and used more daily POD-2.3
pain medication (62.5% vs 25%). Standardized assessment tools for pain Implementation of a clinical practice guideline for assessment
and psychometric contributors showed SP have significantly higher Body and management of ureteric stones in the emergency department
Pain Index (12.2 vs. 43.3, p=0.005), and Pain Disability Index scores (5.9 Cecile Pham , Regine Yan , Emma Richardson , Salonee Phanse , George
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vs. 23.8, p=0.004). SP also scored higher on catastrophizing (15.2 vs. McClintock , Andrew Mitterdorfer , John Boulas , Dinesh Patel , Paul
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31.7, p=0.008), and kinesiophobia inventories (29.5 vs. 40.3, p=0.014). Gassner , Paul Sved 1
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No significant differences were noted in the Modified Somatic Perception 1 Department of Urology, Bankstown-Lidcombe Hospital, Bankstown,
Questionnaire, or Hospital Anxiety and Depression Scale. The Wisconsin Australia; Faculty of Medicine and Health, University of New South Wales,
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Stone QoL tool did not differ between groups, however, the more general- Kensington, Australia; School of Medicine, Western Sydney University,
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ized 15D QoL tool showed a decreased overall health-related quality of Campbelltown, Australia
life in SP (20.3 vs. 26.8, p=0.05). Introduction: Renal colic is a common emergency department (ED) presen-
Conclusions: Our preliminary analysis of the SNORC cohort identifies tation, however, there are no existing clinical practice guidelines at a local
potential psychometric contributors to symptomatic complaints related to level. Subsequent variations in assessment and management of suspected
stone disease. Future studies based on these findings will attempt to further renal colic may have significant implications on both patient and hospital
define this challenging population. outcomes. We developed a clinical practice guideline to standardize the
assessment and management of ureteric stones in the ED. We subsequently
POD-2.2 compared patient and hospital outcomes pre- and post-guideline imple-
Renal colic imaging practice patterns in Ontario — a population- mentation.
based study Methods: The guidelines were implemented at our institution in November
Danielle Jenkins , Gregory Hosier , Marlo Whitehead , Rebecca Griffiths , 2018. We standardized the analgesia regimen in the ED and on discharge,
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Thomas McGregor , D. Robert Siemens 1 urology consult criteria, imaging modality, patient education, and followup
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1 Department of Urology, Queen’s University, Kingston, ON, Canada; instructions. All patients with computed tomography (CT)-confirmed stone
2 Department of Urology, University of California San Francisco, San received an X-ray kidney-ureter-bladder, and if the stone was radio-opaque,
Francisco, CA, United States; ICES, Queen’s University, Kingston, ON, X-ray was used for followup imaging. We undertook an observational cohort
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Canada study of patients presenting with renal colic prospectively (December 2018
Introduction: Computed tomography (CT) is associated with increased cost to May 2019) after guideline implementation and retrospectively (December
and exposure to radiation when compared to ultrasound (US). Choosing 2017 to May 2018) prior to guideline implementation.
Wisely recommends that US be used over CT in uncomplicated presenta- Results: A total of 528 patients (pre-guideline group n=283; post-guideline
tions of renal colic for patients under age 50. This objective of this study group n=245) were included in our study. The number of CT scans each
was to describe imaging practice patterns in Ontario among patients pre- patient received was reduced in the post-guideline group (p=0.034). There
senting with renal colic. was a reduced ED length of stay after guideline implementation (p=0.017).
S8 CUAJ • June 2022 • Volume 16, Issue 6(Suppl1)
© 2022 Canadian Urological Association