Page 81 - CUA Absracts 2022_Fulldraft

Poster 8: Endourology, Renal Transplant

MP-8.6 MP-8.7
Ureteroscopy with thulium fiber laser lithotripsy vs. percutaneous The impact of bilateral stone disease on patients’ disease
nephrolithotomy for the treatment of renal stones 15–20 mm progression and quality of life
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Abdulghafour Halawani , Jessica Que , Victor Wong , Ben Chew 1 Brendan Lapointe Raizenne , Claudia Deyirmendjian , Maimouna Balde ,
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1 Department of Urologic Sciences, University of British Columbia, Seth K. Bechis , Roger L. Sur , Stephen Y. Nakada , Jodi A. Antonelli ,
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Vancouver, BC, Canada Necole M. Streeper , Sri Sivalingam , Davis P. Viprakasit , Timothy D.
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Introduction: Endourology has experienced revolutionary inventions in Averch , Thomas Chi , Kristina L. Penniston , Naeem Bhojani 1
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the last few decades. Thulium fiber laser (TFL) is the latest laser technol- 1 Division of Urology, Centre Hospitalier de l’Université de Montréal,
ogy that has shown promising advantages in both pre-clinical and clinical Montreal, QC, Canada; Faculty of Medicine, Université de Montréal,
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settings, which may allow larger stones to be treated ureteroscopically. Montreal, QC, Canada; Faculty of Sciences and Technologies, Gaston
This study aimed to compare the effectiveness of TFL ureteroscopy vs. Berger University, Saint Louis, Senegal; Department of Urology, University
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percutaneous nephrolithotomy (PCNL) in the management of renal stones of California San Diego, San Diego, CA, United States; Department of
15–20 mm. Urology, University of Wisconsin School of Medicine and Public Health,
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Methods: We retrospectively analyzed the medical records of 42 patients Madison, WI, United States; Department of Urology, University of Texas
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who underwent either TFL lithotripsy (n=21) or PCNL (n=21) for 15–20 Southwestern Medical Center, Dallas, TX, United States; Division of
mm renal stones. Stone-free rate (SFR) was assessed with one or combined Urology, Pennsylvania State University College of Medicine, Hershey,
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imaging modalities with either non-contrast computed tomography (CT), PA, United States; Glickman Urological and Kidney Institute, Cleveland
kidney-bladder-ureter (KUB) ultrasound, or X-ray. Other variables, includ- Clinic, Cleveland, OH, United States; Department of Urology, University
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ing operative time, stone size and density, and prior ureteral stenting, of North Carolina School of Medicine, Chapel Hill, NC, United States;
were recorded. In the case of multiple stones, the total stone surface 10 Department of Urology, Palmetto Health USC Medical Group, Columbia,
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area was measured. SC, United States; Department of Urology, University of California San
Results: Characters such as patients’ age (years), prior ureteral stenting, Francisco, San Francisco, CA, United States
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number of stones, stone density, and total stone surface area (mm ) were Introduction: Kidney stone disease is associated with significant morbid-
similar between the groups (Table 1). The length of surgery was signifi- ity and functional impairment. Few studies have examined the impact of
cantly lower in the TFL group (p=0.002) (Table 1). Compared to TFL, the bilateral kidney stones on disease progression. We sought to determine
PCNL group had longer hospital stays (p=0.0001) (Table 1). Our data the impact of bilateral stone disease on age of onset, number of stone
showed no statistically significant difference in SFR between the TFL events, and individual patient Health-Related Quality of Life (HRQOL)
and PCNL groups. by querying the validated and prospectively collected Wisconsin Stone
Conclusions: This study revealed that TFL lithotripsy produced a similar Quality of Life (WISQOL) database.
SFR to PCNL, with significantly lower operative time and hospital stay. Methods: Cross-sectional data were obtained from 2906 kidney stone for-
TFL can be an effective alternative to PCNL in the management of 15–20 mers from 14 institutions in North America who completed the WISQOL
mm renal stones; however, further randomized trials are warranted. questionnaire from 2014–2019. The 28-question survey has a 1–5-point
scale for each item (total score range 0–140). Kidney stone formers were
further stratified according to the presence of bilateral or unilateral kidney
MP-8.6. Table 1. Stone and operative outcome thulium stones. Categorical variables were reported and compared using a Chi-
fiber laser lithotripsy vs. PCNL squared test. A multivariable linear regression model assessed the impact
of bilateral kidney stone disease on HRQOL.
Thulium PCNL p Results: Of 2906 kidney stone formers, 1340 had unilateral kidney stones
Number of subjects 21 21 - and 1566 had bilateral kidney stones. Bilateral kidney stone formers had a
Age, years 57.57 54 0.5019 younger mean (standard deviation) age of kidney stone onset (37.2±15.8
Pre-stented, % yes 33% (7/21) 19% (4/21) 0.4876 vs. 46.4±15.9 years of age, p<0.001). Bilateral kidney stone formers had
a higher number of stone events than unilateral kidney stone formers
Surgery length, MM: SS 51:48 (23.98) 93:10 (52.43) 0.0020 (p<0.001). Bilateral kidney stone formers had a higher mean (standard
(SD) deviation) number of comorbidities (2.02±1.82 vs. 1.87±1.77, p<0.05).
Number of stones, mean 2.86 (1.85) 2.43 (2.20) 0.4990 Among those comorbidities, bilateral kidney stone disease was associated
(SD) with an increased number of depression/anxiety symptoms (350, [22.4%]
vs. 247 [18.4%], p<0.05). Bilateral and unilateral kidney stone formers did
Total stone surface area 355.63 569.70 0.2259 not differ for calcium oxalate, calcium phosphate, uric acid, and mixed
(mm ), mean (SD) (341.72) (720.59) stone composition (p>0.05) (Table 1). On multivariable analysis, bilateral
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Total stone density, HU 1031.24 1151.71 0.3089 kidney stone disease was an independent predictor of worse HRQOL
(SD) (443.97) (299.79) (β=-11.2, confidence interval -19.5 to -3.0 points, p<0.05) (Table 2).
Ureteral/renal pelvis 5% (1/21) 10% (2/21) 1.000 Conclusions: Bilateral kidney stone formers had a younger age of kid-
ney stone onset and a higher number of stone events than unilateral
injury, % yes kidney stone formers. The presence of bilateral kidney stones negatively
Length of hospital stay, 0.52 (1.29) 2.19 (0.60) 0.0001 impacted HRQOL. Therefore, clinicians should pay closer attention to
days (SD) bilateral kidney stone patients on clinical presentation and their risk for
Stone-free, % yes 52% (11/21) 76% (16/21) 0.1971 disease progression.
CUAJ • June 2022 • Volume 16, Issue 6(Suppl1) S79