Page 7 - [Podium Sessions] CUA 2022 Annual Meeting Abstracts

Podium 2: Endourology

3. Ploussard G, Dumonceau O, Thomas L, et al. Multi-institutional POD-2.5. Table 1. Ultrasound-only PCNL was associated
assessment of routine same-day discharge surgery for robot- with shorter operative time, less blood loss, and
assisted radical prostatectomy. J Urol 2020;204:956-61. https://
doi.org/10.1097/JU.0000000000001129 similar complication and stone-free rates compared
4. Rahota RG, Salin A, Gautier JR, et al. Same-day discharge vs. to fluoroscopy-directed PCNL in which any amount of
inpatient surgery for robot-assisted radical prostatectomy: A fluoroscopy was used
comparative study. J Clin Med Res 2021;10:61. https://doi. Ultrasound- Fluoroscopy- p
org/10.3390/jcm10040661 only directed
5. Agarwal DK, Large T, Tong Y, et al. Same-day discharge is a suc-
cessful approach for the majority of patients undergoing holmium n=141 n=147
laser enucleation of the prostate. Eur Urol Focus 2022;8:228-34. n (%) n (%)
https://doi.org/10.1016/j.euf.2020.12.018 Age, years (median, IQR) 56 (42–66) 55 (40–64) 0.48
6. Assmus MA, Large T, Lee MS, et al. Same-day discharge follow- BMI, kg/m (median, IQR) 28.5 (24–33) 28.9 (24–33) 0.6
2
ing holmium laser enucleation in patients assessed to have large
gland prostates (≥175 cc). J Endourol 2021; 35:1386-92. https:// ASA 3 and 4 40 (28) 30 (20) 0.12
doi.org/10.1089/end.2020.1218 Guy score 3 and 4 50/102 (49) 46/119 (39) 0.1355
Positioning <0.001
POD-2.5 Prone 44 (31) 110 (75)
Ultrasound-only percutaneous nephrolithotomy is safe and
effective compared to fluoroscopy-directed percutaneous Supine 97 (69) 36 (25)
nephrolithotomy Missing 0 (0) 1 (1)
Gregory Hosier , Nizar Hakam , Xavier Cortez , Fadl Hamouche , Leslie Sum max stone diameter, 30 (17–45) 30 (18–51) 0.31
1
1
1
1
Charondo , Heiko Yang , Carter Chan , Kevin Chang , David Bayne , mm (median, IQR)
1
1
1
1
1
Marshall Stoller , Thomas Chi 1
1
1 Urology, University of California, San Francisco, San Francisco, CA, Access person <0.001
United States Attending 53 (38) 56 (38)
Introduction: Use of ultrasound guidance for percutaneous nephro- Fellow 23 (16) 46 (31)
lithotomy (PCNL) access has gained popularity. However, reports on
ultrasound-only PCNL, in which ultrasound is used for all steps of the Resident 54 (38) 24 (16)
procedure, are limited, as fluoroscopy is often used for dilation and to Missing 11 (8) 21 (14)
check for residual stones. The study goal was to compare outcomes for Total operative time, 99 (74–129) 126 (100–159) <0.001
ultrasound-only PCNL compared to fluoroscopy-directed PCNL.
Methods: Prospectively collected data from the Registry for Stones of minutes (median, IQR)
the Kidney and Ureter (ReSKU) database was reviewed for all patients % drop in hematocrit 2.7 (-1.4–6.7) 4.9 (0.5–9.5) 0.02
who underwent PCNL at one academic center from 2015–2021. Primary (median, IQR)
outcomes were complications (Clavien-Dindo classification) and stone- Stone-free 100 (71) 95 (64) 0.72
free rates (no residual fragments ≥3 mm) compared between those who (<3 mm fragment)
underwent ultrasound-only PCNL and fluoroscopy-directed PCNL in
which any amount of fluoroscopy was used. Postoperative 0.85
Results: A total of 141 patients were identified who underwent ultrasound- complications
only PCNL and 147 who underwent fluoroscopy-directed PCNL. The (Clavien-Dindo)
mean maximum summative stone diameter was 30 mm and 44% were No complications 117 (83) 119 (81)
Guy score 3 or 4. Stone and patient characteristics were similar between
both groups. There was no difference in complication rates (15% vs. Grade 1 1 (1) 3 (2)
16%, p=0.87) or stone-free status (71% vs. 65%, p=0.72) between those Grade 2 14 (10) 15 (10)
who underwent ultrasound-only PCNL and fluoroscopy-directed PCNL, Grade 3a 3 (2) 3 (2)
respectively. Ultrasound-only PCNL was associated with shorter opera-
tive time (median 99 minutes vs. 126 minutes, p<0.001), lower percent 3b 1 (1) 1 (1)
drop in hematocrit (2.7% vs. 4.9%, p=0.02), higher success rate of access 4a 0 0
achieved by resident (38% vs. 16%, p<0.001), and more frequent use of 4b 1 (1) 0 (0)
supine positioning (69% vs. 25%, p<0.001) compared to fluoroscopy-
directed PCNL. After adjusting for body mass index, American Society Missing 4 (3) 6 (4)
of Anesthesiology score, stone size, and stone complexity by Guy score,
ultrasound-only PCNL was not associated with any increased odds of POD-2.6
complications (odds ratio [OR] 0.7, 95% confidence interval [CI] 0.3–1.6, Stones and bones: Evaluating the impact of metabolic stone
p=0.42) or residual stone fragment ≥3 mm (OR 0.9, 95% CI 0.5–1.8, disease on bone health
p=0.97) compared to fluoroscopy-directed PCNL (Table 1). Jennifer Bjazevic , Fernanda Gabrigna Berto , William Luke , Linda Nott ,
1
1
1
1
Conclusions: Ultrasound-only PCNL is safe and achieves similar stone- Hassan Razvi 1
free rates compared to fluoroscopy-directed PCNL, with added benefits 1 Department of Surgery, Western University, London, ON, Canada
of shorter operative time, less blood loss, and avoidance of radiation. Introduction: Urolithiasis is associated with lower bone mineral density
(BMD), the development of osteopenia and osteoporosis, and fragility
fractures. Our study aimed to further delineate the prevalence of low BMD
in a metabolic stone population and to characterize metabolic risk factors.
Methods: A retrospective analysis of a prospectively maintained metabolic
stone clinic database from September 2001 to December 2019 was per-
formed. Patients who underwent BMD testing with a dual-energy X-ray
absorptiometry (DEXA) scan were reviewed and correlation between BMD
CUAJ • June 2022 • Volume 16, Issue 6(Suppl1) S11