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MP30-13 PREOPERATIVE FACTORS AFFECTING RADIATION TIME DURING PERCUTANEOUS NEPHROLITHOTOMY: A MULTI-INSTITUTIONAL ANALYSIS
THE JOURNAL OF UROLOGYâ
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13/14 (92.9%)has spontaneous passage of RFs (p¼0.001). The remaining 40/54 with RFs 5mm were never stone free, and of this, 37/40 (92.5%) is asymptomatic, while 3/40 (7.5%) underwent secondary treatment (p¼0.001). The commonest site for RFs is lower calyx (71.3%). The location of RFs however does not significantly influence with the need for additional procedure or subsequent spontaneous passage of RFs CONCLUSIONS: The size and multiplicity of residual fragments are predictors of persistent RF. Residual fragments size of 5mm, in multiples of 3 RFs located in one single pole can be considered as clinically insignificant Source of Funding: None
MP30-13 PREOPERATIVE FACTORS AFFECTING RADIATION TIME DURING PERCUTANEOUS NEPHROLITHOTOMY: A MULTIINSTITUTIONAL ANALYSIS Zhamshid Okhunov*, Orange, CA; Vincent Bird, Arash Akhavein, Gainesville, FL; Daniel Moreira, Arvin George, Sammy Elsamra, Hempstead, NY; Brian Duty, Portland, OR; Michael Del Junco, Orange, CA; Fotima Asquarova, Michael Rothberg, Mantu Gupta, New York, NY; Chad Tracy, Mark Newton, Iowa City, IA; Kevan Sternberg, Benjamin King, Burlington, VT; Edan Shapiro, New York, NY; Jorge Moreno, Mexico City, Mexico; Christopher Pulford, Orange, CA; Juan Carlos Rosales, Caracas, Venezuela; Arun Srinivasan, Philadelphia, PA; Yasser Noureldin, Sero Andonian, Montreal, Canada; Nazih Khater, Duane Baldwin, Loma Linda, CA; Khurshid Ghani, Maksim Shlykov, Ann Arbor, MI; Ramy Youssef, Orange, CA; Brian Shinsky, Madison, WI; Justin Friedlander, Philadelphia, PA; Steven Nakada, Madison, WI; Stuart Wolf Jr., Ann Arbor, MI; Arthur D. Smith, Zeph Okeke, Hempstead, NY; Jaime Landman, Orange, CA INTRODUCTION AND OBJECTIVES: Percutaneous nephrolithometry (PCNL) may be associated with significant ionizing radiation exposure for patients and operating room personnel. We conducted a multicenter study to assess the predictors of increased radiation exposure during PCNL. METHODS: We performed a multicenter retrospective review of patients undergoing PCNL. Patient demographics, stone characteristics and perioperative data including fluoroscopy time were recorded and analyzed. Preoperative CT images were reviewed and S.T.O.N.E. score was assigned to each patient. RESULTS: A total of 1700 patients were included in the analysis. The mean age and body mass index (BMI) were 63.415 and 31.27kg/m2 respectively. Mean stone size and mean overall nephrolithometry score was 3.7 and 8.3 (SD¼2.2) respectively. Overall single procedure stone-free rate was 72%. In logistic regression analysis, stone size (p<0.01), number of calyces (p<0.01), BMI (p<0.01), longer procedure time (p<0.01), skin-to-stone distance (p<0.01) and S.T.O.N.E. score (p<0.01) were significantly associated with increased fluoroscopy time. Stone-free patients had statistically significant lower radiation exposure compared to patients with residual stones (8.7 vs. 16.9 minutes, respectively; P<0.001). On average, for each increase in one unit of S.T.O.N.E score, there was additional 1.5 minutes of fluoroscopy time. In risk stratification, low-risk patients with 5-7 scores had 7.8 minutes of fluoroscopy time, compared to medium-risk (8-10) and high-risk patients (11-13) who had 12.8 and 15.8 minutes of fluoroscopy time, respectively (p¼0.001). CONCLUSIONS: In this multicenter study, patients with greater stone size, BMI, number of calyces, skin-to-stone distance and S.T.O.N.E. nephrolithometry were associated with increased radiation exposure during PCNL. Alternative modified pulsed fluoroscopy techniques or radiation-free imaging modalities such as ultrasound should be used in order to reduce the amount of ionizing radiation during the PCNL procedures. Source of Funding: None
Vol. 193, No. 4S, Supplement, Saturday, May 16, 2015
MP30-14 UPPER POLE UROLOGIST-OBTAINTED PERCUTANEOUS RENAL ACCESS FOR PCNL IS SAFE AND EFFICACIOUS Amar Patel*, Don Bui, John Pattaras, Kenneth Ogan, Atlanta, GA INTRODUCTION AND OBJECTIVES: Interventional radiologist may be hesitant to obtain upper pole access for percutaneous nephrolithotomy (PCNL) due to a higher complication rate. Renal access gained by a urologist may achieve higher stone-free rates with similar complication rates. We discuss our institution’s contemporary results of percutaneous renal access in the upper pole for nephrolithotomy by a urologist. We believe that urologist-obtained upper pole access for PCNL is both safe and efficacious. METHODS: We performed a retrospective chart review of PCNL performed by a fellowship-trained endourlogist from 2003 to 2014 at a single institution. The inclusion criteria included patients in which renal access was obtained by the urologist via the upper pole for subsequent nephrolithotomy. Variables analyzed include age, gender, BMI, ASA, operative time, rib level, initial stone size, change in hemoglobin (hgb), length of stay (LOS), and post-operative complications. Stone-free status was determined by either KUB or CT scan on post-operative day (POD) #1. Patients without stones visible on KUB or stones less than 4 mm on CT were considered stone-free. RESULTS: A total of 144 renal units were percutaneously accessed via the upper pole for subsequent nephrolithotomy. Baseline demographics included, mean age of 52.7 years, 51 males, 93 females, mean BMI of 29.7, median ASA of 3, mean Hgb change on POD #1 of 1.8 g/dL, and a mean hospital stay of 2.5 days. There were a total of 53 (36.8%) stones classified as a staghorn calculi, or which 35 (24.3%) were partial staghorn stones. Renal access was obtained above 11th rib in 12.5% (n¼18), above 12th rib in 57.6% (n¼83), subcostal in 14.6% (n¼21) and undetermined in the rest. Complications were seen in 18 (12.5%) of patients. Hydropneumothorax requiring chest tube was seen in 8 (4.9%) of patients. Postoperative imaging confirmed 93 (64.6%) patients stone-free, and 35 (24.3%) required a second look PCNL. CONCLUSIONS: Our experience with upper pole percutaneous renal access for nephrolithotomy has shown that it has an acceptable complication risk. There is an increased chance of thoracic complications but this can be mitigated with technical maneuvers. It should be a part of an endourologist armamentarium who operate on large burden, complex stones or ureteral pathology. Source of Funding: None
MP30-15 PREDICTORS OF HOSPITAL READMISSION AFTER PERCUTANEOUS NEPHROLITHOTOMY: ANALYSIS OF MORE THAN 700 CONSECUTIVE PATIENTS FROM A TERTIARY REFERRAL CENTER Yasser Osman, Ahmed Harraz, Diaa-Eldin Taha*, Amr Elsawy, Nasr ElTabey, Ahmed El-Nahas, Ahmed Shoma, Ahmed Shokeir, Mansoura, Egypt INTRODUCTION AND OBJECTIVES: The morbidity of percutaneous nephrolithotomy (PNL) extends beyond hospital discharge if the patient developed a complication requiring hospital readmission (HR). The study was conducted to report the incidence, causes and predictors of HR in a large series from a tertiary referral center. METHODS: A retrospective analysis of 746 PNL procedures in 708 patients in a tertiary referral center was performed between January 2011 and January 2014. All patients had preoperative non-contrast CT scan (NCCT) for evaluating nephrolithiasis. The primary outcome was to evaluate the development of complications requiring HR within 3 months of hospital discharge. Patients’ demographics, stone characteristics and perioperative data were tested for prediction of PNL-related HR using univariate and multivariate analyses.
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13/14 (92.9%)has spontaneous passage of RFs (p¼0.001). The remaining 40/54 with RFs 5mm were never stone free, and of this, 37/40 (92.5%) is asymptomatic, while 3/40 (7.5%) underwent secondary treatment (p¼0.001). The commonest site for RFs is lower calyx (71.3%). The location of RFs however does not significantly influence with the need for additional procedure or subsequent spontaneous passage of RFs CONCLUSIONS: The size and multiplicity of residual fragments are predictors of persistent RF. Residual fragments size of 5mm, in multiples of 3 RFs located in one single pole can be considered as clinically insignificant Source of Funding: None
MP30-13 PREOPERATIVE FACTORS AFFECTING RADIATION TIME DURING PERCUTANEOUS NEPHROLITHOTOMY: A MULTIINSTITUTIONAL ANALYSIS Zhamshid Okhunov*, Orange, CA; Vincent Bird, Arash Akhavein, Gainesville, FL; Daniel Moreira, Arvin George, Sammy Elsamra, Hempstead, NY; Brian Duty, Portland, OR; Michael Del Junco, Orange, CA; Fotima Asquarova, Michael Rothberg, Mantu Gupta, New York, NY; Chad Tracy, Mark Newton, Iowa City, IA; Kevan Sternberg, Benjamin King, Burlington, VT; Edan Shapiro, New York, NY; Jorge Moreno, Mexico City, Mexico; Christopher Pulford, Orange, CA; Juan Carlos Rosales, Caracas, Venezuela; Arun Srinivasan, Philadelphia, PA; Yasser Noureldin, Sero Andonian, Montreal, Canada; Nazih Khater, Duane Baldwin, Loma Linda, CA; Khurshid Ghani, Maksim Shlykov, Ann Arbor, MI; Ramy Youssef, Orange, CA; Brian Shinsky, Madison, WI; Justin Friedlander, Philadelphia, PA; Steven Nakada, Madison, WI; Stuart Wolf Jr., Ann Arbor, MI; Arthur D. Smith, Zeph Okeke, Hempstead, NY; Jaime Landman, Orange, CA INTRODUCTION AND OBJECTIVES: Percutaneous nephrolithometry (PCNL) may be associated with significant ionizing radiation exposure for patients and operating room personnel. We conducted a multicenter study to assess the predictors of increased radiation exposure during PCNL. METHODS: We performed a multicenter retrospective review of patients undergoing PCNL. Patient demographics, stone characteristics and perioperative data including fluoroscopy time were recorded and analyzed. Preoperative CT images were reviewed and S.T.O.N.E. score was assigned to each patient. RESULTS: A total of 1700 patients were included in the analysis. The mean age and body mass index (BMI) were 63.415 and 31.27kg/m2 respectively. Mean stone size and mean overall nephrolithometry score was 3.7 and 8.3 (SD¼2.2) respectively. Overall single procedure stone-free rate was 72%. In logistic regression analysis, stone size (p<0.01), number of calyces (p<0.01), BMI (p<0.01), longer procedure time (p<0.01), skin-to-stone distance (p<0.01) and S.T.O.N.E. score (p<0.01) were significantly associated with increased fluoroscopy time. Stone-free patients had statistically significant lower radiation exposure compared to patients with residual stones (8.7 vs. 16.9 minutes, respectively; P<0.001). On average, for each increase in one unit of S.T.O.N.E score, there was additional 1.5 minutes of fluoroscopy time. In risk stratification, low-risk patients with 5-7 scores had 7.8 minutes of fluoroscopy time, compared to medium-risk (8-10) and high-risk patients (11-13) who had 12.8 and 15.8 minutes of fluoroscopy time, respectively (p¼0.001). CONCLUSIONS: In this multicenter study, patients with greater stone size, BMI, number of calyces, skin-to-stone distance and S.T.O.N.E. nephrolithometry were associated with increased radiation exposure during PCNL. Alternative modified pulsed fluoroscopy techniques or radiation-free imaging modalities such as ultrasound should be used in order to reduce the amount of ionizing radiation during the PCNL procedures. Source of Funding: None
Vol. 193, No. 4S, Supplement, Saturday, May 16, 2015
MP30-14 UPPER POLE UROLOGIST-OBTAINTED PERCUTANEOUS RENAL ACCESS FOR PCNL IS SAFE AND EFFICACIOUS Amar Patel*, Don Bui, John Pattaras, Kenneth Ogan, Atlanta, GA INTRODUCTION AND OBJECTIVES: Interventional radiologist may be hesitant to obtain upper pole access for percutaneous nephrolithotomy (PCNL) due to a higher complication rate. Renal access gained by a urologist may achieve higher stone-free rates with similar complication rates. We discuss our institution’s contemporary results of percutaneous renal access in the upper pole for nephrolithotomy by a urologist. We believe that urologist-obtained upper pole access for PCNL is both safe and efficacious. METHODS: We performed a retrospective chart review of PCNL performed by a fellowship-trained endourlogist from 2003 to 2014 at a single institution. The inclusion criteria included patients in which renal access was obtained by the urologist via the upper pole for subsequent nephrolithotomy. Variables analyzed include age, gender, BMI, ASA, operative time, rib level, initial stone size, change in hemoglobin (hgb), length of stay (LOS), and post-operative complications. Stone-free status was determined by either KUB or CT scan on post-operative day (POD) #1. Patients without stones visible on KUB or stones less than 4 mm on CT were considered stone-free. RESULTS: A total of 144 renal units were percutaneously accessed via the upper pole for subsequent nephrolithotomy. Baseline demographics included, mean age of 52.7 years, 51 males, 93 females, mean BMI of 29.7, median ASA of 3, mean Hgb change on POD #1 of 1.8 g/dL, and a mean hospital stay of 2.5 days. There were a total of 53 (36.8%) stones classified as a staghorn calculi, or which 35 (24.3%) were partial staghorn stones. Renal access was obtained above 11th rib in 12.5% (n¼18), above 12th rib in 57.6% (n¼83), subcostal in 14.6% (n¼21) and undetermined in the rest. Complications were seen in 18 (12.5%) of patients. Hydropneumothorax requiring chest tube was seen in 8 (4.9%) of patients. Postoperative imaging confirmed 93 (64.6%) patients stone-free, and 35 (24.3%) required a second look PCNL. CONCLUSIONS: Our experience with upper pole percutaneous renal access for nephrolithotomy has shown that it has an acceptable complication risk. There is an increased chance of thoracic complications but this can be mitigated with technical maneuvers. It should be a part of an endourologist armamentarium who operate on large burden, complex stones or ureteral pathology. Source of Funding: None
MP30-15 PREDICTORS OF HOSPITAL READMISSION AFTER PERCUTANEOUS NEPHROLITHOTOMY: ANALYSIS OF MORE THAN 700 CONSECUTIVE PATIENTS FROM A TERTIARY REFERRAL CENTER Yasser Osman, Ahmed Harraz, Diaa-Eldin Taha*, Amr Elsawy, Nasr ElTabey, Ahmed El-Nahas, Ahmed Shoma, Ahmed Shokeir, Mansoura, Egypt INTRODUCTION AND OBJECTIVES: The morbidity of percutaneous nephrolithotomy (PNL) extends beyond hospital discharge if the patient developed a complication requiring hospital readmission (HR). The study was conducted to report the incidence, causes and predictors of HR in a large series from a tertiary referral center. METHODS: A retrospective analysis of 746 PNL procedures in 708 patients in a tertiary referral center was performed between January 2011 and January 2014. All patients had preoperative non-contrast CT scan (NCCT) for evaluating nephrolithiasis. The primary outcome was to evaluate the development of complications requiring HR within 3 months of hospital discharge. Patients’ demographics, stone characteristics and perioperative data were tested for prediction of PNL-related HR using univariate and multivariate analyses.