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MP40-09 SURGICAL OUTCOMES FOR PEDIATRIC UROLITHIASIS: INCREASED RETREATMENT RATES WITH SHOCKWAVE LITHOTRIPSY COMPARED TO URETEROSCOPY
THE JOURNAL OF UROLOGYâ
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Vol. 193, No. 4S, Supplement, Sunday, May 17, 2015
MP40-10 COMPLETE BLOOD COUNT PARAMETERS AS A PREDICTOR OF TESTICULAR SURVIVAL FOLLOWING ACUTE TESTICULAR TORSION IN CHILDREN Cagatay E. Afsarlar*, Engin Yilmaz, Yilmaz Aslan, Jason Au, Irina Stanasel, David Roth, Chester J. Koh, Houston, TX
Source of Funding: National Institute of Diabetes and Digestive and Kidney Diseases (K08-DK100534, PI: Routh)
MP40-09 SURGICAL OUTCOMES FOR PEDIATRIC UROLITHIASIS: INCREASED RETREATMENT RATES WITH SHOCKWAVE LITHOTRIPSY COMPARED TO URETEROSCOPY Hsin-Hsiao Wang*, Rohit Tejwani, John Wiener, Jonathan Routh, Durham, NC INTRODUCTION AND OBJECTIVES: Although shock wave lithotripsy (SWL) has long been the standard option for treatment of kidney stones in children, in recent years ureteroscopy (URS) has become increasingly common. However, there is little data comparing surgical outcomes between SWL and URS in pediatric stone disease on the population level. Our objective was to utilize state-wide datasets to compare surgical outcomes between SWL and URS. METHODS: We searched the 2007-2010 CA, FL, NC, UT, and NY 2008-2010 State Ambulatory Surgery and Service Databases (SASD), State Emergency Department Databases (SEDD), and State Inpatient Databases (SID) to identify pediatric (<¼18 years) renal or ureteral stone patients who received either SWL or URS as initial surgical intervention. Unplanned readmissions, additional procedures, and ER visits were extracted. Statistical analysis was performed using multivariate logistic regression and GEE to adjust for hospital-level clustering. RESULTS: We identified 1,001 SWL and 1,095 URS patients. Compared with patients undergoing SWL, URS patients were more likely to be older (15.4 v. 14.7 years, p<0.001), female (64 v. 55%, p<0.001), & privately insured (66 v. 56%, p<0.001); URS was also more likely to be used for ureteral v. renal stones (82 v. 35%, p<0.001). URS had a significantly lower rate of repeat urolithiasis procedures (98 (9.8%) v. 54 (4.9%), p<0.001) but had similar rates of readmission (69 (6.3) v. 54 (5.4%), p¼0.15) and unplanned ER visits (159 (14.5%) v. 126 (12.6%), p¼0.07). After adjusting for age, gender, insurance status, Charlson comorbidity score, treatment year, stone location, income, and hospital clustering, patients treated with SWL remained significantly more likely to undergo repeat urolithiasis procedures (OR¼1.71, p¼0.008). CONCLUSIONS: In our population, URS was a more common intervention for pediatric urolithiasis than SWL. Postoperative readmissions and ER visits were uncommon after surgical intervention for pediatric urolithiasis. Even after correcting for multiple other clinical factors, however, surgical retreatment rates were twice as high for SWL as compared to URS. Source of Funding: Dr. Routh is supported by grant number K12-DK100024 from the National Institute of Diabetes and Digestive and Kidney Diseases
INTRODUCTION AND OBJECTIVES: Complete blood count (CBC) provides simple systemic inflammatory response parameters such as white blood cell count (WBC), neutrophil count, lymphocyte count, neutrophil/lymphocyte (N/L) ratio, and platelet/lymphocyte (P/L) ratio. Previous clinical studies have demonstrated increased N/L and P/ L ratios following ischemic conditions. The objective of this study was to determine if CBC parameters could predict the eventual survival of torsed testicles. METHODS: A retrospective chart review of patients with acute testicular torsion between January 2009 and October 2014 was conducted. Patients with a preoperative CBC were identified and included in the study while those without a CBC were excluded. Patient demographics, duration of pain, CBC parameters, imaging studies, type of surgical procedure, and follow-up were assessed. Patients with clinical and radiographic evidence of acute epididymitis and torsed testicular and epididymal appendages were excluded. RESULTS: A total of 184 patients with acute testicular torsion were identified, and 27 patients with a preoperative CBC were identified. Scrotal exploration was performed if absent or decreased blood flow was demonstrated by Doppler US or if indicated by clinical history and exam. Median patient age was 12.6 years. Nine patients underwent detorsion and fixation, and 18 patients underwent orchiectomy. Concomitant contralateral testicular fixation was performed in all patients. Duration of pain, WBC, and neutrophil count were significantly higher in orchiectomy patients (p¼0.003, p¼0.006, and p¼0.012, respectively) as compared to patients who had a detorsed testis. Additionally, 86.7% of orchiectomy patients had an elevated WBC count >10,000 as compared to only 13.3% of detorsion patients (p¼0.014). There was no significant difference in terms of N/L and P/L ratio between the groups (p¼0.28, and p¼0.797, respectively). CONCLUSIONS: Since CBC is a simple and cost effective study that is widely available, CBC parameters (WBC and neutrophil count) can be utilized to help predict the outcome of a torsed testicle. This can be helpful to determine the urgency of the scrotal exploration when available surgical time is limited. A significant difference of N/L and P/L ratios was not demonstrated as seen in previous studies. Source of Funding: none
MP40-11 PROSPECTIVE ASSESSMENT OF PEDIATRIC RADIATION EXPOSURE: THE PEDIATRIC UROLOGY RADIATION SAFETY EVALUATION (PURSE) STUDY Anne Dudley*, Moira Dwyer, Pankaj Dangle, Omaya Banihani, Heidi Stephany, Glenn Cannon, Francis Schneck, Michael Ost, Pittsburgh, PA INTRODUCTION AND OBJECTIVES: Pediatric urologic patients often undergo procedures guided by fluoroscopy. Pediatric tissues are exquisitely sensitive to ionizing radiation, and patients are at risk for detrimental long term effects throughout their lifetimes. We sought to prospectively monitor radiation exposure in our pediatric urologic patients using single point dosimeters during fluoroscopic guided operative procedures. METHODS: Pediatric patients undergoing fluoroscopic guided urologic procedures from August 2013 through October 2014 were prospectively enrolled in the IRB approved study. After obtaining informed consent from the patient’s guardian, single point dosimeters were affixed to the flank of the planned procedural side with a transparent adhesive dressing. Patient demographics, procedural variables,
e466
Vol. 193, No. 4S, Supplement, Sunday, May 17, 2015
MP40-10 COMPLETE BLOOD COUNT PARAMETERS AS A PREDICTOR OF TESTICULAR SURVIVAL FOLLOWING ACUTE TESTICULAR TORSION IN CHILDREN Cagatay E. Afsarlar*, Engin Yilmaz, Yilmaz Aslan, Jason Au, Irina Stanasel, David Roth, Chester J. Koh, Houston, TX
Source of Funding: National Institute of Diabetes and Digestive and Kidney Diseases (K08-DK100534, PI: Routh)
MP40-09 SURGICAL OUTCOMES FOR PEDIATRIC UROLITHIASIS: INCREASED RETREATMENT RATES WITH SHOCKWAVE LITHOTRIPSY COMPARED TO URETEROSCOPY Hsin-Hsiao Wang*, Rohit Tejwani, John Wiener, Jonathan Routh, Durham, NC INTRODUCTION AND OBJECTIVES: Although shock wave lithotripsy (SWL) has long been the standard option for treatment of kidney stones in children, in recent years ureteroscopy (URS) has become increasingly common. However, there is little data comparing surgical outcomes between SWL and URS in pediatric stone disease on the population level. Our objective was to utilize state-wide datasets to compare surgical outcomes between SWL and URS. METHODS: We searched the 2007-2010 CA, FL, NC, UT, and NY 2008-2010 State Ambulatory Surgery and Service Databases (SASD), State Emergency Department Databases (SEDD), and State Inpatient Databases (SID) to identify pediatric (<¼18 years) renal or ureteral stone patients who received either SWL or URS as initial surgical intervention. Unplanned readmissions, additional procedures, and ER visits were extracted. Statistical analysis was performed using multivariate logistic regression and GEE to adjust for hospital-level clustering. RESULTS: We identified 1,001 SWL and 1,095 URS patients. Compared with patients undergoing SWL, URS patients were more likely to be older (15.4 v. 14.7 years, p<0.001), female (64 v. 55%, p<0.001), & privately insured (66 v. 56%, p<0.001); URS was also more likely to be used for ureteral v. renal stones (82 v. 35%, p<0.001). URS had a significantly lower rate of repeat urolithiasis procedures (98 (9.8%) v. 54 (4.9%), p<0.001) but had similar rates of readmission (69 (6.3) v. 54 (5.4%), p¼0.15) and unplanned ER visits (159 (14.5%) v. 126 (12.6%), p¼0.07). After adjusting for age, gender, insurance status, Charlson comorbidity score, treatment year, stone location, income, and hospital clustering, patients treated with SWL remained significantly more likely to undergo repeat urolithiasis procedures (OR¼1.71, p¼0.008). CONCLUSIONS: In our population, URS was a more common intervention for pediatric urolithiasis than SWL. Postoperative readmissions and ER visits were uncommon after surgical intervention for pediatric urolithiasis. Even after correcting for multiple other clinical factors, however, surgical retreatment rates were twice as high for SWL as compared to URS. Source of Funding: Dr. Routh is supported by grant number K12-DK100024 from the National Institute of Diabetes and Digestive and Kidney Diseases
INTRODUCTION AND OBJECTIVES: Complete blood count (CBC) provides simple systemic inflammatory response parameters such as white blood cell count (WBC), neutrophil count, lymphocyte count, neutrophil/lymphocyte (N/L) ratio, and platelet/lymphocyte (P/L) ratio. Previous clinical studies have demonstrated increased N/L and P/ L ratios following ischemic conditions. The objective of this study was to determine if CBC parameters could predict the eventual survival of torsed testicles. METHODS: A retrospective chart review of patients with acute testicular torsion between January 2009 and October 2014 was conducted. Patients with a preoperative CBC were identified and included in the study while those without a CBC were excluded. Patient demographics, duration of pain, CBC parameters, imaging studies, type of surgical procedure, and follow-up were assessed. Patients with clinical and radiographic evidence of acute epididymitis and torsed testicular and epididymal appendages were excluded. RESULTS: A total of 184 patients with acute testicular torsion were identified, and 27 patients with a preoperative CBC were identified. Scrotal exploration was performed if absent or decreased blood flow was demonstrated by Doppler US or if indicated by clinical history and exam. Median patient age was 12.6 years. Nine patients underwent detorsion and fixation, and 18 patients underwent orchiectomy. Concomitant contralateral testicular fixation was performed in all patients. Duration of pain, WBC, and neutrophil count were significantly higher in orchiectomy patients (p¼0.003, p¼0.006, and p¼0.012, respectively) as compared to patients who had a detorsed testis. Additionally, 86.7% of orchiectomy patients had an elevated WBC count >10,000 as compared to only 13.3% of detorsion patients (p¼0.014). There was no significant difference in terms of N/L and P/L ratio between the groups (p¼0.28, and p¼0.797, respectively). CONCLUSIONS: Since CBC is a simple and cost effective study that is widely available, CBC parameters (WBC and neutrophil count) can be utilized to help predict the outcome of a torsed testicle. This can be helpful to determine the urgency of the scrotal exploration when available surgical time is limited. A significant difference of N/L and P/L ratios was not demonstrated as seen in previous studies. Source of Funding: none
MP40-11 PROSPECTIVE ASSESSMENT OF PEDIATRIC RADIATION EXPOSURE: THE PEDIATRIC UROLOGY RADIATION SAFETY EVALUATION (PURSE) STUDY Anne Dudley*, Moira Dwyer, Pankaj Dangle, Omaya Banihani, Heidi Stephany, Glenn Cannon, Francis Schneck, Michael Ost, Pittsburgh, PA INTRODUCTION AND OBJECTIVES: Pediatric urologic patients often undergo procedures guided by fluoroscopy. Pediatric tissues are exquisitely sensitive to ionizing radiation, and patients are at risk for detrimental long term effects throughout their lifetimes. We sought to prospectively monitor radiation exposure in our pediatric urologic patients using single point dosimeters during fluoroscopic guided operative procedures. METHODS: Pediatric patients undergoing fluoroscopic guided urologic procedures from August 2013 through October 2014 were prospectively enrolled in the IRB approved study. After obtaining informed consent from the patient’s guardian, single point dosimeters were affixed to the flank of the planned procedural side with a transparent adhesive dressing. Patient demographics, procedural variables,