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MP41-16 PREDICTORS OF URINARY TRACT INFECTION IN PATIENTS WITH URETERAL STENTS TREATED WITH URETEROSCOPY
THE JOURNAL OF UROLOGYâ
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RESULTS: 60.2% (3,037/5,048) of patients with urolithiasis and CT abdomen/pelvis received IV fluid boluses. 21.4% (617/2,882) of patients had a BUN: Creatinine profile indicative of hypovolemia and therefore such IV hydration was justified. The majority of patients who received a fluid bolus (79.12%) did not meet criteria for volume depletion based on their BUN: Creatinine ratio or urine specific gravity, and therefore IV fluid resuscitation was not apparently indicated. In addition, there was no statistically significant difference in the proportion of patients with BUN:Cr ratio>20 among patients who received fluid boluses (25.50%, 617/2420) and those who did not (25.45%, 408/1603, p¼1.00). Those who received unexplained fluid boluses based on BUN: Creatinine ratio were more likely to be male (p <0.0001). CONCLUSIONS: Forced fluids continue to be a common practice in EDs, and they are frequently administered despite normal BUN:Cr ratios. It can be inferred that fluids were not necessarily administered due to volume depletion, but rather due to practice approaches based on historical dogma that forced fluids promotes stone passage. This practice may represent part of a standardized care path for renal stones, or may result from the lack of treatment guidelines on this subject. This information highlights the need for improved care pathways in the ED for patients with renal colic.
Vol. 193, No. 4S, Supplement, Sunday, May 17, 2015
Univariate analysis of risk factors for the development of post-operative sepsis. Variable Age
No. Patients with sepsis (n¼11)
No. Patients without sepsis (n¼286)
P value
Mean 60.6, SD 15.6
Mean 52.9, SD 17.7
0.15 0.019
Gender (female)
7 (64%)
83 (29%)
Positive UC
3 (27%)
52 (18%)
0.4
Positive STC
7 (64%)
45 (16%)
0.0015
Procedure (URS and RIRS)
5 (45%)
124 (43%)
0.89
Operative time
Mean 49.3, SD 16.9
Mean 49.5, SD 26.5
0.11
Time from stent insertion
Mean 52.6, SD 34.4
Mean 68.1, SD 46.9
0.18
5 (45%)
53 (18%)
0.027
Stent inserted because of sepsis
SD- Standard deviation, UC- urine culture, STC- stent tip culture, URS- ureteroscopy, RIRS e retrograde intra-renal surgery.
Source of Funding: none
Source of Funding: none
MP41-17 MP41-16 PREDICTORS OF URINARY TRACT INFECTION IN PATIENTS WITH URETERAL STENTS TREATED WITH URETEROSCOPY Amihay Nevo*, Lifshitsz David, Jack Baniel, Petach Tikva, Israel INTRODUCTION AND OBJECTIVES: Placement of ureteral stents has become an established method for the drainage of the upper urinary tract. Although not mandatory before every ureteroscopy, it facilitates the ureteroscopic management of stones, improves the stone free rate, and reduces complications. The aim of the present study was to evaluate the rate and predictors of post-ureteroscopy sepsis in patients who underwent ureteral stent insertion prior to ureteroscopy (URS) for the treatment of urinary stones. To investigate whether routine stent tip culture (STC) may alter treatment in these patients. METHODS: A single institution, prospectively collected database, was queried for all patients undergoing URS between October 2010 and January 2014 who had a ureteral stent before the operation. Pre-operative prophylactic antibiotics were administered according to a standard protocol. Urine culture (UC) and STC were obtained for all patients. Demographic, pre-operative and operative data were collected. The primary study endpoint was post-ureteroscopy sepsis within 24 hours of the procedure. Univariate analyses were performed to identify predictors of post-ureteroscopy sepsis. RESULTS: The study group comprised 297 patients at a median age of 56 years; 90 patients (30%) were females. Positive UC were found in 52 patients (18%) and positive STC in 52 patients. Twenty-four patients (8%) had both positive UC and STC, but only 15/24 had identical bacteria in both cultures. The indication for stent insertion was sepsis in 58 patients (19%). Eleven patients (3.7%) had post-ureteroscopy sepsis, of which 7 (64%) had positive STC, 7 (64%) were female and 5 (46%) had a stent inserted because of sepsis. On univariate analysis female gender, positive STC, and stent insertion due to sepsis were significantly associated with post-ureteroscopy sepsis. The antibiotic regimen in 3 patients with urospesis was modified according to the STC results. CONCLUSIONS: Female gender, stent insertion due to sepsis, and positive STC were associated with a higher risk of post-ureteroscopy sepsis in patients with an indwelling ureteral stent. STC may direct the proper antibiotic regimen for septic patients after URS. Obtaining STC from high risk patients may increase the yield and costefficiency of this test.
EFFECTS OF TAMSULOSIN, SOLIFENACIN MONOTHERAPY AND COMBINATION THERAPY FOR THE RELIEF OF URETERAL STENT-RELATED SYMPTOMS: AN OPEN-LABEL RANDOMIZED CONTROLLED TRIAL Jinsung Park*, Daejeon, Korea, Republic of; Changhee You, Chuncheon, Korea, Republic of; Deok Hyun Han, Dong Wook Shin, Seoul, Korea, Republic of INTRODUCTION AND OBJECTIVES: Although there are studies regarding the efficacy of medical therapy for relieving ureteral stent-related symptoms (SRS), the results have been inconsistent. We assessed the efficacy of alpha-blocker (tamsulosin) and anti-cholinergics (solifenacin) medication, and combination therapy of both drugs on SRS. METHODS: An open-label, randomized controlled multicenter trial was conducted with patients who underwent unilateral ureteral stent positioning following ureteroscopic stone surgery. A total of 112 patients were randomized with a 2x2 factorial design to group A (control), B (tamsulosin 0.2mg once daily, initial approved dosage in Asian), C (solifenacin 5mg once daily), or D (both active treatments). Patients were evaluated at week 2 (the day of stent removal) and week 6 (4 weeks after stent removal) by validated Korean version of ureteral stent symptom questionnaire (USSQ). The primary end-point was urinary symptom score in the USSQ, and the secondary end-points were other 5 domain score (body pain, general health, work performance, sexual matters, and global quality-of-life (QOL)), Euro-QOL score, and oral analgesic requirements during 2 weeks. Efficacy outcomes were estimated in per-protocol population who were compliant (>80% medication). RESULTS: The four groups were well balanced in terms of baseline characteristics except height, i.e. group B patients were smaller than other groups. Post-treatment drop out occurred due to follow-up loss (20, 17.9%) and poor medication compliance (11, 9.8%), thus 81 patients (72.3%) formed the per-protocol population. In the efficacy analysis, no differences were found between the four groups in urinary symptom score and the other 5 USSQ domain scores. Similarly, in the analysis to evaluate the medication effect, no differences were observed regardless of tamsulosin or solifenacin medication (all p>0.05). Other secondary outcomes including EuroQOL score and oral analgesic requirements were not different depending on either drug medication. Among 84 patients, except control group, who took their medications at least once, 6 (2 in group A, 4 in group D) underwent treatment-related adverse events. CONCLUSIONS: Our findings indicate that neither 0.2mg tamsulosin nor 5mg solifenacin medication had beneficial effect on SRS
e506
RESULTS: 60.2% (3,037/5,048) of patients with urolithiasis and CT abdomen/pelvis received IV fluid boluses. 21.4% (617/2,882) of patients had a BUN: Creatinine profile indicative of hypovolemia and therefore such IV hydration was justified. The majority of patients who received a fluid bolus (79.12%) did not meet criteria for volume depletion based on their BUN: Creatinine ratio or urine specific gravity, and therefore IV fluid resuscitation was not apparently indicated. In addition, there was no statistically significant difference in the proportion of patients with BUN:Cr ratio>20 among patients who received fluid boluses (25.50%, 617/2420) and those who did not (25.45%, 408/1603, p¼1.00). Those who received unexplained fluid boluses based on BUN: Creatinine ratio were more likely to be male (p <0.0001). CONCLUSIONS: Forced fluids continue to be a common practice in EDs, and they are frequently administered despite normal BUN:Cr ratios. It can be inferred that fluids were not necessarily administered due to volume depletion, but rather due to practice approaches based on historical dogma that forced fluids promotes stone passage. This practice may represent part of a standardized care path for renal stones, or may result from the lack of treatment guidelines on this subject. This information highlights the need for improved care pathways in the ED for patients with renal colic.
Vol. 193, No. 4S, Supplement, Sunday, May 17, 2015
Univariate analysis of risk factors for the development of post-operative sepsis. Variable Age
No. Patients with sepsis (n¼11)
No. Patients without sepsis (n¼286)
P value
Mean 60.6, SD 15.6
Mean 52.9, SD 17.7
0.15 0.019
Gender (female)
7 (64%)
83 (29%)
Positive UC
3 (27%)
52 (18%)
0.4
Positive STC
7 (64%)
45 (16%)
0.0015
Procedure (URS and RIRS)
5 (45%)
124 (43%)
0.89
Operative time
Mean 49.3, SD 16.9
Mean 49.5, SD 26.5
0.11
Time from stent insertion
Mean 52.6, SD 34.4
Mean 68.1, SD 46.9
0.18
5 (45%)
53 (18%)
0.027
Stent inserted because of sepsis
SD- Standard deviation, UC- urine culture, STC- stent tip culture, URS- ureteroscopy, RIRS e retrograde intra-renal surgery.
Source of Funding: none
Source of Funding: none
MP41-17 MP41-16 PREDICTORS OF URINARY TRACT INFECTION IN PATIENTS WITH URETERAL STENTS TREATED WITH URETEROSCOPY Amihay Nevo*, Lifshitsz David, Jack Baniel, Petach Tikva, Israel INTRODUCTION AND OBJECTIVES: Placement of ureteral stents has become an established method for the drainage of the upper urinary tract. Although not mandatory before every ureteroscopy, it facilitates the ureteroscopic management of stones, improves the stone free rate, and reduces complications. The aim of the present study was to evaluate the rate and predictors of post-ureteroscopy sepsis in patients who underwent ureteral stent insertion prior to ureteroscopy (URS) for the treatment of urinary stones. To investigate whether routine stent tip culture (STC) may alter treatment in these patients. METHODS: A single institution, prospectively collected database, was queried for all patients undergoing URS between October 2010 and January 2014 who had a ureteral stent before the operation. Pre-operative prophylactic antibiotics were administered according to a standard protocol. Urine culture (UC) and STC were obtained for all patients. Demographic, pre-operative and operative data were collected. The primary study endpoint was post-ureteroscopy sepsis within 24 hours of the procedure. Univariate analyses were performed to identify predictors of post-ureteroscopy sepsis. RESULTS: The study group comprised 297 patients at a median age of 56 years; 90 patients (30%) were females. Positive UC were found in 52 patients (18%) and positive STC in 52 patients. Twenty-four patients (8%) had both positive UC and STC, but only 15/24 had identical bacteria in both cultures. The indication for stent insertion was sepsis in 58 patients (19%). Eleven patients (3.7%) had post-ureteroscopy sepsis, of which 7 (64%) had positive STC, 7 (64%) were female and 5 (46%) had a stent inserted because of sepsis. On univariate analysis female gender, positive STC, and stent insertion due to sepsis were significantly associated with post-ureteroscopy sepsis. The antibiotic regimen in 3 patients with urospesis was modified according to the STC results. CONCLUSIONS: Female gender, stent insertion due to sepsis, and positive STC were associated with a higher risk of post-ureteroscopy sepsis in patients with an indwelling ureteral stent. STC may direct the proper antibiotic regimen for septic patients after URS. Obtaining STC from high risk patients may increase the yield and costefficiency of this test.
EFFECTS OF TAMSULOSIN, SOLIFENACIN MONOTHERAPY AND COMBINATION THERAPY FOR THE RELIEF OF URETERAL STENT-RELATED SYMPTOMS: AN OPEN-LABEL RANDOMIZED CONTROLLED TRIAL Jinsung Park*, Daejeon, Korea, Republic of; Changhee You, Chuncheon, Korea, Republic of; Deok Hyun Han, Dong Wook Shin, Seoul, Korea, Republic of INTRODUCTION AND OBJECTIVES: Although there are studies regarding the efficacy of medical therapy for relieving ureteral stent-related symptoms (SRS), the results have been inconsistent. We assessed the efficacy of alpha-blocker (tamsulosin) and anti-cholinergics (solifenacin) medication, and combination therapy of both drugs on SRS. METHODS: An open-label, randomized controlled multicenter trial was conducted with patients who underwent unilateral ureteral stent positioning following ureteroscopic stone surgery. A total of 112 patients were randomized with a 2x2 factorial design to group A (control), B (tamsulosin 0.2mg once daily, initial approved dosage in Asian), C (solifenacin 5mg once daily), or D (both active treatments). Patients were evaluated at week 2 (the day of stent removal) and week 6 (4 weeks after stent removal) by validated Korean version of ureteral stent symptom questionnaire (USSQ). The primary end-point was urinary symptom score in the USSQ, and the secondary end-points were other 5 domain score (body pain, general health, work performance, sexual matters, and global quality-of-life (QOL)), Euro-QOL score, and oral analgesic requirements during 2 weeks. Efficacy outcomes were estimated in per-protocol population who were compliant (>80% medication). RESULTS: The four groups were well balanced in terms of baseline characteristics except height, i.e. group B patients were smaller than other groups. Post-treatment drop out occurred due to follow-up loss (20, 17.9%) and poor medication compliance (11, 9.8%), thus 81 patients (72.3%) formed the per-protocol population. In the efficacy analysis, no differences were found between the four groups in urinary symptom score and the other 5 USSQ domain scores. Similarly, in the analysis to evaluate the medication effect, no differences were observed regardless of tamsulosin or solifenacin medication (all p>0.05). Other secondary outcomes including EuroQOL score and oral analgesic requirements were not different depending on either drug medication. Among 84 patients, except control group, who took their medications at least once, 6 (2 in group A, 4 in group D) underwent treatment-related adverse events. CONCLUSIONS: Our findings indicate that neither 0.2mg tamsulosin nor 5mg solifenacin medication had beneficial effect on SRS