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MP66-02 PRE-OPERATIVE TAMSULOSIN AND URETERAL ORIFICE NAVIGATION IN PEDIATRIC PATIENTS: IS THERE ANY BENEFIT?
THE JOURNAL OF UROLOGYâ
e862
Vol. 197, No. 4S, Supplement, Sunday, May 14, 2017
Pediatrics: Testis, Varicocele & Stones Moderated Poster 66 Sunday, May 14, 2017
3:30 PM-5:30 PM
MP66-01 EMERGENCY DEPARTMENT REVISITS FOR CHILDREN FOLLOWING AN ACUTE URINARY STONE EPISODE Jane Kurtzman*, Brooklyn, NY; Lihai Song, Michelle Ross, Philadelphia, PA; Charles Scales Jr., Durham, NC; Gregory Tasian, Philadelphia, PA INTRODUCTION AND OBJECTIVES: Revisiting the emergency department (ED) after discharge is an undesired clinical outcome that remains unstudied in children with kidney stones. We sought to determine the rate of stone-related ED revisits among children, to characterize the reasons for revisiting and to identify patient-, hospitaland clinical characteristics associated with ED revisit. METHODS: In a retrospective population-based cohort study of patients 18 years with urinary stone disease, ED revisits within 180 days of the index visit were identified in the South Carolina Medical Encounter database. This database includes all ED visits in the state from December 30, 1995 to September 30, 2015. We used discrete time failure models to describe the rate of ED revisit risk over the 180-day period following the index visit. Multivariable logistic regression models were used to estimate the association between patient, hospital and clinical characteristics and ED revisit. RESULTS: Among 5,642 index stone episodes, 11% led to a stone-related ED revisit within 180 days of discharge. Nearly 60% of these revisits occurred within 30 days of discharge. The odds of revisit within the first 2 days after discharge were 23 times higher than the odds of revisit after 2 weeks from discharge (OR 22.6, 95% CI 18.0 28.5, Figure 1). The most common documented symptom at revisit was pain, which occurred in 40% of patients. Nearly 40% of patients underwent surgery and/or hospital admission at the time of revisit. Each year increase in age (OR 1.06, 95% CI 1.03 - 1.10) and public insurance (OR 1.46, 95% CI 1.21 - 1.77) were associated with an increased risk of ED revisit. Patients with a history of stone disease were two times more likely to revisit than patients with no prior history (OR 2.1, 95% CI 1.74 - 2.56). Patients evaluated by a urologist were 40% less likely to revisit the hospital than those who were not (OR 0.6, 95% CI .42 - 0.86). CONCLUSIONS: Children who present to the ED with kidney stones are at most likely to return to the ED within 48 hours of discharge. Older children, publicly insured patients and repeat stoneformers are at greatest risk of ED revisit. Urology consultation is associated with a decreased risk of revisit. Future studies should seek to identify processes of care that decrease ED revisits among high-risk patients.
Source of Funding: None
MP66-02 PRE-OPERATIVE TAMSULOSIN AND URETERAL ORIFICE NAVIGATION IN PEDIATRIC PATIENTS: IS THERE ANY BENEFIT? Chad Morley*, Morgantown, WV; Ali Hajiran, Morgantown, WV; Morris Jessop, Morgantown, WV; Osama AL-Omar, Morgantown, WV INTRODUCTION AND OBJECTIVES: Alpha-1 adrenergic receptors are densely located in the intramural ureter, which can be too narrow to navigate during ureteroscopy (URS). Balloon dilation of the ureteral orifice (UO) is not recommended in pediatric patients, as it may lead to vesicoureteral reflux, ureteral stricture, or rupture. Therefore, ureteral stents (US) are usually placed for passive dilation resulting in another procedure. We aim to evaluate whether pre-operative tamsulosin increases the rate of ureteral navigation for URS. METHODS: We retrospectively reviewed all pediatric patients who underwent URS at our institution from January 2013 to October 2016. Procedures were identified by searching the electronic medical records for cases billed as URS. All cases were performed by a single surgeon using a standard approach for UO navigation based on location of the stone, semi-rigid ureteroscope (Wolf 4.5 Fr) for distal and mid ureteral stones, and flexible ureteroscope (Storz 7.5 Fr) with or without a ureteral access sheath (Cook 9.5 Fr) for proximal ureteral and kidney stones. Patients were separated into 2 groups: those who took tamsulosin 0.4 mg daily for at least 48 hours pre-operatively and those who did not take tamsulosin pre-operatively. Exclusion criteria included any patient who had a US placed previously. The student T test, Z test, and chi square test were used for statistical analysis. RESULTS: A total of 55 patients underwent URS with 22 taking pre-operative tamsulosin, 19 without tamsulosin, and 14 patients were excluded. There was no significant difference between the groups with consideration to age and weight of the patients and size or location of the stones. We were able to navigate the ureter in 19 of 22 patients (86.4%) who took tamsulosin and 10 of 19 patients (52.6%) who did not take tamsulosin (p ¼ 0.018). Further stratification was made between distal and proximal stone location. We were able to navigate the ureter in 9 of 10 patients (90.0%) in the tamsulosin group and 1 of 4 patients (25.0%) in the no tamsulosin group for mid and distal stones (p ¼ 0.015). For proximal ureteral and renal stones, we were able to navigate the ureter in 10 of 12 patients (83.3%) in the tamsulosin group and 9 of 15 patients (60.0%) in the no tamsulosin group (p ¼ 0.187). We did not observe any adverse effect from tamsulosin. CONCLUSIONS: Pre-operative tamsulosin did significantly increase the success rate of ureteral navigation for URS, particularly during semi-rigid ureteroscopy for distal or mid ureteral stones, thus decreasing the number of surgeries in our pediatric patients. Source of Funding: None
e862
Vol. 197, No. 4S, Supplement, Sunday, May 14, 2017
Pediatrics: Testis, Varicocele & Stones Moderated Poster 66 Sunday, May 14, 2017
3:30 PM-5:30 PM
MP66-01 EMERGENCY DEPARTMENT REVISITS FOR CHILDREN FOLLOWING AN ACUTE URINARY STONE EPISODE Jane Kurtzman*, Brooklyn, NY; Lihai Song, Michelle Ross, Philadelphia, PA; Charles Scales Jr., Durham, NC; Gregory Tasian, Philadelphia, PA INTRODUCTION AND OBJECTIVES: Revisiting the emergency department (ED) after discharge is an undesired clinical outcome that remains unstudied in children with kidney stones. We sought to determine the rate of stone-related ED revisits among children, to characterize the reasons for revisiting and to identify patient-, hospitaland clinical characteristics associated with ED revisit. METHODS: In a retrospective population-based cohort study of patients 18 years with urinary stone disease, ED revisits within 180 days of the index visit were identified in the South Carolina Medical Encounter database. This database includes all ED visits in the state from December 30, 1995 to September 30, 2015. We used discrete time failure models to describe the rate of ED revisit risk over the 180-day period following the index visit. Multivariable logistic regression models were used to estimate the association between patient, hospital and clinical characteristics and ED revisit. RESULTS: Among 5,642 index stone episodes, 11% led to a stone-related ED revisit within 180 days of discharge. Nearly 60% of these revisits occurred within 30 days of discharge. The odds of revisit within the first 2 days after discharge were 23 times higher than the odds of revisit after 2 weeks from discharge (OR 22.6, 95% CI 18.0 28.5, Figure 1). The most common documented symptom at revisit was pain, which occurred in 40% of patients. Nearly 40% of patients underwent surgery and/or hospital admission at the time of revisit. Each year increase in age (OR 1.06, 95% CI 1.03 - 1.10) and public insurance (OR 1.46, 95% CI 1.21 - 1.77) were associated with an increased risk of ED revisit. Patients with a history of stone disease were two times more likely to revisit than patients with no prior history (OR 2.1, 95% CI 1.74 - 2.56). Patients evaluated by a urologist were 40% less likely to revisit the hospital than those who were not (OR 0.6, 95% CI .42 - 0.86). CONCLUSIONS: Children who present to the ED with kidney stones are at most likely to return to the ED within 48 hours of discharge. Older children, publicly insured patients and repeat stoneformers are at greatest risk of ED revisit. Urology consultation is associated with a decreased risk of revisit. Future studies should seek to identify processes of care that decrease ED revisits among high-risk patients.
Source of Funding: None
MP66-02 PRE-OPERATIVE TAMSULOSIN AND URETERAL ORIFICE NAVIGATION IN PEDIATRIC PATIENTS: IS THERE ANY BENEFIT? Chad Morley*, Morgantown, WV; Ali Hajiran, Morgantown, WV; Morris Jessop, Morgantown, WV; Osama AL-Omar, Morgantown, WV INTRODUCTION AND OBJECTIVES: Alpha-1 adrenergic receptors are densely located in the intramural ureter, which can be too narrow to navigate during ureteroscopy (URS). Balloon dilation of the ureteral orifice (UO) is not recommended in pediatric patients, as it may lead to vesicoureteral reflux, ureteral stricture, or rupture. Therefore, ureteral stents (US) are usually placed for passive dilation resulting in another procedure. We aim to evaluate whether pre-operative tamsulosin increases the rate of ureteral navigation for URS. METHODS: We retrospectively reviewed all pediatric patients who underwent URS at our institution from January 2013 to October 2016. Procedures were identified by searching the electronic medical records for cases billed as URS. All cases were performed by a single surgeon using a standard approach for UO navigation based on location of the stone, semi-rigid ureteroscope (Wolf 4.5 Fr) for distal and mid ureteral stones, and flexible ureteroscope (Storz 7.5 Fr) with or without a ureteral access sheath (Cook 9.5 Fr) for proximal ureteral and kidney stones. Patients were separated into 2 groups: those who took tamsulosin 0.4 mg daily for at least 48 hours pre-operatively and those who did not take tamsulosin pre-operatively. Exclusion criteria included any patient who had a US placed previously. The student T test, Z test, and chi square test were used for statistical analysis. RESULTS: A total of 55 patients underwent URS with 22 taking pre-operative tamsulosin, 19 without tamsulosin, and 14 patients were excluded. There was no significant difference between the groups with consideration to age and weight of the patients and size or location of the stones. We were able to navigate the ureter in 19 of 22 patients (86.4%) who took tamsulosin and 10 of 19 patients (52.6%) who did not take tamsulosin (p ¼ 0.018). Further stratification was made between distal and proximal stone location. We were able to navigate the ureter in 9 of 10 patients (90.0%) in the tamsulosin group and 1 of 4 patients (25.0%) in the no tamsulosin group for mid and distal stones (p ¼ 0.015). For proximal ureteral and renal stones, we were able to navigate the ureter in 10 of 12 patients (83.3%) in the tamsulosin group and 9 of 15 patients (60.0%) in the no tamsulosin group (p ¼ 0.187). We did not observe any adverse effect from tamsulosin. CONCLUSIONS: Pre-operative tamsulosin did significantly increase the success rate of ureteral navigation for URS, particularly during semi-rigid ureteroscopy for distal or mid ureteral stones, thus decreasing the number of surgeries in our pediatric patients. Source of Funding: None