You have accessJournal of UrologyBladder Cancer: Epidemiology & Evaluation I (MP05)1 Apr 2019MP05-19 OUTCOMES OF SALVAGE CYSTECTOMY AFTER FAILURE OF TRIMODALITY THERAPY Jim Shen*, Nora Ruel, Mitchell Bassett, Brian Blair, Alexander Cantrell, Kevin Chan, Clayton Lau, Jonathan Yamzon, Ali Zhumkhawala, and Bertram Yuh Jim Shen*Jim Shen* More articles by this author , Nora RuelNora Ruel More articles by this author , Mitchell BassettMitchell Bassett More articles by this author , Brian BlairBrian Blair More articles by this author , Alexander CantrellAlexander Cantrell More articles by this author , Kevin ChanKevin Chan More articles by this author , Clayton LauClayton Lau More articles by this author , Jonathan YamzonJonathan Yamzon More articles by this author , Ali ZhumkhawalaAli Zhumkhawala More articles by this author , and Bertram YuhBertram Yuh More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000554990.15052.1eAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: A minority of patients undergoing trimodality therapy for bladder cancer will go on to require salvage cystectomy. We report the outcomes in a small cohort of open and minimally invasive salvage cystectomies with both incontinent and continent urinary diversions. METHODS: From April 1998 to October 2013, 16 cystectomies were performed on patients with a known history of bladder cancer treated with both chemotherapy and radiation therapy. Demographics, pathology, complications, and outcomes data were collected by chart review. The Kaplan-Meier method was used to calculate metastasis-free and overall survival. The log-rank test was used to compare survival curves. RESULTS: Cystectomy was done for locally recurrent disease in 15 patients and refractory hematuria in one patient. Median age was 75.5 years. Median BMI was 23.6 kg/m2. Median Charlson comorbidity index was 6. 10 of 16 cystectomies were started via a minimally invasive approach (8 robotic, 2 laparoscopic). One robotic and one laparoscopic cystectomy was converted to open. In patients who had lymphadenectomy, median nodal yield was 13 (IQR 6-30). 11 patients had ileal conduit urinary diversion and 5 had continent diversion (4 Indiana pouch, 1 Studer neobladder). Median estimated blood loss was 500 mL and 9 patients required intraoperative blood transfusion. At 90 days after surgery, 5 patients developed a Clavien-Dindo complication grade ≥3 (1 mortality). Median hospital stay was 11 days. Five patients developed distant metastasis at a median of 13.3 months after surgery. Median overall survival was 31.4 months (95% CI 4.2-96.8). Patients who had cisplatin-based chemotherapy experienced longer overall survival than those who had non cisplatin-based chemotherapy (67.9 vs. 16.3 months, p=0.03). CONCLUSIONS: Although salvage cystectomy is a morbid surgery, a subset of patients experienced significant metastasis-free and overall survival. Robotic approaches and continent urinary diversions are feasible. Additional study is needed to guide management in this rarely studied patient population. Source of Funding: None Duarte, CA© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e46-e47 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jim Shen* More articles by this author Nora Ruel More articles by this author Mitchell Bassett More articles by this author Brian Blair More articles by this author Alexander Cantrell More articles by this author Kevin Chan More articles by this author Clayton Lau More articles by this author Jonathan Yamzon More articles by this author Ali Zhumkhawala More articles by this author Bertram Yuh More articles by this author Expand All Advertisement PDF downloadLoading ...

Solitary Kidney [ 25 Bilateral Cancer [ 8 Non-functioning contralateral kidney [ 3 Tumour size 6.2 cm (2.6-18 cm) Single tumour [ 31 Multi-focal disease [ 5 R.E.N.A.L. Nephrometry score Highly complex [ 34 Moderately complex [ 2 Peri-operative outcomes Positive Surgical Margins 2/36 (5.5%) Post operative dialysis 18/36 (50%) Complications (Clavien III-V) 20/36 (56%) 30 day mortality 2/36 (5.6%)Long term outcomes Duration of Follow up: Mean [ 60 months (6-156) Cancer Specific Survival 96% Recurrence free Survival 79% Overall Survival 88% Dialysis free survival 83% of patients still alive CONCLUSIONS: EPN though complex and potentially hazardous offers an excellent chance of renal preservation without compromising cancer control EPN should be considered a viable treatment option in selected patients

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Ureter (including Pyeloplasty) and Bladder Reconstruction (including fistula), Augmentation, Substitution, Diversion II (MP61)1 Apr 2019MP61-17 OUTCOMES OF CONTINENT AND INCONTINENT URINARY DIVERSION DURING PELVIC EXENTERATION FOR NON-UROLOGIC MALIGNANCY: A CANCER CENTER EXPERIENCE Brian M. Blair*, Jim Shen, Nora Ruel, Jonathan Yamzon, Ali Zhumkhawala, Clayton Lau, Bertram Yuh, and Kevin Chan Brian M. Blair*Brian M. Blair* More articles by this author , Jim ShenJim Shen More articles by this author , Nora RuelNora Ruel More articles by this author , Jonathan YamzonJonathan Yamzon More articles by this author , Ali ZhumkhawalaAli Zhumkhawala More articles by this author , Clayton LauClayton Lau More articles by this author , Bertram YuhBertram Yuh More articles by this author , and Kevin ChanKevin Chan More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000556819.78973.59AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: Radical cystectomy during multi-visceral resection for locally advanced pelvic malignancy requires urinary diversion. Outcomes with incontinent and continent urinary diversions performed during pelvic exenteration for non-urologic malignancy are not well documented in urologic literature. The aim of the study is to report our experience with urinary reconstruction in this complex operation. METHODS: A single tertiary-care institution, multi-surgeon, retrospective chart review was performed for patients undergoing urinary diversion as part of pelvic exenteration for non-urologic malignancy between February 1999 and April 2017. Patient demographics, surgical parameters, and complication rates were analyzed and then compared by diversion type. Statistical significance was set at p<0.05. RESULTS: 57 patients were included with a median age of 56.0 years (IQR 47.0 - 67.0) and BMI 27.1 kg/m2 (IQR 21.8 - 31.5). 70.2% (n=40) were female and 29.8% male (n=17), with 68.4% having an ASA classification ≥ III. Patient’s primary malignancy was categorized as colorectal for 49.1%, gynecologic for 43.9%, and other for 7.0% (sarcoma, adenocarcinoma). Prior chemotherapy (77.2%), pelvic radiation (71.9%), or chemoradiation (63.2%) was common. Indiana pouch (IP) continent diversion was used in 19.3% (n=11), and incontinent diversions included ileal conduit (IC) in 77.2% (n=44) and colon conduit in 3.5% (n=2). Comparing IP to IC diversions, there was no difference in age, gender, BMI, or tumor type. Those undergoing IP were less likely to have prior chemotherapy (36.4 vs 88.6%, p=0.0007) or radiation (63.6 vs 72.7%, p=0.007), and less likely to require intraoperative (36.4 vs 75.7%, p=0.02) or postoperative transfusion (18.2 vs 27.3%, p=0.02). Clinically, operative time was longer in patients who underwent IP compared to IC (650.5 vs 480 minutes, p=0.2), with comparable 30-day (63.6 vs 72.7%, p=0.4) and 31-90-day (36.4 vs 29.5%, p=0.3) complications. Fewer IP patients underwent adjuvant chemotherapy (9.1 vs 34.1%, p=0.05), and follow-up was longer for the IP group (34.1 vs 10.0 months, p=0.03), perhaps owing to better disease prognosis in those receiving a continent diversion. CONCLUSIONS: This data provides insight into a scarcely reported topic in urologic literature. Diversion type should be individualized, with continent diversions in patients undergoing pelvic exenteration for non-urologic malignancy remaining a feasible option with comparable outcomes to incontinent diversions in appropriately selected patients. Source of Funding: None Duarte, CA© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e884-e884 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Brian M. Blair* More articles by this author Jim Shen More articles by this author Nora Ruel More articles by this author Jonathan Yamzon More articles by this author Ali Zhumkhawala More articles by this author Clayton Lau More articles by this author Bertram Yuh More articles by this author Kevin Chan More articles by this author Expand All Advertisement PDF downloadLoading ...

Fracture of the penis is a well-recognized yet relatively uncommon urologic event. Forceful, blunt trauma with lateral bending of the penis in an erect state typically results in a transverse rupture of the tunica albuginea of the corpus cavernosum. Longitudinal tears of the corpus cavernosum are by themselves considered infrequent. We present a rare case of a patient with longitudinal rupture of the distal corpus cavernosum with concomitant extension to the corpus spongiosum causing partial urethral disruption as a result of trauma during sexual intercourse. (C) 2018 Elsevier Inc.

Background: To evaluate early consequences of 2012 United States Preventive Services Task Force (USPSTF) recommendations for decreased prostate-specific antigen (PSA) screening on prostate biopsy characteristics and prostate cancer presentation. Materials and methods: A single tertiary-care institution, multisurgeon, prospectively maintained database was queried for patients undergoing prostate biopsy from October 2005 to September 2016. Patient demographics, biopsy characteristics, and extent of disease were reported. Patient cohorts before and after USPSTF recommendations were compared using two-sample t test, Chi-square test, and Wilcoxon rank sum test with significance at P < 0.05. Results: A total of 2,000 patients were analyzed, including 1,440 patients before and 560 patients after USPSTF recommendations. Following the recommendations, patients had higher prebiopsy PSA (5.90 vs. 6.70, P < 0.001). Overall, 817 (40.9%) patients had prostate cancer detected at biopsy with an increase from 37.0% before to 50.8% after (P < 0.001). Biopsies detected less low-risk Gleason <6 prostate cancer (47.4% vs. 41.1%) and more intermediate-risk Gleason 7 cancer (30.9% vs. 39.7%), with comparable findings of high-risk Gleason >= 8 cancer (21.7% vs. 19.2%), P = 0.042. In addition, greater percentage of core involvement (P < 0.001) was seen. At the time of diagnosis, extraprostatic extension identified by pelvic imaging increased from 12.6% to 18.9%, P = 0.039, with a trend toward lymph node positivity (1.1% vs. 2.2%, P = 0.078). Of those with metastatic disease, bony involvement occurred more often (1.7% vs. 3.2%, P = 0.041). Conclusions: After 2012 USPSTF guidelines, patients presented with higher PSA with prostate cancer were detected more frequently. More adverse, pathologic prostate cancer features were found on biopsy with the extent of disease implicating locally advanced/metastatic disease. These findings should be considered when counseling patients about prostate cancer screening importance. (c) 2018 Asian Pacific Prostate Society, Published by Elsevier Korea LLC. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

The purpose of the study was to evaluate the accuracy of the American College of Surgeons NSQIP Surgical Risk Calculator for predicting risk-adjusted 30-day outcomes for patients undergoing partial nephrectomy (PN) for renal cell carcinoma (RCC).

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Quality of Life & Shared Decision Making III1 Apr 2018PD52-10 EFFECT OF 2012 USPSTF RECOMMENDATIONS ON PROSTATE BIOPSY CHARACTERISTICS AND PROSTATE CANCER PRESENTATION AT A TERTIARY-CARE MEDICAL CENTER Brian M. Blair, Haley Robyak, Joseph Y. Clark, Matthew G. Kaag, Erik B. Lehman, and Jay D. Raman Brian M. BlairBrian M. Blair More articles by this author , Haley RobyakHaley Robyak More articles by this author , Joseph Y. ClarkJoseph Y. Clark More articles by this author , Matthew G. KaagMatthew G. Kaag More articles by this author , Erik B. LehmanErik B. Lehman More articles by this author , and Jay D. RamanJay D. Raman More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2362AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES In May 2012, the United States Preventive Services Task Force (USPSTF) made recommendations against the use of PSA-based screening for prostate cancer. We evaluated the early consequences of decreased PSA screening on prostate biopsy characteristics and presentation of prostate cancer in our clinical practice to better identify the impact of the USPSTF recommendations. METHODS A single tertiary-care institution, multi-surgeon, prospectively maintained database was queried for patients undergoing prostate biopsy from October 2005 - September 2016. Patient demographics, biopsy characteristics, and extent of disease were reported. Patient cohorts before and after USPSTF recommendations were compared using two-sample t-test, Chi-square, and Wilcoxon Rank Sum tests with significance at p<0.05. RESULTS 2,000 patients were analyzed, including 1,440 patients before and 560 patients after USPSTF recommendations. Following the recommendations, patients had higher pre-biopsy PSA (5.90 vs. 6.70, p<0.001). Overall, 817 (40.9%) patients had prostate cancer detected at biopsy with an increase from 37.0% before to 50.8% after (p<0.001). Biopsies detected less low-risk Gleason ≤6 prostate cancer (47.4% vs. 41.1%), more intermediate-risk Gleason 7 cancer (30.9% vs. 39.7%), with comparable findings of high-risk Gleason ≥8 cancer (21.7% vs. 19.2%), p=0.042. Additionally, greater percent core involvement (p<0.001) was seen. At time of diagnosis, extraprostatic extension identified by pelvic imaging increased from 12.6% to 18.9%, p=0.039, with a trend towards lymph node positivity (1.1% vs. 2.2%, p=0.078). Of those with metastatic disease, bony involvement occurred more often (1.7% vs. 3.2%, p=0.041). (Table) CONCLUSIONS After 2012 USPSTF guidelines, patients presented with higher PSA with prostate cancer detected more frequently. More adverse, pathologic prostate cancer features were found on biopsy with extent of disease demonstrating reverse stage migration toward more locally advanced/metastatic prostate cancer at presentation. Consideration towards these findings should be used in shared decision making about prostate cancer screening importance. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e985 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Brian M. Blair More articles by this author Haley Robyak More articles by this author Joseph Y. Clark More articles by this author Matthew G. Kaag More articles by this author Erik B. Lehman More articles by this author Jay D. Raman More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy IV1 Apr 2016PD41-09 ACTUAL VERSUS ESTIMATED CLINICAL OUTCOMES USING THE ACS SURGICAL RISK CALCULATOR IN PATIENTS UNDERGOING PARTIAL NEPHRECTOMY FOR RENAL CELL CARCINOMA Brian Blair, Erik Lehman, Syed Jafri, and Jay Raman Brian BlairBrian Blair More articles by this author , Erik LehmanErik Lehman More articles by this author , Syed JafriSyed Jafri More articles by this author , and Jay RamanJay Raman More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1555AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The American College of Surgeons (ACS) National Surgical Quality Improvement Project (NSQIP) Surgical Risk Calculator is a predictive tool to estimate risk-adjusted 30-day patient outcomes following an index procedure. We evaluated the accuracy of the NSQIP calculator for patients undergoing partial nephrectomy (PN) for renal cell carcinoma (RCC). METHODS A single institution, multi-surgeon, prospectively maintained database was queried for all patients undergoing PN for RCC from 1998-2015. 21 preoperative factors were analyzed for each patient with predicted risk for 30-day perioperative complications, mortality, and length of stay (LOS) calculated. The difference between the mean predicted risk and observed rate of surgical outcomes was determined using a two-sided one-sample t-test with significance set at 0.05. A subgroup analysis of outcomes of surgical approach comparing open and minimally invasive PN (MIPN) was also performed. RESULTS 470 patients with complete data available undergoing PN for RCC were included for analysis. In comparing predicted to observed outcomes, the NSQIP calculator significantly underestimated the risk of overall complications (p<0.001), pneumonia [PNA] (p< 0.001), cardiac event (p<0.001), surgical site infection [SSI] (p<0.001), urinary tract infection [UTI] (p<0.001), venous thromboembolism [VTE] (p=0.002), return to OR (p<0.001), and LOS (p<0.001). Conversely, it significantly overestimated the risk of severe complications (p<0.001), acute renal failure [ARF] (p=0.031), and death (p<0.001). On subgroup analysis, 209 open PN and 261 MIPN were performed. The NSQIP calculator consistently underestimated overall complications, SSI, UTI, return to OR, and LOS (p<0.001) among both surgical approaches. (Table) CONCLUSIONS The ACS NSQIP Surgical Risk Calculator for patients undergoing PN for RCC had significant differences among observed and predicted perioperative surgical outcomes. Additional analysis showed that these differences remained significant for the surgical approach performed. Creating procedure-specific preoperative risk factors and using the ACS NSQIP Procedure-Targeted option may allow for more accurate risk assessment to guide surgical decisions and informed consent. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e943 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Brian Blair More articles by this author Erik Lehman More articles by this author Syed Jafri More articles by this author Jay Raman More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Quality of Life and Shared Decision Making II1 Apr 2016PD17-09 RISING RATES OF UROTHELIAL CARCINOMA WITH UNDERUTILIZATION OF SYSTEMIC CHEMOTHERAPY – A 25-YEAR CANCER REGISTRY REVIEW Brian Blair, Fabian Camacho, Eugene Lengerich, and Jay Raman Brian BlairBrian Blair More articles by this author , Fabian CamachoFabian Camacho More articles by this author , Eugene LengerichEugene Lengerich More articles by this author , and Jay RamanJay Raman More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1174AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The incidence of urothelial carcinoma (UC) continues to rise within the United States. Level I evidence suggests a survival advantage for muscle-invasive bladder cancer (MIBC) patients receiving systemic chemotherapy (SC) in conjunction with radical cystectomy (RC). We reviewed 25 years of data from a state cancer registry to determine incidence trends of UC, integration of SC for MIBC, as well as factors associated with SC delivery. METHODS Age-adjusted UC incidence rates were calculated from the Pennsylvania Cancer Registry in 5-year intervals. Chloropleth maps plotting incidence rates across time and counties were created using GeoDa statistical package, and spatial Empirical Bayes Smoothing technique was used to shrink rates toward local area means. Multivariate logistic regression analyzed predictive factors including age, gender, race, and SEER stage for association with delivery of SC. Interactions between each of these predictors and year were examined for statistical significance (p<0.05). RESULTS A total of 93,748 cases of UC were recorded from 1986-2010. Stage distribution (SEER summary) included: in situ 30.9%, local 50.3%, regional 9.5%, distant 3.8%, and unstaged 5.5%. The age-adjusted rate of UC rose from 23.0 to 26.2 patients per 100,000 representing an average annual percentage change (APC) of 0.6% (95% CI 0.3-0.8). While the rates of in situ disease increased over the past 25 years (APC 7.6%), there was also a concerning increase in distant UC (APC 0.6%) with a particularly significant rise over the past 15 years (APC 4.5% from 1996-2010). Complete data for review of SC trends was available for 38,685 patients. Amongst this cohort, 14% of patients received SC with an increase from 2001-2010 of 8.6% to 19.0% (p<0.0001). During this timeframe, RC was performed in 15.3% of patients. In the final year of analysis (2010), only 30.6% of patients undergoing RC received perioperative SC. In a multivariate model, younger patient age (OR 1.02, 95% CI 1.02-1.03, p=0.02), male gender (OR 1.12, 95% CI 1.04-1.20, p<0.01), and white, non-Hispanic race (OR 1.28, 95% CI 1.12-1.47, p<0.01) were associated with receipt of SC. CONCLUSIONS UC incidence has continued to rise over the past 25 years, with a 4.5% annual percentage increase in distant disease over the past 15 years in our study cohort. Under one-third of patients undergoing RC received perioperative SC. These patients would theoretically benefit from receipt of SC, yet factors including age, gender, and race may serve as barriers to delivery. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e402 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Brian Blair More articles by this author Fabian Camacho More articles by this author Eugene Lengerich More articles by this author Jay Raman More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

PURPOSE:Radiation exposure from fluoroscopy during percutaneous nephrostolithotomy contributes to patient overall exposure, which may be significant. We compared fluoroscopy times and treatment outcomes before and after implementing a reduced fluoroscopy protocol during percutaneous nephrostolithotomy.MATERIALS AND METHODS:We retrospectively reviewed the charts of patients treated with percutaneous nephrostolithotomy at a single academic institution by a single surgeon. We compared 40 patients treated before implementation of a reduced fluoroscopy protocol to 40 post-protocol patients. The reduced protocol included visual and tactile cues, fixed lowered mAs and kVp, a laser guided C-arm and designated fluoroscopy technician, and single pulse per second fluoroscopy. Preoperative characteristics, fluoroscopy and operative time, complications and treatment success were examined using univariate and multivariate analysis.RESULTS:There was no significant difference in body mass index, stone size, success rate, operative time or complications between the groups. After protocol implementation fluoroscopy time decreased from 175.6 to 33.7 seconds (p<0.001). A longer average hospital stay was seen in the pre-protocol group (3.9 vs 3.6 days, p=0.027). Stays greater than 2 days were associated with a body mass index of greater than 30 kg/m2 on multivariate analysis. No complication in either group was attributable to fluoroscopic technique.CONCLUSIONS:Implementing a decreased fluoroscopy protocol during percutaneous nephrostolithotomy resulted in an 80.9% reduction in fluoroscopy time while maintaining success rates, operative times and complications similar to those of the conventional technique. Adopting this reduced fluoroscopy protocol safely decreased radiation exposure to patients, surgeons and operating room staff during percutaneous nephrostolithotomy.

You have accessJournal of UrologyStone Disease: New Technology/SWL, Ureteroscopic or Percutaneous Stone Removal IV1 Apr 20121949 LOW-DOSE FLUOROSCOPY DURING PERCUTANEOUS NEPHROSTOLITHOTOMY FEASIBILITY, OUTCOMES, AND EFFECTS ON RADIATION EXPOSURE Kirk Anderson, Amy Schlaifer, Roger Li, Brian Blair, Catherine Chen, Don Arnold, Damien Smith, and D. Duane Baldwin Kirk AndersonKirk Anderson Loma Linda, CA More articles by this author , Amy SchlaiferAmy Schlaifer Loma Linda, CA More articles by this author , Roger LiRoger Li Loma Linda, CA More articles by this author , Brian BlairBrian Blair Loma Linda, CA More articles by this author , Catherine ChenCatherine Chen Loma Linda, CA More articles by this author , Don ArnoldDon Arnold Loma Linda, CA More articles by this author , Damien SmithDamien Smith Loma Linda, CA More articles by this author , and D. Duane BaldwinD. Duane Baldwin Loma Linda, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.2107AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Patients with large renal stones are subjected to radiation exposure during pre and postoperative imaging and during fluoroscopy used during percutaneous nephrostolithotomy (PCNL). The use of low dose CT imaging for pre and postoperative imaging is now well established, but there is little data regarding the feasibility of low-dose fluoroscopy protocols during PCNL. The purpose of this study is to compare fluoroscopy times and treatment outcomes before and after implementation of a low-dose fluoroscopy protocol during PCNL. METHODS A retrospective chart review was conducted of patients treated with PCNL at a single academic institution by a single surgeon. Forty patients treated prior to implementation of a low-dose fluoroscopy protocol were compared to 40 patients treated after protocol implementation. Specific features of the reduced fluoroscopy protocol included substitution of visual and tactile cues in place of radiographic images, use of low mAs and kVp settings, use of a laser guided C-arm, a designated fluoroscopy technician, and use of single pulse per second image acquisition. Fluoroscopy time, operative time, complications, and stone-free rates were recorded and compared between the pre- and post-protocol implementation groups. Statistical analysis was performed with a student's t-test and Mann-Whitney test. RESULTS There were 42 males and 38 females with average body mass index (BMI) of 31.4. There were 31 right-sided stones and 49 left-sided stones. There was no statistically significant difference in stone size, stone-free rate, BMI, operative time or complications between the two groups. Fluoroscopy time was significantly decreased following protocol implementation from 175.6 s to 33.6 s (p<0.05). CONCLUSIONS Implementation of a low-dose fluoroscopy protocol during PCNL resulted in an 80.9 % reduction in radiation exposure while maintaining a similar stone-free rate and complication rate compared to a conventional technique. This low fluoroscopy protocol should be considered during PCNL to reduce radiation exposure to the patient, physician and operating room staff. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e786-e787 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kirk Anderson Loma Linda, CA More articles by this author Amy Schlaifer Loma Linda, CA More articles by this author Roger Li Loma Linda, CA More articles by this author Brian Blair Loma Linda, CA More articles by this author Catherine Chen Loma Linda, CA More articles by this author Don Arnold Loma Linda, CA More articles by this author Damien Smith Loma Linda, CA More articles by this author D. Duane Baldwin Loma Linda, CA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...