Pyeloplasty is the definitive management of ureteropelvic junction obstruction (UPJO). One of the challenging questions is when to perform pyeloplasty. We studied if improvement post-pyeloplasty in the first 3 months of life could show greater improvement in hydronephrosis than surgery at an older age. Patients with postnatally diagnosed UPJO and underwent pyeloplasty in the first year of life were retrospectively reviewed. We excluded patients with concomitant vesicoureteral reflux, and patients who had pyeloplasty because of UTI or missed follow-up. Patients were divided into two groups, according to the age at pyeloplasty, before and after the age of 3 months. We collected patients’ demographics, anteroposterior diameter of the renal pelvis (APD), SFU grade, renogram data, perioperative data (surgery duration, hospital stay, and ureteral stent duration) and postoperative ultrasound changes. The percentage of change of APD (Δ

You have accessJournal of UrologyCME1 May 2022MP17-06 EVALUATION OF RENAL MEASUREMENTS OF ISOLATED HIGH-GRADE CONGENITAL HYDRONEPHROSIS (HGH) IN BOTH SUPINE AND PRONE POSITIONS Amr Hodhod, Carolina Fermin-Risso, Mutaz Farhad, Anthony Cook, Jarrah Aburezeq, Steven Lu, and Bryce Weber Amr HodhodAmr Hodhod More articles by this author , Carolina Fermin-RissoCarolina Fermin-Risso More articles by this author , Mutaz FarhadMutaz Farhad More articles by this author , Anthony CookAnthony Cook More articles by this author , Jarrah AburezeqJarrah Aburezeq More articles by this author , Steven LuSteven Lu More articles by this author , and Bryce WeberBryce Weber More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002550.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Some studies have questioned the optimal positioning for the assessment of urinary tract dilatation. Prone position offers better visualization of the kidneys in comparison to the supine position in which other abdominal organs can interfere with the ultrasound scan. In this study, we compared the ultrasound renal measurements in both prone and supine positions. METHODS: We conducted a retrospective review of patients presented with congenital isolated HGH, in the first year of life, from 2017-2019. A control group of patients with normal contralateral kidneys was included. The renal length, anteroposterior diameter of the renal pelvis (APD), parenchymal thickness (PT) and pyramidal thickness (PyT) were measured by a single investigator. APD was measured at the renal contour in the mid-renal transverse plane. Both PT and PyT were measured in the mid-zone of the renal sagittal plane. All measurements were obtained in both supine and prone positions. RESULTS: Of 81 patients presented with congenital HGH, 65 patients (117 renal units) were included in our study. Contralateral normal forty-two renal units were included. Patients’ demographics are demonstrated in Table 1. Renal measurements in both positions are presented in Table 2. Prone measurements of renal length, in HGH and normal groups, were significantly higher (0.003, 0.005 respectively). In HGH group, although APD measurements in prone position exceeded those in the supine position (p<0.001), PT measurements were significantly greater in the supine position (p=0.012). In the normal group, both PT and PyT measurements were lower in a supine position when compared to those in the prone position (p=0.006, <0.001 respectively). CONCLUSIONS: There is a significant difference between renal measurements in both positions. However, the clinical impact of this difference should be further evaluated. Due to the prominence of hydronephrosis in the prone position, the PT and PyT measurements were less than the supine ones. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e286 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Amr Hodhod More articles by this author Carolina Fermin-Risso More articles by this author Mutaz Farhad More articles by this author Anthony Cook More articles by this author Jarrah Aburezeq More articles by this author Steven Lu More articles by this author Bryce Weber More articles by this author Expand All Advertisement PDF DownloadLoading ...

You have accessJournal of UrologyPediatric Urology II (MP44)1 Sep 2021MP44-20 INTRODUCTION OF MERCAPTOACETYLTRIGLYCINE-SUSPECTED OBSTRUCTION SCORING SYSTEM (MAG-SOS) AS A DIAGNOSTIC TOOL FOR URETEROPELVIC JUNCTION OBSTRUCTION Amr Hodhod, Carolina Fermin-Risso, Mutaz Farhad, Steven Lu, Jarrah Aburezeq, Anthony Cook, and Bryce Weber Amr HodhodAmr Hodhod More articles by this author , Carolina Fermin-RissoCarolina Fermin-Risso More articles by this author , Mutaz FarhadMutaz Farhad More articles by this author , Steven LuSteven Lu More articles by this author , Jarrah AburezeqJarrah Aburezeq More articles by this author , Anthony CookAnthony Cook More articles by this author , and Bryce WeberBryce Weber More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002065.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Mercaptoacetyltriglycine (MAG-3) renogram is one of the gold standard diagnostic tools of ureteropelvic junction obstruction (UPJO); however, there is no widely agreed indications of pyeloplasty based on MAG3 findings. In this study, we introduce a renogram scoring system that can help improve the prognostic value of MAG-3 renogram and in the decision making of pyeloplasty. METHODS: We retrospectively reviewed consecutive pyeloplasties for antenatal hydronephrosis (AHN) from 2015 to 2020. A control group was included of non-operatively managed SFU grade 3 and 4. We excluded patients who presented with UTI and loin pain. The initial renal ultrasound and preoperative MAG-3 Lasix renogram were reviewed for differential renal function (DRF), type of renogram curve and tracer washout half-time (T1/2). The MAG-SOS system is illustrated in Table 1. A ROC curve was used to evaluate the cut-off points that can predict obstruction. A multivariate linear regression model was used to assess the best renogram parameter that can predict surgical intervention. RESULTS: Of 117 patients, we included 97 patients with 101 renal units. Patients’ demographics and renogram data are presented in Table 2. The median age for pyeloplasty was 4.4 months (1-35.3). The MAG-SOS showed significant results in predicting pyeloplasty (AUC=0.959, %95 CI= 0.932-0.987, p<0.005). A score of 5 is 100% specific for obstruction. 65/101 units required surgical intervention (64.4%) had a MAG-SOS score of >=5 while all units of the control group had a range of score 0-4. Using the multivariate analysis, the MAG-SOS system showed to the only independent predictor for pyeloplasty (HR = 0.15, 95%CI= 0.12-0.18, p<0.001). CONCLUSIONS: MAG-SOS system showed to be a useful tool that can predict pyeloplasty; moreover, it’s the only independent predictor in the multivariate analysis. A score of 5 has 100% specificity for patients having a pyeloplasty performed. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e800-e801 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Amr Hodhod More articles by this author Carolina Fermin-Risso More articles by this author Mutaz Farhad More articles by this author Steven Lu More articles by this author Jarrah Aburezeq More articles by this author Anthony Cook More articles by this author Bryce Weber More articles by this author Expand All Advertisement PDF downloadLoading ...

BACKGROUND:Ureteral stents with magnetic tips (Blackstar©) were recently approved for use in Canada. To our knowledge this is the first published evidence of their use in pediatric patients. Traditionally, pediatric stent insertion and removal are performed under general anesthetic. Magnetic stents have three main benefits in pediatric patients; cost savings, decreased OR time and reduced general anesthetic exposure. METHODS:This study was a proof of concept pilot, ran from May 2017-May 2018 to demonstrate the safety and efficacy of magnetic stents in pediatric patients. Patients undergoing ureteroscopy, ureteric re-implantation, and pyeloplasty with simultaneous magnetic stent insertion. Forty (40) patients had regular double J stents removed under anesthesia and served as control cases, and 40 patients had a magnetic double J at initial surgery at two different sites, CHU de Quebec and Alberta Children's Hospital. RESULTS:Overall, 39 magnetic stents were successfully retrieved without general anesthetic, representing a retrieval failure rate of only 2.5%. CONCLUSION:As demonstrated in our research, magnetic stents represent a safe and equally effective alternative to traditional stents, especially in a pediatric patient. This is because, at worst, if retrieval of the magnetic stent fails, traditional cystoscopic removal can be performed, so nothing is lost. STUDY TYPE:Case-control study. LEVEL OF EVIDENCE:Level III.

You have accessJournal of UrologyStone Disease: Surgical Therapy V (PD59)1 Apr 2019PD59-05 OUTCOMES OF MEDICAL VS INTERVENTIONAL MANAGEMENT FOR ACUTE URETERAL COLIC IN EMERGENCY DEPARTMENT PATIENTS Grant Innes, Alec Mitchell*, Bryce Weber, Joel Teichman, Kevin Carlson, Andrew McRae, Michael Law, Frank Scheuermeyer, Eric Grafstein, and James Andruchow Grant InnesGrant Innes More articles by this author , Alec Mitchell*Alec Mitchell* More articles by this author , Bryce WeberBryce Weber More articles by this author , Joel TeichmanJoel Teichman More articles by this author , Kevin CarlsonKevin Carlson More articles by this author , Andrew McRaeAndrew McRae More articles by this author , Michael LawMichael Law More articles by this author , Frank ScheuermeyerFrank Scheuermeyer More articles by this author , Eric GrafsteinEric Grafstein More articles by this author , and James AndruchowJames Andruchow More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000557217.76960.69AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: Ureteric colic is a common condition that causes severe pain and generates substantial health system utilization. Traditional management includes analgesia and a trial of spontaneous passage, which can succeed, but passage may take weeks and cause severe morbidity. Early stone removal is an alternative, but uptake is variable. Stone removal rapidly improves patient outcomes by relieving obstruction and pain, but to date there has not been a study comparing early intervention with spontaneous passage, and there is little evidence clarifying patients most likely to benefit. METHODS: We looked at two health regions, Calgary Health Region, which serves 1.4 million people and Vancouver Coastal Health (VCH) region which serves 1.2 million. Using regional admin databases we identified all emergency department (ED) patients with a diagnosis of renal colic based on ICD-10 codes. Eligible patients had CT to confirm a stone 2.0-9.9mm in size. Exclusion criteria were used based on stone and patient specific factors. Two cohorts were studied; an early intervention group, which underwent surgical intervention within 3 days of ED presentation and a trial of spontaneous passage group, which did not receive intervention for >5 days. RESULTS: We studied 3081 ED patients with well-characterized ureteral stones. 1168 (37.9%) underwent early surgical intervention and 1913 (62.0%) had a trial of spontaneous passage. Patients that underwent spontaneous passage saw adverse outcomes increase in linear fashion with increasing stone width and proximal location. In early intervention patients, outcomes are relatively constant regardless of stone size, but worse with proximal location. See table 1. CONCLUSIONS: This study provides strong evidence for specific stone parameters to guide early intervention in patients presenting with ureteral colic. This data suggests that patients having low risk stones (width <5mm) undergo a trial of spontaneous passage, that patients having high-risk stones (width >7.0mm or proximal-middle >5mm) be offered early surgical intervention, and that those with medium-risk stones (distal, >5.0mm) be managed on a case-by-case basis. These recommendations are more aggressive than current American guidelines, which recommend a trial of spontaneous passage at <10mm. Source of Funding: none Calgary, Canada; Vancouver, Canada; Calgary, Canada; Vancouver, Canada; Calgary, Canada© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e1092-e1092 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Grant Innes More articles by this author Alec Mitchell* More articles by this author Bryce Weber More articles by this author Joel Teichman More articles by this author Kevin Carlson More articles by this author Andrew McRae More articles by this author Michael Law More articles by this author Frank Scheuermeyer More articles by this author Eric Grafstein More articles by this author James Andruchow More articles by this author Expand All Advertisement PDF downloadLoading ...

BACKGROUNDSome centres favour early intervention for ureteral colic while others prefer trial of spontaneous passage, and relative outcomes are poorly described. Calgary and Vancouver have similar populations and physician expertise, but differing approaches to ureteral colic. We studied 60-day hospitalization and intervention rates for patients having a first emergency department (ED) visit for ureteral colic in these diverse systems.METHODSWe used administrative data and structured chart review to study all Vancouver and Calgary patients with an index visit for ureteral colic during 2014. Patient demographics, arrival characteristics and triage category were captured from ED information systems, while ED visits and admissions were captured from linked regional hospital databases. Laboratory results were obtained from electronic health records and stone characteristics were abstracted from diagnostic imaging reports. Our primary outcome was hospitalization or urological intervention from 0 to 60 days. Secondary outcomes included ED revisits, readmissions and rescue interventions. Time to event analysis was conducted and Cox Proportional Hazards modelling was performed to adjust for covariate imbalance.RESULTSWe studied 3283 patients with CT-defined stones. Patient and stone characteristics were similar for the cities. Hospitalization or intervention occurred in 60.9% of Calgary patients and 31.3% of Vancouver patients (p<0.001). Calgary patients had higher index intervention rates (52.1% v. 7.5%), and experienced more ED revisits and hospital readmissions during follow-up. The data suggest that outcome events were associated with overtreatment of small stones in one city and undertreatment of large stones in the other.CONCLUSIONSAn early interventional approach was associated with higher ED revisit, hospitalization and intervention rates. If these events are markers of patient disability, then a less interventional approach to small stones and earlier definitive management of large stones may reduce system utilization and improve outcomes for patients with acute ureteral colic.

You have accessJournal of UrologyStone Disease: Medical & Dietary Therapy1 Apr 2017MP90-16 PREDICTORS OF FAILURE OF SPONTANEOUS STONE PASSAGE AFTER EMERGENCY DEPARTMENT DISCHARGE IN PATIENTS WITH RENAL COLIC PREMAL PATEL, Taylor Remondini, Bruce Gao, Ravneet Dhaliwal, Navraj Dhaliwal, Adrian Frusescu, Anthony Cook, Grant Innes, and Bryce Weber PREMAL PATELPREMAL PATEL More articles by this author , Taylor RemondiniTaylor Remondini More articles by this author , Bruce GaoBruce Gao More articles by this author , Ravneet DhaliwalRavneet Dhaliwal More articles by this author , Navraj DhaliwalNavraj Dhaliwal More articles by this author , Adrian FrusescuAdrian Frusescu More articles by this author , Anthony CookAnthony Cook More articles by this author , Grant InnesGrant Innes More articles by this author , and Bryce WeberBryce Weber More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2835AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES A majority of patients with acute renal colic are discharged from the emergency department (ED) after initial diagnosis and symptom management. Unfortunately 20-30% of these patients require repeat ED visit for ongoing symptom control and 15%-25% require urgent urological intervention. If these patients destined for outpatient failure could be identified prior to discharge, they may benefit from early intervention to reduce morbidity as well as reduce health care expenditure of a repeat ED visit. Our objective was to identify predictors of outpatient treatment failure, defined as the need for hospitalization or urgent intervention within 60 days of ED discharge. METHODS Prospectively gathered administrative data from 4 hospitals in Calgary, Alberta, Canada of patients with an ED diagnosis of renal colic from January 1st, 2014 to December 31st, 2014 was collected. Imaging reports were reviewed for stone characteristics. Data was linked to regional hospital databases to identify ED revisits, hospital admissions and surgical procedures. Patients were excluded if they were non-residents of Calgary or if they had a previous renal colic visit within 30 days. RESULTS Of 3104 patients with first ED visit for acute renal colic, 1081 were discharged without intervention for a trial of spontaneous passage. Median patient age was 50 and 72% were males. As per table 1, on multivariate analysis we demonstrate the only predictor for outpatient treatment failure was proximal and mid-ureteric stone location. We found no association between gender, degree of hydronephrosis or stone size. CONCLUSIONS Using a prospectively gathered database we demonstrate patients with stones in their proximal or mid ureter are almost 3 times as likely to require 60-day hospital readmission or urgent intervention. Our results demonstrate treatment options should be considered for these patients prior to discharge. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1216 Advertisement Copyright & Permissions© 2017MetricsAuthor Information PREMAL PATEL More articles by this author Taylor Remondini More articles by this author Bruce Gao More articles by this author Ravneet Dhaliwal More articles by this author Navraj Dhaliwal More articles by this author Adrian Frusescu More articles by this author Anthony Cook More articles by this author Grant Innes More articles by this author Bryce Weber More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

A 16-year-old female with a complex medical history, including myelomeningocele and nephrolithiasis, presented with severe chest pain and dyspnea following nephrolithotomy and nephrostomy tube insertion. Chest X-ray and CT scan revealed a unilateral pleural effusion, while laboratory studies revealed elevated levels of creatinine in pleural fluid, thereby establishing the diagnosis of a urinothorax. This is an unusual cause of pleural effusion, caused by either an obstructive uropathy or direct injury to the pleural cavity. Treatment is largely symptomatic, with consideration of thoracentesis for large effusions. Urinothorax should be considered as a cause of pleural effusion in patients.

Introduction: Circumcision is the most common surgical procedure performed by pediatric urologists. Ketorolac has been shown to have an efficacy similar to morphine in multimodal analgesic regimens without the commonly associated adverse effects. Concerns with perioperative bleeding limit the use of ketorolac as an adjunct for pain control in surgical patients. As such, we sought to evaluate our institutional outcomes with respect to ketorolac and postoperative bleeding.Methods: We retrospectively reviewed all pediatric patients undergoing circumcision from January 1, 2014 to December 31, 2015 at the Alberta Children’s Hospital. Demographics, perioperative analgesic regimens, and return to emergency department or clinic for bleeding were gathered through chart review.Results: A total of 475 patients undergoing circumcisions were studied, including 150 (32%) who received perioperative ketorolac and 325 (68%) who received standard analgesia. Patients receiving ketorolac were more likely to return to the emergency department or clinic for bleeding (ketorolac group 19/150 [13%], non-ketorolac group 16/325 [5.0%]; p=0.005). Patients receiving ketorolac were more likely to have postoperative sanguineous drainage (ketorolac group 96/150 [64%], non-ketorolac group 150/325 [46%]; p<0.001). There was no significant difference in the number of patients requiring postoperative admission or further medical intervention.Conclusions: Although a promising analgesic, ketorolac requires additional investigation for safe usage in circumcisions due to possible increased risk of bleeding.

You have accessJournal of UrologyStone Disease: Surgical Therapy VII1 Apr 2017MP75-20 EVALUATION OF THE TREATMENT OF DISTAL URETRAL STONES CAUSING RENAL COLIC IN A HIGH INTERVENTION SETTING Bruce Gao, Taylor Remondini, Premal Patel, Navraj Dhaliwal, Ravneet Dhaliwal, Adrian Frusescu, Anthony Cook, Grant Innes, and Bryce Weber Bruce GaoBruce Gao More articles by this author , Taylor RemondiniTaylor Remondini More articles by this author , Premal PatelPremal Patel More articles by this author , Navraj DhaliwalNavraj Dhaliwal More articles by this author , Ravneet DhaliwalRavneet Dhaliwal More articles by this author , Adrian FrusescuAdrian Frusescu More articles by this author , Anthony CookAnthony Cook More articles by this author , Grant InnesGrant Innes More articles by this author , and Bryce WeberBryce Weber More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2168AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Renal colic is a common condition affecting up to 10% of the population causing significant morbidity. Research has shown that an unsuccessful trial of medical expulsive therapy has no detrimental impact on the patients (Portis et al., Urology 2015). Therefore, we wish to evaluate a large cohort of renal colic patients in a high intervention setting to determine the effect of stone location and treatment on patient outcomes. METHODS This multicenter administrative database study retrospectively reviewed the all Calgary patients with an ED diagnosis of renal colic between Jan 1, 2014 and Dec 31, 2014. Demographics were captured from the regional ED database, tests and treatments from the order entry database, and ED revisits, admissions and interventions from the discharge abstract database. Events were collated from all regional hospitals (4 sites). RESULTS 3104 renal colic visits were studied at 4 hospitals, including 921 (29.7%) with an index surgical intervention and 2183 (70.3%) managed medically. 1850 (59.6%) had imaging confirmed ureteral stones with 752 (40.6%) of these patients receiving surgery at an index visit. While proximally located ureteral stones were more likely to receive surgery at the index visit (OR = 2.177, 95% CI 1.80-2.64; P< 0.001), distally located stones were still frequently operated on with 34% of distal stones receiving surgery. Distal stones that are treated surgically at the index visit are more likely to re-visit the emergency department (OR = 2.011, 95% CI 1.535-2.635; p<0.001) and be admitted (OR = 3.103, 95% CI 2.130-4.520; p<0.001). There was no significant difference in patients returning for further surgery within 60 days of the index visit between these two groups (p=0.232). CONCLUSIONS Patients that present with acute renal colic and have an imaging confirmed distal ureteral stones are commonly operated on at the sites analyzed. Distal ureteral stones that were managed surgically were more likely than those that received conservative management to re-visit the emergency department and be admitted. These findings suggest that conservatively managing patients with distally located stones does not have a negative effect on these patients. This retrospective study does not consider complicating factors that may have influenced the treatment of these patients. Surgical intervention remains an appropriate treatment for distal ureteral stones depending on the individual contexts of patient cases. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1011 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Bruce Gao More articles by this author Taylor Remondini More articles by this author Premal Patel More articles by this author Navraj Dhaliwal More articles by this author Ravneet Dhaliwal More articles by this author Adrian Frusescu More articles by this author Anthony Cook More articles by this author Grant Innes More articles by this author Bryce Weber More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Purpose: An accelerated clinical care pathway for solid organ abdominal injuries was implemented at a level one pediatric trauma center. The impact on resource utilization and demonstration of protocol safety was assessed.Methods: Data were collected retrospectively on patients admitted with blunt abdominal solid organ injuries from 2012 to 2015. Patients were subdivided into pre- and post-protocol groups. Length of hospital stay (LOS) and failure of non-operative treatment were the primary outcomes of interest.Results: 138 patients with solid organ injury were studied: 73 pre-(2012-2014) and 65 post-protocol (2014-2015). There were no significant differences in age, gender, injury severity score (ISS), injury grade, or mechanism (p > 0.05). LOS was shorter post-protocol (mean 5.6 vs. 3.4 days; median 5.0 vs. 3.0 days; p = 0.0002), resulting in average savings of $5966 per patient. Patients in the protocol group mobilized faster (p < 0.0001) and experienced fewer blood draws (p = 0.02). On multivariate analysis, protocol group (p < 0.001) and ISS (p < 0.001) were independently associated with LOS. There were no differences between groups in the need for operation, embolization, or transfusion.Conclusion: An accelerated care pathway is safe and effective in the management of pediatric solid organ injuries with early mobilization, less blood draws, and decreased LOS without significant morbidity and mortality. (C) 2017 Elsevier Inc. All rights reserved.

You have accessJournal of UrologyStone Disease: Surgical Therapy V1 Apr 2016MP51-01 SIXTY-DAY OUTCOMES AFTER SURGICAL VS. MEDICAL TREATMENT OF ACUTE RENAL COLIC Taylor Remondini, Samir Sami, Bryce Weber, Dean Wong, Anthony Cook, and Grant Innes Taylor RemondiniTaylor Remondini More articles by this author , Samir SamiSamir Sami More articles by this author , Bryce WeberBryce Weber More articles by this author , Dean WongDean Wong More articles by this author , Anthony CookAnthony Cook More articles by this author , and Grant InnesGrant Innes More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.456AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Renal colic is a common condition, affecting up to 10% of the population. Recent research suggests that medical expulsive therapy may be less effective in successful passage rates. Therefore we wish to evaluate a large cohort of renal colic patients in a high intervention setting to determine their characteristics and health care burden. METHODS This multicenter administrative database study retrospectively reviewed the all Calgary patients with an ED diagnosis of renal colic between Jan 1, 2014 and Dec 31, 2014. Demographics were captured from the regional ED database, tests and treatments from the order entry database, and ED revisits, admissions and interventions from the discharge abstract database. RESULTS 3104 renal colic visits were studied at 4 hospitals, including 921 (30%) with an index surgical intervention and 2183 (70%) managed medically. 1850 (54%) had confirmed ureteric stones and of these 752 (41%) had surgery at index visit with an additional 137 (8%) having surgery with in 60 days. Patients were more likely to have surgery if had a proximal ureteric stone (P<0.001, OR 2.2), stone larger than 5 mm (P<0.001, OR 4.4), or hydronephrosis (p<0.001, OR 2.3). Within 60 days surgical patients had higher need for readmission (p<0.001, OR 2.2) and emergency visits (p<0.001, OR 1.8). The presence of a proximal stone at index visit was the main risk factor for surgical patients requiring further ED visits, and readmission (p<0.001, OR 1.2). Medically managed patients had a trend toward more surgical procedures (p=0.06, OR 0.74) in the following sixty days and the main risk factor being the presence of a proximal stone (p<0.001, OR 2.9) at index visit. CONCLUSIONS Patients who undergo early surgical intervention for acute renal colic have more hospital visits and less surgical procedures in the following 60-days than medically treated patients; however, outcome differences are driven by stone location. Stone size and the presence of hydronephrosis were deciding factors in need for surgery yet did not lead to more ED visits, admissions or procedures post index visit. Yet proximal stones not only were more likely to have index surgery but also had more ED visits, and admissions post initial procedure. Similarly if a proximal stone is managed medically it is also more likely to require a procedure with in 60 days possibly just delaying the issues with surgery in this cohort. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e681 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Taylor Remondini More articles by this author Samir Sami More articles by this author Bryce Weber More articles by this author Dean Wong More articles by this author Anthony Cook More articles by this author Grant Innes More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

BACKGROUND:Sex-related differences occur in many areas of medicine. Emergency department (ED) studies have suggested differences in access to care, diagnostic imaging use, pain management, and intervention. We investigated sex-based differences in the care and outcomes for ED patients with acute renal colic.METHODS:This was a multicenter population-based retrospective observational cohort study using administrative data and supplemented by structured chart review. All patients seen in Calgary Health Region EDs between January 1 and December 31, 2014, with an ED diagnosis of renal colic based on the following ICD-10 codes were eligible for inclusion: calculus of kidney (N200), calculus of ureter (N201), calculus of kidney with calculus of ureter (N202), hydronephrosis with renal and ureteral calculous obstruction (N132), unspecified renal colic (N23), and unspecified urinary calculus (N209). ED visit data and test results were accessed in the regional ED clinical database. Stone characteristics were captured from diagnostic imaging reports. Regional hospital databases were used to identify subsequent ED encounters, hospital admissions, and surgical procedures within 60 days. Outcomes were stratified by sex. The primary outcome, intended as a marker of overall effectiveness of ED care, was the unscheduled 7-day ED revisit rate among patients who were discharged home after their index ED visit. Secondary outcomes included ED pain management as reflected by administration of narcotics or intravenous nonsteroidals, the performance of advanced imaging-either ultrasound (US) or computed tomography (CT), and the proportion of patients who required hospitalization or surgical intervention within 60 days.RESULTS:From January 1 to December 31, 2014, a total of 3,104 eligible patients were studied: 1,111 women (35.8%) and 1,993 men (64.2%). Baseline characteristics, access times, analgesic use, and admission rates were similar in both groups. Men were more likely to have CT (68.9% vs. 58.5%, difference = 10.4%, 95% confidence interval [CI] = 6.8 to 14.0) while women were more likely to have US (20.8% vs. 9.6%, difference = 11.2%, 95% CI = 8.4 to 13.9). At 7 days, 17.9% of women and 19.0% of men who were discharged after their index ED visit required an ED revisit (difference = 1.1%, 95% CI = -2.8 to 4.9). Men were more likely to be hospitalized at 7 days (9.8% vs. 6.5%, difference = 3.3%, 95% CI = 0.6 to 6.0).CONCLUSION:This study shows greater reliance on US in females but no other sex-specific differences in the management of ED patients with acute renal colic. Higher CT use in men was not associated with improved outcomes, and we found no important differences in access to care, diagnostic or treatment intensity, or revisit rates as a marker of care effectiveness.

Hypothesis / aims of study Many individuals with neurogenic detrusor overactivity due to conditions such as multiple sclerosis (MS) or spinal cord injury (SCI), commonly referred to as neurogenic bladder, require mechanical bladder emptying via catheters. For those with limited mobility, poor dexterity, and/or lack of support, indwelling catheters (IC) may be preferred over intermittent catheterization. Unfortunately, resulting challenges such as bypassing, bladder neck incompetence and autonomic dysreflexia can be frustrating for patients, caregivers, and physicians alike. In such cases, when oral medications fail, BTA may offer efficacious detrusor relaxation and improve patients’ quality of life.

You have accessJournal of UrologyInfections/Inflammation of the Genitourinary Tract: Kidney & Bladder II1 Apr 2015MP20-02 CONDITIONED MEDIA FROM INFECTED UROTHELIAL CELLS CONTAIN EXOSOMES WITH EPIGENETIC POTENTIAL. Kenneth Ting, Alaleh Samiei, Karen J. Aitken, Bryce Weber, Fadi Ibrahim, Akshita Kapila, Cornelia Tolg, and Darius Bagli Kenneth TingKenneth Ting More articles by this author , Alaleh SamieiAlaleh Samiei More articles by this author , Karen J. AitkenKaren J. Aitken More articles by this author , Bryce WeberBryce Weber More articles by this author , Fadi IbrahimFadi Ibrahim More articles by this author , Akshita KapilaAkshita Kapila More articles by this author , Cornelia TolgCornelia Tolg More articles by this author , and Darius BagliDarius Bagli More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.974AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Urinary tract infection (UTI) is the second most common infection in children, and results in recurrent/chronic infection in 25–40% of patients of all ages. Chronic in vitro infection of urothelial cell lines leads to increased nuclear localization of DNA methyltransferase 1 (DNMT1) and decreased p16 expression along with a rise in CpG methylation near the first exon (Lab Invest 91:825-36). We noted that uninfected cells neighbouring infected cells upregulated DNMT1. Our objective here is to study if infection-induced secreted factors (e.g. LPS, conditioned media and exosomes) alter the regulation of epigenetic writers (DNMT 1, 3A and 3B, and EZH2) and p16 in naive cells. METHODS HTB9 or normal primary urothelial cells were innoculated with 2 moi of UT189 Escherichia coli, or FimH+/- derivatives or vehicle for 2 hrs. Cells were washed in PBS+50 ug/mL gentamycin and maintained in RPMI+10 ug/mL gentamycin+5% serum. Exosome-free serum was used for exosome isolations. Conditioned media (CM) was collected every 2 days, by centrifugation of cell debris and passing through 0.2 micron filters. Exosomes were isolated from CM using Exoquick TC, and characterized by Nanosight + transmission EM. Factors secreted by host cells (CM at 50% of total media, exosomes at a ratio of 1/2 of starting CM volume and LPS (200 ng/mL)), were added to naive urothelial cells for 2 hours, or 1, 2, 6 days. mRNA of DNMT1, 3a and 3b was examined by QPCR in response to LPS and CM. p16, DNMTs and EZH2 were localized by immunofluorescence. RESULTS CM significantly increased all mRNA expression of DNMT1,3A and 3B at more than one timepoint post-infection (p<0.001). DNMT1, but not DNMT3B, localized to the nucleus during treatment with CM from infected cells, concurrent with p16 protein downregulation. LPS increased DNMTs by immunofluorescence (p<0.0001), yet upregulated mRNA of DNMTs only at discrete time points. Nuclear EZH2 was increased by infection, infection-induced CM and infection-induced exosomes, in primary and HTB9 cells (p<0.005). Exosomes from control cells had the opposite effect, leading to downregulation of EZH2 at day 2. DNMT1 but not DNMT3B was increased by infection-induced exosomes (p<0.005). CONCLUSIONS Infection and secreted factors induced by infection broadly and persistently alter p16INK4A downregulation, alongside DNMT and EZH2 upregulation. DNMT3B is regulated by LPS alone, while EZH2 and DNMT1 are upregulated by both exosomes and CM from infected cells. Dysregulation of epigenetic machinery by secreted factors may have implications in urothelial maintenance and defence. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e223-e224 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kenneth Ting More articles by this author Alaleh Samiei More articles by this author Karen J. Aitken More articles by this author Bryce Weber More articles by this author Fadi Ibrahim More articles by this author Akshita Kapila More articles by this author Cornelia Tolg More articles by this author Darius Bagli More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

OBJECTIVE:To examine the development of recurrent urinary tract infections (UTIs) in boys who have undergone hypospadias repair.MATERIALS AND METHODS:We retrospectively reviewed the records of all boys who had recurrent UTIs after primary or redo tubularized incised plate (TIP) or transverse island flap (TVIF) repairs, between 1998 and 2009. Data on age, operating details, postoperative complications and imaging studies were collected. We attempted to identify risk factors for recurrent UTIs after hypospadias repair.RESULTS:During the study period, 43/2249 boys (1.91%) were diagnosed with recurrent UTIs after hypospadias repair. The boys' mean (range) age at repair was 14 (6-24) months and the median (range) follow-up was 6.5 (1.5-11) years. Primary TIP and TVIF were performed in 47% (20/43) and 35% (15/43) of the boys, respectively. Redo surgeries were performed in 18% of the boys (8/43). The initial meatal location was proximal in all TVIF and redo repairs, and in one of the TIP repairs. Postoperative voiding cysto-urethrography, ultrasonography and dimercapto-succinic acid (DMSA) scans were performed in 58% (25/43), 90% (39/43) and 19% (8/43) of the boys, respectively. Abnormalities were noted. Of those boys who underwent a TVIF repair, urethral diverticula were seen in 47% (7/15) and urethral fistulae were also seen in 47% (7/15). Conversely, in those who had a TIP repair, an elevated PVR and vesico-ureteric reflux were more common; they were found in 40% (8/20) and 50% (10/20) of patients, respectively.CONCLUSIONS:The pathophysiology of recurrent UTI is multifactorial, but postoperative complications seem to vary with type of procedure. Recurrent UTIs after hypospadias surgery should prompt a specific assessment for potentially functionally relevant and correctable anatomical abnormalities.

You have accessJournal of UrologyUrethra: Benign & Malignant Disease1 Apr 2014MP13-20 THE DEVASTATED URETHRA: OUR EXPERIENCE IN THE MANAGEMENT OF REFRACTORY POST-PROSTATE THERAPY URETHRAL STRICTURES Daniel Yanko, Kevin Carlson, Trafford Crump, Bryce Weber, and Richard Baverstock Daniel YankoDaniel Yanko More articles by this author , Kevin CarlsonKevin Carlson More articles by this author , Trafford CrumpTrafford Crump More articles by this author , Bryce WeberBryce Weber More articles by this author , and Richard BaverstockRichard Baverstock More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.689AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Urethral strictures may develop from the treatment of both benign and malignant prostate etiologies and can be challenging to manage. We reviewed our local experience in managing refractory post-prostate therapy urethral strictures (PPUS) via a novel treatment pathway. METHODS We performed a retrospective analysis of all patients at our Centre diagnosed with a urethral stricture following various prostate therapies between May 2008 and October 2013. Multiple variables were assessed, including: initial diagnosis, method of stricture treatment and number of treatments. All patients underwent initial endoscopic management followed by a standardized self-catheterization program developed at our Centre. RESULTS Forty-six patients were identified with initial diagnoses of prostate cancer in 28 (61%) and benign prostatic hyperplasia (BPH) in 18 (39%). All patients underwent initial endoscopic management [direct visual internal urethrotomy (DVIU) or transurethral incision of bladder neck (TUIBN)] by us (38) and/or the referring urologist (8). In total, a mean of 1.50 (95%CI 1.22-1.78) endoscopic procedures were performed per patient. 41 (89%) patients were stabilized following endoscopic resection combined with a standardized self-dilation program. Five (11%) patients were refractory to the above measures and required more invasive treatment: 2 (4.3%) cystectomy with ileal conduit, 2 (4.3%) open vesicourethral anastamotic revision, 1 (2.2%) YV-plasty. All three patients who underwent open bladder neck reconstructive procedures remain with stable outlets at cystoscopic follow-up (6-48 months). CONCLUSIONS In our large cohort of refractory PPUS, we have demonstrated successful outcome in the majority of cases with minimal operative intervention. In select cases, a variety of reconstructive surgical procedures may be required. These observations support our novel simplified approach to these refractory patients. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e183 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Daniel Yanko More articles by this author Kevin Carlson More articles by this author Trafford Crump More articles by this author Bryce Weber More articles by this author Richard Baverstock More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Neurogenic Voiding Dysfunction1 Apr 2014MP80-13 INTRAVESICAL ONABOTULINUMTOXIN A FOR BLADDER DYSFUNCTION IN “REAL WORLD” CLINICAL PRACTICE Richard Baverstock, Bryce Weber, Trafford Crump, Daniel Yanko, and Kevin Carlson Richard BaverstockRichard Baverstock More articles by this author , Bryce WeberBryce Weber More articles by this author , Trafford CrumpTrafford Crump More articles by this author , Daniel YankoDaniel Yanko More articles by this author , and Kevin CarlsonKevin Carlson More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2536AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Intravesical BOTOX (Onabotulinumtoxin A, BTA) injections for lower urinary tract dysfunction was first described in 1987, and has been used at our institution since 2004. It was approved for use in North America for refractory neurogenic detrusor overactivity (NDO) in 2012, and for idiopathic detrusor overactivity (IDO) in Canada in October 2013. BTA remains off-label for refractory bladder pain syndrome (BPS). Few studies have been published to confirm the long-term safety and efficacy of intravesical BTA, nor the adherence to this form of treatment. We report our long-term “real-world” clinical experience with BTA for refractory bladder storage dysfunction (NDO, IDO, BPS) in our high-volume institution, with attention to baseline data, growth in uptake, and persistence with therapy. METHODS A retrospective chart review of all patients injected between July 20, 2009 (when charts became available via EMR) and October 30, 2013 was performed. RESULTS Overall a total of 1265 injections were performed on 443 unique patients with mean age of 56 years (19 – 88). The majority of patients (66%) were injected under local anesthesia only. The number of BTA treatments ranged from 1 – 14. 63% of patients have received more than 1 injection while 41% have received 3 or more, and 14% 6 or more. Overall, 43% discontinued BTA at any time due to attrition, lack of effect, or change in bladder management. In 2010, 207 injections (17/month) were performed, while 270 were done in 2011 (23/month), and 330 in 2012 (28/month). In the first 10 months of 2013, 377 injections have been performed (38/month). Indications included NDO in 55%, IDO in 40%, BPS in 5%. For the NDO group, 65% were female, compared to 86% of the IDO and 100% of the BPS groups. In the NDO group, 28% had spinal cord injury (SCI), 34% multiple sclerosis (MS), and 38% had other causes. Twenty percent of the entire cohort initiated clean intermittent catheter (CIC), 20% already performed CIC, and 16% had indwelling catheters. No serious adverse events or hospital admissions were observed. CONCLUSIONS Intravesical BTA is a well-tolerated and safe procedure that is performed under local anesthetic in the majority of cases. Repeat treatments are common and popularity of BTA for patients with bladder dysfunction is growing. A significant number of patients initiated CIC in our blended cohort. Persistence with treatment is high, at 57%, despite the challenging nature of the patient population. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e942 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Richard Baverstock More articles by this author Bryce Weber More articles by this author Trafford Crump More articles by this author Daniel Yanko More articles by this author Kevin Carlson More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

A 58-year-old physician with an elevated prostate specific antigen developed severe septic shock following a repeat transrectal prostate biopsy despite standard preoperative prophylactic protocol. This case highlights the significance of harbouring antibiotic-resistant bacteria and the risk of previous quinolone exposure. We believe this case may herald a rare but potentially serious consequence of increasingly common antibiotic resistance and that high-risk patients should be studied to determine their likelihood of carrying antibiotic-resistant flora in their genitourinary/gastrointestinal tract.

A 26-year-old male body builder diagnosed with renal artery stenosis and middle aortic syndrome underwent an autotransplantation with bench reconstruction and end-to-end anastomosis using the hypogastric artery. Shortly after the procedure, the patient developed rhabdomyolysis and renal insufficiency, possibly related to his increased muscle mass, potentially greater susceptibility to hypertrophic skeletal muscle cells or his unique vascular condition. We review the risk factors, diagnosis, management and outcome of a case of rhabdomyolysis in a male patient who underwent autotransplantation for renal vascular hypertension.