INTRODUCTION AND OBJECTIVE: PCNL requires a lithotrite to efficiently break and remove stones. We set out to determine the efficacy and safety of a new lithotrite, the EMS Lithoclast Trilogy, in the first reported prospective European multicentre evaluation. We compare it to published clinical stone clearance rates based on surface area for other lithotrites (24-32.3 mm2/min), and using the 3D calculated stone volume, to the single published series for the Lithoclast Trilogy (591mm3/min). METHODS: A total of 10 European centres took part in this prospective non-randomised study. Objective measures of stone clearance rate, device malfunction, stone-free rate, and complications were assessed. Each surgeon evaluated subjective parameters, including ergonomic and device effectiveness, for each case, on a 1-10 scale (10 = extremely ergonomic / effective), and compared it to their usual lithotrite on a 1-10 scale (10 = extremely effective). RESULTS: 53 patients undergoing PCNL were included. The mean stone clearance rate was 58mm2/minute, or 1202 mm3/minute based on calculated 3D stone volume. The stone-free rate on fluoroscopy screening at the end of the case was 75%. Long term follow up is awaited. The subjective surgeon feedback for ergonomic score was 8.2, the least satisfactory element. The highest feedback was for suction effectiveness at 9.4, with 9.3 for combination effectiveness and 9.13 for overall effectiveness compared to lithotrite most commonly used previously. Three patients required a blood transfusion, two patients developed post-op sepsis, two required subsequent JJ stent placement, and one patient had a prolonged bleed from a subcutaneous vessel. Five cases experienced a probe breakage, and there were two other device related complications, none of which required using a different lithotrite. CONCLUSIONS: This multicentre prospective study has demonstrated that the new Lithoclast Trilogy is highly effective at stone removal. The stone removal efficiency of Trilogy is almost 100% greater compared to published data on other Lithotrites. In addition, comparing stone removal based on volume, it is over twice as effective as in the single published study on Swiss Lithoclast Trilogy. The device was perceived by surgeons to be highly effective overall and compared to the most commonly used previous lithotrite. The probe breakage rate was 9%, which may represent the learning curve of lack of familiarity with a new device, or may suggest that manufacturing or control box parameters require modifications. Source of Funding: This study was supported by a grant from EMS.

You have accessJournal of UrologyStone Disease: Surgical Therapy IV (PD42)1 Apr 2019PD42-07 RISK FACTORS FOR SEPSIS FOLLOWING PERCUTANEOUS NEPHROLITHOTOMY IN THE UNITED KINGDOM Stuart Irving*, William Finch, Daron Smith, Sarah Fowler, John Withington, and Oliver Wiseman Stuart Irving*Stuart Irving* More articles by this author , William FinchWilliam Finch More articles by this author , Daron SmithDaron Smith More articles by this author , Sarah FowlerSarah Fowler More articles by this author , John WithingtonJohn Withington More articles by this author , and Oliver WisemanOliver Wiseman More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000556563.62341.2eAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: Percutaneous nephrolithotomy (PCNL) is routinely utilized in the management of large renal stones and staghorn calculi. PCNL is more efficacious when compared to other treatment modalities but carries an increased risk of morbidity. Sepsis is a known complication of PCNL with Significant associated morbidity. We sought to describe procedural and patient risk factors for blood transfusion using a national prospective data registry. METHODS: Surgeon reported data submitted to the British Association of Urological Surgeons PCNL data registry between 2011 and 2017 was analyzed for reported rates of sepsis. We assessed risk factors for sepsis, including sex, age, BMI, comorbidity, previous infections and their management, pre-existing tubes, pre op work up, induction antibiotics, stone complexity defined by Guys Stone Score (I-II versus III-IV) and patient position (prone versus supine). RESULTS: Of the 11673 PCNL procedures reported sepsis was seen in 2.5%. Significant differences were seen with higher reported rates of sepsis in female patients, the over 70's, patients with significant comorbidity, a previous history of urinary tract infections, pure or mixed growth on pre-operative MSU and more complex stone scores. There was no difference in the post-operative sepsis rates seen in obese patients, prophylactic induction antibiotic use, operative patient position, or existence of a pre-existing catheter or nephrostomy tube. CONCLUSIONS: Higher risk of post-operative sepsis can be identified in older female patients, patients with a prior history of urinary tract infections, a pre-operative MSU showing a pure growth or the presence of mixed growth. Failure to use induction antibiotics, indwelling catheters or nephrostomy tubes or patient position for surgery did not in our series increase the risk of post-operative sepsis. Source of Funding: None Norwich, United Kingdom; London, United Kingdom; Cambridge, United Kingdom© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e752-e752 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Stuart Irving* More articles by this author William Finch More articles by this author Daron Smith More articles by this author Sarah Fowler More articles by this author John Withington More articles by this author Oliver Wiseman More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologyStone Disease: Surgical Therapy III (MP23)1 Apr 2019MP23-09 PRE-PCNL INFECTION AND ITS EFFECT ON POST-PCNL OUTCOMES Daron Smith*, Stuart Irving, Sarah Fowler, John Withington, Ben Turney, Oliver Wiseman, and Will Finch Daron Smith*Daron Smith* More articles by this author , Stuart IrvingStuart Irving More articles by this author , Sarah FowlerSarah Fowler More articles by this author , John WithingtonJohn Withington More articles by this author , Ben TurneyBen Turney More articles by this author , Oliver WisemanOliver Wiseman More articles by this author , and Will FinchWill Finch More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000555615.97678.2aAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: Details regarding infections treated before undergoing PCNL were added to the BAUS PCNL database in 2014. We analysed these data to assess the implications that pre-operative infection would have on the outcome of PCNL, especially for post-operative complications particularly regarding sepsis. METHODS: Data from the National UK PCNL database recorded between 2014-16 for patients with pre-operative treated infections were categorised into four groups: •patients who had received oral antibiotics •patients admitted for iv antibiotics •patients who required emergency drainage (either by JJ stent or nephrostomy) •patients who required an ITU admission for sepsis Chi squared analysis was performed between patients with and without prior infections RESULTS: 2630 patients were analysed. 1379 (52.4%) had no pre-PCNL infection (“Controls”). 1251 patients (47.6%) had prior treatment for infection, of whom 30.7% received at least one course of oral antibiotics, 6.9% required at least one admission for iv antibiotics, 8.3% required drainage before definitive surgery and 1.7% required an ITU admission for sepsis. Details regarding the relative likelihood of case abandonment, transfusion, Intra- and post-operative complications including fever and sepsis and Stone clearance results are shown in table 1. CONCLUSIONS: Patients who require treatment of infection prior to PCNL have an INCREASED risk of post-op complications, especially of fever and sepsis, with the highest risk in patients who have had a previous ITU admission for Sepsis. Interestingly, post-operative stone clearance rates were DECREASED in patients with prior infection. These findings are useful for pre-operative counselling, postoperative vigilance and the interpretation of PCNL outcomes in the context of case complexity. Source of Funding: None London, United Kingdom; Norwich, United Kingdom; london, United Kingdom; London, United Kingdom; Oxford, United Kingdom; Cambridge, United Kingdom; Norwich, United Kingdom© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e328-e329 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daron Smith* More articles by this author Stuart Irving More articles by this author Sarah Fowler More articles by this author John Withington More articles by this author Ben Turney More articles by this author Oliver Wiseman More articles by this author Will Finch More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologyStone Disease: Medical & Dietary Therapy I1 Apr 2018PD17-08 THE EFFECTS OF MEDICALLY EXPULSIVE THERAPY (MET) ON SPONTANEOUS STONE PASSAGE (SSP) IN PATIENTS PRESENTING WITH ACUTE URETERIC COLIC Taimur T Shah, Chuanyu Gao, Aidan O' Keefe, Todd Manning, Anthony Peacocke, Sophia Cashman, Arjun Nambiar, Ben Lamb, Marcus Cumberbatch, Nicholas Ivin, Jonathan Maw, Cissy Ali Abdaal, Sami Al Hayek, Daniel Christidis, Damien Bolton, Nathan Lawrentschuk, Shahid Khan, Sibel Demirel, Stuart Graham, Jonathan Chuo Min Lee, Simon Evans, Samantha Koschel, Henry Badgery, Janelle Brennan, Luke Wang, Tatenda Nzenza, Paul Ruljancich, Ruzi Begum, Shazia Hamad, Aarti Shetty, Daniel Swallow, Morrow Jessica S, David Curry, Michael Young, Hamid Abboudi, Rozh Jalil, Ranan Dasgupta, Fraser Cameron, Connie Shingles, Cherrie Ho, Iram Parwaiz, John Henderson, Kenneth R Mackenzie, Kyle Reid, Nkemi Umeni-Eronini, Nazrin Assaf, Adekinte Oyekan, Seshadri Sriprasad, Zara Hayat, Victoria Morrison-Jones, Christopher Steen, Matthew Alberto, Paul Rujancich, Alex Laird, Abhishek Sharma, Simon Phipps, Andrew Harris, Alistair Rogers, Simeon Ngweso, Munyaradzi Nyandoro, Dickon Hayne, Jane Hendry, Lynne Kerr, Craig Mcilhenny, Flora Rodger, Emma Docherty, Alicia Ng, Lisette Seaward, David Eldred-Evans, Matthew Bultitude, Haitham Abdelmoteleb, Amr Hawary, Rebecca Tregunna, Husam Ibrahim, Shannon Mc Grath, Jonathan O’ Brien, Angus Campbell, Peter Cronbach, Amar Paget, Lokesh Suraparaj, James O' Brien, Suresh K Gupta, Campbell Tait, Ashok Sakthivel, Rahul Pankhania, Zubair Al-Qassim, Monika Rezacova, Eric Edison, Sarbjinder Sandhu, Robert Foley, Abisoye Akintimehin, Azhar Khan, Nkwam Nkwam, Peter Grice, Masood Khan, Florence Kashora, David Manson-Bahr, Nadine Mc Cauley, Osayuki Nehikhare, John Bycroft, Kishan Tailor, Asad Saleemi, Wesam Al-Dhahir, Mohamed Abu Yousif, John O' Rourke, Angus On Luk Chin, Ian Pearce, James Olivier, Joel Tay, Andrea Cannon, James Akman, Zahid Hussain, Jack Coode-Bate, Madhavi Natarajan, Stuart Irving, Kevin Murtagh, Anne Carrie, Marek Miller, Manar Malki, Frances Burge, Harry Ratan, Nishant Bedi, Raj Kavia, Thomas Stonier, Nick Simson, Harpreet Singh, Emer Hatem, Manit Arya, Iannish Sadien, Iqbal Miakhil, Sunil Sharma, Patrick Olaniyi, Roelof Stammeijer, Hannah Mason, Andrew Symes, Lisa Lavan, Carl Rowbotham, Carol Wong, Sarah Al-Shakhshir, Mohammed Belal, Alastair Crawford Mc Kay, John Graham, Lucy Simmons, Sinan Khadouri, John Withington, Leye Ajayi, Leye Ajayi, Li June Tay, Alex Ward, Bo Parys, Matthew Liew, Richard Simpson, David Ross, Robert Adams, Asfand Baig Mirza, Pete Acher, Michael Gallagher, Yaamini Premakumar, Michael Ager, Benjamin Ayres, Karl Pang, Jake Patterson, Andrei Adrian Kozan, Ata Jaffer, Waqas Din, Chandra Shekhar Biyani, Johnson Pok-Him Tam, Edward Tudor, John Llewellyn Probert, Mudit Matanhelia, Mohammed Hegazy, David Quinlan, Daniel Ness, Bharat Gowardhan, Kellie Bateman, Slawomir Wozniak, Gidon Ellis, Daron Smith, Laura Derbyshire, Karyee Chow, Rebecca Mosey, Banan Osman, Howard Kynaston, Joshua Clements, Gemma Hann, Sam Gray, Omid Yassaie, George Weeratunga, Cristian Udovicich, James Mbuvi, Heather Stewart, Azizan Samsudin, Archie Hughes-Hallet, Francesca Kum, Rebecca Symes, Rob Frymann, Barnaby Chappell, Sean Rezvani, Issam Ahmed, Iqbal Shergill, Su-Min Lee, Ali Hussain, Robert Pickard, Paul Erotocritou, Daron Smith, and Veeru Kasivisvanathan Taimur T ShahTaimur T Shah More articles by this author , Chuanyu GaoChuanyu Gao More articles by this author , Aidan O' KeefeAidan O' Keefe More articles by this author , Todd ManningTodd Manning More articles by this author , Anthony PeacockeAnthony Peacocke More articles by this author , Sophia CashmanSophia Cashman More articles by this author , Arjun NambiarArjun Nambiar More articles by this author , Ben LambBen Lamb More articles by this author , Marcus CumberbatchMarcus Cumberbatch More articles by this author , Nicholas IvinNicholas Ivin More articles by this author , Jonathan MawJonathan Maw More articles by this author , Cissy Ali AbdaalCissy Ali Abdaal More articles by this author , Sami Al HayekSami Al Hayek More articles by this author , Daniel ChristidisDaniel Christidis More articles by this author , Damien BoltonDamien Bolton More articles by this author , Nathan LawrentschukNathan Lawrentschuk More articles by this author , Shahid KhanShahid Khan More articles by this author , Sibel DemirelSibel Demirel More articles by this author , Stuart GrahamStuart Graham More articles by this author , Jonathan Chuo Min LeeJonathan Chuo Min Lee More articles by this author , Simon EvansSimon Evans More articles by this author , Samantha KoschelSamantha Koschel More articles by this author , Henry BadgeryHenry Badgery More articles by this author , Janelle BrennanJanelle Brennan More articles by this author , Luke WangLuke Wang More articles by this author , Tatenda NzenzaTatenda Nzenza More articles by this author , Paul RuljancichPaul Ruljancich More articles by this author , Ruzi BegumRuzi Begum More articles by this author , Shazia HamadShazia Hamad More articles by this author , Aarti ShettyAarti Shetty More articles by this author , Daniel SwallowDaniel Swallow More articles by this author , Morrow Jessica SMorrow Jessica S More articles by this author , David CurryDavid Curry More articles by this author , Michael YoungMichael Young More articles by this author , Hamid AbboudiHamid Abboudi More articles by this author , Rozh JalilRozh Jalil More articles by this author , Ranan DasguptaRanan Dasgupta More articles by this author , Fraser CameronFraser Cameron More articles by this author , Connie ShinglesConnie Shingles More articles by this author , Cherrie HoCherrie Ho More articles by this author , Iram ParwaizIram Parwaiz More articles by this author , John HendersonJohn Henderson More articles by this author , Kenneth R MackenzieKenneth R Mackenzie More articles by this author , Kyle ReidKyle Reid More articles by this author , Nkemi Umeni-EroniniNkemi Umeni-Eronini More articles by this author , Nazrin AssafNazrin Assaf More articles by this author , Adekinte OyekanAdekinte Oyekan More articles by this author , Seshadri SriprasadSeshadri Sriprasad More articles by this author , Zara HayatZara Hayat More articles by this author , Victoria Morrison-JonesVictoria Morrison-Jones More articles by this author , Christopher SteenChristopher Steen More articles by this author , Matthew AlbertoMatthew Alberto More articles by this author , Paul RujancichPaul Rujancich More articles by this author , Alex LairdAlex Laird More articles by this author , Abhishek SharmaAbhishek Sharma More articles by this author , Simon PhippsSimon Phipps More articles by this author , Andrew HarrisAndrew Harris More articles by this author , Alistair RogersAlistair Rogers More articles by this author , Simeon NgwesoSimeon Ngweso More articles by this author , Munyaradzi NyandoroMunyaradzi Nyandoro More articles by this author , Dickon HayneDickon Hayne More articles by this author , Jane HendryJane Hendry More articles by this author , Lynne KerrLynne Kerr More articles by this author , Craig McilhennyCraig Mcilhenny More articles by this author , Flora RodgerFlora Rodger More articles by this author , Emma DochertyEmma Docherty More articles by this author , Alicia NgAlicia Ng More articles by this author , Lisette SeawardLisette Seaward More articles by this author , David Eldred-EvansDavid Eldred-Evans More articles by this author , Matthew BultitudeMatthew Bultitude More articles by this author , Haitham AbdelmotelebHaitham Abdelmoteleb More articles by this author , Amr HawaryAmr Hawary More articles by this author , Rebecca TregunnaRebecca Tregunna More articles by this author , Husam IbrahimHusam Ibrahim More articles by this author , Shannon Mc GrathShannon Mc Grath More articles by this author , Jonathan O’ BrienJonathan O’ Brien More articles by this author , Angus CampbellAngus Campbell More articles by this author , Peter CronbachPeter Cronbach More articles by this author , Amar PagetAmar Paget More articles by this author , Lokesh SuraparajLokesh Suraparaj More articles by this author , James O' BrienJames O' Brien More articles by this author , Suresh K GuptaSuresh K Gupta More articles by this author , Campbell TaitCampbell Tait More articles by this author , Ashok SakthivelAshok Sakthivel More articles by this author , Rahul PankhaniaRahul Pankhania More articles by this author , Zubair Al-QassimZubair Al-Qassim More articles by this author , Monika RezacovaMonika Rezacova More articles by this author , Eric EdisonEric Edison More articles by this author , Sarbjinder SandhuSarbjinder Sandhu More articles by this author , Robert FoleyRobert Foley More articles by this author , Abisoye AkintimehinAbisoye Akintimehin More articles by this author , Azhar KhanAzhar Khan More articles by this author , Nkwam NkwamNkwam Nkwam More articles by this author , Peter GricePeter Grice More articles by this author , Masood KhanMasood Khan More articles by this author , Florence KashoraFlorence Kashora More articles by this author , David Manson-BahrDavid Manson-Bahr More articles by this author , Nadine Mc CauleyNadine Mc Cauley More articles by this author , Osayuki NehikhareOsayuki Nehikhare More articles by this author , John BycroftJohn Bycroft More articles by this author , Kishan TailorKishan Tailor More articles by this author , Asad SaleemiAsad Saleemi More articles by this author , Wesam Al-DhahirWesam Al-Dhahir More articles by this author , Mohamed Abu YousifMohamed Abu Yousif More articles by this author , John O' RourkeJohn O' Rourke More articles by this author , Angus On Luk ChinAngus On Luk Chin More articles by this author , Ian PearceIan Pearce More articles by this author , James OlivierJames Olivier More articles by this author , Joel TayJoel Tay More articles by this author , Andrea CannonAndrea Cannon More articles by this author , James AkmanJames Akman More articles by this author , Zahid HussainZahid Hussain More articles by this author , Jack Coode-BateJack Coode-Bate More articles by this author , Madhavi NatarajanMadhavi Natarajan More articles by this author , Stuart IrvingStuart Irving More articles by this author , Kevin MurtaghKevin Murtagh More articles by this author , Anne CarrieAnne Carrie More articles by this author , Marek MillerMarek Miller More articles by this author , Manar MalkiManar Malki More articles by this author , Frances BurgeFrances Burge More articles by this author , Harry RatanHarry Ratan More articles by this author , Nishant BediNishant Bedi More articles by this author , Raj KaviaRaj Kavia More articles by this author , Thomas StonierThomas Stonier More articles by this author , Nick SimsonNick Simson More articles by this author , Harpreet SinghHarpreet Singh More articles by this author , Emer HatemEmer Hatem More articles by this author , Manit AryaManit Arya More articles by this author , Iannish SadienIannish Sadien More articles by this author , Iqbal MiakhilIqbal Miakhil More articles by this author , Sunil SharmaSunil Sharma More articles by this author , Patrick OlaniyiPatrick Olaniyi More articles by this author , Roelof StammeijerRoelof Stammeijer More articles by this author , Hannah MasonHannah Mason More articles by this author , Andrew SymesAndrew Symes More articles by this author , Lisa LavanLisa Lavan More articles by this author , Carl RowbothamCarl Rowbotham More articles by this author , Carol WongCarol Wong More articles by this author , Sarah Al-ShakhshirSarah Al-Shakhshir More articles by this author , Mohammed BelalMohammed Belal More articles by this author , Alastair Crawford Mc KayAlastair Crawford Mc Kay More articles by this author , John GrahamJohn Graham More articles by this author , Lucy SimmonsLucy Simmons More articles by this author , Sinan KhadouriSinan Khadouri More articles by this author , John WithingtonJohn Withington More articles by this author , Leye AjayiLeye Ajayi More articles by this author , Leye AjayiLeye Ajayi More articles by this author , Li June TayLi June Tay More articles by this author , Alex WardAlex Ward More articles by this author , Bo ParysBo Parys More articles by this author , Matthew LiewMatthew Liew More articles by this author , Richard SimpsonRichard Simpson More articles by this author , David RossDavid Ross More articles by this author , Robert AdamsRobert Adams More articles by this author , Asfand Baig MirzaAsfand Baig Mirza More articles by this author , Pete AcherPete Acher More articles by this author , Michael GallagherMichael Gallagher More articles by this author , Yaamini PremakumarYaamini Premakumar More articles by this author , Michael AgerMichael Ager More articles by this author , Benjamin AyresBenjamin Ayres More articles by this author , Karl PangKarl Pang More articles by this author , Jake PattersonJake Patterson More articles by this author , Andrei Adrian KozanAndrei Adrian Kozan More articles by this author , Ata JafferAta Jaffer More articles by this author , Waqas DinWaqas Din More articles by this author , Chandra Shekhar BiyaniChandra Shekhar Biyani More articles by this author , Johnson Pok-Him TamJohnson Pok-Him Tam More articles by this author , Edward TudorEdward Tudor More articles by this author , John Llewellyn ProbertJohn Llewellyn Probert More articles by this author , Mudit MatanheliaMudit Matanhelia More articles by this author , Mohammed HegazyMohammed Hegazy More articles by this author , David QuinlanDavid Quinlan More articles by this author , Daniel NessDaniel Ness More articles by this author , Bharat GowardhanBharat Gowardhan More articles by this author , Kellie BatemanKellie Bateman More articles by this author , Slawomir WozniakSlawomir Wozniak More articles by this author , Gidon EllisGidon Ellis More articles by this author , Daron SmithDaron Smith More articles by this author , Laura DerbyshireLaura Derbyshire More articles by this author , Karyee ChowKaryee Chow More articles by this author , Rebecca MoseyRebecca Mosey More articles by this author , Banan OsmanBanan Osman More articles by this author , Howard KynastonHoward Kynaston More articles by this author , Joshua ClementsJoshua Clements More articles by this author , Gemma HannGemma Hann More articles by this author , Sam GraySam Gray More articles by this author , Omid YassaieOmid Yassaie More articles by this author , George WeeratungaGeorge Weeratunga More articles by this author , Cristian UdovicichCristian Udovicich More articles by this author , James MbuviJames Mbuvi More articles by this author , Heather StewartHeather Stewart More articles by this author , Azizan SamsudinAzizan Samsudin More articles by this author , Archie Hughes-HalletArchie Hughes-Hallet More articles by this author , Francesca KumFrancesca Kum More articles by this author , Rebecca SymesRebecca Symes More articles by this author , Rob FrymannRob Frymann More articles by this author , Barnaby ChappellBarnaby Chappell More articles by this author , Sean RezvaniSean Rezvani More articles by this author , Issam AhmedIssam Ahmed More articles by this author , Iqbal ShergillIqbal Shergill More articles by this author , Su-Min LeeSu-Min Lee More articles by this author , Ali HussainAli Hussain More articles by this author , Robert PickardRobert Pickard More articles by this author , Paul ErotocritouPaul Erotocritou More articles by this author , Daron SmithDaron Smith More articles by this author , and Veeru KasivisvanathanVeeru Kasivisvanathan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.970AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES There is conflicting evidence on the role of medical expulsive therapy (MET) in spontaneous stone passage in patients with acute ureteric colic. Randomised trial data has not shown a role for MET use, though these have been underpowered to explore its role in specific patient subgroups. It is unknown whether MET use may have a role in aiding stone passage for stones of a particular size or specific position in the ureter.We undertook MIMIC, a multi-centre international cohort study in 71 centres disseminated via the UK British Urology Researchers in Surgical Training (BURST) to assess whether MET use improved rates of SSP adjusting for key confounders such as stone size and stone position. METHODS Multivariable mixed effects logistic regression models were created fitted for MET use, Age, Gender, Stone size and Stone position. To explore the effect of stone size (mm) and stone position (upper ureter, middle ureter and lower ureter) on whether MET use had an effect on SSP, an interaction term was fitted between these variables. RESULTS Data were collected from 4181 patients admitted with acute ureteric colic. 75% (n=3127) were discharged with conservative management. 80% (n=2516) had a confirmed outcome of SSP and were included in the multivariable analysis. The unadjusted odds ratio for the association of MET use with SSP from univariable analysis was 1.250 (95%CI, 1.041, 1.501). However, following a multivariable mixed effects logistic regression model adjusting for age, gender, stone size, position, treating stone size and stone position as interaction terms, there was no association of MET use with SSP in any subgroup irrespective of stone size (OR 1.085, 95%CI 0.978, 1.205) or stone position: middle ureter (OR 0.808, 95%CI 0.458, 1.424), upper ureter (OR 1.086, 95%CI 0.716, 1.645)). The overall OR for MET use was 0.861 (95%CI 0.521, 1.424). CONCLUSIONS Our data shows that in patients with acute ureteric colic who are suitable for initial conservative management, MET use has no benefit in spontaneous stone passage, regardless of stone size or stone position. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e387-e388 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Taimur T Shah More articles by this author Chuanyu Gao More articles by this author Aidan O' Keefe More articles by this author Todd Manning More articles by this author Anthony Peacocke More articles by this author Sophia Cashman More articles by this author Arjun Nambiar More articles by this author Ben Lamb More articles by this author Marcus Cumberbatch More articles by this author Nicholas Ivin More articles by this author Jonathan Maw More articles by this author Cissy Ali Abdaal More articles by this author Sami Al Hayek More articles by this author Daniel Christidis More articles by this author Damien Bolton More articles by this author Nathan Lawrentschuk More articles by this author Shahid Khan More articles by this author Sibel Demirel More articles by this author Stuart Graham More articles by this author Jonathan Chuo Min Lee More articles by this author Simon Evans More articles by this author Samantha Koschel More articles by this author Henry Badgery More articles by this author Janelle Brennan More articles by this author Luke Wang More articles by this author Tatenda Nzenza More articles by this author Paul Ruljancich More articles by this author Ruzi Begum More articles by this author Shazia Hamad More articles by this author Aarti Shetty More articles by this author Daniel Swallow More articles by this author Morrow Jessica S More articles by this author David Curry More articles by this author Michael Young More articles by this author Hamid Abboudi More articles by this author Rozh Jalil More articles by this author Ranan Dasgupta More articles by this author Fraser Cameron More articles by this author Connie Shingles More articles by this author Cherrie Ho More articles by this author Iram Parwaiz More articles by this author John Henderson More articles by this author Kenneth R Mackenzie More articles by this author Kyle Reid More articles by this author Nkemi Umeni-Eronini More articles by this author Nazrin Assaf More articles by this author Adekinte Oyekan More articles by this author Seshadri Sriprasad More articles by this author Zara Hayat More articles by this author Victoria Morrison-Jones More articles by this author Christopher Steen More articles by this author Matthew Alberto More articles by this author Paul Rujancich More articles by this author Alex Laird More articles by this author Abhishek Sharma More articles by this author Simon Phipps More articles by this author Andrew Harris More articles by this author Alistair Rogers More articles by this author Simeon Ngweso More articles by this author Munyaradzi Nyandoro More articles by this author Dickon Hayne More articles by this author Jane Hendry More articles by this author Lynne Kerr More articles by this author Craig Mcilhenny More articles by this author Flora Rodger More articles by this author Emma Docherty More articles by this author Alicia Ng More articles by this author Lisette Seaward More articles by this author David Eldred-Evans More articles by this author Matthew Bultitude More articles by this author Haitham Abdelmoteleb More articles by this author Amr Hawary More articles by this author Rebecca Tregunna More articles by this author Husam Ibrahim More articles by this author Shannon Mc Grath More articles by this author Jonathan O’ Brien More articles by this author Angus Campbell More articles by this author Peter Cronbach More articles by this author Amar Paget More articles by this author Lokesh Suraparaj More articles by this author James O' Brien More articles by this author Suresh K Gupta More articles by this author Campbell Tait More articles by this author Ashok Sakthivel More articles by this author Rahul Pankhania More articles by this author Zubair Al-Qassim More articles by this author Monika Rezacova More articles by this author Eric Edison More articles by this author Sarbjinder Sandhu More articles by this author Robert Foley More articles by this author Abisoye Akintimehin More articles by this author Azhar Khan More articles by this author Nkwam Nkwam More articles by this author Peter Grice More articles by this author Masood Khan More articles by this author Florence Kashora More articles by this author David Manson-Bahr More articles by this author Nadine Mc Cauley More articles by this author Osayuki Nehikhare More articles by this author John Bycroft More articles by this author Kishan Tailor More articles by this author Asad Saleemi More articles by this author Wesam Al-Dhahir More articles by this author Mohamed Abu Yousif More articles by this author John O' Rourke More articles by this author Angus On Luk Chin More articles by this author Ian Pearce More articles by this author James Olivier More articles by this author Joel Tay More articles by this author Andrea Cannon More articles by this author James Akman More articles by this author Zahid Hussain More articles by this author Jack Coode-Bate More articles by this author Madhavi Natarajan More articles by this author Stuart Irving More articles by this author Kevin Murtagh More articles by this author Anne Carrie More articles by this author Marek Miller More articles by this author Manar Malki More articles by this author Frances Burge More articles by this author Harry Ratan More articles by this author Nishant Bedi More articles by this author Raj Kavia More articles by this author Thomas Stonier More articles by this author Nick Simson More articles by this author Harpreet Singh More articles by this author Emer Hatem More articles by this author Manit Arya More articles by this author Iannish Sadien More articles by this author Iqbal Miakhil More articles by this author Sunil Sharma More articles by this author Patrick Olaniyi More articles by this author Roelof Stammeijer More articles by this author Hannah Mason More articles by this author Andrew Symes More articles by this author Lisa Lavan More articles by this author Carl Rowbotham More articles by this author Carol Wong More articles by this author Sarah Al-Shakhshir More articles by this author Mohammed Belal More articles by this author Alastair Crawford Mc Kay More articles by this author John Graham More articles by this author Lucy Simmons More articles by this author Sinan Khadouri More articles by this author John Withington More articles by this author Leye Ajayi More articles by this author Leye Ajayi More articles by this author Li June Tay More articles by this author Alex Ward More articles by this author Bo Parys More articles by this author Matthew Liew More articles by this author Richard Simpson More articles by this author David Ross More articles by this author Robert Adams More articles by this author Asfand Baig Mirza More articles by this author Pete Acher More articles by this author Michael Gallagher More articles by this author Yaamini Premakumar More articles by this author Michael Ager More articles by this author Benjamin Ayres More articles by this author Karl Pang More articles by this author Jake Patterson More articles by this author Andrei Adrian Kozan More articles by this author Ata Jaffer More articles by this author Waqas Din More articles by this author Chandra Shekhar Biyani More articles by this author Johnson Pok-Him Tam More articles by this author Edward Tudor More articles by this author John Llewellyn Probert More articles by this author Mudit Matanhelia More articles by this author Mohammed Hegazy More articles by this author David Quinlan More articles by this author Daniel Ness More articles by this author Bharat Gowardhan More articles by this author Kellie Bateman More articles by this author Slawomir Wozniak More articles by this author Gidon Ellis More articles by this author Daron Smith More articles by this author Laura Derbyshire More articles by this author Karyee Chow More articles by this author Rebecca Mosey More articles by this author Banan Osman More articles by this author Howard Kynaston More articles by this author Joshua Clements More articles by this author Gemma Hann More articles by this author Sam Gray More articles by this author Omid Yassaie More articles by this author George Weeratunga More articles by this author Cristian Udovicich More articles by this author James Mbuvi More articles by this author Heather Stewart More articles by this author Azizan Samsudin More articles by this author Archie Hughes-Hallet More articles by this author Francesca Kum More articles by this author Rebecca Symes More articles by this author Rob Frymann More articles by this author Barnaby Chappell More articles by this author Sean Rezvani More articles by this author Issam Ahmed More articles by this author Iqbal Shergill More articles by this author Su-Min Lee More articles by this author Ali Hussain More articles by this author Robert Pickard More articles by this author Paul Erotocritou More articles by this author Daron Smith More articles by this author Veeru Kasivisvanathan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

You have accessJournal of UrologyStone Disease: Surgical Therapy I1 Apr 2018PD35-02 RISK FACTORS FOR BLOOD TRANSFUSION FOLLOWING PERCUTANEOUS NEPHROLITHOTOMY IN THE UK. Adam B Althaus, John Withington, Will Finch, Daron Smith, Ben Turney, Sarah Fowler, Jim Armitage, Stuart Irving, Neil Burgess, and Oliver J. Wiseman Adam B AlthausAdam B Althaus More articles by this author , John WithingtonJohn Withington More articles by this author , Will FinchWill Finch More articles by this author , Daron SmithDaron Smith More articles by this author , Ben TurneyBen Turney More articles by this author , Sarah FowlerSarah Fowler More articles by this author , Jim ArmitageJim Armitage More articles by this author , Stuart IrvingStuart Irving More articles by this author , Neil BurgessNeil Burgess More articles by this author , and Oliver J. WisemanOliver J. Wiseman More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1713AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Percutaneous nephrolithotomy (PCNL) is routinely utilized in the management of large renal stones and staghorn calculi. PCNL is more efficacious when compared to other treatment modalities but carries an increased risk of morbidity. Vascular injury and hemorrhage are known complications of PCNL with associated risk of blood transfusion. We sought to describe procedural and patient risk factors for blood transfusion using a national prospective data registry. METHODS Data submitted to the British Association of Urological Surgeons PCNL data registry between 2011 and 2017 were analyzed for rates of blood transfusion. We assessed risk factors for transfusion, including operator performing renal puncture (urologist versus radiologist), patient position (prone versus supine), size of renal access (6-24 French versus 25-30 French), stone size (< 2 cm versus >2 cm), stone complexity defined by Guy′s stone score (I-II versus III-IV), patient comorbidities (spina bifida, kyphoscoliosis, and spinal cord injury), BMI, and preoperative hemoglobin. RESULTS Of 9,139 PCNL′s, 198 patients required blood transfusion (2.2%). Significantly greater transfusion rates were observed for patients with more complex stones, larger stones, larger renal access size, and preop Hb <120 (Table 1). Underweight patients and patients with normal BMI had higher transfusion rates when compared to overweight and obese patients. No difference was observed with patient position, patient comorbidity, or operator performing renal puncture. CONCLUSIONS Risk of transfusion after PCNL increases with larger more complex stones and when larger renal access size is used. Patients with low preoperative Hb and patients with low and normal BMI may be at increased risk for transfusion. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e721 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Adam B Althaus More articles by this author John Withington More articles by this author Will Finch More articles by this author Daron Smith More articles by this author Ben Turney More articles by this author Sarah Fowler More articles by this author Jim Armitage More articles by this author Stuart Irving More articles by this author Neil Burgess More articles by this author Oliver J. Wiseman More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

You have accessJournal of UrologyStone Disease: Surgical Therapy V1 Apr 2017MP50-15 ASSESSING THE VOLUME-OUTCOME RELATIONSHIP FOR PCNL IN 2014 AND 2015 - ANALYSIS USING NATIONAL REGISTRY DATA OF OVER 4000 CASES John Withington, Sarah Fowler, James Armitage, Jonathan Glass, William Finch, Stuart Irving, Neil Burgess, and Oliver Wiseman John WithingtonJohn Withington More articles by this author , Sarah FowlerSarah Fowler More articles by this author , James ArmitageJames Armitage More articles by this author , Jonathan GlassJonathan Glass More articles by this author , William FinchWilliam Finch More articles by this author , Stuart IrvingStuart Irving More articles by this author , Neil BurgessNeil Burgess More articles by this author , and Oliver WisemanOliver Wiseman More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1603AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES This study aims to investigate the relationship between surgeon case volume and outcomes after percutaneous nephrolithotomy (PCNL) within the UK. METHODS The study used data from the BAUS registry, a mandatory databse which records information on all PCNLs performed, for 2014 and 2015. Details were retrieved from the highest quartile volume surgeons and compared to the lowest quartiule volume surgeons. A series of comparisons of outcomes was then made between the high volume and the low volume groups. These outcomes included clearance on imaging at day one, blood transfusion, sepsis, complcations and post-operative length of stay. These comparisons were made for all stones accoridng to their Guys Stone Score (GSS) complexity, graded from 1-4. Comparisons were carried out using Fishers exact test. RESULTS 4035 PCNL were recorded. Those surgeons in the lower quartile performed 5 and 4 PCNLs or less in 2014 and 2015 respectively, and those in the upper quartile over 18 and 17 in the same time frames. Overall stone clearance, by imaging at day one, was higher in the higher volume surgeons for GSS1 (93% v 80%, p=0.01), GSS2 (74% v 63%, p=0.01), GSS3 (66% v 50%) and GSS 4 stones (37% v 35%, p=0.41), although not significantly for the latter. There was no difference in post op transfusion rates or sepsis. Conplication rates were higher for lower volume surgeons (9.6% v 4.7%, p=0.009). CONCLUSIONS Lower volume surgeons have higher complcations rates and lower stone free rates after PCNL. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e690 Advertisement Copyright & Permissions© 2017MetricsAuthor Information John Withington More articles by this author Sarah Fowler More articles by this author James Armitage More articles by this author Jonathan Glass More articles by this author William Finch More articles by this author Stuart Irving More articles by this author Neil Burgess More articles by this author Oliver Wiseman More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

You have accessJournal of UrologyStone Disease: Surgical Therapy V1 Apr 2017MP50-17 A REVIEW OF PERCUTANEOUS NEPHROLITHOTOMY FOR SMALL (LESS THAN 1CM) AND STAGHORN RENAL STONES: OUTCOMES FROM THE UK NATIONAL DATA REGISTRY Ben Pullar, John Withington, James Armitage, Sarah Fowler, William Finch, Stuart Irving, Jonathon Glass, Neil Burgess, and Oliver Wiseman Ben PullarBen Pullar More articles by this author , John WithingtonJohn Withington More articles by this author , James ArmitageJames Armitage More articles by this author , Sarah FowlerSarah Fowler More articles by this author , William FinchWilliam Finch More articles by this author , Stuart IrvingStuart Irving More articles by this author , Jonathon GlassJonathon Glass More articles by this author , Neil BurgessNeil Burgess More articles by this author , and Oliver WisemanOliver Wiseman More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1605AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES PCNL is an effective method of treating renal stones. Surgeons in the UK performing PCNL are mandated to submit data to the PCNL national registry. This study looks at differences in management and outcomes of patients with two subsets of stones: those under 1cm compared to all other stones and staghorn stones compared to all others treated by PCNL. METHODS The registry was analysed for stone characteristics (stones up to 1cm, staghorn stones and all others), procedure details and outcomes (complications and stone free rates) for the two year period period January 2014 - December 2015. The fisher test was used for statistical analysis except for length of stay (LOS) which used confidence interval analysis. RESULTS A total of 4166 procedures were performed by 183 UK surgeons (median number 17) over this time period. Of these 404 (9%) were for stones <1cm and 600 (14%) for staghorn stones. All other stones accounted for the remaining 3162. Females were more likely to have a staghorn stone (p < 0.01). Larger amplatz sheath sizes (27ch+) were used for staghorn stones (78% vs 29 % for smaller stones p<0.01). Staghorn stones were more likely to have a post-procedure nephrostomy tube (78% vs 69% for smaller stones, p<0.05) whereas stones <1cm were less likely to have a post-operative nephrostomy tube (p < 0.01). Overall intra-operative and post operative complications lower in the stones <1cm group (<0.05) where as these were higher in the staghorn group (sepsis p < 0.01 and transfusion rates p = 0.04) compared to all other stones. There was no difference in more severe (Clavien III+) complications in any of the stone size groups. LOS was significantly shorter for stones <1cm (mean LOS 3.09 days) and longer for staghorn stones (mean LOS 4.71 days). Stone free rates were as stones <1cm were as follows: 72.5% on fluoroscopic imaging and 77% on imaging at follow up. Stone free rates for staghorn stones were 44.8% on fluoroscopic imaging and 46.9% on imaging at follow up. CONCLUSIONS Around 10% of PCNLs in the UK between Jan 2014 and Dec 2015 were done for small stones <1cm. Excellent stone free rates are achieved with few complications. It is expected that with miniturisation techniques, PCNL for small stones will continue to be utilised as an effective treatment option. 14% of all PCNLs performed in the UK were for staghorn stones. PCNL for staghorn stones was less likely to achieve complete stone clearance compared to other stone sizes (p < 0.01). Complications were higher in the staghorn stone group compared to PCNLs for smaller stone sizes and overall length of stay was longer. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e690 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Ben Pullar More articles by this author John Withington More articles by this author James Armitage More articles by this author Sarah Fowler More articles by this author William Finch More articles by this author Stuart Irving More articles by this author Jonathon Glass More articles by this author Neil Burgess More articles by this author Oliver Wiseman More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

You have accessJournal of UrologyStone Disease: Surgical Therapy I1 Apr 2017PD16-10 IS PCNL A SAFE AND EFFECTIVE OPTION FOR OCTOGENARIAN PATIENT?. ANALYSIS OF OVER 4000 CASES FROM A NATIONAL DATABASE. Stuart Irving, Oliver Wiseman, William Finch, James Armitage, Sarah Fowler, John Withington, Jonathan Glass, and Neil Burgess Stuart IrvingStuart Irving More articles by this author , Oliver WisemanOliver Wiseman More articles by this author , William FinchWilliam Finch More articles by this author , James ArmitageJames Armitage More articles by this author , Sarah FowlerSarah Fowler More articles by this author , John WithingtonJohn Withington More articles by this author , Jonathan GlassJonathan Glass More articles by this author , and Neil BurgessNeil Burgess More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.844AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES It is commonly believed that elderly octogenarian (>80 yrs) patients may not be offered PCNL because of the possible additional risks of major surgery associated with advanced age. We analyzed 4166 cases performed over a 2 year period and compared the stone complexity, complication rate and outcomes of the octogenarian patient (OP) compared to the younger patient (YP) aged under 80 years. METHODS The British Association of Urological Surgeons (BAUS) PCNL database has invited data submission for PCNL since 2011. We extracted data from the database for a 2 year period 2014-15. Comparisons were made using Chi Squared testing. RESULTS 4166 PCNL procedures performed between 01/01/2014 and 31/12/2015 were abstracted from the BAUS (British Association of Urological Surgeons) PCNL database. 172 procedures (4.1 %) were performed in OP who make up 4.9% of the UK population. M:F 84:88 , L:R:bilat = 88:83:1. BMI analysis revealed that fewer octogenarian patients were categorised as overweight or obese than the younger population (p< 0.05). There was no difference in the size or complexity of stone between the 2 group (p=0.68)) or stone dimension differences (<2cms vs >2cms) between the 2 populations. Complications both intraoperative (OP:YP, 22:314 p<0.05) and postoperative (OP:YP 21:285 p<0.05) were more common in the older patient group. However there was no difference comparing the incidence of Clavien Dindo (CD) 2 or less (OP:YP 14:188) to CD3b and above (OP:YP 7:92) between the 2 groups. Transfusion rates were commoner in the older age group (OP:YP 8:49 p<0.05) relating to more complex stones (GSS 3-4). Sepsis was not significantly more common in the older patient group by either stone size or complexity. Older patients length of stay (LOS) was significantly longer (5.06 vs 3.24 days 95%CI) for stones of lower complexity (GSS 1-2). There was no difference in LOS for more complex stones (GSS 3-4). There were no significant differences in stone clearance rates by stone complexity between the 2 groups either prior to discharge or at follow up. There were no differences in follow up rates between the 2 populations. CONCLUSIONS PCNL is a safe option for elderly patients. The outcomes were equivalent to younger patients. There were increased complications amongst the older patient group especially relating to transfusion associated with more complex stones. There was no difference in the serious complication rates between the 2 groups. Length of stay was significantly longer for older patients with less complex stones.There is no difference in stone free rates at follow up between the older and younger patient groups © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e351 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Stuart Irving More articles by this author Oliver Wiseman More articles by this author William Finch More articles by this author James Armitage More articles by this author Sarah Fowler More articles by this author John Withington More articles by this author Jonathan Glass More articles by this author Neil Burgess More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

OBJECTIVE:To compare outcomes of urologist vs interventional radiologist (IR) access during percutaneous nephrolithotomy (PCNL) in the contemporary UK setting.PATIENTS AND METHODS:Data submitted to the British Association of Urological Surgeons PCNL data registry between 2009 and 2015 were analysed according to whether access was obtained by a urologist or an IR. We compared access success, number and type of tracts, and perceived and actual difficulty of access. Postoperative outcomes, including stone-free rates, lengths of hospital stay and complications, including transfusion rates, were also compared.RESULTS:Overall, percutaneous renal access was undertaken by an IR in 3453 of 5211 procedures (66.3%); this rate appeared stable over the entire study period for all categories of stone complexity and in cases where there was predicted or actual difficulty with access. Only 1% of procedures were abandoned because of failed access and this rate was identical in each group. IRs performed more multiple tract access procedures than urologists (6.8 vs 5.1%; P = 0.02), but had similar rates of supracostal punctures (8.2 vs 9.2%; P = 0.23). IRs used ultrasonograhpy more commonly than urologists to guide access (56.6% vs 21.7%, P < 0.001). There were no significant differences in complication rates, lengths of hospital stay or stone-free rates.CONCLUSIONS:Our findings suggest that favourable PCNL outcomes may be expected where access is obtained by either a urologist or an IR, assuming that they have received the appropriate training and that they are skilled and proficient in the procedure.

You have accessJournal of UrologyStone Disease: Epidemiology & Evaluation II1 Apr 2016PD47-01 ASSESSING THE VOLUME-OUTCOME RELATIONSHIP FOR PCNL IN 2014- ANALYSIS USING UK NATIONAL REGISTRY DATA OF OVER 2000 CASES John Withington, William Finch, Sarah Fowler, James Armitage, Jonathan Glass, Stuart Irving, Neil Burgess, Kay Thomas, and Oliver Wiseman John WithingtonJohn Withington More articles by this author , William FinchWilliam Finch More articles by this author , Sarah FowlerSarah Fowler More articles by this author , James ArmitageJames Armitage More articles by this author , Jonathan GlassJonathan Glass More articles by this author , Stuart IrvingStuart Irving More articles by this author , Neil BurgessNeil Burgess More articles by this author , Kay ThomasKay Thomas More articles by this author , and Oliver WisemanOliver Wiseman More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2689AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Volume-outcome studies in PCNL have reported mixed findings. In the UK, PCNL was previously shown to be equally safe in high and low volume hospitals; this study investigates the relationship between volume and stone clearance, adjusted for stone complexity. METHODS Data from the prospective British Association of Urological Surgeons PCNL registry in 2014 were analysed. Two groups were defined; hospitals performing fewer than 20 and those performing 20 or more cases per year. Comparisons performed between these groups included stone complexity and outcomes, including stone clearance at day one, blood transfusion, sepsis and median post-operative length of stay (LOS). Subgroups of complex (Guy’s Stone Score III-IV) and non-complex (GSS I-II) stones were also compared. RESULTS 2042 procedures were recorded in the registry in 2014. There was no significant difference between stone complexity (p=0.056), or stone dimensions (p=0.18) of cases undertaken at high and low volume centres. Overall stone clearance, by imaging at day 1, was higher in the high volume group than the low volume group (73% vs 63%, p<0.05). This was true for both complex and non-complex stones (55%vs 45%, p<0.05; 85% vs 77%, p<0.05). Blood transfusion rates did not differ significantly between high and low volume groups overall (2.5% vs 2.6%, p=0.92), or when subdivided by stone complexity (GSS III-IV: 3.0% vs 4.9%, p=0.22; GSS I-II, 0.9%vs 2.2%, p=0.09). Post-operative sepsis occurred in 3.1% patients overall. Hospital volume made no significant difference overall (p=0.1), in complex stones (p=0.09) or in non-complex stones (p=0.97). Overall, median total length of stay (LOS) was shorter at high volume centres than low volume centres (2d v 3d). For GSS I-II stones, LOS was shorter for high volume (2d v 3d); this difference was less for GSS III-IV (3.5d v 4d). CONCLUSIONS Hospital volume does not appear to significantly affect transfusion or sepsis rates post-PCNL; stone complexity seems to be more relevant to these outcomes. Stone clearance, however is clearly associated with hospital volume, higher volume centres achieving significantly higher stone free rates. These findings may inform the debate around centralisation of complex PCNL. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e1170 Advertisement Copyright & Permissions© 2016MetricsAuthor Information John Withington More articles by this author William Finch More articles by this author Sarah Fowler More articles by this author James Armitage More articles by this author Jonathan Glass More articles by this author Stuart Irving More articles by this author Neil Burgess More articles by this author Kay Thomas More articles by this author Oliver Wiseman More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

You have accessJournal of UrologyStone Disease: Surgical Therapy III1 Apr 2016MP33-10 PCNL IN THE UNITED KINGDOM: TRENDS IN 5000 CASES FROM BAUS PCNL REGISTRY William Finch, Robert Calvert, Sarah Fowler, James Armitage, Jonathan Glass, John Withington, Oliver Wiseman, Stuart Irving, and Neil Burgess William FinchWilliam Finch More articles by this author , Robert CalvertRobert Calvert More articles by this author , Sarah FowlerSarah Fowler More articles by this author , James ArmitageJames Armitage More articles by this author , Jonathan GlassJonathan Glass More articles by this author , John WithingtonJohn Withington More articles by this author , Oliver WisemanOliver Wiseman More articles by this author , Stuart IrvingStuart Irving More articles by this author , and Neil BurgessNeil Burgess More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1367AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES PCNL continues to be used for the management of large upper tract renal stones. BAUS developed an online data registry in January 2010 that now includes >5000 procedures. We evaluate current practice, outcomes and trends in PCNL compared with the initial 1000 procedures. METHODS The BAUS PCNL registry was analyzed between 2010 and 2015 for patient and procedural data. HES data for PCNL was evaluated to indicate trends in surgeons reporting of data. RESULTS 5191 PCNL procedures were compared with a previous analysis of 1028 PCNLs in 2011. The majority of PCNL is still prone but supine positioning has significantly increased (16.2%vs6%, p=0.0001). Percutaneous access by radiology showed a small significant upward trend (66.2% vs. 62%, p<0.006). Balloon dilatation has increased in usage (63.4% vs 48%, p=0.0001) with a reduction in metal/Teflon serial dilator usage. Significantly more Consultants perform PCNL themselves than compared with 2011 (84.4% vs. 79%, p=0.0001). Ultrasound fragmentation devices are more widely used (48.8% vs 42.2%, p=0.0002). Lift out PCNL is seen significantly less (-5.6%, p=0.0001). Nephrostomy drainage usage post operatively was similar. Intraoperatively 78.6% of patients were believed to be stone free, confirmed in 68.6% with postop imaging, similar to data in 2011. Complication rates are similar and presented in Table 1. Comparison with English HES data suggests increasing reporting of PCNL cases to the BAUS data registry following compulsory participation in 2014 (Table 2.) CONCLUSIONS The BAUS PCNL registry is a unique resource for UK surgeons, providing vital data on current practice, and trends representing evolving PCNL practices. Compulsory participation from 2014 highlights increasing participation in the registry. The registry allows audit of individual practice against national outcome data and helps surgeons to counsel patients for this complex index endourological procedure. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e440 Advertisement Copyright & Permissions© 2016MetricsAuthor Information William Finch More articles by this author Robert Calvert More articles by this author Sarah Fowler More articles by this author James Armitage More articles by this author Jonathan Glass More articles by this author John Withington More articles by this author Oliver Wiseman More articles by this author Stuart Irving More articles by this author Neil Burgess More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

PURPOSE:This study aims to investigate the relationship between hospital case volume and safety-related outcomes after percutaneous nephrolithotomy (PCNL) within the English National Health Service (NHS).PATIENTS AND METHODS:The study used the Hospital Episode Statistics (HES) database, a routine administrative database, recording information on operations, comorbidity, and outcomes for all NHS hospital admissions in England. Records for all patients undergoing an initial PCNL between April 1, 2006 and March 31, 2012 were extracted. NHS trusts were divided into low-, medium-, and high-volume groups, according to the average annual number of PCNLs performed. We used multiple regression analyses to examine the associations between hospital volume and outcomes incorporating risk adjustment for sex, age, comorbidity, and hospital teaching status. Postoperative outcomes included: Emergency readmission, infection, and hemorrhage. Mean length of stay was also measured.RESULTS:There were 7661 index elective PCNL procedures performed in 163 hospital trusts, between April 2006 and March 2012. There were 2459 patients who underwent PCNL in the 116 units performing fewer than 10 PCNL procedures per year; 2643 patients in the 37 units performing 10 to 19 procedures per year; and 2459 patients in the 9 hospitals performing more than 20 procedures per year. For low-, medium-, and high-volume trusts, there was little variation in the rates of emergency readmission (L 9.7%, M 9.3%, H 8.4%), infection (3.0%, 4.2%, 3.8%), or hemorrhage (1.3%, 1.5%, 1.5%), and there was no statistical evidence that volume was associated with adjusted outcomes. Mean length of stay was slightly shorter in the medium- (5.0 days) and high-volume (5.0) groups compared with the low-volume group (5.3). The effect remained statistically significant after adjusted for confounding.CONCLUSION:Hospital volume was not associated with emergency readmission, infection, or hemorrhage. Length of stay appears to be shorter in higher volume units.

BJU InternationalVolume 115, Issue 2 p. 181-183 Comment ‘Measurement for Improvement Not Judgement’ – the Case of Percutaneous Nephrolithotomy John Withington, Corresponding Author John Withington Department of Urology, Guy's and St Thomas’ NHS Hospitals Trust, London, Norfolk, UK Correspondence: John Withington, Department of Urology, Guy's Hospital, Great Maze Pond, London SE1 9RT, UK. e-mail: john.withington@gstt.nhs.ukSearch for more papers by this authorJames Armitage, James Armitage Department of Urology, Addenbrooke's Hospital, Cambridge, Norfolk, UKSearch for more papers by this authorWilliam Finch, William Finch Department of Urology, Norfolk and Norwich University Hospital Foundation Trust, Norwich, Norfolk, UKSearch for more papers by this authorBen Hughes, Ben Hughes Department of Urology, Addenbrooke's Hospital, Cambridge, Norfolk, UKSearch for more papers by this authorJonathan M. Glass, Jonathan M. Glass Department of Urology, Guy's and St Thomas’ NHS Hospitals Trust, London, Norfolk, UKSearch for more papers by this authorOliver J. Wiseman, Oliver J. Wiseman Department of Urology, Addenbrooke's Hospital, Cambridge, Norfolk, UKSearch for more papers by this authorStuart O. Irving, Stuart O. Irving Department of Urology, Norfolk and Norwich University Hospital Foundation Trust, Norwich, Norfolk, UKSearch for more papers by this authorNeill A. Burgess, Neill A. Burgess Department of Urology, Norfolk and Norwich University Hospital Foundation Trust, Norwich, Norfolk, UKSearch for more papers by this author John Withington, Corresponding Author John Withington Department of Urology, Guy's and St Thomas’ NHS Hospitals Trust, London, Norfolk, UK Correspondence: John Withington, Department of Urology, Guy's Hospital, Great Maze Pond, London SE1 9RT, UK. e-mail: john.withington@gstt.nhs.ukSearch for more papers by this authorJames Armitage, James Armitage Department of Urology, Addenbrooke's Hospital, Cambridge, Norfolk, UKSearch for more papers by this authorWilliam Finch, William Finch Department of Urology, Norfolk and Norwich University Hospital Foundation Trust, Norwich, Norfolk, UKSearch for more papers by this authorBen Hughes, Ben Hughes Department of Urology, Addenbrooke's Hospital, Cambridge, Norfolk, UKSearch for more papers by this authorJonathan M. Glass, Jonathan M. Glass Department of Urology, Guy's and St Thomas’ NHS Hospitals Trust, London, Norfolk, UKSearch for more papers by this authorOliver J. Wiseman, Oliver J. Wiseman Department of Urology, Addenbrooke's Hospital, Cambridge, Norfolk, UKSearch for more papers by this authorStuart O. Irving, Stuart O. Irving Department of Urology, Norfolk and Norwich University Hospital Foundation Trust, Norwich, Norfolk, UKSearch for more papers by this authorNeill A. Burgess, Neill A. Burgess Department of Urology, Norfolk and Norwich University Hospital Foundation Trust, Norwich, Norfolk, UKSearch for more papers by this author First published: 12 February 2014 https://doi.org/10.1111/bju.12660Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Volume115, Issue2February 2015Pages 181-183 RelatedInformation

BJU InternationalVolume 113, Issue 2 p. 184-185 Comment The dilemma of post-ureteroscopy stenting Ben Hughes, Corresponding Author Ben Hughes Cambridge University Hospitals (CUH), Cambridge, UK Correspondence: Ben Hughes, Urology Department, Cambridge University Hospitals (CUH), Hills Road, Cambridge CB2 0QQ, UK. e-mail: [email protected]Search for more papers by this authorOliver J. Wiseman, Oliver J. Wiseman Cambridge University Hospitals (CUH), Cambridge, UKSearch for more papers by this authorTrevor Thompson, Trevor Thompson Belfast City Hospital, Belfast, UKSearch for more papers by this authorJunaid Masood, Junaid Masood Barts Health NHS Trust, London, UKSearch for more papers by this authorR. Daron Smith, R. Daron Smith University College London Hospitals (UCLH), London, UKSearch for more papers by this authorCraig McIlhenny, Craig McIlhenny Forth Valley Royal Hospital, Larbert, UKSearch for more papers by this authorStuart Irving, Stuart Irving Norfolk and Norwich University Hospitals (NNUH), Norwich, UKSearch for more papers by this authorRanan Dasgupta, Ranan Dasgupta Imperial College Healthcare, St Mary's Hospital, London, UKSearch for more papers by this authorMatthew F. Bultitude, Matthew F. Bultitude Guy's and St. Thomas' Hospitals (GSTT), London, UKSearch for more papers by this author Ben Hughes, Corresponding Author Ben Hughes Cambridge University Hospitals (CUH), Cambridge, UK Correspondence: Ben Hughes, Urology Department, Cambridge University Hospitals (CUH), Hills Road, Cambridge CB2 0QQ, UK. e-mail: [email protected]Search for more papers by this authorOliver J. Wiseman, Oliver J. Wiseman Cambridge University Hospitals (CUH), Cambridge, UKSearch for more papers by this authorTrevor Thompson, Trevor Thompson Belfast City Hospital, Belfast, UKSearch for more papers by this authorJunaid Masood, Junaid Masood Barts Health NHS Trust, London, UKSearch for more papers by this authorR. Daron Smith, R. Daron Smith University College London Hospitals (UCLH), London, UKSearch for more papers by this authorCraig McIlhenny, Craig McIlhenny Forth Valley Royal Hospital, Larbert, UKSearch for more papers by this authorStuart Irving, Stuart Irving Norfolk and Norwich University Hospitals (NNUH), Norwich, UKSearch for more papers by this authorRanan Dasgupta, Ranan Dasgupta Imperial College Healthcare, St Mary's Hospital, London, UKSearch for more papers by this authorMatthew F. Bultitude, Matthew F. Bultitude Guy's and St. Thomas' Hospitals (GSTT), London, UKSearch for more papers by this author First published: 04 October 2013 https://doi.org/10.1111/bju.12482Citations: 16Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. References 1 European Association of Urology. European Association of Urology Guidelines on Urolithiasis, 2013. Available at: http://www.uroweb.org/gls/pdf/21_Urolithiasis_LRV4.pdf. Accessed October 2013 2 Nabi G, Cook J, N'Dow J, McClinton S. Outcomes of stenting after uncomplicated ureteroscopy: systematic review and meta-analysis. BMJ 2007; 334: 572–578 3 Ramsay JW, Payne SR, Gosling PT, Whitfield HN, Wickham JE, Levison DA. The effects of double J stenting on unobstructed ureters. An experimental and clinical study. Br J Urol 1985; 57: 630–634 4 Mangera A, Parys B. BAUS Section of Endourology national ureteroscopy audit: setting the standards for revalidation. J Clin Urol 2013; 6: 45–49 5 Auge BK, Sarvis JA, L'Esperance JO, Preminger GM. Practice patterns of ureteral stenting after routine ureteroscopic stone surgery: a survey of practicing urologists. J Endourol 2007; 21: 1287–1291 6 Boddy SA, Nimmon CC, Jones S et al. Acute ureteric dilatation for ureteroscopy. An experimental study. Br J Urol 1988; 61: 27–31 Citing Literature Volume113, Issue2February 2014Pages 184-185 ReferencesRelatedInformation

You have accessJournal of UrologyStone Disease: Therapy II1 Apr 2014MP18-03 DOES HOSPITAL VOLUME AFFECT OUTCOME AFTER PERCUTANEOUS NEPHROLITHOTOMY IN ENGLAND? John Withington, Susan Charman, James Armitage, Jan van der Meulen, David Cromwell, William Finch, Ben Hughes, Oliver Wiseman, Stuart Irving, Jonathan Glass, and Burgess Neil John WithingtonJohn Withington More articles by this author , Susan CharmanSusan Charman More articles by this author , James ArmitageJames Armitage More articles by this author , Jan van der MeulenJan van der Meulen More articles by this author , David CromwellDavid Cromwell More articles by this author , William FinchWilliam Finch More articles by this author , Ben HughesBen Hughes More articles by this author , Oliver WisemanOliver Wiseman More articles by this author , Stuart IrvingStuart Irving More articles by this author , Jonathan GlassJonathan Glass More articles by this author , and Burgess NeilBurgess Neil More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.765AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES This study investigates the relationship between hospital volume and safety-related outcomes following Percutaneous Nephrolithotomy (PCNL) within the English National Health Service (NHS), incorporating risk-adjustment for sex, age and comorbidity. METHODS The study used the Hospital Episode Statistics database (HES), which records data on operations, comorbidity and outcomes for all admissions to NHS hospitals in England. Since 2006, PCNL has been recorded in HES using a single procedure code (M164). Records for all patients undergoing PCNL between March 2006 and January 2011 were extracted. Hospitals were divided, a priori, into high, medium and low volume tertiles, at the level of the individual patient. Multiple logistic regression analyses were carried out using Stata™ software RESULTS 5750 index elective PCNL procedures were performed in 156 hospitals. Three groups of patients were defined by volume: 1786 patients underwent PCNL in the 111 hospitals performing under 10 PCNL procedures per year; 2046 patients in the 36 hospitals performing 10-20 procedures per year; and 1918 patients in the 9 hospitals performing 21-113 procedures per year. After adjusting for age, sex and comorbidity, volume did not significantly affect rates of emergency readmission, infection, haemorrhage or mortality. Median length of stay was shorter in the medium and high volume groups compared with the low volume group. Linear regression, incorporating risk-adjustment confirmed this effect. CONCLUSIONS Hospital volume had no significant effect on emergency readmission, infection, haemorrhage or mortality, despite the appearance of a trend toward lower mean rates of infection and emergency readmission in higher volume centres. The average length of stay however was longer in the low volume group. Improved risk-adjustment, incorporating stone complexity in particular, will be of interest because it is likely that higher volume, tertiary referral centres operate on more complex patients. Table: Summary of effects of volume on outcome (CI = confidence interval, SD = standard deviation) Low Volume Medium Volume High Volume Overall Emergency Readmission (%) 9.52 9.43 8.08 9.00 (SD 4.48) Odds ratio (CI, p>[z]) 1 1.00 (0.80-1.24, 0.98) 0.83 (0.66-1.05, 0.12) - Median length of stay (days) 5 4 4 4 Regression coefficient (CI, p>[t]) 1 -0.42 (-0.69 - - 0.15, < 0.01) -0.47 (-0.74 - - 0.20, < 0.01) - Infection (%) 4.37 3.81 3.55 3.99 (SD 4.13) Odds ratio (CI, p>[z]) 1 0.87 (0.63-1.21, 0.42) 0.80 (0.58-1.12, 0.20) - Haemorrhage (%) 1.34 1.32 1.56 1.41 (SD 1.95) Odds ratio (CI, p>[z]) 1 0.99 (0.57-1.73, 0.98) 1.17 (0.68-2.00, 0.58) - Mortality (%) 0.17 0.24 0.26 0.23 (SD 0.62) Odds ratio (CI, p>[z]) 1 1.52 (0.36-6.43, 0.57) 1.59 (0.38-6.71, 0.53) - © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e204-e205 Advertisement Copyright & Permissions© 2014MetricsAuthor Information John Withington More articles by this author Susan Charman More articles by this author James Armitage More articles by this author Jan van der Meulen More articles by this author David Cromwell More articles by this author William Finch More articles by this author Ben Hughes More articles by this author Oliver Wiseman More articles by this author Stuart Irving More articles by this author Jonathan Glass More articles by this author Burgess Neil More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

OBJECTIVE:To investigate the postoperative outcomes of percutaneous nephrolithotomy (PCNL) in English National Health Service (NHS) hospitals.PATIENTS AND METHODS:We extracted records from the Hospital Episode Statistics (HES) database for all patients undergoing PCNL between March 2006 and January 2011 in English NHS hospitals. Outcome measures were haemorrhage, infection within the index admission, and rates of emergency readmission and in-hospital mortality within 30 days of surgery.RESULTS:A total of 5750 index PCNL procedures were performed in 165 hospitals. During the index admission, haemorrhage was recorded in 81 patients (1.4%), 192 patients (3.8%) had a urinary tract infection (UTI), 95 patients (1.7%) had fever, and 41 patients (0.7%) had sepsis. There were 595 emergency readmissions in 518 patients (9.0%). Reasons for readmission were varied: 70 (1.2%) with UTI, 15 (0.3%) sepsis, 73 (1.3%) haematuria, 25 (0.4%) haemorrhage, and 25 (0.4%) acute urinary retention. There were 13 (0.2%) in-hospital deaths within 30 days of surgery.CONCLUSIONS:Haemorrhage and infection represent relatively common and potentially severe complications of PCNL. Mortality is extremely rare after PCNL (about one in 400 procedures overall) but almost one in 10 patients have an unplanned hospital readmission within 30 days of surgery. Complications of PCNL may be under-reported in the HES database and need to be corroborated using other data sources.

What's known on the subject? and What does the study add? One of the suggested factors for stent‐related symptoms is that excess distal intravesical stent mass may cause bladder irritation. There is a lack of studies investigating this in a randomised controlled fashion using a validated questionnaire. This study compared two of the most commonly used length of stents (a 30 cm multi‐length vs a 24 cm long stent) and showed no significance difference in stent‐related symptoms in patients with either of these stents. Objective To investigate whether excessive redundant intravesical stent component contributes to the severity of stent‐related symptoms in patients with a ureteric stent. We compared stent‐related symptoms in patients who had either a standard 24 cm or multi‐length ureteric stent. Patients and Methods I n all, 162 patients with upper urinary tract calculi requiring ureteric stent insertion were randomised to receive either a 6 F × 24 cm Contour TM or multi‐length 6 F × 22–30 cm C ontour VL TM stent. Patients were requested to complete the validated B ristol U reteric S tent S ymptom Q uestionnaire ( USSQ ) at 1 and 4 weeks after stent insertion and 4 weeks after removal. The mean scores for each domain of the USSQ for both groups were compared using the Student's t ‐test. Any adverse events, e.g. stent migration, early removal of stent due to stent‐related symptoms and failure of stent insertion, were also recorded. Results In all, 153 patients who had successful stent insertion were requested to complete the USSQ and 74% of patients returned at least the week 1 questionnaire. At 1 and 4 weeks with the stent in situ , comparison of the mean scores showed no significant difference in urinary symptoms, pain, general health, work performance, sexual dysfunction and number of days patients stayed in bed or reduced their routine activities. Three (2%) patients had their stent removed early due to stent‐related symptoms and five (3%) had failed stent insertion. Conclusions This study did not find any difference in symptoms between the 24 cm or multi‐length C ontour stents. However, the study was not powered to detect small differences particularly for the pain symptom domain. Stents should only be used sparingly and the stent dwell‐time should be minimised.