CUA 2018: Impact of Percutaneous Nephrolithotomy (PCNL) on Renal Function
Halifax, Nova Scotia (UroToday.com) Percutaneous nephrolithotomy (PCNL) remains the gold standard treatment for large kidney stones (>2cm). Patients with large and staghorn stones often experience renal functional deterioration due to chronic obstruction of the collecting system. Infectious stones with chronic pyelonephritis tend to even further decrease renal functional outcomes. When it comes to less invasive management of kidney stones, urologists nowadays have two or three options depending on the stone size and patients characteristics. PCNL is probably most invasive compared to ureteroscopy and shock wave lithotripsy.
CUA 2018: Duration of Antibiotic Therapy for Obstructive Infected Urinary Stones: An Analysis of Patients in a Tertiary Care Centre
Halifax, Nova Scotia (UroToday.com) The American Urological Association (AUA) and European guidelines recommend that infected urinary stone removal be undertaken only once the infection has been adequately treated, but the optimal duration of antibiotics in these cases is not defined.
This was a retrospective observational study of patients admitted with obstructive infected kidney stone(s) at The Ottawa Hospital (TOH), Ontario, Canada.
CUA 2018: Ureteral Stent Versus no Ureteral Stent for Ureteroscopy in the Management of Renal and Ureteral Calculi: A Cochrane Review
Halifax, Nova Scotia (UroToday.com) Urolithiasis is one of the most common urologic diseases with an increasing prevalence in United States and Worldwide. According to recent data, approximately 8% and 10% women and men have urolithiasis in the United States, respectively. With stone being so common, there are treatment modalities that are being developed for effective surgical management. With advancement of surgical endoscopic technology, ureteroscopy (URS) is being used more frequently in the management of amenable stones less than 2cm in size.
CUA 2018: Effects of a Changing Patient Population on Percutaneous Nephrolithotomy Outcomes
Halifax, Nova Scotia (UroToday.com) Percutaneous nephrolithotomy (PCNL) remains the treatment of choice for large kidney stones. According to current guidelines of both leading Urological organizations such American Urological Association as well as the European Association of Urology, PCNL is the gold standard for stones larger than 2cm. Due to complex nature of the procedure, there have been many modifications proposed to improve the outcomes of the procedure. These changes are thought to improve the surgical outcomes. In this regard, studies assessing the PCNL outcomes over time with different types of surgical techniques is of value for the current state of the literature.
CUA 2018: Minimizing Ionizing Radiation Exposure During Retrograde Fluoroscopic Guided Ureteral Stent Insertion in the Pregnant Patient
Halifax, Nova Scotia (UroToday.com) Management of urolithiasis and establishing a definitive diagnosis during pregnancy poses a significant challenge to urologists. Symptomatic stone events are associated with preterm rupture of membranes, preterm labor, and mild pre-eclampsia. Ultrasonography is the 1st line imaging modality for the diagnosis of urolithiasis in pregnant patients. However, when intervention is required to resolve the renal colic, ultrasonography may be suboptimal and often fluoroscopy is used to navigate and guide the procedure.
CUA 2018: Assessing the Relationship Between Obstructive Sleep Apnea and Stone Disease
Halifax, Nova Scotia (UroToday.com) Obstructive sleep apnea (OSA) is an important clinical problem in the chronic kidney disease population. OSA is associated with induction of hypoxemia and sleep fragmentation, which activates the patient's sympathetic nervous system, the renin-angiotensin-aldosterone system, changes cardiovascular hemodynamics, and results in a free radical generation. This, in turn, causes a variety of inflammatory processes, platelet aggregation, atherosclerosis, predisposing patients to metabolic syndrome and abnormalities.
CUA 2018: Metabolic Evaluation Guidelines in Patients With Nephrolithiasis: Are They Being Followed? Results of a National, Multi-Institutional Quality Assessment Study
Halifax, Nova Scotia (UroToday.com) As Naeem Bhojani, MD, opened his presentation, he began by discussing the current state of kidney stone disease and how its morbidity, recurrent nature, and the significant cost is a burden to society. Therefore, he stressed that clinical endourologist focus more heavily on kidney stone prevention rather than treatment. Bhojani reminded the audience in regard to the AUA’s guidelines and how it recommended metabolic evaluation for high-risk stone formers as well as interested stone formers. Though this is highly recommended, these procedures are seldom carried out. Therefore, Bhojani and his team at the University of Montreal set out to determine the efficacy of metabolic evaluation prescription patterns in stone formers and to assess the patient’s understanding of the disease and their willingness to diet to prevent recurrence.