Kamaljot Kaler

MP75-14 THE IMPACT OF ONE WEEK OF PRE-OPERATIVE TAMSULOSIN ON DEPLOYMENT OF 16-FRENCH URETERAL ACCESS SHEATHS

quantified by the number of ureteroscope passes through a ureteral access sheath (UAS). METHODS: We prospectively evaluated patients undergoing URS with laser lithotripsy at our institution from December 2015 to October 2016. UAS were used in all patients except those with distal ureteral stones. Every attempt was made to extract all stone fragments, regardless of size, after fragmentation. Patient demographics, stone number, size, and location, and the number of passes of the ureteroscope were recorded. SFR was determined using non-contrast CT scan approximately 8 weeks after the procedure. Stone free (SF) cohort was compared to the residual fragment (RF) cohort using the student0s T-test and the chi-squared test, and binary logistic regression identified factors associated with stone free status. Statistical significance was set at p < 0.05. RESULTS: In total, 104 patients (141 renal units) underwent URS, with 67 patients (84 renal units) completing radiographic follow up to date. Mean number of stones was 3.3 and mean aggregate stone size was 13mm. Our overall SFR was 55%, with a mean number of ureteroscope passes of 44 (range 1 164). On univariate comparison between the SF and RF cohorts, SF patients had fewer numbers of stones (2.4 vs. 4.3, p1⁄40.001), smaller aggregate stone size (11 vs. 15mm, p1⁄40.02), and a smaller proportion of renal or renal and ureteral stones (54% and 15% vs. 66% and 26%, respectively, p1⁄40.003). There were no significant differences in OR time, UAS size, or the number of ureteroscope passes (41 vs. 48, p1⁄40.4) between groups. Binary logistic regression revealed no significant factors predictive of SF status. CONCLUSIONS: SFRs by CT after URS are disappointingly low even with aggressive manual fragment retrieval. Larger sample size is likely to identify select cohorts of patients that benefit most from URS.

Cost Comparisons Between Different Techniques of Percutaneous Renal Biopsy for Small Renal Masses

PURPOSE To compare the costs associated with ultrasound (US)-guided hospital-based (UGHB), CT-guided hospital-based (CTG), and US-guided office-based (UGOB) percutaneous renal biopsy (PRB) for small renal masses (SRMs). METHODS We retrospectively analyzed patient demographics, tumor characteristics, R.E.N.A.L. nephrometry scores, and cost data of patients undergoing PRB for SRM at our institution from May 2012 to September 2015. Cost data, including facility costs, professional fees, and pathology, were obtained from the departments of urology, radiology, and pathology. RESULTS A total of 78 patients were included in our analysis: 19, 31, and 28 UGHB, CTG, and UGOB, respectively. There was no difference in age, gender distribution, or tumor size among the three groups (p-values 0.131, 0.241, and 0.603, respectively). UGOB tumors had lower R.E.N.A.L. nephrometry scores (p=0.008). There were no differences in nondiagnostic rates between the UGHB, CTG, and UGOB groups [4 (21%), 5 (16%), and 6 (21%)] (p=0.852). There were no differences in final tumor treatment strategies utilized among the UGHB, CTG, and UGOB groups (p=0.447). There were 0, 2 (6%), and 0 complications in the UGHB, CTG, and UGOB biopsy groups. Total facility costs were

Ureteroscopy with conscious sedation for distal ureteric calculi: 10-year experience.

3449,

Precise Characterization and 3-Dimensional Reconstruction of the Autonomic Nerve Distribution of the Human Ureter

3280, and

Delayed Nephropleural Fistula After Percutaneous Nephrolithotomy.

1056 for UGHB, CTG, and UGOB PRB, respectively (p<0.0001). There was no difference between the urologists and radiologists professional fees (p=0.066). Total costs, including facility costs, pathology fees, and professional fees, were

MP24-15 SURFACE-TREATED PELLETHANE: COMPARATIVE QUANTIFICATION OF ENCRUSTATION IN ARTIFICIAL URINE SOLUTION

4598,

Inguinal Hernia Repair

4470, and

Nerve Sparing Robot-Assisted Radical Prostatectomy: Assessment of Clinical and Technical Factors Impacting Recovery of Sexual Function

2129 for UGHB, CTG, and UGOB renal biopsy, respectively (p<0.0001). CONCLUSION For select patients with less anatomically complex, exophytic, and posteriorly located tumors, UGOB PRB provides equivalent diagnostic and complication rates while being significantly more cost-effective than either UGHB or CTG renal biopsy.

Skin-to-tumor Distance Predicts Treatment Failure of T1A Renal Cell Carcinoma Following Percutaneous Cryoablation

INTRODUCTION Distal ureteroscopy for stone extraction is a common procedure that is generally performed with spinal or general anesthesia. We retrospectively reviewed all distal ureteroscopy performed for ureteric stone extraction with conscious sedation at our institution over a 10-year period to determine its efficacy and safety. METHODS A retrospective chart review was performed of all distal ureteroscopy performed for calculus removal from 2004 to 2014. Patient characteristics, analgesic requirement, tolerability, procedure time, stone size and composition, method of stone extraction, success rate, and complications were collected. RESULTS Between 2004 and 2014, 314 procedures were performed. Mean age was 53.74 years, with 160 males and 154 females. A success rate of 97% and 10 (3.2%) complications were reported. Mean analgesic requirement was 189 μg of fentanyl (range: 50-400) and 2.79 mg of midazolam (range: 0-8). A total of 263 patients (83.7%) tolerated the procedure well, with only seven (2.2%) having poor tolerability. When comparing females to males, females were found to require less fentanyl (p=0.0001) and midazolam (p=0.0001). When calculi >5 mm were compared to those <5 mm, there was no statistically significant difference in success rate, procedure time, analgesic requirement, tolerability, or complications. CONCLUSION Distal ureteroscopy with conscious sedation is safe and efficacious. To our knowledge, this is the first report demonstrating stones >5 mm can be safely and effectively treated with conscious sedation during this procedure. The context of our findings must be understood within the limitations of our retrospective analysis.

PD41-10 EVALUATION OF THE FEASIBILITY OF REMOTELY MANUFACTURED LOW-COST THREE-DIMENSIONALLY PRINTED LAPAROSCOPIC TRAINERS AND COMPARISON TO STANDARD LAPAROSCOPIC TRAINERS

Purpose: We sought to characterize and 3‐dimensionally reconstruct the distribution of the autonomic innervation of the human ureter. Materials and Methods: Three male and 3 female pairs of ureters were evaluated at 2 mm serial transverse sections along the entire length of the ureter. The location of nerve tissue was immunohistochemically identified using the neuronal marker, S100 protein. ImageJ software was used to calculate nerve count and density in the adventitia and smooth muscle. Blender® graphics software was used to create a 3‐dimensional reconstruction of autonomic nerve distribution. Results: Within the adventitia nerve density was highest in the mid and distal ureter (females 2.87 and 2.71 nerves per mm2, and males 1.68 and 1.69 nerves per mm2) relative to the proximal ureter (females and males 1.94 and 1.22 nerves per mm2, respectively, p >0.0005). Females had significantly higher nerve density throughout the adventitia, especially in the distal ureter (2.87 vs 1.68 nerves per mm2, p <0.0005). In smooth muscle the nerve density progressively increased from the proximal to the distal ureter (p >0.0005). Smooth muscle nerve density was similar in the 2 genders (p = 0.928). However, in females nerve density was significantly higher in the first 2 cm of the distal ureter relative to the second 2 cm (3.6 vs 1.5 nerves per mm2, p <0.001) but not in males (3.0 vs 2.1 nerves per mm2, p = 0.126). Conclusions: Nerve density was highly concentrated at the distal ureter in the adventitia and smooth muscle of the male and female human ureters. The female ureter had greater nerve density in the adventitia, and in smooth muscle nerves were significantly concentrated at the ureteral orifice and the ureteral tunnel.