Tony Chen

Prospective, randomized, double-blind study of safety and tolerability of intravesical resiniferatoxin (RTX) in interstitial cystitis (IC)

Objective: To determine the safety and tolerability of intravesical resiniferatoxin (RTX) in interstitial cystitis (IC) patients. Materials and Methods: IC patients were instilled with 50xa0cc of test solution containing either placebo, 0.05xa0μM or 0.10xa0μM RTX in the bladder. Plasma concentration of RTX and its degradant resiniferonol 9-, 13-, 14-orthophenylacetate was measured. Immediate post-treatment blood sampling and cystoscopy were performed. Symptoms were evaluated before treatment, at 4- and at 12-week follow-ups, using VAS indicator for pain, voiding diary, and O’Leary’s IC symptom/problem indices. Results: Among 22 patients observed (ten in 0.10xa0μM RTX, eight in 0.05xa0μM RTX, and four in placebo groups), the most commonly reported adverse event was pain during instillation (80.0%, 87.5%, and 25.0%). No serious adverse events were reported. Conclusions: Use of intravesical RTX in IC patients is associated with important tolerability issues but safe at 0.10xa0μM and 0.05xa0μM.

2105 THE EFFECT OF RESTRICTIVE BARIATRIC SURGERY ON UROLITHIASIS

Abstract Background and Purpose: Roux-en-Y gastric bypass (RYGB) surgery, a mixed malabsorptive/restrictive procedure, is associated with enteric hyperoxaluria and an increased risk of kidney stones. The incidence of nephrolithiasis after purely restrictive bariatric procedures such as adjustable gastric banding or sleeve gastrectomy has not been well described. We aim to analyze the incidence of kidney stones in patients who undergo either adjustable gastric banding or sleeve gastrectomy. Patients and Methods: In a retrospective study, we analyzed a pool of 332 patients who underwent adjustable gastric banding and 85 patients who underwent sleeve gastrectomy at the University of California, San Diego Center for the Treatment for Obesity within a 54-month period (September 2006 to February 2011). The primary outcomes of urinary calculus diagnosis and surgical treatment were investigated using manual chart review and International Classification of Diseases and Related Health Problems-9 code electronic sea...

MP95-19 IMPACT OF A CLINICAL PATHWAY FOR ACUTE NEPHROLITHIASIS IN A PEDIATRIC EMERGENCY DEPARTMENT

INTRODUCTION AND OBJECTIVES: NHS outpatient waiting lists are ever increasing. In January 2016, 976 patients were awaiting a Urology appointment in Brighton. Urgent referrals to a dedicated stone clinic were seen after 12-14 weeks, with routine referrals seen after 6 months. Patient experience was poor, with stone clinic DNA rates of 14%. Innovative changes were needed and a virtual stone clinic (VSC) was set up to improve the service. METHODS: VSC set up was based on Brighton0s award-winning virtual fracture clinic. A consultant-led once-weekly VSC was supported by a MDT of the stone registrar, ESWL radiographer and stone nurse. Referrals were triaged direct from source (ED, GPs, inpatient teams, post-lithotripsy). A target of 20-30 patients per week was set and a tariff of £64 agreed. We aimed to assess the effectiveness following the first 2 months of running the service. RESULTS: 212 patients were seen. 90 (42.5%) were discharged without any further investigations after the first VSC. Of the 122 (57.5%) who required follow up, 89 were brought back to the VSC, and only 33 patients (15%) were invited to attend face-to-face outpatient appointment, to either discuss more invasive treatment (PCNL) or for metabolic evaluation. 83% were discharged following a second virtual clinic review. Treatment was offered to 38 patients (18%); 23 had ESWL, 10 URS, 3 PCNL, and 2 stent/stent removal. Total income, over 2 months, from the 1h-long weekly VSC was £13 568, vs. £24 960 from 4h-long comparable outpatients clinics. The projected income, had the VSC run for 4h, would have however been £54 272. The 6 month waiting list was cleared in the 2 months period. All new referrals are now reviewed by a Consultant in less than 1 week. Feedback from patients was good with only 1 complaint (0.5%) and 8 DNAs (3.8%). We expect to see nearer a 1000 patients by May 2017, and will present updated results. CONCLUSIONS: VSC is a viable and appropriate way for managing patients0 stones. It is cost effective and has a clear advantage with regards to reducing waiting lists. VSCs avoid the time consuming telephone follow-up clinic and free-up traditional outpatient appointments for other activity or complex metabolic stone patients. Early experience suggests patients enjoy the service. Virtual clinics have been gaining popularity across the world, improving the quality and access to care for patients. To the best of our knowledge, this is the first virtual clinic dedicated to patients with urolithiasis in the world. Given the encouraging preliminary results of our study, VSC has the scope to be introduced on a much wider scale.