William Finch

Percutaneous nephrolithotomy in England: practice and outcomes described in the Hospital Episode Statistics database.

To investigate the postoperative outcomes of percutaneous nephrolithotomy (PCNL) in English National Health Service (NHS) hospitals.

Measuring stone volume – three-dimensional software reconstruction or an ellipsoid algebra formula?

To determine the optimal method for assessing stone volume, and thus stone burden, by comparing the accuracy of scalene, oblate, and prolate ellipsoid volume equations with three‐dimensional (3D)‐reconstructed stone volume. Kidney stone volume may be helpful in predicting treatment outcome for renal stones. While the precise measurement of stone volume by 3D reconstruction can be accomplished using modern computer tomography (CT) scanning software, this technique is not available in all hospitals or with routine acute colic scanning protocols. Therefore, maximum diameters as measured by either X‐ray or CT are used in the calculation of stone volume based on a scalene ellipsoid formula, as recommended by the European Association of Urology.

Tips and tricks of ureteroscopy: consensus statement Part I. Basic ureteroscopy

Ureteroscopy is fast becoming the first line treatment option for the majority of urinary tract stones. Ureteroscopy training can be performed in a variety of ways including simulation, hands on ureteroscopy courses and supervised operative experience. We report an “expert consensus view” from experienced endourological surgeons, on all aspects of basic ureteroscopic techniques, with a particular focus on avoiding and getting out of trouble while performing ureteroscopy. In this paper we provide a summary of treatment planning, positioning, cannulation of ureteric orifice, guidewire placement, rigid ureteroscopy and stone fragmentation.

PCNL Access by Urologist or Interventional Radiologist: Practice and Outcomes in the United Kingdom

To compare outcomes of urologist vs interventional radiologist (IR) access during percutaneous nephrolithotomy (PCNL) in the contemporary UK setting.

Radiation dosage in the urolithiasis population: Do we over-radiate our patients?

Introduction: There is increasing concern about the amount of radiation that patients with urolithiasis receive. Ensuring patients are exposed to the minimum necessary radiation is imperative. Here we review the radiation dosages that newly diagnosed urolithiasis patients received in the year following their presentation, both those presenting acutely and those referred electively. Patients and methods: A retrospective study of 95 treatment-naïve patients (47 acute, 48 elective) referred for management of urolithiasis was undertaken. The analysis included all imaging modalities related to stone disease for both patient groups within one year following presentation. The total effective dose (mSV) in one year was calculated by summing the dose for each individual radiation exposure. Results: An average of 5.6 radiological investigations (range 1–14) was carried out for acute patients and 4.57 for elective patients (range 1–11). The mean total effective dose was 14.45 mSV for the acute cases and 12.87 mSV for the elective cases. The maximum radiation dose reached 30.1 mSV in acute patients and 36.51 mSV in elective ones. None of the patients exceeded the maximal annual dose recommended by the International Commission on Radiological Protection (ICRP) of 50 mSV. Conclusion: Management of acute and elective urolithiasis patients can be achieved with acceptable radiation dose exposure. It is extremely important to keep the hazards of radiation in mind whilst managing patients with urolithiasis and clinicians need to remember adherence to the ALARA principle.

Defining working patterns for UK consultant urologists: results of a national census

Objective Our aim was to determine current working patterns for consultant urological specialists in the United Kingdom (UK), to create a contemporary job plan template for the ‘average’ UK urologist and to use this data to predict the workforce required to deliver UK Urology services in the future. Patients and methods A questionnaire-based study of 790 full British Association of Urological Surgeons (BAUS) members was undertaken. This was specifically designed to provide information on the demographics of the workforce, individual consultant job plans and service provision. Data was analysed in conjunction with independent BAUS workforce reports, UK national statistics and Hospital Episodes statistics data to model future Urology workforce activity and numbers. Results In total, 415 responses were completed, representing an overall response rate of 53%. The average job plan consisted of 11 programmed activities per week comprising eight direct clinical care sessions and two supporting professional activities, with a median on-call intensity of 1:6. Some 90% of consultants provide a general urology outpatient clinic, seeing a mean of 7 new and 9 follow-up patients; 67% of respondents provide some-sort of sub-specialist clinic. Dedicated day case operating lists are in the job plans of 56% of urologists and typically comprise five general anaesthetic cases. Inpatient theatre activity is in the job plan of 96%, with a mean activity of four surgical cases on a general urology half-day list and two cases on a subspecialist half-day list. Conclusions This workforce survey highlights the different ways consultants deliver a urological service across the UK. The survey has enabled BAUS to develop a template for the job plan of the ‘average’ urologist. This essential information can assist colleagues in their individual job plan negotiations and help BAUS prepare a comprehensive consultant workforce that can meet the future urological demands of the UK population.

Is PCNL changing in the UK – analysis of 9500 cases from the BAUS PCNL Registry

Introduction and methods: Percutaneous nephrolithotomy (PCNL) indications and techniques are evolving. BAUS developed an online data registry in January 2010 that now includes over 9500 procedures. We evaluate outcomes and practices in PCNL and compare with previous analyses of the registry at 1K and 5K procedures to highlight significant changes in PCNL practice in the UK. Results: A total of 9536 procedures were analysed and compared with previous analyses of 1028 cases (2011, 1K) and 5191 cases (2015, 5K). Submission of cases has stabilised at approximately 2200 cases per year. Most PCNL is still prone, but supine continues to increase significantly from 5K analysis (22.4% vs. 16.2%, P = 0.0001). Access by an interventional radiologist showed a small but significant decrease from 5K analysis (63.3% vs. 66.3%, P = 0.0004), but not significantly different from 1K analysis. No significant changes in tract dilatation methods are seen, with balloon dilatation most popular (64.3%). Consultants increasingly perform PCNL themselves rather than their trainees (96.5% vs. 84.4% (5K) vs. 79.0% (1K), P = 0.0001). Laser fragmentation usage has significantly increased (9.4% vs.7.0% (5K) vs. 5.8% (1K), P = 0.0001), with similar usage of ultrasound/lithoclast/lift out. Sub-analysis of 4490 cases showed 25.8% of cases used multiple stone fragmentation modalities. Nephrostomy tube usage postoperatively is significantly reduced (72.6% vs. 75.6% (5K), P = 0.0001). Intraoperatively 78.5% of patients were recorded as stone-free, which was confirmed in 69.1% on postoperative imaging, similar to previous analyses. Complication rates are shown in Table 1. Conclusions: PCNL practices continue to evolve in the UK. Continued contribution of data and subsequent careful analysis of the registry allows us a better understanding of PCNL in the UK.

PD16-10 IS PCNL A SAFE AND EFFECTIVE OPTION FOR OCTOGENARIAN PATIENT?. ANALYSIS OF OVER 4000 CASES FROM A NATIONAL DATABASE.

CONCLUSIONS: Patients experiencing more pain with their stent than the inciting stone are less willing to treat asymptomatic renal stones and are more willing to accept greater postoperative risk in order to forgo future ureteral stents. With increased emphasis on shared medical decision making, an enhanced understanding of factors affecting these decisions is important in order to appropriately counsel patients.

PD18-04 PCNL ACCESS BY UROLOGIST OR RADIOLOGIST: AN ANALYSIS OF THE BAUS PCNL REGISTRY

INTRODUCTION AND OBJECTIVES: Obtaining percutaneous access to the collecting system of the kidney is fundamental to safe and effective PCNL. Practice varies between countries, hospitals and individual surgeons as to whether access is obtained by a urologist or an interventional radiologist (IR). The objective of this study was to compare outcomes of urologist versus IR tracts using data from the BAUS PCNL data registry. METHODS: Data submitted to the BAUS PCNL data registry between 2009 and 2015 were analysed according to whether access was obtained by a urologist or an IR. We evaluated access success, number and type of tracts, perceived and actual access difficulty, as well as outcomes including stone free rate, length of stay and complications including transfusion rates. Stone complexity was assessed using the Guy’s Stone Score. Two-tailed Fisher’s exact test was used to assess differences between the groups. RESULTS: Overall, percutaneous renal access was undertaken by an IR in 3,453 of 5,211 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 (see Table). IRs did more multiple tracts than urologists (6.8% vs 5.1%, p1⁄40.02) but did similar rates of supracostal punctures (8.2% vs 9.2%, p1⁄40.23). Ultrasound was used more commonly by IRs than urologists (56.6% vs 21.7%, p1⁄40.0001) to guide access. There were no significant differences in complication rates, lengths of stay or stone free rates on Day 1 post-operative imaging. CONCLUSIONS: In the UK most access for PCNL is obtained by an interventional radiologist. There do not appear to be any differences in outcomes of PCNL according to whether access is obtained by a urologist or an interventional radiologist. Our findings suggest that favourable PCNL outcomes may be expected where access is obtained by individuals who have been appropriately trained and who are skilled and proficient in the procedure. However, we believe that a multidisciplinary approach to the management of patients with complex stones may lead to better outcomes.

575 PCNL access by urologist or radiologist: An analysis of the BAUS PCNL Registry

INTRODUCTION AND OBJECTIVES: Obtaining percutaneous access to the collecting system of the kidney is fundamental to safe and effective PCNL. Practice varies between countries, hospitals and individual surgeons as to whether access is obtained by a urologist or an interventional radiologist (IR). The objective of this study was to compare outcomes of urologist versus IR tracts using data from the BAUS PCNL data registry. METHODS: Data submitted to the BAUS PCNL data registry between 2009 and 2015 were analysed according to whether access was obtained by a urologist or an IR. We evaluated access success, number and type of tracts, perceived and actual access difficulty, as well as outcomes including stone free rate, length of stay and complications including transfusion rates. Stone complexity was assessed using the Guy’s Stone Score. Two-tailed Fisher’s exact test was used to assess differences between the groups. RESULTS: Overall, percutaneous renal access was undertaken by an IR in 3,453 of 5,211 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 (see Table). IRs did more multiple tracts than urologists (6.8% vs 5.1%, p1⁄40.02) but did similar rates of supracostal punctures (8.2% vs 9.2%, p1⁄40.23). Ultrasound was used more commonly by IRs than urologists (56.6% vs 21.7%, p1⁄40.0001) to guide access. There were no significant differences in complication rates, lengths of stay or stone free rates on Day 1 post-operative imaging. CONCLUSIONS: In the UK most access for PCNL is obtained by an interventional radiologist. There do not appear to be any differences in outcomes of PCNL according to whether access is obtained by a urologist or an interventional radiologist. Our findings suggest that favourable PCNL outcomes may be expected where access is obtained by individuals who have been appropriately trained and who are skilled and proficient in the procedure. However, we believe that a multidisciplinary approach to the management of patients with complex stones may lead to better outcomes.