UROFAIR Virtual 2020

© The Canadian Journal of Urology TM : International Supplement, July 2020 To Assess the Benefits of ERAS in Live Kidney Donors Aditya Pradhan (1) (1) BLK Superspeciality Hospital New Delhi Introduction andObjectives: There have been constant efforts to improve the outcomes in kidney transplants and concurrently reduce donor morbidity. The application of the ERAS (enhanced recovery after surgery) protocol to enhance the functional recovery of the donor and reduce length of stay can help to meet this aim. We report our experience with ERAS in donor nephrectomy. Methods: Retrospective analysis of all live related kidney donors done from April 2012 to April 2019. Patients were divided in two groups, Gp 1-Patients operated betweenApril 2012-April 2014 before application of ERAS protocol (n- 70) and group 2-Patients operated between 2014- 2019 in whom ERAS protocol was followed (n- 220). Comparison of two groups was done on basis of perioperative parameters. ERAS protocol includes incentive spirometry, minimizing dosage of opioids, TAPP block with bupivacaine, laparoscopic/ mini-incision nephrectomy using small subcostal incision and vascular clipping with angled clip applicators, no drains, single dose antibiotic, early catheter removal, early enteral feeding and early ambulation. Results: Mean age of donors in both groups were comparable. Mean length of stay in group 1 was 4.5 + 1 days vs. 3.4 + 1 days in Gp2. Mean pain score after 6 hrs, 24 hrs and at discharge were significantly lower in group 2. Bowel movement was earlier in Group 2. None of the patients in either group had wound infection. Conclusions: ERAS protocol can give donors early and smooth recovery. We recommend easy to follow steps of ERAS should be used routinely in donor nephrectomies. Would you like Apnoea for Extracorporeal Shockwave Lithotripsy (ESWL)? A Pilot, Prospective Study Thomas Ahn (1) (1) The Prince Charles Hospital Introduction and Objectives: ESWL is commonly used for the treatment of urolithiasis, facilitated by general anaesthesia (GA). Inherent with ventilation is diaphragmatic movement causing movement of urolith/s. This may result in increased shockwaves, operating time and risk of injury to adjacent renal tissue. High flow nasal oxygenation (HFNO) incorporating a muscle relaxant is an alternative anaesthetic technique that provides oxygenation during extended periods of apnoea. Our aim was to assess the safety and feasibility of this for patients undergoing ESWL in this pilot study. Methods: The study population comprised a consecutive number of voluntary patients undergoing ESWL and HFNO over a 6-month period in 2017. Data was prospectively collected to include baseline patient characteristics (age, sex, BMI), anaesthetic measures (duration, drugs, assisted ventilation) and surgical procedure (stone/s size and side, screening time, total shocks). Blood pressure, heart rate, oxygenation and transcutaneous carbon dioxide (CO2) were recorded at baseline and at 5-minute intervals during the procedure. Results: 26 patients were included in the analysis. Mean age, BMI, surgery time, anaesthetic time and duration of muscle paralysis were 49 years, 27 kg/m 2 , 23 minutes, 40 minutes and 25 minutes respectively. Oxygenation was maintained within normal range for all patients. However, CO2 levels increased progressively over time, especiallywhenmuscle relaxant was active (OR: 7.2; 95% CI 2.3-22.7). No patients required conversion to GA. Conclusions: This pilot study demonstrated progressive hypercarbia over time in patients who underwent ESWL with HFNO. Future studies are necessary to evaluate if decreasing respiratory-induced motion results in improved clinical outcomes. C-10060 C-10051 Kidney Transplant in Patients with Severely Low Ejection Fraction (15- 20%) - Our Experience Aditya Pradhan (1) (1) BLK Superspeciality Hospital New Delhi Introduction and Objectives: A significant percentage of ESRD patients on hemodialysis have concomitant heart failure of varying severity. Because of concern about perioperative cardiovascular events and mortality, delayed or nonfunctional grafts the decision of transplant in this subgroup of patients is not straightforward. We present our experience of 10 such patients with EF 15-20%. Methods: We analyzed the records of total 150 transplants done between July 2017 - July 2019. 10 patients had severe systolic dysfunction - EF 15-20%with features of CHF having NYHA class - I/II. All patients were assessed and evaluated by cardiologist and cardiac anaesthetist for better peri-operative optimisation and received rigorous hemodialysis for 2-3 weeks. In only 2/10 patients, coronary angiography was done which did not reveal significant disease. All patients were monitored intensively with Flo trac monitoring system for 24 hrs. Results: Mean age of patients was 52.6 + 4.1 years. 7/10 patients were male. Mean EF 15-20%. All patients had good diuresis after transplantation. 3 patients were electively ventilated for 24 hrs. Post operatively, fall of creatinine was satisfactory. Mean nadir creatinine was 1.2 + 0.3 at time of discharge. There was no rejection/graft dysfunction at 6 months followup. All patients had improvement in the cardiac function post-operatively. Conclusions: In these subgroup of patients, improvement in LV systolic function is significant provided the perioperative issues are tackled diligently along with the cardiologist and cardiac anaesthetist. These patients should not be denied a renal transplant solely on account of poor cardiac function. Is it Start of the End of Non-Endoscopic Stone Treatment in Australia? A Study of Medicare Claims Data in the Last Decade Thomas Ahn (1) (1) The Prince Charles Hospital Introduction and Objectives: The incidence of urolithiasis has been increasing worldwide coupled with an increasing number of interventions. Endoscopic management has become mainstay treatment for majority of stones given laser technology advances, innovations and availability. With increasing utilisation of endoscopic treatment, our objective was to assess the contemporary trends of non-endoscopic stone treatment over the past decade in Australia and examine for any regional variations given our countrys unique diversity in geography. Methods: Medicare Australia databases were used to extract total number and population data (per 100,000) of procedural interventions for stone disease per calendar year, state and gender between 2010-2018. Item rebate codes were used pertaining to ureteroscopy/pyeloscopy, extracorporeal shockwave lithotripsy (SWL), nephrolithotomy/pyelolithotomy and percutaneous nephrolithotomy (PCNL). Results: In Australia between January 2008 and December 2018, a total of 172,732 stone-related cases were performed. 10,803 (40 per 100,000 population) were performed in 2008 compared with 20,079 (65 per 100,000) in 2018. The increasing number of procedural interventions for stone disease is primarily related to endoscopic treatment whereby there has been in absolute terms, population adjusted, 3.9 per 100,000 yearly increase. In contrast there has been a decline in SWL and PCNL of -0.74 and -0.07 per 100,000 respectively. Nephrolithotomy/pyelolithotomy have remained stable. Conclusions: In the last decade, there has been a significant increase in the number of urolithiasis-related interventions performed on Australian adults. A continual yearly incline in utilisation of endoscopic procedures was observed in all Australian states with a corresponding decline in ESWL and PCNL. C-10058 C-10050 6