The value of the immediate post-operative CT in Spina Bifida patients undergoing PCNL
Author(s):
Mr Vimoshan Arumuham
,
Mr Vimoshan Arumuham
Affiliations:
Miss Rebecca Dale
,
Miss Rebecca Dale
Affiliations:
Mr James Fish
,
Mr James Fish
Affiliations:
Dr Clare Allen
,
Dr Clare Allen
Affiliations:
Miss Sian Allen
,
Miss Sian Allen
Affiliations:
Mr Simon Choong
,
Mr Simon Choong
Affiliations:
Mr Daron Smith
Mr Daron Smith
Affiliations:
BAUS ePoster online library. Arumuham V. 06/26/17; 177365; P3-9
Mr. Vimoshan Arumuham
Mr. Vimoshan Arumuham
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Abstract
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INTRODUCTION
Urolithiasis in Spina Bifida presents a complex challenge. There is a paucity of information regarding the outcomes following Percutaneous Nephrolithotomy on such patients: we present our series of 21 cases treated at a tertiary stone centre.

METHODS
We reviewed the case notes and imaging of all patients with Spina Bifida who underwent stone surgery at our centre between 2006 to 2016. During this ten year period, 21 patients underwent a total of 44 PCNLs. Patient demographics, existing stone burden, transfusion requirements, complication rates and stone free status were collected.

RESULTS
Of the 21 patients, 4 were male (31-52yrs) and 17 were female (23-65yrs). 20 patients were ASA 3 and one ASA 4. By definition, all were Guys Score IV. Only 25% retained their native bladders. Access was infra-twelfth in 69.7%, 24.2% supra-twelfth and 6.1% supra-eleventh; 90% were single-track,10% 2 tracks. Post-PCNL transfusion rate was 4.5%; median length of stay 11.3 days (1-30days). Stone composition was 50% Struvite and 43% Calcium Phosphate. 48% of stones had positive microbiology and 46% were discharged on antibiotics.

84% of PCNLs had an immediate post-op CT KUB, of which 39% were completely stone free. Of the PCNLs with residual stones, 36% underwent a “2nd look” procedure during the same admission (the remaining 64% had a further PCNL at a subsequent admission). Subsequently, the overall stone-free rate at first follow-up was 61%.

CONCLUSION
Use of the immediate post-operative CT facilitates a second-look procedure allowing complete stone clearance to be safely achieved during the same admission.
INTRODUCTION
Urolithiasis in Spina Bifida presents a complex challenge. There is a paucity of information regarding the outcomes following Percutaneous Nephrolithotomy on such patients: we present our series of 21 cases treated at a tertiary stone centre.

METHODS
We reviewed the case notes and imaging of all patients with Spina Bifida who underwent stone surgery at our centre between 2006 to 2016. During this ten year period, 21 patients underwent a total of 44 PCNLs. Patient demographics, existing stone burden, transfusion requirements, complication rates and stone free status were collected.

RESULTS
Of the 21 patients, 4 were male (31-52yrs) and 17 were female (23-65yrs). 20 patients were ASA 3 and one ASA 4. By definition, all were Guys Score IV. Only 25% retained their native bladders. Access was infra-twelfth in 69.7%, 24.2% supra-twelfth and 6.1% supra-eleventh; 90% were single-track,10% 2 tracks. Post-PCNL transfusion rate was 4.5%; median length of stay 11.3 days (1-30days). Stone composition was 50% Struvite and 43% Calcium Phosphate. 48% of stones had positive microbiology and 46% were discharged on antibiotics.

84% of PCNLs had an immediate post-op CT KUB, of which 39% were completely stone free. Of the PCNLs with residual stones, 36% underwent a “2nd look” procedure during the same admission (the remaining 64% had a further PCNL at a subsequent admission). Subsequently, the overall stone-free rate at first follow-up was 61%.

CONCLUSION
Use of the immediate post-operative CT facilitates a second-look procedure allowing complete stone clearance to be safely achieved during the same admission.
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