A. Andrew Ray

No AccessJournal of UrologyAdult Urology1 Aug 2011A Clinical Nomogram to Predict the Successful Shock Wave Lithotripsy of Renal and Ureteral Calculi Joshua D. Wiesenthal, Daniela Ghiculete, A. Andrew Ray, R. John D.'A. Honey, and Kenneth T. Pace Joshua D. WiesenthalJoshua D. Wiesenthal , Daniela GhiculeteDaniela Ghiculete , A. Andrew RayA. Andrew Ray , R. John D.'A. HoneyR. John D.'A. Honey , and Kenneth T. PaceKenneth T. Pace View All Author Informationhttps://doi.org/10.1016/j.juro.2011.03.109AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Although shock wave lithotripsy is dependent on patient and stone related factors, there are few reliable algorithms predictive of its success. In this study we develop a comprehensive nomogram to predict renal and ureteral stone shock wave lithotripsy outcomes. Materials and Methods: During a 5-year period data from patients treated at our lithotripsy unit were reviewed. Analysis was restricted to patients with a solitary renal or ureteral calculus 20 mm or less. Demographic, stone, patient, treatment and 3-month followup data were collected from a prospective database. All patients were treated using the Philips Lithotron® lithotripter. Results: A total of 422 patients (69.7% male) were analyzed. Mean stone size was 52.3 ± 39.3 mm2 for ureteral stones and 78.9 ± 77.3 mm2 for renal stones, with 95 (43.6%) of the renal stones located in the lower pole. The single treatment success rates for ureteral and renal stones were 60.3% and 70.2%, respectively. On univariate analysis predictors of shock wave lithotripsy success, regardless of stone location, were age (p = 0.01), body mass index (p = 0.01), stone size (p <0.01), mean stone density (p <0.01) and skin to stone distance (p <0.01). By multivariate logistic regression for renal calculi, age, stone area and skin to stone distance were significant predictors with an AUC of 0.75. For ureteral calculi predictive factors included body mass index and stone size (AUC 0.70). Conclusions: Patient and stone parameters have been identified to create a nomogram that predicts shock wave lithotripsy outcomes using the Lithotron lithotripter, which can facilitate optimal treatment based decisions and provide patients with more accurate single treatment success rates for shock wave lithotripsy tailored to patient specific situations. References 1 : 2007 Guideline for the management of ureteral calculi. Eur Urol2007; 52: 1610. Google Scholar 2 : Management of kidney stones. BMJ2007; 334: 468. Google Scholar 3 : Two-year experience with ureteral stones: extracorporeal shockwave lithotripsy v ureteroscopic manipulation. J Endourol1998; 12: 501. 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Link, Google Scholar Division of Urology, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada© 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byMannil M, von Spiczak J, Hermanns T, Poyet C, Alkadhi H and Fankhauser C (2018) Three-Dimensional Texture Analysis with Machine Learning Provides Incremental Predictive Information for Successful Shock Wave Lithotripsy in Patients with Kidney StonesJournal of Urology, VOL. 200, NO. 4, (829-836), Online publication date: 1-Oct-2018.Choo M, Uhmn S, Kim J, Han J, Kim D, Kim J and Lee S (2018) A Prediction Model Using Machine Learning Algorithm for Assessing Stone-Free Status after Single Session Shock Wave Lithotripsy to Treat Ureteral StonesJournal of Urology, VOL. 200, NO. 6, (1371-1377), Online publication date: 1-Dec-2018.Griebling T (2018) Re: Age-Related Delay in Urinary Stone Clearance in Elderly Patients with Solitary Proximal Ureteral Calculi Treated by Extracorporeal Shock Wave LithotripsyJournal of Urology, VOL. 195, NO. 5, (1493-1494), Online publication date: 1-May-2016.Assimos D (2018) Re: S.T.O.N.E. Nephrolithometry: Novel Surgical Classification System for Kidney CalculiJournal of Urology, VOL. 190, NO. 6, (2124-2125), Online publication date: 1-Dec-2013.Assimos D (2018) Re: Predictive Factors of the Outcome of Extracorporeal Shockwave Lithotripsy for Ureteral StonesJournal of Urology, VOL. 188, NO. 6, (2257-2257), Online publication date: 1-Dec-2012. Volume 186Issue 2August 2011Page: 556-562 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.Keywordstreatment outcomeurolithiasisnomogramslithotripsyMetricsAuthor Information Joshua D. Wiesenthal Nothing to disclose. More articles by this author Daniela Ghiculete Nothing to disclose. More articles by this author A. Andrew Ray Nothing to disclose. More articles by this author R. John D.'A. Honey Financial interest and/or other relationship with Cook, Boston Scientific and Pleuromed. More articles by this author Kenneth T. Pace Financial interest and/or other relationship with Sanofi-Synthelabo, Cook Urological Inc., Baxter Inc. and Pharmascience Inc. More articles by this author Expand All Advertisement PDF downloadLoading ...

OBJECTIVES: Percutaneous nephrolithotomy is commonly performed in the prone position. Knowledge of renal anatomy and the relationship of adjacent organs is essential to minimize patient morbidity and iatrogenic organ injury. We present the anatomical basis for a prone-flexed modification to patient positioning and review the advantages and disadvantages of alternate positions. METHODS: Triphasic computed tomography was conducted with the patient in supine, prone, and prone-flexed positions, and an anatomical survey was conducted. A 30 degrees angle was used to approximate the plane of nephrostomy access and the risk of organ injury. RESULTS: For upper pole punctures, the liver and spleen were more medially situated, and thus more likely to be injured with supine positioning, compared with either prone or prone-flexed positioning (p < 0.001). In contrast, for lower pole punctures, the colon was more medially situated in the prone and prone-flexed positions compared to supine (p < 0.001). With prone-flexed positioning, the left kidney was displaced lower than the right in 92.3% of cases. The prone-flexed modification increased the distance from the posterior iliac crest to the 12th and 11th ribs by 2.9 and 3.0 cm, respectively (p < 0.001). If access was performed in the most superior calyx, this would have converted an upper pole access above the 11th rib to one above the 12th rib in 5 of 11 patients (45.5%). CONCLUSIONS: Prone-flexed positioning is a simple modification that provides improved access to the upper pole and more mobility for lower pole percutaneous nephrolithotomy. This position is well tolerated and has several advantages over other patient positions, including the supine position.

BACKGROUND: The Queen Elizabeth II Health Sciences Centre uses a weekly peer-review conference of cardiovascular experts to prioritize each surgical case to 1 of 4 queues with the use of standardized criteria of coronary anatomy, stress test result, and symptoms. We examined the hazard of waiting as well as the impact of waiting on surgical outcomes. METHODS AND RESULTS: Analysis was performed for 2102 consecutive patients queued for CABG, aortic valve replacement, or CABG+aortic valve replacement between January 1, 1998, and December 31, 1999. Among 1854 patients undergoing surgery, median waiting times on the respective queues were as follows: in-house urgent group, 8 days; semiurgent A group, 37 days; semiurgent B group, 64 days; and elective group, 113 days. There were 13 deaths (12 cardiac) that occurred during the waiting period (0.7% of the patients). Of the 8.7% patients upgraded to a more urgent queue, 86.1% required hospitalization before surgery. Although female sex was not associated with prolonged waiting time, it was predictive of urgent status (P=0.001). The incidence of postoperative complications was 25.0%, and operative mortality was 2.86%. Both were more frequent among patients undergoing surgery early (P=0.01); however, this difference was attributable to the in-house urgent queue. The median length of stay was 7 days for all patients and was not affected by waiting time. CONCLUSIONS: Death and upgrades while the patients were waiting tended to occur early in the queuing process, and prolonged waiting was not associated with worse surgical outcomes. The cost of reducing waiting times could in part be offset by prevention of hospital admissions among upgraded patients.

BACKGROUND: Clefting of the lip, palate, or both is a common congenital abnormality. Inadequate treatment for pain in children may result from concerns over opioid-related adverse effects. Providing adequate pain control with minimal adverse effects remains challenging in children. OBJECTIVES: To assess opioid-sparing effects of oral or intravenous acetaminophen following primary cleft palate repair in children. METHODS: Prospective randomized controlled trial in 45 healthy children, ages 5 months to 5 years, using standardized general anesthesia and lidocaine infiltration of the operative field. Patients were allocated to groups: intravenous acetaminophen/oral placebo (intravenous), oral acetaminophen/intravenous placebo (oral), or intravenous/oral placebo (control). Groups were compared for differences in opioid administration during the 24-h study period (morphine equivalents µg·kg(-1) ; 95% confidence interval). RESULTS: Intravenous acetaminophen decreased opioid requirement after surgery (P = 0.003). Patients in the intravenous group received less opioid (272.9; 202.9-342.8 µg·kg(-1) ) than control patients (454.2; 384.3-524.2 µg·kg(-1) ; P < 0.002). Opioid requirement in oral patients (376.5; 304.1-448.9 µg·kg(-1) ) was intermediate and not significantly different from either intravenous (P = 0.11) or control (P = 0.27). During the ward phase of care, intravenous had better analgesia than control (P = 0.002), and both intravenous and oral group patients received less opioid than control (P = 0.01). CONCLUSION: Intravenous acetaminophen given to young children undergoing primary cleft palate repair was associated with opioid-sparing effects compared to placebo. The fewer morphine doses during ward stay in both intravenous and oral may be important clinically in some settings.