MP29-10: Office-Based Removal of Small Residual Kidney Stone Fragments Reduces Relapse Rates
Saturday, May 4, 2024 9:30 AM to 11:30 AM · 2 hr. (US/Central)
302B
Abstract
Information
Full Abstract and Figures
Author Block
Mathew D. Sorensen*, Barbrina Dunmire, Jeff Thiel, Bryan W. Cunitz, Barbara H. Burke, Branda J. Levchak, Christina Popchoi, Arturo E. Holmes, John C. Kucewicz, M. Kennedy Hall, Manjiri Dighe, Seattle, WA, Jessica C. Dai, Kirkland, WA, Fionnuala C. Cormack, Seattle, WA, Ziyue Liu, Indianapolis, IN, Michael R. Bailey, Michael P. Porter, Jonathan D. Harper, Seattle, WA
Introduction
The benefit of removing residual kidney stone fragments is unknown. U.S. urology guidelines recommend imaging after surgery to detect fragments and offering a second endoscopic surgery to remove fragments as patients with fragments frequently require additional clinical care. Human feasibility studies and randomized clinical trials have shown fragments may be removed by nonsurgical, noninvasive technologies.
Methods
In a multi-center, randomized, controlled trial, 82 adults with residual kidney stone fragments (individually = 5 mm) were randomized to receive a noninvasive, nonsurgical investigative procedure to attempt to facilitate fragment clearance or no procedure and observation of their fragments (ClinicalTrials.gov number, NCT02028559). The primary outcome was relapse as measured by future symptomatic, unscheduled medical visits, surgeries, or stone growth measured on annual CT exams.
Results
Demographic and clinical characteristics were similar (Table 1). After a median follow-up of 2.4 years, the risk of relapse was 68% lower in the treatment group than the control group (odds ratio 0.32, 95% confidence interval 0.14-0.73) with absolute difference in relapse of 20% vs. 48% (treatment versus control). The treatment group had 51% longer time-to-relapse than controls (restricted mean of 1505 ± 99 days for treatment vs 995 ± 120 days for control, p<0.004, log-rank test) (Fig. 1). Excluding 3 participants not asked about passage, asymptomatic passage of fragments within the first 3 weeks was over 12-fold higher in the treatment group (n=24, 63%) compared to control (n=2, 5%). After 3 weeks, asymptomatic passage was similar between groups (n=10 treatment vs 12 control subjects). Average number of treatments was 1.35. Adverse events were mild and transient and included 1 report of a bruise and 11 cases of mild discomfort.
Conclusions
Removal of residual fragments by ultrasonic propulsion added minimal risk and reduced relapse.
Source Of Funding
Funding provided by the NIH NIDDK P01 DK043881 and the Puget Sound Veterans Affairs.
Author Block
Mathew D. Sorensen*, Barbrina Dunmire, Jeff Thiel, Bryan W. Cunitz, Barbara H. Burke, Branda J. Levchak, Christina Popchoi, Arturo E. Holmes, John C. Kucewicz, M. Kennedy Hall, Manjiri Dighe, Seattle, WA, Jessica C. Dai, Kirkland, WA, Fionnuala C. Cormack, Seattle, WA, Ziyue Liu, Indianapolis, IN, Michael R. Bailey, Michael P. Porter, Jonathan D. Harper, Seattle, WA
Introduction
The benefit of removing residual kidney stone fragments is unknown. U.S. urology guidelines recommend imaging after surgery to detect fragments and offering a second endoscopic surgery to remove fragments as patients with fragments frequently require additional clinical care. Human feasibility studies and randomized clinical trials have shown fragments may be removed by nonsurgical, noninvasive technologies.
Methods
In a multi-center, randomized, controlled trial, 82 adults with residual kidney stone fragments (individually = 5 mm) were randomized to receive a noninvasive, nonsurgical investigative procedure to attempt to facilitate fragment clearance or no procedure and observation of their fragments (ClinicalTrials.gov number, NCT02028559). The primary outcome was relapse as measured by future symptomatic, unscheduled medical visits, surgeries, or stone growth measured on annual CT exams.
Results
Demographic and clinical characteristics were similar (Table 1). After a median follow-up of 2.4 years, the risk of relapse was 68% lower in the treatment group than the control group (odds ratio 0.32, 95% confidence interval 0.14-0.73) with absolute difference in relapse of 20% vs. 48% (treatment versus control). The treatment group had 51% longer time-to-relapse than controls (restricted mean of 1505 ± 99 days for treatment vs 995 ± 120 days for control, p<0.004, log-rank test) (Fig. 1). Excluding 3 participants not asked about passage, asymptomatic passage of fragments within the first 3 weeks was over 12-fold higher in the treatment group (n=24, 63%) compared to control (n=2, 5%). After 3 weeks, asymptomatic passage was similar between groups (n=10 treatment vs 12 control subjects). Average number of treatments was 1.35. Adverse events were mild and transient and included 1 report of a bruise and 11 cases of mild discomfort.
Conclusions
Removal of residual fragments by ultrasonic propulsion added minimal risk and reduced relapse.
Source Of Funding
Funding provided by the NIH NIDDK P01 DK043881 and the Puget Sound Veterans Affairs.