565 ASSESMENT OF PEDIATRIC RADIATION EXPOSURE DURING URETEROSCOPY
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Ob-gyn residents felt significantly more comfortable than urology resi- dents in performing neonatal circumcisions (mean of 5.9 vs. 4.4, p0.003 - range 1 (very uncomfortable) to 7 (very comfortable)), though urology residents increased in comfort-level as PGY increased. Ob-gyn residents felt less comfortable than urology residents (mean 3.9 vs. 5.1 on scale of 7, p 0.04) evaluating if the penis of a newborn may undergo circumcision safely. Urology residents performed better than ob-gyn residents at identifying contraindications to routine circum- cision in our 10 scenarios (mean 63% vs. 43% p 0.001). Both felt that an online-module was a good alternative to practical experience. CONCLUSIONS: This needs assessment outlines that the ma- jority of ob-gyn and urology residents have little formalized training in the contraindications and performance of neonatal circumcision. While ob-gyn residents are comfortable performing routine neonatal circum- cisions, they feel significantly less comfortable evaluating the newborn penis. By contrast, urology residents are more confident with their evaluation and are better at identifying contraindications, but are less comfortable performing the procedure. This needs assessment high- lights the need for further curriculum development and formalized training. Source of Funding: None Pediatrics: Imaging/Infections & Vesicoureteral Reflux Moderated Poster 19 Sunday, May 15, 2011 3:30 PM-5:30 PM 565 ASSESMENT OF PEDIATRIC RADIATION EXPOSURE DURING URETEROSCOPY Paul Kokorowski*, Jeanne Chow, Keith Strauss, Melanie Pennison, Caleb Nelson, Boston, MA INTRODUCTION AND OBJECTIVES: Pediatric patients are more sensitive to ionizing radiation than adults. The as low as reason- ably achievable (ALARA) principle requires efforts to minimize expo- sure to the patient, but little is known about radiation exposure during urologic procedures in children, including ureteroscopy (URS) for uro- lithiasis. The aim of this study was to measure radiation exposure during pediatric URS and identify opportunities for quality improvement. METHODS: We performed a prospective direct observation of URS procedures as part of a quality improvement initiative. Information regarding pre-operative patient characteristics, operative factors, fluo- roscopy unit settings and radiation exposure were recorded. Primary outcomes were total fluoroscopy time (min) and patient skin entrance dose (SED, in mGy). Specific modifiable factors were identified from observations as targets for potential quality improvement. Univariate tests of association were used to identify specific patient and operative factors associated with primary outcomes. RESULTS: Direct observation was performed on 48 consecu- tive ureteroscopic procedures at a single institution. 34 procedures were included in our analysis after excluding two procedures for arterio- venous malformations, one terminated procedure, and 11 non-pediatric patients (21 years of age). Median patient age was 16.5 years old (range 7.4 to 19.2). 21% (7/34) procedures resulted in failure to treat a stone due to spontaneous passage or difficult access. Median total fluoroscopy time was 2.85 min (range 0.4 – 6.7) and median SED was 42.7mGy (range 2.23–223.4).For reference purposes, SED for chest x-ray in a 15 year old is 0.16 mGy. There was considerable variability across multiple examined factors and thus no single factor was signif- icantly associated with fluoroscopy time and only source to skin dis- tance (SSD) was associated with skin entrance dose (p0.02). How- ever, several other modifiable factors including fluoroscopic image rate and field of view demonstrated opportunities for dose reduction. CONCLUSIONS: Pediatric patients receive considerable radi- ation exposure during ureteroscopic procedures. No specific modifiable factors were consistently predictive of total fluoroscopy time and only SSD was associated with skin entry dose. Large variations limited the power to detect differences. Multiple potential methods for potential radiation reduction were identified and future efforts will focus on implementing dose reduction strategies consistent with the ALARA principle. Source of Funding: K23-DK088943 (CN), T32-DK60442 (PK) 566 FEASIBILITY OF TRANSSCROTAL NEAR-INFRARED SPECTROSCOPY (NIRS) IN THE EVALUATION OF ACUTE SCROTUM: A PILOT HUMAN STUDY Berk Burgu*, O. Aydogdu, Tandogan/Ankara, Turkey; Rong Huang, Dallas, TX; T. Soygur, Tandogan/Ankara, Turkey; Linda A. Baker, Dallas, TX INTRODUCTION AND OBJECTIVES: Doppler testicular ultra- sound for testicular torsion is inaccurate and relatively slow, potentially delaying diagnosis and treatment. A rapid, simple to perform, noninva- sive test for torsion would improve testicular salvage rates. Similar to pulse oximetry, near infrared spectroscopy (NIRS) quantitates deep tissue oxygen saturation (%StO2) and successfully identifies experi- mentally-induced testicular torsion in animal models. We report the first pilot study of transcutaneous NIRS in humans with acute scrotum. METHODS: With IRB approval, males presenting to ER with unilateral acute scrotum underwent bilateral transscrotal NIRS (Invos, Somanetics-Covidien) and Doppler US. If surgically explored, NIRS was performed at surgery and 1 day post detorsion. Investigators were blinded to NIRS data; unaffected testis served as internal control. Testicular %StO2 and mean normalized %StO2 (%StO2 unaffected testis - %StO2 affected testis) were compared by two-sample t-tests. RESULTS: 16 consecutive males, mean age 18.27 (range 11–33), presented with acute scrotum of mean duration 12 hours (range 2– 48). Of 5 pts without torsion, mean %StO2 of affected and unaffected testes were 61.4 and 62.4%, respectively (pNS). In every case without torsion, affected testis %StO2 was higher or no more than 10 points lower than contralateral unaffected testis %StO2. Of 11 torsion pts undergoing surgical exploration on average 1.5 hours after presentation, mean %StO2 of the affected testis at presentation and at surgery dropped from 40.09% to 37.18%, respectively while mean %StO2 of the unaffected testis remained at 63.09% at presentation and surgery (p0.0001). In every case with torsion, the affected testis %StO2 was more than 12 points lower than the contralateral unaffected testis %StO2. The 4 patients who underwent orchiectomy had a mean %StO2 at surgery was 36.3% (range 33%– 44%). Seven patients underwent testicular detorsion. At 1 day after detorsion, affected testis %StO2 had improved a normalized mean of 22.67% in 6/7 patients; it had worsened by 5% in one patient. Long-term detorsion viability parameters are pending. CONCLUSIONS: In this pilot study, transscrotal NIRS correctly identified all testicular torsion cases, with the affected testis %StO2 at least 12 points lower than the contralateral unaffected testis. Transs- crotal NIRS is rapid, non-invasive, safe and easily performed without a specially trained technician. NIRS holds great promise for facilitating rapid ER evaluation of the acute scrotum. Source of Funding: None 567 DIAGNOSTIC PERFORMANCE OF ULTRASOUND IN LOCALIZING NON-PALPABLE TESTES: A SYSTEMATIC REVIEW AND META-ANALYSIS Gregory Tasian*, Hillary Copp, San Francisco, CA INTRODUCTION AND OBJECTIVES: Ultrasound is frequently obtained during the pre-surgical evaluation of boys with non-palpable e228 THE JOURNAL OF UROLOGY Vol. 185, No. 4S, Supplement, Sunday, May 15, 2011
Transcript of 565 ASSESMENT OF PEDIATRIC RADIATION EXPOSURE DURING URETEROSCOPY
Ob-gyn residents felt significantly more comfortable than urology resi-dents in performing neonatal circumcisions (mean of 5.9 vs. 4.4,p�0.003 - range 1 (very uncomfortable) to 7 (very comfortable)),though urology residents increased in comfort-level as PGY increased.Ob-gyn residents felt less comfortable than urology residents (mean3.9 vs. 5.1 on scale of 7, p � 0.04) evaluating if the penis of a newbornmay undergo circumcision safely. Urology residents performed betterthan ob-gyn residents at identifying contraindications to routine circum-cision in our 10 scenarios (mean 63% vs. 43% p � 0.001). Both felt thatan online-module was a good alternative to practical experience.
CONCLUSIONS: This needs assessment outlines that the ma-jority of ob-gyn and urology residents have little formalized training inthe contraindications and performance of neonatal circumcision. Whileob-gyn residents are comfortable performing routine neonatal circum-cisions, they feel significantly less comfortable evaluating the newbornpenis. By contrast, urology residents are more confident with theirevaluation and are better at identifying contraindications, but are lesscomfortable performing the procedure. This needs assessment high-lights the need for further curriculum development and formalizedtraining.
Source of Funding: None
Pediatrics: Imaging/Infections & VesicoureteralReflux
Moderated Poster 19
Sunday, May 15, 2011 3:30 PM-5:30 PM
565ASSESMENT OF PEDIATRIC RADIATION EXPOSURE DURINGURETEROSCOPY
Paul Kokorowski*, Jeanne Chow, Keith Strauss, Melanie Pennison,Caleb Nelson, Boston, MA
INTRODUCTION AND OBJECTIVES: Pediatric patients aremore sensitive to ionizing radiation than adults. The �as low as reason-ably achievable� (ALARA) principle requires efforts to minimize expo-sure to the patient, but little is known about radiation exposure duringurologic procedures in children, including ureteroscopy (URS) for uro-lithiasis. The aim of this study was to measure radiation exposureduring pediatric URS and identify opportunities for quality improvement.
METHODS: We performed a prospective direct observation ofURS procedures as part of a quality improvement initiative. Informationregarding pre-operative patient characteristics, operative factors, fluo-roscopy unit settings and radiation exposure were recorded. Primaryoutcomes were total fluoroscopy time (min) and patient skin entrancedose (SED, in mGy). Specific modifiable factors were identified fromobservations as targets for potential quality improvement. Univariatetests of association were used to identify specific patient and operativefactors associated with primary outcomes.
RESULTS: Direct observation was performed on 48 consecu-tive ureteroscopic procedures at a single institution. 34 procedureswere included in our analysis after excluding two procedures for arterio-venous malformations, one terminated procedure, and 11 non-pediatricpatients (�21 years of age). Median patient age was 16.5 years old(range 7.4 to 19.2). 21% (7/34) procedures resulted in failure to treat astone due to spontaneous passage or difficult access. Median totalfluoroscopy time was 2.85 min (range 0.4–6.7) and median SED was42.7mGy (range 2.23–223.4).For reference purposes, SED for chestx-ray in a 15 year old is 0.16 mGy. There was considerable variabilityacross multiple examined factors and thus no single factor was signif-icantly associated with fluoroscopy time and only source to skin dis-tance (SSD) was associated with skin entrance dose (p�0.02). How-ever, several other modifiable factors including fluoroscopic image rateand field of view demonstrated opportunities for dose reduction.
CONCLUSIONS: Pediatric patients receive considerable radi-ation exposure during ureteroscopic procedures. No specific modifiablefactors were consistently predictive of total fluoroscopy time and onlySSD was associated with skin entry dose. Large variations limited thepower to detect differences. Multiple potential methods for potentialradiation reduction were identified and future efforts will focus onimplementing dose reduction strategies consistent with the ALARAprinciple.
Source of Funding: K23-DK088943 (CN), T32-DK60442 (PK)
566FEASIBILITY OF TRANSSCROTAL NEAR-INFRAREDSPECTROSCOPY (NIRS) IN THE EVALUATION OF ACUTESCROTUM: A PILOT HUMAN STUDY
Berk Burgu*, O. Aydogdu, Tandogan/Ankara, Turkey; Rong Huang,Dallas, TX; T. Soygur, Tandogan/Ankara, Turkey; Linda A. Baker,Dallas, TX
INTRODUCTION AND OBJECTIVES: Doppler testicular ultra-sound for testicular torsion is inaccurate and relatively slow, potentiallydelaying diagnosis and treatment. A rapid, simple to perform, noninva-sive test for torsion would improve testicular salvage rates. Similar topulse oximetry, near infrared spectroscopy (NIRS) quantitates deeptissue oxygen saturation (%StO2) and successfully identifies experi-mentally-induced testicular torsion in animal models. We report the firstpilot study of transcutaneous NIRS in humans with acute scrotum.
METHODS: With IRB approval, males presenting to ER withunilateral acute scrotum underwent bilateral transscrotal NIRS (Invos,Somanetics-Covidien) and Doppler US. If surgically explored, NIRSwas performed at surgery and 1 day post detorsion. Investigators wereblinded to NIRS data; unaffected testis served as internal control.Testicular %StO2 and mean normalized %StO2 (%StO2 unaffectedtestis - %StO2 affected testis) were compared by two-sample t-tests.
RESULTS: 16 consecutive males, mean age 18.27 (range11–33), presented with acute scrotum of mean duration 12 hours(range 2–48). Of 5 pts without torsion, mean %StO2 of affected andunaffected testes were 61.4 and 62.4%, respectively (p�NS). In everycase without torsion, affected testis %StO2 was higher or no more than10 points lower than contralateral unaffected testis %StO2. Of 11torsion pts undergoing surgical exploration on average 1.5 hours afterpresentation, mean %StO2 of the affected testis at presentation and atsurgery dropped from 40.09% to 37.18%, respectively while mean%StO2 of the unaffected testis remained at 63.09% at presentation andsurgery (p�0.0001). In every case with torsion, the affected testis%StO2 was more than 12 points lower than the contralateral unaffectedtestis %StO2. The 4 patients who underwent orchiectomy had a mean%StO2 at surgery was 36.3% (range 33%–44%). Seven patientsunderwent testicular detorsion. At 1 day after detorsion, affected testis%StO2 had improved a normalized mean of �22.67% in 6/7 patients;it had worsened by �5% in one patient. Long-term detorsion viabilityparameters are pending.
CONCLUSIONS: In this pilot study, transscrotal NIRS correctlyidentified all testicular torsion cases, with the affected testis %StO2 atleast 12 points lower than the contralateral unaffected testis. Transs-crotal NIRS is rapid, non-invasive, safe and easily performed without aspecially trained technician. NIRS holds great promise for facilitatingrapid ER evaluation of the acute scrotum.
Source of Funding: None
567DIAGNOSTIC PERFORMANCE OF ULTRASOUND INLOCALIZING NON-PALPABLE TESTES: A SYSTEMATIC REVIEWAND META-ANALYSIS
Gregory Tasian*, Hillary Copp, San Francisco, CA
INTRODUCTION AND OBJECTIVES: Ultrasound is frequentlyobtained during the pre-surgical evaluation of boys with non-palpable
e228 THE JOURNAL OF UROLOGY� Vol. 185, No. 4S, Supplement, Sunday, May 15, 2011
