Perioperative Aspirin Use Is Associated with Bleeding Complications during Robotic Partial Nephrectomy.

PURPOSE: Daily aspirin use following cardiovascular intervention is commonplace and creates concern regarding bleeding risk in patients undergoing surgery. Despite its cardio-protective role, aspirin is often discontinued 5-7 days prior to major surgery due to bleeding concerns. Single institution studies have investigated perioperative outcomes of aspirin use in robotic partial nephrectomy (RPN). We sought to evaluate the outcomes of perioperative aspirin (pASA) use during RPN in a multicenter setting. MATERIALS AND METHODS: We performed a retrospective evaluation of patients undergoing RPN at 5 high volume RPN institutions. We compared perioperative outcomes of patients taking pASA (81 mg) to those not on aspirin. We analyzed the association between pASA use and perioperative transfusion. RESULTS: Of 1,565 patients undergoing RPN, 228 (14.5%) patients continued pASA and were older (62.8 vs 56.8 years, p <0.001) with higher Charlson scores (mean 3 vs 2, p <0.001). pASA was associated with increased perioperative blood transfusions (11% vs 4%, p <0.001) and major complications (10% vs 3%, p <0.001). On multivariable analysis, pASA was associated with increased transfusion risk (OR 1.94, 1.10-3.45, 95% CI). CONCLUSIONS: In experienced hands, perioperative aspirin 81 mg use during RPN is reasonable and safe; however, there is a higher risk of blood transfusions and major complications. Future studies are needed to clarify the role of antiplatelet therapy in RPN patients requiring pASA for primary or secondary prevention of cardiovascular events.

Percutaneous Removal of Retained Metallic Ureteral Stent with a Looped Polytetrafluoroethylene-Coated Guidewire.

Background: Ureteral stricture disease is a troubling urologic issue that can be managed with surgical reconstruction or, more conservatively, with chronic nephrostomy tubes or ureteral stents. These indwelling tubes require exchanges and are prone to complications such as encrustation or stent failure. Metallic ureteral stents are designed to be more resistant to extrinsic compression and allow for exchanges at longer intervals. However, encrustation or tissue ingrowth can occur with these stents as well. The removal of encrusted or embedded metallic ureteral stents poses a difficult clinical scenario. We present a case of an encrusted metallic stent embedded in a proximal ureteral stricture requiring percutaneous endoscopic removal with a novel looped-wire technique. Case Presentation: A 50-year-old Caucasian man with bilateral ureteral stricture disease, managed with chronic indwelling metallic stents, failed retrograde removal on the right during routine exchange. Staged procedures with percutaneous nephrostomy, followed by combined percutaneous antegrade and retrograde endoscopy were required to observe and access the embedded stent. The exposed metallic surface was unable to be grasped by available instruments through flexible endoscopy. Under endoscopic control with fluoroscopic guidance, a polytetrafluoroethylene (PTFE)-coated guidewire was looped around the metallic stent. With gentle traction on the wire loop, the embedded stent curl was delivered out of the stricture and into the renal pelvis from where it was extracted carefully with graspers inserted through a rigid nephroscope. Follow-up antegrade fluoroscopic studies with contrast showed no extravasation. Conclusion: Percutaneous removal of metallic stents retained within the ureter has unique challenges. We present a novel method of extraction of a retained metallic stent with a looped PTFE-coated guidewire, which may safely and effectively be used in complex situations.