The "Tri-Glide" Technique: A Case Report on a Novel Intraoperative Approach for Removal of Retained and Encrusted Ureteral Stents.

BACKGROUND: Retained ureteral stents can result in significant morbidity and can be surgically challenging to urologists. A multimodal approach is often necessary for removal, potentially including retrograde and antegrade procedures performed over multiple anesthetic sessions. We describe the novel "Tri-Glide" technique for treating retained stents, particularly those with stent shaft encrustation prohibiting safe removal. Case Presentation. Two patients with nephrolithiasis and retained, encrusted ureteral stents were managed with the "Tri-Glide" technique. Patient #1 was a 58-year-old man with a severely calcified ureteral stent, retained for 14 years. After undergoing simultaneous cystolitholapaxy and percutaneous nephrolithotomy to treat proximal and distal encrustations, the stent shaft remained trapped in the ureter due to heavy calcifications. Three hydrophilic guidewires were passed alongside the stent, allowing it to easily slide out of the ureter intact. Patient #2 was a 74-year-old man who after only 3-months of stent dwell time developed severe stent shaft encrustation preventing removal. After multiple maneuvers failed, the "Tri-Glide" technique was used to create a smooth track for stent to slide out intact with gentle traction. Both patients did well postoperatively with no complications. CONCLUSION: The "Tri-Glide" technique can aid in the management of complex encrusted stent extractions, especially when there is significant shaft encrustation.

The Perioperative Morbidity of Transurethral Resection of Bladder Tumor: Implications for Quality Improvement.

OBJECTIVES: To characterize the perioperative morbidity of transurethral resection of bladder tumor (TURBT) in order to identify important determinants of both quality and cost in the delivery bladder cancer care. METHODS: We identified 24,100 patients aged 18-89 years who underwent TURBT from 2010 to 2015 in the National Surgical Quality Improvement Program database. Multivariable logistic regression was performed to evaluate the associations of patient features and tumor size (<2 cm, 2-5 cm, or >5 cm) with 30-day perioperative outcomes. RESULTS: Thirty-day postoperative complications occurred in 5.1% of patients, perioperative blood transfusion in 1.5% of patients, hospital readmission in 3.7% of patients, reoperation in 1.5% of patients, and mortality in 0.8% of patients. The most common reasons for readmission were bleeding (29%) and infectious (21%) complications. Although several patient features were associated with increased perioperative morbidity on multivariable analysis, including congestive heart failure, renal failure, higher American Society of Anesthesiology class, and dependent functional status, only larger tumor size was independently associated with increased risks of all perioperative endpoints. CONCLUSION: Perioperative morbidity following TURBT is substantial and represents an important target for quality improvement. Extent of resection, patient functional status, and specific comorbidities are independently associated with increased risks of perioperative morbidity and mortality. These results have implications for patient counseling, perioperative management, and quality improvement programs.