Andrew Portis, MD

Smart stone mgmt is critical as resources tighten Consider Stone Pass for telehealth to keep pts out of ED and hospital Share with your ED MDs NOW DOWNLOAD FREE - hope it helps @promisNIH @bsc_urology @MattBultitude @BEkidneystone @m_e_nielsen @daviesbj

And here it is unrolled: typefully.com/CanesDavid/Dk0…

Fantastic resource. Great work!!

@DrDAgarwal April Fools Day coming a little early this year? 🙄😂🙄

CDC recommends ESWL for all staghorn calculi, especially those with history of brushite stones

@UrologyUK @WayneLam_Urol @EndoLuminalEndo @DocGauhar @Volkan_Ulker_MD @Shresthanyl @TFL_URO_APIS @PETRAurogroup @so_uro @OTRAXER @dravinashsingh @DrVCMohan @DrPKandarp @MrUrologo @iTRUEGroup @docmeetings @GuidoGiusti @chuikalun1 @mallikuro7 @drnanjappa @MohsinUrologist @UrowebESU @eau_yuo Agree with Daron If you think you’re going over an hour for URS, probably better suited for PCNL

@WayneLam_Urol @EndoLuminalEndo @DocGauhar @Volkan_Ulker_MD @Shresthanyl @TFL_URO_APIS @PETRAurogroup @so_uro @OTRAXER @dravinashsingh @DrVCMohan @DrPKandarp @MrUrologo @iTRUEGroup @docmeetings @GuidoGiusti @chuikalun1 @mallikuro7 @drnanjappa @MohsinUrologist @UrowebESU @eau_yuo What size stone is being lasered for a 3 hour case? Not sure where that fits into the schedule @AndrewPortis

Maximum hrs RIRS surgery can b done safely ?? @PETRAurogroup @so_uro @OTRAXER @Shresthanyl @dravinashsingh @DrVCMohan @DrPKandarp @MrUrologo @iTRUEGroup @docmeetings @DocGauhar @EndoLuminalEndo @GuidoGiusti @chuikalun1 @mallikuro7 @drnanjappa @MohsinUrologist @UrowebESU @eau_yuo

Happy Canada Day 🇨🇦🇨🇦🇨🇦🇨🇦 Let the laser light show commence!!

Great slide, very visual @AndrewPortis 😊👍 #baus2021 #BAUS2021 #stonesandgroans #renalcolic

@EndoLuminalEndo Daron, Thanks for the opportunity to share that we create most stone “emergencies”. Huge opportunity to advance care for patients and take stress off limited resources BTW — Pre-recorded presentations are a paradigm shift — usually the audience is sleeping 😎

Thanks @AndrewPortis for the “how to maximise treat to street time” 🔵 majority of stones are small and distal 🔵Aim to discharge patients from ED; anyone admitted is an emergency+treated as such. 🔵And useful prediction of passage tools. Thanks Andy - hope you’re sleeping well

We can’t wait to officially welcome Dr. Deepak Agarwal to our faculty later this summer! Welcome & congratulations!! We are so excited to have you join the team. @DrDAgarwal @IUendourology #holep #endourology

DECADE is just smart

@uroharper @michael_gorin Nuff said

@michael_gorin Routine follow up of (radiopaque) stone formers. Neglecting cost is not great, especially since there is out of pocket costs to the patient. Also, some insurances do not approve CT routinely. “Low dose” CT order does not always result in a low dose CT delivered.

@uroharper @michaelconlin @PatrickSelph I've been using Boston angled dual floppy sensor for ureteral stones for about a month. Haven't needed a second wire yet Best of 3 worlds?

@michaelconlin @PatrickSelph Agree. Angled hydrophilic wire all day for impacted stones or difficult access. Not a fan of hybrid wires in these scenarios. Don’t find they help in difficult situations.

Glide wires are crap

@VicentiniUro @FCAFigueiredo @Endo_Society @sbusp_oficial @peepeeDoctor Gravity is your friend

@FCAFigueiredo @Endo_Society @sbusp_oficial @peepeeDoctor @AndrewPortis Very interesting Felipe. I've been doing RIRS in Trendelemburg position also. And, for distal ureteral stones, in the oposite (proclive).

RIRS is a work in progress. With single use flex scopes, it's not necessary to relocate lower pole stones to preserve the scope. We can use reusable fibers and, with fine dusting, basket is not necessary for all cases, reducing costs. @Endo_Society @sbusp_oficial

@FCAFigueiredo @VicentiniUro @Endo_Society @sbusp_oficial @peepeeDoctor @OTRAXER @emiliani_e @exkeller @sbinhamrii @endouro Still using standard approach 1) extract all small stones and plaques 2) translocate all larger stones to most accessible calyx Considering that all patients have multiple stones (especially after laser is fired) it’s efficient and effective to control the operative field.

@VicentiniUro @Endo_Society @sbusp_oficial @peepeeDoctor @AndrewPortis So I would be highly interested in the data backing this new recommendation from our Stone Wizard , Prof. @OTRAXER ... Saving the cost of a basket just to compensate a Single Use Flex Ureteroscope doesn’t seem a reasonable trade off. @emiliani_e @exkeller @sbinhamrii @endouro

@leogomeslopes @EndoLuminalEndo @drkemalsarica @BURSTurology @NICEComms @ajdcaseytown We have not found pain scores in ED to be helpful - most start 10/10 and find relief PROMIS Pain scores in the first few days after discharge predict decision making. Good metric of symptom control strategy

@AndrewPortis @EndoLuminalEndo @drkemalsarica @BURSTurology @NICEComms @ajdcaseytown That’s is really a great point. We can see that those patients with better immediate pain control in the emergency room have a better chance to accept clinical treatment and are less prone to return sooner to Hospital with another colic!

36 years old male, Right Gr II hydro, mid-ureteric stone ( 8x6 mm, HU 1500) severe colic, urine analysis micro hematuria. Following pain relief in ED, what will be your preferred treatment at the next step?

@leogomeslopes @EndoLuminalEndo @drkemalsarica @BURSTurology @NICEComms @ajdcaseytown We have found pain to be a valuable predictor of pt attempt / success in SSP. Importantly, working with pts, pain can be managed and outcomes can be improved. With Stone Pass, can simulate +/- pain control so pts can see how their outcomes might change

@EndoLuminalEndo @drkemalsarica @AndrewPortis @BURSTurology @NICEComms @ajdcaseytown Great @EndoLuminalEndo ! I tried out @AndrewPortis stone pass app using the data of @drkemalsarica patient You just gave me another tool to help patients counseling about stone treatment!

@diesantillan Consider categories Anatomic - size, location Local response - hydro, strand, uret thick Symptoms - pain severity (PROMIS), duration Infectious markers - CRP, WBC, procalc are independent factors which mandate intervention so not relevant to predictive models

🎓 Other (though controversial) factors affecting ureteral stone passage that have been assesed. -Duration of symptoms -Degree of hydronephrosis -Procalcitonin, CRP, ESR -WBC & Neutrophil count -Perinephric fat stranding -Rim Sign (Ureteral wall thickness) @AndrewPortis

📘 Based on 12th Urology by Campbell #endourology #quiz📊 #UroSoMe @ResidentesAEU @Urologeman @sbinhamrii @BodoKnudsen @VicentiniUro @UroResidency 🚩 Factors affecting the probability of spontaneous passage of ureteral calculi include all of the following EXCEPT:

@ryansteinbergmd @JodiAntonelli @peggypearle @UTSWUrology Yet again Adequacy of stone clearance is best predictor of freedom from future events

#AUA2020: Every fragment matters after URS, regardless of size and location. If you fragment/extract, gotta try to get it all. If you dust, has to be fine enough not to show on CT. cdmcd.co/KrKym6 #AUAVirtualSci @JodiAntonelli @peggypearle @UTSWUrology

@UrologyUK @EndoLuminalEndo @mudhar_hasan @kevanms42 @VicentiniUro Brilliant Brevity is the soul of wit

@AndrewPortis @EndoLuminalEndo @mudhar_hasan @kevanms42 @VicentiniUro Big pot. More tea. The British interpretation of your ECG/EKG Andrew. Been brushing up on my acute medicine for urologists.

From the COVID is NOT the Only Disease Dept: Solo funct kidney & stone Hx shelter in place Avoided ED til decompensated The stones (& MI's & CVA's) are still out there ... suspect there are tales to share @EndoLuminalEndo @mudhar_hasan @kevanms42 @VicentiniUro with consent

@mborofsk @VikramNarayan @ali_ordo @umbreite @urodocLim @EBMUrology @McAGES @mchlrisk @GiuliaILane Very interesting anaesthesia link. Deep in document echoes concerns I have heard regarding MAC and spinal. IF HEAVY SEDATION NECESSITATES HIGH FLOW O2 THERE MAY BE AN AEROSOLIZATION RISK. Need to think carefully about advantages of control with ETT vs spinal or MAC

Hypothetical potentially upcoming/current general urology scenario: Pt who is febrile with COVID19+ PNA and incidentally also found to have an obstructing ureteral stone (not vented). Do you: @mborofsk @ali_ordo @umbreite @urodocLim @EBMUrology @McAGES @mchlrisk @GiuliaILane