Ureteric stents are widely used for the management of obstructive uropathy and intraoperative identification of the ureters. Despite undergoing numerous modifications since their introduction in 1967, they are frequently associated with complications ranging from irritative symptoms to migration of the stent. Proximal migration of ureteric stents is a relatively uncommon occurrence, with a reported incidence of 1–4.2%; it is usually associated with inappropriate stent length, poor positioning or incorrect deployment of the stent. Here we discuss an interesting case of a patient who unfortunately suffered proximal ureteric stent migration associated with pelvico-ureteric junction obstruction, despite appropriate stent choice, adequate deployment and confirmation of correct positioning. This complication likely occurred secondary to mechanical disruption of the stent caused by the presence of a large staghorn calculus within the renal pelvis.

e18918 Background: Costs associated with treatment of Chronic Myeloid Leukemia (CML), along with out of pocket (OOP) expenses related to cancer care, put CML patients at risk for financial toxicity (FT). Although FT is considered a side effect of many cancer treatments, little is known about how FT affects quality of life among CML patients treated with Tyrosine Kinase Inhibitors (TKIs). In this study, we examined the association between FT, demographic factors, and health related quality of life (HRQOL). Methods: A secondary analysis was conducted using data from a parent study examining adherence trajectories in people with CML treated with TKIs. Descriptive, bivariate, and multivariate analyses were used to describe the sample, assess demographic and disease-specific FT correlates, and assess the predictive value of FT on HRQOL. FT was assessed by the Comprehensive Score for Financial Toxicity (COST Facit V2; higher scores were better) along with the Medical Expenditure Panel Survey (MEPS). HRQOL was assessed using the EuroQol 5-Dimension (EQ-5D-5L) single summary index score. Results: Of the 118 participant sample, about half were male (52%), White (57%), married (53%), and currently employed (59%) with a mean age of 49. Most had some college credit (76%). Many reported making financial sacrifices because of cancer costs (42% reduced spending on vacation/leisure activities, 31% delayed large purchases, 24% reduced spending on basics like food and clothing, and 27% used savings set aside for other purposes). Most (62%) reported ever being worried about having to pay large medical bills related to their cancer and 15% reported borrowing money or going into debt to cover cancer care costs. About half (51%) reported never discussing OOP costs for cancer care with their doctor. Overall, participants reported low FT (mean = 25, standard deviation = 11), but approximately 26% of respondents noted FT levels associated with significant financial burden (COST < 17.5). In bivariate analyses, greater FT was associated with Black race, not married/partnered status, unemployed, high school education or less, and lower income. FT was not significantly associated with gender or age. In multivariable models, FT was significantly associated with HRQOL index (β = 0.011, SE = 0.002, P < 0.001) after adjusting for individual characteristics. Age (β = -.003, SE = 0.001, P = 0.01) and education (β = .125, SE = 0.05, P = 0.027) also seemed to be important correlates of HRQOL index. Conclusions: Financial concerns are a common worry for individuals receiving treatment for CML. The association between FT and HRQOL suggests a need for assessing and addressing FT as part of routine care of people with CML who are taking TKIs. Further work is needed to understand the longitudinal experience of FT of people with CML on continuous treatment to help identify individuals who are most in need of intervention across the treatment continuum.

BackgroundBotulinum toxin was first described in 1895. It is a potent neurotoxin released by clostridium, a gram-negative, anaerobic, rod-shaped bacterium. Initially, it was considered to be the cause of life-threatening disease. However, research demonstrated it to be a novel and effective therapy in managing a range of diseases, including some that affect the urinary bladder. It was approved by the Food and Drug Administration (FDA) in 1898. ObjectivesThis study aimed to evaluate the long-term effects of intravesical botulinum toxin A (BTA) injections in patients with an indwelling long-term catheter for detrusor overactivity. The patients selected for this study were experiencing significant catheter-associated symptoms such as bypassing, bladder spasms, intractable pain, blockages, and recurrent infections. MethodA retrospective cohort study was conducted in patients that received intravesical BTA after the failure of symptom management using oral anticholinergic and beta 3-adrenocepter agonist. A group of 12 patients was identified, and they were followed up in the clinic after receiving treatment. ResultsAll of the patients included in this study had relief of their symptoms following administration of intravesical BTA. Almost 58% (n = 7) of patients required 3 or fewer treatments with BTA to gain symptom control, with the remaining patients gaining control after 4 treatments. There were no significant adverse events reports with only mild and temporary side effects, such as haematuria, experienced. ConclusionThis study demonstrated that intravesical BTA can significantly improve symptoms associated with long-term indwelling catheters and may help avoid more complex and invasive interventions.