- Email: [email protected]
1040 A single centre evaluation of the durability of a new generation of flexible ureterorenoscope
PBt IJR~EROSCOP¥-MOVINGAHEAD Saturday,19 March, 14:00q 5:30, Room5,MHa!I5
038
~,0137
QUALITY OF LIFE AFTER STENTING IN PATIENTS W I T H URINARY STONE: THE IMPACT OF THE STENT DIAMETER
F R O M B E N C H T O P TO URETEROSCOPY: A COMPARISON OF URETERAL ACCESS SHEATH PHYSICAL PROPERTIES
Autorino R., De Sio M., Damiano R., Cosentino L., Pane U., Quarto G., Di Giacomo F., Mordente S., Giordano D., D' Armiento M.
Beiko D.I, Watterson j.2
Second University of Naples, Urology, Naples, Italy I N T R O D U C T I O N & OBJECTIVES: We report our experience on the evaluation of symptoms related to indwelling double-pigtail stents and their impact on the quality of life based on different stent diameters. MATERIAL & METHODS: We prospectively considered 34 patients (mean age 49 years; 15 male, 10 female) with unilateral ureteral obstruction due to urinary stone undergoing ureteral stenting. In 17 patients (group A) a 4.8 Fr stent was placed, a 6 Fr stent being placed in the other 17 patients (group B). A third group of patients with lower urinary tract symptoms from other causes was used as control group. Two questionnaires, one generic on the general health (Euro QoL) and another specific on the stent-related morbidity (SSQ), were administered between 7 and 14 days after the endoscopic procedure. The questionnaire responses were analyzed using descriptive statistics. RESULTS: The groups were comparable in respect of sex, age, stone size and localization. In the evaluation of general health, Euro QoL analysis revealed a significant association between the stent state and responses regarding the different domains considered by the questionnaire, with pain/discomfort being the most bothersome feeling for the patients. This relationship was confirmed when compared with the results obtained from the control group (p<0.02). However, no differences were found when comparing the two stented group (p>0.07). Similarly, the specific questionnaire analysis demonstrated a significative difference between the prevalence of urinary symptoms and pain associated with the stents as well as the negative impact on daily life compared to no-stent status (p<0.0l). Dysuria, bladder pain and use of anti-inflammatory/antibiotic drugs were the most reported items. Again, no significative advantage of one stent diameter over another was found (p<0.09). CONCLUSIONS: Urinary symptoms and pain are specifically associated to indwelling pigtail stents. Different stent diameter (4.8 vs. 6 Fr) has similar negative impact on patients' quality of life. Further studies in this field are warranted and the use of validated specific questionnaire is desirable in daily clinical practice.
1Queen's University, Dept. of Urology, Kingston, Ontario, Canada, 2Unive'sity of Ottawa, Dept. of Urology, Kingston, Ontario, Canada INTRODUCTION & OBJECTIVES: When choosing an access sheath, one must consider its physical properties. Inner diameter size and kink resistance may atfect the ease of ureteroscope passage and size of retrieved stone fragments. Lubricity and buckling may determine the ease of insertion of the access sheath. The 'perfect' access sheath has yet to be designed. The objectives of this study were two-fold: first, to evaluate and compare the physical properties of different ureteral access sheaths in an in vitro setting; second, to make recommendations, based on our results, regarding the use of access sheaths in the clinical setting. MATERIAL & METHODS: Four access sheaths were compared: Applied Medical Forte®XE; Cook Urological Flexor®; Boston Scientific Microvasive Urology NavigatorTM; ACMI UroPass®: Physical properties tested included timer diameter size, lubricity, kink resistance and buckling. The inner diameter size was measured by determining the size of the largest steel ball capable of rolling through the access sheath in various positions, including: straight; 30 degrees; 60 degrees. Access sheath lubricity was tested by measuring the force required to pass each sheath through a silicone disc. Kink resistance was measured by wrapping the access sheath around a gauge pin and measuring the bend radius that resulted in kinking. Buckling was tested by applying incremental pressure at a point 25cm from the tip of the access sheath and measuring the peak pressure during buckling. RESULTS: In the straight position and 30 degree bend positions, the Cook and ACMI access sheaths were found to have the greatest inner diameter, whereas in the 6(t degree bend position, the ACMI and Applied Medical sheaths had the greatest inner diameter. The ACMI access sheath was found to have the highest lubricity, followed by the Boston Scientific and Cook sheaths. The ACMI and Applied Medical access sheaths were the most resistant to kinking. The ACMI access sheath had the greatest resistance to buckling, followed by the Cook sheath. CONCLUSIONS: Physical properties that are important for a particular case must be considered when choosing an access sheath. When it is desired to remove larger stone fragments, the Cook and ACMI access sheaths are recommended. When outer lubricity for ease of access is important, the ACMI, Boston Scientific and Cook sheaths are recommended. If buckling is a problem while achieving access, the ACMI and Cook sheaths are recommended. Clinical trials are required in order to further validate our results.
1039
1040
PROSPECTIVE RANDOMIZED COMPARISON OF URETEROSCOPIC ENDOPYELOTOMY USING HOLMIUM: YAG LASER AND ACUCISE ENDOPYELOTOMY
A SINGLE CENTRE EVALUATION OF THE DURABILITY OF A NEW GENERATION OF FLEXIBLE URETERORENOSCOPE
E1Nahas A., Shoma A., Eraky I., Elkenawy M., Elkappany H.
Traxer O., Dubosq F., Federieo P., Beley S., Chambade D., Sebe P., Gattegno B., Thibault P.
Urology and Nephrology Center, Dept. of Urology, Mansora, Egypt
H6pital Tenon, Urology, Paris, France
INTRODUCTION & OBJECTIVES: The aim of this work was to compare the safety and efficacy of the two retrograde endopyelotomy techniques.
INTRODUCTION & OBJECTIVES: Many studies have concluded that the fragility of the flexible ureterorennscope (URS) limited its availability to general urology practice because of high maintenance and a need for repair after only few procedures. The objective of this study was to determine the deterioration in the maximal active deflection and flow capabilities of a new generation flexible URS with time during regular endourologic use.
MATERIAL & METHODS: A prospective study was conducted between January 2001 and October 2003. Preoperative radiologic evaluation included multiphasic helical CT and diuretic renography. Exclusion criteria included any of the following, marked hydronephrosis, selective ipsilateral flmction less than 25% of the total renal fi.mction, presence of renal stones or significant crossing vessel at the ureteropelvic junction (UP J). Eligible patients were randomized (using closed envelops) between ureteroscopic Laser endopyelotomy (20 patients) and retrograde Acucise endopyelotomy (20 patients). Laser energy of 1-1.2 Joule at a frequency of 10 Hertz was delivered. The Acucise RP-35 catheter was used. The UPJ was incised in lateral direction then endopyelotomy JJ stent was left for 6 weeks. Both subjective and objective outcomes were evaluated at 3 and 6 months after removal of the stent then every 6 months. Pearson chi-sqnare and independent sample t-test were used to compare variables between both groups. Paired sampie t-test was used to compare preoperative and postoperative selective renal function in the same group to determine significance of improvement. RESULTS: The mean patients' age was 39 years (range 16-69). UPJ obstruction was primary in 14 and secondary in 26 patients. The mean operative time was comparable for both groups (66 minutes J: 21 for Laser and 61 ± 19 for Acucise). Ureteroscopy was necessary in 3 patients of the Acucise group to complete full thickness incision of the UPJ due to rupture of the balloon in one case and failure to demonstrate contrast extravasafion in 2 patients. The overall complication rate for Acucise (25%) was more than Laser (10%). Moreover, the complications of Acucise were more severe as postoperative heamaturia necessitating hospital admission and blood transfusion were encountered in 3 patients. After mean follow-up of 21.7 months (range 6-36), Laser group showed higher success rate (85%) in comparison to Acucise (65%). Furthermore, among successful cases, the improvement of selective renal function was statistically significant in Laser group but not significant in the Acucise group (p-0.024 and 0.34 respectively). CONCLUSIONS: Although ureteroscopic Laser endopyelotomy is more technically challenging than Acucise endopyelotomy, the safety and efficacy of Laser endopyelotomy are better than Acucise.
European Urology Supplements 4 (2005) No. 3, pp. 262
MATERIAL & METHODS: Between April 2004 and July 2004, we performed 50 ureterorenoscopy (47 patients) using the same URS. The indications were as follows: 29 stones (27 patients), 8 urothelial turnouts, 1 benign tumour, 1 removal of a foreign body, 2 ureteral strictures and 9 explorative ureteroscopy. The URS used was the Karl Storz 11278 AU1 "Flex-X'. The Flex-X is a 7.5 F diameter model capable of a 270 ° active deflection on both ventral and dorsal directions with a 3.6 F working channel. Pre- and postoperatively, we evaluated the URS for maximal active ventral arLd dorsal deflection range, irrigation flow at 100 cm H20 and nmnber of broken optical fibers. We also evaluated the procedures in terms of working time, success, surgeon overall impression of difficulty of the procedure and manoeuvrability of the scope: score from 1 (very good) to 5 (bad). RESULTS: The URS has been used for a total of 76 hours 15 min (average: 91 min per procedure). The procedure was considered as a success 45 times. The most fragile part of the endoscope was the deflection unit. The maximal ventral deflection has deteriorated from 270 ° initially to 204.2° at the last procedure (total lost of 24.3%). Respectively, the maximal dorsal deflection was 270 ° initially to 122.5° (total lost of 54.6%). The irrigation flow at 100 cm H20 decreased from 50 ml/min initially to 40 ml/min at the last procedure. The number of broken image fibers reached 6 at the 50,h procedure. Manoeuvrability of the scope decrease from an average of 2.17 for the first 23 cases to 1.70 for the last 27. We had to deplore one repair at the 50th procedm'e: perforation of the working channel by a laser fiber. CONCLUSIONS: Our URS durability data showed that the Storz Flex-X still does not represent such delicate tools. Needs of repairing are actually less frequent with new generation of URS, especially when they are used by a well-trained endo-urologist. Incorporating new technology into URS, furore models will undoubtedly provide better optics, increased durability, and improved capabilifies, resulting in greater manoeuvrability and success.
038
~,0137
QUALITY OF LIFE AFTER STENTING IN PATIENTS W I T H URINARY STONE: THE IMPACT OF THE STENT DIAMETER
F R O M B E N C H T O P TO URETEROSCOPY: A COMPARISON OF URETERAL ACCESS SHEATH PHYSICAL PROPERTIES
Autorino R., De Sio M., Damiano R., Cosentino L., Pane U., Quarto G., Di Giacomo F., Mordente S., Giordano D., D' Armiento M.
Beiko D.I, Watterson j.2
Second University of Naples, Urology, Naples, Italy I N T R O D U C T I O N & OBJECTIVES: We report our experience on the evaluation of symptoms related to indwelling double-pigtail stents and their impact on the quality of life based on different stent diameters. MATERIAL & METHODS: We prospectively considered 34 patients (mean age 49 years; 15 male, 10 female) with unilateral ureteral obstruction due to urinary stone undergoing ureteral stenting. In 17 patients (group A) a 4.8 Fr stent was placed, a 6 Fr stent being placed in the other 17 patients (group B). A third group of patients with lower urinary tract symptoms from other causes was used as control group. Two questionnaires, one generic on the general health (Euro QoL) and another specific on the stent-related morbidity (SSQ), were administered between 7 and 14 days after the endoscopic procedure. The questionnaire responses were analyzed using descriptive statistics. RESULTS: The groups were comparable in respect of sex, age, stone size and localization. In the evaluation of general health, Euro QoL analysis revealed a significant association between the stent state and responses regarding the different domains considered by the questionnaire, with pain/discomfort being the most bothersome feeling for the patients. This relationship was confirmed when compared with the results obtained from the control group (p<0.02). However, no differences were found when comparing the two stented group (p>0.07). Similarly, the specific questionnaire analysis demonstrated a significative difference between the prevalence of urinary symptoms and pain associated with the stents as well as the negative impact on daily life compared to no-stent status (p<0.0l). Dysuria, bladder pain and use of anti-inflammatory/antibiotic drugs were the most reported items. Again, no significative advantage of one stent diameter over another was found (p<0.09). CONCLUSIONS: Urinary symptoms and pain are specifically associated to indwelling pigtail stents. Different stent diameter (4.8 vs. 6 Fr) has similar negative impact on patients' quality of life. Further studies in this field are warranted and the use of validated specific questionnaire is desirable in daily clinical practice.
1Queen's University, Dept. of Urology, Kingston, Ontario, Canada, 2Unive'sity of Ottawa, Dept. of Urology, Kingston, Ontario, Canada INTRODUCTION & OBJECTIVES: When choosing an access sheath, one must consider its physical properties. Inner diameter size and kink resistance may atfect the ease of ureteroscope passage and size of retrieved stone fragments. Lubricity and buckling may determine the ease of insertion of the access sheath. The 'perfect' access sheath has yet to be designed. The objectives of this study were two-fold: first, to evaluate and compare the physical properties of different ureteral access sheaths in an in vitro setting; second, to make recommendations, based on our results, regarding the use of access sheaths in the clinical setting. MATERIAL & METHODS: Four access sheaths were compared: Applied Medical Forte®XE; Cook Urological Flexor®; Boston Scientific Microvasive Urology NavigatorTM; ACMI UroPass®: Physical properties tested included timer diameter size, lubricity, kink resistance and buckling. The inner diameter size was measured by determining the size of the largest steel ball capable of rolling through the access sheath in various positions, including: straight; 30 degrees; 60 degrees. Access sheath lubricity was tested by measuring the force required to pass each sheath through a silicone disc. Kink resistance was measured by wrapping the access sheath around a gauge pin and measuring the bend radius that resulted in kinking. Buckling was tested by applying incremental pressure at a point 25cm from the tip of the access sheath and measuring the peak pressure during buckling. RESULTS: In the straight position and 30 degree bend positions, the Cook and ACMI access sheaths were found to have the greatest inner diameter, whereas in the 6(t degree bend position, the ACMI and Applied Medical sheaths had the greatest inner diameter. The ACMI access sheath was found to have the highest lubricity, followed by the Boston Scientific and Cook sheaths. The ACMI and Applied Medical access sheaths were the most resistant to kinking. The ACMI access sheath had the greatest resistance to buckling, followed by the Cook sheath. CONCLUSIONS: Physical properties that are important for a particular case must be considered when choosing an access sheath. When it is desired to remove larger stone fragments, the Cook and ACMI access sheaths are recommended. When outer lubricity for ease of access is important, the ACMI, Boston Scientific and Cook sheaths are recommended. If buckling is a problem while achieving access, the ACMI and Cook sheaths are recommended. Clinical trials are required in order to further validate our results.
1039
1040
PROSPECTIVE RANDOMIZED COMPARISON OF URETEROSCOPIC ENDOPYELOTOMY USING HOLMIUM: YAG LASER AND ACUCISE ENDOPYELOTOMY
A SINGLE CENTRE EVALUATION OF THE DURABILITY OF A NEW GENERATION OF FLEXIBLE URETERORENOSCOPE
E1Nahas A., Shoma A., Eraky I., Elkenawy M., Elkappany H.
Traxer O., Dubosq F., Federieo P., Beley S., Chambade D., Sebe P., Gattegno B., Thibault P.
Urology and Nephrology Center, Dept. of Urology, Mansora, Egypt
H6pital Tenon, Urology, Paris, France
INTRODUCTION & OBJECTIVES: The aim of this work was to compare the safety and efficacy of the two retrograde endopyelotomy techniques.
INTRODUCTION & OBJECTIVES: Many studies have concluded that the fragility of the flexible ureterorennscope (URS) limited its availability to general urology practice because of high maintenance and a need for repair after only few procedures. The objective of this study was to determine the deterioration in the maximal active deflection and flow capabilities of a new generation flexible URS with time during regular endourologic use.
MATERIAL & METHODS: A prospective study was conducted between January 2001 and October 2003. Preoperative radiologic evaluation included multiphasic helical CT and diuretic renography. Exclusion criteria included any of the following, marked hydronephrosis, selective ipsilateral flmction less than 25% of the total renal fi.mction, presence of renal stones or significant crossing vessel at the ureteropelvic junction (UP J). Eligible patients were randomized (using closed envelops) between ureteroscopic Laser endopyelotomy (20 patients) and retrograde Acucise endopyelotomy (20 patients). Laser energy of 1-1.2 Joule at a frequency of 10 Hertz was delivered. The Acucise RP-35 catheter was used. The UPJ was incised in lateral direction then endopyelotomy JJ stent was left for 6 weeks. Both subjective and objective outcomes were evaluated at 3 and 6 months after removal of the stent then every 6 months. Pearson chi-sqnare and independent sample t-test were used to compare variables between both groups. Paired sampie t-test was used to compare preoperative and postoperative selective renal function in the same group to determine significance of improvement. RESULTS: The mean patients' age was 39 years (range 16-69). UPJ obstruction was primary in 14 and secondary in 26 patients. The mean operative time was comparable for both groups (66 minutes J: 21 for Laser and 61 ± 19 for Acucise). Ureteroscopy was necessary in 3 patients of the Acucise group to complete full thickness incision of the UPJ due to rupture of the balloon in one case and failure to demonstrate contrast extravasafion in 2 patients. The overall complication rate for Acucise (25%) was more than Laser (10%). Moreover, the complications of Acucise were more severe as postoperative heamaturia necessitating hospital admission and blood transfusion were encountered in 3 patients. After mean follow-up of 21.7 months (range 6-36), Laser group showed higher success rate (85%) in comparison to Acucise (65%). Furthermore, among successful cases, the improvement of selective renal function was statistically significant in Laser group but not significant in the Acucise group (p-0.024 and 0.34 respectively). CONCLUSIONS: Although ureteroscopic Laser endopyelotomy is more technically challenging than Acucise endopyelotomy, the safety and efficacy of Laser endopyelotomy are better than Acucise.
European Urology Supplements 4 (2005) No. 3, pp. 262
MATERIAL & METHODS: Between April 2004 and July 2004, we performed 50 ureterorenoscopy (47 patients) using the same URS. The indications were as follows: 29 stones (27 patients), 8 urothelial turnouts, 1 benign tumour, 1 removal of a foreign body, 2 ureteral strictures and 9 explorative ureteroscopy. The URS used was the Karl Storz 11278 AU1 "Flex-X'. The Flex-X is a 7.5 F diameter model capable of a 270 ° active deflection on both ventral and dorsal directions with a 3.6 F working channel. Pre- and postoperatively, we evaluated the URS for maximal active ventral arLd dorsal deflection range, irrigation flow at 100 cm H20 and nmnber of broken optical fibers. We also evaluated the procedures in terms of working time, success, surgeon overall impression of difficulty of the procedure and manoeuvrability of the scope: score from 1 (very good) to 5 (bad). RESULTS: The URS has been used for a total of 76 hours 15 min (average: 91 min per procedure). The procedure was considered as a success 45 times. The most fragile part of the endoscope was the deflection unit. The maximal ventral deflection has deteriorated from 270 ° initially to 204.2° at the last procedure (total lost of 24.3%). Respectively, the maximal dorsal deflection was 270 ° initially to 122.5° (total lost of 54.6%). The irrigation flow at 100 cm H20 decreased from 50 ml/min initially to 40 ml/min at the last procedure. The number of broken image fibers reached 6 at the 50,h procedure. Manoeuvrability of the scope decrease from an average of 2.17 for the first 23 cases to 1.70 for the last 27. We had to deplore one repair at the 50th procedm'e: perforation of the working channel by a laser fiber. CONCLUSIONS: Our URS durability data showed that the Storz Flex-X still does not represent such delicate tools. Needs of repairing are actually less frequent with new generation of URS, especially when they are used by a well-trained endo-urologist. Incorporating new technology into URS, furore models will undoubtedly provide better optics, increased durability, and improved capabilifies, resulting in greater manoeuvrability and success.