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278 Extracorporeal shockwave lithotripsy in pediatric ureteral stones: Retrospective analysis of 168 cases
277 THE EFFICACY OF TRIPSY IN PAEDIATRIC Q&&.,
EXTRACORPOREAL LOWER POLE
SHOCK STONES
WAVE
LITHO-
Demirkesen O., Tansu N., Kalkan M., Y&in V., Oner A
Cerrahpasa School of Medicine, Istanbul University,
278 EXTRACORPOREAL URETERAL STONES: Altunrende
F., Karadag
SHOCKWAVE RETROSPECTIVE M., Tefekli
LITHOTRIPSY ANALYSIS
A., Erkan
E., Sarilar
IN PEDIATRIC OF 168 CASES O., Muslumanoglu
A.
Department of Urology, Istanbul, Turkey
INTRODUCTION & OBJECTIVES: To evaluate the efficacy of extracorporeal shock wave lithotripsy (SWL) monotherapy for isolated lower pole nephrolithiasis in paediatric population and compare it to those of isolated middle/upper caliceal and renal pelvis stone. MATERIAL & METHODS: We treated 125 renal units (RU) with Isolated caliceal and renal pelvis stones using a Siemens Litho star lithotriptor. Stone load was recorded in square centimetres (cm’). Patients were stratified into 3 groups based on stone localization; lower calyx, middle/upper calices and pelvis renalis stones as group 1, 2 and 3 respectively. The stones were localized in the lower, middle/upper calices and renal pelvis in 40, 24 and 61 RU’s, respectively. Patients were evaluated by intravenous urogram and ultrasonogmphy 12 weeks after the last session. They were designated as stone-free or CIRF (nonobstmctive and non-infectious insignificant fragments C4 mm). SWL was regarded as failure if no fragmentation was noted after the 3rd session. The results were compared with respect to renal localization. RESULTS: The median patient age was 9 years (range 21 months to 16 years). The median stone burden was 0.9cm2 (0.2-7). The median number of shock waves and energy used for the entire patient populatmn was 1500 and 17.2kV, respectively. Auxiliary procedures were used in 12.8 % before treatment. General anaesthesia was given to 9 (7.2 %). The stone and treahnent characteristics and results of 125 renal units were shown in the table. Complication occurred in 9 patients. Only one Datient reauired hosoitalization due to fever. Steinstraw develoved in 8 uatients. All of these oatients were succ&fully n&aged by repeat SWL monotherapy with&t using Auxiliary procedures:
CONCLUSIONS: There is no significant difference for success rates between the lower, middle/upper calices and pelvis stones treated with ESWL in paediatric population.
279
Haseki
Teaching
And Research
Hospital,
Urology,
Istanbul,
Turkey
INTRODUCTION & OBJECTIVES: Management of ureteral stones in children represents a challenging problem Extracorporeal shockwave lithotripsy (SWL) can be considered as first line treatment alternative for pediatric ureteral stones. In this study, we retrospectively analyzed our experience with SWL in 168 children with ureteral stones. MATERIAL & METHODS: Between 1990-2001, 168 cases in pediatric age group (114 years old) were treated with Siemens Lithostar Plus for ureteral stones. All cases were evaluated with urine analysis, urine culture, coagulation profile, serum creatinine level, plain radiography of the urinary tract, intravenous urography and/or ultrasonography before SWL application. There were 3 1 stones in proximal ureter, 16 in mid ureter and 121 in distal ureter. Stone free and clinically insignificant residual fragments (CIRF) were defined successfQ1 and SWL was regarded as failed if no fragmentation was seen after 3 sessions. RESULTS: Mean patient age was 8.7h3.9 years (6 months-14 years). There were 108 boys (64.2%) and 60 girls (35.8%). All patients were treated as outpatients with intravenous sedation in 64 cases (3&l%), general anesthesia in 60 cases (35.7%) and no anesthesia in 44 (26.2%). A maximum of 3500 shocks and 18kV per session were applied in all cases. A primary double-j ureteral stent was placed before SWL in 4 children (2.3%) with obstructing distal ureteral stones. A 100% success rate was achieved in all proximal (n: 3 1) and mid ureteral stones (n: 16). Besides this, stone free and CIRF rates for distal ureter cases (n: 121) were 90.6% and 3.1% in stones less than 1 cm in diameter (n: 91), 91.7% and 8.3% in stones between 1-2 cm (n: 24). In 1 case having distal ureter stone bigger than 2 cm, no success was achieved and open surgery was applied. Overall retreatment and efficacy quotient rates for proximal ureteral stones were 45.1% and 68.9%, 62.5% and 61.5% for mid, 49.6% and 60.0% for distal ureteral stones. CONCLUSIONS: SWL can be considered as first line treatment alternative for ureteral stones in pediatric age group regarding stone location and size. Especially, proximal and mid ureter stones are having higher success rates than distal ureter stones. PI 6 TREATMENT AND PROGNOSIS IN RENAL CELL CARClNOMA Thursday, 25 March, 15.30-17.00, Hall HI Blue level RESULTS OF THE RANDOMIZED TRIAL COMPARING PARTIAL NEPHRECTOMY FOR SMALL KIDNEY EORTC PROTOCOL 30904
280 RADICAL AND NEOPLASMS
Van PoDpel H.‘, Rigatti P.‘, Albrecht W.‘, Matveev V.‘, Bono A.5, De Prijk Klaessens I.“, Sylvester R.O, EORTC GU group, Brussels, Belgium
L.“,
‘UZ Gasthuisberg, Department of Urology, Leuven, Belgium, 2San Raffaele Hospital, Department of Urology, Milan, Italy, ‘Rudolfstiftung, Department of Urology, Vienna, Austria, 4Cancer Research Centre, Department of Urology, Moscow, Russia, iOspedale di Circolo e Fondazione Macchi, Department of Urology, Varese, Italy, ‘EORTC Data Centre, Brussels, Belgium
INTRODUCTION & OBJECTIVES: Partial nephrectomy is more and more applied although its side effects and his oncological equivalence to radical nephrectomy is never been studied in a randomized fashion.
WITHDRAWN
MATERIAL & METHODS: 541 patients with a solitary solid NOM0 tumour suspicious to be adenocarcinoma, <= 5 centimetres in largest diameter and with a normal contralateral kidney were randomized to undergo radical (n=273) or partial nephrectomy (n=268) together with a limited lymph node dissection. RESULTS: 30 patients underwent a radical and 33 a partial nephrectomy for non malignant disease (mostly oncocytoma). Distribution and location of the tumours were comparable in both arms. In the partial nephrectomy arm 13.4% of patients finally underwent a radical nephrectomy. Peri-operative blood loss was less than 0.5 litre in 90.5 and 8 1 %, and severe haemorrhage occurred in 1.1 and 3.4 % after radical and partial nephrectomy respectively. Reoperation for complications was necessary in 2.2 and 4.1% respectively. Postoperative CT scan was three times as often abnormal after partial than after radical nephrectomy. CONCLUSIONS: Without having oncological results at this moment, partial nephrectomy seems an acceptable approach for smaller kidney neoplasms with a slightly higher complication rate. Technical improvements and the analysis of the oncological results of this trial will demonstrate the correct place of kidney sparing surgery for kidney cancer.
European
Urology
Supplements
3 (2004)
No. 2, pp. 72
EXTRACORPOREAL LOWER POLE
SHOCK STONES
WAVE
LITHO-
Demirkesen O., Tansu N., Kalkan M., Y&in V., Oner A
Cerrahpasa School of Medicine, Istanbul University,
278 EXTRACORPOREAL URETERAL STONES: Altunrende
F., Karadag
SHOCKWAVE RETROSPECTIVE M., Tefekli
LITHOTRIPSY ANALYSIS
A., Erkan
E., Sarilar
IN PEDIATRIC OF 168 CASES O., Muslumanoglu
A.
Department of Urology, Istanbul, Turkey
INTRODUCTION & OBJECTIVES: To evaluate the efficacy of extracorporeal shock wave lithotripsy (SWL) monotherapy for isolated lower pole nephrolithiasis in paediatric population and compare it to those of isolated middle/upper caliceal and renal pelvis stone. MATERIAL & METHODS: We treated 125 renal units (RU) with Isolated caliceal and renal pelvis stones using a Siemens Litho star lithotriptor. Stone load was recorded in square centimetres (cm’). Patients were stratified into 3 groups based on stone localization; lower calyx, middle/upper calices and pelvis renalis stones as group 1, 2 and 3 respectively. The stones were localized in the lower, middle/upper calices and renal pelvis in 40, 24 and 61 RU’s, respectively. Patients were evaluated by intravenous urogram and ultrasonogmphy 12 weeks after the last session. They were designated as stone-free or CIRF (nonobstmctive and non-infectious insignificant fragments C4 mm). SWL was regarded as failure if no fragmentation was noted after the 3rd session. The results were compared with respect to renal localization. RESULTS: The median patient age was 9 years (range 21 months to 16 years). The median stone burden was 0.9cm2 (0.2-7). The median number of shock waves and energy used for the entire patient populatmn was 1500 and 17.2kV, respectively. Auxiliary procedures were used in 12.8 % before treatment. General anaesthesia was given to 9 (7.2 %). The stone and treahnent characteristics and results of 125 renal units were shown in the table. Complication occurred in 9 patients. Only one Datient reauired hosoitalization due to fever. Steinstraw develoved in 8 uatients. All of these oatients were succ&fully n&aged by repeat SWL monotherapy with&t using Auxiliary procedures:
CONCLUSIONS: There is no significant difference for success rates between the lower, middle/upper calices and pelvis stones treated with ESWL in paediatric population.
279
Haseki
Teaching
And Research
Hospital,
Urology,
Istanbul,
Turkey
INTRODUCTION & OBJECTIVES: Management of ureteral stones in children represents a challenging problem Extracorporeal shockwave lithotripsy (SWL) can be considered as first line treatment alternative for pediatric ureteral stones. In this study, we retrospectively analyzed our experience with SWL in 168 children with ureteral stones. MATERIAL & METHODS: Between 1990-2001, 168 cases in pediatric age group (114 years old) were treated with Siemens Lithostar Plus for ureteral stones. All cases were evaluated with urine analysis, urine culture, coagulation profile, serum creatinine level, plain radiography of the urinary tract, intravenous urography and/or ultrasonography before SWL application. There were 3 1 stones in proximal ureter, 16 in mid ureter and 121 in distal ureter. Stone free and clinically insignificant residual fragments (CIRF) were defined successfQ1 and SWL was regarded as failed if no fragmentation was seen after 3 sessions. RESULTS: Mean patient age was 8.7h3.9 years (6 months-14 years). There were 108 boys (64.2%) and 60 girls (35.8%). All patients were treated as outpatients with intravenous sedation in 64 cases (3&l%), general anesthesia in 60 cases (35.7%) and no anesthesia in 44 (26.2%). A maximum of 3500 shocks and 18kV per session were applied in all cases. A primary double-j ureteral stent was placed before SWL in 4 children (2.3%) with obstructing distal ureteral stones. A 100% success rate was achieved in all proximal (n: 3 1) and mid ureteral stones (n: 16). Besides this, stone free and CIRF rates for distal ureter cases (n: 121) were 90.6% and 3.1% in stones less than 1 cm in diameter (n: 91), 91.7% and 8.3% in stones between 1-2 cm (n: 24). In 1 case having distal ureter stone bigger than 2 cm, no success was achieved and open surgery was applied. Overall retreatment and efficacy quotient rates for proximal ureteral stones were 45.1% and 68.9%, 62.5% and 61.5% for mid, 49.6% and 60.0% for distal ureteral stones. CONCLUSIONS: SWL can be considered as first line treatment alternative for ureteral stones in pediatric age group regarding stone location and size. Especially, proximal and mid ureter stones are having higher success rates than distal ureter stones. PI 6 TREATMENT AND PROGNOSIS IN RENAL CELL CARClNOMA Thursday, 25 March, 15.30-17.00, Hall HI Blue level RESULTS OF THE RANDOMIZED TRIAL COMPARING PARTIAL NEPHRECTOMY FOR SMALL KIDNEY EORTC PROTOCOL 30904
280 RADICAL AND NEOPLASMS
Van PoDpel H.‘, Rigatti P.‘, Albrecht W.‘, Matveev V.‘, Bono A.5, De Prijk Klaessens I.“, Sylvester R.O, EORTC GU group, Brussels, Belgium
L.“,
‘UZ Gasthuisberg, Department of Urology, Leuven, Belgium, 2San Raffaele Hospital, Department of Urology, Milan, Italy, ‘Rudolfstiftung, Department of Urology, Vienna, Austria, 4Cancer Research Centre, Department of Urology, Moscow, Russia, iOspedale di Circolo e Fondazione Macchi, Department of Urology, Varese, Italy, ‘EORTC Data Centre, Brussels, Belgium
INTRODUCTION & OBJECTIVES: Partial nephrectomy is more and more applied although its side effects and his oncological equivalence to radical nephrectomy is never been studied in a randomized fashion.
WITHDRAWN
MATERIAL & METHODS: 541 patients with a solitary solid NOM0 tumour suspicious to be adenocarcinoma, <= 5 centimetres in largest diameter and with a normal contralateral kidney were randomized to undergo radical (n=273) or partial nephrectomy (n=268) together with a limited lymph node dissection. RESULTS: 30 patients underwent a radical and 33 a partial nephrectomy for non malignant disease (mostly oncocytoma). Distribution and location of the tumours were comparable in both arms. In the partial nephrectomy arm 13.4% of patients finally underwent a radical nephrectomy. Peri-operative blood loss was less than 0.5 litre in 90.5 and 8 1 %, and severe haemorrhage occurred in 1.1 and 3.4 % after radical and partial nephrectomy respectively. Reoperation for complications was necessary in 2.2 and 4.1% respectively. Postoperative CT scan was three times as often abnormal after partial than after radical nephrectomy. CONCLUSIONS: Without having oncological results at this moment, partial nephrectomy seems an acceptable approach for smaller kidney neoplasms with a slightly higher complication rate. Technical improvements and the analysis of the oncological results of this trial will demonstrate the correct place of kidney sparing surgery for kidney cancer.
European
Urology
Supplements
3 (2004)
No. 2, pp. 72