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UP-01.005 Endovascular Management of Hemorrhagic Complications After Percutaneous Nephrolithotomy
UNMODERATED POSTER SESSIONS
UP-01.005 Endovascular Management of Hemorrhagic Complications After Percutaneous Nephrolithotomy Braticevici B1, Ambert V1, Jinga V1, Salaheddin Y1, Popescu M1, Diaconescu D1, Radavoi D1, Dorobat B2 1 Dept. of Urology, Th. Burghele Hostital; 2 Dept. of Radiology, Emergency University Hospital, Bucharest, Romania
of the endovascular renal approach with selective/over selective embolisation in the control of severe post-PCNL hemorrhages. Materials and Methods: We retrospectively analyzed 1290 patients who had undergone PCNL for removal of renal calculi between July 2007 and March 2011. A number of 172 hemorrhagic complications were observed but only 15 (1.1%) patients with a mean age of 52.4 years presented severe post-PCNL hemorrhage that required angiography and/or embolization for bleeding control. The arterial approach was femoral (four cases) or brachial (eleven cases). After initial aortography a selective renal arteriography is performed. Rapid filming sequences are necessary to identify arteriovenous fistulas or the origin of pseudoaneurysms. Vascular lesions are embolised using microsphere or metallic coils. Results: The mean time between PCNL and moment of angiography was 7.4 days for the hospitalized patients and 16 hours for those with late post-PCNL bleeding (two cases). Renal arteriography revealed arteriovenous fistula in 3 patients (20%), pseudoaneurysm in 9 (60%) and no lesion in 3 patients (20%). The hematuria persisted 24 hours after the embolisation in one case and an emergency nephrectomy was necessary. In 11 patients, successful embolization of the offending vessel was achieved. Metallic coils were used in 6 patients (1 or 2 spirals), microspheres in three, and coils plus microspheres in three patients. In patients with normal arteriography, a cystoscopic evaluation revealed hemorrhagia from median prostatic lobe or at a lesion above ureteral meatus. Conclusions: The incidence of post PCNL severe hemorrhagic complications is low (1.1%) which indicates PCNL as a safe and efficient surgical technique. The gold standard treatment in post PCNL vascular renal lesions is the selective angioembolization. By shortening the period between the complication diagnostic and the endovascular treatment the number of hospitalization days could be reduced.
Introduction and Objective: The origin of an adrenal tumor is important to a patient’s endocrinological function and also indicates the tumor’s benign or maglinant charecteristics. Adrenal lipomatous tumors (ALT) are rarely seen, most ALT cases are initially reported after radiological investigation or autopsy. In this study we try to evaluate the clinical, the biochemical and the pathological characteristics of the ALT. Materials and Methods: We retrospectively reviewed 51 pathologically confirmed cases of ALT from 1980 to 2010 in Ruijin hospital, China. They were 24 males and 27 females, with an average age of 52.81⫾10.23 years. Tumors of 27 cases were found in the left adrenal gland,22 cases in the right, and another 2 cases were bilateral tumors. Results: Among 51 cases of ALT, 45 cases were myelolipoma (88.2%), 2 cases were teratoma (3.9%), 2 cases were angioleiomyolipoma (3.9%), 1 case was lipoma (3.9%), and 1 case was liposarcoma (2.0%). The size of the tumors was between (4.0cm⫻3.5cm) and (28.6cm⫻16.7cm). The weight of the tumors ranged from 25 to 586 g. The lab examinations showed that 1 case had high serum aldosterone, 1 case had high serum cortisol, 1 case had high serum androgen and 1 case showed severe anemia. There were 44 cases (86.3%) definitely diagnosed by pre-operative imaging examination, all 51 cases (100%) were definitely diagnosed by light microscopic examination. Conclusions: ALT is uncommon in clinical practice. Most of the patients are nonfunctional and asymptomatic. Different types of lipomatous tumors can be found in the adrenal gland, commonly including myelolipoma, lipoma, angioleiomyolipoma, teratoma and liposarcoma. They are often asymptomatic and non-functional. Most of the ALT are definitely diagnosed by imaging examination before operation. The ALT patients whose tumors are symptomatic or greater than 3.5cm or preoperatively diagnosed teratoma or liposarcoma should undergo surgical treatment.
Introduction: Percutaneous nephrolithotomy (PCNL) represents a safe and efficient procedure in the surgical management of renal lithiasis. The hemorrhagic complications include: intraoperative bleeding, hematoma, arterio-venous fistula and pseudo-aneurysm. In most of the cases the injuries are self-limited and do not need a surgical intervention. The purpose of this study is to prove the efficacy
UP-01.006 Clinical and Pathological Analyses of Adrenal Lipomatous Tumors: Experience With 51 Cases in China Sun F, Zhong S, Zhou W, Xin H, Dai J, Wang X, Shen Z Dept. of Urology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
UP-01.007 Is the Short-Term Outcome of Transurethral Resection of the Prostate Affected by Preoperative Degree of Bladder Outlet Obstruction by Urodynamic Study? Yoo T1, Min D1, Cho J1, Kim H2 1 Euliji University, Eulji Hospital, Seoul; 2 Konkuk University, Chungju Hospital,
UP-01.004 Utilization of Allium Ureteral Stent in the Endoscopic Treatment of Ureteral Stenosis: Our Experience and Preliminary Results Tartaglia N, Salvitti M, Caliolo C, Petrucci F, Franco G, De Dominicis C, Leonardo C Dept. of Urology, Sapienza University of Rome, Italy Introduction and Objective: The aim of our study is to value the efficacy of selfexpandible Allium ureteral stent in the treatment of ureteral stenosis. Materials and Methods: From January 2010 to June 2010, we randomized 3 patients, aged from 23 to 64 years. Two patients were affected by congenital GPU stenosis and one patient by surgical bilateral ureteral stenosis. All the pts showed hydronephrosis before the stenotic lesion and pain. In all the pts, we use a 30 Fr, 8-10cm length self-expandible Allium ureteral stent. The Allium stent is a opencoiled NITILON (nichel ⫹ titanium skeleton) with a co-polymer cover. The indewelling time is up to 1 year. The medium follow-up is 8 months. Results: The pts who underwent the procedure were immediately free of pain. We didn’t experience intra, peri and post-operative complications. In all the pts, a complete correction of the stenotic lesion was obtained, as proved by radiological imaging. Follow-up at 3 and 6 months didn’t show post-operative complication or recurrence of stenosis. Conclusions: Self-expandible Allium ureteral stenosis represents an effective treatment of ureteral stenosis in patients not suitable for surgery.
UROLOGY 78 (Supplement 3A), September 2011
S185
UP-01.005 Endovascular Management of Hemorrhagic Complications After Percutaneous Nephrolithotomy Braticevici B1, Ambert V1, Jinga V1, Salaheddin Y1, Popescu M1, Diaconescu D1, Radavoi D1, Dorobat B2 1 Dept. of Urology, Th. Burghele Hostital; 2 Dept. of Radiology, Emergency University Hospital, Bucharest, Romania
of the endovascular renal approach with selective/over selective embolisation in the control of severe post-PCNL hemorrhages. Materials and Methods: We retrospectively analyzed 1290 patients who had undergone PCNL for removal of renal calculi between July 2007 and March 2011. A number of 172 hemorrhagic complications were observed but only 15 (1.1%) patients with a mean age of 52.4 years presented severe post-PCNL hemorrhage that required angiography and/or embolization for bleeding control. The arterial approach was femoral (four cases) or brachial (eleven cases). After initial aortography a selective renal arteriography is performed. Rapid filming sequences are necessary to identify arteriovenous fistulas or the origin of pseudoaneurysms. Vascular lesions are embolised using microsphere or metallic coils. Results: The mean time between PCNL and moment of angiography was 7.4 days for the hospitalized patients and 16 hours for those with late post-PCNL bleeding (two cases). Renal arteriography revealed arteriovenous fistula in 3 patients (20%), pseudoaneurysm in 9 (60%) and no lesion in 3 patients (20%). The hematuria persisted 24 hours after the embolisation in one case and an emergency nephrectomy was necessary. In 11 patients, successful embolization of the offending vessel was achieved. Metallic coils were used in 6 patients (1 or 2 spirals), microspheres in three, and coils plus microspheres in three patients. In patients with normal arteriography, a cystoscopic evaluation revealed hemorrhagia from median prostatic lobe or at a lesion above ureteral meatus. Conclusions: The incidence of post PCNL severe hemorrhagic complications is low (1.1%) which indicates PCNL as a safe and efficient surgical technique. The gold standard treatment in post PCNL vascular renal lesions is the selective angioembolization. By shortening the period between the complication diagnostic and the endovascular treatment the number of hospitalization days could be reduced.
Introduction and Objective: The origin of an adrenal tumor is important to a patient’s endocrinological function and also indicates the tumor’s benign or maglinant charecteristics. Adrenal lipomatous tumors (ALT) are rarely seen, most ALT cases are initially reported after radiological investigation or autopsy. In this study we try to evaluate the clinical, the biochemical and the pathological characteristics of the ALT. Materials and Methods: We retrospectively reviewed 51 pathologically confirmed cases of ALT from 1980 to 2010 in Ruijin hospital, China. They were 24 males and 27 females, with an average age of 52.81⫾10.23 years. Tumors of 27 cases were found in the left adrenal gland,22 cases in the right, and another 2 cases were bilateral tumors. Results: Among 51 cases of ALT, 45 cases were myelolipoma (88.2%), 2 cases were teratoma (3.9%), 2 cases were angioleiomyolipoma (3.9%), 1 case was lipoma (3.9%), and 1 case was liposarcoma (2.0%). The size of the tumors was between (4.0cm⫻3.5cm) and (28.6cm⫻16.7cm). The weight of the tumors ranged from 25 to 586 g. The lab examinations showed that 1 case had high serum aldosterone, 1 case had high serum cortisol, 1 case had high serum androgen and 1 case showed severe anemia. There were 44 cases (86.3%) definitely diagnosed by pre-operative imaging examination, all 51 cases (100%) were definitely diagnosed by light microscopic examination. Conclusions: ALT is uncommon in clinical practice. Most of the patients are nonfunctional and asymptomatic. Different types of lipomatous tumors can be found in the adrenal gland, commonly including myelolipoma, lipoma, angioleiomyolipoma, teratoma and liposarcoma. They are often asymptomatic and non-functional. Most of the ALT are definitely diagnosed by imaging examination before operation. The ALT patients whose tumors are symptomatic or greater than 3.5cm or preoperatively diagnosed teratoma or liposarcoma should undergo surgical treatment.
Introduction: Percutaneous nephrolithotomy (PCNL) represents a safe and efficient procedure in the surgical management of renal lithiasis. The hemorrhagic complications include: intraoperative bleeding, hematoma, arterio-venous fistula and pseudo-aneurysm. In most of the cases the injuries are self-limited and do not need a surgical intervention. The purpose of this study is to prove the efficacy
UP-01.006 Clinical and Pathological Analyses of Adrenal Lipomatous Tumors: Experience With 51 Cases in China Sun F, Zhong S, Zhou W, Xin H, Dai J, Wang X, Shen Z Dept. of Urology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
UP-01.007 Is the Short-Term Outcome of Transurethral Resection of the Prostate Affected by Preoperative Degree of Bladder Outlet Obstruction by Urodynamic Study? Yoo T1, Min D1, Cho J1, Kim H2 1 Euliji University, Eulji Hospital, Seoul; 2 Konkuk University, Chungju Hospital,
UP-01.004 Utilization of Allium Ureteral Stent in the Endoscopic Treatment of Ureteral Stenosis: Our Experience and Preliminary Results Tartaglia N, Salvitti M, Caliolo C, Petrucci F, Franco G, De Dominicis C, Leonardo C Dept. of Urology, Sapienza University of Rome, Italy Introduction and Objective: The aim of our study is to value the efficacy of selfexpandible Allium ureteral stent in the treatment of ureteral stenosis. Materials and Methods: From January 2010 to June 2010, we randomized 3 patients, aged from 23 to 64 years. Two patients were affected by congenital GPU stenosis and one patient by surgical bilateral ureteral stenosis. All the pts showed hydronephrosis before the stenotic lesion and pain. In all the pts, we use a 30 Fr, 8-10cm length self-expandible Allium ureteral stent. The Allium stent is a opencoiled NITILON (nichel ⫹ titanium skeleton) with a co-polymer cover. The indewelling time is up to 1 year. The medium follow-up is 8 months. Results: The pts who underwent the procedure were immediately free of pain. We didn’t experience intra, peri and post-operative complications. In all the pts, a complete correction of the stenotic lesion was obtained, as proved by radiological imaging. Follow-up at 3 and 6 months didn’t show post-operative complication or recurrence of stenosis. Conclusions: Self-expandible Allium ureteral stenosis represents an effective treatment of ureteral stenosis in patients not suitable for surgery.
UROLOGY 78 (Supplement 3A), September 2011
S185