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1674 TREATMENT OF CALICEAL DIVERTICULAR CALCULI BY PERCUTANEOUS NEPHROLITHOTOMY
Vol. 189, No. 4S, Supplement, Tuesday, May 7, 2013
2.47) or Hispanic race (OR 1.70, CI 1.25, 2.24), age (p⫽0.046), and diabetes (OR 1.67, CI 1.07, 2.59) were associated with receiving a semi-rigid implant. CONCLUSIONS: Rates of re-operation for infectious or mechanical failure are the same between the semi-rigid and inflatable penile prostheses. The revision rate for penile prosthesis procedures in community practice is substantially higher than the currently quoted rates in the published literature. Socio-demographic factors appear to significantly influence the type of prosthesis a patient receives. Source of Funding: Washington University Institute of Clinical and Translational Sciences grant UL1 TR000448 from the National Center for Advancing Translational Sciences Grant Number R24 HS19455 through the Agency for Healthcare Research and Quality (AHRQ).
Stone Disease: SWL, Ureteroscopy or Percutaneous Stone Removal (II) Moderated Poster Session 62 Tuesday, May 7, 2013
10:30 AM-12:30 AM
1674 TREATMENT OF CALICEAL DIVERTICULAR CALCULI BY PERCUTANEOUS NEPHROLITHOTOMY Viorel Jinga, Daniel Badescu, Salaheddin Youssef, George Daniel Radavoi*, Bucharest, Romania INTRODUCTION AND OBJECTIVES: Caliceal diverticula are rare renal anomalies, associated with calculi when urinary stasis inside the diverticulum leads to stone formation. We report a retrospective review of outcomes and complications from our series of patients who were treated with a percutaneous nephrolitotomy approach for symptomatic diverticular lithiasis. METHODS: A retrospective study was performed on 36 patients during a 4 years period, 2007-2011. Our preferred method in these patients is direct puncture into the diverticulum under fluoroscopic guidance, tract dilatation with a nephrostomy dilator set, use of a rigid nephroscope, advancement of a guidewire through the infundibular neck and diverticular neck incision/dilatation, improving drainage. Ablation/fulguration of diverticulum was performed only in patients with long communicating diverticular neck. RESULTS: The mean age was 47 years (range 19-70 years). Diverticula were located throughout the kidney including the upper [15], middle [13] and lower [8] calices. All patients presented a single or multiple diverticular calculi. Size of diverticula ranged from 7 to 35 mm. The average duration of surgery was 72 minutes (45-129 min) with an average hospital stay of 4.2 days. Trans-diverticular drainage was maintained from 3 to 4 days. Twenty-eight patients underwent infundibulum incision/dilatation (77.7%) and eight (22.2%) experienced ablation/fulguration of diverticular neck. There were a total of 8 complications, of which 3 necessitated additional intervention. Complication that occurred during the procedure include: renal pelvis perforation, haemothorax, haemorrhage, urine/irrigation liquid extravasation. An 94,4% stone free rate was achieved at 1 year. Patients returned to normal activity in 12 days (⫾1.74). CONCLUSIONS: The percutaneous management of caliceal diverticular calculi is highly effective and offers long-term symptomatic relief with minimal complications. PCNL is the first option treatment in selected cases with this pathology, when small, posterior calyceal diverticula are present. Source of Funding: None
THE JOURNAL OF UROLOGY姞
e689
1675 PERCUTANEOUS TREATMENT OF CALYCEAL DIVERTICULUM: ACCESS, STONE EXTRACTION, AND FULGURATION Sammy Elsamra*, Hector Motato, Justin Friedlander, Zeph Okeke, New Hyde Park, NY INTRODUCTION AND OBJECTIVES: Few reports have been published on the treatment of calyceal diverticulum (CD) and their associated stones. Herein, we report our experience with percutaneous treatment of calyceal diverticulum. METHODS: Retrospective review of all patients who underwent percutaneous treatment of CD from July 2006 to Sept 2012 was performed. Pre, intra, and postoperative parameters were tabulated. Descriptive statistics were used. RESULTS: 27 CDs in 26 patients were treated percutaneously. Mean Age was 35.6 years. CDs were right-sided in 16 (59%), associated with pre-operative pain in 17(65%), hematuria in 7(27%), recurrent UTI in 3 (12%). They were located in upper pole, interpolar, and lower pole in 11 (41%), 5 (19%), and 6 (22%), respectively and were an average of 29 mm in diameter (average stone burden was 13 mm). 13 (50%) patients underwent 19 prior procedures unsuccessfully, including 5 prior unsuccessful percutaneous stone extractions. 18 (67%) CDs were associated with stones. 12 were able to have analysis. Most common stone component was calcium phosphate in 10 (83%) followed by oxalate in 6 (50%). 17 (63%) CDs had detectable communication between the diverticulum and the collecting system, 15 of which underwent dilation of that infundibulum. Fulguration of CD was performed in 23 (85%), whereas one patient had the lining of the CD stripped. All but one patient underwent successful treatment percutaneously (our technical failure rate was 4%). All but 2 patients (88%) demonstrated resolution of their pain. Postoperative imaging revealed resolution in all but 2 CDs (93%). Two patients required transfusion of pRBC and selective angioembolization for post-operative hemorrhage, one patient required thoracostomy tube placed intraoperatively for hydrothorax. CONCLUSIONS: Treatment of CD is feasible and can result in improvement of flank pain, hematuria, or UTIs. The most common stone within a CD is calcium phosphate. Given the difficult anatomy, treatment of CDs should be performed only by those with significant experience as it is associated with high complication rates. Source of Funding: None
1676 RADIATION EXPOSURE OF THE PATIENT SUBMITTED TO ENDOUROLOGIC TREATMENT FOR URETERAL CALCULI Filippo Nigro*, Paolo Ferrarese, Giuseppe Benedetto, Enrico Scremin, Emiliano Bratti, Sergio Savastano, Andrea Tasca, Vicenza, Italy INTRODUCTION AND OBJECTIVES: Patients treated for ureteral calculi are at risk to receive high levels of ionizing radiation during their clinical state. We measured the total amount of radiation exposure for a group of patients affected by ureteral stones, from the onset of their symptoms to the conclusion of their clinical fate. METHODS: Monocentric retrospective study including 64 patients submitted in 2010 to ureterorenoscopy (URS) for ureteral calculi, localised at pielo-ureteral junction (13 cases, 20% - group 1), lumbar tract (22 cases, 35% - group 2), pelvic tract (16 cases, 25% - group 3), ureterovesical junction (13 cases, 20% - group 4). All 64 patients underwent abdominal X-ray (KUB) and ultrasonography (US); 49 patients (77%) required an additional CT scan to improve the diagnosis. The total amount of radiation exposure from the onset of symptoms, during endourologic treatment, to 3 months of follow up was measured, using Gray (Gy), the unit of the absorbed dose, and Sievert (Sv), expressing the equivalent dose, i.e. the stochastic biological effects of ionizing radiation. The measured data were related to location and volume of the stones.
2.47) or Hispanic race (OR 1.70, CI 1.25, 2.24), age (p⫽0.046), and diabetes (OR 1.67, CI 1.07, 2.59) were associated with receiving a semi-rigid implant. CONCLUSIONS: Rates of re-operation for infectious or mechanical failure are the same between the semi-rigid and inflatable penile prostheses. The revision rate for penile prosthesis procedures in community practice is substantially higher than the currently quoted rates in the published literature. Socio-demographic factors appear to significantly influence the type of prosthesis a patient receives. Source of Funding: Washington University Institute of Clinical and Translational Sciences grant UL1 TR000448 from the National Center for Advancing Translational Sciences Grant Number R24 HS19455 through the Agency for Healthcare Research and Quality (AHRQ).
Stone Disease: SWL, Ureteroscopy or Percutaneous Stone Removal (II) Moderated Poster Session 62 Tuesday, May 7, 2013
10:30 AM-12:30 AM
1674 TREATMENT OF CALICEAL DIVERTICULAR CALCULI BY PERCUTANEOUS NEPHROLITHOTOMY Viorel Jinga, Daniel Badescu, Salaheddin Youssef, George Daniel Radavoi*, Bucharest, Romania INTRODUCTION AND OBJECTIVES: Caliceal diverticula are rare renal anomalies, associated with calculi when urinary stasis inside the diverticulum leads to stone formation. We report a retrospective review of outcomes and complications from our series of patients who were treated with a percutaneous nephrolitotomy approach for symptomatic diverticular lithiasis. METHODS: A retrospective study was performed on 36 patients during a 4 years period, 2007-2011. Our preferred method in these patients is direct puncture into the diverticulum under fluoroscopic guidance, tract dilatation with a nephrostomy dilator set, use of a rigid nephroscope, advancement of a guidewire through the infundibular neck and diverticular neck incision/dilatation, improving drainage. Ablation/fulguration of diverticulum was performed only in patients with long communicating diverticular neck. RESULTS: The mean age was 47 years (range 19-70 years). Diverticula were located throughout the kidney including the upper [15], middle [13] and lower [8] calices. All patients presented a single or multiple diverticular calculi. Size of diverticula ranged from 7 to 35 mm. The average duration of surgery was 72 minutes (45-129 min) with an average hospital stay of 4.2 days. Trans-diverticular drainage was maintained from 3 to 4 days. Twenty-eight patients underwent infundibulum incision/dilatation (77.7%) and eight (22.2%) experienced ablation/fulguration of diverticular neck. There were a total of 8 complications, of which 3 necessitated additional intervention. Complication that occurred during the procedure include: renal pelvis perforation, haemothorax, haemorrhage, urine/irrigation liquid extravasation. An 94,4% stone free rate was achieved at 1 year. Patients returned to normal activity in 12 days (⫾1.74). CONCLUSIONS: The percutaneous management of caliceal diverticular calculi is highly effective and offers long-term symptomatic relief with minimal complications. PCNL is the first option treatment in selected cases with this pathology, when small, posterior calyceal diverticula are present. Source of Funding: None
THE JOURNAL OF UROLOGY姞
e689
1675 PERCUTANEOUS TREATMENT OF CALYCEAL DIVERTICULUM: ACCESS, STONE EXTRACTION, AND FULGURATION Sammy Elsamra*, Hector Motato, Justin Friedlander, Zeph Okeke, New Hyde Park, NY INTRODUCTION AND OBJECTIVES: Few reports have been published on the treatment of calyceal diverticulum (CD) and their associated stones. Herein, we report our experience with percutaneous treatment of calyceal diverticulum. METHODS: Retrospective review of all patients who underwent percutaneous treatment of CD from July 2006 to Sept 2012 was performed. Pre, intra, and postoperative parameters were tabulated. Descriptive statistics were used. RESULTS: 27 CDs in 26 patients were treated percutaneously. Mean Age was 35.6 years. CDs were right-sided in 16 (59%), associated with pre-operative pain in 17(65%), hematuria in 7(27%), recurrent UTI in 3 (12%). They were located in upper pole, interpolar, and lower pole in 11 (41%), 5 (19%), and 6 (22%), respectively and were an average of 29 mm in diameter (average stone burden was 13 mm). 13 (50%) patients underwent 19 prior procedures unsuccessfully, including 5 prior unsuccessful percutaneous stone extractions. 18 (67%) CDs were associated with stones. 12 were able to have analysis. Most common stone component was calcium phosphate in 10 (83%) followed by oxalate in 6 (50%). 17 (63%) CDs had detectable communication between the diverticulum and the collecting system, 15 of which underwent dilation of that infundibulum. Fulguration of CD was performed in 23 (85%), whereas one patient had the lining of the CD stripped. All but one patient underwent successful treatment percutaneously (our technical failure rate was 4%). All but 2 patients (88%) demonstrated resolution of their pain. Postoperative imaging revealed resolution in all but 2 CDs (93%). Two patients required transfusion of pRBC and selective angioembolization for post-operative hemorrhage, one patient required thoracostomy tube placed intraoperatively for hydrothorax. CONCLUSIONS: Treatment of CD is feasible and can result in improvement of flank pain, hematuria, or UTIs. The most common stone within a CD is calcium phosphate. Given the difficult anatomy, treatment of CDs should be performed only by those with significant experience as it is associated with high complication rates. Source of Funding: None
1676 RADIATION EXPOSURE OF THE PATIENT SUBMITTED TO ENDOUROLOGIC TREATMENT FOR URETERAL CALCULI Filippo Nigro*, Paolo Ferrarese, Giuseppe Benedetto, Enrico Scremin, Emiliano Bratti, Sergio Savastano, Andrea Tasca, Vicenza, Italy INTRODUCTION AND OBJECTIVES: Patients treated for ureteral calculi are at risk to receive high levels of ionizing radiation during their clinical state. We measured the total amount of radiation exposure for a group of patients affected by ureteral stones, from the onset of their symptoms to the conclusion of their clinical fate. METHODS: Monocentric retrospective study including 64 patients submitted in 2010 to ureterorenoscopy (URS) for ureteral calculi, localised at pielo-ureteral junction (13 cases, 20% - group 1), lumbar tract (22 cases, 35% - group 2), pelvic tract (16 cases, 25% - group 3), ureterovesical junction (13 cases, 20% - group 4). All 64 patients underwent abdominal X-ray (KUB) and ultrasonography (US); 49 patients (77%) required an additional CT scan to improve the diagnosis. The total amount of radiation exposure from the onset of symptoms, during endourologic treatment, to 3 months of follow up was measured, using Gray (Gy), the unit of the absorbed dose, and Sievert (Sv), expressing the equivalent dose, i.e. the stochastic biological effects of ionizing radiation. The measured data were related to location and volume of the stones.