- Email: [email protected]
1829 LASER LITHOTRIPSY VERSUS ESWL FOR LOWER CALYCEAL RENAL STONES
Vol. 189, No. 4S, Supplement, Tuesday, May 7, 2013
METHODS: From June 2011 to May 2012, 20 symptomatic adults (20-50 years) who had isolated IC stone between 10-20 mm were underwent RIRS. Outcomes of these patients were compared with 20 control patients from same age group who underwent ESWL for same size IC calculi during the study period. Patients with distal obstruction, calyceal diverticulum, pregnancy, active urinary tract infection, radiolucent stones, and serum creatinine ⬎ 3 mg /dl were excluded. ESWL were done by Dornier compact alpha lithotripter (Dornier MedTech System GmbH, 2500-4500 shocks per session) under intra venous sedation. RIRS were done by 7.5 Fr flexible ureterorenoscope with holmium:YAG laser (Lumenis/Versa Pulse Power Suite) lithotripsy under combined spinal and epidural anesthesia. The parameter compared were stone free rate (SFR) on X-Ray KUB at 3 weeks, mean operative time, hospital stay, complications and patient reported outcomes ie.voiding symptoms, time to return normal activity and satisfaction rate using self made non validated questionnaire. RESULTS: Baseline parameters (age, sex, body mass index, side treated) were comparable in groups. Mean stone size was 14.05 ⫾ 2.56 cm in RIRS and 14.45 ⫾ 3.28 cm in ESWL. SFRs after the first, second, and third sessions of ESWL were 30, 45, and 50 %, respectively and 85 % after one session of RIRS (p⫽0.04).The mean procedure time (80.7⫾19.03 versus 40.25 ⫾ 7.34 min.P⫽ ⬍0.0001) and hospital stay (36 ⫾ 10.3 versus 6.2 ⫾ 4.3 hrs, P⫽ ⬍0.0001) were significantly higher in RIRS than ESWL for single session. The overall complications were comparable (RIRS 35%, ESWL 30%). The satisfaction score (2.9⫾1.33 versus 1.9⫾1.16, P⫽0.0159) was significantly higher in RIRS than ESWL. Average time to return to normal activity (8.4⫾2.4 versus 2.4⫾1.3 days P⫽ ⬍.0001) was significantly higher in RIRS than ESWL after single session. Voiding symptoms score (RIRS 2.6⫾0.88, ESWL 2.45⫾0.82, P⫽ 0.582) was comparable in both groups. CONCLUSIONS: For moderate size (1-2cm) lower calyceal calculi, RIRS is superior to ESWL in term of SFR and patient satisfaction. Source of Funding: None
1829 LASER LITHOTRIPSY VERSUS ESWL FOR LOWER CALYCEAL RENAL STONES Ahmed Salem, Ismail Saad*, Ashraf Emran, Mahmoud Abdelhakiem, Omar Abdelrazzak, Mongy Abdelkader, Cairo, Egypt INTRODUCTION AND OBJECTIVES: Urolithiasis, especially lower calyceal (LC) stones, is a common medical problem. Its prevalence is around 2% to 3 % in general population. With advances of endourologic and laser technology, flexible ureterorenoscopy (FURS) and laser lithotripsy (LL) are considered the second line therapy in ESWL-resistent LC stones. This study aimed to assess safety, efficacy and outcome of FURS and holmium:YAG LL comparing its results to ESWL in LC stones. METHODS: A prospective randomized study was done from May 2010 to May 2012. It included patients with radiopaque unilateral, single or multiple, LC ⱕ 20mm. Patients were divided into 2 groups. In Group I, patients underwent FURS and LL using 365 m laser fiber. In Group II, patients underwent ESWL. Patients were followed for 3 months by KUB to assess stone-free status defined as no fragments or fragment ⱕ 3mm. In each group, multiple parameters (age, sex, stone size and number, and LC anatomy) were examined to assess impact on stone-free status. Additionally stone-free status and complications were compared in both groups. RESULTS: 60 patients were included in the study. In Group I (N⫽30), mean age was 44.2 years and mean stone size was 11.5mm. 26 patients (86.7%) had single stone and 4 patients (13.3%) had multiple stones. Stone free status was achieved in 29 patients (96.7%). Complication rate was 16.7%. Age, sex, stone size and number, and LC anatomy did not correlate with stone-free status in Group I. In Group II (N⫽30), mean age was 35.5 years and mean stone size was 11.3mm. 28 patients (93.3%) had single stone and 2 patients (6.7%) had multiple stones. Stone-free status was achieved in 17 patients (56.7%). Complication rate was 23.3%. Stone size (⬍10mm) only
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correlated with stone-free status in Group II. FURS and LL achieved significantly better stone-free rates compared to ESWL (96.7% vs 56.7%, p⫽ 0.001), with no difference in complication rate between both groups (16.7% vs 23.3%, p⫽ 0.5). CONCLUSIONS: Both FURS with LL and ESWL are considered safe in treating LC stones less than 20mm with minimal complication rates. However, FURS with LL achieved significantly better stone-free rates. Stone size could predict stone-free status in ESWL. Source of Funding: None
Kidney Cancer: Advanced (I) Podium Session 31 Tuesday, May 7, 2013
1:00 PM-3:00 PM
1830 IMPACT OF HISTOLOGIC SUBTYPE ON TUMOR THROMBUS LEVEL AND CANCER-SPECIFIC SURVIVAL IN PATIENTS WITH RENAL CELL CARCINOMA AND VENA CAVA THROMBUS Derya Tilki*, Marc A. Dall’Era, Hao G. Nguyen, Sacramento, CA; Roberto Bertini, Milano, Italy; Joaquín A. Carballido, Madrid, Spain; Thomas Chromecki, Graz, Austria; Gaetano Ciancio, Miami, FL; Sia Daneshmand, Los Angeles, CA; Paolo Gontero, Torino, Italy; Javier Gonzalez, Madrid, Spain; Axel Haferkamp, Frankfurt, Germany; Markus Hohenfellner, Heidelberg, Germany; William C. Huang, New York, NY; Theresa M. Koppie, Portland, OR; Adam Lorentz, Atlanta, GA; Juan I. Martinez-Salamanca, Madrid, Spain; Viraj A Master, Atlanta, GA; Rayan Matloob, Milano, Italy; James M. McKiernan, Carrie M. Mlynarczyk, New York, NY; Francesco Montorsi, Milano, Italy; Giacomo Novara, Padua, Italy; Sascha Pahernik, Heidelberg, Germany; Juan Palou, Barcelona, Spain; Raj S. Pruthi, Chapel Hill, NC; Krishna Ramaswamy, New York, NY; Oscar Rodriguez Faba, Barcelona, Spain; Paul Russo, Shahrokh F. Shariat, New York, NY; Martin Spahn, Wu¨rzburg, Germany; Carlo Terrone, Novara, Italy; Daniel Vergho, Wu¨rzburg, Germany; Eric M. Wallen, Chapel Hill, NC; Evanguelos Xylinas, New York, NY; Richard Zigeuner, Graz, Austria; John A. Libertino, Burlington, MA; Christopher P. Evans, Sacramento, CA INTRODUCTION AND OBJECTIVES: While different prognostic factors for patients with renal cell cancer (RCC) and vena cava tumor thrombus have been studied, the prognostic value of histological subtype in these patients remains unclear. We analyzed the impact of histologic subtype on tumor thrombus (TT) level and cancer specific survival (CSS). METHODS: We retrospectively analyzed the records of 1213 patients with RCC and vena cava thrombus who underwent radical nephrectomy and tumor thrombectomy from 1971 to 2012 at 22 US and European centers. Multivariable ordered logistic and Cox regression models were used to quantify the impact of tumor histology on TT level and CSS. RESULTS: Overall 5-year-CSS was 48.5% (CI 44.7%-52.1%) and TT level (according to the Mayo classification of macroscopic venous invasion in RCC) was I in 355 (29.3%) patients, II in 403 (33.2%), III in 249 (20.5%) and IV in 206 (17.0%). Histologic subtypes were clear cell carcinoma (cRCC) in 87% of the patients, papillary (pRCC) in 10.9% and chromophobe in 1.4%. In univariate analysis, cRCC was associated with a significantly better CSS (p⬍0.0001) and lower TT level (p⬍0.0001), while patients with pRCC had worse CSS (p⬍0.0001) and higher TT level (p⬍0.01). In multivariable analyses, presence of pRCC was independently associated with cancer-specific death (HR 2.4, CI 1.6 ? 3.5, p⬍0.001) and higher TT level (OR 1.7, CI 1.1 - 2.7, p⬍0.05) compared to cRCC (HR 0.7, CI 0.5 ? 0.9, p⬍0.05 and OR 0.6, CI 0.4 - 0.9, p⬍0.01, respectively). Fuhrman grade (HR 1.8, CI 1.4 ? 2.2, p⬍.001) and TT level (HR 1.2, CI 1.1 ? 1.4, p⬍.001) were also independently associated with CSS.
METHODS: From June 2011 to May 2012, 20 symptomatic adults (20-50 years) who had isolated IC stone between 10-20 mm were underwent RIRS. Outcomes of these patients were compared with 20 control patients from same age group who underwent ESWL for same size IC calculi during the study period. Patients with distal obstruction, calyceal diverticulum, pregnancy, active urinary tract infection, radiolucent stones, and serum creatinine ⬎ 3 mg /dl were excluded. ESWL were done by Dornier compact alpha lithotripter (Dornier MedTech System GmbH, 2500-4500 shocks per session) under intra venous sedation. RIRS were done by 7.5 Fr flexible ureterorenoscope with holmium:YAG laser (Lumenis/Versa Pulse Power Suite) lithotripsy under combined spinal and epidural anesthesia. The parameter compared were stone free rate (SFR) on X-Ray KUB at 3 weeks, mean operative time, hospital stay, complications and patient reported outcomes ie.voiding symptoms, time to return normal activity and satisfaction rate using self made non validated questionnaire. RESULTS: Baseline parameters (age, sex, body mass index, side treated) were comparable in groups. Mean stone size was 14.05 ⫾ 2.56 cm in RIRS and 14.45 ⫾ 3.28 cm in ESWL. SFRs after the first, second, and third sessions of ESWL were 30, 45, and 50 %, respectively and 85 % after one session of RIRS (p⫽0.04).The mean procedure time (80.7⫾19.03 versus 40.25 ⫾ 7.34 min.P⫽ ⬍0.0001) and hospital stay (36 ⫾ 10.3 versus 6.2 ⫾ 4.3 hrs, P⫽ ⬍0.0001) were significantly higher in RIRS than ESWL for single session. The overall complications were comparable (RIRS 35%, ESWL 30%). The satisfaction score (2.9⫾1.33 versus 1.9⫾1.16, P⫽0.0159) was significantly higher in RIRS than ESWL. Average time to return to normal activity (8.4⫾2.4 versus 2.4⫾1.3 days P⫽ ⬍.0001) was significantly higher in RIRS than ESWL after single session. Voiding symptoms score (RIRS 2.6⫾0.88, ESWL 2.45⫾0.82, P⫽ 0.582) was comparable in both groups. CONCLUSIONS: For moderate size (1-2cm) lower calyceal calculi, RIRS is superior to ESWL in term of SFR and patient satisfaction. Source of Funding: None
1829 LASER LITHOTRIPSY VERSUS ESWL FOR LOWER CALYCEAL RENAL STONES Ahmed Salem, Ismail Saad*, Ashraf Emran, Mahmoud Abdelhakiem, Omar Abdelrazzak, Mongy Abdelkader, Cairo, Egypt INTRODUCTION AND OBJECTIVES: Urolithiasis, especially lower calyceal (LC) stones, is a common medical problem. Its prevalence is around 2% to 3 % in general population. With advances of endourologic and laser technology, flexible ureterorenoscopy (FURS) and laser lithotripsy (LL) are considered the second line therapy in ESWL-resistent LC stones. This study aimed to assess safety, efficacy and outcome of FURS and holmium:YAG LL comparing its results to ESWL in LC stones. METHODS: A prospective randomized study was done from May 2010 to May 2012. It included patients with radiopaque unilateral, single or multiple, LC ⱕ 20mm. Patients were divided into 2 groups. In Group I, patients underwent FURS and LL using 365 m laser fiber. In Group II, patients underwent ESWL. Patients were followed for 3 months by KUB to assess stone-free status defined as no fragments or fragment ⱕ 3mm. In each group, multiple parameters (age, sex, stone size and number, and LC anatomy) were examined to assess impact on stone-free status. Additionally stone-free status and complications were compared in both groups. RESULTS: 60 patients were included in the study. In Group I (N⫽30), mean age was 44.2 years and mean stone size was 11.5mm. 26 patients (86.7%) had single stone and 4 patients (13.3%) had multiple stones. Stone free status was achieved in 29 patients (96.7%). Complication rate was 16.7%. Age, sex, stone size and number, and LC anatomy did not correlate with stone-free status in Group I. In Group II (N⫽30), mean age was 35.5 years and mean stone size was 11.3mm. 28 patients (93.3%) had single stone and 2 patients (6.7%) had multiple stones. Stone-free status was achieved in 17 patients (56.7%). Complication rate was 23.3%. Stone size (⬍10mm) only
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correlated with stone-free status in Group II. FURS and LL achieved significantly better stone-free rates compared to ESWL (96.7% vs 56.7%, p⫽ 0.001), with no difference in complication rate between both groups (16.7% vs 23.3%, p⫽ 0.5). CONCLUSIONS: Both FURS with LL and ESWL are considered safe in treating LC stones less than 20mm with minimal complication rates. However, FURS with LL achieved significantly better stone-free rates. Stone size could predict stone-free status in ESWL. Source of Funding: None
Kidney Cancer: Advanced (I) Podium Session 31 Tuesday, May 7, 2013
1:00 PM-3:00 PM
1830 IMPACT OF HISTOLOGIC SUBTYPE ON TUMOR THROMBUS LEVEL AND CANCER-SPECIFIC SURVIVAL IN PATIENTS WITH RENAL CELL CARCINOMA AND VENA CAVA THROMBUS Derya Tilki*, Marc A. Dall’Era, Hao G. Nguyen, Sacramento, CA; Roberto Bertini, Milano, Italy; Joaquín A. Carballido, Madrid, Spain; Thomas Chromecki, Graz, Austria; Gaetano Ciancio, Miami, FL; Sia Daneshmand, Los Angeles, CA; Paolo Gontero, Torino, Italy; Javier Gonzalez, Madrid, Spain; Axel Haferkamp, Frankfurt, Germany; Markus Hohenfellner, Heidelberg, Germany; William C. Huang, New York, NY; Theresa M. Koppie, Portland, OR; Adam Lorentz, Atlanta, GA; Juan I. Martinez-Salamanca, Madrid, Spain; Viraj A Master, Atlanta, GA; Rayan Matloob, Milano, Italy; James M. McKiernan, Carrie M. Mlynarczyk, New York, NY; Francesco Montorsi, Milano, Italy; Giacomo Novara, Padua, Italy; Sascha Pahernik, Heidelberg, Germany; Juan Palou, Barcelona, Spain; Raj S. Pruthi, Chapel Hill, NC; Krishna Ramaswamy, New York, NY; Oscar Rodriguez Faba, Barcelona, Spain; Paul Russo, Shahrokh F. Shariat, New York, NY; Martin Spahn, Wu¨rzburg, Germany; Carlo Terrone, Novara, Italy; Daniel Vergho, Wu¨rzburg, Germany; Eric M. Wallen, Chapel Hill, NC; Evanguelos Xylinas, New York, NY; Richard Zigeuner, Graz, Austria; John A. Libertino, Burlington, MA; Christopher P. Evans, Sacramento, CA INTRODUCTION AND OBJECTIVES: While different prognostic factors for patients with renal cell cancer (RCC) and vena cava tumor thrombus have been studied, the prognostic value of histological subtype in these patients remains unclear. We analyzed the impact of histologic subtype on tumor thrombus (TT) level and cancer specific survival (CSS). METHODS: We retrospectively analyzed the records of 1213 patients with RCC and vena cava thrombus who underwent radical nephrectomy and tumor thrombectomy from 1971 to 2012 at 22 US and European centers. Multivariable ordered logistic and Cox regression models were used to quantify the impact of tumor histology on TT level and CSS. RESULTS: Overall 5-year-CSS was 48.5% (CI 44.7%-52.1%) and TT level (according to the Mayo classification of macroscopic venous invasion in RCC) was I in 355 (29.3%) patients, II in 403 (33.2%), III in 249 (20.5%) and IV in 206 (17.0%). Histologic subtypes were clear cell carcinoma (cRCC) in 87% of the patients, papillary (pRCC) in 10.9% and chromophobe in 1.4%. In univariate analysis, cRCC was associated with a significantly better CSS (p⬍0.0001) and lower TT level (p⬍0.0001), while patients with pRCC had worse CSS (p⬍0.0001) and higher TT level (p⬍0.01). In multivariable analyses, presence of pRCC was independently associated with cancer-specific death (HR 2.4, CI 1.6 ? 3.5, p⬍0.001) and higher TT level (OR 1.7, CI 1.1 - 2.7, p⬍0.05) compared to cRCC (HR 0.7, CI 0.5 ? 0.9, p⬍0.05 and OR 0.6, CI 0.4 - 0.9, p⬍0.01, respectively). Fuhrman grade (HR 1.8, CI 1.4 ? 2.2, p⬍.001) and TT level (HR 1.2, CI 1.1 ? 1.4, p⬍.001) were also independently associated with CSS.