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1898 THE IMPACT OF URETERAL ACCESS SHEATHS ON STONE FREE RATES AFTER FLEXIBLE URETEROSCOPY
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THE JOURNAL OF UROLOGY姞
Source of Funding: None
1898 THE IMPACT OF URETERAL ACCESS SHEATHS ON STONE FREE RATES AFTER FLEXIBLE URETEROSCOPY Carlos Mendez Probst*, Linda Nott, London, Canada; Darren Beiko, Kingston, Canada; Ben Chew, Vancouver, Canada; Tim Wollin, Edmonton, Canada; Hassan Razvi, London, Canada INTRODUCTION AND OBJECTIVES: Ureteral access sheaths (UAS) were developed to facilitate initial ureteroscope entry or re-entry to the upper urinary tract. Their impact on stone free rates (SFR), have only been sporadically investigated by retrospective studies. We present the preliminary results of a multicentre prospective controlled randomized trial to determine the impact of the use of UAS on SFR at 3 months. METHODS: Patients with either proximal or renal calculi were randomized 1:1 to either the use of a ureteral access sheath (UAS) or no sheath at 4 Canadian centres. Flexible ureteroscopy with Ho:YAG laser lithotripsy was performed according to each of the institutions standard protocols using a Navigator 11/13 Fr UAS (Boston Scientific). Primary outcome was SFR at 3 months post URS. Secondary outcomes such as operative time, complications and stent insertion were recorded. RESULTS: Twenty-five patients were randomized to UAS and 24 to no UAS. No significant difference was found in patient age (55 UAS vs 52 non UAS p⫽0.40), gender (16 vs 17 males) BMI (32 vs 29 p⫽0.11), stone size 10 vs 9 mm p⫽0.9), operative time (59 min vs 51 p⫽0.7)), or SFR (16 vs 14 p⫽0.10) or need for post operative stent insertion (23 vs 17 p⫽0.12). No major complications occurred in either group. CONCLUSIONS: Our preliminary data show that use of a UAS does not increase the SFR at 3 months, nor reduce surgical time or need for stent placement.
Vol. 183, No. 4, Supplement, Wednesday, June 2, 2010
tion was calcium oxalate (68%), calcium phosphate (21%), uric acid (9%), or cystine (1%). Computed tomography (CT) was performed approximately 1 month after surgery in 181 (76%) renal units and categorized as stone free (49%), ⬍2mm (22%), 2-4mm (19%), ⬎4mm (10%). Mean follow-up was 3.8⫾1.3 years. Future ipsilateral procedures were performed in 28 (12%) patients at an average of 1.2⫾1.2 years. Retreatment was greater in renal units with multiple calculi (17% vs 7%, p⫽0.02) and nephrocalcinosis (25% vs 10%, p⫽0.02). There was no difference in retreatment by stone volume, location or composition. Cumulative retreatment rate (CRR) at 5 years was associated with size of residual fragments with stone free (5.7%), ⬍2mm (5.3%), 2-4mm (20.5%), and ⬎4mm (44.4%) (p⬍0.001, figure 1). Cox regression demonstrated that patients with ⬎ 2mm residual fragments were 4.6 times more likely to be retreated than stone-free patients after adjustment for stone number and nephrocalcinosis. There was no increased risk of retreatment for patients with ⱕ2mm residual fragments compared to stone-free. After adjustment for residual fragments, neither multiple stones nor nephrocalcinosis increased risk of retreatment. CONCLUSIONS: Patients with residual fragments ⬍ 2mm on postoperative CT following URS can expect long-term freedom from retreatment. Residual fragments ⬎ 2mm were associated with higher retreatment rates.
Source of Funding: None
Source of Funding: None
1899
Benign Prostatic Hyperplasia: Surgical Therapy and New Technology I
LONG-TERM RETREATMENT AFTER URETEROSCOPIC LASER LITHOTRIPSY DEPENDS ON EFFECTIVENESS OF INITIAL FRAGMENT CLEARANCE Penny Tatman, Andrew Heinisch, Mark Laliberte, Caroline Dietz-Carlson, Andrew Portis*, St. Paul, MN INTRODUCTION AND OBJECTIVES: Ureteroscopic laser lithotripsy (URS) is an effective method for clearing moderate volume stone burden. In long-term follow-up, we examine retreatment rates and explore prognostic factors. METHODS: All patients treated by flexible URS with laser lithotripsy for upper tract calculi by a single surgeon with a standardized technique attempting complete fragment clearance between 04/2003 and 05/2005 were identified. Combining chart review and computer record review, details of procedures and outcomes were collected. RESULTS: A total of 239 renal units in 227 subjects were evaluated. Multiple calculi were treated in 43% of renal units. Excluding renal units with nephrocalcinosis, the average number of stones was 1.7⫾1.2. Stones were located in the proximal ureter (42%), lower pole (38%), and renal non-lower pole (54%). Predominant stone composi-
Moderated Poster 56 Wednesday, June 2, 2010
10:30 AM-12:30 PM
1900 A PROSPECTIVE CONTROLLED STUDY COMPARING BIPOLAR VERSUS MONOPOLAR TRANSURETHRAL RESECTION OF THE PROSTATE Michael Neyer*, Bregenz, Austria; Daniel Engeler, Christoph Schwab, St. Gallen, Switzerland; Josef Pointner, Bregenz, Austria; Timo Gru¨n, Hans-Peter Schmid, St. Gallen, Switzerland; Andreas Reissigl, Bregenz, Austria INTRODUCTION AND OBJECTIVES: We compared bipolar and monopolar transurethral resection of the prostate (TUR-P) in a prospective controlled study at two urology centers. A minimum of 100
THE JOURNAL OF UROLOGY姞
Source of Funding: None
1898 THE IMPACT OF URETERAL ACCESS SHEATHS ON STONE FREE RATES AFTER FLEXIBLE URETEROSCOPY Carlos Mendez Probst*, Linda Nott, London, Canada; Darren Beiko, Kingston, Canada; Ben Chew, Vancouver, Canada; Tim Wollin, Edmonton, Canada; Hassan Razvi, London, Canada INTRODUCTION AND OBJECTIVES: Ureteral access sheaths (UAS) were developed to facilitate initial ureteroscope entry or re-entry to the upper urinary tract. Their impact on stone free rates (SFR), have only been sporadically investigated by retrospective studies. We present the preliminary results of a multicentre prospective controlled randomized trial to determine the impact of the use of UAS on SFR at 3 months. METHODS: Patients with either proximal or renal calculi were randomized 1:1 to either the use of a ureteral access sheath (UAS) or no sheath at 4 Canadian centres. Flexible ureteroscopy with Ho:YAG laser lithotripsy was performed according to each of the institutions standard protocols using a Navigator 11/13 Fr UAS (Boston Scientific). Primary outcome was SFR at 3 months post URS. Secondary outcomes such as operative time, complications and stent insertion were recorded. RESULTS: Twenty-five patients were randomized to UAS and 24 to no UAS. No significant difference was found in patient age (55 UAS vs 52 non UAS p⫽0.40), gender (16 vs 17 males) BMI (32 vs 29 p⫽0.11), stone size 10 vs 9 mm p⫽0.9), operative time (59 min vs 51 p⫽0.7)), or SFR (16 vs 14 p⫽0.10) or need for post operative stent insertion (23 vs 17 p⫽0.12). No major complications occurred in either group. CONCLUSIONS: Our preliminary data show that use of a UAS does not increase the SFR at 3 months, nor reduce surgical time or need for stent placement.
Vol. 183, No. 4, Supplement, Wednesday, June 2, 2010
tion was calcium oxalate (68%), calcium phosphate (21%), uric acid (9%), or cystine (1%). Computed tomography (CT) was performed approximately 1 month after surgery in 181 (76%) renal units and categorized as stone free (49%), ⬍2mm (22%), 2-4mm (19%), ⬎4mm (10%). Mean follow-up was 3.8⫾1.3 years. Future ipsilateral procedures were performed in 28 (12%) patients at an average of 1.2⫾1.2 years. Retreatment was greater in renal units with multiple calculi (17% vs 7%, p⫽0.02) and nephrocalcinosis (25% vs 10%, p⫽0.02). There was no difference in retreatment by stone volume, location or composition. Cumulative retreatment rate (CRR) at 5 years was associated with size of residual fragments with stone free (5.7%), ⬍2mm (5.3%), 2-4mm (20.5%), and ⬎4mm (44.4%) (p⬍0.001, figure 1). Cox regression demonstrated that patients with ⬎ 2mm residual fragments were 4.6 times more likely to be retreated than stone-free patients after adjustment for stone number and nephrocalcinosis. There was no increased risk of retreatment for patients with ⱕ2mm residual fragments compared to stone-free. After adjustment for residual fragments, neither multiple stones nor nephrocalcinosis increased risk of retreatment. CONCLUSIONS: Patients with residual fragments ⬍ 2mm on postoperative CT following URS can expect long-term freedom from retreatment. Residual fragments ⬎ 2mm were associated with higher retreatment rates.
Source of Funding: None
Source of Funding: None
1899
Benign Prostatic Hyperplasia: Surgical Therapy and New Technology I
LONG-TERM RETREATMENT AFTER URETEROSCOPIC LASER LITHOTRIPSY DEPENDS ON EFFECTIVENESS OF INITIAL FRAGMENT CLEARANCE Penny Tatman, Andrew Heinisch, Mark Laliberte, Caroline Dietz-Carlson, Andrew Portis*, St. Paul, MN INTRODUCTION AND OBJECTIVES: Ureteroscopic laser lithotripsy (URS) is an effective method for clearing moderate volume stone burden. In long-term follow-up, we examine retreatment rates and explore prognostic factors. METHODS: All patients treated by flexible URS with laser lithotripsy for upper tract calculi by a single surgeon with a standardized technique attempting complete fragment clearance between 04/2003 and 05/2005 were identified. Combining chart review and computer record review, details of procedures and outcomes were collected. RESULTS: A total of 239 renal units in 227 subjects were evaluated. Multiple calculi were treated in 43% of renal units. Excluding renal units with nephrocalcinosis, the average number of stones was 1.7⫾1.2. Stones were located in the proximal ureter (42%), lower pole (38%), and renal non-lower pole (54%). Predominant stone composi-
Moderated Poster 56 Wednesday, June 2, 2010
10:30 AM-12:30 PM
1900 A PROSPECTIVE CONTROLLED STUDY COMPARING BIPOLAR VERSUS MONOPOLAR TRANSURETHRAL RESECTION OF THE PROSTATE Michael Neyer*, Bregenz, Austria; Daniel Engeler, Christoph Schwab, St. Gallen, Switzerland; Josef Pointner, Bregenz, Austria; Timo Gru¨n, Hans-Peter Schmid, St. Gallen, Switzerland; Andreas Reissigl, Bregenz, Austria INTRODUCTION AND OBJECTIVES: We compared bipolar and monopolar transurethral resection of the prostate (TUR-P) in a prospective controlled study at two urology centers. A minimum of 100