1931 PERCUTANEOUS NEPHROLITHOTOMY IN PATIENTS WITH A SOLITARY KIDNEY: COMPARING CHARACTERISTICS AND OUTCOMES

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2%), prolonged bleeding (8%, 4% and 6%) and fever (4%, 4% and 14%) were comparable among the groups. The mean hospital stay was 6.2⫾3.2; 5.1⫾2.3 and 4.4⫾1.9 days for group 1, 2 and 3, respectively. CONCLUSIONS: Percutaneous stone treatment under combined sonographic/fluoroscopic guided puncture can be performed safe and efficiently even during the learning curve. The lower expertise causes longer operation times and a higher re-intervention rate without compromising the patients⬘ safety. Source of Funding: None

1929 THE COMBINATION OF PERCUTANEOUS CATHETER DISSOLUTION BY IRRIGATION WITH POTASSIUM BICARBONATE AND EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY IN LARGE(>2CM) RADIOLUCENT RENAL CALCULI Chan Dong Yeom*, Hyun Ho Han, Seung Hwan Lee, Sang Yol Mah, Mun Su Chung, Kyung Kgi Park, Chung Byung Ha, Seoul, Korea, Republic of INTRODUCTION AND OBJECTIVES: Extracorporeal shock wave lithotripsy (ESWL) is one of the most effective management method on upper urinary tract calculi. However, it has limitation to manage the large radiolucent calculi and its effectiveness is also controversial. The aim of this study was to investigate the effectiveness of the combination of percutaneous catheter dissolution by irrigation with potassium bicarbonate and ESWL in large(⬎2cm) radiolucent renal calculi. METHODS: The study was performed on the 34 patients (male 18, female 16) who had the more than 2cm sized radiolucent renal calculi between 2001 and june 2010. All patients were diagnosed by computed tomography (CT) or intravenous pyelography. Percutaneous nephrostomy was done to make passage for irrigation in all patients. The irrigation of potassium bicarbonate was discontinued when the renal calculi appeared to less than 0.5 cm size in follow up CT or anterograde pyelography and regarded as treatment success. We daily measured random urine analysis and serum creatinine during the irrigation of potassium bicarbonate. RESULTS: The mean patient age was 72.7 years (range, 30 –77) and the mean renal calculi size was 2.6cm (2.0 – 4.3cm). Their medical history was diabetes mellitus (n⫽27), hypertension (n⫽21), angina pectoris (n⫽17), single kidney(n⫽17), etc.(n⫽3). The mean duration of percutaneous nephrostomy and irrigation with potassium bicarbonate was 10.3 and 8.8 days, respectively. The mean times of performed ESWL was 2.8 times (1–5 times). 2 male and 1 female patients admitted at our institute more two times due to pain or gross hematuria. Ureteroscopic ureterolithotomy was performed on 1 male and 1 female during the study period. One patient re-admitted and dissolution by irrigation was done again. Open nephrolithotomy was performed on one patient because of complication of potassium bicarbonate after 2 days of irrigation (metabolic alkalosis). The success of combination treatment was 30/35(85.7%). CONCLUSIONS: In management of radiolucent large renal calculi, combined ESWL and percutaneous alkalinization is highly effective, safe method especially on old patients who have underlying comorbidities and risk to surgical management. Patients characteristics Mean age Mean renal calculi size

72.7 yrs 2.6 cm

Mean duration of PCN

10.3 days

Mean duration of irrigation

8.8 days

Mean times of performed ESWL

2.8 times

Source of Funding: None

1930 MINIMAL INVASIVE PCNL (MPCNL) - PROVEN EFFICIENCY AND SAFETY AFTER MORE THAN 650 CONSECUTIVE PATIENTS Volker Zimmermanns*, Peter Liske, Sven Lahme, Pforzheim, Germany INTRODUCTION AND OBJECTIVES: Modern treatment of nephrolithiasis tends towards endourological options instead of extensive use of extracorporal shock wave lithotripsy (ESWL). Background of this trend are enhanced or newly invented techniques like MPCNL, flexible ureterorenoscopy (fURS) and laser devices. The specific values of these developments are still to be discussed and conflicting data exists about many of the issues. This study contributes one of the largest series of MPCNL. METHODS: 652 consecutive patients (mean age 54.1 ⫾ 15.7) were treated. Data on the stone size and location, stone-free rate, blood transfusions, operating time and complications were recorded prospectively. A subgroup with a stone size of 5cm2 or larger on the plain x-ray film ( n ⫽ 183 ) was analyzed separately to determine the applicability to larger stone loads. RESULTS: In 649 patients access was possible. On average retreatment rate was 26.4% (subgroup: 35.5%). The mean stone size was 4.1 cm2 (subgroup: 9.5 cm2) The average operating time was 65 ⫾ 31 min. (subgroup: 77 ⫾ 34 min). Overall stone-free rate was 93.6% (subgroup: 91.8%). Blood transfusions were needed in nine cases (1.4%, subgroup: 1.1%). Febrile pyelonephritis was observed in 49 patients (7.5%, subgroup: 8.7%). One arterio-venous fistula and two recurrent arterial bleedings occurred. Two of the patients needed interventional radiology to resolve the problem. One cerebral ischemia was observed on the first postoperative day. CONCLUSIONS: MPCNL proofs to be a reliable and effective technique for percutaneous surgery. Complication rate is similar to that of ESWL and lower than the rates reported in most PCNL studies. Originally intended to be an alternative for ESWL in cases of lower pole calicyal stones or smaller stones in the renal pelvis, MPCNL demonstrates to be effective and equally save in larger stone burden as well. Source of Funding: None

1931 PERCUTANEOUS NEPHROLITHOTOMY IN PATIENTS WITH A SOLITARY KIDNEY: COMPARING CHARACTERISTICS AND OUTCOMES Viorel Bucuras*, Timisoara, Romania; Ganesh Gopalakrishnan, RS Puram, India; J. Stuart Wolf, jr., Ann Arbor, MI; Yinghao Sun, Shanghai, China, People’s Republic of; Giampaolo Bianchi, Modena, Italy; Tibet Erdogru, Antalya, Turkey; Luigi Cormio, Foggia, Italy; Jean de la Rosette, Amsterdam, Netherlands INTRODUCTION AND OBJECTIVES: Treatment of patients with solitary kidney having complex stones is one of the most challenging problems in urology. In this study the characteristics and outcomes between solitary kidneys and bilateral kidneys were compared. METHODS: The Clinical Research Office of the Endourological Society (CROES) centrally collected prospective data for a full year on all consecutive patients treated with PCNL. All patients enrolled in the Global PCNL study who had the status of solitary kidney were recorded in the Global PCNL Database. The patients were divided into two groups, those with a solitary kidney and those with two kidneys. RESULTS: The total number of patients whose kidney status was recorded was 5745. The total number of patients with a solitary kidney was 189(3.3%). The mean age was slightly higher in the group of patients with a solitary kidney. The incidence of cardiovascular disease was significantly higher (35.1%/22.9%) in the solitary kidney group. Also the patients in the solitary kidney group more often use anticoagulants. Patients with a solitary kidney have had more often surgery for obstruction of stones (esp. pyelolithotomy and nephrostomy). The ASA score 3 (15.4%/10.7%) and 4 (2.2%/0.9%) are higher for patients with a solitary kidney compared to patients with a two

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kidneys. There were no intraoperative differences found. The median operating time is 75 minutes in both groups. The stone free rate is significantly higher in the normal group (65.4%/76.1%) and there were more blood transfusion in the group of solitary kidney patients. CONCLUSIONS: The incidence of cardiovascular disease is higher in the solitary kidney group. Also the patients with a solitary kidney seem at higher risk as they have a higher ASA 3 and 4 score compared to patients with normal kidneys. The operating time is the same but more often blood transfusion is needed. The stone free rate is higher for the group with two kidneys. Source of Funding: Olympus

1932 PERCUTANEOUS NEPHROLITHOTOMY IN PATIENTS WITH RENAL ANOMALIES: COMPARING CHARACTERISTICS AND OUTCOMES Palle Osther*, Fredericia, Denmark; Hassan Razvi, London, Canada; Evangelos Liatsikos, Patras, Greece; Timothy Averch, Pittsburgh, PA; Alfonso Crisci, Firenze, Italy; Juan Lo`pez Garcia, San Sebastian, Spain; Arup Mandal, Chandigarh, India; Jean de la Rosette, Amsterdam, Netherlands INTRODUCTION AND OBJECTIVES: Percutaneous Nephrolithotomy (PCNL) is an effective procedure for the management of patients with large or otherwise-complex stones. However, the performance of percutaneous procedures may be impacted by the abnormal kidney anatomy. In this study the characteristics and outcomes of PCNL between renal malformations and normally developed upper urinary tracts were compared. METHODS: The Clinical Research Office of the Endourological Society (CROES) centrally collected prospective data for a full year on all consecutive patients treated with PCNL. All patients enrolled in the Global PCNL study were registered whether or not they had a renal congenital malformation. The patients were divided into two groups depending on the presence or absence of malformations. RESULTS: The total number of patients whose renal malformation status was recorded was 5542.The total number of patients with renal anomalies was 202(3.6%). 26 (0.5%) patients had an ectopic kidney, 102 (1.8%) had a horseshoe kidney and 74 (1.3%) a malrotated kidney. There were significantly more males with renal anomalies (65.3/34.7 years) and they presented at a slightly younger age. The median stone burden was somewhat greater (392/375mm2), although there were fewer staghorn stones (19.3%/27.4%) in the group of malformed kidneys. There were no significant differences with regard to previous procedures and ASA score between the two groups. The puncture site was more often upper or middle calyx in the malformed kidney group. Also there were slightly more punctures above the 12th rib (19.8%/14.7%). The median operating time was significantly longer for the group of patients with malformed kidneys (87/75 min). Also the number of failed procedures was significantly higher (5.0%/1.7%) for the malformed kidney group. The hospital stay was comparable in the two groups. CONCLUSIONS: The patient characteristics for the group with malformed kidneys revealed that the patients were more often males and slightly younger than patients with normal kidneys. The stone burden was larger in the malformed kidney group and punctures were more often done through the upper pole. The patients in the malformed kidney group also have longer operative times and are more likely to fail the initial procedure than their counterpart. Source of Funding: Olympus

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1933 THE OPTIMAL DRAINAGE METHOD FOR INFECTED HYDRONEPHROSIS SECONDARY TO UPPER URINARY TRACT CALCULI CONSIDERING SUBSEQUENT STONE LITHOTRIPSY Shinsuke Okada*, Yuji Kato, Daisuke Kudo, Takao Yamauchi, Hiroyasu Miura, Hachinohe, Japan INTRODUCTION AND OBJECTIVES: Emergency drainage is needed for infected hydronephrosis secondary to upper urinary tract calculi. Drainage is performed by percutaneous nephrostomy or ureteral stenting. Although these methods are effective only for decompression, the optimal method considering subsequent stone treatment has yet to be established. We retrospectively evaluated which of these 2 methods was superior for subsequent stone lithotripsy. METHODS: Between April 2008 and September 2010, 764 patients were treated for upper urinary tract calculi with transureteral lithotripsy. Of these, 53 patients showed infected hydronephrosis due to urinary calculi. For drainage, 27 patients underwent percutaneous nephrostomy (PNS group) and 16 patients underwent ureteral stenting (Stenting group) preceding stone lithotripsy. The other 10 patients underwent stone lithotripsy without urinary drainage (No drainage group). In these 53 patients with infected hydronephrosis, the course of the procedure, perioperative complication rate and clinical course were evaluated. RESULTS: Percutaneous nephrostomy was successfully completed in 100% of patients. However, in the Stenting group, misplacement of the ureteral stent to the submucous ureter occurred in 3 patients (18.3%) and stent obstruction occurred in 2 patients (11.0%), although the procedure was completed in all 16 patients. There was a significant difference in the interval until stone lithotripsy between these two drainage groups (p⫽0.03) (7.4 days in the PNS group and 20.8 days in the Stenting group). Average procedure duration for stone lithotripsy was 38.3 min (43.9 min in the PNS group, 31.4min in the Stenting group and 34.2 min in the No drainage group). Although the procedure duration was significantly longer in the PNS group compared to those in the other two groups (p⫽0.01), average duration of fever over 38 degrees in the PNS group was significantly shorter than those in the other two groups (0.9 days in the PNS group, 1.2 days in the Stenting group and 1.9 days in the No drainage group) (p⫽0.01 vs Stenting group, p⬍0.01 vs No drainage group). One patient died due to urosepsis in the No drainage group. CONCLUSIONS: Intraoperative continuous drainage from percutaneos nephrostomy could promote safety in stone lithotripsy under an inflammatory state. Our outcomes demonstrated that percutaneous nephrostomy is superior to ureteral stenting for drainage of stoneinduced infected hydronephrosis considering the potential for complication by the drainage procedure and subsequent stone lithotripsy. Source of Funding: None

1934 URETEROSCOPY FOR TRANSPLANT LITHIASIS Elias Hyams*, Baltimore, MD; Aron Bruhn, New York, NY; Adrienne Quirouet, Sero Andonian, Montreal, Canada; Ojas Shah, New York, NY; Brian Matlaga, Baltimore, MD INTRODUCTION AND OBJECTIVES: The optimal management of renal and ureteral calculi in a transplant kidney is not well defined. Although complex stone burdens are generally treated with percutaneous nephrolithotomy, there are certain cases in which the stone burden is simple and may be reasonably approached with ureteroscopy (URS). For such cases, either retrograde URS or antegrade URS without tract dilation may be an optimal approach. However, there are few reports describing such procedures for the treatment of transplant lithiasis. We report a multi-center experience with ureteroscopy for transplant lithiasis. METHODS: URS procedures performed at 3 stone-referral centers between 2006 –2009 were reviewed. All procedures that