- Email: [email protected]
294 PERCUTANEOUS MANAGEMENT OF STAGHORN RENAL CALCULI COMBINED WITH REMOVAL STONES FROM URETER IN CHILDREN
73.3 yrs (Group B) received PRA. 22/78 pts, mean age 74.5 were only followed (AS) (Group C). In Group A: M/F 23/4 vs. 20/6 in Group B vs. 16/6 in Group C. The mean tumour diameter was 2.1 cm, 2.5 cm and 2.2 cm in Group A, B and C. General anaesthesia was always used in Group A while local anaesthesia along the needle tract was used in pts receiving RFA. In this group 2 pts were not treated because of the difficult tumour location. In the AS arm pts were followed every 6 months with CT. Results: Mean F-UP was: 60.1, 62.1 and 56.3 mos in group A, B, C respectively. Histology: Group A: 23/27 = renal cell carcinoma, 1 angiomiolipoma and 3 oncocitomas (11.1%). Grade: G1=6, G2=12, Chromophobe =2, papillary=3. Mean blood loss: 127.6 cc (50-400cc). Intra-op margins were always negative. Mean hospital stay was 5.4 days. Complications: no major. 3/27 pts (11.1%) had 2 units of blood transfused in the post-op. Group B: no biopsy were done. F-Up: Group A (5-yrs): 2/27 pts (7.4%) died of pulmonary embolism and cardiac failure after 2 and 3 years from surgery. 25/27 (92.6%) are NED. Group B (62.1 mos): Mean hospital stay: 1 day. Complications: 1 pt ad nausea. 10/24pts (42%) died of other causes. 2/24 pts. (8.3%) had a complete response at CT, 3/24 (12.5%) an increase in tumour diameter of 5 mm after 56,59, 72 mos and 17/24 pts (70.1%) had stable disease. Group C (56.3 mos): 2/22pts (10%) died of other causes .3/22 (17%) progressed: 0.5, 0.6 and 2 cm in diameter. 2 of them received surgery: path.= adenoca. 1/3 still in AS. Conclusions: Open surgery(mininvasive TE) resulted the best therapeutic option for old patients with small renal tumours. The oncological outcomes were excellent and the complication rate low. RFA or AS can be offered to pts. at a very high risk or refusing surgery.
Poster Session 25 UTI, VUR, HYDRONEPHROSIS AND VOIDING DYSFUNCTION Saturday, 19 March, 16.00-17.30, Room J565
291
The role of urinary IL 8 level in diagnosis and differentiation between different types of urinary tract infection in children
Tealab A.A.1, Kholy O.2, Saad M.1, Gaballah A.3 1 Zagazig University Hospital, Dept. of Urology, Zagazig, Egypt, 2Zagazig University Hospital, Dept. of Paediatric, Zagazig, Egypt, 3Zagazig University Hospital, Dept. of Clinical Pathology, Zagazig, Egypt Introduction & Objectives: The Interleukin (IL)-8 act as a potent neutrophils chemotactant responsible for the migration of neutrophils into the infected renal tissue to protect against the invading pathogens. The aim of our work is the study of the role of urinary IL-8 in the diagnosis and differentiation between different forms of urinary tract infections and its role in detection of the effect of treatment. Materials & Methods: We evaluated 50 children with different forms of urinary tract infections and classified into three groups: Group I: included children diagnosed as pyelonephritis included 20 patients ( their age range from 6 m to 10 y), Group II: included children with acute cystitis included 15 patients ( their ages from 1y to 12 y ) and Group III: included children with asymptomatic bacteruria included 15 patients ( their ages from 5 m to 10 y ) and group III will be considered as control group as bacteriuria was detected during routine urine examination. All groups are urine culture positive. Inflammatory markers including erythrocyte sedimentation rate, C-reactive protein, leukocyte count, and urinary IL-8, together with the results of ultrasonography and dimercaptosuccinic acid renal scintigraphy (DMSA) were evaluated in these children. The ratios of urinaryIL-8 to creatinine (IL-8/C) before and after the treatment by 72 hours were compared with each other. Results: The initial urine IL-8 concentrations were significantly higher in the children with acute pyelonephritis than in the lower UTI group and also higher than the asymptomatic group (all P < 0.001). After 72 hours a significant decrease in the urinary IL-8 level in all groups of study (all P value < 0.001). There were positive correlations between urine IL-8 concentrations and leukocyturia in children with acute pyelonephritis ( r = 0.43, P < 0.001, ). In children with lower UTI group, no correlations were found between urine IL-8 values and leukocyturia. Renal injury was found in 6 children with pyelonephritis detected by DMSA scanning and those 6 patients having the highest level of urinary IL 8 among those of pyelonephritis group after 6 months. Conclusions: From this study we conclude the importance of urinary IL-8 as a non invasive test in diagnosis and differentiation between different forms of urinary tract infections in children (upper UTI from lower UTI and from those with asymptomatic bacteruria) and also its importance in detection of treatment efficacy.
292
Autologous transplantation of cultured fibroblasts for potential bulking agent at the ureterovesical junction
Pichler R.1, Ladurner Rennau M.1, Klima G.2, Schlenck B.1, Radmayr C.1, Oswald J.1 1 Medical University, Dept. of Urology, Innsbruck, Austria, 2Medical University, Dept. of Histology and Embryology, Innsbruck, Austria
Introduction & Objectives: To investigate the behaviour of donor fibroblasts at the vesico-ureteric junction (VUJ) and to evaluate their potential as an autologous bulking agent in the treatment of vesicoureteral reflux (VUR) as fibroblast transplantation has been shown to regenerate damaged or degenerated tissue. Materials & Methods: Muscle biopsies were obtained from the lower limb muscles of 4 pigs, Cell nuclei of fibroblasts were labelled with micron-sized iron oxide particles. Six weeks after taking of the muscle biopsies all pigs underwent cell transplantation. 3 x106 cells suspended in transplantation medium (in 1 mL syringes) were injected at the VUJ using modified STING technique. Animals were sacrificed 8 weeks later, seeded fibroblasts were identified using Prussian blue staining protocol, histological evaluation and morphological analysis were performed by light microscopy (Mayer´s haematoxylin-eosin staining), bladders were scanned by MRI for visualization and localization of the iron-labelled donor cells. Results: Donor fibroblast presence and cellular viability at the VUJ was demonstrated by MRI and histochemically indicating cellular uptake of iron particles and proliferation at the VUJ. It was also evident that transplanted fibroblasts integrate into the extracellular matrix of the distal ureter augmenting ureteral host tissue. Conclusions: Labelled implanted autologous fibroblasts persisted at the VUJ, suggesting that in vitro seeded fibroblasts survive, proliferate and augment ureteral tissue in vivo after transplantation.
293
Ureteral catheters after ureteral reimplantation do not cause bacterial urinary tract infections in children
Van Baelen A.1, Uvin P.1, Verhaegen J.2, Bogaert G.A.1 UZ Leuven, Dept. of Urology, Leuven, Belgium, 2UZ Leuven, Dept. of Clinical Biology, Leuven, Belgium
1
Introduction & Objectives: Leaving an indwelling catheter in the ureter after ureteral reimplantation is safer to minimize postoperative obstruction. However, it can act as a foreign body and therefore can be a possible source of bacterial infection. This prospective study is designed to determine the incidence of bacterial colonization and the risk of bacterial infection of indwelling double-J stents in children who underwent a ureteral reimplantation. Materials & Methods: Between 2005 and 2010, 209 children (138 girls, 71 boys; median age 3.8 year) with vesicoureteral reflux underwent unilateral or bilateral cross-trigonal ureteral reimplantation (352 ureters). All children received a single dose of gentamycine (2mg/kg body weight), a preoperative bladder rinse with 10% polividone-saline solution and a transurethral catheter was left postoperatively for 2 (unilateral) or 3 (bilateral) days. The ureter was stented with a multilength catheter 8-22 cm (Cook®). 3 weeks later, the ureteral catheters were removed and investigated for bacterial colonization. Results: 10/209 (4.8%) children developed a urinary tract infection within the first six weeks after ureteral reimplantation. 13 from the remaining 199 (6.5%) children without any symptoms had a positive urine culture at the time of removal. 90/199 (45.2%) children without any symptoms had a positive culture of one or more segments of the double-J catheter. Conclusions: Although the ureteral catheters were most frequently colonized, the rate of urinary tract infection during the first six weeks after ureteral reimplantation with indwelling ureteral catheters was only 4.8% (10/209 children). We conclude that the placement of indwelling ureteral catheters after ureteral reimplantation does not cause a higher incidence of bacterial infections in children.
294
Percutaneous management of staghorn renal calculi combined with removal stones from ureter in children
Nadjimitdinov S. Republican Specialized Center of Urology, Dept. of Pediatric Urology, Tashkent, Uzbekistan Introduction & Objectives: To assess efficacy and safety of performing simultaneous endourologic procedures at children with stone in kidney and ureter. Materials & Methods: From 2000 to 2008 percutaneous nephrolithotomy (PCNL) was performed in 160 children of 4 to 15 years old. There were 117 boys (73,3%) and 43 girls (26,7%). There were a obstructing ureteral calculus in 43 (27,8%) patients. Average ureteral stone was 7,8±1,4 mm. In 21 patients’ stones were located in distal part of ureter, in 12 cases in middle and in 10th in proximal. Results: In all cases the first procedure was PCNL. At 30 (70%) children stone was displacement from ureter to pelvis and than removed. Nine (20%) patients underwent retrograde endoscopic procedures (contact ureterolithotripsy or ureteroscopic extraction). Antegrade ureterolithotripsy was used in four (10%) patients. All procedures were successfully completed without major perioperative complications. The average hospital stay was similar - 3,1±1,2 days (range 2 to 4) in the PCNL group and 4,2±0,6 days (range 3 to 5) in the combined endoscopic procedure group. Complete stone clearance was achieved at the end of the procedure in all patients (success rate 100%). Conclusions: Our results support the concept of performing simultaneous endourologic procedures - PCNL and ureterolithotripsy in one session. This approach obviates the need for repeat anaesthesia, patient inconvenience, the psychological stress related to multiple operations, and reduces the total hospital stay.
Eur Urol Suppl 2011;10(2):111
Poster Session 25 UTI, VUR, HYDRONEPHROSIS AND VOIDING DYSFUNCTION Saturday, 19 March, 16.00-17.30, Room J565
291
The role of urinary IL 8 level in diagnosis and differentiation between different types of urinary tract infection in children
Tealab A.A.1, Kholy O.2, Saad M.1, Gaballah A.3 1 Zagazig University Hospital, Dept. of Urology, Zagazig, Egypt, 2Zagazig University Hospital, Dept. of Paediatric, Zagazig, Egypt, 3Zagazig University Hospital, Dept. of Clinical Pathology, Zagazig, Egypt Introduction & Objectives: The Interleukin (IL)-8 act as a potent neutrophils chemotactant responsible for the migration of neutrophils into the infected renal tissue to protect against the invading pathogens. The aim of our work is the study of the role of urinary IL-8 in the diagnosis and differentiation between different forms of urinary tract infections and its role in detection of the effect of treatment. Materials & Methods: We evaluated 50 children with different forms of urinary tract infections and classified into three groups: Group I: included children diagnosed as pyelonephritis included 20 patients ( their age range from 6 m to 10 y), Group II: included children with acute cystitis included 15 patients ( their ages from 1y to 12 y ) and Group III: included children with asymptomatic bacteruria included 15 patients ( their ages from 5 m to 10 y ) and group III will be considered as control group as bacteriuria was detected during routine urine examination. All groups are urine culture positive. Inflammatory markers including erythrocyte sedimentation rate, C-reactive protein, leukocyte count, and urinary IL-8, together with the results of ultrasonography and dimercaptosuccinic acid renal scintigraphy (DMSA) were evaluated in these children. The ratios of urinaryIL-8 to creatinine (IL-8/C) before and after the treatment by 72 hours were compared with each other. Results: The initial urine IL-8 concentrations were significantly higher in the children with acute pyelonephritis than in the lower UTI group and also higher than the asymptomatic group (all P < 0.001). After 72 hours a significant decrease in the urinary IL-8 level in all groups of study (all P value < 0.001). There were positive correlations between urine IL-8 concentrations and leukocyturia in children with acute pyelonephritis ( r = 0.43, P < 0.001, ). In children with lower UTI group, no correlations were found between urine IL-8 values and leukocyturia. Renal injury was found in 6 children with pyelonephritis detected by DMSA scanning and those 6 patients having the highest level of urinary IL 8 among those of pyelonephritis group after 6 months. Conclusions: From this study we conclude the importance of urinary IL-8 as a non invasive test in diagnosis and differentiation between different forms of urinary tract infections in children (upper UTI from lower UTI and from those with asymptomatic bacteruria) and also its importance in detection of treatment efficacy.
292
Autologous transplantation of cultured fibroblasts for potential bulking agent at the ureterovesical junction
Pichler R.1, Ladurner Rennau M.1, Klima G.2, Schlenck B.1, Radmayr C.1, Oswald J.1 1 Medical University, Dept. of Urology, Innsbruck, Austria, 2Medical University, Dept. of Histology and Embryology, Innsbruck, Austria
Introduction & Objectives: To investigate the behaviour of donor fibroblasts at the vesico-ureteric junction (VUJ) and to evaluate their potential as an autologous bulking agent in the treatment of vesicoureteral reflux (VUR) as fibroblast transplantation has been shown to regenerate damaged or degenerated tissue. Materials & Methods: Muscle biopsies were obtained from the lower limb muscles of 4 pigs, Cell nuclei of fibroblasts were labelled with micron-sized iron oxide particles. Six weeks after taking of the muscle biopsies all pigs underwent cell transplantation. 3 x106 cells suspended in transplantation medium (in 1 mL syringes) were injected at the VUJ using modified STING technique. Animals were sacrificed 8 weeks later, seeded fibroblasts were identified using Prussian blue staining protocol, histological evaluation and morphological analysis were performed by light microscopy (Mayer´s haematoxylin-eosin staining), bladders were scanned by MRI for visualization and localization of the iron-labelled donor cells. Results: Donor fibroblast presence and cellular viability at the VUJ was demonstrated by MRI and histochemically indicating cellular uptake of iron particles and proliferation at the VUJ. It was also evident that transplanted fibroblasts integrate into the extracellular matrix of the distal ureter augmenting ureteral host tissue. Conclusions: Labelled implanted autologous fibroblasts persisted at the VUJ, suggesting that in vitro seeded fibroblasts survive, proliferate and augment ureteral tissue in vivo after transplantation.
293
Ureteral catheters after ureteral reimplantation do not cause bacterial urinary tract infections in children
Van Baelen A.1, Uvin P.1, Verhaegen J.2, Bogaert G.A.1 UZ Leuven, Dept. of Urology, Leuven, Belgium, 2UZ Leuven, Dept. of Clinical Biology, Leuven, Belgium
1
Introduction & Objectives: Leaving an indwelling catheter in the ureter after ureteral reimplantation is safer to minimize postoperative obstruction. However, it can act as a foreign body and therefore can be a possible source of bacterial infection. This prospective study is designed to determine the incidence of bacterial colonization and the risk of bacterial infection of indwelling double-J stents in children who underwent a ureteral reimplantation. Materials & Methods: Between 2005 and 2010, 209 children (138 girls, 71 boys; median age 3.8 year) with vesicoureteral reflux underwent unilateral or bilateral cross-trigonal ureteral reimplantation (352 ureters). All children received a single dose of gentamycine (2mg/kg body weight), a preoperative bladder rinse with 10% polividone-saline solution and a transurethral catheter was left postoperatively for 2 (unilateral) or 3 (bilateral) days. The ureter was stented with a multilength catheter 8-22 cm (Cook®). 3 weeks later, the ureteral catheters were removed and investigated for bacterial colonization. Results: 10/209 (4.8%) children developed a urinary tract infection within the first six weeks after ureteral reimplantation. 13 from the remaining 199 (6.5%) children without any symptoms had a positive urine culture at the time of removal. 90/199 (45.2%) children without any symptoms had a positive culture of one or more segments of the double-J catheter. Conclusions: Although the ureteral catheters were most frequently colonized, the rate of urinary tract infection during the first six weeks after ureteral reimplantation with indwelling ureteral catheters was only 4.8% (10/209 children). We conclude that the placement of indwelling ureteral catheters after ureteral reimplantation does not cause a higher incidence of bacterial infections in children.
294
Percutaneous management of staghorn renal calculi combined with removal stones from ureter in children
Nadjimitdinov S. Republican Specialized Center of Urology, Dept. of Pediatric Urology, Tashkent, Uzbekistan Introduction & Objectives: To assess efficacy and safety of performing simultaneous endourologic procedures at children with stone in kidney and ureter. Materials & Methods: From 2000 to 2008 percutaneous nephrolithotomy (PCNL) was performed in 160 children of 4 to 15 years old. There were 117 boys (73,3%) and 43 girls (26,7%). There were a obstructing ureteral calculus in 43 (27,8%) patients. Average ureteral stone was 7,8±1,4 mm. In 21 patients’ stones were located in distal part of ureter, in 12 cases in middle and in 10th in proximal. Results: In all cases the first procedure was PCNL. At 30 (70%) children stone was displacement from ureter to pelvis and than removed. Nine (20%) patients underwent retrograde endoscopic procedures (contact ureterolithotripsy or ureteroscopic extraction). Antegrade ureterolithotripsy was used in four (10%) patients. All procedures were successfully completed without major perioperative complications. The average hospital stay was similar - 3,1±1,2 days (range 2 to 4) in the PCNL group and 4,2±0,6 days (range 3 to 5) in the combined endoscopic procedure group. Complete stone clearance was achieved at the end of the procedure in all patients (success rate 100%). Conclusions: Our results support the concept of performing simultaneous endourologic procedures - PCNL and ureterolithotripsy in one session. This approach obviates the need for repeat anaesthesia, patient inconvenience, the psychological stress related to multiple operations, and reduces the total hospital stay.
Eur Urol Suppl 2011;10(2):111