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544 Ureteral stenting following ureteroscopy for ureteral lithiasis: Is it really necessary?
541 SPLIT FUNCTION GLOMERULAR FLEXIBLE URETERORENOSCOPY Bultitude
M., Dasgupta
Guy’s and Kingdom
P., Tiptaft
St. Thomas’
FILTRATION
RATE
AFTER
Pardalidis
R., Glass J.
Hospital,
Department
of
Urology,
London,
United
INTRODUCTION & OBJECTIVES: Flexible ureterorenoscopy has become a well-established treatment for diagnosis and treatment of upper tract pathology. It is minimally invasive, requiring short in-patient stays and has low morbidity. However the effect of ureteroscopy on renal function is unknown. MATERIAL & METHODS: We have measured the split function glomerular filtration rate (GFR) on a series of patients before and after flexible ureterorenoscopy as an accurate determination of renal function. Appropriate ethical approval and ARSAC nuclear medicine licence were obtained. All patients were undergoing treatment for renal stone disease. Patients underwent a 99mTcDMSA renogram and GFR measurement using 51Cr-EDTA prior to the procedure and within 24 hours afterwards. If significant decrease in function was found, patients were invited to undergo further scans at 3 months. RESULTS: To date nineteen patients have completed the trial and at the time of submission results are available for fifteen. There are ten male and five female patients with a mean age of 48.0 years (34- 75). Only one patient to date has had a significant reduction in renal function post- procedure. His single kidney GFR was reduced from 60.2 mls/min to 43.4 mls/min and he is awaiting a third scan. His stone had actually dropped into the lower ureter and underwent only rigid URS to the lower ureter and was not stented. This change may therefore be attributable to ureteric oedema. All other patients GFR’s have remained stable with no significant change. We anticipate full data to be available at the time of the meeting. CONCLUSIONS: ureterorenoscopy
542 PREVENTION
This data would appear to is a safe procedure with no significant
suggest that loss of function.
flexible
H.AF
OF RETROGRADE
N., Andriopoulos
Hospital,
during
of Urology,
ureteroscopy
located
stone extraction.
our clinical
RESULTS:
In all patients
and fluoroscopic
procedures
in 25 patients
whereas
residual
in 4 cases (31%),
CONCLUSIONS: migration
The
and allows
A low incidence are observed
auxiliary
stone
cone
safe removal
of significant
comparing
procedures device
successfully
residual
fragments
to the conventional
IN URETEROSCOPY FOR HOW MANY PROCEDURES SKILLS?
Botoca M., Bucuras
V., Boiborean
University
Department
Hospital,
P., Herman of Urology,
I., Cumpanas Timisoara,
THE TREATMENT ARE NEEDED
TO
A., Miclea F.
Romania
via cystoscopy
less than 3mm remained
during
in 2 (15%).
proximal ureteroscopic
and fewer
in
than 3mm were
were required
auxiliary
ureteral
stone
lithotripsy. procedures
flat wire basket.
543 THE LEARNING CURVE OF URETERIC STONES. ACHIEVE SATISFACTORY
compared
in 4. No patient required
stones greater
minimizes
of fragments
(EHL)
with intact
flat wire basket.
and ureteroscopy stone fragments
while
lithotripsy
prospectively
using a standard
3 stone cone cases. In the flat wire basket residual present
with a flat wire
7 cases were managed
the stone cone was placed
guidance
the
joint in 15 cases, over the hydraulic
15 cases were
lithotripsy
thus
clinically
use of the stone cone in 29
in 9 cases. Electra
The later
13 cases of ureteroscopic
and distal
to 40%,
calculi.
above the sacroiliac
in 22 cases, while the remaining
in 5%
it prospectively
for ureteral
We report
stones,
joint in 5 cases and below
ureteroscopic
of proximal
rate. We assessed
of the stone cone and compared
with ureteral
auxiliary
migration
procedures
& METHODS:
with
Kidney
and auxiliary
MATERIAL
was performed
Greece
occurs
retrograde
sacroiliac
Halandri,
E.
lithotripsy
basket during
patients
MIGRATION
ureteroscopic
the morbidity
safety and efficacy
STONE
A., Kosmaoglou
& OBJECTIVES:
stones
increasing
N., Michalakis
Department
INTRODUCTION ureteral
URETERAL
544 URETERAL URETERAL Giacomelli Maria
STENTING LITHIASIS: G., Bozzo
Vittoria
Hospital,
FOLLOWING IS IT REALLY
URETEROSCOPY NECESSARY?
R.E., Manzo
M., Gastaldi
Department
of Urology,
L., Moroni Turin,
FOR
M.
Italy
INTRODUCTION & OBJECTIVES: Ureteroscopy is a common procedure for the treatment of ureteric stones in our department since 1992, routinely practiced by 5 members of the staff. The aim of the study is to evaluate how accumulating experience leads to a satisfactory level of skills. A secondary objective is to asses the impact of individual, clinical and technically related factors, on the success rate.
INTRODUCTION & OBJECTIVES: Placement of ureteral stens following uncomplicated ureteroscopy for ureteral lithiasis is a common procedure. Ureteral stens maintain ureteral drainage until edema resolves. We evaluated the effectiveness and utility of ureteral stenting or non-stenting after operative ureteroscopy.
MATERIAL & METHODS: The results of ureteroscopy of each urologist were analyzed, from the first procedure, over a period of 10 years, with respect to success rate and intraoperative complications. Success was defined as ability to pass the ureteroscope, visualise and treat the stone. Pushing the stone back followed by ESWL, was not considered as failure. The results were analyzed for increments of 50 procedures, as a median of the team and individually. The influence of sex, left or right side, location of stone, prior JJ stenting and need of ureteral orifice dilatations, on the success rate was also assessed. We defined the acceptable level of skills, as the moment when the rates of success and complications showed a tendency to plateau at a level similar the results mentioned in the EAU Guidelines.
MATERIAL & METHODS: From January 200 1 to September 2003,70 patients, equally randomized into a stented or non-stented group, underwent rigid ueteroscopy for ureteral stones (distal or mid-ureteral 7-15 mm stones). The operation was performed with a 11 Fr rigid ureteroscope without ureteral dilatation. Stones were fragmented with electro hydraulic lithotriptor and/or extracted with Dormia basket. A 5 Fr simple ureteral stent was placed in the stented group for 24-48 hours after ureteroscopy. All patients were evaluated with regard to pain and LUTS on dimission to the hospital and 3 days postoperatively.
RESULTS: During the 10 years period, a total number of 670 ureteroscopies for ureteral stones have been performed, individual experiences ranging from 88 to 228 The overall success and complications rates were 92% and 5.5% respectively. The individual performances ranged from 87 % to 97 ‘??. The tendency to plateau appeared after approximately 50 procedures without wide variations between individuals. We also considered the number of ureterolithotomies performed in the same period by the same urologists, as an indirect negative proof of successful ureteroscopy. The tendency was to reduce the proportion of cases operated openly, parallel to the success rate of ureteroscopy, for the whole group and each urologist. The factors that showed an influence on the rate of success were: location of the stone along the ureter and gender. Prior JJ stenting, as well as better (thinner, semi rigid) ureteroscopes, made ureteroscopy much easier. CONCLUSIONS: Ureteroscopy is a safe and effective procedure in the treatment of ureteral stones, which tends to replace open surgery. The learning curve is relatively long, a number of at least 50 procedures being necessary to achieve a satisfactory level of skills. Individual skills may differ in a team of urologists and each may have an own learning curve pattern. European
Urology
Supplements
3 (2004)
No. 2, pp. 138
RESULTS: Of the 70 renal units treated, 45 received ureteral stent while the remaining 25 were treated without stent. The stone free rate was 100% in each group. Flank pain was significatively greater in the non stented group, ~~0.05. Among the stented group, flank pain was significatively reduced in patients with stent for 48 hours. The amount of extra-parenteral analgesic used was the same greater between the non stented group. The difference between LUTS in the 2 groups was non significative with a little prevalence for the stented group, p>O,O5. 3/25 (12%) non-stented patients required postoperative application of ureteral stent. Operative time was non-statistically different in the 2 groups. CONCLUSIONS: In our experience, after simple ureteroscopy for ureteral stones routine ureteral stenting for at least 48 hours appear to be warranted in all cases, to limit pain postoperatively. This procedure does not increase operative time. The effect of stenting does not seem to increase significatively LUTS post-procedure. Ureteral stenting moreover coul decrease the rate of re-hospitalization and emergency room revisits.
M., Dasgupta
Guy’s and Kingdom
P., Tiptaft
St. Thomas’
FILTRATION
RATE
AFTER
Pardalidis
R., Glass J.
Hospital,
Department
of
Urology,
London,
United
INTRODUCTION & OBJECTIVES: Flexible ureterorenoscopy has become a well-established treatment for diagnosis and treatment of upper tract pathology. It is minimally invasive, requiring short in-patient stays and has low morbidity. However the effect of ureteroscopy on renal function is unknown. MATERIAL & METHODS: We have measured the split function glomerular filtration rate (GFR) on a series of patients before and after flexible ureterorenoscopy as an accurate determination of renal function. Appropriate ethical approval and ARSAC nuclear medicine licence were obtained. All patients were undergoing treatment for renal stone disease. Patients underwent a 99mTcDMSA renogram and GFR measurement using 51Cr-EDTA prior to the procedure and within 24 hours afterwards. If significant decrease in function was found, patients were invited to undergo further scans at 3 months. RESULTS: To date nineteen patients have completed the trial and at the time of submission results are available for fifteen. There are ten male and five female patients with a mean age of 48.0 years (34- 75). Only one patient to date has had a significant reduction in renal function post- procedure. His single kidney GFR was reduced from 60.2 mls/min to 43.4 mls/min and he is awaiting a third scan. His stone had actually dropped into the lower ureter and underwent only rigid URS to the lower ureter and was not stented. This change may therefore be attributable to ureteric oedema. All other patients GFR’s have remained stable with no significant change. We anticipate full data to be available at the time of the meeting. CONCLUSIONS: ureterorenoscopy
542 PREVENTION
This data would appear to is a safe procedure with no significant
suggest that loss of function.
flexible
H.AF
OF RETROGRADE
N., Andriopoulos
Hospital,
during
of Urology,
ureteroscopy
located
stone extraction.
our clinical
RESULTS:
In all patients
and fluoroscopic
procedures
in 25 patients
whereas
residual
in 4 cases (31%),
CONCLUSIONS: migration
The
and allows
A low incidence are observed
auxiliary
stone
cone
safe removal
of significant
comparing
procedures device
successfully
residual
fragments
to the conventional
IN URETEROSCOPY FOR HOW MANY PROCEDURES SKILLS?
Botoca M., Bucuras
V., Boiborean
University
Department
Hospital,
P., Herman of Urology,
I., Cumpanas Timisoara,
THE TREATMENT ARE NEEDED
TO
A., Miclea F.
Romania
via cystoscopy
less than 3mm remained
during
in 2 (15%).
proximal ureteroscopic
and fewer
in
than 3mm were
were required
auxiliary
ureteral
stone
lithotripsy. procedures
flat wire basket.
543 THE LEARNING CURVE OF URETERIC STONES. ACHIEVE SATISFACTORY
compared
in 4. No patient required
stones greater
minimizes
of fragments
(EHL)
with intact
flat wire basket.
and ureteroscopy stone fragments
while
lithotripsy
prospectively
using a standard
3 stone cone cases. In the flat wire basket residual present
with a flat wire
7 cases were managed
the stone cone was placed
guidance
the
joint in 15 cases, over the hydraulic
15 cases were
lithotripsy
thus
clinically
use of the stone cone in 29
in 9 cases. Electra
The later
13 cases of ureteroscopic
and distal
to 40%,
calculi.
above the sacroiliac
in 22 cases, while the remaining
in 5%
it prospectively
for ureteral
We report
stones,
joint in 5 cases and below
ureteroscopic
of proximal
rate. We assessed
of the stone cone and compared
with ureteral
auxiliary
migration
procedures
& METHODS:
with
Kidney
and auxiliary
MATERIAL
was performed
Greece
occurs
retrograde
sacroiliac
Halandri,
E.
lithotripsy
basket during
patients
MIGRATION
ureteroscopic
the morbidity
safety and efficacy
STONE
A., Kosmaoglou
& OBJECTIVES:
stones
increasing
N., Michalakis
Department
INTRODUCTION ureteral
URETERAL
544 URETERAL URETERAL Giacomelli Maria
STENTING LITHIASIS: G., Bozzo
Vittoria
Hospital,
FOLLOWING IS IT REALLY
URETEROSCOPY NECESSARY?
R.E., Manzo
M., Gastaldi
Department
of Urology,
L., Moroni Turin,
FOR
M.
Italy
INTRODUCTION & OBJECTIVES: Ureteroscopy is a common procedure for the treatment of ureteric stones in our department since 1992, routinely practiced by 5 members of the staff. The aim of the study is to evaluate how accumulating experience leads to a satisfactory level of skills. A secondary objective is to asses the impact of individual, clinical and technically related factors, on the success rate.
INTRODUCTION & OBJECTIVES: Placement of ureteral stens following uncomplicated ureteroscopy for ureteral lithiasis is a common procedure. Ureteral stens maintain ureteral drainage until edema resolves. We evaluated the effectiveness and utility of ureteral stenting or non-stenting after operative ureteroscopy.
MATERIAL & METHODS: The results of ureteroscopy of each urologist were analyzed, from the first procedure, over a period of 10 years, with respect to success rate and intraoperative complications. Success was defined as ability to pass the ureteroscope, visualise and treat the stone. Pushing the stone back followed by ESWL, was not considered as failure. The results were analyzed for increments of 50 procedures, as a median of the team and individually. The influence of sex, left or right side, location of stone, prior JJ stenting and need of ureteral orifice dilatations, on the success rate was also assessed. We defined the acceptable level of skills, as the moment when the rates of success and complications showed a tendency to plateau at a level similar the results mentioned in the EAU Guidelines.
MATERIAL & METHODS: From January 200 1 to September 2003,70 patients, equally randomized into a stented or non-stented group, underwent rigid ueteroscopy for ureteral stones (distal or mid-ureteral 7-15 mm stones). The operation was performed with a 11 Fr rigid ureteroscope without ureteral dilatation. Stones were fragmented with electro hydraulic lithotriptor and/or extracted with Dormia basket. A 5 Fr simple ureteral stent was placed in the stented group for 24-48 hours after ureteroscopy. All patients were evaluated with regard to pain and LUTS on dimission to the hospital and 3 days postoperatively.
RESULTS: During the 10 years period, a total number of 670 ureteroscopies for ureteral stones have been performed, individual experiences ranging from 88 to 228 The overall success and complications rates were 92% and 5.5% respectively. The individual performances ranged from 87 % to 97 ‘??. The tendency to plateau appeared after approximately 50 procedures without wide variations between individuals. We also considered the number of ureterolithotomies performed in the same period by the same urologists, as an indirect negative proof of successful ureteroscopy. The tendency was to reduce the proportion of cases operated openly, parallel to the success rate of ureteroscopy, for the whole group and each urologist. The factors that showed an influence on the rate of success were: location of the stone along the ureter and gender. Prior JJ stenting, as well as better (thinner, semi rigid) ureteroscopes, made ureteroscopy much easier. CONCLUSIONS: Ureteroscopy is a safe and effective procedure in the treatment of ureteral stones, which tends to replace open surgery. The learning curve is relatively long, a number of at least 50 procedures being necessary to achieve a satisfactory level of skills. Individual skills may differ in a team of urologists and each may have an own learning curve pattern. European
Urology
Supplements
3 (2004)
No. 2, pp. 138
RESULTS: Of the 70 renal units treated, 45 received ureteral stent while the remaining 25 were treated without stent. The stone free rate was 100% in each group. Flank pain was significatively greater in the non stented group, ~~0.05. Among the stented group, flank pain was significatively reduced in patients with stent for 48 hours. The amount of extra-parenteral analgesic used was the same greater between the non stented group. The difference between LUTS in the 2 groups was non significative with a little prevalence for the stented group, p>O,O5. 3/25 (12%) non-stented patients required postoperative application of ureteral stent. Operative time was non-statistically different in the 2 groups. CONCLUSIONS: In our experience, after simple ureteroscopy for ureteral stones routine ureteral stenting for at least 48 hours appear to be warranted in all cases, to limit pain postoperatively. This procedure does not increase operative time. The effect of stenting does not seem to increase significatively LUTS post-procedure. Ureteral stenting moreover coul decrease the rate of re-hospitalization and emergency room revisits.