- Email: [email protected]
548 Is MRI mandatory to manage clinically prostate cancer patients?
545 URETERORENOSCOPY AND PNEUMATIC TREATMENT OF URETERAL CALCULI
LITHOTRIPSY
IN
Tefekli
A., Erkan
E., Altunrende
O., Muslumanoglu
A.Y.
Haseki
Teaching
and Research
F., Caklr Hospital,
T., Sarilar Department
of Urology,
Istanbul,
546
THE
FLEXIBLE A NEW CLINICAL
University
MATERIAL & METHODS: During a period of 4 years, a total of 257 ureteral calculi in 253 patients (140 men, 113 women) with a mean age of 43.7~tl2.1 (range: 17-73) years were treated with ureteroscopic pneumatic lithotripsy. During the procedures, 10 F and/or 8 F Storz@ semi rigid nreteroscopes were used. For stone fragmentation, Elmed VibrolithB pneumatic lithotriptor were used in addition to 0.8 or 1.2 mm pneumatic lithotripsy probes. Of the stones 189, 37 and 31 were in the distal, mid, and proximal ureter, respectively. The stone sizes ranged from 0.8 to 3.0 (mean: 1.7+0.6) cm. RESULTS: The mean operation time was 28.519.8 (range: 15-60) minutes. Balloon dilatation was necessary in 16 (6.5%) cases. Complete fragmentation was achieved in 168 (66.4%) cases and partial fragmentation in 74 (29.1%) cases. Fragmentation did not occur in the remaining 11 cases (4.5%) with relatively impacted stones, and were referred to open surgery Baskets were used in 103 (40.7%) cases to remove fragments > 3 mm. Proximal migration of small fragments were observed in 25 (9.8%) cases, but successfully retrieved in the majority by intravenous furosemide administration. Ureteral stents were placed overnight in 115 (45.4%) cases while double-J stents were required in 20 (7.9%) patients with solitary kidney and/or elevated serum creatinine level. No stent was used in 132 (52.1%) cases. No ureteral injury or perforation, but minor mucosal lacerations were encountered in 11 (4.3%) cases. In 3 (1 .l%) cases, obstruction due to small fragments left for spontaneous passage occurred in early period postoperatively and re-ureterorenoscopy was needed. Silent obstruction was seen in 2 (0.7%) cases. The overall stone-free rate at 3 months was 93%. CONCLUSIONS: Our results indicate that pneumatic lithotripsy is a highly safe, efficient and cost-effective method in the treatment of ureteral calculi, however, careful postoperative follow up should be done to avoid uncommon complications.
547
Gunlusov Izmir
B., Arslan
Ssk Education
M., Deginnenci Hospital,
T., Nergiz
Urology,
Izmir,
N., Minareci
STONES WITH 1529 CASES
S., Ayder A.R., Cicek
S.
to be an effective In this study, we techniques with
MATERIAL & METHODS: A total of 1529 ureteroscopic procedures were done between May 1992 and April 2003, 1207 of these patients who underwent ureteroscopic lithotripsy were reviewed retrospectively. Median age was 38.2 years (range between 17 - 64). The average stone size was 7.8 mm. (ranging between 3 to 18 mm). At ureteroscopy, the calculi were present in the upper-ureter in 16 (1.3%), mid-ureter in 72 (6%) and lower ureter in 1119 (92.7%) of the patients. In the treatment of stones; electrohydraulic in 25 stones (25%), ultrasonic in 284 stones (23.5%), pulse-dye laser in 292 stones (24.5%) and pneumatic lithotripsy in 606 stones (50%) were used as ureteroscopic procedures. For removal of stones; basket extraction or foreign body forceps were used in combination with lithotripsy techniques. Size and location of the stones, success and complication rates were evaluated. Intravenous urography or renal ultrasonography and direct urinary system graphy were done 6 weeks after procedure to follow-up. RESULTS: The overall success rate was 88.4% for all procedures. Among different techniques, pneumatic lithotripsy was determined to be most effective procedure with a 96.5% success rate. Complications were post-operative fever in 41 (3.3%), urinary tract infection in 28 (2.3%), mucosal lesions (small) in 52 (4.3%), ureteral perforation in 19 (1.5%), stone migration in 67 (5.5%) and ureteral stricture (late complication) in 16 (1.3%) patients. Ureteral perforations went to open surgery and uretero-ureterostomy was done in two patients for distal localized stricture. CONCLUSIONS: Ureteroscopy has a high success rate with low morbidity tolerable complications. Pneumatic lithotripsy is our treatment of choice with failure rates.
and low
Hospital
Mannheim,
Department
G., Alken P., Michel
of Urology,
Mannheim,
M.S Germany
INTRODUCTION & OBJECTIVES: Flexible ureterorenoscopy is used in minimal invasive endourological procedures for the disintegration and removal of urinary caculi. Working probes inhibit the max. deflection of the scopes and therefore the access to the lower pole might be impossible in patients with steep infundibulopelvinic angles. Furthermore, a high frequence of damage and the consecutive costs limit the spread of the procedure. Recently, a newly developed ureterorenoscope with a semiflexible shaft and a maximized angle of deflection was introduced to overcome these problems. Aim of the study was to compare this new scope with an established device in an in vitro, ex viva and in clinical approach. MATERIAL & METHODS: The new scope (7.5 Fr. tip diameter and 8.4 Fr. shaft, Flex-X, Karl Storz, Germany) was compared to a comparable standard 7.5 Fr. flexible ureterorenoscope. Angles of maximum active deflection and maximum irrigation flow of each scope were measured with an empty working channel and after introduction of 7 different lithotripsy and stone extraction probes. Afterwards, 100 flexible ureterorenoscopies with introduction of a laser fibre and lower pole access were performed in an ex viva pig cadaver model to evaluate the durability of the scopes. Afterwards, the remaining max. deflection and number of broken optic fibres were assessed. The clinical performance was recorded and evaluated in 30 patients for treatment of lower pole stones. RESULTS: Compared to the standard scope, the new semiflexible ureterorenoscope displayed highly improved deflection: deflection angles of up to 270” with empty working channel were achieved. Thin probes such as the nitinol baskets do not largely inhibit maximum deflection. Durability in ex viva trials was high. Only minimal loss of maximal deflection and three optical tibres broken were observed after 100 procedures. The stone free rate in the clinical usage was 96.7% after 4 weeks. With the new scope, in three patients the opening mechanism of a basket did not work with maximal deflection due to high friction. In those patients the stone could be treated by laser lithotripsy. CONCLUSIONS: The new semiflexible ureterorenoscope can facilitate retrograde stone treatment, and might lower repair intervals. Further development of comparable devices will support manifestation of flexible ureterorenoscopy as a standard stone treatment procedure. 012
LOCALIZED PROSTATE CANCER: STAGING Friday, 26 March, 15.45-l 7.15, Hall E2/ Yellow level
IS MRI CANCER
Turkey
INTRODUCTION & OBJECTIVES: Ureteroscopy continues treatment modality for ureteral stones in different localizations. evaluate our experience in ureteroscopy with different conventional rigid ureteroscope.
FOR STONE TREATMENT USING SCOPE - IN VITRO, EX VIVO AND
Knoll T., Haecker A., Trojan L.: Wendt Nordahl
Turkey
INTRODUCTION & OBJECTIVES: Ureterorenoscopy with intracorporeal lithotripsy is accepted to be an efficient method in the surgical treatment of ureteral calculi. In this study, we retrospectively assessed the outcome of ureteral stones treated with ureterorenoscopy; including the long term results.
URETEROSCOPIC MANAGEMENT OF URETERAL DIFFERENT LOCALIZATION: UPDATE STUDY WITH
URETERORENOSCOPY 270” SEMIFLEXIBLE APPLICATION
MANDATORY PATIENTS?
TO
MANAGE
Destafano V., Montoya G., Salomon L., Vordos Chopin D., Abbou C., De la Taille A.
D., Ruiz
CHU
France
Mondor,
Department
of Urology,
Creteil,
548
CLINICALLY
PROSTATE
L., Hoznek,4.,
Yiou R.,
INTRODUCTION & OBJECTIVES: Magnetic resonance imaging (MRI) is suggested as a mandatory preoperative examination to manage clinically localized prostate cancer patients. This study evaluates the diagnostic accuracy of MRI in staging prostate cancer. MATERIAL & METHODS: The authors retrospectively evaluated MRI reports obtained with an endorectal surface coil from 104 consecutive patients with known prostate cancer treated at our institution between January 2001 and 30 June 2003. The MR imaging studies were made by two independent centres by 2 experienced radiologists. MRI results did not change the decision of radical prostatectomy. MRI findings were correlated with the histopathologic results. The sensitivity, specificity, positive and negative predictive values, and accuracy of the MRI to predict established extra capsular extension (ECE) and seminal vesicle invasion (SVI) were calculated. The accuracy to predict the final TNM was also calculated. RESULTS: The sensitivity, specifity, positive and negative predictive values, accuracy to predict established ECE and SVI in clinical stage Tl, T2 patients 37.9%, 76%, 37.9%, 76% and 66.35% for established ECE respectively, 25.0%; 88.6%, 28.6%, 86.7% and 78.8% for SVI respectively. The accuracy MR images to predict the pathological TNM was 23.1%. No difference observed between the 2 centres.
and were and of was
CONCLUSIONS: The sensitivity of this radiological examination seems to be very low in this group of patients. More patients will be reviewed in order to draw conclusion about the indication of MRI in clinically localized prostate cancer patients and further prospective studies are needed to determine the role of endorectal coil MR imaging in the staging of prostate cancer. European
Urology
Supplements
3 (2004)
No. 2, pp. 139
LITHOTRIPSY
IN
Tefekli
A., Erkan
E., Altunrende
O., Muslumanoglu
A.Y.
Haseki
Teaching
and Research
F., Caklr Hospital,
T., Sarilar Department
of Urology,
Istanbul,
546
THE
FLEXIBLE A NEW CLINICAL
University
MATERIAL & METHODS: During a period of 4 years, a total of 257 ureteral calculi in 253 patients (140 men, 113 women) with a mean age of 43.7~tl2.1 (range: 17-73) years were treated with ureteroscopic pneumatic lithotripsy. During the procedures, 10 F and/or 8 F Storz@ semi rigid nreteroscopes were used. For stone fragmentation, Elmed VibrolithB pneumatic lithotriptor were used in addition to 0.8 or 1.2 mm pneumatic lithotripsy probes. Of the stones 189, 37 and 31 were in the distal, mid, and proximal ureter, respectively. The stone sizes ranged from 0.8 to 3.0 (mean: 1.7+0.6) cm. RESULTS: The mean operation time was 28.519.8 (range: 15-60) minutes. Balloon dilatation was necessary in 16 (6.5%) cases. Complete fragmentation was achieved in 168 (66.4%) cases and partial fragmentation in 74 (29.1%) cases. Fragmentation did not occur in the remaining 11 cases (4.5%) with relatively impacted stones, and were referred to open surgery Baskets were used in 103 (40.7%) cases to remove fragments > 3 mm. Proximal migration of small fragments were observed in 25 (9.8%) cases, but successfully retrieved in the majority by intravenous furosemide administration. Ureteral stents were placed overnight in 115 (45.4%) cases while double-J stents were required in 20 (7.9%) patients with solitary kidney and/or elevated serum creatinine level. No stent was used in 132 (52.1%) cases. No ureteral injury or perforation, but minor mucosal lacerations were encountered in 11 (4.3%) cases. In 3 (1 .l%) cases, obstruction due to small fragments left for spontaneous passage occurred in early period postoperatively and re-ureterorenoscopy was needed. Silent obstruction was seen in 2 (0.7%) cases. The overall stone-free rate at 3 months was 93%. CONCLUSIONS: Our results indicate that pneumatic lithotripsy is a highly safe, efficient and cost-effective method in the treatment of ureteral calculi, however, careful postoperative follow up should be done to avoid uncommon complications.
547
Gunlusov Izmir
B., Arslan
Ssk Education
M., Deginnenci Hospital,
T., Nergiz
Urology,
Izmir,
N., Minareci
STONES WITH 1529 CASES
S., Ayder A.R., Cicek
S.
to be an effective In this study, we techniques with
MATERIAL & METHODS: A total of 1529 ureteroscopic procedures were done between May 1992 and April 2003, 1207 of these patients who underwent ureteroscopic lithotripsy were reviewed retrospectively. Median age was 38.2 years (range between 17 - 64). The average stone size was 7.8 mm. (ranging between 3 to 18 mm). At ureteroscopy, the calculi were present in the upper-ureter in 16 (1.3%), mid-ureter in 72 (6%) and lower ureter in 1119 (92.7%) of the patients. In the treatment of stones; electrohydraulic in 25 stones (25%), ultrasonic in 284 stones (23.5%), pulse-dye laser in 292 stones (24.5%) and pneumatic lithotripsy in 606 stones (50%) were used as ureteroscopic procedures. For removal of stones; basket extraction or foreign body forceps were used in combination with lithotripsy techniques. Size and location of the stones, success and complication rates were evaluated. Intravenous urography or renal ultrasonography and direct urinary system graphy were done 6 weeks after procedure to follow-up. RESULTS: The overall success rate was 88.4% for all procedures. Among different techniques, pneumatic lithotripsy was determined to be most effective procedure with a 96.5% success rate. Complications were post-operative fever in 41 (3.3%), urinary tract infection in 28 (2.3%), mucosal lesions (small) in 52 (4.3%), ureteral perforation in 19 (1.5%), stone migration in 67 (5.5%) and ureteral stricture (late complication) in 16 (1.3%) patients. Ureteral perforations went to open surgery and uretero-ureterostomy was done in two patients for distal localized stricture. CONCLUSIONS: Ureteroscopy has a high success rate with low morbidity tolerable complications. Pneumatic lithotripsy is our treatment of choice with failure rates.
and low
Hospital
Mannheim,
Department
G., Alken P., Michel
of Urology,
Mannheim,
M.S Germany
INTRODUCTION & OBJECTIVES: Flexible ureterorenoscopy is used in minimal invasive endourological procedures for the disintegration and removal of urinary caculi. Working probes inhibit the max. deflection of the scopes and therefore the access to the lower pole might be impossible in patients with steep infundibulopelvinic angles. Furthermore, a high frequence of damage and the consecutive costs limit the spread of the procedure. Recently, a newly developed ureterorenoscope with a semiflexible shaft and a maximized angle of deflection was introduced to overcome these problems. Aim of the study was to compare this new scope with an established device in an in vitro, ex viva and in clinical approach. MATERIAL & METHODS: The new scope (7.5 Fr. tip diameter and 8.4 Fr. shaft, Flex-X, Karl Storz, Germany) was compared to a comparable standard 7.5 Fr. flexible ureterorenoscope. Angles of maximum active deflection and maximum irrigation flow of each scope were measured with an empty working channel and after introduction of 7 different lithotripsy and stone extraction probes. Afterwards, 100 flexible ureterorenoscopies with introduction of a laser fibre and lower pole access were performed in an ex viva pig cadaver model to evaluate the durability of the scopes. Afterwards, the remaining max. deflection and number of broken optic fibres were assessed. The clinical performance was recorded and evaluated in 30 patients for treatment of lower pole stones. RESULTS: Compared to the standard scope, the new semiflexible ureterorenoscope displayed highly improved deflection: deflection angles of up to 270” with empty working channel were achieved. Thin probes such as the nitinol baskets do not largely inhibit maximum deflection. Durability in ex viva trials was high. Only minimal loss of maximal deflection and three optical tibres broken were observed after 100 procedures. The stone free rate in the clinical usage was 96.7% after 4 weeks. With the new scope, in three patients the opening mechanism of a basket did not work with maximal deflection due to high friction. In those patients the stone could be treated by laser lithotripsy. CONCLUSIONS: The new semiflexible ureterorenoscope can facilitate retrograde stone treatment, and might lower repair intervals. Further development of comparable devices will support manifestation of flexible ureterorenoscopy as a standard stone treatment procedure. 012
LOCALIZED PROSTATE CANCER: STAGING Friday, 26 March, 15.45-l 7.15, Hall E2/ Yellow level
IS MRI CANCER
Turkey
INTRODUCTION & OBJECTIVES: Ureteroscopy continues treatment modality for ureteral stones in different localizations. evaluate our experience in ureteroscopy with different conventional rigid ureteroscope.
FOR STONE TREATMENT USING SCOPE - IN VITRO, EX VIVO AND
Knoll T., Haecker A., Trojan L.: Wendt Nordahl
Turkey
INTRODUCTION & OBJECTIVES: Ureterorenoscopy with intracorporeal lithotripsy is accepted to be an efficient method in the surgical treatment of ureteral calculi. In this study, we retrospectively assessed the outcome of ureteral stones treated with ureterorenoscopy; including the long term results.
URETEROSCOPIC MANAGEMENT OF URETERAL DIFFERENT LOCALIZATION: UPDATE STUDY WITH
URETERORENOSCOPY 270” SEMIFLEXIBLE APPLICATION
MANDATORY PATIENTS?
TO
MANAGE
Destafano V., Montoya G., Salomon L., Vordos Chopin D., Abbou C., De la Taille A.
D., Ruiz
CHU
France
Mondor,
Department
of Urology,
Creteil,
548
CLINICALLY
PROSTATE
L., Hoznek,4.,
Yiou R.,
INTRODUCTION & OBJECTIVES: Magnetic resonance imaging (MRI) is suggested as a mandatory preoperative examination to manage clinically localized prostate cancer patients. This study evaluates the diagnostic accuracy of MRI in staging prostate cancer. MATERIAL & METHODS: The authors retrospectively evaluated MRI reports obtained with an endorectal surface coil from 104 consecutive patients with known prostate cancer treated at our institution between January 2001 and 30 June 2003. The MR imaging studies were made by two independent centres by 2 experienced radiologists. MRI results did not change the decision of radical prostatectomy. MRI findings were correlated with the histopathologic results. The sensitivity, specificity, positive and negative predictive values, and accuracy of the MRI to predict established extra capsular extension (ECE) and seminal vesicle invasion (SVI) were calculated. The accuracy to predict the final TNM was also calculated. RESULTS: The sensitivity, specifity, positive and negative predictive values, accuracy to predict established ECE and SVI in clinical stage Tl, T2 patients 37.9%, 76%, 37.9%, 76% and 66.35% for established ECE respectively, 25.0%; 88.6%, 28.6%, 86.7% and 78.8% for SVI respectively. The accuracy MR images to predict the pathological TNM was 23.1%. No difference observed between the 2 centres.
and were and of was
CONCLUSIONS: The sensitivity of this radiological examination seems to be very low in this group of patients. More patients will be reviewed in order to draw conclusion about the indication of MRI in clinically localized prostate cancer patients and further prospective studies are needed to determine the role of endorectal coil MR imaging in the staging of prostate cancer. European
Urology
Supplements
3 (2004)
No. 2, pp. 139