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C163 PCNL IN SUPINE POSITION
were statistically significant older (56 vs 48,6 years) and treated with higher number of shock waves (3010 vs 2050). Functional defects occured in 19 out of 45 (42 %) patients with calyceal lithiasis and in 8 out of 22 (36 %) cases of pelvical stones. There were statistically significant changes in split function of the treated kidney from 49.9 +/- 6.3% to 46.6 +/- 8.2 % (p = 0.003), effective renal plasma flow from 166 +/- 43 to 155+/- 51 ml/min/m2 (p = 0.049), parenchymal transit time (PTT) from 134 +/- 28 to 168 +/- 84 s (p = 0.02) and mean transit time (MTT) from 192 +/- 79 to 234 +/-106 s, before and 7 days after ESWL. All parameters mentioned above did not differ significantly from the initial values at one month follow-up. Conclusions: Extracorporeal shock wave lithotripsy caused transient detorioration of regional renal function in 40 % of treated patients. The probablility of functional defects increased with patient age and the number of shock waves delivered during procedure.
C163
PCNL in supine position
Vavic B.V., Aleksic D.J.A., Milosevic A.M., Patrnogic S.P. Clinical Center Zvezdara, Dept. of Urology, Belgrade, Serbia Introduction & Objectives: PCNL is usually performed in the prone or lithotomy position. These positions can lead to dificultiesin intubation of the patient. Stent placement must be done in supine position. After that patient must turn to prone or lythotomy position. This can be avoided if the intervention works in the supine position. Material & Methods: The patients previously placed in standing position and marking the last axilary line to below the twelfth rib and iliac crest, and then at right angles mark the two lines. The line in the pojection of the twelfth rib and the projection of lines in iliac crest. Puncture site is located between these 2 lines. Puntion was performed under the control of the ultrasound through the minimum skin incision. After placing the guide wire, dilatation of percutaneous working channel was performed by balloon which is under presure to 18 mm Hg. Amplatz Ch 28 was placed, and through him nephroscop which we performe balistic lithotripsion with pneumatic lithotriptor. Results: The first patient was 50 years o;d who undergone several ESWL. X ray film show five stones of 5 to8 mmand one of 10mm. Another patient was 30 years old. Pyelolithotomy done twiceand ESWL under protection of JJ stent several times. X ray show stone 40x20 mm and incrustation JJ stent which could not be extracted. Fragmented stones were extracted in both of patient by forceps. Nephrostome catheter was extracted after 24 hours. Intervention lasted approximatelz 50 minutes. We had no complications exept for minor bleeding that wes intercepted by short term occlusion nefrostome. Conclusions: Th adventage of PCNL in supine position are easier intrduction to anethesia (no problems with intubation of patient, without rotation of the head), the possibility of using retrograde (ureterorenoscopy) and antegrade method (nephroscopy), which is better and easier to do disintegration and extraction of stones.
C164
Outcomes of percutaneous nephrolithotomy treatment in patients with solitary kidney: A single center experience
Akman T., Binbay M., Tekinarslan E., Kezer C., Berberoglu Y., Baykal M., Muslumanoglu A.Y. Haseki Training and Research Hospital, Dept. of Urology, Istanbul, Turkey Introduction & Objectives: The aim of the present study was to evaluate outcome of percutaneous nephrolithotomy (PCNL) in the patients with solitary kidney Material & Methods: Between 2002 and 2009, 47 patients with a solitary kidney, which was congenital in 10 patients (21.3%), contralateral nephrectomy in 22 (46.8%), non functional kidney in 15 (31.9%). underwent PCNL. Serum creatinine was measured preoperatively, at discharge and on every follow-up visit. The 4-variable modification of diet in renal disease equation was used to calculate estimated glomerular filtration rate (eGFR). The 5-stage classification of chronic kidney disease was used according to the National Kidney Foundation published guidelines. Fourty-four of 47 patients were followed least 6 months but three patients were lost to follow-up. Results: Success was achieved in 84.1% (37/44) of patients after one session PCNL. Complete or partial staghorn stones were detected in 12 (27.27%) patients. Of the patients 23.4% (n: 11) required multiple accesses. Overall complications developed in 5(10.6%) patients. As auxiliary treatment alternatives, ESWL was performed all of patients with rest calculi. At a mean follow-up time of 18.7±11.8 (6- 60) months, the overall success rate improved to 97.4%. eGFR was 76.4±27.1, 73.4±26.1, 83.5±29.4 ml per minute per 1.73 m2 at preoperative period, immediately postoperatively, at last follow up (> 6 months), respectively, (p< 0.001). CKD classification was stable, improved and worse in 63.6% (n: 28), 29.5% (n: 13) and 6.8% (n: 3) of patients, respectively. Conclusions: PCNL is safe with an acceptably low complication rate in patients with solitary kidney. The renal function of 93.2% of the patients improved or stabilized after PCNL at long term follow up.
Eur Urol Suppl 2010;9(6):660
C165
Tubeless procedure is most important factor in reducing length of hospitalization after percutaneous nephrolithotomy: Results of univariable and multivariable models
Akman T., Binbay M., Yuruk E., Sari E., Seyrek M., Kezer C., Berberoglu Y., Muslumanoglu A.Y. Haseki Training and Research Hospital, Dept. of Urology, Istanbul, Turkey Introduction & Objectives: Recently, increases in healthcare costs have highlighted the importance of evaluating the cost-effectiveness of a treatment as much as its efficacy. The aim of the present study was to evaluate the effects of kidney stones and patient-related parameters on the length of hospitalization(LOH), which is one important factor affecting the cost effectiveness of percutaneous nephrolithotomy(PCNL). Material & Methods: During an eight-year period, the records of 1669 patients with renal calculi who underwent PCNL were reviewed retrospectively. Eleven patients with urosepsis were excluded from present study. A total of 1658 patients were categorized into two groups (group 1= ≤ 2 two days; group 2= >two days) according to the median LOH (median= two days). Multivariate binary logistic regression analysis was used to detect the effects of independent variables, including the patient age, gender, body mass index, history of ESWL or open surgery, stone size and opacity, presence of hydronephrosis and localization and number of accesses, on the LOH after PNL. Results: Overall success was achieved in 86.2% of cases after one session of PCNL. The mean length of hospitalization was 2.89±1.66 (range: 1-21) days. According to the outcome of the multivariate analysis, diabetes (p=0.0001, OR=1.67), impaired kidney function (p=0.03, OR=1.64), stone size (p=0.031, OR=1.31), number of accesses (p=0.001, OR=1.59), intercostal access (p=0.001, OR=1.79) and tubeless procedure (p=0.0001, OR=0.23) were variables influencing LOH. Conclusions: The presence of diabetes, a large stone burden, intercostals access, multiple accesses and impaired kidney function prolong the LOH after PCNL. The use of the tubeless procedure was able to diminish the LOH.
C166
Endovascular control of hemorrhagic complication associated with percutaneous nephrolithotomy
Ambert A.1, Braticevici B.1, Jinga V.1, Diaconescu D.S.2, Popescu M.C.1, Calin C.1, Petca R.1, Hainagiu L.1, Salaheddyn Y.1, Dorobat B.3 1 Prof Dr Th BurgheleHospital, Dept. of Urology, Bucharest, Romania, 2Prof Dr Th Burghele Hospital, Dept. of Urology, Bucharest, Romania, 3University Emergency Hospital Bucharest, Dept. of Interventional Radiology, Bucharest, Romania Introduction & Objectives: The aim of this study is to identify the efficacy of renal arteriography with or without selective embolisation in control of hemorrhagic complication post PCNL. Material & Methods: This retrospective study has been developed between July 2007 and June 2010 in the Urology Departament of “Prof Th Burghele” Hospital on 1132 patients with pelvicalyceal lithiasis. A total of 142 hemorrhagic complications were observed. Ten patients underwent endovascular control of bleeding. Analysed parameters were: time until embolisation, requirement of blood transfusion, the status after embolisation. Results: Tubeless PCNL was performed on 7 patients. The acces was made by postero-inferior calyx. The medium number of pre-embolisation transfusions was 2.9 units (range 2 to 5 units) and the medium decrease of hemoglobin was 4,7g/dl. The embolisation agents included coils (n = 7) and Gelaspon particles (n = 1). Conclusions: Selective renal angiography with embolisation is an effective method for managing hemorrhagic complication post PCNL. This also helps in shortening the overall treatment duration and leads to significant savings as compared to the cost of other modalities, optimizes the chances for the problem to be managed safely, promptly and economically.
C167
Management of hemorrhagic complications associated with percutaneous nephrolithotomy
Ambert V., Braticevici B., Jinga V., Petca R.C., Sallahedin Y., Diaconescu D., Hainagiu L., Calin C., Bengus F. Prof. Dr. Th. Burghele Clinical Hospital, Dept. of Urology, Bucharest, Romania Introduction & Objectives: To report the hemorrhagic complications associated with percutaneous nephrolithotomy (PCNL) and review the necessary therapeutic interventions. Material & Methods: A total of 1132 PCNLs were performed in our clinic in three years (july 2007 – june 2010) and charts were retrospectively reviewed focusing on hemorrhagic complications observed. PCNL was performed in 520 cases (45.93%), ureteroscopy followed by PCNL in 135 cases (11.92%) and tubeless PCNL in 477 cases (42.13%). Results: A total of 393 complications were observed in 346 (30.56%) patients. Hemorrhagic complications were present at 142 patients (12.54%) and were
C163
PCNL in supine position
Vavic B.V., Aleksic D.J.A., Milosevic A.M., Patrnogic S.P. Clinical Center Zvezdara, Dept. of Urology, Belgrade, Serbia Introduction & Objectives: PCNL is usually performed in the prone or lithotomy position. These positions can lead to dificultiesin intubation of the patient. Stent placement must be done in supine position. After that patient must turn to prone or lythotomy position. This can be avoided if the intervention works in the supine position. Material & Methods: The patients previously placed in standing position and marking the last axilary line to below the twelfth rib and iliac crest, and then at right angles mark the two lines. The line in the pojection of the twelfth rib and the projection of lines in iliac crest. Puncture site is located between these 2 lines. Puntion was performed under the control of the ultrasound through the minimum skin incision. After placing the guide wire, dilatation of percutaneous working channel was performed by balloon which is under presure to 18 mm Hg. Amplatz Ch 28 was placed, and through him nephroscop which we performe balistic lithotripsion with pneumatic lithotriptor. Results: The first patient was 50 years o;d who undergone several ESWL. X ray film show five stones of 5 to8 mmand one of 10mm. Another patient was 30 years old. Pyelolithotomy done twiceand ESWL under protection of JJ stent several times. X ray show stone 40x20 mm and incrustation JJ stent which could not be extracted. Fragmented stones were extracted in both of patient by forceps. Nephrostome catheter was extracted after 24 hours. Intervention lasted approximatelz 50 minutes. We had no complications exept for minor bleeding that wes intercepted by short term occlusion nefrostome. Conclusions: Th adventage of PCNL in supine position are easier intrduction to anethesia (no problems with intubation of patient, without rotation of the head), the possibility of using retrograde (ureterorenoscopy) and antegrade method (nephroscopy), which is better and easier to do disintegration and extraction of stones.
C164
Outcomes of percutaneous nephrolithotomy treatment in patients with solitary kidney: A single center experience
Akman T., Binbay M., Tekinarslan E., Kezer C., Berberoglu Y., Baykal M., Muslumanoglu A.Y. Haseki Training and Research Hospital, Dept. of Urology, Istanbul, Turkey Introduction & Objectives: The aim of the present study was to evaluate outcome of percutaneous nephrolithotomy (PCNL) in the patients with solitary kidney Material & Methods: Between 2002 and 2009, 47 patients with a solitary kidney, which was congenital in 10 patients (21.3%), contralateral nephrectomy in 22 (46.8%), non functional kidney in 15 (31.9%). underwent PCNL. Serum creatinine was measured preoperatively, at discharge and on every follow-up visit. The 4-variable modification of diet in renal disease equation was used to calculate estimated glomerular filtration rate (eGFR). The 5-stage classification of chronic kidney disease was used according to the National Kidney Foundation published guidelines. Fourty-four of 47 patients were followed least 6 months but three patients were lost to follow-up. Results: Success was achieved in 84.1% (37/44) of patients after one session PCNL. Complete or partial staghorn stones were detected in 12 (27.27%) patients. Of the patients 23.4% (n: 11) required multiple accesses. Overall complications developed in 5(10.6%) patients. As auxiliary treatment alternatives, ESWL was performed all of patients with rest calculi. At a mean follow-up time of 18.7±11.8 (6- 60) months, the overall success rate improved to 97.4%. eGFR was 76.4±27.1, 73.4±26.1, 83.5±29.4 ml per minute per 1.73 m2 at preoperative period, immediately postoperatively, at last follow up (> 6 months), respectively, (p< 0.001). CKD classification was stable, improved and worse in 63.6% (n: 28), 29.5% (n: 13) and 6.8% (n: 3) of patients, respectively. Conclusions: PCNL is safe with an acceptably low complication rate in patients with solitary kidney. The renal function of 93.2% of the patients improved or stabilized after PCNL at long term follow up.
Eur Urol Suppl 2010;9(6):660
C165
Tubeless procedure is most important factor in reducing length of hospitalization after percutaneous nephrolithotomy: Results of univariable and multivariable models
Akman T., Binbay M., Yuruk E., Sari E., Seyrek M., Kezer C., Berberoglu Y., Muslumanoglu A.Y. Haseki Training and Research Hospital, Dept. of Urology, Istanbul, Turkey Introduction & Objectives: Recently, increases in healthcare costs have highlighted the importance of evaluating the cost-effectiveness of a treatment as much as its efficacy. The aim of the present study was to evaluate the effects of kidney stones and patient-related parameters on the length of hospitalization(LOH), which is one important factor affecting the cost effectiveness of percutaneous nephrolithotomy(PCNL). Material & Methods: During an eight-year period, the records of 1669 patients with renal calculi who underwent PCNL were reviewed retrospectively. Eleven patients with urosepsis were excluded from present study. A total of 1658 patients were categorized into two groups (group 1= ≤ 2 two days; group 2= >two days) according to the median LOH (median= two days). Multivariate binary logistic regression analysis was used to detect the effects of independent variables, including the patient age, gender, body mass index, history of ESWL or open surgery, stone size and opacity, presence of hydronephrosis and localization and number of accesses, on the LOH after PNL. Results: Overall success was achieved in 86.2% of cases after one session of PCNL. The mean length of hospitalization was 2.89±1.66 (range: 1-21) days. According to the outcome of the multivariate analysis, diabetes (p=0.0001, OR=1.67), impaired kidney function (p=0.03, OR=1.64), stone size (p=0.031, OR=1.31), number of accesses (p=0.001, OR=1.59), intercostal access (p=0.001, OR=1.79) and tubeless procedure (p=0.0001, OR=0.23) were variables influencing LOH. Conclusions: The presence of diabetes, a large stone burden, intercostals access, multiple accesses and impaired kidney function prolong the LOH after PCNL. The use of the tubeless procedure was able to diminish the LOH.
C166
Endovascular control of hemorrhagic complication associated with percutaneous nephrolithotomy
Ambert A.1, Braticevici B.1, Jinga V.1, Diaconescu D.S.2, Popescu M.C.1, Calin C.1, Petca R.1, Hainagiu L.1, Salaheddyn Y.1, Dorobat B.3 1 Prof Dr Th BurgheleHospital, Dept. of Urology, Bucharest, Romania, 2Prof Dr Th Burghele Hospital, Dept. of Urology, Bucharest, Romania, 3University Emergency Hospital Bucharest, Dept. of Interventional Radiology, Bucharest, Romania Introduction & Objectives: The aim of this study is to identify the efficacy of renal arteriography with or without selective embolisation in control of hemorrhagic complication post PCNL. Material & Methods: This retrospective study has been developed between July 2007 and June 2010 in the Urology Departament of “Prof Th Burghele” Hospital on 1132 patients with pelvicalyceal lithiasis. A total of 142 hemorrhagic complications were observed. Ten patients underwent endovascular control of bleeding. Analysed parameters were: time until embolisation, requirement of blood transfusion, the status after embolisation. Results: Tubeless PCNL was performed on 7 patients. The acces was made by postero-inferior calyx. The medium number of pre-embolisation transfusions was 2.9 units (range 2 to 5 units) and the medium decrease of hemoglobin was 4,7g/dl. The embolisation agents included coils (n = 7) and Gelaspon particles (n = 1). Conclusions: Selective renal angiography with embolisation is an effective method for managing hemorrhagic complication post PCNL. This also helps in shortening the overall treatment duration and leads to significant savings as compared to the cost of other modalities, optimizes the chances for the problem to be managed safely, promptly and economically.
C167
Management of hemorrhagic complications associated with percutaneous nephrolithotomy
Ambert V., Braticevici B., Jinga V., Petca R.C., Sallahedin Y., Diaconescu D., Hainagiu L., Calin C., Bengus F. Prof. Dr. Th. Burghele Clinical Hospital, Dept. of Urology, Bucharest, Romania Introduction & Objectives: To report the hemorrhagic complications associated with percutaneous nephrolithotomy (PCNL) and review the necessary therapeutic interventions. Material & Methods: A total of 1132 PCNLs were performed in our clinic in three years (july 2007 – june 2010) and charts were retrospectively reviewed focusing on hemorrhagic complications observed. PCNL was performed in 520 cases (45.93%), ureteroscopy followed by PCNL in 135 cases (11.92%) and tubeless PCNL in 477 cases (42.13%). Results: A total of 393 complications were observed in 346 (30.56%) patients. Hemorrhagic complications were present at 142 patients (12.54%) and were