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E145 Comparative evaluation of mini-perc versus conventional percutaneous nephrolithotomy in pediatrie renal calculi
friday 9 september 2011 / european urology supplements 10 (2011) 501–525
decrease of urine volume during hot seasons. Increase of DS contributes to decrease of urinary stone risk factors (USRF). But the increase in fluid consumption alone to achieve the increase of DS is not sufficient. That’s why there is a necessity of its additional stimulation. The major available means in most cases are diuretic medicinal plants (MPs). Material and Methods: It has been investigated the ability of the influence of MPs’ infusions to DS and activity of lithogenesis, what has been estimated on the base of crystalluria (CU) degree. During long period in our clinic it has been investigated such MPs as Herniaria glabra (HG), Glycyrrhiza glabra (GG), Hypericum perforatum (HP), Mentha piperita (MPP), Alhagi pseudalhagi (AP), Aerva lanata (AL), Maydis stigmatum (MS), Achillea millefolium (AM), Zizyphus Jujuba (ZJ), Bidens tripartite (BT), Origanum L. (OL), Helichrysum archarium Samarkand (HAS) and Aqua disstillate (AD) as control. Results: It has been revealed that the infusions of MPs have different degree of diuretic effect (DE). Also it has been noticed, that the most significant changes of USRF readings were observed after 30 days of phytotherapy and it was not depend from the degree of DS’ increase. In particularly, MPs with strong DE: AP increased DS for 68.5% and decreased the level of CU for 13.4%, AL for 52.4% and 3.7%, HG for 51.2% and 9.45%, suitably. The infusions with moderate DE: MS increased DS for 42.4% and decreased CU for 7.68%, GG for 40.9% and 5.4%, AM for 34.3% and 6.0%, HP for 31.3% and 1.0%, suitably. And MPs with mild DE: ZJ increased DS for 23.1% and decreased CU for 6.83%, MPP for 19.2% and 0.53%, HAS for 12.9% and 4.65%, BT for 12.4% and 3.15%, OL for 6.6% and 3.13%, and control – AD for 15.4% and 4%, suitably. The results of investigations showed that the infusions of MPs besides DE have the ability to change of crystal formation activity (CFA) in most cases. The different degree of DE depends on the chemical composition of the MPs, i.e. from the contents of biological active substances and their combinations. Perhaps, the observed changes are the result of the effect of chemical contents’ complex of MPs’. Conclusions: So the ability of MPs to change the level of DS and CFA indicates to the necessity of additional investigation of MPs’ effect to other USRF for the effective usage in metaphylaxys of idiopathic calcium UL. 14:00–15:30 Poster session 9: Paediatric stones
Miles Room
E145 Comparative evaluation of mini-perc versus conventional percutaneous nephrolithotomy in pediatric renal calculi O. Tanriverdi1 , M. Kendirci1 , M. Aydin1 , M. Kadihasanoglu1 , K. Sarica2 , C. Miroglu1 . 1 Sisli Etfal Training and Research Hospital, Dept. of 2nd Urology, Istanbul, 2 Yeditepe University Medical School, Dept. of Urology, Istanbul, Turkey Introduction and Objectives: To assess the safety and surgical outcomes of two different percutaneous nephrolithotomy (PNL) procedures (mini-perc versus standard-PNL) in pediatric renal stone. Material and Methods: During a 4-year period, a total of 31 consecutive children with mean age of 10.3 years (range: 3.5 to 16 years) undergoing two different PNL procedures were retrospectively evaluated. Depending on the type of the procedure performed, children were divided as follows: Group 1 (n = 17); undergoing mini-perc procedure and Group 2 (n = 16); undergoing standard-PNL procedure with adult-size instruments. A number of clinical and surgical parameters, including patient demographics, stone profile, success rates in terms of stone-free status, complication rates as well as need for auxiliary procedures were statistically compared between the two groups.
505
Results: A total of 33 primary PNL procedures performed in 31 children were evaluated. Mean age was significantly lower in children undergoing mini-perc procedure (8.7 vs 11.8 years; p < 0.05). In addition, the parameters related to the procedures; such as operation and fluoroscopy times, number of access made, rate for blood transfusion, and mean removal time for nephrostomy catheter were all comparable in both groups. Last but not least, mean duration of hospitalization, stone-free rates at 3-month period, and minor complication rates were similar in both groups. No major complications have been noted either during or after these two different surgical approaches. Conclusions: PNL is a safe management alternative in the complete removal of pediatric renal stones, with satisfactory stone-free rates and minimal complications. Related with the ongoing hesitancy for the use of adult-size equipments in this specific population during PNL procedure; our findings did clearly reveal comparable results in two different approaches where standard and mini-PNL procedures demonstrated the same success as well as complication rates. E146 Role of pneumatic lithotripsy by using ureterscope in paediatric bladder stones: “I will not cut upon stone” L. Ali, N. Orakzai. Institute of Kidney Diseases Hayatabad, Dept. of Urology, Peshawar, Pakistan Introduction and Objectives: Background: Stone formation in urinary bladder is an ancient disease known to the history of man kind as the shadows of bladder stone can be cited in Hippocratic Oath. Bladder stone in children is an endemic problem of developing world. Although there has been tremendous development in endo-urological equipments for management of adult bladder stones but the narrow urethra of a child limits the use of conventional stone punch and lithotrite. So majority of the bladder stones in children are managed as formal vesicolithotomy or percutaneous cystolitholapaxy. The aim of our study is to share our initial experience of an innovative technique by using ureteroscope with pneumatic lithotripsy in children with bladder stone. Objective: To study the efficacy and safety of ureteroscope (URS) with pneumatic lithotripsy in paediatric bladder stone disease in Pakistan. Material and Methods: It is a descriptive study that was conducted in department of Urology (Team ‘C’) at Institute of Kidney Diseases Hayatabad Peshawar from 1st January 2009 till date. Total numbers of 70 children with bladder stones were selected by non probability convenient sampling. Stones in the bladder were fragmented by pneumatic lithotripsy using URS and the larger stone pieces of 5–6 mm were retrieved by graspers. All the pre-operative, per-operative and postoperative data was recorded on structured Proforma and was analyzed on SPSS version 17. Results: The mean age of the patients was 6.5 years (Range 3–12 years). The mean stone size was 12 mm (Range 8–20 mm). 16 (53.3%) patients presented with acute urinary retention, 10 patients with crying for micturation and pulling of their penis, 4 with recurrent febrile urinary tract infection. URS with Pneumatic lithotripsy was successful in all the patients. Mean operative time was 27.3 min (Range 15–40 min) and the mean hospital stay was 1.2 days (Range 1–3 days). All the patients were completely stone free at 3rd Post operative day. Early complications were recorded in 9 patients (13%) that included mild haematuria in 6 patients and febrile UTI in 3 patients. So far no significant late complication like urethral stricture has been recorded in mean follow up of 12 months. Conclusions: Use of URS with pneumatic lithotripsy is minimally invasive, effective and safe modality in management of paediatric bladder stone.
decrease of urine volume during hot seasons. Increase of DS contributes to decrease of urinary stone risk factors (USRF). But the increase in fluid consumption alone to achieve the increase of DS is not sufficient. That’s why there is a necessity of its additional stimulation. The major available means in most cases are diuretic medicinal plants (MPs). Material and Methods: It has been investigated the ability of the influence of MPs’ infusions to DS and activity of lithogenesis, what has been estimated on the base of crystalluria (CU) degree. During long period in our clinic it has been investigated such MPs as Herniaria glabra (HG), Glycyrrhiza glabra (GG), Hypericum perforatum (HP), Mentha piperita (MPP), Alhagi pseudalhagi (AP), Aerva lanata (AL), Maydis stigmatum (MS), Achillea millefolium (AM), Zizyphus Jujuba (ZJ), Bidens tripartite (BT), Origanum L. (OL), Helichrysum archarium Samarkand (HAS) and Aqua disstillate (AD) as control. Results: It has been revealed that the infusions of MPs have different degree of diuretic effect (DE). Also it has been noticed, that the most significant changes of USRF readings were observed after 30 days of phytotherapy and it was not depend from the degree of DS’ increase. In particularly, MPs with strong DE: AP increased DS for 68.5% and decreased the level of CU for 13.4%, AL for 52.4% and 3.7%, HG for 51.2% and 9.45%, suitably. The infusions with moderate DE: MS increased DS for 42.4% and decreased CU for 7.68%, GG for 40.9% and 5.4%, AM for 34.3% and 6.0%, HP for 31.3% and 1.0%, suitably. And MPs with mild DE: ZJ increased DS for 23.1% and decreased CU for 6.83%, MPP for 19.2% and 0.53%, HAS for 12.9% and 4.65%, BT for 12.4% and 3.15%, OL for 6.6% and 3.13%, and control – AD for 15.4% and 4%, suitably. The results of investigations showed that the infusions of MPs besides DE have the ability to change of crystal formation activity (CFA) in most cases. The different degree of DE depends on the chemical composition of the MPs, i.e. from the contents of biological active substances and their combinations. Perhaps, the observed changes are the result of the effect of chemical contents’ complex of MPs’. Conclusions: So the ability of MPs to change the level of DS and CFA indicates to the necessity of additional investigation of MPs’ effect to other USRF for the effective usage in metaphylaxys of idiopathic calcium UL. 14:00–15:30 Poster session 9: Paediatric stones
Miles Room
E145 Comparative evaluation of mini-perc versus conventional percutaneous nephrolithotomy in pediatric renal calculi O. Tanriverdi1 , M. Kendirci1 , M. Aydin1 , M. Kadihasanoglu1 , K. Sarica2 , C. Miroglu1 . 1 Sisli Etfal Training and Research Hospital, Dept. of 2nd Urology, Istanbul, 2 Yeditepe University Medical School, Dept. of Urology, Istanbul, Turkey Introduction and Objectives: To assess the safety and surgical outcomes of two different percutaneous nephrolithotomy (PNL) procedures (mini-perc versus standard-PNL) in pediatric renal stone. Material and Methods: During a 4-year period, a total of 31 consecutive children with mean age of 10.3 years (range: 3.5 to 16 years) undergoing two different PNL procedures were retrospectively evaluated. Depending on the type of the procedure performed, children were divided as follows: Group 1 (n = 17); undergoing mini-perc procedure and Group 2 (n = 16); undergoing standard-PNL procedure with adult-size instruments. A number of clinical and surgical parameters, including patient demographics, stone profile, success rates in terms of stone-free status, complication rates as well as need for auxiliary procedures were statistically compared between the two groups.
505
Results: A total of 33 primary PNL procedures performed in 31 children were evaluated. Mean age was significantly lower in children undergoing mini-perc procedure (8.7 vs 11.8 years; p < 0.05). In addition, the parameters related to the procedures; such as operation and fluoroscopy times, number of access made, rate for blood transfusion, and mean removal time for nephrostomy catheter were all comparable in both groups. Last but not least, mean duration of hospitalization, stone-free rates at 3-month period, and minor complication rates were similar in both groups. No major complications have been noted either during or after these two different surgical approaches. Conclusions: PNL is a safe management alternative in the complete removal of pediatric renal stones, with satisfactory stone-free rates and minimal complications. Related with the ongoing hesitancy for the use of adult-size equipments in this specific population during PNL procedure; our findings did clearly reveal comparable results in two different approaches where standard and mini-PNL procedures demonstrated the same success as well as complication rates. E146 Role of pneumatic lithotripsy by using ureterscope in paediatric bladder stones: “I will not cut upon stone” L. Ali, N. Orakzai. Institute of Kidney Diseases Hayatabad, Dept. of Urology, Peshawar, Pakistan Introduction and Objectives: Background: Stone formation in urinary bladder is an ancient disease known to the history of man kind as the shadows of bladder stone can be cited in Hippocratic Oath. Bladder stone in children is an endemic problem of developing world. Although there has been tremendous development in endo-urological equipments for management of adult bladder stones but the narrow urethra of a child limits the use of conventional stone punch and lithotrite. So majority of the bladder stones in children are managed as formal vesicolithotomy or percutaneous cystolitholapaxy. The aim of our study is to share our initial experience of an innovative technique by using ureteroscope with pneumatic lithotripsy in children with bladder stone. Objective: To study the efficacy and safety of ureteroscope (URS) with pneumatic lithotripsy in paediatric bladder stone disease in Pakistan. Material and Methods: It is a descriptive study that was conducted in department of Urology (Team ‘C’) at Institute of Kidney Diseases Hayatabad Peshawar from 1st January 2009 till date. Total numbers of 70 children with bladder stones were selected by non probability convenient sampling. Stones in the bladder were fragmented by pneumatic lithotripsy using URS and the larger stone pieces of 5–6 mm were retrieved by graspers. All the pre-operative, per-operative and postoperative data was recorded on structured Proforma and was analyzed on SPSS version 17. Results: The mean age of the patients was 6.5 years (Range 3–12 years). The mean stone size was 12 mm (Range 8–20 mm). 16 (53.3%) patients presented with acute urinary retention, 10 patients with crying for micturation and pulling of their penis, 4 with recurrent febrile urinary tract infection. URS with Pneumatic lithotripsy was successful in all the patients. Mean operative time was 27.3 min (Range 15–40 min) and the mean hospital stay was 1.2 days (Range 1–3 days). All the patients were completely stone free at 3rd Post operative day. Early complications were recorded in 9 patients (13%) that included mild haematuria in 6 patients and febrile UTI in 3 patients. So far no significant late complication like urethral stricture has been recorded in mean follow up of 12 months. Conclusions: Use of URS with pneumatic lithotripsy is minimally invasive, effective and safe modality in management of paediatric bladder stone.