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E28 Transurethral cystolithotripsy with holmium laser under sedoanalgesia with ureteroscope
wednesday 7 september 2011 / european urology supplements 10 (2011) 461–474
II: 45.7±29.9 min.). Re-treatment rate of patients with residual stones were 6/9 in group I and 2/6 in group II (p = 0.04). Overall complication rates were comparable between the groups. Conclusions: URS post failed SWL is safe and effective. In a matched pair control, operating time seems longer in patients post failed SWL and the need for surgical re-treatment is higher. E28 Transurethral cystolithotripsy with holmium laser under sedoanalgesia with ureteroscope H. Uzun1 , Y. Tomak2 , O.U. Zorba1 , H. Bostan2 . 1 Rize School of Medicine, Dept. of Urology, Rize, 2 Rize School of Medicine, Dept. of Anaesthesiology, Rize, Turkey Introduction and Objectives: To present the feasibility and effectiveness of of transurethral holmium:yttrium-aluminumgarnet (YAG) laser cystolithotripsy under sedoanalgesia with a ureteroscope. Ureteroscope has less potential for bleeding and less pain score during cystolithotripsy compared to cystoscopes due to smaller size and spinal anaesthesia is more susceptible to complications compared to sedoanalgesia. Material and Methods: 14 male patients with bladder stones of different etiologies underwent transurethral holmium:YAG cystolithotripsy under sedoanalgesia with a semi-rigid ureteroscope. 0.03 mg/kg midazolam and 7 mg/kg alfentanil and 10 cc intraurethral 2% lodicaine gel was used for local and sedoanalgesia. One patient with a bladder stone of 7 cm turned to open cystolithotomy because of probability of 2–3 hour operation duration due to stone composition. There were 18 stones in other 13 patients with a diameter of 17.6 (12–30) mm. An urethral catheter was placed in all patients. Results: The duration of operation was 21.6 (4–60) minutes depending on stone size and composition. Complete stone clearance was achieved and the whole procedure was well tolerated in all patients with low pain scores. The urethral catheter was removed and all patients were dischaged on the same day. No complication and bleeding was seen in any patient. After a mean follow up of 9 months, no recurrent stone and urethral stricture was developed. Conclusions: Transurethral holmium:YAG cystolithotripsy with ureteroscope is a well tolerated procedure for bladder stones in selected patiens. E29 International cooperation in endourology: Ureteral access sheath utility during flexible ureteroscopy for lower pole kidney stones F. Sanguedolce1 , C. Cracco2 , S. Grande2 , C. Scoffone2 , P. Kallidonis3 , E. Liatsikos3 , R. Sabockis4 , M. Brehmer4 , J. Jessen5 , T. Knoll5 , M. Franke6 , P.J.S. Osther6 , O. Traxer7 , T. Hermann8 , A. Merseburger8 , U. Nagele9 , F. Millan1 , A. Breda1 . 1 Autonoma University, Fundacion Puigvert, Dept. of Urology, Barcelona, Spain; 2 San Luigi Hospital, Dept. of Urology, Turin, Italy; 3 Patras University, Dept. of Urology, Patras, Greece; 4 Karolinska University Hospital, Dept. of Urology, Stockholm, Sweden; 5 Klinikum Sindelfingen-Boblingen, University of Tuebingen, Dept. of Urology, Tuebingen, Germany; 6 Fredericia Hospital, University of Southern Denmark, Dept. of Urology, Fredericia, Denmark; 7 Tenon Hospital, 6th University of Paris, Dept. of Urology, Paris, France; 8 Medical School of Hannover, Dept. of Urology, Hannover, Germany; 9 General Hospital Hall in Tyrol, Dept. of Urology, Tyrol, Austria Introduction and Objectives: Flexible ureteroscopy for the treatment of renal stone disease is slowly entering into the realm of the urologists. New technology has led to the development of new generation ureteroscopes as well as new devices to facilitate flexible ureteroscopy. Among these, ureteral access sheaths (UAS) have been popularized and studies have
471
shown their utility in facilitating ureteroscopic access and lowering intrarenal pressures. However there have been some criticisms on the risk of complications specifically related to their use, including ureteral perforation and development of ureteral strictures. Furthermore, few data is available on stone free rate with their use. We herein present the results from a homogeneous series of flexible ureteroscopies for the treatment of lower pole kidney stones. Materials and Methods: A database was created and the centers retrospectively entered their data related to flexible ureteroscopic management of lower pole kidney stones. Patients included were treated between January 2005 and January 2010. Variables analyzed included case load number, stone burden, UAS use, visual clarity, operative time, stone free rate, complication rate and follow-up time. Stone free rate was defined as no residual fragments, or single fragment <2 mm in size at follow-up imaging. Results: 140 patients met the criteria for inclusion. The mean stone burden was 0.56±1.05 cm2 as documented by preoperative CT scan. There were 66 cases (47%) performed with the help of a UAS and 74 cases without (53%). Inner access sheath diameter was equally divided between 9.5 Fr and 12 or 13 Fr (50 and 50% of the cases). UAS length was 35 cm, 45 cm and 55 cm in 55%, 45% and 5% of the cases respectively. Mean stone burden was 0.75±0.78 cm2 and 0.66±1.12 cm2 for UAS and no UAS group respectively (p = 0.2). Holmium laser was used in 97% of the cases. Stone free rate after a single treatment was 85% and 71% for UAS vs. no UAS group, respectively (p = 0.07). Mean operative time was 65.03±38 and 65.24±40 minutes for UAS and no UAS groups, respectively (p = 0.2). Subjective visual clarity was defined as good in 84% and 72% of the UAS and no UAS groups, respectively (p = 0.09). There was 1 major complications (0.7%) for both groups (ureteral perforation) (p = 0.9), however no ureteral stricture was reported in the postoperative period with a mean follow-up of 25 months. Conclusions: The data highlight that the use of ureteral access sheath is not associated with an increased risk of intra and postoperative ureteral complications. Furthermore, although statistical significance was not reached, the use of UAS appears to be associated with higher stone free rate and better visualization when treating lower pole kidney stones. E30 Hemorrhagic complications after flexible URS – a rare but severe circumstance – retrospective multicenter analysis G. Raynal1 , V. Estrade2 , K. Bensalah3 , E. Chabannes4 , E. Lechevallier5 , A. Thomas1 , O. Traxer1 . 1 Tenon Hospital, Dept. of Urology, Paris, 2 General Hospital, Dept. of Urology, Angoulˆeme, 3 CHU, Dept. of Urology, Rennes, 4 CHU, Dept. of Urology, Besancon, ¸ 5 APHM, Dept. of Urology, Marseille, France Introduction and Objectives: Retrograde intra-renal surgery is now a standard approach for the treatment of renal stones. Although its morbidity seems very low, there is few specifical data upon hemorragic complications. The aim of this study is to collect data on hemorragic complications after retrograde intra renal surgery. Material and Methods: We reviewed files from patients with hemorragic complication after retrograde intra-renal surgery and collected data such as operative indication and duration, consequences, and existence of a blood coagulation disorder. Results: From 2001 to 2009, more than 2000 RIRS were performed in our 5 centers. We found 13 cases (frequency <0.65%) of hemorragic complication listed as follows: 1 subcapsular hematoma, 5 retroperitoneal hematomas and 7 upper urinary tract clotting. Diagnosis was made before the third post-operative day in 6 patients and within the month for the rest. As a consequence, nephrectomy was performed in
II: 45.7±29.9 min.). Re-treatment rate of patients with residual stones were 6/9 in group I and 2/6 in group II (p = 0.04). Overall complication rates were comparable between the groups. Conclusions: URS post failed SWL is safe and effective. In a matched pair control, operating time seems longer in patients post failed SWL and the need for surgical re-treatment is higher. E28 Transurethral cystolithotripsy with holmium laser under sedoanalgesia with ureteroscope H. Uzun1 , Y. Tomak2 , O.U. Zorba1 , H. Bostan2 . 1 Rize School of Medicine, Dept. of Urology, Rize, 2 Rize School of Medicine, Dept. of Anaesthesiology, Rize, Turkey Introduction and Objectives: To present the feasibility and effectiveness of of transurethral holmium:yttrium-aluminumgarnet (YAG) laser cystolithotripsy under sedoanalgesia with a ureteroscope. Ureteroscope has less potential for bleeding and less pain score during cystolithotripsy compared to cystoscopes due to smaller size and spinal anaesthesia is more susceptible to complications compared to sedoanalgesia. Material and Methods: 14 male patients with bladder stones of different etiologies underwent transurethral holmium:YAG cystolithotripsy under sedoanalgesia with a semi-rigid ureteroscope. 0.03 mg/kg midazolam and 7 mg/kg alfentanil and 10 cc intraurethral 2% lodicaine gel was used for local and sedoanalgesia. One patient with a bladder stone of 7 cm turned to open cystolithotomy because of probability of 2–3 hour operation duration due to stone composition. There were 18 stones in other 13 patients with a diameter of 17.6 (12–30) mm. An urethral catheter was placed in all patients. Results: The duration of operation was 21.6 (4–60) minutes depending on stone size and composition. Complete stone clearance was achieved and the whole procedure was well tolerated in all patients with low pain scores. The urethral catheter was removed and all patients were dischaged on the same day. No complication and bleeding was seen in any patient. After a mean follow up of 9 months, no recurrent stone and urethral stricture was developed. Conclusions: Transurethral holmium:YAG cystolithotripsy with ureteroscope is a well tolerated procedure for bladder stones in selected patiens. E29 International cooperation in endourology: Ureteral access sheath utility during flexible ureteroscopy for lower pole kidney stones F. Sanguedolce1 , C. Cracco2 , S. Grande2 , C. Scoffone2 , P. Kallidonis3 , E. Liatsikos3 , R. Sabockis4 , M. Brehmer4 , J. Jessen5 , T. Knoll5 , M. Franke6 , P.J.S. Osther6 , O. Traxer7 , T. Hermann8 , A. Merseburger8 , U. Nagele9 , F. Millan1 , A. Breda1 . 1 Autonoma University, Fundacion Puigvert, Dept. of Urology, Barcelona, Spain; 2 San Luigi Hospital, Dept. of Urology, Turin, Italy; 3 Patras University, Dept. of Urology, Patras, Greece; 4 Karolinska University Hospital, Dept. of Urology, Stockholm, Sweden; 5 Klinikum Sindelfingen-Boblingen, University of Tuebingen, Dept. of Urology, Tuebingen, Germany; 6 Fredericia Hospital, University of Southern Denmark, Dept. of Urology, Fredericia, Denmark; 7 Tenon Hospital, 6th University of Paris, Dept. of Urology, Paris, France; 8 Medical School of Hannover, Dept. of Urology, Hannover, Germany; 9 General Hospital Hall in Tyrol, Dept. of Urology, Tyrol, Austria Introduction and Objectives: Flexible ureteroscopy for the treatment of renal stone disease is slowly entering into the realm of the urologists. New technology has led to the development of new generation ureteroscopes as well as new devices to facilitate flexible ureteroscopy. Among these, ureteral access sheaths (UAS) have been popularized and studies have
471
shown their utility in facilitating ureteroscopic access and lowering intrarenal pressures. However there have been some criticisms on the risk of complications specifically related to their use, including ureteral perforation and development of ureteral strictures. Furthermore, few data is available on stone free rate with their use. We herein present the results from a homogeneous series of flexible ureteroscopies for the treatment of lower pole kidney stones. Materials and Methods: A database was created and the centers retrospectively entered their data related to flexible ureteroscopic management of lower pole kidney stones. Patients included were treated between January 2005 and January 2010. Variables analyzed included case load number, stone burden, UAS use, visual clarity, operative time, stone free rate, complication rate and follow-up time. Stone free rate was defined as no residual fragments, or single fragment <2 mm in size at follow-up imaging. Results: 140 patients met the criteria for inclusion. The mean stone burden was 0.56±1.05 cm2 as documented by preoperative CT scan. There were 66 cases (47%) performed with the help of a UAS and 74 cases without (53%). Inner access sheath diameter was equally divided between 9.5 Fr and 12 or 13 Fr (50 and 50% of the cases). UAS length was 35 cm, 45 cm and 55 cm in 55%, 45% and 5% of the cases respectively. Mean stone burden was 0.75±0.78 cm2 and 0.66±1.12 cm2 for UAS and no UAS group respectively (p = 0.2). Holmium laser was used in 97% of the cases. Stone free rate after a single treatment was 85% and 71% for UAS vs. no UAS group, respectively (p = 0.07). Mean operative time was 65.03±38 and 65.24±40 minutes for UAS and no UAS groups, respectively (p = 0.2). Subjective visual clarity was defined as good in 84% and 72% of the UAS and no UAS groups, respectively (p = 0.09). There was 1 major complications (0.7%) for both groups (ureteral perforation) (p = 0.9), however no ureteral stricture was reported in the postoperative period with a mean follow-up of 25 months. Conclusions: The data highlight that the use of ureteral access sheath is not associated with an increased risk of intra and postoperative ureteral complications. Furthermore, although statistical significance was not reached, the use of UAS appears to be associated with higher stone free rate and better visualization when treating lower pole kidney stones. E30 Hemorrhagic complications after flexible URS – a rare but severe circumstance – retrospective multicenter analysis G. Raynal1 , V. Estrade2 , K. Bensalah3 , E. Chabannes4 , E. Lechevallier5 , A. Thomas1 , O. Traxer1 . 1 Tenon Hospital, Dept. of Urology, Paris, 2 General Hospital, Dept. of Urology, Angoulˆeme, 3 CHU, Dept. of Urology, Rennes, 4 CHU, Dept. of Urology, Besancon, ¸ 5 APHM, Dept. of Urology, Marseille, France Introduction and Objectives: Retrograde intra-renal surgery is now a standard approach for the treatment of renal stones. Although its morbidity seems very low, there is few specifical data upon hemorragic complications. The aim of this study is to collect data on hemorragic complications after retrograde intra renal surgery. Material and Methods: We reviewed files from patients with hemorragic complication after retrograde intra-renal surgery and collected data such as operative indication and duration, consequences, and existence of a blood coagulation disorder. Results: From 2001 to 2009, more than 2000 RIRS were performed in our 5 centers. We found 13 cases (frequency <0.65%) of hemorragic complication listed as follows: 1 subcapsular hematoma, 5 retroperitoneal hematomas and 7 upper urinary tract clotting. Diagnosis was made before the third post-operative day in 6 patients and within the month for the rest. As a consequence, nephrectomy was performed in