- Email: [email protected]
E38 Urinary lithiasis in 2436 functioning kidney transplants: A single-center experience over 33 years
44
THURSDAY 10 SEPTEMBER 2015 / EUROPEAN UROLOGY SUPPLEMENTS 14 (2015) 29–78
of the epidemiology of urinary lithiasis in a health area in the Western hemisphere over the past four decades. Materials and methods: We retrospectively reviewed all of the lithiases analysed in a Spanish health area between 1980 and 2015. The variables collected were the chemical composition of the lithiasis, the date of the analysis, and the sex and age of the patient at the time thereof. The compositions were grouped into seven categories (oxalates, phosphates, uric acid, infectious, cystine, mixed, other), and the dates were grouped into four periods (1980–1989, 1990–1999, 2000–2009, and 2010–2015). Results: A total of 2,704 lithiases were studied (58.7% in men vs. 41.3% in women). The proportion of lithiases in males increased progressively over time (from 51.4% initially up to 60.0% in the last five years, p < 0.001) compared to females (from 48.6% down to 40.0%, p < 0.001). The mean age at diagnosis was 48.32 years (49.37 in men vs. 46.53 in women, p = 0.005). Uric acid lithiases were more frequent in patients with an older mean age, whereas cystine lithiases were more frequent in younger patients (59.01 vs. 34.2 years, respectively, p < 0.001). Also, a significant upward trend in the mean age at diagnosis was observed: 42.0 years in 1980–1989 vs. 46.3 years in 2010–2015 (p = 0.017), always above 40 years. Of all of the lithiases, the most frequent were those composed of oxalates (43.3%), especially calcium oxalate monohydrate (24.9%), followed by uric acid (16.9%) and infectious types (10.7%). The uric acid and oxalate lithiases were more common in men than in women (67.4% vs. 32.6% and 59.1% vs. 40.9%, respectively, p < 0.001). In contrast, the lithiases of infectious origin were more frequent in women than in men (56.3% vs. 43.7%, p < 0.001). Characteristically, it was observed that in males, the proportions of oxalate, uric acid, and mixed calculi have shown tendencies to increase since the decade of the 80s until the last five years. Specifically, oxalate calculi increased from 50.3% to 63.1% (p = 0.037), uric acid calculi from 61.3% to 66.7% (p = 0.100), and mixed calculi from 49.7% to 64.1% (p = 0.004). For its part, the lithiasis of infectious origin decreased from 13.9% in the decade of the 80s to 7.2% in 2000 but rose again to 13.5% over the last five years (p < 0.001). Conclusions: Throughout the time period under study, a trend of increasing oxalic lithiases and decreasing uric acid and phosphate lithiases was observed. Characteristically, an increase of infectious lithiases over the past five years was observed. An upward trend in the age of diagnosis of this pathology is found in our population, as well as an increased proportion of urinary lithiases diagnosed in men. E38 Urinary lithiasis in 2436 functioning kidney transplants: A single-center experience over 33 years Vázquez-Martul Pazos D.1, Lancina Martín J.A.1, Aller-Rodríguez M.1, Fernandez Rivera C.2, López García D.1, Chantada Abal V.1 1A Coruña University Hospital, Dept. of Urology, A Coruña, Spain, 2A Coruña University Hospital, Dept. of Nephrology, A Coruña, Spain Introduction and objectives: Urolithiasis in kidney transplant is an infrequent complication with an incidence around 1-2%; even though it is not extent of complications that may even lead to graft loss. There are few studies published to date reporting short cohorts of cases. Stones in renal graft can appear by de novo formation, or rarely, by direct transference from donor. Transplanted patients present both local and metabolic risk factors that may promote stone formation. Diagnosis is usually confirmed by imaging techniques. The aim of our study is to analyze the characteristics of patients presenting renoureteral stones in kidney functioning graft.
Materials and methods: A retrospective study of at least one-year functioning grafts with diagnosis of urolithiasis was carried out from the total kidney transplants performed in our Institution between January 1981 and December 2014: 2272 deceased-donor and 164 living-donor transplants were found. Transplantation was performed in right or left iliac fossa and extravesical ureteroneocystostomy was done in over 90% of cases with routine use of ureteral stent. We analysed symptoms, time from kidney transplant, risk factors, stone location, size, composition and treatment. Results: 39 (1.6%) patients were found with diagnosis of urolithiasis, 38 had a deceased-donor graft and 1 was a livingdonor kidney transplant: 20 women (51.3%) and 19 men (48.7%) with a mean age of 46 years. Mean time since kidney transplant was 44.9 months. The minimum time of follow-up was 1 year. 25 patients (64.1%) had one or more metabolic risk factors for urolithiasis, 14 patients (35.9%) local risk factors and 4 cases were found to have a donor-transferred stone. Symptoms found at diagnosis were haematuria in 3 patients, oligoanuria in 13, referred pain in 2 and fever in 7; 14 (35.9%) patients were asymptomatic. The mean stone size was 10.8 mm (1.4-24) and the most prevalent composition was uric acid (15) and calcium (13). Stone location was ureteral in 11 cases (28.2%), pyelic in 8 (20.5%) and calyceal in 21 (53.8%). Treatments performed were: External shock-wave lithotripsy in 6 cases, percutaneous nephrolithotomy in 3, endoscopic combined intrarenal surgery in 1, percutaneous nephrostomy and local alkalization in 8, ureteral stenting in 2 and 2 cases were treated with open pyelolithotomy. 5 patients received oral chemolysis treatment and 9 passed stones spontaneously. One case was followed up (cautious observation) and 2 died before any treatment10 (25.6%) patients presented recurrent disease. Conclusions: Urolithiasis is a rare complication in renal transplantation and treatments do not differ so much from those in general population. In our study, stones in kidney grafts have an equitable distribution by sex with an important presence of asymptomatic patients. We observe both a high incidence of uric stones and urolithiasis in inferior calyces.
E39 Current trends in urolithiasis treatment in various European health systems Durner L.1, Bach C.2, El Howairis M.3, Kachrilas S.4, Papatsoris A.5, Hakenberg O.6, Buchholz N.4 1Royal London Hospital, Dept. of Urology, London, United Kingdom, 2Freeman Hospital, Dept. of Urology, Newcastle, United Kingdom, 3Mediclinic City Hospital, Dept. of Urology, Dubai, United Arab Emirates, 4Sobeh’s Vascular and Medical Center, Dept. of Urology, Dubai, United Arab Emirates, 5 Sismanoglio Hospital, Dept. of Urology, Athens, Greece, 6University Hospital Rostock, Dept. of Urology, Rostock, Germany Introduction and objectives: In spite of readily available evidence based guidelines on urolithiasis treatment, practical applications of treatments vary from country to country, or even within countries. The choice of treatment depends not only on the evidence, but often on general non-medical decision factors such as infrastructure, expertise, trends, patient demands, industry drive, and reimbursement levels. In turn, many of these factors are interdependent and a result of the individual national health system. Materials and methods: In an attempt to get a crude picture of trends and practices in stone treatment across Europe, a group of well renowned international experts in the field were asked to reply to a set of standard questions relating to stone treatments,
THURSDAY 10 SEPTEMBER 2015 / EUROPEAN UROLOGY SUPPLEMENTS 14 (2015) 29–78
of the epidemiology of urinary lithiasis in a health area in the Western hemisphere over the past four decades. Materials and methods: We retrospectively reviewed all of the lithiases analysed in a Spanish health area between 1980 and 2015. The variables collected were the chemical composition of the lithiasis, the date of the analysis, and the sex and age of the patient at the time thereof. The compositions were grouped into seven categories (oxalates, phosphates, uric acid, infectious, cystine, mixed, other), and the dates were grouped into four periods (1980–1989, 1990–1999, 2000–2009, and 2010–2015). Results: A total of 2,704 lithiases were studied (58.7% in men vs. 41.3% in women). The proportion of lithiases in males increased progressively over time (from 51.4% initially up to 60.0% in the last five years, p < 0.001) compared to females (from 48.6% down to 40.0%, p < 0.001). The mean age at diagnosis was 48.32 years (49.37 in men vs. 46.53 in women, p = 0.005). Uric acid lithiases were more frequent in patients with an older mean age, whereas cystine lithiases were more frequent in younger patients (59.01 vs. 34.2 years, respectively, p < 0.001). Also, a significant upward trend in the mean age at diagnosis was observed: 42.0 years in 1980–1989 vs. 46.3 years in 2010–2015 (p = 0.017), always above 40 years. Of all of the lithiases, the most frequent were those composed of oxalates (43.3%), especially calcium oxalate monohydrate (24.9%), followed by uric acid (16.9%) and infectious types (10.7%). The uric acid and oxalate lithiases were more common in men than in women (67.4% vs. 32.6% and 59.1% vs. 40.9%, respectively, p < 0.001). In contrast, the lithiases of infectious origin were more frequent in women than in men (56.3% vs. 43.7%, p < 0.001). Characteristically, it was observed that in males, the proportions of oxalate, uric acid, and mixed calculi have shown tendencies to increase since the decade of the 80s until the last five years. Specifically, oxalate calculi increased from 50.3% to 63.1% (p = 0.037), uric acid calculi from 61.3% to 66.7% (p = 0.100), and mixed calculi from 49.7% to 64.1% (p = 0.004). For its part, the lithiasis of infectious origin decreased from 13.9% in the decade of the 80s to 7.2% in 2000 but rose again to 13.5% over the last five years (p < 0.001). Conclusions: Throughout the time period under study, a trend of increasing oxalic lithiases and decreasing uric acid and phosphate lithiases was observed. Characteristically, an increase of infectious lithiases over the past five years was observed. An upward trend in the age of diagnosis of this pathology is found in our population, as well as an increased proportion of urinary lithiases diagnosed in men. E38 Urinary lithiasis in 2436 functioning kidney transplants: A single-center experience over 33 years Vázquez-Martul Pazos D.1, Lancina Martín J.A.1, Aller-Rodríguez M.1, Fernandez Rivera C.2, López García D.1, Chantada Abal V.1 1A Coruña University Hospital, Dept. of Urology, A Coruña, Spain, 2A Coruña University Hospital, Dept. of Nephrology, A Coruña, Spain Introduction and objectives: Urolithiasis in kidney transplant is an infrequent complication with an incidence around 1-2%; even though it is not extent of complications that may even lead to graft loss. There are few studies published to date reporting short cohorts of cases. Stones in renal graft can appear by de novo formation, or rarely, by direct transference from donor. Transplanted patients present both local and metabolic risk factors that may promote stone formation. Diagnosis is usually confirmed by imaging techniques. The aim of our study is to analyze the characteristics of patients presenting renoureteral stones in kidney functioning graft.
Materials and methods: A retrospective study of at least one-year functioning grafts with diagnosis of urolithiasis was carried out from the total kidney transplants performed in our Institution between January 1981 and December 2014: 2272 deceased-donor and 164 living-donor transplants were found. Transplantation was performed in right or left iliac fossa and extravesical ureteroneocystostomy was done in over 90% of cases with routine use of ureteral stent. We analysed symptoms, time from kidney transplant, risk factors, stone location, size, composition and treatment. Results: 39 (1.6%) patients were found with diagnosis of urolithiasis, 38 had a deceased-donor graft and 1 was a livingdonor kidney transplant: 20 women (51.3%) and 19 men (48.7%) with a mean age of 46 years. Mean time since kidney transplant was 44.9 months. The minimum time of follow-up was 1 year. 25 patients (64.1%) had one or more metabolic risk factors for urolithiasis, 14 patients (35.9%) local risk factors and 4 cases were found to have a donor-transferred stone. Symptoms found at diagnosis were haematuria in 3 patients, oligoanuria in 13, referred pain in 2 and fever in 7; 14 (35.9%) patients were asymptomatic. The mean stone size was 10.8 mm (1.4-24) and the most prevalent composition was uric acid (15) and calcium (13). Stone location was ureteral in 11 cases (28.2%), pyelic in 8 (20.5%) and calyceal in 21 (53.8%). Treatments performed were: External shock-wave lithotripsy in 6 cases, percutaneous nephrolithotomy in 3, endoscopic combined intrarenal surgery in 1, percutaneous nephrostomy and local alkalization in 8, ureteral stenting in 2 and 2 cases were treated with open pyelolithotomy. 5 patients received oral chemolysis treatment and 9 passed stones spontaneously. One case was followed up (cautious observation) and 2 died before any treatment10 (25.6%) patients presented recurrent disease. Conclusions: Urolithiasis is a rare complication in renal transplantation and treatments do not differ so much from those in general population. In our study, stones in kidney grafts have an equitable distribution by sex with an important presence of asymptomatic patients. We observe both a high incidence of uric stones and urolithiasis in inferior calyces.
E39 Current trends in urolithiasis treatment in various European health systems Durner L.1, Bach C.2, El Howairis M.3, Kachrilas S.4, Papatsoris A.5, Hakenberg O.6, Buchholz N.4 1Royal London Hospital, Dept. of Urology, London, United Kingdom, 2Freeman Hospital, Dept. of Urology, Newcastle, United Kingdom, 3Mediclinic City Hospital, Dept. of Urology, Dubai, United Arab Emirates, 4Sobeh’s Vascular and Medical Center, Dept. of Urology, Dubai, United Arab Emirates, 5 Sismanoglio Hospital, Dept. of Urology, Athens, Greece, 6University Hospital Rostock, Dept. of Urology, Rostock, Germany Introduction and objectives: In spite of readily available evidence based guidelines on urolithiasis treatment, practical applications of treatments vary from country to country, or even within countries. The choice of treatment depends not only on the evidence, but often on general non-medical decision factors such as infrastructure, expertise, trends, patient demands, industry drive, and reimbursement levels. In turn, many of these factors are interdependent and a result of the individual national health system. Materials and methods: In an attempt to get a crude picture of trends and practices in stone treatment across Europe, a group of well renowned international experts in the field were asked to reply to a set of standard questions relating to stone treatments,