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E41 Effectiveness of NTrap in ureteroscopic Ho: YAG laser lithotripsy for upper ureteral calculi
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thursday 5 september 2013 / european urology supplements 12 (2013) 29–68
laser lithotripsy and operational parameters were compared in-between. Results: Neither group had obvious complications. There were no differences in operation time (P > 0.05), intraoperative success rate (100%, respectively), postoperative stone-free rate (P > 0.05) between the 2 groups. Conclusions: This new device (Innovex) is clinically parallel to the effectiveness and safety of NTrap while costing merely the half and is clinically valid for extensive use. However more investigations were warranted to confirm the efficacy and to contribute to device modification. E41 Effectiveness of NTrap in ureteroscopic Ho:YAG laser lithotripsy for upper ureteral calculi Z. Wu, C. Feng, H. Jiang, P. Gao, L. Wang, Q. Ding. Huashan Hospital Affiliated To Fudan University, Dept. of Urology, Shanghai, China Introduction & Objectives: To evaluate the effectiveness and safety of NTrap against stone retropulsion in ureteroscopic Ho:YAG laser lithotripsy for upper ureteral stones. Material & Methods: A total of 398 patients with upper ureteral calculi were stratified into 2 groups. Group 1 included 200 patients without NTrap use and Group 2 included 198 patients with NTrap use. All subjects were treated with ureteroscopic Ho:YAG laser lithotripsy. General and operation related parameters of both groups were statistically analyzed. Results: There was insignificant difference in patient age, gender and stone size between both groups. Group 2 showed a significantly higher intraoperative success rate (100% vs 72.0%, P < 0.001) and a lower stone retropulsion rate (0% vs 28.0%, P < 0.0001) compared with Group 1. The clearance rate was significantly higher in Group 2 than in Group 1 (96.5% vs 86.0%, P < 0.05). No major complications such as perforations or ureteral avulsions were encountered during the procedures. Conclusions: NTrap is an effective and safe device in prevention of stone retropulsion during ureteroscopic Ho:YAG laser lithotripsy. E42 Complication rate on URS and lithotripsy in upper part of ureter A. Gaizauskas. Republic Vilnius University Hospital, Dept. of Urology, Vilnius, Lithuania Introduction & Objectives: Ureteral stone management is a revelant question in everyday urological practice. Nowadays we have a big range of options how to treat patients with ureteral stones. Endoscopic equipment and accessories become better and better and it helps achieve good succsess in removing stones from ureter. But upper part ureter stone treatment can still be a big challenge. Stone free rate after URS in upper part of ureter is similar as in lower part, but complication rate is higher. Material & Methods: We registered and treated all upper part URS with laser lithotripsy complications in period from May 2011 to April 2013. In this period we performed 26 upper part ureteroscopies for stones in upper part of ureter. Stone range was from 5 to 13 mm in the greatest diameter. All patients were stented after procedure. Stent was removed 2 weeks after operation. Control sonoscopies were performed 1 and 3 months after ureteroscopy. Results: After 26 ureteroscopies we succeeded 96.2% (25/26) stone free rate. We divided complications in two groups: minor and major. Minor complications (27%): severe symptoms realated with stent (1 patient), stone migration to kidney (6 patients). Major complications (11.5%): ureter strictures (2 patients),
complete ureter avulsion (1 patient). We registered no minor or greater infections episodes, sepsis after surgery. Minor complications. 1 patient who had severe symptoms related to stent, on the second day after surgery we removed the stent. 6 patients had stone migration to kidney from ureter just before lithotripsy. During the same procedure we performed retrograde ureteropyeloscopy with lithotripsy. Major complications: Both patients who visited the urologist on the 3. month after ureteroscopy were asymptomatic, but during sonoscopy ureterohydronephrosis was diagnosed. One stricture was found in lower part of ureter and was managed by repeated ureteroscopy and dilation of ureter. The second patient had complete ureteral stricture in upper part of ureter. Ureter resection and neoanastomosis “end to end” was performed. The biggest complication was complete ureter avulsion – “scabbard avulsion”. During the same operation we performed lumbotomy and closed pyeloureteric junction, inserted nephrostomic tube. After 5 months a reconstruction surgery was performed. We used 25 cm of ileum segment to replace ruptured ureter. Conclusions: As first line stone treatment for upper part of ureter ESWL and URS is recomended. Before planning which way is the best for the patient, urologists always have to consider stone free and complication rates and decide together with the patient, which treatment tactic is the most propriate. We recommend (even asymptomatic) patient visits to the urologist after 1 and 3 months after ureteroscopy to evaluate the absence of hydronephrosis. E43 Comparison of different ureteroscope sizes in treating ureteral calculi in adult patients G. Atıs, ¸ O. Arikan, C. Gurbuz, A. Yildirim, B. Erol, S. Pelit, I. Ulus, T. Caskurlu. Goztepe Training and Research Hospital, Dept. of Urology, Istanbul, Turkey Introduction & Objectives: To compare the success and complication rates of a 4.5–6.5 F semirigid ureteroscope (S-URS) with an 8.5–11.5 F S-URS in treating ureteral stones in adult patients. Material & Methods: Between March 2012 and October 2012, 52 patients with ureteral stones were treated with 4.5–6.5 F S-URS (Group 1). The patient outcomes were compared with patients who were treated with 8.5–11.5 F S-URS using a matched-pair analysis (Group 2). The matching parameters were the size, lateralization, location and impaction of the stones as well as the patient age, gender and body-mass index (BMI), and the presence of hydronephrosis. The stones were fragmented with Holmium-YAG laser. Results: The matching parameters were comparable between the two groups. The stone-free rates (SFR) were 88.5% in group 1 and 84.6% in group 2 (p = 0.566) after a single procedure. The mean operative times for groups 1 and 2 were 32.7±5.8 and 30.2±5.4 minutes, respectively (p = 0.06). Post-operative hematuria was detected in 1.9% and 13.5% of patients in groups 1 and 2 (p = 0.027). Ureteral balloon dilation was needed in 1.9% and 15.4% of patients in groups 1 and 2, respectively (p = 0.015). Mucosal injury was observed in 1.9% and 13.5% of the patients in groups 1 and 2, respectively (p = 0.027). No major complications were noted in either group. Table 1. The operative and post-operative outcomes of the groups
Operative time (minute) Stone migration (n, %) Inability to introduce the URS (n, %) Residual fragments (n, %) Balloon dilation (n, %) Stent placement (n, %) Auxillary procedure (n, %) SFR after a single procedure (n/total) (%) Lenght of hospital stay (day)
Group 1 (4.5–6.5 F; n = 52)
Group 2 (8.5–11.5 F; n = 52)
p value
32.7±5.8 2 (3.8%) 1 (1.9%) 3 (5.8%) 1 (1.9%) 11(21.2%) 6 (11.5%) 46/52 (88.5%) 1.15±0.64
30.2±5.4 3 (5.8%) 3 (5.8%) 2 (3.8%) 8 (15.4%) 13 (25%) 8 (15.4%) 44/52 (84.6%) 1.21±0.74
0.06 0.647 0.112 0.647 0.015 0.642 0.566 0.696
thursday 5 september 2013 / european urology supplements 12 (2013) 29–68
laser lithotripsy and operational parameters were compared in-between. Results: Neither group had obvious complications. There were no differences in operation time (P > 0.05), intraoperative success rate (100%, respectively), postoperative stone-free rate (P > 0.05) between the 2 groups. Conclusions: This new device (Innovex) is clinically parallel to the effectiveness and safety of NTrap while costing merely the half and is clinically valid for extensive use. However more investigations were warranted to confirm the efficacy and to contribute to device modification. E41 Effectiveness of NTrap in ureteroscopic Ho:YAG laser lithotripsy for upper ureteral calculi Z. Wu, C. Feng, H. Jiang, P. Gao, L. Wang, Q. Ding. Huashan Hospital Affiliated To Fudan University, Dept. of Urology, Shanghai, China Introduction & Objectives: To evaluate the effectiveness and safety of NTrap against stone retropulsion in ureteroscopic Ho:YAG laser lithotripsy for upper ureteral stones. Material & Methods: A total of 398 patients with upper ureteral calculi were stratified into 2 groups. Group 1 included 200 patients without NTrap use and Group 2 included 198 patients with NTrap use. All subjects were treated with ureteroscopic Ho:YAG laser lithotripsy. General and operation related parameters of both groups were statistically analyzed. Results: There was insignificant difference in patient age, gender and stone size between both groups. Group 2 showed a significantly higher intraoperative success rate (100% vs 72.0%, P < 0.001) and a lower stone retropulsion rate (0% vs 28.0%, P < 0.0001) compared with Group 1. The clearance rate was significantly higher in Group 2 than in Group 1 (96.5% vs 86.0%, P < 0.05). No major complications such as perforations or ureteral avulsions were encountered during the procedures. Conclusions: NTrap is an effective and safe device in prevention of stone retropulsion during ureteroscopic Ho:YAG laser lithotripsy. E42 Complication rate on URS and lithotripsy in upper part of ureter A. Gaizauskas. Republic Vilnius University Hospital, Dept. of Urology, Vilnius, Lithuania Introduction & Objectives: Ureteral stone management is a revelant question in everyday urological practice. Nowadays we have a big range of options how to treat patients with ureteral stones. Endoscopic equipment and accessories become better and better and it helps achieve good succsess in removing stones from ureter. But upper part ureter stone treatment can still be a big challenge. Stone free rate after URS in upper part of ureter is similar as in lower part, but complication rate is higher. Material & Methods: We registered and treated all upper part URS with laser lithotripsy complications in period from May 2011 to April 2013. In this period we performed 26 upper part ureteroscopies for stones in upper part of ureter. Stone range was from 5 to 13 mm in the greatest diameter. All patients were stented after procedure. Stent was removed 2 weeks after operation. Control sonoscopies were performed 1 and 3 months after ureteroscopy. Results: After 26 ureteroscopies we succeeded 96.2% (25/26) stone free rate. We divided complications in two groups: minor and major. Minor complications (27%): severe symptoms realated with stent (1 patient), stone migration to kidney (6 patients). Major complications (11.5%): ureter strictures (2 patients),
complete ureter avulsion (1 patient). We registered no minor or greater infections episodes, sepsis after surgery. Minor complications. 1 patient who had severe symptoms related to stent, on the second day after surgery we removed the stent. 6 patients had stone migration to kidney from ureter just before lithotripsy. During the same procedure we performed retrograde ureteropyeloscopy with lithotripsy. Major complications: Both patients who visited the urologist on the 3. month after ureteroscopy were asymptomatic, but during sonoscopy ureterohydronephrosis was diagnosed. One stricture was found in lower part of ureter and was managed by repeated ureteroscopy and dilation of ureter. The second patient had complete ureteral stricture in upper part of ureter. Ureter resection and neoanastomosis “end to end” was performed. The biggest complication was complete ureter avulsion – “scabbard avulsion”. During the same operation we performed lumbotomy and closed pyeloureteric junction, inserted nephrostomic tube. After 5 months a reconstruction surgery was performed. We used 25 cm of ileum segment to replace ruptured ureter. Conclusions: As first line stone treatment for upper part of ureter ESWL and URS is recomended. Before planning which way is the best for the patient, urologists always have to consider stone free and complication rates and decide together with the patient, which treatment tactic is the most propriate. We recommend (even asymptomatic) patient visits to the urologist after 1 and 3 months after ureteroscopy to evaluate the absence of hydronephrosis. E43 Comparison of different ureteroscope sizes in treating ureteral calculi in adult patients G. Atıs, ¸ O. Arikan, C. Gurbuz, A. Yildirim, B. Erol, S. Pelit, I. Ulus, T. Caskurlu. Goztepe Training and Research Hospital, Dept. of Urology, Istanbul, Turkey Introduction & Objectives: To compare the success and complication rates of a 4.5–6.5 F semirigid ureteroscope (S-URS) with an 8.5–11.5 F S-URS in treating ureteral stones in adult patients. Material & Methods: Between March 2012 and October 2012, 52 patients with ureteral stones were treated with 4.5–6.5 F S-URS (Group 1). The patient outcomes were compared with patients who were treated with 8.5–11.5 F S-URS using a matched-pair analysis (Group 2). The matching parameters were the size, lateralization, location and impaction of the stones as well as the patient age, gender and body-mass index (BMI), and the presence of hydronephrosis. The stones were fragmented with Holmium-YAG laser. Results: The matching parameters were comparable between the two groups. The stone-free rates (SFR) were 88.5% in group 1 and 84.6% in group 2 (p = 0.566) after a single procedure. The mean operative times for groups 1 and 2 were 32.7±5.8 and 30.2±5.4 minutes, respectively (p = 0.06). Post-operative hematuria was detected in 1.9% and 13.5% of patients in groups 1 and 2 (p = 0.027). Ureteral balloon dilation was needed in 1.9% and 15.4% of patients in groups 1 and 2, respectively (p = 0.015). Mucosal injury was observed in 1.9% and 13.5% of the patients in groups 1 and 2, respectively (p = 0.027). No major complications were noted in either group. Table 1. The operative and post-operative outcomes of the groups
Operative time (minute) Stone migration (n, %) Inability to introduce the URS (n, %) Residual fragments (n, %) Balloon dilation (n, %) Stent placement (n, %) Auxillary procedure (n, %) SFR after a single procedure (n/total) (%) Lenght of hospital stay (day)
Group 1 (4.5–6.5 F; n = 52)
Group 2 (8.5–11.5 F; n = 52)
p value
32.7±5.8 2 (3.8%) 1 (1.9%) 3 (5.8%) 1 (1.9%) 11(21.2%) 6 (11.5%) 46/52 (88.5%) 1.15±0.64
30.2±5.4 3 (5.8%) 3 (5.8%) 2 (3.8%) 8 (15.4%) 13 (25%) 8 (15.4%) 44/52 (84.6%) 1.21±0.74
0.06 0.647 0.112 0.647 0.015 0.642 0.566 0.696