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E54 Ureteroscopy versus shockwave lithotripsy for the management of proximal ureteral stones ≤15 mm
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thursday 5 september 2013 / european urology supplements 12 (2013) 29–68
surgery was conducted. Endoscopic procedures were done by means of 270°-deflectable ureterorenoscopes (VIPER, Richard Wolf GmbH, Germany) using an ureteral access sheath of 12, 14 or 16 F. Lithotripsy or incision was done by means of a holmium-laser. All patients received a DJ-stent for 7days after the procedure and a transurethral catheter for 24 hours. Data was collected for stone-free rate, operating time, hospital stay length, complication rate, stone analysis, localisation of the stone and auxiliary procedures. Results: Mean operating time was 46.6 min. In 1032 procedures urinary tract stones were detected and treated, 178 procedures were done for diagnosis or tumor therapy. Mean stone size was 53.8 mm2 . In 53.7% Holmium-laser lithotripsy was performed. 20.6% of the patients had been pretreated by SWL and flexible uretero-renoscopy was used to remove residual fragments. Complication rate was 9.3% for pyelonephritis and 1.5% for ureteral perforation. No complication required any further intervention. Overall stone-free rate was 94.4%. Mean length of postoperative stay was 2.38 days.
Conclusions: Based on the presented results we conclude that flexible ureterorenoscopy is a reliable and effective diagnostic and treatment modality for different pathologies of the upper urinary tract. Nephrolithiasis can be treated endoscopically as well as anatomical abnormalities, calyceal stenosis, and urothelial tumors of the upper urinary tract. In the therapy of nephrolithiasis the main advantage in comparison to SWL is a high stone-free rate and a reduced treatment time associated with a low complication rate. E54 Ureteroscopy versus shockwave lithotripsy for the management of proximal ureteral stones ≤15 mm I. Saltirov, K. Petkova, T. Petkov. Military Medical Academy, Dept. of Urology and Nephrology, Sofia, Bulgaria Introduction & Objectives: Ureteroscopy (URS) and shockwave lithotripsy (SWL) are both the standard of care for proximal ureteral stones. However, the choice of treatment is based on multiple factors such as stone size, location and composition, patient factors, surgeon’s experience and equipment availability. The objective of this retrospective study is to compare the efficacy and safety of ureteroscopy (URS) and shockwave lithotripsy (SWL) for the management of proximal ureteral stones ≤15 mm. Material & Methods: The medical records of 471 consecutive patients with proximal ureteral stones ≤15 mm treated between January 2009 and October 2012 were retrospectively reviewed. A total of 517 procedures were performed – 269 URS (52%) and 248 SWL (48%). The stone-free rates, retreatment rates, need for auxiliary procedures and complications rates were compared. The follow-up protocol included plain abdominal radiography and ultrasonography at 1st month postoperatively. Results: Mean stone size was significantly higher in the URSgroup (10.3±2.2 vs 9.2±2.0 mm; p < 0.001). Stone-free rate after single procedure was 88.6% for the URS-group and 83.5% for
the SWL-group (p < 0.001). The retreatment rate and the need for auxiliary procedures were significantly higher in the SWLgroup (1.9% vs 9.7%; p = 0.001 and 4.1% vs 5.2%; p < 0.001). The efficiency quotient for URS and SWL was 0.84 and 0.73, respectively. There was no statistically significant difference in the overall complications rate between the two groups (4.5% vs 4.0%; p = 0.604). Conclusions: The results of this retrospective study suggest that both URS and SWL are effective and safe treatment options for proximal ureteral stones ≤15 mm. However, in this study, URS results in significantly higher stone-free rate and lower retreatment rate compared to SWL. E55 Endoscopic treatment of impacted and non-impacted ureteral stones: Outcome and complications K. Hauner, S. Schwab, F.D. Kurtz, J.E. Gschwend, M. Straub. Technische Universit¨ at M¨ unchen, Rechts Der Isar Medical Center, Dept. of Urology, Stone Clinic, Munich, Germany Introduction & Objectives: According to the recent EAUguidelines ureterorenoscopic laserlithotripsy is a valid treatment option for ureter stones. Aim of the present study was to evaluate the stone clearance, the short- and the longterm complication rate for impacted and non-impacted ureteral stones with regard to ureteral stricture and kidney function. Material & Methods: From January 2007 to July 2009 364 patients with stones were treated with ureterorenoscopy. 55 patients fulfilled the criteria for our retrospective assessment. Out of them 32 had impacted stone situation with severe inflammation of the ureteral mucosa and 23 had non-impacted stones ≥5 mm. For endoscopic in situ lithotripsy a holmium-YAG laser was used. The intervention ended routinely with ureteral stenting. After a mean period of 22.5 months all patients had a follow-up examination including ultrasound of the kidneys, urine analysis and blood chemistry. Results: A total of 79 calculi were included in the assessment. In 17 cases simultaneous stones were found in renal calices. Out of the 62 ureter stones 31 were located in the proximal and 31 in the distal ureter respectively. The average size of the ureter stones was 7.5 mm, the mean operation time was calculated 59.1 minutes for impacted and 40.6 minutes for nonimpacted stones. Primary stone-free rate was 85% for impacted and 96% for non-impacted stones. Complications were observed in 13% including fever, ureteral perforation, bleeding, prolonged haematuria, lesion of the ureteral mucosa and urethral stricture. In non-impacted stones only 4% had minor complications. For impacted stones complications were observed in 19%. Fortunately, the follow-up examination revealed no patient with ureteral stricture or pathologic changes in renal function after the operation. However, 27% of our patients developed stone recurrence within the follow-up period. Conclusions: Ureterorenoscopic laserlithotripsy of impacted ureter stones is safe and efficient. Primary stone-free rate in the impacted situation was 85%! Despite a higher risk for intra-operative complications no long-term complications were observed. E56 Does the use of ureteric access sheaths decrease intrarenal pressures during flexible ureterorenoscopy? A prospective study C. Poullis, A. Simoes, S. Malde, R. Krishnan. East Kent Hospitals, Dept. of Urology, Canterbury, Kent, United Kingdom Introduction & Objectives: Pelvic pressure during intrarenal surgery has been studied in cadavers. Very little evidence exists regarding any association between raised intrapelvic pressure with or without access sheaths in vivo. Our aim was
thursday 5 september 2013 / european urology supplements 12 (2013) 29–68
surgery was conducted. Endoscopic procedures were done by means of 270°-deflectable ureterorenoscopes (VIPER, Richard Wolf GmbH, Germany) using an ureteral access sheath of 12, 14 or 16 F. Lithotripsy or incision was done by means of a holmium-laser. All patients received a DJ-stent for 7days after the procedure and a transurethral catheter for 24 hours. Data was collected for stone-free rate, operating time, hospital stay length, complication rate, stone analysis, localisation of the stone and auxiliary procedures. Results: Mean operating time was 46.6 min. In 1032 procedures urinary tract stones were detected and treated, 178 procedures were done for diagnosis or tumor therapy. Mean stone size was 53.8 mm2 . In 53.7% Holmium-laser lithotripsy was performed. 20.6% of the patients had been pretreated by SWL and flexible uretero-renoscopy was used to remove residual fragments. Complication rate was 9.3% for pyelonephritis and 1.5% for ureteral perforation. No complication required any further intervention. Overall stone-free rate was 94.4%. Mean length of postoperative stay was 2.38 days.
Conclusions: Based on the presented results we conclude that flexible ureterorenoscopy is a reliable and effective diagnostic and treatment modality for different pathologies of the upper urinary tract. Nephrolithiasis can be treated endoscopically as well as anatomical abnormalities, calyceal stenosis, and urothelial tumors of the upper urinary tract. In the therapy of nephrolithiasis the main advantage in comparison to SWL is a high stone-free rate and a reduced treatment time associated with a low complication rate. E54 Ureteroscopy versus shockwave lithotripsy for the management of proximal ureteral stones ≤15 mm I. Saltirov, K. Petkova, T. Petkov. Military Medical Academy, Dept. of Urology and Nephrology, Sofia, Bulgaria Introduction & Objectives: Ureteroscopy (URS) and shockwave lithotripsy (SWL) are both the standard of care for proximal ureteral stones. However, the choice of treatment is based on multiple factors such as stone size, location and composition, patient factors, surgeon’s experience and equipment availability. The objective of this retrospective study is to compare the efficacy and safety of ureteroscopy (URS) and shockwave lithotripsy (SWL) for the management of proximal ureteral stones ≤15 mm. Material & Methods: The medical records of 471 consecutive patients with proximal ureteral stones ≤15 mm treated between January 2009 and October 2012 were retrospectively reviewed. A total of 517 procedures were performed – 269 URS (52%) and 248 SWL (48%). The stone-free rates, retreatment rates, need for auxiliary procedures and complications rates were compared. The follow-up protocol included plain abdominal radiography and ultrasonography at 1st month postoperatively. Results: Mean stone size was significantly higher in the URSgroup (10.3±2.2 vs 9.2±2.0 mm; p < 0.001). Stone-free rate after single procedure was 88.6% for the URS-group and 83.5% for
the SWL-group (p < 0.001). The retreatment rate and the need for auxiliary procedures were significantly higher in the SWLgroup (1.9% vs 9.7%; p = 0.001 and 4.1% vs 5.2%; p < 0.001). The efficiency quotient for URS and SWL was 0.84 and 0.73, respectively. There was no statistically significant difference in the overall complications rate between the two groups (4.5% vs 4.0%; p = 0.604). Conclusions: The results of this retrospective study suggest that both URS and SWL are effective and safe treatment options for proximal ureteral stones ≤15 mm. However, in this study, URS results in significantly higher stone-free rate and lower retreatment rate compared to SWL. E55 Endoscopic treatment of impacted and non-impacted ureteral stones: Outcome and complications K. Hauner, S. Schwab, F.D. Kurtz, J.E. Gschwend, M. Straub. Technische Universit¨ at M¨ unchen, Rechts Der Isar Medical Center, Dept. of Urology, Stone Clinic, Munich, Germany Introduction & Objectives: According to the recent EAUguidelines ureterorenoscopic laserlithotripsy is a valid treatment option for ureter stones. Aim of the present study was to evaluate the stone clearance, the short- and the longterm complication rate for impacted and non-impacted ureteral stones with regard to ureteral stricture and kidney function. Material & Methods: From January 2007 to July 2009 364 patients with stones were treated with ureterorenoscopy. 55 patients fulfilled the criteria for our retrospective assessment. Out of them 32 had impacted stone situation with severe inflammation of the ureteral mucosa and 23 had non-impacted stones ≥5 mm. For endoscopic in situ lithotripsy a holmium-YAG laser was used. The intervention ended routinely with ureteral stenting. After a mean period of 22.5 months all patients had a follow-up examination including ultrasound of the kidneys, urine analysis and blood chemistry. Results: A total of 79 calculi were included in the assessment. In 17 cases simultaneous stones were found in renal calices. Out of the 62 ureter stones 31 were located in the proximal and 31 in the distal ureter respectively. The average size of the ureter stones was 7.5 mm, the mean operation time was calculated 59.1 minutes for impacted and 40.6 minutes for nonimpacted stones. Primary stone-free rate was 85% for impacted and 96% for non-impacted stones. Complications were observed in 13% including fever, ureteral perforation, bleeding, prolonged haematuria, lesion of the ureteral mucosa and urethral stricture. In non-impacted stones only 4% had minor complications. For impacted stones complications were observed in 19%. Fortunately, the follow-up examination revealed no patient with ureteral stricture or pathologic changes in renal function after the operation. However, 27% of our patients developed stone recurrence within the follow-up period. Conclusions: Ureterorenoscopic laserlithotripsy of impacted ureter stones is safe and efficient. Primary stone-free rate in the impacted situation was 85%! Despite a higher risk for intra-operative complications no long-term complications were observed. E56 Does the use of ureteric access sheaths decrease intrarenal pressures during flexible ureterorenoscopy? A prospective study C. Poullis, A. Simoes, S. Malde, R. Krishnan. East Kent Hospitals, Dept. of Urology, Canterbury, Kent, United Kingdom Introduction & Objectives: Pelvic pressure during intrarenal surgery has been studied in cadavers. Very little evidence exists regarding any association between raised intrapelvic pressure with or without access sheaths in vivo. Our aim was