Independent predictors of failure following shockwave lithotripsy for ureteral stones, employing a second-generation lithotriptor

45

46

INDEPENDENT

FOLLOWING PREDICTORS OF FAILURE LITHOTRIPSY FOR URETERAL STONES, SHOCKWAVE EMPLOYING A SECOND-GENERATION LITHOTRIPTOR

SPIRAL-JJ-STENT VERSUS STANDARD_JJ_STENT IN PATIENTS WITH MIDIUM SIZE RENAL STONES TREATED BY ESWL: WHICH RANDOMISED TRIAL STEm WORKS BETTER? A PROSPECTIVELY

Daskaloooulos

Grrber.

(;meral

G., Karyotis I., Heretis I.. Delakas D

University Hospital, Heraklion.

llrology,

Hernklion.

require alternative treatments for stone removal. The aim of this study is to detine factors associated with the failure of SWL in the treatment of ureterel stones. MATERIAL & METHODS: In the period 1994 to 2001, we retrospectively studied a total of 688 patients (405 men, 283 women; mean age 52.6 years) who underwent SWL with a second-generation lithotriptor. WC evaluated available clinical and radiological parameters that might have been related to failure of SWL thcrapq RESULTS: SWL \\a5 successful in 502 patients (73”~) and a failure in 186 (27?/0) who finally underwent cndourologic alternatives. Multivariate logistic regression analysis revealed that unsuccessful outcome wah significantly related to: distal stones (Odds ratio 4.02, 9.5% C.1: I .97, 8. I9), stone size > I Omm (odds C.1: 2.16. 5.53), the prescncc ofobstruction (odds ratio I .93,95”/0 C.1: 0.99, 3.77). and the presence of obesity (odds ratio I .87. 95% C.1: 0.95. 3.77). Although the predictive value of each parameter was relatively low (15.3%27.9%) the cumulative risk was X2,95% when patients had all four parameters. The strongest independent predictors of failure after SWL were distal

ratio 3.46,95%

predictive

value 57.3%).

CONCI,USIONS: These variables may enable Idrnrdicatlon of a subgroup of patients who wdl fall initial SWL. These pancnts may be candidates for endourologic

alternatives

as first line trratmcm.

47 IS REPEAT JI’STIFIED Daskaloooulos I).

SHOCK WAVE LITHOTRIPSY FOR URETERAL STONES FOI,I.OWIN~ THE FAILURE OF INITIALTREATMENT? I).. Karyotis I.. Anc/inls

C?cncrnl I:ni\crSity

hospital

of llcraklion.

P.. Nor&kos M.. Mctaxarl M.. Dclakas

Urology. flcraklion.

C;rccce

INTRODUCTION & OBJECTIVES: Ihere I’\ no con~cn\us on the numbci ul shock wave lithotripsy (SWL) treatments for ureteral stones that should bc administered for a single stone before alternates modalities arc used. We compared the success rate of initial SWL for ureteral stones with that of rubsequent treatments to determine whether more than out treatment is.justified after failed initial treatment. MATERIAI. lithotriptcr

& METHODS:

X55 ureteral

were studied. WC compared

stones

the stone-tree

using

the MPL 9000X

rate of the mmal SWI.

treatment and rc-treatments for a single stone using the last treatment result available before any further therapy for the stone. Treatment success rates were stratified according 10 location and s)Le ofthc stones, urctcral stcnting and patient \veight. The stone silt wah classified as .:I 5 mm and .‘I 5 mm. determined by measuring the longest diameter. RESULTS: The stone free rate after thbtirst session of SWL wab 63”% (539 01 X55 stones) but it decreased significantly to 44% (82 of 186) after I and to 2X.5’);, (22 of 77) after 2 re-treatments. The success rate of initial treatment for stones I 5 mm was 7l”/o vcrsub 42%. Ke-treatment I and 2 stone-free rates were higher for stones 5 IS mmthan 215 mm (5 I “h versus 38% and 46% versus 34%. respectively). The stone-free rate decreased with more distal stones for initial and subsequent SWL sessions. Patient body weight and uretcral stcnting were not significant predictors of treatment outcome. CONCLUSIONS: [Jreteral stones that fail to clear atier initial SWL are less likely to clear after subsequent re-treatment. Our \tudy demonstrates that ureteroscopic management of ureteral stones may be a better alternative than SWI. m cases for which initial SWL fails, particularly for distal stones greatet than I5 mm. European

Urology

Supplements

2 (2003) No. 1, pp. 14

M., Studcl- (J.. Danuser H

UniversityHospital of Hem. Department

Greece

INTRODUCTION & OBJECTIVES: Although in situ shock wave lithothripsy (SWL) has been successfully employed for ureteral stones, some cases fail and

stones and stones greater than I Omm (cumulative

Nitz C.. Schumacher

of Urologv. Bern, Switzerland

INTRODUCTION & OBJECTIVES: It has been proposed that ureteric stone fragment elimination with the new spiral JJ-atent is faster than with a standard JJstent. WC therefore evaluated stcnt inserting time. peri-and postinterventional complications as well as stone clearance in a prospccti\elyrandomized trial in patients with medium size kidney stones treated by ESWL. PATIENTS & METHODS: From 1999 2001 29 patients were randomised for preoperative insertion of a spiral stcnt (n=l6) or a standard JJ-stent (n=13). Stone volume was measured on abdominal plain films. Stent inserting time, peri- and postoperative complications and clearance of stone fragments were compared. Follow-up was performed with ultrasound and an abdominal plain film on day I and at the end of \veek I. 2 and 6 abler treatment or until stone fragments were completely cleared. RESULTS: Median stone \olumc was I .8 cc (0.4-S.?) in the spiral stent group and 1.3 cc (0.1-2.6) m the conventional JJ-stent group. Median stent inserting time was 2 lmin (1O-60) for the rpiral stent and 18min (5-45) for the standard JJstent. Inscning difficulties occurred in 6/16 patients with spiral stents and in none with the standard JJ-stent (p=O.Ol). Spontaneous stem displacement occurred in 4116 patients in the spiral stent group and never in Ihe standard JJ-stent group (p=O.OS). Percentage of stone elimination after I day, I, 2 and 6 weeks after treatment was O%, 6%, 25”/0 and 3 I % in the spiral stcnt group and 9%. 18’%, 27% and 27% in the standard JJ-stent group (p=O. 19). CONCLUSIONS: Spiral stents arc more difficult to insert, dislocate apontancously more often and ha\c no advantage in overall stone clearance compared with standard JJ-stents. Based on these results WC do not recommend the use of spiral stenls in clinical practice. P3

NEW APPROACHESINGENITOURINARY INFECTIONS Thursday, March 13, 11.45-l 3.15 hrs, Room N109

SEMINAL INFLAMMP;TION MARKERS IN CHRONIC SYNDROME (CPPSI: SUGGESTION FOR CUTPOINTS Ludule

M. Vidal .A. , Ifuwc

P

Pabst U.

48 PELVIC PAIN

. I.aillng K. Wcidmr\I’.

‘I Inl\ cr&itsklinikum. Ciiesscn. Ilrology, (;lesaen, (icrmany. Justus-Liebigliniversitit. C;lcssen, Veterinary Medicine. Ciicsscn, Germany, ‘Univcrsit&skllnikum. (ilessen. Medical Statistics. (iiesaen. (icnnany INTROD~C‘I ION & OBJECTI\‘ES: Th c u\ oluation of scm~nal leukocyte\ Ilab been integrated in the classitication system of CPPS to delineate inflammatory (NIH IIIA) from non-inflammatory (NIH 1118) disease. The aim 01 this study was to investigate whether leukocyres in prostatic secretions predict the presence of leukocytes and elastase (an inflammation marker) in the ejaculate and whether the cutpoint for significant leukocytospermla ( I mill/ml) as indicated by the WHO is applicable also in this disease. YIATERIAI, & .METNODS: I I2 consecutive symptomatic patients (34.3; 2 I 64 years) underwent a 4-glass-test including leukocyte analysis followed by an tijaculate analysis according to WHO criteria. Patients with ?I 0 leukocytes in EPS (1000x) or ~10 in VB3 (300x) were considered NIH IIIA. Patients with urcthritis and bactcrlal prostatitis were excluded. Ejaculate analysis included Pcroxidase Positive I.eukocytcs (PPL) and elastase. Statistical analysis was done using Mann-Whitney U-&t. Wilcoxon rank sum test and receiver operating characteristic curves. RESULTS: 64 men demonstrated increased leukocytes in EPS or VB3 (inflammatory CPPS NIH IllA). whereas 4X did not (non-inflammatory CPPS NIH IIIB). Seminal leukocytes and elastasc in seminal plasma were significantly increased in men with elevated leukocytes in EPS/VB 3 (p