- Email: [email protected]
MEMOKATH STENTING IN NEOPLASTIC EXTRINSIC URETERAL STENOSIS
V5
ENDOSCOPIC SURGERY OF THE UPPER URINARY TRACT Thursday, 27 March, 15.45-17.15, eURO Auditorium
V25
V26
MEMOKATH STENTING IN NEOPLASTIC EXTRINSIC URETERAL STENOSIS
FLEXIBLE URETEROSCOPIC APPROACH IN PYELOCALICEAL DIVERTICULA LITHIASIS
Geavlete P., Nita Gh., Geavlete B.
Geavlete P., Multescu R., Georgescu D., Mirciulescu V., Geavlete B.
Saint John Clinical Hospital, Dept. of Urology, Bucharest, Romania
Saint John Emergency Clinical Hospital, Dept. of Urology, Bucharest, Romania
Introduction & Objectives: Patients with benign or malignant ureteral stenosis often QHHGORQJWHUPLQWHUQDOGUDLQDJHZLWKSHULRGLFDOO\FKDQJHG--VWHQWV7KH0HPRNDWK LV D WKHUPRH[SDQGDEOH WLWDQLXPQLFNHO VSLUDO GHYHORSHG IRU ORQJWHUP XUHWHUDO stenting. The aim of this study was to determine the drainage and safety aspects of this stent.
Introduction & Objectives: Recently, the minimally invasive technologies radically changed the management and treatment of pyelocaliceal diverticula. 2XU JRDO ZDV WR HYDOXDWH WKH HᚑFLHQF\ RI UHWURJUDGH ᚐH[LEOH XUHWHURVFRSLF approach in the treatment of patients with intradiverticular lithiasis.
Material & Methods: Between March and October 2007, in the Clinical Department RI 8URORJ\ RI WKH ಯ6DLQW -RKQರ (PHUJHQF\ &OLQLFDO +RVSLWDO ZH PRXQWHG 0HPRNDWK thermo-expandable metallic ureteral stents in 9 patients with pelvic ureteral stricture due to cervix neoplasia, operated and irradiated. The inclusion criteria were: presence of extrinsic ureteral obstruction secondary to pelvic or abdominal malignancy, life expectancy greater than 6 months, preoperative medical examination clearing the patient for general or spinal anesthesia, no active urinary tract infection by urinalysis and urine culture. All patients were drained by JJ stent (7 cases) or percutaneous QHSKURVWRP\ FDVH 7KHLQWHUYHQWLRQWRRNSODFHXQGHUJHQHUDORUVSLQDODQHVWKHVLD 7KHSURFHGXUHWRRNSODFHXQGHUᚐXRURVFRSLFFRQWURODQGVWDUWHGE\VWULFWXUHGLODWLRQ using the dilator included in the mounting set. Afterwards, we introduced the stent through the dilator sheath and correctly positioned it. The distal end of the stent was expanded by injecting 20 ml of sterile water preheated to 60 degrees C. At the end of WKHSURFHGXUHZHSHUIRUPHGWKHᚐXRURVFRSLFDQGXUHWHURVFRSLFFRQWUROUHJDUGLQJWKH correct stent position. The follow-up period was between 1 and 7 months.
Material & Methods: Between February 1993-August 2007, 10 patients with intradiverticular lithiasis (4 with superior, 3 with medium and 3 with inferior caliceal diverticula) were evaluated and treated. One of these patients presented PHGLXP FDOLFHDO GLYHUWLFXOD 2QH SDWLHQW SUHVHQWHG LQWUDGLYHUWLFXODU PLON RI calcium stone. Simptomatology included: lumbar pain (9/11 cases), hematuria (3/11 cases) and recurrent urinary tract infections (6/11 cases) with E. Colli and Proteus. Incision of the diverticular isthmus (electric or Nd:YAG laser) was necessary in 9 cases. The electrohydraulic lithotripsy was performed with 1.61.9 F probes.
Results: Metallic stents were successfully inserted in all cases. Pre-insertion dilatation ZDVGLᚑFXOWLQRQHSDWLHQW7KHUHZHUHQRLQWUDRUSRVWRSHUDWLYHFRPSOLFDWLRQV7KH KRVSLWDOL]DWLRQ SHULRG ZDV KRXUV 8OWUDVRQRJUDSK\ UHYHDOHG UHVROXWLRQ RI SUH existing hydronephrosis. One ureter was occluded 3 months after stent placement EHFDXVHRIVWHQWPLJUDWLRQUHTXLULQJWKHUHSRVLWLRQLQJRIWKHVWHQW7KHRWKHUXUHWHUV showed no signs of obstruction during follow-up. No tissue ingrowth was seen. Conclusions: Our results suggest that insertion of a metallic stent in the ureter is feasible and safe for the treatment of malignant ureteral strictures. However, more ZRUNQHHGVWREHGRQHLQRUGHUWRHVWDEOLVKWKHXVHRIWKHVHVWHQWVIRUWKHWUHDWPHQW of ureteral obstruction.
Results: ,QFDVHV LQFOXGLQJWKHSDWLHQWVZLWKಯPLONRIFDOFLXPVWRQHರDQG WKHRQHZLWKPHGLXPFDOLFHDOGLYHUWLFXOD ᚐH[LEOHXUHWHURVFRSLFDSSURDFKRI the diverticula was successful. All these 7 patients were stone-free at the end of the procedure. In the other 3 cases, failure of retrograde incision imposed percutaneous approach, especially for inferior location of the PD. Postoperative complications were represented by persistent bleeding (1 case), fever (1 case) DQGᚐDQNSDLQ FDVH 3RVWRSHUDWLYHHYDOXDWLRQDWPRQWKVGHPRQVWUDWHG a large passage between pyelocaliceal diverticula and collecting system in 6 patients. Conclusions: 5HWURJUDGHᚐH[LEOHXUHWHURVFRSLFDSSURDFKRIWKHVPDOOFDOLFHDO GLYHUWLFXODZLWKLQWUDGLYHUWLFXODUOLWKLDVLVPD\EHXVHGDVᚏUVWWUHDWPHQWRSWLRQ This treatment intends to render the patient stone-free and to provide a large non obstructive communication between the diverticula and the pyelocaliceal system.
V27 RETROGRADE INTRARENAL SURGERY (RIRS) IN THE TREATMENT OF RENAL CALCULI LARGER THAN 2 CM: MYTH OR REALITY? Giusti G. 3LFFLQHOOL $ 7DYHUQD * 3DVLQL / 0DXJHUL 2 %HQHWWL $ &RULQWL 0 =DQGHJLDFRPR 6 *UD]LRWWL3 Istituto Clinico Humanitas, IRCCS, Dept. of Urology, Milan, Italy Introduction & Objectives: 3HUFXWDQHRXVQHSKUROLWKRWRP\ 31/ UHPDLQVWKHJROGHQVWDQGDUGRIFDUHLQ case of renal calculi more than 2 cm in diameter. Nevertheless, with the ever growing interest worldwide IRUWKHಯQDWXUDORULᚏFHVVXUJHU\ರWKHPDQDJHPHQWRIXULQDU\VWRQHVLVFRQWLQXLQJWRHYROYH)XUWKHUPRUHLQ WKHODVWIHZ\HDUVWKHSURJUHVVLYHLPSURYHPHQWLQWHFKQLTXHWRJHWKHUZLWKUHFHQWDGYDQFHPHQWVLQᚐH[LEOH ureteroscopes with the advent of digital technology have been very impressive. As such, retrograde approach to renal calculi, considered till few years ago pure myth, is becoming a reasonable and attractive DOWHUQDWLYHWR31/HYHQIRUVWRQHODUJHUWKDQFP Material & Methods: In this videotape we present step by step our retrograde ureteroscopic approach WRDOHIWUHQDOVWRQHRIFPLQGLDPHWHU6RIDUZLWKWKHVDPHWHFKQLTXHZHWUHDWHGSDWLHQWVZLWKD mean stone burden of 7.0 cm2 7HFKQLTXH 2QFHZHJHWLQWRWKHUHQDOSHOYLVYLVXDOL]LQJWKH VWRQHZLWKWKHVHPLULJLGVFRSHDPLFURQVKROPLXPODVHUᚏEHUVHWDWORZHQHUJ\ZLWKKLJKSXOVHUDWH is introduced and stone fragmentation begun. Our policy is to continue the lithotripsy the longer we can ZLWKWKHVHPLULJLGVFRSHLQRUGHUWRSUHVHUYHWKHGHOLFDWHDQGYHU\FRVWO\ᚐH[LEOHXUHWHURVFRSH2QFHWKH UHVLGXDOIUDJPHQWVDUHQRORQJHUUHDFKDEOHGLUHFWO\ZLWKWKHVHPLULJLGLQVWUXPHQWZHFKDQJHWRᚐH[LEOH scope. When facing stones of such dimensions, we routinely place a 14 French ureteral access sheat in order to avoid prolonged intrarenal high pressure and damage to the ureter while facilitating spontaneous SDVVDJH RI VPDOO GHEULV 7KHQ D PLFURQV ODVHU ᚏEUH LV LQWURGXFHG ZLWK WKH VDPH SRZHU VHWWLQJ WR complete fragmentation. When stone fragments appeared to be less than 2 mm on the basis of mobility ZLWK LUULJDWLRQ DQG XVLQJ WKH ODVHU ᚏEHU DV YLVXDO JDXJHV WKH SURFHGXUH LV FRQVLGHUHG WHUPLQDWHG 1R attempt to extract physically all debris is pursued. At the end of the procedure, a 6 French JJ stent is placed DQGDQLQGZHOOLQJ))ROH\FDWKHWHULVOHIWRYHUQLJKW--VWHQWKDVWKHQEHHQUHPRYHGDIWHUZHHNE\ PHDQVRIᚐH[LEOHF\VWRVFRS\RQRXWSDWLHQWEDVLV Results: Mean OR time (min) ˂+E PJGO Sepsis SHULUHQDODEVFHVVUHTXLULQJRSHQGUDLQDJH Hospital stay (d) Stone free rate after 1 procedure Stone free rate after 2 procedures Stone free rate after 3 procedures Procedures per stone rate
121.4 (41.0-153.0) 1,0 (-0,4-2,7) ; 0% transfusion rate 2/35 (5.7%) 1/35 (2.8%) 1,5 (1-7) 24/35 (68.5%) 28/35 (80%) 30/35 (85.7%) 1.34
Conclusions: 31/ VWLOO UHPDLQV WKH JROG VWDQGDUG LQ WKH WUHDWPHQW RI UHQDO VWRQH ODUJHU WKDQ FP However, based on our experience, RIRS can be considered a reasonable and attractive alternative. 2EYLRXVO\SDWLHQWVKDYHWREHIXOO\LQIRUPHGDERXWTXLWHORZHUVWRQHIUHHUDWHDIWHUVLQJOHSURFHGXUHDQG eventual need for further retreatments and anesthesiae when are candidate to RIRS.
V28 ENDOSCOPIC COMBINED INTRA-RENAL SURGERY (ECIRS) FOR THE TREATMENT OF COMPLEX UROLOGICAL PATHOLOGIES USING GALDAKAO-MODIFIED SUPINE VALDIVIA POSITION 6FRᚎRQH&1, Morra I.1, Cracco C.1, Ragni F.1, Poggio M.1, Cossu M.1, Vaccino D.1, Billia M.1, Grande S.1, Scarpa R.M.1,EDUOX]HD*2, Valdivia Uria J.G.3 6DQ /XLJL +RVSLWDO 'HSW RI 8URORJ\ 2UEDVVDQR ,WDO\ 2*DOGDNDR +RVSLWDO 'HSW RI 8URORJ\%L]NDLD6SDLQ3/R]DQR%OHVD+RVSLWDO'HSWRI8URORJ\6DUDJR]]D6SDLQ
1
Introduction & Objectives: 6LQFH WKHSHUFXWDQHRXVDFFHVVWRWKHNLGQH\ZDVPDLQO\ performed with the patient in the prone position. Anaesthesiological problems and the need for a combined access to the upper urinary tract encouraged urologists to go in search of alternative positions. In fact, the prone position has several disadvantages, including SDWLHQWಬVGLVFRPIRUWDQLQFUHDVHGUDGLRORJLFDOKD]DUGWRWKHXURORJLVWQHFHVVLW\RIDKLJK number of nurses for the correct preoperative and intraoperative positioning of the patient LQ FDVH RI VLPXOWDQHRXV UHWURJUDGH LQVWUXPHQWDWLRQ RI WKH XUHWHU D PRUH HYLGHQW ULVN UHODWHG WR SUHVVXUH SRLQWV FLUFXODWRU\ DQG YHQWLODWRU\ GLᚑFXOWLHV HVSHFLDOO\ LQ PRUELGO\ REHVHN\SKRWLFDQGGHELOLWDWHGSDWLHQWV HQGRFULQHDQGSKDUPDFRNLQHWLFHᚎHFWV$PRQJ DOOWKHQHZO\SURSRVHGSRVLWLRQVWKH*DOGDNDRPRGLᚏHGVXSLQH9DOGLYLDSRVLWLRQJUDQWVRXU QHHGWRWUHDWLQDVLQJOHVWHSSURFHGXUHVRPHGLᚑFXOWFDVHVE\VLPXOWDQHRXVDQWHURJUDGH DQGUHWURJUDGHDSSURDFK7KLVSRVLWLRQZDVᚏUVWGHVFULEHGLQ E\*DEULHO9DOGLYLD8U®D LQ *DVSDU,EDUOX]HDPDGHLWHYHQEHWWHUZLWKWKHORZHUOLPEVLQDVOLJKWO\PRGLᚏHG OLWKRWRPLF SRVLWLRQ 7KH DGYDQWDJHV RI WKH *DOGDNDRPRGLᚏHG 9DOGLYLD VXSLQH SRVLWLRQ are relevant. First of all, it allows a great versatility of combined direct percutaneous and UHWURJUDGHXUHWHURVFRSLFPDQRHXYUHVZLWKULJLGDQGᚐH[LEOHLQVWUXPHQWVDQGQRQHHGRI multiple accesses. During the percutaneous approach it is possible to follow endoscopically the correct entry of the puncture needle on the tip of the renal papilla within the renal cavities. Complex urolithiasis or other pathologies, such as ureteral or uretero-intestinal strictures, can be solved with a single-step procedure. The supine position is certainly ideal IRUWKHWUHDWPHQWRIXURHQWHULFVWULFWXUHVRISDWLHQWVZLWKXULQDU\GLYHUVLRQV LH%ULFNHURU colon conduit), which are already in the optimal position for the procedure. Material & Methods: In this video we present some intriguing cases, successfully treated ZLWKWKHSDWLHQWLQWKH*DOGDNDRPRGLᚏHG9DOGLYLDVXSLQHSRVLWLRQ:HVKRZWKHUHPRYDO RIDGDPDJHGDQGHQFUXVWHGVWHQWLQNLGQH\JUDIWWKHWUHDWPHQWRIDXURHQWHULFVWULFWXUH LQDSDWLHQWZLWKXULQDU\GLYHUVLRQ %ULFNHU RIDFRPSOH[UHQDOXUROLWKLDVLVDQGRIDVWRQH in a hydrocalix. Conclusions: ECIRS (Endoscopic Combined Intra-Renal Surgery) is a new way to face complex ureteral and renal pathologies, allowing to solve them with a single-step procedure
Eur Urol Suppl 2008;7(3):335
ENDOSCOPIC SURGERY OF THE UPPER URINARY TRACT Thursday, 27 March, 15.45-17.15, eURO Auditorium
V25
V26
MEMOKATH STENTING IN NEOPLASTIC EXTRINSIC URETERAL STENOSIS
FLEXIBLE URETEROSCOPIC APPROACH IN PYELOCALICEAL DIVERTICULA LITHIASIS
Geavlete P., Nita Gh., Geavlete B.
Geavlete P., Multescu R., Georgescu D., Mirciulescu V., Geavlete B.
Saint John Clinical Hospital, Dept. of Urology, Bucharest, Romania
Saint John Emergency Clinical Hospital, Dept. of Urology, Bucharest, Romania
Introduction & Objectives: Patients with benign or malignant ureteral stenosis often QHHGORQJWHUPLQWHUQDOGUDLQDJHZLWKSHULRGLFDOO\FKDQJHG--VWHQWV7KH0HPRNDWK LV D WKHUPRH[SDQGDEOH WLWDQLXPQLFNHO VSLUDO GHYHORSHG IRU ORQJWHUP XUHWHUDO stenting. The aim of this study was to determine the drainage and safety aspects of this stent.
Introduction & Objectives: Recently, the minimally invasive technologies radically changed the management and treatment of pyelocaliceal diverticula. 2XU JRDO ZDV WR HYDOXDWH WKH HᚑFLHQF\ RI UHWURJUDGH ᚐH[LEOH XUHWHURVFRSLF approach in the treatment of patients with intradiverticular lithiasis.
Material & Methods: Between March and October 2007, in the Clinical Department RI 8URORJ\ RI WKH ಯ6DLQW -RKQರ (PHUJHQF\ &OLQLFDO +RVSLWDO ZH PRXQWHG 0HPRNDWK thermo-expandable metallic ureteral stents in 9 patients with pelvic ureteral stricture due to cervix neoplasia, operated and irradiated. The inclusion criteria were: presence of extrinsic ureteral obstruction secondary to pelvic or abdominal malignancy, life expectancy greater than 6 months, preoperative medical examination clearing the patient for general or spinal anesthesia, no active urinary tract infection by urinalysis and urine culture. All patients were drained by JJ stent (7 cases) or percutaneous QHSKURVWRP\ FDVH 7KHLQWHUYHQWLRQWRRNSODFHXQGHUJHQHUDORUVSLQDODQHVWKHVLD 7KHSURFHGXUHWRRNSODFHXQGHUᚐXRURVFRSLFFRQWURODQGVWDUWHGE\VWULFWXUHGLODWLRQ using the dilator included in the mounting set. Afterwards, we introduced the stent through the dilator sheath and correctly positioned it. The distal end of the stent was expanded by injecting 20 ml of sterile water preheated to 60 degrees C. At the end of WKHSURFHGXUHZHSHUIRUPHGWKHᚐXRURVFRSLFDQGXUHWHURVFRSLFFRQWUROUHJDUGLQJWKH correct stent position. The follow-up period was between 1 and 7 months.
Material & Methods: Between February 1993-August 2007, 10 patients with intradiverticular lithiasis (4 with superior, 3 with medium and 3 with inferior caliceal diverticula) were evaluated and treated. One of these patients presented PHGLXP FDOLFHDO GLYHUWLFXOD 2QH SDWLHQW SUHVHQWHG LQWUDGLYHUWLFXODU PLON RI calcium stone. Simptomatology included: lumbar pain (9/11 cases), hematuria (3/11 cases) and recurrent urinary tract infections (6/11 cases) with E. Colli and Proteus. Incision of the diverticular isthmus (electric or Nd:YAG laser) was necessary in 9 cases. The electrohydraulic lithotripsy was performed with 1.61.9 F probes.
Results: Metallic stents were successfully inserted in all cases. Pre-insertion dilatation ZDVGLᚑFXOWLQRQHSDWLHQW7KHUHZHUHQRLQWUDRUSRVWRSHUDWLYHFRPSOLFDWLRQV7KH KRVSLWDOL]DWLRQ SHULRG ZDV KRXUV 8OWUDVRQRJUDSK\ UHYHDOHG UHVROXWLRQ RI SUH existing hydronephrosis. One ureter was occluded 3 months after stent placement EHFDXVHRIVWHQWPLJUDWLRQUHTXLULQJWKHUHSRVLWLRQLQJRIWKHVWHQW7KHRWKHUXUHWHUV showed no signs of obstruction during follow-up. No tissue ingrowth was seen. Conclusions: Our results suggest that insertion of a metallic stent in the ureter is feasible and safe for the treatment of malignant ureteral strictures. However, more ZRUNQHHGVWREHGRQHLQRUGHUWRHVWDEOLVKWKHXVHRIWKHVHVWHQWVIRUWKHWUHDWPHQW of ureteral obstruction.
Results: ,QFDVHV LQFOXGLQJWKHSDWLHQWVZLWKಯPLONRIFDOFLXPVWRQHರDQG WKHRQHZLWKPHGLXPFDOLFHDOGLYHUWLFXOD ᚐH[LEOHXUHWHURVFRSLFDSSURDFKRI the diverticula was successful. All these 7 patients were stone-free at the end of the procedure. In the other 3 cases, failure of retrograde incision imposed percutaneous approach, especially for inferior location of the PD. Postoperative complications were represented by persistent bleeding (1 case), fever (1 case) DQGᚐDQNSDLQ FDVH 3RVWRSHUDWLYHHYDOXDWLRQDWPRQWKVGHPRQVWUDWHG a large passage between pyelocaliceal diverticula and collecting system in 6 patients. Conclusions: 5HWURJUDGHᚐH[LEOHXUHWHURVFRSLFDSSURDFKRIWKHVPDOOFDOLFHDO GLYHUWLFXODZLWKLQWUDGLYHUWLFXODUOLWKLDVLVPD\EHXVHGDVᚏUVWWUHDWPHQWRSWLRQ This treatment intends to render the patient stone-free and to provide a large non obstructive communication between the diverticula and the pyelocaliceal system.
V27 RETROGRADE INTRARENAL SURGERY (RIRS) IN THE TREATMENT OF RENAL CALCULI LARGER THAN 2 CM: MYTH OR REALITY? Giusti G. 3LFFLQHOOL $ 7DYHUQD * 3DVLQL / 0DXJHUL 2 %HQHWWL $ &RULQWL 0 =DQGHJLDFRPR 6 *UD]LRWWL3 Istituto Clinico Humanitas, IRCCS, Dept. of Urology, Milan, Italy Introduction & Objectives: 3HUFXWDQHRXVQHSKUROLWKRWRP\ 31/ UHPDLQVWKHJROGHQVWDQGDUGRIFDUHLQ case of renal calculi more than 2 cm in diameter. Nevertheless, with the ever growing interest worldwide IRUWKHಯQDWXUDORULᚏFHVVXUJHU\ರWKHPDQDJHPHQWRIXULQDU\VWRQHVLVFRQWLQXLQJWRHYROYH)XUWKHUPRUHLQ WKHODVWIHZ\HDUVWKHSURJUHVVLYHLPSURYHPHQWLQWHFKQLTXHWRJHWKHUZLWKUHFHQWDGYDQFHPHQWVLQᚐH[LEOH ureteroscopes with the advent of digital technology have been very impressive. As such, retrograde approach to renal calculi, considered till few years ago pure myth, is becoming a reasonable and attractive DOWHUQDWLYHWR31/HYHQIRUVWRQHODUJHUWKDQFP Material & Methods: In this videotape we present step by step our retrograde ureteroscopic approach WRDOHIWUHQDOVWRQHRIFPLQGLDPHWHU6RIDUZLWKWKHVDPHWHFKQLTXHZHWUHDWHGSDWLHQWVZLWKD mean stone burden of 7.0 cm2 7HFKQLTXH 2QFHZHJHWLQWRWKHUHQDOSHOYLVYLVXDOL]LQJWKH VWRQHZLWKWKHVHPLULJLGVFRSHDPLFURQVKROPLXPODVHUᚏEHUVHWDWORZHQHUJ\ZLWKKLJKSXOVHUDWH is introduced and stone fragmentation begun. Our policy is to continue the lithotripsy the longer we can ZLWKWKHVHPLULJLGVFRSHLQRUGHUWRSUHVHUYHWKHGHOLFDWHDQGYHU\FRVWO\ᚐH[LEOHXUHWHURVFRSH2QFHWKH UHVLGXDOIUDJPHQWVDUHQRORQJHUUHDFKDEOHGLUHFWO\ZLWKWKHVHPLULJLGLQVWUXPHQWZHFKDQJHWRᚐH[LEOH scope. When facing stones of such dimensions, we routinely place a 14 French ureteral access sheat in order to avoid prolonged intrarenal high pressure and damage to the ureter while facilitating spontaneous SDVVDJH RI VPDOO GHEULV 7KHQ D PLFURQV ODVHU ᚏEUH LV LQWURGXFHG ZLWK WKH VDPH SRZHU VHWWLQJ WR complete fragmentation. When stone fragments appeared to be less than 2 mm on the basis of mobility ZLWK LUULJDWLRQ DQG XVLQJ WKH ODVHU ᚏEHU DV YLVXDO JDXJHV WKH SURFHGXUH LV FRQVLGHUHG WHUPLQDWHG 1R attempt to extract physically all debris is pursued. At the end of the procedure, a 6 French JJ stent is placed DQGDQLQGZHOOLQJ))ROH\FDWKHWHULVOHIWRYHUQLJKW--VWHQWKDVWKHQEHHQUHPRYHGDIWHUZHHNE\ PHDQVRIᚐH[LEOHF\VWRVFRS\RQRXWSDWLHQWEDVLV Results: Mean OR time (min) ˂+E PJGO Sepsis SHULUHQDODEVFHVVUHTXLULQJRSHQGUDLQDJH Hospital stay (d) Stone free rate after 1 procedure Stone free rate after 2 procedures Stone free rate after 3 procedures Procedures per stone rate
121.4 (41.0-153.0) 1,0 (-0,4-2,7) ; 0% transfusion rate 2/35 (5.7%) 1/35 (2.8%) 1,5 (1-7) 24/35 (68.5%) 28/35 (80%) 30/35 (85.7%) 1.34
Conclusions: 31/ VWLOO UHPDLQV WKH JROG VWDQGDUG LQ WKH WUHDWPHQW RI UHQDO VWRQH ODUJHU WKDQ FP However, based on our experience, RIRS can be considered a reasonable and attractive alternative. 2EYLRXVO\SDWLHQWVKDYHWREHIXOO\LQIRUPHGDERXWTXLWHORZHUVWRQHIUHHUDWHDIWHUVLQJOHSURFHGXUHDQG eventual need for further retreatments and anesthesiae when are candidate to RIRS.
V28 ENDOSCOPIC COMBINED INTRA-RENAL SURGERY (ECIRS) FOR THE TREATMENT OF COMPLEX UROLOGICAL PATHOLOGIES USING GALDAKAO-MODIFIED SUPINE VALDIVIA POSITION 6FRᚎRQH&1, Morra I.1, Cracco C.1, Ragni F.1, Poggio M.1, Cossu M.1, Vaccino D.1, Billia M.1, Grande S.1, Scarpa R.M.1,EDUOX]HD*2, Valdivia Uria J.G.3 6DQ /XLJL +RVSLWDO 'HSW RI 8URORJ\ 2UEDVVDQR ,WDO\ 2*DOGDNDR +RVSLWDO 'HSW RI 8URORJ\%L]NDLD6SDLQ3/R]DQR%OHVD+RVSLWDO'HSWRI8URORJ\6DUDJR]]D6SDLQ
1
Introduction & Objectives: 6LQFH WKHSHUFXWDQHRXVDFFHVVWRWKHNLGQH\ZDVPDLQO\ performed with the patient in the prone position. Anaesthesiological problems and the need for a combined access to the upper urinary tract encouraged urologists to go in search of alternative positions. In fact, the prone position has several disadvantages, including SDWLHQWಬVGLVFRPIRUWDQLQFUHDVHGUDGLRORJLFDOKD]DUGWRWKHXURORJLVWQHFHVVLW\RIDKLJK number of nurses for the correct preoperative and intraoperative positioning of the patient LQ FDVH RI VLPXOWDQHRXV UHWURJUDGH LQVWUXPHQWDWLRQ RI WKH XUHWHU D PRUH HYLGHQW ULVN UHODWHG WR SUHVVXUH SRLQWV FLUFXODWRU\ DQG YHQWLODWRU\ GLᚑFXOWLHV HVSHFLDOO\ LQ PRUELGO\ REHVHN\SKRWLFDQGGHELOLWDWHGSDWLHQWV HQGRFULQHDQGSKDUPDFRNLQHWLFHᚎHFWV$PRQJ DOOWKHQHZO\SURSRVHGSRVLWLRQVWKH*DOGDNDRPRGLᚏHGVXSLQH9DOGLYLDSRVLWLRQJUDQWVRXU QHHGWRWUHDWLQDVLQJOHVWHSSURFHGXUHVRPHGLᚑFXOWFDVHVE\VLPXOWDQHRXVDQWHURJUDGH DQGUHWURJUDGHDSSURDFK7KLVSRVLWLRQZDVᚏUVWGHVFULEHGLQ E\*DEULHO9DOGLYLD8U®D LQ *DVSDU,EDUOX]HDPDGHLWHYHQEHWWHUZLWKWKHORZHUOLPEVLQDVOLJKWO\PRGLᚏHG OLWKRWRPLF SRVLWLRQ 7KH DGYDQWDJHV RI WKH *DOGDNDRPRGLᚏHG 9DOGLYLD VXSLQH SRVLWLRQ are relevant. First of all, it allows a great versatility of combined direct percutaneous and UHWURJUDGHXUHWHURVFRSLFPDQRHXYUHVZLWKULJLGDQGᚐH[LEOHLQVWUXPHQWVDQGQRQHHGRI multiple accesses. During the percutaneous approach it is possible to follow endoscopically the correct entry of the puncture needle on the tip of the renal papilla within the renal cavities. Complex urolithiasis or other pathologies, such as ureteral or uretero-intestinal strictures, can be solved with a single-step procedure. The supine position is certainly ideal IRUWKHWUHDWPHQWRIXURHQWHULFVWULFWXUHVRISDWLHQWVZLWKXULQDU\GLYHUVLRQV LH%ULFNHURU colon conduit), which are already in the optimal position for the procedure. Material & Methods: In this video we present some intriguing cases, successfully treated ZLWKWKHSDWLHQWLQWKH*DOGDNDRPRGLᚏHG9DOGLYLDVXSLQHSRVLWLRQ:HVKRZWKHUHPRYDO RIDGDPDJHGDQGHQFUXVWHGVWHQWLQNLGQH\JUDIWWKHWUHDWPHQWRIDXURHQWHULFVWULFWXUH LQDSDWLHQWZLWKXULQDU\GLYHUVLRQ %ULFNHU RIDFRPSOH[UHQDOXUROLWKLDVLVDQGRIDVWRQH in a hydrocalix. Conclusions: ECIRS (Endoscopic Combined Intra-Renal Surgery) is a new way to face complex ureteral and renal pathologies, allowing to solve them with a single-step procedure
Eur Urol Suppl 2008;7(3):335