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MP-03.05: Tubeless percutaneous nephrolithotomy: five years of experience, review of 201 patients
MODERATED POSTER SESSIONS
MP-03.02 A double-blind, placebo-controlled comparison of voltaren and tramadol for acute renal colic Ahmadnia H, Darabi M, Ghanbarizadeh S, Molaee M, Shokohian M Ghaem Medical Sciences, Mashad University of Medical Sciences, Mashad, Iran Objective: The objective is to compare the effectiveness of intramuscular using Tramadol and Voltaren in l00 patients with renal colic. Materials & Methods: A double-blind, randomized clinical study was performed in the Emergency Department of Urology in Ghaem Hospital. Patients with suspected renal colic (n⫽ l00, F⫽ 16, M⫽88, mean age ⫽ 35.6 ⫹ 11.3) were randomized to apply intramuscular, either Tramadol 100mg (n⫽48) or Voltaren 75mg (n⫽52). Patients’ information was recorded. The diagnosis of renal colic was made by a typical presentation of the acute onset of flank pain associated with the presence of renal calculus shown by KUB or Ultrasonography. The side effects were recorded. All patients had urine examinations. Results: At the beginning of our study, visual analogue scale (VAS) pain scores in both groups were equal .In the Voltaren group, 42 patients (80.8%) showed a good response, but in the Tramadol group, only 30 cases (62.5%) had improved (P⫽0.04). In the Voltaren group, degree of pain relief was more than that in the Tramadol group, at the 30 and 60 minute evaluations. There were significant differences between the Tramadol and Voltaren groups, in the time of response to pain and their efficacy. Relief duration in the Voltaren group (17.8 min) is shorter than the Tramadol group (24.5 min) (P⫽0.001). Five patients in the Tramadol group showed side-effects including nausea, vertigo and weakness. Conclusion: Our study showed that Voltaren is potentially more effective than Tramadol in the treatment of renal colic. MP-03.03 In situ de novo ESWL of ureteral stones: evolution in treatment results 1990-2007 Tailly GG AZ Klina, Brasschaat, Belgium Introduction: Since 1990, we have treated the majority of ureteral stones in situ and de novo. In that time period, we consecutively used four different Dornier lithotriptors, always adhering to the same treatment strategy. The results were periodically evaluated for each machine at the time of usage. Methods: For the period of January 1990 until September 2006, we retrospectively
compared the results of in situ and de novo ESWL of ureteral stones with the electrohydraulic Dornier MPL 9000X (N⫽175), the electromagnetic Dornier U/50 with standard EMSE 220 and the Dornier Lithotripter S with EMSE 220F-XP (N⫽137) and EMSE 220F-XXP (N-376). Results: There is no difference in the stone free rate for the different groups. The retreatment rate with the EMSE 220F-XXP is significantly better than with the MPL 9000X and the Dornier U/50 (p⬍ 0.0001), but does not differ significantly (p ⫽ 0.9) from the EMSE 220F-XP. The auxiliary procedure rate with the EMSE 220F-XXP is significantly lower than with the MPL 9000 X, the Dornier U/50 and the DoLiS with EMSE 220F-XP. There is a steady improvement in EQ from 66.0 with the MPL9000X to 80.0 with the DoLiS equipped with the EMSE 220F-XXP. Conclusion: With EQ’s ranging from 66.0 (MPL9000X) to 80.0 (DoLiS with EMSE 220F-XXP) in situ and de novo ESWL of ureteral stones proves to be a highly efficient treatment modality for ureteral stones of all sizes at all levels of the ureter. With an unprecedented EQ of 80.0 the DoLiS with EMSE 220F-XXP outscores any other machine or SW-source currently available. With the EMSE 220F-XXP results for in situ and de novo ESWL of ureteral stones are comparable to the treatment results for stones of comparable size in the renal pelvis. MP-03.04 Retrograde proximal rigid ureteroscopy and pyeloscopy: its safety and efficacy Hidoussi A, Jaidane M, Slama A, Youssef A, Kalel Y, Ben Sorba N, Mosbah AF Department of Urology, Ho ˆ pital Sahloul, Sousse, Tunisia Introduction: Traditionally, rigid ureteroscopy has been reserved for distal ureteral procedures, due to the risk of injury associated with proximal ureteroscopy. We report the results of rigid ureteropyeloscopy for the management of upper ureteral and renal pelvic calculi. Methods: A retrospective review was performed of all proximal rigid ureteroscopy and pyeloscopy performed during 5 years. The indications for ureteroscopy were treatment of ureteral and/or renal pelvic calculi. All patients were evaluated postoperatively with renal and bladder ultrasonography and urography. Results: A total of 33 ureteropyeloscopy were performed (15 males and 18 females), the mean age was 29 years (5 to 64 years old). Stones were located in the renal pelvis in 10 cases (30.3%) and proxi-
UROLOGY 70 (Supplment 3A), September 2007
mal ureter in 23 (69.6%). Stone size ranged from 6 to 20 mm (mean 10.8). Follow up was 3 to 60 months (mean 11). Stone-free rate after initial ureteroscopy was 88% (29 cases). 3 patients with proximal ureteral stones 8 to 14 mm in diameter (mean 11.3mm) required a secondary procedure (extra corporal shock wave lithotripsy in 2 cases and repeat ureteroscopy in 1 case) to become stone-free. One patient with a renal pelvic stone measuring 18 mm required percutaneous nephrostolithotomy. There were no complications during any of the procedures. Conclusion: Proximal rigid ureteroscopy and pyeloscopy can be a safe and efficient treatment for upper ureteral and renal pelvic stones. MP-03.05 Tubeless percutaneous nephrolithotomy: five years of experience, review of 201 patients Karami H, Jabbari M Shahid Beheshti Tehran Univesity, Tehran, Iran Background: Our aim was to evaluate the safety, efficacy and feasibility of tubeless PCNL. Patient & Method: From June 2000 to September 2005, 201 patients with renal stone ⬎2 cm underwent tubeless PCNL by a single surgeon. We report our outcome in details. Results: Complete stone Clearance rate was 91.04% (183 patients). After surgery 18 patients (8.96%) had stones (mean size ⫽ 7mm) detected at plain abdominal film or ultrasound examination and referred for ESWL. The mean stone size was 30 mm (range, 20-40). The mean operation time was 35 minutes (range, 30-60) and the mean hospital stay was 3.5 days (range, 2-5). Post operative ultrasonography did not reveal considerable fluid collection. There were no visceral injuries. 22 patients (10.9%) had transfusion and 16 (7.9%) had urinary tract infection. Conclusion: In our experience, tubeless PCNL is safe, effective and feasible without any discomfort for patients. MP-03.06 Oxalate-induced nadph oxidase mediated free radical generation is protein kinase C-dependent in renal epithelial cells Thamilselvan V, Menon M, Thamilselvan S Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI USA Introduction: Hyperoxaluria is one of the major risk factors for kidney stone formation and 60 to 80% of renal calculi
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MP-03.02 A double-blind, placebo-controlled comparison of voltaren and tramadol for acute renal colic Ahmadnia H, Darabi M, Ghanbarizadeh S, Molaee M, Shokohian M Ghaem Medical Sciences, Mashad University of Medical Sciences, Mashad, Iran Objective: The objective is to compare the effectiveness of intramuscular using Tramadol and Voltaren in l00 patients with renal colic. Materials & Methods: A double-blind, randomized clinical study was performed in the Emergency Department of Urology in Ghaem Hospital. Patients with suspected renal colic (n⫽ l00, F⫽ 16, M⫽88, mean age ⫽ 35.6 ⫹ 11.3) were randomized to apply intramuscular, either Tramadol 100mg (n⫽48) or Voltaren 75mg (n⫽52). Patients’ information was recorded. The diagnosis of renal colic was made by a typical presentation of the acute onset of flank pain associated with the presence of renal calculus shown by KUB or Ultrasonography. The side effects were recorded. All patients had urine examinations. Results: At the beginning of our study, visual analogue scale (VAS) pain scores in both groups were equal .In the Voltaren group, 42 patients (80.8%) showed a good response, but in the Tramadol group, only 30 cases (62.5%) had improved (P⫽0.04). In the Voltaren group, degree of pain relief was more than that in the Tramadol group, at the 30 and 60 minute evaluations. There were significant differences between the Tramadol and Voltaren groups, in the time of response to pain and their efficacy. Relief duration in the Voltaren group (17.8 min) is shorter than the Tramadol group (24.5 min) (P⫽0.001). Five patients in the Tramadol group showed side-effects including nausea, vertigo and weakness. Conclusion: Our study showed that Voltaren is potentially more effective than Tramadol in the treatment of renal colic. MP-03.03 In situ de novo ESWL of ureteral stones: evolution in treatment results 1990-2007 Tailly GG AZ Klina, Brasschaat, Belgium Introduction: Since 1990, we have treated the majority of ureteral stones in situ and de novo. In that time period, we consecutively used four different Dornier lithotriptors, always adhering to the same treatment strategy. The results were periodically evaluated for each machine at the time of usage. Methods: For the period of January 1990 until September 2006, we retrospectively
compared the results of in situ and de novo ESWL of ureteral stones with the electrohydraulic Dornier MPL 9000X (N⫽175), the electromagnetic Dornier U/50 with standard EMSE 220 and the Dornier Lithotripter S with EMSE 220F-XP (N⫽137) and EMSE 220F-XXP (N-376). Results: There is no difference in the stone free rate for the different groups. The retreatment rate with the EMSE 220F-XXP is significantly better than with the MPL 9000X and the Dornier U/50 (p⬍ 0.0001), but does not differ significantly (p ⫽ 0.9) from the EMSE 220F-XP. The auxiliary procedure rate with the EMSE 220F-XXP is significantly lower than with the MPL 9000 X, the Dornier U/50 and the DoLiS with EMSE 220F-XP. There is a steady improvement in EQ from 66.0 with the MPL9000X to 80.0 with the DoLiS equipped with the EMSE 220F-XXP. Conclusion: With EQ’s ranging from 66.0 (MPL9000X) to 80.0 (DoLiS with EMSE 220F-XXP) in situ and de novo ESWL of ureteral stones proves to be a highly efficient treatment modality for ureteral stones of all sizes at all levels of the ureter. With an unprecedented EQ of 80.0 the DoLiS with EMSE 220F-XXP outscores any other machine or SW-source currently available. With the EMSE 220F-XXP results for in situ and de novo ESWL of ureteral stones are comparable to the treatment results for stones of comparable size in the renal pelvis. MP-03.04 Retrograde proximal rigid ureteroscopy and pyeloscopy: its safety and efficacy Hidoussi A, Jaidane M, Slama A, Youssef A, Kalel Y, Ben Sorba N, Mosbah AF Department of Urology, Ho ˆ pital Sahloul, Sousse, Tunisia Introduction: Traditionally, rigid ureteroscopy has been reserved for distal ureteral procedures, due to the risk of injury associated with proximal ureteroscopy. We report the results of rigid ureteropyeloscopy for the management of upper ureteral and renal pelvic calculi. Methods: A retrospective review was performed of all proximal rigid ureteroscopy and pyeloscopy performed during 5 years. The indications for ureteroscopy were treatment of ureteral and/or renal pelvic calculi. All patients were evaluated postoperatively with renal and bladder ultrasonography and urography. Results: A total of 33 ureteropyeloscopy were performed (15 males and 18 females), the mean age was 29 years (5 to 64 years old). Stones were located in the renal pelvis in 10 cases (30.3%) and proxi-
UROLOGY 70 (Supplment 3A), September 2007
mal ureter in 23 (69.6%). Stone size ranged from 6 to 20 mm (mean 10.8). Follow up was 3 to 60 months (mean 11). Stone-free rate after initial ureteroscopy was 88% (29 cases). 3 patients with proximal ureteral stones 8 to 14 mm in diameter (mean 11.3mm) required a secondary procedure (extra corporal shock wave lithotripsy in 2 cases and repeat ureteroscopy in 1 case) to become stone-free. One patient with a renal pelvic stone measuring 18 mm required percutaneous nephrostolithotomy. There were no complications during any of the procedures. Conclusion: Proximal rigid ureteroscopy and pyeloscopy can be a safe and efficient treatment for upper ureteral and renal pelvic stones. MP-03.05 Tubeless percutaneous nephrolithotomy: five years of experience, review of 201 patients Karami H, Jabbari M Shahid Beheshti Tehran Univesity, Tehran, Iran Background: Our aim was to evaluate the safety, efficacy and feasibility of tubeless PCNL. Patient & Method: From June 2000 to September 2005, 201 patients with renal stone ⬎2 cm underwent tubeless PCNL by a single surgeon. We report our outcome in details. Results: Complete stone Clearance rate was 91.04% (183 patients). After surgery 18 patients (8.96%) had stones (mean size ⫽ 7mm) detected at plain abdominal film or ultrasound examination and referred for ESWL. The mean stone size was 30 mm (range, 20-40). The mean operation time was 35 minutes (range, 30-60) and the mean hospital stay was 3.5 days (range, 2-5). Post operative ultrasonography did not reveal considerable fluid collection. There were no visceral injuries. 22 patients (10.9%) had transfusion and 16 (7.9%) had urinary tract infection. Conclusion: In our experience, tubeless PCNL is safe, effective and feasible without any discomfort for patients. MP-03.06 Oxalate-induced nadph oxidase mediated free radical generation is protein kinase C-dependent in renal epithelial cells Thamilselvan V, Menon M, Thamilselvan S Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI USA Introduction: Hyperoxaluria is one of the major risk factors for kidney stone formation and 60 to 80% of renal calculi
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