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PCNL VS. OPEN SURGERY IN THE TREATMENT OF STAGHORN CALCULI
469 SEXUAL DYSFUNCTION PREVALENCE IN WOMEN AFTER KIDNEY TRANSPLANTATION AND IN DIALYSIS THERAPY Filocamo M.T.1, Li Marzi V.1, Zanazzi M.2, Mancini G.2, Guidoni L.1, Dattolo E.1, Marzocco M.1, Nicita G.1 University of Florence, Dept. of Urology, Florence, Italy, 2Careggi University Hospital, Renal Unit, Florence, Italy
470 EVALUATION SAFETY AND EFFICACY OF BREMELANOTIDE IN FEMALE SUBJECTS WITH AROUSAL DISORDER: A DOUBLE BLIND PLACEBO-CONTROLLED, FIXED DOSE, RANDOMISED STUDY Safarinejad M.R.
1
Introduction & Objectives: Female sexual dysfunction (FSD) are a common feature in women with chronic renal failure. The majority of pre-menopausal women, undergoing long-term dialysis, experience anovulation, abnormal menstrual cycles, often associated with amenorrhoea, loss of libido and inability to reach orgasm. The genesis of FSD is multifactorial and it is primarily organic in origin. After renal transplantation (RT) the majority of pre-menopausal women restored their PHQVHV DQG IHUWLOLW\ GXH WR D QRUPDOL]DWLRQ RI KRUPRQDO VHUXP SURᚏOH 7KH DLP RI WKLV VWXG\ LV to determine if sexual function improve after RT as well as hormonal status, comparing a group of pre-menopausal women in dialysis with an age-matched group of women after RT with fully functioning allograft. Material & Methods: :HHQUROOHGZRPHQ PHDQDJHs RQGLDO\VLVWKHUDS\ PHDQ DJHs DQGKDGKDGD57 PHDQDJHs $OOZRPHQXQGHUJRQHDJHQHUDODQG urogynecological examination, a Female Sexual Dysfunction Index (FSFI) and a Back Depression Inventory questionnaire (BDI) were administered to all of them. The results of questionnaires were analyzed with unpaired Wilcoxon test. The number of pts with an active sexual life in the two groups were analyzed with Fisher’s exact test. Results: The mean time after RT was 26 months (range 14-75) all RT pts were under 6 months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ᚏHGVXEJURXSVRI)6' (sexual desire disorder, sexual arousal disorder, orgasmic and sexual pain disorder). 8/10 RT pts complained of a sexual desire disorder, 7/10 complained of a sexual arousal disorder associated with a reduction of vaginal lubrication. 10/10 had an orgasmic phase disorder, with delayed orgasm LQSWVDQGFRPSOHWHDQRUJDVPLDLQSWV7KHSWVLQGLDO\VLVWKHUDS\FRPSODLQHGRIDVH[XDO desire disorder and an orgasmic disorder, 7 had a sexual arousal disorder, and 2 had a sexual pain disorder. The mean score of BDI questionnaire was 7 (range 6-11) and 11 (range 7-19) in RT and GLDO\VLVSWVUHVSHFWLYHO\ZLWKDVWDWLVWLFDOUHOHYDQWGLᚎHUHQFH S Conclusions: This study demonstrate, although the small number of patients, that a successful renal transplantation should improve sexual function in women.
P29 OPEN SURGERY AND PCNL FOR STONES Thursday, 27 March, 12.15-13.45, Purple Hall 1
Urology and Nephrology Research Centre, Shaheed Beheshti University of Medical Sciences, Dept. of Urology, Tehran, Iran Introduction & Objectives: Of the female sexual disorders (FSD), female sexual arousal disorder (FSAD) is a highly prevalent problem. Reliable and pleasurable sexual arousal is one of the most essential components of the female sexual response cycle in that it helps initiate sexual desire for many women. There are no FDA approved drug treatments for WKH)6$'2XUDLPVZHUHWRHYDOXDWHVDIHW\DQGHᚑFDF\RIEUHPHODQRWLGHLQPHQVWUXDWLQJ women with female sexual arousal disorder (FSAD) as a sole entity. Material & Methods: $WRWDORIPDUULHGZRPHQ PHDQDJH\HDUV ZLWK)6$'ZHUH randomly assigned to receive 20 mg bremelanotide as an intranasal spray (group 1, n=40) on “as required” basis 45 to 60 minutes before attempting sexual intercourse, or a similar regimen of placebo (group 2, n=40). Patients were asked to use at least 20 attempts at home, but not to exceed more than 1 attempt per day. They were underwent preliminary assessment, including medical and sexual history, blood chemistry, measurement of serum levels of sex hormones and prolactin, and self–administered Female Sexual Function Index )6), 3ULPDU\HᚑFDF\HQGSRLQWVZHUH)6),TXHVWLRQV UDWHRIDURXVDODQGIHHOLQJLQ the genital area during intercourse or stimulation) and 14-16 (increased satisfaction with LQWHUFRXUVH DQGRU IRUHSOD\ 6HFRQGDU\ HᚑFDF\ HQG SRLQWV LQFOXGHG WKH UHPDLQLQJ LWHPV IURPWKLVTXHVWLRQQDLUH7KHHᚑFDF\RIWZRWUHDWPHQWVZDVDVVHVVHGHYHU\DWWHPSWVGXULQJ treatment and at the end of study, using responses to FSFI, and evaluation of total number of VH[XDOHYHQWVWRWDOQXPEHURIRUJDVPSHUVRQDOGLVWUHVVDQGDGYHUVHGUXJHᚎHFWV Results: Mean pre-treatment arousal score of 2.7 and 2.8 in groups 1 and 2, increased WR DQG UHVSHFWLYHO\ DW WKH HQG RI WULDO 3 %UHPHODQRWLGH JURXS UHSRUWHG VLJQLᚏFDQWO\ JUHDWHU LQWHUFRXUVH VDWLVIDFWLRQ WKDQ WKRVH LQ SODFHER JURXS 3 7KH adjusted mean frequency of total satisfying episodes was 67%greater from baseline for the women in the bremelanotide group than for women receiving placebo (P=0.028). Women WUHDWHG ZLWK EUHPHODQRWLGH DOVR H[SHULHQFHG VWDWLVWLFDOO\ VLJQLᚏFDQW LQFUHDVHV LQ WKH WRWDO number of sexual events and the total number of orgasms at the end of trial compared with ZRPHQUHFHLYLQJSODFHER 3 DQGUHVSHFWLYHO\ 0RUHGUXJUHODWHGDGYHUVHHᚎHFWV occurred in bremelanotide group and 2 (5%) had to discontinue treatment (P =0.01). Conclusions: %UHPHODQRWLGHZDVHᚎHFWLYHDQGZHOOWROHUDWHGLQPHQVWUXDWLQJZRPHQZLWK )6$'DVDVROHHQWLW\)XUWKHUVWXGLHVDUHUHTXLUHGWRGUDZᚏQDOFRQFOXVLRQVRQWKHHᚑFDF\ and safety of this drug in FSAD.
471
472
PCNL VS. OPEN SURGERY IN THE TREATMENT OF STAGHORN CALCULI
MANAGEMENT OF LOWER POLE STONES OF 0.8 - 1.5CM MAXIMAL DIAMETER BY MINIMAL INVASIVE PERCUTANEOUS APPROACH
Botoca M., Boiborean P., Bucuras V., Herman I., Minciu R., Cumpanas A., Miclea F.
Nagele U., Renninger M., Schilling D., Sievert K.D., Stenzl A., Kuczyk M.
University of Medicine and Pharmacy, Dept. of Urology, Timisoara, Romania
Introduction & Objectives: In the treatment of small lower pole stones (LPS) miniaturisized percutaneous procedures are reported as a suitable alternative to shock wave lithotripsy, ureteroscopy or percutaneous nephrolithotomy (PCNL). Additionally to the use of a PLQLDWXULVL]HGQHSKURVFRSHPLQLPDOO\LQYDVLYH 0LQL 3&1/ZDVGHᚏQHGDVVXUJLFDOWHFKQLTXH with the following features: ultrasound guided puncture, low pressure irrigation system, stone retraction by irrigation and a sealed and tubeless access tract with primary closure of the channel independent of haemorrhage and without a second look procedure.
Introduction & Objectives: Since PCNL and ESWL have been introduced in the clinical practice, the treatment of staghorn calculi completely changed, although some cases are still treated by open surgery as primary intention. The aim of the study was to compare the results of PCNL and open surgery of a centre which has an experience of more than 2000 cases of PCNL procedures. Material & Methods: We retrospectively analyzed the cases treated in our department for staghorn calculi during an 8-year period comparing the stone free rates, incidents and complications for PCNL (group A) and open surgical SURFHGXUHV JURXS% VWUDWLᚏHGE\WKHW\SHRIVWDJKRUQFDOFXOLDFFRUGLQJWR 0RRUHV2ಬ%R\OHFODVVLᚏFDWLRQ Results: In the group A (n=151 cases) the majority of stones were partial, OHVVEUDQFKHGVWDJKRUQW\SH&,QJURXS% Q FDVHV WKHPRVWSDUW of the stones were complete or large staghorn, type A: 112 cases and type B 59 cases. The overall stone free rate for PCNL and open surgery as single SURFHGXUHZHUHDQGUHVSHFWLYHO\%\WKHW\SHRIVWRQHWKHVWRQH IUHHUDWHZDV W\SH$ LQJURXS$DQGLQJURXS% W\SH% LQJURXS $DQG LQJURXS% W\SH& LQJURXS$DQGLQJURXS% W\SH' LQJURXS$LQJURXS%(6:/DVVHFRQGDU\WKHUDS\VLJQLᚏFDQWO\ UDLVHG WKH VWRQH IUHH UDWHV &RPSOLFDWLRQV ZHUH HQFRXQWHUHG LQ FDVHV LQJURXS$DQG FDVHV LQJURXS% Conclusions: For complete or otherwise large staghorn calculi, the open surgery is a viable option when ESWL as secondary therapy to PCNL is not DYDLODEOHRUZKHQVWRQHIUHHDWᚏUVWDWWHPSWLVDPXVW)RUVPDOOHUDQGOHVV branched staghorn calculi PCNL is the method of choice.
Eur Urol Suppl 2008;7(3):188
Eberhard-Karls-University, Dept. of Urology, Tübingen, Germany
Material & Methods: 29 patients revealing with LPS with a largest diameter of 8-15 mm were treated by a minimally invasive percutaneous approach. Access was obtained under sonographic guidance. After single step dilatation, an 18 Fr. metal Amplatz-sheath was inserted. Stone disintegration was achieved with ballistic lithotripsy through a 12 Fr. Mini-scope with a 6 Fr. working channel (Storz Mini-PCNL set by Nagele, Karl Storz, Tuttlingen, Germany). +\GURG\QDPLF HᚎHFWV RI D VSHFLDOO\ GHVLJQHG $PSODW]VKHDWK ZHUH XVHG WR HYDFXDWH fragmented stones without additional pressure or suction. A double-J stent was placed antegradely. The metal Amplatz sheath was withdrawn out of the collecting system under visual control without irrigation until the urothelium collapsed. Gelatine Matrix Haemostatic Sealant (FLOSEAL/ Baxter, Heidelberg, Germany) sealant was injected simultaneously during the retraction of the Amplatz sheath into the channel of the kidney parenchyma and Para renal VSDFH7KHVNLQLQFLVLRQVZHUHFORVHGZLWKVWHULVWULSV2QWKHᚏUVWSRVWRSHUDWLYHGD\DSODLQ ᚏOPRIWKHDEGRPHQDQGDQXOWUDVRXQGH[DPLQDWLRQZDVSHUIRUPHGVXEVHTXHQWO\ Results: All patients received a one-stage Mini-PCNL procedure through a single access WUDFW 0HDQ VWRQH VL]H ZDV FPt 0HDQ RSHUDWLYH WLPH ZDV PLQXWHV The abdominal x-ray demonstrated a stone free status in 28 patients (96%). Transient fever was recorded in one patient without any laboratory signs of urosepsis. One patient presented with an extravasation as detected by ultrasound examination. Therefore the double-J stent ZDVH[FKDQJHGLQWKLVFDVH WZRSDWLHQWVGHYHORSHGDXULQDU\WUDFWLQIHFWLRQZLWKRXWUHYHDOLQJ general symptoms. Postoperatively blood transfusions did not have to be administered in any FDVH$YHUDJHSRVWRSHUDWLYHKRVSLWDOVWD\ZDV GD\V2QHSDWLHQWUHFHLYHGDᚐH[LEOH ureteroscopy for the removement of residual stone fragments and was stone free thereafter. Conclusions: The excellent stone clearance and the low morbidity associated with the procedure and as well the advantages, when economical aspects are addressed, minimally invasive percutaneous stone surgery appears as an attractive alternative to conventional PHWKRGVIRUVWRQHWUHDWPHQWLQFOXGLQJ6:/DQGSULPDU\ᚐH[LEOH856HYHQLQVPDOO/36
470 EVALUATION SAFETY AND EFFICACY OF BREMELANOTIDE IN FEMALE SUBJECTS WITH AROUSAL DISORDER: A DOUBLE BLIND PLACEBO-CONTROLLED, FIXED DOSE, RANDOMISED STUDY Safarinejad M.R.
1
Introduction & Objectives: Female sexual dysfunction (FSD) are a common feature in women with chronic renal failure. The majority of pre-menopausal women, undergoing long-term dialysis, experience anovulation, abnormal menstrual cycles, often associated with amenorrhoea, loss of libido and inability to reach orgasm. The genesis of FSD is multifactorial and it is primarily organic in origin. After renal transplantation (RT) the majority of pre-menopausal women restored their PHQVHV DQG IHUWLOLW\ GXH WR D QRUPDOL]DWLRQ RI KRUPRQDO VHUXP SURᚏOH 7KH DLP RI WKLV VWXG\ LV to determine if sexual function improve after RT as well as hormonal status, comparing a group of pre-menopausal women in dialysis with an age-matched group of women after RT with fully functioning allograft. Material & Methods: :HHQUROOHGZRPHQ PHDQDJHs RQGLDO\VLVWKHUDS\ PHDQ DJHs DQGKDGKDGD57 PHDQDJHs $OOZRPHQXQGHUJRQHDJHQHUDODQG urogynecological examination, a Female Sexual Dysfunction Index (FSFI) and a Back Depression Inventory questionnaire (BDI) were administered to all of them. The results of questionnaires were analyzed with unpaired Wilcoxon test. The number of pts with an active sexual life in the two groups were analyzed with Fisher’s exact test. Results: The mean time after RT was 26 months (range 14-75) all RT pts were under 6 months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ᚏHGVXEJURXSVRI)6' (sexual desire disorder, sexual arousal disorder, orgasmic and sexual pain disorder). 8/10 RT pts complained of a sexual desire disorder, 7/10 complained of a sexual arousal disorder associated with a reduction of vaginal lubrication. 10/10 had an orgasmic phase disorder, with delayed orgasm LQSWVDQGFRPSOHWHDQRUJDVPLDLQSWV7KHSWVLQGLDO\VLVWKHUDS\FRPSODLQHGRIDVH[XDO desire disorder and an orgasmic disorder, 7 had a sexual arousal disorder, and 2 had a sexual pain disorder. The mean score of BDI questionnaire was 7 (range 6-11) and 11 (range 7-19) in RT and GLDO\VLVSWVUHVSHFWLYHO\ZLWKDVWDWLVWLFDOUHOHYDQWGLᚎHUHQFH S Conclusions: This study demonstrate, although the small number of patients, that a successful renal transplantation should improve sexual function in women.
P29 OPEN SURGERY AND PCNL FOR STONES Thursday, 27 March, 12.15-13.45, Purple Hall 1
Urology and Nephrology Research Centre, Shaheed Beheshti University of Medical Sciences, Dept. of Urology, Tehran, Iran Introduction & Objectives: Of the female sexual disorders (FSD), female sexual arousal disorder (FSAD) is a highly prevalent problem. Reliable and pleasurable sexual arousal is one of the most essential components of the female sexual response cycle in that it helps initiate sexual desire for many women. There are no FDA approved drug treatments for WKH)6$'2XUDLPVZHUHWRHYDOXDWHVDIHW\DQGHᚑFDF\RIEUHPHODQRWLGHLQPHQVWUXDWLQJ women with female sexual arousal disorder (FSAD) as a sole entity. Material & Methods: $WRWDORIPDUULHGZRPHQ PHDQDJH\HDUV ZLWK)6$'ZHUH randomly assigned to receive 20 mg bremelanotide as an intranasal spray (group 1, n=40) on “as required” basis 45 to 60 minutes before attempting sexual intercourse, or a similar regimen of placebo (group 2, n=40). Patients were asked to use at least 20 attempts at home, but not to exceed more than 1 attempt per day. They were underwent preliminary assessment, including medical and sexual history, blood chemistry, measurement of serum levels of sex hormones and prolactin, and self–administered Female Sexual Function Index )6), 3ULPDU\HᚑFDF\HQGSRLQWVZHUH)6),TXHVWLRQV UDWHRIDURXVDODQGIHHOLQJLQ the genital area during intercourse or stimulation) and 14-16 (increased satisfaction with LQWHUFRXUVH DQGRU IRUHSOD\ 6HFRQGDU\ HᚑFDF\ HQG SRLQWV LQFOXGHG WKH UHPDLQLQJ LWHPV IURPWKLVTXHVWLRQQDLUH7KHHᚑFDF\RIWZRWUHDWPHQWVZDVDVVHVVHGHYHU\DWWHPSWVGXULQJ treatment and at the end of study, using responses to FSFI, and evaluation of total number of VH[XDOHYHQWVWRWDOQXPEHURIRUJDVPSHUVRQDOGLVWUHVVDQGDGYHUVHGUXJHᚎHFWV Results: Mean pre-treatment arousal score of 2.7 and 2.8 in groups 1 and 2, increased WR DQG UHVSHFWLYHO\ DW WKH HQG RI WULDO 3 %UHPHODQRWLGH JURXS UHSRUWHG VLJQLᚏFDQWO\ JUHDWHU LQWHUFRXUVH VDWLVIDFWLRQ WKDQ WKRVH LQ SODFHER JURXS 3 7KH adjusted mean frequency of total satisfying episodes was 67%greater from baseline for the women in the bremelanotide group than for women receiving placebo (P=0.028). Women WUHDWHG ZLWK EUHPHODQRWLGH DOVR H[SHULHQFHG VWDWLVWLFDOO\ VLJQLᚏFDQW LQFUHDVHV LQ WKH WRWDO number of sexual events and the total number of orgasms at the end of trial compared with ZRPHQUHFHLYLQJSODFHER 3 DQGUHVSHFWLYHO\ 0RUHGUXJUHODWHGDGYHUVHHᚎHFWV occurred in bremelanotide group and 2 (5%) had to discontinue treatment (P =0.01). Conclusions: %UHPHODQRWLGHZDVHᚎHFWLYHDQGZHOOWROHUDWHGLQPHQVWUXDWLQJZRPHQZLWK )6$'DVDVROHHQWLW\)XUWKHUVWXGLHVDUHUHTXLUHGWRGUDZᚏQDOFRQFOXVLRQVRQWKHHᚑFDF\ and safety of this drug in FSAD.
471
472
PCNL VS. OPEN SURGERY IN THE TREATMENT OF STAGHORN CALCULI
MANAGEMENT OF LOWER POLE STONES OF 0.8 - 1.5CM MAXIMAL DIAMETER BY MINIMAL INVASIVE PERCUTANEOUS APPROACH
Botoca M., Boiborean P., Bucuras V., Herman I., Minciu R., Cumpanas A., Miclea F.
Nagele U., Renninger M., Schilling D., Sievert K.D., Stenzl A., Kuczyk M.
University of Medicine and Pharmacy, Dept. of Urology, Timisoara, Romania
Introduction & Objectives: In the treatment of small lower pole stones (LPS) miniaturisized percutaneous procedures are reported as a suitable alternative to shock wave lithotripsy, ureteroscopy or percutaneous nephrolithotomy (PCNL). Additionally to the use of a PLQLDWXULVL]HGQHSKURVFRSHPLQLPDOO\LQYDVLYH 0LQL 3&1/ZDVGHᚏQHGDVVXUJLFDOWHFKQLTXH with the following features: ultrasound guided puncture, low pressure irrigation system, stone retraction by irrigation and a sealed and tubeless access tract with primary closure of the channel independent of haemorrhage and without a second look procedure.
Introduction & Objectives: Since PCNL and ESWL have been introduced in the clinical practice, the treatment of staghorn calculi completely changed, although some cases are still treated by open surgery as primary intention. The aim of the study was to compare the results of PCNL and open surgery of a centre which has an experience of more than 2000 cases of PCNL procedures. Material & Methods: We retrospectively analyzed the cases treated in our department for staghorn calculi during an 8-year period comparing the stone free rates, incidents and complications for PCNL (group A) and open surgical SURFHGXUHV JURXS% VWUDWLᚏHGE\WKHW\SHRIVWDJKRUQFDOFXOLDFFRUGLQJWR 0RRUHV2ಬ%R\OHFODVVLᚏFDWLRQ Results: In the group A (n=151 cases) the majority of stones were partial, OHVVEUDQFKHGVWDJKRUQW\SH&,QJURXS% Q FDVHV WKHPRVWSDUW of the stones were complete or large staghorn, type A: 112 cases and type B 59 cases. The overall stone free rate for PCNL and open surgery as single SURFHGXUHZHUHDQGUHVSHFWLYHO\%\WKHW\SHRIVWRQHWKHVWRQH IUHHUDWHZDV W\SH$ LQJURXS$DQGLQJURXS% W\SH% LQJURXS $DQG LQJURXS% W\SH& LQJURXS$DQGLQJURXS% W\SH' LQJURXS$LQJURXS%(6:/DVVHFRQGDU\WKHUDS\VLJQLᚏFDQWO\ UDLVHG WKH VWRQH IUHH UDWHV &RPSOLFDWLRQV ZHUH HQFRXQWHUHG LQ FDVHV LQJURXS$DQG FDVHV LQJURXS% Conclusions: For complete or otherwise large staghorn calculi, the open surgery is a viable option when ESWL as secondary therapy to PCNL is not DYDLODEOHRUZKHQVWRQHIUHHDWᚏUVWDWWHPSWLVDPXVW)RUVPDOOHUDQGOHVV branched staghorn calculi PCNL is the method of choice.
Eur Urol Suppl 2008;7(3):188
Eberhard-Karls-University, Dept. of Urology, Tübingen, Germany
Material & Methods: 29 patients revealing with LPS with a largest diameter of 8-15 mm were treated by a minimally invasive percutaneous approach. Access was obtained under sonographic guidance. After single step dilatation, an 18 Fr. metal Amplatz-sheath was inserted. Stone disintegration was achieved with ballistic lithotripsy through a 12 Fr. Mini-scope with a 6 Fr. working channel (Storz Mini-PCNL set by Nagele, Karl Storz, Tuttlingen, Germany). +\GURG\QDPLF HᚎHFWV RI D VSHFLDOO\ GHVLJQHG $PSODW]VKHDWK ZHUH XVHG WR HYDFXDWH fragmented stones without additional pressure or suction. A double-J stent was placed antegradely. The metal Amplatz sheath was withdrawn out of the collecting system under visual control without irrigation until the urothelium collapsed. Gelatine Matrix Haemostatic Sealant (FLOSEAL/ Baxter, Heidelberg, Germany) sealant was injected simultaneously during the retraction of the Amplatz sheath into the channel of the kidney parenchyma and Para renal VSDFH7KHVNLQLQFLVLRQVZHUHFORVHGZLWKVWHULVWULSV2QWKHᚏUVWSRVWRSHUDWLYHGD\DSODLQ ᚏOPRIWKHDEGRPHQDQGDQXOWUDVRXQGH[DPLQDWLRQZDVSHUIRUPHGVXEVHTXHQWO\ Results: All patients received a one-stage Mini-PCNL procedure through a single access WUDFW 0HDQ VWRQH VL]H ZDV FPt 0HDQ RSHUDWLYH WLPH ZDV PLQXWHV The abdominal x-ray demonstrated a stone free status in 28 patients (96%). Transient fever was recorded in one patient without any laboratory signs of urosepsis. One patient presented with an extravasation as detected by ultrasound examination. Therefore the double-J stent ZDVH[FKDQJHGLQWKLVFDVH WZRSDWLHQWVGHYHORSHGDXULQDU\WUDFWLQIHFWLRQZLWKRXWUHYHDOLQJ general symptoms. Postoperatively blood transfusions did not have to be administered in any FDVH$YHUDJHSRVWRSHUDWLYHKRVSLWDOVWD\ZDV GD\V2QHSDWLHQWUHFHLYHGDᚐH[LEOH ureteroscopy for the removement of residual stone fragments and was stone free thereafter. Conclusions: The excellent stone clearance and the low morbidity associated with the procedure and as well the advantages, when economical aspects are addressed, minimally invasive percutaneous stone surgery appears as an attractive alternative to conventional PHWKRGVIRUVWRQHWUHDWPHQWLQFOXGLQJ6:/DQGSULPDU\ᚐH[LEOH856HYHQLQVPDOO/36