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UP-03.065 Outcome of One Stage Ureteroscopy for Bilateral Ureteric Stones
UNMODERATED POSTER SESSIONS
Study end points i.e. stone free status; number of shock waves used; and number of sessions; were correlated with variables like LPC anatomy, and stone size, to evaluate the possible effect of the age of the patient on those variables outcomes and on the stone clearance rate. Results: At three months’ follow-up after ESWL in elderly patients (ⱖ 60 years), the clearance for LPC stone ⱕ 10mm, and 11–20mm. was 33% and 41% respectively. However for those control patients less than 60 years old, the clearance rate was 60% and 62% respectively. This difference in clearance rate between the old group and the control group was statistically significant (P: 0.006). Although acute pelvic-calyceal angle (⬍90°) and narrow infundibulum (⬍ 4mm.) in elderly patients (ⱖ 60 years) have required more ESWL sessions, shock waves, and give less LPC stone clearance rate, but still not statistically significant different than those patients having obtuse angle (⬎90°) and wide infundibulum (⬎ 4mm). Significantly more ESWL sessions are required for the elderly patients above 60 years to be stone free (P: 0.003). Conclusion: From this study it is apparent that successful ESWL is highly sensitive to the age of the patient. Clearance of the LPC stones in elderly patients (ⱖ 60 years) is significantly lower than those in younger patients. Also, elderly patients need more ESWL sessions for achieving stone-free status.
UP-03.065 Outcome of One Stage Ureteroscopy for Bilateral Ureteric Stones Galal E Dept. of Urology, Minia University Hospital, Minia, Egypt Introduction and Objective: To obviate the need for multiple sessions, we reviewed our experience with one stage ureteroscopy for bilateral ureteric stones. Materials and Methods: In the period between March 2008 and November 2010 at Minia University Hospital, a total of 34 patients (20 men and 14 women) with a mean age of 38.4⫾13.6 years (16-82) years, underwent one stage ureteroscopy for bilateral ureteric stones using 8Fr semirigid ureteroscope. The procedure commences by placing of a 0.038 inch floppy- tipped guidewire through the selected ureteric orifice under direct vision and fluoroscopic monitoring. Balloon dilation of intramural ureter was done in most cases and stone treatment decided according to its size either by direct ex-
S364
traction or lithotripsy using the pneumatic lithoclast. Postoperatively unilateral or bilateral ureteral stenting (either a double-j or ureteric catheter) was done for an average 2 days to 6 weeks. Results: Sixty-four ureteroscopic procedures were successfully completed to treat 32 patients underwent one stage ureteroscopy. Bilateral ureteric stones were the indication for ureteroscopy in all cases. Stone size ranged from 3-20mm with a mean size 8.3mm. The stones were radio-opaque in 28 patients (87.5%) and poor density in 4 patients (12.5%). A single stone was found in 30 patients (93.75%) while 2 patients (6.25%) had multiple stones. In 18 patients (56.25%) calculi were retrieved intact using baskets, whereas in 14 patients (43.75%) lithotripsy was required. Intraoperatively we determined that 25 of 32 patients (78.2%) were stone-free bilaterally and another 7 patients (21.8%) were stone-free unilaterally. The mean operative time was 85 minutes with a range of (35-150 min). Early postoperative complications were rare including fever in 4 (12.5%) patients; however, no long-term complications observed. Conclusion: One stage ureteroscopy for bilateral ureteric stones is a safe and effective procedure that could achieve a satisfactory results compared to those of unilateral ureteroscopy.
UP-03.066 Is Routine Post-Operative Renal Tract Stone Culture Necessary? Allen D, Bycroft J, Philp T, Choong S, Snith D Dept. of Urology, University College Hospital, London, UK Introduction and Objective: To evaluate the clinical utility of routine microbiological analysis of surgically removed renal tract calculi. Materials and Methods: All calculi sent for culture between 2008 and 2009 from both PCNLs and ureteroscopies were identified. The clinical notes and laboratory findings were then correlated. Results: Of the 403 stones cultured 66 (16%) revealed bacterial growth, with clinical information available in 77%. The commonest organisms identified included proteus (17), e coli (8) and enterococcus (5). Stone biochemistry most frequently revealed a calcium oxalate/phosphate mix (44%), struvite (32%) and pure calcium oxalate (10%). Of 51 patients, 19 (37%) had a positive pre-operative msu with an identical organism cultured from the calculus in 74% of
cases. Antibiotic treatment was instituted prior to surgery in all cases where a positive msu was obtained; otherwise, patients received prophylactic antibiotics on induction of anaesthesia. Eight patients developed post-operative pyrexia, with 84% of positive stone culture patients developing no clinical signs of sepsis. Two of the 8 septic patients had a positive pre-operative urine specimen. Seven of the 8 had foreign bodies within the urinary tract (4 with JJ stents, 2 suprapubic catheters and 1 nephrostomy tube) and the other a staghorn calculus. All 4 patients with a JJ stent had negative pre-operative urine cultures as did one patient with a suprapubic catheter but all were taking prophylactic antibiotics. Seven patients clinically improved with broad spectrum antibiotics guided either by their pre-operative urine specimen or chosen empirically. One MS patient with a long-term suprapubic catheter who was treated prior to surgery for a proteus UTI developed multi-organ failure and died. Conclusion: Routine post-operative stone culture is rarely useful in identifying patients who will become septic following surgery. Furthermore, results are unavailable when it does develop and treatment with broad spectrum antibiotics is adequate in the majority of cases. Foreign bodies within the urinary tract appear to elevate the risk of sepsis and terminating prophylactic antibiotic use prior to urine culture may increase the diagnostic yield. The patient who died in our series was already being treated with appropriate antibiotics based on a positive msu.
UP-03.067 The Most Important Metabolic Risk Factors in Recurrent Urinary Stone Formers in Iran Basiri A, Shakhssalim N, Parvin M, Miladipour A, Golestan B, Mohammadi Torbati P, Azadvari M, Eftekhari S Urology and Nephrology Research Center, SBMU, Tehran, Iran Introduction and Objective: Since the metabolic causes in urinary stone formation may be different in our region from western countries, this study was performed to evaluate a variety of urinary factors contributing to idiopathic calcium stone disease in our country in order to implement appropriate medical or dietary interventions for prevention in this part of the world. Materials and Methods: Two 24-hour urine samples were obtained from 106 recurrent idiopathic calcium stone former men and another 109 randomly selected men without any history of stone diseases
UROLOGY 78 (Supplement 3A), September 2011
Study end points i.e. stone free status; number of shock waves used; and number of sessions; were correlated with variables like LPC anatomy, and stone size, to evaluate the possible effect of the age of the patient on those variables outcomes and on the stone clearance rate. Results: At three months’ follow-up after ESWL in elderly patients (ⱖ 60 years), the clearance for LPC stone ⱕ 10mm, and 11–20mm. was 33% and 41% respectively. However for those control patients less than 60 years old, the clearance rate was 60% and 62% respectively. This difference in clearance rate between the old group and the control group was statistically significant (P: 0.006). Although acute pelvic-calyceal angle (⬍90°) and narrow infundibulum (⬍ 4mm.) in elderly patients (ⱖ 60 years) have required more ESWL sessions, shock waves, and give less LPC stone clearance rate, but still not statistically significant different than those patients having obtuse angle (⬎90°) and wide infundibulum (⬎ 4mm). Significantly more ESWL sessions are required for the elderly patients above 60 years to be stone free (P: 0.003). Conclusion: From this study it is apparent that successful ESWL is highly sensitive to the age of the patient. Clearance of the LPC stones in elderly patients (ⱖ 60 years) is significantly lower than those in younger patients. Also, elderly patients need more ESWL sessions for achieving stone-free status.
UP-03.065 Outcome of One Stage Ureteroscopy for Bilateral Ureteric Stones Galal E Dept. of Urology, Minia University Hospital, Minia, Egypt Introduction and Objective: To obviate the need for multiple sessions, we reviewed our experience with one stage ureteroscopy for bilateral ureteric stones. Materials and Methods: In the period between March 2008 and November 2010 at Minia University Hospital, a total of 34 patients (20 men and 14 women) with a mean age of 38.4⫾13.6 years (16-82) years, underwent one stage ureteroscopy for bilateral ureteric stones using 8Fr semirigid ureteroscope. The procedure commences by placing of a 0.038 inch floppy- tipped guidewire through the selected ureteric orifice under direct vision and fluoroscopic monitoring. Balloon dilation of intramural ureter was done in most cases and stone treatment decided according to its size either by direct ex-
S364
traction or lithotripsy using the pneumatic lithoclast. Postoperatively unilateral or bilateral ureteral stenting (either a double-j or ureteric catheter) was done for an average 2 days to 6 weeks. Results: Sixty-four ureteroscopic procedures were successfully completed to treat 32 patients underwent one stage ureteroscopy. Bilateral ureteric stones were the indication for ureteroscopy in all cases. Stone size ranged from 3-20mm with a mean size 8.3mm. The stones were radio-opaque in 28 patients (87.5%) and poor density in 4 patients (12.5%). A single stone was found in 30 patients (93.75%) while 2 patients (6.25%) had multiple stones. In 18 patients (56.25%) calculi were retrieved intact using baskets, whereas in 14 patients (43.75%) lithotripsy was required. Intraoperatively we determined that 25 of 32 patients (78.2%) were stone-free bilaterally and another 7 patients (21.8%) were stone-free unilaterally. The mean operative time was 85 minutes with a range of (35-150 min). Early postoperative complications were rare including fever in 4 (12.5%) patients; however, no long-term complications observed. Conclusion: One stage ureteroscopy for bilateral ureteric stones is a safe and effective procedure that could achieve a satisfactory results compared to those of unilateral ureteroscopy.
UP-03.066 Is Routine Post-Operative Renal Tract Stone Culture Necessary? Allen D, Bycroft J, Philp T, Choong S, Snith D Dept. of Urology, University College Hospital, London, UK Introduction and Objective: To evaluate the clinical utility of routine microbiological analysis of surgically removed renal tract calculi. Materials and Methods: All calculi sent for culture between 2008 and 2009 from both PCNLs and ureteroscopies were identified. The clinical notes and laboratory findings were then correlated. Results: Of the 403 stones cultured 66 (16%) revealed bacterial growth, with clinical information available in 77%. The commonest organisms identified included proteus (17), e coli (8) and enterococcus (5). Stone biochemistry most frequently revealed a calcium oxalate/phosphate mix (44%), struvite (32%) and pure calcium oxalate (10%). Of 51 patients, 19 (37%) had a positive pre-operative msu with an identical organism cultured from the calculus in 74% of
cases. Antibiotic treatment was instituted prior to surgery in all cases where a positive msu was obtained; otherwise, patients received prophylactic antibiotics on induction of anaesthesia. Eight patients developed post-operative pyrexia, with 84% of positive stone culture patients developing no clinical signs of sepsis. Two of the 8 septic patients had a positive pre-operative urine specimen. Seven of the 8 had foreign bodies within the urinary tract (4 with JJ stents, 2 suprapubic catheters and 1 nephrostomy tube) and the other a staghorn calculus. All 4 patients with a JJ stent had negative pre-operative urine cultures as did one patient with a suprapubic catheter but all were taking prophylactic antibiotics. Seven patients clinically improved with broad spectrum antibiotics guided either by their pre-operative urine specimen or chosen empirically. One MS patient with a long-term suprapubic catheter who was treated prior to surgery for a proteus UTI developed multi-organ failure and died. Conclusion: Routine post-operative stone culture is rarely useful in identifying patients who will become septic following surgery. Furthermore, results are unavailable when it does develop and treatment with broad spectrum antibiotics is adequate in the majority of cases. Foreign bodies within the urinary tract appear to elevate the risk of sepsis and terminating prophylactic antibiotic use prior to urine culture may increase the diagnostic yield. The patient who died in our series was already being treated with appropriate antibiotics based on a positive msu.
UP-03.067 The Most Important Metabolic Risk Factors in Recurrent Urinary Stone Formers in Iran Basiri A, Shakhssalim N, Parvin M, Miladipour A, Golestan B, Mohammadi Torbati P, Azadvari M, Eftekhari S Urology and Nephrology Research Center, SBMU, Tehran, Iran Introduction and Objective: Since the metabolic causes in urinary stone formation may be different in our region from western countries, this study was performed to evaluate a variety of urinary factors contributing to idiopathic calcium stone disease in our country in order to implement appropriate medical or dietary interventions for prevention in this part of the world. Materials and Methods: Two 24-hour urine samples were obtained from 106 recurrent idiopathic calcium stone former men and another 109 randomly selected men without any history of stone diseases
UROLOGY 78 (Supplement 3A), September 2011