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UP-03.082 Percutaneous Nephrolithotomy Under General versus Spinal-Epidural Anesthesia
UNMODERATED POSTER SESSIONS
der (KUB) studies and ultrasonography performed 4 weeks after the procedure. Complete clearance and success was defined as the absence of any fragments on post operation KUB and ultrasonography images. Results: Average patient age, male to female ratio and stone size were similar between groups. Mean post operation ⫾ SD hospital stay was 25.3 ⫾ 0.3 and 24.4⫾3.2 hours in pneumatic and laser group respectively. Success rate was 85.7% in pneumatic group and 100% in holmium: YAG laser group (p⫽0.003). Stone migration up in the pelvicalyceal system was observed only in 8 cases of pneumatic group. Injury to ureteral wall or adjacent organs did not occur. One patient (1.8%) of laser and two patients (3.6%) of pneumatic group experienced fever after surgery and was managed with conservative treatment. Conclusion: According to our experience, for ureteral stone larger than 1cm, treatment with ureteroscopy and laser lithotripsy is the preferred approach, with favorable operation time and hospital admission, and no more significant complications.
UP-03.082 Percutaneous Nephrolithotomy Under General versus Spinal-Epidural Anesthesia Yesilli C1, Uzun F2, Hamarat M1, Erkul A1, Aras &1, Komesli G3, Ozyurek Y4 1 Dept. of Urology, Yunus Emre State Hospital, 2Dept. of Anesthesia, Sakarya Hospital, 3Dept. of Urology, Military Hospital, 4Dept. of Urology, Sakarya Hospital, Eskisehir, Turkey Introduction and Objective: To compare the results of patients who underwent percutaneous nephrolithotomy (PCNL) for management of kidney stone disease under spinal-epidural anesthesia and compared surgical parameters and outcomes with a matched control group who underwent PCNL under general anesthesia. Material and Methods: A total of 62 patients were studied in two groups between July 2009 and January 2011. Group 1 (n⫽30) consisted of the patients who underwent spinal-epidural anesthesia and group 2 (n⫽32) comprised those who received general anesthesia. Results: The mean ages of patients in group 1 and group 2 were 45 ⫾ 12 and 46 ⫾ 15 years, respectively. The mean areas of the stones in group 1 and group
S370
2 were 732⫾376mm2 and 740⫾380mm2, respectively. There were no significant differences between groups 1 and 2 among surgical parameters, including age, stone area, operation time, irrigation fluids, fluoroscopy time, serum biochimical analyse and CBC results and hospitalization time (p⫽0.547). At the end of the surgery, stone-free rates were 78% in group 1 and 80% in group 2; clinically insignificant residue fragments rates were 20% in group 1 and 18% in group 2 (p⫽0.552). Conclusions: Spinal-epidural anesthesia is a feasible, safe and effective technique in PCNL operations. Morever, the technique should be a suitable alternative, especially for the patients who have risks for general anesthesia, such as having a history of difficult intubation, allergic reaction to anesthesia drugs and fear.
UP-03.083 Study of Phosphocalcium Metabolism and Markers of Bone Modelling in Patients with Calcium Lithiasis Arrabal-Polo M1, Jimenez-Pacheco A2, Arrabal-Martin M1, Lahoz-Garcia C1, Merino-Salas S1, Gonzalez-Torres S1, Palao-Yago F1, Zuluaga-Gomez A1 1 Dept. of Urology, San Cecilio University Hospital, 2Dept. of Surgery, Santa Ana Hospital, Granada, Spain Introduction and Objective: In calcium nephrolithiasis many factors are involved, among them, the alteration in phosphocalcium and bone metabolism. The relationship between calcium lithiasis and bone metabolism is being studied from the clinical, analytical, and genetic point of view. The purpose of this paper is to study bone markers in patients with recurrent calcium nephrolithiasis. Material and Methods: Cross-sectional study with control group including a total of 180 patients divided into 3 groups:Group O: 60 patients with lithiasic pathology with ages ranging from 30 to 60 years old.-Group A: 60 patients with only one episode of calcium lithiasis with ages ranging from 30 to 60 years old.-Group B: 60 patients with recurrent calcium lithiasis with ages ranging from 30 to 60 years old.We consider recurrent lithiasis as two or more episodes of lithiasis in one year. The following blood parameters were analyzed: Osteocalcin (ng/ml), -crosslaps (ng/ml), FA (U/L), PTHi (pg/ml), Vitamin D (ng/ml), Calcium (mg/dl), Phosphor (mg/dl), -crosslaps/ Osteocalcin and crosslaps/FA; urine parameters: Calcium (mg/dl) and Phosphor (mg/dl). We used
SPSS 17.0 program (Pⱕ0.05) for the analysis. Results: Average age of the patients was 49.8 years old, Group O; 44.7 years old, Group A; 46.1 years old, Group B (p⫽0.075). After applying ANOVA test, we found significant differences in osteolcin levels [13,93 group O; 14,46 group A; 17.28 group B; p⫽0.002], -crosslaps [0.340 group O; 0.354 group A; 0.516 group B; p⫽0.000], -crosslaps/ Osteocalcin quotient [0.252 group O; 0.259 group A; 0.310 group B; p⫽0.01], -crosslaps/FA [0,0056 group O; 0,0058 group A; 0.0074 group B; p⫽0.001], PHTi levels [45.3 group O; 48.3 group A; 56 group B; p⫽0.013] and calciuria [10.7 group O; 15.9 group A; 16.3 group B; p⫽ 0.000]. No differences with the remaining parameters. After analyzing the linear relationship between calcium and bone markers, there is only negative correlation between - crosslaps/FA and calciuria [R⫽0.164; p⫽0.030] Conclusion: Patients with recurrent calcium nephrolithiasis present an accelerated bone metabolism with increase of negative balance of calcium in bone that is translated into higher calciuria levels and consequently more incidence of calcium nephrolithiasis.
UP-03.084 Effect of Alendronate Sodium and 2Year Follow-Up of Patients with Recurrent Calcium Nephrolithiasis Arrabal-Polo M1, Arrabal-Martin M1, Jimenez-Pacheco A2, Lahoz-Garcia C1, Valle-Diaz de la Guardia F3, Merino-Salas S1, Palao-Yago F1, Zuluaga-Gomez A1 1 Dept. of Urology, San Cecilio University Hospital, 2Dept. of Surgery, Santa Ana Hospital, Granada, 3San Juan de la Cruz Hospital, Jaen, Spain Introduction and Objective: Bisphosphonates are mainly used as inhibitors of bone resorption, although recently new properties are being discovered. The purpose of this paper is to present the 2-year follow-up in a series of 30 patients with serious recurrence of calcium nephrolithiasis and loss of bone mass treated with alendronate sodium. Material and Methods: Unique cohort study (before-after) with 30 patients diagnosed with serious recurrence of calcium nephrolithiasis and loss of bone mass measured through bone densitometry. The mean follow-up time per patient was 2 years. Two lithiasis episodes in one year
UROLOGY 78 (Supplement 3A), September 2011
der (KUB) studies and ultrasonography performed 4 weeks after the procedure. Complete clearance and success was defined as the absence of any fragments on post operation KUB and ultrasonography images. Results: Average patient age, male to female ratio and stone size were similar between groups. Mean post operation ⫾ SD hospital stay was 25.3 ⫾ 0.3 and 24.4⫾3.2 hours in pneumatic and laser group respectively. Success rate was 85.7% in pneumatic group and 100% in holmium: YAG laser group (p⫽0.003). Stone migration up in the pelvicalyceal system was observed only in 8 cases of pneumatic group. Injury to ureteral wall or adjacent organs did not occur. One patient (1.8%) of laser and two patients (3.6%) of pneumatic group experienced fever after surgery and was managed with conservative treatment. Conclusion: According to our experience, for ureteral stone larger than 1cm, treatment with ureteroscopy and laser lithotripsy is the preferred approach, with favorable operation time and hospital admission, and no more significant complications.
UP-03.082 Percutaneous Nephrolithotomy Under General versus Spinal-Epidural Anesthesia Yesilli C1, Uzun F2, Hamarat M1, Erkul A1, Aras &1, Komesli G3, Ozyurek Y4 1 Dept. of Urology, Yunus Emre State Hospital, 2Dept. of Anesthesia, Sakarya Hospital, 3Dept. of Urology, Military Hospital, 4Dept. of Urology, Sakarya Hospital, Eskisehir, Turkey Introduction and Objective: To compare the results of patients who underwent percutaneous nephrolithotomy (PCNL) for management of kidney stone disease under spinal-epidural anesthesia and compared surgical parameters and outcomes with a matched control group who underwent PCNL under general anesthesia. Material and Methods: A total of 62 patients were studied in two groups between July 2009 and January 2011. Group 1 (n⫽30) consisted of the patients who underwent spinal-epidural anesthesia and group 2 (n⫽32) comprised those who received general anesthesia. Results: The mean ages of patients in group 1 and group 2 were 45 ⫾ 12 and 46 ⫾ 15 years, respectively. The mean areas of the stones in group 1 and group
S370
2 were 732⫾376mm2 and 740⫾380mm2, respectively. There were no significant differences between groups 1 and 2 among surgical parameters, including age, stone area, operation time, irrigation fluids, fluoroscopy time, serum biochimical analyse and CBC results and hospitalization time (p⫽0.547). At the end of the surgery, stone-free rates were 78% in group 1 and 80% in group 2; clinically insignificant residue fragments rates were 20% in group 1 and 18% in group 2 (p⫽0.552). Conclusions: Spinal-epidural anesthesia is a feasible, safe and effective technique in PCNL operations. Morever, the technique should be a suitable alternative, especially for the patients who have risks for general anesthesia, such as having a history of difficult intubation, allergic reaction to anesthesia drugs and fear.
UP-03.083 Study of Phosphocalcium Metabolism and Markers of Bone Modelling in Patients with Calcium Lithiasis Arrabal-Polo M1, Jimenez-Pacheco A2, Arrabal-Martin M1, Lahoz-Garcia C1, Merino-Salas S1, Gonzalez-Torres S1, Palao-Yago F1, Zuluaga-Gomez A1 1 Dept. of Urology, San Cecilio University Hospital, 2Dept. of Surgery, Santa Ana Hospital, Granada, Spain Introduction and Objective: In calcium nephrolithiasis many factors are involved, among them, the alteration in phosphocalcium and bone metabolism. The relationship between calcium lithiasis and bone metabolism is being studied from the clinical, analytical, and genetic point of view. The purpose of this paper is to study bone markers in patients with recurrent calcium nephrolithiasis. Material and Methods: Cross-sectional study with control group including a total of 180 patients divided into 3 groups:Group O: 60 patients with lithiasic pathology with ages ranging from 30 to 60 years old.-Group A: 60 patients with only one episode of calcium lithiasis with ages ranging from 30 to 60 years old.-Group B: 60 patients with recurrent calcium lithiasis with ages ranging from 30 to 60 years old.We consider recurrent lithiasis as two or more episodes of lithiasis in one year. The following blood parameters were analyzed: Osteocalcin (ng/ml), -crosslaps (ng/ml), FA (U/L), PTHi (pg/ml), Vitamin D (ng/ml), Calcium (mg/dl), Phosphor (mg/dl), -crosslaps/ Osteocalcin and crosslaps/FA; urine parameters: Calcium (mg/dl) and Phosphor (mg/dl). We used
SPSS 17.0 program (Pⱕ0.05) for the analysis. Results: Average age of the patients was 49.8 years old, Group O; 44.7 years old, Group A; 46.1 years old, Group B (p⫽0.075). After applying ANOVA test, we found significant differences in osteolcin levels [13,93 group O; 14,46 group A; 17.28 group B; p⫽0.002], -crosslaps [0.340 group O; 0.354 group A; 0.516 group B; p⫽0.000], -crosslaps/ Osteocalcin quotient [0.252 group O; 0.259 group A; 0.310 group B; p⫽0.01], -crosslaps/FA [0,0056 group O; 0,0058 group A; 0.0074 group B; p⫽0.001], PHTi levels [45.3 group O; 48.3 group A; 56 group B; p⫽0.013] and calciuria [10.7 group O; 15.9 group A; 16.3 group B; p⫽ 0.000]. No differences with the remaining parameters. After analyzing the linear relationship between calcium and bone markers, there is only negative correlation between - crosslaps/FA and calciuria [R⫽0.164; p⫽0.030] Conclusion: Patients with recurrent calcium nephrolithiasis present an accelerated bone metabolism with increase of negative balance of calcium in bone that is translated into higher calciuria levels and consequently more incidence of calcium nephrolithiasis.
UP-03.084 Effect of Alendronate Sodium and 2Year Follow-Up of Patients with Recurrent Calcium Nephrolithiasis Arrabal-Polo M1, Arrabal-Martin M1, Jimenez-Pacheco A2, Lahoz-Garcia C1, Valle-Diaz de la Guardia F3, Merino-Salas S1, Palao-Yago F1, Zuluaga-Gomez A1 1 Dept. of Urology, San Cecilio University Hospital, 2Dept. of Surgery, Santa Ana Hospital, Granada, 3San Juan de la Cruz Hospital, Jaen, Spain Introduction and Objective: Bisphosphonates are mainly used as inhibitors of bone resorption, although recently new properties are being discovered. The purpose of this paper is to present the 2-year follow-up in a series of 30 patients with serious recurrence of calcium nephrolithiasis and loss of bone mass treated with alendronate sodium. Material and Methods: Unique cohort study (before-after) with 30 patients diagnosed with serious recurrence of calcium nephrolithiasis and loss of bone mass measured through bone densitometry. The mean follow-up time per patient was 2 years. Two lithiasis episodes in one year
UROLOGY 78 (Supplement 3A), September 2011