UNMODERATED POSTER SESSIONS
pneumatic and ultrasonic probes were used through nephroscopy for lithotripsy. 4 of these were horseshoe kidneys, 6 of these were rotation anomalies kidney. Mean patient age was 27.8 ⫾ 16.1 years (range: 5 to 42 year). Mean stone size: 2.72 ⫾ 1.3cm^2. Mean hospital stay after PCNL was 2.86 ⫾ 0.9 days (range: 2-5 day) Results: The mean operative time was 80 ⫾ 34 minutes (range 35 to 120) and average surgical bleeding was 125 ml (range 50 to 200). A single renal tract was used and one step procedure to remove the stones in all of the patients. Haemorrhage occurred in 1 patients after 1 weeks of operation, the patient was recovered after conservative treatment without blood transfusion. Postoperative fever occurred in one other patient. The stone cleared rate was 90.0% (9/10).1 case needed ESWL after PCNL. The stone-free rate in all was 100% (10/10) at 4 month followup. Conclusions: Calculi in kidneys with rotation and fusion anomalies can be managed safely and effectively with PCNL.
UP-3.175 Percutaneous Nephrolithotomy in the Treatment of Calculi in Kidneys with Congenital Anomalies Guo J, Wang G, Xu Z, Zhu Y, Hu X, Yang Y, Xu Y Dept. of Urology, Zhongshan Hospital, Fudan University, Shanghai, China Introduction and Objective: Percutaneous nephrolithotomy (PCNL) has become the standard treatment of renal calculi. However, PCNL within renal congenital anomalies can be challenging. We present our experience to assessment of the efficacy and safety of PCNL in the treatment of calculi in renal congenital anomalies. Materials and Methods: Between Dec 2006 and Dec 2008, a total of 386 patients (396 renal units) with stones in kidneys received PCNL procedures in our hospital, among them, 27(7.0%) with congenital anomalies. Combined pneumatic and ultrasonic probes were used through nephroscopy for lithotripsy. All patients were investigated by intravenous urography (IVU) and CT to confirm the diagnosis. There were 10 patients with ureteropelvic junction obstruction (UPJO), 4 with horseshoe kidneys, 6 with solitary kidney, 6 with malrotated kidneys, and 1 patient with polycystic kidney. The mean diameter of calculi in renal units was 2.5 cm.
Mean patient age was 40.9⫾ 18.4 years (range: 3 to 69 years). Mean hospital stay after PCNL was 3.6⫾1.2 days (range:26day). D-J stents were inserted after PCNL. Results: In 27 patients, 25 (92.6%) were completely cleared of stones after PCNL. Colonic perforation occurred in one patient. None of the other patients developed any major complications. No significant adverse changes in renal function tests were observed at 3-month follow-up. Conclusion: Calculi in kidneys with congenital anomalies may be treated successfully by PCNL. The stone-free rate was influenced and reduced by stone size and location in the pelvi– calyceal system.
UP-3.176 Remedial Treatment of Failure in Ureterscopic Lithotripsy in 126 Proximal Ureteral Stone Patients Wang D China Urology Association, Shanghai, China Introduction and Objective: Ureteroscopic lithotripsy fail to treat of proximal ureteral stones sometimes. we summarize the experience of appropriate minimally invasive treatment of failure in ureteroscopic lithotripsy in treatmenting proximal ureteral stone. Materials and Methods: From February 2004 to March 2009, 126 cases of proximal ureteral calculi patients who failed in the operation of pneumatic lithotripsy or Ho:YAG laser lithotripsy, stone could not be seen in 86 cases due to N-type warping and polypus or stenosis of the ureteral at the distally of the stone, all patients underwent minimal invasive percutaneous nephrolithotomy (mPCNL) to clear the stones; Stones or the large fragments went up to pelvis or kidney in 40 patients, all cases accepted extracorporeal shock-wave lithotripsy (ESWL). Results: Eighty-six patients treated by mPCNL, all the stone was removed one time; 40 of them received double-J tube and ESWL, complete stone clearance was achieved in 24 cases in rechecking KUB or ultrasound after 1 month, 16 cases with remained stone after ESWL need mPCNL to remove the stone. There were no several complications in operation. Conclusion: mPCNL and ESWL are equally safe and effective minimally invasive remedial treatment to remove proximal ureteral stone of failure in ureteroscopic lithotripsy, mPCNL can get rapid removal of stone.
UROLOGY 74 (Supplment 4A), October 2009
UP-3.177 Comparative Study of Ultrasonographic with Fluoroscopic Guided Renal Access in Percutaneous Nephrolithotomy Guo J, Wang G, Xu Z, Yang Y, Hu X, Zhu Y Dept. of Urology, Zhongshan Hospital, Fudan University, Shanghai, China Introduction: To compare our experience retrospectively treated with percutaneous nephrolithotomy (PNL) in using ultrasonographic (US) or fluoroscopic guided in the established renal access. Materials and Methods: There were 312 patients with renal and/or proximal ureteric stones who underwent PNL in our department between Dec 2006 and Dec 2008. The renal accesses in 86 (27.6%) patients were established with US guided puncture, while in other 226 (72.4%) patients with fluoroscopic guidance. Combined ultrasonic and pneumatic probes were used for lithotripsy. We evaluated the success rate, operative duration and the incidence of complications between the US and fluoroscopic guided. Results: Of the 86 patients with US guided, 81 of them were succeed in the procedure of established renal accesses, 5 failed cases alternative to fluoroscopy guided, while in other 226 fluoroscopic guided cases were succeed in the procedure. The mean operative duration in established renal access between US and fluoroscopy were 14⫾6 and 13⫾7 min separately (p⬎0.05). The incidence of clinically significant bleeding and adjacent organ injuries were not occurred. Conclusions: The US guided puncture may safely in the procedure of established renal access compared with fluoroscopy. UP-3.178 Transurethral Cystolithotripsy with Holmium Laser under Local Anesthesia in Selected Patients Kara C, Resorlu B, Bayy´ndy´r M, Unsal A Ministry of Health, Kecioren Training and Research Hospital,Department of Urology, Ankara, Turkey Introduction and Objective: To evaluate the feasibility and effectiveness of transurethral holmium:YAG laser cystolithotripsy under local anesthesia in selected patients. Materials and Methods: Between February 2006 and December 2007, 13 consecutive male patients with large bladder calculi (3 cm or greater) caused by benign prostatic hyperplasia underwent transurethral cystolithotripsy using by holmium: YAG laser under local anesthesia in our institution. Patients with a prostate vol-
UNMODERATED POSTER SESSIONS
ume ⬎ 50 cc and urinary retantion history, were excluded the study. The operation was performed with the all patients in the lithotomy position (except 3 with pelvic prosthesis in supine position). Pethidine HCl (50 mg intramuscularly) was used for premedication and 10 ml of 2% lidocaine gel was instilled and a penile clamp was placed for 10 minutes. A flexible cystoscope was used in all procedures. Pain was evaluated with a 10-cm (0: no pain, 10: worst possible pain) visual analog scale (VAS) at the beginning of the procedure. A urethral Foley catheter was placed postoperatively. Results: Thirteen patients with a mean age of 58.2 years (range 52 to 75) were managed with holmium:YAG laser cystolithotripsy. All patients were rendered stone free, regardless of stone size. No patients underwent transurethral resection of the prostate at the completion of the procedure. The mean stone size was 3.6 cm (range 3 to 5) and the mean operative time was 51 minutes (range 45 to 65). The whole procedure well tolerated and no significant differences were found in the mean VAS score between the transurethral laser cystolithotripsy group and a group of male patients who underwent flexible cystoscopy under local anesthesia (2.15 ⫾ 0.89 versus 1.86 ⫾ 0.74, respectively, p⫽ 0.467). No major intraoperative complication was occurred. Fever was developed in one patient and treated with conservatively. The average hospitalization was 2.3 days (range 1 to 5). After a mean follow-up of 16.6 months (range 12 to 24), no recurrent stone, urinary retantion, and urethral stricture developed. Conclusion: Transurethral holmium:YAG laser lithotripsy under local anesthesia appears to be safe and effective technique for the large bladder calculi. Thus, it may be used as an alternative treatment option in selected patients.
UP-3.179 Percutaneous Nephrolithotomy for Complex Caliceal and Staghorn Stones in Patients with Solitary Kidney Resorlu B, Kara C, Bayindir M, Unsal A Ministry of Health, Kecioren Training and Research Hospital, Department of Urology, Ankara, Turkey Introduction and Objective: Treatment of patients with solitary kidney having complex caliceal stones is one of the most challenging problems in urology. We present our experience with PNL in treating 16 patients with staghorn stones in a
solitary kidney to determine long-term renal functional results. To the best of our knowledge this study is the first series reported in the literature. Materials and Methods: We retrospectively reviewed the records of 16 patients with complex caliceal or staghorn stones in a solitary kidney treated with PNL. We defined complex calculi as either staghorn or those with a stone bulk larger than 5 cm, involving more than one calix, or stone in anomalous kidney. Demographic data, number and location of accesses, hemoglobin values, stone analyses, and complications were studied. Serum creatinine, creatinine clearence, systolic and diastolic blood pressure, new onset hypertension, and kidney morphology were determined preoperatively and postoperatively at 1 month and 1 year. Results: Male to female ratio was 14:2 and mean age was 49.6 years (range 31– 55). of these, 10 (62.5%) patients required a single tract, while 6 (37.5%) required multiple tracts. We used the infracostal approach in 17 (77.2%) patients and the supracostal approach in 5 (22.8%) patients. The calculi were extracted or fragmented successfully in 13 (81.3%) patients and complete stone clearance was achieved after the first stage. In 2 patients with residual calculi, a double-J catheter was inserted and extracorporeal shock wave lithotripsy (SWL) was performed. There were no significant intraoperative problems except in one patient, who had bleeding from an infundibular tear attributable to torquing. The procedure was terminated and a second look procedure performed 6 days later. During the 1-year study period none of the patients progressed to end stage renal disease requiring dialysis. We demonstrated a significant improvement in creatinine clearence from preoperatively to 1 year follow-up. The number of patients with hypertension before PNL was 6 and by the end of follow-up there was no new onset hypertension. Conclusions: In our experience, PNL for large staghorn calculi in solitary kidney is a safe and feasible method for maximal clearance of stone burden and should be the treatment of choice in skilled hands. UP-3.180 Does Previous Open Renal Surgery and Extracorporeal Shock Wave Lithotripsy affect the Performance and Outcomes of Percutaneous Nephrolithotomy Resorlu B, Kara C, Senocak C, Cicekbilek I, Unsal A Ministry of Health, Kecioren Training and Research Hospital, Department of Urology, Ankara, Turkey
Introduction and Objective: Percutaneous nephrolithotomy (PNL) is a minimally invasive surgical procedure for removal of large renal and upper-ureteral calculi. Before the PNL, extracorporeal shock wave lithotripsy (SWL) and open nephrolithotomy were the primary treatment modalities for these stones and many patients who previously underwent open nephrolithotomy or SWL are now presenting with a recurrent stone in the same kidney and need PNL. In this study, we evaluated the effects of previous open renal surgery and unsuccessful SWL treatment on the performance and outcomes of PNL. Materials and Methods: A total of 410 consecutive PNL procedures for renal calculi were performed at our institution from November 2006 to March 2009 under the supervision of a single surgeon (AU). Of these 410 patients, 86 (20.9%) with a history of failed SWL on the same side categorized as group I and 132 (32.2%) who had previous open renal surgery (⫾ SWL) on the same kidney categorized as group II. The remaining 192 patients (46.9%) without a history of SWL or open renal surgery comprised group III. Patient demographics, stone characteristics, operative findings, including operative time, time to access the collecting system, flouroscopy time, success rate, need for auxiliary treatments and complications observed, were documented in detail and compared in each groups. Results: There were no differences between the three groups in age, gender, weight and stone laterality. In the postSWL group mean stone burden was significantly lower than group II and III. Mean operative time, time to access the collecting system, fluoroscopic screening time, complication rates, nephrostomy removal times and hospitalization times were similar in the each groups (p ⬎ 0.05 for each parameter). The stone-free rates after PNL was 93.2% in group I; 89.4% in group II; and 92.2% in group III. These rates increased to 98.8%, 96.2%, and 96.8%, in groups I, II and III, respectively, after a second intervention (PNL, SWL, or ureterorenoscopy). Conclusions: Our study clearly demonstrates that PNL with standard technique can be done safely in patients with a history of open nephrolithotomy or SWL without a higher risk of complications and with a success rate similar to that of PNL in patients with no prior intervention.
UROLOGY 74 (Supplment 4A), October 2009