POS-01.101: One stage tract dilation for percutaneous nephrolithotomy: is it justified?
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differences for the postoperative compli- cations and hemoglobin decline between the Amplatz and balloon dilation. POS-01.98 Efficiency of combined pneumatic and ultrasonic lithotripsy with transluminal suction in percutaneous nephrolithotripsy Etemadian M, Shadpour P, Saidi A, Solemani MJ Hasheminejad Kidney Center (HKC), Iran University of Medical Science, Teh- ran, Iran Objective: Cross sectional analysis of the performance & efficacy of combined pneumatic/ultrasonic lithotripsy plus si- multaneous transluminal suction for per- cutaneous nephrolithotripsy (PCNL). Method: From Oct 2005 to June 2006, fifty one patients underwent single session PCNL for upper urinary tract stone using this instrument. Performance and efficacy were measured by using procedure dura- tion, stone size, residual stones and com- plications as the indicators of success. Results: Stone size was 20 to 45 mm. The procedure spanned 65 to 110 minutes (85 on average). Of the 51 patients 88.23% were free of any fragment 2mm and the remaining 6 patients were rendered stone free by SWL.Two developed fever and another two had temporary urine leakfrom their nephrostomy site. No hem- orrhage occurred. Instruments required to be removed from the working sheath only 3 times per patient on average, even then for a plugged suction tip; consequently not a single displacement of Amplatz’ sheath was encountered. Conclusion: Combined pneumatic/ultra- sonic lithotripsy and suction is a depend- able, effective and rapid instrument for lithotripsy through PCNL. POS-01.99 Percutaneous nephrolithotomy (PCNL) in pediatric patients Hosseini M 1 , Shakeri S 1 , Khezri A 1 , Basiri A 3 , Inaloo R 2 , Yousefi A 2 , Hasanpour A 2 1 Shiraz Medical University, 2 Jahrom Medical University, 3 Shahid Behshti Medical University, Iran Objective: To evaluate feasibility, safety and efficacy of PCNL in pediatric age group. Patients & Methods: From Feb.,2001 to Nov. 2006, 56 patients, 11 mo.-15 years old(Mean 8.6y), underwent PCNL in our centers, 35 boys, 21 girls, mean stone size 28mm (20-44), 7 were bilateral, 2 horse- shoe kidney, 38 at least one session SWL, 24 had previous open nephrolithotomy and/or pyeloplasty. Results: Of total 63 renal units, 55(87.3%) were stone-free in post-op. KUB x-ray, 3 had residual10mm, SWL done, 3 passed fragments5-6mm in 2 wks., one Re-PNL, and one underwent uretros- copy for migrated stone into distal ureter. Post-op. fever seen in 6 patiens, managed conservatively, Sodium depletion seen in 2 patients(Pure water irrigation), BUN, Cr. Raised in one of bilateral cases. No any other intra or post-op. complications. Conclusion: PCNL seems safe, effective and feasible in pediatric, as such as adults, with no more complications. POS-01.100 Management of 10-15 mm proximal ureteral stones: ureteroscopy or ESWL, a prospective patient preference trial Ziaee SAM 1 , Halimi MR 1 , Aminsharifi A 1 , Shafi H 2 , Basiri A 1,2 1 Urology Nephrology Research Center, Shaheed Beheshti Uinversity of Medical Sciences, 2 Babol Uinversity of Medical Sciences, Tehran, Iran Introduction: To provide an appropriate evidence for treatment planning of pa- tients with upper ureteral stone, sized between 10-15mm by analyzing therapeu- tic outcomes in those undergoing semi- rigid ureteroscopic holmium:YAG-laser lithotripsy (URSL) and shock wave litho- tripsy (SWL) prospectively. Methods: During the study period, 197 patients with 10-15 mm proximal ureteral stone were included, of whom 166 were analyzed. Both URSL and SWL have been offered to them and based on patients’ preference the procedure have been con- templated. Ureteroscopy was conducted by a 7-8.9 Fr semirigid ureteroscope (Rich- ard wolf G.mbH, Knittlingen, Germany) and holmium: YAG laser (Coherent Medi- cal Systems, Santa Clara, California) with its 200m quartz fiber was utilized for lithotripsy. The endpoint of the study was stone free- ness on 3 months imaging studies. Pa- tients’ demographics, stone-free rate, op- eration time, complications and the need for any ancillary procedure were analyzed prospectively in the two groups. Results: 40 of 166 patients (24%) chose URSL and remaining 126 (76%) were un- dergone SWL. After 3 months of fellow up, the stone free rates of URSL (29 of 40 patients (75.5%)) and SWL (99 of 126 (78.6%)) groups, were statistically equal. (P0.42). Also mean operative time, the need for application of salvage procedures and post procedural complication rates were comparable between the two groups. Conclusion: We have shown that SWL has enough capacity for management of proximal ureteral stones sized 10 to 15mm. Despite the fact that ureteroscopy tends to make patients stone free faster, due to minimally invasive nature of SWL, patients still favors it to the ureteroscopy. POS-01.101 One stage tract dilation for percutaneous nephrolithotomy: is it justified? Ziaee SAM, Karami H, Aminsharifi A, Mehrabi S, Zand S, Javaherforooshzadeh A Urology Nephrology Research Center, Tehran, Iran Introduction: To assess the feasibility of one stage acute dilation of the nephrostomy tract with a 30F Amplatz dilator in patients candidate for percutaneous nephrolithot- omy (PCNL) regardless of having previous renal scar to make the procedure less time consuming and more cost effective. Methods: The outcome of one stage tract dilation for PCNL in 100 consecutive pa- tients with and without previous history of ipsilateral open stone surgery (OSS), treated by one surgeon was examined prospectively. Forty-six patients (group I) had previous history of ipsilateral OSS and 54 patients (group II) did not have such history. Demographic data as well as intraopera- tive information such as the access time and radiation exposure time during access were registered. Furthermore, the success- fulness of access technique and its bleed- ing complication were analyzed between the 2 groups. Results: By applying “one stage” tech- nique, with success rate of 93% the tar- geted calyx could be entered. There was no difference in procedural success rate between groups I and II (93.5% versus 92.6%; respectively). All 7 failures (7%; 3 with prior OSS) were managed success- fully using Alken dilator to gain access to the proposed calyx on the same session. Previous OSS did not have any impact on access time, radiation exposure time dur- ing access, post operational hemoglobin drop and bleeding complications. There were no visceral and vascular injuries. Conclusion: One stage tract dilation for PCNL is a safe and effective method in almost every adult patient; and can be effectively targeted every kidney calyces in a timely manner. UNMODERATED POSTER SESSIONS 220 UROLOGY 70 (Supplment 3A), September 2007
Transcript of POS-01.101: One stage tract dilation for percutaneous nephrolithotomy: is it justified?
differences for the postoperative compli-cations and hemoglobin decline betweenthe Amplatz and balloon dilation.
POS-01.98Efficiency of combined pneumaticand ultrasonic lithotripsy withtransluminal suction in percutaneousnephrolithotripsyEtemadian M, Shadpour P, Saidi A,Solemani MJHasheminejad Kidney Center (HKC),Iran University of Medical Science, Teh-ran, Iran
Objective: Cross sectional analysis of theperformance & efficacy of combinedpneumatic/ultrasonic lithotripsy plus si-multaneous transluminal suction for per-cutaneous nephrolithotripsy (PCNL).Method: From Oct 2005 to June 2006,fifty one patients underwent single sessionPCNL for upper urinary tract stone usingthis instrument. Performance and efficacywere measured by using procedure dura-tion, stone size, residual stones and com-plications as the indicators of success.Results: Stone size was 20 to 45 mm. Theprocedure spanned 65 to 110 minutes (85on average). Of the 51 patients 88.23%were free of any fragment ��2mm andthe remaining 6 patients were renderedstone free by SWL.Two developed feverand another two had temporary urineleakfrom their nephrostomy site. No hem-orrhage occurred. Instruments required tobe removed from the working sheath only3 times per patient on average, even thenfor a plugged suction tip; consequentlynot a single displacement of Amplatz’sheath was encountered.Conclusion: Combined pneumatic/ultra-sonic lithotripsy and suction is a depend-able, effective and rapid instrument forlithotripsy through PCNL.
POS-01.99Percutaneous nephrolithotomy(PCNL) in pediatric patientsHosseini M1, Shakeri S1, Khezri A1, BasiriA3, Inaloo R2, Yousefi A2, Hasanpour A2
1Shiraz Medical University, 2JahromMedical University, 3Shahid BehshtiMedical University, Iran
Objective: To evaluate feasibility, safetyand efficacy of PCNL in pediatric agegroup.Patients & Methods: From Feb.,2001 toNov. 2006, 56 patients, 11 mo.-15 yearsold(Mean 8.6y), underwent PCNL in ourcenters, 35 boys, 21 girls, mean stone size28mm (20-44), 7 were bilateral, 2 horse-shoe kidney, 38 at least one session SWL,
24 had previous open nephrolithotomyand/or pyeloplasty.Results: Of total 63 renal units, 55(87.3%)were stone-free in post-op. KUB x-ray, 3had residual��10mm, SWL done, 3passed fragments��5-6mm in 2 wks.,one Re-PNL, and one underwent uretros-copy for migrated stone into distal ureter.Post-op. fever seen in 6 patiens, managedconservatively, Sodium depletion seen in2 patients(Pure water irrigation), BUN, Cr.Raised in one of bilateral cases. No anyother intra or post-op. complications.Conclusion: PCNL seems safe, effectiveand feasible in pediatric, as such as adults,with no more complications.
POS-01.100Management of 10-15 mm proximalureteral stones: ureteroscopy orESWL, a prospective patientpreference trialZiaee SAM1, Halimi MR1, Aminsharifi A1,Shafi H2, Basiri A1,2
1Urology Nephrology Research Center,Shaheed Beheshti Uinversity of MedicalSciences, 2Babol Uinversity of MedicalSciences, Tehran, Iran
Introduction: To provide an appropriateevidence for treatment planning of pa-tients with upper ureteral stone, sizedbetween 10-15mm by analyzing therapeu-tic outcomes in those undergoing semi-rigid ureteroscopic holmium:YAG-laserlithotripsy (URSL) and shock wave litho-tripsy (SWL) prospectively.Methods: During the study period, 197patients with 10-15 mm proximal ureteralstone were included, of whom 166 wereanalyzed. Both URSL and SWL have beenoffered to them and based on patients’preference the procedure have been con-templated. Ureteroscopy was conductedby a 7-8.9 Fr semirigid ureteroscope (Rich-ard wolf G.mbH, Knittlingen, Germany)and holmium: YAG laser (Coherent Medi-cal Systems, Santa Clara, California) withits 200�m quartz fiber was utilized forlithotripsy.The endpoint of the study was stone free-ness on 3 months imaging studies. Pa-tients’ demographics, stone-free rate, op-eration time, complications and the needfor any ancillary procedure were analyzedprospectively in the two groups.Results: 40 of 166 patients (24%) choseURSL and remaining 126 (76%) were un-dergone SWL. After 3 months of fellowup, the stone free rates of URSL (29 of 40patients (75.5%)) and SWL (99 of 126(78.6%)) groups, were statistically equal.(P�0.42). Also mean operative time, theneed for application of salvage procedures
and post procedural complication rateswere comparable between the twogroups.Conclusion: We have shown that SWLhas enough capacity for management ofproximal ureteral stones sized 10 to15mm. Despite the fact that ureteroscopytends to make patients stone free faster,due to minimally invasive nature of SWL,patients still favors it to the ureteroscopy.
POS-01.101One stage tract dilation forpercutaneous nephrolithotomy: is itjustified?Ziaee SAM, Karami H, Aminsharifi A,Mehrabi S, Zand S, Javaherforooshzadeh AUrology Nephrology Research Center,Tehran, Iran
Introduction: To assess the feasibility ofone stage acute dilation of the nephrostomytract with a 30F Amplatz dilator in patientscandidate for percutaneous nephrolithot-omy (PCNL) regardless of having previousrenal scar to make the procedure less timeconsuming and more cost effective.Methods: The outcome of one stage tractdilation for PCNL in 100 consecutive pa-tients with and without previous historyof ipsilateral open stone surgery (OSS),treated by one surgeon was examinedprospectively. Forty-six patients (group I)had previous history of ipsilateral OSS and54 patients (group II) did not have suchhistory.Demographic data as well as intraopera-tive information such as the access timeand radiation exposure time during accesswere registered. Furthermore, the success-fulness of access technique and its bleed-ing complication were analyzed betweenthe 2 groups.Results: By applying “one stage” tech-nique, with success rate of 93% the tar-geted calyx could be entered. There wasno difference in procedural success ratebetween groups I and II (93.5% versus92.6%; respectively). All 7 failures (7%; 3with prior OSS) were managed success-fully using Alken dilator to gain access tothe proposed calyx on the same session.Previous OSS did not have any impact onaccess time, radiation exposure time dur-ing access, post operational hemoglobindrop and bleeding complications. Therewere no visceral and vascular injuries.Conclusion: One stage tract dilation forPCNL is a safe and effective method inalmost every adult patient; and can beeffectively targeted every kidney calycesin a timely manner.
UNMODERATED POSTER SESSIONS
220 UROLOGY 70 (Supplment 3A), September 2007
