Modified Clavien System Research Articles

Cryotherapy versus radical prostatectomy as a salvage treatment for radio-recurrent prostate cancer.

The aim of this study is to compare outcomes of SRP (salvage radical prostatectomy) with SCAP (salvage cryoablation of the prostate) in local radio-recurrent PCa (prostate cancer) patients. A retrospective analysis of a multicentric European Society of Uro-technology (ESUT) database was performed. Data on patients with local recurrent PCa after radiotherapy who underwent salvage treatment were collected. Patients and their respective disease characteristics, perioperative complications as well as oncological outcomes were then described. The treatment success rate was defined as PSA nadir < 0,4 ng/ml. Any complications were graded according to the modified Clavien system. A descriptive and comparative analysis was performed using SPSS software. 25 patients underwent SRP and 71 patients received SCAP. The mean follow-up was 24 months. The median PSA level before initial treatment was 8.3 (range 7-127) ng/ml. The success rates of SRP and SCAP were largely comparable (88% (22 patients) vs. 67.7% (48 patients), respectively, p = 0.216). The mean serum PSA levels at 12 months after salvage treatment were 1.2 ± 0.2 ng/mL vs. 0.25 ± 0.5 ng/mL, p > 0.05). During the follow-up period, only 3 (12%) patients in the SRP group had PSA recurrence compared with 21 patients (29.6%) in the SCAP group. The 5-year BRFS was similar (51,6% and 48,2%, p = 0,08) for SRP and SCAP respectively. The 5-year overall survival rate was 91.7%, and 89,7% (p = 0.669) and the 5-year cancer-specific survival was 91.7%, and 97,1% (p = 0.077), after SRP and SCAP respectively. No difference was found regarding the complications. Both SRP and SCAP should be considered as valid treatment options for patients with local recurrence of PCa after radiotherapy. SCAP has a potentially lower risk of morbidity and acceptable intermediate-term oncological efficacy, but a longer follow up and a higher number of patients is ideally needed to draw any long-term conclusions regarding the oncological data.

Safety and Efficacy of Angio-embolization for Complex Renal Cell Carcinoma and Angiomyolipoma: Experience and Results in 20 Patients

<i>Objective:</i> To evaluate the efficacy and safety of renal artery embolization in treatment of complex angiomyolipoma and renal cell carcinoma. <i>Patients and Methods: </i>Twenty patients were included in this study, 11 patients with primary renal cell carcinoma and 9 patients with AML. These patients were examined by US, CT or and MRI before RAE to evaluate size of the tumor, assess extension of renal cell carcinoma, exclude distant metastasis and assess the complications of angiomyolipoma. Renal artery embolization yield, complications and the impact of patient`s management were analyzed. <i>Results</i>: This study included 20 patients (12 males and 8 females). The age range was 17-75 (47.8±15.5) years. The type of renal masses were renal cell carcinoma in 11 patients and angiomyolipoma in 9 patients (5 bilateral and 4 unilateral). According to the modified Clavien system, 4 patients developed Grade I complication (3 patients developed flank pain (15%) treated with oral analgesics and 1 patient (5%) developed self-limiting perinephric hematoma which resolved spontaneously under antibiotic coverage. <i>Conclusion: </i>RAE is a safe, effective and well tolerated treatment of AML either if large sized which is liable to rupture or symptomatic to stop bleeding. Also, it allows preoperative de-vascularization of RCC to facilitate its surgical resection and as palliative treatment if RCC is un-resectable or metastatic.

The Correlation Between STONE Nephrolithometry Score and Hemoglobin Drop in Patients Undergoing Percutaneous Nephrolithotomy.

ObjectiveIn this study, we aimed to determine the correlation between the STONE score [(S)ize of the stone, (T)opography or location, degree of (O)bstruction of the urinary system, (N)umber of stones, and (E)valuation of Hounsfield units] and postoperative hemoglobin drop in patients undergoing percutaneous nephrolithotomy (PCNL).MethodsThis was a prospective observational study and all adult patients aged 18-65 years undergoing unilateral, single-tract PCNL using 26 Ch. Amplatz sheath for renal calculi were included. The five variables of the STONE nephrolithometry score were calculated prior to the procedure. The stone-free rates were assessed on imaging at four weeks and complications were graded using the modified Clavien system.ResultsOf the 142 patients included, 75% were below 55 years of age. More than half of our patients were diabetic with more than 60% having a body mass index (BMI) above 25 kg/m2. The mean STONE score was 7 with 33% having a high (>9) STONE score. The mean hemoglobin drop was 1.15 +0.92 g/dL with eight patients (5.63%) requiring transfusion and one (0.7%) requiring angioembolization; one patient required readmission for observation. Complete STONE clearance was achieved with PCNL alone in 78.2% of the patients. There was a significant correlation of hemoglobin drop with the STONE score, stone size, and preoperative creatinine clearance. Patients with a hemoglobin drop of >1 g/dL had a higher STONE score and mean stone size. The overall complication rate was significantly higher (10.5%) in patients with a hemoglobin drop of >1 g/dL as compared to those with a hemoglobin drop of <1 g/dL (2.8%).ConclusionStone complexity as measured by the STONE score correlates with post-PCNL hemoglobin drop, stone clearance, and complication rates. The STONE score may be used for preoperative counseling and to evaluate the potential need for transfusion.

Preoperative risk factors for complications of percutaneous nephrolithotomy.

This study was conducted to evaluate preoperative risk factors for development of complications of percutaneous nephrolithotomy (PCNL). All consecutive patients aged ≥ 16years who underwent PCNL during 2015 were retrospectively reviewed. Non-contrast CT (NCCT) was performed for all patients to evaluate stone complexity. The technique of PCNL was the same for all patients. Intra-operative and postoperative complications were recorded and classified based on modified Clavien system. The differences in preoperative data (patients, renal and stone characteristics including Guy's and STONE scores) between complicated and uncomplicated cases were compared using univariate and multivariate statistical analyses for detection of independent risk factors. The study included 1178 patients (61% were males). Mean age was 50 ± 12years, and mean BMI was 30.7 ± 5.7kg/m2. Complicated group included 166 patients (14.1%). Independent risk factors on multivariate analysis were infected preoperative urine culture (RR: 2.098, P 0.001, 95%CI: 1.380-3.189), largest stones diameter 30mm or more (RR: 2.481, P > 0.001, 95%CI: 1.697-3.627) and number of calyces affected by the stones (RR: 2.431, P 0.002, 95%CI: 1.400-4.222 for affection of two calyces and RR: 2.778, P 0.005, 95%CI: 1.357-5.684 for affection of three calyces). While two scoring systems (Guy's and STONE) were not predictive of complications after PCNL, preoperative risk factors were infected preoperative urine culture, distribution of the stones or stone branches in two or three calyceal groups and stone size 30mm or more.

PD55-01 A PROSPECTIVE SINGLE-BLINDED RANDOMIZED CONTROLLED CLINICAL TRIAL OF PERIOPERATIVE GOAL-DIRECTED FLUID THERAPY VERSUS STANDARD FLUID THERAPY FOR PATIENTS UNDERGOING OPEN RADICAL CYSTECTOMY ON A STANDARDIZED POSTOPERATIVE ENHANCED RECOVERY PATHWAY

You have accessJournal of UrologyBladder Cancer: Invasive V (PD55)1 Apr 2020PD55-01 A PROSPECTIVE SINGLE-BLINDED RANDOMIZED CONTROLLED CLINICAL TRIAL OF PERIOPERATIVE GOAL-DIRECTED FLUID THERAPY VERSUS STANDARD FLUID THERAPY FOR PATIENTS UNDERGOING OPEN RADICAL CYSTECTOMY ON A STANDARDIZED POSTOPERATIVE ENHANCED RECOVERY PATHWAY Sherri M. Donat*, Kay See Tan, Guido Dalbagni, Alessia C. Pedoto, Harry W. Herr, Bernard H. Bochner, Eugene K. Cha, Timothy F. Donahue, Mary Fischer, and Vittoria Arslan-Carlon Sherri M. Donat*Sherri M. Donat* More articles by this author , Kay See TanKay See Tan More articles by this author , Guido DalbagniGuido Dalbagni More articles by this author , Alessia C. PedotoAlessia C. Pedoto More articles by this author , Harry W. HerrHarry W. Herr More articles by this author , Bernard H. BochnerBernard H. Bochner More articles by this author , Eugene K. ChaEugene K. Cha More articles by this author , Timothy F. DonahueTimothy F. Donahue More articles by this author , Mary FischerMary Fischer More articles by this author , and Vittoria Arslan-CarlonVittoria Arslan-Carlon More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000965.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Postoperative ileus (POI) is a common complication of intra-abdominal surgeries, including radical cystectomy (RC) with reported POI rates as high as 32%. Targeted individualized perioperative fluid management has been shown to improve postoperative outcomes and POI for abdominal surgeries, compared to standard fluid therapy (SFT). We investigated whether goal-directed fluid therapy (GDFT) during open RC is associated with POI incidence (main outcome) and other perioperative/postoperative complications by 30 days post-surgery. METHODS: This prospective, single-blinded trial at a US cancer center randomized patients undergoing open RC to GDFT or SFT. Participants were ≥21 years old, had body mass index ≤45, and no active atrial fibrillation. The algorithm determining amount of fluid to administer combines preoperative and postoperative stroke volume optimization and intraoperative stroke volume variation minimalization, using the EV1000 clinical monitoring platform via a Flotrac sensor. All patients were treated on a standardized postoperative enhanced recovery pathway. Complications were collected prospectively up to 30 days postsurgery using the modified Clavien system and compared between groups using Fisher’s exact test. RESULTS: Between August 2014 and April 2018, 283 randomized RC patients received their assigned intervention, 142 GDFT and 141 SFT (ClinicalTrials.gov NCT02145871, no longer recruiting patients). Incidence of POI was similar between GDFT and SFT arms (25% vs 21%, p=0.5), as was incidence of grade 3-5 complications (15% vs 16%, p=0.7). Patients in the GDFT arm were more likely to experience at least one complication (96% vs 89%, p=0.028) and acute kidney injury (AKI) (56% vs 40%, p=0.006). All patients with AKI recovered to preoperative baseline by discharge, and no patient required dialysis. Median length of stay was 7 days in both arms (p=0.6), with similar urgent care visit and readmission rates between arms. CONCLUSIONS: In patients undergoing open RC, we found no significant benefit in rate reduction of POI or other high-grade perioperative/postoperative complications with individualized GDFT versus SFT. For future comparison, studies should standardize definitions of outcomes and better delineate their patient populations. Source of Funding: Supported by the Gary Gladstein Family, the Sidney Kimmel Center for Prostate and Urologic Cancers, Ruth L. Kirschstein National Research Service Award T32CA082088 (MG), and the P30-CA008748 National Institutes of Health cancer center support grant © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1182-e1182 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sherri M. Donat* More articles by this author Kay See Tan More articles by this author Guido Dalbagni More articles by this author Alessia C. Pedoto More articles by this author Harry W. Herr More articles by this author Bernard H. Bochner More articles by this author Eugene K. Cha More articles by this author Timothy F. Donahue More articles by this author Mary Fischer More articles by this author Vittoria Arslan-Carlon More articles by this author Expand All Advertisement PDF downloadLoading ...

Utility of the Guy’s Stone Score in predicting different aspects of percutaneous nephrolithotomy

ObjectiveTo evaluate Guy’s scoring system (GSS) as a grading system for complexity of kidney stone before percutaneous nephrolithotomy (PCNL) as a predictor for different items of outcome. Patients and methodsBetween July 2014 till July 2015, 100 patients with renal stone (s) and candidates for prone PCNL were evaluated and graded by GSS preoperatively. All intraoperative and postoperative data and complications using modified Clavien system were recorded, collected and statistically analyzed in relation to different grades of GSS to evaluate its predictive ability to different items of outcome. ResultsMean age of the patients was 47.38±14.6 years. The patients were distributed in different grades of GSS with no statistically significant difference as mean age, sex, and mean BMI of the patients, stone side and previous renal surgery. There was high statistically significant difference in mean operative time, rate of blood transfusion, and mean number of renal punctures between different Guy’s scores, with all of them showed the highest values at GS IV. There was significant correlation between increase in the grade of GS and the need for re-PCNL and auxiliary procedures. The final stone free rate (SFR) was 93% and complication rate was 27% with significant increase in the immediate success rate, SFR, and complication rate with advancement of the grade of GSS. ConclusionGSS has a positive correlation with SFR, re-treatment rate, need for auxiliary procedure, and rate of complication.

Upper pole access is safe and effective for pediatric percutaneous nephrolithotomy

Upper pole access in percutaneous nephrolithotomy (PCNL) provides a straight tract to the ureter, resulting in easier placement of a guidewire to the ureter, good exposure of the pelvis, calices, and upper ureter, and comfortable manipulations. However, despite these benefits, upper pole access is usually avoided because of the risk of chest complications in both pediatric and adult patients. We aimed to evaluate the safety and morbidity of single upper pole access in pediatric patients undergoing PCNL. We retrospectively reviewed patients aged ≤17 years with renal stones who underwent PCNL with a single access between August 2004 and February 2016. The patients were separated into two groups: the single upper pole access group (SUPAG) and the single other pole access group (SOPAG). We compared the SUPAG and SOPAG in terms of the demographic features of the patients, stone burden and location, operative data, and postoperative outcomes. Complications were classified according to the modified Clavien system. During the study period, 101 PCNL procedures were performed, 77 of which were managed with only one access. The median age of the 77 patients managed with a single access was 12 years (range 3-17 years). The number of cases in the SUPAG and SOPAG was 10 and 67, respectively. There were no statistically significant differences between the SUPAG and SOPAG in terms of age, sex, stone location, hydronephrosis status, stone area, side of kidney, and previous stone treatment or renal surgery. Furthermoret, there were no significant differences between the groups in terms of the operative parameters. Although the difference was insignificant, the median operation times in the SUPAG and SOPAG were 37 and 45min, respectively. There was no chest complication or bleeding that required transfusion in the SUPAG. Two cases required transfusion, and one case was managed with a double pigtail catheter (double-J) placement because of prolonged extravasation in the SOPAG. The stone-free ratios were 100% and 82.1% in the SUPAG and SOPAG, respectively. Upper pole access provides similar outcomes to other (middle and lower) pole accesses, and may be performed without serious complications. These results indicate that this is a safe and effective approach of PCNL, and it presents a good alternative for removal of renal stones in pediatric patients.

Evaluation of complications according to the modified Clavien system adapted for percutaneous nephrolithotomy

Evaluation of complications according to the modified Clavien system adapted for percutaneous nephrolithotomy

Using the Modified Clavien Grading System to Classify Complications of Percutaneous Nephrolithotomy

Purpose: A modified Clavien classification system has been proposed to grade perioperative complications. We share our experience in grading the complications of percutaneous nephrolithotomy (PNL), according to this new classification. Methods: A total of 809 PNLs performed between 2010 and 2014 were reviewed retrospectively. The modified Clavien classification system, which classifies the perioperative complications into 5 grades, was applied. Grade wise comparison of complications between the patients with simple and complex calculi was done. We also carried out a univariate analysis of different predictors of complications after surgery. Results: A total of 253 perioperative complications were observed in 237 (29.29%) patients. Most complications were related to bleeding and urinary leakage. Patients with complex calculi had significantly more number of complications across all Clavien groups. In a univariate analysis, positive preoperative urine culture and multiple access for stone clearance were identified to be the independent predictors of complications. Conclusion: The modified Clavien system is a simplistic grading system for classification of postoperative complications. However, it suffers from various shortcomings. Therefore, till the proposition of a more comprehensive classification system, the modified Clavien system is useful for reporting the complications and short-term outcomes of PNL.

Robot-assisted radical prostatectomy in the setting of previous abdominal surgery: Perioperative results, oncological and functional outcomes, and complications in a single surgeon's series

BackgroundData on safety and efficacy of robot-assisted radical prostatectomy (RARP) after previous abdominal surgery are scarce. Hence, we assessed perioperative, oncological and functional outcomes, and complications of RARP in patients with previous abdominal surgery after 1-year minimum follow-up. Materials and methodsProspectively collected data from 339 consecutive patients undergoing transperitoneal RARP by a single surgeon (AM) between November 2008 and May 2014 were analysed. Complications were classified according to Modified Clavien System. Biochemical recurrence (BCR) was defined as two consecutive PSA values ≥ 0.2 ng/ml. Functional outcomes were assessed using validated, self-administered questionnaires. In particular, only patients undergoing nerve-sparing RARP with no erectile dysfunction (baseline IIEF-5 score >21) and no use of phosphodiesterase-5 inhibitors preoperatively who were interested in erections and required no adjuvant therapy (radiation, orchiectomy and androgen-deprivation therapy) were evaluated concerning potency recovery. Patients without and with previous abdominal surgery were compared using Mann-Whitney and chi-square tests (or Fisher exact test). ResultsOn 339 patients, 247 (71.6%) had not undergone previous abdominal surgery (Group 1) and 92 (28.4%) were pre-operated (Group 2). There were no statistically significant differences between Groups 1 and 2 regarding mean operative time (260 vs. 257 min; p = 0.597), median number of resected nodes (16 vs. 17; p = 0.484), mean length of stay (7.2 vs. 7.1 d; p = 0.151), positive surgical margin (12.5% vs. 16.3%; p = 0.233) and complication rates (26.7% vs. 31.5%; p = 0.187).Median (IQR) follow-up was 36 (12–48) months. For Groups 1 and 2, BCR-free survival rates were 78.5% and 79.8% (p = 0.467); continence rates were 97.9% and 100% (p = 0.329), whereas a potency recovery was achieved in 69.5% and 62.2% of patients (p = 0.460), respectively. ConclusionsTransperitoneal RARP is a safe and efficient treatment for clinically localised prostate cancer even in patients with previous abdominal surgery. However, further studies with higher number of patients are warranted.

Standardized Grading of Shock Wave Lithotripsy Complications with Modified Clavien System

Introduction: Definitive consensus on grading of complications of shock wave lithotripsy (SWL) does not exist. The objective of this study was to grade complications of SWL in relation to different stone and shock wave parameters, according to the modified Clavien system. Materials and Methods: Complications observed in 2,648 patients who underwent SWL between January 2003 and May 2014 were evaluated statistically and stratified into 5 grades by the modified Clavien system focusing on stone and shock wave parameters. Results: Statistically significant association (p ≤ 0.05) was found between SWL outcome, Clavien grade of complications and stone and shock wave parameters. According to the modified Clavien system, grades I, II, IIIa, IIIb, IV and V complications were observed in 1,811 (68.39%), 619 (23.37%), 183 (6.91%), 34 (1.28%), nil (0.00%) and 1 (0.03%) patients, respectively. The overall success rate at 3 months was 87.72%. Conclusions: The modified Clavien system provides a standardized grading of SWL complications and can be used to standardize procedural errors and maintain quality, thereby preventing associated complications and improving the overall management and hence outcome of SWL.

Functional evaluation of a modified Studer ileal neobladder

ObjectivesTo evaluate the results of using a shorter ileal segment (40cm only) in reconstructing Studer ileal neobladder after radical cystectomy. Subjects and methodsRadical cystectomy and modified Studer ileal neobladder was performed in 60 patients for invasive bladder cancer. Only 40cm of the ileum was used; 32cm segment for constructing the body of the neobladder, while the remaining 8cm as an isoperistaltic intact limb for ureteral reimplantation. After one year, evaluation included clinical, laboratory, radiographic and urodynamic studies to determine the functional and oncological outcomes. ResultsEarly complications occurred in 5 patients (8.6%). According to the modified Clavien system, two patients had grade I complications, IIIb occurred in one patient and two patients had grade V complications. Late complications (8.6%) included incisional hernia in 2 patients, deep venous thrombosis, bilateral uretero-ileal anastomotic stricture and intestinal obstruction each occurred in one patient. At one year, daytime and nighttime continence was 93.1% and 89.7%, respectively. Reflux was observed in 6 patients (10.3%) which was unilateral in 3 patients and bilateral in 3 without affecting the renal functions. Neobladder pressure was 7–18cmH2O at half capacity and 13–38cmH2O at full capacity with no uninhibited contractions. ConclusionMinimizing the length of the ileum for Studer neobladder reconstruction is feasible and with acceptable results.

Feasibility of a 2nd generation MR-compatible manipulator for transrectal prostate biopsy guidance

ObjectivesTo assess the feasibility of a 2nd generation MR-compatible, remote-controlled manipulator (RCM) as an aid to perform MR-guided transrectal prostate biopsy in males with suspicion of prostate cancer (PCa).MethodsThis prospective phase I study was approved by the local ethical committee and written informed consent was obtained from each patient. Twenty patients with ≥1 cancer suspicious region (CSR) with a PI-RADS score of ≥3 detected on the diagnostic multi-parametric MRI and no prior prostate treatment underwent MR-guided biopsy with the aid of the RCM. Complications were classified according to the modified Clavien system for reporting surgical complications. For evaluation of the workflow, procedure- and manipulation times were recorded.ResultsAll CSR’s (n=20) were reachable with the MR-compatible RCM and the cancer detection rate was 70 %. The median procedure time was 36:44 minutes (range, 23 – 61 minutes) and the median manipulation time for needle guide movement was 5:48 minutes (range, 1:15 – 18:35 minutes). Two Clavien grade 1 complications were reported.ConclusionsIt is feasible and safe to perform transrectal MR-guided prostate biopsy using a MR-compatible RCM as an aid. It is a fast and efficient way to biopsy suspicious prostate lesions with a minimum number of biopsies per patient.Key Points• It is feasible to perform transrectal prostate biopsy using a MR-compatible RCM.• Using a RCM for MR-guided biopsy is safe, fast, and efficient.• All cancer suspicious regions were reachable with the RCM.

Salvage cryotherapy with third-generation technology for locally recurrent prostate cancer after radiation therapy.

To present the intermediate results of the use of third-generation cryotherapy as salvage treatment for locally recurrent prostate cancer after radiation therapy. From January 2006 to July 2010, 32 patients with locally recurrent prostate cancer after radiotherapy underwent salvage cryoablation using third-generation technology. Biochemical recurrence-free survival (BRFS) was defined as the time period from salvage treatment to the date of biochemical recurrence (Phoenix definition of nadir+2ng/ml). Complications were classified as grades 1-5 according to the modified Clavien system. Multivariate logistic regression analysis was performed to identify potential risk factors associated with recurrence after salvage cryotherapy. The median follow-up was 63months (range 38-92). Mild complications (grades 1 and 2) included mild incontinence (9.4%), acute rectal pain (31.3%), hematuria (6.3%), scrotal edema (9.4%), urinary tract infection (3.1%), lower urinary tract symptoms (15.6%) and erectile dysfunction (57.1%). Severe events (grade 3) included severe incontinence (3.1%) and urethral sloughing (3.1%). The rate of rectourethral fistula and urinary retention was absent. The 5-year overall survival was 92.3%. The 5-year cancer-specific survival was 100%. The 5-year BRFS rate using the Phoenix definition was 43.5%. A multivariate analysis disclosed that PSA at cryoablation was the only predictive factor for biochemical recurrence. Salvage cryotherapy using third-generation technology offers a safe and effective alternative for locally recurrent prostate cancer after radiation therapy. Additional studies with longer follow-up are necessary to determine the sustained efficacy of this procedure.

MP54-20 ACCURACY OF ULTRASONOGRAPHY FOR THE EVALUATION OF UROLITHIASIS IN PATIENTS UNDERGOING EXTRACORPOREAL SHOCKWAVE LITHOTRIPSY: COMPARISON WITH NON-CONTRAST COMPUTED TOMOGRAPHY

INTRODUCTION AND OBJECTIVES: percutaneous nephrolithotomy (PNL) is the preferred treatment of high dense renal stones. In this study we tried to compare the outcomes of PNL versus shock wave lithotripsy (SWL) for high density (1000-1500 HU on non-contrast computed tomography [NCCT]) moderate sized (1025mm) renal calculi as regards stone-free rate and procedure morbidity. METHODS: A prospective study was conducted in our department from March 2012 to May 2014. Eighty consecutive patients; excluding lower calyceal stones; were randomized to receive either PNL or SWL (40 in each arm). Patients were followed-up by abdominal ultrasound and plain X-Ray (NCCT if indicated) till clearance of stone. Outcomes, complications (the modified Clavien system), costs, and SF8 Health Survey scoring were recorded for each group. Median followup was 8 months (range 6 to 30). RESULTS: Basic characteristics of both groups were comparable. After single treatment session, 3-week success rates were 80 and 27.5% for PNL and SWL respectively (p < 0.001). Overall 3-month stone free rates after PNL and SWL monotherapy were 87.5 vs. 90%, respectively (p 1⁄4 0.723). Median number of required maneuvers till stone clearance was one (range 1-3) for PNL vs. two (range 1-4) for SWL (p < 0.001). The complication rates for the PNL and SWL were 10 and 7.5%, respectively (p 1⁄4 0.692). SWL was done as outpatient procedure while median hospitalization time per patient was 2 days (range 2-6) in the PNL group. The cost of SWL was significantly lower (p < 0.001). Patient-reported outcomes, including overall physical and mental health status, were comparable for both PNL and SWL. On multivariate analysis, single renal stone was an independent predictor for complete stone clearance after 2 sessions of SWL (OR 7.26, 95% CI 1.1346.62, p1⁄40.037). CONCLUSIONS: For treatment of moderate-sized high density renal stones, PNL provides significantly higher initial success and lower retreatment rates compared with SWL. Although PNL is effective, it has some limitations including invasiveness and cost. SWL is another alternative especially for single moderate-sized high density renal stone.

MP54-19 PERCUTANEOUS NEPHROLITHOTOMY VERSUS SHOCK WAVE LITHOTRIPSY FOR MODERATE-SIZED HIGH DENSITY KIDNEY STONES: A PROSPECTIVE RANDOMIZED TRIAL

You have accessJournal of UrologyStone Disease: Shock Wave Lithotripsy1 Apr 2016MP54-19 PERCUTANEOUS NEPHROLITHOTOMY VERSUS SHOCK WAVE LITHOTRIPSY FOR MODERATE-SIZED HIGH DENSITY KIDNEY STONES: A PROSPECTIVE RANDOMIZED TRIAL Ahmad A Elderwy, Mohamed Gadelmoula, Ghaleb Althamthami, and Ahmad Abdulmoneim Ahmad A ElderwyAhmad A Elderwy More articles by this author , Mohamed GadelmoulaMohamed Gadelmoula More articles by this author , Ghaleb AlthamthamiGhaleb Althamthami More articles by this author , and Ahmad AbdulmoneimAhmad Abdulmoneim More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.589AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES percutaneous nephrolithotomy (PNL) is the preferred treatment of high dense renal stones. In this study we tried to compare the outcomes of PNL versus shock wave lithotripsy (SWL) for high density (1000-1500 HU on non-contrast computed tomography [NCCT]) moderate sized (10- 25mm) renal calculi as regards stone-free rate and procedure morbidity. METHODS A prospective study was conducted in our department from March 2012 to May 2014. Eighty consecutive patients; excluding lower calyceal stones; were randomized to receive either PNL or SWL (40 in each arm). Patients were followed-up by abdominal ultrasound and plain X-Ray (NCCT if indicated) till clearance of stone. Outcomes, complications (the modified Clavien system), costs, and SF-8 Health Survey scoring were recorded for each group. Median followup was 8 months (range 6 to 30). RESULTS Basic characteristics of both groups were comparable. After single treatment session, 3-week success rates were 80 and 27.5% for PNL and SWL respectively (p < 0.001). Overall 3-month stone free rates after PNL and SWL monotherapy were 87.5 vs. 90%, respectively (p = 0.723). Median number of required maneuvers till stone clearance was one (range 1-3) for PNL vs. two (range 1-4) for SWL (p < 0.001). The complication rates for the PNL and SWL were 10 and 7.5%, respectively (p = 0.692). SWL was done as outpatient procedure while median hospitalization time per patient was 2 days (range 2-6) in the PNL group. The cost of SWL was significantly lower (p < 0.001). Patient-reported outcomes, including overall physical and mental health status, were comparable for both PNL and SWL. On multivariate analysis, single renal stone was an independent predictor for complete stone clearance after 2 sessions of SWL (OR 7.26, 95% CI 1.13- 46.62, p=0.037). CONCLUSIONS For treatment of moderate-sized high density renal stones, PNL provides significantly higher initial success and lower retreatment rates compared with SWL. Although PNL is effective, it has some limitations including invasiveness and cost. SWL is another alternative especially for single moderate-sized high density renal stone. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e734 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Ahmad A Elderwy More articles by this author Mohamed Gadelmoula More articles by this author Ghaleb Althamthami More articles by this author Ahmad Abdulmoneim More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Safety and efficacy of minimally invasive percutaneous nephrolithotomy in the treatment of patients with medullary sponge kidney.

The purpose of this study was to review the safety and efficacy of the minimally invasive percutaneous nephrolithotomy in the treatment of medullary sponge kidney patients with complex renal calculi. Sixteen medullary sponge kidney patients with complex renal calculi underwent minimally invasive percutaneous nephrolithotomy procedures in our center were entered into this retrospective study. The data analyzed included patients' demographics, stone burden, operative time, operative blood loss, length of hospital stay, complications according to the modified Clavien system, and stone-free rate. All the patients in this study had complex renal stones that included 14 multiple stones and 3 partial staghorn calculi. The mean stone surface area was 779.5±421.1mm(2). Preoperative urinary tract infection was noted in 5 (31.2%) patients. Minimally invasive percutaneous nephrolithotomy was successfully completed in 15 renal units in 14 patients. Two patients failed the procedure. The mean operative time was 87.3±32.3min. Mean hemoglobin drop was 25.3±16.5g/L. An initial stone-free rate of 60% was achieved after the procedure, and the final stone-free rate was 86.6% after auxiliary second look and/or shock-wave lithotripsy. Clavien grade I and II complications occurred in 3 (21.4%) patients including the one (7.1%) patient who required transfusion. All the complications were managed conservatively. No major complications occurred. This retrospective analysis confirmed that minimally invasive percutaneous nephrolithotomy was a safe alternative treatment for the medullary sponge kidney patients with complex renal calculi. This procedure provided an acceptable stone-free rate and low incidence of high-grade complications. Stone-free rate further could be further improved with auxiliary procedures.

Feasibility and safety of laparoscopic nephrectomy in uremic patients with end-stage renal disease.

The purpose of this study was to analyse the feasibility and safety of laparoscopic radical nephrectomy (LRN) vs. open radical nephrectomy (ORN), in terms of perioperative and postoperative outcomes, in uremic patients. Between September 2007 and December 2013, 19 patients with end-stage renal disease (ESRD), who underwent LRN or ORN for chronic pyelonephritis, renal calculi, hydronephrosis, renal tumors, complicated cyst, or associated polycystic kidney, were retrospectively analysed. All patients with complete preoperative clinical and intraoperative parameters, including age at surgery, gender, body mass index (BMI), American Society of Anesthesiologists (ASA) score, surgical technique, operation time, complications, were available for further analyses. The 30-day complication rate in both groups was retrospectively review and graded according to the modified Clavien System in five grades. Overall, nine (47.3%) vs. 10 (52.7%) patients underwent LRN vs. ORN, respectively. The mean ASA score (2.7 ± 0.8 vs. 2.9 ± 0.7) did not show statistically significant differences in both groups (p = 0.632). None of the patients in G1 was converted to open surgery for intraoperative complications or CO2 retention. The estimated blood loss was 223 ± 155 mL in G1 and 455 ± 134 mL in G2 (p&lt;0.005). Both groups were comparable with regard to mean operation time. The mean hospital stay was 5.95 ± 1.85 days in G1 and 8.10 ± 1.67 days in G2 (p&lt;0.001). The present study revealed that laparoscopic surgery in uremic patients might be performed safely under the expertise of an experienced laparoscopic team. This surgical technique is a minimally invasive treatment, reduces blood loss, shortens postoperative hospital stay, minimizes wound pain, and encourages an earlier return to normal activity.

Prospective evaluation of outcome of percutaneous nephrolithotomy using the ‘STONE’ nephrolithometry score: A single-centre experience

ObjectiveTo assess the prediction of stone clearance and complications of percutaneous nephrolithotomy (PCNL) using the ‘STONE’ nephrolithometry score, assessing stone size, tract length (skin-to-stone distance), degree of obstruction, number of calyces involved and stone essence (density). Patients and methodsThis was a prospective study of patients undergoing single-tract PCNL while prone, conducted at a university hospital. All patients had non-contrast-enhanced computed tomography within 3weeks of the procedure. Only patients with a unilateral procedure and radio-opaque stones were included. The five variables of the STONE nephrolithometry score were calculated before the procedure. The stone-free rates were assessed with a plain abdominal film at 4weeks and complications were graded using the modified Clavien system. ResultsIn all, 107 patients were included in the final analysis. Overall, 80% of patients were rendered stone-free. Among the individual variables, a larger stone (P=0.002) and the involvement of multiple calyces (P=0.04) were associated with residual stones, while tract length (skin-to-stone distance), stone density and presence of hydronephrosis were not. Patients who were rendered stone-free had a statistically significant lower overall STONE score than those with residual stones, at 7.24 vs. 8.14 (P=0.02). The score also correlated with operative duration, which was significantly longer with a higher STONE score (P=0.03). The complication rate was 18% and most complications were Clavien grade 2, with bleeding requiring a blood transfusion (11 patients) being the commonest. There were no deaths within 30days of surgery, but there was no correlation between the STONE score and complications. ConclusionThe STONE nephrolithometry score is a simple and easy to apply system for predicting complexity in stone clearance with PCNL.

Patients With Prostatic Inflammation Undergoing Transurethral Prostatic Resection Have a Larger Early Improvement of Storage Symptoms

To evaluate the association between prostate inflammation, metabolic syndrome (MetS), and postoperative lower urinary tract symptoms in patients treated with transurethral resection of the prostate (TURP). From April 2011, a consecutive series of patients treated with TURP were prospectively included in this observational study. MetS was defined according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATPIII) criteria. Patients were evaluated at baseline and 1month postoperative with the International Prostate Symptom Score (IPSS), including the storage IPSS (sIPSS) and voiding IPSS (vIPSS) subscores, the Overactive Bladder questionnaire (OAB-q), and uroflowmetry. Prostate volume was evaluated at baseline. Complications were classified using the modified Clavien system. TURP specimens were examined to define grade, location, and extent of the inflammatory infiltrate according to the standardized classification system of chronic prostatitis and/or chronic pelvic pain syndrome. One hundred and thirty-one subjects were enrolled, in which 54 patients (41.3%) presented with MetS. No differences were observed in terms of preoperative prostate-specific antigen, OAB score, IPSS, vIPSS, sIPSS, Qmax, post void residual, and prostate volume in subjects with and without MetS. An incidence of postoperative complications of 10.6% was recorded: 79% were classified as Clavien type I or II; 21% Clavien IIIb. Of 131 subjects, 97 (74.1%) presented with an inflammatory infiltrate. Patients with MetS presented a high proportion of inflammatory infiltrates compared to patients without MetS (45 of 54; 83% vs 52 of 77; 67%, P= .01). Patients with prostate inflammation presented a 50% risk reduction of postoperative storage urinary symptoms. We confirmed the association between MetS and prostate inflammation.Patients with inflammatory infiltrates mostly benefit from TURP, particularly regarding storage symptoms.