MP-08.12: Holmium: YAG Laser Lithotripsy with Semirigid Ureterorenoscope for Treatment of Ureteral Calculi: Report of 1398 Cases

MP-08.12: Holmium: YAG Laser Lithotripsy with Semirigid Ureterorenoscope for Treatment of Ureteral Calculi: Report of 1398 Cases

MODERATED POSTER SESSIONS (UPJO)]. No bleeding or other serious complications were encountered during the procedures. 4 patients with severe UO ⬎ 2.5...

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MODERATED POSTER SESSIONS

(UPJO)]. No bleeding or other serious complications were encountered during the procedures. 4 patients with severe UO ⬎ 2.5cm were changed to open surgery. With a median follow-up of 5.8 months (range 1-12 months) in 64 patients, the success rate was 73.4% (47/64). Fourteen patients with an obstruction length ⬎2cm and 3 patients ⱕ2cm developed recurrences postoperatively. Of the 17 patients, 13 of whom (11 with UO, 2 with UPJO ) needed a repeat laser incision, 2 of whom with UO ⬎ 2.5 cm was changed to open surgery, and the other 2 were performed 3rd laser incision . Urinary tract infections were observed in 8 patients postoperatively and were managed with anti-infectious therapy. Conclusions: Retrograde ureterorenoscopic incision with holmium: YAG laser is an effective, safe and minimally invasive therapy for patients with ureteral/ureteropelvic junction obstruction (ⱕ2cm). MP-08.11 Flexible Ureteroscopy with Holmium: YAG Laser Lithotripsy for Treatment of Renal Stones Wu Z, Ding Q, Jiang H, Gao P, Zhang Y Department of Urology, Huashan Hospital Affiliated To Fudan University, Shanghai, China Introduction and Objective: To evaluate the efficacy and safety of flexible ureteroscopy with holmium: YAG laser lithotripsy for treatment of renal stones. Materials and Methods: A total of 68 patients with renal stones (ⱕ2cm) underwent flexible ureteroscopy with holmium: YAG laser lithotripsy from November 2007 to February 2009. Of the patients, 20 with original renal stones (had history of a prior treatment failure by SWL), 48 with renal stones from retrograde migration of proximal ureteral stones during the holmium: YAG laser lithotripsy with a semirigid ureterorenoscope. Results: The overall successful fragmentation rate for all renal stones in a single session achieved 88.2% (60/68). Flexible ureteroscopy access failure happened in 8 patients, 3 of whom with severe hydronephrosis, and the other 5 with severe ureteral avulsion. No intraoperative perforations or bleeding were encountered during the procedures. Two weeks⬃3 months (with a mean of 1.9 months ) follow up revealed that the overall stone-free rate for all renal stones achieved 83.3%(50/60). Conclusions: Flexible ureteroscopy with holmium: YAG laserlithotripsy is a highly effective, minimally invasive and safe ther-

apy for some renal stones. It should be indicated as a treatment choice for patients with renal stones (ⱕ2cm, with treatment failure by SWL or semirigid ureterorenoscopic lasertripsy). MP-08.12 Holmium: YAG Laser Lithotripsy with Semirigid Ureterorenoscope for Treatment of Ureteral Calculi: Report of 1398 Cases Wu Z, Ding Q, Jiang H, Gao P, Zhang Y Department of Urology, Huashan Hospital Affiliated To Fudan University, Shanghai, China Introduction and Objective: To evaluate the efficacy and safety of holmium: YAG laser lithotripsy with semirigid ureterorenoscope for treatment of ureteral calculi. Materials and Methods: A total of 1398 patients with ureteral calculi underwent holmium: YAG laser lithotripsy with a semirigid ureterorenoscope from September 2002 to February 2009. The stones were located in the upper ureter in 372 patients, the mid ureter in 338, and the distal ureter in 688. Results: The overall successful fragmentation rate for all ureteral stones in a single session achieved 93.0% (1300/1398). The successful fragmentation rate stratified by stone location was 79.8% (297/372) in the upper ureter, 93.5%(316/338)in the mid ureter, and 99.9%(687/688) in the distal ureter. Six intraoperative perforations were encountered during the procedures. Ureterorenoscopy access failure was happened in 5 patients. Twenty-one patients complicated with urinary tract infection including 6 with infective shock postoperatively were successfully managed. Two weeks⬃6 months (with a mean of 3.6 months ) follow-up revealed that the overall stone-free rate for all ureteral stones achieved 95.2% (1219/1280). Conclusions: Holmium: YAG laser lithotripsy with semirigid ureterorenoscope is a highly effective, minimally invasive and safe therapy for ureteral calculi. It should be indicated as a first choice of treatment for patients with ureteral calculi, especially for the ones in midureter and distal ureter MP-08.13 Acucise® as Treatment Option for 18 Ureteral Strictures Between UPJ and UVJ in Twelve Patients Trip E1, De Kemp V2, Lock T1,3 1 Dept of Urology, University Medical Center Utrecht, Utrecht, the Netherlands; 2 Meander Medical Centre Amersfoort, The Netherlands; 3Central Military Hospital, Utrecht, the Netherlands

UROLOGY 74 (Supplment 4A), October 2009

Introduction and Objectives: The Acucise® was introduced in 1990 by Ralph Clayman; it was not frequently used as a treatment option for ureteral strictures. Cautery wire balloon incision (Acucise®) is an accepted treatment for UPJ-stenosis in mild hydronephrosis. We used this technique to treat ureteral strictures between the UPJ and UVJ. Materials and Methods: Between June 2004 and November 2008 a total of 12 patients were treated with Acucise® (cutting balloon catheter) for ureteral strictures (below UPJ and above UVJ). In order to localize and determine the length of the stricture, pre- and peroperative imaging was performed. The ureteral strictures were probably secondary to stones (n⫽6), complicated surgery (n⫽5) and post-operative radiotherapy. In total 18 strictures (7 proximal, 5 midureteral and 6 distal) were treated with the Acucise®. Mean patient age was 57 years (range 3678). The stricture was incised until the hourglass-like shape in the balloon had disappeared. After the procedure, a 7 or 8 Fr double J catheter was placed for 6 weeks. CT-urography, X-RPG and/or renal scintigraphy imaging were performed to evaluate the result of the procedure. Results: Incision of the ureteral stricture was successful in all patients. The overall success rate, defined as resolution of obstruction radio graphically or decrease of symptoms, or both, was 75% with a mean follow-up of 26 months. One patient had a complication post-operatively; he developed a retroperitoneal haematoma with a decrease in Hb-level. This complication could be treated conservatively. Conclusions: In consideration of its minimal invasiveness and acceptable long-term success in our experience, the Acucise® seems to be an effective, rapid and save alternative for the management of (short) ureteral strictures, especially when previous treatment was unsuccessful. When desirable results can not be realized, surgical correction is still a treatment option. Proper patient selection may further improve long-term results of this simple and innovative technique. MP-08.14 Introducing the Peritrocar Sealer of Retroperitoneoscopy Liu Y, Bi X, Gong J, Yu Y Department of Surgery, the Second Hospital of WuHan Iron and Steel Corporation, Hubei, China Introduction and Objective: Creating optimal artificial carbon dioxide pneumoretroperitoneum or adequate working

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