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Volume 7 Issue 3 March 2008 15SN1559-9055

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European Association of Urology

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Annual EAU Congress, Milan, 26-29 March 2008

II

Members EAU Scientific Congress Office Members EAU Video Committee

ChairmanF.C Hamdy. Sheffield IGBIMembersP-A. Abrohamssan. Malmb ISEIW. Artiboni Padua IInGA Bagaert. Leuven IBEIx. Cathelrneou. Pons IFR)CR Chapple. Sheffield 1GB!FR Cruz, Porta IPnP. Dobronski Worscr.:v IPLiI. Eordle\!. Leeds IGBI·G. Janetschek. Linz lAnU. Jonas. Hanover IDEI

26--29 March 2008

C. Liorente Aborca. Madrid I(5)M. r-iorberoer. Vienna lAnV. Mirane. Naples IInPF.A Mulders. Nijmegen INUJ-J Rambeaud. Grenoble IFRIP. Rigatti. Milan linJA Scholken. Nijmegen INUC. Selli. Prso liT!A.Stenzl. Iubinqen IDE)G.N. Tholmann. Berne ICHIM. Wirth. Dresden IDE)H Van Poppel. Leuven IBE)AR Zlona. Toronto 1CA)

ChairmanRJA Van Maarselaor. Amsterdar.1I1'ILiMembersP. Albers. KassellDE)A. Akoroz. Barcelona !ES)IJ. Dc Jonq. Granlngen INUPA Geovlete. BuchoreSllROIA Messas. Nanterre IFRIM. Zerbib, Pons IFRI

Milan

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23rd Annual Congress ofthe European Association

of Urology, Milan, Italy,26-29 March 2008

Abstract Book

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.,~ETERIC STENTS COMPROMISE STONE CLEARANCE

-')LLOWrNG SWL FOR URETERIC STONES. RESULTS OF A~~<("TCHED-PAIR ANALYSIS

37

W~s!ern General Hospital. Dept. of Urology, Edinburgh, United Kingdom

,~t!oduclion & Objectives: To identify the effect of the presence of a ureteric stent.., rbe outcome 01 SWL, by comparing patients with ureteric stones with matched-calf analysis.

r"'<Iterial & Methods: Patients undergoing SWL with the Technomed Sonolith",3ion lithotriptor (Technomed Medical Systems, Vaulx-en-Velin, France) were':kntifled from our prospectively maintained database. Only adult patients with a~(lHC!ry, radiopaque. previously untreated ureteric stone were considered for further,,,'?Iysis. A follow-up of at least 3 months with a KUB film was used to identify-e,icJual fragments. Patients were exactly matched for gender, side, location inl~e ureter and size (In two dimensions, with an approximation of ± 2 mm). If bothdiameters could not be matched exactly, the size was extended to :!: 1 mm and'''s~to ! 2 mm of both diameters. An effort was finally made to match patients by~ge. The treatment outcome in tenms of stone-free (SF) rates was assessed andcompared using McNemar's test.

R%ults: A total of 45 patients with a ureteric stent in place during SWL were found.-:-ile only patient that could not be adequately matched was a 40-year-old manwith an 8x3 mm stone in the upper ureter. The majority were located in the upperureter (77.3%). Mean stone size was 8.5 and 8.6 mm, respectively. No statisticalI],iiecellces were found between the two groups for age and size of stones (p=0.41ana p=O.8G, Student's t-test). In 12 pairs only patients without a stent were SF.compared 10 2 pairs where the patient with a stent was SF. Using the McNemar'slest. the OR was 6.0 (95% Cl 1.3-55.2) and the difference between the groups was,.t.)tlstk~ally Significant (p=0.016).

Concluslons: These results clear1y demonstrate that the presence of a stent leadsto a worse outcome following SWL for ureteric stones. Ureteric stents should stillt,e used in cases of obstruction, when there is a risk of sepsis, and in patientsWith intolerable pain or deteriorating renal function. However. their use in patientsofjered SWL for ureteric stones should be considered with caution.

39FA!N DURING ESWL - ARE THERE ANY PARAMETERS TO PREDICTfP-lE QUANTITY OF ANALGETIC REQUIREMENT?

(' Ch3IJSSy C .. ,futrgsdorf T .. Thueroff S.

'., ,:I,,,,I:urn Harlaching. Dept. of Urology, Munich. Germany

:'ntroduction & Objectives: Extracorporeal shockwave lithotripsy is a non invasive,to:11 painful procedure. Sufficient analgesia is recommended, 10 avoid pain inducedmovements and excessive respiratory excursions. The quantity of required analgesia isfluctuatinq over a wide range. In our retrospective analysis of 1000 ESWL-treatmenls,e tried to ir1entlfy parameters. that allow a prediction of analgetic need.

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,'>,aterial & Methods: From 01/2006 to 10/2007. 1.000 ESWL-treatments have beenpenormed with two electromagnetic shockwave systems (SIEMENS Multiline"lS:EM[NS Llthoskop") in on-demand i.v, analgesia with alfentanil (Rapifen"') aftera load dose of 0.5 - 1.0 mg alfentanil. All relevant data. such as patient- and stone.'naracteristics. shockwave data and amount of analgesia have been recorded in an MS".,,~essdatabase for analysis. Subjective pain level was assessed with visual analoguescaie VAS (0-10). -

Results: 1.000 patients with an age from 20 1089 years received 0.5 - 4.0 mg alfentanil(sveraqe: 1,7 mg) for analgesia. The subjective pain level was reported with 3,1 on""2';)ge. The analqetic demand was higher in lithotripter with big focal spot and small,';Jenure (SIEMENS t.ithoskop") compared to SIEMENS Multiline" with small focal areaand bigoer aper1ure (2.2 mg attentanu vs. 1.5 mg). Stone localization was a furtheroarameter: stone localization close to bone structures (upper caliceal stone. lowerureteral stone) were associated with a higher demand for analgesia. Older patientsr.ac less need for analgesia than younger patients « 50 years: av. 1.9 mg alfentanilversus > 50 years: av. 1.5 mg alfentanil). Stratified to ethnic groups, westem European,,'<>itle and Asian patients had an analgetic demand. that is below the average (av.: 1.5m!J aiientarul). Pauents from turkey and Mediterranean countries (Italy, Spain, Greece)required higher analgetic dosage (av.: 2,1 mg alfentanil). In these ethnic subgroups,patient's sex is a factor for different analgetic need.

Conclusions: The need of analgesia for ESWL-treatment is related to many factors.Characteristics of used lithotripsy device. stone localization and patient data allow anestimation of analgetic requirernant. Lithotripters with small apenure. stones in theupper pole and lower ureter. young age and origin from Mediterranean countries aremdicators for a higher consumption of analgetic drugs.

::Cur Urol Suppl 2008;7(3):80

STENTlNG IN EX1:RACORPOREAL SHOCKWAVE LlTHOTRIPSY;'rTOPAHENH THE PASSAGE OF THE FRAGMENTS? \{ U-r>..c.",\Mustafa M.', Ali-EI-Dein B'

'Osmaniye State Hospital, Dept. of Urology, Osmaniye. Turkey. 'Urology led,ci)1CcNephrology Centre. Dept. of Urology, Mansoura. Egypt "SCs the

ept, of Url

Introduction & Objectives: To evaluate the role of double J (DJ) stent in enhar,mellluthe passage of fragments in patients undergoing extracorporeal shockwave lithotltroducti((ESWL) for renal stones With diameters less than 2.5 cm. ling ESI'

Material & Methods: Between November 2005 and January 2007. 38 patients wrterial &mean age of 47.05 years (range: 16-73) were included into thrs study and undeoo undo...•,ESWL for renal stones. The inctusion criteria were: radio-opaque renal stone'dlcal ,e!<located in the lower pole, complete disintegration of the stone, normal renal fun,va Drrex ,no metabolic abnormalities. no major renal abnormalities and no symptomatic ur.ned'Jle!),tract infection. In 11 of these patients stents (DJ) were used while in the rema le SJ"'pJ,.27 no stents were utilized. The average stone diameters in stentless and steio

ndanc

groups were 1.54 cm and 1.77 cm, respectively (p= 0.16). There was no statlstr~r:~::~',~,significant difference between the mean ages of both groups (p=O 47). Double J~noos ai'lwas removed when there was no further passage of the fragments for 6 weeks.n Studenstone disintegration. All patients were given non-steroidal anti-inflammatory drugd,cswereone week after ESWL treatment. Stone passage and the data of DJ were detemtl mag",r"with plain X-ray of the urinary tract. The severity of lower urinary tract symptom;pain and the need for intravenous and/or intramuscular analoesics were recoro(sults: Cc

.... hOloglc;:)'

Results: The overall stone-free rate at 3 months was 92.1'10. Two patients .:;~~: ~:;.stented and one patient in the stentiess group were partially free of stones (P=:'UP 54 ~ 1Steinstrasse were observed in two patients (5.3%): one patient In the stentless ; Ihe fourtand another one after the removal of DJ stent. Only one patient In the stented f,ess Ihe ,had severe lower urinary tract symptoms which responded neither to oral nor toanqes ( \

forms of analgesics, and therefore DJ stent was removed. The remaining p~"aged Vi

were in no need for analgesics other than the oral therapy. erogene"cy10Iog''''

Conclusions: Placement of DJ stent for the purpose of irnprovrnq free store ~';I,o~,~al.or enhancing the passage of the fragments during ESWL IS unnecessary ir 'u~.~~~~'stone with diameters less than 2.5 cm. However, further prospective trials shoe .designed to define the criteria for stented ESWL. nelusion

c!romagn

OVARIAN APOPTOSIS AFTER SHOCK WAVE LITHOTRIPSY FOR lE CONDISTAL URETERAL STONES :RAZO~

Bayrak 0', Cimentepe E.', Karatas OF', Aker A.', Bayrak ISSAGE

Yildirim ME', Unsal A.', Unal D.' Li!r~Q.R

'Fatih University, Dep\. of Urology, Ankara, Turkey, 2Fatih University. organ Unof Obstetric and Gynecology, Ankara, Turkey, 3Fatih University, D~Pathology, Ankara. Turkey, "Kecioren Training and Research Hospital.lroductilof Urology, Ankara. Turkey ysicians

ssaqe G

Introduction & Objectives: To identify any apoptotic effect of shocksp'tallz;)lithotripsy (SWL) for distal ureteral stones on ovarian tissue. j Terazc

tnes ane

Material & Methods: Twenty-one female New Zealana white rabbnsdivided into three groups of seven rabbits each: I (control), 11 and III (lr-'tcrialu&and sacrificed 14 and 28 days after SWL, respectively). The left distal uc"gan( r

.. . )UPS easegment of the anesthetized (ketamrne HCI, 20 mg/kg) animals In gro.39 8± i I,and III were exposed to 1500 shockwaves at 17 kV. Localization of the:lofenacureteral segments was achieved following contrast medium (lohexol3lre gIVE!nof IlmL) injection. The animals were sacrificed on cay 14 or 28 after 'up C WI

and the ovaries were removed. The follicle number with apoptotic Ching In acin ovarian tissue was compared to control group Apoptotic change,"r lithotldetermined by terminal deoxynucleotidyl transferase dUTP nick andlne pass(TUNEL) method. estronna

·nths waResults: No increased apoptosis was detected in all groups. The'number of TUNEL positive follicle in group I. 11 and III were 9.3 t 2,C5ults: Tt 2.6 and 8.7 ± 2.9, respectively. There were no statistically slg~'UP 8 a,differences among all groups regarding the number of TUNEL-p:'uP 8 w.follicle (p = 0.647). Also no histomorphological change other than apo;re thanwas detected in study groups. .ra anal

an curr

Conclusions: SWL treatment for distal ureteral stones does no! rn cont«

apoptotic chariges on ovarian tissue. so it is a safe treatment opn'nclusiowomen of reproductive ages. nptoms