S189 DOES ENDOSCOPIC REMOVAL OF LOWER URETER STONES AFFECT URINARY FLOW RATE? A PROSPECTIVE CLINICAL TRIAL

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S189 DOES ENDOSCOPIC REMOVAL OF LOWER URETER STONES AFFECT URINARY FLOW RATE? A PROSPECTIVE CLINICAL TRIAL
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  Eur Urol Suppl 2010;9(6):604 stones sizes was 10.02 mm (3-20mm). Preoperative mean maximum and medium ow rates were 20,95 ml/sec (range:10-40 ml/sec) and 10,50 ml/sec (range: 5-22ml/sec). Postoperative mean maximum and medium ow rates were 27.45ml/sec (range:15-45 ml/sec) and 13.65 ml/sec (range:5-27 ml/sec). Postoperative uroowmetric values (maximum and medium) were signicantly increased before preoperative measurements (p<0.001). No signicant dierences were observed between stone size and uroowmetric values (p=0.624, r=-0.073) Conclusions: Lower ureter stones decrease uroometric values and removal of stone corrects uroow rates. S190 THE EFFECTS OF SURGICAL POSITIONING ON PATIENTS’ ARTERIAL BLOOD GASES DURING PERCUTANEOUS NEPHROLITHOTOMY OPERATION Karami H., Rezaei A.R. , Mazloomfard M.M., Rezaei I. Urology and Nephrology Research Center (UNRC), Shahid Beheshti University, Dept. of Urology, Tehran, Iran Introduction & Objectives: Alterations in distribution of pulmonary ventilation and perfusion are known to occur with change of position. Each position has its own eects on the patients’ oxygenation and ventilation. Arterial blood gas analysis has a key role in assessing a patient’s oxygenation and ventilation. We compared blood gas analysis of patients, who underwent percutaneous nephrolithotomy in ank position under ultrasonography guidance, with percutaneous nephrolithotomy in prone and supine positions under uoroscopic guidance. Material & Methods: In a clinical trial, some 90 patients with no upper urinary tract abnormalities were selected from the percutaneous nephrolithotomy candidates, and they were randomly assigned into three groups. Patients in group 1 underwent ultrasonography guided percutaneous nephrolithotomy in ank position. Patients in groups 2 and 3 underwent uoroscopic guided percutaneous nephrolithotomy in prone and supine positions (30 patients in each group). All patients received balanced anaesthesia comprising of induction with fentanyl 2 to 6 µg/kg and propofol 1-2mg/kg, muscle relaxation with atracurium 0.5mg/kg, endotracheal intubation and IPPV with nitrous oxide, oxygen and isourane 0.5-1.0 MAC. Throughout the study, the ventilator settings (tidal volume, respiratory rate, I: E ratio and FiO2) were maintained constant. Arterial blood gas was taken just before, and 20 minutes after repositioning. Results: The patients’ mean ages were 40.8 ± 6.9, 39.4 ± 10.6, and 37.2 ± 11.1 years old in ank, prone, and supine positions, respectively (P = 0.69). The mean body mass index (BMI) were 27.8 ±3.4, 26.7 ± 4.7, and 28.1± 5.1 kg/m 2  ank, prone and supine positions, respectively (P = 0.21). PaO2 increased signicantly in ank (111.7±43.8 to 132.8±58.1 mmHg; p = 0.01) and prone (118.6±50.2 to 134.6±58.5 mmHg; p< 0.001) positions and decreased non-signicantly in supine group (121.7±64.5 to 119.7±60.9 mmHg; p= 0.23). With surgical positioning, there were no signicant changes demonstrated in PaCO2 and serum concentration of HCO3 in the ank, prone, and supine groups. Conclusions: Flank and prone positions during surgery have positive eects on patients’ oxygenation. We did not obtain arterial blood gas serially and after operation ended. Hence, in order to examine more chronic eects of patients’ position on oxygenation and ventilation, serial arterial blood gas analyses during longer operations could be a helpful guide. S191 BLIND VERSUS FLUOROSCOPY-GUIDED PERCUTANEOUS NEPHROLITHOTOMY: A RANDOMIZED CLINICAL TRIAL Karami H., Mohammad Hosseini M., Rezaei A.R., Mazloomfard M.M. Urology and Nephrology Research Center (UNRC), Shahid Beheshti University, Dept. of Urology, Tehran, Iran Introduction & Objectives: Because of its safety and low incidence of complications, now PCNL is the treatment of choice in patients with kidney calculi > 2 cm in diameter and in whom shock wave lithotripsy has failed. According to the negative impact of radiation on the patient and the surgical team during percutaneous nephrolithotomy (PCNL), we evaluate success rate and complications of blind access for PCNL using lumbar notch landmark and compare with conventional uoroscopy-guided access. Material & Methods: In a clinical trial, 100 patients candidate for PCNL were assigned into blind (group 1) and uoroscopy-guided (group 2) randomly. In group 1 the lumbar notch was used to guide percutaneous access and control uoroscopy performed after needle insertion, after Amplatz placement and at the end of surgery. If the access failed, we would repeat puncturing up to 5 times. In group 2, access was achieved using full uoroscopy guidance. All patients underwent postoperative assessment including KUB and ultrasonography. Results: Both mean access time and mean operation time were statically similar in group 1 and group 2 (3.3± 0.5 min vs. 3.6 ± 0.7 min and 35.2 ± 4.6 min vs. 38.9 ± 4.1min; respectively). A successful puncture was achieved in 86% and 94% of the patients in groups 1 and 2, respectively (P =0.18). Total success rate of procedure was 80% and 88% of the patients in groups 1 and 2 (P =0.27). From patients with failed PCNL, 12 patients underwent classic PCNL and ESWL performed in 4 patients. Table 1 demonstrates the details of the treatments in each group. There were no dierences with regards to hospitalization day, hemoglobin S187 PERCUTANEOUS NEPHROLITHOTOMY (PCNL) WITH ONE-SHOT METALIC CONE-TIP DILATOR Hosseini M.M. 1 , Aminshari A.R. 1 , Ariafar A. 1 , Tadayyon A.R. 1 , Ahmad E. 1 , Manaheji F. 1 , Shakeri S. 1 , Hosseini Niashiran D. 2 1 Shiraz University of Medical Sciences, Dept. of Urology, Shiraz, Iran, 2   Adrian Machine Company, Dept. of Medical Instruments, Shiraz, Iran Introduction & Objectives: Today PCNL become standard treatment for large renal stone.Nephrostomy tract creation and dilatation usually perform with Alken telescopic metalic dilators, 9 to 30 F or one-step Amplatz dilator.We evaluated a new device, cone-tip 27 Fr. metailc dilator in one-shot manner. Material & Methods: Three-handred Ninety-six patients, 254 men, 141 women,mean age 41.6year(19-73),mean stone size 28mm(22-61),scheduled for PCNL. After puncture of the target calyx under oroscopy and sending guide-wire into system, ball-tip 9F dilator of telescopic Alken dilator system pushed on it.Then cone-tip 27 F metalic dilator(new device) combined with Amplatz sheath 30F pushed on 9F dilator in one-shot manner.Then nephroscopy and lithotripsy by pneumatic lithoclast performed. Results: Of 396 patients, 279 were rst episode and 117 recurrent diseases. Access to system achieved in all cases. Stone-free rate in postop. KUB radiography was 94.4%(374/396). .Perforation of pelvicaliceal system(PCS) occurred in 6,hemorrhage and transfusion in 5 patients and fever in 9 cases. Ancillary procedures(URS,SWL,Re-PCNL) needed in 14 cases .No any other complications. Conclusions: One-shot nephrostomy tract dilatation by metalic cone-tip dilator seems as safe and eective as telescopic dilators, with shorter radiation exposure and no more complication. S188 RADIATION-FREE PERCUTANEOUS NEPHROLITHOTOMY (PCNL) IN PREGNANCY Hosseini M.M. 1 , Aminshari A.R. 1 , Mostafavi M. 2 1 Shiraz University of Medical Sciences, Dept. of Urology, Shiraz, Iran, 2  Shiraz University of Medical Sciences, Dept. of Anesthesiology, Shiraz, Iran Introduction & Objectives: Urolithiasis during pregnancy is a clinical dilemma due to potential risks for mother and fetus.Management of these patients needs a multidisciplinary approach including urologist,obstetrician,anesthesiologist,radi ologist and perinatalogist.We repot our experince of PCNL in pregnancy without radiation. Material & Methods: Our case is a 14 weeks pregnant woman who referred by her obstetrician because of fever,urinary symptoms, several episodes of severe right ank pain and gross hematuria since 11 weeks of her gestation.She is a 26 years old woman in second pregnancy and had history of renal stone and one session PCNL of left kidney 2 years ago.Ultrasonography(US) revealed a 13 weeks plus 5 days normal alive fetus,right side severe hydronephrosis and 3 stones measuring 12,14 and 18 mm,largest one in ureteropelvic junction causes obstruction.Left kidney also showed mild to moderate hydronephrosis and a 6mm stone in lower pole calyx.Patient refused any temporary procedure such as jj stent or percutaneous nephrostomy and even abbreviated excretory urography,compeleted and signed consent for PCNL with US guide.So,second US performed by an expert radiologist and underwent PCNL with US guide. Results: Stone-free state in sonography 2 weeks after operation and left side stone also passed spontaneously 3 weeks later with hydration. No any complication in perioperative period.She is symptom-free with good condition of fetus at 37 th  weeks of pregnancy now. Conclusions: PCNL with guide of US seems safe and eective modality for large symptomatic stone during pregnancy without any radiation to mothe or fetus. S189 DOES ENDOSCOPIC REMOVAL OF LOWER URETER STONES AFFECT URINARY FLOW RATE? A PROSPECTIVE CLINICAL TRIAL Emir L., Dadalı M., Sunay M., Aydoğmuş Y., Aydın A., Erol D. Ministry of Health, Ankara Training and Research Hospital, 1st Clinic of Urology,  Ankara, Turkey  Introduction & Objectives: We investigated whether lower ureter stones decrease urinary ow rates or not. Material & Methods: 25 male and 15 female patients with lower ureter stones were enrolled into the study in the last 6 months. Exclusion criteria were the presence of benign prostatic hyperplasia, history of prostatitis, overactive bladder, urethral stricture disease, urogenital surgeries like mid urethral sling and bladder stone and patients taking medications aecting lower urinary tract. Urinary ow rates were measured before and 3 months after the ureterolithotripsy. Complete stone removal was the absolute inclusion criteria into the study. Dimensions of the stones were calculated on abdominal radiographies. A correlation between the stone size and the improvement in the urine ow rate was also investigated. Results: Ages of the patients ranged between 20 and 66 (Mean: 43.35). Mean
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