Treatment of Bladder Stones in Adults and Children: A Systematic Review and Meta-analysis on Behalf of the European Association of Urology Urolithiasis Guideline Panel

Bladder stones (BS) constitute 5% of urinary stones. Currently, there is no systematic review of their treatment.To assess the efficacy (primary outcome: stone-free rate [SFR]) and morbidity of BS treatments.This systematic review was conducted in accordance with the European Association of Urology Guidelines Office. Database searches (1970-2019) were screened, abstracted, and assessed for risk of bias for comparative randomised controlled trials (RCTs) and nonrandomised studies (NRSs) with ≥10 patients per group. Quality of evidence (QoE) was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool.A total of 2742 abstracts and 59 full-text article…

Instrumentation and Surgical Technique

Guías EAU sobre incontinencia urinaria

Resumen Contexto Las primeras directrices sobre incontinencia de la European Association of Urology (EAU) se publicaron en 2001. Dichas directrices se han actualizado con regularidad en los ultimos anos. Objetivo El objetivo de este articulo es ofrecer un resumen de la actualizacion de las directrices sobre incontinencia urinaria (IU) de la EAU realizada en 2009. Recogida de evidencias El comite de trabajo de la EAU formo parte de la IV Consulta Internacional sobre Incontinencia (ICI) y, con permiso de la ICI, llevo a cabo la extraccion de la informacion de relevancia. La metodologia de la IV ICI consistio en una amplia revision de la literatura por parte de expertos internacionales y en la…

Physics of Shock-wave Lithotripsy

Obesity Triples the Radiation Dose of Stone Protocol Computerized Tomography

Patients with recurrent nephrolithiasis are often evaluated and followed with computerized tomography. Obesity is a risk factor for nephrolithiasis. We evaluated the radiation dose of computerized tomography in obese and nonobese adults.We scanned a validated, anthropomorphic male phantom according to our institutional renal stone evaluation protocol. The obese model consisted of the phantom wrapped in 2 Custom Fat Layers (CIRS, Norfolk, Virginia), which have been verified to have the same radiographic tissue density as fat. High sensitivity metal oxide semiconductor field effect transistor dosimeters were placed at 20 organ locations in the phantoms to measure organ specific radiation dose…

Low-frequency extracorporeal shock wave lithotripsy improves renal pelvic stone disintegration in a pig model.

OBJECTIVE To compare disintegration rates for renal stones treated by 60 vs 120 shock waves (SW)/min at the same energy settings, using standardized validated artificial stones in a pig model. MATERIALS AND METHODS Gypsum artificial stones (13 × 6 mm) were inserted into the renal pelvis on either side of 12 anaesthetized pigs by open surgery. Extracorporeal SW lithotripsy (ESWL) was applied using a new electromagnetic lithotripter (Lithoskop®, Siemens AG Healthcare, Munich, Germany) at 60 and 120 SW/min; 3000 SW were applied to each kidney with the same energy settings. Stone fragments were collected after nephrectomy, passed through calibrated test sieves, and weighed. Fragment size catego…

AR-V7 Protein Expression in Circulating Tumour Cells Is Not Predictive of Treatment Response in mCRPC

<b><i>Introduction:</i></b> Androgen receptor variant 7 (AR-V7) plays an important role in the progression of castration-resistant prostate cancer (CRPC) and has shown potential as a predictive biomarker in circulating tumour cells (CTCs) isolated from the bloodstream in terms of a liquid biopsy. Studies have shown that AR-V7 is a potential surrogate for selecting drug classes for systemic treatment by detecting nuclear AR-V7 by immunofluorescence or measuring AR-V7 messenger RNA by quantitative PCR. Here, we assessed the predictive value of AR-V7 detected by classical immunohistochemistry (IHC) for treatment response. <b><i>Methods:</i></b> C…

Contemporary Management of Struvite Stones Using Combined Endourologic and Medical Treatment: Predictors of Unfavorable Clinical Outcome

Struvite stones have been associated with significant morbidity and mortality, yet there has not been a report on the medical management of struvite stones in almost 20 years. We report on the contemporary outcomes of the surgical and medical management of struvite stones in a contemporary series.A retrospective review of patients who were treated with percutaneous nephrolithotomy (PCNL) for struvite stones at Duke University Medical Center between January 2005 and September 2012 identified a total of 75 patients. Of these, 43 patients had adequate follow-up and were included in this analysis. Stone activity, defined as either stone recurrence or stone-related events, and predictors of acti…

Assessment of a Modified Acoustic Lens for Electromagnetic Shock Wave Lithotripters in a Swine Model

The acoustic lens of the Modularis electromagnetic shock wave lithotripter (Siemens, Malvern, Pennsylvania) was modified to produce a pressure waveform and focal zone more closely resembling that of the original HM3 device (Dornier Medtech, Wessling, Germany). We assessed the newly designed acoustic lens in vivo in an animal model.Stone fragmentation and tissue injury produced by the original and modified lenses of the Modularis lithotripter were evaluated in a swine model under equivalent acoustic pulse energy (about 45 mJ) at 1 Hz pulse repetition frequency. Stone fragmentation was determined by the weight percent of stone fragments less than 2 mm. To assess tissue injury, shock wave trea…

Digital Tomosynthesis: A New Technique for Imaging Nephrolithiasis. Specific Organ Doses and Effective Doses Compared With Renal Stone Protocol Noncontrast Computed Tomography

Objective To determine organ-specific doses (ODs) and effective dose (ED) for digital tomosynthesis (DT) and compare it with our institutional renal stone protocol noncontrast computed tomography (NCCT). Methods A validated anthropomorphic male phantom was placed supine on a digital GE Definium 8000 radiological scanner. Thermoluminescent dosimeters were placed in 256 locations and used to measure OD. A routine DT study was performed consisting of 2 scout images and 1 tomographic sweep in a 14.2-degree arc over the phantom. Software is used to recreate a series of coronal images from the sweep. ODs were determined as the sum of the doses for the study. Equivalent doses were calculated by mu…

Future perspectives of flexible ureteroscopy

Purpose of review In the recent past, there were numerous and promising technological developments in the field of endourology leading to tremendous changes in the management of urolithiasis. This review will try to weave ancient stone therapy with the very modern advent of flexible ureteroscopy and recent developments in robotic systems. Recent findings In the broad field of flexible ureteroscopy for stone surgery, new disposable scopes have been developed and established. The use of robotic instruments is also a new and interesting concept. Additionally, clinical research on the understanding of laser features leads to a specific and appropriate use of lasers for lithotripsy, both holmium…

Robot-assisted ascending-descending laparoscopic nerve-sparing prostatectomy

Stone-Free Rate after Treating Kidney Stones Exceeding 10 mm via Flexible Ureteroscopy: Can Endoscopic Assessment Replace Low-Dose Computed Tomography Control?

<b><i>Introduction:</i></b> It is unclear whether endoscopic assessment of the stone-free rate after flexible ureteroscopy (fURS) is as effective as assessment with low-dose computed tomography (CT) scan. <b><i>Methods:</i></b> Prospective documentation of patients with kidney stones > 10 mm diameter from 2 different centers (Freiburg, Regensburg), who underwent fURS and were declared to be endoscopically completely stone-free. Low-dose CT control performed 4–8 weeks postoperatively. <b><i>Results/Conclusion:</i></b> Thirty-eight patients were treated between October 2015 and August 2016 (12 F, 26 M). Average a…

Perioperatives Outcome in Korrelation zur Lernkurve bei robotisch assistierter partieller Nephrektomie: Die ersten 109 Fälle unserer Klinik

Hintergrund: Die robotisch assistierte partielle Nephrektomie (RAPN) zeigt im Gegensatz zur konventionellen laparoskopischen Nierenteilresektion eine steile Lernkurve und kurzere warme Ischamiezeiten (WIZ). Dies ermoglicht es Patienten mit einem Nierentumor im Stadium cT1a, bei vergleichbaren onkologischen Ergebnissen, die Vorteile eines minimalinvasiven Operationsverfahrens zukommen zu lassen. Ziel der vorliegenden Studie war es, das perioperative Outcome unserer Patienten nach RAPN zu untersuchen und die Lernkurve anhand charakteristischer Werte, wie z. B. der WIZ, zu illustrieren. Material und Methode: Die Daten von 109 Patienten, die in unserer Klinik von Januar 2010 bis April 2015 eine…

Guías EAU sobre incontinencia urinaria

Contexto: Las primeras directrices sobre incontinencia de la European Association of Urology (EAU) se publicaron en 2001. Dichas directrices se han actualizado con regularidad en los últimos años. Objetivo: El objetivo de este artículo es ofrecer un resumen de la actualización de las directrices sobre incontinencia urinaria (IU) de la EAU realizada en 2009. Recogida de evidencias: El comité de trabajo de la EAU formó parte de la IV Consulta Internacional sobre Incontinencia (ICI) y, con permiso de la ICI, llevó a cabo la extracción de la información de relevancia. La metodología de la IV ICI consistió en una amplia revisión de la literatura por parte de expertos internacionales y en la crea…

Treatment of cT1a Renal Tumours in Germany: A Nationwide Survey.

<b><i>Objective:</i></b> To identify clinical parameters influencing German urologists treating cT1a renal tumours, we performed a nationwide survey among members of the German urological associations (DGU and BDU). <b><i>Material and Methods:</i></b> In spring 2012, DGU and BDU members were invited to complete our survey. For 8 cases and 3 index patients, participants were asked about their preferred treatment. Multivariate analyses were used to identify significant parameters leading the responders to favour radical nephrectomy (RN) over nephron sparing surgery (NSS) as well as active surveillance (AS) over invasive treatment. <b><i…

Incidence of Cardiovascular Events after Nephrectomy - A Single Centre, Matched Pair Analysis between Donor and Tumour Nephrectomy in a Long Term Follow-Up.

<b><i>Introduction:</i></b> The study aimed to compare the incidence of cardiovascular events (CVEs) after donor nephrectomy (DN) and radical tumor nephrectomy (RN), according to an estimated glomerular filtration rate (eGFR), were evaluated over time. <b><i>Materials and Methods:</i></b> Follow-up was collected for DN who underwent surgery from 1998 to 2007 for CVE and renal function. All DN were matched for age to patients treated by RN or adenoma enucleation (control group), who were eligible for DN. eGFR was estimated using the Cockgroft-Gould formula. Patients with preoperative comorbidities were excluded. <b><i>Results:</i…

Robot-Assisted Transvesical Enucleation of Benign Prostatic Hyperplasia: Lessons from a Single Surgeon’s Learning Curve

Abstract Introduction Open simple prostatectomy is a well-established and effective operation for prostate volumes greater than 80 gm but also associated with bleeding and urinary incontinence. To benefit from the advances of laparoscopy, robot-assisted simple prostatectomy was established. We determined the learning curve of this minimally invasive surgery by evaluating the first procedures by an experienced robotic surgeon. Methods Patients presenting for surgical therapy with prostate volumes greater than 80 gm were considered for the study. Evaluation included validated questionnaires preoperatively, and at 6 and 12 weeks postoperatively. Blood loss, transfusions, operation time and pad…

Treatment Response in Patients with Stones, and Low Urinary pH and Hypocitraturia Stratified by Body Mass Index.

Obesity has been shown to be a risk factor for kidney stone formation. Obesity leads to insulin resistance which subsequently leads to low urinary pH. Low urinary pH is typically treated with potassium citrate. We determined if the response to potassium citrate for the treatment of low urinary pH and hypocitraturia varied when patients were stratified by body mass index.We retrospectively reviewed the records of patients with urolithiasis and concomitant hypocitraturia and low urinary pH as unique abnormalities upon metabolic evaluation treated exclusively with potassium citrate. Based on body mass index the cohort was divided into the 4 groups of normal weight, overweight, obese and morbid…

MP-09.16 Does a Patient With Parkinson's Disease and Benign Prostatic Obstruction or Hypocontractility of the Detrusor Benefit From a Transurethral Resection of the Prostate

Incidence, Risk Factors and Management of Symptomatic Lymphoceles after Radical Retropubic Prostatectomy

Abstract Introduction We investigated the incidence, clinical course and risk factors for symptomatic lymphoceles after radical retropubic prostatectomy with pelvic lymph node dissection. Moreover, we explored parameters for the failure of percutaneous lymphocele drainage. Methods The incidence of symptomatic lymphoceles in patients with prostate cancer who underwent radical retropubic prostatectomy with pelvic lymph node dissection in our department between 2008 and 2013 was investigated retrospectively. The occurrence of lymphoceles was correlated with several clinical and histopathological parameters. In addition, logistic regression analysis was performed to assess the value of independ…

Ureteral Stones: Shockwave Lithotripsy or Ureteroscopy, Which is Best?

Background Renal stone disease is common and can cause emergency presentation with acute pain due to ureteric colic. International guidelines have stated the need for a multicentre randomised controlled trial (RCT) to determine whether a non-invasive outpatient (shockwave lithotripsy [SWL]) or surgical (ureteroscopy [URS]) intervention should be the first-line treatment for those needing active intervention. This has implications for shaping clinical pathways. Objective To report a pragmatic multicentre non-inferiority RCT comparing SWL with URS. Design, setting, and participants This trial tested for non-inferiority of up to two sessions of SWL compared with URS as initial treatment for ur…

Survival outcomes in patients with large (≥7cm) clear cell renal cell carcinomas treated with nephron-sparing surgery versus radical nephrectomy: Results of a multicenter cohort with long-term follow-up

Background Does the dogma of nephron sparing surgery (NSS) still stand for large renal masses? Available studies dealing with that issue are considerably biased often mixing imperative with elective indications for NSS and also including less malignant variants or even benign renal tumors. Here, we analyzed the oncological long-term outcomes of patients undergoing elective NSS or radical tumor nephrectomy (RN) for non-endophytic, large (≥7cm) clear cell renal carcinoma (ccRCC). Methods Prospectively acquired, clinical databases from two academic high-volume centers were screened for patients from 1980 to 2010. The query was strictly limited to patients with elective indications. Surgical co…

Pancreatic Fistulae after Urologic Surgery - A Single Centre Experience.

<b><i>Introduction:</i></b> To evaluate incidence, symptoms and management of postoperative pancreatic fistula (POPF) after urologic surgery based on our experience. <b><i>Material and Methods:</i></b> Database was searched for clinically evident POPF after urologic surgery between 1998 and 2014. Fistulae were graded using the POPF classification. Clinical course of every POPF patient was evaluated. <b><i>Results:</i></b> During this time, 3,200 surgeries for renal, adrenal and retroperitoneal pathologies were performed. Twelve POPF occurred postoperatively in this series. Eight fistulae were POPF grade A, 3 POPF grade …

Pregnancy After Urinary Diversion at Young Ages-Risks and Outcome.

Objective To assess the urologic and obstetric outcomes during and after pregnancy following urinary diversion (UD) performed during childhood or adolescence. Materials and Methods From our UD database, we identified 25 women who became pregnant between 1981 and 2013. Reasons for UD were neurogenic bladder, exstrophy, trauma, sinus urogenitalis, and interstitial cystitis. Seventeen had continent cutaneous diversion, 4 had continent anal diversion, and 4 had colonic conduit. Results The average age at delivery was 27.8 (18-39) years. Thirty-seven pregnancies occurred; 1 patient decided for an induced abortion. Thirty-two healthy children were born. Five patients had a spontaneous abortion be…

Imaging modalities and treatment of paediatric upper tract urolithiasis: A systematic review and update on behalf of the EAU urolithiasis guidelines panel.

Prompt diagnosis and treatment of paediatric urolithiasis are required to avoid long term sequelae of renal damage.To systematically review the literature regarding the diagnostic imaging modalities and treatment approaches for paediatric urolithiasis.PubMed, Science Direct, Scopus and Web of Science were systematically searched from January 1980-January 2019. 76 full-text articles were included.Ultrasound and Kidney-Ureter-Bladder radiography are the baseline diagnostic examinations. Non-contrast Computed Tomography (CT) is the second line choice with high sensitivity (97-100%) and specificity (96-100%). Magnetic Resonance Urography accounts only for 2% of pediatric stone imaging studies. …