REVISTA ROMÂNÆ DE UROLOGIE

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2 REVISTA ROMÂNÆ DE UROLOGIE Editor Øef: Prof. Dr. Ioanel Sinescu Editor Fondator: Prof. Dr. Doc. Eugeniu Proca Comitet Editorial Naflional: Prof. Dr. Petriøor Geavlete, Bucureøti Dr. Costicæ Novac, Iaøi Dr. Radu Constantiniu, Bucureøti Prof. Dr. Radu Boja, Târgu Mureø Conf. Dr. Ioan Coman, Cluj-Napoca Conf. Gabriel Glück, Bucureøti Conf. Dr. Valentin Ambert, Bucureøti Prof. Dr. Gheorghe Bumbu, Oradea Prof. Dr. Viorel Tode, Constanfla Prof. Dr. Ioan Ioiart, Arad Comitet Editorial Internaflional: Prof. Dr. John Denstedt (Ontario, Canada) Prof. Dr. Imre Romics (Budapesta, Ungaria) Prof. Dr. Rien Nijman (Groningen, Olanda) Prof. Dr. Hendrik Van Poppel (Leuven, Belgia) Prof. Dr. Andrzej Borowska (Varøovia, Polonia) Peter Hammerer (Braunschweig, Germania) Dr. Cælin Ciofu (Paris, Franfla) Prof. Dr. Mircea Golimbu (New York, SUA) Prof. Dr. Michael Marberger (Viena, Austria) Prof. Dr. Dirk De Ridder (Leuven, Belgia) Prof. Dr. Theo M. de Reijke (Amsterdam, Olanda) Prof. Dr. Marek Sosnowski (Lodz, Polonia) Per-Anders Abrahamsson (Malmö, Suedia) Editor executiv: Dr. Constantin Gîngu, Bucureøti Editor executiv adjunct: Dr. Cristian Surcel, Bucureøti Redactori: Dr. Sorin Titus Pætræøcoiu, Bucureøti Dr. Robert Stoica, Bucureøti Dr. Alexandru Dick, Bucureøti Redacflia: Centrul de Chirurgie Urologicæ, Dializæ øi Transplant Renal, Institutul Clinic Fundeni, Bucureøti Øos. Fundeni nr. 258, sect. 2, Bucureøti, România Tel./fax: ,

3 Program øtiinflific Topici de congres Scientific programme Congress topics Sesiuni postere Poster Sessions 1. Litiazæ Lithiasis 2. Transplant Transplantation Hipertrofie benignæ a prostatei Benign Prostate Hyperplasia 3. Cancerul de prostatæ Prostate Cancer 4. Uretræ, penis Urethra, Penis 5. Urologie funcflionalæ øi reconstructivæ Functional and reconstructive urology 6. Tumori vezicale Bladder Tumors 7. Oncologie, Cancerul renal Oncology, Renal Cancer Sesiuni postere nemoderate Varia Sesiune Video Unmoderated Poster Sessions Varia Video Session 1. Varia Varia 2. Infertilitate Infertility 3. Hipertrofie benignæ a prostatei Benign Prostate Hyperplasia 4. Cancerul de prostatæ Prostate Cancer Tumori vezicale Bladder Cancer Urologie femininæ Female Urology Incontinenflæ Incontinence 5. Litiazæ, Oncologie Lithiasis, Oncology

4 PM.1.1. Abordul terapeutic complex al litiazei renale dure voluminoase V. Mitroi 1, L. Teodorescu 1, B. Mihai 1, A. Chuaibi 1, L. Pojoga 2, V. Cauni 1 1 Clinica de Urologie, Spitalul Clinic Colentina, Bucureøti 2 Clinica de ATI, Spitalul Clinic Colentina, Bucureøti Combined lithotripsy methods in the management of large hard renal stones V. Mitroi 1, L. Teodorescu 1, B. Mihai 1, A. Chuaibi 1, L. Pojoga 2, V. Cauni 1 1 Urology Department, Colentina Clinical Hospital, Bucharest 2 ICU Department, Colentina Clinical Hospital, Bucharest Litiazæ Introducere. Scopul acestei lucræri este de a prezenta experienfla noastræ iniflialæ în abordul litiazei renale dure voluminoase prin litotritie mixtæ: laser (Ho: Yag) øi balisticæ (Lithoclast). Material øi metodæ. În perioada 1 iunie februarie 2013, 27 de pacienfli cu litiazæ renalæ duræ voluminoasæ (calculi coraliformi øi pielici voluminoøi) au beneficiat de nefrolitotomie percutanatæ (NLP) cu litotriflie combinatæ: laser Holmium (Calculase II de 20 W) cu scopul de a scædea rezistenfla calculului, urmatæ apoi de litotriflie balisticæ (Lithoclast Calcusplit). Vârsta medie a pacienflilor a fost de 49 de ani, cu un timp operator mediu de 50 de minute. Mærimea medie a calculului a fost de 4,8 cm. Au fost analizate ratele de fragmentare øi de stone-free, timpul operator øi rata complicafliilor. Rezultate. Rata de fragmentare a fost de 88.8 %, iar rata de stone-free a fost de 81,5 % (100% pentru calculii pielici øi 81.5% pentru calculii coraliformi). Litiaza rezidualæ imediatæ a fost înregistratæ la 5 pacienfli (18.5%). Complicafliile postoperatorii au fost reprezentate de febræ (11.1%), din care 1 pacient a prezentat sepsis. Sângerarea postproceduralæ a fost minoræ øi nu a necesitat transfuzie. Concluzii. Cazurile complexe de litiazæ renalæ impun accesul la mai multe metode de fragmentare. În litiaza renalæ duræ utilizarea doar a unei metode de fragmentare poate conduce la creøterea ratei complicafliilor sau la scæderea ratei de fragmentare øi de stone-free. Sursele de fragmentare trebuie sæ fie utilizate în mod flexibil în funcflie de particularitæflile fiecærui caz în parte, asocierea acestora conducând la rezultate superioare. Introduction. The aim of this study is to present our experience in combined Holmium laser (Ho Yag) and ballistic (Lithoclast) lithotripsy for large renal lithyasis. Patients and methods. Between 1 st June th February 2013, 27 patients with large renal lithyasis (complete staghorn and pyelic calculi) underwent percutaneous nephrolithotomy (PCNL) with combined lithotripsy: laser Holmium lithotripsy using a 20 W Holmium laser (Storz Calculase II) with the purpose of decreasing the stone resistance followed by ballistic lithotripsy (Lithoclast Calcusplit). The mean age of the patients was 49 years, with a mean operative time of 50 minutes. The mean stone size was 4.8 cm. The stone-free rates and fragmentation rates, operative time and complications were analyzed. Results. The fragmentation rate was 88.8% and the stonefree rate was 81.5% (100% for pyelic stones and 81.5 % for staghorn calculi). Immediate residual lithyasis was recorded in 5 patients (18.5%). Postoperative complications were represented by fever (11.1%), with one patient with urinary sepsis. The bleeding after these interventions was minor; no blood transfusions were required. Conclusions. The complex cases of renal lithiasis require the use of different methods of fragmentation. In large renal lithyasis, the employment of a single method of fragmentation can increase the complication rates or reduce the fragmentation and stone free rates. The lithotripsy sources must be used in a flexible way depending on the particularities of each case, the association of different methods leading to much better results. nr. 2 / 2013 vol 12 Revista Românæ de Urologie 3

5 Litiazæ PM.1.2. Experienfla Clinicii de Urologie,,Prof. Dr. Theodor Burghele în nefrolitotomia percutanatæ efectuatæ la 36 de pacienfli cu rinichi unic M. Merticariu, M. Dumitrache, S. Raøcu, A. Rusu, D. Bædescu, V Jinga Clinica de Urologie, Spitalul Clinic Prof. Dr. Th. Burghele, Bucureøti Prof. Dr. Theodor Burghele Clinic of Urology s Experience with Percutaneous Nephrolitotomy on 36 Patients with Solitary Kidney M. Merticariu, M. Dumitrache, S. Raøcu, A. Rusu, D. Bædescu, V Jinga Clinic of Urology, Prof. Dr. Th. Burghele Hospital, Bucharest Introducere: Nefrolitotomia percutanatæ este o intervenflie chirurgicalæ endoscopicæ de extragere a calculilor renali cu dimensiuni mai mari de 2 cm prin intermediul unei incizii minime cutanate. Complicafliile frecvente sunt reprezentate de sângerare, perforaflie a cæii urinare sau a organelor învecinate, hidrotorax øi sepsis. Nefrolitotomia percutanatæ reprezintæ o metodæ de tratament minim invaziv în cazul litiazei urinare pe rinichi unic. Obiective: Lucrarea urmæreøte experienfla clinicii din ultimii 3 ani în efectuarea nefrolitotomiei percutanate la pacienfli cu rinichi unic. Material øi metodæ: Au fost incluøi în studiu 36 de pacienfli cu rinichi unic chirurgical sau congenital la momentul intervenfliei la care s-a practicat nefrolitotomie percutanatæ în perioada martie martie S-au urmærit urmætorii parametrii: prevalenflæ, caracteristicile pacienflilor, tehnica intraoperatorie, durata medie a intervenfliei, complicafliile intra øi postoperatorii, incidenfla øi tipul reintervenfliilor. Rezultate: Au fost analizate datele provenite de la 36 de pacienti (reprezentând 2% din numærul total de pacienfli la care s-a efectuat NLP în perioada urmæritæ) cu vârsta medie de 58 de ani, dintre care 1/4 cu DZII, 1/3 cu factori de risc cardio-vasculari øi 10% din pacienfli aflafli sub tratament anticoagulant. Aproximativ 1/3 au avut urocultura pozitivæ preoperator, iar raportul calcul non- coraliform vs calcul coraliformi a fost de 2 la 1. La majoritatea pacienflilor s-a practicat Tubeless NLP cu puncflionarea calicelui inferior øi montare de sondæ dublu J. Dilatarea traiectului de puncflie s-a efectuat cu dilatatoare rigide sub control fluoroscopic în toate cazurile. Cele mai frecvente complicaflii intraoperatorii øi postperatorii precoce au fost sângerarea la 5%, febra la 20% din pacienfli remisæ sub tratament convenflional, iar 10% din pacienfli au necesitat ESWL postprocedural. Concluzii: În ciuda factorilor de risc mai mari comparativ cu pacienflii cu ambii rinichi prezenfli; morbiditatea, mortalitatea øi necesitatea reintervenfliilor aratæ cæ nefrolitotomia percutanatæ se poate efectua în condiflii de siguranflæ în cazul pacienflilor cu rinichi unic. Introduction: PCNL is an endoscopic procedure used for the treatment of renal calculi greater than 2 cm using a minimum skin incision. The most frequent complications related to the procedure are bleeding, fever, perforation of the urinary tract or adjacent organs, hydrothorax and sepsis. PCNL can be safely used on patients with solitary kidney. Background and Purpose: This paper reviews our 3 year experience with PCNL on 36 patients with preexisting solitary kidney. Patients and Methods: In the study report we included 36 patients with preexisting solitary kidney (congenital or surgically removed) who underwent PCNL in the last 3 years. The following variables were included: prevalence, patient characteristics, surgical technique, mean time of intervention, intra and postoperative complications and the incidence and type of reintervention. Results: We analyzed the data from 36 patients with preexisting solitary kidney (representing 2% of the total number PCNL s performed in the last 3 years in our clinic. The mean patient age was 58 years old of which 1/3 had diabetes mellitus, 1/4 had associated cardio-vascular disease,1/3 had positive urine culture and 10% were on anticoagulants prior to surgery. The ratio staghorn calculi vs non-staghorn calculi was 1:2. On the majority of patients we performed Tubeless PCNL with puncture of the inferior calyx and double J uretheral stent placement. The access was performed under radiological control and we used rigid dilators in all cases. The most frequent intra and postoperative complications were bleeding which occurred in 5% of patients and fever in 20% of patients with remision under conventional treatment. The most frequent type of reintervention was ESWL which was performed on 10% of the patients. Conclusions: Despite the higher risks in patients with solitary kidney compared with patients having bilateral kidneys, the morbidity, mortality and risk of reintervention demonstrates that PCNL can be safely performed on patients with solitary kidney. 4 Revista Românæ de Urologie nr. 2 / 2013 vol 12

6 PM.1.3. Rezultatele nefrolitotomiei percutanate la pacienflii cu litiazæ renalæ coraliformæ versus litiazæ renalæ noncoraliformæ B. Braticevici, Y.Salaheddin, F. Tænase, M. Mansour, M. Pascu, R. Petca, V. Jinga Spitalul Clinic Prof Dr. Th. Burghele Percutaneous Nephrolithotomy results in pacients with staghorn calculi vs nonstaghon B. Braticevici, Y. Salaheddin, F. Tænase, M. Mansour, M. Pascu, R. Petca, V. Jinga Spitalul Clinic Prof Dr. Th. Burghele Litiazæ Obiectiv: Compararea rezultatelor nefrolitotomiei percutanate (NLP) la pacienflii cu calculi coraliformi versus calculi noncoraliformi în Clinica de Urologie a Spitalului Prof. Dr. Th. Burghele. Materiale øi metode: Studiu retrospectiv derulat pe o perioadæ de un an de zile: între øi ce include 615 pacienfli cu litiazæ renalæ la care s-a practicat NLP. Vârsta medie a pacienflilor a fost de 53,3 ani. Au fost analizate foile de observaflie øi s-au urmærit: caracteristicile pacienflilor, abordul calculului, numærul de traiecte, complicafliile postoperatorii øi durata spitalizærii. Rezultate: Repartiflia pe sexe a fost - 58,5% femei øi 41,5% bærbafli. 129 (20,9%) au avut litiazæ coraliformæ øi 486 (79,1%) litiazæ noncoraliformæ. Incidenfla calculilor coraliformi a fost mai mare la femei (23.3%) faflæ de bærbafli (17,6%). Urocultura a fost pozitivæ la 29,4% dintre pacienflii cu litiazæ coraliformæ vs 20,5 %. Au necesitat mai multe traiecte pacienflii cu calcul coraliform (33,3% vs 9,4%). Litiaza restantæ a fost în 37,9% dintre cazurile cu calculi coraliformi vs 10,6%. Spitalizarea medie a fost mai mare în cazul litiazei coraliforme, fiind crescutæ de complicafliile postoperatorii mai frecvente, dar øi de necesitatea unei a doua intervenflii în unele cazuri. Concluzii: Nefrolitotomia percutanatæ este o proceduræ siguræ în litiaza renalæ. În litiaza renalæ coraliformæ NLP reprezintæ intervenflia de elecflie. Pacienflii cu calculi coraliformi necesitæ de multe ori o a doua intervenflie ceea ce duce la o spitalizare mai lungæ. Objective: Comparing results in patients with staghorn or nonstaghorn stones who were treated with percutaneous nephrolithotomy (PCNL) in Prof. Dr. Th. Burghele Clinical Hospital Methods: This is a retrospective study over one year, between and Data from 615 patients treated for renal stones with PCNL were collected. The following parameters were analyzed: patient characteristics, access method, puncture frequency, complications and duration of hospital stay. Results: Patient average age was 53,3 years old. There were 129 (20,9%) patients with staghorn calculi and 486 (79,1%) with nonstaghorn calculi. Incidence of stagohrn calculi were higher in women (23,3%) comparing to men (17,6%). Positive urine culture was 29,4% in staghorn and 20,5% in nonstaghorn calculi. Patients with staghorn stones underwent multiple punctures more frequently than those with nonstaghorn stones (33,3% vs 9,4%). Stone free rates were 62,1% vs 89.4% (staghorn vs nonstaghorn stones). Duration of hospital stay was longer in patients with staghorn calculi mostly because some of them needed a second intervention. Conclusions: PCNL is a safe procedure with good results in renal stones treatment and represents first-line treatment in staghorn calculi. Patients with staghorn stones have a longer hospital stay due to more frequent complications and the need for a second procedure. nr. 2 / 2013 vol 12 Revista Românæ de Urologie 5

7 Litiazæ PM.1.4. Nefrolitotomia percutanatæ în abordul litiazei renale experienflæ personalæ D. Porav-Hodade, C. Todea Universitatea de Medicinæ øi Farmacie, Clinica de Urologie, Târgu Mureø Percutaneous nephrolithotomy approach for renal stones Personal experience D. Porav-Hodade, C. Todea University of Medicine and Pharmacy, Department of Urology, Târgu Mureø Introducere øi obiective. Nefrolitotomia percutanatæ (NLP) reprezintæ tehnica de referinflæ în abordul litiazei renale Obiectivele acestei lucræri sunt reprezentate de evaluarea experienflei inifliale personale în abordul percutanat al litiazei renale. Material øi metodæ. Studiul retrospectiv s-a efectuat în perioada august 2009-martie În aceastæ perioadæ am efectuat 565 de intervenflii la nivelul aparatului urinar înalt (495 de NLP øi 70 de nefrostomii percutanate). Toate intervenfliile au fost efectuate în anestezie rahidianæ sau epiduralæ. Nefrostomia percutanatæ a fost pæstratæ pentru 48 de ore la pacienflii cu NLP. Postoperator tofli pacienflii au urmat tratament antibiotic injectabil pe perioada internærii øi 7 zile tratament oral în regim ambulator. Rezultate. Un numær de 436 de pacienfli au necesitat o singuræ øedinflæ de NLP, 59 de pacienfli (11,9%) necesitând mai multe øedinfle de NLP si/sau alte tipuri de intervenflii (ureteroscopie, ESWL). Durata medie de spitalizare postoperatorie a fost de 3,8 zile. 4 pacienfli au necesitat intervenflii chirurgicale postoperatorii datoritæ unor complicaflii. Pentru 3 pacienfli s-a practicat laparoscopie exploratorie pentru urohemoperitoneu cu drenaj peritoneal øi retroperitoneal. O pacientæ a necesitat lombotomie cu nefrorafie. Nu au fost cazuri de nefrectomie de hemostazæ sau decese. Concluzii. Rata complicafliilor precum øi rezultatele postoperatorii sunt comparabile cu cele ale literaturii de specialitate. Introduction and objectives. Percutaneous Nephrolithotomy (PCNL) is the reference technique for the kidney stone pathology. The objectives of this paper are to evaluate the personal initial experience of percutaneous approach for urolithiasis. Materials and methods. The retrospective study was conducted from August 2009 to March During this period I performed 565 intervention at the upper urinary tract (495 PCNL and 70 percutaneous nephrostomy). All interventions were performed in spinal or epidural anesthesia. Percutaneous nephrostomy was kept for 48 hours in patients with PCNL. All patients were treated postop with intravenous antibiotic during hospitalization and another 7 days with oral therapy. Results. A total of 436 patients required one session of PCNL, 59 patients (11.9%) requiring several sessions of PCNL and / or other types of interventions (ureteroscopy, ESWL). The average length of hospitalization was 3.8 days. 4 patient required surgery due to complications after PCNL. For 3 patients was performed exploratory laparoscopy for urohaemoperitoneum with peritoneal and retroperitoneal drenage. One patient required lombotomy with renal parenchyma suture. There were no cases of nephrectomy for hemostasis or deaths. Conclusions. The rate of postoperative complications and the results are comparable with those of the literature. 6 Revista Românæ de Urologie nr. 2 / 2013 vol 12

8 PM.1.5. Caracteristici ale nefrolitotomiei percutanate la pacienflii vârstnici S. Nedelea 1, R. Borcæiaø 1, I. Dragomiriøteanu 1, D. Bædescu 1, V. Ambert 1, V. Salaheddin 1, M. Pascu 2, C. Mocanu 2 1 Spitalul Clinic Prof. Dr. Th. Burghele, Clinica de urologie 2 Spitalul Clinic Prof. Dr. Th. Burghele, Characteristics of percutaneous nephrolithotomy in elderly patients S. Nedelea 1, R. Borcæiaø 1, I. Dragomiriøteanu 1, D. Bædescu 1, V. Ambert 1, V. Salaheddin 1, M. Pascu 2, C. Mocanu 2 1 Prof. Dr. Theodor Burghele Clinical Hospital, Clinical Department of Urology 2 Prof. Dr. Theodor Burghele Clinical Hospital, Department of Radiology Litiazæ Departamentul de radiologie Introducere. Scopul studiului a fost reprezentat de evidenflierea caracteristicilor nefrolitotomiei percutanate practicate în tratamentul litiazei reno-ureterale la pacienflii vârstnici. Material øi metode. A fost efectuat un studiu descriptiv øi retrospectiv în care au fost incluøi pacienflii vârstnici, internafli în perioada , cu litiaza reno-ureteralæ pentru care s-a practicat nefrolitotomie percutanatæ. Am definit ca pacienfli vârstnici pe cei cu vârsta mai mare sau egalæ cu 70 de ani la data intervenfliei chirurgicale. Au fost studiate comorbiditæflile, caracterele litiazei, aspecte ale intervenfliei chirurgicale øi evoluflia postoperatorie. Rezultate. Au fost efectuate un numær de 61 de nefrolitotomii percutanate la vârstnici în cele 12 luni studiate, reprezentând 9,91% din numærul total de 615 efectuate. Vârsta medie în lotul studiat a fost de 74,26±3,04 ani. Durata medie a internærii postoperatorii la aceøti pacienfli a fost de 7,10 zile foarte apropiatæ de a pacienflilor cu vârste mai mici, de 6,84 zile. O pætrime din calculii întâlnifli la aceastæ categorie de vârstæ au fost coraliformi. Cu excepflia pacienflilor care au necesitat un al doilea timp operator, la care s-a montat drenaj urinar extern între intervenflii, s-a practicat în exclusivitate drenajul urinar intern postoperator. Concluzii. Nefrolitotomia percutanatæ la pacienflii vârstnici are rezultate comparabile cu cele întâlnite la pacienflii mai tineri. Comorbiditæflile pot încetini evoluflia postoperatorie la aceøti pacienfli. Introduction. This study aimed to highlight de characteristic of percutaneous nephrolithotomy as treatment for renoureteral lithiasis in elderly patients. Materials and methods. A descriptive and retrospective study was performed. It included elderly patients admitted from to diagnosed with reno-ureteral lithiasis and treated by percutaneous nephrolithotomy. Elderly patients were considered those 70 years old and more. We studied comorbidities, stone type and location, intervention and postoperative characteristics. Results. 61 percutaneous nephrolithotomies were performed, representing 9,91 % of the total of 615 performed during the 12 months. Average age was 74,26±3,04 years. Mean postoperative admission time was 7,10 days close to the 6,84 days in younger patients. Staghorn calculi represent a quarter of all lithiasis found in this group. Postoperative external urinary drainage was only used for patients that required additional percutaneous nephrolithotomies. We have used internal urinary drainage for all the other patients. Conclusions. Percutaneous nephrolithotomy in elderly patients is similar to that in younger ones. Comorbidities may slow postoperative recovery at elderly patients. nr. 2 / 2013 vol 12 Revista Românæ de Urologie 7

9 Litiazæ PM.1.6. Eficienfla øi siguranfla nefrolitotomiei percutanate (NLP) la pacienflii peste 70 de ani cu litiazæ renalæ C. Todea, D. Porav, R. Boja, S. Nedelcu, Orsolya Martha UMF Târgu Mureø, Clinica de Urologie, Spitalul Clinic Judeflean, Clinica de Urologie Percutaneous nephrolitotomy (PCNL) efficacy and safety in patients over 70 years with kidney stones C.Todea, D. Porav, R. Boja, S. Nedelcu, Orsolya Martha UMF Târgu Mureø, Clinic of Urology, County Hospital, Department of Urology Introducere øi obiective. NLP reprezintæ principala indicaflie pentru pacienflii cu calculi renali, chiar în prezenfla a numeroase comorbiditæfli. În clinica noastra operafliile deschise pentru aceastæ patologie reprezintæ sub 0,5% din totalul operafliilor pentru litiazæ renalæ. Obiectivul acestei lucræri reprezintæ evaluarea siguranflei øi eficienflei acestei proceduri la pacienflii având vârsta de peste 70 de ani. Material øi metodæ. S-a efectuat un studiu retrospectiv pe o perioadæ de 16 ani ( ), pe 323 de pacienfli (162 femei, 161 bærbafli), cu vârste peste 70, având litiazæ renoureteralæ, rezolvatæ endoscopic prin NLP sau uretroscopie anterogradæ (URSA). 85 pacienfli (26,31%) au avut comorbiditæfli care au fost diagnosticate øi tratate preoperator, acolo unde a fost necesar. Rezultate. Per ansamblu starea stone free la terminarea operafliei a fost prezentæ la 263 pacienfli (81,42%). 60 pacienfli (18,58%) au avut fragmente reziduale. Calculii reziduali s-au rezolvat printr-o nouæ øedintæ de NLP, eliminare spontanæ, sau ESWL. Cele mai frecvente complicaflii au fost hemoragia øi infecflia. Nu am avut decese. NU am efectuat nefrectomii cu scop hemostatic. Concluzii. Comorbiditæflile recunoscute preoperator nu constituie factori de risc particulari la vârstnici, dar se impune o evaluare riguroasæ a lor în perioada preoperatorie, respectiv tratamentul acestora. Numærul, volumul øi complexitatea calculului influenfleazæ direct starea stone free la terminarea intervenfliei de extragere a acestor calculi. Introduction and objectives. PCNL represent the main indication for patients with kidney stones, even in the presence of various comorbidities. In our clinic open surgery for this pathology is less than 0.5% of all procedures for renal stones. The objective of this paper is to assess the safety and efficacy of this procedure in patients over 70 years. Material and methods. A retrospective study was performed for a period of 16 years ( ), A totally of 323 patients entered in this study (162 women, 161 men), aged over 70 with renal stones They were treated endoscopically by PCNL or anterograde ureteroscopy. 85 patients (26.31%) had comorbidities that were preoperatively diagnosed and treated where necessary. Results. Overall status of stone free at the end of surgery was present in 263 patients (81.42%). 60 patients (18.58%) had residual fragments. Residual stones were solved by a new PCNL session, spontaneous elimination or ESWL. The most common complications were bleeding and infection. We had no deaths. No hemostasis nephrectomy was necessary. Conclusions. Recognized preoperative comorbidities do not represent risk factors in elderly patients, but it requires a rigorous evaluation in the preoperative period. The number, size and complexity calculation directly influences the state stone free at the end of surgery. 8 Revista Românæ de Urologie nr. 2 / 2013 vol 12

10 PM.1.7. Prelungirea duratei de viaflæ a ureteroscoapelor flexibile R. Mulflescu, R. Satalan, D. Georgescu, B. Geavlete, P. Geavlete Clinica de Urologie, Spitalul Clinic de Urgenflæ Sf. Ioan, Bucureøti Improving the lifespan of the flexible ureteroscopes R. Mulflescu, R. Satalan, D. Georgescu, B. Geavlete, P. Geavlete Department of Urology, Saint John Emergency Clinical Hospital, Bucharest Litiazæ Introducere: Îmbunætæflirea durabilitæflii, miniaturizarea øi tehnologia digitalæ au fost obiectivele principale de dezvoltare ale ureteroscoapelor flexibile. Au fost analizate metodele de prelungire a duratei de viaflæ a modelului Storz Flex-Xc. Material øi metodæ: În perioada Mai-Decembrie 2012 au fost analizate ureteroscopiile flexibile realizate cu douæ astfel de ureteroscoape flexibile (douæ grupuri). Relocarea calculilor din calicele inferior a fost realizatæ ori de câte ori posibil. În cea de a doua serie, teaca de acces ureteral a fost retrasæ în bloc cu endoscopul, pentru a preveni deteriorarea pærflii distale a acestuia. Rezultate: Au fost realizate 247 proceduri (229 pacienfli): 96 proceduri (90 pacienfli) în primul grup øi 151 proceduri (139 pacienfli) în al doilea grup. Teaca de acces ureteral a fost utilizatæ în 72% din cazuri. Primul endoscop a fost utilizat pentru 67,1 ore (timp procedural mediu de 8 minute pentru cele diagnostice øi 45 minute pentru cele terapeutice) în timp ce al doilea a fost utilizat 107,7 ore (timp procedural mediu 10 minute pentru cele diagnostice øi 49 de minute pentru cele terapeutice). Calculii caliceali inferiori au fost prezenfli în 36,7% din cazuri din primul grup (27,7% fiind relocafli) øi în 38,8% din grupul al doilea (33,1% fiind relocafli). Reparaflii majore au fost necesare dupæ deteriorarea înveliøului exterior, respectiv deteriorarea sistemului de deflexie. Concluzii: Flex-Xc pare un ureteroscop flexibil durabil. Utilizarea tecii de acces ureteral øi evitarea suprasolicitærii mecanismului de deflexie prin relocarea calculilor caliceali inferiori pare sæ aibæ un aport semnificativ în relungirea duratei de viaflæ a acestor endoscoape costisitoare. Introduction: Improved durability, miniaturization and going digital were the development goals for flexible ureteroscopes. We aimed to analyze the Storz Flex-Xc model and to highlight methods to increase its lifespan. Methods: Betweend May-December 2012, flexible ureteroscopic procedures performed with two Storz Flex-Xc were analyzed. The patients were divided in two groups, one for each endoscope. Relocation of the lower pole stones was performed in all cases when possible. In the second series the access sheath was retracted together with the flexible ureteroscope to prevent the damages it may inflict on the endoscope. Results: 247 procedures were performed on 229 patients: first group with 96 procedures (90 patients) and second group of 151 procedures (139 patients). Ureteral access sheath was used in 72% of the cases. The first endoscope was used for 67.1 hours (mean procedural time of 8 minutes for diagnostic and 45 minutes for therapeutic ones) while the second lasted for hours (mean procedural time of 10 minutes for diagnostic and 49 minutes for therapeutic ones). Lower pole stone were recorded in 36.7% of patients of the first group (27.7% being relocated), and in 38.8% of the second group (33.1% being relocated). Major repairs were needed after damages of the outer coating and deterioration of the deflecting mechanism, respectively. Conclusions: Storz Flex-Xc seems to be a durable flexible ureteroscope. Use of ureteral access sheath and avoidance of overstressing the deflection mechanism by relocating lower pole stones offers a substantial advantage in prolonging the lifespan of these expensive instruments. nr. 2 / 2013 vol 12 Revista Românæ de Urologie 9

11 Litiazæ PM.1.8. O comparaflie criticæ a performanflelor øi limitærilor a trei dintre ultimele modele de ureteroscoape flexibile R. Mulflescu, D. Georgescu, B. Geavlete, M. Dræguflescu, R. Satalan, P. Geavlete Clinica de Urologie, Spitalul Clinic de Urgenflæ Sf. Ioan, Bucureøti A critical comparison of the performances and limitations of three of the latest models of flexible ureteroscopes R. Mulflescu, D. Georgescu, B. Geavlete, M. Dræguflescu, R. Satalan, P. Geavlete Department of Urology, Saint John Emergency Clinical Hospital, Bucharest Introducere: În ultimele decade a fost urmæritæ continuu îmbunætæflirea durabilitæflii, vizibilitæflii øi manevrabilitæflii ureteroscoapelor flexibile. Au fost studiate comparativ trei dintre ultimele modele de ureteroscoape flexible. Material øi metodæ: Karl Storz Flex-Xc, Olympus URF-Vo and Wolf Cobra au fost evaluate pe parcursul a 90 de proceduri, câte 20 terapeutice øi câte 10 diagnostice pentru fiecare din ele. Uøurinfla inserfliei, manevrabilitatea øi vizibilitatea în cursul fiecærei proceduri au fost notate de la 1 la 5. Fluxul irigafliei øi deflexiunea maximæ au fost mæsurate ex vivo, cu canalul de lucru gol, respectiv cu instrumente accesorii inserate. Durabilitatea endoscoapelor a fost de asemenea evaluatæ. Rezultate: Toate modelele au demonstrat o bunæ manevrabilitate, cu un uøor avantaj pentru Flex-Xc. În procedurile diagnostice, întregul sistem pielo-caliceal nu a putut accesat în 2 cazuri de cætre URF-Vo (tije caliceale subfliri) øi într-un caz de Cobra (arhitecturæ calicealæ complexæ). Modelele digitale au obflinut un scor similar pentru vizibilitate, mai mare decât Cobra. Pierderea deflexiei øi a irigafliei la inserflia diferitelor instrumente accesorii a fost similaræ la toate modelele, Cobra oferind totuøi irigaflie suplimentaræ prin canalul secundar. Pierderea deflexiei maxime în timp a fost de 5% pentru URF-Vo, 9% pentru Flex- Xc øi 10% pentru Cobra. Calitatea imaginii modelelor digitale a ræmas neschimbatæ, în timp ce la Cobra au fost înregistrate 58 de fibre optice rupte. Concluzii: Ultimele modele de ureteroscoape flexibile se dovedesc instrumente eficiente în intervenfliile destinate cæii urinare superioare, cu un avantaj în ceea ce priveøte vizibilitatea pentru cele digitale. Introduction: A continuous struggle to improve durability, visibility and maneuverability of the flexible ureteroscopes was undergone during the last decades. We aimed to comparatively study three of the latest models of flexible ureteroscopes. Methods: Karl Storz Flex-Xc, Olympus URF-Vo and Wolf Cobra were evaluated during 90 procedures, 20 therapeutic for pyelocaliceal lithiasis and 10 diagnostic for each one. Ease of insertion, maneuverability and visibility during each procedure were scored from 1 to 5 and compared, while the irrigation flow and maximal deflection was measured in an ex vivo setting, with an empty working channel and with accessory instruments in place. Instruments durability was also reviewed. Results: All models demonstrated good maneuverability, with a slight advantage for Flex-Xc. During diagnostic procedures, failure to access the entire pyelocaliceal system occurred in 2 cases for URF-Vo, both due to thin caliceal infundibulum, and in 1 case for Cobra, due to complex caliceal architecture. Regarding visibility, while the performances of the digital models were similar, Cobra achieved a lower score. Loss of deflection and irrigation when using ancillary instruments was similar for all endoscopes, but Cobra offered supplementary flow through a secondary channel. Mean deflection loss was 5% for URF- Vo, 9% for Flex-Xc and 10% for Cobra. The visual quality of the digital models remained unchanged during study, but in the fiberoptic ureteroscope 58 optic fibers broke. Conclusions: The latest models of flexible ureteroscopes prove to be effective instruments for upper urinary tract endoscopic interventions, with an advantage regarding visibility for the digital ones. 10 Revista Românæ de Urologie nr. 2 / 2013 vol 12

12 PM.1.9. Litotriflia laser intracorporealæ dust vs. fragmente extractabile în tratamentul litiazei renale R. Mulflescu, D. Georgescu, M. Dræguflescu, E. Alexandrescu, R. Satalan, P. Geavlete Clinica de Urologie, Spitalul Clinic de Urgenflæ Sf. Ioan, Bucureøti Intracorporeal lithotripsy into dust vs. extractable fragments in renal stones treatment R. Mulflescu, D. Georgescu, M. Dræguflescu, E. Alexandrescu, R. Satalan, P. Geavlete Department of Urology, Saint John Emergency Clinical Hospital, Bucharest Litiazæ Introducere: Abordul calculilor pielocaliceali utilizând ureteroscopul flexibil ridicæ o serie de probleme legate de timpul operator, morbiditatea asociatæ øi costuri, în special prin potenfliala deteriorare a endoscoapelor. Material øi metodæ: Au fost analizate 5 serii de câte 20 de pacienfli cu litiazæ pielocalicealæ unicæ: Grupul I cu calculi < 1 cm fragmentafli dust, Grupul II cu calculi < 1 cm cu litotriflie în fragmente, Grupul III cu calculi între 1-2 cm fragmentafli dust, Grupul IV cu calculi între 1-2 cm cu litotriflie în fragmente, Grupul V cu calculi între 1-2 cm la care s-a practicat litotriflie dust pânæ la 1 cm dupæ care litotriflie în fragmente extractabile. În toate cazurile a fost utilizat un ureteroscop flexibil Storz Flex-Xc øi un laser Ho:YAG. Rezultate: Teaca de acces ureteral a fost utilizatæ în 70% din cazuri. Volumul mediu al calculilor în grupul I vs. II, respectiv în grupurile II, III øi IV au fost similare. Rata de succes a procedurilor a fost statistic similaræ în cele 5 grupuri. Timpii operatori medii au fost de 39 minute în grupul I, 21 minute în grupul II, 112 minute în grupul III, 72 minute în grupul IV, 51 minute în grupul V. Au fost înregistrate complicaflii minore în 7 cazuri øi o singuræ complicaflie majoræ, în Grupul IV. Concluzii: Metoda cea mai eficientæ de litotriflie a calculilor sub 1 cm pare a fi în fragmente extractabile. Pentru calculii voluminoøi metoda este utilæ distrucflia în dust pânæ la 1 cm, apoi litotriflia putând fi realizatæ în fragmente. Introduction: Pyelocaliceal calculi flexible ureteroscopic approach raises problems related with operative time, associated morbidity and costs, especially by potential endoscope damage. Methods: 5 series, each of 20 patients with single pyelocaliceal lithiasis were analyzed: Group I with calculi < 1 cm fragmented to dust, Group II with calculi < 1 cm with lithotripsy in fragments, Group III with calculi of 1-2 cm fragmented to dust, Group IV with calculi of 1-2 cm with lithotripsy in fragments, Group V with calculi of 1-2 cm fragmented to dust until they reached 1 cm, and lithotripsy in fragments afterwards. In all cases were used a flexible Story Flex-Xc ureteroscope and Ho:YAG lithotripsy. Results: Ureteral access sheath was used in 70% of the cases. Mean stone volume in groups I and II, and groups II, IV and V were similar. Success rate in all groups was statistically similar. Mean operating time was 39 min in group I, 21 min in Group II, 112 min in group III, 72 min in group IV and 51 min in group V. Minor complications occurred in 7 cases, while a single major complication occurred in group IV. Conclusions: The optimal lithotripsy method of calculi < 1 cm seems to be in extractable fragments. Larger calculi should be fragmented to dust until they reach 1 cm and then the lithotripsy should be continued into extractable fragments. nr. 2 / 2013 vol 12 Revista Românæ de Urologie 11

13 Litiazæ PM ESWL vs ureteroscopie flexibilæ în tratamentul litiazei renale C. Persu, V. Mirciulescu, G. Niflæ, A. Mihalache, P. Geavlete Clinica de Urologie, Spitalul Clinic de Urgenflæ Sf. Ioan, Bucureøti SWL vs Flexible Ureteroscopy for the treatment of renal stones a single center experience C. Persu, V. Mirciulescu, G. Niflæ, A. Mihalache, P. Geavlete Department of Urology, Saint John Emergency Clinical Hospital, Bucharest Introducere. Tehnica ESWL este de obicei perceputæ de pacienfli ca fiind non-invazivæ, devenind astfel prima opfliune în tratamentul litiazei renale. Scopul acestui studiu este sæ compare prospectiv ESWL øi ureteroscopia flexibilæ cu litotriflie cu Ho:Laser în tratamentul litiazei renale. Material øi metodæ. Între Ianuarie 2012 øi Ianuarie 2013, 85 pacienfli au fost tratafli prin ureteroscopie flexibilæ, iar 81 pacienfli au fost tratafli prin ESWL, pentru litiazæ renalæ cu diametru maxim de 3 cm. Pacienflii au fost ulterior împærflifli în douæ subgrupe, în funcflie de dimensiunea calculului: 96 cazuri cu pietre sub 1 cm, iar 71 au avut calculi peste 1 cm. Analiza statisticæ a comparat ESWL øi ureteroscopia în cele douæ grupe, urmærind rata de stone-free, timpul operator øi incidenfla complicafliilor. Rezultate. Rata globalæ de succes dupæ o singuræ proceduræ a fost de 87% dupæ ureteroscopie øi 55 % dupæ ESWL. Dupæ a doua proceduræ, rata de stone-free a crescut la 98% dupæ ureteroscopie øi 72 % dupæ ESWL. Timpul operator mediu a fost de 24(±7) min dupæ ESWL øi 46(±17) min dupæ uretroscopie. Rata globalæ a complicafliilor nu a avut diferenfle semnificative statistic între cele douæ tehnici. În grupul pacienflilor cu calculi sub 1 cm, cele douæ tehnici au avut rate de succes similare (95%, respectiv 96%), iar timpii operatori au fost asemnænætori. În cel de-al doilea grup, ESWL a avut rate de succes inferioare uretroscopiei flexibile. Concluzii. Ambele tehnici au demonstrat un profil de siguranflæ foarte bun, dar uretroscopia oferæ o mai bunæ ratæ de stone-free øi un timp mai scurt pânæ la eliminarea completæ a calculului, în condifliile unei spitalizæri de duratæ mai lungæ. ESWL ræmâne mai ieftin øi foarte potrivit ca proceduræ ambulatorie. Introduction: SWL is usually perceived by the patients as non-invasive, tending to become the first option for renal stones. Our study aims to prospectively compare SWL with flexible uretheroscopy with Ho:Laser lithotripsy for the treatment of renal lithiasis. Materials and Methods: Between January 2012 and January 2013, 85 patients underwent flexible ureteroscopy with Ho:Laser lithotripsy and other 81 patients were treated by SWL for renal stones with a maximum diameter of 3cm. The patients were further divided into two groups, according to the size of the stone 96 cases had stones less than 1 cm, other 71 had stones over 1 cm. The statistical analysis compared SWL and ureteroscopy in the two groups, looking at stone free rate, operative time and complications. Results: The overall success rate after one procedure was 87% for ureteroscopy and 55% for SWL. After the second procedure, the stone free rate was 98% for uretheroscopy and 72% for SWL. The mean operating time was 24(±7) min for SWL and 46(±17) min for ureteroscopy. The overall complication rate showed no statistical significant differences between groups or techniques. In the group of stones under 1cm diameter, SWL and ureteroscopy showed similar success rates (95% and 96% respectively) and operating times. In the other group, SWL had significantly lower success rates. Conclusions: While both techniques are safe, flexible ureteroscopy offers a higher stone free rate and a shorter time until complete removal of the stone, with a longer hospital stay. SWL seems less expensive and very suitable as an outpatient procedure. 12 Revista Românæ de Urologie nr. 2 / 2013 vol 12

14 PM Experienfla clinicii de Urologie Prof. Dr. Th. Burghele în managementul colicii renale la gravidæ M. Dumitrache, M. Merticariu, S. Raøcu, A. Rusu, D. Bædescu, V. Jinga Clinica de Urologie, Spitalul Clinic Prof. Dr. Th. Burghele Prof. Dr. Theodor Burghele Urology Clinic s Experience with the management of renal colic in pregnancy M. Dumitrache, M. Merticariu, S. Raøcu, A. Rusu, D. Bædescu, V Jinga Clinic of Urology, Prof. Dr. Th. Burghele Hospital, Bucharest Litiazæ Introducere. Colica renalæ la gravidæ reprezintæ o provocare de diagnostic pentru medicul urolog datoritæ riscului mutagen al acfliunii radiafliilor ionizante asupra fætului. De asemenea, tratamentul, fie el chirurgical sau conservator (medicamentos) comportæ riscuri atât materne cât øi fetale. Materiale øi metodæ. Au fost analizate retrospectiv datele de la 22 de cazuri de colicæ renalæ la gravide, paciente ale clinicii noastre, în intervalul S-au urmærit: vârsta gestaflionalæ, sensibilitatea ecografiei ca metodæ diagnosticæ, modificærile bio-umorale asociate, localizarea obstrucfliei øi indicaflia terapeuticæ. Rezultate. Vârsta gestaflionalæ medie a fost 22,36 de sæptæmâni (trimestrul al 2-lea). Ecografia a identificat corect calculul în 54% din cazuri, furnizând, de asemenea, detalii despre gradul de distensie øi conflinutul SPC. În 7 cazuri a fost suficientæ administrarea de tratament medicametos øi monitorizare. 10 paciente (45%) au prezentat obstrucflie øi retenflie septicæ în calea urinaræ. Drenaj urinar sonda JJ sau nefrostomie minimæ percutanatæ - s-a efectuat la 12 paciente. Într-un caz, simptomatologia algicæ a fost determinatæ de sindrom de JPU, suspicionat ecografic øi confirmat urografic post-partum. Concluzii. Ecografia este metoda de elecflie pentru stabilirea etiologiei colicii renale la gravide, deoarece nu prezintæ risc fetal. Tratamentul conservator este de primæ intenflie, dar abordarea endoscopicæ reprezintæ o alternativæ fezabila, în cazurile complicate sau a celor care nu ræspund la tratament medicamentos. Pacientele necesitæ urmarire pe toatæ perioada gestaflionalæ øi definitivarea tratamentului urologic postpartum. Introduction. Renal colic during pregnancy represents a diagnostic challenge for the urologist, due to the mutagen risk of fetal exposure to X-rays. Medical and surgical treatment alike, present risks for the fetus and the mother. Materials and method. 22 cases of renal colic during pregnancy, admitted in our clinic between 2010 and 2013, were retrospectively analyzed. We analyzed the mean gestational age, the sensibility of ultrasound as a diagnostic tool, laboratory findings associated, level of the obstruction and therapeutic approach. Results. The mean gestational age was weeks (second trimester). Ultrasound correctly identified the stone and it s location, the degree of distension and characteristics of the content of the urinary tract. In 7 cases, medical therapy and follow-up was sufficient. 10 patients (45%) had obstruction and associated UTI. Urinary drainage, either by JJ stent insertion or nephrostomy, was performed in 12 patients. In 1 case the pain was determined by a UPJ obstruction, which was discovered by ultrasound examination and confirmed by IVP postpartum. Conclusions. Ultrasound is the method of choice for investigating renal colic during pregnancy, because it represents no risk for the fetus. Conservatory management is the first choice, but endoscopic treatment is also feasible in complicated cases and for those patients in which conservatory management fails. Patients need to be reevaluated throughout pregnancy. Completion of the urological treatment sould be attempted postpartum. nr. 2 / 2013 vol 12 Revista Românæ de Urologie 13

15 Litiazæ PM Tratamentul intervenflional al litiazei ureterale la gravide D. Georgescu, R. Mulflescu, V. Mirciulescu, B. Geavlete, E. Alexandrescu, V. Iordache, P. Geavlete Clinica de Urologie, Spitalul Clinic de Urgenflæ Sf. Ioan, Bucureøti Active treatment of urolithiasis during pregnancy D. Georgescu, R. Mulflescu, V. Mirciulescu, B. Geavlete, E. Alexandrescu, V. Iordache, P. Geavlete Department of Urology, Saint John Emergency Clinical Hospital, Bucharest Introducere: Litiaza urinaræ la gravide constituie o provocare atât în ceea ce priveøte diagnosticul cât øi atitudinea terapeuticæ. Scopul studiul a fost reprezentat de evaluarea metodelor de tratament interventional la gravidele cu litiazæ ureteralæ obstructive. Material øi metodæ: În perioada ianuarie ianuarie 2012, în clinica noastræ, 54 de gravide au beneficiat de tratament intervenflional activ al litiazei ureterale, la 38 dintre ele efectuându-se abord ureteroscopic retrograd. Vârsta medie a pacientelor a fost de 27,2 ani (între 20 øi 37 de ani) sarcina fiind cuprinsæ între 12 øi 35 de sæptæmâni. Din acest lot, 38 de paciente au prezentat hematurie microscopicæ, 18 leucociturie øi 6 infecflie urinaræ. Ureteroscopia retrogradæ semirigidæ a reprezentat prima alternativæ terapeuticæ în primele 2 trimestre, iar în trimestrul ultim, primele opfliuni fiind abordul flexibil sau endoprotezarea ureteralæ. În 42 de cazuri intervenflia s-a efectuat sub anestezie rahidianæ, iar în 12 sub anestezie generalæ. Rezultate: Ureteroscopia semirigidæ a permis rezolvarea litiazei în 28/32 de cazuri. La 17 paciente a fost necesaræ fragmentarea balisticæ sau cu laser Ho:YAG a calculilor, în timp ce în 11 cazuri s-a practicat extragerea intactæ a acestora. La 5 paciente au fost înregistrate complicaflii intraoperatorii minore: leziuni ale mucoasei ureterale, edem, sângerare. Postoperator, 4 paciente au prezentat infecflii urinare, 2 hematurie persistentæ, în 3 cazuri fiind descrise simptome vezicale iritative. Ureteroscopia flexibilæ a fost efectuatæ cu succes în toate cazurile, færæ complicaflii intra sau postoperatorii. Toate pacientele au næscut la termen. Concluzii: Ureteroscopia cu litotriflie pneumaticæ sau cu laser Ho:YAG poate fi consideratæ o metodæ terapeuticæ de primæ linie, eficientæ øi siguræ, la gravidele cu litiazæ ureteralæ care necesitæ tratament intervenflional. Introduction: Urolithiasis during pregnancy remains both a diagnostic and treatment challenge. The aim of the study was to assess the results of minimally invasive alternatives in pregnant women with obstructive ureteral calculi. Material & Methods: Between January 2006 and January 2012, in our clinical department, 54 pregnant women underwent active treatment for ureteral lithiasis and in 38 of these cases ureteroscopy was applied as definitive therapy. The average patients age was 27.2 years (range years) and the gestation period varied between 12 to 35 weeks. In this series, 38 patients had microscopic hematuria, 18 leucocituria and 6, urinary tract infection. Semirigid ureteroscopy was the first choice alternative for the first 2 trimesters while flexible approach or double J indwelling were preferred for patients in the last trimester of pregnancy. Regional anesthesia was used in 42 cases and general anesthesia in 12 patients. Results: Semirigid ureteroscopy allowed stone treatment in 28/32 cases. In 17 patients, calculi fragmentation using Ho:YAG laser or ballistic lithotripsy were performed, while in 11 cases, the stone was removed intact. Minor intraoperative complications such as ureteral edema, mild ureteral laceration, or bleeding were encountered in 5 patients. Postoperatively, urinary tract infection developed in 4 patients, renal colic in 2 and prolonged hematuria in one case, while 4 patients complained of stent-induced bladder irritation. Flexible ureteroscopy was successfully completed in all patients. There were no complications related to this procedure. All pregnancies were carried out to full term. Conclusions: Ureteroscopy with intracorporeal pneumatic or holmium laser lithotripsy may be considered a safe and effective first-line definitive therapeutic option in pregnant patients requiring intervention for stone disease. 14 Revista Românæ de Urologie nr. 2 / 2013 vol 12

16 PM Este necesaræ montarea unui stent dupæ litotriflie balisticæ sau cu laser? S. fiîrlea, S. Ionescu, Beatrice Bunea Spitalul Clinic pentru Copii M.S. Curie, Bucureøti, România Is it necessary to stent after ballistic/laser shock wave lithotriptoscopy? S. fiîrlea, S. Ionescu, Beatrice Bunea M. S. Curie Children Hospital, Bucharest, Romania Litiazæ Scop: Scopul acestui studiu este de a evalua eficacitatea litotrifliei endoscopice, rezultatele obflinute la copiii øi adolescenflii cu calculi ureterali, vezicii urinare sau uretrali precum øi dacæ este necesar sau nu montarea unui stent. Metode: Am realizat analiza retrospectivæ a fiøelor medicale la 75 de copii tratafli în perioada , la Spitalul Clinic de Copii M.S. Curie, Bucureøti, cu calculi ureterali, ai vezicii urinare sau uretrale; 50 de pacienfli au venit pentru reevaluare. Rezultate: În aceastæ perioadæ, 53 de pacienfli cu calculi uretrali, 16 pacienfli cu calculi ai vezicii urinare øi 6 pacienfli cu calculi uretral au fost tratafli utilizând aceastæ proceduræ endoscopicæ. Copiii au vârste cuprinse între ani. În caz de localizare ureteralæ bilateralæ am realizat litotriflie în douæ etape, a doua dupæ o perioadæ de douæ sæptæmâni. Tratamentul medical conservator a fost ineficient în toate aceste cazuri. Nu au fost incidente sau accidente grave în timpul sau dupæ proceduræ. Dimensiunea calculilor a variat între cm în diametru. Stent Cook a fost utilizat la primii 21 de pacienfli cu calculi ureteral øi a fost scos dupæ de zile ca o proceduræ în ambulatoriu. La tofli pacienflii s-a pus sonda urinaræ timp de 1-2 zile. Perioada de spitalizare a fost de 3-4 zile. Profilaxie antibioticæ s-a fæcut prin administrarea unei singure doze în timpul funcflionærii. Pentru localizæri urterale, timpul de intervenflie mediu a fost de 45 de minute øi a variat de la 75 minute (în primele cazuri) la 25 de minute ulterior. Concluzii: Aceastæ tehnicæ este o metodæ siguræ øi eficientæ de tratament a litiazei tractului urinar ce poate fi consideratæ o alternativæ mai ieftinæ faflæ de ESWL. Plasarea unui stent Cook nu este obligatorie. Purpose: The aim of this study is to evaluate the endoscopic lithotripsy efficiency and outcomes in pediatric patients with ureteral, vesical and urethral calculi and if stenting is necessary or not. Methods: A retrospective review of medical records of 75 patients with ureteral, vesical and urethral calculi, operated between , in M. S. Curie Children Hospital, Bucharest, was conducted; 50 patients came for the checkup. Results: In this period, 53 patients with ureteral calculi, 16 patients with vesical calculi and 6 patients with urethral calculi underwent this endoscopic procedure. Children were aged between years. In case of ureteral bilateral localization we realized two step lithotripsy, the second after 2 weeks period. The medical conservative treatment was inefficient in all those cases. There were not significant incidents or accidents, during or after the procedure. The size of the calculi ranged between cm in diameter. The Cook stent was placed in the first 21 patients with ureteral calculi and took out after days, as an outpatient procedure. In all patients a bladder catheter was placed for 1-2 days. We registered a hospitalization period of 3-4 days. One single dose prophylactic antibiotherapy was administrated during the operation. For urteral localizations, the mean operating time was 45 minutes and varied from 75 minutes for the first cases to 25 minutes for the last ones. Conclusions: This technique is a safe, effective method of treatment of urinary tract lithiasis. It can be considered a cheaper alternative of ESWL. Placing a Cook stent is not compulsory. nr. 2 / 2013 vol 12 Revista Românæ de Urologie 15