Alexey Pisarev

MP24-13 A NEW MOBILE APPLICATION FOR KIDNEY STONE PATIENTS

INTRODUCTION AND OBJECTIVES: Our recent studies have revealed that adipocytokines secreted by adipocytes are important for the formation of kidney stones. b3-adrenergic receptor agonist is reported to differentiate white adipocytes into beige cells, which improves metabolic syndrome via the specific protein uncoupling protein 1 (UCP1) expression. In this study, we investigated the effect of transdifferentiation from white adipocytes to beige cells on kidney stone formation. METHODS: Mice were administered daily intra-abdominal injection of saline (control group) or 1.0 mg/kg b3-agonist CL316243 (b3 group) for 12 days. From days 6 to 12, we induced renal crystal deposits by daily intra-abdominal injection of 80 mg/kg glyoxylate. Fat tissues and kidneys were extracted at days 0, 6, and 12. We examined the morphology as well as histology of fat tissues. Total RNA of fat tissue and kidneys were isolated and reverse-transcribed into double-stranded cDNA. Then, the expression of UCP1, adipocytokines, and stonerelated genes was assessed using quantitative real-time polymerase chain reaction (PCR). The formation of renal crystal deposits was observed using polarized light microscopy, and percentages of the depots as the total tissue area of the renal cross-section were expressed using the Image Pro software. RESULTS: b3-agonist treatment reduced lipid droplets in adipocytes and provided differentiation from white adipocytes into beige cells. The expression levels of UCP1 and adiponectin in the adipose tissue in the b3 group increased by 8.1-fold and 4.2-fold compared with those in the control group at day 12 (P < 0.01, P 1⁄4 0.01). The expression levels of IL-6 and osteopontin decreased by 0.3-fold and 0.1-fold (p 1⁄4 0.03, p 1⁄4 0.02). In the kidneys, the expression levels of SOD1 increased by 2.3-fold, and EMR1 decreased by 0.4-fold (P 1⁄4 0.04). The formation of renal crystal deposits decreased to 17.0% in the b3 group (P 1⁄4 0.03). CONCLUSIONS: Our results showed that transdifferentiation from white adipocytes into beige cells suppressed renal crystal formation by reducing pro-inflammatory adipocytokine secretion and improving antioxidant action. This is the first report on the therapeutic role of beige cells for kidney stone formation.

V2-05 THE NOVEL TECHNIQUE OF POST-HYSTERECTOMY VAGINAL VAULT PROLAPSE REPAIR: APICAL SLING AND “NEOCERVIX” FORMATION

tension-free, multilayer closure is feasible, the use of tissue interposition can achieve higher closure rates in larger fistulae or where the surrounding tissue is devitalized. Different materials have been described for fistula closure, including peritoneal tissue and gluteal muscle as well as artificial materials. METHODS: Our videopresentsa robot-assisted techniqueusing a peritoneal flap patch for reconstruction of the VVF. A daVinci SI-system with 4 arms and 6-port access was used. Preoperatively a Fogarthy catheter is placed through the fistula to mark the fistula channel , and the ureters are also stented. After initial adhesiolysis and preparation of the vesicovaginal space, the vagina is incised. Then, the fistula is identified and excised with the surrounding tissue both on the vaginal and bladder side. Following the closure of the vagina, a pedicle peritoneal flap is harvested and interposed between vagina and dorsal bladder wall. Finally, the bladder closure is performed with double-layer sutures. The analysis was performed retrospectively including operative parameters, perioperative complications and functional outcome for all patients. RESULTS: Median operative time (skin to skin) was 219 (181331) minutes without relevant blood loss. Median length of hospital stay was 8 (4-13) days. The indwelling catheter was removed after 10 days and a normal cystogram. Postoperatively all patients (n1⁄410) showed a recurrence-free total continence (0 pad/day). The highest postoperative complication was fever requiring antibiotic treatment (Clavien grade II). CONCLUSIONS: Robotic vesicovaginal repair of high vesicovaginal fistulae and peritoneal flap inlay is a safe minimal invasive approach with a high satisfaction rate and no recurrences in this pilot series to date.

PD02-09 ADJUSTABLE MIDURETHRAL TAPE FOR SURGICAL TREATMENT OF STRESS URINARY INCONTINENCE: SHORT-TERM OUTCOMES.

follow up of 17.9 months. 98 patients were evaluable post-operatively. 47/57 (82%) initially dry patients elected no concomitant MUS, and ultimately 5/47 (11%) of those chose a delayed sling at an average follow up time of 23.9 months. 10/57 (18%) preoperatively dry women elected to undergo a concomitant MUS at the time of RSC. Those undergoing delayed sling reported similar post-operative pad use, UDI-6, QoL, and IIQ-7 scores (Table 1) compared with those not undergoing a sling, suggesting that a delayed sling did not have a negative impact on QoL. Those choosing to undergo concomitant MUS reported more pads per day preoperatively (2.6 vs. 0.4) including pad use from urge incontinence. With regard to satisfaction the patients who were dry pre-operatively and chose no sling scored better (2.25 vs. 6.2, p<0.01) on the IIQ-7 compared with those choosing a concomitant sling. CONCLUSIONS: Patients undergoing RSC without concomitant MUS have similar de-novo SUI rates to those undergoing open colpopexy. There appears to be no advantage to concomitant MUS at the time of RSC for women exhibiting no preoperative SUI.

Pathogenic Variants of Urolithiasis

The essence of Urolithiasis - one of the oldest diseases known by the mankind - is still not understood completely. For a long time the comprehension of Urolithiasis was based on matrix, colloid, ionic, inhibitory and precipitation theories. In these cases it was impossible to single out separate pathogenetic patterns. Besides, in spite of the absence of in vivo proofs the fact that new concrement nucleus forming (de novo nucleation) is only possible outside of the stone-forming metastability range should be taken into consideration for metaphilactic purposes. Fortunately, certain progress in understanding Urolithiasis started with the onset of studies devoted to detailed scrutiny of stone-forming patients’ metabolic peculiarities as well as with the introduction into clinical practice of the up-to-date digital endoscopes. Based on existing publications one may classify pathogenesis of stone-forming into 4 major groups: growth of calcium-oxalic stones on Randall’s plaques in patients with hypercalciumuria; excrescences on the of Belliny’s ducts’ “gags”; microlites forming within the internal medullar layer discharging tubules’ lumen in patients with cystineuria; stones forming in free solution. There is no doubt this classification is not the final one, neither does it exclude mixed variants, however better understanding of the aforementioned pathogenic variants would facilitate a novel view at Urolithiasis and in patients with kidney stones would increase anti-relapse measures’ effectiveness.

ADJUSTABLE TRANSOBTURATOR SLING FOR TREATING PATIENTS WITH COMPLICATED STRESS URINARY INCONTINENCE

Introduction . The optimal tension of suburethral tape is an important component of effectiveness and safety of the surgery. By now, there is no common standardized guidance on the tensioning of the sling. There is a limited number of publications, devoted to adjustable systems with the ability to correct tape tension in postoperative period. To evaluate the effectiveness of this method, the long-term results of postoperative adjustment of the sling are necessary. Aim . To evaluate the results of complicated stress urinary incontinence (SUI) surgical treatment using a transobturator adjustable sling Urosling (Lintex). Materials and methods . The study included 89 women with complicated SUI. All patients underwent the transobturator adjustable midurethral tape placement. The tension adjustment was performed during 3 days after surgery. Postoperative evaluation included vaginal examination, cough stress test, 1-h Pad-test, uroflowmetry, bladder ultrasound and post-void residual (PVR) urine measurement, validated questionnaires (UDI-6, UIQ-7, ICIQ-SF, PICQ-12) and visual analogue scale (VAS). Results . Mean operative time was 15.74±7.49 min. The tension adjustment was performed in 45.0% (40/89) patients the next day after surgery. On the second day tension re-adjustment was required in 14,6% (13/89) patients. In 3.4% (3/89) women the tension was also tuned on the 3 day. The loosening of the sling was needed in 13.5% (12/89) patients. After adjustment, all patients were continent without any signs of bladder outlet obstruction (BOO). Mean follow-up was 14.3±2.1 months. The objective cure rate was 92.9%. There was no statistically significant difference in the urodynamic parameters. Assessment of patient satisfaction showed that 95.2% (80/84) of the patients were «very» or «very» satisfied. Conclusion. The adjustable transobturator suburethral tape Urosling allows to achieve high effectiveness of treatment in female patients with complicated SUI and to reduce the risk of postoperative BOO development.

The role of local anesthesia to reduce pain after PСNL

The goal of the study was to assess the level of postoperative pain in patients undergoing PCNL after paratubal infiltration with local anesthetic to compare this method of anesthesia with a control group where local anesthesia was not provided. 63 patients were included with kidney stones, confirmed by computer tomography (CT), who were planned to undergo percutaneous nephrolithitomy (P С NL). During the observation 6 patients have been excluded in accordance with the exclusion criteria. The remaining 57 patients were randomized into 2 groups: group A ( n = 28) at the end of the operation received paratubal infiltration of 0.5% sol. ropivacaine; group B ( n = 29) (controls) — local anesthesia was not used. Postoperative pain was assessed by means of VAS-score 1 hour, 6 hours and 24 hours after surgery. Systemic analgesia was performed with NSAIDs (intramuscular injection of 100 mg ketoprofen) when requested by the patient (Patient-Controlled Analgesia). In patients with local anesthesia, the total VAS score evaluated after 1 and 6 hours after the operation was significantly lower than in the control group. The average amount of ketoprofen required for postoperative analgesia in the group of patients with paratubal infiltration was significantly lower than in the control group. Paratubal infiltration of local anesthetic after PCNL significantly reduced postoperative pain and tended to reduce the amount of NSAIDs to eliminate pain, which in turn may reduce the risk of complications associated with NSAID.