G. Berquet

Prospective evaluation of ambulatory laser vaporization of the prostate for benign prostatic hyperplasia

Photoselective vaporization of the prostate (PVP) is an alternative to transurethral resection of the prostate in the surgical treatment of benign prostatic hyperplasia (BPH). Our objective was to prospectively evaluate the feasibility, safety, and efficacy of ambulatory photoselective vaporization of the prostate for benign prostatic hyperplasia.

A Fatal Case of Massive Incarcerated Genital Prolapse

Genital prolapse is usually seen as a benign condition warranting treatment only when bothersome. We report the case of a 77-year-old woman who presented with massive incarcerated pelvic organ prolapse, which led to bladder necrosis, cystectomy with bilateral cutaneous ureterostomy, and death from medical complications 5 weeks after the initial presentation. This first case report of death from bladder necrosis after incarcerated genital prolapse could warrant treatment of massive prolapse even when apparently well tolerated.

Impact of the acquisition of a flexible ureteroscope on the management of upper urinary tract stones in children

INTRODUCTION Firstly reported in the early 1990s for the treatment of upper urinary tract stones in adult patients, flexible ureteroscopy (F-URS) has been used in children during the past 10 years and is now considered as a viable, but still second-line alternative to extracorporeal shockwave lithotripsy in these patients (ESWL). The aim of this study was to assess the impact of the acquisition of a F-URS on the management of upper urinary tract stones in children. PATIENTS AND METHODS Data of all ESWL, F-URS and percutaneous nephrolithotomy performed for upper urinary tract stones in children from 0 to 18 years old in a single center from 2000 to 2014 have been collected retrospectively. Patients have been divided into two groups: group 1 before the acquisition of the F-URS (2000-2008) and group 2 after the acquisition of the F-URS (2008-2014). Preoperative data and peri-operative outcomes were compared between both groups using the χ(2) test and Fisher exact test for discrete variables and the Mann-Whitney test for continuous variables. RESULTS Thirty-seven children have been treated during the first era and 32 during the second one. The two groups were similar in terms of age (7.2 years vs 8.1 years; P=0.54), size of the largest stone (15 mm vs 16.2mm; P=0,56) and number of stones per patient (1.4 vs 2; P=0,07) but the sum of stone diameters was higher in group 2 (16.9 mm vs 24.2mm; P=0,048). The stone-free rates were comparable in both groups (28.1% vs 32.2% after the first procedure; P=0.72), as were the mean number of procedures per patient (2.4 vs 2.5; P=0.78), the total length of stay (2.7 days vs 2.9 days; P=0.77), and the number of patients who experienced at least one complication (37.8% vs 40.6%; P=0.87). CONCLUSION The acquisition of a F-URS allowed the treatment of more complex stones with a similar efficacy and without increasing morbidity. Further studies are needed to define the role of F-URS in the management of upper urinary tract stones in children.

MP38-10 EXTRACORPOREAL SHOCKWAVE LITHOTRIPSY VERSUS FLEXIBLE URETEROSCOPY FOR THE MANAGEMENT OF UPPER TRACT URINARY STONES IN CHILDREN:A CASE-CONTROL NON RANDOMIZED STUDY

INTRODUCTION AND OBJECTIVES: Current guidelines recommend extracorporeal lithotripsy (ESWL) as first-line treatment of kidney stones 4mm on the imaging performed at three months postoperatively. RESULTS: Over the study period 100 ESWL and 46 F-URS were conducted in children. The ESWL and F-URS groups were comparable in terms of stone size (14.6 vs. 13.2 mm, p 1⁄4 0.32) but there were more multiple stones (31% vs. 57%; p 1⁄4 0.003) and lower pole calculi (14% vs. 37%; p 1⁄4 0.003) in the F-URS group. The SF rates after one procedure was almost two times higher in the F-URS group compared to the ESWL group (37% vs. 21%; p 1⁄4 0.04) without increasing the complication rate (23% vs. 16% ; p 1⁄4 0.31) but with a more frequent use of general anesthesia (100% vs. 81%; p 1⁄4 0.0005) and a monger length of stay (1.4 vs. 0.9 days; p 1⁄4 0.02). CONCLUSIONS: This study is the first to compare the results of ESWL and F-URS for the treatment of upper tract urinary stones in children. F-URS provides a higher SF rate despite more complex urinary stones (multiple, lower pole,..) without increasing morbidity.