Hyoung Keun Park

Characteristics of bacterial colonization and urinary tract infection after indwelling of double-J ureteral stent

OBJECTIVESnTo investigate the natural history of bacterial colonization on the stent and in the urine after different periods of indwelling ureteral stent placement.nnnMETHODSnA total of 57 double-J stents from 52 patients (21 men and 31 women, mean age 52 years, range 20 to 79) were examined. In all patients, short-term (2 to 3 days) antimicrobial therapy was administered at the time of stenting. Regular urinalysis and urine culture were performed until the stent was removed. The stents were removed by aseptic manipulation, and the proximal and distal tip segments of the stents were obtained. Three culture specimens were acquired from each stent segment (inner surface washing suspension, outer surface washing suspension, and from the stent tip itself).nnnRESULTSnBacterial colonies were found in 44% (25 of 57) of the stents. Of the multiple pathogens identified, Enterococcus species (6 of 25) was the most common, followed by Escherichia coli (5 of 25). After short-term antibiotic prophylaxis, the bacteria did not colonize within the first 2 weeks of stent placement. However, the colonization rate increased as the duration of the stent placement lengthened. Colonization of the stent was followed by colonization of the urine.nnnCONCLUSIONSnThe results of our study demonstrated that bacterial colonization at the stent began 2 weeks after indwelling stent placement and that stent colonization preceded urine colonization. The rate of colonization increased with longer periods of stenting.

Direct ureteric length measurement from intravenous pyelography: does height represent ureteric length?

Ureteric length is the most important factor for determining the ideal length of a ureteric stent. In most of the literature, ureteric length is estimated according to a patient’s height. We investigated the reliability of a patient’s height as a measure of ureteric length. We measured the actual length of the ureteric trace (ALUT) and the linear distance (LD) from the ureterorenal junction to the ureterovesical junction by intravenous pyelography (IVP), using a 15xa0min view. A total of 203 patients (100 men, 103 women, 406 ureters) with normal findings were studied, and ALUT, LD and height were measured. The mean patient height was 164.3±8.3(SD)xa0cm. Mean ALUTs of the right and left ureters were 23.4±1.9xa0cm and 24.4±2.0xa0cm, respectively, and the mean LDs of the right and left ureters were 22.1±1.9xa0cm and 22.9±2.0xa0cm, respectively. Height was significantly correlated with the ALUTs of both sides, but these were not linear (r2=0.024 right, 0.059 left). However, LD showed significant linear correlations with the ALUTs of both sides (r2=0.879 right, 0.884 left). Two formulas to estimate the ALUT from LD were suggested: right ALUT=0.94×right LD+2.6, left ALUT=0.96×left LD+2.4. Our results demonstrated that patient height does not provide a reliable estimate of ureteric length. LD by IVP is preferable to patient height when estimating the ureteric length.

How painful are shockwave lithotripsy and endoscopic procedures performed at outpatient urology clinics

AbstractsOur aim was to investigate the subjective pain felt by patients during shockwave lithotripsy (SWL) and endoscopic procedures such as cystoscopy, retrograde ureteral stenting, retrograde pyelography (RGP), and ureteroscopic lithotripsy performed in an outpatient clinic, and to identify how severe pain during such procedures is. We estimated subjective pain in 984 patients after SWL (186), cystoscopy (489), retrograde ureteral stenting (127), RGP (97), and ureteroscopic lithotripsy (85) performed by a single expert in an outpatient clinic using a prospective questionnaire with a ten point visual analog scale between January 2001 and December 2003. There was no premedication in any procedure except ureteroscopic lithotripsy for which an intramuscular injection of analgesics (pethidine HCl 50xa0mg) was used. The pain scale score in SWL was 6.62±2.27, the highest among the procedures (P<0.05). Pain scores for endoscopies were 4.48±2.07 in retrograde ureteral stenting, 3.81±2.06 in ureteroscopic lithotripsy, 3.72±1.75 in RGP, and 3.08±1.95 in cystoscopy. In this study, we observed that patients feel most pain in SWL without anesthesia, and that pain during ureteroscopic lithotripsy under local anesthesia is not high, compared with other endoscopic procedures.

Clinical value of acute pyelonephritis grade based on computed tomography in predicting severity and course of acute pyelonephritis.

Purpose This study aimed to evaluate the efficacy of computed tomography (CT)–based acute pyelonephritis (APN) grades for predicting clinical severity and disease course. Materials and Methods This study involved the analysis of the data of 204 consecutive patients with APN who underwent a CT examination at admission. Patients who had undergone prior treatment and those with ureteral calculi or an abscess by CT were excluded. Computed tomographic findings were divided into 4 grades according to renal parenchymal involvement, as follows: no renal parenchyma involvement (grade 1), less than 25% involvement (grade 2), 25% to 50% involvement (grade 3), and greater than 50% (grade 4). Patients with these grades were compared with respect to APN severity index (highest body temperature, initial C-reactive protein, and leukocytosis) and recovery index (hospital stay, fever duration, and leukocytosis duration). Results A total of 204 patients of mean age 39.3 years were included. Acute pyelonephritis severity indices and recovery indices increased with APN grade. Mean highest body temperature values were 38.3°C and 38.9°C in grades 1 and 4, respectively (P = 0.002). Mean hospital stay increased from 5.7 days for grade 1 to 7.6 days for grade 4 (P < 0.001). Initial C-reactive protein, initial leukocytosis, fever duration, and leukocytosis duration also increased with APN grade. Conclusions This study suggests that APN grades, as determined by CT examination, valuably predict the clinical course of APN.

Sensitivity of digital abdominal radiography for the detection of ureter stones by stone size and location.

Objective: To assess the sensitivity of digital abdominal radiography in the detection of ureteral stones by stone size and location. Materials and Methods: We retrospectively reviewed the digital abdominal radiography of 163 patients for the detection of ureteral stones. Each ureteral stone was confirmed by unenhanced computed tomography (CT) in the emergency department between January and December, 2009. Stone location was defined as proximal or distal by the level where the ureter crossed anterior to iliac vessels, and the stone size was defined as small if smaller than 5 mm and large if larger than 5 mm on unenhanced CT. The interpretation of digital abdominal radiography was classified as visible, invisible, or equivocal. Results: In 163 ureteral stones, 77 stones (47.2%) were in the proximal ureter and 86 stones (52.8%) were in the distal ureter. The mean (SD) size of the ureteral stones was 3.4 (1.7) mm (range, 1-9 mm). Overall sensitivity of digital radiography for ureteral stones was 29.4%. The sensitivity of digital radiography for the proximal ureteral stones was 37.7% and that for the distal ureteral stones was 22.1% (P < 0.05). The sensitivity of digital radiography for small ureteral stones was 23.6% and that for large ureteral stones was 50.0% (P < 0.05). As a group, the sensitivity of digital radiography for large proximal ureteral stones was the highest sensitivity-72.2%-in all groups (P < 0.05). Conclusion: Digital abdominal radiography is useful in detecting large proximal ureteral stones.

Comparison of Nonspherical Polyvinyl Alcohol Particles and Microspheres for Prostatic Arterial Embolization in Patients with Benign Prostatic Hyperplasia

Purpose To report early results following prostatic artery embolization (PAE) and compare outcomes between nonspherical polyvinyl alcohol (PVA) particles and microspheres to treat lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). Methods PAE was performed in nine patients (mean age: 78.1 years) with symptomatic BPH. Embolization was performed using nonspherical PVA particles (250–355u2009μm) in four patients and microspheres (300–500u2009μm) in five patients. Results PAE was technically successful in all nine patients (100%). During a mean follow-up of 10.1 months, improvements in mean International Prostate Symptom Score (IPSS), Quality of Life (QoL), prostatic volume (total volume and transition zone), and peak urinary flow (Qmax) were 9.8 points, 2.3 points, 28.1u2009mL, 17.8u2009mL, and 4.5u2009mL/s, respectively. Clinical success was obtained in seven of nine patients (78%). Patients in the microsphere group showed greater improvement in IPSS, QoL, prostatic volume, and Qmax compared to patients in the nonspherical PVA particle group. However, significant difference was noted only in the prostatic volume. Conclusion PAE is a feasible, effective, and safe treatment option for BPH with LUTS. Use of microspheres showed greater prostatic volume reduction compared to nonspherical PVA particles.

MP13-11 FACTORS THAT INFLUENCE ON LOWER URINARY TRACT SYMPTOM (LUTS) RELATED QUALITY OF LIFE (QOL)

but a significant difference was observed in terms of energy ratio 1⁄4 Energy delivered / prostate volume (Graphic 2) : 3.2kJ / ml [ 2.5 , 4.1kJ] ( Montreal ) vs 2.5kJ / ml [ 1.7-3.0] ( Paris ) vs 4.1kJ / ml [ 2.9-5.2] (Toulouse) (p < 0.0001). (Figure 2) No differences were observed in terms of postoperative complications (17.6% vs. 22.3% vs. 19.8%; p1⁄40.64) CONCLUSIONS: This is the first study to support that the outcomes obtained during PVP learning curve may be influenced by patients and surgeons’ characteristics. In this study, 100 Greenlight 180-W XPS PVP procedures were required before to reach a plateau in intraoperative parameters.

6544 POSTER Chemoradiotherapy for Extrahepatic Bile Duct Cancer With Gross Residual Disease After Surgery

BACKGROUNDnThe purpose of the present study was to analyze the outcome of chemoradiotherapy for extrahepatic bile duct (EHBD) cancer patients with gross residual disease after surgical resection.nnnPATIENTS AND METHODSnWe retrospectively analyzed 30 patients with EHBD adenocarcinoma who underwent chemoradiotherapy after palliative resection (R2 resection). Postoperative radiotherapy was delivered to the tumor bed including residual tumor and regional lymph nodes (range=40-55.8 Gy). Most patients underwent chemoradiotherapy concurrently with 5-fluorouracil (5-FU) or gemcitabine.nnnRESULTSnThe 2-year locoregional progression-free, distant metastasis-free and overall survival rates were 33.3%, 42.4% and 44.5%, respectively. High radiation dose≥50 Gy had a marginally significant impact on superior locoregional progression-free survival compared to 40 Gy (p=0.081). One patient developed grade 3 late gastrointestinal toxicity.nnnCONCLUSIONnAdjuvant chemoradiotherapy for EHBD cancer patients with gross residual disease after surgery was well-tolerated. There could be a chance for durable locoregional control and even long-term survival in selected patients.