Category: Clinical Stones: PCNL

MP26-12 - Evaluation Of Efficacy And Safety Profile Of Bilateral Synchronous Simultaneous Stone Surgery For Kidney Stones: Preliminary Results

Sun, Sep 23
10:00 AM - 12:00 PM

Introduction & Objective :

Introduction:


Advancements in technology and endourological armamentarium provides multiple surgical options for complicated stone patients. To avoid multiple operations and shorten total operation durations, bilateral synchronous simultaneous stone surgery (BSSSS) has been popularized in recent years.


Aim:


To evaluate the preliminary outcomes of BSSSS in patients undergoing supine percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS).


Methods :

Materials &
Method:


Patients presenting with an indication for PCNL for one kidney and FURS for the contralateral kidney stones according to European Association of Urology (EAU) guidelines were prospectively evaluated. All patients were evaluated with a noncontrast computed tomography (NCCT) scan and kidney-ureter-bladder (KUB) X-ray before the procedure.


Pre-operative stone burdens were evaluated for each kidney by calculating the cumulative stone volumes with appropriate formulation. Primary outcome is to evaluate the safety and efficiency profile of BSSSS by determining the stone-free status and complications. Immediate stone-free status was decided according to the endoscopic view at the end of the procedure and the post-operative imaging with KUB x-ray. Stone-free was defined as having fragments less than 3 mm. Post-operative complications were graded using the Clavien-Dindo grading system.


Results :
Results:


A total of 18 patients were operated between September 2017 and April 2018. Mean patient age and male/female ratio was found to be 50.7 +/- 14.9 years and 1.6 (Male=11, Female=7), respectively. No patient had any urinary diversion prior to the operations. Mean stone burden on PCNL and RIRS sides were found to be 4792.9 +/- 3039.6 mm3 and 1013.7 +/- 993.1 mm3, respectively. Mean operative duration was 154.5 +/- 46.7 min and mean floroscopy dose was 76.9 +/- 43.6 mGy. Following the operation a statistically significant hemoglobin drop was found in patients (p=0.004; 1.9 +/- 2.2 gr/dl). Diversions were done with either DJ stent (n=3) or nephrostomy tube (n=11) and in 4 patients with both on the PCNL side. Mean hospital duration was 6.1 ± 3.0 days. Residual stones (>3 mm) were found on both sides in one patient (5.6%) and on RIRS side in one patient (5.6%). All observed complications were graded as Clavien–Dindo Grade 2 (n=4; 22.2%).


Conclusions :


Conclusion:


Bilateral synchronous simultaneous stone surgery appears to be safe and feasible in selected patients. With growing incidence of complex stone disease, advancing endourological equipments can provide ending-up stone free in a single session without compromising the safety profile.

Tarık Emre Sener

Urologist
Marmara University, Department of Urology, Istanbul, Turkey
Istanbul, Istanbul, Turkey

Tarik Emre SENER, MD, FEBU
Marmara University, School of Medicine
Department of Urology
Istanbul / Turkey

Tarik Emre Sener, after graduating from French high school Lycée Saint-Joseph, Istanbul, studied Medicine between the years 2004-2010 in Marmara University, School of Medicine in Istanbul. He completed his residency training in Urology between the years 2011-2016 in Marmara University, School of Medicine, Department of Urology. During his residency, he completed 3 months of Endourology Fellowship in Tenon University Hospital, Paris alongside Professor Olivier Traxer. During his medical and residency training, he has presented several abstracts at international meetings and has authored many peer-reviewed articles covering a broad range of topics in Endourology, Pediatric Urology, Pharmacology and Physiology.
He is currently working in Marmara University, School of Medicine, where he is involved in all the medical and surgical management of patients as well as many scientific research projects.
He is the founder member and current general secretary of PETRA Urogroup, an international collaboration group dedicated to scientific and surgical activities on Endourology and Stone Diseases.

Address: Acıbadem Mahallesi Çeçen Sokak, Almondhill Konutları B8 blok Daire:6 Üsküdar İstanbul Türkiye 34660
Contact Information:
Cellular: +90 533 762 07 12
E-mail: dr.emresener@gmail.com
Twitter: @dremresener

PETRA Urogroup Website: http://www.petraurogroup.org/council/emre-sener/
Link to Research Gate: https://www.researchgate.net/profile/Tarik_Emre_Sener


Gunal Ozgur

MD
Marmara University, Department of Urology, Istanbul, Turkey
Istanbul, Istanbul, Turkey

Yiloren Tanidir

Director of Endourology and Stone disease
Marmara University, Department of Urology, Istanbul, Turkey
Istanbul, Istanbul, Turkey

Dr. Tanidir obtained his medical degree from Hacettepe University in Ankara, Turkey in 2001. He completed his urology residency at Marmara University School of Medicine in Istanbul, Turkey between 2002-2007.

Dr. Tanidir joined the faculty of Marmara University School of Medicine in 2014. Initially, he served as a Lecturer and Urology Specialist in the Urology Department. In 2015, he promoted to Assistant Professor of Urology and finally in April 2018, he became an Associate Professor of Urology. He is an expert in endoscopic surgery of urinary tract stone disease. He is both involved in the medical and surgical management of patients, education of urology residents and medical students. He is the primary investigator of many on-going scientific research projects.

His main primary research areas are endourological interventions, urinary tract stone disease, and metabolic stone disease. His secondary research areas are reconstructive urology, pediatric urology, functional urology, and urooncology. He serves as a member on the Patient Information Group of European Urology Association (EAU) since 2016. He is in the editorial board of Uropedia since 2016 and recently became a board member in The Society of Minimal Invasive Urology in Turkey.

Dr. Tanidir has published research, covering a broad range of topics in urology, in numerous formats, including book sections and articles in peer-reviewed journals. He also has been invited as a speaker to various congress and meetings.