Simultaneous vs staged treatment of urolithiasis in patients undergoing radical prostatectomy

作     者：Boyd R Viers Matthew K Tollefson David E Patterson Matthew T Gettman Amy E Krambeck 

作者机构：Mayo Clinic Department of Urology Rochester MN 55902 United States 

出 版 物：《世界临床病例杂志》 

年 卷 期：2014年第2卷第11期

页      面：698-704页

核心收录：

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

主　　题：Urolithiasis Kidney stone Prostate cancer Radical prostatectomy 

摘      要：AIM: To assess the outcomes of men treated for urolithiasis at the time of radical ***: From 1991 to 2010, 22 patients were retrospectively identified who were treated simultaneously(n = 10) at radical prostatectomy, or(n = 12) within 120 d prior to prostatectomy, for urolithiasis. Clinical characteristics were reviewed including: type of prostatectomy and stone surgery, location and amount of stone burden, perioperative change in hemoglobin and creatinine, stent frequency, total hospital d, stone-free rates, additional stone procedures and complications. Long-term functional outcomes including stress urinary incontinence and bladder neck contracture were reported. Differences between cohorts(simultaneous vs staged treatment) were assessed. RESULTS: Among men undergoing radical prostatectomy, primary stone procedures included 12 ureteroscopy, 6 shock wave lithotripsy, 2 open nephrolithotomyand 2 percutaneous nephrolithotomy. In staged shock wave lithotripsy there were 4 complications and 3 additional procedures vs 1(P = 0.5) and 0(P = 0.2) in the simultaneous cohort. Meanwhile in staged ureteroscopy there were 5 complications and 1 additional procedure vs 1(P = 0.2) and 1(P = 0.9) in the simultaneous cohort. Additional procedures for residual stones was greater among patients with asymptomatic upper tract calculi 3(60%) relative to patients with symptomatic stones 2(13%; P = 0.02). Likewise, patients with proximal or multiple calculi had a greater total hospital days 5.5 vs 4.1(P = 0.04), additional procedures 6 vs 0(P = 0.04) and lower stone-free rates 39% vs 89%(P = 0.02) relative to men with distal stones. Finally, there was no difference in the incidence of bladder neck contracture(P = 0.4) or stress urinary incontinence(P = 0.7) between ***: Ureteroscopic treatment of symptomatic distal urolithiasis at radical prostatectomy appears to be safe and efficacious with a low rate of adverse postoperative outcomes.