Simultaneous vs staged treatment of urolithiasis in patients undergoing radical prostatectomy

摘要

AIM:To assess the outcomes of men treated for urolithiasis at the time of radical prostatectomy.METHODS: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 nephrolithotomy and 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 cohorts.CONCLUSION:Ureteroscopic treatment of symptomatic distal urolithiasis at radical prostatectomy appears to be safe and efficacious with a low rate of adverse postoperative outcomes.