4th iranian endourology & urolaparoscopy society congress, 24‐26 feb 2011, tehran

4th Iranian Endourology & Urolaparoscopy Society Congress, 24‐26 Feb. 2011, Tehran, Olympic Hotel

The 4th congress of Iranian Endourology and Urolaparoscopy Society is a great opportunity for our colleagues and us to share the experiences and knowledge in endoscopic and laparoscopic treatments of the urinary tract disorders. Our aim in the organizing and scientific committees is to provide a favorable atmosphere that makes this gathering fruitful. We hope that our welcomed guests spend their precious time on a useful and nice assembly of their friends and colleagues when they are away from clinical activities for a while.

As one of the leading countries in this field, Iran enjoys more than 20 years experience with more than 32000 cases of PCNL and uncountable cases of other endourologic procedures and also more than 6000 cases of laparoscopic surgeries.

We would like to share our experiences with you and learn more from your expertise in the field and further expand minimally invasive surgeries especially in the region.

Diverse programs including lectures, panel discussions, debates, workshops, and live surgeries are planned as well as paper and video presentations. We are making our best efforts to present interactive discussions to fulfill the essential requirements and promote practical potentials of participants. Also, by holding pleasant social programs, we look forward to the opportunity to make our colleagues friendship tighter and thank them for accompanying us in a memorable meeting.

President of the Congress Mohammad Reza Razzaghi M.D

Secretary - General of the Congress Seyed Habibollah Mousavi-Bahar M.D

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4th Iranian Endourology & Urolaparoscopy Society Congress, 24‐26 Feb. 2011, Tehran, Olympic Hotel

Chairman of Scientific Committee: Seyed Habibollah Mousavi-bahar MD Scientific Committee Members (Alphabetic):

Abedinzadeh, Mehdi

Jaladat, Hooman

Najjarantoosi, Vahid

Aghamir, S. M. Kazem

Karami(Kerman), Hossein

Naseh, Hamidreza

Ahmadnia, Hasan

Karami, Hossein

Nasehi, Abdollah

Aminsharifi, Alireza

Khayamfar, Fareidoon

Nikoobakht, M. Reza

Amjadi, Mohsen

Khorrami, M. Hatef

Niroomand, S. Reza

Ardestanizadeh, Arash

Kianian, Hamidreza

Nouralizadeh, Akbar

Aslezare, Mohammad

Maghsoudi, Robab

Nourimahdavi, Kia

Basiri, Abbas

Masoudi, Parham

Shahrokhi, S. Saeed

Behjati, Saeed

Mehrabi, Sadrollah

Sharifiaghdas, Farzaneh

Darabi, M. Reza

Mohammadisijani, Mehrdad

Shayaninasab, Hamid

Eshratkhah, Ramin

Mombeini, Hayat

Simforoosh, Naser

Etemadian, Masoud

Moradi, Aliakbar

Soofimajidpour, Heshmatollah

Farahi, Faramarz

Mousanejad, Nadali

Vahidi, Serajeddin

Heidari, Fatemeh

Mousapour, Esmaeil

Younesi, Mehdi

Hosseini, M. Mehdi

Mousavi, Ebrahim

Zand, Saeed

Hosseini, S. Reza

Mousavi-bahar, S. Habibollah

Ziaee, S. A. Mohsen

Ijadi, Amir

Najafisemnani, Mohammad

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4th Iranian Endourology & Urolaparoscopy Society Congress, 24‐26 Feb. 2011, Tehran, Olympic Hotel

Chairman of organizing committee:

Akbar Nouralizadeh MD Organizing Committee Members (Alphabetic):

Farahani, Roghayeh Golshan, Shabnam Hosseini, Hamidreza Kaveh, Javid Khoddam, Mojgan Ramatizadeh, Morteza

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4th Iranian Endourology & Urolaparoscopy Society Congress, 24‐26 Feb. 2011, Tehran, Olympic Hotel

Invited Faculty Prof. Dr. J.J.M.C.H. de la Rosette Minimal Invasive Urology and Oncological Urology, AMC University Hospital Head of Global Studies of Endourological Studies EAU Guideline Committee Member Prof. Dr. Med. Dr. H.C. Jens Rassweiler Chairman EAU- Sedion of Urotechnology Klinikdirektor Urologic Abolfazl Hosseini, M. D., PhD, FEBU Head for bladder cancer team Department of urology Karolinska university hospital, solna 171 76 Stockholm, Sweden Massoud Ahmadzadeh MD Germany

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4th Iranian Endourology & Urolaparoscopy Society Congress, 24‐26 Feb. 2011, Tehran, Olympic Hotel

OP1-1: Treatment of renal colic with papaverine hydrochloride: A prospective double blind randomized study Seyed Alaeddin Asgari, Mani Mohiti Asli, Ali Hamidi Madani, Parvaneh Arab Maghsoudi, Mandana Mansour Ghanaie, Alireza Farzan, Ahmad Enshaei, Maryam Shakiba, Samaneh Esmaeili Urology Research Center, Guilan University of Medical Science Objective Phosphodiestrase (PDE) receptor inhibitors in ureteral smooth muscles may be useful in renal colicky pain. We assessed the efficacy of papaverine hydrochloride (nonselective PDE inhibitor) in combination with sodium diclofenac for the treatment of renal colicky pain and compared it with diclofenac sodium suppository alone.

Material and methods A prospective, double-blind clinical study was performed. A total of 550 acute renal colic were randomized to 2 groups of A and B. Patients in group A received diclofenac sodium suppository 100 mg plus saline normal 0.9% (placebo) and group B received diclofenac sodium suppository 100 mg plus papaverine hydrochloride 120 mg intravenously. Pain intensity was assessed with the visual analog scale at 0, 20, 40 minutes after treatment. Further analgesia given at patients consisted of 25 mg intramuscular pethidine. All adverse effects were recorded.

Results Baseline characteristics (sex, age, history of similar pains) were similar in the 2 groups. There were significant differences in pain score at 20 minutes and 40 minutes from baseline in both groups (P < 0.001).

The study revealed that papaverine hydrochloride plus diclofenac sodium to be effective in the treatment of renal colic in 90.9% of patients compared to the diclofenac sodium of 77.1% (P<0.001).

Conclusion Papaverine hydrochloride plus diclofenac Na suppository are more effective than diclofenac sodium for relief of acute renal colic pain. We suggest that intravenously papaverine hydrochloride may be a useful supplemental therapy for renal colic especially in combination with NSAIDs.

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4th Iranian Endourology & Urolaparoscopy Society Congress, 24‐26 Feb. 2011, Tehran, Olympic Hotel

OP1-2: Surface Anatomy of Colon to Determine Safe Landmarks in Accessing Kidneys in Supine Position According To CT-Scan Findings faramarz Mohammadalibeigi, mohammad moazeni Shahrekord University of medical sciences, Shahrekord, Iran Purpose The aim of the study was to determine the surface anatomy of colon for detection of safe landmarks in accessing kidneys in supine position.

Material and methods We performed 102 consecutive spiral CT scans in patients in the supine position in 2009-2010, which were studied prospectively. Then two radio-opaque markers fixed on their posterior axillary lines. We detected in every patient Age, Sex and BMI and then we measured distance of colon from posterior axillary line in CT scans of patients and correlation of colon position with aforementioned parameters determined Results According to this research, by considering posterior axillary line as a skin marker in right and left side of patient, mean distance of colon from this line in the lower pole of kidneys was 5.3±2.6cm and 5.2±2.6cm respectively. In the middle pole, mean distance to mentioned marker in right and left were 7±2.7cm and 5±2.7cm respectively. In the lower, middle and upper pole of left kidney, there was one case of retro renal colon. In the upper pole of left kidney, mean distance of colon from mentioned marker was 7±3 cm. In the right side and the upper pole of kidney, we did not find any juxtaposition between them.

Conclusion Posterior axillary line is a safe marker for accessing kidneys in supine position and the rate of retro renal colon in supine position (1%) is less than prone position (10%).

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4th Iranian Endourology & Urolaparoscopy Society Congress, 24‐26 Feb. 2011, Tehran, Olympic Hotel

OP1-3: Comparison between One-Shot and Telescopic Technique for Tract Dilatation in Percutaneous Nephrolithotomy Shahriar Amirhassani, Seyed Habibollah Mousavi-bahar, Mohamad Ali Amirzargar, Sasan Mehrabi Urology department, Hamedan University of Medical Sciences, Hamedan, Iran Introduction Dilatation of the nephrostomy tract is achieved using an Amplatz dilator or telescopic metal dilators. The aim of this study was to assess the feasibility and morbidity of single-step acute dilatation, named "one-shot" technique, including a single dilatation of the nephrostomy tract with a 28F or 30F Amplatz dilator in spite of telescopic dilatation technique.

Materials and methods 100 patients enrolled in the study from 2010 to 2011, and they were randomly divided into two groups according to the type of tract dilatation technique: group 1 (50 patients), telescopic dilators; group 2 (50 patients), one-shot technique was used. Past surgical history, surgical time, X-ray exposure time, success rate, blood loss, grade of hydronephrosis and other complications were evaluated.

Results One-shot technique was compared using telescopic dilators without an increase in morbidity and without significant reduction in X-ray exposure (p=0.028). There was no significant difference in the procedural success rate between groups 1 and 2 (p=0.003). There was no any significant difference in complications and other things. Access time was similar in both groups (p=0.03).

Conclusion One-shot dilatation is as safe and effective as the telescopic procedure. In this study, procedural success rate in One-shot dilatation was higher than telescopic procedure.

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4th Iranian Endourology & Urolaparoscopy Society Congress, 24‐26 Feb. 2011, Tehran, Olympic Hotel

OP1-4: Percutaneous Removal of Kidney Sludge Mimicking Complete Bilateral Renal Staghorne Stone Amjadi.M. Ensannejad.AH. Noorizadeh.D. Urology Department, Tabriz University of Medical Sciences, Tabriz, Iran Introduction Sludge in kidney is a very rare finding. This sludge, mimics renal stone and may influence treatment options especially when it completely fills the whole upper collecting system.

However, with percutaneous procedure we can completely clean the sludge by washing the system under direct vision.

Case Report A sixty-year-old male patient with history of bilateral open nephrolithotomy was referred to our clinic with bilateral complete staghorn stones. His creatinine was 3.2 and generally he was ill patient without fever. The patient underwent percutaneous nephrolithotomy for the purpose of extracting the stones to the possible extent. After puncturing the kidney and inserting amplatz sheath, we were faced with a considerable amount of retained sludge in the collecting system without any hard stone. We removed all of the sludge with grasping forceps and washing the collecting system via amplatz sheath with normal salin under fluoroscopic control and direct vision. After 7 days, when the control culture was negative, the nephrostomy tube was removed and the patient was discharged. After one month, the patient underwent the same procedure on the contralateral side and all of the sludge was washed out from the collecting system.

Conclusion Upper urinary tract sludge mimics semi opaque staghorne stones in some cases. When the sludge completely fills the whole collecting system, urologist may decide to perform open anatrophic nephrolithotomy for these patients. However, percutaneous nephrolithotomy is an effective and minimally invasive procedure to complete the removal of kidney sludge.

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4th Iranian Endourology & Urolaparoscopy Society Congress, 24‐26 Feb. 2011, Tehran, Olympic Hotel

OP1-5: Prevention of Major Complications Following Percutaneous Nephrolithotomy in 1000 Patient with Renal Calculi Amjadi M. Farshi A. Ensannajad A.H. Urology Department, Emam Reza Hospital, Tabriz University of Medical sciences, Tabriz, Iran Introduction A total complication rate of up to 83% following percutaneous nephrolithotomy has been reported. These complications were mostly clinically insignificant. The frequency of major complications is rare but when most of them happen are disasters. In this study we discuss our schemes to reduce these disasters.

Methods and materials Proper patient selection, preoperative imaging for planning the operation, hospitalization of patient a day before operation, mechanical bowl preparation, adequate antibiotic prophylaxis and therapy, ultrasonogrphic evaluation of flank area preoperatively, manipulation of the collecting system only under fluoroscopic or endoscopic control, use of a continuous flow system, use of normal saline as irrigant fluid, adequate blood reservation, judicious stone fragmentation and finally fluoroscopic monitoring of nephrostomy tube insertion are necessary to prevent percutaneous nephrolithotomy complications.

Results We retrospectively analyzed the data of 1000 patients who had under gone PCNLl for removal of renal calculi at our hospital between 2001and 2010. Mean age of patients was 46(6-78), mean stone size was 34 +_8.6 cm. Stone free rate was 76.95. Transfusion rate was 4.5%, post operative diarrhea which suspect colon perforation was seen in 2 patient but we cannot showed colon injury with radiological contrast study.2 patient had delayed hemorrhage due to arteriovenous fistula which controlled by selective angioiembolization. One patient had intraperitoneal extravasations. One of our patient expired due to pulmonary embolism. We had not any main vascular, liver or splenic injury. We never need change to open surgery in our patients.

Conclusion With some simple and planed schemes the endourologist can reduce severe complication of PCNL and when it occurs because of preoperative preparations he can control them easier than unplanned situations.

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4th Iranian Endourology & Urolaparoscopy Society Congress, 24‐26 Feb. 2011, Tehran, Olympic Hotel

OP1-6: Endourologic Treatment of Severely Encrusted Double J Stent in a forty-one-year old man Amjadi.M. Ensannejad.AH. Farshi A. Urology Department, Tabriz University of Medical Sciences, Tabriz, Iran Introduction Encrustation of double J stent in the urinary tract is a known complication of minimally invasive urologic surgery. The main reason for this complication is the missed double J stent, which means that removal of double J stent was forgotten either by the urologist or by the patient. In our case, a double J Stent encrusted very severely in the bladder and kidney portion which had been missed for three years was removed by percutaneous nephrolithotomy and cystolithotripsy.

Case Report A forty one-year-old male patient had undergone ureteroneocystostomy because of lower ureter stricture three years before. After discharging from hospital, the patient had never come back to follow up. After three years, the patient was referred to our clinic with lower urinary tract symptoms. Investigations revealed there was a missed double J stent with severely encrusted ends like a large stone in the bladder and kidney. The patient underwent cystolithotripsy and all of the stones in the distal portion of double J stent were removed in the first session. In the following session we performed percutaneous nephrolithotomy and removed the stone in the proximal portion of double J stent. Surprisingly, the body of stent was not encrusted and was easily removed from nephrostomy tract.

Conclusion Percutaneous and transurethral minimally invasive procedures play an important role in the management of encrusted missed double J stent especially when the body of double J stent is not encrusted.

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4th Iranian Endourology & Urolaparoscopy Society Congress, 24‐26 Feb. 2011, Tehran, Olympic Hotel

OP1-7: Results of percutaneous Nephrolithotomy (PCNL) of upper caliceal stone with subcostal access Mohammad Reza Darabi, Mohammad Mehdy Rahmany Mashhad University of Medical Sciences, Mashhad, Iran Purpose Intercostal or supracostal access tract is usual access for percutaneous Nephro-lithotomy (PCNL) for upper calices stones. But pleural complications of these tracts are high. In this study tried to treat upper calices stone with subcostal access.

Patients and Methods 17 patients with stones limited to upper calices, candidated for PCNL. Ultrasonography and intravenous urography were performed for all patients before surgery. In all patients PCNL performed in prone position and access is made at prolonged and deep inspiration from subcostal with fluoroscopic guidance. After access to upper calices guide wire inserted and dilatation of tract up to 28 or 30 Fr informed. After insertion of 28 or 30 Fr Amplatz sheat nephroscopy performed.

Results In 1 patient distorted and abnormal system and in another patient with history of previous renal surgery subcostal access filed and an intercostal access preformed. In 15 patients subcostal access performed successfully (88.2 %). In 5 patients stones of less than 10 mm extracted with grasps. In 10 patients after pneumatic lithotripsy, particles of tones removed. 11 patients rendered stone free (77.3%) 3 patients needed infandibular dilatation for complete stone extraction .No infection, transfusion, pneumothorax, hydrothorax , respiratory discomfort in operation and post operation period were seen. In one patient a perirenal collection of liquid with diameter of 5 cm was detected. In post operation sonography control that resolved and in control sonography one week later disappeared 3 weeks later.

Conclusion PCNL with subcostal access for upper calices stones is a feasible and safe with low complication and can be performed instead of supracostal access tracts that pass pleura and have high pleural and respiratory complications and discomforts.

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4th Iranian Endourology & Urolaparoscopy Society Congress, 24‐26 Feb. 2011, Tehran, Olympic Hotel

OP1-8: Evaluation of the Pleural Injuries after Intercostal Access in Percutaneous Nephrostolithotomy Masood Etemadian , Pejman Shadpour, Robab Maghsoudi, Behkam Rezaimehr, Mohammad reza Mokhtary, Javid Samady, Hossein Akhiary Hasheminejad Kidney Center (HKC), Tehran University of Medical Sciences, Tehran, Iran Purpose Percutaneous nephrstolithotomy is the preferred approach in the treatment of large and complex renal stone. Pulmonary complications may be encountered during formation of a percutaneous nephrostomy tract. Intraoperative fluoroscopy of the chest should be used in every case of intercoastal access to evaluate for fluid. In our experience, fluoroscopy is not very helpful to diagnose and manage these complications. Thus we decided to determine if intraoperative fluoroscopic evaluation is necessary.

Materials and Methods In 1408 percutaneous nephrostolithotomy procedures that we have done in our center 263 of them were done intercostaly. Intercostal access was taken in deep expiration. Postoperative chest radiography were done for all of the patients to evaluate pleural injury .We followed them up for two weeks and if any pathological findings were found, follow up was continued for 3 months.

Results Only in 3 patients pleural injury was detected during the operation depending on physical examination and chest tube was placed at that time. None of the other of 260 PCNL procedures showed any pathological findings that need intervention .The most pathological finding was blunting of the costovertebral angle that was observentionaly removed without any interventions.

Conclusion To our knowledge all of the studies recommend intraoperative fluoroscopy after intercostals access in PCNL and some of them believe on a postoperative chest X ray also is necessary for diagnosis of plural injuries. We think intraoperative fluoroscopic evaluation of the chest is not necessary if chest physical examination is normal, and also postoperative chest X-ray (posteroanterior) should be done only in symptomatic patients or in patients with pathological findings in physical examination.

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4th Iranian Endourology & Urolaparoscopy Society Congress, 24‐26 Feb. 2011, Tehran, Olympic Hotel

OP1-9: Comparison of outcomes of single-tract percutaneous nephrolithotomy (PCNL) with multi-tract PCNL in patients with Stag horn calculi Etemadian Masoud, Maghsoudi Robab, Shadpour Pejman ,Ghasemi Hadi Hasheminejhad Clinical Research Development Center (HCRD), Tehran University of Medical Science (TUMS), Tehran, Iran Background Staghorn renal stones must be extracted completely because of significant morbidity and even mortality if remained untreated. This study was performed to compare the outcomes of singletract percutaneous nephrolithotomy versus multi-tract PCNL in patients with Stag horn calculi.

Methods and Materials This is a comparative semi experimental (before – after) study that performed between February 2010 and March 2010. A total of 100 patients who underwent PCNL were included. Group one were 50 patients who underwent single tract PCNL, and group two were 50 patients who undergone PCNL with multiple tracts (three or more tracts) for stag horn renal calculi.

Results The mean age (±standard deviation) was 47.16 ± 15.89 years and 52.12 ± 13.01(P > 0.05) and the mean stone size (±standard deviation) was 29.62 ± 9.35 millimeters and 55 ± 8.86 millimeters in patients with single and multiple tracts, respectively (P < 0.0001). The mean number of tracts in multiple tracts group was 3.78 ± 1.01(range 3 – 7). Forty- five patients (90%) in single tract group and forty patients (80%) in multiple tracts group were stone free in imaging two weeks after surgery (P=0.161). There were no differences about the stone free rates and complications such as bleeding or sepsis in two groups of single and multiple tracts groups (P < 0.05).

Conclusion Percutaneous Nephrolithotomy (PCNL) using multiple tracts is effective in achieving stoneclearance rate in patients with stag horn calculi similar to single tract PCNL with similar complication.

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4th Iranian Endourology & Urolaparoscopy Society Congress, 24‐26 Feb. 2011, Tehran, Olympic Hotel

OP1-10: Percutaneous Nephrolithotomy in Children by Using Adult Size Instruments; 3 Years Experience Masoud etemadian, Robab maghsoudi, Pejman shadpour, Mohammad-reza mokhtari, Behkam rezaeimehr Hasheminejhad clinical research development center (hcrdc), Tehran University of Medical Sciences (tums) Background Although SWL is the first choice of treatment in children with stone disease, some conditions such as large stone burden, cystein stones, failed SWL mandate other modalities such as PCNL or open surgery. It has been shown that adult size instrument can be used safely in children but smaller size result in lesser hemorrhage and other complications. In this study we report our 3 years experience in tubeless PCNL using adult size instrument in children.

Material& Method We retrospectively reviewed medical records of 48 patients younger than 13 years old who underwent 54 tubeless PCNLs from January 2007 to November 2010.laboratory parameters, complicat-ions, size of stone ,hospital stay, site and number of tracts were recorded .All of operations were done by standard PCNL and the irrigation fluid was reversed osmosis 24-26 centigrade still water .

Results There were 28 male and 20 female with the range of 12 month to 13 years old (mean 7.7±4.5 years).33 PCNL were done on the right and 21 on the left. Mean stone size was 2.85±0.9cm, mean Hb drop was 1.2 ±o.55 g/dl, mean hospital stay was 3.6±1.7 days, stone free rate in monotherapy with PCNL was 76%and 85% in combined with SWL. The amplatz size of 30, 26 and 24F were used in 41,7 and 7 renal units respectively.8 cases had intercostals access (11th intercostals space) without any adverse effect. The most common complication was fever and this result in prolonged hospitalization. Only 1 patient transfused and none of them had organ injury. No hypothermia or hyponatremia was seen.

Conclusion Although it is ideal to use small size instrument for children PCNL, but we can use adult size instrument with acceptable complication even, when we perform it tubeless.

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4th Iranian Endourology & Urolaparoscopy Society Congress, 24‐26 Feb. 2011, Tehran, Olympic Hotel

OP1-11: Complete Supine Percutaneous Nephrolithotomy in patients with and without a history of open stone surgery: The time for change from prone to supine position has come!

Siavash Falahatkar, Mani Mohiti Asli, Seyedeh Atefeh Emadi, Ahmad Enshaei, Hedayat Pourhadi, Aliakbar Allahkhah Urology Research Center, Guilan University of Medical Science, Rasht, Iran Purpose To determine the effects of previous open stone surgery on the results of complete supine percutaneous nephrolithotomy (csPCNL) Material and Methods We reviewed 81 patients undergoing csPCNL at our center between March 2007 and March 2009. The principle aim in our study was whether prior open nephrolithotomy affects the outcome of PCNL. The results of the study were analyzed using SPSS 11 software.

Results Our patients were divided to two groups. Group 1 was consisted of patients with a history of open stone surgery and in group 2 the patients had not a history of open renal surgery. Mean operative time in group 1 was 98.75± 56.31 min, and in group 2 it was 99.71± 45.9 min(p=0.93).

Bleeding required transfusion as a complication during the operation time occurred in 4(14.2%) patients in group 1, and in 8(15.09%) patients in group 2(p=0.826). Fever was not detected in any patients in group 1, and in 4(7.5%) patients in group 2(p=0.136). Postoperative hematoma was seen in 1(3.5%) patients in group 1 and there was not any hematoma in group 2(p=0.166).

Conclusion This is the first experience of csPCNL in patients with and without a history of open renal surgery. We found that there was no differenece in results between the two groups undergone complete supine PCNL. So CsPCNL with a history of open stone surgery is safe and effective.

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4th Iranian Endourology & Urolaparoscopy Society Congress, 24‐26 Feb. 2011, Tehran, Olympic Hotel

OP1-12: Single Tract Access in Tubeless Complete Supine Percutaneous Nephrolithotomy for Complex Upper Urinary Tract Stones Siavash Falahatkar, Abdorasoul Sobhani, Keivan Gholamjani Moghaddam, Mani Mohiti Asli, Ahmad Asadollahzade, Alireza Farzan, Reza Shahrokhi Damavand, Arshak Shafiei Kamel, Samaneh Esmaeili Urology Research Center, Guilan University of Medical Science, Rasht, Iran Purpose Nowadays, percutaneous nephrolithotomy (PCNL) is preferable procedure for treatment of complex upper urinary tract stones, staghorn stones and some upper ureteral stones. In complex stones, PCNL may require multiple percutaneous tracts for complete removal of stones and this matter may increase operative time, potential risk of bleeding and complications. In this study, we have investigated our experience about single tract access in tubeless complete supine PCNL for management of complex upper tract stones.

Materials & Methods We studied data of 84 patients with complex upper urinary tract stones underwent single tract access tubeless complete supine PCNL using posterior subcostal approach and pneumatic lithotripsy from February 2008 to March 2010. Inclusion criteria for complex stones were staghorn stones and multiple location stones. Residual stone <4 millimeters in first day after operation by KUB or ultrasonography was described Stone Free.

Results Mean age was 47.9±10.8 (21-75) years. Mean BMI was 27.3±4.8 (19.4-46.7). Thirty five patients (41.7%) had previous stone surgery and 38 patients (45.2%) had previous ESWL. Sixteen patients (19%) had staghorn stones and 68 patients (81%) had multiple location stones.

Opaque/Lucent ratio was 66 (78.6%)/18 (21.4%). Mean stone burden was 37.9±12.4 millimeters.

Target calices for access to collecting system were upper calyx 2.4%, middle calyx 26.2% and lower calyx 71.4%. Mean operative time was 77.9±41.4 (15-210) minutes. Mean postoperative hospital stay was 2.16±0.81 (1-6) days. Stone free rate was 73.8%. Mean hemoglobin drop was 1.1±1.1 (0-7.5) g/dl. Complication rate was 9.5% (N=8). Transfusion, fever and extravasation rates were 3.6% (N=3), 4.8% (N=4) and 1.2% (N=1) respectively. Clot retention and ureteral obstruction due to delayed gross hematuria occurred in two patients (2.4%).

Conclusion Our acceptable results revealed that single tract access in tubeless complete supine PCNL can be a suitable approach for management of complex upper urinary tract stones.

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4th Iranian Endourology & Urolaparoscopy Society Congress, 24‐26 Feb. 2011, Tehran, Olympic Hotel

OP1-13: Comparison of Totally Ultrasound with Fluoroscopically Guided Complete Supine Percutaneous Nephrolithotomy: A Randomized Clinical Trial Siavash Falahatkar, Aliakbar Allahkhah, Majid Kazemzadeh, Ahmad Enshaei, Maryam Shakiba, Fahimeh Moghaddas Urology Research Center, Guilan University of Medical Science, Rasht, Iran Objective To compare complications and outcomes of complete supine percutaneous nephrolithotomy (csPCNL) with totally ultrasound guided csPCNL and fluoroscopically guided procedure.

Materials & Methods In this randomized clinical trial study from January 2009 to September 2010, 26 of 51 patients with renal stones underwent csPCNL with ultrasonographic guidance in all steps of the procedure (group A), and the other 25 patients underwent standard fluoroscopically guided csPCNL (group B). All of the patients underwent PCNL in the complete supine position.

Statistical analysis was performed with SPSS16 software.

Results Mean BMI was 28.14 in group A and 26.31 in group B (ρ 0.30). The mean stone burden was 26.48 and 30.44 in groups A and B, respectively (ρ 0.20). The stone free rate was 88.5% in group A and 75.5% in group B, that was no significant (ρ 0.16). Overall 2 patients (7.7%) in group A and 6 patients (24%) in group B had complications (ρ 0.11). Mean operative time in group A was 88.46 minutes, and in group B it was 79.58 minutes (ρ 0.39). Mean hospital stay was 69.70 and 61.79 hours in group A and B, respectively (ρ 0.22). There is no visceral injury in groups.

Conclusion This randomized study showed that totally ultrasonic had the outcomes like fluoroscopically csPCNL in selected cases. The ultrasound-guided PCNL had some benefits: doing x-ray-free PCNL, doing PCNL without contrast material, and avoid injury to the adjacent organs, visibility of all tissue between the skin and kidney, not necessary to wear a lead shield and safety and feasibility for reoperated patients.

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4th Iranian Endourology & Urolaparoscopy Society Congress, 24‐26 Feb. 2011, Tehran, Olympic Hotel

OP1-14: Safety and Efficacy of Percutaneous Nephrolithotomy in Toddlers Seyed habibollah Mousavi-bahar, Mohammad Mehdi Fazlian, Babak Borzouei Urology Department, Hamedan University of Medical Science, Hamedan, Iran Purpose This survey aimed to evaluate the efficacy and safety of percutaneous nephron-nlithotomy (PCNL) in toddlers (12 to 36 months) retrospectively during eight years period.

Materials & Methods Fifteen toddlers underwent PCNL procedures in Shahid Beheshti referral university hospital of Hamedan University of Medical Sciences. Of the patients, 3 had previous open renal surgery, 6 were ESWL failures and 7 reported any intervention for treatment. Operations were performed under general anesthesia the guidance of monoplane fluoroscopy. Pneumatic lithotripsy, forceps extraction and 22F nephroscope were used for the procedure.

Results Toddlers mean age was 2.6±0.86 years. According to weight and gender there was no significant deference in toddlers' age. 14 had hydronephrosis, one had bilateral and 8 had left renal calculi. 7 patients referred with less than 20mm stones and maximum stone size was 30 mm. Lithotripsy performed for 10 patients and in only one patient intraoperative hemorrhage occurred. Stone free status and complete clearance obtained in all cases and post-operative complication were not reported. The operative time was 34.33 ± 13.61 minutes. Also for all operations, single percutaneous tracts were placed.

Conclusion In our experience, PCNL was effective and safe in toddlers, with a clearance rate of 100% without any major complication.

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4th Iranian Endourology & Urolaparoscopy Society Congress, 24‐26 Feb. 2011, Tehran, Olympic Hotel

OP1-15: Tubeless PCNL in Supine Position under Epidural Anesthesia Hossein Karami. mohammadi Shahid Beheshti University of Medical sciences, Tehran, Iran Objectives Percutaneous nephrolithotomy (PCNL) has historically been performed with the patient in the prone position, which has inherent drawbacks. Supine PCNL has numerous benefits in terms of safety, efficacy, and versatility and is comparable with respect to vascular and bowel injury. This study was intended to prove that PCNL with the patient in the supine position is an alternative method of doing PCNL along with comprehensive technique.

Methods A total of 40 patients with underwent tubeless supine PCNL from 2009 to May 2010. Their mean age was 32 years and mean weight 62 kg. After insertion of a retrograde 5F ureteral catheter, the patient was placed in the supine position with a small towel roll under the ipsilateral flank, raising it by 20 degrees. Caliceal entry was achieved with an 18-gauge spinal needle, and the tract was dilated up to 27F with Alken dilators over a 0.032-in. guide wire using fluoroscope only, with the patient under epidural anesthesia.

Results Primary stone clearance was achieved in 84% patients. Of the40 patients, 35 had a single and 5 had a double tract; 50% of patients had a pelvis and, 25% lower and 12/5% upper ureteral and 12/5% an upper caliceal stones. The mean single stone size was 2.5 cm,. No vascular or splanchnic injury or bowel injury was observed. Tubeless PCNL was possible all patients; 2 patients required transfusion, and 1 patient had a perinephric collection Conclusions Tubeless PCNL with the patient in the supine position is an independent method of treating renal stones without complementing PCNL in the prone position. It adds ease and comfort to the patient, anesthesiologist, and surgeon.

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4th Iranian Endourology & Urolaparoscopy Society Congress, 24‐26 Feb. 2011, Tehran, Olympic Hotel

OP1-16: The effects of double-J ureteral stent on post operative complication in percutaneous nephrolithotomy for staghorn and complex renal stones Javadneia-AH, Mousapour-E, Taee-K, Kheradmand-AR, Hakimelahi-H Urology department, Gollestan hospital, Jundishapur (Ahvaz) university of medical sciences, Ahvaz, Iran Introduction To evaluate effect of double-J stent placement after percutaneous nephron-lithotomy on postoperative complication Methods and Materials 120 patients with staghorn renal stones aged 20-60 years were divided in two control and treatment groups. All underwent percutaneous nephrolithotomy. In control group double-J was not inserted, but in treatment group DJ was inserted antegradely at the end of the surgery and the nephrostomy tube was placed too. Fever and duration of fever, duration of pain and analgesic dosages, length of hospital staying, leaving time of nephrostomy tube and urine leakage, changes in hemoglobin and creatinine and rest duration at home were detected for each patient and two groups were compared.

Results Changes in hemoglobin, creatinine, fever, pain, analgesic and hospital staying were not significantly different between two groups. But urinary leakage, leaving time of nephrostomy tube and duration of rest at home were different between them significantly. Treatment group had no urinary leakage but 14 patients in control group had it for an average of 3.1 days. The mean leaving duration of nephrostomy tube in treatment group was 1.1 and in control was 4.5 days.

Mean days of rest at home in treatment group was 2.8 days and in control group was 7.2 days.

Conclusion Use of double-J after PNL of staghorn stones not only does not increase symptoms such as bleeding, infection, postoperative pain and renal insufficiency but also accelerates removing of nephrostomy tube, minimizes urinary leakage and returns the patient to normal daily activities.

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4th Iranian Endourology & Urolaparoscopy Society Congress, 24‐26 Feb. 2011, Tehran, Olympic Hotel

OP1-17: Outcomes of Percutaneous Nephrolithotomy (PCNL) In Patients with Chronic Renal Insufficiency Robab Maghsoudi, Masoud Etemadian, Pejhman Shadpour, Hadi Ghasemi Hasheminejhad Clinical Research Development Center (HCRDC), Tehran University of Medical Science (TUMS) Background Since finding an optimal method in patients with chronic renal failure who suffer from kidney stones is crucial, performing studies about the safety of available methods should be considered.

Accordingly this study was conducted to determine the outcomes of percutaneous nephrolithotomy (PCNL) in renal function in patients with chronic renal insufficiency.

Methods and Materials It was a descriptive study that performed between October 2009 and March 2010. A total of 60 patients with creatinine level more than 1.5 mg/dL who underwent PCNL were included.

Patients with pregnancy and uncorrected urinary tract infection (UTI) were excluded. Serum creatinine level of these patients who undergone PCNL was assessed as a renal function index with comparison of its change in pre and postoperative period.

Results The mean stone size was 31.13 ± 9.38 (range 15 to 55) millimeters. The mean preoperative and two weeks postoperative serum creatinine levels were 2.43± .075 (range 1.6 to 5) mg/dl and2.08± .078 (range 1.o to 4.8) mg/dl respectively. There was a statistically significant difference between the creatinine levels in all postoperative days compared with the day before PCNL was performed (P < 0.05). Fifty of 60 patients (83.3%) were stone free. Ten patients (16.6%) developed postoperative fever. In two week follow up we had not any mortality.

Conclusion Our study showed that percutaneous nephrolithotomy (PCNL) is a safe and effective therapeutic option in patients with chronic renal failure that suffered from renal stones and resulted in renal function improvement in these patients.

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4th Iranian Endourology & Urolaparoscopy Society Congress, 24‐26 Feb. 2011, Tehran, Olympic Hotel

OP1-18: Percutaneous Nephrolithotomy (PCNL) with One-Shot Metalic Cone-Tip Dilator Mohammad Mehdi Hosseini, Alireza Aminsharifi, Ali Ariafar, Ejaz Ahmad, Farhad Manaheji, Saeed Shakeri, Alireza Tadayyon Endourology Ward, Urology Department, Shiraz University of Medical Sciences, Shiraz, IRAN Introduction Today PCNL become standard treatment for large renal stone. Nephrostomy tract creation and dilatation usually perform with Alken telescopic metallic dilators, 9 to 30 F or one-step Amplatz dilator. We evaluated a new device, cone-tip 27 Fr. metallic dilator in one-shot manner.

Patients and Methods Three-hundred Ninety-six patients,254 men,141 women, mean age 41.6year(19-73),mean stone size 28mm(22-61),scheduled for PCNL. After puncture of the target calyx under fluoroscopy and sending guide-wire into system, ball-tip 9F dilator of telescopic Alken dilator system pushed on it. Then cone-tip 27 F metallic dilator (new device) combined with Amplatz sheath 30F pushed on 9F dilator in one-shot manner. Then nephroscopy and lithotripsy by pneumatic lithoclast performed.

Results Of 396 patients, 279 were first episode and 117 recurrent diseases.Access to system achieved in all cases. Stone-free rate in postop. KUB radiography was 94.4% (374/396). .Perforation of pelvicaliceal system (PCS) occurred in 6, hemorrhage and transfusion in 5 patients and fever in 9 cases. Ancillary procedures (URS, SWL, Re-PCNL) needed in 14 cases .No any other complications.

Conclusion One-shot nephrostomy tract dilatation by metallic cone-tip dilator seems as safe and effective as telescopic dilators, with shorter radiation exposure and no more complication.

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4th Iranian Endourology & Urolaparoscopy Society Congress, 24‐26 Feb. 2011, Tehran, Olympic Hotel

OP1-19: Prevalence of Bacteriuria in Patients scheduled for Percutaneous Nephrolithotomy (PCNL) M. Mehdi Hosseini , L. Ghahramani, E. Ahmad, F. Manaheji, M. Mahjoob, A. Aminsharifi, A. Ariafar, A. Yousefi, M. Z. Abbasi, L. Dehghanian, M. Amini Endourology Unit of Urology Department, Shiraz, Jahrom and Bushehr Universities of Medical Sciences, Shiraz, IRAN Introduction Patients who have nephrolithiasis and schedule for operation may have symptomatic or asymptomatic bacteriuria, which should be treated before intervention. we evaluated our patients for prevalence of bacteriuria before PCNL. Patients and Methods One-Thousand Two-handred Fifty-seven patients,826 men,431 women, mean age 38.6 years(2176),evaluated including complete blood count, renal function, excretory urography, urine analysis and culture preoperatively. In this study we recorded the prevalence of bacteriuria.

Results Of 1257 patients, 764 were first episode of stone formation and 493 had recurrent diseases.

Overall 267 patients had bacteriuria (21.24%),which is more common in recurrent group(29.4% vs. 15.96%).Symptomatic bacteruria also was more common in recurrent cases(18.67% vs.

11.47%).

Conclusion Bacteriuria is a common finding in patients with nephrolithiasis, that seems is more common in recurrent diseases, so, urine culture and appropriate treatment highly recommended before any intervention for prevention of serious complications such as infection and sepsis.

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4th Iranian Endourology & Urolaparoscopy Society Congress, 24‐26 Feb. 2011, Tehran, Olympic Hotel

OP1-20: Radiation-Free Percutaneous Nephrolithotomy (PCNL) In Pregnancy Mohammad Mehdi Hosseini, Alireza Aminsharifi, Abdoreza Haghpanah, Zahra Zare, Sedighe Amooee Urology, Radiology and Obstetrics/ Gynecology Departments, Shiraz University of Medical Sciences, Shiraz, Iran Introduction Urolithiasis during pregnancy is a clinical dilemma due to potential risks for mother and fetus.

Management of these patients needs a multidisciplinary approach including urologist, obstetrician, anesthesiologist, radiologist and peri-natalogist.

Purpose We repot our experience of PCNL in pregnancy under ultrasound guide completely.

Materials and Methods Our cases were 9 and 14 weeks pregnant women who referred by her obstetrician because of fever, urinary symptoms, and several episodes of severe right flank pain and gross hematuria.

Both were in second pregnancy and had history of renal stone. One of them had history of one session PCNL of left kidney 2 years ago. Ultrasonography (US) revealed normal alive fetus, right side severe hydronephrosis and multiple stones measuring 7 to 21mm, largest one in ureteropelvic junction causes obstruction. Patients refused any temporary procedure such as jj stent or percutaneous nephrostomy and even abbreviated excretory urography, completed and signed consent for PCNL with US guide. So, second US performed by an expert radiologist and underwent PCNL with US guide.

Results Stone-free state in sonography 2 weeks after operation. No any complication in perioperative period. They are symptom-free, with good condition of fetus at 13rd weeks of pregnancy, and 3 months old boy, respectively, now.

Conclusions PCNL with guide of US seems safe and effective modality for large symptomatic stone during pregnancy without any radiation to mother or fetus.

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4th Iranian Endourology & Urolaparoscopy Society Congress, 24‐26 Feb. 2011, Tehran, Olympic Hotel

OP1-21: Tubeless Mini-Perc Percutaneous Nephrolithotomy (MPCNL) in Preschool Children M. Mehdi Hosseini, A. Ariafar, A. R. Aminsharifi, F. Manaheji, E. Ahmad, F. Emamghorayshi, M. Mahjoob, M. Basiratnia, A. Derakhshan Nephrology-Urology Research center Shiraz University of Medical Sciences, Shiraz, IRAN Introduction Today nephrolithiasis is common in children, and needs good approach in diagnosis, treatment and prevention, because of its recurrent nature. ESWL is the best modality for renal stone in children, but in some circumstances other interventions may indicated. In such cases PCNL seems the less invasive and safest method. We evaluated the Mini-perc nephrolithotomy with semirigid ureteroscope.

Patients and Methods Eighteen children, 11 boys, 7 girls, mean age 3.2 years (9mo-6y) with renal stone>20mm, who had failure or their parents refuse SWL scheduled for PCNL. Procedure was done under general anesthesia, with ureteral catheter 3-4 F, diluted contrast injection and fluoroscopic guided nephrostomy by Chiba needle 18G. Tract dilation performed with Alken telescopic dilators up to 21F, which the last (21F) hold instead of Amplatz sheath in collecting system. Nephroscopy and lithotripsy done with semirigid ureteroscope and pneumatic lithoclast and removed. Saline solution used as irrigation for prevention of hyponatremia. No nephrostomy (tubeless) and ureteral catheter removed 12-24 hours after operation.

Results Mean operation time was 65min(45-80) and radiation 0.7 min(0.3-1.7).One patient had residual fragment 5mm in upper pole calyx that passed spontaneously 2 weeks after operation. No any intra or postoperative complications.

Conclusion We suggest Miniperc as a good alternative method to standard PCNL for preschool children.

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4th Iranian Endourology & Urolaparoscopy Society Congress, 24‐26 Feb. 2011, Tehran, Olympic Hotel

OP1-22: Totally tubeless percutaneous nephrolithotomy in upper pole renal stone from sub costal access Seyed Mohamad Kazem Aghamir, Seyed Saeed Modaresi, Ali tajik, Mehdi Aloosh Urology department, Tehran University of medical sciences Introduction To assess the outcome and safety of the totally tubeless precutaneous nephrolithotomy in upper pole renal stone from subcostal access Patients and methods During a prospective randomized clinical trial from April 2003 to November 2008, 70 patients with only upper pole renal stones were included in our study. The patients were divided into two age, sex, body mass index, stone burden matched groups. Totally tubeless procedures were performed on 35 patients and another 35 patients underwent standard percutaneous nephrolithotomy. The incidence of complications, hospital stay, transfusion rate and stone free rate as well as analgesic use were compared in the two groups.

Results In the totally tubeless PCNL group (group A), the mean stone burden was 2.81 cm2 (Standard deviation (SD) = 0/59). Hospitalization averaged 1.49 (SD=0/7) days. The average analgesics use was 8.2 (SD=3.59) mg of morphine. The patients returned to normal activity in 11 (SD=4.2) days and there was post operative transfusion in two patients (5.7%). There was no significant complication. The stone free rate was 86% for the standard PCNL group.in group B , the mean stone burden was 2.87 (SD = 0/62) cm2. Hospitalization averaged 2.89 (SD = 0/99) days. The average analgesics use was 14.3 (SD=5.99) mg of morphine. Returning to normal activity took 17.6 (SD=4) days. Three patients (8.57%) required postoperative transfusions. There was no significant complication. The stone free rate was 83%. The differences between operation time, transfusion rate, complications, retreatment and the overall stone free rate were not statistically significant in the two groups but days of hospital stay (P<0.001), analgesics use (P<0.001) and time of return to normal activity (P<0.001) were statistically significant.

Conclusion Totally tubeless percutaneous nephrolithotomy for upper pole renal stone from subcostal access is a safe, effective and cost-beneficial procedure.

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4th Iranian Endourology & Urolaparoscopy Society Congress, 24‐26 Feb. 2011, Tehran, Olympic Hotel

OP1-23: Combined percutaneous and transurethral lithotripsy for Forgotten Ureteral Stents with giant encrustation Seyed Mohammadreza Rabani Beheshti Hospital; Yasouj University of Medical Sciences; Yasouj; Iran Purpose To present our experience with the approaches for treating forgotten ureteral stents associated with giant stone formation.

Materials and methods During the last 10 years, 74 patients with forgotten ureteral stents were managed by different open (nephrolithotomy and/or cystolithotomy), or endoscopic procedures in our center. Among these, 11 patients (5 women and 6 men) had severe encrustation (stones larger than 35 mm within the bladder or kidney) and 7 patients of these group (including 4 females and 3 males), presented at our department between July 2007 and December 2010. The mean patient age was 44.6 years (range 32-56 years) and the average indwelling time of the stent was 4.4 years (range 1-8 years). Combined endourological procedures PCNL, Cystolithotripsy (CLT), retrograde ureteroscopy with intracorporeal lithotripsy were performed in one session.

Results In 5 out of 7 patients, the initial indication for stent placement was for urinary stone disease after open nephrolithtomy and pyeloplasty in other centers and in 2 patients after TUL. All patients underwent the procedure(s) under spinal anesthesia and all received antibiotics in perioperative period. No intra operative complications occurred in any patient. All the stents were removed intact and from the percutaneous tract. The only available source of energy in our center was pneumatic lithotripsy.

Discussion and conclusion Forgotten ureteral stents are observed in urologic practice because of poor compliance of the patient or failure of the physician to adequately counsel the patient. Retained ureteral stents with encrustation is a challenging problem for urologists. Very often, multiple endourological approaches or even open surgery are needed because of encrustations and the associated stone burden that may involve bladder, ureter and kidney. This may require single or multiple endourological sessions or rarely open surgical removal of the encrusted stents.

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4th Iranian Endourology & Urolaparoscopy Society Congress, 24‐26 Feb. 2011, Tehran, Olympic Hotel

OP1-24: The comparison between two groups of patients under operation and lithotripsy due to UT stones from the aspect of epidemiologic parameters during years 2003 -2006 admitted at urology department of Imam Reza hospital Rahim Taghavi, Kamyar Tavakoli, Reza Mahdavi, Mohammad Reza Darabi, Farnaz Kalani Moghaddam Urology Department, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran Background Urolithiasis is one of the most frequent diseases of urinary system which forms high percentage of patients visited by urologist .Therefore, studying the epidemiological characteristics of patients can be helpful in making the best general decision.

Material & Methods First, we divided 5133 cases who had come to Urology department of our hospital during 2003 2006, in 2 groups and then in 6 groups. We investigated and compared 2 groups of lithotripsy and surgery from the aspect of epidemiological characteristics. So we did for 6 groups: 1) pyelolithotomy and nephrolithotomy 2) ureterolithotomy 3) ureteroscopy and TUL 4) PNL 5) ESWL 6)cystolitholapaxy.

Results From 5133 cases, mean age was 43.41 and men to female ratio was 2.1. 90.1% had done lithotripsy and 9.2% surgery. The Percentage of patients who had pyelolithotomy and nephrolithotomy was 3.5%, ureterolithotomy 0.8%, ureteroscopy and TUL 39.5%, PNL 4.9%, ESWL 49.5%, cystolitholapaxy 1.9%. Mean stay in hospital for lithotripsy was 1.31+/- 0.38, for surgery was 4.84+/- 0.32, for ESWL was 0.81+/- 0.5 and in pyelolithotomy and nephrolithotomy was 5.09+/- 0.34 days. During the years 2003-5 the percentage of ESWL was 59.9, 51.4 & 38.4%of all admissions in these years, respectively. PNL’s percentage was 3.8, 5.51, and 5.53% respectively. Choosing PNL in urban people was the highest (84.5%) and in rural people pyelolithotomy and nephrolithotomy were the most frequent technique used.

Conclusion In contrast to other advanced countries high percentage of our patients undergo open surgery especially rural people. So we should provide facilities of education and financials and lower the costs of urinary tract stone treatments.

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4th Iranian Endourology & Urolaparoscopy Society Congress, 24‐26 Feb. 2011, Tehran, Olympic Hotel

OP1-25: COMPARISON OF Fentanyl and combination of Midazolam and Pethedine for pain control during extracorporeal shockwave lithotripsy (ESWL) Sadrollah Mehrabi Shaheed Beheshti hospital, Urology Department, Yasouj university of medical science Yasouj, Iran Introduction A cooperative patient is essential in maintaining stone targeting for optimal fragmentation during extracorporeal shock wave lithotripsy. We compare the efficacy and adverse effects of Fentanyl and combination of Midazolam and Pethedine for pain control during extracorporeal shockwave lithotripsy (ESWL) Material and Methods From September2008 to December 2009, 140 Patients older than 18 years old with renal or upper ureteral stones that were candidate for ESWL randomly allocated in two groups. Patients with active infection, azotemia, uncontrolled coagoulopathy and uncontrolled hypertension excluded from study.

Then In first group 50 milligrams of Pethedine and 1 milligram of Midazolam injected intravenously 5 minutes before starting ESWL. In second group 50 micrograms of Fentanyl injected same as first group. Before operation and every 20 minutes blood pressure checked and severity of pain and patients satisfaction checked according to visual analogue scale and seven point verbal test.

Results Demographic characteristics of patients such as age, sex and BMI in two groups were similar. The total number of shock waves delivered, the maximum voltage used, and ESWL duration were statistically greater in group two (p=0.03). The VAS scores at 20, 40 and 60 minutes and the supplemental analgesia requirement were statistically more in combined group (group 1) (P < 0.05).

Discussion The use of a low dose intravenous Fentanyl during SWL provides adequate analgesia with minimal morbidity, avoids the need for potential analgesics and their attendant side effects, and improves the success rate of SWL.

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4th Iranian Endourology & Urolaparoscopy Society Congress, 24‐26 Feb. 2011, Tehran, Olympic Hotel

OP1-26: Comparison of Efficacy of ARIAN 101 Lithotriptor in Treatment of Renal and Upper Ureteral Stones Sadrollah Mehrabi Shaheed Beheshti hospital, Yasouj university of medical science Yasouj, Iran Introduction Kidney stones occur in approximately 3-5% of the population during their life time. The development of extracorporeal shockwave Lithotripsy (SWL) has revolutionized therapy of urolithiasis.

Objectives To review our experience with an Iranian model lithotriptor , Arian 101 , in adult patients undergoing extracorporeal shock wave lithotripsy for kidney and upper ureteral calculi Methods We performed 180 shock wave lithotripsy procedures by Arian 101 from October 2008 to December 2009 in adult patients older than 15 years old with stone sizes less than 20 millimeter .

All procedures were performed under intravenous sedation. Stone-free status according to stone size was defined as the absence of any fragments, and success as the absence of stone fragments >4 mm, on follow-up sonography and KUB after a single session treatment.

Results The stone-free rate 1 month after a single shock wave lithotripsy session in kidney and upper ureter stones larger than 10 millimeter was 45% and 33% respectively (p=.03). The stone success rate 1 month after treatment in renal and ureteral stones were 52 % and 46% respectively (p>.05). The mean sock number in all patients was 3805±452 shock and there was no significant difference between renal and ureteral calculi. The overall complication rate was 15% including severe pain, need to admission and transient hypertension. The median time in the procedure room was 45 minutes.

Conclusion The Arian 101 provides modest, single-treatment stone-free and success rates, with a reasonable safety profile, requiring intravenous sedation but need more shock number than other lithotriptors.

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4th Iranian Endourology & Urolaparoscopy Society Congress, 24‐26 Feb. 2011, Tehran, Olympic Hotel

OP1-27: Air Pyelogram in Comparison to Dye Contrast Pyelogram in Percutaneous Nephrolithotripsy (PCNL) Sadrollah Mehrabi Shaheed Beheshti hospital, Yasouj university of medical science Yasouj, Iran Objectives Access to collecting system in PCNL is usually achieved using fluoroscopy by injecting air or dye in pyelocaliceal system. We compare efficacy and adverse effects of air pyelogram with dye pyelogram in PCNL Methods From March, 2007 to November 2010 two hundred and fifty Patients older than 18 years old with renal or upper ureteral stones that were candidate for PCNL randomly allocated in two groups. In first group 15-30 milliliters of room air injected via ureteral catheter for visualizing pyelocaliceal system under guide of fluoroscopy. In second group 15- 30 milliliters of contrast media injected by the same method. Then PCNL performed in all patients with standard technique. Intraoperative and postoperative variables such as access time, number of puncture.

Radiation time, pulmonary complications and Stone-free rate were compared between two groups by statistical tests.

Results Mean stone size were similar in two groups. Mean access time in group one and two were 5±2 minutes and 7±2 minutes respectively (p=03). Mean puncture for entrance to target calyx were 3±1 and 4±2 respectively (p>.05) .radiation time in two groups were similar and there was no Intraoperative pulmonary complication. Two days after operation one patient in group 1 developed pulmonary emboli that were not related to air injection .The stone-free rate two week after operation were similar in two groups.

Conclusion Visualizing pyelocaliceal system by room air pyelogram in PCNL is feasible, safe and efficient for taking access without any coast and will be a good alternative for dye pyelogram.

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4th Iranian Endourology & Urolaparoscopy Society Congress, 24‐26 Feb. 2011, Tehran, Olympic Hotel

OP1-28: Totally Tubeless Versus Tubeless and Classic Percutaneous Nephrolithotomy Shahrokh Sakhaei, Akbar Haidaripur, Babak Kazemzadeh, Bahram Samadzade, Abdolrasul Bardide, Mahmudreza Moradi, Hasan Omidvar Department of urology, Imam Reza Hospital, Kermanshah Medical Science University, Kermanshah, Iran Purpose Nowadays the choice of treatment for nonstaghorn renal stones that are not suitable for ESWL or don't answer to ESWL, is PCNL, and using of PCNL is rising day by day in all over the world.

This is a survey on results and complications of classic PCNL (with nephrostomy tube and ureter stenting), tubeless PCNL (with Dj stenting) and totally tubeless PCNL (with or without a ureter stenting) Methods In a retrospective study, 105 patiants referring to our urology clinic in Imam Reza hospital,Kermanshah, Iran, from 2007 to 2009,with mean stone burden 33mm and the average of 41 years old, with or without history of ipsilateral open renal surgery, undergone PCNL with STORZ-SLX-MX generator ,were analyzed. Patients with supracostal access or need more than one access and those with residual stone had been excluded. There was 28 classic PCNL, 37 tubeless and 50 totally tubeless PCNL. Results In all three groups the stone free rate is similar(85%), but need for transfusion , analgesic and hospital staying time was more in classic PCNL than tubeless and totally tubeless PCNL. and patients satisfaction was higher in tubeless and totally tubeless than classic PCNL. Conclusion PCNL without tube (nephrostomy and Dj) is a safe procedure and can be done in a shorter time and has better acceptance by patients and less need for analgesic and hospital staying.

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4th Iranian Endourology & Urolaparoscopy Society Congress, 24‐26 Feb. 2011, Tehran, Olympic Hotel

OP1-29: Ultrasonographic Guided Versus Fluoroscopic Guided Percutaneous Nephrolithotomy: A Randomized Clinical Trial Hamid Shayani nasab, Seyed Habibollah Mousavi-bahar, Gharekhanloo Farideh Urology Department, Hamedan University of Medical Sciences, Hamedan, Iran Purpose Ultrasonography has many advantages for guidance of percutaneous nephrolitho-tomy (PNL).

For compare of safety and efficacy of these methods we conducted this trial and here is the report of preliminary results Patient and methods From September 2008 to October 2010 , 40 adult patient with no abnormality of upper urinary tract in intravenous urography, were randomly categorized. in two groups 20 Patients ultrasonographic guided ( group one ) and 20 patients fluoroscopic guided ( group two ).and PNL was done in prone position . In group one location of target. Calyx was determined in transverse and sagital planes then puncture of target calyx was done with chiba needle from ultrasonographic probe needle holder and tract dilatation and stone lithotripsy and stone extraction were done with ultrasonography guide. At the end of procedure, stone free state was checked.

Results mean patient age was 32.1 y (18 – 71 years old ) and 34.5y ( 24 – 65 years old )in group one and group two respectively and mean stone size was 28 mm ( 15 mm to 45 mm ) and 30 mm ( 20 to 30 mm ) respectively , mean operative time was 95min ( 65 – 140 min) and 85min ( 60 – 125 min ) respectively. Mean hemoglobin drop after 24 hours was 1.5 mg/dl (0.5 to 2.4mg/dl) and 1.7 mg/ dl (0.7 to 2.5mg/dl). The stone free rate on the day after surgery was 80 % and 85% respectively. Blood transfusion was done in one patient of group two. None of patients in two groups have major visceral of chest injury.

Conclusion PNL with ultrasonographic guide is a safe and effective method but detection of residual stones after lithotripsy demands high experience in ultrasonographic skills.

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4th Iranian Endourology & Urolaparoscopy Society Congress, 24‐26 Feb. 2011, Tehran, Olympic Hotel

OP1-30: Effect of Climate Conditions on Mineralogy of Urinary Stones, in the Khuzestan Province, Iran E. Zarasvandi, E. Mousapoor, S. Modabberi and M. Heidari Department of Geology, Shahid Chamran University (SCU), Ahvaz, Iran Department of Urology, Jundishapur University (AJUMS), Ahvaz, Iran Department of Geology, Tehran University (UT), Tehran, Iran Urinary calculi disease, widely known as kidney stones is one of the common and most painful medical problems encountered all over the world such as Middle East. Also Urinary stone diseases in the Khuzestan province, in the southwest of Iran is growing and it required extensive studies on the urinary stones formation in this area. In this research, mineralogical distribution of urinary stones and role of climate factor in this stones diversity in Khuzestan province has been studied. Mineralogical studied using X-ray diffraction and scanning electron microscope techniques show that collected samples from different areas of the Khuzestan province can be divided in to four mineralogical groups: Uric acid, Calcium oxalate (whewellite and wheddellite), Uric acid-Oxalate and Struvite. These results show that a significant difference between the distribution of urinary stones in the province and studies done in some regions of the world. Presence of Niahite mineral which has been reported rarely in other studies, real's this difference. Also the results which attained from climate conditions effect investigation on the mineralogy of urinary stones, confirms that from Mediterranean sub-humid climates (northeastern area of the province) to warm and dry climates (south and southwest area of the province), oxalate stones and urate stones concentration decreases and increases respectively. For instance in some warm and dry climates which have the highest annual average temperature, uric acid stones are the only mineralogy phases.

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4th Iranian Endourology & Urolaparoscopy Society Congress, 24‐26 Feb. 2011, Tehran, Olympic Hotel

OP1-31: The possibility of access to the kidneys from the posterior auxillary line in supine position Ali Tabibi, Amir H Kashi, Seyyed Ali Mohammad Mirjalili, Paria Kashani, Babak Salevatipour, Nastaran Mahmudnejad, Mohammad Hossein Soltani, Reza Farjad Urology and Nephrology Research Center (UNRC), Shaheed Labbafinejad Medical Center, Shaheed Beheshti University of Medical Sciences, Tehran, I.R. Iran Background To evaluate the possibility of access to the left and right kidneys from the posterior axiliary line in supine position Methods Ureteral catheter was attached with adhesive tapes to the posterior axillary line in 102 consecutive patients who were candidates for abdomino-pelvic computed tomography scan.

Access was considered impossible when a solid organ or colon existed within the access tract, in its 1 cm vicinity or medial to the access tract. In cases of impossible access, the point on the posterior surface of body which permitted safe access was determined and the percent of movement toward body midline (relative to the posterior axillary line) was calculated (M.PER).

The associations of demographic variables with access possibility were examined.

Results Access was possible 13-14% of upper poles and about 75% of middle poles. Access to lower pole was possible in 90% of right lower poles and 79% of left lower poles. (p=0.03) Access to left and right upper poles was more possible in older individuals. Access to right middle and left lower poles were more possible in individuals with higher body mass index. In cases with impossible access from the posterior axillary line, the M.PER for a safe access was 46-47% for upper poles and 35-38% for middle and lower poles.

Conclusion Access to kidney upper poles from the posterior axillary lines was limited in most individuals because of spleen and liver. Presence of colon made access impossible in the lower right and left poles in about 10% and 20% of individuals. In upper poles, more deviation toward midline was necessary to establish a safe access compared with middle and lower poles.

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4th Iranian Endourology & Urolaparoscopy Society Congress, 24‐26 Feb. 2011, Tehran, Olympic Hotel

OP1-32: The Effect of Dormia Basket Dilatation in Quality of Stone Clearing After URSLithotripsy Ali Asghar Ketabchi Physiology research center, Kerman University of Medical Sciences, Kerman, Iran Background The expelling of ureteral calculi gravels after ureteroscopic lithotripsy often has significant complications and ordinary for facilitation of gravel expelling there is some suggestions from pharmacies and manipulations, but since the role of orificial and distal ureter dilatation in URSlithotripsy is not assessed clearly.

Material and Methods We performed basket dilatation in 47 patients with distal ureter stone before URS-lithotripsy and compared the results of stone expelling quality after URS ( stone expelling rate ,stone clearing and complications) with 52 distal ureter stone patients for URS-lithotripsy without basket dilatation, for statistical comparing of all data’s between two groups we used SPSS-15 software .

Intervention Our method was inserting of a Dormia basket in ureter just distal to ureter stone and after opening basket and withdrawening it gently and repeating it (one to three times before URSlithotripsy).

Results The main outcome results in study and control groups were stone expelling rate <24 h. and 24 72 h, after 24 h. stone clearing 85% and 43%(P<0.05) , complications( obstruction , sepsis ,intractable pains ,hematuria and repetition or alternative procedure) 10% and 35% (P<0.05) respectively.

Discussion and Conclusion From results of this study the non-invasive Dormia basket dilatation in URS-lithotripsy procedures will be useful and in addition of facilitation of gravel expelling it significantly decrease procedure complications.

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4th Iranian Endourology & Urolaparoscopy Society Congress, 24‐26 Feb. 2011, Tehran, Olympic Hotel

OP1-33: Comparing extracorporeal shock wave lithotripsy and transureteral lithotripsy for treatment of ureteral calculi: a prospective study Mahdavi Reza, Mogharabian Nasser Imam Reza and Bent Al Hoda hospitals, Mashhad university of medical sciences, Iran Objectives To compare the safety and efficacy of shock wave lithotripsy (SWL) and ureteroscopy (URS).

Controversy still exists regarding whether SWL or URS is the best management of upper ureteral calculi.

Methods A total of 200 patients were included in the study. They were randomized into 2 equal groups.

Group A underwent in situ SWL as a primary therapy. Group B underwent URS, using semirigid URS with intracorporeal pneumatic lithotripsy. Efficiency, cost analysis, complications and predictors of failure were estimated for both techniques and the results compared using SPSS program and significant differences were found by Chi-square test. The success defined as being stone free or residual fragments less than 2 mm without need for further intervention.

Results Total success rates for TUL and ESWL after 3 months were 88% and 74% and total complication rates were 33% and 90%, respectively. Success rates for upper and lower ureteral stones with TUL were 59.1% and 96.2% and with SWL were 88.7% and 78.9%, respectively.

The most common complications in both groups were hematuria, pain and fever, respectively.

Hematuria and pain were significantly higher in SWL than TUL, but not for fever.

Conclusion Total success rate is higher in TUL than SWL group. Decrease in success respect to increase in stone size is more significant in TUL. Success rate for TUL is higher for lower stones, but for SWL higher for upper stones. Complications (hematuria and pain) are higher in SWL. The overall cost of TUL is higher. The time lasting to be stone free is longer for SWL.SWL is more comfortable and acceptable for patients.

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OP1-34: Tamsulosin May Facilitates Ureteroscopy Seyed Mohammadreza Rabani, Seyed Hamid Niknam; Beheshti Hospital, Yasouj University of Medical Sciences, Yasouj, Iran Purpose The aim of this prospective study was to evaluate the effect of tamsulosin on facilitating the URS procedure on adult patients that were on the period of watchful waiting for ureteral stones.

Materials and Methods 50 patients with ureteral stones were allocated randomly in 2 groups when they were in watchful waiting period or in appointment for intervention. The demographic pattern of the 2 groups (each group 25 patients) was almost similar. We used semi rigid wolf (8/9.8F) ureteroscope for all patients. In group one tamsulosin 0.4mg orally was prescribed for 5 days before performing the procedure and other measures were the same in both 2 groups.

Results URS was easily done in 24 patients of group one, in the remaining one patient a double j stent was inserted. In the group 2 URS was successfully done in 20 patients at the first attempt and failed in 5 patients.

Conclusion Active dilation may have its own complication. Passive dilation was a better alternative for facilitating URS. In the other hand alpha adrenergic blockers such as tamsulosin has been suggested as agents that may increase the spontaneous passage of the stone by 30%, although recent studies have, however, questioned this claim, there may be a controversy among the urologic literatures about the effect of alpha blockers on stone passage. The aim of this prospective study was to evaluate the effect of tamsulosin on facilitating the ureteroscopy procedure on patients that were on the period of watchful waiting for ureteral stones. The results of our study showed successful URS in 24 patients(96%) in Tamsulosin group and and in 20 patients(80%) in group without receiving tamsulosin, and this means the effect of this drug on smooth muscles of the ureter and facilitating the procedure, but further studies are needed to cofirm this claim.

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OP1-35: Endoscopic Management of Ureteral Stones in Children Seyed Mohammadreza Rabani; Beheshti Hospital; Yasouj University of Medical Sciences; Yasouj; Iran Purpose Ureteral stones in children can be managed by extracorporeal shock wave lithotripsy (SWL), stenting and open surgery, while the smaller dimensions of the pediatric urinary tract may limits the endourologic procedures. Our aim of this study was to assess the feasibility of endoscopic intervention in the management of pediatric ureteral calculi.

Materials and Methods Between Apr.2006 and Nov. 2010, 64 transureterolithotripsy (TUL) were performed in 60 children (42male and 18 female), aged 22 months to 15 years (mean 9.8 years),Using a semirigid 8F - 9.8F ureteroscope and pneumatic lithotriptor; stone size 6-14mm with a mean of 7.2 mm. in 4 patients TUL was done bilaterally. The procedure was under general anesthesia, using a wolf 8f – 9.8f ureteroscope, if ureteroscopy and stone access was easily possible, stone fragmentation was the aim, otherwise insertion of a 16cm; 3Fr jj stent was the aim to achieve passive dilatation of the ureter for the 2nd intervention.

Results In 43units (67%) including 28 males and 15 females, stone access and fragmentation was feasible in the 1st session. In 2 patients the stones were passed spontaneously in the period of stenting and in one patient it was impossible to access the stone and through a blind push back technique the stone was displaced toward the kidney and the patient was referred for shock wave lithotripsy (SWL), and in the remaining 18 units, a 2nd intervention between 3 to 36 days after the 1st session was done. a smaller size ureteroscope was not available in our center.

Conclusion Like adults, conservative management of ureteral stones may be the best way of treatment, but even in the best situation, there is a limitation for an approach and in the presence of risk factors such as fever, pain, and deterioration of renal function, proper intervention may be mandatory. In this study we showed that ureteroscopy is a safe and effective option for early results for treating ureteral stones in pediatric age group, providing no force at all during performing the procedure.

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4th Iranian Endourology & Urolaparoscopy Society Congress, 24‐26 Feb. 2011, Tehran, Olympic Hotel

OP1-36: Laser in urology MR. Razaghi Laser Application in Medical Sciences Research Center Introduction Since the invention of lasers in the 1960s, the use of lasers has expanded exponentially in medicine, especially in urology. LASER is an acronym for light amplification by stimulated emission of radiation. A laser emits a focused, monochromatic beam of light, of almost uniform wave-length that is composed of photons which oscillate in phase. Therefore, most laser beams have minimal divergence, have directionality, and produce strong beams of energy that target with precision. Various lasers have been used to treat clinical problems including benign prostate hyperplasia (BPH), urolithiasis, stricture disease, ureteropelvic junction (UPJ) obstruction, skin lesions and urogenital malignancy. As research in these areas continues to progress, new laser technologies show promise in Urology. During the last decade some laser technologies have become established as standard modalities widely available to urologists, while others are still under investigation for applications in the field. Recent advances in lasers and fiber-optics make them ideally suited to travel through routes in the human body where no hand or scalpel has gone before. With its widespread use of small-diameter endoscopic instruments, urology has been drastically and positively influenced by this technology, perhaps more so than any other medical subspecialty.

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4th Iranian Endourology & Urolaparoscopy Society Congress, 24‐26 Feb. 2011, Tehran, Olympic Hotel

VP-1: Infantile Cushing syndrome: laparoscopic management M. Aslzare, A. Shamsa Urology Department, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran Introduction Adrenal tumors are an important cause of pediatric cushing syndrome. Infrequent indications for adrenalectomy and concerns about small body habitus have contributed to a delay in the application of the laparoscopy. Although laparoscopic adrenalectomy has been shown to have advantages over the open procedure in adults, the experience in the children is still limited, but continues to grow.

Materials and Methods A 22 month male infant with cushing syndrome and a left large adrenal mass in MRI had underwent transperitoneal laparoscopic adrenalectomy. The patient was placed in the lateral decubitus position with the first trocar in the umbilicus for a 0◦ laparoscope and the secondary trocars in subxiphoid and anterior axillary line. The 4th trocar was placed in inguinal crease. After colon medialization, renal vein was exposed then ligation of the adrenal vein was performed. The remaining gland was freed by circumferential dissection. The specimen was placed in a bag and removed from incision in the inguinal crease by extension of lower port.

Results The operative time was 65 minutes, and estimated blood loss was less than 30 ml. Pathology showed 6 cm adenoma with 55 gm in weight. There were no perioperative complications and no need for transfusions or open conversion. Hospital stay was two days.

Conclusion Laparoscopic adrenalectomy seems to be a safe and effective procedure in pediatric adrenal mass. The transperitoneal approach provides excellent exposure and adequate working space in children, with the additional benefits of minimally invasive surgery such as less postoperative pain, shorter hospital stay, and early return to normal activity.

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4th Iranian Endourology & Urolaparoscopy Society Congress, 24‐26 Feb. 2011, Tehran, Olympic Hotel

VP- 2: Laparoscopic Management of Symptomatic Paracalyceal Diverticulum A. Basiri, A. Mir, M. Khazaeli*, M. Nikkar Shaheed Labbafinejad Hospital, Tehran, Iran Introduction A calyceal diverticulum is a smoothly outlined, intrarenal sac that communicates with the pelvicalyceal system by means of a narrow neck. (1)Large peripheral diverticula, those located medially near the renal hilum and those in an anterior location, may be treated using laparoscopic techniques. (1)In this video transabdominal approach was used to manage a symptomatic paracalyceal diverticulum.

Material and Methods A 26 years old woman with a past history of two open flank surgery for proposed right renal cyst ablation with prolonged postoperative urinary leakage was evaluated for right flank pain. In the CT scan a large cystic mass was found in the middle of right kidney which did not enhanced. In contrast with the earlier retrograde pyelograghy which did not show any communication between the cyst and collecting system, the pyelography wich was performed preoperatively showed the communication and confirmed the diagnosis of paracalyceal diverticulum. The patient was positioned to left decubitus and transperitoneal laparoscopy started. Gerota facia was opened and the location of the diverticulum was confirmed by intracorporeal ultrasonography and percutaneous needle aspiration. The diverticular wall was opened and the neck position was detected by retrograde injection of methylen blue. The orifice was cauterized and suture closed. The inner surface of the diverticulum was cauterized and perirenal fat was secured to the cavity. Double pigtail was inserted retrogradly at the end of operation.

Results and Conclusion The patient was discharged home with good condition and no leakage. Laparoscopic ablation of the paracalyceal diverticulum is a feasible operation and can reproduce the open surgical techniques. Follow-up of the patient is pending.

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4th Iranian Endourology & Urolaparoscopy Society Congress, 24‐26 Feb. 2011, Tehran, Olympic Hotel

VP- 3: Laparoscopic Surgery in Adrenal Myelolipoma (Case Report) Siavash Falahatkar, Ahmad Enshaei, Amin Afsharimoghaddam, Samaneh Esmaeili, Ahmad Enshaei Urology Research Center, Guilan University of Medical Science, Rasht, Iran Adrenal myelolipoma is a rare benign adrenal tumor composed of adipose tissue and hematopoietic elements. Myelolipomas are often asymptomatic and hormonally nonfunctional.

The preferred diagnostic imaging modality is CT, which shows focal fatty density within the mass. The adrenal gland myelolipoma doesn’t require any special treatment when it is not symptomatic and the tumor’s diameter measured by ultrasound or CT scan is less than 5 cm. In myelolipoma larger than 5 cm, surgical intervention is recommended, because large tumor could not be differentiated from necrosis in adrenal carcinoma or renal angiomyolipoma and retroperitoneal liposarcoma.

A 52 year old female patient was referred to our medical center for chronic dull abdominal pain. Ultrasonography revealed a solid echogenic mass in left and a similar smaller one in right suprarenal regions.

Computed tomography demonstrated left (6.5×7cm) and right (1×2.5cm) well outlined adrenal masses with a fat density. Adrenal masses were hormonally nonfunctional.

The patient was underwent laparoscopic left adrenalectomy and the right mass was left intact because of its small size. There wasn't any complication. Histo-pathological examination revealed Myelolipoma.

Laparoscopic Adrenalectomy could be a safe and effective treatment in selected adrenal masses like Myelolipoma.

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4th Iranian Endourology & Urolaparoscopy Society Congress, 24‐26 Feb. 2011, Tehran, Olympic Hotel

VP- 4: Is Bipolar Transurethral Resection in Saline (TURis) a Good Alternative For Laser?

Siavash Falahatkar, Gholamreza Mokhtari, Alireza Farzan, Amin Afsharimoghaddam, Ahmad Enshaei, Majid Kazemzadeh, Aliakbar Allahkhah Urology Research Center, Guilan University of Medical Science, Rasht, Iran Purpose To assess the efficacy and safety of bipolar transurethral resection or vaporization in saline Materials and Methods During two months period, November and December 2009, 24 men with BPH related lower urinary tract symptoms or bladder tumors were enrolled into this study.

Inclusion criteria for transurethral resection of prostate (TURP) were benign prostatic hyperplasia-induced obstruction; prostatic volume between 30 and 80 ml, IPSS> 13 and inclusion criteria for transurethral resection of bladder tumor (TURBT) was endoscopic evidence of intravesical lesions. 9 TURBT, 1 TUVBT, 8 TURP and 6 TUVP were performed during the study. All procedures were carried out with a bipolar device in physiologic saline.

Results None of the patients experienced a TUR syndrome. Mean age was 73 years. Mean tumor size was 6.6 cm. Mean prostate volume was 46.6 cc. Early postoperative retention occurred in 3 patients and one patient needed one unit blood transfusion. Only 2 patients of 10 submitted to TUR-BT experienced stimulation of obturator reflex. The mean preoperative International Prostate Symptom Score (IPSS) was 21. The mean operative time was 51.8 minutes. The mean BMI was 23.8kg/m2. The mean post-op catheterization time was about 5.2 days. The mean hospital stay was 3 days. The mean pre & post operative serum Na+ was 145.4mEq/L and 137.4mEq/L, respectively. The mean pre & post operative serum K+ was 4.2mEq/L and 4mEq/L, respectively. The mean volume of saline irrigation was 19 litters. We found no cases with post operative TUR syndrome or urethral stricture.

Conclusion TURis seems to be effective and safe especially in regard to the avoidance of TUR syndrome.

Despite other studies, obturator reflex was stimulated in two patients in our study. Because TURis system is cheaper than laser, it can be good alternative for treatment of BPH and bladder tumor.

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4th Iranian Endourology & Urolaparoscopy Society Congress, 24‐26 Feb. 2011, Tehran, Olympic Hotel

VP- 5: Complete Supine Percutaneous Nephrolithotomy with Lung Inflation Avoids the Need for a Supracostal Puncture Siavash Falahatkar, Ahmad Enshaei, Amin Afsharimoghaddam, Seyedeh Atefeh Emadi, Aliakbar Allahkhah Urology Research Center, Guilan University of Medical Science, Rasht, Iran Purpose The aim of this study was to evaluate the safety and efficacy of subcostal upper pole (UP) access in complete supine percutaneous nephrolithotomy (csPCNL).

Materials & Methods From July 2008 to February 2009, we performed 20 PCNLs in complete supine position. We present our experience of percutaneous approach in complete supine position to the renal superior calix, while insisting on renal displacement technique to facilitate the puncture of the superior calices and to decrease intrathoracic morbidity. The renal displacement technique was carried out with lung inflation.

Results The percutaneous subcostal access of the renal UP was performed in 20 cases and no failure occurred. The overall stone-free rate was 85%, and the stone-free rate for upper calix was 95%.

The mean operative time in our study was 102.25_41.56 minutes. The mean hospital stay was 92.4_30.43 hours. The transfusion rate as a complication was 1 (5%), and no intrathoracic complication was noted.

Conclusion The renal UP percutaneous access can be performed using several techniques. The superior calyx was accessible in csPCNL with the renal displacement technique (lung inflation) subcostally while intrathoracic complications may be avoided. UP puncture in csPCNL with this technique was associated with minimal morbidity and avoids the need for a supracostal puncture, and the stone-free rate appeared to be more.

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4th Iranian Endourology & Urolaparoscopy Society Congress, 24‐26 Feb. 2011, Tehran, Olympic Hotel

VP- 6: Supine Percutaneous Nephrolithotomy Siavash Falahatkar, Aliakbar Allahkhah Urology Research Center, Guilan University of Medical Science, Rasht, Iran Nowadays percutaneous nephrolithotomy (PCNL) is considered as the treatment of choice for large kidney calculi. This technique performed with the patient in various positions including standard prone, semisupine, flank, supine with a pad under the leg or buttock, and complete supine positions. Despite numerous advantages in supine PCNL and routine use of it in some surgical centers throughout the world, its universality in the field of urology is still minimal entirely. We search all available databases, including PubMed/ Medline (US National Library of Medicine), and Embase Biomedical Database® (Elsevier; Amsterdam, Netherlands), to find any articles related to PCNLs performed in the supine position. There were a total of 1914 patients studied. The mean age of patients, mean stone burden, stone-free rate, hospital stay, transfusion, fever, pleural effusion, postoperative hematoma, renal pelvis perforation, and visceral organ trauma in two groups perused and the results were not significant. Only the results of mean operative time were significant. csPCNL suggests these potential advantages for the patients: 1) Less patient handling, 2) The need to drape only once, 3) Easier access to the urethra, 4) Decline the hazards during access and better achievement to the airway, 5) Easier gaining access to upper calyces, 6) Facilitation of drainage of stone fragment with the Amplatz sheath, 7) Less anesthesia time toward prone position, 8) Lack of hypothermia’s risk because of little irrigation fluid falling on the patient, 9) Less anterior kidney displacement due to lying the kidney in its normal anatomical position, 10) Less risk of colon injury, 11) More tolerable for the patients with pulmonary or cardiovascular disease, 12) Better position for morbid obese patients, 13) Reduce overall operative time. csPCNL suggests these potential advantages for the endourologist: 1) The fluoroscopy tube is far from the puncture site, thus, the space is open for the surgeon to work.

2) The density overlap with vertebrae that occurs in the semisupine position can avoid.

3) Decrease overall operative time in comparison with the prone position.

4) The surgeon can perform the procedure from a more comfortable seated position.

In conclusion csPCNL is safe, effective, and suitable for most patients and it is feasible for all types of stones, such as calyceal, pelvic, multiple, staghorn, or upper pole calyceal stones.

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4th Iranian Endourology & Urolaparoscopy Society Congress, 24‐26 Feb. 2011, Tehran, Olympic Hotel

VP- 7: Advantages of a New Ergonomic Operating Platform for Laparoscopic Procedures A Jalal, AS Gözen, G Pini, M Schulze and J Rassweiler SLK Kliniken Heilbronn, Urology Department, Heidelberg University, Germany Introduction Laparoscopy has expanded in Urology and considered as therapy of choice for many operations with well known advantages. Ergonomics gained recently wide popularity in operative surgery and it had been recognized, that laparoscopic surgery can also harm laparoscopic surgeons because of non-ergonomical circumstances. Recently an operating chair is on the market which is allowing the surgeon to operate in an sitting ergonomic position. Herein we present in our video our experience with this operating platform during Laparoscopic Radical Prostatectomy and laparoscopic kidney procedures.

Material and Method Since August 2010 we have started using ETHOS Ergonomic Surgical Platform™ in our institution and performed 53 laparoscopic radical prostatectomies and 34 laparoscopic kidney procedures. Radical prostatectomies were performed using retroperitoneal approach with standard Heilbronn technique.

ETHOS Surgical Platform is brought from patient’s head end enabling the operating surgeon sitting over the head of the patient, and the monitor is kept between the legs of the patient with an ergonomic horizontal or chin down position. An extraperitoneal approach was used for kidney procedures and the platform was placed on the operating side when patients were in Flank position.

Results All the operations were accomplished without any complication or technical problem due to surgical chair. The ergonomic sitting surgeon posture has reduced leg and lower back pain and arm rests provided stability and reduced the tremor. The position has reduced also mainly the pain and fatigue syndrome.

Conclusion The ETHOS Surgical Platform improved the ergonomics of laparoscopic surgery and allowed the surgeon to work in a less stressed position during prostate and kidney procedures.

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4th Iranian Endourology & Urolaparoscopy Society Congress, 24‐26 Feb. 2011, Tehran, Olympic Hotel

VP- 8: Laparoscopic Dismembered Pyeloplasty Hamidreza Nasseh, Seyed Alaeddin Asgari Urology Research Center, Razi Hospital, Guilan University of medical sciences, Rasht, Iran Introduction In this video, we present a laparoscopic dismembered pyeloplasty.

Methods A 25 years old woman with ureteropelvic junction obstruction was referred to our center and became a candidate for laparoscopic pyeloplasty.

Results Laparoscopic dismembered pyeloplasty was done successfully. DJS was inserted laparoscopically. No intraoperative or postoperative complication occurred.

Conclusion Advanced laparoscopic procedures are now feasible at many centers in Iran without major complication.

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4th Iranian Endourology & Urolaparoscopy Society Congress, 24‐26 Feb. 2011, Tehran, Olympic Hotel

VP- 9: A 27 Years Old Man with 4 cm Right Adrenal Pheochromocytoma Hamidreza Nasseh, Farshid Pourreza Urology Research Center, Razi Hospital, Guilan University of medical sciences, Rasht, Iran Introduction In this video, we present a laparoscopic adrenalectomy (pheochromocytoma).

Methods A 27 years old man with 4 cm right adrenal mass was referred to our center.24 hours urine cathecolamins were high.

Results Laparoscopic adrenalectomy after one week alpha blockade was done. No intraoperative or postoperative complication occurred.

Conclusion Advanced laparoscopic procedures are now feasible at many centers in Iran without major complication.

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4th Iranian Endourology & Urolaparoscopy Society Congress, 24‐26 Feb. 2011, Tehran, Olympic Hotel

VP- 10: Laparoscopic Lower Ureterolithotomy after Pyonephrosis Drainage Hamidreza Nasseh Urology Research Cente, Razi Hospital, Guilan University of medical sciences, Rasht, Iran Introduction In this video, we present a laparoscopic ureterolithotomy in lower ureter.

Methods A 54 years old man with right lower ureter stone was referred to our center. Pyonephrosis history of diabetes and history of ipsilateral inguinal hernia repairment were present.

Results Laparoscopic lower ureterolithotomy after 2 weeks percutaneous pyonephrosis drainage was done. DJS was inserted laparoscopically. No intraoperative or postoperative complication occurred.

Conclusion Advanced laparoscopic procedures are now feasible at many centers in Iran without major complication.

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4th Iranian Endourology & Urolaparoscopy Society Congress, 24‐26 Feb. 2011, Tehran, Olympic Hotel

VP- 11: An Adult Man with Bilateral Cryptorchidism and Splenogonadal Fusion Pejman Shadpour, Behkam Rezaimehr Hasheminejad Clinical Research Development Center, Hasheminejad Kidney Center (HKC), Tehran University of Medical Sciences, Tehran, Iran Background splenogonadal fusion is a rare malformation in which there is an abnormal fusion between the spleen and the gonad or derivatives of the mesonephros . It can occur in both sexes but has been reported far more frequently in males.

Materials and Methods We present a 30 years old man with bilateral cryptorchidism (nonpalpable testis) whom laparoscopic exploration was done for him. In the left side an atrophic testis without vas deferens was found that was connected to two small oval shaped structures. Right side orchiopexy was done and the left gonad was excised in conjunction with two other oval shaped structures as a rosary.

Results Histological evaluation revealed testicular tissue and two other oval shaped structures were splenic tissue.

Discussion and conclusion Splenogonadal fusion is a rare condition but sometimes it can be find in male cryptorchidism.

Awareness from this condition can be helpful in decision making during exploration for nonpalpable testis. We think such as every other nonpalpable testis laparoscopic exploration can be more useful in the diagnosis and treatment of these cases.

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4th Iranian Endourology & Urolaparoscopy Society Congress, 24‐26 Feb. 2011, Tehran, Olympic Hotel

VP- 12: Simultaneous Bilateral Transmesenteric Laparoscopic Pyeloplasty in Patients with Ureteropelvic Junction Obstruction in Horseshoe Kidney H.S. Sofimajidpour Urology Department, Kurdistan University of Medical Sciences, Sanandaj, Iran Introduction Traditionally transperitoneal laparoscopic access to ureteropelvic junction obstruction has been performed in retrocolic fashion. We performed transmesenteric laparoscopic pyeloplasty to correct simultaneous bilateral ureteropelvic junction obstruction in patients with horseshoe kidney.

Materials and Methods Between July 2003 and May 2009, 3 men and 1 woman with horseshoe kidneys were referred to our institution for management of symptomatic ureteropelvic junction obstruction. Mean patient age was 27 years (range 23 to 35). One patient had a history of abdominal surgery.

Results Mean operative time was 185 minutes (range 126 to 260) and mean estimated blood loss was 120 cc (range 40 to 180). No patient in this series required transfusion. Average length of hospital stay was 3 days (range 2 to 5). There were no major complications. Mean clinical and radiographic followup was 24 (range 4 to 60) and 18 (range 6 to 48) months, respectively. Renal function improves after surgery in all patients.

Conclusion Laparoscopic transmesenteric pyeloplasty is an effective treatment alternative for ureteropelvic junction obstruction in patients with horseshoe kidney.

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4th Iranian Endourology & Urolaparoscopy Society Congress, 24‐26 Feb. 2011, Tehran, Olympic Hotel

VP-13: Adapting Laparoscopic Extrapelviceal Vessel Suspension to the Treatment of Renal Outlet Obstruction in the Horseshoe Kidney Pejman Shadpour, Robab Maghsoudi, Masoud Etemadian, Mohamad Reza Mokhtari Hasheminejad Kidney Center, Tehran University of Medical Science, Tehran, Iran Propose We present our video on the treatment of a horseshoe kidney using a laparoscopic vascular relocation and extrapelvic plication technique for the ureteropelvic junction obstruction.

Patient & Method A 4 year old boy with history of left flank pain, intermittent nausea and vomiting since 2 month ago was worked up. Radiologic studies showed a horse shoe kidney with hydronephrosis on the left side, DTPA scan was obstructive, there wasn’t any scar on DMSA scan and RNC was negative for reflux. Urinalysis was normal & culture negative. Serum creatinine was 0.6 mg/dl. The patient was scheduled for laparoscopic repair of UPJO through transmesoic approach. There were found a dilated pelvis and multiple aberrant vessels, one set of which was implicated in the obstruction. The short vein was transected, and after cephalad transposition of the corresponding artery, the pelvis was plicated with PGA to maintain this orientation. The pelvis drained well and there was convincing ureteral peristalsis during hydration. A JJ stent was placed retrogradely.

Result The patient was discharged on postoperative day 1 and the stent removed 4 weeks after the operation. Symptoms have abated post operatively and radiologic results are confirmatory.

Discussion Dismembered pyeloplasty remains the reference standard for treating UPJO. Relocation of the crossing vessels on the pelvic wall (Hellström technique) is a less complicated alternative method to manage select cases. Morphological and functional status of the UPJO during surgery affects the decision. Studies have shown that in carefully selected patients the success rate is acceptable. Our video confirms that this technique is also applicable to the unique situation of numerous aberrant vessels in the horseshoe kidney.

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4th Iranian Endourology & Urolaparoscopy Society Congress, 24‐26 Feb. 2011, Tehran, Olympic Hotel

OP2-1: Finger assisted Laparoscopic Burch procedure for treatment of female Stress Urinary Incontinence Mohammad Ali Amirzargar, Mahnaz Yavangi, Seyed Habibollah Mousavi-Bahar, Nasibeh Amirzargar Department of Urology, Hamedan University of Medical Sciences, Hamedan, Iran Purpose Stress urinary incontinence (SUI) is defined as the escape of small amounts of urine during stress activity. It is one of the most common diseases in females (30%) especially after third delivery.

We evaluated the long-term efficacy of laparoscopic Burch procedure with finger assisted for SUI in women.

Materials & Methods A total of 21patients were identified, and their data from symptom-specific questionnaires, urodynamic studies and urogynaecological assessment were collected.

Results Objective and subjective cure rates were near 100%. Post-operative urodynamics revealed a significant decrease in urinary flow rate (p < 0.05) but with no difference in urinary residuals or maximum urethral closure pressure.

Discussion and Conclusion Laparoscopic Burch procedure with finger assisted is an effective and safe surgical option which increases success rate. With this method, the procedure becomes more simple and faster.

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4th Iranian Endourology & Urolaparoscopy Society Congress, 24‐26 Feb. 2011, Tehran, Olympic Hotel

OP2-2: Laparoscopic Adrenalectomy in a Large Pheochromocytoma M. Aslzare, A.A. Yarmohamadi, A.A. Asadpour Urology Department, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran Introduction Pheochromocytomas may be some of the more challenging adrenal tumors to approach laparoscopically. Intraoperative hypertension or hypotension also poses hazards. Despite technical refinements including early ligation of the vein and minimizing manipulation, these hemodynamic changes remain significant. Larger tumors are inherently more difficult to manipulate, and as size increases, these tumors may abut or invade adjacent vascular structures including the vena cava and renal vessels. Early ligation of the adrenal vein can be challenging secondary to a bulky anatomy.

Materials and Methods The patient underwent laparoscopic transperitoneal right adrenalectomy in lateral position.

Dissections from renal vein and vena cava were the most difficult part that was done meticulously. One venous branch that was drained into the right renal vein was clipped and divided. Early ligation of the main adrenal vein was not possible. The vein was doubly clipped and divided after the gland was almost completely dissected. Postoperatively, the patient was observed in the intensive care unit and transferred to the ward on the first postoperative day. The Patient was discharged on 3rd day when blood pressure was well controlled Results The operation time was 150 minutes. The procedure was completed uneventfully; the estimated blood loss was less than 50 ml. A single episode of intraoperative hypertension (systolic pressure, 210 mmHg) was noted during the procedure. The hospital length of stay was 3 days.

Patholoy showed pheochromocytoma with 13×10×8 cm in size and 360 gm in weight.

Conclusion Large pheochromocytomas can be safely approached laparoscopically. This should only be attempted by experienced surgeons. Also should maintain a low threshold for conversion to open.

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4th Iranian Endourology & Urolaparoscopy Society Congress, 24‐26 Feb. 2011, Tehran, Olympic Hotel

OP2-3: Infantile Cushing syndrome: laparoscopic management M. Aslzare, A. Shamsa Urology Department, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran Introduction Adrenal tumors are an important cause of pediatric cushing syndrome. Infrequent indications for adrenalectomy and concerns about small body habitus have contributed to a delay in the application of the laparoscopy. Although laparoscopic adrenalectomy has been shown to have advantages over the open procedure in adults, the experience in the children is still limited, but continues to grow.

Materials and Methods A 22 month male infant with cushing syndrome and a left large adrenal mass in MRI had underwent transperitoneal laparoscopic adrenalectomy. The patient was placed in the lateral decubitus position with the first trocar in the umbilicus for a 0◦ laparoscope and the secondary trocars in subxiphoid and anterior axillary line. The 4th trocar was placed in inguinal crease.

After colon medialization, renal vein was exposed then ligation of the adrenal vein was performed. The remaining gland was freed by circumferential dissection. The specimen was placed in a bag and removed from incision in the inguinal crease by extension of lower port.

Results The operative time was 65 minutes, and estimated blood loss was less than 30 ml. Pathology showed 6 cm adenoma with 55 gm in weight. There were no perioperative complications and no need for transfusions or open conversion. Hospital stay was two days.

Conclusion Laparoscopic adrenalectomy seems to be a safe and effective procedure in pediatric adrenal mass. The transperitoneal approach provides excellent exposure and adequate working space in children, with the additional benefits of minimally invasive surgery such as less postoperative pain, shorter hospital stay, and early return to normal activity.

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4th Iranian Endourology & Urolaparoscopy Society Congress, 24‐26 Feb. 2011, Tehran, Olympic Hotel

OP2-4: Laparoscopic Management of Symptomatic Paracalyceal Diverticulum A. Basiri, A. Mir, M. Khazaeli*, M. Nikkar Shaheed Labbafinejad Hospital, Tehran, Iran Introduction A calyceal diverticulum is a smoothly outlined, intrarenal sac that communicates with the pelvicalyceal system by means of a narrow neck. (1)Large peripheral diverticula, those located medially near the renal hilum and those in an anterior location, may be treated using laparoscopic techniques. (1)In this video transabdominal approach was used to manage a symptomatic paracalyceal diverticulum.

Material and Methods A 26 years old woman with a past history of two open flank surgery for proposed right renal cyst ablation with prolonged postoperative urinary leakage was evaluated for right flank pain. In the CT scan a large cystic mass was found in the middle of right kidney which did not enhanced. In contrast with the earlier retrograde pyelograghy which did not show any communication between the cyst and collecting system, the pyelography wich was performed preoperatively showed the communication and confirmed the diagnosis of paracalyceal diverticulum. The patient was positioned to left decubitus and transperitoneal laparoscopy started. Gerota facia was opened and the location of the diverticulum was confirmed by intracorporeal ultrasonography and percutaneous needle aspiration. The diverticular wall was opened and the neck position was detected by retrograde injection of methylen blue. The orifice was cauterized and suture closed. The inner surface of the diverticulum was cauterized and perirenal fat was secured to the cavity. Double pigtail was inserted retrogradly at the end of operation.

Results and Conclusion The patient was discharged home with good condition and no leakage. Laparoscopic ablation of the paracalyceal diverticulum is a feasible operation and can reproduce the open surgical techniques. Follow-up of the patient is pending.

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OP2-5: Pyeloplasty in Uretero-Pelvic Junction Obstruction, Laparoscopic or Open?

Siavash Falahatkar, Ali Roushani, Hamidreza Nasseh, Majid Kazemzadeh, Mani Mohiti Asli, Majid Kazemzadeh, Alireza Farzan, Seyedeh Mahboobe Raoofi, Keivan Gholamjani Moghaddam Urology Research Center, Guilan University of Medical Science, Rasht, Iran Purpose Uncorrected Uretero-Pelvic Junction (UPJ) Obstruction (UPJO) results in symptoms, hydronephrosis and progressive renal damage. Open pyeloplasty (OP) has remained gold standard surgical treatment of UPJO. It seems that Laparoscopic pyeloplasty (LP) is an obvious candidate to become the new "gold standard" for management of UPJO based on surgical outcomes. For confirmation of this idea, comparison of LP and OP is essential.

Materials & Methods From March 2008 to August 2009, needful parameters were compared between 21 and 25 patients with UPJO undertaking transperitoneal laparoscopic and open dismembered pyeloplasty respectively. Independent T, Mann-Whitney, Chi-square and Fisher exact tests were used for statistical analysis by SPSS v.17.

Results No significant differences were seen in mean age (years, LP=27.5±15.2, OP=17.7±19.4, P=0.07) and gender (P=0.895) between two groups. Mean operative time (minutes) was significantly higher in LP (280±95) than OP (204±59) (P=0.003). Mean analgesic (meperidine) used dosage (mg) was lower in LP (26.25±35.79) than OP (38.33±55.45) (P=0.744, non-significant). No significant differences were seen in mean duration of drain insertion (P=0.31) and mean postoperative hospital stay (P=0.934) between LP (2.5±1.56, 4.6±1.76; days) and OP (2.1±1.14, 4.3±1.55; days) respectively. Neither mortality nor failure was seen. Complication rate in LP (23.8%) was non-significantly less than OP (36%) (P=0.791). Only complication of LP was fever.

Conclusion Aside from longer operative room time and according to significant shorter duration of return to normal activity after discharge, non-significant lower analgesic dosage and complication rate and similar duration of drain insertion and postoperative hospital stay, laparoscopic pyeloplasty can to be a gold substitute for open pyeloplasty and a new gold standard treatment in UPJ obstruction.

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OP2-6: Robotic Assisted Laparoscopic Partial Nephrectomy: A Review of Surgical Outcomes from a Single Institution’s Initial Experience S. Reza Ghasemian, Keith Christiansen, Keith Kowalczyk, Ashish Behari, Mohan Verghese, Jonathan Hwang Department of Urology, Georgetown University Hospital/Washington Hospital Center, Washington DC. Introduction Herein, we report on the initial 3 year experience with robotic assisted laparoscopic partial nephrectomy (RLPN) at one institution and compare the outcomes to that of laparoscopic partial nephrectomy (LPN) and open partial Nephrectomy (OPN) approaches during the concurrent time period.

Methods A retrospective review was conducted on all partial nephrectomies performed at a single institution from July 2006 to October 2009 for T1 renal lesions. Records were compared between 46 patients undergoing RLPNs, 36 patients undergoing LPNs and 36 patients undergoing OPNs. Various parameters analyzed included tumor size, estimated blood loss (EBL), ischemia time, length of stay (LOS), and final pathology and perioperative complications.

Results The mean tumor sizes of patients treated were 3.0 cm in RLPN group, 2.9 cm in LPN group and 3.3 cm in OPN group. When comparing LPN to OPN, there was no significant difference in ischemia time and EBL but there was a statistically shorter LOS in LPN group (p=0.002). When comparing RLPN to OPN, there was a statistically significant difference in LOS (p<0.001) and EBL (p=0.01) but no difference in ischemia time. Finally, when comparing RLPN to LPN there was no statistically significant difference in LOS and EBL but a statistically shorter ischemia time in RLPN group (p<0.001).

Conclusion RLPN is an acceptable and feasible approach for T1 renal lesions. Consistent with current literature, RLPN is associated with less EBL and shorter LOS when compared to OPN. In addition, RLPN offers reduced warm ischemia time when compared to LPN which may lead to improved renal preservation. Thus, RLPN may shorten the learning curve for minimally invasive management of small renal tumors.

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OP2-7: Right Laparoscopic Donor Nephrectomy: The Washington Hospital Center Experience S.R. Ghasemian, B. Radolinski, E.K. Diner, J.D. Murdock Department of Urology and Transplantation Services, Washington Hospital Center, Washington DC Introduction We reviewed 167 consecutive laparoscopic living donor nephrectomies performed at the Washington Hospital Center to determine if the side of extraction, right versus left, affected operative outcomes.

Methods Between January 2008 and June 2010, 167 consecutive patients (127 left and 40 rights) underwent laparoscopic living donor nephrectomy. The right- and left-sided procedures were compared in the following categories: operative time, warm ischemia time, length of stay, complications, and immediate transplant outcome.

Results Mean operative time for a right donor nephrectomy was 220 minutes versus 228 minutes on the left side. Mean estimated blood loss was 115 ml versus 106 ml on the left side. Mean warm ischemia time was 5.32 minutes versus 4.91 minutes on the left side. Median length of stay was 3 days in both groups. There were 5 minor and 1 major complications, including one patient who required reoperation for a bladder injury.

Conclusion Historically, laparoscopic living donor nephrectomy was performed solely on the left side due to the increased length of the left renal vein. In our experience, however, operative parameters and post-operative results were equivalent in both right and left laparoscopic donor nephrectomy groups. We therefore recommend the removal of the more appropriate kidney, regardless of side.

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OP2-8: Laparoscopic Varicocelectomy Using Bipolar Electrocautery versus Open Inguinal Technique: A Randomized, Clinical Trial Hossein Karami, Alireza tabrizi Shahid Beheshti University of Medical Sciences, Tehran, Iran Purpose The aim of this investigation was to compare laparoscopic management of varicocele using bipolar cautery with open inguinal technique.

Materials and Methods A total of 220 infertile men with varicocele underwent laparoscopic or open inguinal technique varicocelectomy. To evaluate the clinical efficiency of the treatment, the patients were divided randomly into two groups. A laparoscopic varicocelectomy (LV) was performed on 100patients, and an open varicocelectomy (OV) was performed on 100 patients .in both group operating time, relapse rate, hydrocele formation, ,hospital stay, and pain control were evaluated.

Results The operative time was 17 minutes in LV versus 15minutes; in OV (P = .00). In LV versus OV, relapse rates were 6% versus 12% (P > 0.05), hydrocele occurrence was 10% versus 20% (P > 0.05), and Hospital stay was an average of 6 LV and 12 hours in OV. Postoperative analgesic use was 2.5 +/- 0.4 mg in LV versus 3.5 +/- 0.5 mg in OV (P > 0.05).

Conclusion In comparison with open varicocelectomy laparoscopy has better out come and low hospital stay and low pain, low relapse and hydrocele formation low pain.

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OP2-9: Is Ureteral Stenting Necessary During Laparoscopic Ureterolithotomy for Management of Large Ureteric Calculi?

Hossein karami, hooman mokhtarpoor, alireza valipoor Shahid Beheshti University of Medical Sciences, Shohada hospital, Tehran,Iiran Objective To evaluate the place ureteral stenting during laparoscopic ureterolithotomy in the management of ureteric calculi for which extracorporeal shockwave lithotripsy (ESWL) and endourological techniques are unsuitable.

Patients and Methods Laparoscopic ureterolithotomy was attempted 40patients (25t men, 15 woman) with an age range of 26-81 years (mean 55.5) who had large, long standing and impacted calculi in the upper and mid ureter. The stone size ranged from 10 to 28 mm (mean 13.2) and stone duration ranged from one to 24 months (mean 8.2). patients randomly were divided 2 groups and at the end of stone removing suturing of ureter was done by using vicril 04.in grupe1 a double j stent was inserted and in grup2 we did not use doublej stent.

The transperitoneal laparoscopic ureterolithotomy was used for removing of stones in all patients.

Results The stones were successfully removed in all patients. The operative time ranged from 30 to 120 minutes. No intra-operative complication was encountered and no patient required a blood transfusion. Post-operative complications included urinary leak and fever.in3 patients in grup2 .mean post-operative stay was 2days in group 1and 4days in group 2 Conclusions Laparoscopic ureterolithotomy has definite advantages over open ureterolithotomy. For large, hard, long-standing and impacted ureteric calculi, one laparoscopic ureterolithotomy as initial therapy may be preferable to multiple endourological and ESWL procedures .in our experience ureteral stenting is necessary after large stones removing by Laparoscopic ureterolithotomy and decrease leakage and hospital stay.

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OP2-10: Laparoscopic Nephrectomy: Evaluation of Practical Issues and Complications; in Rafsanjan University of Medical Sciences, Rafsanjan, Iran Mehdi Abedinzadeh, Mohammad Kazem Moslemi Department of Urology, Moradi Hospital, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.

Department of Urology, Kamkar Hospital, School of Medicine, Qom University of Medical Sciences, Qom, Iran.

Purpose This study was conducted since beginning of 2008 to the end of 2010. In this time period, 6 cases of transperitoneal laparoscopic nephrectomy (radical nephrectomy; 2 cases, simple nephrectomy; 4 cases) performed. The mean (range) of ages was 47 (37-55) years. Two cases were female and four, males.

Results All of procedures were done by one surgeon, successfully. In one case, right nephrectomy, and in remaining cases left nephrectomy performed. The indications of nephrectomy were as follows: pyelonephritic kidney; 3 cases, renal cell carcinoma; 2 cases, and hypoplastic kidney; one case.

No mortality was seen. Only in one case post-operative deep vein thrombosis was seen, that treated medically.

Discussion Less invasive and non-invasive surgeries are well-known to every urologist. One of the major draw-back of their slow progression is shortage of expensive laparoscopy instruments and having of adequate surgeons’ learning-curve. It is clear that insurance companies support can accelerate the development of these highly advanced, less complicated, and patients accepted surgeries.

Conclusion Urolaparoscopy procedures are still practical in secondary referral centers. However, providing the proper instruments with paying attention to the surgeons learning curve are incredible issues that their importance should not be overlooked.

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OP2-11: Laparoscopic Management of Ureteropelvic Junction Obstruction – Experience from Birjand University of Medical Sciences Mohammad Nadjafi-Semnani, Nahid Ghanbarzadeh, Shima Badiehneshin, Fatima NadjafiSemnani Urology Departement, Birjand University of Medical Sciences, Birjand, Iran Introduction Laparoscopic pyeloplasty (LP) has been introduced as an alternative to open pyeloplasty with comparable results. We present the results of our series of patients and our experience with laparoscopic management of ureteropelvic junction obstruction (UPJO).

Material and Method The medical record of all patients with the diagnosis of UPJO who underwent laparoscopic management at Emam Reza medical center-Birjand was reviewed. From April 2005 to August 2010 twelve consecutive patients (9 male and three females) with significant UPJO were treated with laparoscopic management, performed by one surgeon. Patients were followed up with ultrasound (US) at two week and U/S or intravenous pyelogram (IVP) at 12 weeks. Diuretic renogram and US or IVP were done at 6 months. Later follow-up were performed with US or IVP as well as clinical evaluation.

Result All patients were evaluated. Twelve consecutive patients (9 male and three females) with mean age 22.4 (4-64 years) underwent LP. Five (41.6%) patients had less than 11 years age. One male patient had bilateral UPJO. 9 (70%) and 4 (30%) patients had Right and left side obstruction respectively. One patient with bilateral UPJO and two other patients had stones in the obstructed kidney and concomitant pyelolithotomy were done. Dismembered pyeloplasty, vertical flap, Fenger plasty technique was used in 10, 1 and one patient respectively. In one 10 year old patient, no formal pyeloplasty was performed but the aberrant vein was cut and artery was relocated cephalad and fixed by suture. Mean hospital stay was 2.54 (1-5) days. The success rate was 93% and one case with the operative technique of vertical flap has symptoms and recurrent urinary tract infection postoperatively. No patient needed any reopation.

Conclusion Our success rates are consistent with the laparoscopic report of other centers and are comparable with rates for the open technique. Patients had short hospital stays. With experienced surgeons, LP should be the first-line treatment for ureteropelvic junction obstruction.

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OP2-12: Is Laparoscopic Re-evaluation Justified After Previously Failed Open Exploration For Undescended Testis?

Pejman Shadpour, Robab Maghsoudi, Masoud Etemadian, Behkam Rezaimehr Mohammadreza Mokhtary , Hosein Akhiary , Javid Samady Hasheminejad Clinical Research Development Center, Hasheminejad Kidney Center (HKC), Tehran University of Medical Sciences, Tehran, Iran Background Prior to the availability of laparoscopic orchiopexy, a nonpalpable testis was concluded to be absent if open exploration failed to show the gonad. This report shows our experience with laparoscopic re-evaluation of such cases at a later age.

Material & Methods The surgical findings in all patients undergoing laparoscopic exploration for nonpalpable undescended testis (UDT) at our center between Aug 2003 and Dec 2010 were reviewed retrospectively. Data on those patients with past history of open inguinal exploration were analyzed.

Results Over this period, out of 141 laparoscopic explorations were done and 171 nonpalpable testes were explored .sixteen patients (19 gonads) had already undergone open inguinal exploration by some other surgeon in the past, almost always under two years of age. One of seven right testes, two of six testes, and two patients of 3 bilateral cases (4 testes), altogether seven gonads were found by laparoscopy and orchiopexy were done for six of them and one atrophic gonad was removed.

Discussion and conclusion Previous report of absent testis in open inguinal exploration for nonpalpable testis (UDT) must not preclude laproscopic re-exploration, particularly when a child with previous history of bilateral negative inguinal exploration presents at a later age with hormonal evidence of some functional gonadal tissue.

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OP2-13: Comparison of Three Various Laparoscopic Entry Techniques (Prospective Study) Hamid Shayani nasab, Mohammadali Amir Zargar, Seyed Habibollah Mousavi-bahar, Farideh Gharekhanloo Urology Department, Hamedan University of Medical Sciences, Hamedan, Iran Purpose The majority of laparoscopic complications occur at time of laparoscopic entry. There are various entry techniques. This study was conducted to evaluate and compare safety and efficacy of three common laparoscopic entry techniques.

Methods From September 2005 until December 2010 prospectively 384 patients scheduled for laparoscopic diagnostic or therapeutic surgery without previous abdominal surgery or morbid obesity were non randomly included in three groups 140 patients : Veress needle entry ( group one) , 130 patients direct trocar insertion (group two) and 114 patients modified open access (group three) The entry technique was chosen by surgeon preference.

Results Patients age was 29.4 , 31.5 , and 34.2 yrs respectively ( 0.8 – 78 yrs ).Body mass index was 25.2 , 24.5 and 26.1 Kg/ m respectively . failed entries were 12 patients of group one (Repeated veress needle in 4 , classic open access in 8 patients ) , 8 patients of group two ( 6 classic open access and two patients converted to open surgery ) and six from group three ( classic open access ).Time to camera was 350 , 250 and 170 second respectively .Gas leakage and camera trocar unstability in 8 , 4 and 14 patients respectively . Minor complications in 12, 4 and 11 Patients respectively. Major complications were seen in two patients of group one (one liver left lobe Laceration and one iliac vein injury), three patients of group two (one major abdominal Vessel injury and one bowel injury) and one patient of group three (bladder perforation).

Conclusion Major complications related to Laparoscopic entry are rare but serious. There is no clear evidence for preferred entry technique however direct trocar insertion is blind method withProbable major complications.

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OP2-14: Transperitoneal Laparoscopy versus Ureteroscopy for Management of Large Mid Ureteral Calculi H.S. Sofimajidpour Urology, kurdistan university of medical science, sanandaj, Iran Introduction Before the 1980s, ureteric stones were managed by open ureterolithotomy. Since the introduction of shock-wave lithotripsy (SWL) and ureteroscopy, the use of an open surgical approach for the removal of ureteric stones has rapidly declined. Open surgery, which is currently being replicated by laparoscopic techniques, is generally indicated for failed endourologic procedures, particularly in centers that do not have flexible Ureteroscopy or laser lithotripter, and in patients with larger stones. Considering this, we conducted a randomise study to compare the, ureteroscopic pneumatic lithotripsy (URS) and laparoscopic ureterolithotomy for the management of midureteric calculi of more than 1 cm.

Materials and Methods Between August 2006 and February 2010, a total of 31 patients with midureteric calculi (>1 cm in size) were treated with the, ureteroscopic pneumatic lithotripsy (URS) and laparoscopic ureterolithotomy. Data were collected and all the patients were analyzed for stone-free rate, intraoperative and immediate postoperative complications and the results were calculated.

Results Stone clearance was 75% (12/16) with ureteroscopic pneumatic lithotripsy (group 1), and 100% (15/15) with the laparoscopic method (group 2), with a statistically significant difference between groups 1 and groups 2. The TPUL was successful in all cases. The mean operating time was 56 minutes. Two patients required no narcotic analgesics, while the other patients received a mean of 25–50-mg doses of pethedine for postoperative pain relief. The mean hospital stay was 2 days. There were no major intraoperative or postoperative complications. Prolonged urine leakage for 1 and 2 days occurred in two patients, which was managed conservatively. In URS group, surgical failure occurred in 4 cases, including 1 case with difficult entry of the ureter, 2 with stone displacement to the kidneys, and 1 with residual stones over 4 mm.

Conclusion Laparoscopic transperitoneal ureterolitho-tomy is a feasible technique for the management of large mid-ureteral stones. It is a minimally invasive, less-morbid alternative to open transperitoneal ureter-olithotomy. Laparoscopic ureterolitho-tomy is a minimally invasive treatment and may be considered as the useful first-line management for large impacted mid ureteric stones.

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OP2-15: Laparoscopic Anatrophic Nephrolithotomy for Management of Staghorn Renal Stone Nasser Simforoosh, Akbar Nouralizadeh, Ali Tabibi, Mohammad Hadi Radfar, Reza Sarhangnejad Urology and Nephrology Research Center (UNRC), Shaheed Labbafinejad Medical Center, Shaheed Beheshti University of Medical Sciences, Tehran, I.R. Iran Objectives To evaluate safety and efficacy of laparoscopic anatrophic nephrolithotomy for management of staghorn renal stones Materials and Methods Twenty four patients with staghorn renal calculi underwent 25 laparoscopic anatrophic nephrolithtomy. Patient and stone characteristics along with perioperative features such as operation time, transfusion, ischemic time, hospitalization, stone free rate, and biochemical data were recorded prospectively. We applied one-layer knotless technique for renorrhaphy repair.

Results Mean age of the patients was 55.1± 10.9 years (range: 28-74 years). Eleven (44%) operations were done on the right side and 14 (56%) on the left side. Complete and partial staghorn stone existed in 17 (68%) and 8 (32%) renal units, respectively. Mean stone size was 61.5±11.5 mm.

Ischemic time was 30.4±7.55 minutes. Stone free rate was 88% on discharge, and 92% after one session of extracorporeal shockwave lithotripsy.

Conclusion Laparoscopic anatrophic nephrolithotomy is a safe and feasible option for treatment of staghorn renal stone.

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OP2-16: Laparoscopic Management of Ureteropelvic Junction Obstruction by Division of Anterior Crossing Vein and Cephalad Relocation of Anterior Crossing Artery: A LongTerm Follow-up of 59 cases Akbar Nouralizadeh., Nasser Simforoosh, Mohammad Hossein Soltani, Abbas Basiri, Seyed Amir Mohsen Ziaee, Ali Tabibi, and Hossein Kilani Shahid Labbafinejad Medical Center, Urology and Nephrology Research Center (UNRC), Shahid Beheshti University, M.C. (SBMU), Tehran, Iran.

Introduction To demonstrate the update report of our experience with laparoscopic management of ureteropelvic junction (UPJ) obstruction by division of the aberrant crossing vein and cephalad relocation of crossing artery in large group of patients with long term follow up.

Material and Method From Jun 2001 to Mar 2010, 367 patients elected for transperitoneal laparoscopy for management of UPJ obstruction. Intraoperatively, we identified lower pole crossing vessels in 134 patients. After laparoscopic division of the aberrant crossing vein, aberrant crossing artery was relocated cephalad and fixed to peripelvic tissue with interrupted absorbable sutures.

Regarding to significant renal pelvic emptying with proper pyeloureteral peristalsis, dismembered pyeloplasty was not performed in 83 cases and no JJ stent was required in any patients. Postoperative outcomes were assessed with intravenous urography (IVU) and isotope scan.

Results The mean age of patients was 27.6 (1 - 69) years. The mean operative duration was 123 (55-235) minutes and blood loss was negligible. Mean hospital stay was 2 (1-7) days and mean follow up was 29.2 (3-84) months. Successful rate was 90% and recurrence of obstruction was noted in two patients six months and five years later, respectively. No significant complication was happened.

Conclusion Transposition of lower pole crossing artery after ligation of crossing vein in selected cases is an ideal alternative for classic dismembered pyeloplasty with noticeable outcomes.

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OP2-17: Laparoscopic Pyelolithotomy for Management of Staghorn Renal Calculi Akbar Nouralizadeh., Nasser Simforoosh, Seyed Amir Mohsen Ziaee, Mohammad Hossein Soltani, Reza Sarhangnejad, Arash Ardestani Zadeh, Vahid Nadjaran Shahid Labbafinejad Medical Center, Urology and Nephrology Research Center (UNRC), Shahid Beheshti University, M.C. (SBMU), Tehran, Iran.

Introduction Recent developments in laparoscopic and retroperitoneoscopic techniques modified the treatment of renal and ureteral stones. We present the efficacy and possible adverse complications of laparoscopic pyelolithotomy for treatment of staghorn stones as an alternative to PCNL in our single-surgeon series.

Patients and Methods Thirteen patients (10 male and 3 female) underwent transperitoneal laparoscopic pyelolithotomy for staghorn stones removal. Mean stone size was 5.11cm (range 4-6.5cm). All patients had large stone in the renal pelvis and several calices (more than two calices) with extra renal pelvis.

Results Mean operative time was 177 min (range 110-240 min) and mean hospital stay was 4 days (range 3-7 days). Transfusion was not required in any patients and open conversion was not happened.

Overall success rate was 84.6 % (11/13) and two patients had residual stones that were managed with ESWL. Six patients had low grade fever (< 38.5 C) for less than 48 hours which was resolved by antibiotic therapy. One patient had collection in suprarenal area which was managed conservatively and subsided in a few days. No major complications (bleeding, sepsis, bowel injury and urinary leakage) were happened.

Conclusion The role of laparoscopic kidney stone surgery has not been well defined but laparoscopic transperitoneal pyelo-lithotomy may be performed with noticeable results and negligible complications in skillful hands. It may be a suitable alternative to PCNL for the treatment of staghorn stones in selected cases.

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OP2-18: The Effect of Botulinum-A Toxin in Treatment of Painful Bladder Syndrome Hassan Ahmadnia, Ali Shamsa, Mohamad Khoje Daloee, Saeed Reza Ghanbarizadeh Mashhad University of Medical Sciences, Mashhad, Iran Introduction Painful bladder syndrome diagnosed by clinical symptoms and roll out of other causes. Several treatments including conservative therapies, oral treatment, intravesical injection, and surgery in these patients have been used. Each of the treatments listed have been accompanied by various success rates and numerous complications. Recently botulinum toxin A for treatment of excessive smooth muscle activity and urinary tract dysfunction has been used. In this study, we tried to assess the effects of botulinum toxin A in the treatment of this syndrome in a randomized controlled clinical trial.

Materials & Methods 24 patients with painful bladder syndrome refractory to conventional oral therapies were selected, and then divided randomly in two groups; control (normal saline for interavesical injection) and study group (interavesical injection Botulinum toxin A). Before intervention, the basic assessments were done. Also before and one month after the intervention, for all patients, urodynamic study, voiding dairy, as well as quantitative assessment of pain using the VAS was performed. Under short general anesthesia in study group 2001U of botulinum toxin A (Dysport) diluted in normal saline) and in control group; normal saline were injected through cystoscopic needle submucosally into trigone and lateral walls of the bladder. Then in formations were collected and compared under statistical methods.

Results Statistically significant differences between the two groups in terms of pain, Frequency, Nacturia after Dysport injection. Satisfaction of patients in study group was significantly higher.

Conclusion Botulinum toxin A is an effective agent with minimal side effects in the treatment of painful bladder syndrome.

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OP2-19: The Less Invasive Open Pyeloplasty Seyed Alaeddin Asgari, Mandana Mansour Ghanaie, Afshin Safaee Asl Urology Research Center, Guilan University of Medical Science Objective Recently with the advent of improved minimally invasive techniques and equipment, laparascopic pyeloplasty has gained popularity. We present our experience with a less invasive open dismembered pyeloplasty.

Materials and Methods Between May 1999 and April 2009, we retrospectively reviewed of the consecutive open pyeloplasties was performed with regard to age, surgical operative time, length of hospital stay and surgical success.

Results One hundred-fifty nine patients had a dismembered pyeloplasty using an open flank incision: 81 patients (< 1 years), 50 patients (1-5 years) and 28 (5-12 years). The mean operative time and incision sizes were 99 ± 27 min and 3.1 ± 0.6 respectively. The mean hospital stay was 36 hour (24-72 h). The last of 4 year the mean time of operation, hospital stay and incision sizes were decreased 80 ± 12, 24 h (16-48 h) and 2.6 ± 0.4 cm respectively. The successful pyeloplasty was seen in 154/159 (%97.5).

Conclusion The less invasive open pyeloplasty is a safe and effective for UPJO. The results of this procedure can challenge the current trend in the literature for laparoscopy pyeloplasty.

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OP2-20: Assessment of Oral Acetazolamide on Postoperative Pain After Laparoscopic Cholecystectomy faramarz Mohammadalibeigi, mohammad moazeni Shahrekord University of medical sciences, Shahrekord, Iran Purpose Carbon dioxide (Co2) is used during laparoscopy for producing pneumoperi-toneum.

Combination of this gas with irrigation fluid in the abdomen produces carbonic acid which creates two kinds of abdominal and referred pain to right shoulder. In the present research, we have studied the effect of oral acetazolamide in reducing postoperative pain after laparoscopic cholecystectomy.

Methods This clinical trial was performed in 88 patients with cholelithiasis without any complication that were candidate for laparoscopic cholecystectomy. The patients divided randomly and equally in two groups (The experimental group received Acetazolamide 250 mg every 8 hours, orally, 24hours before surgery and control group received placebo ) Abdominal and shoulder pain measured using McGill pain score by a person who was blind for both groups. Pain measurement was performed in four different times, before and after the surgery, discharge from recovery and 24 hours after surgery. Data were analyzed by using SPSS software.

Results We observed that mean pain scores was significantly higher in acetazolamide group compared to the placebo group, 24 hours after the operation (P<0.05). However; no significant changes were observed between groups in other times (P>0.05) Conclusion Although acetazolamide can reduce abdominal pain referred to right shoulder by reducing acidity in peritoneal irrigation fluid, but this drug can increase abdominal pain in the site of surgery with damaged tissues by producing tissue acidosis (as a side effect of drug).

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OP2-21: Which Technique Can Maximize the Result of Antegrade Endopyelotomy in UPJO? Mohammad Ali Amirzargar, Seyed Habibollah Mousavi-bahar, Sasan Mehrabi, Shahriar Amirhasani Department of Urology, Hamedan University of Medical Sciences, Hamedan, Iran We assessed the results of antegrade enopyelototmy alone and antegrade combined with retrograde patients with a primary ureteropelvic junction obstruction (UPJO).

A total 32 patients 18 to 60 years old with UPJO were treated.

Antegrade endopyelotomy alone was performed in 14 patients and antegrade combin with retrograde andopyelotomy in 18 patients. A stent was left in place for average of 8 weeks. The two gropes have a nephrostomy tub for one week. When we want to basket the double J in the grope 2 (18 patients) retrograde endopyelotomy also done.

The success rate for antegrade endopyelotomy combine with retrograde endopyelotomy is better than antegrade endopyelotomy alone.

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4th Iranian Endourology & Urolaparoscopy Society Congress, 24‐26 Feb. 2011, Tehran, Olympic Hotel

OP2-22: Adjustable Pubourethral Sling for Male Incontinence Abbas Basiri, Ramin Khoddam Urology and Nephrology Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Purpose To demonstrate a technique of inserting a specific type of tape for male incontinence Technique Under regional or general anesthesia in lithotomy position, using two incisions in the perineum and the suprapubic area, the bulbospongiose muscle, the corpus covernosa, and the rectus fascia were exposed. Two arms of the sling device were passed through the pelvic diaphragm between the urethra and the corpus covernosa to the suprapubic area and fixed over the fascia using specific washer and nut. The tension of both arms increased to the level that the pressure of silicon pad on the urethra can inhibit the flow of saline with 40 cmH20. The skin was repaired and the procedure finished.

Result All of the 5 patients treated with this technique were completely dry, using no pad. Only one patient required CIC for 1 month. No surgical complications occurred.

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4th Iranian Endourology & Urolaparoscopy Society Congress, 24‐26 Feb. 2011, Tehran, Olympic Hotel

OP2-23: The assessment of transurethral injection of Botulinum toxin-A effect on BPH refractory to current medical treatment in poor surgical candidates Ali Hamidi Madani, Ahmad Enshaei, Gholamreza Mokhtari, Abtin Heidarzadeh Urology Research Center, Guilan University of Medical Science Objective Benign Prostatic Hyperplasia (BPH) is a pathologic process which is the main cause of Lower Urinary Tract Symptoms (LUTS) in elderly men. In this study we evaluated the effectiveness of transurethral prostate injection of botulinum toxin-A in BPH refractory to current medical treatment in poor surgical candidates, Prospectively.

Materials & Methods In this clinical trial 10 patients with LUTS suggestive of BPH who had responded poorly to medical therapy with one of alpha-blockers and/or finasteride for a minimum of 3 months and were poor surgical candidate due to comorbidity or who were not interested in surgery, received transurethral Botulinum A injection based on their prostate volume. The prostate volume, PSA, Qmax, IPSS, PVR and nocturia before and after treatment were evaluated and compared.

Results The mean IPSS was 24.50±3.8 and 13.40±2.67 before and after treatment, respectively (P<0.001). The mean prostate volume was 41.50±10.85ml and 30.40±8.05 ml before and after treatment, respectively (P<0.001). The Qmax was 7.87±2.01 ml/s and 16.19±1.76 ml/s before and after treatment, respectively (P< 0.001). The mean PVR was 75.6±51.63ml and 63.50±36.59ml before and after treatment, respectively (P=0.096).

The mean number of nocturia decreased from 4.1±0.87 to 2.4±0.84 (P< 0.001).

The mean IPSS, Prostate volume, nocturia and PSA significantly decreased. The mean PVR decreased but it was not statistically significant. The mean Qmax significantly increased.

There wasn’t any significant side effect except one case of gross hematuria, which was treated conservatively.

Conclusion Prostate injection of botulinum-A may be an effective and safe treatment for symptomatic BPH in selected patients who are poor surgical candidates and/or in whom medical treatment has failed.

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4th Iranian Endourology & Urolaparoscopy Society Congress, 24‐26 Feb. 2011, Tehran, Olympic Hotel

OP2-24: Complications of open living donor nephrectomy: A review of 10-year experience Hayat Moombini, Dinyar Khazaeli, Mohammad Ali Hosseini, Kian Omidbakhsh Joundi shapour University of Medical Sciences, Ahvaz, Iran Introduction Open living donor nephrectomy has brought hope for many patients suffering from 3hours a day 3 times a week hemodialysis, the hope of getting rid of being dependent to these large machines. However this technique has its own complications and risks for the kidney donors. In this study we reviewed complications of this technique during last 10 years.

Materials & Methods We reviewed the operative complications of open living donor kidney transplantations during the last 10 years.

Results and Limitations Of 761 kidney donors 523 (68.72%) were male and 238 (31.28%) were female. Donated side was 181 (23.78%) kidneys from the right side and 580 (76.21%) from the left side. We had no case of mortality from open kidney donation during this 10-year period. Operative or post operative bleeding necessitating blood transfusion was 27 (3.54%) cases. Pleural injury happened in 27 (3.54%) of cases, of which 3 (0.39%) cases needed chest tube placement. Post operative fever was seen in 53 cases (6.96%) of which 12 (1.57%) cases stayed in the hospital for more than 5 days. The average operative time was 138.4 minutes.

Discussion and Conclusion Living kidney donation is associated with low surgical morbidity and mortality, while it is donation of freedom from dependence to machinery dialysis and its complications.

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4th Iranian Endourology & Urolaparoscopy Society Congress, 24‐26 Feb. 2011, Tehran, Olympic Hotel

OP2-25: Preoperative imaging may overestimate kidney tumor size Hamidreza Nasseh, Siavash Falahatkar, Hossein Bagheri Chenari, Atefeh Ghanbari Urology Research Center, Razi Hospital, Guilan University of medical sciences Introduction This study was aimed to compare kidney tumor size on radical nephrectomy pathology specimen with size estimated by computerized tomography CT-scanning and ultrasonography before operation.

Materials and methods From March 2003 till March 2009, 40 patients (25male and 15 female) with a mean age of 64.12 years (range: 42-79 years), underwent radical nephrectomy at our center. The tumor size on pathology specimen was compared with preoperation CT scanning and ultrasonography size estimation. The t-test was utilized to compare the means.

Results All tumors were Renal cell carcinoma .Mean tumor size on pathology specimen was 6.2±1.1cm.

Mean tumor size estimated by preoperation CT scanning and ultrasonography was 7.34±1.83 cm and 7.4±1.96 cm, respectively (p value=0.001 for comparing both with pathologic size). Tumor stage did not affect this significant difference. There was not any significant difference between tumor size estimated by CT scanning or ultrasonography (p value>0.05) Conclusion CT scanning and ultrasonography both may overestimate renal tumor size. This point must be considered in clinical staging and treatment selection. Multicentric prospective comparison is suggested.

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4th Iranian Endourology & Urolaparoscopy Society Congress, 24‐26 Feb. 2011, Tehran, Olympic Hotel

OP2-26: Comparing PSA & free PSA serum levels in fresh and frozen blood Rahim Taghavi, Kamyar Tavakkoli Tabasi, Behtash Pedram Rad Urology Department, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran Background In many industrial countries this antigen is assayed immediately after sampling and its scale is evaluated. But in many laboratories of our county the sample is frozen for a long period about 72 to 96 hours or more in freezers with unstable temperatures usually about ̵ 20 to ̵ 30 ̊ C, and after this period it is evaluated.

It seems that this way of freezing the sample for the reason of long term preservation, regard to 1-structure of PSA, 2-period of sample preservation, 3-value of freezing and, 4-way of preservation in our laboratories can affect the scale of the sampling in the fresh and frozen plasma PSA. This study is to evaluate the effect of freezing & method of preservation in laboratories of our country on the scale of total & free PSA in fresh & frozen plasma.

Materials & Methods 110 Patient's with LUTS symptom referred to the urology clinic from Nov 2008 to May 2009 are elected and referred to laboratory for four samplings: two samples for each laboratory that in each laboratory one sample has been freeze and evaluated after 72 hour and the other sample immediately evaluated and then the results were compared with each other.

Results Ι- By comparing the results of individual lab: A- In lab1: There was not any significant difference between the level of PSA in the fresh and frozen samples of bloods with Mono bind kit (Eliza assaying). (PAB=0.454) B- In lab 2: There was not any significant difference between the level of PSA in the fresh and frozen samples of blood with Immune tech kit (Eliza assaying). (PAB=0.789) II- In comparison between two laboratories: 1- There was not any significant difference between the levels of PSA in fresh and frozen bloods with Mono bind kit and Immune tech kit (Eliza assaying). (PB2.1=0.791, PA2.1=0.908) 2- Significant correlation is observed between the level of f-PSA in the fresh and frozen samples (P2, 1=0.001) Conclusion At this time there are no differences between evaluating of fresh & frozen blood for PSA antigen but in free PSA there is difference and we advise that it is better to evaluate the fresh blood sample.

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4th Iranian Endourology & Urolaparoscopy Society Congress, 24‐26 Feb. 2011, Tehran, Olympic Hotel

OP2-27: Evaluation of Early and Late Post Renal Transplant Levels of Prostate Specific Antigen and Testosterone Reza Mahdavi Zafarghandi, Abbas Ali Zeraati, Keyvan Aghamohammadpour, Farnaz Kalani Moghaddam Urology Department, Mashhad University of Medical Sciences, Mashhad, Iran Introduction The relationship between androgen action and PSA concentrations in patients undergoing renal transplantation remains unclear. This study is to evaluate the impact of renal transplantation on serum prostate specific antigen (total & free PSA) and testosterone levels.

Materials & Methods Thirty patients who had no history of prostate cancer and underwent renal transplantation at the Renal Transplantation department of Imam Reza university hospital, Mashhad, Iran were studied.

The Immunosuppressive protocol was uniform during the study period, namely, cyclosporine, mycophenolate mofetile and prednisolone. Induction therapy with antilymphocyte globulin (ATG) was used only in highly sensitized patients or in the presence of delayed graft function (DGF). The PSA (free and total) and testosterone levels were measured immediately before renal transplantation and on post transplant days 1, 7, 90 and 180. The paired t-test and Pearson correlation analysis were used to assess the statistical significance of differences and relationship between variables, respectively.

Results and Limitations A significant decrease was noticed in serum fPSA and testosterone levels on post transplant days 1, 7, 90 and 180 (P<.05) and in total PSA on post transplant days 1 and 7. No significant changes of total PSA was detected on post transplant days 90 and 180. A significant inverse correlation between testosterone and total PSA revealed six month after transplantation (r =- 0.635, P = 0.049). There was no significant correlation between total PSA and testosterone on post transplant days 1 and 7 and between testosterone and fPSA in early and late post transplant period.

Conclusion Our study showed a significant decrease of free PSA and testosterone levels in early and late transplantation period. Total PSA had a significant decrease in the first week after renal transplantation. Also a significant negative correlation between testosterone and total PSA was detected on the 6th month after transplantation.

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4th Iranian Endourology & Urolaparoscopy Society Congress, 24‐26 Feb. 2011, Tehran, Olympic Hotel

OP2-28: The role of Trans-urethral resection of prostate in detecting prostate cancer in patients with previously negative biopsy, elevated PSA levels and positive lower urinary tract symptoms Reza Mahdavi Zafarghandi, Keyvan Aghamohammadpour, Alireza Ghoreifi, Farnaz Kalani Moghaddam Urology Department, Mashhad University of Medical Sciences, Mashhad, Iran Background In some patients with elevated levels of PSA, transrectal biopsy with 10-12 cores turns out to be negative for prostate cancer which might be due to the site of the cancer – transitional zone. In this study we evaluated the role of transurethral resection of prostate (TURP) in detecting prostate cancer in patients with elevated PSA levels and positive lower urinary tract symptoms (LUTS) but previously negative transrectal ultrasound (TRUS) guided biopsies.

Materials & Methods In this cross-sectional study a total of 40 patients who presented to the urology department of Imam Reza university hospital, Mashhad, Iran from November 2008 to November 2009 with elevated PSA levels, positive LUTS and negative 10-12 core TRUS biopsies were evaluated.

After a 6 month follow up, the patients with persistently elevated PSA levels and a second negative biopsy underwent TURP. All data including demographic, IPSS, DRE, PSA levels, TRUS biopsy and also TURP results were analyzed using the T-Test.

Results and Limitations After evaluating TURP results 14 patients (35%) were diagnosed with prostate cancer (4 of which developed high grade prostate cancer, 6 had Gleason score 3+4 and 4 had Gleason Score 2+3). According to their age, PSA, IPSS and prostate size, there were no significant differences between the groups with and without cancer.

Conclusion TURP is beneficial to detect prostate cancer in patients with previously negative TRUS biopsies who have positive LUTS and elevated PSA levels.

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4th Iranian Endourology & Urolaparoscopy Society Congress, 24‐26 Feb. 2011, Tehran, Olympic Hotel

OP2-29: Percutaneous Cystolitholapaxy (PCCL) by Retrograde Approach Shahrokh Sakhaei, Babak Kazemzadeh, Akbar Haidaripour, Bahram Samadzade, Abdolrasul Bardide, Mahmudreza Moradi, Hasan Omidvar Urology Department, Kermanshah University of Medical Sciences, Kermanshah, Iran Purpose There are several surgical techniques for removal of bladder stones such as: endoscopic cystolitholapaxy, per-cutaneous cystolitholapaxy (antegrade or classic) and open cystolithotomy.

The purpose of this newsletter is to introduce a new method; we called it pecutaneous cystolitholapaxy, by retrograde approach, and compared it with other methods.

Patients and Methods Under general or regional anesthesia in lithotomy and telenderenburge position, a metallic Lowsley sound was conducted through urethra in to the bladder. An incision was done over the tip of the sound while it was palpating in suprapubic region. Incision was deepened until the tip of the sound was appeared. Then amplatz sheet was placed over the sound’s tip pushing into the bladder over the sound. After grasping the amplatz sheet, the sound was withdrawn from the urethra. Then nephroscopy and lithothripsy would be done.

Results and conclusion This method was done in 12 patients with bladder stone (burden: 20-100 mm), and the advantages of this procedure was: 1. More quickly than classic or endoscopic cystolitholapaxy.

2. To be safer than endoscopic cysto-litholapaxy (not to traumatize urethra and bladder neck).

3. Possibility to simultaneously perform cyctolitholapaxy and transurethral resection of prostate (TUR.P) whereas performing cystostomy that leads to less fluid absorption, because of less time of the operation especially in cardio-pulmonary patients.

4. Less damage to the posterior wall of bladder and also rectum due to less dilatator over advancement than classic PCCL. 5. This method does not need to two operators at the same time, one for cystoscopy and the other for dilating the surgical site, and can be done by one operator. Also it is not mandatory being an endourologists or a skilled urologist.

6. Open prostatectomy indications would be changed by this method.

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4th Iranian Endourology & Urolaparoscopy Society Congress, 24‐26 Feb. 2011, Tehran, Olympic Hotel

OP2-30: Early Results of Using the Mini Sling Ophira for the Treatment of Stress Urinary Incontinence in Two Hospitals at Tehran City Sharifiaghdas F, Ghaderian N. Urology and Nephrology Research Center (UNRC), Shaheed Beheshti University of Medical Sciences, Lolagar Hospital, Tehran, Iran Purpose To evaluate the efficacy and complications of the mini sling Ophira for SUI in women.

Patients and Methods Between March 2010 and February 2011, 32 women (mean age 54 years , range 36-83) With stress urinary incontinence underwent Ophira mini Sling surgery. %30 also complained of urgency and urge incontinence. All had routine blood tests , urine analysis and culture, ultrasonography, cystoscopy, Marshall test. Preop urodynamic study was done in 15 patients.

Cough stress test was positive in all. Patients underwent spinal (30) and general (2) anesthesia.

The mean operative time was 16 minutes, and the mean hospital stay was one day. The Foley catheter was removed after 12 hours. In the follow up , patients were visited at 3,7,30 and 90 days as to urine analysis and culture, ultra-sonography, cough stress test and satisfactions forms. The mean follow up was 3 months.

Results 87/5% women were completely dry, 12/5% had improved and statisfactory outcomes were 78%.

One patient suffered from Dyspareunia. 2 from incomplete voiding (residue Less than 50cc in ultrasonography) and 4 from unresolved urge incontinence. Mild SUI was observed in 4.

Infection and vaginal erosion were not detected in any.

Conclusion In this study short term outcomes of the mini sling Ophira surgery were comparable to the other anti SUI procedures. Long term Follow up is necessary.

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