Published online Nov 16, 2014. doi: 10.12998/wjcc.v2.i11.698
Revised: September 17, 2014
Accepted: October 1, 2014
Published online: November 16, 2014
Processing time: 138 Days and 23.6 Hours
AIM: To assess the outcomes of men treated for urolithiasis at the time of radical prostatectomy.
METHODS: From 1991 to 2010, 22 patients were retrospectively identified who were treated simultaneously (n = 10) at radical prostatectomy, or (n = 12) within 120 d prior to prostatectomy, for urolithiasis. Clinical characteristics were reviewed including: type of prostatectomy and stone surgery, location and amount of stone burden, perioperative change in hemoglobin and creatinine, stent frequency, total hospital d, stone-free rates, additional stone procedures and complications. Long-term functional outcomes including stress urinary incontinence and bladder neck contracture were reported. Differences between cohorts (simultaneous vs staged treatment) were assessed.
RESULTS: Among men undergoing radical prostatectomy, primary stone procedures included 12 ureteroscopy, 6 shock wave lithotripsy, 2 open nephrolithotomy and 2 percutaneous nephrolithotomy. In staged shock wave lithotripsy there were 4 complications and 3 additional procedures vs 1 (P = 0.5) and 0 (P = 0.2) in the simultaneous cohort. Meanwhile in staged ureteroscopy there were 5 complications and 1 additional procedure vs 1 (P = 0.2) and 1 (P = 0.9) in the simultaneous cohort. Additional procedures for residual stones was greater among patients with asymptomatic upper tract calculi 3 (60%) relative to patients with symptomatic stones 2 (13%; P = 0.02). Likewise, patients with proximal or multiple calculi had a greater total hospital days 5.5 vs 4.1 (P = 0.04), additional procedures 6 vs 0 (P = 0.04) and lower stone-free rates 39% vs 89% (P = 0.02) relative to men with distal stones. Finally, there was no difference in the incidence of bladder neck contracture (P = 0.4) or stress urinary incontinence (P = 0.7) between cohorts.
CONCLUSION: Ureteroscopic treatment of symptomatic distal urolithiasis at radical prostatectomy appears to be safe and efficacious with a low rate of adverse postoperative outcomes.
Core tip: Prostate cancer and urolithiasis can present simultaneously. An acute stone event in the immediate perioperative radical prostatectomy period poses unique management issues. Herein, we describe our experience with the simultaneous treatment of urolithiasis at the time of prostatectomy. We concluded that simultaneous ureteroscopy among symptomatic men with distal ureteral calculi appears to be safe and efficacious. Whereas, in asymptomatic men, or those with proximal/multiple calculi, one should consider treatment in a staged fashion secondary to an increased risk of additional procedures and lower stone-free rates.