Læknablaðið : fylgirit - 01.06.2009, Blaðsíða 28

2 7 T H CONGR SCAND ASSOC UROL
F Y L G I R I T 6 1
two systems. The anterior wall was closed by a running 6-0
absorbable suture. A 4.7 F multipurpose stent was placed with
its lower end in the ureter, upper end in the upper moiety and
the loop across the lower moiety UPJ. Finally the posterior wall
was closed.
Results: Operative time was 150 minutes. There were no per
or postoperative complications. Hospital stay was 2 days.
Three months post surgery the patient was asymptomatic, and
ultrasound showed no residual dilatation.
Conclusions: Robotic retroperitoneoscopic pyeloplasty is a
minimally invasive procedu re, giving direct access to UPJ and
offers excellent overview which allows tackling both normal
and anomalous anatomy.
56 Procalcitonine in diagnostics and therapy of acute
pyelonephritis
P Nencka’, R Zachoval’, V Vik1, V Borovicka1, J Granatova2
1Department ofUrology and 2Department of Clinical Biochemistry, Teaching
Thomayer's Hospital, Prague, Czech Republic
petr. nencka@ftn.cz
Aim: To asses the dynamics of serum concentrations of procal-
citonine (PCT) in patients with acute non obstructive pyelone-
phritis in comparison with other markers of acute inflammation
(CRP, leucocytes) and to asses the potential use in diagnostics
and therapy.
Material and methods: The prospective study included 20 pa-
tients with clinical symptoms and positive leucocytes in urinary
sediment admitted to our department in the period 5/07-3/08.
Antibiotic monotherapy was dispensed empirically. The levels
of markers at the time of admission, after 24 and 72 hours (h)
were assessed.
Results and discussion: All cases showed good response to the
therapy after 48h in average (3-72). The average level of PCT at
the admission was 0.35 ug/1, after 24h 1.398 ug/1 and after 72h
0.48 ug/1. The average level of CRP was 131.8 mg/1 at the admis-
sion, after 24h 159.1 mg/1 and after 72h 111.9mg/l. The average
level of leucocytes was 14.600/ml at the admission, after 24h
12.600/ml and after 72h 6.800/ml. The elevation of PCT was not
detected in 7 cases (35%) in any of examination performed while
the elevation of other markers was present. The levels of PCT
and CRP culminate in first 24h followed by decrease in 72h. The
level of leucocytes culminates before the therapy starts followed
by decrease in 24 and 72h.
Conclusion: The use of PCT as a universal marker in diagnostics
and therapy of acute pyelonephritis in adults is limited by sig-
nificant number of normal values of PCT detected in our series.
57 Renal axis: Another anatomical factor leading lower
caliceal stone formation
U Karaoglan, B Kupeli, C Acar, S Gurocak, I Bozkirli
Gazi University School ofMedicine, Department ofUrology, Ankara, Turkey
borakupeli@yahoo.com
Aim: To investigate the effect of renal axis on stone formation in
lower caliceal stones(LCS).
Methods: The clinical records of patients with solitary lower
caliceal stones who underwent SWL were reviewed. After
exclusion of patients with hydronephrosis, major renal anatomic
anomalies, non-calcium stones, history of recurrent stone disease
and previous renal surgery, 96 patients were enrolled into the
study. Lower pole infundibulopelvic angle(IPA),infundibular
length(IL),width(IW), pelvicaliceal volume and renal axis of
both the stone bearing and contra lateral normal kidneys were
measured from intravenous pyelography.
Results: The stones were left and right sided in 50 and 46
patients, respectively. The mean renal axis angle of stone-bearing
right kidneys and contra lateral kidneys were 16,04°±4,5° and
19,2°±4,7°, respectively(p=0,002). These values were 18,5°±4,7°
and 17,2°±5,2° for left stone-bearing kidneys and their contra
lateral partners(p=0,15). Lower pole IW(p=0,001) for right
kidneys with LCS and lower pole IPA(p=0,001) for left kidneys
with LCS were statistically different when compared with contra
lateral normal kidneys.
Conclusions: Our study shows that renal axis should also be
taken into account especially for right LCS. More acute renal
axis -perhaps due to the liver on the right side- may behave as an
acute IPA resulting an abnormal urodynamic and morphologic
lower calyx for stone formation especially when combined with
other anatomical or metabolic factors.
58 Stone clearance after shockwave lithotripsy
influenced by renal axis of kidney
B Kupeli, U Karaoglan, C Acar, S Gurocak, I Bozkirli
Cazi University School of Medicine, Department of Urology, Ankara, Turkey
borakupeli@yahoo.com
Aim: To investigate the influence of renal axis on stone clearance
after shockwave lithotripsy (SWL) in solitary lower caliceal
stones(LCS).
Methods: The records of patients with solitary LCS who
underwent SWL were reviewed. After exclusion of patients
with hydronephrosis, major renal anatomic anomalies, non-
calcium stones, history of recurrent stone disease and previous
renal surgery, 96 patients were enrolled into the study. Lower
pole infundibulopelvic angle(IPA), infundibular length(IL),
width(IW), pelvicaliceal volume and renal axis of stone-bearing
kidneys were measured from intravenous pyelography.
Results: The stones were left and right sided in 50 and 46
patients, respectively. Stone-free rate of right LCS was 54,3% and
left LCS was 80%(p=0,007). Lower IPA and IW of left LCS were
significantly more acute and narrow than right LCS(p=0,03,
28 LÆKNAblaðið 2009/95