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Carlier M, Baboudjian M, Govidin L, Yahia M, Chiappini J, Lechevallier E, Boissier R. [Single-use versus reusable flexible ureteroscope: Technical and medico-economic aspects]. Prog Urol 2021; 31:937-942. [PMID: 34456138 DOI: 10.1016/j.purol.2021.08.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 08/12/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Sate of the art on the indications, methods of implementation and medico-economic considerations of reusable flexible ureteroscopes (URSr) vs single use (URSuu)? METHOD Review of the literature (Pubmed) on reusable and single-use ureteroscopes, as well as on the expertise of our center. A PubMed search and narrative review of the data was performed in July 2021. Only articles in French or English were selected. RESULTS The URSr and URSuu have similar technical characteristics and are suitable for the exploration of the upper urinary excretory tract: treatment of stones of the kidney <2cm or of the ureter. The URSr is the most common type of ureteroscope. URSuu are newer and associated with many advantages: no sterilization procedure, immediate availability of equipment in the operating room, reduced waste production at the institutional level. A hybrid use of URSr and URSuu currently seems to be the best compromise from a medico-economic point of view for high volume centers. In the case of a smaller activity or a secondary site, URSuu are more advantageous and the reduction in purchasing costs should accentuate this benefit. CONCLUSION URSr and URSuu are technically similar and allow identical treatment of upper urinary tract pathologies. Their complementary use optimizes the care of urology patients. The barrier to the exclusive use of URSuu remains their cost.
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Fahmy O, Shsm H, Lee C, Khairul-Asri MG. Impact of Preoperative Stenting on the Outcome of Flexible Ureterorenoscopy for Upper Urinary Tract Urolithiasis: A Systematic Review and Meta-Analysis. Urol Int 2021; 106:679-687. [PMID: 34515258 DOI: 10.1159/000518160] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 06/22/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE This study aimed to investigate the effect of preoperative stenting (POS) on the perioperative outcomes of flexible ureterorenoscopy (fURS). MATERIALS AND METHODS A systematic review and meta-analysis was conducted based on the PRISMA statement. From the initially retrieved 609 reports, we excluded the ineligible studies at 2 stages. We only included studies that contained fURS patients with and without POS in the same report. Data of patients who underwent semirigid ureteroscope only were excluded from the analysis. The Newcastle-Ottawa Scale (NOS) system was applied for risk of bias assessment. RESULTS A total of 20 studies including 5,852 patients were involved. 48.5% of the patients had preoperative stent. Stone-free rate was significantly higher with prestenting; odds ratio (OR) was 1.98 (95% CI: 1.51-2.58) (Z = 5.02; p = 0.00001). It also displayed tendency toward lower complications; OR was 0.74 (95% CI: 0.52-1.05) (Z = 1.67; p = 0.09). POS significantly increased the use of ureteral access sheath; OR was 1.49 (95% CI: 1.05-2.13) (Z = 2.22; p = 0.03). Risk of bias assessment showed 13 and 7 studies with low and moderate risk, respectively. CONCLUSIONS POS clearly improves the stone-free rates after fURS. It might reduce the complications, especially ureteral injury. These findings might help solve the current debate and can be useful for urologists during patient counselling for a proper decision-making.
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Can the introduction of single-use flexible ureteroscopes increase the longevity of reusable flexible ureteroscopes at a high volume centre? World J Urol 2021; 40:251-256. [PMID: 34424373 DOI: 10.1007/s00345-021-03808-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 08/04/2021] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVES To assess whether the introduction of single use flexibles ureteroscopes (su-fURS) at our high-volume centre had an advantageous impact on the turn-over and breakage rates of reusable fURS (re-fURS). METHODS We analysed re-fURS number of usages and breakages at our centre between February 2015 and December 2018. We recorded the number of usages for analysed scope between the first usage until a breakage requiring reconditioning. Usage count was restarted following each reconditioning episode. Since su-fURS (Lithovue, Boston Scientific, USA) were introduced at our center in September 2016, we had the chance to compare different re-fURS life cycles according to both su-fURS availability and usage intensity (i.e., number of su-fURS used during each re-fURS life cycle). We then explored the relationship between su-fURS usage intensity and reusable scope survival (i.e., number of utilizations before any breakage requiring reconditioning) using locally weighted scatterplot smoothing (LOWESS) approach. RESULTS Five different re-fURSs were employed at our centre, for a total of 1820 usages and 40 breakages requiring reconditioning. The overall mean (SD) number of usages before breaking was 40 (22). After su-fURS introduction, mean (SD) re-fURS number of usages increased from 35 (22) to 49 (20), (+ 40%, p = 0.02). The relationship between su-fURS usage intensity and reusable scopes survival showed a linear survival increase after 10 or more su-fURS scopes were used per life cycle. CONCLUSIONS The life cycle of re-fURS increased by 40% after the introduction of su-fURS. Ten or more used su-fURS per life cycle were associated with increased re-fURS survival.
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A randomized prospective study: assessment of transient ureteral stenting by mono-J insertion after primary URS and stone extraction (FaST 3). Urolithiasis 2021; 49:599-606. [PMID: 34146117 PMCID: PMC8560672 DOI: 10.1007/s00240-021-01277-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 05/24/2021] [Indexed: 10/28/2022]
Abstract
To compare the outcome of a short-term insertion of a mono-J catheter for 6 h following ureteroscopic stone removal to a conventional double-J catheter. This single-center academic study (Fast Track Stent study 3) evaluated stenting in 108 patients with urinary calculi after ureterorenoscopy. Patients were prospectively randomized into two study arms before primary ureterorenoscopy: (1) mono-J insertion for 6 h after ureterorenoscopy and (2) double-J insertion for 3-5 days after ureterorenoscopy. Study endpoints were stent-related symptoms assessed by an ureteral stent symptom questionnaire (USSQ) and reintervention rates. Stone sizes and location, age, operation duration, BMI, and gender were recorded. Of 67 patients undergoing ureterorenoscopy, 36 patients were analyzed in the double-J arm and 31 patients in the mono-J arm. Mean operation time was 27.5 ± 1.3 min versus 24.0 ± 1.3 min, and stone size was 5.2 mm versus 4.5 mm for mono-J versus double-J, respectively (p = 0.06 and p = 0.15). FaST 3 was terminated early due to a high reintervention rate of 35.5% for the mono-J group and 16.7% for the double-J group (p = 0.27). One day after ureterorenoscopy, USSQ scores were similar between the study arms (Urinary Index: p = 0.09; Pain Index: p = 0.67). However, after 3-5 weeks, the Pain Index was significantly lower in those patients who had a double-J inserted after ureterorenoscopy (p = 0.04). Short-term insertion of mono-J post-ureterorenoscopy results in similar micturition symptoms and pain one day after ureterorenoscopy compared to double-J insertion. The reintervention rate was non-significant between the treatment groups most likely due to the early termination of the study (p = 0.27). Ethics approval/Trail Registration: No. 18-6435, 2018.
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Çakıcı MÇ, Kazan Ö, Çiçek M, İplikçi A, Yıldırım A, Atış G. Predictive risk factors of urinary tract infection following flexible ureteroscopic lithotripsy. ARCH ESP UROL 2021; 74:503-510. [PMID: 34080570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVES The goal of current study was to evaluate prevalence of postoperative urinary tract infections (UTI) following flexible ureteroscopy (f-URS) and to determine predictive factors for those UTIs. METHODS A total of 420 patients with urolithiasis that underwent f-URS between August 2018 and August 2019 were enrolled in the study. Peri-operative characteristics of patients with and without postoperative UTIs were compared using univariate analyses. Predictive factors for UTIs following f-URS were determined using multivariate logistic regression analysis. RESULTS Forty-one (9.8%) out of 420 patients had postoperative urinary infection after f-URS and those patients were classified as group 1. Group 2 consisted of 379 patients that did not develop postoperative UTIs. The percentage of female gender was 58.5% vs 42% in groups 1 and 2, respectively (p=0.042). The preoperative UTI history rate was 51.2% vs 20.8% (p<0.001) and preoperative double J stent (DJS) insertion rate 39% vs 17.7% in groups 1 and 2, respectively (p=0.001). Univariate regression analyses showed that the female gender (OR=1.98), history of UTI (OR=3.99), and preoperative DJS insertion (OR=2.98) significantly increased the possibility of postoperative UTI (p<0.05). Multivariate regression analyses revealed that history of UTI (OR=3.41, 95%CI:1.73-6.72, p<0.001) and preoperative DJS insertion (OR=2.30, 95%CI:1.13-4.68, p=0.021) were independent risk factors for infectious complications following f-URS. If both factors are present, the probability of infection is 55.2%. CONCLUSIONS Even if f-URS is considered a safe procedure, the risk of postoperative infectious complications is far from negligible. We found that the presence of UTI history and preoperative DJS were independent risk factors for UTI after f-URS.
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Chang X, Wang Y, Li J, Han Z. Prestenting Versus Nonprestenting on the Outcomes of Flexible Ureteroscopy for Large Upper Urinary Stones: A Systematic Review and Meta-Analysis. Urol Int 2021; 105:560-567. [PMID: 33857952 DOI: 10.1159/000506652] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 02/18/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The purpose of this article is to evaluate the efficacy and safety of prestenting (PS) versus non-PS (NPS) of flexible ureteroscopy (fURS) to treat large upper urinary stones. METHODS We conducted a systematic literature research of PubMed, Ovid, Scopus (up to August 2019), and citation lists to identify eligible studies. All studies comparing PS versus NPS of fURS were included. Data were analyzed using the Cochrane Collaboration's Review Manager (RevMan) 5.3 software. RESULTS Overall, 7 studies including 3,145 patients (PS 1,408; NPS 1,737) were included in this article. PS group was associated with older age (weighted mean difference [WMD] 0.91 year; p < 0.001) and more male patients (odds ratio [OR] 1.34; p < 0.001). There were no statistical differences between PS and NPS in BMI (WMD 0.34 kg/m2; p = 0.13), stone size (WMD 0.13 mm; p = 0.77), and operative time (WMD 0.44 min; p = 0.86). Compared with NPS, PS showed better initial success rate (OR 4.04; p < 0.001) and higher SFR (OR 1.64; p < 0.001). There were no statistical differences for complications (OR 0.84; p = 0.42) and Clavien-Dindo score ≥3 complications (OR 1.04; p = 0.93). CONCLUSION PS could improve initial success rate and avoid secondary general anesthesia for first ureteral access sheath failed patients. PS could provide better SFR than NPS in the treatment of large upper urinary stones with fURS.
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Wen CY, Lin JT, Yu CC, Kuo WT. Ex vivo removal of the lower calyceal stone in a living donor via flexible ureteroscopy. Asian J Surg 2021; 44:775. [PMID: 33781682 DOI: 10.1016/j.asjsur.2021.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 02/21/2021] [Indexed: 11/15/2022] Open
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Barghouthy Y, Wiseman O, Ventimiglia E, Letendre J, Cloutier J, Daudon M, Kleinclauss F, Doizi S, Corrales M, Traxer O. Silicone-hydrocoated ureteral stents encrustation and biofilm formation after 3-week dwell time: results of a prospective randomized multicenter clinical study. World J Urol 2021; 39:3623-3629. [PMID: 33688992 DOI: 10.1007/s00345-021-03646-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 02/19/2021] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE To explore the risk of encrustation and biofilm formation for silicone ureteral stents compared to percuflex polymer stents, through a randomized multicenter study. PATIENTS AND METHODS Design, setting and participants: A Multicenter, prospective, randomized, single blind, comparative study of hydrocoated silicone stent (Coloplast Imajin® hydro) versus Percuflex™ Plus stent (Boston Scientific), in 141 patients treated by flexible URS for a kidney stone. The study had ethical committee approval in the respective hospitals. Outcome measurements and statistical analysis: Endpoints related to encrustation were biofilm formation and mineral encrustation after a period of 3-week indwelling time. They were evaluated at removal through a scoring scale of ureteral stents encrustation, infrared spectroscopy and optical microscopy of inner and outer surfaces of tips, angles and along the stent's body. Comparison was performed using ANOVA. RESULTS 119 stents were available after removal for analysis, 56 in the silicone and 63 in the Percuflex TM Plus group. Mean dwelling duration was 21.8 days for silicone, 22.1 days for PercuflexTM Plus. There was significantly more biofilm on Percuflex™ Plus compared to silicone (1.24 ± 0.08 vs 0.93 ± 0.09, p = 0.0021), and more mineral encrustation (1.22 ± 0.10 vs 0.78 ± 0.11, p = 0.0048), respectively. CONCLUSIONS This multicenter randomized study shows that silicone-hydrocoated stents are less prone to encrustation than PercuflexTM Plus after a 3-week dwelling period and confirms the low encrustation potential of silicone.
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Kirecci SL, Ilgi M, Yesildal C, Yavuzsan AH, Albayrak AT, Sarica K. The impact of the pelvicalyceal anatomy characteristics on the prediction of flexible ureteroscopy outcomes. Urol Ann 2021; 13:105-110. [PMID: 34194134 PMCID: PMC8210722 DOI: 10.4103/ua.ua_19_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 09/16/2020] [Indexed: 11/04/2022] Open
Abstract
Background The anatomical architecture is a prominent factor in the outcomes of flexible ureteroscopy (FURS). Aims and Objectives The aim to regard the success of procedures based on Pelvicalyceal body that called Sampaio classification system. Materials and Methods A total of 125 FURS procedures were reviewed between December 2012 and December 2016 in our department. Seven patients were excluded from the study due to the horseshoe kidney in two cases and recurrent cystine stone configuration in five patients. The patient's renal collecting system anatomy characteristics are regarded, and they are classified into four main groups based on the mid-renal-zone anatomy assessed according to Sampaio Classification. Results Total stone-free rate (SFR) during the postoperative 1st-month evaluation was noncontrast computerized tomography 75 (63.6%). The evaluation of the SFR in all subgroup of cases based on Sampaio classification noticed easily, SFR was significantly lower in subgroup A2 (30.4%) (P = 0.00), significantly higher in subgroup B2 (P = 0.008). The comparative analysis of the operative duration defined that it was the shortest (75.3 ± 18.1 min) in Type B1 subgroup cases, and the longest (84.7 ± 25.7 min) in the Type A2 subgroup cases. Even though this duration was found to be relatively higher in Type A2 subgroup cases than the others, this difference was not statistically significant (P = 0.271). Fluoroscopy time was noted to be the shortest (11.9 ± 13.4 s) in B1 subgroup and the longest in A2 subgroup with a statistically significant different (median: 21.3 ± 30.4) (P = 0.04). While 6 (5.1%) cases had Clavien 2 and 3 (2.5%) cases, demonstrated Clavien 3a complications. Conclusion The calyceal structure of the kidney affects the SFR; therefore, a detailed classification of pelvicalyceal could improve the outcomes, decrease the rate of auxiliary procedures and prevent the complications.
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Adan MM, Yan M, Xiang W, Dai Y. A combination of laparoscopic ureteroplasty and flexible uteroscopic lithotripsy in the treatment of circumcaval ureter and right renal calculi: A case report. Urol Case Rep 2021; 37:101609. [PMID: 33665130 PMCID: PMC7907231 DOI: 10.1016/j.eucr.2021.101609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/08/2021] [Accepted: 02/13/2021] [Indexed: 12/01/2022] Open
Abstract
Patients with circumcaval ureter and right renal calculi are not often seen in the clinical practice and require special approach. Hereby we report a case of a 34-year-old male that was diagnosed with circumcaval ureter complicated by right kidney stones. Laparoscopic ureteroplasty and flexible ureteroscopic lithotripsy were implemented in the treatment of both of these entities. A combination of these approaches allowed us to perform the surgery effectively, efficiently and safely without having to do the second one.
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Ozimek T, Hochguertel L, Hupe MC, Struck JP, Wiessmeyer JR, Gilbert N, Merseburger AS, Kramer MW. Risk Factors for a Complicated Postoperative Course in Flexible Ureteroscopy. Urol Int 2021; 105:611-618. [PMID: 33596569 DOI: 10.1159/000512892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 11/04/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The goal was to determine risk factors for Clavien-Dindo (CD) grade ≥2 complications, with special focus on early postoperative systemic inflammatory response syndrome (SIRS), for flexible ureteroscopy (fURS). MATERIALS AND METHODS A retrospective monocentric statistical analysis relating to 32 factors was performed with the χ2 test, Mann-Whitney U tests, and multivariate logistic regression. RESULTS In total, 416 consecutive fURS performed between September 2013 and June 2017 were analyzed; 283 (68.03%) of these were for stone surgery and 133 (31.97%) for diagnostic purposes. In 43 cases (10.34%), CD ≥2 occurred; 31 cases (72.09%) of these were SIRS. On multivariate logistic regression, positive preoperative urine culture and steep pyelographic and CT-based infundibulopelvic angle (IPA) have been confirmed as independent risk factors for both CD ≥2 and SIRS. Greater maximal median stone diameter and female gender were significantly associated only with a higher CD ≥2 prevalence, but not with SIRS. The influence of ureteral access sheath (UAS) on CD ≥ 2 or SIRS occurrence could not be confirmed on multivariate analysis. Perioperative antibiotic prophylaxis for patients with negative urine culture showed no difference regarding SIRS prevalence. CONCLUSION Steep CT-based IPA can be considered as a new radiologic predictor of complicated postoperative course and SIRS. The role of UAS as well as indications for perioperative antibiotic prophylaxis should be determined in prospective studies.
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Stone size on endoscopic view as a predictor of successful stone retrieval during flexible ureteroscopy: an in vitro analysis. World J Urol 2021; 39:3587-3591. [PMID: 33512571 DOI: 10.1007/s00345-021-03593-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 01/08/2021] [Indexed: 10/22/2022] Open
Abstract
PURPOSE Basketing plays an important role during flexible ureteroscopy, but it can be time-consuming, especially when fragments are too large to pass through the ureteral access sheath. We aim to present the optimal on-screen, endoscopic stone size that predicts successful basketing through various access sheaths. METHODS A tipless basket, individually extended to 5 mm from multiple ureteroscopes: (Flex-Xc, Karl Storz; Flex-X2s, Karl Storz; LithoVue, Boston Scientific; or URF-P6R, Olympus) and via differently sized access sheaths (10-12 Fr through 13-15 Fr), was used in retrieval attempts of various artificial stone sizes (2 mm through 5 mm). A relative endoscopic stone size was recorded as the stone's maximum diameter on endoscopic view compared to the total image diameter. RESULTS Basketing of stones up to 2.5 mm, yielding relative endoscopic stone sizes of 0.38 (Flex-Xc), 0.30 (Flex-X2s), 0.32 (LithoVue), and 0.34 (URF-P6R), was successful using all access sheaths. Only the 12-14 Fr and greater sheaths allowed for successful basketing of 3 mm stones. Larger stones did not successfully pass through any of the access sheaths. CONCLUSION Successful stone retrieval can be predicted by estimating the stone's size on screen, which is influenced by the type of flexible ureteroscope and access sheath. In our testing, stones of approximately one-third of the screen size passed successfully in all cases.
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Inoue T, Okada S, Hamamoto S, Fujisawa M. Retrograde intrarenal surgery: Past, present, and future. Investig Clin Urol 2021; 62:121-135. [PMID: 33660439 PMCID: PMC7940851 DOI: 10.4111/icu.20200526] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/09/2020] [Accepted: 12/10/2020] [Indexed: 12/18/2022] Open
Abstract
With the recent technological advancements in endourology, retrograde intrarenal surgery has become a more popular procedure for treatment of urolithiasis. Furthermore, since the introduction of new laser systems and advanced flexible ureteroscopy with miniaturized ureteroscopes, the treatment indications for retrograde intrarenal surgery have expanded to include not only larger renal stones of >2 cm but also upper urinary tract urothelial carcinoma, ureteral stricture, and idiopathic renal hematuria. Clinicians must keep up with these trends and make good use of these technologies in the rapidly changing field of endourology. Simultaneously, we must consider the risk of various complications including thermal injury due to laser use, ureteral injury caused by the ureteral access sheath, and radiation exposure during retrograde intrarenal surgery with fluoroscopic guidance. This review focuses on the past, present, and future of retrograde intrarenal surgery and provides many topics and clinical options for urologists to consider.
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Wang T, Chen X, Qu H. Economical and efficient autonomous ureteroscopic irrigation systems. Asian J Surg 2020; 44:409-411. [PMID: 33176969 DOI: 10.1016/j.asjsur.2020.10.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 10/18/2020] [Indexed: 11/30/2022] Open
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Ventimiglia E, Sindhubodee S, Besombes T, Pauchard F, Quadrini F, Delbarre B, Jiménez Godínez A, Barghouthy Y, Corrales Acosta MA, Kamkoum H, Villa L, Doizi S, Somani BK, Traxer O. Operator-assisted vs self-achieved basketing during ureteroscopy: results from an in vitro preference study. World J Urol 2020; 39:2169-2175. [PMID: 33025141 DOI: 10.1007/s00345-020-03431-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 08/30/2020] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES A recently introduced device (LithoVue Empower™ or LE, Boston Scientifics, USA) allows the surgeon to directly control the stone-retrieving basket without the need of an assistant during flexible ureteroscopy. We aimed to evaluate the stone-retrieval performance of this device. METHODS We used a bench-training model for flexible ureteroscopy, the Key-box (K-Box®, Porgès-Coloplast, France), to compare the LE configured with a 1.9F stone-retrieval tipless basket (ZeroTip™, Boston Scientific, USA) and a traditional assistant-maneuvered 1.9F stone-retrieval tipless basket. Seven experienced endo-urologists and seven residents-in-training retrieved a fake stone from three different renal cavities of the K-Box with increasing access complexity first with the traditional basket and then with the LE device. We recorded retrieval time and all the operators filled in the NASA Task Load Index (TLI) for the self-evaluation of their performance. We then compared the use of LE in terms of retrieval time, failure rates, and NASA-TLI scores. RESULTS Stone retrieval times and failure rates were similar according to the retrieval technique, although residents had non-statistically significant shorter times with the LE. NASA-TLI scores revealed lower frustration (p = 0.03) when LE was used by experienced urologists as compared to the traditional basketing. When stratifying the analyses according to surgical experience, fully trained urologists performed faster stone retrieval and showed lower effort scores than residents-in-training (p < 0.05). CONCLUSIONS The individually controlled retrieval system is an effective device assisting stone retrieval and does not necessitate specific training among experienced endo-urologists. Young residents might benefit from LE during their learning curve.
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Emiliani E, Piccirilli A, Cepeda-Delgado M, Kanashiro AK, Mantilla D, Amaya CA, Sanchez-Martin FM, Millan-Rodriguez F, Territo A, Amón-Sesmero JH, Palou-Redorta J, Angerri-Feu O. Flexible ureteroscopy in extreme elderly patients (80 years of age and older) is feasible and safe. World J Urol 2020; 39:2703-2708. [PMID: 32960326 DOI: 10.1007/s00345-020-03448-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 09/05/2020] [Indexed: 01/16/2023] Open
Abstract
PURPOSE To compare the safety and efficacy of RIRS in patients ≥ 80 years to a younger population. METHODS We retrospectively compared the data from patients ≥ 80 years of age undergoing RIRS with the data of a group of patients from 18 and < 80 years. Perioperative outcomes, complications and emergency department visits were compared between two groups. RESULTS A total of 173 patients were included in the study. Mean age was 44 (27-79) and 81 years-old (80-94), for younger and elderly group, respectively. Elderly patients had higher ASA scores (≥ 3) (28.6% vs 75.8%; p = 0.0001) and Charlson comorbidity index (1.99 vs 7.86; p = 0.0001), more diabetes (p = 0.006) and respiratory comorbidities (p = 0.002). No statistical difference was found between two groups in stone size (p = 0.614) and number (p = 0.152). Operative time (74.48 vs 102.96 min; p = 0.0001) and duration of hospitalisation (1.7 vs 2.9 days; p = 0.001) were longer for the elderly. Intraoperative complication rate did not show differences between the two groups (p = 0.166). Postoperative complications rates were similar between the cohorts (7.7% vs 9.5%; p = 0.682). The success rates were 67.5% in the younger group and 71.4% in the elderly group (p = 0.584). No difference was seen in stone recurrence (p = 0.73). A higher rate of visits to the emergency department was found in younger cohort (23.6% vs 11.6%; p = 0.046), mostly duo to stent-related symptoms. CONCLUSIONS Despite the higher rate of comorbidity in the elderly group, RIRS was a safe procedure with similar complication rate and outcomes at an expense of higher operative time and hospital stay.
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Pan Y, Chen G, Chen H, Zhu Y, Chen H. The left ureterocele and stone of calyceal diverticulum in the patient with bilateral incomplete duplex kidneys managed by flexible ureteroscopy: a case report and literature review. BMC Urol 2020; 20:35. [PMID: 32228555 PMCID: PMC7106577 DOI: 10.1186/s12894-020-00604-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 03/23/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Duplex kidneys are one of the most common renal congenital abnormalities, mostly asymptomatic and of no clinical significance. There are little reports about the left ureterocele and stone of calyceal diverticulum in patients with bilateral incomplete duplex kidneys managed by flexible ureteroscopy. CASE PRESENTATION A 69-year-old Chinese woman was presented with left waist pain for 1 month. A preoperative computed tomography (CT) scan and intravenous pyelogram revealed the left ureterocele which located in the left ureterovesical junction, and stone of calyceal diverticulum which located in the upper kidney of left incomplete duplex kidneys. The ureterocele was confirmed in view of ureteroscopy and the holmium laser was used for the resection of ureterocele. It took us a lot of efforts to find out the stone because of diverticular neck stenosis. Fortunately, when diverticular neck stenosis was incised internally by holmium laser, the stone was discovered clearly and removed using the holmium laser and nitinol stone basket through flexible ureteroscopy. A double-J ureteral stent was inserted and remained in place for 1 month. The symptom disappeared postoperatively and no complications were developed during the placement of the stent. There were no stone residents observed on CT scan before removing the ureteral stent 1 month later. CONCLUSIONS Flexible ureteroscopy with holmium laser is feasible to manage the ureterocele and calyceal diverticulum stones in patients with bilateral incomplete duplex kidneys in one operation.
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Radiation exposure during retrograde intrarenal surgery (RIRS): a prospective multicenter evaluation. World J Urol 2020; 39:217-224. [PMID: 32200411 PMCID: PMC7858553 DOI: 10.1007/s00345-020-03160-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 03/06/2020] [Indexed: 12/29/2022] Open
Abstract
Purpose Retrograde intrarenal surgery (RIRS) may require extensive X-ray usage. We evaluated the impact of preoperative surgeon briefing regarding the inclusion and evaluation of fluoroscopy time (FT) and dose area product (DAP) in a multicenter study on the applied X-ray usage. Methods A prospective multicenter study of 6 tertiary centers was performed. Each center recruited up to 25 prospective patients with renal stones of any size for RIRS. Prior to study´s onset, all surgeons were briefed about hazards of radiation and on strategies to avoid high doses in RIRS. Prospective procedures were compared to past procedures, as baseline data. FT was defined as the primary outcome. Secondary parameters were stone-free rate (SFR), complications according to the Clavien, SATAVA and postureteroscopic lesion scale. Results were analyzed using T test, chi-squared test, univariate analysis and confirmed in a multivariate regression model. Results 303 patients were included (145 retro- and 158 prospective). Mean FT and DAP were reduced from 130.8 s/565.8 to 77.4 s/357.8 (p < 0.05). SFR was improved from 85.5% to 93% (p < 0.05). Complications did not vary significantly. Neither stone position (p = 0.569), prestenting (p = 0.419), nor surgeons’ experience (> 100 RIRS) had a significant impact on FT. Significant univariate parameters were confirmed in a multivariate model, revealing X-ray training to be radiation protective (OR − 44, p = 0.001). Conclusions Increased surgeon awareness of X-ray exposure risks has a significant impact on FT and DAP. This “awareness effect” is a simple method to reduce radiation exposure for the patient and OR staff without the procedures´ outcome and safety being affected.
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Xu C, Song R, Lu P, Jiang M, Zeng G, Zhang W. A retrospective study comparing super-mini percutaneous nephrolithotomy and flexible ureteroscopy for the treatment of 20-30 mm renal stones in obese patients. PeerJ 2020; 8:e8532. [PMID: 32095357 PMCID: PMC7017787 DOI: 10.7717/peerj.8532] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 01/07/2020] [Indexed: 12/23/2022] Open
Abstract
Objective This study aimed to compare the efficacy and safety of Super-mini percutaneous nephrolithotomy (SMP) and flexible ureteroscopy (F-URS) in the treatment of 20–30 mm renal stones in obese patients. Methods We conducted a retrospective analysis of outcomes of patients who underwent SMP and F-URS to treat 20–30 mm renal stones from August 2017 to September 2018. Patients with BMI >30 kg/m2 were enrolled into this study. Forty-eight patients underwent SMP, while 104 patients underwent F-URS by the same surgeon. The patients’ demographic data, stone characteristics, perioperative parameters and outcomes, complications, stone-free rate (SFR) and overall costs were retrospectively assessed. Results No significant differences were found between the two groups in terms of age, gender, BMI, operation side, stone size, number, locations, stone compositions and CT value. The mean operation time was significantly shorter in the SMP group (p < 0.001), while the F-URS group had significantly shorter postoperative stays (p < 0.001) and lower complication rates (p < 0.001). Both groups had similar SFR at a 3-month follow-up (p = 0.190), while the SMP group achieved significant higher SFR 3 days after the operation (p < 0.001). The SMP group had a significantly lower overall cost and fewer stage-2 procedures than the F-URS group. Conclusion SMP and F-URS are equally effective in obese patients with 20–30 mm renal stones. However, F-URS offers the advantage of a lower complication rate, while SMP performed better in terms of operation time, tubeless rate, stage-2 procedures and overall costs.
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Alhunaidi O, Ahmad AA, El-Nahas AR, Akroof B, Alamiri A, Al-Ajrawi F, Al-Terki A, El-Shazly M. Impact of case volume per year on flexible Ureteroscopy practice: an internet based survey. BMC Urol 2019; 19:134. [PMID: 31852477 PMCID: PMC6921597 DOI: 10.1186/s12894-019-0568-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 12/12/2019] [Indexed: 11/20/2022] Open
Abstract
Background To report current worldwide variation in techniques and clinical practice of flexible ureteroscopy (FURS) among endourologists of different case volumes per year. Methods Two invitations to complete an internet survey were emailed to Endourological Society members. Some of survey questions asked about indications of using FURS for renal and upper ureteral stones. Others were concerned with clinical practice of FURS (such as preoperative stenting, use of ureteral access sheath (UAS) and safety guidewire, technique of Laser lithotripsy and fragment retrieval, and post-FURS stenting. Responders were distributed into two groups; high-volume (> 100 cases/year) and low-volume surgeons (< 100 cases/year) and data were compared between both groups. Results Responses were received from 146 endourologists all over the world (62 high-volume and 84 low-volume). FURS for intrarenal stone > 20 mm was used by 61% of high-volume surgeons compared with 28.6% for low-volume (P < 0.001). Semirigid URS was used for upper ureteric stones in 68% among high-volume group and 82% in low-volume group (P = 0.044). UAS was used by 62% in low-volume group and 69% in high volume group (P = 0.516). Laser stone dusting was preferred by 63% in low-volume group versus 45% by high-volume (P = 0.031). More responders in low-volume group preferred to leave the stent for 6 weeks (P = 0.042). Conclusions The use of FURS for treating upper tract calculi has expanded by high volume endourologists to include large renal stones > 20 mm. Low-volume surgeons prefer to use semi-rigid URS for treatment of upper ureteral stones, to apply Laser stone dusting and maintain ureteral stents for longer periods.
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Future of kidney stone surgery: will we treat small stones with large-sized PCNL and big stones with RIRS? World J Urol 2019; 38:3291-3292. [PMID: 31628511 DOI: 10.1007/s00345-019-02983-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 10/04/2019] [Indexed: 10/25/2022] Open
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Hosny K, Clark J, Srirangam SJ. Handling and protecting your flexible ureteroscope: how to maximise scope usage. Transl Androl Urol 2019; 8:S426-S435. [PMID: 31656748 DOI: 10.21037/tau.2019.07.08] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Flexible ureteroscopy is an important therapeutic and diagnostic procedure and has seen rapid rise in its utilisation in recent years. There have been numerous developments in flexible ureteroscope (fURS) technology but scope fragility, and the associated high maintenance costs, remains a concern. A comprehensive Medline search for related publications from the last 20 years was undertaken to identify common causes of fURS damage and ascertain practices to minimise this. Flexible ureteroscopy can be due to intraoperative causes (loss of the deflection mechanism, damage to the working channel due and fibreoptic bundle injury) and non-operative damage which occur during cleaning, sterilisation and handling of the fURS. The review summarises the available literature to help highlight common mechanisms of scope damage, and outlines evidence-based measures to reduce the risk of damage and maximise durability. Scope fragility remains a problem with significant associated cost implications. In a culture of rising fURS use and reducing re-imbursement for endourologists, prolonging the longevity of the fURS is imperative for maintaining profitability. There are simple and inexpensive practices which can be immediately adopted to maximise fURS use and reduce the need for repairs.
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Wilhelm K, Hahn O, Schoenthaler M, Hein S, Neubauer J, Schnabel M, Neisius A. Stone-Free Rate after Treating Kidney Stones Exceeding 10 mm via Flexible Ureteroscopy: Can Endoscopic Assessment Replace Low-Dose Computed Tomography Control? Urol Int 2019; 103:326-330. [PMID: 31394535 DOI: 10.1159/000502264] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 07/21/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION It is unclear whether endoscopic assessment of the stone-free rate after flexible ureteroscopy (fURS) is as effective as assessment with low-dose computed tomography (CT) scan. METHODS Prospective documentation of patients with kidney stones > 10 mm diameter from 2 different centers (Freiburg, Regensburg), who underwent fURS and were declared to be endoscopically completely stone-free. Low-dose CT control performed 4-8 weeks postoperatively. RESULTS/CONCLUSION Thirty-eight patients were treated between October 2015 and August 2016 (12 F, 26 M). Average age was 55.9 years (range 19-82, SD 17.24), and body mass index was 29.7 kg/m2 (range 23.5-42.5, SD 4.37). There were 2.0 (range 1-7, SD 1.55) stones with a mean diameter of 15 mm (range 10-40, SD 6.78) per kidney. Mean surgery time was 74 min (range 38-124, SD 24.28), and lithotripsy was necessary in 33 cases. CT was performed 5.4 weeks afterwards (range 4-8, SD 1.43). One patient had a 2 mm residual which was extracted by URS. Strictly speaking, endoluminal stone removal control failed in only that patient, yielding a negative predictive value of 97%. A routine postoperative CT scan would thus appear unnecessary in the case of negative endoscopic control for residual fragments and should be avoided to reduce radiation exposure. Further investigations with larger patient populations are necessary.
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Karim SS, Hanna L, Geraghty R, Somani BK. Role of pelvicalyceal anatomy in the outcomes of retrograde intrarenal surgery (RIRS) for lower pole stones: outcomes with a systematic review of literature. Urolithiasis 2019; 48:263-270. [PMID: 31372691 PMCID: PMC7220875 DOI: 10.1007/s00240-019-01150-0] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 07/25/2019] [Indexed: 02/07/2023]
Abstract
Controversies exist on the influence of lower pole anatomy (infundibular pelvic angle, IPA; infundibular length, IL; and infundibular width, IW) for success and outcomes related to the treatment of stones in the lower pole. We wanted to look at the role of lower pole anatomy to study clinical outcomes in patients treated for isolated lower pole stones (LPS) using retrograde intra renal surgery (RIRS), and also perform a review to look at the published literature on the influence of pelvicalyceal anatomy on success with RIRS. Data were prospectively collected (June 2013-June 2016) for all patients who underwent RIRS for LPS, and the imaging was then retrospectively reviewed to calculate the IPA, IL and IW using the Elbahnasy method. A systematic review was also conducted for all English language articles between January 2000 and April 2018, reporting on the impact of pelvicaliceal anatomy on RIRS. A total of 108 patients with LPS were included with a male to female ratio of 2:3 and a mean age of 54.7 years. The mean lower pole stone size was 9.3 mm (range 3-29 mm) and 102/108 (94.4%) patients were stone free (SF) at the end of their procedure. While steep IPA (< 30°), operative time duration and larger stone size were significant predictors of failure, the placement of ureteric access sheath, IW and IL did not influence treatment outcomes. Six studies (460 patients) met the inclusion criteria for our review. The IPA, IW, IL for failure ranged from 26° to 38°, 5.5-7 mm and 24-34 mm, respectively. The SFR ranged from 78 to 88% with a metaanalysis showing IPA as the most important predictor of treatment outcomes for LPS. Infundibular pelvic angle seems to be the most important predictor for the treatment of LPS using RIRS. Pelvicalyceal anatomy in conjunction with stone size and hardness seem to dictate the success, and decisions on the type of surgical interventions should reflect this.
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Al-Balushi K, Martin N, Loubon H, Baboudjian M, Michel F, Sichez PC, Martin T, Di-Crocco E, Gaillet S, Delaporte V, Akiki A, Faure A, Karsenty G, Lechevallier E, Boissier R. Comparative medico-economic study of reusable vs. single-use flexible ureteroscopes. Int Urol Nephrol 2019; 51:1735-1741. [PMID: 31317310 DOI: 10.1007/s11255-019-02230-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 07/08/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE Reusable flexible-ureteroscopes (fURS) require personnel and budget for processing and repairing, whereas single-use fURS were recently developed. After exclusive reusable fURS since 2011, we experienced high repair costs and single-use fURS were therefore introduced in mid-2017. We aimed to evaluate economic and practical advantages and disadvantages of reusable versus single-use fURS. MATERIALS AND METHODS First, we evaluated the incidence of breakage and repairs of reusable fURS in 2017. We assessed the overall operational costs of reusable fURS including purchase, processing, and repairing in our institution from 2011 to 2017. Following our experience, we created a model to compare operation costs/procedure of single-use fURS with reusable fURS depending on repair costs. RESULTS In 2017, repair costs of reusable fURS increased by 345% compared with the period 2011-2016, causing: a median unavailability per reusable fURS of 200 days/year (100-249), median number of functioning fURS 0/5-3/5 per operating day, while unavailability of reusable fURS had become the first reason for cancellation of procedure. Since it was introduced, single-use fURS accounted for 59% of the flexible ureteroscopy activity. Taking into account the costs of processing, maintenance and repair, in 2011-2016 versus 2017, the single-use fURS was cost-effective compared with the reusable fURS until the 22nd procedure versus the 73rd procedure, respectively. CONCLUSIONS After years of exclusive reusable fURS, the rising incidence of breakage not only increased maintenance costs but also hampered daily activity owing to unavailability of the devices. The introduction of single-use with reusable fURS provided substantial help to maintain our activity.
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Nora A, Omar A, Abdullah A, Emre ST, Saeed BH. An unusual retained object post laser flexible ureteroscopy (retained broken tip of disposable ureteroscope). Urol Case Rep 2019; 24:100855. [PMID: 31211066 PMCID: PMC6562288 DOI: 10.1016/j.eucr.2019.100855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 01/27/2019] [Accepted: 02/19/2019] [Indexed: 10/27/2022] Open
Abstract
Flexible Ureterorenoscopy (F-URS) has dramatically changed the era of Renal stone management. One of its rare complications is retained objects. Some reports, described accidental breakage is reusable ureteroscope. Here we present 36-year-old male patient who underwent to F-URS in another institute March 2018. Four months later presented to our hospital with right flank pain. Renal Us showed mild hydronephrosis associated with 13 mm renal stones. Patient underwent F-URS, when we found the broken tip of disposable ureteroscope retained from the first operation. Urologist should always pay careful attention to the flexible ureteroscpe to check for any sign of breakage before and after the procedure.
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[The basis of endoscopic stones recognition, a prospective monocentric study]. Prog Urol 2019; 29:312-317. [PMID: 31151916 DOI: 10.1016/j.purol.2019.04.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 03/03/2019] [Accepted: 04/18/2019] [Indexed: 11/21/2022]
Abstract
INTRODUCTION To evaluate by junior urologists the morphology of urinary stone using visual endoscopic recognition after expert teaching. Material From December 2017 to May 2018, surface and section stone pictures extracted from digital ureteroscopy had been submitted to description and recognition. Participants could take benefit from an expert coaching. Each stone was evaluated by a different coherence questionnaire (score 1-5). RESULTS Nine stones had been analyzed by 15 junior urologists. Mean score was initially 1.94/4 and then from 2.07 to 4.07/5 during the study. A perfect stone recognition and a matching etiological lithiasis research had been observed in 40.7% and 55.6% of cases respectively. CONCLUSION This first teaching experience of the urinary stone morphological endoscopic typing confirms the possibility to train urologists to gain this specific initial skill. Thereby, they could play a more important role in the etiological and diagnostic lithiasis research.
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Abstract
PURPOSE OF REVIEW The link between metabolic syndrome (MetS)/obesity and kidney stone disease (KSD) has gained importance over recent years due to the increasing prevalence and healthcare burden worldwide. This review analyses the literature exploring the link between MetS/obesity and KSD and the impact that obesity has on KSD management. RECENT FINDINGS Metabolic syndrome has been shown to increase an individual's risk of developing kidney stone disease, with insulin resistance forming a core component of the pathophysiology. The body habitus of an individual also influences the type of intervention that is most appropriate, with flexible ureteroscopy increasingly being the preferred option in obese patients. It is important for urologists to consider the features of metabolic syndrome to effectively manage episodes of KSD in obese patients. In addition, better quality evidence is required to effectively compare different treatment options in this group of patients.
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El-Nahas AR, Almousawi S, Alqattan Y, Alqadri IM, Al-Shaiji TF, Al-Terki A. Dusting versus fragmentation for renal stones during flexible ureteroscopy. Arab J Urol 2019; 17:138-142. [PMID: 31285926 PMCID: PMC6600060 DOI: 10.1080/2090598x.2019.1601002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2018] [Indexed: 12/23/2022] Open
Abstract
Objectives: To compare stone dusting and spontaneous passage vs fragmentation and active fragment retrieval during flexible ureteroscopy (fURS) for renal calculi. Patients and methods: The study included patients who underwent fURS and holmium laser lithotripsy for renal calculi from January 2015 to March 2017. Dusting was done using low energy and high frequency (0.3–0.5 J and 15–20 Hz, respectively), and fragmentation was done with higher energy and lower frequency (1–1.2 J and 6–10 Hz, respectively) and then stone fragments were extracted using a basket. The stone-free rate (SFR) was evaluated after 2 months with non-contrast computed tomography. Operative time, complication rate, SFR, and the need for secondary procedures were compared. Results: The study included 107 consecutive patients, with a mean (SD) age of 49 (13) years. Dusting was performed in 51 patients and fragmentation in 56. The patients’ demographics, laboratory tests, preoperative stents, stone and renal characteristics were comparable for both groups. Operative time was significantly shorter for dusting than fragmentation (76 vs 91 min, P = 0.009). Complication rates were comparable between the groups (7.8% for dusting and 8.9% for fragmentation, P = 0.840). The mean hospital stay was comparable for both groups (P = 0.686). The SFR was significantly better in fragmentation group (78.6%) compared with the dusting group (58.6%, P = 0.035). The need for a secondary procedure was 33.3% in the dusting group and 23.3% in fragmentation group (P = 0.244). Conclusions: During fURS for renal stones, the dusting technique had a significantly shorter operation time, whilst the fragmentation technique led to a significantly better SFR. Both techniques have comparable safety, hospital stay, and requirement for secondary procedures. Abbreviations: fURS: flexible ureteroscopy/ureteroscope; ICU: intensive care unit; KUB: plain abdominal radiograph of the kidney, ureter and bladder; NCCT: non-contrast CT; SFR: stone-free rate; SWL: shockwave lithotripsy; UAS: ureteric access sheath
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Breda A, Territo A, Sanguedolce F, Basile G, Subiela JD, Reyes HV, Ferrer OM, Gaya JM, Palou J. Comparison of biopsy devices in upper tract urothelial carcinoma. World J Urol 2018; 37:1899-1905. [PMID: 30560298 DOI: 10.1007/s00345-018-2586-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 11/27/2018] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION A correct characterization of upper tract urothelial carcinoma (UTUC) lesions is fundamental to appropriately select patients suitable for endoscopic management. We analyzed the diagnostic yield of three different biopsy tools for the histology evaluation of the UTUC. Furthermore, the concordance between biopsy grading and final UTUC pathology results at specimen (i.e., after ureterectomy or radical nephroureterectomy-RNU) was evaluated. MATERIALS AND METHODS Three different devices were evaluated: 3F biopsy forceps, 6F BIGopsy® Backloading biopsy forceps and the 2.2F Nitinol Basket. Data were collected between January 2015 and October 2017 and retrospectively analyzed. Univariate and multivariate logistic regression analyses were performed to identify the variables related to diagnosis. RESULTS A total of 302 biopsies were taken: lesions could be characterized in 236 (78.2%) specimens by the pathologist. Positive biopsies for UTUC were found in 140 specimens. In 66 biopsies (21.8%), the quality of the tissue sampled was inadequate for a histological characterization; of these, 55 (83.3%) were taken using 3F forceps and 11 (16.7%) using BIGopsy forceps. No inadequate specimen arose using the 2.2F Nitinol Basket. Among 28 patients who underwent distal ureterectomy or RNU, the tumor was upgraded to high grade in 9 (32%), while in 19 (68%) the grading was confirmed. CONCLUSION In comparison to 3F forceps, the BIGopsy forceps showed to be more accurate in obtaining sufficient specimen for pathologic examination. In papillary lesions, the 2.2F Nitinol basket achieves a final histology characterization in 100% of the cases. For tumor < 2 cm, there is a high concordance between URS biopsy grade and final pathology (distal ureterectomy or RNU).
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Chen H, Chen G, Zhu Y, Yang Z, Xiong C, Pan Y. Analysis of Prestenting on Outcomes of Flexible Ureteroscopy for Upper Urinary Urolithiasis: A Historical Control Study. Urol Int 2018; 102:175-180. [PMID: 30415258 DOI: 10.1159/000494362] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 10/05/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The aim of this study is to explore the efficacy and safety of flexible ureteroscopy (fURS) with prestenting (PS) for patients and a newly starting department. METHOD The data of patients who underwent fURS for calculi with nonprestenting (NPS) after a clinical practice change was compared with PS patients before. RESULT In all, 199 patients met the inclusion criteria. There was no significant difference for both groups in basic demography except that the NPS group included more proximal ureteral stone. Subgroup analysis was then used by a different site. There was no significance in sheath success (4/100 vs. 1/99, p = 0.369). Stone free rate (SFR) and success rate between PS and NPS group showed significant difference in total (96.94 vs. 89.58%, p = 0.048, 96.97 vs. 85.00%, p = 0.005 respectively). Better SFR and success rate were found only for the renal stones in subgroup analysis (97.67 vs. 80.49%, p = 0.014, 97.67 vs. 74.42%, p = 0.003 respectively). Operative time was significantly longer based on stenting status (45.969 ± 19.4732 vs. 30.553 ± 8.9645 min, p = 0.01) and there was no difference in subgroup analysis. More complications were found in the NPS group, but no severe complications were encountered. CONCLUSION Intentional PS is a feasible try for an amateur fURS surgeon or a newly started department in order to gain a better outcome and lower complications in the whole time. It improves the outcomes when additional small surgery is not the trouble.
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Zhang H, Hong TY, Li G, Jiang N, Hu C, Cui X, Chu C, Zhao JL. Comparison of the Efficacy of Ultra-Mini PCNL, Flexible Ureteroscopy, and Shock Wave Lithotripsy on the Treatment of 1-2 cm Lower Pole Renal Calculi. Urol Int 2018; 102:153-159. [PMID: 30352443 DOI: 10.1159/000493508] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 09/04/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To compare the efficacy of new percutaneous technique ("ultra-mini PCNL", UMP), shock wave lithotripsy (SWL) and flexible ureteroscopy (FURS) on the treatment of 1-2 cm lower pole kidney stones, and to determine the advantages and disadvantages of each method. MATERIALS AND METHODS This prospective study was based on data collected from the files of patients between March 2015 and March 2017. This study recruited a total of 180 patients with single radio-opaque lower caliceal calculi of 1-2 cm. All patients were randomly divided into 3 groups: group A was treated with UMP, group B was treated with FURS by using holmium laser and group C was treated with SWL by using the electromagnetic lithotripter. The average age, sex, size of the stone, the time of operation, the rate of no stone, the time of hospitalization, the rate of retreatment, the cost and the complications of the 3 groups were compared. The success of the operation was defined as no residual stone or < 0.3 cm on computed tomography at 3 months postoperatively. RESULTS The stone burdens of the groups were equivalent. The re-treatment rate in group C was significantly higher than that in group A and B (30 vs. 1.6%, 5%). The average operating time in group B (93.35 ± 21.64 min) was statistically significantly longer than that in group A and C (68.58 ± 15.82 min, 46.33 ± 5.81 min). Although the time of hospitalization of group A (5.32 ± 1.20 day) was longer than that of group B (3.22 ± 0.52 day) and C (1.08 ± 0.28 day; p < 0.05). The stone-free rate (SFR) in UMP, FURS, SWL were 98, 92, and 73% respectively; the highest SFR was in the UMP group (p < 0.05). The complication rates were evaluated by using the Clavien grading system, which were determined to be 16.67% in UMP, 6.67% in SWL and 8.33% in FURS. In particular, the complications of GI and GII were more common in group A (p < 0.05). CONCLUSIONS UMP, FURS, and SWL are all safe and effective in the treatment of 1-2 cm lower pole kidney stones. UMP and FURS had a better SFR than SWL, but the time of hospitalization in UMP group was longer and there were more complications in the UMP group. In addition, the operation time of FURS is longer as compared to UMP and SWL, and there is a higher rate of postoperative fever. The invasiveness and cost of SWL were lower than that of UMP and FURS, but the re-treatment rate was higher.
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Zhu Z, Cui Y, Zeng F, Li Y, Chen Z, Hequn C. Comparison of suctioning and traditional ureteral access sheath during flexible ureteroscopy in the treatment of renal stones. World J Urol 2018; 37:921-929. [PMID: 30120500 DOI: 10.1007/s00345-018-2455-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 08/14/2018] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To compare the efficiency and safety of suctioning ureteral access sheath (UAS) and traditional UAS during flexible ureteroscopy (FURS) for treatment of renal stones. METHODS Between January 2015 and December 2017, 165 patients who had renal stones successfully underwent FURS with suctioning UAS created by connecting a channel on the tail of the suctioning UAS to a vacuum device. The outcomes of these patients were compared with those of 165 patients undergoing FURS with traditional UAS using a 1:1 scenario matched-pair analysis. The matching parameters were age, gender and stone burden. RESULTS The baseline characteristics were homogeneous between the two groups. The suctioning UAS group had significantly higher SFR one day postoperatively (82.4% vs. 71.5%; P = 0.02), but SFR 1 month postoperatively was comparable in the two groups (P = 0.13). The incidence of overall complications was significantly higher in the traditional UAS group (24.8% vs 11.5%; P < 0.001). Regarding individual complications, the traditional UAS group was associated with a significantly higher incidence of fever (13.9% vs 5.5%; P = 0.009) and urosepsis requiring only additional antibiotics (6.7% vs 1.8%; P = 0.029). No significant difference was noted in the incidence of septic shock, hematuria, steinstrasse or ureteral stricture. The suctioning UAS group had significantly shorter operative time (49.7 + 16.3 min vs. 57.0 ± 14.0 min; P < 0.001). CONCLUSIONS Compared to traditional UAS during FURS for treating renal stones, suctioning UAS had the advantages of higher SFR 1 day postoperatively, a lower incidence of infectious complications and a shorter operative time. Further well-designed studies are required to confirm the results.
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Yang J, Tao RZ, Lu P, Chen MX, Huang XK, Chen KL, Huang YH, He XR, Wan LD, Wang J, Tang X, Zhang W. Efficacy analysis of self-help position therapy after holmium laser lithotripsy via flexible ureteroscopy. BMC Urol 2018; 18:33. [PMID: 29739380 PMCID: PMC5941477 DOI: 10.1186/s12894-018-0348-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 05/02/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To observe the efficacy of self-help position therapy (SHPT) after holmium laser lithotripsy via flexible ureteroscopy (FURS). METHODS From January 2010 to November 2015, 736 nephrolithiasis patients who had received FURS lithotripsy were analyzed retrospectively. In position group, 220 cases accepted SHPT after lithotripsies, and 428 cases as control, coming from another independent inpatient area in the same center. The stone-free status (SFS) between two groups were compared at the 2nd, 4th and 12th week ends by X-ray examinations. RESULTS The preoperative incidence of hydronephrosis (25.9% vs. 18.0%, p = 0.018) or lower calyceal seeper (33.6% vs. 24.3%, p = 0.012) and the proportion of patients with > 2.0 cm stones (33.6% vs. 24.3%, p = 0.003) were all significantly higher in position group than in control group. There were no substantial difference between two groups in age, BMI, gender and medical histories. In postoperative followup, the incidence of hydronephrosis in position group was significantly lower than in control group (9.5% vs. 15.7%, p = 0.032) after removing double-J stents. In position group, the SFS of the 2nd week end (60.9% vs. 47.2%, p = 0.001), the 4th week end (74.1% vs. 62.8%, p = 0.004) and the 12th week end (86.9% vs. 79.4%, p = 0.021) were all significantly higher than those in control group. CONCLUSIONS SHPT after holmium laser lithotripsy via FURS may increase postoperative SFS, accelerate stone fragment clearance, and decrease the incidence of hydronephrosis after removal of double-J stents. The therapy does not require professional assistance and is economical, simple, and effective.
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Mancini V, Cormio L, d'Altilia N, Benedetto G, Ferrarese P, Balzarro M, Defidio L, Carrieri G. Retrograde Intrarenal Surgery for Symptomatic Renal Sinus Cysts: Long-Term Results and Literature Review. Urol Int 2018; 101:150-155. [PMID: 29719301 DOI: 10.1159/000488685] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 03/21/2018] [Indexed: 11/19/2022]
Abstract
INTRODUCTION To report the long-term multicenter experience with retrograde intrarenal holmium-laser incision (RIR-HoLI) in the management of symptomatic renal sinus cysts (RSCs). In the literature, RIR-HoLI has been shown to be a safe and effective treatment, but there are only a few reports regarding long-term results and reproducibility of this procedure. MATERIAL AND METHODS From June 2010 to June 2015, 14 patients with symptomatic RSCs underwent RIR-HoLI. The mean age was 52.1 ± 11.28 years (range 28-77) and the mean cyst size was 53.2 ± 14.23 mm (range 35-90). In all cases, contrast-enhanced computer tomography (CT) showed compression of the renal pelvis by the cyst (no malignancy). Surgical outcome was assessed in terms of symptoms improvement (measured by Visual Analogue Scale [VAS] for pain) and renal ultrasound findings at 3-6-12 months postoperatively and then yearly. CT scan was carried out at 12 months follow-up. RESULTS RIR-HoLI was successful in all patients. The mean operative time was 47.8 ± 13.54 min (range 30-80) and mean hospital stay was 3.5 days (range 2-5). There were 2 Clavien grade II complications (flank pain and urgency delaying discharge). After surgery, all patients -became asymptomatic (VAS score change, p = 0.0001). One patient had persistence of a small cyst (10 mm). Mean follow-up is 44 ± 17.24 months (range 24-84); all patients remained asymptomatic, with no signs of recurrence. CONCLUSIONS RIR-HoLI proved to be a safe and effective treatment for symptomatic RSCs. In our experience, it provided excellent long-term results and was reproducible at 4 different -institutions.
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Davis NF, Quinlan MR, Browne C, Bhatt NR, Manecksha RP, D'Arcy FT, Lawrentschuk N, Bolton DM. Single-use flexible ureteropyeloscopy: a systematic review. World J Urol 2017; 36:529-536. [PMID: 29177820 DOI: 10.1007/s00345-017-2131-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 11/13/2017] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Data assessing the effectiveness of single-use flexible ureteropyeloscopy (FURS) are limited. This study evaluates and compares single-use FURS with conventional reusable FURS. METHODS A systematic search using electronic databases (Pubmed and Embase) was performed for studies evaluating single-use FURS in the setting of urinary tract stone disease. Outcome measures included a comparative evaluation of their mechanical, optical and clinical outcomes. RESULTS Eleven studies on 466 patients met inclusion criteria. In vitro comparative data were available on three single-use flexible ureteropyeloscopes (LithoVue™, Polyscope™ and SemiFlex™) and clinical data were available on two (LithoVue™ and Polyscope™). The overall stone-free rate and complication rate associated with single-use FURS was 87 ± 15% and 9.3 ± 9%, respectively. There were no significant differences in procedure duration, stone size, stone clearance and complication rates when single-use FURS and reusable FURS were compared (duration: 73 ± 27 versus 74 ± 13 min, p = 0.99; stone size: 1.36 ± 0.2 versus 1.34 ± 0.18 cm, p = 0.93; stone-free rate: 77.8 ± 18 versus 68.5 ± 33%, p = 0.76; complication rate 15.3 ± 10.6 versus 15 ± 1.6%, p = 0.3). CONCLUSIONS Single-use FURS demonstrates comparable efficacy with reusable FURS in treating renal calculi. Further studies on clinical efficacy and cost are needed to determine whether single-use FURS will reliably replace its reusable counterpart.
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Ilgi M, Kutsal C, Yesildal C, Dalkilinc A, Kirecci SL. The rarest phenomenon of flexible ureterolithotripsy: Kidney stone in supernumerary type combination with a horseshoe kidney. Urol Ann 2017; 9:384-386. [PMID: 29118544 PMCID: PMC5656967 DOI: 10.4103/ua.ua_56_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The horseshoe kidney (HSK) is common and supernumerary kidney is the rarest developmental anomaly of the urogenital system. The supernumerary kidney in a HSK conjunction is extremely rare, and prevalence of it is unknown. A review of literature, there have been a few case reports about the supernumerary and HSK combination, however, none of which also had a concomitant kidney stone and obstructive pathology. Our case indicated that patient referred to flank pain and visible hematuria to our clinic, and further investigations demonstrate supernumerary kidney in a horseshoe configuration and kidney stone. Kidney stone could not be found at the first attempt because of the anatomical malformation. Retrograde pyelography showed ureteral branching and helps to define the placement of stone. This stone was fragmented with flexible ureteroscopy in the lower pole of the middle kidney in the second session. There was no stone fragments absence at the 1st-month control. This exceedingly rare type case should be evaluated meticulously on preoperative duration otherwise can be a challenge for surgeons. Visualize pelvicalyceal system under the fluoroscope is a vital step in this regard to being guidance during the procedure.
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Yuruk E, Tuken M, Gonultas S, Colakerol A, Cakir OO, Binbay M, Sarica K, Muslumanoglu AY. Retrograde intrarenal surgery in the management of pediatric cystine stones. J Pediatr Urol 2017; 13:487.e1-487.e5. [PMID: 28262541 DOI: 10.1016/j.jpurol.2017.01.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 01/07/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate the efficacy and safety of retrograde intrarenal surgery (RIRS) in the treatment of pediatric cystine stones. STUDY DESIGN Data of the pediatric patients who underwent RIRS for kidney stones were retrospectively evaluated. A total of 14 children with cystine stones managed with RIRS were identified. In addition to the patient demographics and stone characteristics, all retrospectively obtained operative data were evaluated and discussed in detail, with an emphasis on the success and complication rates. RESULTS Mean age of the 14 cases was 10.9 ± 2.2 years (range: 7-15). Mean stone size was 13.6 ± 2.4 mm (range: 10-18) (Summary table). Of these stones, four were located in the renal pelvis, three were in the lower, three were in the middle and the remaining four were located in upper calyx. Ureteral access sheath was used in 12 (85.7%) patients. The double-J ureteral stent was placed pre-operatively in one case and was inserted postoperatively in 12 cases. Mean operation time was 38.2 ± 7.2 min (range: 30-50). Complications were observed in two cases: mild ureteral laceration in the first and fever on the second postoperative day in the second patient. All of the patients were stone free on sonographic evaluation at the 4-week follow-up evaluation. Although potassium citrate treatment was initiated in 11 patients, tiopronin treatment was initiated in four patients for recurrence prophylaxis during long-term follow-up. During a mean follow-up period of 25.7 ± 5.2 months, stone recurrence was noted in one patient. DISCUSSION Treatment of patients with cystine stones is challenging, due to high risk of rapid recurrence in the presence of residual fragments. Besides allowing complete stone clearance in all cases in the current series, RIRS is a highly reproducible method that can be safely performed, even in recurrences. The major limitations of the current study were low number of patients and short follow-up period. CONCLUSION The results clearly indicated that RIRS is a safe treatment modality in the management of pediatric cystine stones.
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Cepeda M, Amón JH, Mainez JA, de la Cruz B, Rodríguez V, Alonso D, Martínez-Sagarra JM. Retrograde intrarenal surgery and micro-percutaneous nephrolithotomy for renal lithiasis smaller than 2 CM. Actas Urol Esp 2017; 41:516-521. [PMID: 28389028 DOI: 10.1016/j.acuro.2017.02.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Revised: 02/05/2017] [Accepted: 02/06/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Microperc is the upgraded form of percutaneous nephrolithotomy miniaturization. The aim of this study is to compare prospectively microperc and retrograde intrarenal surgery for the treatment of renal stones smaller than 2 cm. MATERIAL AND METHODS A comparative prospective study of both techniques was carried out between January 2014 and June 2015. Thirty-five patients were divided in two groups: Group A, 17 patients treated by retrograde intrarenal surgery and Group B, 18 patients treated by microperc. Stone clearance was assessed using CT scan 3 months after surgery. RESULTS Both groups were statistically comparable as demographic variables and stone size was similar (16.76 mm Group A vs 15.72 mm Group B). Success rate, hospital stay and JJ stenting were similar for both groups. There was no statistically significant difference regarding post-operatory complications: 17.64% Group A vs 5.56% Group B (p=0,062), all of them Clavien I and II. Surgical time was statistically different (63.82 min Group A vs 103.24 min Group B) as well as hemoglobin drop (0.62 g/dl Group A and 1.89 g/dl Group B). CONCLUSION Microperc is an effective and safe procedure for the treatment of renal lithiasis smaller than 2 cm, which makes it a good alternative to retrograde intrarenal surgery for this stone size. However, more prospective studies that include a larger cohort are necessary to confirm our results.
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Bosquet E, Peyronnet B, Mathieu R, Khene ZE, Pradere B, Manunta A, Vincendeau S, Guille F, Bensalah K, Verhoest G. [Safety and feasibility of outpatient flexible ureteroscopy for urinary stones: A retrospective single-center study]. Prog Urol 2017; 27:1043-1049. [PMID: 28869170 DOI: 10.1016/j.purol.2017.07.246] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 06/16/2017] [Accepted: 07/22/2017] [Indexed: 12/23/2022]
Abstract
AIM Management of urolithiasis has changed over the past decades. Outpatient surgery has become a major issue for healthcare systems. The aim of this study was to assess the feasibility of outpatient flexible ureteroscopy. METHODS A single-center retrospective study has been conducted including all patients who underwent an outpatient flexible ureteroscopy between January 2012 and December 2013. Failure of outpatient management was defined as length of hospital stay>12 hours or readmission within 48 hours after discharge. Univariate analysis was performed to seek for predictors of failure of outpatient management. RESULTS One hundred and fifty-seven patients who underwent a total of 174 procedures were included. They were mostly men (57.5 %), with a mean body mass index of 25.2kg/m2 (±4.3). The stones were mostly unique (64.3 %), with a mean size of 14.2mm (±11.2). Eighty patients had a double J stent preoperatively (46.5 %), and mean operative time was 64.2 minutes (±34.1). An ureteral access sheath was used in 39 procedures (22.4 %). A double J stent was left postoperatively in 103 patients (59.1 %). In total, 165 procedures (94.8 %) were performed successfully as outpatient surgery. On postoperative imaging, the stone-free rate was 69.5 %. Postoperative complications occurred in 3.4 % of cases and were mostly minor (i.e. Clavien 1-2; 83.3 %). Predictive factors of failed outpatient management were male gender (P=0.04), BMI (P=0.03), and anticoagulants intake (P=0.003). CONCLUSION Outpatient flexible ureteroscopy for urinary stones is feasible and its low failure and complications rate may allow a wider spread of its use. LEVEL OF EVIDENCE 4.
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Kılıç Ö, Akand M, Van Cleynenbreugel B. Retrograde intrarenal surgery for renal stones - Part 2. Turk J Urol 2017; 43:252-260. [PMID: 28861294 DOI: 10.5152/tud.2017.22697] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 06/21/2017] [Indexed: 12/17/2022]
Abstract
Retrograde intrarenal surgery (RIRS) has become an effective and safe treatment modality in the management of urinary system stone disease. Recent developments and innovations in the flexible ureterorenoscope and auxiliary equipment have made this procedure easier and more effective with increased success rates. RIRS can be used as a primary treatment in patients with renal stones smaller than 2 cm, prior unsuccessful shock wave lithotripsy, infundibular stenosis, renoureteral malformation, skeletal-muscular deformity, bleeding diathesis and obese patients. In the second part of this detailed review for RIRS, effect of stone composition on success rate, preoperative assessment of stone-free rate, the cost of this modality, education for RIRS, fluoroscopy use, the current role of RIRS in the treatment of various urolithiasis types and special conditions, and combined treatment methods are discussed with up-to-date literature.
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A review study to evaluate holmium:YAG laser lithotripsy with flexible ureteroscopy in patients on ongoing oral anticoagulant therapy. Lasers Med Sci 2017; 32:1615-1619. [PMID: 28733910 DOI: 10.1007/s10103-017-2289-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 07/13/2017] [Indexed: 10/19/2022]
Abstract
The objective of this study was to evaluate the safety and efficacy of flexible ureteroscopy (FURS) and holmium:YAG laser lithotripsy for the treatment of upper urinary tract stones in patients on active oral anticoagulants. The records of 1081 patients who underwent flexible ureteroscopic holmium:YAG (Ho:YAG) laser lithotripsy for upper ureteral and renal calculi from 1999 to 2015 were retrospectively reviewed. A total of 84 patients on continuous oral anticoagulation or antiplatelet therapy (warfarin, aspirin, or clopidogrel) were identified. Of these patients, 40 were on warfarin, 25 on aspirin, 11 on clopidogrel, and 8 on both aspirin and clopidogrel. The drugs were not discontinued. The baseline characteristics, indications for anticoagulation therapy, perioperative data, stone-free rate, and complications were documented. Evaluation of outcomes was assessed at 1-, 3-, and 6-month follow-up postoperatively. Mean stone size was 19.7 ± 9.4 (range 8 to 31 mm). Twenty patients had upper ureteral and 64 patients had intrarenal calculi. Two patients had bilateral renal calculi. Mean operation time was 78.2 ± 23.8 min (range 17 to 144 min). Two procedures (2.3%) in warfarin group were terminated due to persistent bleeding causing visual impairment. No transfusions were required. The mean serum hemoglobin levels did not change significantly (12.9 ± 3.7 to 12.2 ± 3.3 g/dL). No thromboembolic or cardiac adverse events were observed perioperatively. The double-j (DJ) ureteral catheterization time was 29.6 ± 9.3 days (range 14 to 68 days) and the hospital stay was 1.6 ± 0.6 days (range 1 to 4). The stone-free rate was 95.2% (80 patients) at 6 months. Flexible ureteroscopic Ho:YAG laser lithotripsy in patients requiring long-term anticoagulation therapy seems to be a safe and effective procedure and should be considered as a first-line treatment option in such patients for the surgical management of upper urinary tract stones.
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Modern flexible ureteroscopy in Cohen cross-trigonal ureteral reimplantations. J Pediatr Urol 2017; 13:329-331. [PMID: 28392131 DOI: 10.1016/j.jpurol.2017.03.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 03/05/2017] [Indexed: 11/21/2022]
Abstract
PURPOSE We describe a feasible flexible ureteroscopy (fURS) technique with the latest instruments to and to discuss their advantages. METHODS Three patients underwent a fURS for stone treatment. A 7F angled orifice catheter and a hydrophilic angled tip stiff wire is used to guide the wire in the proper ureteral direction sighting the ureter allowing the use of a 10/12 ureteral access sheath. A single use ureteroscope was used. RESULTS All of them had successful ureteral access and laser lithotripsy being stone free endoscopically. No complications reported. CONCLUSION The modern fURS technique was found feasible and safe in patients with cross-trigonal ureteroneocystostomy.
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Van Cleynenbreugel B, Kılıç Ö, Akand M. Retrograde intrarenal surgery for renal stones - Part 1. Turk J Urol 2017; 43:112-121. [PMID: 28717532 DOI: 10.5152/tud.2017.03708] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 04/12/2017] [Indexed: 12/20/2022]
Abstract
The main aim in the treatment of renal stones is to clearance of the stones completely with the least morbidity. Parallel to the improvements in technology during recent years, new flexible ureterorenoscopes and effective lithotripters such as holmium laser have been developed, thus retrograde intrarenal surgery (RIRS) has become an efficient and safe option in the management of urinary system stone disease with a gradually increasing popularity. Therewithal, innovations in auxiliary equipment such as guide-wires, ureteral access sheath and stone baskets have made this procedure more effective. With this modality, nowadays, the vast majority of renal stones can be treated successfully without need of open surgery or percutaneous nephrolithotomy. RIRS can be used as a primary treatment in patients with renal stones smaller than 2 cm, in cases with prior unsuccessful shock wave lithotripsy (SWL), infundibular stenosis, renoureteral malformation, musculoskeletal deformity, bleeding diathesis as well as obese patients. The efficiency of this procedure has been also proved in pediatric patients. In the first part of this detailed review for RIRS, history, indications and contraindications, preoperative preparation, antibiotic prophylaxis, anesthesia, surgical technique related to flexible ureteroscopes and auxiliary equipment being used, postoperative care and complications of this operation are discussed with up-to-date literature.
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Berardinelli F, De Francesco P, Marchioni M, Cera N, Proietti S, Hennessey D, Dalpiaz O, Cracco C, Scoffone C, Giusti G, Cindolo L, Schips L. RIRS in the elderly: Is it feasible and safe? Int J Surg 2017; 42:147-151. [PMID: 28476544 DOI: 10.1016/j.ijsu.2017.04.062] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 04/27/2017] [Indexed: 01/15/2023]
Abstract
BACKGROUND The aim of this study was to compare the safety and efficacy of RIRS in men ≥65 years to those <65 years. MATERIALS AND METHODS Patients who underwent RIRS were prospectively collected from March 2013 to March 2014 in 5 European centers. Perioperative outcomes and complications in elderly men were compared with men <65 years. Univariable and multivariable analyses were performed for factors predicting overall complications. The groups were compared using Mann-Whitney U test. Categorical variables were compared using chi-squared test and the Yates correction or the Fisher's exact test. RESULTS A total of 399 patients with renal stones were included, 308 (77.19%) were aged <65 years, 91 (22.8%) were aged ≥65 years. Elderly patients were more likely to have higher ASA scores (35.7% vs 92.3%; p < 001), Charlson Comorbidity Index (1.8 vs. 5.2, p < 0.001), hyperlipidemia (10.06% vs. 30.76%; p = 0,0005) and coronary heart disease (5.51% vs. 17.58; p = 0.005) compared to younger cohort. Perioperative outcomes (stone free rate, operative time and re-intervention rate) did not show differences between the two groups (p > 0.05). Surgical and medical complication rates were similar between the cohorts (14.28% vs 9.89%; p = 0.38). Multivariate analysis did not identify any predictive factors of complications among the two groups (p > 0.05). CONCLUSIONS In this study, elderly RIRS patients had comparable short term efficacy and perioperative complications to younger patients, despite a higher prevalence of comorbidity. Age itself should not be considered as a risk factor for the development of complications in patients undergoing RIRS for renal stone.
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Del Santo K, Audouin M, Ouzaid I, Ravery V, Traxer O. [Evaluation of the operating results and costs associated with the implementation of a flexible ureteroscopy activity within a university hospital center]. Prog Urol 2017; 27:375-380. [PMID: 28434755 DOI: 10.1016/j.purol.2017.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 02/17/2017] [Accepted: 02/27/2017] [Indexed: 12/23/2022]
Abstract
INTRODUCTION The increasing use of flexible ureteroscopy (USSR) sets the cost problems inevitably associated with the fragility of these endoscopes. The aim of this work is to clear from a recent example (universitary hospital) results, costs during the implementation of this technique. MATERIAL AND METHODS This is a retrospective study conducted from December 2012 (date of introduction of the activity) in March 2015 concerning the USSR made in a French universitary hospital for stone disease. In this analysis, the cost of consumables was not evaluated, nor the costs of the operating theater or hospitalization. RESULTS One hundred forty-one hundred and thirteen patients USSR were conducted by seven surgeons. Seventeen breakages and failures have been identified and have led to the sending of the endoscope for repair. Breakage rate and failure was 12%. All failures were treated with a standard exchange of the device (including 4 standard exchanges made under warranty). The estimated average cost of outages was 3600 euros. This represents an average cost per procedure of about 625 euros (acquisition plus cost of failures) without counting the costs of sterilization or high-level disinfection. The impossibility of relocating the lower calyx stones is associated with an excess risk of breakage (odd ratio: 2.92 CI95: [1.02; 8.37]). CONCLUSION This study is novel because it focuses on the cost of implementing a technique in a French university hospital. The use of flexible ureteroscope to unique uses might be an interesting source of savings in the implementation of this technique. This remains to be evaluated. LEVEL OF EVIDENCE 5.
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Pieras E, Tubau V, Brugarolas X, Ferrutxe J, Pizá P. Comparative analysis between percutaneous nephrolithotomy and flexible ureteroscopy in kidney stones of 2-3cm. Actas Urol Esp 2017; 41:194-199. [PMID: 27793365 DOI: 10.1016/j.acuro.2016.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Revised: 08/07/2016] [Accepted: 08/08/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION To compare percutaneous nephrolithotomy and flexible ureterorenoscopy for treating kidney stones between 2 and 3cm. MATERIAL AND METHODS A prospective, comparative, nonrandomised study was conducted with 108 patients with kidney stones between 2 and 3cm. Fifty-four patients underwent percutaneous nephrolithotomy and 54 underwent flexible ureteroscopy. We compared the following variables: lithiasis-free rate (%), surgical time, the need for an auxiliary process, postoperative complications, hospital stay, readmission rates and recovery time. RESULTS There were no differences in the lithiasis-free rate between the 2 surgical techniques (76% for ureteroscopy vs. 87% for nephrolithotomy; P=.1) or in the complications (29% for nephrolithotomy vs. 27% for ureteroscopy; P=.4). A larger number of auxiliary process were needed for the ureteroscopy group (20%) than for the nephrolithotomy group (7%) (P=.04). The surgical time was longer for the nephrolithotomy group (121±52min) than for the ureteroscopy group (93±42min) (P=.004). The ureteroscopy group had shorter hospital stays (2.1±1.6 vs. 3.9±1.9 days; P=.002), shorter convalescence (8.1±4.9 vs. 13.3±4.2 days; P=.005) and higher readmission rates (7.4% vs. 0%, P=.05) than the nephrolithotomy group. CONCLUSIONS Nephrolithotomy and ureteroscopy have similar efficacy for treating kidney stones measuring 2-3cm, with no differences in complications. Ureteroscopy results in shorter hospital stays, quicker recoveries but more readmissions and a greater need for auxiliary procedures.
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[Flexible ureterorenoscopy and laser lithotripsy for upper urinary tract stones in neurologic patients with severe motor disability]. Prog Urol 2017; 27:369-374. [PMID: 28377080 DOI: 10.1016/j.purol.2017.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 02/27/2017] [Accepted: 03/07/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The study's objective was to evaluate the effectiveness and morbidity of flexible ureterorenoscopy and laser lithotripsy for upper urinary tract stones in patients with a nervous system pathology including severe motor disability. METHODS Between 2006 and 2013, we retrospectively analyzed 83 flexible ureterorenoscopy to treat 63 kidneys in 42 patients. Stone free (SF) kidneys defined as an absence of stones on computerized tomography, renal ultrasound, X-ray or direct ureterorenoscopy, were considered a surgical success. Complications were classified according to the Clavien-Dindo system. RESULTS Success rates were 49.2 %, 57.1 % and 58.7 %, respectively after first, second and third flexible ureterorenoscopy procedure. Clearance after one procedure was achieved in 64.3 % of cases involving less than 20mm stones. No major complication (Clavien-Dindo>2) was described (0 %). Complication rates were 44.7 %, with 31.6 % Clavien-Dindo 2. The main complication was urosepsis, which occurred in 27.6 % of cases. CONCLUSION Flexible ureteroscopy and laser lithotripsies for upper urinary tract stones in neurologic patients with severe motor disability are associated with a lower success rate and some frequent low grade complications compared to overall population. In clinical practice, the indications of flexible ureterorenoscopy for these patients seem restricted. LEVEL OF EVIDENCE 5.
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Featherstone NC, Somani BK, Griffin SJ. Ureteroscopy and laser stone fragmentation (URSL) for large (≥1 cm) paediatric stones: Outcomes from a university teaching hospital. J Pediatr Urol 2017; 13:202.e1-202.e7. [PMID: 28336220 DOI: 10.1016/j.jpurol.2016.07.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 07/19/2016] [Indexed: 12/23/2022]
Abstract
INTRODUCTION The treatment of large renal stones (≥1 cm) in paediatric patients is challenging. The usual treatment options include percutaneous nephrolithotomy (PCNL) or shockwave lithotripsy (SWL). There is a rise in the use of ureteroscopy and laser stone fragmentation (URSL) for paediatric stones; however, outcomes of treatment for large renal stones in this age group are still largely unknown. OBJECTIVE To investigate the outcome of URSL for large paediatric renal stones ≥1 cm treated at the present institution over the last 5 years. METHODS A retrospective review was performed of outcomes from the prospectively maintained stone database. Only paediatric patients undergoing ureteroscopic (rigid or flexible ureteroscopy (URS)) procedures for stones ≥1 cm were included. Patient demographics, operative details, stone burden, hospital stay, complications and stone clearance were recorded and analysed. RESULTS From April 2010 to June 2015, 18 paediatric patients with a mean age of 10.4 years (range 3.6-15) underwent 35 ureteroscopic procedures for large stones (≥1 cm). The stone location was in the kidney (n = 14), ureter (n = 1), and in both the kidney and ureter for the remaining three patients. Nine patients had multiple stones. There was a preceding history of PCNL in four patients, with one patient having URS combined with a PCNL. The mean follow-up was 2.7 years (range 0-5). A postoperative stent was inserted in 21 (60%) patients. The overall stone-free rate (SFR) was 89% for a mean of 1.8 procedures per patient (range 1-4) - see Summary Table below. There was an inability to access stone within a lower pole calyx in one patient, despite maximum deflection of the ureteroscope. No intra- or post-operative complications were noted, and mean hospital stay was 1.1 days (range 0-5). DISCUSSION Published papers in adult literature have shown that ureteroscopy and laser fragmentation (URSL) is a viable alternative to PCNL. Newer equipment and improved techniques have resulted in SFRs being comparable with PCNL. A recent systematic review reported an SFR of 91% for large adult stones (>2 cm) for a mean 1.45 procedures per patient, and an overall complication rate of 8.6%. The present study has also demonstrated excellent outcomes in the use of ureteroscopy and laser fragmentation for the management of large paediatric stones with no complications. CONCLUSION The results show that paediatric URSL for large stones achieves a good SFR with minimal morbidity and is a good treatment option in established endourological units.
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Guzelburc V, Balasar M, Colakogullari M, Guven S, Kandemir A, Ozturk A, Karaaslan P, Erkurt B, Albayrak S. Comparison of absorbed irrigation fluid volumes during retrograde intrarenal surgery and percutaneous nephrolithotomy for the treatment of kidney stones larger than 2 cm. SPRINGERPLUS 2016; 5:1707. [PMID: 27757377 PMCID: PMC5050171 DOI: 10.1186/s40064-016-3383-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 09/25/2016] [Indexed: 11/26/2022]
Abstract
Purpose Irrigation-induced increase in intrarenal pressure is of concern because it may cause infection due to increased pyelovenous and pyelolymphatic absorption. This study is the first to compare prospectively the absorbed fluid volumes during percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS) for stones larger than 2 cm. Materials and methods General anesthesia was applied to all patients. Isotonic solution containing 1 % ethanol was used as irrigation fluid. Venous blood ethanol concentration was first measured with the start of irrigation and thereafter every 15 min until the patients left the recovery room. Absorbed fluid volumes were measured using the blood ethanol concentrations. Duration of irrigation, irrigated fluid volume, stone size and grade of hydronephrosis were also recorded. Results A total of 60 patients were included the study. Fluid absorption occurred in all patients. Minimum and maximum ranges of fluid absorption were 20–573 mL for RIRS and 13–364 mL for PCNL. The increase in fluid absorbed volume was observed as a result of the given amount of irrigating fluid used in the PCNL group. Also prolongation of operation led to a significant increase in absorption in the PCNL group. Increase in body mass index, stone size, and hydronephrosis did not affect fluid absorption significantly in either of the two operation techniques in correlation analyzes. Conclusion Both RIRS and PCNL are conducted under high pressure and can be accompanied potential complications such as SIRS. The fluid absorption confirmed in our study should be taken into consideration during RIRS and PCNL.
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