Use of tube cystostomy in the surgical management of obstructive urolithiasis in a Bactrian camel

CASE DESCRIPTION

A 6-year-old castrated male Bactrian camel was evaluated because of a 14hour history of oliguria and stranguria that progressed to anuria.

CLINICAL FINDINGS

Perineal urethral pulsations and intermittent tail flagging with no accompanying urination were observed. Ultrasonography of the urethra revealed multiple hyperechoic foci with shadowing artifact indicative of calculi present in the penile urethra distal to the sigmoid flexure. Rectal palpation revealed a pulsating hard urethra and intact distended urinary bladder. Further clinical examination was not possible because of challenges associated with handling the camel.

TREATMENT AND OUTCOME

Urethral catheterization through a perineal urethral incision failed to achieve urinary bladder decompression. Tube cystostomy was performed to prevent bladder rupture. Urethrocystography performed 3 days after surgery revealed a urethral rupture at the level of the prepuce. Five weeks after surgery, the camel could urinate a steady stream via the urethrotomy site. Seven weeks after surgery, the cystostomy tube was removed, and the urethrotomy site was modified to provide a permanent urethral opening via perineal urethrostomy. During 6 years of subsequent periodic follow-up by telephone, the owner reported that the camel continued to do well and urinate through the revised opening.

CLINICAL RELEVANCE

To the authors' knowledge, this is the first detailed description of a tube cystostomy in an adult camel with obstructive urolithiasis that includes information on the patient's long-term outcome. This technique was a viable option in the surgical management of obstructive urolithiasis in this camel and may be useful for other large camelids as well.

The efficacy and safety of diuretics on extracorporeal shockwave lithotripsy treatment of urolithiasis: A systematic review and meta analysis

BACKGROUND

The aim of this systematic review and meta-analysis was to demonstrate the efficacy and safety of diuretics on extracorporeal shockwave lithotripsy (SWL) treatment of urolithiasis.

METHODS

The databases MEDLINE, EMBASE, and the Cochrane Controlled Trial Register of Controlled Trials from January 1980 until November 2019 were searched to identify randomized controlled trials that referred to the use of diuretics on extracorporeal SWL treatment of urolithiasis.

RESULTS

Six randomized controlled trials containing 1344 patients were included in this meta-analysis, which compared diuretics with placebo on extracorporeal SWL treatment of urolithiasis. In the analysis, we found that diuretics on extracorporeal SWL treatment were more effective for the management of urinary stones. Compared with placebo, patients who received diuretics during extracorporeal SWL treatment had significantly higher successful stone clearance rate (Odds ratio; 1.73, 95% confidence interval (CI); 1.35 to 2.21, P < .0001), higher stone fragmentation rate (odds ratio; 2.83, 95% CI; 1.30 to 6.16, P = .009), less average number of sessions per stone (mean difference; -0.13; 95% CI, -0.25 to -0.01, P = .03) and similar average number of shocks per stone (mean difference; -126.89; 95% CI, -394.53 to 140.76, P = .35).

CONCLUSION

This systematic review and meta-analysis indicates that diuretics during extracorporeal SWL was effective in the management of urolithiasis with lower risk of complications.

Switching to Single-use Flexible Ureteroscopes for Stones Management: Financial Impact and Solutions to Reduce the Cost Over a 5-Year Period

OBJECTIVES

To assess the financial impact of switching to single-use ureteroscopes (sURS) in urolithiasis management for a hospital, over a 5-year period, and to identify possible solutions to contain or reduce it.

METHODS

A Budget Impact (BI) model was designed for a public hospital performing around 200 ureteroscopies or extracorporeal shockwave lithotripsies per year. The BI was estimated as the difference between financial balances (between costs and revenues) of 2 environments (with and without sURS). The population was defined as adults treated for urolithiasis. The BI model was based on assumptions about the expected progression in the incidence of urolithiasis, and the expected change in clinical practices due to the availability of sURS. We considered the costs and revenues of hospital stays, the purchase price of sURS and the costs of digital or fiberoptic reusable ureteroscopes (rURS). Univariate and multivariate sensitivity analyses were performed.

RESULTS

The cumulative 5-year financial impact of switching completely to sURS was €807,824 and €649,677 in comparison with fiberoptic and digital rURS respectively. This impact could be reduced by half or more if the health-care facility were to adopt different solutions, including negotiating the purchase price of sURS, developing outpatient activity and reducing production costs for ureteroscopy procedures.

CONCLUSION

The BI model gives decision-makers a more accurate picture of the financial impact of switching to sURS and highlights ways to reduce the expected additional cost.

[Significance of definition category of complexity of urinary stones in the systematization of complications of endosopic surgery of urolitiasis]

AIM

To determine the complexity of urinary stones from the standpoint of endoscopic surgery in order to create the standard for the postoperative course of endoscopic surgery for urolithiasis.

MATERIAL AND METHODS

A total of 1317 endoscopic operations (PNL, URS), performed for upper urinary tract stones, were analyzed. Treatment results of 290 patients were studied prospectively, taking into account a stone density, determined by MSCT using HU scale. In 1027 patients, results were studied retrospectively, with a consideration of stone quantitative characteristics, size and shape.

RESULTS

According to the study, stone density does not have a significant impact on the frequency and severity of complications and the efficacy of endoscopic treatment for urolithiasis. The number of stones, their size and stereometric configuration have a significant influence on the surgical procedure. From the position of endoscopic interventions, single upper urinary tract stones were determined as "simple", while multiple and staghorn stones were considered as "complexed" cases.

CONCLUSION

The "standard of the postoperative period" of endoscopic surgery for urolithiasis created with a consideration of specific features of endoscopic surgery for urolithiasis and the complexity of urinary stones is proved to be objective. Any deviation in the postoperative period from the standard course should be regarded as a complication and it is necessary to systematize them according to the Clavien-Dindo classification.

[Nephroprotective effect of calcium channel blocker lercanidipine in treatment of patients with urolithiasis and urinary tract obstruction and monitoring of the serum cytokine profile]

OBJECTIVE

to evaluate the nephroprotective effect of lercanidipine, its effect on the dynamics of creatinine clearance and blood cytokine levels in patients with nephrolithiasis with obstructive uropathy during renal drainage.

MATERIAL AND METHODS

66 patients were included in the study with concretions of the pelvic segment and the presence of obstruction according to instrumental methods of examination. In order to prevent the occurrence of infectious complications before lithotripsy patients the first stage was performed installation of nephrostomic drainage, followed by antibacterial, anti-inflammatory therapy. Patients were divided into 2 groups: the first (33 patients) received standard therapy, the second (33 people) additionally received lercanidipine at a dose of 10 mg per day for 1 month. Determined the concentration of IL-8, VEGF, MCP-1, G-CSF and GM-CSF in the blood serum by the method of solid-phase ELISA. The glomerular filtration rate was calculated using the CKD-EPI formula. All studies were performed at the preoperative stage, on 7, 14, 21 and 28 days after renal drainage.

RESULTS

In the appointment of lercanidipine, there was a more rapid decrease in levels of IL-8, VEGF, MS-1, GM-CSF in serum (21 days), and an improvement in renal function, compared with the group that did not receive nephroprotective therapy.

CONCLUSION

The administration of lercanidipine may contribute to a more rapid recovery of renal function and normalization of blood cytokine levels. This drug can be used in the complex treatment of patients with nephrolithiasis with obstructive uropathy.

Endoscopic diagnosis of renal pseudoaneurysm following ureteroscopy

Renal pseudoaneurysm following ureteroscopy is a rare cause of hematuria usually diagnosed and treated with angiography and embolization. Here we present a case of a small pseudoaneurysm causing intermittent flank pain and gross hematuria associated with clot retention initially diagnosed during ureteroscopy and subsequently treated with a combined endourologic and endovascular approach.

Outcomes of Endourologic Interventions in Patients with Preoperative Funguria

Introduction: Funguria is encountered in 1% to 5% of cultured urine specimens and may be a result of specimen contamination, colonization, or invasive infection. The characteristics and outcomes of patients with funguria undergoing endourologic intervention have not been evaluated. Materials and Methods: Patients with preoperative funguria undergoing endourologic intervention were retrospectively identified. Preoperative funguria was defined as a urine culture containing >10,000 colony forming units of fungus within 30 days of the operative intervention. Univariable and multivariable regression was performed to identify predictors of postoperative systemic inflammatory response syndrome (SIRS). Results: A total of 65 patients with preoperative funguria were identified, of whom 49 (75.4%) underwent ureteroscopy and 16 (24.6%) underwent percutaneous nephrolithotomy. Average patient age was 55.1 ± 18.3 years, body mass index was 31.8 ± 11.0, and Charlson comorbidity index was 2.52 ± 2.0. Twenty-three patients (35.4%) carried a diagnosis of neurogenic bladder, of whom 18 (27.7%) required indwelling or intermittent catheterization. In total 57 patients (87.7%) had been exposed to antibiotics in the 3 months before intervention. Eighteen (27.7%) patients met SIRS criteria postoperatively, of whom 11 (16.9%) required intensive care unit (ICU) admission. Three (4.6%) and two (3.1%) patients developed postoperative fungemia and bacteremia, respectively. All cases of fungemia were caused by Candida glabrata. On univariable analysis, presence of an indwelling catheter (p = 0.009), presence of a known neurological diagnosis (p = 0.02), presence of C. glabrata on preoperative culture (p = 0.04), and longer operative time (p = 0.04) were predictive of development of postoperative SIRS. No significant predictors were identified on multivariable analysis. Conclusions: Patients with preoperative funguria have high rates of comorbid illness, urinary catheterization, and recent exposure to antibiotics. This patient population is at high risk of perioperative infectious complications after endourologic intervention.

Pierre Franco (1505-1578): An Innovative Surgeon of the 16th Century in the Treatment of Hernia and Lithotomy

Pierre Franco (1505-1578) was a brilliant surgeon of the Renaissance, a contemporary of Ambroise Paré. He made an impact on the history of surgery with his innovative approaches in the treatment of hernia, lithotomy, and the use of the suprapubic incision. The purpose of this study is to present a detailed account of his work, innovations, and achievements as well as the impact he made on the surgery of the Renaissance.

Comparison among the available stone treatment techniques from the first European Association of Urology Section of Urolithiasis (EULIS) Survey: Do we have a Queen?

PURPOSE

The miniaturization of instruments has had an impact on stone management. The aims of this study were to highlight surgeon preferences among Retrograde Intra Renal Surgery (RIRS), Regular, Mini-, UltraMini- and Micro- Percutaneous Nephrolithotomy (PCNL) for urolithiasis and to compare the effectiveness and safety of these techniques in a real-life setting.

METHODS

A 12-item survey regarding endourological techniques was conducted through Survey Monkey among attendees of the 2013 European Association of Urology Section of Urolithiasis meeting. We asked responders to share data from the last 5 cases they performed for each technique. Procedures were stratified according to stone size and the centres' surgical volume. Techniques were compared in terms of effectiveness and safety. Analyses were performed on the overall group and a subgroup of 1-2 cm stones.

RESULTS

We collected data from a total of 420 procedures by 30, out of 78, urologists who received the survey (response rate 38%): 140 RIRS, 141 Regular-PCNL (>20 Ch), 67 Mini-PCNL (14-20 Ch), 28 UltraMini-PCNL (11-13 Ch) and 44 Micro-PCNL (4,8-8 Ch). Techniques choice was influenced by stone size and the centre's surgical volume. Effectiveness and safety outcomes were influenced by stone size, independently of the technique. The stone-free rate was significantly lower in Micro-PCNL compared to Regular-PCNL. This was not confirmed for 1-2 cm stones. All techniques presented a lower complication rate than Regular-PCNL, with Mini-PCNL being the most protective technique compared to Regular-PCNL.

CONCLUSIONS

Stone size seems to drive treatment choice. Miniaturized PCNL techniques are widely employed for 1-2 cm stones, in particular in higher surgical volume centres. Mini-PCNL and RIRS are growing in popularity for stones > 2 cm. Mini-PCNL seems to be a good compromise, being the most effective and safe procedure among PCNL techniques. RIRS is characterized by satisfactory stone-free and low complication rates.

Outcome of Percutaneous Nephrolithotomy in the Management of Lower Pole Stones

BACKGROUND

Urolithiasis is a worldwide problem  due to its high prevalence and  recurrence. Percutaneous nephrolithotomy is a minimally invasive surgical option for the treatment of large renal stone burden greater than 20mm, staghorn calculi and lower pole calyceal stone greater than 10 mm. The objective of this study was to evaluate the safety and  efficacy of percutaneous nephrolithotomy in the management of lower pole calyceal stones.

METHODS

Seventy  patients who presented in between June 2013 and September 2017 with  lower pole calyceal stones and lower calyceal stones with pelvic extension  were included in the study. The operating time, the hospital stay, complications rate, stone clearance rate were all noted. Patients were followed up in three and six weeks with X-ray KUB and ultrasonography of abdomen.

RESULTS

Seventy adult patients with lower pole calyceal stones underwent standard percutaneous nephrolithotomy. The mean age was 32 years (18-71 yrs). The mean stone size was 17.6 mm (15 -28 mm). The mean operating time was 62 minutes (48-124 mins) and hospital stay was 4.1 days(4-8 days). The stone clearance rate was 92.6% for stone <20mm and 90.7% stone size >20 mm. The complications noted were fever (8.5%), transient haematuria (20%), urine leak (5.7%), obstruction by residual fragments (5.7%) and one pseudoaneurysm(1.42%). Seven patients (10%) needed blood transfusion.

CONCLUSIONS

Percutaneous nephrolithotomy is a safe, feasible and highly effective method for the treatment of lower pole calyceal stones.

[Non-biological 3D printed simulator for training in percutaneous nephro- lithotripsy]

AIM

To develop a non-biological 3D printed simulator for training and preoperative planning in percutaneous nephrolithotripsy (PCNL), which allows doctors to master and perform all stages of the operation under ultrasound and fluoroscopy guidance.

MATERIALS AND METHODS

The 3D model was constructed using multislice spiral computed tomography (MSCT) images of a patient with staghorn urolithiasis. The MSCT data were processed and used to print the model. The simulator consisted of two parts: a non-biological 3D printed soft model of a kidney with reproduced intra-renal vascular and collecting systems and a printed 3D model of a human body. Using this 3D printed simulator, PCNL was performed in the interventional radiology operating room under ultrasound and fluoroscopy guidance.

RESULTS

The designed 3D printed model of the kidney completely reproduces the individual features of the intra-renal structures of the particular patient. During the training, all the main stages of PCNL were performed successfully: the puncture, dilation of the nephrostomy tract, endoscopic examination, intra-renal lithotripsy.

CONCLUSION

Our proprietary 3D-printed simulator is a promising development in the field of endourologic training and preoperative planning in the treatment of complicated forms of urolithiasis.

Use of percutaneous cystolithotomy for removal of urethral uroliths in a pot-bellied pig

A 6-month-old neutered male pot-bellied pig was presented for an obstructive urethral stone which was successfully removed by percutaneous cystolithotomy (PCCL). The pig recovered well although suspected urethral spasms and pollakiuria persisted for 2 weeks after surgery. The owner reported a good urine stream 2 months after discharge. This novel minimally invasive approach provided excellent visualization and allowed complete evaluation of the lower urinary tract. Percutaneous cystolithotomy holds great promise for the future treatment of various lower urinary tract disorders in this species.

Urethral diverticulum and urolithiasis in a female guinea pig (Cavia porcellus)

CASE DESCRIPTION A 5-year-old sexually intact female guinea pig was evaluated because of mild dysuria and a subcutaneous mass located cranioventral to the urogenital openings. CLINICAL FINDINGS Non-contrast-enhanced CT and surgical exploration of the distal aspect of the urethra revealed a urethral diverticulum with an intraluminal urolith. Analysis revealed that the urolith was composed of calcium carbonate and struvite. TREATMENT AND OUTCOME The urolith was surgically removed and ablation of the urethral diverticulum was attempted. Approximately 3 months later, the guinea pig was reevaluated for masses in the perineal region, and positive-contrast urethrocystography revealed 2 uroliths present in the same diverticulum. Uroliths were manually expressed with the patient under general anesthesia. Approximately 2 weeks later, urethroplasty was performed to create an enlarged stoma with the diverticulum, thereby preventing urine from pooling in the diverticulum and potentially reducing the risk of future urolith formation. The urethroplasty site healed well with no reported complications or evidence of urolith recurrence 6 months after surgery. CLINICAL RELEVANCE Urolithiasis is common in guinea pigs, and urethral diverticulum and intraluminal urolith formation should be considered as a potential differential diagnosis for a subcutaneous mass along the distal aspect of the urethra. Creation of a urethral stoma from a urethral diverticulum via urethroplasty achieved a successful outcome in this patient.

Complications associated with ureterorenoscopy (URS) related to treatment of urolithiasis: the Clinical Research Office of Endourological Society URS Global study

INTRODUCTION

Ureterorenoscopy (URS) is a popular and growing option for management of ureteric and renal stones. The CROES URS Global Study was set up to assess the outcomes of URS in a large worldwide cohort of patients involving multiple centres. In this paper, we analysed the database for intra-operative and post-operative complications associated with ureterorenoscopy.

METHODS

The CROES database was established via collaboration between 114 centres in 32 countries worldwide, and information on both intra-operative and post-operative complications was collected electronically between January 2010 and October 2012.

RESULT

On analysis of a total of 11,885 patients, the overall complication and stone-free rates were found to be 7.4 and 85.6 %, respectively. The intra-operative and post-operative complication rates were 4.2 and 2.6 %, respectively, and in total 5 deaths were reported in the study period. Taking into account different world economies, there were no differences in the complication rates between the developing and developed nations or between different centres from different continents.

CONCLUSION

Ureterorenoscopy is a safe and effective procedure for treatment of stones, the outcomes of which are broadly comparable in different parts of the world for similar patient and stone demographics.

[Urinary lithiasis treatment by laparoscopy. Combined techniques.]

Over the last 30 years, the treatment of urinary lithiasis has changed dramatically. With the advent of extracorporeal lithotripsy and the advances on ureterorenoscopy and percutaneous nephrolithotomy, the need to turn to open and laparoscopic/robotic surgery has diminished. The objective of this article is to review the different indications for open and/or laparoscopic treatment of urinary lithiasis, to achieve its complete elimination with the less invasive possible means and trying to minimize the number of secondary procedures as well as complications.

What should we do with residual fragments

OBJECTIVE

To address various issues concerning the fate of residual fragments (and the patients carrying them), their detection, and current and future techniques to avoid them.

METHODS

Narrative overview of the all relevant articles retrieved from Pubmed research together with the experiences of personal practice was conducted.

RESULTS

Clinically insignificant residual fragments (CIRFs) are defined as asymptomatic, non-obstructing residual fragments smaller than 4 mm (1.6-8) or 5 mm. CIRFs can be diagnosed with either direct endoscopic vision or using imaging modalities including ultrasonography and computerized tomography. Although ultrasonography is radiation-free, the sensitivity and specificity is relatively low when compared to non-contrast computerized tomography.

CONCLUSION

The best and the easiest way to deal with residual fragments is preventing their occurrence. Although asymptomatic residual fragments can be safely followed up, symptomatic fragments should be promptly treated. Several modifications and modalities are currently available to treat the fragments occurring after different treatment options.

Complications of ureteroscopy for stone disease

Ureteroscopy is one of the most commonly performed surgeries for kidney stones and one of the most commonly performed surgeries by urologists overall. Although generally safe, recognizing and understanding the potential complications of ureteroscopy is paramount. Intraoperative complications discussed in this review include difficult access, bleeding, ureteral false passage, perforation, and avulsion. Postoperative considerations discussed include extravasation, infection, postoperative imaging for silent obstruction, and ureteral stricture. We place special emphasis on the management of ureteral stricture, which can be associated with significant morbidity.

Ureteroscopy for management of stone disease: an up to date on surgical technique and disposable devices

The surgical management of urinary stone disease developed substantially over the past decades and advanced minimally invasive techniques have been successfully introduced into clinical practice. Retrograde ureteroscopy and ureterorrenoscopy have become the first-line option for treatment of ureteral and renal stones worldwide with high success rates allied with a low morbidity profile. In this review, we will discuss some key points in ureteroscopy for stone disease, such as the access to upper urinary tract, including balloon and catheter dilation; how to choose and use some disposable devices (hydrophilic versus PTFE guide wires, ureteral catheters, and laser fiber setting); and lastly present and compare different techniques for kidney or ureteral stone treatment (dusting versus basketing).

Outcomes of ureteroscopy

Over the past 2 decades, ureteroscopy has changed from a procedure considered second-line to shockwave lithotripsy to a commonly performed procedure for renal and ureteral stones. The increase in the use of ureteroscopy is due largely to improvements in technique and technology during this time period. Herein we review outcomes of ureteroscopy in terms of success rates, complications, and unique patient populations. This work will synthesize the data as it pertains to the practice of ureteroscopy for all endourological indications, including stone disease and management of upper tract urothelial carcinoma, as well as review state-of-the-art techniques.

Associations between interventions for urolithiasis and urinary tract cancer among patients in Taiwan: The effect of early intervention

The aim of this study was to investigate cancer risk in patients with a history of urolithiasis and to determine whether intervention for calculi attenuated the risk of subsequent urinary tract cancer (UTC).Using data from the National Health Insurance Research Database in Taiwan, we performed a nationwide cohort study enrolling participants (n = 42,732) aged > 30 years who were diagnosed with urinary tract calculi between 2000 and 2009. Age- and gender-matched insured individuals (n = 213,660) found in the health service records over the same period were recruited as the control group. The Cox proportional hazards model and competing risks regression model were used to examine the relationship between urolithiasis and UTC, as well as whether early intervention for urolithiasis decreased the subsequent cancer risk relative to late intervention.Participants with a previous diagnosis of urolithiasis (n = 695) had a 1.82-fold (95% CI: 1.66-1.99, P < 0.001) increased risk of developing UTC. Furthermore, the risk of UTC associated with urolithiasis was higher in women (adjusted HR: 2.43, 95% CI: 1.94-3.05) than in men (adjusted HR: 1.72, 95% CI: 1.55-1.90). When stratified by cancer site, the adjusted HR for bladder, renal pelvis/ureter, renal, and prostate cancers were 1.94 (95% CI: 1.62-2.33), 2.94 (95% CI: 2.24-3.87), 2.94 (95% CI: 2.29-3.77), and 1.45 (95% CI: 1.27-1.65), respectively. Patients who received interventions for urolithiasis within 3 months of detection had a decreased risk of subsequent UTC (adjusted HR: 0.53, 95% CI: 0.40-0.71, P < 0.001).The present study demonstrated that urolithiasis increased the risk of subsequent UTC, especially upper UTC. Hence, it is recommended that physicians administer the appropriate interventions as early as possible upon diagnosis of urolithiasis.

Ureteroscopy: accessory devices

The incidence of stone disease continues to rise. Surgical management options including shockwave laser lithotripsy, percutaneous nephrolithotomy, and ureteroscopy with stone extraction and/or lithotripsy. The technology associated with the ureteroscopic treatment of stones has advanced significantly over the past decade and this review focuses on many of the accessory devices that can be employed to aid in the procedure.

The future of ureteroscopy

Open ureterolithotomy and pyelolithotomy used to be first line therapy for treating kidney and ureteral stones. With the advent of shockwave lithotripsy, open stone surgery became less prevalent, but once ureteroscopy became more prevalent, open stone surgery became all but extinct. Advances in smaller, more flexible endoscopes and improvements in intracorporeal lithotripters, ureteroscopy has become a mainstay of therapy for kidney stones. The holmium:yttrium-aluminium-garnet laser can be utilized through flexible instruments and fragments any stone no matter what it is composed of. Digital image ureteroscopes with chip-on-the-tip technology has improved our visualization during ureteroscopy. What is next? We examine potential directions from current research. Pharmacologic manipulation for ureteral dilation may obviate the need for pre-stenting or balloon dilation. Advances in ureteroscope technology will likely see the biggest advances. Different ureteroscopic platforms and the user interface with the surgeon will progress. Robotic manipulation of the endoscope is an eventual reality with improved ergonomics and improved performance to reach all areas of the kidney. Single-use ureteroscopes are already a reality and offer a digital image with full deflection with every use and without having to worry about sterilization and costly repairs. Lastly, advancements in nanotechnology and robotics will see the potential for miniaturized robots that could be administered intravesically to identify the stone and to disintegrate it. The only prediction that can be made about the future of ureteroscopy is that we do not know how it will look. The future of ureteroscopy is exciting and most definitely will be unrecognizable to the surgeons of today.

Comparative risk of chronic kidney diseases in patients with urolithiasis and urological interventions: a longitudinal population-based study

Large cohort studies on whether any association existed between urological interventions for urolithiasis and the development of CKD are lacking. From claims data of the National Health Insurance (NHI) program of Taiwan, we identified 54,433 patients newly diagnosed with urolithiasis during 1998-2010. For each case, four individuals without urolithiasis were randomly selected and frequency matched by age, sex, and diagnosis year. Both groups were followed up until the end of 2010. Incident CKD events were identified by the International Classification of Diseases, Ninth Revision (ICD-9) code in the NHI registration database. The overall incidence of periodontal diseases was 1.85-fold greater in the urolithiasis group than in the comparison group (33.9 vs 18.3 per 10,000 person-years; 95 % confidence interval [CI] 1.81-1.90). Compared with the adjusted hazard ratios (aHRs) of nonurolithiasis patients, those of patients with urolithiasis increased with the number of medical visits (from 0.91 [95 % CI 0.83-1.00] to 10.6 [95 % CI 9.48-11.8]) and urological interventions (from 1.22 [95 % CI 1.10-1.35] to 86.4 [95 % CI 67.6-110.6]). The aHR was similar in different urological intervention methods, extracorporeal shock wave lithotripsy, ureteroscopy, percutaneous nephrostolithotomy, and open stone surgery. The urological intervention for urolithiasis is associated with an increased risk of CKD. We should be aware of the risk for CKD, especially in patients who have received multiple urological interventions and those elderly.

[Choosing a method of draining the upper urinary tract following percutaneous nephrolithotripsy]

PURPOSE

to compare various methods of upper urinary tract drainage in patients with urolithiasis.

PATIENTS AND METHODS

60 patients were included into a prospective study which ran from March 2013 through December 2014. All patients underwent PCNL with a nephrostomy tract diameter of (28-30 Ch.) at the I.M. Sechenov First Moscow State Medical University urology clinic. Patients were divided into 2 groups. Group 1 30 (patients) underwent nephrostomy after PCNL with nephrostomy tract placement, in group 2 (29 patients) internal drainage was performed. One patient withdrew from the study due to residual stone. Adequacy of urinary tract draining was assessed by operative time and blood loss. A comparative analysis was performed to outline difference in both groups by length of hospital stay, severity of flank pain in early postoperative period and 5 days after the procedure, day of drain removal.

RESULTS

the average operative time in group No1 was 104 minutes (+/-17 min.), and 71 minutes (+/- 19 minutes) in group No2 . The average hemoglobin level before surgery in both groups was roughly comparable and amounted to: 141.5g / l (+/-13) in group No1, in group No 2 143.6 g / l (+/-18). At the same time, hemoglobin level in the early postoperative period varied in both groups and was as follows: 121g / l (+/-13) in group No1, and 128g / l (+/-14) in group 2. Evaluation of pain severity by VAS score showed that severity of pain in an early postoperative period was roughly comparable in both groups and amounted to 6.29 and 6.05 points, respectively, but from the second day, and since the activation of the patients, the values of the intensity of pain in both groups became differ. Group No1: - 5.33 (+/-1.5) on day 2, 3.25 (+/-1.8) on day 3, - 2.5 (+/-1.6) on day 5. A more thorough elucidation of the cause of pain showed that in 56 (88%) patients the pain was due to the nephrostomy and pain in the nephrostomy stroke while driving and only 7 (11%) patients complained of a pain in the operated kidney. Group No2: - 3.5 (+/-1.2) on day 2, - 2.9 (+/-1.4) on day 3, 1.22 (+/-0.8) on day 5.

CONCLUSION

A detailed and thorough history, taking together with multislice computed tomography and multiplanar 3D modeling allows for better preoperative assessment regarding a size, a number and location of stones, vascular architecture of the kidney. This enebles an experienced endoscopic surgeon to plan an operation, and avoid the possible difficulties associated with lithotripsy and choose a more suitable method of pyelocaliceal system draining after the operation. In turn, tubeless PCNL, with proper intraoperative managamant and careful selection of patients appears to be safe and effective. Drainage of the upper urinary tract with internal drainage reduces intensity of postoperative pain, which improves the quality of life of patients in the postoperative period, and reduces the length of postoperative stay.