Ureterorenoskopie (URS) bei Harnsteinen

Ureterorenoscopic (URS) Lithotripsy and Balloon Dilation Cause Acute Kidney Injury and Distal Renal Tubule Damage: A Prospective Study

Ureterorenoscopy (URS) is believed to be a safe and effective procedure for treating ureteral stones or ureteral strictures. Rapidly increasing intrarenal pressure during URS may have a negative impact on the kidney, but its effect on renal function is not well known. The aim of this study was to evaluate whether URS balloon dilation or lithotripsy could cause acute kidney injury (AKI), which was evaluated using urine neutrophil gelatinase-associated lipocalin (NGAL), and renal tubular damage, which was evaluated using urine α-glutathione S-transferase (GST) and πGST. This prospective study included 207 patients with a mean age of 53.8 years between September 2012 and June 2013. Four groups were included: the ureteral stricture group (group 1), the ureteral stone group (group 2), and two control groups. URS increased urine NGAL (uNGAL) levels on days 1 and 14 in both groups, and only elevated uGST levels were noted on day 14 after URS lithotripsy (URS). On day 14, the difference between low-grade and high-grade hydronephrosis was significant in group 1 (p < 0.001) compared to that in group 2 (p = 0.150). Multivariate logistic regression analysis revealed that age, baseline estimated glomerular filtration rate (eGFR), and stone size > 1.0 cm were associated with the complete recovery of hydronephrosis after URS on day 14. Patients with ureteral stones with preserved renal function had more AKI than those with impaired renal function. However, there was no significant difference in URS-related AKI between the ≤1 cm and >1 cm subgroups. In addition, urine αGST and πGST levels were both significantly higher in the stone > 1 cm subgroup than in the ≤1 cm subgroup. In conclusion, URS laser lithotripsy and balloon dilatation resulted in AKI and renal tubular damage on day 14, although post-URS double-J (DBJ) stenting was performed in every patient.

Subcapsular and Perirenal Hematoma after Ureteroscopy and Pneumatic Lithotripsy

Subcapsular or perirenal hematoma is an unusual complication after semirigid ureteroscopy using pneumatic lithotripsy to treat ureteral stones. We present a patient who developed a large subcapsular and perirenal hematoma following ureteroscopy administered to a stone in the right ureter.

Ureteroscopic Holmium:YAG laser lithotripsy is effective for ureteral steinstrasse post-SWL

OBJECTIVE

To evaluate the efficacy of Holmium: YAG laser lithotripsy for ureteral steinstrasse after extracorporeal shock lithotripsy (SWL).

MATERIAL AND METHODS

Holmium: YAG laser lithotripsy was performed on 21 patients who had developed ureteral steinstrasse post-SWL.

RESULTS

Nineteen cases had successful treatment. The ureteral steinstrasse was cleared within one month after the treatment (success rate of 90.48%). Upper ureteral steinstrasse shifted to the renal pelvis was noted in one patient, who underwent a second SWL treatment. Another patient had a severely kinking ureter and underwent open surgery after ureteroscopy failed.

CONCLUSION

Holmium: YAG laser lithotripsy of ureteral steinstrasse post-SWL is an effective clinical modality due to its high success rate, short lithotripsy time, high safety and reliability, and easy feasibility.

[Ureteral reconstruction after ureterorenoscopic injuries]

Ureteral injuries are caused by iatrogenic reasons in about 75% of cases. Among urological procedures ureterorenoscopy (URS) is mainly described as the reason for ureteral injury, although complication rates of URS are generally low. Injuries of the ureter are divided into five grades by the AAST. Grades I-II are referred to as partial and grades III-V as complex ureteral injuries. To avoid higher complication rates there should be no delay in confirmation of diagnosis and initiation of therapy. Correct therapy depends on grade of injury. Partial ureteral injuries are treated by endoscopic inlay of a ureteral stent for approximately 14-21 days. In complex injuries endoscopic ureteroureterostomy could be attempted but leads to rather poor long-term results depending on the length of devascularization of the injured ureter.Procedures with and without use of bowel for ureteral reconstruction and replacement have been described. The type of operative procedure should be selected based on location and degree of ureteral injury. Besides ureteral reconstruction, autotransplantation of the affected kidney can be required in individual cases.

Acute onset of renal colic from bilateral ureterolithiasis: a case report

We report a case of a 32-year-old man, who presented to the emergency department with severe abdominal pain, with radiation to his back. An ultrasound examination revealed mild hydronephrosis bilaterally. A non-enhanced computer tomography was then performed and showed a 9 mm hyperdense image in the left ureter topography along together with an 8-mm hyperdense image in the right ureter topography, allowing us to establish the diagnosis of bilateral ureterolithiasis. The patient was taken to the operating room in order to perform ureteroscopy for endoscopic removal of the stones.

Verletzungen des Nierenbeckens und des Ureters

About 5% of injuries of the urinary tract affect the renal pelvis and ureter and constitute a severe complication. Around 75% of these injuries are iatrogenic and only about 25% are caused by blunt abdominal trauma or perforation. To avoid complications and improve prognosis, immediate diagnosis and therapy are essential. The diagnostic accuracy of preoperative studies is low, therefore frequently injuries are detected during explorative laparotomy. The management of upper urinary tract lesions depends on severity and localization, whereas the ultimate ambition should always be the preservation of the kidney. As a basic rule, ureteral stenting is mostly sufficient for small lesions, and only larger injuries require open reconstructive techniques. Longitudinal studies document a high degree of functional reconstitution if adequate and immediate treatment is carried out.