1
|
Gull S, Para SA, Singh S, Ansari FM, Kumar M, Ashraf W. Safety and Efficacy of Ureteroscopic Laser Lithotripsy in the Management of Ureteric Calculi in Pregnancy-Experience of a Tertiary Care Center. J Obstet Gynaecol India 2024; 74:131-135. [PMID: 38707872 PMCID: PMC11065790 DOI: 10.1007/s13224-023-01889-y] [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: 01/04/2023] [Accepted: 10/15/2023] [Indexed: 05/07/2024] Open
Abstract
Introduction Ureteric colic in pregnancy is one of the common non-obstetric reasons for emergency department visits. Ureteric calculi present a significant threat to maternal and fetal health and definitive management often becomes necessary. Our aim is to assess the safety and efficacy of ureteroscopic laser lithotripsy in the management of ureteric stones in pregnancy. Material and methods This is a prospective observational study of 3 years carried at a tertiary referral center. It includes all pregnant patients who underwent ureteroscopic laser lithotripsy for ureteric stones. Results A total of 29 pregnant patients underwent ureteroscopic laser lithotripsy at our center in 3 years. The mean age of patients was 33.5 ± 6.2 years, and the mean gestation age at the time of ureteroscopy was 23.34 ± 5.9 weeks. The average stone size was 8.3 ± 3.6 mm and was predominantly found in upper ureter (62%). The mean operative time was 31 ± 8.9 min, and the average laser energy spent was 4.3 ± 1.1 kJ/case. There was no major Intraoperative complication, and the average hospital stay was 2.5 ± 1.5 days. Complete stone clearance was achieved in 93.1% of cases. Conclusion Ureteroscopic laser lithotripsy is safe and effective treatment of ureteric stones in terms of obstetric outcome and stone clearance in pregnancy.
Collapse
Affiliation(s)
- Shayista Gull
- Department of Gynecology and Obstetrics, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, 190011 India
| | - Sajad Ahmad Para
- Department of Urology, Sher-i-Kashmir Institute of Medical Sciences, c- quarter Soura, Srinagar, 190011 India
| | - Shashank Singh
- Sher-i-Kashmir Institute of Medical Sciences, Srinagar, 190011 India
| | | | - Manjul Kumar
- Sher-i-Kashmir Institute of Medical Sciences, Srinagar, 190011 India
| | - Waseem Ashraf
- Sher-i-Kashmir Institute of Medical Sciences, Srinagar, 190011 India
| |
Collapse
|
2
|
Tang W, Xie Z, Liu M, Zhao Z, Wu T. Analysis of uroseptic shock after ureteroscopy for ureteral calculi during pregnancy: a case report. BMC Urol 2023; 23:128. [PMID: 37501116 PMCID: PMC10375750 DOI: 10.1186/s12894-023-01299-2] [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: 06/19/2022] [Accepted: 07/21/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Uroseptic shock secondary to ureteral calculi during pregnancy is rare. It is characterized by rapid onset, rapid progression, aggressive disease, limited treatment, poor prognosis, and a mortality rate higher than 20% with improper or delayed management. A clear diagnosis is made based on typical clinical symptoms and abdominal ultrasound, often requiring combined multidisciplinary treatment and the simultaneous release of the obstruction. The high mortality rate is mainly related to inappropriate early treatment of stones and infections or failure to intervene in a timely manner. CASE PRESENTATION A 21-year-old first-time pregnant patient with uroseptic shock was admitted to our intensive care unit. The patient was successfully treated at our hospital with multidisciplinary cooperation, high-dose vasoactive drugs, IABP, CRRT, VA-ECMO, and termination of pregnancy. CONCLUSIONS Timely relief of obstructions, termination of pregnancy, and the provision of IABP, CRRT, and VA-ECMO when necessary in critically ill patients with uroseptic shock during pregnancy can improve the success rate of resuscitation.
Collapse
Affiliation(s)
- Wen Tang
- Department of Urology, The Affiliated Hospital of Zunyi Medical University, No. 149 Road Dalian, Huichuan District, Zunyi, China
| | - Zhifei Xie
- Department of Urology, The Affiliated Hospital of Zunyi Medical University, No. 149 Road Dalian, Huichuan District, Zunyi, China
| | - Mingwen Liu
- Department of Urology, The Affiliated Hospital of Zunyi Medical University, No. 149 Road Dalian, Huichuan District, Zunyi, China
| | - ZeJu Zhao
- Department of Urology, The Affiliated Hospital of Zunyi Medical University, No. 149 Road Dalian, Huichuan District, Zunyi, China.
| | - Tao Wu
- Department of Urology, The Affiliated Hospital of Zunyi Medical University, No. 149 Road Dalian, Huichuan District, Zunyi, China.
| |
Collapse
|
3
|
Jin X, Liu B, Xiong Y, Wang Y, Tu W, Shao Y, Zhang L, Wang D. Outcomes of ureteroscopy and internal ureteral stent for pregnancy with urolithiasis: a systematic review and meta-analysis. BMC Urol 2022; 22:150. [PMID: 36104697 PMCID: PMC9476568 DOI: 10.1186/s12894-022-01100-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 08/31/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES To investigate the outcomes of internal ureteral stents in comparison with ureteroscopy (URS) for pregnant women with urolithiasis. DATA SOURCES Relevant studies published from January 1980 to June 2022 were identified through systematic literature searches of MEDLINE, EMBASE, Web of Science and the Cochrane Library. METHODS OF STUDY SELECTION A total of 499 studies were initially identified. We included pregnant women in any stages of gestation who underwent double-J (D-J) stent insertion only or ureteroscopy for the treatment of urolithiasis; for a study to be included, the number of participants needed to exceed 10. This systematic review was registered on the PROSPERO website (Reference: CRD42020195607). RESULTS A total of 25 studies were identified with 131 cases undergoing serial stenting and 789 cases undergoing URS. The pooled operative success rate was 97% for D-J stent insertion and 99% for URS. Only a few patients passed stones spontaneously after serial D-J stenting. The pooled stone free rate (SFR) in URS operations was about 91%. For internal ureteral stent therapy, the rate of normal fertility outcomes was 99%, although the pooled incidence of complications was approximately 45%. For group receiving URS treatment, the rate of normal fertility outcome was 99% and the pooled incidence of complications was approximately 1%. However, the pooled rate of premature birth and abortion were the similar between the two groups (< 1%); the rate of serious complications was also similar between the two groups. CONCLUSIONS Although internal ureteral stents may cause more minor complications, both ureteroscopy and internal ureteral stents showed had low rates of adverse effects on fertility outcomes when used to treat pregnant women with symptomatic urolithiasis. Evidence suggests that URS may have a greater advantage for pregnant patients with urinary stones when conditions permit. Since, it has been proven to be safe and effective, internal ureteral stents could be considered in emergency or other special situations.
Collapse
Affiliation(s)
- Xingwei Jin
- Department of Urology, School of Medicine, Ruijin Hospital, Shanghai Jiaotong University, No. 197 Ruijin Er Road, Shanghai, 200025, China
| | - Boke Liu
- Department of Urology, School of Medicine, Ruijin Hospital, Shanghai Jiaotong University, No. 197 Ruijin Er Road, Shanghai, 200025, China
| | - Yunqi Xiong
- Department of Gynaecology and Obstetrics, Shanghai TCM College Affiliated Shu Guang Hospital, Shanghai, China
| | - Yuanchun Wang
- Monash Health, Monash Medical Centre, Clayton, VIC, 3168, Australia
| | - Weichao Tu
- Department of Urology, School of Medicine, Ruijin Hospital, Shanghai Jiaotong University, No. 197 Ruijin Er Road, Shanghai, 200025, China
| | - Yuan Shao
- Department of Urology, School of Medicine, Ruijin Hospital, Shanghai Jiaotong University, No. 197 Ruijin Er Road, Shanghai, 200025, China
| | - Lin Zhang
- School of Population Medicine and Public Health, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, 100730, China.
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, 3100, Australia.
- Victorian Comprehensive Cancer Centre, The University of Melbourne Centre for Cancer Research, Parkville, VIC, 3100, Australia.
| | - Dawei Wang
- Department of Urology, School of Medicine, Ruijin Hospital, Shanghai Jiaotong University, No. 197 Ruijin Er Road, Shanghai, 200025, China.
| |
Collapse
|
4
|
Allameh F, Javadi A, Dadkhahfar S, Naeeji Z, Moridi A, Tadayon N, Alahyari S. A Systematic Review of Elective Laser Therapy during Pregnancy. J Lasers Med Sci 2021; 12:e50. [PMID: 34733773 DOI: 10.34172/jlms.2021.50] [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: 03/13/2020] [Accepted: 06/26/2021] [Indexed: 12/15/2022]
Abstract
Introduction: Currently, lasers are used to treat many diseases and their complications. However, the use of lasers in pregnant patients is still controversial. Methods: In this review, the application of lasers in the fields of urology, surgery, obstetrics, dermatology, and musculoskeletal disorders is evaluated. The following keywords were used to search through PubMed, Google Scholar, and Scopus: pregnancy, laser, urolithiasis, endovenous laser ablation (EVLA) or treatment, leg edema, varicose vein, venous insufficiencies, hair removal, pigmentation, telangiectasia, vascular lesions, Q switch laser, diode laser, holmium, holmium-YAG laser, erbium laser and Pulsed dye laser, low-level laser therapy, high-intensity laser therapy, pain, musculoskeletal disorders, twin to twin transfusion syndrome (TTTS), amnioreduction, and safety. Results: Totally, 147 articles were found, and their abstracts were evaluated; out of 53 articles extracted, 14 articles were about dermatology, 24 articles were about urology, 12 articles were about obstetrics and gynecology, 10 articles were about musculoskeletal disorders and three articles were related to surgery. Conclusion: Laser therapy can be used as a safe treatment for urolithiasis, skin diseases, TTTS and varicose veins of the lower extremities. However, the use of laser therapy for musculoskeletal disorders during pregnancy is not recommended due to lack of evidence, and also we cannot recommend endovenous ablation.
Collapse
Affiliation(s)
- Farzad Allameh
- Laser Application in Medical Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Atefeh Javadi
- Physical Medicine and Rehabilitation Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sahar Dadkhahfar
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Naeeji
- Clinical Research Development Center, Mahdiyeh Educational Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Atefeh Moridi
- Department of Gynecology and Obstetrics, Mahdiye Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Niki Tadayon
- Department of General and Vascular Surgery, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sam Alahyari
- Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
5
|
Khusid JA, Hordines JC, Sadiq AS, Atallah WM, Gupta M. Prevention and Management of Infectious Complications of Retrograde Intrarenal Surgery. Front Surg 2021; 8:718583. [PMID: 34434958 PMCID: PMC8381273 DOI: 10.3389/fsurg.2021.718583] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 07/14/2021] [Indexed: 01/11/2023] Open
Abstract
Kidney stone disease (KSD) is a commonly encountered ailment in urologic practice. Urinary tract infection (UTI) is commonly associated with KSD, both as an etiology (e.g., struvite and carbonate apatite stones), and as a complication (i.e., obstructive pyelonephritis and post-operative UTI). Indeed, a significant portion of the economic burden of KSD is skewed toward stones associated with infection. UTI is the most common post-operative complication related to stone intervention with progression to urosepsis as a rare but serious consequence. Risk for infection is influenced by a variety of factors including co-morbid conditions, anatomic abnormalities, prior surgical procedures, and local anti-microbial susceptibility. Understanding these risks and the proper steps to mitigate them is an essential component in reducing post-operative morbidity and mortality. Retrograde intrarenal surgery is routinely used for the treatment of KSD. The objective of this review article is to examine the current literature and guidelines for the prevention and management of stone-related infectious complications associated with retrograde intrarenal surgery. Special attention will be given to the incidence, etiology, and antibiotic prophylaxis choice in the management of stone-related infections. Intraoperative risk mitigation techniques will be discussed in conjunction with the management of post-operative infections. Antibiotic stewardship and the potential benefits of reduced empiric antibiotic treatment will also be discussed.
Collapse
Affiliation(s)
- Johnathan A Khusid
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - John C Hordines
- Department of Urology, SUNY Downstate College of Medicine, Brooklyn, NY, United States
| | - Areeba S Sadiq
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - William M Atallah
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Mantu Gupta
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| |
Collapse
|
6
|
Shalaby EA, Ragab AA, Tawfiek ER, Faisal M. Ultrasound Diagnosis and Active Ureteroscopy for Obstructive Ureteral Calculi during Pregnancy: Multicenter Experience. J Endourol 2021; 35:1460-1466. [PMID: 33769887 DOI: 10.1089/end.2020.1128] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Objectives: To evaluate the safety and efficacy of ultrasound (US) and primary ureteroscopy (URS) in the management of symptomatic obstructive ureteric stones during pregnancy. Patients and Methods: A prospective multicenter study was performed between June 2013 and December 2019, including all consecutive pregnant patients admitted to three urology centers with intractable renal colic with obstructed ureter secondary to obstructive ureteral calculi. Color Doppler ultrasound was used to evaluate renal Resistive Index (RI) and ureter jet. Primary URS was performed to remove the blocking stones. The safety and effectiveness of the procedures were assessed, as well as the stone-free rate (SFR) and the condition of the upper tract after delivery. Results: A total of 111 pregnant patients were included with a mean age of 27.4 ± 4.4 years and a mean renal RI of 0.78 ± 0.02. US diagnosed stones in 46.8% of patients, while 100 (90%) patients had altered lower ureter urinary jet, including 86.5% who had URS-confirmed ureteric stones; SFR was 95.8% with no serious urologic, fetal, or obstetric complications. Nine percent of patients had premature delivery, which was significantly correlated with postoperative urinary tract infection and premature uterine contraction (p ˂ 0.0001). In the third-month follow-up of US, all patients showed no residual hydronephrosis. Postoperative follow-up procedures were required in 15.3% of patients. Conclusion: Obstructive ureteral stones during pregnancy can be detected safely and appropriately with a combined elevated renal RI and absent ureteral jet detected by Doppler US. Definitive URS is an efficient and safe alternative option for those who fail in conservative management.
Collapse
Affiliation(s)
- Essam A Shalaby
- Department of Urology, Suez Canal University, Ismailia, Egypt
| | | | | | - Mahmoud Faisal
- Department of Urology, Al-Azhar University, Cairo, Egypt
| |
Collapse
|
7
|
Demir M, Yagmur İ, Pelit ES, Katı B, Ördek E, Çiftçi H. Urolithiasis and Its Treatment in Pregnant Women: 10-Year Clinical Experience From a Single Centre. Cureus 2021; 13:e13752. [PMID: 33842129 PMCID: PMC8023640 DOI: 10.7759/cureus.13752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Urolithiasis during pregnancy is an important health concern that can affect maternal and foetal health. If left untreated, it can cause obstetric complications, such as spontaneous abortion and preterm delivery. In this study, we aimed to evaluate urolithiasis and its treatment in pregnant women. METHODS We analysed data of 57 patients diagnosed with urolithiasis during pregnancy between January 2010 and December 2020. Patients' age, gestational age, urolithiasis history, physical examination findings, laboratory findings, location and size of the stone and applied treatment methods were examined. The effectiveness and complications of the applied treatment methods were evaluated. RESULTS The mean age of 57 patients included in our study was 27 (27.8 ± 5.6) years and their mean gestational age was 20 (20.3 ± 9.2) weeks. The mean stone size was 9 mm (9.09 ± 4.37). The most common symptom at the time of presentation to the hospital was flank pain (93%). Kidney stones were detected in 34 patients and ureteral stones in 23 patients. Although conservative treatment was sufficient in 26 (45.6%) patients, 31 (54.4%) patients required surgical intervention. Major obstetric complications, such as preterm delivery and abortion, did not occur in any of the patients. CONCLUSION The diagnosis and treatment of pregnant women with urolithiasis should be managed in a multidisciplinary manner. While determining the treatment options, foetal and maternal health should be considered.
Collapse
Affiliation(s)
- Mehmet Demir
- Department of Urology, Harran University, Şanlıurfa, TUR
| | - İsmail Yagmur
- Department of Urology, Harran University, Şanlıurfa, TUR
| | - Eyyup S Pelit
- Department of Urology, Harran University, Şanlıurfa, TUR
| | - Bülent Katı
- Department of Urology, Harran University, Şanlıurfa, TUR
| | - Eser Ördek
- Department of Urology, Harran University, Şanlıurfa, TUR
| | - Halil Çiftçi
- Department of Urology, Harran University, Şanlıurfa, TUR
| |
Collapse
|
8
|
Thakur APS, Sharma V, Ramasamy V, Choudhary A, Patel P, Singh S, Parol S. Management of ureteric stone in pregnancy: a review. AFRICAN JOURNAL OF UROLOGY 2020. [DOI: 10.1186/s12301-020-00070-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Urolithiasis in pregnancy is a major health concern and is one of the most common causes for non-obstetrical abdominal pain and subsequent hospital admission during pregnancy. The incidence of urinary calculi during pregnancy varies in the range of 1/200 to 1/2000. Acute ureteric colic in pregnancy is associated with significant potential risks to both mother and fetus. Significant anatomic and functional changes occur in pregnancy which not only lead to stone formation but also create diagnostic dilemma. The diagnosis of ureteric calculi can be incorrect in about 28% of pregnant patients.
Main body
Management of ureteric stone during pregnancy is remaining to be a challenge for the treating urologist. Because of the inability to use good imaging options for the diagnosis confirmation and more invasive approach for the treatment, management continues to be difficult. The main threats are preterm labor with delivery and premature rupture of membranes. Other pregnancy complications are obstructive uropathy, gestational diabetes mellitus, recurrent abortions and pre-eclampsia. Management of diagnosed ureteric stone is unique in the pregnant population and requires multi-disciplinary care. It should be individualized for each patient and moves preferably from conservative to invasive approaches sequentially. With continued advancements in endourological techniques, few definitive treatment options are also available for such patients.
Conclusion
There are several lacunae related with the diagnostic imaging, medical expulsive therapy, reliability of ureteral stent/percutaneous nephrostomy insertions and safety of ureteroscopy during pregnancy. Herein, we review the management of ureteric stone during pregnancy, the various diagnostic modalities and treatment options with their advantages and disadvantages. We also proposed our management algorithm to deal with such clinical scenario in this particular population.
Collapse
|
9
|
Whitehurst LA, Somani BK. Semi-rigid ureteroscopy: indications, tips, and tricks. Urolithiasis 2017; 46:39-45. [PMID: 29151118 PMCID: PMC5773664 DOI: 10.1007/s00240-017-1025-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 11/11/2017] [Indexed: 12/23/2022]
Abstract
Advances in ureteroscopic technology, alongside broadening treatment options have fuelled the rapid expansion of endourology. Semi-rigid ureteroscopy is a well-known procedure used globally for varying urological conditions, with high success rates. This article aims to provide ‘tips and tricks’ for the semi-rigid ureteroscopy procedure, and the management of commonly encountered pathology such as renal stones, ureteric strictures, and urothelial tumours.
Collapse
Affiliation(s)
- Lily A Whitehurst
- Department of Urology, Royal Hampshire County Hospital, Romsey Road, Winchester, SO22 5DG, UK
| | - Bhaskar K Somani
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK.
| |
Collapse
|
10
|
Somani BK, Dellis A, Liatsikos E, Skolarikos A. Review on diagnosis and management of urolithiasis in pregnancy: an ESUT practical guide for urologists. World J Urol 2017; 35:1637-1649. [PMID: 28424869 DOI: 10.1007/s00345-017-2037-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 04/11/2017] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Management of urolithiasis in pregnancy can be challenging for most urologists with diagnostic and treatment dilemma to ensure the best outcome for both mother and fetus. We wanted to review the literature for urolithiasis in pregnancy with a practical management guide for urologists. METHODS A non-systematic review of literature was carried out for all English language literature using Medline. To ensure a more comprehensive search, the review of diagnosis and management of pregnant patients with urolithiasis was carried out separately, by two authors independently. Due to diagnostic complexity, investigations (US, CT, MRI) carried out were assessed separately. RESULTS Our search included diagnostic studies such as US, CT and MRI (73, 20 and 27 articles, respectively) and management studies (55 articles in total). Details on etiology, radiation risk, safety of various diagnostic modalities, medications and treatment options are covered through an evidence-based approach. We provide a practical guide for urologists in what is clearly a stressful situation for patient and physician alike. CONCLUSIONS Urolithiasis in pregnancy needs a careful multidisciplinary management to achieve good outcomes for both mother and baby. Our review shows that a balanced approach for diagnosis and treatment seems to achieve the best outcomes in pregnancy.
Collapse
Affiliation(s)
| | - Athanasios Dellis
- 1st Department of Urology, Aretaieion Hospital, National and Kapodistrian Univeristy of Athens, Athens, Greece
| | | | - Andreas Skolarikos
- 2nd Department of Urology, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece.
| |
Collapse
|
11
|
Wymer K, Plunkett BA, Park S. Urolithiasis in pregnancy: a cost-effectiveness analysis of ureteroscopic management vs ureteral stenting. Am J Obstet Gynecol 2015. [PMID: 26215329 DOI: 10.1016/j.ajog.2015.07.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the cost-effectiveness of serial stenting vs ureteroscopy for treatment of urolithiasis during pregnancy as a function of gestational age (GA) at diagnosis. STUDY DESIGN We built decision analytic models for a hypothetical cohort of pregnant women who had received a diagnosis of symptomatic ureteral calculi and compared serial stenting to ureteroscopy. We assumed ureteral stent replacement every 4 weeks during pregnancy, intravenous sedation for stent placement, and spinal anesthetic for ureteroscopy. Outcomes were derived from the literature and included stent infection, migration, spontaneous kidney stone passage, ureteral injury, failed ureteroscopy, postoperative urinary tract infection, sepsis, and anesthetic complications. Four separate analyses were run based on the GA at diagnosis of urolithiasis. Using direct costs and quality-adjusted life years, we reported the incremental costs and effectiveness of each strategy based on GA at kidney stone diagnosis and calculated the net monetary benefit. We performed 1-way and Monte-Carlo sensitivity analyses to assess the strength of the model. RESULTS Ureteroscopy was less costly and more effective for urolithiasis, irrespective of GA at diagnosis. The incremental cost of ureteroscopy increased from -$74,469 to -$7631, and the incremental effectiveness decreased from 0.49 to 0.05 quality-adjusted life years for a kidney stone diagnosed at 12 and 36 weeks of gestation, respectively. The net monetary benefit of ureteroscopy progressively decreased for kidney stones that were diagnosed later in pregnancy. The model was robust to all variables. CONCLUSION Ureteroscopy is less costly and more effective relative to serial stenting for urolithiasis, regardless of the GA at diagnosis. Ureteroscopy is most beneficial for women who received the diagnosis early during pregnancy.
Collapse
Affiliation(s)
- Kevin Wymer
- Division of Biological Sciences, Pritzker School of Medicine, University of Chicago, Chicago, IL
| | - Beth A Plunkett
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Evanston, IL
| | - Sangtae Park
- Division of Urology, Department of Surgery, NorthShore University HealthSystem, Evanston, IL.
| |
Collapse
|
12
|
Teleb M, Ragab A, Dawod T, Elgalaly H, Elsayed E, Sakr A, Abdelhameed A, Maarouf A, Khalil S. Definitive ureteroscopy and intracorporeal lithotripsy in treatment of ureteral calculi during pregnancy. Arab J Urol 2014; 12:299-303. [PMID: 26019966 PMCID: PMC4435764 DOI: 10.1016/j.aju.2014.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Revised: 08/12/2014] [Accepted: 08/17/2014] [Indexed: 11/04/2022] Open
Abstract
Objective To evaluate the outcome of using semi-rigid ureteroscopy with or without intracorporeal pneumatic lithotripsy vs. temporary ureteric JJ stenting in the management of obstructing ureteric calculi in pregnant women. Patients and methods This prospective comparative study comprised 43 pregnant women with obstructing ureteric calculi. The diagnosis was based on the acute flank pain as the main symptom, microscopic haematuria, and unilateral hydronephrosis on abdominal ultrasonography (US). The patients were randomly divided into two groups; those in group 1 (22 patients) were treated by temporary ureteric JJ stenting until after delivery, and those in group 2 (21) were treated definitively by ureteroscopic stone extraction with intracorporeal pneumatic lithotripsy. Postoperative complications and the degree of patient satisfaction were reported. Results An obstructing ureteric stone was identified by US in 68% and 76% of groups 1 and 2, respectively. In group 1, nine patients had mid-ureteric stones and 13 had stones in the lower ureter. In group 2, seven patients had mid-ureteric stones, whilst the stones were in the distal ureter in 14. No perioperative foetal complications were detected in any group and all patients completed the full term of pregnancy. In group 1, four patients had a postoperative urinary tract infection (UTI), and the JJ stent was exchanged in seven. Two patients in group 2 had a postoperative UTI. Conclusions Definitive ureteroscopy, even with intracorporeal pneumatic lithotripsy, is an effective and safe treatment for pregnant women with obstructing ureteric calculi. It has a better outcome and is more satisfactory for the patients than a temporary JJ stent.
Collapse
Affiliation(s)
- Mohamed Teleb
- Urology Department, Zagazig University Hospitals, Zagazig, Sharkia, Egypt
| | - Ahmed Ragab
- Urology Department, Zagazig University Hospitals, Zagazig, Sharkia, Egypt
| | - Tamer Dawod
- Urology Department, Zagazig University Hospitals, Zagazig, Sharkia, Egypt
| | - Hazem Elgalaly
- Urology Department, Zagazig University Hospitals, Zagazig, Sharkia, Egypt
| | - Ehab Elsayed
- Urology Department, Zagazig University Hospitals, Zagazig, Sharkia, Egypt
| | - Ahmed Sakr
- Urology Department, Zagazig University Hospitals, Zagazig, Sharkia, Egypt
| | - Ahmed Abdelhameed
- Anesthesiology Department, Zagazig University Hospitals, Zagazig, Sharkia, Egypt
| | - Arif Maarouf
- Urology Department, Zagazig University Hospitals, Zagazig, Sharkia, Egypt
| | - Salem Khalil
- Urology Department, Zagazig University Hospitals, Zagazig, Sharkia, Egypt
| |
Collapse
|
13
|
Giusti G, Proietti S, Peschechera R, Taverna G, Sortino G, Cindolo L, Graziotti P. Sky is no limit for ureteroscopy: extending the indications and special circumstances. World J Urol 2014; 33:257-73. [DOI: 10.1007/s00345-014-1345-y] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 05/14/2014] [Indexed: 12/19/2022] Open
|
14
|
|