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Zeng SP, Sun YF, Yu HY, Yang J, Deng KF. Efficacy of flexible ureterorenoscopy with holmium laser in the management of calyceal diverticular calculi. Urolithiasis 2024; 52:50. [PMID: 38554174 PMCID: PMC10981604 DOI: 10.1007/s00240-024-01552-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 02/29/2024] [Indexed: 04/01/2024]
Abstract
The purpose of this study was to evaluate the efficacy and safety of flexible ureteroscopy with holmium laser lithotripsy in the management of calyceal diverticular calculi. In this study, we retrospectively analyzed the clinical data of 27 patients with calyceal diverticular calculi admitted to the Department of Urology of the Zigong First People's Hospital from May 2018 to May 2021. Intraoperatively, the diverticular neck was found in all 27 patients, but flexible ureterorenoscopy lithotripsy was not performed in 2 cases because of the slender diverticular neck, and the success rate of the operation was 92.6%. Of the 25 patients with successful lithotripsy, the mean operative time was 76.9 ± 35.5 (43-200) min. There were no serious intraoperative complications such as ureteral perforation, mucosal avulsion, or hemorrhage. Postoperative minor complications (Clavien classification I-II) occurred in 4 (16%) patients. The mean hospital stay was 4.4 ± 1.7 (3-12) days. The stone-free rate was 80% at the 1-month postoperative follow-up. After the second-stage treatment, the stone-free rate was 88%. In 22 cases with complete stone clearance, no stone recurrence was observed at 5.3 ± 2.6 (3-12) months follow-up. This retrospective study demonstrated that flexible ureterorenoscopy with holmium laser is a safe and effective choice for the treatment of calyceal diverticular calculi, because it utilizes the natural lumen of the human body and has the advantages of less trauma, fewer complications, and a higher stone-free rate.
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Affiliation(s)
- Shi-Ping Zeng
- Department of Urology, Zigong First People's Hospital, Zigong, Sichuan, China
| | - Yi-Fei Sun
- Neurological Disease Laboratory, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Han-Yang Yu
- Department of Urology, The People's Hospital of Weiyuan, Neijiang, Sichuan, China
| | - Jian Yang
- Department of Urology, Zigong First People's Hospital, Zigong, Sichuan, China
| | - Ke-Fei Deng
- Department of Urology, Zigong First People's Hospital, Zigong, Sichuan, China.
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Zhao Y, Zhang R, Yun Y, Wu X, Li H, Wang J, Wang W, Jia C, Song H. A case report of renal calyceal diverticulum with hypertension in children and review of literature. BMC Pediatr 2022; 22:35. [PMID: 35016649 PMCID: PMC8750799 DOI: 10.1186/s12887-021-03081-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 12/17/2021] [Indexed: 11/12/2022] Open
Abstract
Background Renal calyx diverticulum refers to a cystic lesion covered with the transitional epithelium in the renal parenchyma. Although there is no clear evidence that calyx diverticulum can cause hypertension, there exists a close association between the two, and there are few related reports. Herein, we reported the case of a child with renal calyx diverticulum complicated with hypertension and summarized the diagnosis and treatment. Case presentation Physical examination of the patient, an 11-year-old child, revealed a left renal cyst with hypertension (155/116 mmHg). There were no related symptoms. Routine urine and blood biochemical examinations showed no abnormalities. Imaging revealed left renal cyst compression causing the hypertension. She underwent renal cyst fluid aspiration and injection of a sclerosing agent into the capsule, but her blood pressure increased again 3 days postoperatively. Color Doppler ultrasonography showed that the size of the left renal cyst was the same as that preoperatively. To further confirm the diagnosis, cystoscopic retrograde ureteropyelography was performed to confirm the diagnosis of renal calyx diverticulum. Subsequently, renal calyceal diverticulum resection and calyx neck enlargement were performed. The operation went smoothly and the blood pressure returned to normal postoperatively. No abnormalities were noted at the 7-month postoperative follow-up. Conclusion There exists an association between renal calyx diverticulum and hypertension. Therefore, hypertension can be considered a surgical indication for renal calyx diverticulum. Moreover, renal calyceal diverticulum in children can be easily misdiagnosed as a renal cyst. Therefore, it is important to be vigilant to prevent a series of complications, such as postoperative urine leakage, in such cases.
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Affiliation(s)
- Yongxiang Zhao
- The Fourth Hospital of Baotou, Baotou, Inner Mongolia, China
| | - Ruimin Zhang
- The Fourth Hospital of Baotou, Baotou, Inner Mongolia, China
| | - Ye Yun
- The Fourth Hospital of Baotou, Baotou, Inner Mongolia, China
| | - Xiangming Wu
- The Fourth Hospital of Baotou, Baotou, Inner Mongolia, China
| | - Haowei Li
- The Fourth Hospital of Baotou, Baotou, Inner Mongolia, China
| | - Jun Wang
- The Fourth Hospital of Baotou, Baotou, Inner Mongolia, China
| | - Wei Wang
- The Fourth Hospital of Baotou, Baotou, Inner Mongolia, China
| | - Chunmei Jia
- The Fourth Hospital of Baotou, Baotou, Inner Mongolia, China.
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Lou B, Sun Y, Lin J, Yuan Z, He L, Long C, Lin X. Clinical Features of Endogenous Endophthalmitis Secondary to Minimally Invasive Upper Urinary Tract Calculus Removal. Ocul Immunol Inflamm 2020; 30:104-110. [PMID: 32809901 DOI: 10.1080/09273948.2020.1778732] [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] [Indexed: 12/23/2022]
Abstract
PURPOSE To evaluate endogenous endophthalmitis clinical features following minimally invasive removal of upper urinary tract calculi. METHODS Medical records of twelve patients (17 eyes) with endogenous endophthalmitis secondary to minimally invasive upper urinary tract calculus removal were retrospectively reviewed. RESULTS Diabetes mellitus was found in 7 patients (58%). 10 patients (83%) suffered from fever. The stone extraction and ocular symptom onset interval ranged from 2 to 22 days. All eyes presented as vitritis and fluffy yellow-white retinal exudates. Hypopyon was only found in 3 eyes (18%). 5 patients (42%) were misdiagnosed as uveitis which led to mismanagement. Ocular fluids were culture positive for only C. albicans in 12 eyes (71%). 10 of 12 eyes (83%) with silicon oil tamponade obtained a final BCVA≥0.05. CONCLUSIONS C. albicans was the most common endogenous endophthalmitis pathogen after urinary calculus removal by minimally invasive surgery. Pars plana vitrectomy with silicon oil tamponade may be helpful to achieve a favorable visual outcome. Routine ophthalmologic evaluation by the uveitis or vitreoretinal specialist may be necessary within 2 weeks after the urological procedures.
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Affiliation(s)
- Bingsheng Lou
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yi Sun
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.,Department of Ophthalmology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jialiu Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Zhaohui Yuan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Liwen He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Chongde Long
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xiaofeng Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
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Zhang Z, Zhang Y, Wang X, Chen D, Peng N, Chen J, Bleyer A, Wang Q, Liu Y, Zhang Y. Challenges in the diagnosis of calyceal diverticulum: A report of two cases and review of the literature. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2019; 27:1155-1167. [PMID: 31476195 DOI: 10.3233/xst-190549] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Calyceal diverticula outpouchings that occur rarely in the upper collecting system of the kidney and is often difficult to detect. In this study, we present two cases of calyceal diverticula and discuss their clinical characteristics and radiologic features. PATIENTS AND METHODS In the presented two cases, we applied several imaging examinations, including delayed intravenous pyelography, retrograde pyelography and axial computerized tomographic (CT) scanning of the kidneys with and without contrast. Serum creatinine levels in fluid withdrawn from the diverticula were found to be significantly higher than the simultaneous serum creatinine levels. Intravenous injection of methylene blue through a ureteral catheter was also aided in the diagnosis. Calyceal diverticulum neck dilatation was performed through a percutaneous nephroscope.ResultsThe two cases were diagnosed preoperatively and the operation was successful performed. The nephrostomy tube was removed seven days after surgery without complications. CT scans of the kidney after six months showed that the size of the calyceal diverticulum of two patients were considerably smaller than pre-surgery. There were no reports of pain in the lumbar region or other discomfort. COMMENTS Diagnosis of calyceal diverticulum mainly depend on a variety of imaging examinations, including the delayed intravenous pyelography, retrograde pyelography, and kidney CT plain scan plus enhanced scan. If the patient cannot be diagnosed by above methods, cyst fluid can be aspirated percutaneously to measure the preoperative creatinine level. If it is significantly higher than the serum creatinine level, the cyst fluid is considered urine, which can assist in the diagnosis of calyceal diverticulum. A ureteral catheter should also be inserted before operation namely, intravenous injection of methylene blue through a ureteral catheter is helpful for diagnosis. The choice of surgical treatment is based on the size and location of calyceal diverticulum and clinical manifestations.
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Affiliation(s)
- Zejian Zhang
- Department of Urology, Shenzhen Longhua District Central Hospital, Guangdong, Shenzhen, China
| | - Yixiang Zhang
- Department of Urology, Shenzhen People's Hospital, Guangdong, Shenzhen, China
| | - Xisheng Wang
- Department of Urology, Shenzhen Longhua District Central Hospital, Guangdong, Shenzhen, China
| | - Dong Chen
- Department of Urology, Shenzhen Longhua District Central Hospital, Guangdong, Shenzhen, China
| | - Naixiong Peng
- Department of Urology, Shenzhen Longhua District Central Hospital, Guangdong, Shenzhen, China
| | - Jicheng Chen
- Department of Urology, Shenzhen Longhua District Central Hospital, Guangdong, Shenzhen, China
| | - Anthony Bleyer
- Section on Nephrology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Qinjun Wang
- Department of Urology, Shenzhen Longhua District Central Hospital, Guangdong, Shenzhen, China
| | - Yunfei Liu
- Department of Urology, Shenzhen Longhua District Central Hospital, Guangdong, Shenzhen, China
| | - Yuanyuan Zhang
- Wake Forest Institute for Regenerative Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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Yang H, Yu X, Peng E, Li C, Cui L, Zeng X, Wang S, Wei C, Wang Z, Guo X, Chen Z, Ye Z, Wang S, Zhao C. Urgent laparoscopic ureterolithotomy for proximal ureter stones accompanied with obstructive pyelonephritis: Is it safe and effective without preoperative drainage? Medicine (Baltimore) 2017; 96:e8657. [PMID: 29137105 PMCID: PMC5690798 DOI: 10.1097/md.0000000000008657] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
To evaluate the safety and efficacy of retroperitoneal laparoscopic ureterolithotomy (RLU) in the treatment of proximal ureteral stones accompanied with obstructive pyelonephritis without preoperative drainage.We retrospectively reviewed 21 cases of proximal ureteral stones with infected kidney undergoing RLU between July 2013 and September 2016. Stone-induced obstructive infected hydronephrosis was diagnosed using blood and urine tests and imaging modalities. Empirical effective broad spectrum antibiotic therapy was initiated immediately, and then urgent RLU was performed without preoperative drainage. During the surgical procedure, infected urine was also aspirated before stone was removed. Preoperative, intraoperative, and postoperative clinical data were collected.Operations were performed successfully without open conversion or blood transfusion. The mean operation time was 69.3 ± 12.33 minutes. For all the patients, the level of plasma procalcitonin decreased after RLU. The mean hospital stay duration was 6.4 ± 1.54 days. No septic shock or other severe complications occurred. By discharge, the body temperature and hemogram of each patient returned to normal. A 100% stone-free rate was achieved.Our study suggests that RLU is a potentially safe and effective method to treat proximal ureteral stones accompanied with obstructive pyelonephritis without any need of preoperative drainage.
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Capitanini A, Rosso L, Giannecchini L, Meniconi O, Cupisti A. Sepsis complicated by brain abscess following ESWL of a caliceal kidney stone: a case report. Int Braz J Urol 2016; 42:1033-1036. [PMID: 27583356 PMCID: PMC5066903 DOI: 10.1590/s1677-5538.ibju.2015.0727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 04/05/2016] [Indexed: 11/21/2022] Open
Abstract
A 47-year old, Caucasian man underwent extracorporeal shock wave lithotripsy (ESWL) of a 14mm calcium stone in the right renal pelvis, without urinary tract obstruction or sepsis. 24 hours after ESWL septic shock occurred and the patient was admitted to the Intensive Care Unit (ICU). Escherichia coli emerged from the blood and urine culture. The patient developed acute renal failure and it was necessary to start a continuous renal replacement therapy (CRRT). Infection was successfully treated, patient recovered renal function and an improvement of general condition occurred. The patient was then discharged but three day later the patient returned to the hospital to seek treatment for left facial hemiparesis and hypotonia of his left arm. The brain computed tomography showed a wide abscess (55×75mm) in the frontal right parietal region. A neurosurgical intervention was then performed and the culture of the drained material resulted positive for Escherichia coli. The guidelines of European and American Associations of Urology do not suggest a prophylactic antibiotic therapy for pre-ESWL (except in the presence of risk factors). The serious complication that occurred in the described low risk patient raises the question of whether routine culture and/or antibiotic prophylaxis, is appropriate.
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Affiliation(s)
| | - Luca Rosso
- Unità di Nefrologia, Ospedale di Pescia, Pescia, Italy
| | | | - Ophelia Meniconi
- Dipartimento di Medicina Clinica e Sperimentale, Università di Pisa, Pisa, Italy
| | - Adamasco Cupisti
- Dipartimento di Medicina Clinica e Sperimentale, Università di Pisa, Pisa, Italy
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