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Kwenda EP, Hernandez AD, Di Valerio E, Canales BK. Renal papillary tip biopsy in stone formers: a review of clinical safety and insights. Urolithiasis 2024; 52:93. [PMID: 38888601 DOI: 10.1007/s00240-024-01596-x] [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: 05/07/2024] [Accepted: 06/10/2024] [Indexed: 06/20/2024]
Abstract
Alexander Randall first published renal papillary tip findings from stone formers in 1937, paving the way for endoscopic assessment to study stone pathogenesis. We performed a literature search to evaluate the safety of papillary tip biopsy and clinical insights gained from modern renal papillary investigations. A search on the topic of renal papillary biopsy provided an overview of Randall's plaques (RP), classification systems for renal papillary grading, and a summary of procedure type, complications, and outcomes. Within 26 identified manuscripts, 660 individuals underwent papillary tip biopsy percutaneously (n = 562), endoscopically (n = 37), or unspecified (n = 23). Post-operative hemoglobin changes were similar to controls. One individual (0.2%) reported fever > 38°, and long-term mean serum creatinine post-biopsy (n = 32) was unchanged. Biopsies during ureteroscopy or PCNL added ~20-30 min of procedure time. Compared to controls, papillary plaque-containing tissue had upregulation in pro-inflammatory genes, immune cells, and cellular apoptosis. Urinary calcium and papillary plaque coverage were found to differ between RP and non-RP stone formers, suggesting differing underlying pathophysiology for these groups. Two renal papillary scoring systems have been externally validated and are used to classify stone formers. Overall, this review shows that renal papillary biopsies have a low complication profile with high potential for further research. Systematic adaption of a papillary grading scale, newer tissue analysis techniques, and the development of animal models of Randall's plaque may allow further exploration of plaque pathogenesis and identify targets for prevention therapies in patients with nephrolithiasis.
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Affiliation(s)
- Elizabeth P Kwenda
- Department of Urology, University of Florida, 1600 SW Archer Road, P.O. Box 100247, Gainesville, FL, 32610-0247, USA.
| | | | | | - Benjamin K Canales
- Department of Urology, University of Florida, 1600 SW Archer Road, P.O. Box 100247, Gainesville, FL, 32610-0247, USA
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Almeras C, Estrade V, Meria P. 2022 Recommendations of the AFU Lithiasis Committee: Endoscopic description of renal papillae and stones. Prog Urol 2023; 33:766-781. [PMID: 37918978 DOI: 10.1016/j.purol.2023.08.012] [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: 06/30/2023] [Revised: 07/27/2023] [Accepted: 08/01/2023] [Indexed: 11/04/2023]
Abstract
Endoscopic observation is performed during treatments by flexible ureteroscopy to differentiate in situ between renal papillary abnormalities and stones based on their concordance with Daudon's morphological/composition descriptions adapted to endoscopy. These intraoperative visual analyses are now an integral part of the urinary stone disease diagnostic approach in addition to the morphological/structural and spectrophotometric analysis that remains the reference exam, but that loses information on the stone component representativeness due to the development of in situ laser lithotripsy. These are the first practical recommendations on the endoscopic description of renal papillae and stones. METHODOLOGY: These recommendations were developed using two methods: the Clinical Practice Recommendations (CPR) and the ADAPTE method, depending on whether the question was considered in the European Association of Urology (EAU) recommendations (https://uroweb.org/guidelines/urolithiasis [EAU Guidelines on urolithiasis. 2022]) and their adaptability to the French context.
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Affiliation(s)
- C Almeras
- UroSud, clinique La Croix du Sud, Quint-Fonsegrives, France.
| | - V Estrade
- Department of Urology, Bordeaux Pellegrin University Hospital, Bordeaux, France
| | - P Meria
- Service d'urologie, Hôpital Saint-Louis, AP-HP-Centre université Paris cité, Paris, France
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Touzani A, Pradère B, Beauval JB, Tollon C, Loison G, Ploussard G, Salin A, Almeras C. Reconnaissance endoscopique des anomalies papillaires et des calculs urinaires (REPC) : comment et quel intérêt ? Prog Urol 2022; 32:893-898. [DOI: 10.1016/j.purol.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 08/01/2022] [Indexed: 11/06/2022]
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Danilovic A. Editorial Comment: Classification of the renal papil-lary abnormalities by flexible ureteroscopy: evalua-tion of the 2016 version and update. Int Braz J Urol 2022; 48:361-362. [PMID: 35170902 PMCID: PMC8932033 DOI: 10.1590/s1677-5538.ibju.2022.02.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Alexandre Danilovic
- Departamento de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
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Williams JC, Al-Awadi H, Muthenini M, Bledsoe SB, El-Achkar T, Evan AP, Coe F, Lingeman JE, Worcester EM. Stone morphology distinguishes two pathways of idiopathic calcium oxalate stone pathogenesis. J Endourol 2021; 36:694-702. [PMID: 34915736 PMCID: PMC9145590 DOI: 10.1089/end.2021.0685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Introduction About 1-in-11 Americans will experience a kidney stone, but underlying causes remain obscure. The objective of the present study was to separate idiopathic calcium oxalate stone formers by whether or not they showed positive evidence of forming a stone on Randall's plaque (RP). Materials and Methods In patients undergoing either percutaneous or ureteroscopic procedures for kidney stone removal, all stone material was extracted, and analyzed using micro computed tomographic imaging (micro CT), in order to identify those attached to RP. 24-hour urines were collected weeks after the stone removal procedure and off of medications that would affect urine composition. Endoscopic video was analyzed for papillary pathology (RP, pitting, plugging, dilated ducts, loss of papillary shape) by an observer blinded to the data on stone type. Percent papillary area occupied by RP and ductal plugging was quantified using image analytic software. Results Patients having even 1 stone on RP (N=36) did not differ from Non-RP patients (N=37) in age, sex, BMI, or other clinical characteristics. Compared to the Non-RP group, RP stone formers had more numerous but smaller stones, more abundant papillary RP, and fewer ductal plugs, both by quantitative measurement of surface area (on average, 3 times more plaque area, but only 41% as much plug area as Non-RP) and by semi-quantitative visual grading. Serum and blood values did not differ between RP and Non-RP stone formers by any measure. Conclusions Growth of many small stones on plaque seems the pathogenetic scheme for the RP stone forming phenotype, whereas the Non-RP phenotype stone pathogenesis pathway is less obvious. Higher papillary plugging in Non-RP suggests that plugs play a role in stone formation, and that these patients have a greater degree of papillary damage. Underlying mechanisms that create these distinctive phenotypes are presently unknown.
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Affiliation(s)
- James C Williams
- Indiana University School of Medicine, Department of Anatomy, Cell Biology & Physiology, Indianapolis, Indiana, United States;
| | - Haider Al-Awadi
- Indiana University School of Medicine, Department of Anatomy, Cell Biology & Physiology, Indianapolis, Indiana, United States;
| | - Manognya Muthenini
- Indiana University School of Medicine, Department of Medicine, Indianapolis, Indiana, United States;
| | - Sharon B Bledsoe
- Indiana University School of Medicine, Anatomy, Cell Biology & Physiology, Indianapolis, Indiana, United States;
| | - Tarek El-Achkar
- Indiana University School of Medicine, Department of Medicine , Indianapolis, Indiana, United States;
| | - Andrew P Evan
- indiana University School of Medicine, Anatomy, Cell Biology & Physiology, Indianapolis, Indiana, United States;
| | - Fred Coe
- University of Chicago Pritzker School of Medicine, 12246, Medicine, Chicago, Illinois, United States;
| | - James E Lingeman
- Indiana University School of Medicine, Dept. of Urology, Indianapolis, Indiana, United States;
| | - Elaine M Worcester
- The University of Chicago, Section of Nephrology, Chicago, Illinois, United States;
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Danilovic A. Editorial Comment: Classification of the renal papil-lary abnormalities by flexible ureteroscopy: evalua-tion of the 2016 version and update. Int Braz J Urol 2021; 47:1268-1269. [PMID: 34469678 PMCID: PMC8486451 DOI: 10.1590/s1677-5538.ibju.2021.06.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Alexandre Danilovic
- Departamento de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
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Almeras C, Pradere B, Estrade V, Meria P, French Urological Association OBOTLCOT. Endoscopic Papillary Abnormalities and Stone Recognition (EPSR) during Flexible Ureteroscopy: A Comprehensive Review. J Clin Med 2021; 10:jcm10132888. [PMID: 34209668 PMCID: PMC8267668 DOI: 10.3390/jcm10132888] [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: 05/15/2021] [Revised: 06/18/2021] [Accepted: 06/26/2021] [Indexed: 12/29/2022] Open
Abstract
Introduction: The increasing efficiency of the different lasers and the improved performance of endoscopic devices have led to smaller stone fragments that impact the accuracy of microscopic evaluation (morphological and infrared). Before the stone destruction, the urologist has the opportunity to analyze the stone and the papillary abnormalities endoscopically (endoscopic papillary recognition (EPR) and endoscopic stone recognition (ESR)). Our objective was to evaluate the value for those endoscopic descriptions. Methods: The MEDLINE and EMBASE databases were searched in February 2021 for studies on endoscopic papillary recognition and endoscopic stone recognition. Results: If the ESR provided information concerning the main crystallization process, EPR provided information concerning the origin of the lithogenesis and its severity. Despite many actual limitations, those complementary descriptions could support the preventive care of the stone formers in improving the diagnosis of the lithogenesis mechanism and in identifying high-risk stone formers. Conclusion: Until the development of an Artificial Intelligence recognition, the endourologist has to learn EPSR to minimize the distortion effect of the new lasers on the stone analysis and to improve care efficiency of the stone formers patients.
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Affiliation(s)
- Christophe Almeras
- Department of Urology, La Croix du Sud Clinic-RGDS, UroSud, 52 bis Chemin de Ribaute, Boite 301, 31130 Quint Fonsegrives, France
- French Urological Association (AFU), La Maison de l’Urologie, 11 rue Viète, 31017 Paris, France; (V.E.); (P.M.);
- Correspondence: ; Tel.: +33-53-202-7202; Fax: +33-53-202-7203
| | - Benjamin Pradere
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria;
| | - Vincent Estrade
- French Urological Association (AFU), La Maison de l’Urologie, 11 rue Viète, 31017 Paris, France; (V.E.); (P.M.);
- Department of Urology, CHU Pellegrin, 33300 Bordeaux, France
| | - Paul Meria
- French Urological Association (AFU), La Maison de l’Urologie, 11 rue Viète, 31017 Paris, France; (V.E.); (P.M.);
- Department of Urology, Saint Louis Hospital, Denis Diderot University, 75010 Paris, France
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Jones P, Pietropaolo A, Chew BH, Somani BK. Atlas of scoring systems, grading tools and nomograms in Endourology: A comprehensive overview from The TOWER Endourological Society research group. J Endourol 2021; 35:1863-1882. [PMID: 33878937 DOI: 10.1089/end.2021.0124] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION With an increase in the prevalence of kidney stone disease (KSD), there has been a universal drive to develop reliable and user-friendly tools such as grading systems and predictive nomograms. An atlas of scoring systems, grading tools and nomograms in Endourology is provided in this paper. METHODS A comprehensive search of world literature was performed to identify nomograms, grading systems and classification tools in endourology related to KSD. Each of these were reviewed by the authors and have been evaluated in a narrative format with details on those which are externally validated and their respective citation count on google scholar. RESULTS A total of 54 endourological tools have been described in our atlas of endourological scoring systems, grading tools and nomograms. Of the tools, 23 (43%) are published in the last 3 years showing an increasing interest in this area. This includes 5 for percutaneous nephrolithotomy (PCNL), 6 for flexible ureteroscopy (fURS), 3 for semi-rigid URS (sURS), 9 for shockwave lithotripsy (SWL), 2 for stent encrustations, 3 for intra-operative appearance at the time of URS and 3 to classify intra-operative ureteric injury. There were 3 tools for renal colic assessment, one each for prediction of future stone event, stone classification and stone impaction and 2 for need of emergency intervention in ureteric stone. While 2 tools are related to stone recurrence, 6 are related to post-procedural complications. There are now 2 tools for simulation in endourology and 5 for patient reported outcome measures (PROMS). CONCLUSIONS A number of reliable and established tools exist currently in endourology. Each of these offers their own respective advantages and disadvantages. While nomograms and scoring systems can help in the decision making, these must be tailored to individual patients based on their specific clinical scenarios, expectations and informed consent.
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Affiliation(s)
- Patrick Jones
- Haukeland University Hospital, 60498, Urology, Bergen, Norway;
| | - Amelia Pietropaolo
- University Hospital Southampton NHS Foundation Trust, 7425, Urology, Southampton, Southampton , United Kingdom of Great Britain and Northern Ireland;
| | - Ben H Chew
- University of British Columbia, Urologic Sciences, Vancouver, British Columbia, Canada;
| | - Bhaskar K Somani
- University Hospital Southampton NHS Foundation Trust, 7425, Urology, Southampton, Southampton , United Kingdom of Great Britain and Northern Ireland.,University of Southampton, 7423, Southampton, Hampshire, United Kingdom of Great Britain and Northern Ireland;
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Almeras C, Denis E, Meria P, Estrade V, Raynal G, Hoznek A, Malval B, Dominique S, Bart S, Gautier JR, Abid N. [Recommendations of the Urolithiasis Committee of the French Urology Association for the management and the treatment of the stone formers patients during the COVID-19 pandemic crisis]. Prog Urol 2020; 30:426-429. [PMID: 32389492 PMCID: PMC7198169 DOI: 10.1016/j.purol.2020.04.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 04/22/2020] [Accepted: 04/24/2020] [Indexed: 11/23/2022]
Abstract
Confrontés à une crise d’une ampleur exceptionnelle liée à la pandémie à coronavirus COVID-19 responsable d’une saturation selon les régions des urgences et des places en réanimation, le Comité Lithiase de l’Association Française d’Urologie (CLAFU) a élaboré pour la première fois les recommandations de prise en charge des calculs urinaires durant cette crise sanitaire.
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Affiliation(s)
- C Almeras
- Urologie, Uro. Sud, RGDS Clinique La Croix du Sud, 52 bis, chemin de Ribaute, 31130 Quint Fonsegrives.
| | - E Denis
- Urologie, Centre hospitalier Saint Joseph Saint Luc, Lyon
| | - P Meria
- Urologie, Hôpital Saint Louis, Paris
| | - V Estrade
- Urologie, Centre hospitalier d'Angoulême, France
| | - G Raynal
- Urologie, Clinique médico- chirurgicale Gaston Métivet, Saint-Maur-des-Fossés
| | - A Hoznek
- Urologie, Hôpital Henri Mondor, Créteil
| | - B Malval
- Urologie, Clinique Saint Hilaire, Rouen
| | - S Dominique
- Urologie, Cabinet d'Urologie Paris Opéra, Paris
| | - S Bart
- Urologie, Centre Hospitalier René Dubos, Pontoise
| | - J R Gautier
- Urologie, Uro. Sud, RGDS Clinique La Croix du Sud, 52 bis, chemin de Ribaute, 31130 Quint Fonsegrives
| | - N Abid
- Urologie, Hospices civils de Lyon, Lyon
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Sabaté Arroyo XA, Grases Freixedas F, Bauzà Quetglas JL, Guimerà Garcia J, Pieras Ayala E. Relationship of endoscopic lesions of the renal papilla with type of renal stone and 24 h urine analysis. BMC Urol 2020; 20:46. [PMID: 32334600 PMCID: PMC7183647 DOI: 10.1186/s12894-020-00615-4] [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: 01/23/2020] [Accepted: 04/13/2020] [Indexed: 01/24/2023] Open
Abstract
Background Our purpose was to study the relationship of the 3 different types of endoscopic calcifications of the renal papilla (Randall’s plaque, intratubular calcification, papillary crater) with the type of stone and urine analysis. Methods This prospective study examined 41 patients (age range: 18 to 80 years) who received retrograde intrarenal surgery (RIRS) for renal lithiasis (mean stone size: 15.3 ± 7.2 mm). The renal papilla injuries were endoscopically classified as Randall’s plaque, intratubular calcification, or papillary crater. Calculi were classified as uric acid, calcium oxalate monohydrate (COM; papillary and cavity), calcium oxalate dihydrate (COD), or calcium phosphate (CP). A 24 h urine analysis of calcium, oxalate, citrate, phosphate, and pH was performed in all patients. The relationship of each type of papillary injury with type of stone and urine chemistry was determined. Fisher’s exact test and Student’s t-test were used to determine the significance of relationships, and a p value below 0.05 was considered significant. Results The most common injury was tubular calcification (78%), followed by Randall’s plaque (58%), and papillary crater (39%). There was no significant relationship of Randall’s plaque with type of stone. However, endoscopic intratubular calcification (p = 0.025) and papillary crater (p = 0.041) were more common in patients with COD and CP stones. There were also significant relationships of papillary crater with hypercalciuria (p = 0.036) and hyperoxaluria (p = 0.024), and of Randall’s plaque with hypocitraturia (p = 0.005). Conclusions There are certain specific relationships between the different types of papillary calcifications that were endoscopically detected with stone chemistry and urine analysis. COD and CP stones were associated with endoscopic tubular calcifications and papillary craters. Hypercalciuria was associated with tubular calcification, and hypocitraturia was associated with Randall’s plaque.
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Affiliation(s)
- X A Sabaté Arroyo
- Hospital Universitari Son Espases, Ctra. Valldemossa, 79, Palma de Mallorca, Spain.
| | - F Grases Freixedas
- Universitat de les Illes Balears. IUNICS, Ctra. de Valldemossa, Km. 7.5, Palma de Mallorca, Spain
| | - J L Bauzà Quetglas
- Hospital Universitari Son Espases, Ctra. Valldemossa, 79, Palma de Mallorca, Spain
| | - J Guimerà Garcia
- Hospital Universitari Son Espases, Ctra. Valldemossa, 79, Palma de Mallorca, Spain
| | - E Pieras Ayala
- Hospital Universitari Son Espases, Ctra. Valldemossa, 79, Palma de Mallorca, Spain
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Almeras C, Daudon M, Estrade V, Gautier JR, Traxer O, Meria P. Classification of the renal papillary abnormalities by flexible ureteroscopy: evaluation of the 2016 version and update. World J Urol 2020; 39:177-185. [PMID: 32193654 PMCID: PMC7858204 DOI: 10.1007/s00345-020-03149-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 02/26/2020] [Indexed: 11/18/2022] Open
Abstract
Introduction To assess the use of the 2016 proposed classification of the renal papillary abnormalities during flexible ureteroscopy that aims to standardize their description. Patients and methods We performed a prospective monocentric single operator collection of the data using this classification during 88 consecutive flexible ureteroscopies required for renal stones treatment. Outcome measurements and statistical analysis: data of stones analysis (microscopy and infrared spectrophotometry) and of serum and urines biochemical samples have been compared with the results of the classified endoscopic descriptions. Results Mean duration of description was 81.4 s. We reported that 83% of the patients had Randall plaques (RP), as only 4.5% of the patients had no abnormality. Concerning the papillary stones and anchored stones were observed in 30.7% and aspect of intraductal crystallization (Sc) in 15.9%. Erosions were present in 55.7% and extrophic papillae in 8%. Sa1 and Pa2 were significantly correlated to RP, anchored stones (Sa) to papillary erosions and calcium phosphate stones to intraductal crystallization. Hypercalciuria was significantly higher in Sa2 than Sa1 stones. Conclusions The different descriptions in the 2016 classification were confirmed by the results of this study. Papillary abnormalities are consequences of stones development. Their descriptions could also improve the follow-up and the diagnosis of a metabolic lithogenesis. We recommend their systematic description during ureteroscopy. Some improvements are proposed to update this classification.
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Affiliation(s)
- Christophe Almeras
- Department of Urology, La Croix du Sud Clinic, 52 chemin de Ribaute, 31130, Quint Fonsegrives, France.
| | - Michel Daudon
- Unit of Functional Explorations, Tenon Hospital, Pierre and Marie Curie University, Paris, France
| | | | - Jean Romain Gautier
- Department of Urology, La Croix du Sud Clinic, 52 chemin de Ribaute, 31130, Quint Fonsegrives, France
| | - Olivier Traxer
- Department of Urology, Tenon Hospital, Pierre and Marie Curie University, Paris, France
| | - Paul Meria
- Department of Urology, Saint-Louis Hospital, Denis Diderot University, Paris, France
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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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Borofsky MS, Williams JC, Dauw CA, Cohen A, Evan AC, Coe FL, Worcester E, Lingeman JE. Association Between Randall's Plaque Stone Anchors and Renal Papillary Pits. J Endourol 2019; 33:337-342. [PMID: 30793930 DOI: 10.1089/end.2018.0589] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Renal papillary pits are commonly encountered during ureteroscopy. The mechanism by which such pits arise is unclear. One hypothesis is that pits represent sites where stones overgrowing Randall's plaque (RP) were dislodged. We sought to examine this theory by using digital ureteroscopy and stone μCT. MATERIALS AND METHODS Patients undergoing endoscopic stone removal had procedures recorded and stones analyzed by using μCT. Stones with evidence of Randall's plaque anchors (RPAs) were identified in a blinded fashion. Surgical videos were reviewed independently by two urologists. RESULTS Twenty-eight patients had μCT-confirmed stones with RPA. Among them, 93% were recurrent stone formers and 75% had had prior stone procedures. Metabolic abnormalities were present in 87%, with 79% classified as idiopathic calcium oxalate stone formers. A mean of 7.6 stones with RPA were identified per procedure. In each case, papillary pits were visualized before any stone manipulation and in several cases the active dislodgement of an attached stone led to immediate identification of an underlying pit. Such stones routinely demonstrated an RPA on μCT. The average depth of RPA was 302 ± 172 μm, consistent with the corresponding shallow pits visualized on the papillary surface. CONCLUSIONS Stones overgrowing RP are capable of pulling away a piece of papilla when dislodged, resulting in a visible papillary pit. This process manifests as an RPA on the undersurface of the stone and a papillary pit on the corresponding area of attachment. Identification of pits may help identify patients who form stones primarily by the RP mechanism.
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Affiliation(s)
- Michael S Borofsky
- 1 Department of Urology, University of Minnesota, Minneapolis, Minnesota
| | - James C Williams
- 2 Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Casey A Dauw
- 3 Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Andrew Cohen
- 4 Section of Urology, Department of Surgery, University of Chicago, Chicago, Illinois
| | - Andrew C Evan
- 2 Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Fredric L Coe
- 5 Department of Nephrology, University of Chicago, Chicago, Illinois
| | - Elaine Worcester
- 5 Department of Nephrology, University of Chicago, Chicago, Illinois
| | - James E Lingeman
- 6 Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana
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Xiao J, Wang X, Li J, Wang M, Han T, Zhang C, Du Y, Hao G, Tian Y. Treatment of upper urinary tract stones with flexible ureteroscopy in children. Can Urol Assoc J 2018; 13:E78-E82. [PMID: 30169147 DOI: 10.5489/cuaj.5283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
INTRODUCTION This single-centre, retrospective study aimed to assess the efficacy and safety of flexible ureteroscopy (FURS) combined with holmium laser lithotripsy in treating children with upper urinary tract stones. METHODS From June 2014 to October 2015, a total of 100 children (74 boys and 26 girls) with upper urinary tract stones were treated using FURS. A 4.7 Fr double-J stent was placed two weeks before operation. Patients were considered stone-free when the absence of residual fragments was observed on imaging studies. The preoperative, operative, and postoperative data of the patients were retrospectively analyzed. RESULTS A total of 100 pediatric patients with a mean age of 3.51±1.82 years underwent 131 FURS and holmium laser lithotripsy. Mean stone diameter was 1.49±0.92 cm. Average operation time was 30.8 minutes (range 15-60). The laser power was controlled between 18 and 32 W, and the energy maintained between 0.6 and 0.8 J at any time; laser frequency was controlled between 30 and 40 Hz. Complications were observed in 69 (69.0 %) patients and classified according to the Clavien system. Postoperative hematuria (Clavien I) occurred in 64 (64.0 %) patients. Postoperative urinary tract infection with fever (Clavien II) was observed in 8/113 (7.1%) patients. No ureteral perforation and mucosa avulsion occurred. The overall stone-free rate of single operation was 89/100 (89%). Stone diameter and staghorn calculi were significantly associated with stone-free rate. CONCLUSIONS FURS and holmium laser lithotripsy is effective and safe in treating children with upper urinary tract stones.
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Affiliation(s)
- Jing Xiao
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xiangyu Wang
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jun Li
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Miaoiao Wang
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Tiandong Han
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Caixiang Zhang
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yuan Du
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Gangyue Hao
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Ye Tian
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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15
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Abstract
PURPOSE OF REVIEW The pathophysiological mechanisms in kidney stone formation are insufficiently understood. In order to achieve a better understanding of the complexity of stone formation, studies evaluating anatomical variations in the renal papillae have been performed. This review intends to illuminate recent findings. Moreover, new techniques to improve the understanding and interpretation of crystallization mechanisms are reviewed. RECENT FINDINGS Due to improvements of digital ureteroscopes, detailed endoscopic mapping of renal papillae is now possible. Connections between papillary morphology and histopathological changes in different subsets of stone formers have been documented. The formation of kidney stones seems to take place in relation to Randall's plaques, Ducts of Bellini or by free formation. Additionally, theories of kidney stone formation because of vascular injury or inflammatory events in the papillae have been suggested. SUMMARY Novel techniques including improved digital endoscopic visualization, microcomputed tomography (CT), electron microscopy and energy dispersive compositional analyses of kidney stones seem essential in the search for effective and reliable methods to understand stone forming processes, which ultimately should result in effective measures for more personalized stone prevention strategies in the future.
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16
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Cohen AJ, Borofsky MS, Anderson BB, Dauw CA, Gillen DL, Gerber GS, Worcester EM, Coe FL, Lingeman JE. Endoscopic Evidence That Randall's Plaque is Associated with Surface Erosion of the Renal Papilla. J Endourol 2016; 31:85-90. [PMID: 27824271 DOI: 10.1089/end.2016.0537] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE This study was conducted to assess the reliability and precision of an endoscopic grading scale to identify renal papillary abnormalities across a spectrum of equipment, locations, graders, and patients. MATERIALS AND METHODS Intra- and interobserver reliability of the papillary grading system was assessed using weighted kappa scoring among 4 graders reviewing a single renal papilla from 50 separate patients on 2 occasions. Grading was then applied to a cohort of patients undergoing endoscopic stone removal procedures at two centers. Patient factors were compared with papillary scores on the level of the papilla, kidney, and patient. RESULTS Graders achieved substantial (kappa >0.6) intra- and inter-rater reliability in scored domains of ductal plugging, surface pitting, and loss of contour. Agreement for Randall's Plaque (RP) was moderate. Papillary scoring was then performed for 76 patients (89 kidneys, 533 papillae). A significant association was discovered between pitting and RP that held both within and across institutions. A general linear model was then created to further assess this association and it was found that RP score was a highly significant independent correlate of pitting score (F = 7.1; p < 0.001). Mean pitting scores increased smoothly and progressively with increasing RP scores. Sums of the scored domains were then calculated as a reflection of gross papillary abnormality. When analyzed in this way, a history of stone recurrence and shockwave lithotripsy were strongly predictive of higher sums. CONCLUSIONS Renal papillary pathology can be reliably assessed between different providers using a newly described endoscopic grading scale. Application of this scale to stone-forming patients suggests that the degree of RP appreciated in the papilla is strongly associated with the presence of pitting. It also suggests that patients with a history of recurrent stones and lithotripsy have greater burdens of gross papillary disease.
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Affiliation(s)
- Andrew J Cohen
- 1 Section of Urology, Department of Surgery University of Chicago , Chicago, Illinois
| | - Michael S Borofsky
- 2 Department of Urology, Indiana University School of Medicine , Indianapolis, Indiana
| | - Blake B Anderson
- 1 Section of Urology, Department of Surgery University of Chicago , Chicago, Illinois
| | - Casey A Dauw
- 2 Department of Urology, Indiana University School of Medicine , Indianapolis, Indiana
| | - Daniel L Gillen
- 3 Department of Statistics, Program in Public Health, and Department of Epidemiology, University of California , California, Irvine
| | - Glenn S Gerber
- 1 Section of Urology, Department of Surgery University of Chicago , Chicago, Illinois
| | | | - Fredric L Coe
- 4 Section of Nephrology, University of Chicago , Chicago, Illinois
| | - James E Lingeman
- 2 Department of Urology, Indiana University School of Medicine , Indianapolis, Indiana
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