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Raj K K, Adiga K P, Chandni Clara D'souza R, B N, Shetty M. Assessment of Factors Responsible for Stone-Free Status After Retrograde Intrarenal Surgery. Cureus 2024; 16:e63627. [PMID: 38957512 PMCID: PMC11217185 DOI: 10.7759/cureus.63627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2024] [Indexed: 07/04/2024] Open
Abstract
Aim The study aimed to evaluate the predictive factors that determined stone-free rate (SFR) after retrograde intrarenal surgery (RIRS). Materials and methods This prospective study was conducted on 183 patients undergoing RIRS for renal stones. Patients were categorized into two groups, depending on stone-free status one month following the procedure. SFR was defined as the complete absence of stones or stones <4 mm. The parameters studied included patient demographics, presence of hydronephrosis, presence of preoperative double J-stent, abnormal renal anatomy, and stone characteristics (stone burden, stone number, stone density, stone location, lower pole infundibulopelvic angle, and lower pole renal infundibular length (RIL)). Univariate and multivariate analyses were performed to identify risk factors for residual stones. We assessed the predictive ability of the RIRS score and Resorlu-Unsal stone score (RUSS) for evaluating SFR utilizing receiver operating characteristic (ROC) analysis. Results 183 patients were included in the study with a median age of 51 years. 131 (71.6%) patients were declared stone-free after the procedure. The mean stone size and density were 16.9 SD±7.5 mm and 1038 SD±342 Hounsfield units (HU) respectively. Stone-free patients had lower stone size (14.3 mm vs. 23.6 mm, p<0.01) and stone density (970 HU vs. 1211 HU, p<0.01) compared to non-stone-free patients. Patients with residual stones had steeper lower pole renal infundibulopelvic angle (RIPA) (31.3° vs. 40.7°, p<0.01) and longer RIL (26.6 mm vs. 21.1 mm, p<0.01). Stone multiplicity (p<0.01), lower pole stone location (p<0.01), and renal malformations (p<0.01) were significant influencing factors for residual renal stones after RIRS. Multivariate analysis revealed stone size, stone density (HU), and stone location as independent predictors for SFR after RIRS. Among the scoring systems, the RIRS score had the highest diagnostic accuracy for SFR (area under the curve (AUC): -0.882, 95% CI-0.828-0.936). Conclusion Stone size, stone density (HU), and stone number are important predictors of SFR after RIRS. Lower pole stone location and abnormal renal anatomy play a substantial role in determining SFR after RIRS. In lower pole stones, a long RIL and acute RIPA negatively influence SFR. Additionally, the RIRS score was found to be a better predictor for SFR than the RUSS score.
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Affiliation(s)
- Kishan Raj K
- Urology, Father Muller Medical College and Hospital, Mangalore, IND
| | - Prashant Adiga K
- Urology, Father Muller Medical College and Hospital, Mangalore, IND
| | | | - Nandakishore B
- Urology, Father Muller Medical College and Hospital, Mangalore, IND
| | - Manjunath Shetty
- Urology, Malabar Medical College Hospital and Research Centre, Kozhikode, IND
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Tung YH, Li WM, Juan YS, Huang TY, Wang YC, Yeh HC, Lee HY. New infundibulopelvic angle measurement method can predict stone-free rates following retrograde intrarenal surgery. Sci Rep 2024; 14:9891. [PMID: 38688919 PMCID: PMC11061286 DOI: 10.1038/s41598-024-60248-7] [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: 01/22/2024] [Accepted: 04/20/2024] [Indexed: 05/02/2024] Open
Abstract
To enhance the accuracy of predicting stone-free rates after retrograde intrarenal surgery, we devised a novel approach to assess the renal infundibulopelvic angle. We conducted a retrospective review of patient records for those who underwent retrograde intrarenal surgery for renal stones between April 2018 and August 2019. Patient demographics, stone characteristics, and perioperative data were recorded. Subsequently, we introduced a modified angle measurement called the pelvic stone angle and evaluated its predictive performance for stone-free rates by comparing it with the traditional method in scoring systems. A total of 43 individuals were included in this study. Notable differences in stone burden and Hounsfield unit measurements were found between stone-free and non-stone-free patients. The pelvic stone angle demonstrated a good model fit when used in scoring systems, performing equally well as the conventional approach. The area under the receiver operating characteristic curve for the R.I.R.S. scoring system using the pelvic stone angle and the conventional approach did not show a significant difference. In conclusion, the predictive ability of the pelvic stone angle for stone-free rates was comparable to the old measurement method. Moreover, scoring systems using the pelvic stone angle exhibited a better model fit than those using the conventional approach.
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Affiliation(s)
- Yu-Hung Tung
- Department of Urology, Kaohsiung Medical University Hospital, No. 100, Shih-Chuan 1st Road, Sanmin Dist., Kao-hsiung, 80708, Taiwan
| | - Wei-Ming Li
- Department of Urology, Kaohsiung Medical University Hospital, No. 100, Shih-Chuan 1st Road, Sanmin Dist., Kao-hsiung, 80708, Taiwan
- Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kao-hsiung, Taiwan
- Department of Urology, Ministry of Health and Welfare Pingtung Hospital, Pingtung, Taiwan
- Department of Urology, Kaohsiung Medical University Gang-Shan Hospital, Kao-hsiung, Taiwan
| | - Yung-Shun Juan
- Department of Urology, Kaohsiung Medical University Hospital, No. 100, Shih-Chuan 1st Road, Sanmin Dist., Kao-hsiung, 80708, Taiwan
- Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kao-hsiung, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kao-hsiung, Taiwan
| | - Tsung-Yi Huang
- Department of Urology, Kaohsiung Medical University Hospital, No. 100, Shih-Chuan 1st Road, Sanmin Dist., Kao-hsiung, 80708, Taiwan
| | - Yen-Chun Wang
- Department of Urology, Kaohsiung Medical University Hospital, No. 100, Shih-Chuan 1st Road, Sanmin Dist., Kao-hsiung, 80708, Taiwan
| | - Hsin-Chih Yeh
- Department of Urology, Kaohsiung Medical University Hospital, No. 100, Shih-Chuan 1st Road, Sanmin Dist., Kao-hsiung, 80708, Taiwan
- Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kao-hsiung, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kao-hsiung, Taiwan
- Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kao-hsiung, Taiwan
| | - Hsiang-Ying Lee
- Department of Urology, Kaohsiung Medical University Hospital, No. 100, Shih-Chuan 1st Road, Sanmin Dist., Kao-hsiung, 80708, Taiwan.
- Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kao-hsiung, Taiwan.
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kao-hsiung, Taiwan.
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Singh A, Vaddi CM, Ganesan S, Batra R, Ramakrishna P, Swamy S, Anandan H, Babu M, Panda R, Ganpule A, Sabnis R, Desai M. A multicentric non-randomized prospective observational study on the clinical efficiency of thulium fibre laser in large volume stones (> 1000 mm 3). World J Urol 2023; 41:2289-2295. [PMID: 37418016 DOI: 10.1007/s00345-023-04476-y] [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: 09/23/2022] [Accepted: 06/02/2023] [Indexed: 07/08/2023] Open
Abstract
PURPOSE Our objective was to analyse the clinical efficiency of TFL in large volume stones during retrograde intrarenal surgery. MATERIALS AND METHODS Patients with large volume renal stones (> 1000 mm3) operated at two different centres, from May 2020 to April 2021, were enrolled in this study. Retrograde intrarenal surgery was performed using 60W Superpulse thulium fibre laser™ (IPG Photonics, Russia). Demographic data, stone parameters, laser time, and total operating time were recorded, and laser efficacy (J/mm3) and ablation speed (mm3/s) were calculated. NCCT KUB was done at 3 months postoperatively to calculate stone-free rate. RESULTS A total of 76 patients were included and analysed in the study. Mean stone volume was 1753.12 ± 1245.81 (1169.27-2193.25) mm3, mean stone density was 1104.46 ± 313.09 (875.00-1317.00) HU, mean laser time was 537.79 ± 689.89 (21.00-1080.00) sec, mean operating time was 43.38 ± 12.96 (35.00-51.25) min, mean laser efficacy was 20.30 ± 15.5 (8.88-25.57) J/mm3, and mean ablation speed was 1.32 ± 0.7 (0.82-1.64) mm3/sec. A strong positive correlation was found between the stone volume and ablation speed (r = 0.659, p = 0.000), and a moderate negative correlation was found between the stone volume and laser efficacy (J/mm3) (r = - 0.392, p = 0.000). With increasing volume of the stone, J/mm3 decreased significantly and ablation speed increased significantly (p < 0.001). Complications occurred in 21.05% (16/76) patients, most of which were Clavien grades 1-2. Overall SFR is 96.05%. CONCLUSION Laser efficiency increases at higher stone volumes (> 1000 mm3), as less energy is required to ablate every mm3 of stone.
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Affiliation(s)
- Abhishek Singh
- Muljibhai Patel Urological Hospital, Dr V V Desai Road, Nadiad, Gujarat, 387001, India
| | - Chandra Mohan Vaddi
- Preeti Urology and Kidney Hospital, 307, Remedy Hospital Ln, MIG 1, Kukatpally Housing Board Colony, Kukatpally, Hyderabad, Telangana, 500072, India
| | - Soundarya Ganesan
- Preeti Urology and Kidney Hospital, 307, Remedy Hospital Ln, MIG 1, Kukatpally Housing Board Colony, Kukatpally, Hyderabad, Telangana, 500072, India.
| | - Rohan Batra
- Muljibhai Patel Urological Hospital, Dr V V Desai Road, Nadiad, Gujarat, 387001, India
| | - Paidakula Ramakrishna
- Preeti Urology and Kidney Hospital, 307, Remedy Hospital Ln, MIG 1, Kukatpally Housing Board Colony, Kukatpally, Hyderabad, Telangana, 500072, India
| | - Siddalinga Swamy
- Preeti Urology and Kidney Hospital, 307, Remedy Hospital Ln, MIG 1, Kukatpally Housing Board Colony, Kukatpally, Hyderabad, Telangana, 500072, India
| | - Hemnath Anandan
- Preeti Urology and Kidney Hospital, 307, Remedy Hospital Ln, MIG 1, Kukatpally Housing Board Colony, Kukatpally, Hyderabad, Telangana, 500072, India
| | - Manas Babu
- Preeti Urology and Kidney Hospital, 307, Remedy Hospital Ln, MIG 1, Kukatpally Housing Board Colony, Kukatpally, Hyderabad, Telangana, 500072, India
| | - Rakesh Panda
- Preeti Urology and Kidney Hospital, 307, Remedy Hospital Ln, MIG 1, Kukatpally Housing Board Colony, Kukatpally, Hyderabad, Telangana, 500072, India
| | - Arvind Ganpule
- Muljibhai Patel Urological Hospital, Dr V V Desai Road, Nadiad, Gujarat, 387001, India
| | - Ravindra Sabnis
- Muljibhai Patel Urological Hospital, Dr V V Desai Road, Nadiad, Gujarat, 387001, India
| | - Mahesh Desai
- Muljibhai Patel Urological Hospital, Dr V V Desai Road, Nadiad, Gujarat, 387001, India
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Golomb D, Goldberg H, Tapiero S, Stabholz Y, Lotan P, Darawsha AE, Holland R, Ehrlich Y, Lifshitz D. Retrograde intrarenal surgery for lower pole stones utilizing stone displacement technique yields excellent results. Asian J Urol 2023; 10:58-63. [PMID: 36721691 PMCID: PMC9875154 DOI: 10.1016/j.ajur.2021.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 12/22/2020] [Accepted: 06/25/2021] [Indexed: 02/03/2023] Open
Abstract
Objective To evaluate the long-term stone-free rate (SFR) of retrograde intra-renal surgery (RIRS) in the treatment of lower pole renal calculi using only basket relocation and identify independent predictors of stone-free status. Methods All consecutive patients undergoing RIRS lower pole renal calculi at a single high-volume tertiary center were analyzed retrospectively. Lower pole stones were relocated to the upper pole, where laser lithotripsy was performed. All patients were followed up in the clinic following the surgery and yearly thereafter. The stone-free status was assessed with a combination of an abdominal ultrasound and abdominal X-ray, or an abdominal non-contrast computed tomography if the stones were known to be radiolucent. Results A total of 480 consecutive patients who underwent RIRS for treatment of lower pole renal calculi, between January 2012 and December 2018, were analyzed from a prospectively maintained database of 3000 ureteroscopies. With a median follow-up time of 18.6 months, the mean SFR was 94.8%. The procedures were unsuccessful in 26 (5.4%) patients due to unreachable stones. The median stone size of the unreachable stones was 12 mm (range 10-30 mm). Multivariable logistic regression analysis revealed two predictors of SFR for lower pole stones: a small cumulative stone burden (odds ratio [OR]: 0.903, 95% confidence interval [CI]: 0.867-0.941, p<0.0001) and preoperative ureteral stent insertion (OR: 0.515, 95% CI: 0.318-0.835, p=0.007). Conclusion The long-term SFR of RIRS for the treatment of lower pole stones with basket displacement with appropriate patient selection is high.
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Affiliation(s)
- Dor Golomb
- Department of Urology, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel,Corresponding author.
| | - Hanan Goldberg
- Department of Urology, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel,Department of Urology, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Shlomi Tapiero
- Department of Urology, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yariv Stabholz
- Department of Urology, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Paz Lotan
- Department of Urology, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Abd Elhalim Darawsha
- Department of Urology, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ronen Holland
- Department of Urology, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaron Ehrlich
- Department of Urology, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Lifshitz
- Department of Urology, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Venkatachalapathy VS, Palathullil D, Sam D, Prasad A, Abraham G. Outcomes of retrograde intrarenal surgery in renal calculi of varying size. Indian J Urol 2022; 38:128-134. [PMID: 35400866 PMCID: PMC8992719 DOI: 10.4103/iju.iju_343_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 11/16/2021] [Accepted: 02/05/2022] [Indexed: 11/04/2022] Open
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Fahmy O, Shsm H, Lee C, Khairul-Asri MG. Impact of Preoperative Stenting on the Outcome of Flexible Ureterorenoscopy for Upper Urinary Tract Urolithiasis: A Systematic Review and Meta-Analysis. Urol Int 2021; 106:679-687. [PMID: 34515258 DOI: 10.1159/000518160] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 06/22/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE This study aimed to investigate the effect of preoperative stenting (POS) on the perioperative outcomes of flexible ureterorenoscopy (fURS). MATERIALS AND METHODS A systematic review and meta-analysis was conducted based on the PRISMA statement. From the initially retrieved 609 reports, we excluded the ineligible studies at 2 stages. We only included studies that contained fURS patients with and without POS in the same report. Data of patients who underwent semirigid ureteroscope only were excluded from the analysis. The Newcastle-Ottawa Scale (NOS) system was applied for risk of bias assessment. RESULTS A total of 20 studies including 5,852 patients were involved. 48.5% of the patients had preoperative stent. Stone-free rate was significantly higher with prestenting; odds ratio (OR) was 1.98 (95% CI: 1.51-2.58) (Z = 5.02; p = 0.00001). It also displayed tendency toward lower complications; OR was 0.74 (95% CI: 0.52-1.05) (Z = 1.67; p = 0.09). POS significantly increased the use of ureteral access sheath; OR was 1.49 (95% CI: 1.05-2.13) (Z = 2.22; p = 0.03). Risk of bias assessment showed 13 and 7 studies with low and moderate risk, respectively. CONCLUSIONS POS clearly improves the stone-free rates after fURS. It might reduce the complications, especially ureteral injury. These findings might help solve the current debate and can be useful for urologists during patient counselling for a proper decision-making.
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Affiliation(s)
- Omar Fahmy
- Department of Urology, Universiti Putra Malaysia, Selangor, Malaysia
| | - Hadi Shsm
- Department of Urology, Royal Cornwall Hospital, Truro, United Kingdom
| | - Cks Lee
- Department of Urology, Universiti Putra Malaysia, Selangor, Malaysia
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Ozkent MS, Piskin MM, Balasar M, Goger YE, Sonmez MG. Is Retrograde Intrarenal Surgery as Safe for Children as It Is for Adults? Urol Int 2021; 105:1039-1045. [PMID: 34247163 DOI: 10.1159/000517290] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 04/30/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The primary aim of this study is to compare the efficacy and safety of retrograde intrarenal surgery (RIRS) among the children and adults with similar stone burdens and locations. Also, the secondary aim of this study is to identify the factors affecting the stone-free rates (SFRs) of RIRS. METHODS We retrospectively compared perioperative results, SFRs, and complication rates (CRs) between pediatric (group 1, n: 55) and adult (group 2, n: 220) age groups diagnosed with kidney stones and treated by flexible ureterorenoscopy using the same instruments. Furthermore, multivariate analysis was performed to determine the factors affecting the SFR. RESULTS A total of 275 patients (pediatric group: 55; adult group: 220) were included in this study. The mean age of pediatric and adult groups was 7.2 ± 5.3 and 43.9 ± 15.1, respectively. The mean stone size was 13.9 ± 6.6 mm in the pediatric group compared to 14.8 ± 6.7 mm in the adult group (p = 0.35). Stone localizations and number were similar. JJ stenting for passive dilatation and use of UAS were higher in the pediatric group (p = 0.002; p = 0.017). However, postoperative double pigtail stenting rate was higher in the adult group (p < 0.001). Total CR was 13.8% and mostly Clavien I-II, and no difference was observed between the 2 groups (p = 0.541). The SFRs between the groups were similar (pediatric group: 81.8%; adult group: 78.2%; p = 0.554). On multivariate analysis, stone size (p < 0.001) and lower calyx stone (p < 0.001) were the negative predictive factors for SFR. CONCLUSION There are small technical differences between pediatric patients and adult patients in our study, but RIRS in children is as safe and efficient as it is in adults.
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Affiliation(s)
| | - Mehmet Mesut Piskin
- Department of Urology, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Mehmet Balasar
- Department of Urology, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Yunus Emre Goger
- Department of Urology, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Mehmet Giray Sonmez
- Department of Urology, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey
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Saita A, Villa L, Persico F, Lughezzani G, Prezioso D, Casale P. In-vitro and in-vivo new evidence for Flexor® Vue™ deflecting endoscopic system use: optimization of the stone free rate (SFR) after flexible ureteroscopy and Ho:YAG laser lithotripsy. Urolithiasis 2020; 49:239-245. [PMID: 33005998 DOI: 10.1007/s00240-020-01215-5] [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: 05/19/2020] [Accepted: 09/19/2020] [Indexed: 11/29/2022]
Abstract
To test in-vitro and in-vivo the Flexor® Vue™ deflecting endoscopic system (FVDES) as a new technology able to improve the removal of residual intrarenal fragments.This is an observational prospective "proof of concept" study performed in patients with renal calculi treated with flexible ureteroscopy and Ho:YAG laser lithotripsy (f-URS) in Humanitas Research Hospital (Rozzano, Italy). We assessed feasibility, efficacy and safety of FVDES as an in-vivo tool for removing residual fragments after f-URS. The stone-free rate (SFR) at 30 days post-operatively was evaluated using CT. An in-vitro model was developed to evaluate the FVDES when used for this purpose.Eleven patients (M/F ratio: 7/4, mean age 63.5 ± 8.3) were treated. The stones were located in the lower calyces and the renal pelvis in 3 and 8 patients, respectively. Mean stone size was 18 ± 3.2 mm. The procedure with FVDES was feasible and effective in all the patients. Mean operative time was 82 ± 13.7 min and median hospitalization was of 1.5 days. The SFR after 90 days was 81% (9/11). We reported no relevant complications (Clavien-Dindo > 2); one patient had fever and was treated with antibiotics. The experimental in-vitro model demonstrated the efficacy of FVDES, allowing the removal of about 90% of fragments.Our study showed that FVDES is effective when used as a tool for retrieval of residual fragments at the end of f-URS. This technology could ensure a complete cleaning of the intrarenal collecting system and represent a safe alternative to basketing.
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Affiliation(s)
- Alberto Saita
- Department of Urology, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Luca Villa
- Division of Experimental Oncology/Unit of Urology URI, Ospedale San Raffaele IRCCS, Milan, Italy
| | - Francesco Persico
- Department of Urology, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy. .,Department of Neurosciences, Sciences of Reproduction, and Odontostomatology, University of Naples Federico II, Naples, Italy.
| | - Giovanni Lughezzani
- Department of Urology, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy
| | - Domenico Prezioso
- Department of Neurosciences, Sciences of Reproduction, and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Paolo Casale
- Department of Urology, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
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Danilovic A, Rocha BA, Marchini GS, Traxer O, Batagello C, Vicentini FC, Torricelli FCM, Srougi M, Nahas WC, Mazzucchi E. Computed tomography window affects kidney stones measurements. Int Braz J Urol 2019; 45:948-955. [PMID: 31268643 PMCID: PMC6844354 DOI: 10.1590/s1677-5538.ibju.2018.0819] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 03/19/2019] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES Measurements of stone features may vary according to the non-contrast computed tomography (NCCT) technique. Using magnified bone window is the most accurate method to measure urinary stones. Possible differences between stone measurements in different NCCT windows have not been evaluated in stones located in the kidney. The aim of this study is to compare measurements of kidney stone features between NCCT bone and soft tissue windows in patients submitted to retrograde intrarenal surgery (RIRS). MATERIALS AND METHODS Preoperative and 90th postoperative day NCCT were performed in 92 consecutive symptomatic adult patients (115 renal units) with kidney stones between 5 mm to 20 mm (< 15 mm in the lower calyx) treated by RIRS. NCCT were evaluated in the magnified bone window and soft tissue window in three axes in a different time by a single radiologist blinded for the measurements of the NCCT other method. RESULTS Stone largest size (7.92±3.81 vs. 9.13±4.08; mm), volume (435.5±472.7 vs. 683.1±665.0; mm3) and density (989.4±330.2 vs. 893.0±324.6; HU) differed between bone and soft-tissue windows, respectively (p<0.0001) 5.2% of the renal units (6/115) were reclassified from residual fragments > 2 mm on soft tissue window to 0-2 mm on bone window. CONCLUSION Kidney stone measurements vary according to NCCT window. Measurements in soft tissue window NCCT of stone diameter and volume are larger and stone density is lesser than in bone window. These differences may have impact on clinical decisions.
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Affiliation(s)
- Alexandre Danilovic
- Departamento de Urologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
| | - Bruno Aragão Rocha
- Departamento de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
| | - Giovanni Scala Marchini
- Departamento de Urologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
| | - Olivier Traxer
- Sorbonne Université, GRC n 20 Lithiase Renale, AP-HP, Hôpital Tenon, F-75020 Paris, France. University, Paris, France
| | - Carlos Batagello
- Departamento de Urologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
| | - Fabio Carvalho Vicentini
- Departamento de Urologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
| | | | - Miguel Srougi
- Departamento de Urologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
| | - William Carlos Nahas
- Departamento de Urologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
| | - Eduardo Mazzucchi
- Departamento de Urologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
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Danilovic A, Rocha BA, Torricelli FCM, Marchini GS, Batagello C, Vicentini FC, Traxer O, Viana PCC, Srougi M, Nahas WC, Mazzucchi E. Size is Not Everything That Matters: Preoperative CT Predictors of Stone Free After RIRS. Urology 2019; 132:63-68. [PMID: 31310774 DOI: 10.1016/j.urology.2019.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 07/02/2019] [Accepted: 07/05/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To define computed tomography (CT) predictors of residual fragments after retrograde intrarenal surgery (RIRS) for kidney stones up to 20 mm in patients never submitted to surgical procedures for stone removal. METHODS From August 2016 to August 2017, symptomatic adult patients with kidney stones less than 20 mm treated by RIRS had their pre- and postoperative CT prospectively evaluated in search for predictors of residual stone fragments. Stone size, stone volume, number of stones, stone density, and location were evaluated in preoperative CT and analyzed as predictors for residual stone fragments on 90 POD CT. Stone location was represented by the infundibulopelvic angle (IPA) measured for each stone on preoperative noncontrast CT using multiplanar reconstruction. RESULTS Ninety-two patients were successfully submitted to RIRS. Bilateral procedures were performed in 23 patients (25%) resulting in 115 renal units operated. Operative time was 54.5 ± 26.7 minutes (mean ± SD) and 96.7% (89/92) of the patients were discharged up to 12 hours after the procedure. Postoperative CT demonstrated stone-free in 86 of 115 (74.8%), 0-2 mm in 10 of 115 (8.7%), and > 2 mm residual fragments in 19 of 115 (16.5%) procedures. Logistic regression analysis revealed steep IPA was a predictor for any residual stone fragment after RIRS for kidney stones < 20 mm (P= .012). ROC curve showed that IPA < 41° was associated with a higher chance of residual fragments after RIRS. CONCLUSION IPA < 41° is associated with a higher chance of residual fragments after RIRS for kidney stones up to 20 mm.
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Affiliation(s)
- Alexandre Danilovic
- Department of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil.
| | - Bruno Aragão Rocha
- Department of Radiology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | | | - Giovanni Scala Marchini
- Department of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Carlos Batagello
- Department of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Fabio Carvalho Vicentini
- Department of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Olivier Traxer
- Sorbonne Université, GRC n 20 Lithiase Renale, AP-HP, Hôpital Tenon, Paris, France
| | | | - Miguel Srougi
- Division of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - William C Nahas
- Division of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Eduardo Mazzucchi
- Department of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
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Tonyalı Ş, Yılmaz M, Karaaslan M, Ceylan C, Işıkay L. Prediction of stone-free status after single-session retrograde intrarenal surgery for renal stones. Turk J Urol 2018; 44:473-477. [PMID: 30001208 DOI: 10.5152/tud.2018.88615] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 03/26/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To determine the possible factors effecting stone-free status (SFS) after single-session retrograde intrarenal surgery (RIRS) for renal stones. MATERIAL AND METHODS We retrospectively analyzed the charts of 100 consecutive patients who underwent RIRS. Unilateral procedures performed for single renal stones were included in the study. The studied parameters included patient demographics, stone characteristics (size, volume, location and attenuation according to Hounsfield unit [HU]), operation time, presence of preoperative double-J stent (DJS), use of ureteral access sheath (UAS) and SFS. RESULTS The study population consisted of 100 patients where 43 of them were stone free and remaining 57 had residual stones. The mean age of the patients was 47.2±13.4 years. The mean stone size (largest dimension), stone attenuation and stone volume were 14.8±5.8 mm, 1010±416 HU and 937±929 mm3, respectively. The mean operative time was 60.8±24.2 minutes. Mean stone size, volume and HU were higher in the RS group compared to SF group but without any statistically significant difference, 15.2±6.1 vs. 14.2±5.3 mm, 1056±1037 mm3 vs. 780±745 mm3 and 1061±374 HU vs. 942±462 HU, respectively (p=0.490, p=0.135 and p=0.226). In multivariate regression analysis stone location and UAS use were found to be the significant predictors of SFS. Patients with lower pole stones are 2.25 times likely to have residual stones after RIRS compared to patient's having stones at other localizations (p<0.001). CONCLUSION Stone volume could be a more reliable parameter than stone size in predicting RIRS success. Lower pole stone location and UAS use could be considered the most significant predictors of SFS after single session RIRS for single renal stones.
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Affiliation(s)
- Şenol Tonyalı
- Clinic of Urology, University of Health Sciences Türkiye Yüksek İhtisas Training and Research Hospital, Ankara, Turkey
| | - Mehmet Yılmaz
- Clinic of Urology, University of Health Sciences Türkiye Yüksek İhtisas Training and Research Hospital, Ankara, Turkey
| | - Mustafa Karaaslan
- Clinic of Urology, University of Health Sciences Türkiye Yüksek İhtisas Training and Research Hospital, Ankara, Turkey
| | - Cavit Ceylan
- Clinic of Urology, University of Health Sciences Türkiye Yüksek İhtisas Training and Research Hospital, Ankara, Turkey
| | - Levent Işıkay
- Clinic of Urology, University of Health Sciences Türkiye Yüksek İhtisas Training and Research Hospital, Ankara, Turkey
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Re: Huang et al.: The Application of Suctioning Flexible Ureteroscopy With Intelligent Pressure Control in Treating Upper Urinary Tract Calculi on Patients With a Solitary Kidney (Urology 2018;111:44-47). Urology 2018; 117:166. [PMID: 29729362 DOI: 10.1016/j.urology.2018.02.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 02/19/2018] [Accepted: 02/19/2018] [Indexed: 11/23/2022]
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