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Watanabe T, Komeya M, Odaka H, Kiuchi H, Saigusa Y, Makiyama K, Matsuzaki J. Ureteral stone volume and female gender predicts perioperative complications after complete ipsilateral upper urinary tract stone removal using flexible ureterorenoscopy. Int Urol Nephrol 2024; 56:1611-1616. [PMID: 38123734 DOI: 10.1007/s11255-023-03899-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 11/27/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE To identify the risk factors for perioperative complications to prevent perioperative complications after complete ipsilateral upper urinary stone removal using flexible ureterorenoscopy. MATERIALS AND METHODS We retrospectively examined 111 patients who underwent flexible ureterorenoscopy for ipsilateral renal stones with a diameter ≥ 5 mm at the same time as ureterorenoscopy for ureteric stones. The flexible ureterorenoscopy procedures were performed following the fragmentation technique. Patients who experienced (complication group) and did not experience (non-complication group) perioperative complications were compared. The complication group included 33 patients with Clavien-Dindo classification scores of I, II, III, or IV and/or those with a body temperature of > 37.5 ℃ during hospitalization. RESULTS The overall stone volume, stone-free rate and procedure duration were 1.71 mL, 96.4% and 77 min, respectively. The rate of perioperative complications was 29.7% (grade 1, 2 and 3 was 23.4%, 5.4% and 0.9%, respectively). Severe complications (Clavien-Dindo grade 4) were not observed. Multivariable analysis revealed that ureteral stone volume and female patients were independent predictors of perioperative complications after flexible ureterorenoscopy (p = 0.015 and 0.017, respectively). CONCLUSIONS This study showed that ureteral stone volume and female gender have the possibility to increase perioperative complications. These preliminary data help to select for patients who are at low risk of complications. Therefore, in these selected patients, complete ipsilateral upper urinary tract stone removal using flexible ureterorenoscopy may reduce the recurrence of urolithiasis without increasing perioperative complications.
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Affiliation(s)
- Takahiko Watanabe
- Department of Urology, Ohguchi East General Hospital, 2-19-1 Irie, Kanagawa-Ku, Yokohama, Kanagawa, 221-0014, Japan
| | - Mitsuru Komeya
- Department of Urology, Ohguchi East General Hospital, 2-19-1 Irie, Kanagawa-Ku, Yokohama, Kanagawa, 221-0014, Japan.
- Department of Urology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, Kanagawa, 236-0004, Japan.
| | - Hisakazu Odaka
- Department of Urology, Ohguchi East General Hospital, 2-19-1 Irie, Kanagawa-Ku, Yokohama, Kanagawa, 221-0014, Japan
| | - Hirokazu Kiuchi
- Department of Urology, Ohguchi East General Hospital, 2-19-1 Irie, Kanagawa-Ku, Yokohama, Kanagawa, 221-0014, Japan
| | - Yusuke Saigusa
- Department of Biostatistics, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Kazuhide Makiyama
- Department of Urology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Junichi Matsuzaki
- Department of Urology, Ohguchi East General Hospital, 2-19-1 Irie, Kanagawa-Ku, Yokohama, Kanagawa, 221-0014, Japan
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Abstract
PURPOSE OF REVIEW Radiological imaging techniques and applications are constantly advancing. This review will examine modern imaging techniques in the diagnosis of urolithiasis and applications for surgical planning. RECENT FINDINGS The diagnosis of urolithiasis may be done via plain film X-ray, ultrasound (US), or contrast tomography (CT) scan. US should be applied in the workup of flank pain in emergency rooms and may reduce unnecessary radiation exposure. Low dose and ultra-low-dose CT remain the diagnostic standard for most populations but remain underutilized. Single and dual-energy CT provide three-dimensional imaging that can predict stone-specific parameters that help clinicians predict stone passage likelihood, identify ideal management techniques, and possibly reduce complications. Machine learning has been increasingly applied to 3-D imaging to support clinicians in these prognostications and treatment selection. SUMMARY The diagnosis and management of urolithiasis are increasingly personalized. Patient and stone characteristics will support clinicians in treatment decision, surgical planning, and counseling.
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Başataç C, Özman O, Cakir H, Çinar Ö, Akgül HM, Siddikoglu D, Sancak EBB, Yazici CM, Baseskioglu B, Onal B, Akpinar H. Retrograde intrarenal surgery is a safe procedure in severe obese patients. Is it reality or prediction? A propensity score-matching analysis from RIRSearch study group. J Endourol 2022; 36:891-897. [PMID: 35029126 DOI: 10.1089/end.2021.0887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE The aim of the study was to assess whether severely obese patients have an increased risk of complications during and after retrograde intrarenal surgery. MATERIALS AND METHODS The data of 639 consecutive patients undergoing retrograde intrarenal surgery for the treatment of upper tract urinary stones were analyzed retrospectively. The patients were divided into two groups according to their body mass index numbers (Group 1, <35; Group 2, ≥35). The patients' demographics, stone characteristics, operative outcomes, and complication rates were compared between the groups. The primary objective was to examine whether the intraoperative and postoperative complication rates were higher in patients with a body mass index of ≥35 kg/m2. RESULTS After matching of confounding factors, Group 1 comprised 135 patients, and Group 2 comprised 47 patients. The baseline characteristics were similar between the groups. There were no significant differences between groups for intraoperative complication rates (11.8% and 12.8%, respectively; p=0.97). There was statistically significant difference in favor of Group 2 for postoperative complication rates (12.6% and 29.7%; respectively, p<0.01), overall complication rates (22.9% and 38.2%; respectively, p=0.02), mean operation time (56.15 minute vs 66.45 minute; respectively, p= 0.01) and length of stay (1.4 days vs 2.1 days; p=0.03). Stone free rates (75.5% vs 85.1%; respectively, p=0.17) did not differ between groups. CONCLUSIONS Retrograde intrarenal surgery is an efficient and feasible treatment option for upper urinary tract stones in severe obese patients. However, higher possibility of postoperative, especially infectious, complication rates should be taken into account in these patients.
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Affiliation(s)
- Cem Başataç
- Group Florence Nightingale Hospitals, 74833, Department of Urology, Istanbul, Turkey;
| | - Oktay Özman
- Gaziosmanpaşa Taksim Eğitim ve Araştırma Hastanesi, 147020, Urology Clinic, Gaziosmanpaşa, Istanbul, Turkey, 34000;
| | - Hakan Cakir
- Acibadem Hospitals Group, 64296, Acibadem Fulya Hospital Clinic of Urology Istanbul/Turkey, Istanbul, Turkey;
| | - Önder Çinar
- Bulent Ecevit University , Urology, Kozlu/Zonguldak, Zonguldak, Turkey, 67600;
| | - Hacı Murat Akgül
- Tekirdag Namik Kemal University, Urology, Tekirdag Namik Kemal University Urology Department, tekirdag, Turkey, 59010;
| | | | | | - Cenk Murat Yazici
- Namik Kemal University, Department of Urology, Namik Kemal University Hospital, Deparment of Urology, Tekirdag, Turkey, 59000;
| | - Barbaros Baseskioglu
- Acibadem Hospitals Group, 64296, Acibadem Hospital Clinic of Urology, Eskişehir, Turkey;
| | - Bulent Onal
- Istanbul University- Cerrahpasa, Cerrahpasa School of Medicine, Department of Urology, Istanbul, Turkey;
| | - Haluk Akpinar
- Group Florence Nightingale Hospitals, 74833, Department of Urology, Istanbul, Turkey;
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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: 33] [Impact Index Per Article: 11.0] [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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Basatac C, Özman O, Akgül HM, Ozyaman O, Cinar O, Can G, Sancak EB, Yazici CM, Akpinar H. The Impact of Stone Density on Operative Complications of Retrograde Intrarenal Surgery: A Multicenter Study with Propensity Score Matching Analysis. J Laparoendosc Adv Surg Tech A 2021; 32:142-148. [PMID: 33471596 DOI: 10.1089/lap.2020.0936] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: The aim of the study was to evaluate the impact of stone density on operative complication rates in retrograde intrarenal surgery (RIRS). Materials and Methods: A total of 473 consecutive patients undergoing RIRS for the treatment of upper tract urinary stones were included. To adjust for baseline confounders, one-to-one propensity score matching was performed. After matching, the patients were divided into two groups according to stone density (low density [LD] group, ≤970 Hounsfield unit [HU]; high density [HD] group, >970 HU). The patients' demographics, stone-related features, stone-free rates, and intraoperative and postoperative complication rates were compared between the groups. The primary objective was to evaluate whether the intraoperative and postoperative complication rates were higher in patients whose stone density was greater than 970 HU. Results: After propensity score matching, 170 of 210 LD and 170 of 263 HD patients undergoing RIRS were included. The baseline characteristics did not differ significantly between the groups. There were no significant differences between LD and HD patients with respect to intraoperative (5.9% and 8.8%, respectively; P = .29), postoperative (10.6% and 15.3%, respectively; P = .14), and overall complication rates (15.2% and 21.1%, respectively; P = .16). Stone-free status was achieved in 143 patients (84.1%) in the LD group and 148 patients (87%) in the HD group; the difference was not statistically significant (P = .27). Conclusion: Our results show that RIRS is a safe and effective minimally invasive procedure for the treatment of upper urinary tract stones, even in HD stones.
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Affiliation(s)
- Cem Basatac
- Department of Urology, Group Florence Nightingale Hospitals, Istanbul, Turkey
| | - Oktay Özman
- Department of Urology, Istanbul Gaziosmanpaşa Teaching Hospital, Istanbul, Turkey
| | - Hacı Murat Akgül
- Department of Urology, School of Medicine, Tekirdag Namık Kemal University, Tekirdag, Turkey
| | - Onur Ozyaman
- Department of Urology, School of Medicine, Zonguldak Bulent Ecevit University, Zonguldak, Turkey
| | - Onder Cinar
- Department of Urology, School of Medicine, Zonguldak Bulent Ecevit University, Zonguldak, Turkey
| | - Günay Can
- Department of Public Health, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Eyüp Burak Sancak
- Department of Urology, School of Medicine, Canakkale Onsekiz Mart University, Canakkale, Turkey
| | - Cenk Murat Yazici
- Department of Urology, School of Medicine, Tekirdag Namık Kemal University, Tekirdag, Turkey
| | - Haluk Akpinar
- Department of Urology, Group Florence Nightingale Hospitals, Istanbul, Turkey
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Komeya M, Odaka H, Watanabe T, Kiuchi H, Ogawa T, Yao M, Matsuzaki J. Gap between UAS and ureteroscope predicts renal stone-free rate after flexible ureteroscopy with the fragmentation technique. World J Urol 2020; 39:2733-2739. [PMID: 32986134 DOI: 10.1007/s00345-020-03459-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 09/10/2020] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To assess the effect of our new classification on surgical outcomes after flexible ureteroscopy (fURS) for kidney stones. METHODS We retrospectively examined 128 patients after single renal fURS procedures performed using ureteral access sheaths (UASs) with the fragmentation technique. Based on the gap (calculated by subtracting the ureteroscope diameter from the UAS diameter), enrolled patients were divided into three groups: small (< 0.6 mm), medium (0.6 to < 1.2 mm), and large space groups (≥ 1.2 mm). Stone-free (SF) status was defined as either complete absence of stones (SF) or the presence of stones < 4 mm in diameter on non-contrast computed tomography (NCCT). RESULTS The SF rate was significantly lower in the small space group (50% in small, 97.9% in medium, 89.2% in large; p = 0.001). Perioperative complications over Clavien-Dindo Grade I were observed in 16.7%, 4.2%, and 8.1% of patients, respectively (p = 0.452). The ratio of stone volume and operative time (efficiency of stone removal) was significantly higher in the large space group compared to the small and medium space groups (0.009 ± 0.003 ml/min, 0.013 ± 0.005 ml/min, 0.027 ± 0.012 ml/min, respectively; p < 0.001). CONCLUSION Our findings that gaps > 0.6 mm (1.8 Fr), including the combination of a 9.5-Fr UAS and a small caliber ureteroscope, improve SF rates, and larger gaps facilitate stone removal efficiency providing the basis for future development of clinical protocols aimed at improving outcomes.
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Affiliation(s)
- Mitsuru Komeya
- Department of Urology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan. .,Department of Urology, Yokohama City University Medical Center, 4-57 Urafune, Minami-ku, Yokohama, Kanagawa, 223-0024, Japan.
| | - Hisakazu Odaka
- Department of Urology, Ohguchi East General Hospital, 2-19-1 Irie, Kanagawa-ku, Yokohama, Kanagawa, 221-0014, Japan
| | - Takahiko Watanabe
- Department of Urology, Ohguchi East General Hospital, 2-19-1 Irie, Kanagawa-ku, Yokohama, Kanagawa, 221-0014, Japan
| | - Hirokazu Kiuchi
- Department of Urology, Ohguchi East General Hospital, 2-19-1 Irie, Kanagawa-ku, Yokohama, Kanagawa, 221-0014, Japan
| | - Takehiko Ogawa
- Department of Urology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Masahiro Yao
- Department of Urology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Junichi Matsuzaki
- Department of Urology, Ohguchi East General Hospital, 2-19-1 Irie, Kanagawa-ku, Yokohama, Kanagawa, 221-0014, Japan
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