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Sen V, Irer B, Erbatu O, Yildiz A, Ongun Ş, Cinar O, Cihan A, Sahin M, Sahin MO, Ucer O, Kizilay F, Bozkurt O. Predictive Factors of Ureterorenoscopy Outcomes in Proximal Ureteral Stones: A Multicenter Study of Aegean Study Group of the Society of Urological Surgery. Urol Int 2019; 104:125-130. [PMID: 31825930 DOI: 10.1159/000504790] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 11/13/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We aimed to evaluate the predictive factors in a holistic manner for ureterorenoscopy (URS) outcomes in proximal ureteral stones by a multicenter study. MATERIALS AND METHODS The data of patients who underwent URS for proximal ureteral stones between the years 2015 and 2018 in eight centers were recorded retrospectively. Patients were divided into two groups according to URS success: Group 1 consisted of patients with successful URS, and Group 2 consisted of patients with unsuccessful URS. The two groups were compared in terms of risk factors, stone, and clinical characteristics of patients. RESULTS A total of 638 patients were included in the study. Group 1 consisted of 527 (82.6%) patients, and Group 2 consisted of 111 (17.4%) patients. In multivariate logistic analysis, the key risk factors for URS success was found to be age (OR = 0.980, 95% [CI] = 0.963-0.996, p = 0.018), stone area (OR = 0.993, 95% [CI] = 0.989-0.997, p = 0.002), and operation time (OR = 0.981, 95% [CI] = 0.968-0.994, p = 0.005). CONCLUSIONS To make the treatment decision of proximal ureteral stones, it is necessary to examine several parameters including available equipment, stone, and patient characteristics. Physicians should keep these risk factors in mind in the decision of treatment options.
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Affiliation(s)
- Volkan Sen
- Department of Urology, Manisa State Hospital, Manisa, Turkey,
| | - Bora Irer
- Department of Urology, Izmir Metropolitan Municipality Esrefpasa Hospital, Izmir, Turkey
| | - Oguzcan Erbatu
- Department of Urology, Celal Bayar University School of Medicine, Manisa, Turkey
| | - Alperen Yildiz
- Department of Urology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Şakir Ongun
- Department of Urology, Balikesir University School of Medicine, Balikesir, Turkey
| | - Onder Cinar
- Department of Urology, Bulent Ecevit University School of Medicine, Zonguldak, Turkey
| | - Ahmet Cihan
- Department of Urology, Nigde Omer Halisdemir University School of Medicine, Nigde, Turkey
| | - Mehmet Sahin
- Department of Urology, Ege University School of Medicine, Izmir, Turkey
| | | | - Oktay Ucer
- Department of Urology, Celal Bayar University School of Medicine, Manisa, Turkey
| | - Fuat Kizilay
- Department of Urology, Ege University School of Medicine, Izmir, Turkey
| | - Ozan Bozkurt
- Department of Urology, Dokuz Eylul University School of Medicine, Izmir, Turkey
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Feng C, Wu Z, Jiang H, Ding Q, Gao P. Ureteroscopic Holmium:YAG laser lithotripsy is effective for ureteral steinstrasse post-SWL. MINIM INVASIV THER 2013; 22:279-82. [PMID: 23323772 DOI: 10.3109/13645706.2012.762026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To evaluate the efficacy of Holmium: YAG laser lithotripsy for ureteral steinstrasse after extracorporeal shock lithotripsy (SWL). MATERIAL AND METHODS Holmium: YAG laser lithotripsy was performed on 21 patients who had developed ureteral steinstrasse post-SWL. RESULTS Nineteen cases had successful treatment. The ureteral steinstrasse was cleared within one month after the treatment (success rate of 90.48%). Upper ureteral steinstrasse shifted to the renal pelvis was noted in one patient, who underwent a second SWL treatment. Another patient had a severely kinking ureter and underwent open surgery after ureteroscopy failed. CONCLUSION Holmium: YAG laser lithotripsy of ureteral steinstrasse post-SWL is an effective clinical modality due to its high success rate, short lithotripsy time, high safety and reliability, and easy feasibility.
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Affiliation(s)
- Chenchen Feng
- Department of Urology, Huashan Hospital, Fudan University , Shanghai , China
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Sandhu AS, Srivastava A, Madhusoodanan P, Sinha T, Gupta SK, Kumar A, Sethi GS, Khanna R. Holmium : YAG Laser for Intra Corporeal Lithotripsy. Med J Armed Forces India 2011; 63:48-51. [PMID: 27407938 DOI: 10.1016/s0377-1237(07)80109-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2004] [Accepted: 03/12/2005] [Indexed: 11/16/2022] Open
Affiliation(s)
- A S Sandhu
- Classified Specialist (Surgery & Urology), Command Hospital (Southern Command), Armed Forces Medical College, Pune
| | - A Srivastava
- Classified Specialist (Surgery & Urology), Command Hospital (Central Command), Armed Forces Medical College, Pune
| | | | - T Sinha
- Senior Advisor (Surgery & Urology), Army Hospital (R&R), Command Hospital (Southern Command), Pune 411 040
| | - S K Gupta
- Classified Specialist (Surgery & Urology), Command Hospital (Eastern Command), Command Hospital (Southern Command), Pune 411 040
| | - A Kumar
- Classified Specialist (Surgery & Urology), Command Hospital (AF), Command Hospital (Southern Command), Pune 411 040
| | - G S Sethi
- Classified Specialist (Surgery & Urology), Army Hospital (R&R), Command Hospital (Southern Command), Pune 411 040
| | - R Khanna
- Classified Specialist (Surgery & Urology), Command Hospital (Southern Command), Pune 411 040
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Jakóbczyk B, Wrona M, Lipiński M, Różański W. Comparison of the effectiveness of crushing concrements in the urinary tract with the use of holmium laser and sonotrode. Cent European J Urol 2011; 64:26-9. [PMID: 24578856 PMCID: PMC3921703 DOI: 10.5173/ceju.2011.01.art5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2010] [Revised: 11/21/2010] [Accepted: 12/12/2010] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Holmium lasers and ultrasound probes are widely used in urinary stone lithotripsy. The authors present a comparison of both methods in urinary stones lithotripsy. MATERIALS AND METHODS We analyzed 164-patients who underwent endoscopic lithotripsy. Ninety-eight of them (group I) were treated with the holmium laser Omni-Pulse Max 80 and were compared to the other 66-patients (group II) who were operated on with an ultrasound probe (sonotrode). Prior to the procedures, all patients were exposed to urological ultrasound and radiological imaging in order to localize the stone. The state where the stones were invisible in the radiological and renal ultrasound imaging that was performed after the operation was considered to be effective. Patients were operated under intravenous general or subepidural anesthesia. RESULTS The effectiveness of laser lithotripsy in the bladder amounted to 100% (25 of 25 patients). In the case of stones localized in the ureter it reached 89%. The total effectiveness of the procedure reached 92% (90 out of 98 procedures). In group II, the total effectiveness of the procedure reached 79% (52 out of 66 procedures). In group I, two cases the inflammatory changes of the ureter made the endoscopy impossible. These two patients were operated with open surgery. In one case, the laser lithotripsy was complicated with a perforation of the ureter. CONCLUSION The results prove that laser lithotripsy is a method of high effectiveness with a low risk of complication. It might surpass sonotrode and become its alternative. Both methods have both advantages and disadvantages.
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Affiliation(s)
| | - Marek Wrona
- 2 Clinic of Urology, Department of Urology, Medical University, Łódź, Poland
| | - Marek Lipiński
- 2 Clinic of Urology, Department of Urology, Medical University, Łódź, Poland
| | - Waldemar Różański
- 2 Clinic of Urology, Department of Urology, Medical University, Łódź, Poland
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Nuttall MC, Abbaraju J, Dickinson IK, Sriprasad S. A Review of Studies Reporting on Complications of Upper Urinary Tract Stone Ablation Using the Holmium:YAG Laser. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/j.bjmsu.2010.01.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Purpose: A review of the literature of studies reporting complications of ureteroscopic urinary tract stone ablation using the holmium:YAG laser was performed. Patients and methods: Electronic databases were searched using specific keywords to identify relevant studies. Reference lists of identified articles were scrutinised for other studies and searches were conducted using the names of authors known to have published widely in this field. Two reviewers assessed retrieved articles for inclusion criteria. Patients <16 years old were excluded. Results: Overall, 48 studies published between 1994 and 2007 were included. Half were published since 2000. In total, 4454 patients were identified. Around half of studies were performed in North America (25). The number of patients per study varied from 8 to 598. The study populations were very heterogeneous in terms of stone position and size, and ureteroscope size and rigidity. Overall, 303 (6.8%) complications were identified. Post-operative ureteric stricture and perforation rates were both 1.0%. There were only six major complications identified (0.1%). The post-operative sepsis rate was 2% and one death was reported. Conclusions: Upper urinary tract stone ablation using the holmium:YAG laser is both safe and reliable. Follow-up imaging to detect procedure-specific complications would not appear to be routinely indicated given this low complication rate.
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Affiliation(s)
- Martin C. Nuttall
- Darent Valley Hospital, Dartford and Gravesham NHS Trust, Dartford, UK
| | - Jai Abbaraju
- Darent Valley Hospital, Dartford and Gravesham NHS Trust, Dartford, UK
| | - Ian K. Dickinson
- Darent Valley Hospital, Dartford and Gravesham NHS Trust, Dartford, UK
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Comparative analysis of upper ureteral stones (> 15 mm) treated with retroperitoneoscopic ureterolithotomy and ureteroscopic pneumatic lithotripsy. Int Urol Nephrol 2010; 42:897-901. [PMID: 20169409 DOI: 10.1007/s11255-010-9711-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2009] [Accepted: 01/29/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To investigate an appropriate treatment for patients with upper ureteral stones, > 15 mm in size, by comparing the therapeutic outcomes for those undergoing retroperitoneoscopic ureterolithotomy (RPUL) and rigid ureteroscopic pneumatic lithotripsy (URSPL) retrospectively. PATIENTS AND METHODS During the study period, 81 patients with a large upper ureteral stone (> 15 mm) were divided into two groups. RPUL was performed with retroperitoneal approach, and the stone was removed in group A. URSPL was conducted using a rigid ureteroscope, and pneumatic probe was used for lithotripsy in group B. The patient characteristics, success rate, stone-free rate, operation time, and complications were analyzed prospectively in the two groups. RESULTS The success rates of operation were 94.5% (34/36) in group A and 88.8% (40/45) in group B, but there were no significant differences between two groups (P > 0.05). After 4 weeks of follow-up, the stone-free rate after RPUL (100%, 34/34) and URSPL (77.5%, 31/40) groups were statistically different (P = 0.006). Furthermore, simultaneous ureterolithotomy and ureteroplasty by retroperitoneal laparoscopic surgery were performed on four patients combined with ureteral stricture. However, the mean operation time and hospital staying time after surgery in group A were longer than that in group B, and the differences were statistically significant (P < 0.05). The complication rate after RPUL (17.6%, 6/34) was lower than that after URSPL (20%, 8/40), but the differences were not statistically significant (P > 0.05). CONCLUSION RPUL is a safe and effective treatment technique for large, impacted, upper ureteral stones >15 mm in size when first-line treatments have failed or are unlikely to be effective. It can handle with combined pathologies simultaneously.
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Gupta PK. Is the holmium:YAG laser the best intracorporeal lithotripter for the ureter? A 3-year retrospective study. J Endourol 2007; 21:305-9. [PMID: 17444776 DOI: 10.1089/end.2006.0247] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To study the efficiency and safety of holmium:YAG laser lithotripsy for ureteral stones. PATIENTS AND METHODS A series of 188 patients with 208 ureteral stones were treated with semirigid ureteroscopy and holmium:YAG laser lithotripsy from January 2003 to December 2005. Of the stones, 116 were lower ureteral, 37 middle ureteral, and 55 upper ureteral. RESULTS The success rate was 92.7% at the time of ureteroscopy and 96.7% at 3 months. The failures were secondary to retropulsion of the stones (3.3%). There were no perforations and one stricture. Stenting was done in 90% of patients. CONCLUSIONS The Holmium:YAG laser is an ideal intracorporeal lithotripter for ureteral calculi, with a high success rate and low morbidity.
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Marks AJ, Teichman JMH. Lasers in clinical urology: state of the art and new horizons. World J Urol 2007; 25:227-33. [PMID: 17393172 DOI: 10.1007/s00345-007-0163-x] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2007] [Accepted: 02/12/2007] [Indexed: 11/24/2022] Open
Abstract
We present an overview of current and emerging lasers for Urology. We begin with an overview of the Holmium:YAG laser. The Ho:YAG laser is the gold standard lithotripsy modality for endoscopic lithotripsy, and compares favorably to standard electrocautery transurethral resection of the prostate for benign prostatic hyperplasia (BPH). Available laser technologies currently being studied include the frequency doubled double-pulse Nd:Yag (FREDDY) and high-powered potassium-titanyl-phosphate (KTP) lasers. The FREDDY laser presents an affordable and safe option for intracorporeal lithotripsy, but it does not fragment all stone compositions, and does not have soft tissue applications. The high power KTP laser shows promise in the ablative treatment of BPH. Initial experiments with the Erbium:YAG laser show it has improved efficiency of lithotripsy and more precise ablative and incisional properties compared to Ho:YAG, but the lack of adequate optical fibers limits its use in Urology. Thulium:YAG fiber lasers have also demonstrated tissue ablative and incision properties comparable to Ho:YAG. Lastly, compact size, portability, and low maintenance schedules of fiber lasers may allow them to shape the way lasers are used by urologists in the future.
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Affiliation(s)
- Andrew J Marks
- Division of Urology, Providence Healthcare, and Department of Urological Sciences, University of British Columbia, St. Paul's Hospital, Burrard Bldg. C307, 1081 Burrard St., Vancouver, BC, Canada
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Laser Literature Watch. Photomed Laser Surg 2006. [DOI: 10.1089/pho.2006.24.765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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