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Chai CA, Inoue T, Somani BK, Yuen SKK, Ragoori D, Gadzhiev N, Tanidir Y, Emiliani E, Hamri SB, Lakmichi MA, Chandramohan V, Naselli A, Soebhali B, Gokce MI, Tursunkulov AN, de Fata Chillón FR, Chew BH, Traxer O, Castellani D, Gauhar V. Comparing thulium fiber versus high power holmium laser in bilateral same sitting retrograde intrarenal surgery for kidney stones: Results from a multicenter study. Investig Clin Urol 2024; 65:451-458. [PMID: 39249917 PMCID: PMC11390269 DOI: 10.4111/icu.20240185] [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: 06/03/2024] [Revised: 07/18/2024] [Accepted: 08/05/2024] [Indexed: 09/10/2024] Open
Abstract
PURPOSE Traditionally, bilateral urolithiasis treatment involved staged interventions due to safety concerns. Recent studies have shown that same-sitting bilateral retrograde intrarenal surgery (SSB-RIRS) is effective, with acceptable complication rates. However, there's no clear data on the optimum laser for the procedure. This study aimed to assess outcomes of SSB-RIRS comparing thulium fiber laser (TFL) and high-power holmium:yttrium-aluminum-garnet (Ho:YAG) laser in a multicenter real-world practice. MATERIALS AND METHODS Retrospective analysis was conducted on patients undergoing SSB-RIRS from January 2015 to June 2022 across 21 centers worldwide. Three months perioperative and postoperative outcomes were recorded, focusing on complications and stone-free rates (SFR). RESULTS A total of 733 patients were included, with 415 in group 1 (Ho:YAG) and 318 in group 2 (TFL). Both groups have similar demographic and stone characteristics. Group 1 had more incidence of symptomatic pain or hematuria (26.5% vs. 10.4%). Operation and lasing times were comparable. The use of baskets was higher in group 1 (47.2% vs. 18.9%, p<0.001). Postoperative complications and length of hospital stay were similar. Group 2 had a higher overall SFR. Multivariate regression analysis indicated that age, presence of stone at the lower pole, and stone diameter were associated with lower odds of being stone-free bilaterally, while TFL was associated with higher odds. CONCLUSIONS Our study shows that urologists use both lasers equally for SSB-RIRS. Reintervention rates are low, safety profiles are comparable, and single-stage bilateral SFR may be better in certain cases. Bilateral lower pole and large-volume stones have higher chances of residual fragments.
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Affiliation(s)
- Chu Ann Chai
- Division of Urology, Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | - Takaaki Inoue
- Department of Urology, Hara Genitourinary Private Hospital, Kobe University, Kobe, Japan
| | - Bhaskar Kumar Somani
- Department of Urology, University Hospitals Southampton, NHS Trust, Southampton, UK
| | - Steffi Kar Kei Yuen
- SH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Deepak Ragoori
- Department of Urology, Asian Institute of Nephrology & Urology, Irram Manzil Colony, Hyderabad, India
| | - Nariman Gadzhiev
- Department of Urology, Saint-Petersburg State University Hospital, Saint-Petersburg, Russia
| | - Yiloren Tanidir
- Department of Urology, School of Medicine, Marmara University, İstanbul, Türkiye
| | - Esteban Emiliani
- Department of Urology, Fundacion Puigvert, Autónomos University of Barcelona, Barcelona, Spain
| | - Saeed Bin Hamri
- Division of Urology, Department of Surgery, Ministry of the National Guard Health Affairs, King Saud Bin Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohamed Amine Lakmichi
- Department of Urology, University Hospital Mohammed the VIth of Marrakesh, Marrakesh, Morocco
| | - Vaddi Chandramohan
- Department of Urology, Preeti Urology and Kidney Hospital, Hyderabad, India
| | | | - Boyke Soebhali
- Department of Urology, Abdul Wahab Sjahranie Hospital Medical Faculty, Muliawarman University, Samarinda, Indonesia
| | - Mehmet Ilker Gokce
- Department of Urology, Ankara University School of Medicine, Ankara, Türkiye
| | | | | | - Ben Hall Chew
- Department of Urology, University of British Columbia, Vancouver, Canada
| | - Olivier Traxer
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
| | - Daniele Castellani
- Department of Urology, Sorbonne University, Tenon Hospital, AP-HP, Paris, France
| | - Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital, Singapore
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Jiang Y, Sheng Y, Zhang J, Jiang Y, Shan H, Kang N. Feasibility of Simultaneous Bilateral Endoscopic Surgery in Prone Split-Leg Position for Bilateral Upper Urinary Tract Calculi: A Pilot Study. Urol Int 2024; 108:190-197. [PMID: 38290486 DOI: 10.1159/000536545] [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: 11/12/2023] [Accepted: 01/09/2024] [Indexed: 02/01/2024]
Abstract
INTRODUCTION We explored the viability of simultaneous bilateral endoscopic surgery (SBES) in the prone split-leg position for managing bilateral calculi. METHODS We retrospectively reviewed 72 patients who underwent SBES, with procedures involving ureteroscopy (URS) and contralateral percutaneous nephrolithotomy (PNL) simultaneously, in prone split-leg position. RESULTS Operative times averaged 109.38 ± 30.76 min, with an average hospital stay of 7.79 ± 3.78 days. The bilateral stone-free rate (SFR) was 70.83%, while URS and PNL demonstrated comparable unilateral SFR (83.33% and 79.17%, respectively). Receiver operating characteristics curves for predicting unilateral residual fragments yielded an area under the curve of 0.84 (URS) and 0.81 (PNL) with respective cutoff values of stone diameter of 11.55 mm and 23.52 mm. Fifty-seven (79.17%) and 15 (20.83%) patients encountered grade 0-1/2 complications, with no severe complications (grade 3-5) recorded. No significant changes in blood count or renal function were observed post-SBES. CONCLUSIONS SBES in the prone split-leg position is a viable option for managing bilateral upper tract urolithiasis. Larger scale studies are needed to further assess safety and efficacy in various positions.
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Affiliation(s)
- Yihang Jiang
- Department of Urology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | - Yali Sheng
- Department of Pharmacy, Beijing Hospital, National Center of Gerontology, Beijing, China
- Department of Pharmacy, Beijing Hospital, National Center of Gerontology, Beijing, China
- Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
- Beijing Key Laboratory of Assessment of Clinical Drugs Risk and Individual Application (Beijing Hospital), Beijing, China
| | - Junhui Zhang
- Department of Urology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | - Yuguang Jiang
- Department of Urology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | - Hui Shan
- Department of Urology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | - Ning Kang
- Department of Urology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
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Kamal W, Azhar RA, Hamri SB, Alathal AH, Alamri A, Alzahrani T, Abeery H, Noureldin YA, Alomar M, Al Own A, Alnazari MM, Alharthi M, Awad MA, Halawani A, Althubiany HH, Alruwaily A, Violette P. The Saudi urological association guidelines on urolithiasis. Urol Ann 2024; 16:1-27. [PMID: 38415236 PMCID: PMC10896325 DOI: 10.4103/ua.ua_120_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 12/24/2023] [Accepted: 12/28/2023] [Indexed: 02/29/2024] Open
Abstract
Aims The Saudi Urolithiasis Guidelines are a set of recommendations for diagnosing, evaluating, and treating urolithiasis in the Saudi population. These guidelines are based on the latest evidence and expert consensus to improve patient outcomes and optimize care delivery. They cover the various aspects of urolithiasis, including risk factors, diagnosis, medical and surgical treatments, and prevention strategies. By following these guidelines, health-care professionals can improve care quality for individuals with urolithiasis in Saudi Arabia. Panel The Saudi Urolithiasis Guidelines Panel consists of urologists specialized in endourology with expertise in urolithiasis and consultation with a guideline methodologist. All panelists involved in this document have submitted statements disclosing any potential conflicts of interest. Methods The Saudi Guidelines on Urolithiasis were developed by relying primarily on established international guidelines to adopt or adapt the most appropriate guidance for the Saudi context. When necessary, the panel modified the phrasing of recommendations from different sources to ensure consistency within the document. To address areas less well covered in existing guidelines, the panel conducted a directed literature search for high quality evidence published in English, including meta analyses, randomized controlled trials, and prospective nonrandomized comparative studies. The panel also searched for locally relevant studies containing information unique to the Saudi Arabian population. The recommendations are formulated with a direction and strength of recommendation based on GRADE terminology and interpretation while relying on existing summaries of evidence from the existing guidelines.
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Affiliation(s)
- Wissam Kamal
- Department of Urology, King Fahad General Hospital, Jeddah, Saudi Arabia
| | - Raed A Azhar
- Department of Urology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Abdulaziz H Alathal
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Division of Urology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Abdulaziz Alamri
- Surgery Department, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Tarek Alzahrani
- Dr. Sulaiman Al Habib Hospital (Swaidi), Riyadh, Saudi Arabia
| | | | - Yasser A Noureldin
- Division of Urology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- Department of Urology, Faculty of Medicine, Benha University, Egypt
- Department of Clinical Sciences, Northern Ontario School of Medicine, ON, Canada
| | - Mohammad Alomar
- Department of Urology, King Fahad Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | | | - Mansour M Alnazari
- Department of Urology, College of Medicine, Taibah university, Madinah, Saudi Arabia
| | - Majid Alharthi
- Department of Urology, King Fahad General Hospital, Jeddah, Saudi Arabia
- Seoul National University Hospital, Seoul, South Korea
| | - Mohannad A Awad
- Department of Surgery, King Abdulaziz University, Rabigh, Saudi Arabia
- Department of Urology, University of Texas Southwestern Medical Southwestern Medical Centre, Dallas, TX, USA
| | - Abdulghafour Halawani
- Department of Urology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Hatem Hamed Althubiany
- Department of Urology, Imam Abdulrahman Bin Faisal University, Dammam King Fahd Hospital of the University, Dammam, Saudi Arabia
| | | | - Phillipe Violette
- Woodstock General Hospital, London Ontario, Canada
- McMaster University, London Ontario, Canada
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Raizenne BL, Deyirmendjian C, Lafontaine ML, Balde M, Bechis SK, Sur RL, Nakada SY, Antonelli JA, Streeper NM, Sivalingam S, Viprakasit DP, Averch TD, Landman J, Chi T, Pais VM, Chew BH, Bird VG, Andonian S, Canvasser NE, Harper JD, Penniston KL, Bhojani N. The Impact of Bilateral Stone Disease on Patients' Disease Progression and Health-Related Quality of Life. J Endourol 2023; 37:1289-1294. [PMID: 37767631 DOI: 10.1089/end.2023.0132] [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] [Indexed: 09/29/2023] Open
Abstract
Purpose: Patients with recurring kidney stone events can expect significant morbidity and functional impairment. Few studies have evaluated the effect of bilateral kidney stones on disease progression and quality of life. We wanted to determine the association of bilateral stone disease on age of onset, and the impact on number of stone events and individual kidney stone disease-specific health-related quality of life (HRQOL) by analyzing the validated and prospectively collected Wisconsin Stone Quality of Life (WISQOL) database. Materials and Methods: We studied 2906 stone patients from 16 centers in North America after having completed the WISQOL questionnaire from 2014 to 2019. Kidney stone formers were assessed if kidney stones were bilateral or unilateral on imaging. Analysis with a chi-square test compared categorical variables. Bilateral kidney stone disease and its impact on HRQOL were evaluated through a multivariable linear regression model. Results: Of 2906 kidney stone formers, 1340 had unilateral kidney stones and 1566 had bilateral kidney stones. We observed more frequently that patients with bilateral stones had an increased number of depression/anxiety symptoms, renal tubular acidosis, and rheumatoid arthritis (all p < 0.05). Patients with bilateral stones had a younger mean (standard deviation [SD]) age of kidney stone disease onset (37.2 ± 15.8 vs 46.4 ± 15.9 years of age, p < 0.001). Bilateral kidney stone formers had a higher mean (SD) number of stone events (11.3 ± 21.8) than unilateral kidney stone formers (3.0 ± 5.1) (p < 0.001). Within our multivariable analysis, we found that HRQOL was negatively affected by the presence of bilateral stones for kidney stone patients (β = -11.2 [confidence interval: -19.5 to -3.0] points, p < 0.05). Conclusions: Bilateral kidney stone formers had a younger age of kidney stone disease onset and a higher number of stone events compared with unilateral kidney stone disease formers. The presence of bilateral kidney stone disease negatively impacted HRQOL.
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Affiliation(s)
- Brendan L Raizenne
- Division of Urology, Centre Hospitalier de l'Université de Montréal, Montréal, Canada
| | | | | | - Maimouna Balde
- Faculty of Sciences and Technologies, Gaston Berger University, Saint Louis, Senegal
| | - Seth K Bechis
- Department of Urology, University of California San Diego, San Diego, California, USA
| | - Roger L Sur
- Department of Urology, University of California San Diego, San Diego, California, USA
| | - Stephen Y Nakada
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Jodi A Antonelli
- Division of Urology, Department of Surgery, Duke University, Durham, North Carolina, USA
| | - Necole M Streeper
- Division of Urology, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Sri Sivalingam
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Davis P Viprakasit
- Department of Urology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Timothy D Averch
- Department of Urology, Palmetto Health USC Medical Group, Columbia, South Carolina, USA
| | - Jaime Landman
- University of California Irvine School of Medicine, Orange, California, USA
| | - Thomas Chi
- Department of Urology, University of California San Francisco, San Francisco, California, USA
| | - Vernon M Pais
- Urology Section, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Ben H Chew
- Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Vincent G Bird
- Department of Urology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Sero Andonian
- Division of Urology, McGill University Health Center, Montreal, Canada
| | - Noah E Canvasser
- Department of Urology, University of California Davis, Sacramento, California, USA
| | - Jonathan D Harper
- Department of Urology, University of Washington, Seattle, Washington, USA
| | - Kristina L Penniston
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Naeem Bhojani
- Division of Urology, Centre Hospitalier de l'Université de Montréal, Montréal, Canada
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Tu WC, Zhang XL, Wang J, Huang BX, Zhang DG, Wang DW. Influence of stone load on the outcome of same-session flexible ureteroscopy for bilateral upper urinary tract stones: a multicenter retrospective study. Front Med (Lausanne) 2023; 10:1163371. [PMID: 38034526 PMCID: PMC10684712 DOI: 10.3389/fmed.2023.1163371] [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: 02/10/2023] [Accepted: 10/12/2023] [Indexed: 12/02/2023] Open
Abstract
Purpose This study aimed to evaluate the efficacy and safety of same-session flexible ureteroscopy (fURS) for the treatment of bilateral upper urinary tract stones and to examine the influence of stone load on the outcome of same-session fURS, stratifying by total diameter of stones (TDS) ≤30 mm vs. >30 mm. Patients and methods We retrospectively reviewed all cases of same-session fURS performed for bilateral upper urinary tract stones at four institutions between January 2017 and September 2020. All patients were divided into two groups based on TDS, ≤30 mm and >30 mm. Data on patient demographics, stone characteristics, surgical results, and complications were collected and analyzed for differences between the two groups. Stone-free rate (SFR) was defined as patients endoscopically stone-free or with radiological fragments <2 mm of each renal unit. Results A total of 121 patients with bilateral upper urinary tract stones underwent same-session fURS, consisting of 73 patients in the TDS ≤ 30 mm group and 48 patients in the TDS > 30 mm group. The mean bilateral stone size was 28.2 ± 12.2 mm (range: 9.1-38.4 mm), with a mean operating time of 97.1 ± 39.6 min (range: 19-220 min). The SFR was 54.5% after the first fURS, and SFR increased to 97.5% after re-fURS for residual stones. The operation time for the TDS > 30 mm group was longer than that of the TDS ≤ 30 mm group (85.1 ± 36.5 vs. 115.4 ± 37.4 min, p < 0.001). The SFR after the first fURS was significantly lower in the TDS > 30 mm group than in the TDS ≤ 30 mm group (25.0% vs. 73.9%, p < 0.001). Although there was no statistically significant difference in overall SFR between the two groups (93.7% vs. 100%, p = 0.060), the rate of re-fURS for residual stones was higher in the TDS > 30 mm group than in the TDS ≤ 30 mm group (75% vs. 26%, p < 0.001). There were no significant differences in length of hospital stay (LOS) (2.2 ± 0.7 vs. 2.3 ± 1.0, p = 0.329) or complication rate (10.9% vs. 14.6%, p = 0.582) between the two groups. Conclusion The results suggested that same-session fURS can be effectively performed with a low complication rate. A higher SFR after the first fURS can be achieved in the case of bilateral upper urinary tract stones with TDS ≤ 30 mm, and priority should be given to same-session fURS.
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Affiliation(s)
- Wei-Chao Tu
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xin-Le Zhang
- Department of Urology, Kunshan Integrated Traditional Chinese and Western Medicine Hospital, Suzhou, Jiangsu, China
| | - Jun Wang
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bao-Xing Huang
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ding-Guo Zhang
- Department of Urology, Shanghai Pudong New Area People's Hospital, Shanghai, China
| | - Da-Wei Wang
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Castellani D, Traxer O, Ragoori D, Galosi AB, De Stefano V, Gadzhiev N, Tanidir Y, Inoue T, Emiliani E, Hamri SB, Lakmichi MA, Vaddi CM, Heng CT, Soebhali B, More S, Sridharan V, Gökce MI, Tursunkulov AN, Ganpule A, Pirola GM, Naselli A, Aydin C, Ramón de Fata Chillón F, Mendoza CS, Candela L, Chew BH, Somani BK, Gauhar V. Improving Outcomes of Same-sitting Bilateral Flexible Ureteroscopy for Renal Stones in Real-world Practice-Lessons Learnt from Global Multicenter Experience of 1250 Patients. EUR UROL SUPPL 2023; 52:51-59. [PMID: 37284041 PMCID: PMC10240508 DOI: 10.1016/j.euros.2023.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2023] [Indexed: 06/08/2023] Open
Abstract
Background Bilateral kidney stones are commonly treated in staged procedures. Objective To evaluate outcomes after same-sitting bilateral retrograde intrarenal surgery (SSB-RIRS) for renal stones. Design setting and participants Data from adults who underwent bilateral RIRS in 21 centers were retrospectively reviewed (from January 2015 to June 2022). The inclusion criteria were unilateral/bilateral symptomatic bilateral stone(s) of any size/location in both kidneys and bilateral stones on follow-up with symptom/stone progression. Stone-free rate (SFR) was defined as absence of any fragment >3 mm at 3 mo. Outcome measurements and statistical analysis Continuous variables are presented as medians and 25-75th percentiles. A multivariable logistic regression analysis was performed to evaluate independent predictors of sepsis and bilateral SFR. Results and limitations A total of 1250 patients were included. The median age was 48.0 (36-61) yr. Of the patients, 58.2% were prestented. The median stone diameter was 10 mm on both sides. Multiple stones were present in 45.3% and 47.9% of the left and right kidneys, respectively. Surgery was stopped in 6.8% of cases. The median surgical time was 75.0 (55-90) min. Complications were transient fever (10.7%), fever/infection needing prolonged stay (5.5%), sepsis (2%), and blood transfusion (1.3%). Bilateral and unilateral SFRs were 73.0% and 17.4%, respectively. Female (odds ratio [OR] 2.97, 95% confidence interval [CI] 1.18-7.49, p = 0.02), no antibiotic prophylaxis (OR 5.99, 95% CI 2.28-15.73, p < 0.001), kidney anomalies (OR 5.91, 95% CI 1.96-17.94, p < 0.001), surgical time ≥100 min (OR 2.86, 95% CI 1.12-7.31, p = 0.03) were factors associated with sepsis. Female (OR 1.88, 95% CI 1.35-2.62, p < 0.001), bilateral prestenting (OR 2.16, 95% CI 1.16-7.66, p = 0.04), and the use of high-power holmium:YAG laser (OR 1.63, 95% CI 1.14-2.34, p < 0.01) and thulium fiber laser (OR 2.50, 95% CI 1.32-4.74, p < 0.01) were predictors of bilateral SFR. Limitations were retrospective study and no cost analysis. Conclusions SSB-RIRS is an effective treatment with an acceptable complication rate in selected patients with kidney stones. Patient summary In this large multicenter study, we looked at outcomes after same-sitting bilateral retrograde intrarenal surgery (SSB-RIRS) for renal stones in a large cohort. We found that SSB-RIRS was associated with acceptable morbidity and good stone clearance after a single session.
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Affiliation(s)
- Daniele Castellani
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
| | - Olivier Traxer
- Department of Urology AP-HP, Sorbonne University, Tenon Hospital, Paris, France
| | - Deepak Ragoori
- Department of Urology, Asian Institute of Nephrology & Urology, Irram Manzil Colony, Hyderabad, Telangana, India
| | - Andrea Benedetto Galosi
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
| | - Virgilio De Stefano
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
| | - Nariman Gadzhiev
- Department of Urology, Saint-Petersburg State University Hospital, Saint-Petersburg, Russia
| | - Yiloren Tanidir
- Department of Urology, School of Medicine, Marmara University, İstanbul, Turkey
| | - Takaaki Inoue
- Department of Urology, Hara Genitourinary Private Hospital, Kobe University, Kobe, Japan
| | - Esteban Emiliani
- Department of Urology, Fundacion Puigvert, Autónomos University of Barcelona, Barcelona, Spain
| | - Saeed Bin Hamri
- Division of Urology, Department of Surgery, Ministry of the National Guard Health Affairs, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Mohamed Amine Lakmichi
- Department of Urology, University Hospital Mohammed the VIth of Marrakesh, Marrakesh, Morocco
| | | | - Chin Tiong Heng
- Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Boyke Soebhali
- Department of Urology, Abdul Wahab Sjahranie Hospital, Medical Faculty Mulawarman University, Samarinda, Indonesia
| | - Sumit More
- Department of Urology, Sarvodaya Hospital and Research Centre, Faridabad, India
| | - Vikram Sridharan
- Department of Urology, Sree Paduka Speciality Hospital, Thillai Nagar, India
| | - Mehmet Ilker Gökce
- Department of Urology, Ankara University, School of Medicine, Ankara, Turkey
| | | | - Arvind Ganpule
- Department of Urology, Muļjibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Giacomo Maria Pirola
- Urology Department, San Giuseppe Hospital, IRCCS Multimedica, Multimedica Group, Milan, Italy
| | - Angelo Naselli
- Urology Department, San Giuseppe Hospital, IRCCS Multimedica, Multimedica Group, Milan, Italy
| | - Cemil Aydin
- Department of Urology, Hitit University, School of Medicine, Çorum, Turkey
| | | | - Catalina Solano Mendoza
- Department of Urology AP-HP, Sorbonne University, Tenon Hospital, Paris, France
- Department of Endourology, Uroclin S.A.S, Medellín, Colombia
| | - Luigi Candela
- Department of Urology AP-HP, Sorbonne University, Tenon Hospital, Paris, France
- Division of Experimental Oncology/Unit of Urology, URI-Urological Research Institute IRCCS Ospedale San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
| | - Ben Hall Chew
- Department of Urology, University of British Columbia, Vancouver, Canada
| | - Bhaskar Kumar Somani
- Department of Urology, University Hospitals Southampton, NHS Trust, Southampton, UK
| | - Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore
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Proietti S, Pavia MP, Rico L, Basulto-Martinez M, Yeow Y, Contreras PN, Galosi AB, Gaboardi F, Giusti G. SIMULTANEOUS BILATERAL ENDOSCOPIC SURGERY (SBES): IS IT READY FOR PRIME TIME? J Endourol 2022; 36:1155-1160. [PMID: 35414219 DOI: 10.1089/end.2022.0013] [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
Introduction To date, some data available in literature on simultaneous bilateral endoscopic surgery (SBES) have shown good outcomes in terms of both effectiveness and safety. The aim of this study was to report the outcomes pertaining to the effectiveness and safety of SBES performed in our series of patients with bilateral renal stones. Materials and Methods A prospective analysis of consecutive patients who underwent SBES for bilateral renal stones at our institution between June 2017 and September 2021 was performed. Routine preoperative and 1-month postoperative work-up included history, physical examination, urinalysis, urine culture, and blood tests, including the evaluation of estimated glomerular filtration rate (eGFR) using the Cockcroft-Gault equation. An abdominal non-contrast computerized tomography (NCCT) scan was performed in all cases preoperatively and 1-month postoperatively. Peri/postoperative complications were reported according to the Clavien-Dindo classification system. The primary endpoint of the study was stone-free rate (SFR), and the secondary endpoints were Clavien-Dindo complications grade 1 or higher. Results Altogether, 101 patients met the inclusion criteria and were enrolled in the study. SFR for all renal units was achieved in 82 patients (81.1%) at the 1-month follow-up. Twelve patients underwent additional flexible ureteroscopy for residual fragments, and seven asymptomatic patients with single small residual fragment were observed. Eighteen patients (17.8%) experienced Clavien-Dindo Grade I-II complications, whereas one patient (1%) experienced Clavien-Dindo Grade IIIa complication (renal arteriovenous fistula embolization under local anesthesia). Conclusions SBES is a safe and effective procedure for the treatment of bilateral renal stones. Further randomized studies with larger populations are needed to confirm these favorable outcomes of SBES to establish it as an alternative to staged surgeries in patients with bilateral renal stones. Appropriate patient selection is of paramount importance for achieving good outcomes without experiencing severe complications.
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Affiliation(s)
- Silvia Proietti
- IRCCS Ospedale San Raffaele, 9372, Dept of Urology, Milano, Lombardia, Italy;
| | - Maria Pia Pavia
- Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, 18494, Ancona, Marche, Italy;
| | - Luis Rico
- Hospital Aleman, 62862, Urology Department, Av Pueyrredon 1640, Buenos Aires, Argentina, 1118;
| | - Mario Basulto-Martinez
- Hospital Regional de Alta Especialidad de la Peninsula de Yucatan, 235514, Urology, 7th St. No. 433, Altabrisa, Merida, Yucatán, Mexico, 97133;
| | - Yuyi Yeow
- Tan Tock Seng Hospital, 63703, Urology, Singapore, Singapore;
| | | | - Andrea B Galosi
- Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, 18494, Clinica Urologica, Ancona, Marche, Italy;
| | - Franco Gaboardi
- IRCCS Ospedale San Raffaele, 9372, Urology, Milano, Lombardia, Italy;
| | - Guido Giusti
- IRCCS Ospedale San Raffaele, 9372, Department of Urology, Milano, Lombardia, Italy;
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Banerjee I, Bhat A, Katz JE, Shah RH, Smith NA, Shah HN. Bilateral same session flexible ureterorenoscopy for endoscopic management of bilateral renal calculi is noninferior to unilateral flexible ureterorenoscopy for management of multiple unilateral renal calculi: outcomes of a prospective comparative study. Scand J Urol 2022; 56:244-250. [PMID: 35384790 DOI: 10.1080/21681805.2022.2058606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE The aim of the study was to prospectively evaluate safety and efficacy of bilateral same session ureterorenoscopy (BSS-FURS) for management of bilateral renal calculi. METHODS A prospective comparative study was designed to compare the results of BSS-FURS with unilateral flexible ureterorenoscopy (U-FURS) for management of renal calculi between June 2003 and May 2016. A sample size of 55 patients in each arm was calculated considering a 20% increase in the incidence of complications with BSS-FURS over 15% complication rate in U-FURS (alpha = 0.05; Beta = 0.90). Patient demographics, stone burden, total operative time, postoperative creatinine level, duration of hospital stay, perioperative complications and stone free rate (SFR) were compared in both the groups. The literature pertaining to BSS-FURS was reviewed. RESULTS Although the study group patients had higher overall stone burden (18.60 ± 7.70 mm vs. 13.32 ± 6.43 mm) and significantly longer operative time (48.30 ± 16.71 min vs. 32.95 ± 13.05 min; p < 0.05) as compared to the control group, the length of hospital stay, SFR (67.85% vs. 78.5%; p = 0.436) and perioperative complications were comparable in both the groups. Most patients who developed postoperative fever from both groups had struvite stones. CONCLUSION BSS-FURS is a safe and efficient procedure for the management of bilateral renal calculi in the hands of an experienced endourologist. It has comparable SFR and morbidity compared to U-FURS. Caution should be exercised in patients with struvite stones, as they are more likely to develop postoperative fever.
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Affiliation(s)
- Indraneel Banerjee
- Department of Urology, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Abhishek Bhat
- Department of Urology, Jackson Health System, Miami, FL, USA
| | - Jonathan E Katz
- Department of Urology, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Rashmi H Shah
- Urolap Superspeciality Clinic and S. L. Raheja, Fortis Associate Hospital, Mumbai, India
| | | | - Hemendra N Shah
- Department of Urology, University of Miami, Miller School of Medicine, Miami, FL, USA
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Addar A, Aljuhayman A, Ghazwani Y, Al Khayal A, Alasker A, Emiliani E, Hamri SB. Bilateral same session renal stone surgery tolerance and complications. Urol Ann 2021; 13:336-339. [PMID: 34759642 PMCID: PMC8525472 DOI: 10.4103/ua.ua_128_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 01/25/2021] [Indexed: 11/06/2022] Open
Abstract
Introduction: The prevalence rate of upper urinary tract calculi in Saudi Arabia is one of the highest globally. Bilateral renal stone management is an option but is still controversial. Methodology: The study was a retrospective study, including 31 patients with bilateral renal or ureteric stones who underwent bilateral same-session ureterorenoscopy (BSS-URS). The data collected included age, gender, body mass index (BMI), stone burden bilaterally, operative time bilaterally, hospital stay, stone location, type of anesthesia, stone history, renal anomaly as well as pre- and postoperative JJ stenting. In addition, data related to complications (ureteric injury, renal failure, urinary tract infection, pain requiring an emergency department visit within 1 week of the procedure), the stone-free rate (defined as £ 3 mm asymptomatic stone fragment identified with computed tomography Kidney, Ureter and Bladder 3 months after surgery was also collected. The data were collected from the electronic patient record system, entered in an Excel spreadsheet, and descriptive analysis was done. Results: In total, 31 patients were included, with the majority (80.6%, n = 25) male. The mean age was 41.6 years, the mean BMI 28.7 ± 5.59, the mean operative time for each renal unit 46.53 ± 25.69 min, and the mean hospital stay 17.87 ± 8.43 h. The majority (96.7%, n = 30) received general anesthesia. Less than half (40.3%, n = 25) of the renal units had stones in multiple calyces and the majority (90.3%, n = 56) of the renal units were stone free at the 3-month follow-up. A small proportion (3.2%, n = 2) of the renal units were polycystic. Prestenting was documented in 40.3% (n = 25) of the renal units and the majority (95.2%, n = 59) were stented postoperatively. Conclusion: BSS-URS is a safe and a highly effective management option for bilateral renal stones.
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Affiliation(s)
- Abdulmalik Addar
- Department of Urology, McGill University Health Center, McGill University, Montreal, QC, Canada
| | - Ahmed Aljuhayman
- Department of Urology, College of Medicine, Majmaah University, Al-Majmaah, Saudi Arabia
| | - Yahya Ghazwani
- Division of Urology, Department of Surgery, Ministry of the National Guard - Health Affairs.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abdullah Al Khayal
- Division of Urology, Department of Surgery, Ministry of the National Guard - Health Affairs.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Ahmed Alasker
- Division of Urology, Department of Surgery, Ministry of the National Guard - Health Affairs.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Esteban Emiliani
- PETRA-UROGROUP, Riyadh, Saudi Arabia.,Endourology and Urolithiasis Unit, Fundacio Puigvert, Barcelona, Spain
| | - Saeed Bin Hamri
- Division of Urology, Department of Surgery, Ministry of the National Guard - Health Affairs.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,PETRA-UROGROUP, Riyadh, Saudi Arabia
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Li S, Quarrier S, Serrell EC, Penniston KL, Nakada SY. Should we treat asymptomatic concurrent contralateral renal stones? A longitudinal analysis. Urolithiasis 2021; 50:71-77. [PMID: 34272594 DOI: 10.1007/s00240-021-01281-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 07/06/2021] [Indexed: 11/29/2022]
Abstract
The objective is to explore the need for future surgery among patients treated for asymptomatic concurrent contralateral stones versus those that were not. Upon IRB approval, we retrospectively reviewed records of patients who underwent stone surgeries (SWL, URS, PCNL) from 2009 to 2018. Patients were included if they were greater than 18 years old, had a minimum follow-up of 2 years, and had pre-operative imaging. Patients were divided into three groups: bilateral surgery, ipsilateral surgery with, and without asymptomatic concurrent contralateral stones. Cox regression was used to analyze patients' need for future surgery while controlling demographic and comorbid characteristics. Of the 1666 patients included, 51.9% were men. They were 59.7 ± 15 years and had a BMI of 31.3 ± 8.2 kg/m2. During the follow-up of 5.2 ± 2.2 years (range 2-11 years), patients who had bilateral surgery and patients who had ipsilateral surgery without treatment of the asymptomatic concurrent contralateral stones had no difference in the need for future surgery (41.7% vs. 43%, p = 0.585). When stratified by stone size, patients with contralateral stones > 6 mm were more likely to require future surgical treatment than those treated bilaterally (p < 0.001). Our study demonstrates that treating asymptomatic concurrent contralateral stones does not lower the need for future surgical interventions. However, asymptomatic concurrent contralateral stones > 6 mm may portend earlier need for treatment. Therefore, bilateral treatment should be considered at presentation.
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Affiliation(s)
- Shuang Li
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Medical Foundation Centennial Building, 1685 Highland Avenue, Madison, WI, 53705, USA.
| | - Scott Quarrier
- Department of Urology, University of Rochester Medical Center, Rochester, NY, USA
| | - Emily C Serrell
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Medical Foundation Centennial Building, 1685 Highland Avenue, Madison, WI, 53705, USA
| | - Kristina L Penniston
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Medical Foundation Centennial Building, 1685 Highland Avenue, Madison, WI, 53705, USA
| | - Stephen Y Nakada
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Medical Foundation Centennial Building, 1685 Highland Avenue, Madison, WI, 53705, USA
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Tessi C, Szklarz MT, Imizcoz FL, Ruiz J, Weller S, Sager C, Agustin Schiavo PO, Lechuga PH, Luna A, Corbetta JP. Simultaneous bilateral endoscopic surgery in a pediatric patient: Description of a NOVEL technique. J Pediatr Urol 2021; 17:117-118. [PMID: 33341369 DOI: 10.1016/j.jpurol.2020.11.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 11/28/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Simultaneous bilateral endoscopic surgery (SBES) is the performance of a percutaneous nephrolithotomy (PCNL) on one side and a retrograde intrarenal surgery (RIRS) on the other kidney simultaneously. OBJECTIVE Our aim is to report through a video the surgical technique and the step-by-step details of a SBES performed in a pediatric patient. PATIENTS AND METHODS A 12-year-old male patient with bilateral upper tract urolithiasis. RESULTS Supine PCNL is performed in Galdakao-modified Valdivia position. Ureteroscopic surgeon performs retrograde pyelography on PCNL kidney. Percutaneous access under fluoroscopic guidance trough the lower calyx and dilated with Amplatz dilators to 17.5 Fr. Storz® 17.5 MIP Nephroscope is introduced and fragmentation with pneumatic lithotripter starts. On the other kidney, after introduction of ureteral sheet 12/14 Fr and digital flexible ureteroscope Flex Xc ® 9.5Fr, pulverization of the stone starts with Laser Holmium YAG (Oddysey®). Surgeons work simultaneously and share fluoro-scopic c-arm. CONCLUSION SBES can be reproduced in children. Proper planification and preparation of the involved team and OR set up are essential. Further prospective randomized studies are needed to establish safety and efficacy of SBES in pediatric patients.
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Affiliation(s)
- Catalina Tessi
- Pediatric Urology Department, Hospital "Prof. Dr. Juan P. Garrahan", Pichincha 1890, C1245 CABA, Buenos Aires, Argentina.
| | - María Tatiana Szklarz
- Pediatric Urology Department, Hospital "Prof. Dr. Juan P. Garrahan", Pichincha 1890, C1245 CABA, Buenos Aires, Argentina
| | - Felicitas López Imizcoz
- Pediatric Urology Department, Hospital "Prof. Dr. Juan P. Garrahan", Pichincha 1890, C1245 CABA, Buenos Aires, Argentina
| | - Javier Ruiz
- Pediatric Urology Department, Hospital "Prof. Dr. Juan P. Garrahan", Pichincha 1890, C1245 CABA, Buenos Aires, Argentina
| | - Santiago Weller
- Pediatric Urology Department, Hospital "Prof. Dr. Juan P. Garrahan", Pichincha 1890, C1245 CABA, Buenos Aires, Argentina
| | - Cristian Sager
- Pediatric Urology Department, Hospital "Prof. Dr. Juan P. Garrahan", Pichincha 1890, C1245 CABA, Buenos Aires, Argentina
| | - Pablo Omar Agustin Schiavo
- Telehealth Department, Hospital "Prof. Dr. Juan P. Garrahan", Pichincha 1890, C1245 CABA, Buenos Aires, Argentina.
| | - Pablo Horacio Lechuga
- Telehealth Department, Hospital "Prof. Dr. Juan P. Garrahan", Pichincha 1890, C1245 CABA, Buenos Aires, Argentina
| | - Antonio Luna
- Telehealth Department, Hospital "Prof. Dr. Juan P. Garrahan", Pichincha 1890, C1245 CABA, Buenos Aires, Argentina
| | - Juan Pablo Corbetta
- Pediatric Urology Department, Hospital "Prof. Dr. Juan P. Garrahan", Pichincha 1890, C1245 CABA, Buenos Aires, Argentina
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Danilovic A, Torricelli FCM, Marchini GS, Batagello C, Vicentini FC, Traxer O, Srougi M, Nahas WC, Mazzucchi E. Prospective Evaluation of Bilateral Retrograde Intrarenal Surgery: Is It Really Safe? J Endourol 2020; 35:14-20. [PMID: 32689826 DOI: 10.1089/end.2020.0611] [Citation(s) in RCA: 5] [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
Introduction: The aim of this study was to prospectively compare the outcomes of bilateral same-session retrograde intrarenal surgery (BSS RIRS) with unilateral RIRS and to compare the outcomes of first with second operated kidneys in BSS RIRS. Subjects and Methods: Consecutive symptomatic adult patients with kidney stones up to 20 mm who accepted to be treated by RIRS were prospectively studied. Stone-free rate (SFR) was evaluated by non-contrast CT for each renal unit, and surgical complications were evaluated based on Clavien-Dindo classification. Results: SFR (73.9% vs 76.1%, p = 0.830) and hospitalization time (14.43 ± 18.81 hours vs 13.00 ± 4.89 hours, p = 0.564) were similar between unilateral and BSS RIRS groups, with less consumption of disposable devices in BSS RIRS (p = 0.017). Operative time was longer in BSS RIRS (61.24 ± 26.62 minutes vs 88.65 ± 33.19 minutes, p < 0.001). Bilateral group had significant more overall complications by Clavien-Dindo classification than unilateral (15.9% vs 39.9%, p = 0.030) and more emergency room (ER) visits (11.6% vs 34.8%, p = 0.026). Moreover, although both groups temporarily increased creatinine levels, it was significantly higher in bilateral RIRS (p = 0.019). First operated kidney outcomes were similar to second operated kidney outcomes of BSS RIRS. Conclusion: Although BSS RIRS had similar SFR and consumed less disposable devices, it had a higher overall complication rate, a higher frequency of ER visits, and higher creatinine levels during follow-up than unilateral RIRS. There is no significant outcome difference between first and second operated kidneys in BSS RIRS.
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Affiliation(s)
- Alexandre Danilovic
- Department of Urology, 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
- Department of Urology, Sorbonne Université, GRC n20 Lithiase Renale, AP-HP, Hôpital Tenon, Paris, France
| | - Miguel Srougi
- Department of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - William C Nahas
- Department 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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13
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[Clinical outcomes of simultaneous bilateral endoscopic surgery for bilateral upper urinary tract calculi]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2020. [PMID: 32773799 PMCID: PMC7433631 DOI: 10.19723/j.issn.1671-167x.2020.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To discuss the efficacy and safety of simultaneous bilateral endoscopic surgery (SBES) for bilateral upper urinary tract calculi, and to summarize the initial experience. METHODS Patients diagnosed with bilateral upper urinary tract calculi who underwent SBES in the Department of Urology, Beijing Chao-Yang Hospital from January 2019 to January 2020 were enrolled retrospectively. The demographic and clinical data of the patients were recorded, and the operation status, stone free rate (SFR) and peri-operative complications were analyzed. The primary end point was SFR, and second end point was peri-operative complications. RESULTS A total of 23 patients underwent SBES, of which SBES was completed in 19 patients (12 males, and 7 females). The mean age was (41.3±12.0) years. Fourteen patients underwent modified supine position surgery and 4 patients in prone split-leg position. There was no statistical difference in the demographic and baseline clinical data of the patients in different positions. One patient underwent right percutaneous nephrolithotomy (PCNL) and left endoscopic combined intra-renal surgery (ECIRS) in the prone split-leg position, while 18 patients received simul-taneous surgery with PCNL and contralateral retrograde intra-renal surgery (RIRS). The mean anesthesia and operation time was (128.7±26.5) min and (70.7±20.3) min, respectively, which was significantly longer in the patients with prone split-leg position than in the patients with modified supine position, anesthesia time in the patients with prone split-leg position and modified supine position: (148.4±20.4) min vs. (121.6±25.3) min, respectively, t=-2.121, P=0.049, while the operation time in the patients with prone split-leg position and modified supine position: (86.4±21.1) min vs. (65.1±17.4) min, respectively, t=-2.222, P=0.040. There was no significant difference between the two groups in indwelling of nephrostomy [prone split-leg position and modified supine position: (2.6±0.9) d vs. (2.1±1.0) d, respectively; t=-0.880, P=0.391] and the length of hospital stay [prone split-leg position and modified supine position: (6.0±2.7) d vs. (5.2±1.8) d, respectively; t=-0.731, P=0.475]. One month after the operation, the SFR was 78.9%, and 3 patients had minor peri-operative complications (Clavien-Dindo grades Ⅰ/Ⅱ) without any serious complications (Clavien-Dindo grades Ⅲ/Ⅳ/Ⅴ). CONCLUSION The simultaneous bilateral endoscopic surgery would decrease the operation time and anesthesia exposure under the premise of ensuring the SFR, which is helpful to reduce the risk of peri-operative complications, especially to the patients who can not tolerate the second-stage or long-time operation.
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Outcomes of ureteroscopy (URS) for stone disease in the paediatric population: results of over 100 URS procedures from a UK tertiary centre. World J Urol 2020; 38:213-218. [PMID: 30949802 PMCID: PMC6954136 DOI: 10.1007/s00345-019-02745-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 03/27/2019] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To report the outcomes of paediatric ureteroscopy (URS) for stone disease from a specialist endourology centre in the UK. Ureteroscopy for management of stone disease has increased worldwide and is now being done more commonly in the paediatric age group. METHODS Data were analysed retrospectively from a database maintained between April 2010 and May 2018. Consecutive patients ≤ 16 years of age undergoing semi-rigid or flexible URS for stone disease were included. Stone size and stone-free rate (SFR) were routinely assessed using an ultrasound (USS) and/or plain KUB XR. Complications were graded according to the Clavien-Dindo classification and recorded within 30 days post-procedure and readmissions within 90 days after the procedure were also captured. RESULTS Over the 8-year period between April 2010 and April 2018, 81 patients with a mean age of 8.8 years (range 18 months-16 years) and a male to female ratio 1:1.1 underwent 102 procedures (1.28 procedure/patient to be stone free). Of the 81 patients, 29 (35.8%) had comorbidities, with 26 (32%) having multiple comorbidities. The mean (± SEM) single and overall stone size was 9.2 mm (± 0.48, range 3-30 mm) and 11.5 mm (± 0.74, range 4-46 mm) respectively, with 22 (27.1%) having multiple stones. Thirty-five (34.7%) had stent in situ pre-operatively. The stone location was in the ureter (26.6%), lower pole (35.4%), and renal pelvis (16.5%), with 22/81(27%) having multiple stones and 21/102 (20.5%) where a ureteral access sheath (UAS) was used. With a mean hospital stay of 1.2 days, the initial and final SFR was 73% and 99%, respectively, and 61/102 (60%) had ureteric stent placed at the end of the procedure. While there were no intra-operative complications, the readmission rate was less than 1% and there were only three early complications recorded. This included a case each of prolonged admission for pain control (grade I), urinary retention (grade II) and post-operative sepsis requiring a brief ITU admission (grade IV). CONCLUSION Our study demonstrates that in appropriate setting a high stone-free rate can be achieved with minimal morbidity for paediatric patients. There is potentially a need to factor the increasing role of URS in future paediatric urolithiasis guidelines.
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