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De Stefano V, Castellani D, Somani BK, Giulioni C, Cormio A, Galosi AB, Sarica K, Glover X, da Silva RD, Tanidir Y, Gadzhiev N, Pirola GM, Mulawkar PM, Teoh JYC, Monga M, Herrmann TRW, Gauhar V. Suction in Percutaneous Nephrolithotripsy: Evolution, Development, and Outcomes from Experimental and Clinical studies. Results from a Systematic Review. Eur Urol Focus 2024; 10:154-168. [PMID: 37442721 DOI: 10.1016/j.euf.2023.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 05/02/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023]
Abstract
CONTEXT Controversy exists regarding the therapeutic benefit of suction use during percutaneous nephrolithotripsy (PCNL). OBJECTIVE To review and highlight the options available in the use of suction for PCNL, and to discuss their strengths and limitations. EVIDENCE ACQUISITION A systematic literature search was performed using Scopus, EMBASE, and PubMed. Thirty four studies were included. There was one ex vivo study. Among clinical studies, 24 used a vacuum/suctioning sheath and nine a handpiece suction device/direct-in-scope suction. The suction technique was employed in standard, mini-PCNL, supermini-PCNL, and enhanced supermini‑PCNL techniques. EVIDENCE SYNTHESIS Handpiece suction devices demonstrated better safety and efficiency in treating large stones than nonsuction PCNL and in a much shorter time. Trilogy and ShockPulse-SE were equally effective, safe, and versatile for standard PCNL and mini-PCNL. The heavier handpiece makes Trilogy less ergonomically friendly. Laser suction handpiece devices can potentiate laser lithotripsy by allowing for better laser control with simultaneous suction of small fragments and dust. Integrated suction-based sheaths are available in reusable and disposable forms for mini-PCNL only. Mini-PCNL with suction reported superior outcomes for operative time and stone-free rate to mini-PCNL. This also helped minimize infectious complications by a combination of intrarenal pressure reduction and faster aspiration of irrigation fluid reducing the risk of sepsis, enhance intraoperative vision, and improve lithotripsy efficiency, which makes it a very attractive evolution for PCNL. CONCLUSIONS Suction devices in PCNL are reforming the way PCNL is being done. Adding suction to mini-PCNL reduces infectious complications and improves the stone-free rate. Our review shows that despite the limited evidence, suction techniques appear to improve PCNL outcomes. PATIENT SUMMARY In this review, we looked at the intra- and perioperative outcomes of percutaneous nephrolithotripsy (PCNL) with the addition of suction. With better stone fragmentation and fewer postoperative infections, this technology is very useful particularly for mini-PCNL.
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Affiliation(s)
- Virgilio De Stefano
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy.
| | - Daniele Castellani
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
| | - Bhaskar K Somani
- Department of Urology, University Hospitals Southampton, NHS Trust, Southampton, UK
| | - Carlo Giulioni
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
| | - Angelo Cormio
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
| | - Andrea Benedetto Galosi
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
| | - Kemal Sarica
- Department of Urology, Dr. Lutfi Kirdar Kartal Research and Training Hospital, Istanbul, Turkey
| | - Xavier Glover
- Urology, University of Colorado Denver School of Medicine, Aurora, CO, USA
| | | | - Yiloren Tanidir
- Department of Urology, Marmara University School of Medicine, Istanbul, Turkey
| | - Nariman Gadzhiev
- Department of Urology, Saint-Petersburg State University Hospital, Petersburg, Russia
| | | | - Prashant Motiram Mulawkar
- Department of Urology, Tirthankar Super Speciality Hospital, Akola, India; Professor of Urology, GMC & SSH, Akola, India; University of Edinburgh, Edinburgh, UK
| | - Jeremy Yuen-Chun Teoh
- S.H.Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Manoj Monga
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA, USA
| | - Thomas R W Herrmann
- Department of Urology, Kantonspital Frauenfeld, Spital Thurgau AG, Frauenfeld, Switzerland
| | - Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore
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2
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Giulioni C, Castellani D, Traxer O, Gadzhiev N, Pirola GM, Tanidir Y, da Silva RD, Glover X, Giusti G, Proietti S, Mulawkar PM, De Stefano V, Cormio A, Teoh JYC, Galosi AB, Somani BK, Emiliani E, Gauhar V. Experimental and clinical applications and outcomes of using different forms of suction in retrograde intrarenal surgery. Results from a systematic review. Actas Urol Esp 2024; 48:57-70. [PMID: 37302691 DOI: 10.1016/j.acuroe.2023.06.001] [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: 01/25/2023] [Accepted: 02/24/2023] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To identify the latest advances in suction devices and evaluate their effect in Retrograde intrarenal surgery (RIRS) and ureteroscopy for stones. BASIC PROCEDURES A systematic literature search was performed on 4th January 2023 using Scopus, PubMed, and EMBASE. Only English papers were included; both pediatric and adult studies were accepted. Duplicate studies, case reports, letters to the editor, and meeting abstracts were excluded. MAIN FINDINGS Twenty-one papers were selected. Several methods have been proposed for suction use in RIRS, such as through the ureteral access sheath or directly to the scope. Artificial intelligence can also regulate this system, monitoring pressure and perfusion flow values. All the proposed techniques showed satisfactory perioperative results for operative time, stone-free rate (SFR), and residual fragments. Moreover, the reduction of intrarenal pressure (induced by aspiration) was also associated with a lower infection rate. Even the studies that considered kidney stones with a diameter of 20 mm or higher reported higher SFR and reduced postoperative complications. However, the lack of well-defined settings for suction pressure and fluid flow prevents the standardization of the procedure. CONCLUSION Aspiration device in the surgical treatment of urinary stones favours a higher SFR, reducing infectious complications, as supported by the included studies. RIRS with a suction system provided to be a natural successor to the traditional technique, regulating intrarenal pressure and aspirating fine dust.
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Affiliation(s)
- C Giulioni
- Servicio de Urología, Azienda Ospedaliero-Universitaria delle Marche, Universidad Politécnica Marche, Ancona, Italy.
| | - D Castellani
- Servicio de Urología, Azienda Ospedaliero-Universitaria delle Marche, Universidad Politécnica Marche, Ancona, Italy
| | - O Traxer
- Servicio de Urología, Universidad de La Sorbona, Hospital Tenon (AP-HP), París, France
| | - N Gadzhiev
- Servicio de Endourología, Universidad Médica Estatal de San Petersburgo, Saint-Petersburgo, Russia
| | - G M Pirola
- Servicio de Urología, Hospital San Giuseppe, Grupo MultiMedica, Milán, Italy
| | - Y Tanidir
- Departamento de Urología, Facultad de Medicina, Universidad de Marmara, Estambul, Turkey
| | - R D da Silva
- Departamento de Urología, Facultad de Medicina, Universidad de Colorado, United States
| | - X Glover
- Departamento de Urología, Facultad de Medicina, Universidad de Colorado, United States
| | - G Giusti
- Centro Europeo de Entrenamiento en Endourología, Hospital San Raffaele IRCCS, Milán, Italy
| | - S Proietti
- Centro Europeo de Entrenamiento en Endourología, Hospital San Raffaele IRCCS, Milán, Italy
| | - P M Mulawkar
- Servicio de Urología, Hospital Superespecializado de Tirthankar, Akola, India; Universidad de Edimburgo, Edimburgo, United Kingdom
| | - V De Stefano
- Servicio de Urología, Azienda Ospedaliero-Universitaria delle Marche, Universidad Politécnica Marche, Ancona, Italy
| | - A Cormio
- Servicio de Urología, Azienda Ospedaliero-Universitaria delle Marche, Universidad Politécnica Marche, Ancona, Italy
| | - J Y-C Teoh
- Clínica de Urología S.H. Ho, Servicio de Cirugía, Facultad de Medicina, Universidad China de Hong Kong, Hong Kong, China
| | - A B Galosi
- Servicio de Urología, Azienda Ospedaliero-Universitaria delle Marche, Universidad Politécnica Marche, Ancona, Italy
| | - B K Somani
- Servicio de Urología, Hospital Universitario de Southampton, NHS Trust, Southampton, United Kingdom
| | - E Emiliani
- Servicio de Urología, Fundación Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - V Gauhar
- Servicio de Urología, Hospital General Ng Teng Fong, Singapur, Singapore
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Szczesniewski JJ, Boronat Catalá J, García-Cano Fernández AM, Rodríguez Castro PM, Torres Pérez D, Llanes González L. Vacuum-assisted access sheath in supine mini-percutaneous nephrolithotomy (mini-PCNL). Actas Urol Esp 2023; 47:681-687. [PMID: 37355205 DOI: 10.1016/j.acuroe.2023.06.004] [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: 03/15/2023] [Revised: 04/25/2023] [Accepted: 04/26/2023] [Indexed: 06/26/2023]
Abstract
INTRODUCTION The vacuum-assisted access sheath is a new device for the treatment of kidney stones with percutaneous nephrolithotomy (PCNL). OBJECTIVE Our aim was to compare the stone-free rate (SFR) and complications between standard mini percutaneous nephrolithotomy (Mini-PCNL) and vacuum-assisted PCNL (Va-PCNL). METHODS Retrospective study of patients undergoing Mini-PCNL and Va-PCNL from January 2018 to June 2022. Va-PCNL was performed with a disposable sheath (ClearPetra®) with continuous high-flow irrigation and vacuum fluid dynamics for easier stone fragment removal. Baseline patient characteristics, surgical outcomes, perioperative and postoperative data were collected. We compared SFR and complications. RESULTS A total of 136 patients were identified, 57 (41,9%) underwent Va-PCNL and 79 (58,15%) Mini-PCNL. Mean operative time was significantly shorter in the Va-PCNL group (95 min.) than in Mini-PCNL (146 min; P = ,001) group. The tubeless technique was performed more frequently in Va-PCNL group (61,4% vs. 34,2%; P = ,002). We did not observe any differences in postoperative complications. The mean hospital stay was significantly lower in Va-PCNL with 1,7 ± 1,9 days per patient compared with 2,7 ± 1,5 days in the Mini-PCNL group (P = ,001). There were no differences in SFR at 3 months between Va-PCNL (71,9%) and Mini-PCNL (71,8%; P =v ,848). CONCLUSION Patients treated with Va-PCNL had comparable results to Mini-PCNL, showing equal SFR with similar infectious complications rates. Potential benefits of Va-PCNL include shorter operative time and postoperative stay.
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Affiliation(s)
- J J Szczesniewski
- Servicio de Urología, Hospital Universitario de Getafe, Getafe, Madrid, Spain.
| | - J Boronat Catalá
- Servicio de Urología, Hospital Universitario de Getafe, Getafe, Madrid, Spain
| | | | | | - D Torres Pérez
- Servicio de Urología, Hospital Universitario de Getafe, Getafe, Madrid, Spain
| | - L Llanes González
- Servicio de Urología, Hospital Universitario de Getafe, Getafe, Madrid, Spain; Facultad de Medicina, Universidad Francisco de Vitoria, Madrid, Spain
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Setthawong T, Namwongsa T, Ketsuwan C. Retrograde vacuum-assisted MiniPCNL system for large distal ureteric calculus removal: A case report. Urol Case Rep 2023; 51:102622. [PMID: 38059075 PMCID: PMC10696236 DOI: 10.1016/j.eucr.2023.102622] [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] [Received: 10/16/2023] [Revised: 11/10/2023] [Accepted: 11/14/2023] [Indexed: 12/08/2023] Open
Abstract
Large ureteral calculi are commonly associated with severe colic pain, complex urinary tract infections, severe hematuria, hydronephrosis, and renal deterioration, often requiring immediate surgical intervention. Ureteroscopy is a favored treatment due to its higher stone-free rates; however, it encounters difficulties in cases of a high burden of distal ureteral stones. We present a case where a patient with a significant ureteral calculus was effectively treated with a vacuum-assisted mini-percutaneous nephrolithotomy system in retrograde approach. This intervention enabled the complete removal of the stone, leading to the patient's full recovery without complications.
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Affiliation(s)
- Tarapon Setthawong
- Division of Urology, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Theerawech Namwongsa
- Division of Urology, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chinnakhet Ketsuwan
- Division of Urology, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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5
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Hughes T, Tzelves L, Somani BK. Cystine Stones: Developments in Minimally Invasive Surgery and Their Impact on Morbidity and Stone Clearance. Res Rep Urol 2023; 15:175-185. [PMID: 37303487 PMCID: PMC10254682 DOI: 10.2147/rru.s381190] [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: 03/19/2023] [Accepted: 05/31/2023] [Indexed: 06/13/2023] Open
Abstract
Cystinuria is a rare genetic condition that is responsible for cystine stones. Besides stone recurrence, patients with cystine stones have reduced health-related quality of life, increased rates of chronic kidney disease and hypertension. Although lifestyle measures, medical therapy and close follow up are essential to reduce and monitor cystine stone recurrences, surgical intervention is frequently needed for most cystinuria patients. Shock wave lithotripsy, ureteroscopy, percutaneous nephrolithotomy and active surveillance all have a role, and technological advances in endourology are vital in achieving a stone-free status and to prevent recurrences. The complexity of managing cystine stones necessitates a multidisciplinary team discussion, patient involvement and an individualised approach in a specialist centre for optimum management. Thulium fibre laser and virtual reality may have an increasing role in the future of cystine stone management.
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Affiliation(s)
- Thomas Hughes
- Department of Urology, Warwick Hospital, Warwick, UK
| | - Lazaros Tzelves
- Department of Urology, Sismanogleio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Bhaskar K Somani
- Department of Urology, University Hospital Southampton, Southampton, UK
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6
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Mykoniatis I, Pyrgidis N, Tzelves L, Pietropaolo A, Juliebø-Jones P, De Coninck V, Hameed BMZ, Chaloupka M, Schulz GB, Stief C, Kallidonis P, Somani BK, Skolarikos A. Assessment of single-probe dual-energy lithotripters in percutaneous nephrolithotomy: a systematic review and meta-analysis of preclinical and clinical studies. World J Urol 2023; 41:551-565. [PMID: 36656331 DOI: 10.1007/s00345-023-04278-2] [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: 11/26/2022] [Accepted: 12/30/2022] [Indexed: 01/20/2023] Open
Abstract
PURPOSE To evaluate the safety and efficacy of single-probe dual-energy (SPDE) lithotripters in patients undergoing percutaneous nephrolithotripsy (PCNL) through a systematic review and meta-analysis. METHODS We searched PubMed, Cochrane Library, Scopus and Embase databases until July 2022 for any preclinical or clinical studies, exploring the safety and efficacy of different SPDE lithotripters in patients undergoing PCNL. We performed a meta-analysis to compare stone-free rate, bleeding, or other complications and mean operative time between SPDE lithotripters and other lithotripters (PROSPERO: CRD42021285631). RESULTS We included 16 studies (six preclinical, seven observational and three randomized with 625 participants) in the systematic review and four in the meta-analysis. Preclinical studies suggest that SPDE lithotripters are safe and effective for the management of renal stones. Among clinical studies, four studies assessed Trilogy with no comparative arm, two compared Trilogy or ShockPulse with a dual-probe dual-energy lithotripter, two compared Trilogy with a laser, one compared ShockPulse with a pneumatic lithotripter, and one directly compared Trilogy with ShockPulse. Comparing SPDE lithotripters to other lithotripters, no significant differences were demonstrated in stone free rate (OR 1.13, 95% CI 0.53-2.38, I2 = 0%), postoperative blood transfusion (OR 1.33, 95% CI 0.34-5.19, I2 = 0%), embolization (OR 0.45, 95% CI 0.02-12.06), operative time (WMD: 2.82 min, 95% CI -7.31-12.95, I2 = 78%) and postoperative complications based on the Clavien-Dindo classification. CONCLUSIONS SPDE lithotripters represent a promising treatment modality for patients requiring PCNL. Despite the initial encouraging findings of preclinical and isolated clinical studies, it seems that Trilogy or ShockPulse provide similar efficiency compared to older generation devices.
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Affiliation(s)
- Ioannis Mykoniatis
- First Department of Urology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Young Academic Urologists (YAU), Urolithiasis and Endourology Working Party, Arnhem, the Netherlands
| | - Nikolaos Pyrgidis
- Department of Urology, University Hospital, LMU Munich, Munich-Marchioninistr. 15, 81377, Munich, Germany
| | - Lazaros Tzelves
- Second Department of Urology, Sismanoglio Hospital, Sismanogliou 37, Athens, Greece.,University College of London Hospitals NHS Foundation Trust, London, UK.,Young Academic Urologists (YAU), Urolithiasis and Endourology Working Party, Arnhem, the Netherlands
| | - Amelia Pietropaolo
- Department of Urology, University of Hospital Southampton NHS Trust, Southampton, UK.,Young Academic Urologists (YAU), Urolithiasis and Endourology Working Party, Arnhem, the Netherlands
| | - Patrick Juliebø-Jones
- Department of Urology, Haukeland University Hospital, Bergen, Norway.,Young Academic Urologists (YAU), Urolithiasis and Endourology Working Party, Arnhem, the Netherlands
| | - Vincent De Coninck
- Department of Urology, AZ Klina, Brasschaat, Belgium.,Young Academic Urologists (YAU), Urolithiasis and Endourology Working Party, Arnhem, the Netherlands
| | - Belthangady M Zeeshan Hameed
- Department of Urology, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, India.,Young Academic Urologists (YAU), Urolithiasis and Endourology Working Party, Arnhem, the Netherlands
| | - Michael Chaloupka
- Department of Urology, University Hospital, LMU Munich, Munich-Marchioninistr. 15, 81377, Munich, Germany
| | - Gerald Bastian Schulz
- Department of Urology, University Hospital, LMU Munich, Munich-Marchioninistr. 15, 81377, Munich, Germany
| | - Christian Stief
- Department of Urology, University Hospital, LMU Munich, Munich-Marchioninistr. 15, 81377, Munich, Germany
| | | | - Bhaskar K Somani
- Department of Urology, University of Hospital Southampton NHS Trust, Southampton, UK
| | - Andreas Skolarikos
- Second Department of Urology, Sismanoglio Hospital, Sismanogliou 37, Athens, Greece.
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Tzelves L, Geraghty RM, Hughes T, Juliebø-Jones P, Somani BK. Innovations in Kidney Stone Removal. Res Rep Urol 2023; 15:131-139. [PMID: 37069942 PMCID: PMC10105588 DOI: 10.2147/rru.s386844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 04/05/2023] [Indexed: 04/19/2023] Open
Abstract
Urolithiasis is a common clinical condition, and surgical treatment is performed with different minimally invasive procedures, such as ureteroscopy, shockwave lithotripsy and percutaneous nephrolithotomy. Although the transition from open surgery to endourological procedures to treat this condition has been a paradigm shift, ongoing technological advancements have permitted further improvement of clinical outcomes with the development of modern equipment. Such innovations in kidney stone removal are new lasers, modern ureteroscopes, development of applications and training systems utilizing three-dimensional models, artificial intelligence and virtual reality, implementation of robotic systems, sheaths connected to vacuum devices and new types of lithotripters. Innovations in kidney stone removal have led to an exciting new era of endourological options for patients and clinicians alike.
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Affiliation(s)
- Lazaros Tzelves
- Department of Urology, Sismanogleio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Thomas Hughes
- Department of Urology, Warwick Hospital, Warwick, UK
| | | | - Bhaskar K Somani
- Department of Urology, University Hospital Southampton, Southampton, UK
- Correspondence: Bhaskar K Somani, Department of Urology, University Hospital Southampton NHS Trust, 19 Tremona Road, Southampton, SO535DS, UK, Tel +44-2381206873, Email
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Best Practice in Interventional Management of Urolithiasis: An Update from the European Association of Urology Guidelines Panel for Urolithiasis 2022. Eur Urol Focus 2023; 9:199-208. [PMID: 35927160 DOI: 10.1016/j.euf.2022.06.014] [Citation(s) in RCA: 57] [Impact Index Per Article: 57.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/27/2022] [Accepted: 06/28/2022] [Indexed: 12/28/2022]
Abstract
PURPOSE The European Association of Urology (EAU) has updated its guidelines on clinical best practice in urolithiasis for 2021. We therefore aimed to present a summary of best clinical practice in surgical intervention for patients with upper tract urolithiasis. MATERIALS AND METHODS The panel performed a comprehensive literature review of novel data up to May 2021. The guidelines were updated and a strength rating was given for each recommendation, graded using the modified Grading of Recommendations, Assessment, Development, and Evaluations methodology. RESULTS The choice of surgical intervention depends on stone characteristics, patient anatomy, comorbidities, and choice. For shockwave lithotripsy (SWL), the optimal shock frequency is 1.0-1.5 Hz. For ureteroscopy (URS), a postoperative stent is not needed in uncomplicated cases. Flexible URS is an alternative if percutaneous nephrolithotomy (PCNL) or SWL is contraindicated, even for stones >2 cm. For PCNL, prone and supine approaches are equally safe. For uncomplicated PCNL cases, a nephrostomy tube after PCNL is not necessary. Radiation exposure for endourological procedures should follow the as low as reasonably achievable principles. CONCLUSIONS This is a summary of the EAU urolithiasis guidelines on best clinical practice in interventional management of urolithiasis. The full guideline is available at https://uroweb.org/guidelines/urolithiasis. PATIENT SUMMARY The European Association of Urology has produced guidelines on the best management of kidney stones, which are summarised in this paper. Kidney stone disease is a common condition; computed tomography (CT) is increasingly used to diagnose it. The guidelines aim to decrease radiation exposure to patients by minimising the use of x-rays and CT scans. We detail specific advice around the common operations for kidney stones.
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Tzelves L, Lazarou L, Feretzakis G, Kalles D, Mourmouris P, Loupelis E, Basourakos S, Berdempes M, Manolitsis I, Mitsogiannis I, Skolarikos A, Varkarakis I. Using machine learning techniques to predict antimicrobial resistance in stone disease patients. World J Urol 2022; 40:1731-1736. [PMID: 35616713 DOI: 10.1007/s00345-022-04043-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 05/02/2022] [Indexed: 10/18/2022] Open
Abstract
PURPOSE Artificial intelligence is part of our daily life and machine learning techniques offer possibilities unknown until now in medicine. This study aims to offer an evaluation of the performance of machine learning (ML) techniques, for predicting bacterial resistance in a urology department. METHODS Data were retrieved from laboratory information system (LIS) concerning 239 patients with urolithiasis hospitalized in the urology department of a tertiary hospital over a 1-year period (2019): age, gender, Gram stain (positive, negative), bacterial species, sample type, antibiotics and antimicrobial susceptibility. In our experiments, we compared several classifiers following a tenfold cross-validation approach on 2 different versions of our dataset; the first contained only information of Gram stain, while the second had knowledge of bacterial species. RESULTS The best results in the balanced dataset containing Gram stain, achieve a weighted average receiver operator curve (ROC) area of 0.768 and F-measure of 0.708, using a multinomial logistic regression model with a ridge estimator. The corresponding results of the balanced dataset, that contained bacterial species, achieve a weighted average ROC area of 0.874 and F-measure of 0.783, with a bagging classifier. CONCLUSIONS Artificial intelligence technology can be used for making predictions on antibiotic resistance patterns when knowing Gram staining with an accuracy of 77% and nearly 87% when identifying specific microorganisms. This knowledge can aid urologists prescribing the appropriate antibiotic 24-48 h before test results are known.
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Affiliation(s)
- Lazaros Tzelves
- 2nd Department of Urology, Sismanogleio General Hospital, National and Kapodistrian University of Athens, Sismanogleiou 37, Marousi, 15126, Athens, Greece
| | - Lazaros Lazarou
- 2nd Department of Urology, Sismanogleio General Hospital, National and Kapodistrian University of Athens, Sismanogleiou 37, Marousi, 15126, Athens, Greece
| | - Georgios Feretzakis
- School of Science and Technology, Hellenic Open University, Patras, Greece.,Department of Quality Control, Research and Continuing Education, Sismanogleio General Hospital, Marousi, Greece.,Information Technologies Department, Sismanogleio General Hospital, Marousi, Greece
| | - Dimitris Kalles
- School of Science and Technology, Hellenic Open University, Patras, Greece
| | - Panagiotis Mourmouris
- 2nd Department of Urology, Sismanogleio General Hospital, National and Kapodistrian University of Athens, Sismanogleiou 37, Marousi, 15126, Athens, Greece
| | - Evangelos Loupelis
- Information Technologies Department, Sismanogleio General Hospital, Marousi, Greece
| | - Spyridon Basourakos
- Department of Urology, New York Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA
| | - Marinos Berdempes
- 2nd Department of Urology, Sismanogleio General Hospital, National and Kapodistrian University of Athens, Sismanogleiou 37, Marousi, 15126, Athens, Greece
| | - Ioannis Manolitsis
- 2nd Department of Urology, Sismanogleio General Hospital, National and Kapodistrian University of Athens, Sismanogleiou 37, Marousi, 15126, Athens, Greece.
| | - Iraklis Mitsogiannis
- 2nd Department of Urology, Sismanogleio General Hospital, National and Kapodistrian University of Athens, Sismanogleiou 37, Marousi, 15126, Athens, Greece
| | - Andreas Skolarikos
- 2nd Department of Urology, Sismanogleio General Hospital, National and Kapodistrian University of Athens, Sismanogleiou 37, Marousi, 15126, Athens, Greece
| | - Ioannis Varkarakis
- 2nd Department of Urology, Sismanogleio General Hospital, National and Kapodistrian University of Athens, Sismanogleiou 37, Marousi, 15126, Athens, Greece
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Lievore E, Zanetti SP, Fulgheri I, Turetti M, Silvani C, Bebi C, Ripa F, Lucignani G, Pozzi E, Rocchini L, De Lorenzis E, Albo G, Longo F, Salonia A, Montanari E, Boeri L. Cost analysis between mini-percutaneous nephrolithotomy with and without vacuum-assisted access sheath. World J Urol 2021; 40:201-211. [PMID: 34432135 PMCID: PMC8813798 DOI: 10.1007/s00345-021-03811-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 08/05/2021] [Indexed: 11/28/2022] Open
Abstract
Purpose To perform a cost analysis between vacuum-assisted percutaneous nephrolithotomy (vmPCNL) and minimally invasive PCNL (MIP) and explore potential predictors of costs associated with the procedures. Methods We analyzed data from 225 patients who underwent vmPCNL or MIP at a single tertiary referral academic center between January 2016 and December 2020. We collected patients’ demographics, peri-and postoperative data and detailed expense records. After propensity score matching, 108 (66.7%) vmPCNL and 54 (33.3%) MIP procedures were analyzed. Descriptive statistics assessed differences in clinical and operative parameters. Univariable and multivariable linear regression models tested the association between clinical variables and costs. Results Operative time (OT) was shorter for vmPCNL, and the use of additional instruments to complete litholapaxy was more frequent in MIP (all p ≤ 0.01). Length of stay (LOS) was longer for MIP patients (p = 0.03) and the stone-free (SF) rate was higher after vmPCNL (p = 0.04). The overall instrumentation cost was higher for vmPCNL (p < 0.001), but total procedural costs were equivalent (p = 0.9). However, the overall cost for the hospitalization was higher for MIP than vmPCNL (p = 0.01). Univariable linear regression revealed that patient’s comorbidities, OT, any postoperative complication and LOS were associated with hospitalization costs (all p < 0.001). Multivariable linear regression analysis revealed that LOS and OT were associated with hospitalization costs (all p < 0.001), after accounting for vmPCNL procedure, patients’ comorbidities, and complications. Conclusion vmPCNL may represent a valid option due to clinical and economic benefits. Shorter OT, the lower need for disposable equipment and the lower complication rate reduced procedural and hospitalization costs. Supplementary Information The online version contains supplementary material available at 10.1007/s00345-021-03811-5.
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Affiliation(s)
- Elena Lievore
- Department of Urology, IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Via della Commenda 15, 20122, Milan, Italy
| | - Stefano Paolo Zanetti
- Department of Urology, IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Via della Commenda 15, 20122, Milan, Italy
| | - Irene Fulgheri
- Department of Radiology, Foundation IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Matteo Turetti
- Department of Urology, IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Via della Commenda 15, 20122, Milan, Italy
| | - Carlo Silvani
- Department of Urology, IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Via della Commenda 15, 20122, Milan, Italy
| | - Carolina Bebi
- Department of Urology, IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Via della Commenda 15, 20122, Milan, Italy
| | - Francesco Ripa
- Department of Urology, IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Via della Commenda 15, 20122, Milan, Italy
| | - Gianpaolo Lucignani
- Department of Urology, IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Via della Commenda 15, 20122, Milan, Italy
| | - Edoardo Pozzi
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
| | - Lorenzo Rocchini
- Department of Urology, IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Via della Commenda 15, 20122, Milan, Italy
| | - Elisa De Lorenzis
- Department of Urology, IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Via della Commenda 15, 20122, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Giancarlo Albo
- Department of Urology, IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Via della Commenda 15, 20122, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Fabrizio Longo
- Department of Urology, IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Via della Commenda 15, 20122, Milan, Italy
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
| | - Emanuele Montanari
- Department of Urology, IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Via della Commenda 15, 20122, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Luca Boeri
- Department of Urology, IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Via della Commenda 15, 20122, Milan, Italy.
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