1
|
Li S, Wu J, Li Q, Zhang J. Reverse Trendelenburg Lithotomy with Certain Inclination Angles Reduces Stone Retropulsion during Ureteroscopic Lithotripsy for Proximal Ureteral Stone. J Pers Med 2022; 12:jpm12122020. [PMID: 36556241 PMCID: PMC9785649 DOI: 10.3390/jpm12122020] [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: 11/01/2022] [Revised: 12/01/2022] [Accepted: 12/05/2022] [Indexed: 12/12/2022] Open
Abstract
The objective of this study is to investigate how different inclination angles of reverse Trendelenburg lithotomy affect stone retropulsion and stone-free rates during ureteroscopic lithotripsy for proximal ureteral stones. Patients with proximal ureteral stones undergoing ureteroscopic lithotripsy in our institution between January 2019 and December 2020 were included according to predefined criteria. The rigid ureteroscope and Holmium: YAG laser were utilized to perform lithotripsy, and a stone basket was used to keep the stone in place and to avoid retropulsion. Before initiating lithotripsy, the upper part of the patient’s body was tilted up to establish a reverse Trendelenburg posture with appropriate inclination angles. To quantify the stone-free rate, computed tomography was used to evaluate the residual stones in the kidney one month following surgery. Patients’ clinical data were obtained retrospectively, including age, gender, the largest diameter of stone, stone density on computed tomography, and the distance between stone and ureteral pelvic junction, etc. Patients were divided into four groups based on the inclination angles of reverse Trendelenburg lithotomy: 0°, 10°, 20°, and 30°. The chi-square test was used to compare stone retropulsion and stone-free rates between groups. To discover possible determinants of the stone-free rate, logistic regression analyses were used. There were 189 patients that qualified. There were no differences in clinical characteristics between groups (p > 0.05). Multiple comparisons between groups revealed that the 20° and 30° groups had less retropulsion and a greater stone-free rate than the 0° and 10° groups (p < 0.05), whereas there were no significant differences in stone retropulsion or stone-free rates between the 20° and 30° groups or between the 0° and 10° groups (p > 0.05). The inclination angles as well as distance between the stone and ureteral pelvic junction were identified by using logistic regression analyses as the related factors for the stone-free rate. According to our results, the appropriate inclination angles of reverse Trendelenburg lithotomy during ureteroscopic lithotripsy for proximal ureteral stones would help preclude stone retropulsion and increase the stone-free rate.
Collapse
|
2
|
Impact of forced diuresis on retropulsion of disintegrated ureteral calculi during semi-rigid ureteroscopy: a double-blind randomized-controlled study. Urolithiasis 2022; 50:465-472. [PMID: 35451636 PMCID: PMC9300540 DOI: 10.1007/s00240-022-01324-3] [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: 01/12/2022] [Accepted: 04/03/2022] [Indexed: 11/09/2022]
Abstract
The objective of this study is to assess the safety and efficacy of forced diuresis as an antiretropulsion strategy during the pneumatic disintegration of solitary lower ureteric stones with semi-rigid ureteroscopy (URS). A prospective randomized double-blind study was carried out from March 2019 to June 2021 for patients presented with unilateral solitary radiopaque lower ureteric stones ≤ 20 mm. Patients were randomized for URS into two groups, according to the use of forced diuresis using furosemide 1 mg/kg (GII) or not (GI). Perioperative parameters were compared between both groups, including retropulsion rate, stone-free rate (SFR), and need for auxiliary procedures and complications. A total of 148 patients were included; 72 (48.6%) in GI and 76 in the GII (51.4%), with respective stone size of 11.8 ± 2.6 vs.12.1 ± 2.4 mm. Both groups were comparable in demographic and baseline data, with a mean age of 47 ± 16 and 50 ± 14 years for GI and GII, respectively. GII had a significantly shorter disintegration time (10.5 ± 1.3 vs. 4.2 ± 2.1 min, p < 0.001), shorter operative time (33.1 ± 10.1 vs. 40.8 ± 9.1 min, p < 0.001), lower stone fragments migration rate during disintegration (6.5% vs. 18.1%, p = 0.04), lower retropulsion rate (1.3% vs. 11%, p = 0.02), higher SFR (96.1% vs. 86.1%, p = 0.04), and lower auxiliary procedures (3.9% vs. 13.8%, p = 0.03). Intraoperative and 6-h postoperative changes in heart rate and mean systolic blood pressure were comparable between both groups. Ephedrine injection (6–18 mg) was needed in significantly more GII patients (39.5% vs. 20.8%, p ≤ 0.01). It seems that forced diuresis during pneumatic lithotripsy of the lower ureteric stones is a safe and effective antiretropulsion technique. This would expand the alternative options to the antiretropulsion strategy, especially in centers where the laser and flexible ureteroscopes are not available.
Collapse
|
3
|
Wu W, Zhang J, Yi R, Li X, Yu X. Cost-effectiveness of anti-retropulsive devices varies according to the locations of proximal ureteral stones: a retrospective cohort study. BMC Urol 2022; 22:43. [PMID: 35331199 PMCID: PMC8952225 DOI: 10.1186/s12894-022-00995-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 03/14/2022] [Indexed: 12/23/2022] Open
Abstract
Background Anti-retropulsive devices are often used to prevent stone migration in the treatment of proximal ureteral calculi. They are helpful. However, in the meantime, they also add extra expenses. This study was carried out to investigate the best criteria for treating proximal ureteral stones with anti-retropulsive devices. Methods Data from all patients who underwent ureteroscopic holmium: YAG laser lithotripsy for solitary upper ureteral stones in 2018 were collected. Patients who encountered stone retropulsion during the process of inserting the ureteroscope were excluded. Patients were divided into either group URS or group URS + ARD depending on whether the anti-retropulsive device was used. Then, the stone-free rate, expenses and other criteria were compared between groups according to stone location. Stone-free was defined as no stones present. Results For stones located ≤ 30 mm from the ureteropelvic junction (UPJ), the stone-free rates for the URS group were 80% and 80% at one day and one month after the operation, respectively. Those for the URS + ARD group were 71.4% and 78.6% at one day and one month, respectively. For stones located 31–90 mm from the UPJ, the stone-free rates were 84.7% and 84.7% for the URS group and 89.6% and 95.5% for the URS + ARD group at one day and one month, respectively. A statistically significant difference occurred at one month. For stones located > 90 mm from the UPJ, the two groups were both stone free. In the URS + ARD group, expenses were higher. In addition, the mean diameter of residual stones derived from stones located at 31–90 mm from the UPJ was statistically smaller, and 4 of 7 residual stones passed spontaneously within one month, which was obviously more than that in other locations and the URS group. Other outcomes, including operation time and postoperative stay, showed no significant difference between the groups. Conclusion Anti-retropulsive devices are indeed helpful, but they might be cost-effective for stones located solely in the middle part of the upper ureter, not for those too close to or far from the ureteropelvic junction. Supplementary Information The online version contains supplementary material available at 10.1186/s12894-022-00995-9.
Collapse
Affiliation(s)
- Weisong Wu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiaqiao Zhang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Rixiati Yi
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xianmiu Li
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiao Yu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| |
Collapse
|
4
|
Çeçen K. Cost-effectiveness of using stone cone, balloon dilator, stone basket, and entrapment device in ureteroscopic laser lithotripsy for ureteric stones. J Int Med Res 2021; 49:3000605211061043. [PMID: 34898311 PMCID: PMC8671668 DOI: 10.1177/03000605211061043] [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] [Indexed: 11/23/2022] Open
Abstract
Objective To evaluate the costs and stone-free rates of ureteroscopic laser lithotripsy (ULL) performed with and without auxiliary equipment and to compare first-time ULL with total treatment. Methods One hundred patients who underwent first-time ULL without the use of auxiliary equipment because its unavailability comprised the no-device ULL (ndULL) group. Additionally, 100 patients who underwent first-time ULL with the use of auxiliary equipment when necessary comprised the device ULL (dULL) group. Results In the ndULL and dULL groups, the stone-free rates after first-time ULL were 72% and 94% and the mean cost was US $1037 ± 15.10 and US $1452 ± 19.80 per case, respectively, with a statistically significant difference. The stone-free rates at the end of treatment were 98% and 99%, respectively, without a statistically significant difference. When secondary treatment costs were added to the first ULL costs after failed treatment, the mean total cost was US $1625 ± 12.60 in the ndULL group and US $1566 ± 11.01 in the dULL group without a statistically significant difference. Conclusions The stone-free rates and costs after first-time ULL were significantly different between the groups. However, after total treatment, there was no statistically significant difference between the two groups.
Collapse
Affiliation(s)
- Kürşat Çeçen
- University of Health Sciences, Derince Training and Research Hospital, Department of Urology, Kocaeli, Turkey
| |
Collapse
|
5
|
Fathelbab TK, Abdelhamid AM, Anwar AZM, Galal EM, El-Hawy MM, Abdelgawad AH, Tawfiek ER. Prevention of stone retropulsion during ureteroscopy: Limitations in resources invites revival of old techniques. Arab J Urol 2020; 18:252-256. [PMID: 33312737 PMCID: PMC7717714 DOI: 10.1080/2090598x.2020.1805966] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective To compare a modified technique using the Dormia basket vs Stone Cone for stone entrapment to avoid proximal stone migration during ureteroscopic pneumatic lithotripsy of ureteric stones. Patients and methods Our study included all patients with ureteric stones of <15 mm who underwent ureteroscopic pneumatic lithotripsy from January 2015 to September 2018. The study had two arms that were conducted over two consecutive periods; the first included 72 patients in whom we used the Stone Cone (Group 1) and the second included 86 patients in whom we started to use a Dormia basket with a modification (Group 2) to guard against proximal stone migration. Results Both groups were comparable for gender, age, and stone characteristics. Lower ureteric stones were the most prevalent as they represented 62.5% and 60.5% in groups 1 and 2, respectively; while upper ureteric stones were respectively found in 16.7% and 17.4%. Chemical stone analysis revealed that calcium oxalate stones were most predominant accounting for 51.3% and 51.1% in groups 1 and 2, respectively. Most of the stones were radio-opaque stones representing 57% and 58.1% in groups 1 and 2, respectively. There was a significant difference in operative time, with a mean (SD) operative time was 50.9 (11.2) in Group 1 vs 58.3 (12.4) min in Group 2 (P < 0.001). The success rate, defined as no retropulsion of stone fragments, was 97.7% in Group 2 vs 91.7% in Group 1 (P < 0.01). Complications were minor and comparable between the groups. There was no difference in hospital stay between the groups, but the cost assessment favoured Group 2. Conclusion We found that our modified-basket stone entrapment technique compared favourably with the Stone Cone to guard against stone retropulsion during ureteroscopic pneumatic lithotripsy. Our modification to the basket was found to be feasible, efficient, safe, reproducible and cost-effective in preventing proximal stone migration. This procedure is particularly suitable in cost-limited environments.
Collapse
Affiliation(s)
| | | | | | - Ehab M Galal
- School of Medicine, Minia University, Minia, Egypt
| | | | | | | |
Collapse
|
6
|
Saussine C, Andonian S, Pacík D, Popiolek M, Celia A, Buchholz N, Sountoulides P, Petrut B, de la Rosette JJMCH. Worldwide Use of Antiretropulsive Techniques: Observations from the Clinical Research Office of the Endourological Society Ureteroscopy Global Study. J Endourol 2017; 32:297-303. [PMID: 29256629 DOI: 10.1089/end.2017.0629] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
INTRODUCTION Retropulsion, defined as unintended migration of a stone under the influence of the fragmentation device in ureteroscopy (URS) procedures, occurs in 2% to 60% of the cases. Antiretropulsive devices (ARDs) have been studied in experimental and small clinical studies. The current study aims at describing the worldwide usage of ARD and the outcomes related to their usage. METHODS The Clinical Research Office of the Endourological Society URS Global Study enrolled 11,885 patients who underwent URS and stone fragmentation for ureteral and/or renal stones. Of the 11,885 treated patients, 9877 were treated for ureteral stones, and data were available on stone migration and ARD use. RESULTS Of all procedures, 14.5% were performed with the use of an ARD. Less stone migration (-2.0%; p = 0.050), higher stone-free rates (SFRs) (2.8%; p < 0.001), and shorter length of stay (-4.7%; p = 0.001) were observed in the antiretropulsive group. CONCLUSIONS When an ARD is used during URS, less migration, higher SFRs, and shorter length of hospital stay are observed. This effect is independent from baseline differences and corrected for other treatment characteristics.
Collapse
Affiliation(s)
- Christian Saussine
- 1 Department of Urology, Nouvel Hôpital Civil les Hôpitaux Universitaires , Strasbourg, France
| | - Sero Andonian
- 2 Department of Urology, McGill University Health Centre , Quebec, Canada
| | - Dalibor Pacík
- 3 Department of Urology, Masaryk University Hospital , Brno, Czech Republic
| | - Marcin Popiolek
- 4 Department of Urology, Örebro University Hospital , Örebro, Sweden
| | - Antonio Celia
- 5 Department of Urology, San Bassiano Hospital , Bassano del Grappa, Italy
| | - Noor Buchholz
- 6 Department of Urology, SVMC, Dubai Health Care City , Dubai, UAE
| | | | - Bogdan Petrut
- 8 Department of Urology, Oncological Institute , Cluj-Napoca, Romania
| | | |
Collapse
|
7
|
WEI XL, XUE MF, QIN ZX, BAI XY, DONG FF, ZHANG JJ, LV N, CHEN H, ZHANG J. The Effect of Comprehensive Care on the Patients Received Minimally Invasive Percutaneous Nephrolithotomy. IRANIAN JOURNAL OF PUBLIC HEALTH 2017; 46:923-929. [PMID: 28845403 PMCID: PMC5563874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND We analyzed the effect of comprehensive care on the patients who received minimally invasive percutaneous nephrolithotomy (MPCNL). METHODS Patients hospitalized from 2013-2014 in Zhumadian Central Hospital (n=124) were enrolled and divided into two groups on random basis. The control group was treated with routine nursing model while the observation group was given comprehensive care additionally. The surgery time, degree of comfort, complications and successful cases, hospitalization time, sleep quality, nursing satisfaction and changes of systolic pressure, pulse and respiratory at different time were observed and analyzed. RESULTS The surgery time of the control group was significantly longer than that of observation group (P<0.05). The observation group felt more comfortable and showed more significant successful cases than the control group. Moreover, the hospitalization time were significantly reduced in observation group when compared with control group (P<0.05). The sleep quality of the observation group was significantly better than that of the control group (P<0.05). Before anesthesia, diastolic blood pressure, systolic blood pressure, pulse and respiration were not significantly different between the two groups. The diastolic blood pressure, systolic blood pressure, pulse and respiration after anesthesia, intraoperative 30 min, postoperative 30 min and other moments were significantly different. The incidence of complications in the control group was significantly higher than that in the observation group. The nursing satisfaction of the observation group was significantly higher than that of the control group. CONCLUSION The comprehensive care on the patients undergoing MPCNL was effective, and it can dramatically shorten surgery time, improve the success rate, improve the sleep quality of patients, keep life sign stable and minimize the complications.
Collapse
Affiliation(s)
- Xue-Li WEI
- Dept. of Urinary Surgery No.2, Zhumadian Central Hospital, Zhumadian, China,Corresponding Author:
| | - Mei-Fang XUE
- Physical Examination Center, Zhumadian Central Hospital, Zhumadian, China
| | - Zhao-Xia QIN
- Dept. of Urinary Surgery No.2, Zhumadian Central Hospital, Zhumadian, China
| | - Xing-Yun BAI
- Dept. of Urinary Surgery No.2, Zhumadian Central Hospital, Zhumadian, China
| | - Fang-Fang DONG
- Dept. of Urinary Surgery No.2, Zhumadian Central Hospital, Zhumadian, China
| | - Jin-Jin ZHANG
- Dept. of Urinary Surgery No.2, Zhumadian Central Hospital, Zhumadian, China
| | - Ning LV
- Dept. of Urinary Surgery No.2, Zhumadian Central Hospital, Zhumadian, China
| | - Hui CHEN
- Dept. of Urinary Surgery No.2, Zhumadian Central Hospital, Zhumadian, China
| | - Jia ZHANG
- Dept. of Urinary Surgery No.2, Zhumadian Central Hospital, Zhumadian, China
| |
Collapse
|