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Moretto S, Saita A, Scoffone CM, Talso M, Somani BK, Traxer O, Angerri O, Knoll T, Liatsikos E, Herrmann TRW, Ulvik Ø, Skolarikos A, Cracco CM, Keller EX, Paciotti M, Piccolini A, Uleri A, Tailly T, Carmignani L, Pietropaolo A, Corrales M, Lughezzani G, Lazzeri M, Fasulo V, De Coninck V, Arena P, Nagele U, Ferretti S, Kronenberg P, Perez-Fentes D, Osther PJ, Goumas IK, Acquati P, Ajayi L, Diana P, Casale P, Buffi NM. Ureteral stricture rate after endoscopic treatments for urolithiasis and related risk factors: systematic review and meta-analysis. World J Urol 2024; 42:234. [PMID: 38613692 DOI: 10.1007/s00345-024-04933-2] [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: 02/20/2024] [Accepted: 03/15/2024] [Indexed: 04/15/2024] Open
Abstract
PURPOSE We aimed to accurately determine ureteral stricture (US) rates following urolithiasis treatments and their related risk factors. METHODS We conducted a systematic review and meta-analysis following the PRISMA guidelines using databases from inception to November 2023. Studies were deemed eligible for analysis if they included ≥ 18 years old patients with urinary lithiasis (Patients) who were subjected to endoscopic treatment (Intervention) with ureteroscopy (URS), percutaneous nephrolithotomy (PCNL), or shock wave lithotripsy (SWL) (Comparator) to assess the incidence of US (Outcome) in prospective and retrospective studies (Study design). RESULTS A total of 43 studies were included. The pooled US rate was 1.3% post-SWL and 2.1% post-PCNL. The pooled rate of US post-URS was 1.9% but raised to 2.7% considering the last five years' studies and 4.9% if the stone was impacted. Moreover, the pooled US rate differed if follow-ups were under or over six months. Patients with proximal ureteral stone, preoperative hydronephrosis, intraoperative ureteral perforation, and impacted stones showed higher US risk post-endoscopic intervention with odds ratio of 1.6 (P = 0.05), 2.6 (P = 0.009), 7.1 (P < 0.001), and 7.47 (P = 0.003), respectively. CONCLUSIONS The overall US rate ranges from 0.3 to 4.9%, with an increasing trend in the last few years. It is influenced by type of treatment, stone location and impaction, preoperative hydronephrosis and intraoperative perforation. Future standardized reporting and prospective and more extended follow-up studies might contribute to a better understanding of US risks related to calculi treatment.
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Affiliation(s)
- S Moretto
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy.
| | - A Saita
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - C M Scoffone
- Department of Urology, Cottolengo Hospital, Turin, Italy
| | - M Talso
- Department of Urology, Luigi Sacco University Hospital, Milan, Italy
| | - B K Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - O Traxer
- Department of Urology, Sorbonne Université, Paris, France
| | - O Angerri
- Department of Urology, Fundació Puigvert Univ. Autonoma de Barcelona, Barcelona, Spain
| | - T Knoll
- Department of Urology, Sindelfingen Medical Center, University of Tübingen, Tübingen, Germany
| | - E Liatsikos
- Department of Urology, University Hospital of Patras, Patras, Greece
| | - T R W Herrmann
- Department of Urology, Spital Thurgau AG, Frauenfeld, Switzerland
- Hannover Medical School, Hannover, Germany
- Division of Urology, Department of Surgical Sciences, Stellenbosch University, Western Cape, South Africa
| | - Ø Ulvik
- Department of Urology, Haukeland University Hospital, Bergen, Norway
| | - A Skolarikos
- Second Department of Urology, Sismanoglio Hospital, National and Kapodistrian University of Athen, Athens, Greece
| | - C M Cracco
- Department of Urology, Cottolengo Hospital, Turin, Italy
| | - E X Keller
- Department of Urology, University Hospital Zurich, Zurich, Switzerland
| | - M Paciotti
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - A Piccolini
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - A Uleri
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - T Tailly
- Department of Urology, University Hospital Ghent, Ghent, Belgium
| | - L Carmignani
- Department of Urology, University of Milan, Milan, Italy
| | - A Pietropaolo
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - M Corrales
- Department of Urology, Sorbonne Université, Paris, France
| | - G Lughezzani
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - M Lazzeri
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - V Fasulo
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - V De Coninck
- Department of Urology, AZ Klina, Brasschaat, Belgium
| | - P Arena
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - U Nagele
- Department of Urology, General Hospital Hall in Tirol, Hall in Tirol, Austria
| | - S Ferretti
- Department of Urology, Azienda Ospedaliero-Universitaria di Modena, Baggiovara, Italy
| | - P Kronenberg
- Department of Urology, Hospital CUF Descobertas, Lisbon, Portugal
| | - D Perez-Fentes
- Department of Urology, University Hospital Complex of Santiago de Compostela, Santiago, Spain
| | - P J Osther
- Department of Urology, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - I K Goumas
- Department of Urology, Istituto Clinico Beato Matteo, Vigevano, Italy
| | - P Acquati
- Department of Urology, IRCCS Policlinico San Donato, Milan, Italy
| | - L Ajayi
- Department of Urology, Royal Free London NHS Foundation Trust, London, UK
| | - P Diana
- Department of Urology, Fundació Puigvert Univ. Autonoma de Barcelona, Barcelona, Spain
| | - P Casale
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - N M Buffi
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
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Cheng C, Ma Y, Jin S, Wen J, Jin X. Comparison of the Removal Efficiency and Safety of Magnetic Versus Conventional Ureteral Stents: A Systematic Review and Meta-analysis. EUR UROL SUPPL 2023; 52:22-29. [PMID: 37182117 PMCID: PMC10172693 DOI: 10.1016/j.euros.2023.04.004] [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] [Accepted: 04/05/2023] [Indexed: 05/16/2023] Open
Abstract
Context The incidence of urolithiasis is increasing year by year. Ureteral stents are a popular treatment option for this condition. Efforts to improve the material and structure of stents to increase comfort and reduce complications have led to the introduction of magnetic stents. Objective To evaluate differences in removal efficiency and safety for magnetic and conventional stents. Evidence acquisition This study was conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Data were extracted according to the PRISMA principles. We collected and combined data from randomized controlled trials on magnetic versus conventional stents to evaluate the efficiency of their removal and the associated effects. Data synthesis was performed using RevMan 5.4.1 and heterogeneity was evaluated using I2 tests. A sensitivity analysis was also performed. Key metrics included the stent removal time, Visual Analog Scale (VAS) pain scores, and Ureteral Stent Symptom Questionnaire (USSQ) scores for various domains. Evidence synthesis Seven studies were included in the review. We found that magnetic stents had a shorter removal time (mean difference [MD] -8.28 min, 95% confidence interval [CI] -15.6 to -0.95; p = 0.03) and their removal was associated with less pain (MD -3.01 points, 95% CI -3.83 to -2.19; p < 0.01) in comparison to conventional stents. USSQ scores for urinary symptoms and sexual matters were higher for magnetic than for conventional stents. There were no other differences between the stent types. Conclusions Magnetic ureteral stents have the advantages of a shorter removal time, less pain during removal, and low cost in comparison to conventional stents. Patient summary For patients undergoing treatment of urinary stones, a thin tube called a stent is often temporarily inserted in the tube between the kidney and the bladder to allow stones to pass. Magnetic stents can be removed without any need for a second surgical procedure. Our review of studies comparing two types of stents suggests that magnetic stents are superior to conventional stents in terms of efficiency and comfort during removal.
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Affiliation(s)
- Chao Cheng
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, PR China
| | - Yucheng Ma
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, PR China
| | - Sida Jin
- Department of Cardiology, Western Theater Air Force Hospital, Chengdu, PR China
| | - Jun Wen
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, PR China
| | - Xi Jin
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, PR China
- Corresponding author. Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, Sichuan 610041, PR China. Fax: +86 28 85164161.
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3
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Qi Y, Kong H, Xing H, Zhang Z, Chen Y, Qi S. A randomized controlled study of ureteral stent extraction string on patient's quality of life and stent-related complications after percutaneous nephrolithotomy in the prone position. Urolithiasis 2023; 51:79. [PMID: 37115264 PMCID: PMC10141830 DOI: 10.1007/s00240-023-01451-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 04/16/2023] [Indexed: 04/29/2023]
Abstract
To demonstrate the Tianjin Institute of Urology (TJIU) technique to place and remove the ureteral stent with extraction string after percutaneous nephrolithotomy (PCNL). Additionally, we aim to compare the pain experienced during stent removal, quality of life during stent retention, and stent-related complications between patients with and without extraction string. 65 patients were included in the final analysis in the string group constructed by the TJIU technique and 66 patients in the conventional double-J ureteral stent (non-string) group. All patients underwent the surgery in a prone position under general anesthesia. They completed the Ureteral Stent Symptom Questionnaire (USSQ) on postoperative days (POD) 7, as well as before their ureteral stent was removed. The visual analogue scale (VAS) pain score (0-10) was completed immediately after the removal of the ureteral stent. Moreover, a specialized person was responsible for recording stent-related complications. All patients completed the USSQ on POD 7, and we did not find a difference in scores in each field. However, there was a significant difference in the "sex" domain before removing the ureteral stent (4.34 vs 3.23; p = 0.01). Notably, the use of extraction string after PCNL could decrease the pain associated with stent removal significantly (mean VAS scores 1.45 vs 2.76; p < 0.01). Extraction string did not increase the incidence of stent-related complications. We concluded that placing a ureteral stent with an extraction string after PCNL reduces the pain of ureteral stent removal without increasing complications such as accidental removal of the stent, febrile urinary tract infection (UTI).
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Affiliation(s)
- Yuanjiong Qi
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Hailong Kong
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Haonan Xing
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Zhihong Zhang
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Yue Chen
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, 300211, China.
| | - Shiyong Qi
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, 300211, China.
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Allam CL, Aden JK, Reed AM. The Role of Routine Ureteral Stenting Following Uncomplicated Ureteroscopic Treatment for Upper Ureteral and Renal Stones: A Randomized Control Trial. J Endourol 2023; 37:257-263. [PMID: 36401514 DOI: 10.1089/end.2022.0386] [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: 11/21/2022] Open
Abstract
Purpose: Ureteral stenting following uncomplicated ureteroscopy (URS) is common practice. Several studies have proven the safety of omitting routine stent placement following distal ureteral stone treatment. However, there is a paucity of data regarding the utility of stent placement for proximal URS. We designed a prospective, randomized controlled trial to evaluate the role of ureteral stent placement following URS for proximal ureteral and renal stones. Methods: Seventy-two patients with proximal ureteral or renal stones measuring as much as 1.5 cm were prospectively randomized into stented (37) or unstented (35) groups. The surgeon was blinded to the treatment group until after stone treatment. Patients tracked postoperative pain medications and completed validated pain questionnaires on postoperative days 0, 3, 7, and 28. Stents were removed on postoperative day 7. Postoperative follow-up imaging was obtained at 4 weeks. Results: No statistical differences were observed between the two groups in terms of demographics or stone characteristics. The operative time was longer in the stented group (p < 0.03). Patients in the stented group had more irritative urinary symptoms (p < 0.0001) and pain (p < 0.0001), missed more days of work (p < 0.01), and used more narcotics (p < 0.0005) during the first week, but no differences were observed at 30 days. Emergency room visits and overall complication rates were similar between the two groups. Three nonstented patients required stent placement. Two stented patients required early stent removal. Urinary tract infections developed in three stented patients, but not in unstented patients. Postoperative imaging did not reveal any hydronephrosis in either group, and the total stone-free rate was 94%. Conclusions: For most patients undergoing uncomplicated ureteroscopic treatment for proximal ureteral and kidney stones, it may be safe to omit ureteral stents to potentially decrease urinary symptoms and pain while improving short-term quality of life. Further studies with larger patient cohorts may be warranted to confirm our results.
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Affiliation(s)
- Christopher L Allam
- Urology Clinic, Department of Surgery, Brooke Army Medical Center, Fort Sam Houston, Texas, USA
| | - James K Aden
- Urology Clinic, Department of Surgery, Brooke Army Medical Center, Fort Sam Houston, Texas, USA
| | - Amy M Reed
- Urology Clinic, Department of Surgery, Brooke Army Medical Center, Fort Sam Houston, Texas, USA
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5
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Law YXT, Teoh JYC, Castellani D, Lim EJ, Chan EOT, Wroclawski M, Pirola GM, Giulioni C, Rubilotta E, Gubbioti M, Scarcella S, Chew BH, Traxer O, Somani BK, Gauhar V. Role of pre-operative ureteral stent on outcomes of retrograde intra-renal surgery (RIRS): systematic review and meta-analysis of 3831 patients and comparison of Asian and non-Asian cohorts. World J Urol 2022; 40:1377-1389. [PMID: 35072738 DOI: 10.1007/s00345-022-03935-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 01/07/2022] [Indexed: 12/27/2022] Open
Abstract
PURPOSE To evaluate the outcomes of pre-stented (PS) versus non-pre-stented (NPS) patients who have undergone retrograde intrarenal surgery (RIRS) for renal calculi with subgroup analysis of Asian and non-Asian cohorts. METHODS Protocol is registered in PROSPERO, CRD42021261123. Eligible studies identified from four electronic databases. Meta-analysis was done to enumerate the outcomes of RIRS in between PS and NPS. Secondary sub-analysis was done to look for differences in outcomes in Asian and non-Asian cohorts. RESULTS Fourteen studies involving 3831 patients (4 prospective, 10 retrospective studies) were included. PS patients experienced higher success rates of ureteral access sheath (UAS) insertion than NPS (RR 1.09, 95% CI 1.05-1.13, p < 0.00001). PS patients had lower risk of ureteral injuries from UAS placement (RR 0.69, 95% CI 0.50-0.96, p = 0.03). No significant differences in intra- and postoperative complications between two groups were found. Stone-free rate (SFR) outcomes for residual fragment (RF) cut-off of < 1 mm and < 4 mm favoured the PS patients (RR 1.10, 95% CI 1.04-1.17, p = 0.002 for < 4 mm, RR1.10, 95% CI 1.02-1.19, p = 0.02 for < 1 mm). In the subgroup analysis, PS Asian patients had similar SFR as NPS patients for SFR(< 4 mm) but non-Asian population showed better outcomes in the PS patients for SFR(< 4 mm) (RR 1.31, 95% CI 1.13-1.52, p = 0.0005). CONCLUSIONS This meta-analysis suggests that pre-stenting results in a higher success for UAS placement, minimising intraoperative ureteric injury, with higher overall SFR for any RF cut-off in PS cohorts. In non-Asian cohort, significant differences occurred at SFR < 4 mm but not for SFR < 1 mm. No difference was seen in our Asian cohort for any SFR cut-off in both PS and NPS patients.
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Affiliation(s)
- Y X T Law
- Department of Urology, National University Hospital, National University Health System, Singapore, Singapore.
| | - J Y C Teoh
- S.H. Ho Urology Centre, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - D Castellani
- Urology Division, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Università Politecnica Delle Marche, Ancona, Italy
| | - E J Lim
- Department of Urology, Singapore General Hospital, Singapore, Singapore
| | - E O T Chan
- S.H. Ho Urology Centre, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - M Wroclawski
- Department of Urology, Hospital Israelita Albert Einstein, São Paulo, Brazil.,BP-a Beneficência Portuguesa de São Paulo, São Paulo, Brazil
| | - G M Pirola
- Department of Urology, San Donato Hospital, Arezzo, Italy
| | - C Giulioni
- Urology Division, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Università Politecnica Delle Marche, Ancona, Italy
| | - E Rubilotta
- Department of Urology, A.O.U.I. Verona University, Verona, Italy
| | - M Gubbioti
- Department of Urology, San Donato Hospital, Arezzo, Italy
| | - S Scarcella
- Urology Division, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Università Politecnica Delle Marche, Ancona, Italy
| | - B H Chew
- Department of Urologic Sciences, University of British Columbia, Vancouver, Canada
| | - O Traxer
- Service d'Urologie, Sorbonne Université, Paris, France.,Service d'Urologie, AP-HP, Hôpital Tenon, Paris, France
| | - B K Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - V Gauhar
- Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore
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Kocatürk H, Bedir F, Turangezli Ö, Şebin E, Altay MS, Bedir B, Sarıca K. Time dependant functional and morphological recovery of the kidney after relief of obstruction in patients with impacted ureteral stones. ACTA ACUST UNITED AC 2021; 93:178-183. [PMID: 34286552 DOI: 10.4081/aiua.2021.2.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 05/02/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To assess the course of functional and morphological recovery of the kidney following the relief of obstruction with ureteral JJ stent in cases with unilateral impacted stones. MATERIALS AND METHODS A total of 42 adult patients who were admitted to our clinic with unilateral obstructing impacted ureteral stones requiring JJ stent placement were included in the study. The course of functional recovery was assessed by evaluating the serum creatinine levels, renal resistive index (RRI) values and urinary levels of kidney injury molecule-1, neutrophil gelatinaseassociated lipocalin as well as microalbumin before at 1 day, 1 week and 4 weeks after JJ stent placement. Course of morphologic recovery was evaluated by evaluating the degree of hydronephrosis, kidney size, perirenal straining and ureteral diameter. RESULTS Our results showed that all relevant parameters began to decrease after 24 hours and continue to normalize during 1 week evaluation; majority of these variables indicating the functional and morphological recovery were in normal range after 4 weeks. Decompression of the obstructed kidneys with JJ stent placement in patients with impacted ureteral stones was found to be effective enough with recovery of normal renal functional and morphological status after a minimum time period of 4 weeks. Morphological recovery of affected kidneys following JJ stenting was obtained with a significant difference between baseline and 1-month evaluation findings (p = 0.001, p < 001, p < 001, respectively). KIM-1 excretion began to decline to normal levels after 4 weeks (3.52 ± 0.99 ng/ml versus 2.84 ± 0.66 ng/ml, p < 0.001). The same findings were observed for the urinary excretion levels of NGAL, which normalized at the 1-month evaluation (604.55 ± 140.28 ng/ml versus 596.87 ± 80.17 ng/ml p = 0.895). Urinary microalbumin excretion levels however remained high even until 1-month follow-up with a statistically significant difference when compared with the normal excretion values (p < 0.001). There was a statistically significant difference in RRI values between baseline and 1-month follow-up findings in obstructed kidney (p < 0.001). CONCLUSIONS Elective management of the obstructing impacted ureteral stone(s) will be safer with limited risk of infective complications after functional and morphological normalization in such kidneys following 4 weeks of JJ stent placement.
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Affiliation(s)
- Hüseyin Kocatürk
- Department of Urology Health Sciences University, Erzurum Regional Training and Research Hospital, Erzurum.
| | - Fevzi Bedir
- Department of Urology Health Sciences University, Erzurum Regional Training and Research Hospital, Erzurum.
| | - Ömer Turangezli
- Department of Urology Health Sciences University, Erzurum Regional Training and Research Hospital, Erzurum.
| | - Engin Şebin
- Department of Biochemistry Health Sciences University, Erzurum Regional Training and Research Hospital, Erzurum.
| | - Mehmet Sefa Altay
- Department of Urology Health Sciences University, Erzurum Regional Training and Research Hospital, Erzurum.
| | - Banu Bedir
- Aziziye District Health Directorate, Erzurum.
| | - Kemal Sarıca
- Biruni University, Faculty of Medicine, Department of Urology, Istanbul.
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7
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The Effect of Ureteral Stents on Postoperative Pain. ANADOLU KLINIĞI TIP BILIMLERI DERGISI 2020. [DOI: 10.21673/anadoluklin.778906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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8
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Ureteric stenting with magnetic retrieval: an alternative to traditional methods. Ir J Med Sci 2019; 189:289-293. [DOI: 10.1007/s11845-019-02075-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 07/24/2019] [Indexed: 10/26/2022]
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9
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Ordonez M, Hwang EC, Borofsky M, Bakker CJ, Gandhi S, Dahm P. Reprint - Ureteral stent vs. no ureteral stent for ureteroscopy in the management of renal and ureteral calculi: A Cochrane review. Can Urol Assoc J 2019; 14:61-68. [PMID: 31348748 DOI: 10.5489/cuaj.5957] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We aimed to assess the effects of postoperative ureteral stent placement after uncomplicated ureteroscopy. METHODS We performed a comprehensive search with no restrictions on publication language or status up to February 1, 2019. We only included randomized trials. Two review authors independently examined full-text reports, identified relevant studies, assessed the eligibility of studies for inclusion, extracted data, and assessed risk of bias. We performed statistical analyses using a random-effects model and assessed the certainty of the evidence according to GRADE. RESULTS We included 23 studies with 2656 randomized patients. Primary outcomes: It is uncertain whether stenting reduces the number of unplanned return visits (very low certainty of evidence [CoE]). Pain on the day of surgery is probably similar (mean difference [MD] 0.32; 95% confidence interval (CI) -0.13-0.78; moderate CoE). Pain on postoperative days 1-3 may show little to no difference (standardized mean difference [SMD] 0.25; 95% CI -0.32-0.82; low CoE). It is uncertain whether stented patients experience more pain on postoperative days 4-30 (very low CoE). Stenting may result in little to no difference in the need for secondary interventions (risk ratio [RR] 1.15; 95% CI 0.39-3.33; low CoE). SECONDARY OUTCOMES We are uncertain whether stenting reduces the need for narcotics and reduces ureteral stricture rates up to 90 days (very low CoE). Rates of hospital admission may be slightly reduced (RR 0.70; 95% CI 0.32-1.55; low CoE). This review was limited to patients in whom ureteroscopy was deemed 'uncomplicated.' In addition, time intervals for the grouping for the reported degree of pain were established post-hoc. The CoE for most outcomes was rated as low or very low for methodological reasons. CONCLUSIONS Findings of this review illustrate the tradeoffs of risks and benefits faced by urologists and their patients when it comes to decision-making about stent placement after uncomplicated ureteroscopy for stone disease.
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Affiliation(s)
- Maria Ordonez
- Department of Urology, University of Minnesota, Minneapolis, MN, United States
| | - Eu Chang Hwang
- Department of Urology, University of Minnesota, Minneapolis, MN, United States.,Department of Urology, Chonnam National University Medical School, Hwasun, South Korea.,Urology Section, Minneapolis VA Health Care System, Minneapolis, MN, United States
| | - Michael Borofsky
- Department of Urology, University of Minnesota, Minneapolis, MN, United States
| | - Caitlin J Bakker
- Health Sciences Libraries, University of Minnesota, Minneapolis, MN, United States
| | | | - Philipp Dahm
- Department of Urology, University of Minnesota, Minneapolis, MN, United States.,Urology Section, Minneapolis VA Health Care System, Minneapolis, MN, United States
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10
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Ordonez M, Hwang EC, Borofsky M, Bakker CJ, Gandhi S, Dahm P. Ureteral stent versus no ureteral stent for ureteroscopy in the management of renal and ureteral calculi. Cochrane Database Syst Rev 2019; 2:CD012703. [PMID: 30726554 PMCID: PMC6365118 DOI: 10.1002/14651858.cd012703.pub2] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Ureteroscopy combined with laser stone fragmentation and basketing is a common approach for managing renal and ureteral stones. This procedure is associated with some degree of ureteral trauma. Ureteral trauma may lead to swelling, ureteral obstruction, and flank pain and may require subsequent interventions such as hospital admission or secondary ureteral stent placement. To prevent such issues, urologists often place temporary ureteral stents prophylactically, but the value of doing so remains unclear. OBJECTIVES To assess the effects of postoperative ureteral stent placement after uncomplicated ureteroscopy. SEARCH METHODS We performed a comprehensive search using multiple databases (the Cochrane Library, MEDLINE, Embase, Scopus, Google Scholar, and Web of Science), trials registries, other sources of grey literature, and conference proceedings, up to 01 February 2019. We applied no restrictions on publication language or status. SELECTION CRITERIA We included trials in which researchers randomised participants undergoing uncomplicated ureteroscopy to placement of a ureteral stent versus no ureteral stent. DATA COLLECTION AND ANALYSIS Two review authors independently classified studies and abstracted data from the included studies. We performed statistical analyses using a random-effects model. We rated the certainty of evidence (CoE) according to the GRADE approach. MAIN RESULTS Primary outcomesStenting may slightly reduce the number of unplanned return visits (16 trials with 1970 participants; very low CoE), but we are very uncertain of this finding.Pain on the day of surgery as measured on a visual analogue scale (scale 0 to 10; higher values reflect more pain) is probably similar (mean difference (MD) 0.32 higher, 95% confidence interval (CI) 0.13 lower to 0.78 higher; 4 trials with 346 participants; moderate CoE). Pain on postoperative days 1 to 3 may show little to no difference (standardised mean difference (SMD) 0.25 higher, 95% CI 0.32 lower to 0.82 higher; 8 trials with 683 participants; low CoE). On postoperative days 4 to 30, stented participants may experience more pain (8 trials with 903 participants; very low CoE), but we are very uncertain of this finding.Stenting may result in little to no difference in the need for secondary interventions (risk ratio (RR) 1.15, 95% CI 0.39 to 3.33; 10 studies with 1435 participants; low CoE); this corresponds to three more interventions per 1000 participants (95% CI 13 fewer to 48 more).Secondary outcomesStenting may reduce the need for narcotics (7 trials with 830 participants; very low CoE), but we are very uncertain of this finding.Rates of urinary tract infection (UTI) up to 90 days are probably not substantially different (RR 0.94, 95% CI 0.59 to 1.51; 10 trials with 1207 participants; moderate CoE); this corresponds to three fewer infections per 1000 participants (95% CI 23 fewer to 29 more).Ureteral stricture rates up to 90 days may be slightly reduced (14 trials with 1625 participants; very low CoE), but we are very uncertain of this finding.Rates of hospital admission may be slightly reduced (RR 0.70, 95% CI 0.32 to 1.55; 13 studies with 1647 participants; low CoE). This corresponds to 15 fewer admissions per 1000 participants (95% CI 33 fewer to 27 more). AUTHORS' CONCLUSIONS Findings of this review illustrate the trade-offs of risks and benefits faced by urologists and their patients when it comes to decision-making about stent placement after uncomplicated ureteroscopy for stone disease. We noted that both desirable and undesirable effects were small in absolute terms, with findings based mostly on low and very low CoE. The main issues reducing our confidence in research findings were study limitations (mostly risk of performance and detection bias) and imprecision. We were unable to conduct any of the preplanned subgroup analyses, in particular those based on stone size, stone location, and use of ureteral dilation, which may be important effect modifiers. Given the importance of this question, higher-quality and sufficiently large trials are needed to better inform decision-making.
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Affiliation(s)
- Maria Ordonez
- University of MinnesotaDepartment of Urology420 Delaware Street SE, MMC 394MinneapolisMinnesotaUSA
| | - Eu Chang Hwang
- Chonnam National University Medical School, Chonnam National University Hwasun HospitalDepartment of UrologyHwasunKorea, South
| | - Michael Borofsky
- University of MinnesotaDepartment of Urology420 Delaware Street SE, MMC 394MinneapolisMinnesotaUSA
| | - Caitlin J Bakker
- University of MinnesotaHealth Sciences Libraries303 Diehl Hall, 505 Essex Street SEMinneapolisMinnesotaUSA55455
| | | | - Philipp Dahm
- Minneapolis VA Health Care SystemUrology SectionOne Veterans DriveMail Code 112DMinneapolisMinnesotaUSA55417
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Chen Y, Feng J, Yue Y, Zhao Z, Deng T, Wu W, Zeng G. Externalized Ureteral Catheter Versus Double-J Stent in Tubeless Percutaneous Nephrolithotomy for Upper Urinary Stones: A Systematic Review and Meta-Analysis. J Endourol 2018; 32:581-588. [PMID: 29695185 DOI: 10.1089/end.2018.0066] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE The objective of this meta-analysis was to compare the efficacy and safety of externalized ureteral catheter (EUC) and Double-J stent (DJS) in tubeless percutaneous nephrolithotomy (PCNL) for patients with upper urinary stones based on published literature. MATERIALS AND METHODS A comprehensive literature search using Pubmed, Embase, and Cochrane Library was performed to find studies comparing outcomes of EUC and DJS for treating patients with upper urinary stones up to December 2017. Seven studies, which included 863 patients from 5 randomized controlled trials (RCTs) and 2 non-RCTs published between 2009 and 2017, met our inclusion criteria and were included in this systematic review and meta-analysis. Between-studies heterogeneity was assessed and sensitivity analysis was conducted based on RCTs. RESULTS The stent-related symptoms were higher for DJS compared with EUC (odds ratio [OR]: 0.09; confidence interval [95% CI]: 0.01-0.61; p = 0.01). No significant differences were found in minor (Clavien I-II) complications (OR: 1.37; 95% CI: 0.93-2.01; p = 0.11), major (Clavien III-V) complications (OR: 1.38; 95% CI: 0.73-2.60; p = 0.32), hemoglobin drop (weighted mean difference [WMD]: -1.43 g/L; 95% CI: -3.65 to 0.78; p = 0.2), pain score (VAS) (WMD: 0.01; 95% CI: -0.28 to 0.29; p = 0.95), analgesic required (OR: 1.02; 95% CI: 0.77-1.34; p = 0.91), stone-free rate (risk ratio: 0.98; 95% CI: 0.9-1.07; p = 0.67), duration of hospitalization (WMD: -0.21 days; 95% CI: -0.86 to 0.44; p = 0.53), and operative times (WMD: -7.59 minutes; 95% CI: -18.81 to 3.64; p = 0.19). CONCLUSION We concluded that compared with DJS, EUC is also an effective alternative for patients with upper urinary stones in tubeless PCNL and could help patients by reducing stent-related discomfort and avoiding cystoscopy for DJS removal. However, the inherent limitations of the included studies should be considered, and well-designed RCTs with further large sample size should be performed to validate our findings.
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Affiliation(s)
- Yiwen Chen
- 1 Department of Urology, Minimally Invasive Surgery center, The First Affiliated Hospital of Guangzhou Medical University , Guangzhou, China .,2 Guangdong Key Laboratory of Urology , Guangzhou, China
| | - Jianhua Feng
- 3 Department of Urology, Longgang District Central Hospital , Shenzhen, China
| | - Youwei Yue
- 3 Department of Urology, Longgang District Central Hospital , Shenzhen, China
| | - Zhijian Zhao
- 1 Department of Urology, Minimally Invasive Surgery center, The First Affiliated Hospital of Guangzhou Medical University , Guangzhou, China .,2 Guangdong Key Laboratory of Urology , Guangzhou, China
| | - Tuo Deng
- 1 Department of Urology, Minimally Invasive Surgery center, The First Affiliated Hospital of Guangzhou Medical University , Guangzhou, China .,2 Guangdong Key Laboratory of Urology , Guangzhou, China
| | - Wenqi Wu
- 1 Department of Urology, Minimally Invasive Surgery center, The First Affiliated Hospital of Guangzhou Medical University , Guangzhou, China .,2 Guangdong Key Laboratory of Urology , Guangzhou, China
| | - Guohua Zeng
- 1 Department of Urology, Minimally Invasive Surgery center, The First Affiliated Hospital of Guangzhou Medical University , Guangzhou, China .,2 Guangdong Key Laboratory of Urology , Guangzhou, China
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Paul CJ, Brooks NA, Ghareeb GM, Tracy CR. Pilot Study to Determine Optimal Stent Duration Following Ureteroscopy: Three versus Seven days. Curr Urol 2018; 11:97-102. [PMID: 29593469 PMCID: PMC5836241 DOI: 10.1159/000447201] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 05/22/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Many providers elect to place a stent following ureteroscopy for nephrolithiasis, but little data exists on the optimal duration to leave a stent. We sought to determine whether there are any differences in post-operative outcomes for patients with a 3 versus 7-day stent following ureteroscopy. METHODS We retrospectively reviewed 247 patients who underwent unilateral ureteroscopy with lithotripsy, 79 of whom removed a stent with an extraction string at 3 or 7 days post-operatively. These 2 groups were compared with regard to demographic information, pre-operative variables, and post-operative outcomes. RESULTS Of all patients, 33% experienced a post-procedure related event (phone call, extra clinic visit, and emergency department visit) within 30 days of their procedure, 39% of 3-day stent patients compared to 21% of 7-day patients (p = 0.11). Within the 3 days following stent removal, 3-day stent patients were significantly more likely to have a post-procedure related event than 7-day patients (23 vs. 3%, p = 0.026). CONCLUSION One third of patients with a post-operative ureteral stent will seek medical care in the 30 days following ureteroscopy. Leaving a stent for 3 versus 7 days may lead to worse outcomes with regard to post-operative events and fank pain.
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Affiliation(s)
| | | | | | - Chad R. Tracy
- Department of Urology, The University of Iowa, Iowa City, IA, USA
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Vachon C, Defarges A, Brisson B, Nykamp S, Weese JS, Denstedt J, Berent AC. Passive ureteral dilation and ureteroscopy after ureteral stent placement in five healthy Beagles. Am J Vet Res 2017; 78:381-392. [DOI: 10.2460/ajvr.78.3.381] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Seklehner S, Sievert KD, Lee R, Engelhardt PF, Riedl C, Kunit T. A cost analysis of stenting in uncomplicated semirigid ureteroscopic stone removal. Int Urol Nephrol 2017; 49:753-761. [PMID: 28197765 DOI: 10.1007/s11255-017-1538-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 02/04/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the outcome and the costs of stenting in uncomplicated semirigid ureteroscopic stone removal. MATERIALS AND METHODS A decision tree model was created to evaluate the economic impact of routine stenting versus non-stenting strategies in uncomplicated ureteroscopy (URS). Probabilities of complications were extracted from twelve randomized controlled trials. Stone removal costs, costs for complication management, and total costs were calculated using Treeage Pro (TreeAge Pro Healthcare version 2015, Software, Inc, Williamstown Massachusetts, USA). RESULTS Stone removal costs were higher in stented URS (€1512.25 vs. €1681.21, respectively). Complication management costs were higher in non-stented procedures. Both for complications treated conservatively (€189.43 vs. €109.67) and surgically (€49.26 vs. €24.83). When stone removal costs, costs for stent removal, and costs for complication management were considered, uncomplicated URS with stent placement yielded an overall cost per patient of €1889.15 compared to €1750.94 without stent placement. The incremental costs of stented URS were €138.25 per procedure. CONCLUSION Semirigid URS with stent placement leads to higher direct procedural costs. Costs for managing URS-related complications are higher in non-stented procedures. Overall, a standard strategy of deferring routine stenting uncomplicated ureteroscopic stone removal is more cost efficient.
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Affiliation(s)
- Stephan Seklehner
- Department of Urology, Landesklinikum Baden-Mödling, Waltersdorfer Straße 75, 2500, Baden, Austria.
- Department of Urology, Paracelsus Medical University Salzburg, Strubergasse 21, 5020, Salzburg, Austria.
| | - Karl-Dietrich Sievert
- Department of Urology, Paracelsus Medical University Salzburg, Strubergasse 21, 5020, Salzburg, Austria
| | - Richard Lee
- Department of Urology, Weill Medical College of Cornell University, New York, NY, USA
| | - Paul F Engelhardt
- Department of Urology, Landesklinikum Baden-Mödling, Waltersdorfer Straße 75, 2500, Baden, Austria
- Department of Urology, Paracelsus Medical University Salzburg, Strubergasse 21, 5020, Salzburg, Austria
| | - Claus Riedl
- Department of Urology, Landesklinikum Baden-Mödling, Waltersdorfer Straße 75, 2500, Baden, Austria
| | - Thomas Kunit
- Department of Urology, Paracelsus Medical University Salzburg, Strubergasse 21, 5020, Salzburg, Austria
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Wang H, Man L, Li G, Huang G, Liu N, Wang J. Meta-Analysis of Stenting versus Non-Stenting for the Treatment of Ureteral Stones. PLoS One 2017; 12:e0167670. [PMID: 28068364 PMCID: PMC5221881 DOI: 10.1371/journal.pone.0167670] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 11/20/2016] [Indexed: 12/23/2022] Open
Abstract
Background and aim Ureteroscopic lithotripsy (URL) and extracorporeal shock wave lithotripsy (ESWL) are two widely used methods for the treatment of ureteral stones. The need for ureteral stenting during these procedures is controversial. In this meta-analysis, we evaluated the benefits and disadvantages of ureteral stents for the treatment of ureteral stones. Methods Databases including PubMed, Embase and Cochrane library were selected for systematic review of randomized controlled trials (RCTs) comparing outcomes with or without stenting during URL and ESWL. Meta-analysis was performed using RevMan 5.3 and STATA 13.0 software. Results We identified 22 RCTs comparing stenting and non-stenting. The stented group was associated with longer operation time (WMD: 4.93; 95% CI: 2.07 to 7.84; p < 0.001), lower stone-free rate (OR: 0.55; 95% CI: 0.34 to 0.89; p = 0.01). In terms of complications, the incidence of hematuria (OR: 3.68; 95% CI: 1.86 to 7.29; p < 0.001), irritative urinary symptoms (OR: 4.40; 95% CI: 2.19 to 9.10; p < 0.001), urinary infection (OR: 2.23; 95% CI: 1.57 to 3.19; p < 0.001), and dysuria (OR: 3.90; 95% CI: 2.51 to 6.07; p < 0.001) were significantly higher in the stented group. No significant differences in visual analogue score (VAS), stricture formation, fever, or hospital stay were found between stenting and non-stenting groups. The risk of unplanned readmissions (OR: 0.63; 95% CI: 0.41 to 0.97; p = 0.04) was higher in the non-stented group. Conclusions Our analysis showed that stenting failed to improve the stone-free rate, and instead, it resulted in additional complications. However, ureteral stents are valuable in preventing unplanned re-hospitalization. Additional randomized controlled trials are still required to corroborate our findings.
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Affiliation(s)
- Hai Wang
- Department of Urology, Beijing Jishuitan Hospital, Beijing, China
- * E-mail:
| | - Libo Man
- Department of Urology, Beijing Jishuitan Hospital, Beijing, China
| | - Guizhong Li
- Department of Urology, Beijing Jishuitan Hospital, Beijing, China
| | - Guanglin Huang
- Department of Urology, Beijing Jishuitan Hospital, Beijing, China
| | - Ning Liu
- Department of Urology, Beijing Jishuitan Hospital, Beijing, China
| | - Jianwei Wang
- Department of Urology, Beijing Jishuitan Hospital, Beijing, China
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Zhou Y, Zhu J, Gurioli A, Yuan D, Luo J, Li Z, Zhang W, Xiao S, Liu Y. Randomized Study of Ureteral Catheter vs Double-J Stent in Tubeless Minimally Invasive Percutaneous Nephrolithotomy Patients. J Endourol 2016; 31:278-282. [PMID: 27967216 DOI: 10.1089/end.2016.0759] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To prospectively analyze and compare the outcomes of using externalized ureteral catheter (EUC) vs Double-J ureteral stent (DJ) in tubeless minimally invasive percutaneous nephrolithotomy (MPCNL). PATIENTS AND METHODS A total of 109 patients underwent tubeless MPCNL in our institute and have been enrolled into this study. Fifty-six and 53 patients had EUC and DJ positioning at the conclusion of the procedure, respectively. The two approaches have been compared for operative time, intraoperative blood loss, postoperative visual analogue pain scale (VAS) score, analgesic requirement, stent-related symptoms, hospital stay, degree of vesicoureteral reflux (VUR) on the operative side, and complications according to the modified Clavien system. RESULTS There were no statistically significant differences between the two groups regarding the mean operative times, mean VAS scores, analgesic requirements, mean hemoglobin drop, mean hospital stay, and overall complication rate. However, compared with DJ group, EUC group presented fewer postoperative stent-related symptoms and less occurrence of severe VUR (p < 0.05). CONCLUSION Positioning EUC in tubeless MPCNL is a safe alternative to DJ in patients with renal or upper ureteral calculi. EUC provides several benefits: obviated the need of a second endoscopic procedure, reduced stent-related discomfort, and lowered the occurrence of severe VUR.
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Affiliation(s)
- Yizhou Zhou
- 1 Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University , Guangdong Key Laboratory of Urology, Guangzhou, China
| | - Jianguo Zhu
- 2 Department of Urology, Guizhou Provincial People's Hospital , Guiyang, China
| | - Alberto Gurioli
- 3 Department of Urology, Turin University of Studies , Turin, Italy
| | - Dongbo Yuan
- 2 Department of Urology, Guizhou Provincial People's Hospital , Guiyang, China
| | - Jiawei Luo
- 1 Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University , Guangdong Key Laboratory of Urology, Guangzhou, China
| | - Zhilin Li
- 1 Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University , Guangdong Key Laboratory of Urology, Guangzhou, China
| | - Wei Zhang
- 2 Department of Urology, Guizhou Provincial People's Hospital , Guiyang, China
| | - Shiwei Xiao
- 2 Department of Urology, Guizhou Provincial People's Hospital , Guiyang, China
| | - Yongda Liu
- 1 Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University , Guangdong Key Laboratory of Urology, Guangzhou, China
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Pais VM, Smith RE, Stedina EA, Rissman CM. Does Omission of Ureteral Stents Increase Risk of Unplanned Return Visit? A Systematic Review and Meta-Analysis. J Urol 2016; 196:1458-1466. [PMID: 27287523 DOI: 10.1016/j.juro.2016.05.109] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2016] [Indexed: 01/22/2023]
Abstract
PURPOSE Post-ureteroscopy ureteral stent omission remains controversial. Although omission is associated with reduced postoperative discomfort, concern remains for early obstruction. We performed a systematic review and meta-analysis of trials to compare the risk of unplanned visits with vs without a stent following ureteroscopy for nephrolithiasis. MATERIALS AND METHODS Randomized, controlled trials and observational studies comparing post-ureteroscopic stent omission vs placement and reporting unplanned visits within 30 days were identified via a search of MEDLINE® (1946 to 2015), CENTRAL (Cochrane Central Register of Controlled Trials, 1898 to 2015), Embase® (1947 to 2015), ClinicalTrials.gov (1997 to 2015), AUA (American Urological Association) Annual Meeting abstracts (2011 to 2015) and reference lists of included articles as last updated in October 2015. Two reviewers independently extracted data and assessed methodological quality. ORs, RRs and weighted mean differences were calculated as appropriate for each outcome. RESULTS Of the initial 1,992 studies 17 in a total of 1,943 participants met inclusion criteria. Unstented patients were significantly more likely to have an unplanned medical visit compared to those who received a post-ureteroscopy stent (OR 1.63, 95% CI 1.15-2.30). Unstented patients had shorter operative time (weighted mean difference -3.19 minutes, 95% CI -5.64--0.74) and were less likely to experience dysuria (RR 0.39, 95% CI 0.25-0.62). They were also less likely to experience postoperative infection (OR 0.89, 95% CI 0.59-1.33) and pain (OR 0.64, 95% CI 0.39-1.05), although these results were not significant. CONCLUSIONS Stent omission is associated with an increased risk of unplanned medical visits despite reduced symptoms compared to those in stented patients. Patients and physicians should weigh these trade-offs when considering post-ureteroscopy stent placement.
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Affiliation(s)
- Vernon M Pais
- Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire; Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
| | - Rebecca E Smith
- Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire
| | - Elizabeth A Stedina
- Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire
| | - Cody M Rissman
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
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Zhang P, Hu WL, Cheng B, Cheng L, Zeng YJ, Wang G. α 1-blockers for the reduction of ureteric stent-related symptoms: A systematic review and meta-analysis. Exp Ther Med 2015; 11:660-668. [PMID: 26893663 DOI: 10.3892/etm.2015.2942] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 10/21/2015] [Indexed: 11/06/2022] Open
Abstract
The present meta-analysis aimed to evaluate the current evidence for the use of α1-blockers in relieving ureteric stent-related symptoms (USS). Electronic databases, including PubMed, Embase and Cochrane Library, were searched and two independent reviewers identified relevant parallel randomized controlled trials (RCTs), assessed trial quality and extracted data. Review Manager (version 5.2) was used to conduct a meta-analysis of the data. Significant advantages were demonstrated in the treatment group based on International Prostate Symptom Score (IPSS), voiding symptom sub-scores [mean difference (MD), -2.66; 95% confidence interval (CI), (-4.36, -0.96)], Ureteral Stent Symptom Questionnaire (USSQ) urinary symptoms score (MD, -5.84; 95%CI, -9.35 to -2.33), IPSS quality of life score (MD, -1.46; 95%CI, -2.64 to -0.28) USSQ quality of life score (MD, -0.69; 95%CI, -1.10 to -0.28), USSQ pain score (MD, -3.97; 95%CI, -5.52 to -2.42), Visual Analog Pain Scale (MD, -1.53; 95%CI, -2.25 to -0.80) and USSQ general health score (MD, -1.82; 95%CI, -2.47 to -1.18). No significant differences were detected from the following results: IPSS storage symptom sub-score (MD, -0.93; 95%CI, -2.28 to 0.43), USSQ sexual matters score (MD, -0.10; 95%CI, -0.79 to 0.59), USSQ work performance score (MD, 1.64; 95%CI, -2.18 to 5.47) and USSQ additional problems score (MD, -2.02; 95%CI, -4.55 to 0.52). However, significant between-trial heterogeneity was detected following statistical analysis and there were insufficient data to trace its source. The existing RCT data supported the hypothesis that α1-blockers beneficially influence pain, urinary symptoms and the quality of life of patients with an indwelling ureteral stent.
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Affiliation(s)
- Peng Zhang
- Department of Urology, Zhongnan Hospital, Wuhan University, Wuhan, Hubei 430071, P.R. China
| | - Wan-Li Hu
- Department of Urology, Zhongnan Hospital, Wuhan University, Wuhan, Hubei 430071, P.R. China
| | - Bei Cheng
- Department of Anatomy and Embryology, School of Basic Medical Sciences, Wuhan University, Wuhan, Hubei 430071, P.R. China
| | - Long Cheng
- Department of Urology, Zhongnan Hospital, Wuhan University, Wuhan, Hubei 430071, P.R. China
| | - Yang-Jun Zeng
- Department of Urology, Zhongnan Hospital, Wuhan University, Wuhan, Hubei 430071, P.R. China
| | - Gang Wang
- Department of Urology, Zhongnan Hospital, Wuhan University, Wuhan, Hubei 430071, P.R. China
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Zahran MH, Harraz AM, Taha DE, El-Nahas AR, Elshal A, Shokeir AA. Studying the Morbidity and Renal Function Outcome of Missed Internal Ureteral Stents: A Matched Pair Analysis. J Endourol 2015; 29:1070-5. [PMID: 25793431 DOI: 10.1089/end.2015.0047] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To investigate the effect of missed internal ureteral stents (IUS) on renal function and to describe different modalities of management and associated morbidity. PATIENTS AND METHODS A retrospective study included patients with missed IUS (>1 year). The complications of missed IUS were categorized according to the forgotten, encrusted, calcified (FECal) grading system. The estimated glomerular filtration rate (eGFR) was calculated using the Modification of Diet in Renal Disease (MDRD) equation at time of initial stent placement and time of stent removal. An age- and sex-matched group of patients who had IUS and had available follow-up for the same duration of the study group were used as a control. RESULTS A total of 46 missed IUS in 46 patients were included. Complicated stents were reported in 34 (73.9%) patients. FECal grade 1 was reported in 16 (57.2%) patients followed by grade 2 and 4 in 5 (17.8%) patients each. Retrograde removal, visual cystolitholapaxy, ureteroscopy with laser disintegration of encrustations and combined retrograde and antegrade approach have been used in 21, 5, 10, and 9 patients, respectively. In the missed IUS group, the mean±standard deviation (SD) eGFR has declined from 65.5±26.3 mL/min/1.73m(2) to 54.3±30 mL/min/1.73m(2) (P=0.001). While in the control group, the mean±SD eGFR has increased from 57.5±30 mL/min/1.73 m(2) to 66.7±27 mL/min/1.73 m(2) (P=0.001). CONCLUSIONS Missed IUS were associated with significant complications that necessitated more invasive intervention. In addition, IUS had a negative impact on renal function at time of removal.
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Affiliation(s)
- Mohamed H Zahran
- Department of Urology, Urology and Nephrology Center, Mansoura University , Mansoura, Egypt
| | - Ahmed M Harraz
- Department of Urology, Urology and Nephrology Center, Mansoura University , Mansoura, Egypt
| | - Diaa-Eldin Taha
- Department of Urology, Urology and Nephrology Center, Mansoura University , Mansoura, Egypt
| | - Ahmed R El-Nahas
- Department of Urology, Urology and Nephrology Center, Mansoura University , Mansoura, Egypt
| | - Ahmed Elshal
- Department of Urology, Urology and Nephrology Center, Mansoura University , Mansoura, Egypt
| | - Ahmed A Shokeir
- Department of Urology, Urology and Nephrology Center, Mansoura University , Mansoura, Egypt
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Sfoungaristos S, Lorber A, Gofrit ON, Yutkin V, Landau EH, Pode D, Duvdevani M. Surgical experience gained during an endourology fellowship program may affect fluoroscopy time during ureterorenoscopy. Urolithiasis 2015; 43:369-74. [DOI: 10.1007/s00240-015-0774-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 04/08/2015] [Indexed: 10/23/2022]
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Gönülalan U, Akand M, Hasırcı E, Koşan M. An unusual complication of a double-J ureteral stent: renal parenchymal perforation in a solitary kidney. Turk J Urol 2014; 40:245-7. [PMID: 26328186 DOI: 10.5152/tud.2014.76753] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 03/20/2014] [Indexed: 11/22/2022]
Abstract
Double-J ureteral stenting is commonly used in urological practice and has various complications. We report a patient with a renal parenchymal perforation and perirenal hematoma due to a double-J ureteral stent in a solitary kidney. This complication of ureteral stents is rarely observed and is life-threatening.
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Affiliation(s)
- Umut Gönülalan
- Department of Urology, Başkent University Faculty of Medicine, Konya, Turkey
| | - Murat Akand
- Department of Urology, Selçuk University Faculty of Medicine, Konya, Turkey
| | | | - Murat Koşan
- Department of Urology, Başkent University Faculty of Medicine, Konya, Turkey
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Kuehhas FE, Miernik A, Sharma V, Sevcenco S, Javadli E, Herwig R, Szarvas T, Schoenthaler M, Schatzl G, Weibl P. A prospective evaluation of pain associated with stone passage, stents, and stent removal using a visual analog scale. Urology 2013; 82:521-5. [PMID: 23768523 DOI: 10.1016/j.urology.2013.04.031] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2012] [Revised: 02/23/2013] [Accepted: 04/19/2013] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate the perception of colicky pain due to ureteral stones and double-J (DJ)-associated discomfort and to evaluate the role of clinical parameters that might influence the perception of pain. MATERIALS AND METHODS From November 2011 to May 2012, 124 consecutive patients with colicky pain due to ureteral stones and ureteroscopic stone extraction underwent DJ stent placement. A visual analog scale (VAS) was used to assess the pain at ureteral colic, during indwelling DJ stent, and at DJ stent removal. The association of clinical data with pain scores was also analyzed. RESULTS Pain perception at the time of colic did not vary according to sex (P = .804), age (P = .674), or DJ stent length (P = .389). Stone size (<4 mm) was a predictor of a high VAS score (P = .001). Patients with recurrent stone formation had significantly less pain at the time of colic (P = .004), and DJ stent removal (P = .004) than those with the first instance of stone formation. The clinical experience at cystoscopic DJ stent removal influenced pain perception (P <.001). CONCLUSION Using a VAS for the evaluation of pain perception is a valid method for the objectification of subjective discomfort. The VAS is an easy to administer scale and provides accurate information on the patients' status. Additional studies with larger cohorts focusing on pain perception using the VAS and other validated questionnaires are recommended to produce more consistent data.
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Picozzi SCM, Ricci C, Stubinski R, Casellato S, Ratti D, Macchi A, Bozzini G, Carmignani L. Is stone diameter a variable in the decision process of employing a ureteral stent in patients undergoing uncomplicated ureterorenoscopy and associated intracorporeal lithotripsy? World J Urol 2013; 31:1617-25. [PMID: 23462959 DOI: 10.1007/s00345-013-1046-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Accepted: 02/18/2013] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION A number of randomized trials and meta-analysis in patients who underwent ureteroscopic stone removal investigated the effects of placing a ureteral stent at the end of the procedure on complication rates. However, none of these investigates the stone diameter and its possible influence on complication rates and, as such, if it should be considered a possible variable in the decision process of placing or not a ureteral stent. MATERIALS AND METHODS A bibliographic search covering the period from January 1990 to March 2012 was conducted in PubMed, MEDLINE and EMBASE. This analysis is based on the fifteen remaining studies which fulfilled the predefined inclusion criteria. All statistical evaluations were performed using SAS version 9.2. and by RevMan 5.0. RESULTS A total of 1,416 patients were included. All the studies were published after 2000. Mean stone diameter ranged between 5.3 and 13.3 mm in the non-stented group and between 6.26 and 13.28 mm in the stented group. Meta-analysis showed that stone diameter was not statistically different for stented or non-stented subgroups, whereas surgical operative time was shorter for the non-stented subgroup. The effect of stone diameter, irrespectively if patients were operated with or without stents were grouped or considered separately, did not influence complications of fever, haematuria, unplanned medical visits after surgery and urinary tract infections. CONCLUSIONS Stone diameter is not a variable in the pre- or intraoperative decision process of placing or not placing a ureteral stent in patients undergoing uncomplicated ureterorenoscopy with intracorporeal lithotripsy.
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Affiliation(s)
- Stefano C M Picozzi
- Urology Department, IRCCS Policlinico San Donato, University of Milan, Via Morandi 30, 20097, San Donato Milanese, Milan, Italy,
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Pan J, Chen Q, Xue W, Chen Y, Xia L, Chen H, Huang Y. RIRS versus mPCNL for single renal stone of 2-3 cm: clinical outcome and cost-effective analysis in Chinese medical setting. Urolithiasis 2012; 41:73-8. [PMID: 23532427 DOI: 10.1007/s00240-012-0533-8] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Accepted: 12/08/2012] [Indexed: 02/07/2023]
Abstract
The aim of the study was to compare the clinical outcome and the cost-effectiveness between retrograde intra renal surgery (RIRS) and mini-percutaneous nephrolithotripsy (mPCNL) for the management of single renal stone of 2-3 cm in Chinese medical setting. From May 2005 to February 2011, 115 patients with solitary renal calculi were treated either by RIRS or mPCNL. 56 patients were in RIRS group while 59 were in mPCNL group. Patients' demographics between the two groups, in terms of gender, age, BMI, history of ESWL as well as stone side, stone location and stone size were comparable. Peri-operative course, clinical outcome, complication rates and medical cost were compared. The effective quotient (EQ) of two groups was calculated. Data were analyzed using Fisher's exact test, Chi-square test and Student's t test. EQ for RIRS and mPCNL were 0.52 and 0.90. The initial stone-free rate (SFR) of RIRS group and mPCNL group was 71.4 and 96.6 %, respectively (P = 0.000). The mean procedure number was 1.18 in RIRS group and 1.03 in mPCNL group, respectively (P = 0.035). The operative time for RIRS was longer (P = 0.000) while the mean hospital stay was shorter (P = 0.000). There was no statistical difference in peri-operative complications between the groups. The initial hospitalization cost, laboratory and radiology test cost of RIRS group were lower (P = 0.000). However, counting the retreatment cost in the two groups, the total medical expenditure including the overall hospitalization cost, overall laboratory and radiology test cost and post-operative out-patient department (OPD) visit cost was similar between two groups. In conclusion, with similar total medical cost, mPCNL achieved faster stone clearance and lower retreatment rate without major complications, which implied higher cost-effectiveness for the treatment of single renal stone of 2-3 cm in Chinese medical setting. RIRS is also a safe and reliable choice for patients having contraindications or preference against mPCNL.
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Affiliation(s)
- Jiahua Pan
- Department of Urology, Renji Hospital, Shanghai Jiaotong University, School of Medicine, No.1630 Dong Fang Road, Shanghai, 200127, China.
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Schoenthaler M, Wilhelm K, Kuehhas FE, Farin E, Bach C, Buchholz N, Miernik A. Postureteroscopic lesion scale: a new management modified organ injury scale--evaluation in 435 ureteroscopic patients. J Endourol 2012; 26:1425-30. [PMID: 22698147 DOI: 10.1089/end.2012.0227] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND PURPOSE Objective parameters for the classification of ureteral injuries and resulting indications for ureteral stent placement after ureteroscopy are lacking. We hereby present a new classification system including proof of interrater reliability and validation of recommendations for postoperative ureteral stent placement. PATIENTS AND METHODS The Postureteroscopic Lesion Scale (PULS) was applied in 435 patients undergoing ureteroscopy. Interrater reliability between three surgeons (junior resident, senior resident, and specialist) was evaluated in 112 patients. Postoperative ureteral stent placement was performed according to PULS. For follow-up with ultrasonography, we assumed hydronephrosis to be an indirect sign for significant postoperative ureteral obstruction. RESULTS No ureteral lesion was seen in 46.2% of patients (grade 0). A grade 1, 2, or 3 lesion was seen in 30.8%, 19.1%, and 3.9% of patients, respectively. No grade 4 or 5 lesions were observed in our series. Interrater reliability was high (Kendall W=0.91; mean Spearman Rho=0.86). This was particularly true between senior resident and specialist (Rho=0.95), compared with junior resident and senior resident or specialist (Rho=0.83, Rho=0.79, respectively). All patients with documented lesions had a Double-J stent placed. Indwelling time varied according to PULS. Results of a postoperative ultrasonographic follow-up could be obtained in 95.6% of cases. No patient showed clinical or sonographic signs of upper urinary tract obstruction. CONCLUSIONS According to these preliminary data for the clinical application of PULS, interrater reliability is high. Standardized empiric recommendations for the use and duration of postoperative stent placement after ureteroscopy might be useful in guiding urologists in this conversely discussed issue, ultimately preventing ureteral strictures as a late complication of ureteroscopy. These will have to be confirmed, however, by controlled trials in the future.
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Affiliation(s)
- Martin Schoenthaler
- Department of Urology, University Medical Centre Freiburg, Freiburg, Germany.
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Reply by Authors. J Urol 2012. [DOI: 10.1016/j.juro.2011.12.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Bader MJ, Eisner B, Porpiglia F, Preminger GM, Tiselius HG. Contemporary management of ureteral stones. Eur Urol 2012; 61:764-72. [PMID: 22266271 DOI: 10.1016/j.eururo.2012.01.009] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Accepted: 01/05/2012] [Indexed: 10/14/2022]
Abstract
CONTEXT Ureteral calculi represent a common condition that urologists encounter in everyday practice. Several treatment options are available for calculi that do not pass spontaneously or are unlikely to do so. OBJECTIVE In this nonsystematic review, we summarize the existing data on contemporary management of ureteral stones focusing on medical expulsive therapy (MET) and different treatment modalities. EVIDENCE ACQUISITION A PubMed search was performed. We reviewed the recent literature on the management of ureteral calculi. Articles were considered between 1997 and 2011. Older studies were included selectively if historically relevant. EVIDENCE SYNTHESIS For stones that do not pass spontaneously or with MET, shock wave lithotripsy (SWL) and ureteroscopy (URS) are the most common and efficient treatment modalities. Both techniques have obvious advantages and disadvantages as well as different patterns of complications. For select cases or patients, other modalities may be useful. CONCLUSIONS Ureteral stones of up to 10mm and eligible for observation may be offered MET. For most ureteral calculi that require treatment, advances in SWL and URS allow urologists to take a minimally invasive approach. Other more invasive treatments are reserved for select "nonstandard" cases.
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Affiliation(s)
- Markus J Bader
- Department of Urology, Ludwig-Maximilians-University, Klinikum Grosshadern, Munich, Germany.
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Tang L, Gao X, Xu B, Hou J, Zhang Z, Xu C, Wang L, Sun Y. Placement of Ureteral Stent After Uncomplicated Ureteroscopy: Do We Really Need It? Urology 2011; 78:1248-56. [DOI: 10.1016/j.urology.2011.05.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2011] [Revised: 04/15/2011] [Accepted: 05/05/2011] [Indexed: 11/28/2022]
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Pengfei S, Yutao L, Jie Y, Wuran W, Yi D, Hao Z, Jia W. The results of ureteral stenting after ureteroscopic lithotripsy for ureteral calculi: a systematic review and meta-analysis. J Urol 2011; 186:1904-9. [PMID: 21944085 DOI: 10.1016/j.juro.2011.06.066] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Indexed: 02/05/2023]
Abstract
PURPOSE We evaluated the necessity and adverse effects of routine ureteral stent placement after ureteroscopic lithotripsy for ureteral stones. MATERIALS AND METHODS A systematic search of PubMed®, Embase® and the Cochrane Library was performed to identify all randomized controlled trials. All relevant studies were on the outcomes and complications of ureteroscopic lithotripsy in the management of ureteral stones with or without a Double-J stent. The outcomes and complications included stone-free rate, operative time, lower urinary tract symptoms, hematuria, fever, urinary tract infection, pain and analgesia, unplanned medical visits and late postoperative complications. The Cochrane Collaboration Review Manager software (RevMan 5.0.2) was used for statistical analysis. RESULTS A total of 16 randomized controlled trials were enrolled for analysis and involved 1,573 patients. Of these patients 797 were in the nonstented group and 776 in the stented group. There was a statistically significant difference in mean operative time between the 2 groups. The incidence of lower urinary tract symptoms and pain was significantly higher in the stented group than in the nonstented group. Significant differences between the groups were not found in fever, urinary tract infection, need for analgesia, unplanned readmission and late postoperative complications. CONCLUSIONS This systematic review reveals the obvious disadvantages of ureteral stents after ureteroscopic lithotripsy in lower urinary tract symptoms and pain. Stents do not improve stone-free rate, fever, incidence of urinary tract infection, unplanned medical visits, requirement for analgesia and late postoperative complications. Ureteral stenting after uncomplicated ureteroscopic lithotripsy could be unnecessary.
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Affiliation(s)
- Shen Pengfei
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
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Shigemura K, Yasufuku T, Yamanaka K, Yamahsita M, Arakawa S, Fujisawa M. How long should double J stent be kept in after ureteroscopic lithotripsy? ACTA ACUST UNITED AC 2011; 40:373-6. [PMID: 21927861 DOI: 10.1007/s00240-011-0426-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2010] [Accepted: 08/31/2011] [Indexed: 12/01/2022]
Abstract
Ureteroscopic lithotripsy (UL), for renal or ureteral stones, is a standard technique for every urologist. However, the length of time the double J (DJ) stent needs to be kept in postoperatively is still controversial. This study investigated how the duration of DJ stenting after UL affects postoperative adverse events, especially infection and pain. One hundred and twenty-five patients were enrolled in this study and data were analyzed retrospectively. We set the median duration for keeping the DJ stent postoperatively as 14 days from median value in all cases and compared it to a longer duration group (>15 days) and a shorter duration group (<14 days) in terms of febrile complications, urinalysis, and the need to give antibiotics at the time of DJ stent removal. The duration of DJ stenting was from 3 to 61 (median 14) days. Thirteen patients had adverse events related to DJ stent removal (febrile complications, 11 patients; lumbago, 2 patients). Thirty-one patients were given antibiotics at the time of DJ stent removal. Patients with longer durations (>15 days) of DJ stenting had a significantly higher ratio of adverse events such as fever or lumbago (p = 0.041). In conclusion, this study demonstrated that shorter duration (<14 days) DJ stent use after UL may decrease adverse events and require less antibiotic use. Further prospective studies are needed to determine the optimal duration of DJ stent use after UL.
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Başeskioğlu B, Sofikerim M, Demirtaş A, Yenilmez A, Kaya C, Can C. Is ureteral stenting really necessary after ureteroscopic lithotripsy with balloon dilatation of ureteral orifice? A multi-institutional randomized controlled study. World J Urol 2011; 29:731-6. [PMID: 21590466 DOI: 10.1007/s00345-011-0697-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Accepted: 05/04/2011] [Indexed: 10/18/2022] Open
Abstract
PURPOSE Our aim was to evaluate the role of balloon dilatation of the ureteral orifice on the decision to stent after ureteroscopy. MATERIALS AND METHODS We prospectively enrolled 505 patients from two clinics, undergoing ureteroscopy (URS) for urolithiasis. Patients having balloon dilatation of the ureteral orifice and uncomplicated ureteroscopy were randomized to be either stented (n = 144) or nonstented (n = 142). Ureteroscopy was done with a 9.8 rigid ureteroscope. For dilatation of ureteral orifice, 18Fr-4 cm balloons were used (Uromax™, Boston Scientific, USA). Holmium laser or pneumatic devices were used for lithotripsy. In the second postoperative week, patients were asked to assess: pain, dysuria, and urgency using a 10-cm visual analog score (VAS) and unplanned visits. In each visit, urinalysis, urine culture, plain X-ray, and ultrasound examinations were performed. Six months after URS, follow-up IVU was performed to evaluate ureteral narrowing. Results for the separate clinics were not revealed until the end of study. RESULTS There were no significant differences between the two groups regarding gender, age, preoperative serum creatinine levels, stone size, stone side and location, lithotripsy type, pain, infectious complications, unplanned visits, and ureteral narrowing. However, irritative symptoms were more common in the stented group. Success rates of 97.8 and 97.2% were similar in the unstented and stented groups. CONCLUSION In uncomplicated URS, balloon dilatation of the ureteral orifice should not significantly affect the decision for or against stent placement. Avoiding stents lowers costs and gives fewer irritative symptoms.
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Tanriverdi O, Yencilek F, Koyuncu H, Yencilek E, Sarica K. Emergent Stenting After Uncomplicated Ureteroscopy: Evaluation of 23 Patients. Urology 2011; 77:305-8. [DOI: 10.1016/j.urology.2010.07.472] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Revised: 06/29/2010] [Accepted: 07/19/2010] [Indexed: 10/18/2022]
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Cevik I, Dillioglugil O, Akdas A, Siegel Y. Is stent placement necessary after uncomplicated ureteroscopy for removal of impacted ureteral stones? J Endourol 2010; 24:1263-7. [PMID: 20615145 DOI: 10.1089/end.2009.0153] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND PURPOSE Ureteral stent placement after ureteroscopic lithotripsy has some advantages and disadvantages. In this randomized study, the necessity of ureteral stent placement after uncomplicated ureteroscopy for impacted ureteral stones was assessed. MATERIALS AND METHODS Between 2005 and 2007, 60 evaluable patients were equally randomized to groups with and without stents. Patients underwent ureteroscopic pneumatic lithotripsy for ureteral stones. The operation was completed with or without stent placement according to the randomization order. Excretory urography was performed 3 months after the procedure. All stents were cystoscopically removed at the third postoperative week. Sociodemographic and clinical variables (age, sex, stone location, stone size, operative time, hospital stay, narcotic and nonnarcotic analgesic use), and postoperative complications (fever, pain delaying discharge, emergency department visit, urinary retention, stent-related irritative symptoms) were evaluated. RESULTS Mean stone size was not significantly different in both groups. Mean operative time was significantly longer in the stent group: 30.5 +/- 9.6 vs 43.7 +/- 11.6 minutes. On the operation day and until postoperative day (POD) 5, narcotic (P = 0.004) and nonnarcotic analgesic (P = not significant) use was more frequent in the no-stent group. At POD 5 and later, although narcotic and nonnarcotic analgesic use were frequently necessary in the stent group, both were almost unnecessary in the no-stent patients. Stent-related irritative symptoms were overwhelmingly higher (10% vs 93%) in the stent group. Discharge was delayed (23% vs 10%) and unplanned emergency department visits (20% vs 10%) were exercised almost two times more commonly in the no-stent group. Stone-free rates were identical (n = 29/30; 97%) in both groups. CONCLUSION Routine placement of a ureteral stent is not mandatory in patients without complications after ureteroscopic lithotripsy for impacted ureteral stones. Stent placement can be argued and agreed with the patients preoperatively in the light of the data presented above.
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Krambeck AE, Walsh RS, Denstedt JD, Preminger GM, Li J, Evans JC, Lingeman JE. A Novel Drug Eluting Ureteral Stent: A Prospective, Randomized, Multicenter Clinical Trial to Evaluate the Safety and Effectiveness of a Ketorolac Loaded Ureteral Stent. J Urol 2010; 183:1037-42. [DOI: 10.1016/j.juro.2009.11.035] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2009] [Indexed: 10/19/2022]
Affiliation(s)
- Amy E. Krambeck
- Methodist Hospital Institute for Kidney Stone Disease, Indianapolis, Indiana
| | | | | | | | - Jamie Li
- Boston Scientific Corporation, Natick, Massachusetts
| | - John C. Evans
- Boston Scientific Corporation, Natick, Massachusetts
| | - James E. Lingeman
- Methodist Hospital Institute for Kidney Stone Disease, Indianapolis, Indiana
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Shao Y, Zhuo J, Sun XW, Wen W, Liu HT, Xia SJ. Nonstented versus routine stented ureteroscopic holmium laser lithotripsy: a prospective randomized trial. ACTA ACUST UNITED AC 2008; 36:259-63. [PMID: 18797859 DOI: 10.1007/s00240-008-0153-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2007] [Accepted: 08/29/2008] [Indexed: 12/01/2022]
Abstract
We conducted a prospective, randomized study to evaluate whether postoperative ureteral stenting is necessary after ureteroscopic holmium laser lithotripsy. A total of 115 consecutive patients with distal or middle ureteral calculi amenable to ureteroscopic holmium laser lithotripsy were prospectively randomized into stented group (n = 58) and nonstented group (n = 57). The stent was routinely placed in the treated ureter for 2 weeks. The outcomes were measured with postoperative patient symptoms, stone-free rates, early and late postoperative complications, and cost-effectiveness. The postoperative symptoms were measured with Ureteral Stent Symptom Questionnaire (USSQ). All patients completed a 12-week follow-up. There was no significant difference between two groups with respect to the patient age, stone size, stone location and mean operative time. According to the USSQ, the symptoms of the stented group were significantly worse compared to the nonstented group (P = 0.0001). In the stented group, two patients had high fever for 1 week after the operation, stent migration was found in two patients, and the stents had to be removed earlier in five patients because of severe pain or hematuria. The cost of the stented group was significantly higher than the nonstented group. The stone-free rate was 100% in both groups. No hydronephrosis or ureteral stricture was detected by intravenous pyelogram in the 12th week postoperative follow-up. In conclusion, we believe that routine stenting after ureteroscopic intracorporeal lithotripsy with the holmium laser is not necessary as long as the procedure is uncomplicated for distal or middle ureteral calculis less than 2 cm.
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Affiliation(s)
- Yi Shao
- Department of Urology, Shanghai Jiaotong University Affiliated First People's Hospital, No 85, Wujin road, 200080, Shanghai, China
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Autorino R, Damiano R. Re: Ureteral stenting and urinary stone management: a systematic review G. Haleblian, K. Kijvikai, J. de la Rosette and G. Preminger J Urol 2008; 179: 424-430. J Urol 2008; 180:1573. [PMID: 18718616 DOI: 10.1016/j.juro.2008.06.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2008] [Indexed: 11/18/2022]
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Ibrahim HM, Al-Kandari AM, Shaaban HS, Elshebini YH, Shokeir AA. Role of ureteral stenting after uncomplicated ureteroscopy for distal ureteral stones: a randomized, controlled trial. J Urol 2008; 180:961-5. [PMID: 18639269 DOI: 10.1016/j.juro.2008.05.030] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2008] [Indexed: 10/21/2022]
Abstract
PURPOSE We determined the differences in outcome between ureteral stenting and nonstenting following uncomplicated ureteroscopy for distal ureteral stones. MATERIALS AND METHODS A total of 220 patients treated with successful ureteroscopy for distal ureteral stones were randomized to 2 equal groups according to postoperative placement of a ureteral stent (Cook Ireland, National Technological Park, Ireland), including group 1--without a stent and group 2--with a stent. Outcome measures were flank pain and dysuria at 48 hours and 1 week, early postoperative complications, analgesia need, rehospitalization, return to normal physical activity, stone-free rate, stone recurrence and late postoperative complications. Patients were followed a mean +/- SD of 25 +/- 9 months (range 12 to 49). RESULTS Early postoperative complications, including low grade fever, hematuria and urinary tract infection, were observed in 22 patients (20%) in group 1 and 19 (19%) in group 2, a difference of no significant value. Mean initial hospitalization and time to return to normal physical activity were not different between the 2 groups. At 48 hours and 1 week there was no significant difference in flank pain between the 2 groups, while dysuria was significantly less in the nonstented group. The amount of analgesics required in the recovery room was not different but after discharge from the hospital stented patients used a larger amount of analgesia while the stent was still in the ureter. The stone-free rate at 4 weeks was 100% in each group. Late postoperative sequelae, including stone recurrence and ureteral narrowing, were reported in 6 patients (5.5%) in group 1 and 4 (3.6%) in group 2, a difference of no significant value. CONCLUSIONS Uncomplicated ureteroscopy for treatment of distal ureteral stones is safe without stent placement. Patients without stents have significantly fewer irritative bladder symptoms and are not at risk of increased complications.
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Affiliation(s)
- Hamdy M Ibrahim
- Al-Adan Urology Unit, Ministry of Health, Kuwait City, Kuwait
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Makarov DV, Trock BJ, Allaf ME, Matlaga BR. The Effect of Ureteral Stent Placement on Post-ureteroscopy Complications: A Meta-analysis. Urology 2008; 71:796-800. [DOI: 10.1016/j.urology.2007.10.073] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2007] [Revised: 09/19/2007] [Accepted: 10/25/2007] [Indexed: 11/29/2022]
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Is routine ureteral stenting necessary after uncomplicated ureteroscopic lithotripsy for lower ureteral stones larger than 1 cm? ACTA ACUST UNITED AC 2008; 36:115-9. [PMID: 18385992 DOI: 10.1007/s00240-008-0135-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2007] [Accepted: 03/11/2008] [Indexed: 10/22/2022]
Abstract
We evaluated the need for routine ureteral stenting after uncomplicated ureteroscopic lithotripsy (URSL) without dilation for lower ureteral stones larger than 1 cm. A total of 43 patients underwent URSL for lower ureteral stones larger than 10 mm. They were randomized into a stented (21) or an unstented (22) group. URSL was performed by using a semirigid ureteroscope and pneumatic lithotripter without ureteral dilation. Additional forceps application (AFA) was used to remove fragments > or =4 mm. Patients in each group were assessed for stone-free rate, stone size, operative time, AFA, hospitalization time, postoperative pain, irritative voiding symptoms, hematuria, re-hospitalization and stricture formation. The stone-free rate was 100% in each group. There were no statistical differences in the two groups regarding stone size, operative time, AFA, postoperative pain, hematuria and hospitalization time. However, irritative voiding symptoms of the stented group were significantly higher than those in the unstented group (P < 0.05). One patient (4.5%) in the unstented group required re-hospitalization for severe flank pain with fever (>38 degrees C) compared to one patient (4.7%) in the stented group for proximal stent migration (P > 0.05). Stricture formation was not demonstrated in either group at 3 months follow-up excretory urography (EXU). Our results demonstrate that ureteral stenting after uncomplicated URSL without dilation for lower ureteral stones larger than 1 cm does not appear to be necessary if AFA is used to remove fragments > or =4 mm, thereby reducing morbidity of patients and risk of re-hospitalization.
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Damiano R, Autorino R, De Sio M, Giacobbe A, Palumbo IM, D'Armiento M. Effect of Tamsulosin in Preventing Ureteral Stent-Related Morbidity: A Prospective Study. J Endourol 2008; 22:651-6. [DOI: 10.1089/end.2007.0257] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Rocco Damiano
- Department of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | | | - Marco De Sio
- Department of Urology, Second University of Naples, Naples, Italy
| | - Alessandro Giacobbe
- Department of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy
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Rubenstein RA, Zhao LC, Loeb S, Shore DM, Nadler RB. Prestenting improves ureteroscopic stone-free rates. J Endourol 2008; 21:1277-80. [PMID: 18042014 DOI: 10.1089/end.2007.9888] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Although the use of stents after ureteroscopy has been studied extensively, relatively little has been published about stent placement before complicated ureteroscopic procedures. In this study, we examined our experience with stent placement before ureteroscopic management of renal and ureteral stone disease. PATIENTS AND METHODS A total of 90 patients underwent ureteroscopic surgery on 115 renal units by a single surgeon from 2001 to 2006. All patients had documented follow-up with imaging either by CT or intravenous urography (IVU) with tomography. Patients were classified into two groups depending on whether they had a stent placed before ureteroscopy. Baseline characteristics, operative indications for stent placement, stone-free rates, and complications were compared between groups. RESULTS Baseline characteristics were similar between the groups. The majority of patients received stents before stone management because of technical considerations during surgery (17/36, 47%) or infection (13/36, 37%). Strict stone-free rates after ureteroscopic treatment were 47% in the 79 procedures without previous stents, compared with 67% in the 36 procedures with prestenting (P < 0.05). Including small fragments (2 mm or smaller), stone-free rates improved to 54% v 78%, respectively (P < 0.02). Complications were not significantly different in the two groups (P = 0.70). CONCLUSION Although routine stent placement is not necessary before all ureteroscopic procedures, we demonstrate that it is associated with good stone-free rates and few complications. In this retrospective cohort, prestenting was associated with significantly higher stone-free rates. Prestenting should be considered in challenging cases.
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Affiliation(s)
- Ronald A Rubenstein
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA.
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Haleblian G, Kijvikai K, de la Rosette J, Preminger G. Ureteral Stenting and Urinary Stone Management: A Systematic Review. J Urol 2008; 179:424-30. [PMID: 18076928 DOI: 10.1016/j.juro.2007.09.026] [Citation(s) in RCA: 140] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2007] [Indexed: 10/22/2022]
Affiliation(s)
- George Haleblian
- Comprehensive Kidney Stone Center, Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Kittinut Kijvikai
- Department of Urology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Department of Urology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Jean de la Rosette
- Department of Urology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Glenn Preminger
- Comprehensive Kidney Stone Center, Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina
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Karadag MA, Tefekli A, Altunrende F, Tepeler A, Baykal M, Muslumanoglu AY. Is Routine Radiological Surveillance Mandatory After Uncomplicated Ureteroscopic Stone Removal? J Endourol 2008; 22:261-6. [DOI: 10.1089/end.2006.0445] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mert Ali Karadag
- Department of Urology, Haseki Teaching and Research Hospital, Istanbul, Turkey
| | - Ahmet Tefekli
- Department of Urology, Haseki Teaching and Research Hospital, Istanbul, Turkey
| | - Fatih Altunrende
- Department of Urology, Haseki Teaching and Research Hospital, Istanbul, Turkey
| | - Abdulkadir Tepeler
- Department of Urology, Haseki Teaching and Research Hospital, Istanbul, Turkey
| | - Murat Baykal
- Department of Urology, Haseki Teaching and Research Hospital, Istanbul, Turkey
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Preminger GM, Tiselius HG, Assimos DG, Alken P, Buck C, Gallucci M, Knoll T, Lingeman JE, Nakada SY, Pearle MS, Sarica K, Türk C, Wolf JS. 2007 guideline for the management of ureteral calculi. J Urol 2008; 178:2418-34. [PMID: 17993340 DOI: 10.1016/j.juro.2007.09.107] [Citation(s) in RCA: 501] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2007] [Indexed: 12/28/2022]
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Hao P, Li W, Song C, Yan J, Song B, Li L. Clinical Evaluation of Double-Pigtail Stent in Patients with Upper Urinary Tract Diseases: Report of 2685 Cases. J Endourol 2008; 22:65-70. [PMID: 18177241 DOI: 10.1089/end.2007.0114] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ping Hao
- Oncological Center, Xinqiao Hospital, Third Military Medical University, Chongqing, People's Republic of China
| | - Weibing Li
- Urological Center, Southwest Hospital, Third Military Medical University, Chongqing, People's Republic of China
| | - Caiping Song
- Urological Center, Southwest Hospital, Third Military Medical University, Chongqing, People's Republic of China
| | - Junan Yan
- Urological Center, Southwest Hospital, Third Military Medical University, Chongqing, People's Republic of China
| | - Bo Song
- Urological Center, Southwest Hospital, Third Military Medical University, Chongqing, People's Republic of China
| | - Longkun Li
- Urological Center, Southwest Hospital, Third Military Medical University, Chongqing, People's Republic of China
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Damiano R, Autorino R. Re: Hooman Djaladat, Parvin Tajin, Pooya Payandemehr and Sara Alehashemi. Ureteral catheterization in uncomplicated ureterolithotripsy: a randomized, controlled trial. Eur Urol 2007;52:836-41. Eur Urol 2007; 52:924-5; author reply 926. [PMID: 17493743 DOI: 10.1016/j.eururo.2007.04.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2007] [Accepted: 04/26/2007] [Indexed: 11/24/2022]
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Osorio L, Lima E, Soares J, Autorino R, Versos R, Lhamas A, Marcelo F. Emergency ureteroscopic management of ureteral stones: why not? Urology 2007; 69:27-31; discussion 31-3. [PMID: 17270606 DOI: 10.1016/j.urology.2006.08.1116] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2006] [Revised: 05/19/2006] [Accepted: 08/22/2006] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To describe a single-center experience in the emergency ureteroscopic management of ureteral stones. METHODS We retrospectively considered the data from 144 patients (mean age 49.6 years, range 23 to 82) who had had obstructive ureteral stones and had undergone emergency ureteroscopy with stone retrieval. Intracorporeal pneumatic lithotripsy was performed when necessary. At the end of the procedure, a ureteral catheter was systematically left in place in 100 patients (69.4%) and removed within 24 hours. In the remaining 44 patients, a double-J stent was preferred and was removed within 30 days, depending on the clinical course. Stone-free status was defined as the complete absence of fragments at 1 month of follow-up. RESULTS The calculi were more frequently localized in the distal ureter than in the proximal one (90.3% versus 9.7%, respectively). The overall mean stone diameter was 9.1 mm (range 5 to 20). The overall stone-free rate was 92.4%. A greater stone-free rate was obtained in those with stones less than 10 mm (95.8%) than in those with stones larger than 10 mm (89%, P = 0.002). Similarly, a significantly better outcome occurred for those with stones located in the distal ureter (94.6%) than for those with stones in the proximal one (71.4%, P = 0.004). The overall complication rate was 4.2%. The mean hospital stay was 2.5 days (range 1 to 7). CONCLUSIONS In our experience, emergency ureteroscopy in cases of obstructive ureteral stones proved to be safe and effective. It has the main advantage of offering both immediate relief from pain and stone fragmentation. Additional extensive studies are warranted to corroborate these findings.
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Affiliation(s)
- Luis Osorio
- Department of Urology, Santo Antonio General Hospital, Oporto, Portugal.
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Keeley FX, Timoney AG. Routine stenting after ureteroscopy: think again. Eur Urol 2007; 52:642-4. [PMID: 17275989 DOI: 10.1016/j.eururo.2007.01.087] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2007] [Accepted: 01/25/2007] [Indexed: 11/16/2022]
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