1
|
Khopekar F, Nabi S, Shiva M, Stewart M, Rajendran B, Nabi G. Cost-effectiveness of quality improvement intervention to reduce time between CT-detection and ureteroscopic laser fragmentation in acute symptomatic ureteric stones management. World J Urol 2024; 42:144. [PMID: 38478078 PMCID: PMC10937764 DOI: 10.1007/s00345-023-04694-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 07/25/2023] [Indexed: 03/17/2024] Open
Abstract
OBJECTIVE To prospectively assess clinical and cost effectiveness of emergency ureteroscopic laser fragmentation of urinary stones causing symptoms or obstruction. PATIENTS AND METHODS 100 consecutive patients with an average (median) age 55.6 (57.5) years and average (median) stone size of 8.2 mm (± 7 mm) between October 2018 and December 2021 who underwent emergency ureteroscopy and laser fragmentation formed the study cohort as part of a clinical service quality improvement. Primary outcome was single procedure stone-free rate and cost-effectiveness. The secondary outcomes were complications, re-admission and re-intervention. A decision analysis model was constructed to compare the cost-effectiveness of emergency ureteroscopy with laser fragmentation (EUL) and emergency temporary stenting followed by delayed ureteroscopy with laser fragmentation (DUL) using our results and success rates for modelling. RESULTS Single procedure stone-free rates (SFR) for EUL and DUL were 85%. The re-intervention rate, re-admission and complication rates of the study cohort (EUL) were 9%, 18%, and 4%, respectively, compared to 15%, 20%, and 5%, respectively for the control cohort (DUL). The decision analysis modelling demonstrated that the EUL treatment option was more cost-efficient, averting £2868 (€3260) per patient for the UK health sector. Total cost of delayed intervention was £7783 (€8847) for DUL in contrast to £4915 (€5580) for EUL. CONCLUSIONS Implementation of quality improvement project based on a reduction in CT detection-to-laser fragmentation time interval in acute ureteric obstruction or symptoms caused by stones had similar clinical effectiveness compared to delayed ureteroscopic management, but more cost-effective.
Collapse
Affiliation(s)
| | - Soha Nabi
- University of Aberdeen, Aberdeen, UK
| | | | | | | | - Ghulam Nabi
- Ninewells Hospital, Dundee, UK.
- Division of Imaging Sciences and Technology, School of Medicine, Ninewells Hospital, Dundee, DD1 9SY, UK.
| |
Collapse
|
2
|
DiBianco JM, Conrado B, Daignault-Newton S, Witzke K, Wenzler D, Pimentel H, Ghani KR, Dauw CA. Practice patterns and outcomes of urgent versus elective ureteroscopy in a statewide surgical collaborative. World J Urol 2023; 41:221-227. [PMID: 36326915 PMCID: PMC9631605 DOI: 10.1007/s00345-022-04203-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 10/25/2022] [Indexed: 11/06/2022] Open
Abstract
PURPOSE Urgent indications for nephrolithiasis treatment include obstruction with intractable pain or renal impairment without untreated infection. Patients and hospitals may benefit from urgent primary ureteroscopy. We aimed to examine variation in urgent ureteroscopy utilization and associated outcomes. METHODS Using Reducing Operative Complications from Kidney Stones (ROCKS), we identified all ureteroscopy's between 2016 and 2019. Cases were classified by acuity (elective versus urgent). We assessed practice/urologist variation in urgent ureteroscopy performance. We characterized patients demographic, operative and outcomes data, making bivariate comparisons with elective ureteroscopy to understand implications of urgent surgery. We performed multilevel modeling to understand factors associated with unplanned healthcare encounters after urgent ureteroscopy. RESULTS 12,859 cases were identified from 33 practices and 204 urologists, 10,854 (84.4%) elective and 2005 (15.6%) urgent. Urgent ureteroscopy was performed on younger patients (53 vs 57, p < 0.001), with higher rates of ureteral stones (72.8% vs 56.8%, p < 0.001). Urgent ureteroscopy rates varied widely by practice (2-70%) and urologist (0-98%). Urgent ureteroscopy had higher stenting rates (77.4% vs 72.5%, p < 0.001), stone free rates (66% vs 58.4%, p < 0.001), and postoperative ED visits (11% vs 7.2%, p < 0.001). There were no differences in intraoperative complications or unplanned hospitalizations. Factors predictive of ED visits in urgent ureteroscopy included concomitant ureteral/renal stone location (OR = 1.53, CI = 1.05-2.23, p = 0.035). CONCLUSIONS In Michigan elective ureteroscopy is performed 5 times more frequently than urgent ureteroscopy with wide variation. Urgent ureteroscopy demonstrated low morbidity. Urgent ureteroscopy produced modestly higher stone free rates with a slightly increased frequency of unscheduled ED visits particularly for ureteral stones.
Collapse
Affiliation(s)
| | - Bronson Conrado
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | | | - Karla Witzke
- Department of Urology, University of Michigan, Midland, MI, USA
| | | | | | - Khurshid R Ghani
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Casey A Dauw
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
3
|
Abu-Ghanem Y, Fontaine C, Sehgal R, Forster L, Verma N, Ellis G, Kucheria R, Allen D, Singh P, Goyal A, Ajayi L. Emergency Primary Ureteroscopy for Acute Ureteric Colic-From Guidelines to Practice. J Pers Med 2022; 12:jpm12111866. [PMID: 36579588 PMCID: PMC9695960 DOI: 10.3390/jpm12111866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 10/24/2022] [Accepted: 11/04/2022] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE To review the factors that may influence the ability to achieve the present guidelines' recommendations in a well-resourced tertiary centre. According to current National Institute for Health and Care Excellence (NICE) guidelines, definitive treatment (primary ureteroscopy (URS) or shock wave lithotripsy (ESWL)) should be offered to patients with symptomatic renal colic that are unlikely to pass the stone within 48 h of diagnosis. METHODS Retrospective review of all patients presenting to the emergency department between January and December 2019 with a ureteric or renal stone diagnosis. The rate of emergency intervention, risk factors for intervention and outcomes were compared between patients who were treated by primary definitive surgery vs. primary symptom relief by urethral stenting alone. RESULTS A total of 244 patients required surgical management for symptomatic ureteric colic without symptoms of urinary infection. Of those, 92 patients (37.7%) underwent definitive treatment by either primary URS (82 patients) or ESWL (9 patients). The mean time for the procedure was 25.5 h (range: 1-118). Patients who underwent primary definitive treatment were likelier to have smaller and distally located stones than the primary stenting group. Primary ureteroscopy was more likely to be performed in a supervised setting than emergency stenting. CONCLUSIONS Although definitive treatment carries high success rates, in a high-volume tertiary referral centre, it may not be feasible to offer it to all patients, with emergency stenting providing a safe and quick interim measure. Factors determining the ability to provide definitive treatment are stone location, stone size and resident supervision in theatre.
Collapse
|
4
|
Sehgal R, Abu-Ghanem Y, Fontaine C, Forster L, Goyal A, Allen D, Kucheria R, Singh P, Ellis G, Ajayi L. Primary Definitive Treatment versus Ureteric Stenting in the Management of Acute Ureteric Colic: A Cost-Effectiveness Analysis. J Pers Med 2022; 12:jpm12111773. [PMID: 36579512 PMCID: PMC9697827 DOI: 10.3390/jpm12111773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 10/23/2022] [Accepted: 10/25/2022] [Indexed: 01/01/2023] Open
Abstract
Objectives: To analyze the differences in cost-effectiveness between primary ureteroscopy and ureteric stenting in patients with ureteric calculi in the emergency setting. Patients and Methods: Patients requiring emergency intervention for a ureteric calculus at a tertiary centre were analysed between January and December 2019. The total secondary care cost included the cost of the procedure, inpatient hospital bed days, emergency department (A&E) reattendances, ancillary procedures and any secondary definitive procedure. Results: A total of 244 patients were included. Patients underwent ureteric stenting (62.3%) or primary treatment (37.7%), including primary ureteroscopy (URS) (34%) and shock wave lithotripsy (SWL) (3.6%). The total secondary care cost was more significant in the ureteric stenting group (GBP 4485.42 vs. GBP 3536.83; p = 0.65), though not statistically significant. While mean procedural costs for primary treatment were significantly higher (GBP 2605.27 vs. GBP 1729.00; p < 0.001), costs in addition to the procedure itself were significantly lower (GBP 931.57 vs. GBP 2742.35; p < 0.001) for primary treatment compared to ureteric stenting. Those undergoing ureteric stenting had a significantly higher A&E reattendance rate compared with primary treatment (25.7% vs. 10.9%, p = 0.02) and a significantly greater cost per patient related to revisits to A&E (GBP 61.05 vs. GBP 20.87; p < 0.001). Conclusion: Primary definitive treatment for patients with acute ureteric colic, although associated with higher procedural costs than ureteric stenting, infers a significant reduction in additional expenses, notably related to fewer A&E attendances. This is particularly relevant in the COVID-19 era, where it is crucial to avoid unnecessary attendances to A&E and reduce the backlog of delayed definitive procedures. Primary treatment should be considered concordance with clinical judgement and factors such as patient preference, equipment availability and operator experience.
Collapse
|
5
|
Alsawi M, Nalagatla S, Ahmad N, Chandiramani AS, Mokool L, Nalagatla SK, Somani B, Aboumarzouk OM, Amer T. Primary versus delayed ureteroscopy for ureteric stones: A systematic review and meta-analysis. JOURNAL OF CLINICAL UROLOGY 2022. [DOI: 10.1177/20514158221088687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Ureteric colic is a major clinical and economic burden on the National Health Service. There has been a recent paradigm shift to consider definitive surgery as the primary intervention at the time of initial presentation. Objective: To systematically evaluate the outcomes of primary/emergency ureteroscopy versus delayed/elective ureteroscopy. Methods: We performed a critical review of MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials–CENTRAL, CINAHL, Clinicaltrials.gov, Google Scholar and individual urological journals in April 2020. A robust database search was performed using a combination of the terms ‘primary ureteroscopy’, ‘immediate ureteroscopy’, ‘delayed ureteroscopy’ and ‘emergency ureteroscopy’. Adult patients (> 16 years) with ureteric stones presenting as an emergency were included. Results: Twelve studies met the inclusion criteria, with 4 studies directly comparing primary/emergency to delayed/elective ureteroscopy for an acute presentation of ureteric colic. Across the studies, 1708 patients underwent primary/emergency ureteroscopy for ureteric calculi and 990 underwent delayed ureteroscopy. No significant differences in stone-free rates were found between both groups with primary/emergency achieving 85% and delayed/elective 91% ( p = 0.68). The majority of stones treated were located in the distal ureter in both groups. Overall, there were no differences in complications between the groups ( p = 0.42) or major complications (0.17). However, there were fewer minor complications in the primary URS group ( p = 0.02). Ureteral catheter or double-J stent insertion was used in 71% of delayed/elective ureteroscopy cases, compared to 46.8% of primary/emergency cases (p = 0.001). For patients undergoing primary/emergency ureteroscopy, 6.4% patients required auxiliary procedures. In the delayed/elective group, 7.6% required further definitive treatment (NS). Conclusion: Primary ureteroscopy is a safe and feasible procedure, when performed in suitable patients in the acute setting. It is associated with significantly lower stent usage, equivalent stone clearance, no increase in overall or major complications including sepsis, and fewer minor complications when compared to delayed/elective ureteroscopy. Prospective studies will do well to explore this area further but on current evidence, primary ureteroscopy is the safe procedure. Level of evidence: Not applicable
Collapse
Affiliation(s)
| | | | - Nafees Ahmad
- Department of Urology, University Hospital Monklands, UK
| | | | - Leenesh Mokool
- Department of Urology, University Hospital Monklands, UK
| | | | - Bhaskar Somani
- Department of Urology, University Hospital Southampton NHS Foundation Trust, UK
| | - Omar M Aboumarzouk
- Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Qatar
| | - Tarik Amer
- Department of Urology, University Hospital Monklands, UK
| |
Collapse
|
6
|
Innes GD, Teichman JMH, Scheuermeyer FX, McRae AD, Grafstein E, Andruchow J, Cheng L, Law MR. Does early intervention improve outcomes for patients with acute ureteral colic? CAN J EMERG MED 2021; 23:679-686. [PMID: 34491558 DOI: 10.1007/s43678-020-00016-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 08/26/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Early surgical intervention is increasingly employed for patients with ureteral colic, but guidelines and current practice are variable. We compared 60-day outcomes for matched patients undergoing early intervention vs. spontaneous passage. METHODS This multicentre propensity-matched cohort analysis used administrative data and chart review to study all eligible emergency department (ED) patients with confirmed 2.0-9.9 mm ureteral stones. Those having planned stone intervention within 5 days comprised the intervention cohort. Controls attempting spontaneous passage were matched to intervention patients based on age, sex, stone width, stone location, hydronephrosis, ED site, ambulance arrival and acuity level. The primary outcome was treatment failure, defined as rescue intervention or hospitalization within 60 days, using a time to event analysis. Secondary outcome was ED revisit rate. RESULTS Among 1154 matched patients, early intervention did not reduce the risk of treatment failure (adjusted hazard ratio 0.94; P = 0.61). By 60 days, 21.8% of patients in both groups experienced the composite primary outcome (difference 0.0%; 95% confidence interval - 4.8 to 4.8%). Intervention patients required more hospitalizations (20.1% vs. 12.8%; difference 7.3%; 95% CI 3.0-11.5%) and ED revisits (36.1% vs. 25.5%; difference 10.6%; 95% CI 5.3-15.9%), but (insignificantly) fewer rescue interventions (18.9% vs. 21.3%; difference - 2.4%; 95% CI - 7.0 to 2.2%). CONCLUSIONS In matched patients with 2.0-9.9 mm ureteral stones, early intervention was associated with similar rates of treatment failure but greater patient morbidity, evidenced by hospitalizations and emergency revisits. Physicians should adopt a selective approach to interventional referral and consider that spontaneous passage probably provides better outcomes for many low-risk patients.
Collapse
Affiliation(s)
- Grant D Innes
- Department of Emergency Medicine and Department of Community Health Sciences, University of Calgary, Room C231, Foothills Medical Centre, 1403, 29 Street NW, Calgary, AB, T2N 2T9, Canada.
| | - Joel M H Teichman
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Frank X Scheuermeyer
- Department of Emergency Medicine and Center for Healthcare Evaluation and Outcome Sciences, St Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Andrew D McRae
- Department of Emergency Medicine and Department of Community Health Sciences, University of Calgary, Room C231, Foothills Medical Centre, 1403, 29 Street NW, Calgary, AB, T2N 2T9, Canada
| | - Eric Grafstein
- Department of Emergency Medicine and Center for Healthcare Evaluation and Outcome Sciences, St Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - James Andruchow
- Department of Emergency Medicine and Department of Community Health Sciences, University of Calgary, Room C231, Foothills Medical Centre, 1403, 29 Street NW, Calgary, AB, T2N 2T9, Canada
| | - Lucy Cheng
- Centre for Health Services and Policy Research, School for Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Michael R Law
- Centre for Health Services and Policy Research, School for Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
7
|
Al-Terki A, Alkabbani M, Alenezi TA, Al-Shaiji TF, Al-Mousawi S, El-Nahas AR. Emergency vs elective ureteroscopy for a single ureteric stone. Arab J Urol 2020; 19:137-140. [PMID: 34104487 PMCID: PMC8158266 DOI: 10.1080/2090598x.2020.1813004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective To compare emergency with elective ureteroscopy (URS) for the treatment of a single ureteric stone. Patients and methods The files of adult patients with a single ureteric stone were retrospectively reviewed. Patients with fever or turbid urine on passage of the guidewire beside the stone underwent ureteric stenting or nephrostomy drainage. Patients who underwent URS were included and divided into two groups: the emergency (EM) Group, those who presented with persistent renal colic and underwent emergency URS within 24 h; and the elective (EL) Group, who underwent elective URS after ≥14 days of diagnosis. Patients with ureteric stents were excluded. The technique for URS was the same in both groups. Safety was defined as absence of complications. Efficacy was defined as the stone-free rate after a single URS session. Results From March 2015 to September 2018, 179 patients (107 in the EM Group and 72 in the EL Group) were included. There were significantly more hydronephrosis and smaller stones in the EM Group (P = 0.002 and P = 0.001, respectively). Laser disintegration was needed in more patients in the EL Group (83% vs 68%, P = 0.023). Post-URS ureteric stents were inserted in more patients in the EM Group (91% vs 72%, P = 0.001). Complications were comparable for both groups (4.2% for EL and 5.6% for EM, P = 0.665). Stone-free rates were also comparable (93% in the EL Group and 96% in the EM Group, P = 0.336). Conclusions Emergency URS can be as safe and effective as elective URS for the treatment of a single ureteric stone if it is performed in patients without fever or turbid urine. Abbreviations: EL Group: elective group; EM Group: emergency group; KUB: plain abdominal radiograph of the kidneys, ureters and bladder; MET: medical expulsive therapy; NCCT: non-contrast CT; SFR: stone-free rate; SWL: shockwave lithotripsy; URS: ureteroscopy
Collapse
Affiliation(s)
| | | | | | | | | | - Ahmed R El-Nahas
- Urology Unit, Al-Amiri Hospital, Kuwait City, Kuwait.,Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| |
Collapse
|
8
|
Nestler S, Grüne B, Schilchegger L, Neisius A, Jones J. Evaluation of stone free rates in early versus delayed primary ureteroscopy: time does matter. World J Urol 2020; 39:909-914. [PMID: 32488357 DOI: 10.1007/s00345-020-03235-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 04/28/2020] [Indexed: 11/26/2022] Open
Affiliation(s)
- Sebastian Nestler
- Department of Urology, Hochtaunus Hospital, Bad Homburg, Germany.
- Urogate, Urological Practice, Frankfurt, Germany.
| | - Britta Grüne
- Department of Urology, Hochtaunus Hospital, Bad Homburg, Germany
- Department of Urology, University Medical Center, Mannheim, Germany
| | | | - Andreas Neisius
- Department of Urology, Brüderkrankenhaus Trier, University of Mainz, Trier, Germany
| | - Jon Jones
- Department of Urology, Hochtaunus Hospital, Bad Homburg, Germany
| |
Collapse
|
9
|
Early ureteroscopic lithotripsy in acute renal colic caused by ureteral calculi. Int Urol Nephrol 2019; 52:15-19. [PMID: 31586281 DOI: 10.1007/s11255-019-02298-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 09/23/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE We aimed at comparing the success and complications of early semirigid ureteroscopy (URS) and elective URS in ureteral calculi with renal colic that do not respond to analgesics. METHODS We retrospectively analyzed the data of 690 patients with obstructive ureteral stones who underwent URS with stone retrieval. 247 patients who underwent early URS within the first 12 h were classified as group I and 443 patients who underwent elective URS as group II. Both groups were compared in terms of age, sex, creatinine, eGFR, stone size, laterality, location and number of stones, type of lithotriptor, presence of hydronephrosis and success and complication rates. RESULTS The mean age of the patients was 50.4 (18-89 years) (p > 0.05). There was no statistically significant difference between the groups in terms of age, eGFR, side, presence of hydronephrosis, fever, mucosal damage, stone migration, perforated ureter, ureteral avulsion, ureteral stent insertion at the end of the surgery and sepsis (p > 0.05). Both groups had male dominance (p > 0.05). Creatinine was significantly lower in Group I (p < 0.05). The mean stone size was also significantly lower in Group I (p < 0.05). Middle and proximal ureteral calculi were more common in Group II (p < 0.05). Multiple stones were higher in Group II (p < 0.05). The dominant type of lithotriptor used was pneumatic in Group I and laser in Group II (p < 0.05). Stone-free rates (SFRs) were higher in Group I (98% vs 90% in the first month) (p < 0.05). Postoperative hematuria and infection were more common in Group II (p < 0.05). CONCLUSIONS In selected cases, early ureteroscopy is an effective and safe method for distal ureteral calculi smaller than 10 mm that are painful and resistant to analgesic treatment.
Collapse
|
10
|
Kirshenbaum EJ, Doshi C, Dornbier R, Blackwell RH, Bajic P, Gupta GN, Gorbonos A, Turk TMT, Flanigan RC, Baldea KG. Socioeconomic Disparities in the Acute Management of Stone Disease in the United States. J Endourol 2019; 33:167-172. [PMID: 30612434 DOI: 10.1089/end.2018.0760] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION Patients admitted to the hospital with an acute, noninfected episode of urolithiasis are candidates for medical expulsive therapy, ureteral stent placement, or upfront ureteroscopy (URS). We sought to assess socioeconomic factors influencing treatment decisions in managing urolithiasis and to determine differences in outcomes based on treatment modality. MATERIALS AND METHODS The Healthcare Cost and Utilization Project State Inpatient Database, State Ambulatory Surgery and Services Database, and State Emergency Department Database for California from 2007 to 2011 and for Florida from 2009 to 2014 were utilized. Patients who were admitted to the hospital with a primary diagnosis of kidney or ureteral stone were identified. The initial treatment modality utilized was assessed and factors that influenced that decision were analyzed. Multivariate logistic regression model was fit to determine factors independently associated with upfront URS. Lastly, outcomes of noninfected patients who underwent stent alone vs URS were compared. RESULTS We identified 146,199 patients who had an inpatient admission with urolithiasis. Overall, 45% of patients had no intervention at the time of their evaluation. Of the 55% of patients who underwent surgical intervention, 42% underwent stent alone, 44% underwent upfront URS, 1% had a PCN tube placement, 8% underwent extracorporeal shockwave lithotripsy, while 5% underwent PCNL. On multivariate logistic regression model, minorities, younger patients, publicly uninsured patients, more comorbid patients, those admitted on the weekends, and those admitted to an academic institution had significantly lower odds of undergoing upfront URS. Secondary analysis demonstrated clinical and economic advantages of upfront URS vs stent alone in eligible patients. CONCLUSION Upfront URS is an overlooked procedure that has clinical and cost-saving implications. Unfortunately, minorities, publicly insured patients, and those admitted on the weekend are less likely to undergo upfront URS, a disparity that should be addressed by urologist.
Collapse
Affiliation(s)
- Eric J Kirshenbaum
- 1 Loyola University Medical Center, Department of Urology, Maywood, Illinois
| | - Chirag Doshi
- 1 Loyola University Medical Center, Department of Urology, Maywood, Illinois
| | - Ryan Dornbier
- 1 Loyola University Medical Center, Department of Urology, Maywood, Illinois
| | - Robert H Blackwell
- 2 Southern Illinois University School of Medicine, Division of Urology, Springfield, Illinois
| | - Petar Bajic
- 1 Loyola University Medical Center, Department of Urology, Maywood, Illinois
| | - Gopal N Gupta
- 1 Loyola University Medical Center, Department of Urology, Maywood, Illinois
| | - Alex Gorbonos
- 1 Loyola University Medical Center, Department of Urology, Maywood, Illinois
| | - Thomas M T Turk
- 1 Loyola University Medical Center, Department of Urology, Maywood, Illinois
| | - Robert C Flanigan
- 1 Loyola University Medical Center, Department of Urology, Maywood, Illinois
| | - Kristin G Baldea
- 1 Loyola University Medical Center, Department of Urology, Maywood, Illinois
| |
Collapse
|
11
|
Arcaniolo D, De Sio M, Rassweiler J, Nicholas J, Lima E, Carrieri G, Liatsikos E, Mirone V, Monga M, Autorino R. Emergent versus delayed lithotripsy for obstructing ureteral stones: a cumulative analysis of comparative studies. Urolithiasis 2017; 45:563-572. [DOI: 10.1007/s00240-017-0960-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 01/22/2017] [Indexed: 12/23/2022]
|
12
|
Comparison of prone vs. supine unenhanced CT imaging in patients with clinically suspected ureterolithiasis. Abdom Radiol (NY) 2017; 42:569-576. [PMID: 27670877 PMCID: PMC5331073 DOI: 10.1007/s00261-016-0918-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
PURPOSE To retrospectively evaluate whether prone CT scanning is superior to supine scanning for correct localization of distal urinary calculi in patients with acute flank pain. METHODS Consecutively performed unenhanced CT scans in patients with acute flank pain were retrospectively analyzed in 150 patients in supine and another 150 patients in prone position. Images were reviewed by two radiologists on consensus. Findings in both groups were compared using two-sided Fisher Exact tests and Wilcoxon-Mann-Whitney test. RESULTS Urinary calculi were found in 67% of patients in each group. In the supine scanning group, there were 16 cases, in which the location of the stone was equivocal being either located intramurally at the ureterovesical junction (UVJ) or having already passed into the bladder. In contrast, in the prone imaging group all distal stones could be allocated accurately, either to the intramural UVJ or the urinary bladder (37 intramural UVJ stones and six bladder stones in prone scanning group vs. 21 intramural UVJ stones and one bladder stone when scanned supine). CONCLUSION Prone scanning is superior to supine CT scanning for acute flank pain to accurately distinguish intramural UVJ stones from stones that have already passed into the bladder, a distinction which influences patient management.
Collapse
|
13
|
Dreger NM, von Rundstedt FC, Roth S, Brandt AS, Degener S. The "Guidewire-Coil"-Technique to prevent retrograde stone migration of ureteric calculi during intracorporeal lithothripsy. BMC Urol 2017; 17:3. [PMID: 28056942 PMCID: PMC5217584 DOI: 10.1186/s12894-016-0197-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Accepted: 12/26/2016] [Indexed: 11/17/2022] Open
Abstract
Background Stone retropulsion represents a challenge for intracorporeal lithotripsy of ureteral calculi. The consequences are an increased duration and cost of surgery as well as decreased stone-free rates. The use of additional tools to prevent proximal stone migration entails further costs and risks for ureteral injuries. We present the simple technique of using a coil of the routinely used guidewire to prevent stone retropulsion. Methods We retrospectively evaluated all patients with mid-to-proximal ureteral stones in 2014, which were treated by ureteroscopic lithotripsy (Ho: YAG and/or pneumatic lithotripsy). The preoperative stone burden was routinely assessed using low dose CT scan (if available) and/or intravenous pyelogram. Results The study population consisted of 55 patients with 61 mid-to-proximal calculi. Twentyseven patients underwent semirigid ureterorenoscopy using the “Guidewire-Coil-Technique”, the second group (n = 28) served as control group using the guidewire as usual. There has been a statistically significant reduction of accidental stone retropulsion (2/27 vs. 8/28, p < 0.05) as well as a decreased use of auxiliary procedures (p < 0.05) compared to the control group. No difference was observed in operative time. One ureteral injury in the control group required a prolonged ureteral stenting. Conclusion The “Guidewire-Coil-Technique” is a simple and safe procedure that may help to prevent proximal calculus migration and therefore may increase stone-free rates without causing additional costs.
Collapse
Affiliation(s)
- Nici Markus Dreger
- Department of Urology, Helios Medical Center Wuppertal, Helios University Hospital Wuppertal, University of Witten/Herdecke, Heusnerstraße 40, Wuppertal, 42283, Germany.
| | - Friedrich Carl von Rundstedt
- Scott Department of Urology, Baylor College of Medicine Medical Center, 7200 Cambridge, Houston, TX, USA.,Department of Urology, Jena Medical Center, Friedrich-Schiller University, Bachstraße 18, Jena, 07743, Germany
| | - Stephan Roth
- Department of Urology, Helios Medical Center Wuppertal, Helios University Hospital Wuppertal, University of Witten/Herdecke, Heusnerstraße 40, Wuppertal, 42283, Germany
| | - Alexander Sascha Brandt
- Department of Urology, Helios Medical Center Wuppertal, Helios University Hospital Wuppertal, University of Witten/Herdecke, Heusnerstraße 40, Wuppertal, 42283, Germany
| | - Stephan Degener
- Department of Urology, Helios Medical Center Wuppertal, Helios University Hospital Wuppertal, University of Witten/Herdecke, Heusnerstraße 40, Wuppertal, 42283, Germany
| |
Collapse
|
14
|
Shabana W, Teleb M, Dawod T, Elsayed E, Desoky E. Feasibility and outcome of emergency ureteroscopic removal of lower ureteral stone under intravenous sedation: A prospective study. AFRICAN JOURNAL OF UROLOGY 2016. [DOI: 10.1016/j.afju.2015.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
15
|
Abstract
Ureteric colic is a common presentation to acute emergency services. The gold standard test for the diagnosis of acute ureteric colic is a non-contrast computer tomography of the kidneys ureters and bladder (CT KUB). Non-steroidal anti-inflammatory drugs (NSAIDs) should be used as first-line analgesia, with studies showing that there is no role for steroid or phosphodiesterase-5 inhibitors. There is emerging evidence that a high body mass index (BMI) is a risk factor. The drugs used to facilitate stone passage are known as medical expulsive therapy (MET). The most evaluated being alpha-blockers. The Spontaneous Urinary Stone Passage Enabled by Drugs (SUSPEND) trial was designed to evaluate the use of MET (tamsulosin and nifedipine). This trial showed that there was no difference with MET and placebo for the spontaneous passage of ureteric stones. There is an emerging role for the use of primary ureteroscopy in the management of non-infective ureteric stones.
Collapse
|
16
|
Sanguedolce F, Montanari E, Alvarez-Maestro M, Macchione N, Hruby S, Papatsoris A, Kallidonis P, Villa L, Honeck P, Traxer O, Greco F. Use of XenX™, the latest ureteric occlusion device with guide wire utility: results from a prospective multicentric comparative study. World J Urol 2016; 34:1583-1589. [DOI: 10.1007/s00345-016-1806-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Accepted: 03/11/2016] [Indexed: 11/29/2022] Open
|
17
|
Jessen JP, Breda A, Brehmer M, Liatsikos EN, Millan Rodriguez F, Osther PJS, Scoffone CM, Knoll T. International Collaboration in Endourology: Multicenter Evaluation of Prestenting for Ureterorenoscopy. J Endourol 2016; 30:268-73. [DOI: 10.1089/end.2015.0109] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jan Peter Jessen
- Department of Urology, Sindelfingen-Boeblingen Medical Center, University of Tuebingen, Sindelfingen, Germany
| | - Alberto Breda
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Marianne Brehmer
- Department of Urology, Karolinska University Stockholm Sweden and Aarhus University Hospital, Stockholm, Denmark
| | | | - Felix Millan Rodriguez
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Palle Jörn Sloth Osther
- Department of Urology, Lillebaelt Hospital, University of Southern Denmark, Fredericia, Denmark
| | | | - Thomas Knoll
- Department of Urology, Sindelfingen-Boeblingen Medical Center, University of Tuebingen, Sindelfingen, Germany
| |
Collapse
|
18
|
Shabana W, Teleb M, Dawod T. Safety and efficacy of using the stone cone and an entrapment and extraction device in ureteroscopic lithotripsy for ureteric stones. Arab J Urol 2015; 13:75-9. [PMID: 26413324 PMCID: PMC4561877 DOI: 10.1016/j.aju.2015.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 01/06/2015] [Accepted: 02/08/2015] [Indexed: 11/12/2022] Open
Abstract
Objective To assess the safety and efficacy of using a stone cone and an entrapment and extraction device (N-Trap®, Cook Urological, Bloomington, IN, USA) to avoid stone retropulsion during ureteroscopic lithotripsy for ureteric stones. Patients and methods This retrospective comparative study included 436 patients treated with ureteroscopic lithotripsy for a single ureteric stone from February 2011 to January 2014. The diagnosis of a stone was confirmed by plain spiral computed tomography in all cases. Patients were divided according to the ureteric occlusion device applied to avoid stone retropulsion during pneumatic lithotripsy into three groups; group 1 (156) had no instruments used, group 2 (140) in whom the stone cone was applied, and group 3 (140) in whom the N-Trap was used. Patient demographics, stone criteria, operative duration and complications, and success rates (complete stone disintegration with no upward migration) were reported and analysed statistically. Results The stone was in the lower ureter in >55% of patients in all groups. The mean (SD) of maximum stone length was 9.8 (2.5), 10.4 (2.8) and 9.7 (2.9) in groups 1–3, respectively. The use of the stone cone or N-Trap did not significantly increase the operative duration (P = 0.13) or complication rates (P = 0.67). There was a statistically significant difference (P < 0.001) favouring groups 2 and 3 for retropulsion and success rates, being 83.3% in group 1, 97.1% in group 2 and 95.7% in group 3. Conclusion The stone cone and N-Trap gave high success rates in preventing stone retropulsion during ureteric pneumatic lithotripsy. Both devices caused no increase in operative duration or complications when used cautiously.
Collapse
Affiliation(s)
- Waleed Shabana
- Zagazig University, Faculty of Medicine, Urology Department, Zagazig, Sharkia, Egypt
| | - Mohamed Teleb
- Zagazig University, Faculty of Medicine, Urology Department, Zagazig, Sharkia, Egypt
| | - Tamer Dawod
- Zagazig University, Faculty of Medicine, Urology Department, Zagazig, Sharkia, Egypt
| |
Collapse
|
19
|
Sterling M, Ziemba J, Mucksavage P. Acute management of symptomatic nephrolithiasis. World J Clin Urol 2014; 3:161-167. [DOI: 10.5410/wjcu.v3.i3.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 05/23/2014] [Accepted: 08/29/2014] [Indexed: 02/06/2023] Open
Abstract
Over half a million patients present to emergency departments and nearly 3 million patients visit healthcare providers annually due to problems associated with urolithiasis. Despite updated guidelines from the American Urological Association and European Association of Urology for the evaluation and management of nephrolithiasis, considerable variability still exists regarding treatment for acute symptomatic upper urinary tract stones. Therefore, this article will review the current evaluation and management of acute symptomatic nephrolithiasis. Initial management includes analgesia and antiemetics. Additionally, a urinalysis and creatinine are required laboratory evaluations. Acute imaging with a non-contrast computed tomography (CT) scan is the diagnostic imaging modality of choice. However, concerns over radiation exposure have led towards low-dose and even ultra-low-dose protocols for the detection of urinary calculi. Low-dose non-contrast CT scans are now standard of care for the initial diagnosis of renal colic in patients with a body mass index ≤ 30. Medical expulsive therapy is recommended for patients with a ureteral calculus < 10 mm and no signs of infection. Emergency urinary decompression is mandatory for a specific subset of patients, especially those with infection. Although limited data exists, emergency ureteroscopy or even shock wave lithotripsy may also be therapeutic options.
Collapse
|
20
|
Zargar-Shoshtari K, Anderson W, Rice M. Role of emergency ureteroscopy in the management of ureteric stones: analysis of 394 cases. BJU Int 2014; 115:946-50. [PMID: 24925167 DOI: 10.1111/bju.12841] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To analyse the outcomes of emergency ureteroscopy (URS) cases performed in Auckland City Hospital. METHODS We conducted a retrospective review of all emergency URS procedures performed at Auckland City Hospital between 1 January 2010 and 31 December 2011. Data on patients, stones and procedures were collected and analysed. Emergency URS failure was defined as fragments >3 mm or the need for a repeat procedure. RESULTS A total of 499 URS procedures were identified. Of these 394 (79%) were emergency procedures. The mean (sd; range) patient age was 48 (16; 13-88) years. In all, 83% of emergency URS cases had an American Society of Anesthesiologists (ASA) score of 1 or 2, 25% of stones were >9 mm, with a mean (sd) size of 8 (4) mm, and 285 procedures (72%) were successful. These patients were younger (47 vs 51 years), were more likely to have an ASA score of 1 (103 patients in the successful treatment group vs 26 in the failed treatment group), had smaller stones (7 vs 9 mm) and were more likely to have distal stones (P < 0.05). A total of 20 complications (5%) were recorded including six false passages and three mucosal injuries, one of which required radiological intervention, and 50 patients (13%) re-presented, for pain (76%), bleeding (10%) or infection (14%). CONCLUSION We showed that emergency URS is a feasible approach for the routine management of acute ureteric colic with a low complications rate. A subgroup of younger, healthier patients may benefit the most from the procedure.
Collapse
Affiliation(s)
| | - William Anderson
- Department of Urology, Auckland City Hospital, Auckland, New Zealand
| | - Michael Rice
- Department of Urology, Auckland City Hospital, Auckland, New Zealand
| |
Collapse
|
21
|
Balci M, Tuncel A, Aydin O, Aslan Y, Guzel O, Toprak U, Polat F, Atan A. Tamsulosin versus nifedipin in medical expulsive therapy for distal ureteral stones and the predictive value of Hounsfield unit in stone expulsion. Ren Fail 2014; 36:1541-4. [DOI: 10.3109/0886022x.2014.959023] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
22
|
Panah A, Patel S, Bourdoumis A, Kachrilas S, Buchholz N, Masood J. Factors predicting success of emergency extracorporeal shockwave lithotripsy (eESWL) in ureteric calculi--a single centre experience from the United Kingdom (UK). Urolithiasis 2013; 41:437-41. [PMID: 23748923 PMCID: PMC7120875 DOI: 10.1007/s00240-013-0580-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 05/25/2013] [Indexed: 01/22/2023]
Abstract
Few studies show that "emergency extracorporeal shockwave lithotripsy (eESWL)" reduces the incidence of ureteroscopy in patients with ureteric calculi. We assess success of eESWL and look to study and identify factors which predict successful outcome. We retrospectively studied patients presenting with their first episode of ureteric colic undergoing eESWL (within 72 h of presentation) over a 5-year period. Patient's age, gender, stone size and location, time between presentation and ESWL, number of shock waves and ESWL sessions, and Hounsfield units (HU) were recorded. 97 patients (mean age 40 years; 76 males, 21 females) were included. 71 patients were stone free after eESWL (73.2 %) (group 1) and 26 patients failed treatment and proceeded to ureteroscopy (group 2). The two groups were well matched for age and gender. Mean stone size in group 1 and 2 was 6.4 mm and 7.7 mm, respectively, (p = 0.00141). Stone location was 34, 21, and 16 in upper, middle and lower ureter in group 1 compared to 11, 5, and 10 in group 2, respectively. Mean HU in group 1 was 480 and 612 in group 2 (p value 0.0036). In group 2, significantly, more patients received treatment after 24 h compared with group 1 (38 vs 22.5 %). The number of shock waves, maximal intensity, and ESWL sessions were not significantly different in the two groups. No complications were noted. eESWL is safe and effective in patients with ureteric colic. Stone size and Hounsfield units are important factors in predicting success. Early treatment (≤24 h) minimizes stone impaction and increases the success rate of ESWL.
Collapse
Affiliation(s)
- A Panah
- Endourology and Stone Services, Barts Health NHS Trust, London, UK
| | | | | | | | | | | |
Collapse
|
23
|
Matani YS, Al-Ghazo MA, Al-Azab RS, Hani OB, Ghalayini IF, Hani IB. Emergency versus elective ureteroscopic treatment of ureteral stones. Can Urol Assoc J 2013; 7:E470-4. [PMID: 23914262 DOI: 10.5489/cuaj.1402] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION This retrospective study investigates the role of the emergency ureteroscopic (URS) approach in the definitive treatment of ureteric stones. METHODS We reviewed all patients admitted for ureteric stones from May 2003 to December 2010. Those who underwent URS stone treatment were selected and stratified into emergency (EMG) and elective groups (ELG). Emergency URS is defined as URS being performed within 24 hours of admission to the emergency room. The main indication for emergency treatment was refractory ureteric colic in spite of narcotic analgesia. Both groups were statistically compared in terms of their patient-, stone- and outcome-related variables. The overall success rate was defined by the clearance of the stone and/or presence of residual fragments (<3 mm) at the end of 4-week follow-up period. RESULTS In total, 903 patients were suitable for analysis with 244 and 659 patients in the EMG and ELG, respectively. Age, sex and comorbidities were comparable in both groups. Average ages were 43.4 ± 15.31 and 45.6 ± 13.24 years among EMG and ELG, respectively. Stones had an average size of 0.92 ± 0.49 (in the EMG group) and 0.96 ± 0.53 cm (in the ELG group). We found that 61.1% and 65.7% of stones were distally located in the EMG and ELG, respectively. EMG had a longer operative time (69 ± 21.03 vs. 57 ± 13.45 minutes) with comparable average hospital stays (1.9 days). Intra-operative double-J stents or ureteric catheter insertion was noted in 72.5 and 67.7% of EMG and ELG, respectively. The overall complication rates were reported in 13.1% in EMG and 14.4% in ELG. A higher rate of ureteric injuries (early and late) was documented in the EMG group (7% vs. 5.6%). Most of these injuries were minor and manageable without additional procedure and/or general anesthesia. Success was achieved in 90.6% and 91.8% of the EMG and ELG groups, respectively. CONCLUSION With recent advances in technology, the growing trend toward one-stage definitive treatment, patient acceptability and rising concerns over financial aspects, emergency URS treatment of ureteric stones is evolving as a standard initial management option.
Collapse
Affiliation(s)
- Yousef S Matani
- King Abdullah University Hospital, Department of Surgery and Urology, Jordan University of Science and Technology, Faculty of Medicine, Irbid, Jordan
| | | | | | | | | | | |
Collapse
|
24
|
Gunlusoy B, Degirmenci T, Kozacioglu Z, Arslan M, Ceylan Y, Nergiz N, Minareci S. Factors Affecting the Complications of Pneumatic Lithotripsy for the Treatment of Ureteral Stones with Different Localizations: A Multivariate Analysis of Complications. Urol Int 2013; 91:357-62. [DOI: 10.1159/000350243] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Accepted: 02/21/2013] [Indexed: 11/19/2022]
|
25
|
Elashry OM, Tawfik AM. Preventing stone retropulsion during intracorporeal lithotripsy. Nat Rev Urol 2012; 9:691-8. [DOI: 10.1038/nrurol.2012.204] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
26
|
Gunlusoy B, Degirmenci T, Arslan M, Kozacıoglu Z, Koras O, Ceylan Y, Ors B. Is bilateral ureterorenoscopy the first choice for the treatment of bilateral ureteral stones? An updated study. Urol Int 2012; 89:412-7. [PMID: 23128066 DOI: 10.1159/000342662] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Accepted: 08/07/2012] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We analyze our recent results and discuss the advantages and disadvantages of bilateral single-session ureterorenoscopy (URS) for bilateral ureteral stones. PATIENTS AND METHODS 55 patients underwent URS with pneumatic lithotripsy (PL) for bilateral stones. 61 (55.5%), 28 (25.4%) and 21 (19.1%) stones were located in the lower, middle and upper ureter, respectively. RESULTS Of the 110 stones, 99 (90.0%) were fragmented in a single procedure. The stone clearance rate was 94.5% after the second session. The stone clearance rates with regard to stone location were 71.4, 89.3 and 96.7% for the upper, middle and lower ureter, respectively. An analysis of the clearance rates based on location demonstrated that lower ureteric stones were more successfully removed than upper ureteric stones (96.7 vs.71.4%, p = 0.003). CONCLUSION Bilateral single-session URS with PL is a highly effective treatment modality for bilateral ureteral stones. The success rate of PL is affected by stone size and location.
Collapse
Affiliation(s)
- Bulent Gunlusoy
- Department of Urology, Izmir Education and Research Hospital, Izmir, Turkey.
| | | | | | | | | | | | | |
Collapse
|
27
|
Outcomes of Ureteroscopy for the Management of Impacted Ureteral Calculi With Different Localizations. Urology 2012; 80:811-5. [DOI: 10.1016/j.urology.2012.05.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Revised: 04/18/2012] [Accepted: 05/07/2012] [Indexed: 11/17/2022]
|
28
|
Youn JH, Kim SS, Yu JH, Sung LH, Noh CH, Chung JY. Efficacy and safety of emergency ureteroscopic management of ureteral calculi. Korean J Urol 2012; 53:632-5. [PMID: 23061001 PMCID: PMC3460006 DOI: 10.4111/kju.2012.53.9.632] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Accepted: 07/20/2012] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the efficacy and safety of the ureteroscopic management of ureteral stones immediately after a first colic attack. Materials and Methods We retrospectively analyzed the data of 226 patients with obstructive ureteral stones who underwent ureteroscopy with stone retrieval. The 67 patients in group A underwent ureteroscopy within 48 hours of admission to our emergency department, whereas the 159 patients in group B underwent ureteroscopy more than 48 hours after admission. The chi-square test was used to evaluate and compare stone-free status, auxiliary procedures, and complications and the Kruskal-Wallis and Fisher's exact tests were used to analyze qualitative data. Results Mean stone sizes in groups A and B were 2.41±1.62 mm and 4.11±2.64 mm, respectively. No patient experienced a major complication during or after the procedure. Stone-free rates were 89.55% and 89.93%, respectively. Conclusions Emergency ureteroscopy in cases of obstructive ureteral stones is both safe and effective and offers the advantages of immediate stone fragmentation and the relief of acute-onset colic pain.
Collapse
Affiliation(s)
- Jun Ho Youn
- Department of Urology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | | | | | | | | | | |
Collapse
|
29
|
Picozzi SCM, Ricci C, Gaeta M, Casellato S, Stubinski R, Bozzini G, Pace G, Macchi A, Carmignani L. Urgent ureteroscopy as first-line treatment for ureteral stones: a meta-analysis of 681 patients. ACTA ACUST UNITED AC 2012; 40:581-6. [PMID: 22367457 DOI: 10.1007/s00240-012-0469-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2011] [Accepted: 02/04/2012] [Indexed: 11/30/2022]
Abstract
There are various recent studies on the use of ureteroscopy and debate on whether this should be the first-line treatment for patients with ureteral stones. The aim of this meta-analysis was to understand the role of this surgical procedure in the emergency setting as first-line treatment and to compare the immediate procedure with a delayed one in terms of stone-free rate and complications. A bibliographic search covering the period from January 1980 to March 2010 was conducted in PubMed, MEDLINE and EMBASE. This analysis is based on the six studies found that fulfilled the predefined inclusion criteria. A total of 681 participants were included. The number of participants in each of the studies considered ranged from 27 to 244 (mean 113). Stone-free rates were 81.9% (72.0-91.8) for the proximal ureter, 87.3% (82.6-92.0) for the mid-ureter, 94.9% (92.1-97.6) for the distal ureter and 89.5% (86.5-92.5) overall according to the logistic regression applied. These values are not statistically significantly different from those reported in the AUA and EAU guidelines. The stone diameter seems to affect the stone-free rate. An increase of the stone diameter of 1 mm beyond 8 mm corresponded to a reduction of stone-free rate of 5% (2.4-8.0) and 8.1% (3.8-12.1) for the distal and proximal ureters, respectively. There is a complete lack of information in international guidelines on the ureteroscopic management of ureteral stones in an emergency setting and the currently available results are dispersed in a few studies in the literature. The rationale for using emergency ureteroscopy is more rapid stone clearance and relief from colic pain. According to our meta-analysis, immediate ureteroscopy for ureteral stone colic seems to be a safe treatment with a high success rate. This evidence will be validated by further randomized studies, with larger series of patients.
Collapse
Affiliation(s)
- Stefano C M Picozzi
- Urology Department, IRCCS Policlinico San Donato, University of Milan, San Donato Milanese, MI, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Ding H, Wang Z, Du W, Zhang H. NTrap in Prevention of Stone Migration During Ureteroscopic Lithotripsy for Proximal Ureteral Stones: A Meta-Analysis. J Endourol 2012; 26:130-4. [PMID: 22092448 DOI: 10.1089/end.2011.0392] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Hui Ding
- Institute of Urology, Gansu Nephro-Urological Clinical Center, The Second Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Zhiping Wang
- Institute of Urology, Gansu Nephro-Urological Clinical Center, The Second Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Wan Du
- Otolaryngologic Department, The Second Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Hongjuan Zhang
- Institute of Urology, Gansu Nephro-Urological Clinical Center, The Second Hospital of Lanzhou University, Lanzhou, Gansu, China
| |
Collapse
|
31
|
Abstract
Most ureteral stones can be observed with reasonable expectation of uneventful stone passage. When an active ureteral stone treatment is warranted, the best procedure to choose is dependent on several factors, besides stone size and location, including operators’ experience, patients’ preference, available equipment and related costs. Placement of double-J stent or nephrostomy tube represents the classical procedures performed in a renal colic due to acute ureteral obstruction when the conservative drug therapy does not resolve the symptoms. These maneuvers are usually followed by ureteroscopy or extracorporeal shockwave lithotripsy, which currently represent the mainstay of treatment for ureteral stones. In this review paper a literature search was performed to identify reports dealing with emergency management of renal colic due to ureteral stones. The main aspects related to this debated issue are analyzed and the advantages and disadvantages of each treatment option are carefully discussed.
Collapse
Affiliation(s)
- Luis Osorio
- Department of Urology, Santo Antonio General Hospital, Oporto, Portugal
| | | | | | | |
Collapse
|
32
|
Guercio S, Ambu A, Mangione F, Mari M, Vacca F, Bellina M. Randomized prospective trial comparing immediate versus delayed ureteroscopy for patients with ureteral calculi and normal renal function who present to the emergency department. J Endourol 2011; 25:1137-41. [PMID: 21682597 DOI: 10.1089/end.2010.0554] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To compare the safety and efficacy of emergency vs scheduled ureteroscopy with a prospective study that included patients who presented to the emergency department (ED) with renal colic from ureteral stones. PATIENTS AND METHODS There were 271 consecutive patients who were enrolled in this prospective study. Patients were randomized to emergency ureteroscopy (group A) or delayed ureteroscopy (group B). All patients underwent helical unenhanced CT (HUCT). Stone-free status was defined as the complete absence of residual fragments at 1 week postoperatively, assessed with HUCT, with no need for ancillary interventions after ureteroscopy. RESULTS Group A included 139 assessable patients. The overall stone-free rate was 93%. Neither location nor size was a significant prognostic factor (P>0.05). Single-session ureteroscopy failed to clear nine ureteral stones. A Double-J stent was placed in 27/139 patients. Group B included 100 assessable patients. Patients in the control group were scheduled for ureteroscopy after their departure from the ED. The overall stone-free rate was 90%. Single-session ureteroscopy failed to clear 10 ureteral stones. A Double-J stent was placed in 80/100 patients. There were no statistical differences with regard to stone diameter and location, complications, and stone-free rate between group A and group B patients. The rate of Double-J stent positioning was significantly higher (P<0.05) in group B patients. CONCLUSIONS In our experience, emergency ureteroscopy showed equal efficacy and safety compared with the elective procedure. It has the main advantage of providing both immediate relief from pain and stone fragmentation.
Collapse
Affiliation(s)
- Stefano Guercio
- Department of Urology, Rivoli Hospital, Rivoli, Torino, Italy.
| | | | | | | | | | | |
Collapse
|
33
|
Al-Ghazo MA, Ghalayini IF, Al-Azab RS, Bani Hani O, Bani-Hani I, Abuharfil M, Haddad Y. Emergency ureteroscopic lithotripsy in acute renal colic caused by ureteral calculi: a retrospective study. ACTA ACUST UNITED AC 2011; 39:497-501. [PMID: 21499919 DOI: 10.1007/s00240-011-0381-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2011] [Accepted: 04/07/2011] [Indexed: 12/12/2022]
Abstract
This work was conducted to evaluate the safety and efficacy of emergency ureteroscopic lithotripsy in patients with ureteral stones. From May 2003 to December 2010, 244 patients (184 men and 60 women, mean age 45.6 ± 12.7 years (range 22-73 years) were treated with emergency ureteroscopic lithotripsy for ureteral calculi. All patients were divided into three groups according to the stone location in the ureter. Intracorporeal lithotripsy when necessary was performed with the Swiss lithoclast. The overall stone-free status was defined as the complete absence of stone fragments at 4 weeks, postoperatively. A double J stent was inserted in selected patients if there was significant ureteral wall trauma, edema at the stone impaction site, suspected or proved ureteral perforation, and if the stone migrated to the kidney. The overall success rate was 90.6%. The success rates were different according to the stone site. The success rate of groups A, B and C was 69.4, 94.8 and 96.6%, respectively. The overall rate of ureteral stent insertion at the end of the procedure was 177/244 (72.5%). The rate of stent insertion was 41/49 (83.7%), 32/46 (69.6%) and 104/149 (69.8%) in groups A, B and C, respectively. The overall complication, failure, and stricture rate was 32/244 (13.1%), 23/244 (9.4%) and 0.8%, respectively. With the recent advances in ureteroscopic technology, intracorporeal probes and stone extraction devices, emergency ureteroscopy is found to be a safe and effective procedure with immediate relief from ureteral colic and ureteral stone fragmentation.
Collapse
Affiliation(s)
- Mohammed A Al-Ghazo
- Department of General Surgery and Urology, Faculty of Medicine, Jordan University of Science and Technology, PO Box 3030, Irbid 22110, Jordan.
| | | | | | | | | | | | | |
Collapse
|
34
|
Hamidi Madani A, Kazemzadeh M, Pourreza F, Shakiba M, Farzan A, Asadollahzade A, Esmaeili S. Randomized controlled trial of the efficacy of isosorbide-SR addition to current treatment in medical expulsive therapy for ureteral calculi. UROLOGICAL RESEARCH 2011; 39:361-5. [PMID: 21207018 DOI: 10.1007/s00240-010-0357-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2010] [Accepted: 12/15/2010] [Indexed: 10/18/2022]
Abstract
It has been suggested that nitrates are potent smooth muscle relaxants that may reduce pain and facilitate ureteral stone passage; therefore it may be an option for medical expulsive therapy in ureteral stones. In a prospective randomized controlled clinical trial, we evaluated the efficacy of medical expulsive therapy with isosorbide-SR 40 mg in patients with ureteral stones (≤10 mm). The patients with ureteral stones in KUB or urinary tract ultrasonography were randomized to receive methylprednisolone plus celecoxib without (control group), and with isosorbide-SR 40 mg (treatment group) for 21 days. 66 patients [33(50%) in control, 33(50%) in treatment group] were entered randomly to our study. The stone expulsion rate was not significantly different between two groups (54.5 vs. 45.5%) (P = 0.497). The need for surgical procedures were more common in control group within 21 days (9.4 vs. 6.1%) and more common in treatment group after 21 days (33.3 vs. 21.9%) (P = 0.756).Patients in the treatment group experienced more intractable pain (27.3 vs. 6.1%), intractable vomiting (3 vs. 0%) (P = 0.046) and hospitalization (3 vs. 0%) (P = 0.314). Drug side effects including headache and dizziness were more common in treatment group (39.4 vs. 9.1%) (P = 0.004). In our study, the use of isosorbide-SR in treatment group did not improve the stone expulsion rate in patients with ureteral stones (≤10 mm) but developed more side effects. Then it may not an appropriate alternative for medical expulsive therapy. Of course, further trials are recommended.
Collapse
Affiliation(s)
- Ali Hamidi Madani
- Urology Research Center, Razi Hospital, Guilan University of Medical Sciences, Rasht, Guilan, Iran.
| | | | | | | | | | | | | |
Collapse
|
35
|
A Randomized Prospective Controlled Study for Assessment of Different Ureteral Occlusion Devices in Prevention of Stone Migration During Pneumatic Lithotripsy. Urology 2011; 77:30-5. [DOI: 10.1016/j.urology.2010.05.063] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2009] [Revised: 03/31/2010] [Accepted: 05/27/2010] [Indexed: 11/18/2022]
|
36
|
Ye Z, Yang H, Li H, Zhang X, Deng Y, Zeng G, Chen L, Cheng Y, Yang J, Mi Q, Zhang Y, Chen Z, Guo H, He W, Chen Z. A multicentre, prospective, randomized trial: comparative efficacy of tamsulosin and nifedipine in medical expulsive therapy for distal ureteric stones with renal colic. BJU Int 2010; 108:276-9. [DOI: 10.1111/j.1464-410x.2010.09801.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
37
|
Chen DY, Chen WC. Complications Due to Surgical Treatment of Ureteral Calculi. UROLOGICAL SCIENCE 2010. [DOI: 10.1016/s1879-5226(10)60017-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
38
|
Ramsey S, Robertson A, Ablett MJ, Meddings RN, Hollins GW, Little B. Evidence-Based Drainage of Infected Hydronephrosis Secondary to Ureteric Calculi. J Endourol 2010; 24:185-9. [DOI: 10.1089/end.2009.0361] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Sara Ramsey
- Department of Urology, Ayr Hospital, Ayr, Scotland
| | | | | | | | | | - Brian Little
- Department of Urology, Ayr Hospital, Ayr, Scotland
| |
Collapse
|
39
|
Giannarini G, Autorino R. Recommending Medical Expulsive Therapy for Distal Ureteric Calculi: A Step Back? Eur Urol 2009; 56:413-5; discussion 416-7. [DOI: 10.1016/j.eururo.2009.04.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2009] [Accepted: 04/22/2009] [Indexed: 11/25/2022]
|
40
|
Hermanns T, Sauermann P, Rufibach K, Frauenfelder T, Sulser T, Strebel RT. Is there a role for tamsulosin in the treatment of distal ureteral stones of 7 mm or less? Results of a randomised, double-blind, placebo-controlled trial. Eur Urol 2009; 56:407-12. [PMID: 19375849 DOI: 10.1016/j.eururo.2009.03.076] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2009] [Accepted: 03/24/2009] [Indexed: 12/27/2022]
Abstract
BACKGROUND Numerous randomised trials have confirmed the efficacy of medical expulsive therapy with tamsulosin in patients with distal ureteral stones; however, to date, no randomised, double-blind, placebo-controlled trials have been performed. OBJECTIVE The objective of this trial was to evaluate the efficacy of medical expulsive therapy with tamsulosin in a randomised, double-blind, placebo-controlled setting. DESIGN, SETTING, AND PARTICIPANTS Patients presenting with single distal ureteral stones < or = 7 mm were included in this trial. INTERVENTION Patients were randomised in a double-blind fashion to receive either tamsulosin or placebo for 21 d. The medication was discontinued after either stone expulsion or intervention. Abdominal computed tomography was performed to assess the initial and final stone status. MEASUREMENTS AND LIMITATIONS: The primary end point was the stone expulsion rate. Secondary end points were time to stone passage, the amount of analgesic required, the maximum daily pain score, safety of the therapy, and the intervention rate. RESULTS Ten of 100 randomised patients were excluded from the analysis. No statistically significant differences in patient characteristics and stone size (median: 4.1 mm [tamsulosin arm] vs 3.8 mm [placebo arm], p=0.3) were found between the two treatment arms. The stone expulsion rate was not significantly different between the tamsulosin arm (86.7%) and the placebo arm (88.9%; p=1.0). Median time to stone passage was 7 d in the tamsulosin arm and 10 d in the placebo arm (log-rank test, p=0.36). Patients in the tamsulosin arm required significantly fewer analgesics than patients in the placebo arm (median: 3 vs 7, p=0.011). A caveat is that the exact time of stone passage was missing for 29 patients. CONCLUSIONS Tamsulosin treatment does not improve the stone expulsion rate in patients with distal ureteral stones < or = 7 mm. Nevertheless, patients may benefit from a supportive analgesic effect. CLINICALTRIALS.GOV: NCT00831701.
Collapse
Affiliation(s)
- Thomas Hermanns
- Department of Urology, University of Zürich, University Hospital, Zürich, Switzerland
| | | | | | | | | | | |
Collapse
|
41
|
Urétéroscopie pour calcul du haut appareil urinaire. Prog Urol 2008; 18:912-6. [DOI: 10.1016/j.purol.2008.09.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2008] [Accepted: 09/02/2008] [Indexed: 11/22/2022]
|
42
|
Abstract
Proximal ureteral stone less than 4-6mm may initially be treated by surveillance. Generally, extracorporeal shockwave lithotripsy (ESWL) is the first line treatment for proximal ureteral stones, specially for stones less than 1cm. For stones greater than 1cm, the results of ureteroscopy (URS) are better than the results of ESWL and in these cases URS may be an option. In case of failure of ESWL, URS can be proposed. URS can be the first line treatment in case of severe ureteral obstruction with no urinary infection. Proximal ureteroscopy must be careful because severe complications are not infrequent. Open surgery has very rare indication. Metabolic check-up and annually follow-up with at least a renal imaging at three months are recommended.
Collapse
|
43
|
Seitz C, Memarsadeghi M, Fajkovic H, Tanovic E. Secondary signs of non-enhanced CT prior to laser ureterolithotripsy: is treatment outcome predictable? J Endourol 2008; 22:415-8. [PMID: 18298312 DOI: 10.1089/end.2007.0248] [Citation(s) in RCA: 15] [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 correlate the presence of secondary signs of non-enhanced computed tomography (NECT) in renal units harboring ureteral calculi with intraoperative findings and treatment outcome after holmium:yttrium-aluminum-garnet laser (Ho:YAG) ureterolithotripsy. SUBJECTS AND METHODS Two-hundred patients were prospectively included after ureteral calculi were detected on NECT. All patients underwent Ho:YAG ureterolithotripsy at the Medical University of Vienna. All CT studies were reviewed by one specialized uroradiologist blinded to pre- and postoperative parameters for secondary signs as renal enlargement, perinephric stranding, ureteral dilation, periureteral edema, and ureteral rim sign. The impact of secondary signs on intraoperatively-verified impaction and treatment outcome was evaluated. RESULTS Of the 200 patients 85 (42.5%) harbored proximal and 115 (57.5%) harbored distal ureteral calculi. The stone-free rates for proximal and distal calculi were 80% and 97%, respectively. Although proximal stone location and intraoperatively-verified impaction correlated significantly with stone-free rates (P < 0.0001, P = 0.01), the presence of secondary signs could not predict intraoperatively-verified stone impaction or stone-free rates (renal enlargement: P = 0.2, P = 0.5; perinephric stranding: P = 0.7, P = 0.5; ureteral dilation: P = 0.7, P = 0.7; periureteral edema: P = 0.8, P = 0.06; ureteral rim sign: P = 0.8, P = 0.3). CONCLUSION Preoperative secondary signs seen on NECT in patients harboring ureteral calculi do not correlate with intraoperative findings of impaction, and do not predict treatment outcome after Ho:YAG ureterolithotripsy.
Collapse
|
44
|
Gunlusoy B, Degirmenci T, Arslan M, Kozacýoglu Z, Minareci S, Ayder AR. Is Ureteral Catheterization Necessary after Ureteroscopic Lithotripsy for Uncomplicated Upper Ureteral Stones? J Endourol 2008; 22:1645-8. [DOI: 10.1089/end.2008.0098] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Bulent Gunlusoy
- Department of Urology, Izmir Teaching and Research Hospital, Izmir, Turkey
| | - Tansu Degirmenci
- Department of Urology, Izmir Teaching and Research Hospital, Izmir, Turkey
| | - Murat Arslan
- Department of Urology, Izmir Teaching and Research Hospital, Izmir, Turkey
| | - Zafer Kozacýoglu
- Department of Urology, Izmir Teaching and Research Hospital, Izmir, Turkey
| | - Suleyman Minareci
- Department of Urology, Izmir Teaching and Research Hospital, Izmir, Turkey
| | - Ali Ryza Ayder
- Department of Urology, Izmir Teaching and Research Hospital, Izmir, Turkey
| |
Collapse
|
45
|
Zehri AA, Ather MH, Siddiqui KM, Sulaiman MN. A randomized clinical trial of lidocaine jelly for prevention of inadvertent retrograde stone migration during pneumatic lithotripsy of ureteral stone. J Urol 2008; 180:966-8. [PMID: 18639268 DOI: 10.1016/j.juro.2008.05.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2007] [Indexed: 11/19/2022]
Abstract
PURPOSE We studied the efficacy of lidocaine jelly instillation proximal to the ureteral stone during intracorporeal lithotripsy using a semirigid ureteroscope for the prevention of retrograde migration and improvement in stone-free rate. MATERIALS AND METHODS From November 2006 to September 2007, 50 patients with 5 to 18 mm ureteral stones undergoing ureteroscopic removal using pneumatic lithotripsy were randomized into 2 groups. Group 1 (25 patients) had lidocaine jelly instilled proximal to the stone before and after fragmentation, and group 2 was the control group (25 patients). Ureteroscopy was performed using an 8 or 6.4Fr semirigid ureteroscope. A 5Fr ureteral stent was advanced beyond the stone. Lidocaine jelly (2 ml) was instilled and lithotripsy was performed with a Swiss LithoClast . A 5Fr ureteral catheter was left in place for 24 hours. Patients were followed at 24 hours with plain x-ray of the kidneys, ureters and bladder, and at 2 weeks with noncontrast enhanced computerized tomography of the kidneys, ureters and bladder. RESULTS The 2 groups were comparable with regard to age and stone size. Stone or stone fragment migration occurred in 4% and 28% of patients in groups 1 and 2, respectively, and this difference was statistically significant (p = 0.002). At 2 weeks followup with imaging the stone-free rate was 96% and 72% in groups 1 and 2, respectively, and this difference was also statistically significant (p = 0.045). Although the mean operative time was slightly longer in the treatment group (33.56 +/- 13 vs 35.84 +/- 12.5 minutes) the difference was not significant (p = 0.450). CONCLUSIONS Lidocaine jelly instillation proximal to ureteral calculi during lithotripsy is an effective method of preventing retrograde stone displacement as well as significantly improving the stone-free rate.
Collapse
Affiliation(s)
- Ali A Zehri
- Department of Surgery, The Aga Khan University, Karachi, Sind, Pakistan
| | | | | | | |
Collapse
|
46
|
Choi HW, Kim SD, Kim DB, Sohn DW, Kim SW, Cho YH. Effectiveness of Emergency Ureterorenoscopic Lithotripsy for Distal Ureter Stones. Korean J Urol 2008. [DOI: 10.4111/kju.2008.49.3.257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Hang Won Choi
- Department of Urology, College of Medicine, The Catholic University of Korea, Soeul, Korea
| | - Sung Dae Kim
- Department of Urology, College of Medicine, The Catholic University of Korea, Soeul, Korea
| | - Doo Bae Kim
- Department of Urology, College of Medicine, The Catholic University of Korea, Soeul, Korea
| | - Dong Wan Sohn
- Department of Urology, College of Medicine, The Catholic University of Korea, Soeul, Korea
| | - Sae Woong Kim
- Department of Urology, College of Medicine, The Catholic University of Korea, Soeul, Korea
| | - Yong-Hyun Cho
- Department of Urology, College of Medicine, The Catholic University of Korea, Soeul, Korea
| |
Collapse
|
47
|
Reply to Riccardo Autorino, Luis Osorio and Estevão A. Lima’s Letter to the Editor re: Christian Seitz, Enis Tanovic, Zeljko Kikic, Mazda Memarsadeghi and Harun Fajkovic. Rapid Extracorporeal Shock Wave Lithotripsy for Proximal Ureteral Calculi in Colic versus Noncolic Patients. Eur Urol 2007;52:1223–8. Eur Urol 2007. [DOI: 10.1016/j.eururo.2007.04.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
48
|
Sharma DP. Current opinion amongst radiologists and urologists in the uk on percutaneous nephrostomy and ureteric stent insertion for acute renal obstruction: results of a postal survey. BJU Int 2007; 99:1549. [PMID: 17537224 DOI: 10.1111/j.1464-410x.2007.06970_2.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
49
|
Autorino R, Osorio L, Lima EA. Re: Christian Seitz, Enis Tanovic, Zeljko Kikic, Mazda Memarsadeghi and Harun Fajkovic. Rapid extracorporeal shock wave lithotripsy for proximal ureteral calculi in colic versus noncolic patients. Eur Urol 2007;52:1223-8. Eur Urol 2007; 52:1264-5; author reply 1265-6. [PMID: 17467159 DOI: 10.1016/j.eururo.2007.04.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2007] [Accepted: 04/13/2007] [Indexed: 11/24/2022]
|