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Danilovic A, Suartz CV, Torricelli FCM, Marchini GS, Batagello C, Vicentini FC, Nahas WC, Mazzucchi E. Play it safe: renal function after bilateral flexible ureteroscopy for kidney stones. World J Urol 2024; 42:226. [PMID: 38594574 DOI: 10.1007/s00345-024-04924-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 03/05/2024] [Indexed: 04/11/2024] Open
Abstract
PURPOSE We searched for perioperative renal function deterioration risk factors in patients that underwent bilateral flexible ureteroscopy (fURS) for kidney stones. METHODS From August 2016 to February 2020, symptomatic patients > 18 years old with bilateral kidney stones up to 20 mm in each side were prospectively studied. Serum creatinine samples were collected on admission to surgery, immediate postoperative (IPO), on POD 3, 10, and 30. Estimated glomerular filtration rate (eGFR) was calculated using Chronic Kidney Disease Epidemiology Collaboration equation (CKD-EPI) without a race coefficient. RESULTS Thirty patients underwent bilateral fURS. Comparing to preoperative eGFR, median IPO and POD3 eGFR (p < 0.001) were significantly lower, and POD10 (p = 0.092) and POD30 (p = 0.648) were similar to preoperative eGFR. During follow-up, 22/30 (73.3%), 14/30 (46.7%), and 7/30 (23.3%) of the patients presented a decrease > 10% eGFR, > 20% eGFR, and > 30% eGFR, respectively. Multivariate analysis demonstrated that lower preoperative eGFR is a risk factor for eGFR < 60 mL/min/1.73 m2, p = 0.019 [1.021-1.263; 1.136]; ASA > 1 is a risk factor for decrease of eGFR > 10%, p = 0.028 [1.25-51.13; 8.00]; longer operative time is a risk factor for decrease of eGFR > 20%, p = 0.042 [1.00-1.05; 1.028]; and operative time ≥ 120 min is a risk factor for decrease of eGFR > 30%, p = 0.026 [0.016-0.773; 0.113]. CONCLUSIONS Renal function suffers a reversible decrease after bilateral fURS. Our study suggests that adequate selection of patients and maintaining operative time < 120 min are relevant factors in preventing acute renal function deterioration following bilateral fURS.
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Affiliation(s)
- Alexandre Danilovic
- Urology, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Eneas de Carvalho Aguiar, 255, 7 and. Sala 7175, São Paulo, SP, 05403-000, Brazil.
| | - Caio Vinicius Suartz
- Urology, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Eneas de Carvalho Aguiar, 255, 7 and. Sala 7175, São Paulo, SP, 05403-000, Brazil
| | - Fabio Cesar Miranda Torricelli
- Urology, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Eneas de Carvalho Aguiar, 255, 7 and. Sala 7175, São Paulo, SP, 05403-000, Brazil
| | - Giovanni Scala Marchini
- Urology, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Eneas de Carvalho Aguiar, 255, 7 and. Sala 7175, São Paulo, SP, 05403-000, Brazil
| | - Carlos Batagello
- Urology, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Eneas de Carvalho Aguiar, 255, 7 and. Sala 7175, São Paulo, SP, 05403-000, Brazil
| | - Fabio Carvalho Vicentini
- Urology, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Eneas de Carvalho Aguiar, 255, 7 and. Sala 7175, São Paulo, SP, 05403-000, Brazil
| | - William C Nahas
- Urology, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | - Eduardo Mazzucchi
- Urology, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Eneas de Carvalho Aguiar, 255, 7 and. Sala 7175, São Paulo, SP, 05403-000, Brazil
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Pyrgidis N, Chaloupka M, Ebner B, Stief C, Weinhold P, Marcon J, Schulz GB. Perioperative Outcomes of Same-Session Bilateral vs Unilateral Ureteroscopy for Stone Removal: Results from the GRAND Study. J Endourol 2024; 38:129-135. [PMID: 38019049 DOI: 10.1089/end.2023.0563] [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: 11/30/2023] Open
Abstract
Background: Same-session bilateral ureteroscopy may reduce the number of surgeries for stone removal but can lead to higher overall complication rates. We aimed to compare same-session bilateral ureteroscopy with unilateral ureteroscopy in terms of perioperative outcomes. Methods: We used the GeRmAn Nationwide inpatient Data (GRAND), provided by the Research Data Center of the Federal Bureau of Statistics (2005-2021). We assessed, through multiple patient-level analyses, severe perioperative complications, mortality, length of hospital stay, hospital revenues, intensive care unit admission, and the evolution of ureteroscopy during the last years in Germany. Results: We included 833,609 patients undergoing either same-session bilateral (n = 6914, 0.8%) or unilateral (n = 826,695, 99.2%) ureteroscopy for stone management. Patients undergoing bilateral ureteroscopy presented worse baseline characteristics. After adjusting for these characteristics, same-session bilateral ureteroscopy, compared to unilateral ureteroscopy, was significantly associated with higher odds of postoperative sepsis (odds ratio [OR]: 2.4, 95% confidence interval [CI]: 2-2.8, p < 0.001), myocardial infarction (OR: 2, 95% CI: 1.03-3.5, p = 0.024), acute kidney disease (OR: 2.8, 95% CI: 2.5-3.2, p < 0.001), transfusion (OR: 4.2, 95% CI: 3.6-4.8, p < 0.001), urinary tract infection (OR: 1.6, 95% CI: 1.5-1.7, p < 0.001), intensive care unit admission (OR: 1.9, 95% CI: 1.6-2.3, p < 0.001), and mortality (OR: 3.1, 95% CI: 2.1-4.5, p < 0.001). Similarly, the length of hospital stay was longer, and the in-hospital costs were higher (p < 0.001) after same-session bilateral ureteroscopy. Interestingly, the annual cases of ureteroscopy have undergone about a threefold increase in the last 17 years. Conclusions: The present real-world data demonstrate that same-session bilateral ureteroscopy leads to higher rates of perioperative myocardial infarction, acute kidney disease, transfusion, urinary tract infections, sepsis, and intensive care unit admission, as well as to increased length of hospital stay, costs, and inpatient mortality compared to unilateral ureteroscopy.
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Affiliation(s)
- Nikolaos Pyrgidis
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Michael Chaloupka
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Benedikt Ebner
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Christian Stief
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Philipp Weinhold
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Julian Marcon
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
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Tu WC, Zhang XL, Wang J, Huang BX, Zhang DG, Wang DW. Influence of stone load on the outcome of same-session flexible ureteroscopy for bilateral upper urinary tract stones: a multicenter retrospective study. Front Med (Lausanne) 2023; 10:1163371. [PMID: 38034526 PMCID: PMC10684712 DOI: 10.3389/fmed.2023.1163371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 10/12/2023] [Indexed: 12/02/2023] Open
Abstract
Purpose This study aimed to evaluate the efficacy and safety of same-session flexible ureteroscopy (fURS) for the treatment of bilateral upper urinary tract stones and to examine the influence of stone load on the outcome of same-session fURS, stratifying by total diameter of stones (TDS) ≤30 mm vs. >30 mm. Patients and methods We retrospectively reviewed all cases of same-session fURS performed for bilateral upper urinary tract stones at four institutions between January 2017 and September 2020. All patients were divided into two groups based on TDS, ≤30 mm and >30 mm. Data on patient demographics, stone characteristics, surgical results, and complications were collected and analyzed for differences between the two groups. Stone-free rate (SFR) was defined as patients endoscopically stone-free or with radiological fragments <2 mm of each renal unit. Results A total of 121 patients with bilateral upper urinary tract stones underwent same-session fURS, consisting of 73 patients in the TDS ≤ 30 mm group and 48 patients in the TDS > 30 mm group. The mean bilateral stone size was 28.2 ± 12.2 mm (range: 9.1-38.4 mm), with a mean operating time of 97.1 ± 39.6 min (range: 19-220 min). The SFR was 54.5% after the first fURS, and SFR increased to 97.5% after re-fURS for residual stones. The operation time for the TDS > 30 mm group was longer than that of the TDS ≤ 30 mm group (85.1 ± 36.5 vs. 115.4 ± 37.4 min, p < 0.001). The SFR after the first fURS was significantly lower in the TDS > 30 mm group than in the TDS ≤ 30 mm group (25.0% vs. 73.9%, p < 0.001). Although there was no statistically significant difference in overall SFR between the two groups (93.7% vs. 100%, p = 0.060), the rate of re-fURS for residual stones was higher in the TDS > 30 mm group than in the TDS ≤ 30 mm group (75% vs. 26%, p < 0.001). There were no significant differences in length of hospital stay (LOS) (2.2 ± 0.7 vs. 2.3 ± 1.0, p = 0.329) or complication rate (10.9% vs. 14.6%, p = 0.582) between the two groups. Conclusion The results suggested that same-session fURS can be effectively performed with a low complication rate. A higher SFR after the first fURS can be achieved in the case of bilateral upper urinary tract stones with TDS ≤ 30 mm, and priority should be given to same-session fURS.
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Affiliation(s)
- Wei-Chao Tu
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xin-Le Zhang
- Department of Urology, Kunshan Integrated Traditional Chinese and Western Medicine Hospital, Suzhou, Jiangsu, China
| | - Jun Wang
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bao-Xing Huang
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ding-Guo Zhang
- Department of Urology, Shanghai Pudong New Area People's Hospital, Shanghai, China
| | - Da-Wei Wang
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Banerjee I, Bhat A, Katz JE, Shah RH, Smith NA, Shah HN. Bilateral same session flexible ureterorenoscopy for endoscopic management of bilateral renal calculi is noninferior to unilateral flexible ureterorenoscopy for management of multiple unilateral renal calculi: outcomes of a prospective comparative study. Scand J Urol 2022; 56:244-250. [PMID: 35384790 DOI: 10.1080/21681805.2022.2058606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE The aim of the study was to prospectively evaluate safety and efficacy of bilateral same session ureterorenoscopy (BSS-FURS) for management of bilateral renal calculi. METHODS A prospective comparative study was designed to compare the results of BSS-FURS with unilateral flexible ureterorenoscopy (U-FURS) for management of renal calculi between June 2003 and May 2016. A sample size of 55 patients in each arm was calculated considering a 20% increase in the incidence of complications with BSS-FURS over 15% complication rate in U-FURS (alpha = 0.05; Beta = 0.90). Patient demographics, stone burden, total operative time, postoperative creatinine level, duration of hospital stay, perioperative complications and stone free rate (SFR) were compared in both the groups. The literature pertaining to BSS-FURS was reviewed. RESULTS Although the study group patients had higher overall stone burden (18.60 ± 7.70 mm vs. 13.32 ± 6.43 mm) and significantly longer operative time (48.30 ± 16.71 min vs. 32.95 ± 13.05 min; p < 0.05) as compared to the control group, the length of hospital stay, SFR (67.85% vs. 78.5%; p = 0.436) and perioperative complications were comparable in both the groups. Most patients who developed postoperative fever from both groups had struvite stones. CONCLUSION BSS-FURS is a safe and efficient procedure for the management of bilateral renal calculi in the hands of an experienced endourologist. It has comparable SFR and morbidity compared to U-FURS. Caution should be exercised in patients with struvite stones, as they are more likely to develop postoperative fever.
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Affiliation(s)
- Indraneel Banerjee
- Department of Urology, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Abhishek Bhat
- Department of Urology, Jackson Health System, Miami, FL, USA
| | - Jonathan E Katz
- Department of Urology, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Rashmi H Shah
- Urolap Superspeciality Clinic and S. L. Raheja, Fortis Associate Hospital, Mumbai, India
| | | | - Hemendra N Shah
- Department of Urology, University of Miami, Miller School of Medicine, Miami, FL, USA
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Quality of life study in ophthalmic practice. OPHTHALMOLOGY JOURNAL 2021. [DOI: 10.17816/ov71041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The article discusses various methods for studying the quality of life in all kinds of eye diseases. General and special questionnaires used in modern ophthalmological practice are presented. The presence of a sufficiently large amount of data indicating the relationship between the quality of life and objective indicators of the visual system was established. A fairly good comparability of results obtained in the assessment of various quality of life questionnaires in a patient with ophthalmic condition was revealed.
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Danilovic A, Torricelli FCM, Marchini GS, Batagello C, Vicentini FC, Traxer O, Srougi M, Nahas WC, Mazzucchi E. Prospective Evaluation of Bilateral Retrograde Intrarenal Surgery: Is It Really Safe? J Endourol 2020; 35:14-20. [PMID: 32689826 DOI: 10.1089/end.2020.0611] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: The aim of this study was to prospectively compare the outcomes of bilateral same-session retrograde intrarenal surgery (BSS RIRS) with unilateral RIRS and to compare the outcomes of first with second operated kidneys in BSS RIRS. Subjects and Methods: Consecutive symptomatic adult patients with kidney stones up to 20 mm who accepted to be treated by RIRS were prospectively studied. Stone-free rate (SFR) was evaluated by non-contrast CT for each renal unit, and surgical complications were evaluated based on Clavien-Dindo classification. Results: SFR (73.9% vs 76.1%, p = 0.830) and hospitalization time (14.43 ± 18.81 hours vs 13.00 ± 4.89 hours, p = 0.564) were similar between unilateral and BSS RIRS groups, with less consumption of disposable devices in BSS RIRS (p = 0.017). Operative time was longer in BSS RIRS (61.24 ± 26.62 minutes vs 88.65 ± 33.19 minutes, p < 0.001). Bilateral group had significant more overall complications by Clavien-Dindo classification than unilateral (15.9% vs 39.9%, p = 0.030) and more emergency room (ER) visits (11.6% vs 34.8%, p = 0.026). Moreover, although both groups temporarily increased creatinine levels, it was significantly higher in bilateral RIRS (p = 0.019). First operated kidney outcomes were similar to second operated kidney outcomes of BSS RIRS. Conclusion: Although BSS RIRS had similar SFR and consumed less disposable devices, it had a higher overall complication rate, a higher frequency of ER visits, and higher creatinine levels during follow-up than unilateral RIRS. There is no significant outcome difference between first and second operated kidneys in BSS RIRS.
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Affiliation(s)
- Alexandre Danilovic
- Department of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | | | - Giovanni Scala Marchini
- Department of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Carlos Batagello
- Department of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Fabio Carvalho Vicentini
- Department of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Olivier Traxer
- Department of Urology, Sorbonne Université, GRC n20 Lithiase Renale, AP-HP, Hôpital Tenon, Paris, France
| | - Miguel Srougi
- Department of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - William C Nahas
- Department of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Eduardo Mazzucchi
- Department of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
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Simultaneous Bilateral Endoscopic Surgery (SBES) for Bilateral Urolithiasis: the Future? Evidence from a Systematic Review. Curr Urol Rep 2019; 20:15. [DOI: 10.1007/s11934-019-0877-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Ulker V, Cakmak O, Yucel C, Can E, Celik O, Ilbey YO. The efficacy and safety of bilateral same-session ureteroscopy with holmium laser lithotripsy in the treatment of bilateral ureteral stones. MINERVA UROL NEFROL 2019; 71:174-180. [PMID: 30767494 DOI: 10.23736/s0393-2249.19.03337-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND A staged ureteroscopic procedure is the generally preferred method in the treatment of bilateral ureteral stones due to the risk of bilateral injury. In this study we aimed to evaluate the safety and efficacy of bilateral same-session ureteroscopy (BS-URS) in terms of complications, operation time, serum creatinine, hospital stay and stone-free rates. METHODS A total of 75 patients who underwent BS-URS and holmium laser lithotripsy were evaluated, retrospectively. The patients were re-evaluated postoperatively after four weeks with ultrasonography, X-ray or computed tomography. Pre- and postoperative variables were analyzed. The results of BS-URS were also compared with unilateral URS cases performed in the same time period. RESULTS BS-URS was performed in 58 men and 16 women with a mean age of 46.3 years. The mean operating time was 69 min. In patients with stone burden ≥20 mm, the mean operative time was longer. Intraoperative complications were observed in eight patients, Clavien grade I in seven, and Clavien grade IIIb in one. Early postoperative complications included fever and hematuria were seen in 10.6% of the patients. One patient underwent secondary URS for residual stone. Stone free rate after four weeks was 98.6%. Overall complication and and stone-free rates were similar in BS-URS and unilateral URS groups (P>0.05). The mean operating time was significantly longer in BS-URS patients (P=0.001). CONCLUSIONS BS-URS is as safe and efficient procedure as unilateral ureteroscopy with high stone-free and minimal morbidity rates in the treatment of bilateral ureteral stones in appropriate patients.
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Affiliation(s)
- Volkan Ulker
- Department of Urology, Tepecik Training and Research Hospital, Health Sciences University, Izmir, Turkey -
| | - Ozgur Cakmak
- Department of Urology, Tepecik Training and Research Hospital, Health Sciences University, Izmir, Turkey
| | - Cem Yucel
- Department of Urology, Tepecik Training and Research Hospital, Health Sciences University, Izmir, Turkey
| | - Ertan Can
- Department of Urology, Tepecik Training and Research Hospital, Health Sciences University, Izmir, Turkey
| | - Orcun Celik
- Department of Urology, Tepecik Training and Research Hospital, Health Sciences University, Izmir, Turkey
| | - Yusuf O Ilbey
- Department of Urology, Tepecik Training and Research Hospital, Health Sciences University, Izmir, Turkey
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Arda E, Cakiroglu B. Bilateral same-session flexible ureterorenoscopy for renal and/or ureteric stone disease treatment. Arab J Urol 2018; 16:441-445. [PMID: 30534445 PMCID: PMC6277504 DOI: 10.1016/j.aju.2018.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 03/22/2018] [Accepted: 04/11/2018] [Indexed: 11/03/2022] Open
Abstract
Objective To evaluate the effectiveness and safety of bilateral same-session flexible ureterorenoscopy (f-URS) in the treatment of bilateral renal and/or ureteric stone disease. Patients and methods From October 2007 to December 2015, 62 patients who had undergone bilateral, same-session f-URS were included in the study. The procedures were performed under general anaesthesia, in lithotomy, and initiated on the side in which the patient was clinically symptomatic or on the side in which the stone was smaller. Plain abdominal radiography, intravenous urography, renal ultrasonography and/or non-contrast computed tomography scans were conducted in all patients. The success rate was defined as, patients who were stone-free or only had residual fragments of <3 mm. Results A total of 62 patients (43 male, 19 female), with a mean (SD) age of 39 (15.1) years, were included. The mean (SD) stone size was 23.2 (6.11) mm with a mean (SD) operative time of 58.8 (16.24) min. The stone-free rates were 90.3% and 100% after the first and second procedures, respectively. The mean (SD) hospital stay was 1.58 (0.72) days. There were minor complications (Clavien–Dindo grade I–II) in 10 (16%) patients and major complications (Clavien–Dindo III–IV), e.g. distal ureter laceration and laser injury of the ureter, in two patients. Conclusion Same session bilateral f-URS is a successful and safe method for bilateral renal and/or ureteric stones.
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Key Words
- (f-)URS, (flexible) ureterorenoscopy
- ASA, American Society of Anesthesiologists
- Bilateral
- EAU, European Association of Urology
- Flexible ureterorenoscopy
- KUB, plain radiography of kidney-ureter-bladder
- PCNL, percutaneous nephrolithotomy
- RIRS, retrograde intrarenal surgery
- Renal stones
- SFR, stone-free rate
- SWL, shockwave lithotripsy
- UAS, ureteric access sheath
- USG, renal ultrasonography
- Ureteric stones
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Affiliation(s)
- Ersan Arda
- Department of Urology, Trakya University School of Medicine, Edirne, Turkey
| | - Basri Cakiroglu
- Department of Urology, Hisar Intercontinental Hospital, Istanbul, Turkey
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