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Panchendrabose K, Bal DS, Pierce A, Gebru NT, Grewal R, Jain K, Van Iderstine MG, Blachman-Braun R, Hosier G, Saltel E, Peters B, Bard R, Saranchuk J, Patel P. Evaluating Patient Tolerability for Urological Procedures Under Conscious Sedation: A Prospective Study. Urology 2024; 183:11-16. [PMID: 37923086 DOI: 10.1016/j.urology.2023.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 09/25/2023] [Accepted: 10/16/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE To prospectively evaluate patient-reported tolerability and surgical outcomes of urologic procedures with conscious sedation with or without local anesthesia. Administration of general or spinal anesthesia is associated with anesthetic-related complications, long wait times, and high costs. Using intravenous conscious sedation and/or local anesthesia is an emerging alternative for a myriad of urologic procedures. METHODS Patients were enrolled from June-August 2021 at a tertiary care hospital. All procedures were completed using fentanyl, midazolam, or both with patient and procedural data recorded upon completion. Patients were telephoned 4-6 weeks post-procedure with a standardized patient tolerability questionnaire. A multivariable adjusted logistic regression analysis was performed to evaluate whether a patient would opt for conscious sedation again as opposed to general anesthesia. RESULTS A total of 196 procedures were performed by 6 attending urologists with an overall success rate of 98.5% and 0% intraoperative complication rate. At 4-6 weeks follow-up, 85.6% of patients reported they would opt for conscious sedation as opposed to general anesthesia. Predictors of opting for conscious sedation in the future were older age (Odds Ratio (OR): 1.049; P = .017) and surgeon perceived level of patient tolerability (OR: 2.124; P <.001, scored 1-10). CONCLUSION Physician directed, nursing administered IV conscious sedation is a viable alternative for various urologic procedures and has minimal risk of perioperative complications.
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Affiliation(s)
| | - Dhiraj S Bal
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Andrew Pierce
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Naomi T Gebru
- Department of Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Raman Grewal
- Department of Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kunal Jain
- Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | | | - Gregory Hosier
- Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Eric Saltel
- Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Brian Peters
- Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Robert Bard
- Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jeffrey Saranchuk
- Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Premal Patel
- Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada.
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Jain K, Blachman-Braun R, Jain E, Eng A, Peters B, Patel P. Ureteroscopy under conscious sedation: A proof-of-concept study. Can Urol Assoc J 2022; 16:E461-E467. [PMID: 35426786 PMCID: PMC9484746 DOI: 10.5489/cuaj.7750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Abstract
INTRODUCTION Ureteroscopy (URS) is commonly performed under general anesthesia (GA) to maximize patient tolerability and minimize surgical complications; however, given the improvements in endoscopic technology and risks associated with GA, alternate forms of anesthesia have been postulated. We aimed to evaluate the outcomes of URS under conscious sedation. METHODS We completed a retrospective cohort study from November 2019 to June 2020 at a tertiary-level hospital. All URSs that were performed under urologist-directed conscious sedation were included. Our primary outcome was the ability to complete URS, defined as success rate. Secondary outcomes included: stone-free rate, intraoperative complication rate, hospital admission rate, and sedation requirement. Univariate- and multivariate-adjusted logistic regression analyses were employed. RESULTS Ninety-nine URSs were included. Most (73/99, 73.7%) were performed for urolithiasis. The overall success rate was 83.8% (83/99), with 81.0% (34/42) intra-renal and 70.0% (16/23) proximal ureter success rates. The stone-free rate was 80.8% (59/73). No intraoperative complications nor hospital admissions were reported. The mean amount of sedation required was 3 mg (interquartile range [IQR] 2-4] of midazolam and 100 μg (100-150) of fentanyl. On multivariate analysis, midazolam was significantly associated with increased success (odds ratio 2.496, 95% confidence interval 1.057-5.892, p=0.037). CONCLUSIONS We have shown that proximal and intrarenal URS under conscious sedation is safe and effective. We were limited by our lack of followup, small sample size, selection bias to chose healthy patients, and lack of patient tolerability data. Patients and healthcare systems may benefit from implementing this innovation more broadly.
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Affiliation(s)
- Kunal Jain
- Section of Urology, Department of Surgery, University of Manitoba, Winnipeg, MB, Canada
| | | | - Esha Jain
- Section of Urology, Department of Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - Amanda Eng
- Section of Urology, Department of Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - Brian Peters
- Section of Urology, Department of Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - Premal Patel
- Section of Urology, Department of Surgery, University of Manitoba, Winnipeg, MB, Canada
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Outcomes of loco-regional anaesthesia in ureteroscopy for stone disease: a systematic review. Curr Opin Urol 2020; 30:726-734. [PMID: 32657841 DOI: 10.1097/mou.0000000000000791] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE OF REVIEW Routine ureteroscopy (URS) for stone disease is performed under a general anaesthesia. However, controversy exists on the role of loco-regional anaesthesia and the outcomes associated with it. Here we review the challenges, outcomes and complications of loco-regional anaesthesia for URS. A Cochrane style review was performed in accordance with the preferred reporting items for systematic reviews and meta-analyses guidelines to evaluate the outcomes of loco-reginal anaesthesia for URS in stone disease, including all English language articles from January 1980 and December 2019. RECENT FINDINGS Twenty-one studies (1843 procedures) with a mean age of 46 years and a male : female ratio of 1.2 : 1 underwent URS under loco-regional anaesthesia. The mean stone size was 9 mm (range:4-21 mm) and except five papers, all other papers included stones in the ureter of which the majority were in the distal ureter. The conversion to general anaesthesia was needed in 2.7% patients (range 1-21%) across studies, with a stone free rate of 48-100%. The complication rate varied from 1.4 to 36%. Although the intraoperative complications included ureteric injury (n = 21) or perforation (n = 4), the postoperative complications included fever (n = 37), urinary tract infection (n = 20), haematuria (n = 4), urosepsis (n = 4) and others (n = 7). SUMMARY The present systematic review shows that local anaesthetic URS is a potential alternative to general anaesthetic URS in carefully selected patients. Randomised controlled trials with subgroup analysis are required to further assess whether loco-regional anaesthesia URS is noninferior to general anaesthesia URS and might help determine if the former approach should become more widespread.
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Xu Y, Lu Y, Li J, Luo S, Liu Y, Jia Z, Chen P, Guo Y, Zhao Q, Ma X, Jia S. A meta-analysis of the efficacy of ureteroscopic lithotripsy and extracorporeal shock wave lithotripsy on ureteral calculi. Acta Cir Bras 2014; 29:346-52. [PMID: 24863324 DOI: 10.1590/s0102-86502014000500010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 03/18/2014] [Indexed: 11/22/2022] Open
Affiliation(s)
- Yahong Xu
- Hospital of People's Liberation Army, China
| | - Yi Lu
- Hospital of People's Liberation Army, China
| | - Jian Li
- Hospital of People's Liberation Army, China
| | | | - Yang Liu
- Hospital of People's Liberation Army, China
| | | | - Ping Chen
- Hospital of People's Liberation Army, China
| | - Yu Guo
- Hospital of People's Liberation Army, China
| | - Qihua Zhao
- Hospital of People's Liberation Army, China
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Fuchs GJ, Koopman SG. Ureteroscopy for Ureteric Stones. Urolithiasis 2012. [DOI: 10.1007/978-1-4471-4387-1_57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Gaitan BD, Trentman TL, Fassett SL, Mueller JT, Altemose GT. Sedation and Analgesia in the Cardiac Electrophysiology Laboratory: A National Survey of Electrophysiologists Investigating the Who, How, and Why? J Cardiothorac Vasc Anesth 2011; 25:647-59. [DOI: 10.1053/j.jvca.2010.11.006] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Indexed: 12/27/2022]
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7
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Intravenous sedation for cardiac procedures can be administered safely and cost-effectively by non-anesthesia personnel. J Interv Card Electrophysiol 2008; 21:43-51. [DOI: 10.1007/s10840-007-9191-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2007] [Accepted: 11/28/2007] [Indexed: 10/22/2022]
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8
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Gunlusoy B, Degirmenci T, Arslan M, Kozacioglu Z, Nergiz N, Minareci S, Ayder AR. Ureteroscopic Pneumatic Lithotripsy: Is the Location of the Stone Important in Decision Making? Analysis of 1296 Patients. J Endourol 2008; 22:291-4. [DOI: 10.1089/end.2007.0160] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Bulent Gunlusoy
- Department of Urology, Izmir Education and Teaching Hospital, Izmir, Turkey
| | - Tansu Degirmenci
- Department of Urology, Izmir Education and Teaching Hospital, Izmir, Turkey
| | - Murat Arslan
- Department of Urology, Izmir Education and Teaching Hospital, Izmir, Turkey
| | - Zafer Kozacioglu
- Department of Urology, Izmir Education and Teaching Hospital, Izmir, Turkey
| | - Nihat Nergiz
- Department of Urology, Izmir Education and Teaching Hospital, Izmir, Turkey
| | - Suleyman Minareci
- Department of Urology, Izmir Education and Teaching Hospital, Izmir, Turkey
| | - Ali Riza Ayder
- Department of Urology, Izmir Education and Teaching Hospital, Izmir, Turkey
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9
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Zanin M, Ruggera L, Beltrami P, Zattoni F. Ureterorenoscopy with a flexible instrument. Urologia 2007. [DOI: 10.1177/039156030707400304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Flexible ureterorenoscopy should be routinely used at the Urological Centers that deal with urinary stones. Flexible instruments should be used for both diagnostic and therapeutic purposes, allowing a safe exploration of the whole upper urinary tract. Thanks to their flexibility and to the active and passive deflection of their distal part, these instruments allowed to successfully treat several difficult situations, such as renal caliceal calculi in the lower calices or even in some middle/upper calices or in horseshoe kidneys. The therapeutic potential of this approach is enhanced by the large availability of ancillary instrumentation, such as baskets, grasps, holmium laser fibers, etc, which is continuously growing. On the other side, a steep learning curve of the technique is usually required for the surgeon. Furthermore, the intrinsic fragility of the instrument components and a potentially lower quality, when compared to that of the rigid and semi-rigid ureteroscopes, should be considered.
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Affiliation(s)
- M. Zanin
- Cattedra e Divisione Clinicizzata di Urologia, Università degli Studi di Verona
| | - L. Ruggera
- Cattedra e Divisione Clinicizzata di Urologia, Università degli Studi di Verona
| | - P. Beltrami
- Cattedra e Divisione Clinicizzata di Urologia, Università degli Studi di Verona
| | - F. Zattoni
- Cattedra e Divisione Clinicizzata di Urologia, Università degli Studi di Verona
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Lesani OA, Palmer JS. Retrograde proximal rigid ureteroscopy and pyeloscopy in prepubertal children: safe and effective. J Urol 2006; 176:1570-3. [PMID: 16952683 DOI: 10.1016/j.juro.2006.06.038] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2005] [Indexed: 01/07/2023]
Abstract
PURPOSE Traditionally, rigid ureteroscopy in adults has been reserved for distal ureteral procedures, due to the risk of injury associated with proximal ureteroscopy. However, the safety of proximal rigid ureteroscopy in prepubertal children is not well established. MATERIALS AND METHODS We retrospectively evaluated all prepubertal children (12 years old and younger) who underwent attempted rigid proximal ureteroscopy and pyeloscopy. The indications for ureteroscopy were treatment of ureteral and/or renal pelvic calculi, and evaluation of hematuria. All patients were evaluated postoperatively with renal and bladder ultrasonography and abdominal radiography (if stone was visible before treatment). RESULTS A total of 24 consecutive children 3.4 to 12 years old underwent 24 ureteropyeloscopic procedures. Of these children 20 (83%) successfully underwent 20 rigid ureteroscopic and pyeloscopic procedures. However, 4 procedures (17%) were converted from rigid to flexible endoscopy to perform 4 successful ureteropyeloscopies. The indications for ureteroscopy were treatment of ureteral and/or renal pelvic calculi in 22 patients and evaluation of hematuria in 2. Followup was 0.6 to 3.6 years (mean 1.9) for the patients undergoing rigid ureteropyeloscopy. All children with calculi were rendered stone-free based on direct visualization by complete ureteroscopy and pyeloscopy of the affected system. No complications occurred during any of the procedures. CONCLUSIONS Proximal rigid ureteroscopy and pyeloscopy can be safely applied toward treatment of proximal ureteral and renal pelvic calculi as well as diagnostic ureteropyeloscopy in prepubertal children. The technique has several advantages compared to flexible ureteroscopy.
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Affiliation(s)
- O Alex Lesani
- Division of Pediatric Urology, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio 44106, USA
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11
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Chen CS, Wu CF, Shee JJ, Lin WY. Holmium:YAG Lasertripsy with semirigid ureterorenoscope for upper-ureteral stones >2 cm. J Endourol 2006; 19:780-4. [PMID: 16190827 DOI: 10.1089/end.2005.19.780] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND PURPOSE Shockwave lithotripsy (SWL) has a variable but low success rate for impacted stones of the upper ureter. Ureterorenoscopic stone manipulation is another option, the appropriateness of which decreases with increasing size of the stone. This report examines the feasibility and effectiveness of ureterorenoscopic holmium:YAG lasertripsy (URSL) for impacted upper-ureteral stone >2 cm. PATIENTS AND METHODS Twenty-six patients with impacted upper-ureteral stones >2 cm were treated with URSL using a 6/7.5F semirigid tapered ureterorenoscope and holmium:YAG laser under spinal anesthesia. Double-J ureteral stents were placed in all patients owing to the large stone burden and edema of the intraluminal mucosa. Success was defined as stone-free status on radiography at 1 month. Demographics, stone parameters, and outcomes were analyzed. RESULTS The retrograde accessibility rate of these stones was 96.2% (25 of 26). The stone-free rate achieved after one sitting was 84% (21 of 25). After an auxiliary treatment, the total stone free-rate reached 100%. In only one patient, who had a sharply angulated ureter, did access with the ureterorenoscope fail; this patient received open surgery. There were no intraoperative or postoperative complications. CONCLUSIONS Although 16% of patients need an auxiliary treatment, the holmium:YAG laser combined with a semirigid ureterorenoscope can be considered the first choice for large impacted upper-ureteral stones.
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Affiliation(s)
- Chih Shou Chen
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chia-Yi, Taiwan, R.O.C.
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12
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Abstract
BACKGROUND AND PURPOSE We report our initial experience with a prototype ureteroscope having the smallest tip diameter and shaft with an offset eyepiece for the treatment of ureteral stones. PATIENTS AND METHODS A series of 21 male and 4 female patients between the ages of 1.5 and 57 years underwent treatment with the new ureteroscope for stones in the lower (24) and middle (1) ureter. All four of the children were boys. All patients were operated on by a single urologist. Patient sex, age, side, location and size of stone, type of anesthesia, requirement for a guidewire, use of stent, requirement for ureteral dilatation, operative time, type of intracorporeal lithotripsy used if any, type of stone-grasping device used, success rate, length of hospital stay, and complications were recorded. RESULTS None of the patients required ureteral dilatation, and a guidewire was used in only three patients. Eight patients were operated on with instillation of 2% lidocaine gel alone, while another five patients required intravenous pentazocine and midazolam. Eight patients were operated on with monitored anesthesia care under propofol and one under ketamine. Three patients required general anesthesia. A double-J stent was not required in 15 patients. The success rate was 100%, and complications were minor. CONCLUSION The new ureteroscope can treat the majority of lower-ureteral stones of up to 1.2 cm even in male patients under lidocaine gel with or without intravenous sedation or monitored anesthesia care. These patients can be treated as day-care cases. None of the patients required ureteral dilatation, and stent is now being omitted in most patients. All children were treated in one session.
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Rao MP, Kumar S, Dutta B, Vyas N, Nandy PR, Mahmood M, Dwivedi US, Singh DK, Singh PB. Safety and Efficacy of Ureteroscopic Lithotripsy for Ureteral Calculi Under Sedoanalgesia – A Prospective Study. Int Urol Nephrol 2005; 37:219-24. [PMID: 16142546 DOI: 10.1007/s11255-004-7969-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To establish the safety and efficacy of ureteroscopic lithotripsy (URSL) under sedoanalgesia. PATIENTS AND METHODS This study was conducted at Department of Urology (Banaras Hindu University, India) among 124 patients with ureteral stones, between July 2000 and August 2003. Majority of the patients (59.68%) presented with lower ureteric calculi, 24.19% presented with upper ureteric calculi and 16.13% had middle ureteric calculi. All patients were given injection diclofenac sodium (75 mg) promethazine hydrochloride (12.5 mg) deep intramuscular 30 minutes the before procedure. Injection midazolam 0.03 mg/kg body weight slowly given intravenously immediately before the procedure for achieving sedation. Injection fentanyl 50 mcg intravenously given slowly just before introducing the ureteroscope into ureter for achieving intravenous analgesia. Patients were observed for few hours after completion of procedure and oral questions were asked as per proforma, which included tolerance, intensity of pain and percentage of pain experienced by the patients. Patients were discharged thereafter. RESULTS 87.10% of patients opined that the procedure was acceptable. Only 4.84% opined this procedure was painful. According to present pain intensity score (PPI) in this study 79.03 patients experienced only mild pain, 11.29% cases rated procedure as discomforting, 6.45 rated procedure as distressing and only 3.23% rated as horrible procedure. As per visual analogue scale for assessment of pain 80.65 of cases rated only 20% pain score (in a scale of 0-100). 9.68% cases rated 30% and 6.45% rated 50%. Only two patients in middle ureteric group rated 100% pain. Overall success rate in fragmenting stone was 91.94, where as for lower ureteric calculi it was 97.30%; for upper and, middle ureteric calculi it was 86.66% and 80%, respectively. CONCLUSION Ureteroscopic lithotripsy can be performed on day care basis under sedoanalgesia which is fairly tolerated by the patients with unremarkable complications and difficulty.
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Affiliation(s)
- M Prasad Rao
- Department of Urology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221 005, India
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Tiselius HG. Removal of ureteral stones with extracorporeal shock wave lithotripsy and ureteroscopic procedures. What can we learn from the literature in terms of results and treatment efforts? UROLOGICAL RESEARCH 2005; 33:185-90. [PMID: 15924257 DOI: 10.1007/s00240-005-0462-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2004] [Accepted: 12/17/2004] [Indexed: 05/02/2023]
Abstract
A literature review was made to obtain information on the treatment efforts required for a successful removal of ureteral stones when extracorporeal shock wave lithotripsy (ESWL) or ureteroscopic stone extraction or disintegration (URS) were used as primary procedures. Data were collected from 59 reports on ESWL and 23 on URS. The study thereby comprised 20,659 patients primarily treated with ESWL and 5,520 treated with URS. A treatment index (TI) was formulated from the total number of patients (N(TOT)), the number of stone free patients (N(SF)), the number of patients with retreatment (N(RE)), auxiliary procedures (N(AUX)) and general or regional anaesthesia (N(ANE)). The difference between the TI and the efficiency quotients normally used was the incorporation of the factor N(ANE) that reflected the need for general or regional anaesthesia. TI had the following form: TI = N(SF)/(N(TOT) + N(RE) + N(AUX) + N(ANE). When the groups of treated patients were considered in this way, TI was significantly higher for the patients treated with ESWL than for those treated with URS (P = 0.007). The median (range) for the groups of ESWL-treated patients was 0.50 (0.25-0.90) and for patients treated with URS 0.42 (0.26-0.94). For the combined groups of patients, the TI-values were 0.54 and 0.40, respectively. Although the average retreatment for URS was only 2.2% compared with 12.1 percent for ESWL, the need for general/regional anaesthesia was 94.3% and 28.3% in the two groups, respectively. The advantage of a lower rate of retreatment in patients primarily referred to URS was thus obviously counterbalanced by the much higher need for anaesthesia. For ureteral stones treated with ESWL in the author's department using Dornier HM3, MFL 5000, and Modulith SLX lithotripters, stone free rates of 96%, 97% an 95% were associated with TI-values of 0.61, 0.60 and 0.63, respectively. Both ESWL and URS are excellent procedures for the removal of stones from the ureter. In addition to the different degrees of invasiveness, the need for anaesthesia has to be considered in an objective comparison of the two methods.
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Affiliation(s)
- Hans-Göran Tiselius
- Renal Stone Unit, Department of Urology, Karolinska University Hospital, Huddinge and Karolinska Institutet, Center for Surgical Sciences, 141 86 Stockholm, Sweden.
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16
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Abstract
The advances of technology are having substantial ramifications in medicine and in urology, in particular. This article discusses these advances and explores current trends in ureteroscopy.
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Affiliation(s)
- Gennady Bratslavsky
- Division of Urology, Albany Medical College, 23 Hackett Boulevard, Albany, NY 12208, USA
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17
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Abstract
Ureterorenoscopy (URS) is a vital procedure in the armamentarium of the modern-day urologist for the management of ureteral and renal pathology. With advances in ureteroscopic design and the introduction of short-acting anesthetics, URS can now be performed efficiently with high patient satisfaction and minimal posteroperative recovery time. Recently, URS under local anesthesia, with or without sedation, has become a viable option for a high percentage of correctly selected patients. For those patients who then require deeper sedation or general anesthesia, anesthesia can be induced quickly with the new agents such as remifentanil, propofol, and desflurane, without a prolonged postoperative recovery period.
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Affiliation(s)
- Peter A Cybulski
- Division of Urology, St. Michael's Hospital, University of Toronto, 61 Queen Street East, Toronto, Ontario M5C 2T2, Canada
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18
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Abstract
Ureteroscopy has an important role in the practice of the modern urologist. The procedure is usually performed under locoregional anaesthesia even if general anaesthesia is still considered the standard. Placement of a guide wire (safety guide wire) represents the starting point to perform safely a ureteroscopy, just in case of complications during the endoscopic manoeuvres. There is no consensus on dilation of the ureteral orifice and on ureteral stenting at the end of the procedure. Dilation of the ureteral lumen directly under vision as well as the use of ureteral sheath can be considered in particular cases. Ureteroscopy is largely performed in many urologic centers at the present, but it requires ability and experience.
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Unsal A, Cimentepe E, Balbay MD. Routine ureteral dilatation is not necessary for ureteroscopy. Int Urol Nephrol 2004; 36:503-6. [PMID: 15787325 DOI: 10.1007/s11255-004-0860-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE To present our experience in ureteroscopic lithotripsy and stone extraction without ureteral dilatation. PATIENTS AND METHODS A total of 134 consecutive patients (80 male and 54 female), with a mean age of 36.4 (18-65) years underwent ureteroscopic stone removal. The stones were located in the lower, middle, and upper parts of the ureter in 92, 18 and 24 patients and the mean stone diameters were 9.2 (6-15) mm, 10.5 (8-15) mm and 8.8 (8-10) mm, respectively. A semirigid ureteroscope 8 F in size was used without any ureteral dilatation. The stones were fragmented by a pneumatic lithotripter in the ureter and the fragments were removed by a basket catheter or stone forceps. All patients were re-evaluated with a plain film on postoperative first day and with intravenous urography (IVU) at 3 months. Residual fragments bigger than 3 mm were accepted as treatment failure. RESULTS The mean operation time was 44 (20-120) minutes. After the operation, the stone-free rate was 89/92 (97%) for lower, 15/18 (83%) middle and 18/24 (75%) upper ureteral stones, respectively. Double J catheter replacement was needed in 13 patients due to impacted stone and/or failed procedure. Ureteral perforation did not occur in any patient. Patients were discharched from hospital within 6-24 hours. No ureteral stricture was encountered during the follow-up period. CONCLUSION Our experience suggests that ureteroscopic interventions could be easily performed for all parts of ureter without previous dilatation of the ureter.
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Affiliation(s)
- Ali Unsal
- Department of Urology, Fatih University, School of Medicine, Ankara, Turkey.
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Bilgasem S, Pace KT, Dyer S, Honey RJD. Removal of asymptomatic ipsilateral renal stones following rigid ureteroscopy for ureteral stones. J Endourol 2003; 17:397-400. [PMID: 12965066 DOI: 10.1089/089277903767923182] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To evaluate the feasibility and outcome of flexible ureteroscopic removal of small (<1-cm) asymptomatic renal stone(s) following rigid ureteroscopy for ureteral stones. PATIENTS AND METHODS Ten female and nineteen male patients underwent rigid ureteroscopy and holmium lasertripsy for removal of ureteral stone(s). All had asymptomatic renal stone(s) on the same side, which were then removed using flexible ureteroscopy. The renal stones were either removed intact with a tipless Nitinol basket or fragmented with the laser to small pieces (<2 mm), with basket removal of larger fragments. The number and size of stones, total operative time, added time needed for flexible ureteroscopy, and intraoperative and postoperative complications were recorded. Follow-up at 1 month included a plain abdominal film and renal ultrasonography or noncontrast CT scan. RESULTS Fifty-six renal stones with a mean size of 5.7 mm were treated. Fourteen patients had stones on the right side, and 15 had stones on the left. The mean total operative time was 56.5 minutes, with a mean added time of 16.7 minutes for flexible ureteroscopy. Stones were removed intact in 18 patients and fragmented in 8 patients, resulting in an immediate success rate of 90%. There were three failures. One-month follow-up confirmed all patients were either stone-free or had residual fragments <2 mm in diameter, with no new-onset hydronephrosis. CONCLUSIONS Removal of small asymptomatic renal stones at the time of ureteroscopy for ureteral stones appears safe and effective and requires little additional operative time.
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Affiliation(s)
- Solieman Bilgasem
- Division of Urology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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Tligui M, El Khadime MR, Tchala K, Haab F, Traxer O, Gattegno B, Thibault P. Emergency extracorporeal shock wave lithotripsy (ESWL) for obstructing ureteral stones. Eur Urol 2003; 43:552-5. [PMID: 12706002 DOI: 10.1016/s0302-2838(03)00086-1] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate emergency treatment of obstructing ureteral stones by in situ extracorporeal shock wave lithotripsy (ESWL) during acute renal colic. PATIENTS AND METHODS From January 1994 to February 2000, 200 patients (mean age: 42 years) were treated by ESWL (EDAP LT-02) for obstructing ureteral stones causing acute renal colic refractory to medical treatment or recurring within 24hours of such treatment. Stones were visualised by fluoroscopic imaging and/or ultrasound. Follow-up included radiological and/or ultrasound examinations and lasted three months. RESULTS Mean stone size was 7mm (3-20mm). At three months, 164/200 (82%) patients were stone-free. This rate ranged from 79% to 83% according to the location of the stone, and from 75% to 86% according to the size of the stone. These differences in rate were not significant. Two or three ESWL sessions were required in 79 patients. ESWL was well tolerated in 90% of patients. The only complication was a case of pyelonephritis requiring the placement of a JJ stent, administration of antibiotics, and distant ureteroscopy. The 36 patients, in whom ESWL failed, underwent ureteroscopy (n=23) or lithotripsy with a Dornier machine (n=13). CONCLUSION Non-deferred ESWL for acute renal colic secondary to obstructing ureteral stones has a satisfactory success rate and very low morbidity.
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Affiliation(s)
- M Tligui
- Service d'Urologie, Hôpital Tenon, 4 rue de la Chine, 75020, Paris, France.
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Alapont Alacreu JM, Broseta Rico E, Pontones Moreno JL, Oliver Amorós F, Palmero Martí JL, Boronat Tormo F, Jiménez Cruz JF. Complicaciones de la uretero-renoscopia. Actas Urol Esp 2003; 27:692-9. [PMID: 14626678 DOI: 10.1016/s0210-4806(03)72998-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Since its clinical introduction ureteroscopy (URS) has experienced an impressive development due to the technical improvements of new and smaller urological armamentarium. Currently, ureteroscopy is a worldwide procedure with a varied number of diagnostic and therapeutic possibilities. However, the technique has complications. MATERIAL AND METHODS We analyse the complications of URS in a series of 4.645 ureteroscopic procedures performed from january 1990 to december 2001, 2972 (64%) female and 1673 (36) male. The objectives of URS were diagnostic (haematuria) and therapeutic (ureteral stones, tumors, strictures and placement of stents). RESULTS Fever was the most frequent complication (11.7%), with sepsis in 15 patients. Another complications were: ureteral perforation (1.2%), ureteral avulsion (0.06%), renal injury (0.04%), extrusion (0.4%) and uretero-iliac fistulae (0.02%). The most common treatment was conservative with endourological approach. CONCLUSION Carefully performed ureteroscopy is a superb tool for the urologist either for diagnostic or therapeutic purposes with a low ratio of complications. The majority of these complications can be solved with conservative management.
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Pascual Samaniego M, Calleja Escudero J, Rivero Martínez MD, Rivera Ferro J, Trueba Arguiñarena FJ, Fernández del Busto E. [Endoscopic treatment of ureteral lithiasis. Our experience with 360 retrograde uretero-renal endoscopies in the last ten years]. Actas Urol Esp 2002; 26:339-44. [PMID: 12174742 DOI: 10.1016/s0210-4806(02)72787-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Presentation of results and complications obtained in 360 procedures of transuretral ureterorenoscopy (URS) in ureteral lithiasis performed in our unit from january 1990 to august 2000 in 354 patients: 55% female and 45% male. A rigid ureteroscopy Storz 10.5 Ch. was used and intracorporeal lithotripsy was necessary in 17.31% of cases. URS indications were always treatment of ureteral lithiasis, pelvic ureter localization in most cases (70.33%) being 93.05% the percentage of overall success and with a significant decrease when the calculus was located in the upper third of the ureter. Serious complications were only 3.05% of cases and endoscopic surgery was necessary in three cases of ureteral stenosis. In our experience, URS is our technique of choice for treatment of lower and medium third of the ureter where the percentage of success we have obtained were 98.99% and 95.83% respectively.
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Ghafoor M, Halim A. Extracorporeal shock wave lithotripsy in the treatment of ureteric stones: experience from Tawam Hospital, United Arab Emirates. Ann Saudi Med 2002; 22:18-21. [PMID: 17259760 DOI: 10.5144/0256-4947.2002.18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The optimal treatment of ureteric stones, especially the lower ureteric stone, remains controversial. The purpose of this study was to evaluate the role of extracorporeal shock wave lithotripsy (ESWL) in the management of ureteric stones. MATERIALS AND METHODS A total of 99 patients with ureteric stones at different levels were treated with ESWL from 1994 through 1998 at our hospital. All patients were treated using Siemen Lithostar-II Plus Lithotripter. Of the 99 patients, 20 were excluded from the study because they had no follow-up records of their stone-free status. The clearance rates for ureteric stones of the other 79 patients treated were stratified according to the site, size, and number of treatment sessions required per stone. The stone size was determined by the widest diameters. Based on stone size, the patients were divided into two groups: A (< or =10 mm) and B (11-20 mm). RESULTS The overall clearance rate for ureteric stones treated with ESWL, irrespective of its site and size, was 78.5%. The overall clearance rate for size A (< or =10 mm) stones was 82% and size B (11-20 mm) was 58% regardless of the site of the stone in the ureter. A total of 17 upper ureteric stones were treated with ESWL. The overall clearance rate for upper ureteric stones was 94%. Thirteen patients with mid-ureteric stones were treated with ESWL. The overall clearance rate for the mid-ureteric stones was 92.3%. Forty-nine patients had lower ureteric stones. The overall clearance rate for the lower ureteric stones was 69.3%. CONCLUSIONS ESWL is safe, effective, noninvasive and a convenient way of treatment for all ureteric stones. The clearance rate for stones in the upper and mid-ureter is above 90%. ESWL being an outpatient procedure without any need for anesthesia or any pretreatment intervention, it should be considered as the first line of treatment for all stones in the upper and mid-ureter. The clearance rate for small stones (< or =10mm) in the lower third of the ureter was 73.8% in our study and for these, ESWL may be considered as a primary therapy. For stones larger than 10 mm in the distal third of ureter, the clearance rate was low with a high retreatment rate, and ureteroscopy as primary treatment modality would be more preferable.
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Affiliation(s)
- Mohammad Ghafoor
- Department of Surgery, Urology, Division, Tawam Hospital, Al-Ain, Abu Dhabi, United Arab Emirates
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DELVECCHIO FERNANDOC, KUO RAMSAYL, PREMINGER GLENNM. CLINICAL EFFICACY OF COMBINED LITHOCLAST AND LITHOVAC STONE REMOVAL DURING URETEROSCOPY. J Urol 2000. [DOI: 10.1097/00005392-200007000-00010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Beltrán Aguilar V, Varo Solís C, Soto Delgado M, Bachiller Burgos J. [Ureteroscopy as diagnostic and treatment method in ureteral processes: our experience]. Actas Urol Esp 2000; 24:458-62. [PMID: 11011427 DOI: 10.1016/s0210-4806(00)72483-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Endoscopic approach to the ureter both as a diagnostic procedure in various diseases and treatment of low ureteral lithiasis is a widely used technique. Review of case reports where this technique was used over the last four years. A total of 73 ureteroscopies were conducted, 64 as therapeutic approach (89.04%) and 9 for diagnosis (10.96%) achieving an overall 94.4% success rate. Multiple variables such as type and location of the stones, patient's age and sex, diagnostic methods, length of stay etc. All the above data were used for a descriptive analysis of the situation in our centre. In our experience, ureteroscopy is a good therapeutic option for low ureteral lithiasis, mainly when no extracorporeal lithotrity is available, and an excellent diagnostic tool in other ureteral processes when more traditional methods fail.
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Coz F, Orvieto M, Bustos M, Lyng R, Stein C, Hinrichs A, San Francisco I. Extracorporeal shockwave lithotripsy of 2000 urinary calculi with the modulith SL-20: success and failure according to size and location of stones. J Endourol 2000; 14:239-46. [PMID: 10795612 DOI: 10.1089/end.2000.14.239] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE We analyzed the successes and failures of SWL in the treatment of 2016 urinary calculi stratified according to size and position in the urinary tract. METHODS All the patients were treated with a Modulith SL-20 (Storz Medical). RESULTS The overall stone-free rate, regardless of the size and position of the stone, was 87.4%. The rate was different for kidney and ureteral stones. The stone-free rate observed for the different positions of the calculi within the kidney was upper calix 89.2%, middle calix 90.5% lower calix 84.8%, and renal pelvis 86.0%. For staghorn calculi, the stone-free rate was 60.0%. The stone-free rate for the different positions of calculi within the ureter was: upper ureter 84.3%, iliac ureter 82.4%, and pelvic ureter 91.0%. For calculi >24 mm, the retreatment rate increased, and the success rate dropped sharply. CONCLUSION Extracorporal shockwave lithotripsy should be the first therapeutic option for urinary calculi of <24 mm regardless of their position in the urinary tract.
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Affiliation(s)
- F Coz
- Department of Urology, Military Hospital, Santiago, Chile.
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O'Toole GC, Khan SM, Kelly DG, Quinlan DM. The management of ureteric calculi without extracorporeal shock-wave lithotripsy. Ir J Med Sci 2000; 169:119-21. [PMID: 11006667 DOI: 10.1007/bf03166913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Extracorporeal shock-wave lithotripsy (ESWL) is a relatively new technological adjunct in the treatment of renal calculi, but availability is limited. AIM The aim of this study was to assess the outcome of ureteroscopic procedures in a unit without on-site ESWL facility. METHODS A retrospective study of all cases of ureteric calculi presenting to this hospital during the period 1991 to 1997 was performed. RESULTS One hundred and thirty five patients with a mean age of 46.8 years were evaluated. Ninety-four (69.5%) had their stone successfully manipulated and/or extracted at ureteroscopy. Using strict criteria, 41 patients (30.5%) had failed ureteroscopies. Fourteen (10.4%) suffered complications related to their ureteroscopy, thirteen had their complications treated conservatively and three (2.3%) needed open procedures. CONCLUSION Ureteroscopy has a high success rate and low morbidity. We continue to advocate ureteroscopy in the initial management of ureteric calculi.
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Affiliation(s)
- G C O'Toole
- Department of Urology, St Vincent's University Hospital, Dublin
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Pardalidis NP, Kosmaoglou EV, Kapotis CG. Endoscopy vs. extracorporeal shockwave lithotripsy in the treatment of distal ureteral stones: ten years' experience. J Endourol 1999; 13:161-4. [PMID: 10360494 DOI: 10.1089/end.1999.13.161] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The lower third is the location of the great majority of ureteral stones. Treatment of these stones remains controversial: in situ extracorporeal shockwave lithotripsy (SWL) vs. ureteroscopy (URS). METHODS During the last decade, 633 distal ureteral calculi were treated at our institution using in situ SWL (Siemens Lithostar electromagnetic lithotripter) in 395 patients and URS (with 11.5F instrument and ultrasonic lithotripsy) in 228 patients. The patients' age and stone size were similar in the two groups. All SWL therapies were performed on an outpatient basis. RESULTS The overall success rate was 99% for SWL, and the efficiency quotient (EQ) was 92.4%. The treatment was more effective for <10 mm calculi. In the URS group, there was a 92% overall success rate with an EQ at 91.2%. Compared with SWL, URS was more time consuming, at least for the initial cases; often required intravenous sedation; entailed routine placement of a ureteral stent; and more often led to hospitalization. On the other hand, stone clearance was rapid after URS, although most of the SWL patients were stone free at the end of 6 weeks. The cost was similar in the two groups. CONCLUSION We believe that multiple factors should be considered when deciding the most appropriate approach to distal ureteral calculi. In situ SWL provides optimal first-line treatment for calculi < 10 mm, whereas URS is better reserved for stones >10 mm.
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Affiliation(s)
- N P Pardalidis
- Department of Urology, Hellenic Airforce and V.A. General Hospital, Athens, Greee
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Ferraro RF, Abraham VE, Cohen TD, Preminger GM. A new generation of semirigid fiberoptic ureteroscopes. J Endourol 1999; 13:35-40. [PMID: 10102126 DOI: 10.1089/end.1999.13.35] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Further advances in endoscope technology have allowed the development of a new generation of tightly packed fiberoptics encased within a rigid ureteroscope. The tips of these semirigid ureteroscopes measure between 5.0F and 11.9F, and their working channels measure between 1.8F and 5.5F, which allows passage of routine endoscopc instruments. Additionally, several manufacturers have recently produced straight-channel fiberoptic semirigid endoscopes with an offset lens which allow usage of rigid lithotripsy devices. New fiber-packing techniques provide numerous pixels within the image bundle. These ureteroscopes have varied distal lens systems, but all have excellent vision in the field of view. METHODS Over the past 28 months, we have performed transurethral ureteroscopy in 187 patients, having utilized semirigid ureteroscopes in 158 patients for diagnostic procedures (8.7 %), stone manipulation (78.7 %), removal of migrated stents (4.4%), and surgery of stricture, tumor, or foreign bodies (8.2%). In more than 50% of our cases, ureteral dilation was not necessary, and the semirigid ureteroscope was passed to the area of interest without difficulty. RESULTS We accessed the site of pathology in 96.2% of patients. Overall, complications occurred in 6.9% of patients. However, of these problems, 93.6% were small ureteral perforations (only three of which were caused by the semirigid ureteroscope itself), and all cases but one were managed successfully by a ureteral stent. No postoperative strictures were noted. CONCLUSION This new generation of semirigid fiberoptic ureteroscopes represents another significant advance in the endourologic management of ureteral disease.
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Affiliation(s)
- R F Ferraro
- The Comprehensive Kidney Stone Center, Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA
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A COMPARISON OF URETEROSCOPY TO IN SITU EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY FOR THE TREATMENT OF DISTAL URETERAL CALCULI. J Urol 1999. [DOI: 10.1097/00005392-199901000-00015] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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HOSKING DENISH, McCOLM SHERRELLE, SMITH WILDAE. IS STENTING FOLLOWING URETEROSCOPY FOR REMOVAL OF DISTAL URETERAL CALCULI NECESSARY? J Urol 1999. [DOI: 10.1016/s0022-5347(01)62058-5] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- DENIS H. HOSKING
- Department of Surgery, Section of Urology, University of Manitoba and Adult Ambulatory Care, Section of Urology, Health Sciences Centre, Winnipeg, Manitoba, Canada
| | - SHERRELL E. McCOLM
- Department of Surgery, Section of Urology, University of Manitoba and Adult Ambulatory Care, Section of Urology, Health Sciences Centre, Winnipeg, Manitoba, Canada
| | - WILDA E. SMITH
- Department of Surgery, Section of Urology, University of Manitoba and Adult Ambulatory Care, Section of Urology, Health Sciences Centre, Winnipeg, Manitoba, Canada
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TURK THOMASM, JENKINS ALAND. A COMPARISON OF URETEROSCOPY TO IN SITU EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY FOR THE TREATMENT OF DISTAL URETERAL CALCULI. J Urol 1999. [DOI: 10.1016/s0022-5347(01)62056-1] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- THOMAS M.T. TURK
- Department of Urology, University of Virginia, Charlottesville, Virginia
| | - ALAN D. JENKINS
- Department of Urology, University of Virginia, Charlottesville, Virginia
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Tan PK, Tan SM, Consigliere D. Ureteroscopic lithoclast lithotripsy: a cost-effective option. J Endourol 1998; 12:341-4. [PMID: 9726400 DOI: 10.1089/end.1998.12.341] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Seventy-four consecutive cases of ureteral stones listed for ureteroscopic lithotripsy were studied prospectively. In all cases, the Wolf 7.5F or 9F ureteroscope was used in conjunction with the Swiss Lithoclast system. Dormia baskets were employed on four occasions to prevent forward propulsion of fragments. Ureteroscopic access to the stones was successful in 70 patients (95%). Lithoclast lithotripsy was successfully applied in 68 patients (92%), with complete fragmentation noted in 62 patients (91%), one requiring two sessions. The 6-week stone-free rate was 96% for these patients. Five patients with partial fragmentation had successful adjuvant SWL. The overall successful fragmentation rate was thus 84% (62 of 74) and 91% (67 of 74) in combination with adjuvant SWL. Cost analysis indicated a three-fold advantage for the Lithoclast over Candela lasertripsy. Ureteroscopic Lithoclast lithotripsy is a cost-effective treatment modality for ureteral stones.
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Affiliation(s)
- P K Tan
- Department of General Surgery, Tan Tock Seng Hospital, Singapore
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Yip KH, Lee CW, Tam PC. Holmium laser lithotripsy for ureteral calculi: an outpatient procedure. J Endourol 1998; 12:241-6. [PMID: 9658294 DOI: 10.1089/end.1998.12.241] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A retrospective review was conducted to evaluate the efficacy of ureteroscopic lithotripsy using the holmium laser with a semirigid endoscope in a newly established day surgery center. In 1996, 69 consecutive patients (40 male and 29 female) with a mean age of 46.7 (range 21-73) years and ASA status I or II underwent ureteroscopic lithotripsy for their ureteral calculi using the holmium laser (365-micron fiber; power setting 0.5-1.4 J/5 Hz) and 8.5F semirigid ureteroscope in a day surgery setting. Stone features, postoperative pain scores, readmissions, and complications were evaluated. Eighteen upper, 17 middle, and 34 lower ureteral stones were treated, with a mean size measuring 12.1 (5-45) mm. The mean operative time was 61 minutes including the anesthetic time (range 15-150 minutes), and the success rate was 91% (63/69). The complication rate was 10% (7/69) including four unscheduled readmissions (6%). Telephone follow-up on postoperative Day 1 and Day 3 revealed mean pain scores of 2 and 1, respectively (on a 0-10 scale) and an analgesic requirement of 1 tablet of Dologesic (containing 32.5 mg of dextropropoxyphene + 320 mg of paracetamol) four times a day on both days. Ureteroscopic lithotripsy using the holmium laser and a semirigid endoscope is highly successful and well tolerated and carries a low complication rate. It is indicated as an ambulatory and minimally invasive treatment modality in low-risk patients with ureteral stones.
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Affiliation(s)
- K H Yip
- Department of Surgery, Tung Wah Hospital, University of Hong Kong, Hong Kong
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Harmon WJ, Sershon PD, Blute ML, Patterson DE, Segura JW. Ureteroscopy: current practice and long-term complications. J Urol 1997; 157:28-32. [PMID: 8976208 DOI: 10.1016/s0022-5347(01)65272-8] [Citation(s) in RCA: 287] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE We compared a current cohort of patients who underwent ureteroscopy to a cohort from the early 1980s to determine changes in success, indications and long-term complications of the procedure. MATERIALS AND METHODS A chart review was performed of 194 patients who underwent 209 ureteroscopic procedures at our institution during 1992. This group was then statistically compared to 317 patients who underwent 346 ureteroscopies between 1982 and 1985. RESULTS The current indications for ureteroscopy were calculus extraction (67% of the cases), diagnosis (28%) and stent manipulation (5%). These indications differed from those of the early series, in which 84% of all ureteroscopies were performed for calculus extraction and 16% for diagnosis. Overall ureteroscopic success rate increased from 86 to 96% (p < 0.001). Success of stone extraction improved from 89 to 95% (p = 0.08, distal success rate 95 to 97% and proximal success rate 72 to 77%). Success of diagnostic inspections increased from 73 to 98% (p < 0.001). In the early series failure was usually due to inability to traverse the ureter (54% of the cases), while currently failure is due almost exclusively to impassable ureteral strictures (63%). The overall complication rate decreased from 20 to 12% (p = 0.01) and the rate of significant complications decreased from 6.6 to 1.5% (p < 0.05). Clinical followup (mean 36 months) for all patients and radiological followup (mean 9.8 months) for 67% of eligible patients detected only 1 ureteral stricture. The remaining patients were asymptomatic after the ureteroscopic procedure. CONCLUSIONS Improvements in ureteroscope design, accessories and technique have led to a significant increase in the success of diagnostic and therapeutic ureteroscopy while decreasing morbidity. Outpatient ureteroscopic stone extraction, particularly for distal ureteral calculi, is almost uniformly successful with low morbidity. The long-term complication rate of ureteroscopy is 0.5%.
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Affiliation(s)
- W J Harmon
- Department of Urology, Mayo Clinic, Rochester, Minnesota, USA
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Editorial. J Urol 1997. [DOI: 10.1097/00005392-199701000-00012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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