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Wang Y, Wang J, Sun X. The Effect of High- and Low-power Holmium Laser Settings for Transurethral Lithotripsy in the Management of Adults with Ureteral Stone. JOURNAL OF PHYSIOLOGICAL INVESTIGATION 2024; 67:153-160. [PMID: 38904360 DOI: 10.4103/ejpi.ejpi-d-24-00027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 05/22/2024] [Indexed: 06/22/2024]
Abstract
Since there is insufficient evidence to determine the best treatment of transurethral laser lithotripsy (TLL) in ureteral stones, this study compared the effectiveness and safety of TLL using high-power (HP) (100 W) and low-power (LP) (20 W) laser settings. All patients with maximally sized ureteral stones who were planned for transurethral holmium laser lithotripsy were enrolled in this open study. One of the two laser setting groups-LP or HP-was allocated to each alternate patient. Using IBM SPSS Statistics 24, the treatment groups were compared for operating time, intraoperative and postoperative problems (up to 1 year), and rates of stone-free recovery. Welch tests were employed to compare continuous data, whereas Fisher's exact or Chi-square tests were used to assess categorical variables. At P < 0.05, statistical significance was established. A total of 207 individuals were included and preoperative data were comparable between the two groups. The HP group had a considerably greater ablation rate and a significantly shorter procedure duration (42.61 ± 11.74 min) than the LP group (78.56 ± 25.91 min) ( P = 0.025). The Overactive Bladder Symptom Score and International Prostate Symptom Score were considerably higher in the HP group than in the LP group. Treatment effectiveness was considerably impacted by the location of the ureteral stone, according to univariate and multivariate logistic regression models. A HP laser setting of up to 100 W greatly shortens the duration of the process for treating ureteral stones without raising the risk of problems.
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Affiliation(s)
- Yuhuan Wang
- Department of Urology, Chengde Central Hospital, Chengde, Hebei, China
| | - Jun Wang
- Department of Urology, Chengde Central Hospital, Chengde, Hebei, China
| | - Xiaoping Sun
- The Second Ward of the Department of Critical Care, Chengde Central Hospital, Chengde, Hebei, China
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Abushamma F, Zyoud SH. Analyzing global research trends and focal points in the utilization of laser techniques for the treatment of urolithiasis from 1978 to 2022: visualization and bibliometric analysis. Urolithiasis 2024; 52:67. [PMID: 38630266 DOI: 10.1007/s00240-024-01568-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 04/02/2024] [Indexed: 04/19/2024]
Abstract
Laser lithotripsy is gaining global prominence and is a dynamically progressing field marked by a continual influx of new and comprehensive research each year. Recently, there has been a noticeable shift toward the adoption of various kinds of lasers, such as holmium: yttrium-aluminum-garnet (Ho:YAG) and thulium fiber (TFL) lasers. Consequently, we aim to conduct a bibliometric analysis to analyze key areas of research activity within scientific publications that center on the utilization of laser techniques in urolithiasis. A search of the literature spanning from 1978 to 2022 was carried out on 25 December 2023 using the Scopus database to explore research related to the application of laser techniques for urolithiasis treatment. Visualization analysis was performed using VOSviewer software (version 1.6.20). We examined 962 publications that met the specified criteria, 791 (82.22%) of which were original articles. The analysis of the retrieved publications indicated a consistent increase in research output from 1978 to 2022; a particularly noteworthy surge occurred after 2003. In particular, the U.S. claimed the leading position as the most productive country, contributing 211 articles (21.93%). However, India had the highest research productivity according to the adjustment index of 19.08. In the European region, 324 publications (33.68% of the total) originated from 25 countries. The Journal of Endourology contributed the most between 1978 and 2022 (n = 96, 9.98%). The most cited paper examined the effectiveness of holmium: yttrium-aluminum-garnet (Ho:YAG) lasers, while a subsequent study focused on the use of a thulium fiber laser (TFL), an emerging laser technology that has gained increased recognition. Co-occurrence analysis revealed three distinct clusters focusing on the types of laser technology, minimally invasive approaches, and success rate/postoperative complications. This comprehensive investigation delves into the global landscape of laser use for the treatment of urolithiasis. This review supports the emerging clinical concept of using various types of laser technology for urolithiasis treatment. Moreover, the hot issues that researchers should focus on based on the findings of this study are the use of different types of laser lithotripsy in view of the surgical approach, success rate and complications.
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Affiliation(s)
- Faris Abushamma
- Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine.
- Department of Urology, An-Najah National University Hospital, Nablus, 44839, Palestine.
| | - Sa'ed H Zyoud
- Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine.
- Clinical Research Center, An-Najah National University Hospital, Nablus, 44839, Palestine.
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Chakit M, Aqira A, El Hessni A, Mesfioui A. Place of extracorporeal shockwave lithotripsy in the treatment of urolithiasis in the region of Gharb Chrarda Bni Hssen (Morocco). Urolithiasis 2023; 51:33. [PMID: 36648596 DOI: 10.1007/s00240-023-01407-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 01/09/2023] [Indexed: 01/18/2023]
Abstract
The extracorporeal shockwave lithotripsy (ESWL) is a minimally invasive therapeutic approach which has been widely used through the last years. The aim of this study was to evaluate the effectiveness of ESWL in the treatment of nephrolithiasis in Gharb Chrarda Bni Hssen area (North of Morocco). A retrospective study of 590 patients with urinary stone was conducted between February 2009 and January 2013 in the Centre of Lithotripsy Anoual Clinic Kenitra. The treatment consisted in one or several sessions of ESWL. Evaluation of efficiency was based on radiological examinations using abdominal echography during the consultation with the urologist after the last session. There were 306 males and 184 females aged 17-79 years. The medium size of stone was 12.3 ± 5 mm. The average number of sessions and shock waves were 4 and 2490, respectively. The shockwave session was continued until stone fragmentation was observed when 4000 shocks were given. Failure of stone fragmentation or the presence of fragments larger than 4 mm were indications of repeat ESWL sessions. 92% of patient stones were completely cleared (p < 0,05%). The majority of patients were asymptomatic. This data show that the ESWL is extremely successful in treating human kidney stone. It is the first line of choice as a treatment modality for this pathology by the population of this area.
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Affiliation(s)
- Miloud Chakit
- Biology and Health Laboratory, Department of Biology, Faculty of Sciences, Ibn Tofail University, Kenitra, Morocco.
| | - Aziz Aqira
- Lithotripsy Center, Anoual Clinic, Kenitra, Morocco
| | - Aboubaker El Hessni
- Biology and Health Laboratory, Department of Biology, Faculty of Sciences, Ibn Tofail University, Kenitra, Morocco
| | - Abdelhalim Mesfioui
- Biology and Health Laboratory, Department of Biology, Faculty of Sciences, Ibn Tofail University, Kenitra, Morocco
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Demirelli E, Öğreden E, Tok DS, Demiray Ö, Karadayi M, Oğuz U. Complementary Ureterorenoscopy after extracorporeal Shock Wave Lithotripsy in proximal ureteral stones: success and complications. Rev Assoc Med Bras (1992) 2022; 68:1068-1072. [PMID: 36134836 PMCID: PMC9574975 DOI: 10.1590/1806-9282.20220237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 05/06/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The aim of this study was to demonstrate the effect of extracorporeal shock wave lithotripsy application on the success and complications of ureteroscopic lithotripsy in proximal ureter stones. METHODS The data of 87 patients who did not respond to shock wave lithotripsy and underwent ureteroscopic lithotripsy were retrospectively analyzed and classified as group I, and 99 patients who received ureteroscopic lithotripsy as primary treatment were classified as group II. Demographic features, response to treatment, and preoperative and postoperative complications were compared between the two groups. RESULTS There was no difference between the two groups in terms of gender, operation times, stone sizes, and ureteroscope diameters. (p>0.05). Infective complications such as postoperative fever, pyelonephritis, and urosepsis were similar in both groups (p=0.142, p=0.291, and p=0.948). Stone migration was observed in 10 (11.5%) and 6 (6.1%) patients in groups I and II, respectively (p=0.291). Impacted stone was seen in 47 (54%) patients in group I and in 15 (15.2%) patients in group II (p<0.0001). Mucosal laceration occurred in 11 (12.6%) and 3 (3%) patients in groups I and II, respectively (p=0.028). Ureteral perforation was detected in 3 (3.4%) patients in group I and 1 (1%) patient in group II, whereas ureteral avulsion was not observed in either group (p=0.524). CONCLUSIONS It was concluded that the application of shock wave lithotripsy before ureteroscopic lithotripsy in proximal ureter stones did not affect the success. Although the results are similar in terms of postoperative infection, shock wave lithotripsy application has been found to increase the risk of stone impaction into the mucosa and ureteral laceration.
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Affiliation(s)
- Erhan Demirelli
- Giresun University, Faculty of Medicine, Department of Urology - Giresun, Turkey
| | - Ercan Öğreden
- Giresun University, Faculty of Medicine, Department of Urology - Giresun, Turkey
| | - Doğan Sabri Tok
- Giresun University, Faculty of Medicine, Department of Urology - Giresun, Turkey
| | - Özay Demiray
- Prof. Dr. A. İlhan Özdemir Training and Research Hospital, Department of Urology - Giresun, Turkey
| | - Mehmet Karadayi
- Giresun University, Faculty of Medicine, Department of Urology - Giresun, Turkey
| | - Ural Oğuz
- Giresun University, Faculty of Medicine, Department of Urology - Giresun, Turkey
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El-Abd AS, Tawfeek AM, El-Abd SA, Gameel TA, El-Tatawy HH, El-Sabaa MA, Soliman MG. The effect of stone size on the results of extracorporeal shockwave lithotripsy versus semi-rigid ureteroscopic lithotripsy in the management of upper ureteric stones. Arab J Urol 2021; 20:30-35. [PMID: 35223107 PMCID: PMC8881070 DOI: 10.1080/2090598x.2021.1996820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Objectives Patients and methods Results Conclusion
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Affiliation(s)
- Ahmed S. El-Abd
- Urology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Ahmed M. Tawfeek
- Urology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Shawky A. El-Abd
- Urology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Tarik A. Gameel
- Urology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | | | - Magdy A. El-Sabaa
- Urology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
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Qu X, Ma Y. A commentary on "Optimal management of large proximal ureteral stones (> 10 mm): A systematic review and meta-analysis of 12 randomized controlled trials" (Int J Surg 2020; 80:205-217). Int J Surg 2021; 89:105942. [PMID: 33862257 DOI: 10.1016/j.ijsu.2021.105942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 04/06/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Xiaohua Qu
- Department of Urology, Suzhou BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Suzhou, Jiangsu Province, 215010, China
| | - Yinchao Ma
- Department of Urology, Suzhou BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Suzhou, Jiangsu Province, 215010, China.
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Wang Y, Chang X, Li J, Han Z. Efficacy and safety of various surgical treatments for proximal ureteral stone ≥10mm: A systematic review and network meta-analysis. Int Braz J Urol 2021; 46:902-926. [PMID: 32459455 PMCID: PMC7527111 DOI: 10.1590/s1677-5538.ibju.2019.0550] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 12/08/2019] [Indexed: 12/23/2022] Open
Abstract
Purpose Various surgical options are available for large proximal ureteral stones, such as extracorporeal shock wave lithotripsy (ESWL), ureteroscopic lithotripsy (URSL), percutaneous nephrolithotomy (PCNL) and laparoscopic ureterolithotomy (LU). However, the best option remains controversial. Therefore, we conducted a network meta-analysis comparing various surgical treatments for proximal ureteral stones ≥10mm to address current research deficiencies. Materials and methods We searched PubMed, Ovid, Scopus (up to June 2019), as well as citation lists to identify eligible comparative studies. All clinical studies including patients comparing surgical treatments for proximal ureteral stones ≥10mm were included. A standard network meta-analysis was performed with Stata SE 14 (Stata Corp, College Station, TX, USA) software to generate comparative statistics. The quality was assessed with level of evidence according to the Oxford Centre for Evidence-based Medicine and risk of bias with the Cochrane Collaboration’s Review Manager (RevMan) 5.3 software. Results A total of 25 studies including 2.888 patients were included in this network meta-analysis. Network meta-analyses indicated that LU and PCNL had better stone-free rates and auxiliary procedures. PCNL could result in major complications and severe bleeding. In initial stone-free rate, final stone-free rate, and auxiliary procedures results, SUCRA ranking was: LU> PCNL> URSL> ESWL. In Clavien Dindo score ≥3 complications, SUCRA ranking was: LU> ESWL> URSL> PCNL. In fever, SUCRA ranking was: ESWL> LU> URSL> PCNL. In transfusion, SUCRA ranking was: LU> URSL> ESWL> PCNL. In Cluster analysis, LU had the highest advantages and acceptable side effects. Considering the traumatic nature of PCNL, it should not be an option over URSL. ESWL had the lowest advantages. Conclusions LU have the potential to be considered as the first treatment choice of proximal ureteral stone ≥10mm.
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Affiliation(s)
- Yaxuan Wang
- Department of Urology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xueliang Chang
- Department of Urology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jingdong Li
- Department of Urology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhenwei Han
- Department of Urology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
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Value of early second session shock wave lithotripsy in treatment of upper ureteric stones compared to laser ureteroscopy. World J Urol 2021; 39:3089-3093. [PMID: 33471164 DOI: 10.1007/s00345-020-03560-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 12/11/2020] [Indexed: 10/22/2022] Open
Abstract
PURPOSE The safety and efficacy of early second session shock wave lithotripsy (SWL) compared with laser ureteroscopy (URS) for the treatment of upper ureteric stones were evaluated. METHODS From January to October 2019, 108 patients with upper ureteric stones (< 1.5 cm and ≤ 1000 Hounsfield unit (HU)) were randomized into SWL and laser URS groups. The second SWL session was performed within 48-72 h of the first session. Using plain abdominal X-ray and ultrasonography, patients were evaluated 48-72 h after the first SWL session and one week after the second and third SWL sessions or one week after URS. The procedure was considered a success when no additional procedures were needed to clear the stone. To determine the stone-free rate (SFR), noncontrast computed tomography of the urinary tract was performed three months postoperatively. RESULTS In the SWL group, the success rates were 92.6% and 94.4% after the second and third sessions. The SFR was 96.2% in the laser URS group. The success rates were not significantly different between the second and third SWL sessions versus the laser URS (p = 0.418 and 0.660, respectively). Operative and fluoroscopy times were significantly longer in the SWL group (p = 0.001), and JJ stent insertions were needed after laser URS. CONCLUSION Ultraslow full-power SWL treatment of patients with upper ureteric stones (< 1.5 cm and ≤ 1000 HU) with an early second session is safe and effective compared to laser URS. Patients who do not respond to early second SWL session should be shifted to another treatment modality.
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Al-Dessoukey AA, ElSheemy MS, Abdallah M, Moussa AS, Sayed O, Abdallah R, Massoud AM, Abdelhamid MH, Ragheb AM, Ghoneima W, Abdelbary AM, Elmarakbi AA. Ultraslow full-power shock wave lithotripsy protocol in the management of high attenuation value upper ureteric stones: A randomized comparative study. Int J Urol 2020; 28:33-39. [PMID: 32985780 DOI: 10.1111/iju.14381] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 08/25/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To evaluate the efficacy and safety of ultraslow full-power shock wave lithotripsy protocol in the management of high attenuation value upper ureteric stones compared with slow-rate, power-ramping shock wave lithotripsy. METHODS This was a randomized trial enrolling patients with a single high attenuation value (≥1000 HU) upper ureteric stones between January 2019 and July 2019. Ultraslow full-power shock wave lithotripsy (54 patients) was applied at a rate of 30 shock waves/min with power ramping from 6 to 18 kV for 100 shock waves, then a safety pause for 2 min, followed by ramping 18-22 kV for 100 shock waves, then a safety pause for 2 min. Then, full power (22 kV) was maintained until the end of the session. Slow-rate, power-ramping shock wave lithotripsy (47 patients) was applied at a rate of 60 shock waves/min with power ramping from 6 to 10 kV during the first 500 shock waves, then from 11 to 22 kV during the next 1000 shock waves, then maintained on 22 kV in the last 1500 shock waves. Up to three sessions were carried out with a follow up 3 months after the last session. The primary outcome was the stone-free rate. Perioperative data of the two protocols were compared. RESULTS There was no significant difference in preoperative data. The stone-free rate was significantly higher in ultraslow full-power shock wave lithotripsy after single (92.6% vs 23.4%) and multiple (96.3% vs 63.8%) sessions. Most complications were mild, with no significant difference between both groups (9.3% vs 12.8%; P = 0.573). Logistic regression analysis identified ultraslow full-power shock wave lithotripsy protocol as the only significant independent factor for the stone-free rate (odds ratio 12.589, P = 0.025). CONCLUSION Ultraslow full-power shock wave lithotripsy for high attenuation value upper ureteric stones is associated with a significantly higher stone-free rate, and with mild complications that are comparable to those of standard shock wave lithotripsy.
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Affiliation(s)
- Ahmad A Al-Dessoukey
- Department of Urology, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
| | | | - Mahmoud Abdallah
- Department of Urology, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
| | - Ayman S Moussa
- Department of Urology, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
| | - Osama Sayed
- Department of Urology, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
| | - Rabie Abdallah
- Department of Urology, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
| | - Amr M Massoud
- Department of Urology, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
| | | | - Ahmed M Ragheb
- Department of Urology, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
| | - Waleed Ghoneima
- Department of Urology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed M Abdelbary
- Department of Urology, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
| | - Akram A Elmarakbi
- Department of Urology, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
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Shalini S, Frank DS, Aldoukhi AH, Majdalany SE, Roberts WW, Ghani KR, Matzger AJ. Assessing the Role of Light Absorption in Laser Lithotripsy by Isotopic Substitution of Kidney Stone Materials. ACS Biomater Sci Eng 2020; 6:5274-5280. [PMID: 33455276 DOI: 10.1021/acsbiomaterials.0c00790] [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: 11/29/2022]
Abstract
Understanding the chemical characteristics of kidney stones and how the stone composition affects their fragmentation is key to improving clinical laser lithotripsy. During laser lithotripsy, two mechanisms may be responsible for stone fragmentation: a photothermal mechanism and/or microexplosion mechanism. Herein, we carry out an isotopic substitution of crystal H2O with D2O in calcium oxalate monohydrate and struvite stones to alter their optical properties to study the relationship between the absorption of the stones, at the wavelength of the Ho:YAG (2.12 μm) laser, and the fragmentation behavior. Changing the absorption of the stones at 2.12 μm changes the extent of fragmentation, whereas changing the absorption of the bulk medium has a negligible effect on fragmentation, leading to the conclusion that kidney stone ablation is dominated by a photothermal mechanism.
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Affiliation(s)
- Sorout Shalini
- Department of Chemistry and the Macromolecular Science and Engineering Program, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Derek S Frank
- Department of Chemistry and the Macromolecular Science and Engineering Program, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Ali H Aldoukhi
- Division of Endourology, Department of Urology, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Sami E Majdalany
- Division of Endourology, Department of Urology, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - William W Roberts
- Division of Endourology, Department of Urology, University of Michigan, Ann Arbor, Michigan 48109, United States.,Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Khurshid R Ghani
- Division of Endourology, Department of Urology, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Adam J Matzger
- Department of Chemistry and the Macromolecular Science and Engineering Program, University of Michigan, Ann Arbor, Michigan 48109, United States
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Ali AI, Abdel-Karim AM, Abd El Latif AA, Eldakhakhny A, Galal EM, Anwar AZ, El-Hawy MM, Fathelbab TKH, Elbadry MS, Elsharkawy MS, Tawfiek ER. Stone-free rate after semirigid ureteroscopy with holmium laser lithotripsy versus laparoscopic ureterolithotomy for upper ureteral calculi: a multicenter study. AFRICAN JOURNAL OF UROLOGY 2019. [DOI: 10.1186/s12301-019-0003-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Different treatment options were used to treat upper ureteral calculi. The aim of our study is to compare the stone-free rate and postoperative outcomes between semirigid ureteroscope with holmium laser lithotripsy and laparoscopic ureterolithotomy for the management of large solitary upper ureteral stones. Sixty-seven patients with a solitary upper ureteral stone who had LU or semirigid ureteroscopy in the period between January 2014 and March 2017 were included in our study. Out of the sixty-seven patients, 37 patients had semirigid ureteroscopy and holmium laser lithotripsy (Group A) and 30 patients had laparoscopic ureterolithotomy (Group B). Both groups were compared regarding operative time, intraoperative complications, need for auxiliary procedures, hospital stays, postoperative complications and stone-free rate.
Results
The mean stone size was 1.84 ± 0.12 cm in Group A and 1.79 ± 0.17 cm in Group B, P value = 0.2. The mean operative time was 61.5 ± 3.5 min in Group A and 63 ± 4.2 min in Group B, P value = 0.13. Stone migration was recorded in five cases (14%) in Group A while no cases in Group B had stone migration. Flexible ureteroscope was used as an auxiliary measure in five patients (14%) in Group A at the same session. No auxiliary measures were used in the LU group.
Conclusion
The stone-free rates after semirigid URS and laser lithotripsy are comparable to those following LU, especially when flexible URS is used to manage migrating stone fragments at the same session.
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Esposito C, Masieri L, Bagnara V, Tokar B, Golebiewski A, Escolino M. Ureteroscopic lithotripsy for ureteral stones in children using holmium: yag laser energy: results of a multicentric survey. J Pediatr Urol 2019; 15:391.e1-391.e7. [PMID: 31182399 DOI: 10.1016/j.jpurol.2019.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Accepted: 05/02/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Holmium:YAG (Ho:YAG) laser lithotripsy has broadened the indications for ureteroscopic stone managements in adults, but few evidence are currently available in the pediatric population. OBJECTIVE This article aimed to assess the outcome of Ho:YAG laser lithotripsy during retrograde ureteroscopic management of ureteral stones in different locations in children. STUDY DESIGN The medical records of 149 patients (71 boys and 78 girls; median age 9.2 years) treated with Ho:YAG laser ureteroscopic lithotripsy in five international pediatric urology units over the last 5 years were retrospectively reviewed. Exclusion criteria included patients with renal calculi and/or with a history of ipsilateral stricture, renal failure, active urinary tract infection, or coagulation disorder. RESULTS Stones were treated with dusting technique in all cases. The median stone size was 10.3 mm (range 5-17). Stones were located in the distal ureter in 77 cases (51.7%), in the middle ureter in 23 cases (15.4%), and in the proximal ureter in 49 cases (32.9%). The median operative time was 29.8 min (range 20-95). Intra-operative complications included five bleedings (3.3%) and seven stone retropulsions (4.7%). Overall stone-free rate was 97.3%. Overall postoperative complications rate was 4.0% and included two cases of stent migration (1.3%) (Clavien II) and four residual stone fragments (2.7%) that were successfully treated using the same technique (Clavien IIIb). On multivariate analysis, re-operation rate was significantly dependent on the proximal stone location and presence of residual fragments >2 mm (P = 0.001). DISCUSSION This study is one of the largest pediatric series among those published until now. The study series reported a shorter operative time, a higher success rate, and a lower postoperative complications rate compared with previous series. A limitation of this study is that stone-free rates may be somewhat inaccurate using ultrasonography and plain X-ray compared with computed tomography (CT); the study's 97.3% success rate may be overestimated because no CT scan was done postoperatively to check the stone-free rate. Other limitations of this article include its retrospective nature, the multi-institutional participation, and the heterogeneous patient collective. CONCLUSION The Ho:YAG laser ureteroscopic lithotripsy seems to be an excellent first-line treatment for children with ureteral stones, independently from primary location and size. However, patients with proximal ureteral stones and residual fragments >2 mm reported a higher risk to require a secondary procedure to become stone-free. Combination of techniques as well as appropriate endourologic tools are key points for the success of the procedure regardless of stones' size and location.
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Affiliation(s)
- C Esposito
- Division of Pediatric Surgery, Federico II University of Naples, Naples, Italy.
| | - L Masieri
- Division of Pediatric Urology, Meyer Children Hospital, Florence, Italy
| | - V Bagnara
- Division of Pediatric Urology, Morgagni Policlinico Hospital, Catania, Italy
| | - B Tokar
- Division of Pediatric Surgery, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - A Golebiewski
- Division of Pediatric Urology, Medical University in Gdansk, Pomerania, Poland
| | - M Escolino
- Division of Pediatric Surgery, Federico II University of Naples, Naples, Italy
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13
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Preclinical comparison of superpulse thulium fiber laser and a holmium:YAG laser for lithotripsy. World J Urol 2019; 38:497-503. [PMID: 31055626 DOI: 10.1007/s00345-019-02785-9] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 04/25/2019] [Indexed: 10/26/2022] Open
Abstract
PURPOSE A superpulse (500 W peak power) thulium fiber laser operating at a 1940 nm wavelength, suitable for lithotripsy, has recently been developed. The goal of this study was to compare stone fragmentation and dusting performance of the prototype superpulse thulium fiber laser with leading commercially available, high-power holmium:YAG lithotripters (wavelength 2100 nm) in a controlled in vitro environment. METHODS Two experimental setups were designed for investigating stone ablation rates and retropulsion effects, respectively. In addition, the ablation setup enabled water temperature measurements during stone fragmentation in the laser-stone interaction zone. Human uric acid (UA) and calcium oxalate monohydrate (COM) stones were used for ablation experiments, whereas standard BegoStone phantoms were utilized in retropulsion experiments. The laser settings were matched in terms of pulse energy, pulse repetition rate, and average power. RESULTS At equivalent settings, thulium fiber laser ablation rates were higher than those for holmium:YAG laser in both dusting mode (threefold for COM stones and 2.5-fold for UA stones) and fragmentation mode (twofold for UA stones). For single-pulse retropulsion experiments, the threshold for onset of stone retropulsion was two to four times higher for thulium fiber laser. The holmium:YAG laser generated significantly stronger retropulsion effects at equal pulse energies. The water temperature elevation near the laser-illuminated volume did not differ between the two lasers. CONCLUSIONS Distinctive features of the thulium fiber laser (optimal wavelength and long pulse duration) resulted in faster stone ablation and lower retropulsion in comparison to the holmium:YAG laser.
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14
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Hall LA, Gonzalez DA, Fried NM. Thulium fiber laser ablation of kidney stones using an automated, vibrating fiber. JOURNAL OF BIOMEDICAL OPTICS 2019; 24:1-10. [PMID: 30915783 PMCID: PMC6975225 DOI: 10.1117/1.jbo.24.3.038001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 03/11/2019] [Indexed: 06/09/2023]
Abstract
Our preliminary study investigates an automated, vibrating fiber optic tip for dusting of kidney stones during thulium fiber laser (TFL) lithotripsy. A (0.75-mm diameter and 5-mm length) magnetic bead was attached to the fiber jacket, centered 2 cm from distal fiber tip. A solenoid was placed parallel to the fiber with a 0.5-mm gap between solenoid and magnetic bead on fiber. The solenoid was used to create a magnetic force on the bead, inducing fiber vibration. Calibration tests for fiber motion in both air and water were performed. The ablation crater characteristics (surface area, volume, depth, and major/minor axis) of uric acid stones were measured using optical coherence tomography, after delivery of 1500 TFL pulses at 1908 nm, 33 mJ, 500 μs, and up to 300 Hz, through 50-, 100-, and 150-μm-core fibers. The resonant frequency was dependent on fiber diameter and rigidity, with a cutoff pivot point for optimum vibration amplitude at 4 cm. Maximum fiber displacement is about 1 mm in water and 4 mm in air. For 50-, 100-, and 150-μm-core fibers, ablated surface area averaged 1.7, 1.7, and 2.8 times greater with vibrating fiber than fixed fiber, respectively. For these fibers, ablation volume averaged 1.1, 1.5, and 1.1 times greater with vibrating fiber than fixed fiber, given a fixed energy per pulse, respectively. Our preliminary study demonstrates the functionality of an automated, vibrating fiber system for stone "dusting," with significantly larger surface area but similar ablation volumes as a fixed fiber. Future studies will focus on optimization of fiber parameters (especially displacement) and miniaturization of system components to facilitate integration into ureteroscopes.
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Affiliation(s)
- Layton A. Hall
- University of North Carolina at Charlotte, Department of Physics and Optical Science, Charlotte, North Carolina, United States
| | - David A. Gonzalez
- University of North Carolina at Charlotte, Department of Physics and Optical Science, Charlotte, North Carolina, United States
| | - Nathaniel M. Fried
- University of North Carolina at Charlotte, Department of Physics and Optical Science, Charlotte, North Carolina, United States
- Carolinas Medical Center, McKay Department of Urology, Charlotte, North Carolina, United States
- Johns Hopkins Medical School, Brady Urological Institute, Baltimore, Maryland, United States
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15
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Deng T, Chen Y, Liu B, Laguna MP, de la Rosette JJMCH, Duan X, Wu W, Zeng G. Systematic review and cumulative analysis of the managements for proximal impacted ureteral stones. World J Urol 2018; 37:1687-1701. [PMID: 30430253 DOI: 10.1007/s00345-018-2561-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 11/03/2018] [Indexed: 12/21/2022] Open
Abstract
PURPOSE To compare the efficacy and safety of different treatment options for the management of proximal impacted ureteral stones (PIUS). METHODS A systematic literature search using Pubmed, Medline, Embase and Cochrane Library was conducted to obtain studies concerning different managements for PIUS up to Jan 2018. Summary odds ratios (ORs), standard mean differences (SMDs) or weighted mean differences with their 95% confidence intervals (CIs) were calculated to compare the efficacy and safety of all included treatment methods, registered in PROSPERO under number CRD42018092745. RESULTS A total of 15 comparative studies with 1780 patients were included. Meta-analyses of final stone-free rate (SFR) favored percutaneous nephrolithotomy (PCNL) over ureteroscopic lithotripsy (URL) (OR 10.35; 95% CI 5.26-20.35; P < 0.00001), laparoscopic ureterolithotomy over URL (OR 0.11; 95% CI 0.05-0.25; P < 0.00001) and URL over extracorporeal shockwave lithotripsy (OR 0.47; 95% CI 0.28-0.77; P = 0.003). As to complications, PCNL had a significantly higher blood transfusion rate (OR 7.47; 95% CI 1.3-42.85; P = 0.02) and a lower ureteral injury rate (OR 0.15; 95% CI 0.04-0.52; P = 0.003) compared with URL. It also shared a significantly lower stone-retropulsion rate (OR 0.03; 95% CI 0.01-0.15; P < 0.0001) and higher treatment costs (SMD = 2.71; 95% CI 0.71-4.70; P = 0.008) than URL. CONCLUSIONS Our meta-analysis suggested that PCNL might be the best option for PIUS owing to its higher successful rate. Complications such as hemorrhage could be decreased by the application on mini-PCNL.
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Affiliation(s)
- Tuo Deng
- Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Kangda Road 1#, Haizhu District, Guangzhou, 510230, China.,Guangzhou Institute of Urology, Guangzhou, China.,Guangdong Key Laboratory of Urology, Guangzhou, China
| | - Yiwen Chen
- Department of Urology, Longgang District Central Hospital, Shenzhen, China
| | - Bing Liu
- Department of Ophthalmology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - M Pilar Laguna
- Department of Urology, Istanbul Medipol University, Istanbul, Turkey.,AMC University Hospital, Amsterdam, The Netherlands
| | - Jean J M C H de la Rosette
- Department of Urology, Istanbul Medipol University, Istanbul, Turkey.,AMC University Hospital, Amsterdam, The Netherlands
| | - Xiaolu Duan
- Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Kangda Road 1#, Haizhu District, Guangzhou, 510230, China.,Guangzhou Institute of Urology, Guangzhou, China.,Guangdong Key Laboratory of Urology, Guangzhou, China
| | - Wenqi Wu
- Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Kangda Road 1#, Haizhu District, Guangzhou, 510230, China.,Guangzhou Institute of Urology, Guangzhou, China.,Guangdong Key Laboratory of Urology, Guangzhou, China
| | - Guohua Zeng
- Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Kangda Road 1#, Haizhu District, Guangzhou, 510230, China. .,Guangzhou Institute of Urology, Guangzhou, China. .,Guangdong Key Laboratory of Urology, Guangzhou, China.
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16
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Fallah Karkan M, Ghiasy S, Ranjbar A, Javanmard B. Evaluation of 200 Mm, 365 Mm and 500 Mm Fibers of Ho:YAG Laser in Transurethral Lithotripsy of Ureteral: A Randomize Control Trial. J Lasers Med Sci 2017; 9:69-72. [PMID: 29399315 DOI: 10.15171/jlms.2018.14] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Introduction: Presently, different holmium: yttrium aluminum garnet (Ho:YAG) laser calibers are used for endoscopic stone treatment, which include 200, 365, 500 and 1000 Mm fibers. Currently, there are not enough studies to compare the performance of these fibers. In this retrospective investigation, we compared the outcome of 200, 365 and 500 Mm fibers of Ho:YAG laser in transurethral lithotripsy of ureteral stone. Methods: From January 2016 to June 2017, 74 subjects with mean age of 35.3 ± 5.6 were randomly allocated to 3 groups according to the caliber of laser, 200, 365 and 500 Mm for transurethral lithotripsy. The main purpose of this investigation was to evaluate mean operation time (MOT), stone free rate (SFR) and complications. Results: MOT and SFR were significantly different in 500 Mm laser caliber (P=0.046, P=0.029, respectively). There was no remarkable difference between the 3 groups in this regard. Conclusion: Based upon our data, the clinical potency of the Ho: YAG laser was great in all 3 fiber calibers. The most important results of this comparison were the significantly higher SFR with increased laser caliber.
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Affiliation(s)
- Morteza Fallah Karkan
- Laser Application in Medical Science Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saleh Ghiasy
- Laser Application in Medical Science Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arash Ranjbar
- Laser Application in Medical Science Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Babak Javanmard
- Laser Application in Medical Science Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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17
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Drake T, Grivas N, Dabestani S, Knoll T, Lam T, Maclennan S, Petrik A, Skolarikos A, Straub M, Tuerk C, Yuan CY, Sarica K. What are the Benefits and Harms of Ureteroscopy Compared with Shock-wave Lithotripsy in the Treatment of Upper Ureteral Stones? A Systematic Review. Eur Urol 2017; 72:772-786. [DOI: 10.1016/j.eururo.2017.04.016] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 04/12/2017] [Indexed: 12/23/2022]
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18
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Wang Q, Guo J, Hu H, Lu Y, Zhang J, Qin B, Wang Y, Zhang Z, Wang S. Rigid ureteroscopic lithotripsy versus percutaneous nephrolithotomy for large proximal ureteral stones: A meta-analysis. PLoS One 2017; 12:e0171478. [PMID: 28182718 PMCID: PMC5300230 DOI: 10.1371/journal.pone.0171478] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 01/02/2017] [Indexed: 12/25/2022] Open
Abstract
Object To compare the safety and efficacy of rigid ureteroscopic lithotripsy (rigid URSL) and percutaneous nephrolithotomy (PCNL) in treating large proximal ureteral stones. Methods A systematic search of PubMed, EMBASE, Cochrane Library, and Web of Science databases was performed to find out relevant studies. After literature screening according to the predetermined inclusion and exclusion criteria, data of eligible studies was extracted and then a meta-analysis was conducted via RevMan 5.3 software. Results Five randomized controlled trials (RCTs), one prospective and four retrospective cohort studies involving 837 patients were included. Patients underwent rigid URSL were associated with shorter operation time (WMD, -23.66min; 95%CI, −45.00 to -2.32; p = 0.03), shorter hospital stay (WMD, -2.76d; 95%CI, −3.51 to −2.02; p< 0.00001), lower 3rd-day (RR, 0.73; 95%CI, 0.66 to 0.82; p < 0.00001) and 1st-month (RR, 0.82; 95%CI, 0.77 to 0.87; p < 0.00001) stone-free rate, higher risk of conversion to other surgical procedures (RR, 4.28; 95%CI, 1.93 to 9.46; p = 0.0003), higher incidence of migration (RR, 28.49; 95%CI, 9.12 to 89.00; p < 0.00001) and ureteral perforation (RR, 6.06; 95%CI, 1.80 to 20.44; p = 0.004), lower risk of fever (RR, 0.64; 95%CI, 0.42 to 0.97; p = 0.04), transfusion (RR, 0.19; 95%CI, 0.04 to 0.85; p = 0.03) and hematuria (RR, 0.38; 95%CI, 0.25 to 0.57; p < 0.0001). No significant difference was observed in terms of incidence of embolization, pain and ureterostenosis. When cohort studies or studies in which flexible ureteroscopy was used as an intraoperative auxiliary procedure were excluded, we both found that most of the results kept stable. Conclusions Both PCNL and rigid URSL are safe for patients with large proximal ureteral stones while PCNL is more effective in stone clearance.
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Affiliation(s)
- Qing Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jiachao Guo
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Henglong Hu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yuchao Lu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jiaqiao Zhang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Baolong Qin
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yufeng Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Zongbiao Zhang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Shaogang Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- * E-mail:
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19
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Aboutaleb H, Omar M, Salem S, Elshazly M. Management of upper ureteral stones exceeding 15 mm in diameter: Shock wave lithotripsy versus semirigid ureteroscopy with holmium:yttrium-aluminum-garnet laser lithotripsy. SAGE Open Med 2016; 4:2050312116685180. [PMID: 28348743 PMCID: PMC5354178 DOI: 10.1177/2050312116685180] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 11/27/2016] [Indexed: 11/30/2022] Open
Abstract
Objectives: We conducted a retrospective study to evaluate the efficacy and outcome of shock wave lithotripsy versus semirigid ureteroscopy in the management of the proximal ureteral stones of diameter exceeding 15 mm. Methods: During the 2009−2014 study period, 147 patients presenting with the proximal ureteral stones exceeding 15 mm in diameter were treated. Both shock wave lithotripsy and ureteroscopy with laser lithotripsy were offered for our patients. A 6/8.9 Fr semirigid ureteroscope was used in conjunction with a holmium:yttrium–aluminum–garnet laser. The stone-free rate was assessed at 2 weeks and 3 months post-treatment. All patients were evaluated for stone-free status, operation time, hospital stay, perioperative complications, and auxiliary procedures. Results: Of the 147 patients who took part in this study, 66 (45%) had undergone shock wave lithotripsy and 81 (55%) underwent ureteroscopy. At the 3-month follow-up, the overall stone-free rate in the shock wave lithotripsy group was 39/66 (59%) compared to 70/81 (86.4%) in the ureteroscopic laser lithotripsy group. Ureteroscopic laser lithotripsy achieved a highly significant stone-free rate (p = 0.0002), and the mean operative time, auxiliary procedures, and postoperative complication rates were comparable between the two groups. Conclusion: In terms of the management of proximal ureteral stones exceeding 15 mm in diameter, ureteroscopy achieved a greater stone-free rate and is considered the first-line of management. Shock wave lithotripsy achieved lower stone-free rate, and it could be used in selected cases.
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Affiliation(s)
- Hamdy Aboutaleb
- Department of Urology, Menoufia University Hospital, Shebin El Kom, Egypt
| | - Mohamed Omar
- Department of Urology, Menoufia University Hospital, Shebin El Kom, Egypt
| | - Shady Salem
- Department of Urology, Menoufia University Hospital, Shebin El Kom, Egypt
| | - Mohamed Elshazly
- Department of Urology, Menoufia University Hospital, Shebin El Kom, Egypt
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20
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Kim CH, Kim SJ, Kim MH, Kim KT, Oh JK, Chung KJ, Kim TB, Jung H, Yoon SJ, Kim KH. Are Urologists Performing Semi-rigid Ureteroscopic Lithotripsy Safe From Radiation Exposure? A Guidance to Reduce the Radiation Dose. Urology 2016; 95:54-9. [DOI: 10.1016/j.urology.2016.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 06/01/2016] [Accepted: 06/03/2016] [Indexed: 10/21/2022]
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21
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Kim B, Kim DY. Enhanced Tissue Ablation Efficiency with a Mid-Infrared Nonlinear Frequency Conversion Laser System and Tissue Interaction Monitoring Using Optical Coherence Tomography. SENSORS (BASEL, SWITZERLAND) 2016; 16:E598. [PMID: 27128916 PMCID: PMC4883289 DOI: 10.3390/s16050598] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 04/08/2016] [Accepted: 04/21/2016] [Indexed: 12/21/2022]
Abstract
We report development of optical parametric oscillator (OPO)-based mid-infrared laser system that utilizes a periodically poled nonlinear crystal pumped by a near-infrared (NIR) laser. We obtained a mid-infrared average output of 8 W at an injection current of 20 A from a quasi-phase-matched OPO using an external cavity configuration. Laser tissue ablation efficiency is substantially affected by several parameters, including an optical fluence rate, wavelength of the laser source, and the optical properties of target tissue. Dimensions of wavelength and radiant exposure dependent tissue ablation are quantified using Fourier domain optical coherence tomography and the ablation efficiency was compared to a non-converted NIR laser system.
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Affiliation(s)
- Bongkyun Kim
- Beckman Laser Institute Korea, Dankook University, 119, Dandae-ro, Dongnam-gu, Cheonan-si, Chungnam 31116, Korea.
| | - Dae Yu Kim
- Beckman Laser Institute Korea, Dankook University, 119, Dandae-ro, Dongnam-gu, Cheonan-si, Chungnam 31116, Korea.
- Biomedical Engineering, College of Medicine, Dankook University, 119, Dandae-ro, Dongnam-gu, Cheonan-si, Chungnam 31116, Korea.
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22
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The clinical efficacy of extracorporeal shock wave lithotripsy in pediatric urolithiasis: a systematic review and meta-analysis. Urolithiasis 2015; 43:199-206. [DOI: 10.1007/s00240-015-0757-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 02/10/2015] [Indexed: 10/23/2022]
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23
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Liu CK, Ko MC, Chen SS, Lee WK, Shia BC, Chiang HS. Comparison of extracorporeal shock wave lithotripsy running models between outsourcing cooperation and rental cooperation conducted in Taiwan. J Formos Med Assoc 2015; 114:154-8. [PMID: 25678177 DOI: 10.1016/j.jfma.2012.09.012] [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: 05/02/2012] [Revised: 09/12/2012] [Accepted: 09/13/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/PURPOSE We conducted a retrospective study to compare the cost and effectiveness between two different running models for extracorporeal shock wave lithotripsy (SWL), including the outsourcing cooperation model (OC) and the rental cooperation model (RC). METHODS Between January 1999 and December 2005, we implemented OC for the SWL, and from January 2006 to October 2011, RC was utilized. With OC, the cooperative company provided a machine and shared a variable payment with the hospital, according to treatment sessions. With RC, the cooperative company provided a machine and received a fixed rent from the hospital. We calculated the cost of each treatment session, and evaluated the break-even point to estimate the lowest number of treatment sessions to make the balance between revenue and cost every month. Effectiveness parameters, including the stone-free rate, the retreatment rate, the rate of additional procedures and complications, were evaluated. RESULTS Compared with OC there were significantly less treatment sessions for RC every month (42.6±7.8 vs. 36.8±6.5, p=0.01). The cost of each treatment session was significantly higher for OC than for RC (751.6±20.0 USD vs. 684.7±16.7 USD, p=0.01). The break-even point for the hospital was 27.5 treatment sessions/month for OC, when the hospital obtained 40% of the payment, and it could be reduced if the hospital got a greater percentage. The break-even point for the hospital was 27.3 treatment sessions/month for RC. No significant differences were noticed for the stone-free rate, the retreatment rate, the rate of additional procedures and complications. CONCLUSION Our study revealed that RC had a lower cost for every treatment session, and fewer treatment sessions of SWL/month than OC. The study might provide a managerial implication for healthcare organization managers, when they face a situation of high price equipment investment.
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Affiliation(s)
- Chih-Kuang Liu
- Department of Urology, Taipei City Hospital, Taipei, Taiwan; College of Medicine, Fu-Jen Catholic University, New Taipei, Taiwan; Graduate School of Business Administration, Fu-Jen Catholic University, New Taipei, Taiwan; College of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ming-Chung Ko
- Department of Urology, Taipei City Hospital, Taipei, Taiwan; College of Medicine, Fu-Jen Catholic University, New Taipei, Taiwan; College of Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Shiou-Sheng Chen
- Department of Urology, Taipei City Hospital, Taipei, Taiwan; College of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wen-Kai Lee
- Department of Urology, Taipei City Hospital, Taipei, Taiwan
| | - Ben-Chang Shia
- Graduate School of Business Administration, Fu-Jen Catholic University, New Taipei, Taiwan.
| | - Han-Sun Chiang
- College of Medicine, Fu-Jen Catholic University, New Taipei, Taiwan
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24
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Alexander B, Fishman AI, Grasso M. Ureteroscopy and laser lithotripsy: technologic advancements. World J Urol 2014; 33:247-56. [PMID: 25266163 DOI: 10.1007/s00345-014-1402-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 08/31/2014] [Indexed: 11/26/2022] Open
Abstract
Ureteroscopic lithotripsy has evolved since the first reported cases employing rigid rod-lens endoscopes and stiff ultrasonic lithotrites. Fiber optics facilitated rigid endoscope miniaturization and the development of a steerable, deflectable flexible ureteroscopes. Over 30 years of technical innovations culminating in digital imagers and powerful, precise laser lithotrites, complimented by progressive endoscopic techniques have produced efficient endoscopic therapies with minimal morbidity and commonly performed in an outpatient setting.
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Affiliation(s)
- B Alexander
- Department of Urology, New York Medical College, Valhalla, NY, 10595, USA,
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25
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Cui Y, Cao W, Shen H, Xie J, Adams TS, Zhang Y, Shao Q. Comparison of ESWL and ureteroscopic holmium laser lithotripsy in management of ureteral stones. PLoS One 2014; 9:e87634. [PMID: 24498344 PMCID: PMC3912003 DOI: 10.1371/journal.pone.0087634] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Accepted: 12/29/2013] [Indexed: 11/18/2022] Open
Abstract
Background There are many options for urologists to treat ureteral stones that range from 8 mm to 15 mm, including ESWL and ureteroscopic holmium laser lithotripsy. While both ESWL and ureteroscopy are effective and minimally invasive procedures, there is still controversy over which one is more suitable for ureteral stones. Objective To perform a retrospective study to compare the efficiency, safety and complications using ESWL vs. ureteroscopic holmium laser lithotripsy in management of ureteral stones. Methods Between October 2010 and October 2012, 160 patients who underwent ESWL or ureteroscopic holmium laser lithotripsy at Suzhou municipal hospital for a single radiopaque ureteral stone (the size 8–15 mm) were evaluated. All patients were followed up with ultrasonography for six months. Stone clearance rate, costs and complications were compared. Results Similarity in stone clearance rate and treatment time between the two procedures; overall procedural time, analgesia requirement and total cost were significantly different. Renal colic and gross hematuria were more frequent with ESWL while voiding symptoms were more frequent with ureteroscopy. Both procedures used for ureteral stones ranging from 8 to 15 mm were safe and minimally invasive. Conclusion ESWL remains first line therapy for proximal ureteral stones while ureteroscopic holmium laser lithotripsy costs more. To determining which one is preferable depends on not only stone characteristics but also patient acceptance and cost-effectiveness ratio.
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Affiliation(s)
- Yon Cui
- Department of Urology, Suzhou Municipal Hospital, Suzhou, China
| | - Wenzhou Cao
- Department of Urology, Suzhou Municipal Hospital, Suzhou, China
| | - Hua Shen
- Department of Urology, Suzhou Municipal Hospital, Suzhou, China
| | - Jianjun Xie
- Department of Urology, Suzhou Municipal Hospital, Suzhou, China
| | - Tamara S. Adams
- Center for Cancer Genomics, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States of America
| | - Yuanyuan Zhang
- Wake Forest Institute for Regenerative Medicine, Wake Forest University Health Sciences, Winston-Salem, North Carolina, United States of America
| | - Qiang Shao
- Department of Urology, Suzhou Municipal Hospital, Suzhou, China
- * E-mail:
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26
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Gudkov A, Boshchenko V, Petlin A, Afonin V, Diamant V, Lerner M. Retrograde endoscopic lithotripsy using the innovative nanosecond electropulse method. SPRINGERPLUS 2013; 2:538. [PMID: 24171154 PMCID: PMC3806985 DOI: 10.1186/2193-1801-2-538] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 10/08/2013] [Indexed: 11/10/2022]
Abstract
PURPOSE The purpose of this clinical study is to assess the safety and efficiency of a novel lithotripsy method for endoscopic treatment of urinary stones throughout the urinary tract via semi-rigid and flexible endoscopes. This new method is based on the transfer of nanosecond high voltage electric pulses to the stones through flexible probes of various sizes. METHODS The study involved 879 patients aged 19-88 with renal, ureter and bladder calculi. Gender distribution: 46.3% female and 53.7% male. The prospective single-arm study took place at three centers. The goal of the clinical study was to evaluate the safety and efficacy of a novel lithotripsy method. All treatments were performed retrograde transurethrally. A variety of probes were used for stone fragmentation at different locations. Auxiliary treatments and adverse events were recorded as per protocol. Statistical analysis was conducted using SPSS software. RESULTS Nanosecond electropulse lithotripsy (NEPL) was found to be technically feasible for all patients with stones located in the kidney, UPJ, ureter and bladder. It requires only a few dozen pulses to disintegrate stones while causing only minor stone migration. The overall stone-free rate in the study was 96%. The average time required for executing the entire procedure was 45±28 min. The overwhelming majority of intraoperative complications occurred due to endoscopic manipulation when using a rigid ureterorenoscope and not due to lithotripsy impact. CONCLUSIONS NEPL is a new, efficient and safe method for urinary stone disintegration that can be used throughout the urinary tract using rigid and flexible endoscopes. Intraoperative complications of the NEPL procedure do not exceed the percentage of adverse effects observed in other lithotripsy methods. The main advantages of relatively low-cost NEPL are fast stone fragmentation requiring only a few dozen pulses to disintegrate stones, tissue safety and availability of highly flexible probes for treating stones in the lower pole through a flexible ureterorenoscope.
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Affiliation(s)
- Alexander Gudkov
- Department of Urology, Siberian State Medical University, Lenin Avenue #4, HC SSMU, Tomsk, 634050 Russia
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Comparison of Ho:YAG laser and pneumatic lithotripsy in the treatment of impacted ureteral stones: an analysis of risk factors. Kaohsiung J Med Sci 2013; 30:153-8. [PMID: 24581216 DOI: 10.1016/j.kjms.2013.08.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 05/02/2013] [Indexed: 11/21/2022] Open
Abstract
The aim was to compare pneumatic and holmium:yttrium-aluminum-garnet laser in the treatment of impacted ureteral stones with different locations and to identify the risk factors for complications. Between March 2005 and November 2012, a total of 230 patients underwent ureteroscopic lithotripsy for impacted stones. Of the patients, 117 had pneumatic and 113 had laser lithotripsy for the fragmentation of the stones. Treatment outcomes based on evidence of being stone free were evaluated. Preoperative, operative, and postoperative follow-up findings were analyzed and compared. There was a difference between the two groups according to overall stone clearance rate (93.8% vs. 80.3%, p = 0.002). There was no statistically significant difference for distal location between the laser and pneumatic groups (96.8% vs. 91.7%, p =0.288). For 10 patients with intrarenally migrated stones who were managed with flexible ureterorenoscopy in the same session, laser lithotripsy was more successful than pneumatic for proximal ureteral stone (94.4% vs. 67.9%, p = 0.007). The overall complication rate was 26.1%. There was no statistically significant difference between the two groups (29% vs. 23%, p = 0.296). Multivariate logistic regression analysis revealed that the proximal location was a statistically significant parameter for the occurrence of complications in both groups (p = 0.001 for PL, p = 0.004 for laser). The pneumatic and holmium:yttrium-aluminum-garnet laser lithotripsy are effective in the treatment of distal impacted stones. Both treatments with semirigid ureteroscopy are acceptable for proximal impacted ureteral stones, but holmium laser lithotripsy has an advantage of use with flexible ureteroscope for intrarenally migrated stone.
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Sen H, Bayrak O, Erturhan S, Urgun G, Kul S, Erbagci A, Seckiner I. Comparing of different methods for prevention stone migration during ureteroscopic lithotripsy. Urol Int 2013; 92:334-8. [PMID: 23838044 DOI: 10.1159/000351002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 03/28/2013] [Indexed: 11/19/2022]
Abstract
AIM To compare the effectiveness of Stone Cone™, PercSys and lidocaine jelly instillation to prevent stone migration during ureterorenoscopy (URS). MATERIALS AND METHODS One hundred patients who underwent URS for proximal ureteral stones between 2007 and 2012 were evaluated prospectively. The patients were divided into four groups consecutively. The control group (Group I) consisted of the 25 consecutive patients, in whom no device or method was used to prevent stone migration. Group II consisted of 25 patients treated with the Stone Cone, group III consisted of 25 patients treated with PercSys, and group IV consisted of 25 patients treated with lidocaine jelly instillation. RESULTS The migration rates were 4.5% in group II, 8.7% in group III, 21.7% in group IV, and 31.8% in group I. The migration rate was found to be statistically significantly lower in the groups treated with the Stone Cone and PercSys compared to the control group (p = 0.014, p = 0.048). However, there was no statistically significant difference between the lidocaine jelly group and the control group in terms of migration rates (p = 0.444). CONCLUSIONS Our results suggested that the Stone Cone and PercSys were the most successful methods with significantly low migration rates (4.5 and 8.7%, respectively).
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Affiliation(s)
- Haluk Sen
- Department of Urology, University of Gaziantep, Gaziantep, Turkey
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Khalil M. Management of impacted proximal ureteral stone: Extracorporeal shock wave lithotripsy versus ureteroscopy with holmium: YAG laser lithotripsy. Urol Ann 2013; 5:88-92. [PMID: 23798864 PMCID: PMC3685752 DOI: 10.4103/0974-7796.110004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2011] [Accepted: 05/22/2012] [Indexed: 11/16/2022] Open
Abstract
Objective: Prospective evaluation of the efficacy and safety of the extracorporeal shock wave lithotripsy (SWL) and ureteroscopy with Holmium: YAG laser lithotripsy (URSL) as a primary treatment for impacted stone in the proximal ureter. Patients and Methods: A total of 82 patients with a single impacted stone in the proximal ureter were included in the study. Patients were allocated into two groups according to patient preference for either procedure. The first group included 37 patients who were treated by SWL and the second group included 45 patients treated by URSL. The preoperative data and treatment outcomes of both procedures were compared and analyzed. Results: There was no difference as regards to patient and stone characters between the two groups. There was significantly higher mean session number and re-treatment rate in the SWL group in comparison to URSL group (1.5 ± 0.8 vs. 1.02 ± 0.15 session, and 43.2% vs. 2.2%, respectively). At one month, the stone-free rate of the URSL group was statistically significantly higher than that of the SWL group (80% vs. 67.6%, respectively). The stone-free rate at three months was still higher in the URSL group, but without statistically significant difference (80.2% vs. 78.4%, respectively). There was no statistically significant difference in the rate of complications between the SWL and URSL (24.3% vs. 15.6%, respectively). Conclusion: Both procedures can be used effectively and safely as a primary treatment for impacted stone in the proximal ureter; however, the URSL has a significantly higher initial stone-free rate and lower re-treatment rate.
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Affiliation(s)
- Mostafa Khalil
- Department of Surgery, Division of Urology, Mubarak Al-Kabir Hospital, Ministry of Health, Hawally, Kuwait
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Long Q, Guo J, Xu Z, Yang Y, Wang H, Zhu Y, Zhang Y, Wang G. Experience of mini-percutaneous nephrolithotomy in the treatment of large impacted proximal ureteral stones. Urol Int 2013; 90:384-8. [PMID: 23635397 DOI: 10.1159/000343668] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Accepted: 09/08/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To evaluate the efficacy and safety of mini- percutaneous nephrolithotomy (PCNL) in the treatment of large impacted proximal ureteral stones. METHODS We retrospectively reviewed the outcomes of 163 patients who underwent mini-PCNL between January 2006 and August 2010. Mean age was 48.6 years and mean stone size was 18.4 mm. Hydronephrosis and/or hydroureterosis appeared in all patients. In the prone position, percutaneous access (16-Fr sheath) was established by placement of an access needle into the intended calyx under fluoroscopic guidance or combined with ultrasound guidance for complete obstruction by stones while the contrast agent cannot transit. Pneumatic or ultrasonic probes were used throughout ureterorenoscopy for lithotripsy. The ureteral stents and nephrostomy tube were placed at the end of the procedure. Mean drop in hemoglobin, operative time, success rate, hospital stay, and complications were assessed. RESULTS Mini-PCNL operations were performed successfully in all patients. Mean operation time was 37 min. Mean postoperative hospital stay was 3.6 days. All cases were followed up for 6-20 months. No major complications like hemorrhage, perforation or organic injury were noted during the operation or postoperatively. The stone-free rate in all patients was 95.7%. Calculus had no recurrence during the follow-up period. Hydronephrosis and hydroureterosis disappeared or were relieved. CONCLUSIONS Mini-PCNL is a safe and effective therapy for large impacted proximal ureteral stones.
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Affiliation(s)
- Qilai Long
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China
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Gu XJ, Lu JL, Xu Y. Treatment of large impacted proximal ureteral stones: randomized comparison of minimally invasive percutaneous antegrade ureterolithotripsy versus retrograde ureterolithotripsy. World J Urol 2013; 31:1605-10. [PMID: 23334470 DOI: 10.1007/s00345-013-1026-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2012] [Accepted: 01/05/2013] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To provide appropriate evidence for treatment planning of patients with an impacted proximal ureteral stones ≥1.5 cm in size, by analyzing the therapeutic outcomes for those undergoing minimally invasive percutaneous antegrade ureterolithotripsy and retrograde ureterolithotripsy. PATIENTS AND METHODS From September 2010 to November 2011, eligible patients with impacted proximal ureteral stones ≥1.5 cm in size referred to our institute were considered for this study. The closed envelope method was used to randomize the enrolled patients to mini-PCNL (30) or retrograde ureterolithotripsy (29). The efficiency quotient (EQ) was calculated to specifically address the efficiency for both the techniques. All preoperative and postoperative data for both groups were recorded. RESULTS The initial stone-free rate was 93.3% in the mini-PCNL group and 41.4% in the URSL group (p < 0.001). However, the overall stone-free rate at the 1-month follow-up visit after initial treatment was 100% in the mini-PCNL group and 89.7% in the URSL group (p = 0.07). The EQs for the mini-PCNL and URSL groups were 0.83 and 0.50, respectively. CONCLUSIONS Our study shows that mini-PCNL removal of large impacted proximal ureteral calculi can achieve higher stone-free rates and safe.
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Affiliation(s)
- Xiao-Jian Gu
- Department of Urology; The First Affiliated Hospital (Jiangsu Province Hospital of TCM), Nanjing University of Chinese Medicine, Nanjing, 210046, Jiangsu, China
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Karami H, Mazloomfard MM, Lotfi B, Alizadeh A, Javanmard B. Ultrasonography-guided PNL in comparison with laparoscopic ureterolithotomy in the management of large proximal ureteral stone. Int Braz J Urol 2013; 39:22-8; discussion 29. [DOI: 10.1590/s1677-5538.ibju.2013.01.04] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 08/19/2012] [Indexed: 11/21/2022] Open
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Shock wave lithotripsy versus ureteroscopy for ureteral calculi: a prospective assessment of patient-reported outcomes. World J Urol 2012; 31:1569-74. [DOI: 10.1007/s00345-012-0966-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Accepted: 09/26/2012] [Indexed: 10/27/2022] Open
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Rabani SM, Moosavizadeh A. Management of Large Proximal Ureteral Stones: A Comparative Clinical Trial Between Transureteral Lithotripsy (TUL) and Shock Wave Lithotripsy (SWL). Nephrourol Mon 2012; 4:556-9. [PMID: 23573485 PMCID: PMC3614297 DOI: 10.5812/numonthly.3936] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Revised: 01/13/2012] [Accepted: 01/24/2012] [Indexed: 11/30/2022] Open
Abstract
Background A review of the related medical journals indicates that there is no definite evidence-based option for managing large proximal ureteral stones, although many procedures such as transureteral lithotripsy (TUL), shock wave lithotripsy (SWL), percutaneous nephrolithotripsy, laparoscopic ureterolithotomy, and open ureterolithotomy are currently used to treat this urological problem. Objectives In this study, we tried to determine the most appropriate treatment plan for proximal ureteral stones larger than 12 mm by comparing the two most commonly used procedures. Patients and Methods Between February 2005 and April 2011, 62 patients including 40 males and 22 females (mean age 39.5 years, range 19 to 64) with proximal ureteral stones larger than 12 mm (12–26 mm) with a mean size of 17.64 mm were prospectively divided into two groups consisting of 32 patients who underwent TUL (group A) and 30 who underwent SWL (group B). In unsuccessful cases, repeat SWL or TUL was planned. Patients who could not tolerate the lithotomy position, younger than 18 years, had undergone coagulopathy, had concurrent renal and ureteral stones, were pregnant, or had sepsis were excluded from this study. Results Stone access was successful in 28 patients and the treatment was efficient in 18 patients (56.25%) in group A. For the patients with successful stone access but unsuccessful TUL, a DJ was inserted and a second ureteroscopic intervention was performed. The second intervention was successful in 7 patients (21.87). SWL was successful in 14 patients (46.66%) in the first attempt and in 7 additional patients in the second intervention (23.33%). Conclusions In this study, we showed different success rates for SWL and TUL because of the larger size of the stones. We achieved a success rate of 56.25% in the first attempt in the TUL group, and the overall success rate (after the second TUL) was 78.12%. In comparison, the SWL group had a success rate of 46.66% in the first attempt, and the overall success rate (after the second SWL) was 69.96%.
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Affiliation(s)
- Seyed Mohammadreza Rabani
- Beheshti Teaching Hospital, Yasouj University of Medical Sciences, Yasouj, IR Iran
- Corresponding author: Seyed Mohammadreza Rabani, Beheshti Teaching Hospital, Yasuj University of Medical Sciences, Yasouj, IR Iran. Tel.: +98-7412228212,+98-9177411389, Fax: +98-7412228211, E-mail:
| | - Ali Moosavizadeh
- Epidmiology Department, Yasouj University of Medical Sciences, Yasouj, IR Iran
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Aboumarzouk OM, Kata SG, Keeley FX, McClinton S, Nabi G. Extracorporeal shock wave lithotripsy (ESWL) versus ureteroscopic management for ureteric calculi. Cochrane Database Syst Rev 2012:CD006029. [PMID: 22592707 DOI: 10.1002/14651858.cd006029.pub4] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Ureteral stones frequently cause renal colic, and if left untreated, can lead to obstructive uropathy. Extracorporeal shock wave lithotripsy (ESWL) and ureteroscopy, with or without intracorporeal lithotripsy, are the most common interventions used to treat ureteral stones. ESWL treatment is less invasive than ureteroscopy, but has some limitations such as a high retreatment rate, and is not available in all centres. Recent advances in ureteroscopy have increased success rates and reduced complication rates. OBJECTIVES To examine evidence from randomised controlled trials (RCTs) on the outcomes of ESWL or ureteroscopy in the treatment of ureteric calculi. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL in The Cochrane Library Issue 2, 2011), MEDLINE (1966 to March 2011), EMBASE (1980 to March 2011), CINAHL, Clinicaltrials.gov, Google Scholar, reference lists of articles and abstracts from conference proceedings, all without language restriction. SELECTION CRITERIA RCTs that compared ESWL with ureteroscopic retrieval of ureteric stones were included in this review. Study participants were adults with ureteric stones requiring intervention. Published and unpublished sources were considered for inclusion. DATA COLLECTION AND ANALYSIS Three authors independently assessed study quality, risk of bias, and extracted data. Statistical analyses were performed using the random-effects model. Results were expressed as risk ratios (RR) for dichotomous outcomes or mean differences (MD) for continuous data, both with 95% confidence intervals (CI). MAIN RESULTS Seven RCTs (1205 patients) were included in the review. Stone-free rates were lower in patients who underwent ESWL (7 studies, 1205 participants: RR 0.84, 95% CI 0.73 to 0.96) but re-treatment rates were lower in ureteroscopy patients (6 studies, 1049 participants: RR 6.18, 95% CI 3.68 to 10.38. ESWL-treated patients had less need for auxiliary treatment (5 studies, 751 participants: RR 0.43, 95% CI 0.25 to 0.74; fewer complications (7 studies, 1205 participants: RR 0.54, 95% CI 0.33 to 0.88); and shorter length of hospital stay (2 studies, 198 participants: MD -2.55 days, 95% CI -3.24 to -1.86).Three studies adequately described the randomisation sequence, three studies were unclear on how they randomised, while one study had a high risk of selection bias. All the studies had an unclear risk of performance bias and detection bias, while all had a low risk of attrition bias, reporting bias, or other sources of bias identified. AUTHORS' CONCLUSIONS Compared with ESWL, ureteroscopic removal of ureteral stones achieves a greater stone-free state, but with a higher complication rate and longer hospital stay.
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Aboumarzouk OM, Kata SG, Keeley FX, Nabi G. Extracorporeal shock wave lithotripsy (ESWL) versus ureteroscopic management for ureteric calculi. Cochrane Database Syst Rev 2011:CD006029. [PMID: 22161396 DOI: 10.1002/14651858.cd006029.pub3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Ureteral stones frequently cause renal colic, and if left untreated, can lead to obstructive uropathy. Extracorporeal shock wave lithotripsy (ESWL) and ureteroscopy, with or without intracorporeal lithotripsy, are the most common interventions used to treat ureteral stones. ESWL treatment is less invasive than ureteroscopy, but has some limitations such as a high retreatment rate, and is not available in all centres. Recent advances in ureteroscopy have increased success rates and reduced complication rates. OBJECTIVES To examine evidence from randomised controlled trials (RCTs) on the outcomes of ESWL or ureteroscopy in the treatment of ureteric calculi. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL in The Cochrane Library Issue 2, 2011), MEDLINE (1966 to March 2011), EMBASE (1980 to March 2011), CINAHL, Clinicaltrials.gov, Google Scholar, reference lists of articles and abstracts from conference proceedings, all without language restriction. SELECTION CRITERIA RCTs that compared ESWL with ureteroscopic retrieval of ureteric stones were included in this review. Study participants were adults with ureteric stones requiring intervention. Published and unpublished sources were considered for inclusion. DATA COLLECTION AND ANALYSIS Three authors independently assessed study quality, risk of bias, and extracted data. Statistical analyses were performed using the random-effects model. Results were expressed as risk ratios (RR) for dichotomous outcomes or mean differences (MD) for continuous data, both with 95% confidence intervals (CI). MAIN RESULTS Seven RCTs (1205 patients) were included in the review. Stone-free rates were lower in patients who underwent ESWL (7 studies, 1205 participants: RR 0.84, 95% CI 0.73 to 0.96) but re-treatment rates were lower in ureteroscopy patients (6 studies, 1049 participants: RR 6.18, 95% CI 3.68 to 10.38. ESWL-treated patients had less need for auxiliary treatment (5 studies, 751 participants: RR 0.43, 95% CI 0.25 to 0.74; fewer complications (7 studies, 1205 participants: RR 0.54, 95% CI 0.33 to 0.88); and shorter length of hospital stay (2 studies, 198 participants: MD -2.55 days, 95% CI -3.24 to -1.86).Three studies adequately described the randomisation sequence, three studies were unclear on how they randomised, while one study had a high risk of selection bias. All the studies had an unclear risk of performance bias and detection bias, while all had a low risk of attrition bias, reporting bias, or other sources of bias identified. AUTHORS' CONCLUSIONS Compared with ESWL, ureteroscopic removal of ureteral stones achieves a greater stone-free state, but with a higher complication rate and longer hospital stay.
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Affiliation(s)
- Omar M Aboumarzouk
- Department of Urology, Academic Clinical Practice, Division of Clinical and Population Sciences, University of Dundee, Dundee, Scotland, UK, DD1 9SY
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Resorlu B, Kara C, Resorlu EB, Unsal A. Effectiveness of ultrasonography in the postoperative follow-up of pediatric patients undergoing ureteroscopic stone manipulation. Pediatr Surg Int 2011; 27:1337-41. [PMID: 21953523 DOI: 10.1007/s00383-011-2979-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/12/2011] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To evaluate the effectiveness of ultrasonography and to determine whether ionizing radiation is necessary in the postoperative follow-up of children undergoing ureteroscopy. METHODS We reviewed the charts of 49 children who underwent 51 ureteroscopic procedures for ureteral calculi. Renal ultrasound and intravenous urography were performed in all patients at 3 months after surgery for postoperative evaluation. RESULTS In three cases, stones migrated to the kidney. Retrograde intrarenal surgery was performed in two patients and one patient required shockwave lithotripsy to become stone-free. Fourty-six children were completely stone-free and 3 had residual fragments on plain film in the postoperative 3 month. The sensitivity, specificity, negative and positive predictive values of ultrasonography for detecting hydronephrosis were 85.7, 100, 97.7 and 100%, respectively. Two patients under observation and three patients under medical expulsive therapy had resolution of hydronephrosis on follow-up. One patient required ureteroscopy for residual obstructing fragments. CONCLUSIONS Ultrasonography has limited accuracy for detecting residual ureteral stones, but it is a highly specific and reasonably sensitive test for detecting hydronephrosis. A combination of ultrasonography and plain film is a safe and effective imaging procedure in postoperative follow-up of children undergoing ureteroscopy.
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Affiliation(s)
- Berkan Resorlu
- Ministry of Health, Kecioren Training and Research Hospital, Ankara, Turkey.
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Arrabal-Polo MA, Arrabal-Martin M, Palao-Yago F, Mijan-Ortiz JL, Zuluaga-Gomez A. Value of focal applied energy quotient in treatment of ureteral lithiasis with shock waves. ACTA ACUST UNITED AC 2011; 40:377-81. [PMID: 22002726 DOI: 10.1007/s00240-011-0430-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Accepted: 10/04/2011] [Indexed: 11/27/2022]
Abstract
The treatment of ureteral lithiasis by extracorporeal shock wave lithotripsy (ESWL) is progressively being abandoned owing to advances in endoscopic lithotripsy. The purpose of this paper is to analyze the causes as to why ESWL is less effective-with a measurable parameter: focal applied energy quotient (FAEQ) that allows us to apply an improvement project in ESWL results for ureteral lithiasis. A prospective observational cohort study with 3-year follow-up and enrollment period was done with three groups of cases. In Group A, 83 cases of ureteral lithiasis were treated by endoscopic lithotripsy using Holmiun:YAG laser. In Group B, 81 cases of ureteral lithiasis were treated by ESWL using Doli-S device (EMSE 220F-XXP). In Group C, 65 cases of ureteral lithiasis were treated by ESWL using Doli-S device (EMSE 220F-XXP) (FAEQ >10). Statistical study and calculation of RR, NNT, Chi-square test, Fisher's exact test, and Student's t test were done. Efficiency quotient (EQ) and focal applied energy quotient [FAEQ = (radioscopy seconds/number of shock waves) × ESWL session J] were analyzed. From the results, the success rate of the treatment using Holmium:YAG laser lithotripsy and ESWL is found to be 94 and 48%, respectively, with a statistically significant difference (p < 0.001). Success rate of endoscopic laser lithotripsy for lumbar ureteral stones was 82% versus 57% of ESWL (p = 0.611). In Group B, FAEQ was 8.12. In Group C, success rate was 93.84% with FAEQ of 10.64%. When we compare results from endoscopic lithotripsy with Holmium:YAG laser in Group B with results from ESWL with FAEQ >10, we do not observe absolute benefit choosing one or the other. In conclusion, the application of ESWL with FAEQ >10, that is, improving radiologic focalization of the calculus and increasing the number of Joules/SW, makes possible a treatment as safe and equally efficient as Holmium:YAG laser lithotripsy in ureteral lithiasis less than 13 mm.
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Affiliation(s)
- Miguel Angel Arrabal-Polo
- Department of Urology, San Cecilio University Hospital, Camino de Ronda Street, 143, 4°F, 18003 Granada, Spain.
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Bastawisy M. A comparison of Stone Cone versus lidocaine jelly in the prevention of ureteral stone migration during ureteroscopic lithotripsy. Ther Adv Urol 2011; 3:203-10. [PMID: 22046198 PMCID: PMC3199590 DOI: 10.1177/1756287211419551] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Intracorporeal lithotripsy modalities and stone removal devices have been created to facilitate endoscopic management of ureteral stones. These devices, along with improved techniques, have resulted in stone-free rates greater than 95% with low morbidity. However, problems remain that preclude consistent 100% stone-free rates with endoscopic treatment of ureteral calculi. Retrograde migration during ureteroscopic procedures remains a significant problem. OBJECTIVES The aim of this study was to compare the Stone Cone device and instillation of lubricating lidocaine jelly as two methods to prevent retrograde stone migration during ureteroscopic lithotripsy. PATIENTS AND METHODS This study included patients suffering from ureteral stones that were treated with intracorporeal lithotripsy using the pneumatic Lithoclast. These patients were divided into two groups. In group I, the Stone Cone device was used, while in group II, lidocaine jelly 2% concentration was used. RESULTS This study included 40 patients with a mean age of 38.6 ± 9.3 years (20 patients in each group). There was no significant difference between the groups with regards to stone site, size or state of the upper urinary tract by excretory urography. The pneumatic Lithoclast allowed successful fragmentation of all calculi into small fragments. Upward stone migration did not occur in patients in the Stone Cone group, while in the lidocaine jelly group it occurred in three patients (15%). The operative time in the Stone Cone group ranged between 30 and 55 minutes (mean, 41.8 ± 5.3), while in the lidocaine jelly group it ranged between 40 and 71 minutes (mean, 51.4 ± 3.4), and this difference was statistically significant (p < 0.05). CONCLUSION The Stone Cone is safe and efficient in preventing proximal stone migration during ureteroscopic pneumatic lithotripsy. It maintained continuous ureteral access and demonstrated a statistically significant advantage over the lidocaine jelly in terms of proximal stone migration, operative time, and the need for auxiliary procedures.
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Affiliation(s)
- Mohamed Bastawisy
- Department of Urology, Tanta University, 20 Bahr Street, Tanta, Egypt
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Abstract
OBJECTIVE To summarize the changes in prevalence and treatment of upper urinary tract stone disease in the UK over the last 10 years. METHODS Data from the Hospital Episode Statistics (HES) website (http://www.hesonline.nhs.uk) were extracted, summarized and presented. RESULTS The number of upper urinary tract stone hospital episodes increased by 63% to 83,050 in the 10-year period. The use of shock wave lithotripsy (SWL) for treating all upper tract stones increased from 14,491 cases in 2000-2001 to 22,402 cases in 2010 (a 55% increase) with a 69% increase in lithotripsy for renal stones. There was a 127% increase in the number of ureteroscopic stone treatments from 6,283 to 14,242 cases over the 10-year period with a 49% increase from 2007/2008 to 2009/2010. There was a decline in open surgery for upper tract stones from 278 cases in 2000/2001 to 47 cases in 2009/2010 (an 83% reduction). Treatment for stone disease has increased substantially in comparison with other urological activity. In 2009/2010, SWL was performed almost as frequently as transurethral resection of the prostate or transurethral resection of bladder tumour, ureteroscopy for stones was performed more frequently than nephrectomy, radical prostatectomy and cystectomy combined, and percutaneous nephrolithotomy was performed more frequently than cystectomy. CONCLUSIONS The present study highlights the increase in prevalence and treatment of stone disease in the UK over the last 10 years. If this trend continues it has important implications for workforce planning, training, service delivery and research in the field of urolithiasis.
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Affiliation(s)
- Benjamin W Turney
- Oxford Stone Group, Department of Urology, Nuffield Department of Surgical Sciences, The Churchill Hospital, Oxford, UK.
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Zhang J, Shi Q, Wang GZ, Wang F, Jiang N. Cost-effectiveness analysis of ureteroscopic laser lithotripsy and shock wave lithotripsy in the management of ureteral calculi in eastern China. Urol Int 2011; 86:470-5. [PMID: 21597268 DOI: 10.1159/000324479] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2010] [Accepted: 01/19/2011] [Indexed: 11/19/2022]
Abstract
INTRODUCTION It was the aim of this study to compare the efficiency and safety between shock wave lithotripsy (SWL) and ureteroscopic holmium laser lithotripsy (URL) methods for ureteral calculi while also determining which option is more cost-effective. PATIENTS AND METHODS During January 2008 to September 2009, a prospective randomized study was conducted to compare both modalities for the management of solitary radiopaque ureteral stones. Patient and stone characteristics, treatment outcome and charges were documented. Both options were compared using univariate statistical tests to identify the efficiency quotient and cost-effectiveness for ureteral calculi according to the stone location. RESULTS A total of 257 patients were in the SWL group, while 269 were in the URL group. The efficiency quotients for SWL and URL were 0.81 and 0.88, respectively. The initial stone-free rate of URL for lower ureteral calculi was higher (p = 0.002), while the complication rate of SWL for upper ureteral calculi was lower (p = 0.027). The SWL group required lower hospitalization charges (USD 440 vs. 1,221; p < 0.001), lower total charges (USD 454 vs. 1,284; p < 0.001) and a shorter period of hospitalization (5.4 vs. 6.6 days; p < 0.001) compared with the URL group for all ureteral locations. For mid and lower ureteral calculi, the postoperative office visits of the URL group were fewer (1.03 vs. 1.1 times; p = 0.001). CONCLUSIONS Primary in situ SWL for upper and middle ureteral calculi showed lower complication rates compared to URL and was more cost-effective in Eastern China. However, primary URL was a better option for treating lower ureteral stones with a higher stone-free rate but was more expensive.
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Affiliation(s)
- Jing Zhang
- Department of Urology, Shanghai Pudong New Area Gongli Hospital, Shanghai, China
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Wang CJ, Huang SW, Chang CH. Randomized Trial of NTrap for Proximal Ureteral Stones. Urology 2011; 77:553-7. [DOI: 10.1016/j.urology.2010.07.497] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Revised: 07/21/2010] [Accepted: 07/24/2010] [Indexed: 10/18/2022]
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Khairy-Salem H, el-Ghoneimy M, el-Atrebi M. Semirigid ureteroscopy in management of large proximal ureteral calculi: is there still a role in developing countries? Urology 2011; 77:1064-8. [PMID: 21272925 DOI: 10.1016/j.urology.2010.08.067] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Revised: 08/16/2010] [Accepted: 08/21/2010] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To evaluate the outcome and complications of the use of semirigid ureteroscopy (URS) together with intracorporeal pneumatic lithotripsy in the management of upper ureteral calculi >10 mm in diameter. METHODS A total of 75 patients (41 women and 34 men), with a mean age of 48 years (range 25-60), underwent primary URS for solitary radiopaque proximal ureteral calculi 10-20 mm in diameter (average 13.1). Dilation of the intramural ureter was done in 60 cases (80% of patients), and intracorporeal lithotripsy was required in 56 (74.6%). Ureteral catheters were left for drainage in 60% of patients, 26.7% were left unstented, and only 13.3% required an indwelling stent. RESULTS Of the 75 stones, 60 (80%) were successfully cleared after a single endoscopic procedure. Our initial stone-free rate was 90.6% at 2 weeks after the primary endoscopic procedure and had reached 98.6% at 3 months. Antegrade URS for migrating stones was done successfully in 6 cases in a tubeless fashion, and open ureterolithotomy was required in 1 case. No major complications were encountered. The minor complications included only mild extravasation and self-limited postoperative fever and hematuria. The risk factors for URS failure included male gender, the severity of the hydronephrosis, the severity of impaction, and the occurrence of extravasation. CONCLUSIONS The results of our study have shown that semirigid URS is a safe and successful alternative to open ureterolithotomy in the management of large proximal ureteral calculi in the absence of flexible instruments.
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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]
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Shelbaia A, Abd ELRahman S, Hussein A. Ureteroscopic Management of Proximal Ureteric Calculi Using Stone Cone. UROTODAY INTERNATIONAL JOURNAL 2011; 04. [DOI: 10.3834/uij.1944-5784.2011.12.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Stamatiou KN, Heretis I, Takos D, Papadimitriou V, Sofras F. Extracorporeal shock wave lithotripsy in the treatment of pediatric urolithiasis: a single institution experience. Int Braz J Urol 2010; 36:724-30; discussion 731. [DOI: 10.1590/s1677-55382010000600011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2010] [Indexed: 11/22/2022] Open
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Lee JH, Woo SH, Kim ET, Kim DK, Park J. Comparison of Patient Satisfaction with Treatment Outcomes between Ureteroscopy and Shock Wave Lithotripsy for Proximal Ureteral Stones. Korean J Urol 2010; 51:788-93. [PMID: 21165201 PMCID: PMC2991578 DOI: 10.4111/kju.2010.51.11.788] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Accepted: 10/05/2010] [Indexed: 11/25/2022] Open
Abstract
Purpose We examined patient satisfaction with treatment outcomes after shock wave lithotripsy (SWL) and ureteroscopic removal of stone (URS) for proximal ureteral stones. Materials and Methods We evaluated 224 consecutive patients who underwent SWL (n=156) or URS (n=68) for a single radiopaque proximal ureteral stone. Stone-free rates, defined as no visible fragment on a plain X-ray; complications; and patient satisfaction were compared. Patient satisfaction was examined through a specifically tailored questionnaire that included overall satisfaction (5 scales) and 4 domains (pain, voiding symptoms, cost, and stone-free status). Results The stone-free rates after the first, second, and third sessions of SWL were 36.5%, 65.4%, and 84.6%, respectively. The overall stone-free rate of URS was 82.4%, which was comparable to that of the third session of SWL. Complications were similar between the two groups except for greater steinstrasse in the SWL group. Overall satisfaction and voiding symptoms, cost, and stone-free status showed no significant difference between the groups. In the pain domain, the SWL group had a relatively lower satisfaction rate than did the URS group (p=0.05). Subanalysis showed that the satisfaction rate of the URS group with stone-free status was significantly lower than that of the SWL group in patients with ≥10 mm stones (p=0.032). Conclusions Overall treatment outcomes and patient satisfaction were not significantly different between SWL and URS. However, patients undergoing URS for ≥10 mm proximal ureteral stones had lesser satisfaction with stone-free status, because of relatively lower stone-free rates due to upward stone migration. We suggest that factors regarding the subjective satisfaction of patients be included in counseling about treatment options for proximal ureteral stones.
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Affiliation(s)
- Jong-Hyun Lee
- Department of Urology, Eulji University Hospital, Eulji University College of Medicine, Daejeon, Korea
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Nuttall MC, Abbaraju J, Dickinson IK, Sriprasad S. A Review of Studies Reporting on Complications of Upper Urinary Tract Stone Ablation Using the Holmium:YAG Laser. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/j.bjmsu.2010.01.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Purpose: A review of the literature of studies reporting complications of ureteroscopic urinary tract stone ablation using the holmium:YAG laser was performed. Patients and methods: Electronic databases were searched using specific keywords to identify relevant studies. Reference lists of identified articles were scrutinised for other studies and searches were conducted using the names of authors known to have published widely in this field. Two reviewers assessed retrieved articles for inclusion criteria. Patients <16 years old were excluded. Results: Overall, 48 studies published between 1994 and 2007 were included. Half were published since 2000. In total, 4454 patients were identified. Around half of studies were performed in North America (25). The number of patients per study varied from 8 to 598. The study populations were very heterogeneous in terms of stone position and size, and ureteroscope size and rigidity. Overall, 303 (6.8%) complications were identified. Post-operative ureteric stricture and perforation rates were both 1.0%. There were only six major complications identified (0.1%). The post-operative sepsis rate was 2% and one death was reported. Conclusions: Upper urinary tract stone ablation using the holmium:YAG laser is both safe and reliable. Follow-up imaging to detect procedure-specific complications would not appear to be routinely indicated given this low complication rate.
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Affiliation(s)
- Martin C. Nuttall
- Darent Valley Hospital, Dartford and Gravesham NHS Trust, Dartford, UK
| | - Jai Abbaraju
- Darent Valley Hospital, Dartford and Gravesham NHS Trust, Dartford, UK
| | - Ian K. Dickinson
- Darent Valley Hospital, Dartford and Gravesham NHS Trust, Dartford, UK
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Rane A, Bradoo A, Rao P, Shivde S, Elhilali M, Anidjar M, Pace K, D'A Honey JR. The Use of a Novel Reverse Thermosensitive Polymer to Prevent Ureteral Stone Retropulsion During Intracorporeal Lithotripsy: A Randomized, Controlled Trial. J Urol 2010; 183:1417-21. [DOI: 10.1016/j.juro.2009.12.023] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2009] [Indexed: 10/19/2022]
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Salem HK. A prospective randomized study comparing shock wave lithotripsy and semirigid ureteroscopy for the management of proximal ureteral calculi. Urology 2009; 74:1216-21. [PMID: 19815264 DOI: 10.1016/j.urology.2009.06.076] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2008] [Revised: 06/04/2009] [Accepted: 06/10/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To conduct a prospective randomized study comparing both techniques for the management of solitary radio-opaque upper ureteral stones < 2 cm in diameter. The ideal treatment for upper ureteral stones > 1 cm size remains to be determined with shock wave lithotripsy (SWL) and ureteroscopy (URS) being acceptable options. METHODS A total of 200 patients were included in the study. They were randomized into 2 equal groups. Group A underwent in situ SWL as a primary therapy. Group B underwent URS, using semirigid URS with intracorporeal lithotripsy. Efficiency quotient (EQ), cost analysis, and predictors of failure were estimated for both techniques. RESULTS For stones of size > or = 1 cm, the initial stone-free rate for URS and SWL was 88% and 60%, respectively. The estimated EQ was 0.79 and 0.43 for both techniques respectively. For stones < 1 cm, the initial stone-free rate for URS and SWL was 100% and 80%, respectively. The estimated EQ was 0.88 and 0.70 for both techniques, respectively. The mean cumulative costs were significantly more in SWL group (P <.05). Predictors of URS failure included; male gender, failure to pass guidewire beyond the stone, and extravasation. Predictors of SWL failure included large stone size > 1 cm, calcium oxalate monohydrate stone, and higher degrees of hydronephrosis. CONCLUSIONS URS with intracorporeal lithotripsy is an acceptable treatment modality for all proximal ureteral calculi, particularly stones > 1 cm. SWL should remain the first-line therapy for proximal ureteral calculi < or = 1 cm because of the less invasive nature and lower anesthesia (i.v. sedation).
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Affiliation(s)
- Hosni K Salem
- Department of Urosurgery, Kasr El-Einy Hospital, Cairo, Egypt.
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