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Devos B, Vanderbruggen W, Claessens M, Duchateau A, Hente R, Keller EX, Pietropaolo A, Van Cleynenbreugel B, De Coninck V. Risk factors of early infectious complications after ureterorenoscopy for stone disease: a prospective study. World J Urol 2024; 42:277. [PMID: 38691160 DOI: 10.1007/s00345-024-04983-6] [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: 12/19/2023] [Accepted: 03/25/2024] [Indexed: 05/03/2024] Open
Abstract
PURPOSE To prospectively evaluate the rate and associated risk factors of early infectious complications after ureterorenoscopy for urolithiasis. METHODS After ethical committee approval, 400 therapeutic retrograde ureterorenoscopy procedures between August 3, 2020 and November 24, 2021 were included for analysis in a single-center study. Postoperative infection was defined as an afebrile urinary tract infection, fever (≥ 38 °C) with pyuria (≥ 300 WBC/μL) or proven urinary pathogen, and urosepsis. The primary outcome was the rate of infectious complications after ureterorenoscopy. Secondary outcomes were the perioperative factors that increased the risk of infectious complications within 30 days of surgery using univariate and multivariate logistic regression analysis. RESULTS Twenty-nine of four hundred (7.3%) patients developed an infectious complication within 30 days after ureterorenoscopy. Ten (2.5%) patients developed an afebrile urinary tract infection, eight (2.0%) developed fever with pyuria, five (1.3%) febrile urinary tract infection, and six (1.5%) urosepsis. On univariate analysis, preoperative stent-type JFil® pigtail suture stent was significantly associated with the dependent variable (p < 0.001). On multivariate logistic regression analysis, older age (OR 1.035; 95% CI 1.006-1.070; p = 0.02) was found to be significantly associated with developing a postoperative infectious complication. CONCLUSIONS A 7.3% rate of postoperative infectious complications and 1.5% urosepsis rate were observed after therapeutic ureterorenoscopy, without the need of intensive care admission. The only significant risk factors were preoperative stent type (JFil® pigtail suture stent) on univariate analysis, and older age on multivariate logistic regression analysis. Further multicentric prospective observational data are needed in this field.
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Affiliation(s)
- Brecht Devos
- Faculty of Medicine, University Hospitals Leuven, Louvain, Belgium
| | | | - Marc Claessens
- Department of Urology, AZ Klina, Augustijnslei 100, 2930, Brasschaat, Belgium
| | - Aline Duchateau
- Department of Urology, AZ Klina, Augustijnslei 100, 2930, Brasschaat, Belgium
| | - Robert Hente
- Department of Urology, AZ Klina, Augustijnslei 100, 2930, Brasschaat, Belgium
| | - Etienne Xavier Keller
- Young Academic Urologists (YAU), Urolithiasis & Endourology Working Party, 6846, Arnhem, Netherlands
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Amelia Pietropaolo
- Young Academic Urologists (YAU), Urolithiasis & Endourology Working Party, 6846, Arnhem, Netherlands
- Department of Urology, University Hospital Southampton, Southampton, UK
| | - Ben Van Cleynenbreugel
- Faculty of Medicine, University Hospitals Leuven, Louvain, Belgium
- Department of Development and Regeneration, KU Leuven, Louvain, Belgium
| | - Vincent De Coninck
- Department of Urology, AZ Klina, Augustijnslei 100, 2930, Brasschaat, Belgium.
- Young Academic Urologists (YAU), Urolithiasis & Endourology Working Party, 6846, Arnhem, Netherlands.
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Policastro C, Dispagna M, Smith G, Byler T, Wiener S. Factors associated with unplanned clinical encounters for ureteral stent-related symptoms. World J Urol 2024; 42:74. [PMID: 38324162 DOI: 10.1007/s00345-024-04768-x] [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: 04/05/2023] [Accepted: 01/02/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND, INTRODUCTION AND AIM Ureteral stent-related symptoms (USRS) often result in unplanned phone calls and ER visits. We hypothesize that patient factors can be identified to predict these unplanned encounters. METHODS AND MATERIALS Retrospective analysis of indwelling ureteral stent placements from 2014 to 2019 at a single institution by CPT code was performed. Patient demographics, discharge medications, and clinical factors were evaluated using multiple logistic regression with respect to postoperative telephone and emergency room (ER) encounters for USRS. RESULTS Of 374 patients, 75 (20.1%) had one or more encounters for USRS: 48 (12.8%) called the clinic and 39 (10.4%) returned to the ER. Chronic opioid use was predictive of calls to clinic and ER visits (OR 3.21 [CI 1.42-6.97], p < 0.01 and OR 3.64 [CI 1.45-8.98], p < 0.01). Survival analysis stratified by history of chronic opioid use and discharge opioid prescriptions demonstrated that opioid naïve patients receiving opioids at discharge had unplanned encounters sooner and more often [Calls p = 0.025, ER p = 0.041]), whereas patients with chronic opioid use returned to the ER sooner and more frequently when prescribed additional opioids (Calls p = 0.4, ER p = 0.002). CONCLUSION Patients with a history of chronic opioid use may experience more intense USRS or have a lower threshold to seek medical care than opioid naïve patients and tend to bypass calling the clinic for the ER. Given that none of the studied medications reduced unplanned patient contact for USRS, urologists should consider upfront definitive management of urinary obstruction when appropriate.
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Affiliation(s)
- Connor Policastro
- Department of Urology, SUNY Upstate Medical University, 750 E Adams St, CWB 2nd Floor, Syracuse, NY, 13210, USA
| | - Mauro Dispagna
- School of Medicine, SUNY Upstate Medical University, Syracuse, NY, 13210, USA
| | - Garrett Smith
- Department of Urology, SUNY Upstate Medical University, 750 E Adams St, CWB 2nd Floor, Syracuse, NY, 13210, USA
| | - Timothy Byler
- Department of Urology, SUNY Upstate Medical University, 750 E Adams St, CWB 2nd Floor, Syracuse, NY, 13210, USA
| | - Scott Wiener
- Department of Urology, SUNY Upstate Medical University, 750 E Adams St, CWB 2nd Floor, Syracuse, NY, 13210, USA.
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Outcomes and Complications from a Randomized Controlled Study Comparing Conventional Stent Placement Versus No Stent Placement after Ureteroscopy for Distal Ureteric Calculus < 1 cm. J Clin Med 2022; 11:jcm11237023. [PMID: 36498598 PMCID: PMC9740435 DOI: 10.3390/jcm11237023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 11/21/2022] [Accepted: 11/23/2022] [Indexed: 11/29/2022] Open
Abstract
Ureteric stent insertion following ureteroscopic lithotripsy (URSL) is a common and widely accepted procedure. However, there is no agreement on whether a ureteric stent should be placed following an uncomplicated URSL. Furthermore, the definition of uncomplicated URSL remains debatable. To compare the efficacy, safety, and morbidity of no stent placement with the conventional stent placement after uncomplicated retrograde semirigid URS for a distal ureteric calculus of size ≤1 cm, we compared the corresponding complication rates, emergency visits, secondary interventions, and pain at follow-up. Following an uncomplicated ureteroscopic lithotripsy, 104 patients were randomized into the conventional stented group (CSG) and nonstented group (NSG). Lower urinary tract symptoms and sexual function were evaluated using validated questionnaires (IPSS + IIEF-5 + MSHQ-EjD/FSFI) preoperatively and at 4 weeks during follow-up. Pain scores at follow-up were recorded using a visual analogue scale (VAS). Patients who visited the emergency room or needed secondary interventions before the recommended follow-up time were noted. The Generalized Estimating Equations method was used to explore the difference in change in the domains of IPSS, IIEF-5, MSHQ-EjD, and FSFI between the two groups over time. A significant difference was noted in the following IPSS domains: Frequency, Urgency, Nocturia, Storage Symptoms, Total IPSS Score (p ≤ 0.001), and QoL (p = 0.002); IIEF-5 domains: Overall Score (p = 0.004); MSHQ-EjD domains: Ejaculation Bother/Satisfaction (p ≤ 0.001); and FSFI domains: Lubrication (p ≤ 0.001), Satisfaction (p = 0.006), and Overall Score (p = 0.004). There was no significant difference between the various groups in terms of distribution of emergency visits, readmission and secondary interventions, pain at follow-up (VAS), and need for long-term analgesia. Nonplacement of stents after uncomplicated URS decreases stent-related symptoms and preserves QoL without placing the patient under increased postoperative risk.
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Sharma S, Sabale V, Mulay A, Mhaske S, Satav V, Nihar S. Use of conventional DJ stent and single loop stent with string after ureterorenoscopic lithotripsy: Can we use? Can it be effective? Urol Ann 2021; 13:362-366. [PMID: 34759647 PMCID: PMC8525471 DOI: 10.4103/ua.ua_113_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 02/11/2021] [Indexed: 11/30/2022] Open
Abstract
Context: Use of conventional double j stent with string and single loop stent with string after ureterorenoscopy. Aim: The aim of this study was to compare the use of both types of stents using the Ureteral Symptom Score Questionnaire (USSQ) and assess proximal migration. Settings and Design: This was a single institute study. Subjects and Methods: A total of 96 female patients with unilateral ureteric stones were enrolled. Patients underwent ureterorenoscopic lithotripsy, conventional double J (DJ) stent with string and single loop stent with string was placed. Before stent removal at 7–10 days, they were evaluated with X-ray kidney ureter bladder for proximal migration and USSQ for stent-related complaints. Statistical Analysis Used: Data were analyzed using Chi-square and Student's t-test. Results: In our study, Group A (DJ loop with string) had 51 patients and Group B (single J loop with string) had 47 patients. The mean stone size in group A was 10.06 mm and Group B was 9.7 mm. Both groups had one case each of early stent expulsion and none had proximal migration of the stent. Group A had two cases of urinary tract infection and Group B had one case which resolved on antibiotics. Evaluating the USSQ questionnaire in both groups, urinary symptoms such as urgency (P = 0.03), dysuria (P = 0.02), interference with life (P = 0.01), and quality impact overall (P = 0.016) were statistically significant. Evaluating pain, sleep disturbance (P = 0.04), pain at voiding (P = 0.03), and flank pain during voiding (P = 0.018) was statistically significant. In general health, difficulty with heavyweight physical activity (P = 0.02), feeling calm (P = 0.16), social life enjoyment (P = 0.26), and need for extra help (P = 0.008) was significant. In sexual matters, 13 (28%) patients in Group B had no active sex (conscious) and 6 (12%) patients had stopped intercourse due to stent-related symptoms, whereas in Group A, it was 10 (20%) and 2 (4%) patients, respectively. Conclusions: The use of a single J stent with string is an effective method, has lesser complication, and is easier to remove.
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Affiliation(s)
- Sonu Sharma
- Department of Urology, Renal Transplant and Robotics, Dr D Y Patil Medical College, Pune, Maharastra, India
| | - Vilas Sabale
- Department of Urology, Renal Transplant and Robotics, Dr D Y Patil Medical College, Pune, Maharastra, India
| | - Abhirudra Mulay
- Department of Urology, Renal Transplant and Robotics, Dr D Y Patil Medical College, Pune, Maharastra, India
| | - Sunil Mhaske
- Department of Urology, Renal Transplant and Robotics, Dr D Y Patil Medical College, Pune, Maharastra, India
| | - Vikram Satav
- Department of Urology, Renal Transplant and Robotics, Dr D Y Patil Medical College, Pune, Maharastra, India
| | - Surya Nihar
- Department of Urology, Renal Transplant and Robotics, Dr D Y Patil Medical College, Pune, Maharastra, India
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The Efficacy and Safety of Ureteric Stent Removal with Strings versus No Strings: Which Is Better? BIOMED RESEARCH INTERNATIONAL 2020; 2020:4081409. [PMID: 33123574 PMCID: PMC7584935 DOI: 10.1155/2020/4081409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 09/30/2020] [Indexed: 11/17/2022]
Abstract
Objective To evaluate the current evidence on the effectiveness and safety of ureteric stent removal using strings compared to conventional methods. Materials and Methods The electronic databases PubMed, Embase, China National Knowledge Infrastructure (CNKI), and the Cochrane Library were systematically searched up to March 2020. Two reviewers searched the literature, independently extracted the data, and evaluated the quality of the studies according to the inclusion and exclusion criteria. The data analysis was performed with the software program Review Manager 5.3. Results Eleven studies with a total of 1809 patients were included in the analysis based on the inclusion criteria. Our meta-analysis showed that visual analogue scale (VAS) scores were significantly lower in the string group than in the conventional group (weighted mean difference (WMD) -2.63; 95% confidence interval (CI) -3.68, -1.58; P < 0.00001). In terms of stent dwell time, the string group had an advantage (WMD -9.53; 95% CI -14.20, -4.86; P < 0.0001). In addition, no significant differences in the occurrence of urinary tract infection (UTI) (odds ratio (OR) 1.03; 95% CI 0.62, 1.72; P = 0.92), emergency room visits (OR 0.99; 95% CI 0.59, 1.67; P = 0.97), or other complications (P > 0.05) were observed between the two groups. Conclusion Our findings suggest that an extraction string is an effective and safe method for the removal of ureteric stents. This method gives patients the benefits of reduced pain and shortened stent dwell time without increasing the risk of UTI. Nevertheless, these findings should be further confirmed through large-volume, well-designed prospective randomized controlled trials (RCTs).
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6
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Souhail B, Charlot P, Deroudilhe G, Coblentz Y, Pierquet G, Gimel P, Challut N, Levent T, Cusumano S, Dautezac V, Roger PM. Urinary tract infection and antibiotic use around ureteral stent insertion for urolithiasis. Eur J Clin Microbiol Infect Dis 2020; 39:2077-2083. [PMID: 32591897 DOI: 10.1007/s10096-020-03953-1] [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: 02/03/2020] [Accepted: 06/15/2020] [Indexed: 12/23/2022]
Abstract
Urolithiasis is the main indication for a ureteral JJ stent. Our aim was to determine the incidence of urinary tract infections (UTIs) after a JJ stent for urolithiasis, with an emphasis on antibiotic use. Prospective, multicenter, cohort study over a 4-month period including all of the patients with urolithiasis requiring JJ stent insertion. The clinical and microbiological data and therapeutic information were recorded until removal of the JJ stent. Two hundred twenty-three patients at five French private hospitals were included. A urine culture was performed for 187 patients (84%) prior to insertion of a JJ stent, 36 (19%) of which were positive. One hundred thirty patients (58%) received an antibiotic therapy during surgery: 74 (33%) prophylaxis and 56 (25%) empirical antibiotic therapy, comprising 17 different regimens. The rate of prophylaxis varied according to the center, from 0 to 70%. A total of 208 patients were followed-up until removal of the first stent. The rate of UTIs was 6.3% (13/208); 8.1% of the patients who did not receive a prophylaxis had a UTI versus 1.4% of those who did receive a prophylaxis (p = 0.057). Seven empirical antibiotic regimens were used to treat these 13 patients. Another large panel of antibiotic prescriptions was observed at the time of JJ stent removal. The incidence of a UTI after JJ stent insertion for urolithiasis was 6.3%, in part due to a lack of prophylaxis. An unwarranted diversity of antibiotic use was observed at each step of care.
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Affiliation(s)
| | - Patrick Charlot
- Elsan, Clinique Inkermann, 84 Rte d'Aiffres, 79000, Niort, France
| | - Gilles Deroudilhe
- Elsan, Clinique Saint Augustin, 114 Ave d'Arès, 33000, Bordeaux, France
| | - Yves Coblentz
- Elsan, Clinique Inkermann, 84 Rte d'Aiffres, 79000, Niort, France
| | - Gregory Pierquet
- Elsan, Clinique Saint Augustin, 114 Ave d'Arès, 33000, Bordeaux, France
| | - Pierre Gimel
- Elsan, Clinique Saint-Roch 5 Rue Ambroise Croizat, 66330, Cabestany, France
| | - Nathalie Challut
- Elsan, Clinique Saint-Roch 5 Rue Ambroise Croizat, 66330, Cabestany, France
| | - Thierry Levent
- Elsan, Clinique Vauban, 10 Avenue Vauban, 59300, Valenciennes, France
| | - Stéphane Cusumano
- Elsan, Clinique du Sidobre, Chemin de St Hyppolyte, 81100, Castres, France
| | - Véronique Dautezac
- Elsan, Clinique du Sidobre, Chemin de St Hyppolyte, 81100, Castres, France
| | - Pierre-Marie Roger
- Réso-Infectio-PACA-Est, Nice, France.,Elsan, Clinique Les Fleurs,, Avenue Frédéric Mistral, 83190, Ollioules, France.,Faculté de Médecine, Université Côte d'Azur, 28 Avenue de Valombrose, 06107, Nice, France
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7
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Complications of ureteroscopy: a complete overview. World J Urol 2019; 38:2147-2166. [DOI: 10.1007/s00345-019-03012-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 11/05/2019] [Indexed: 12/18/2022] Open
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8
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Weltings S, Schout BM, Roshani H, Kamphuis GM, Pelger RC. Lessons from Literature: Nephrostomy Versus Double J Ureteral Catheterization in Patients with Obstructive Urolithiasis—Which Method Is Superior? J Endourol 2019; 33:777-786. [DOI: 10.1089/end.2019.0309] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Saskia Weltings
- Department of Urology, Haga Teaching Hospital, The Hague, The Netherlands
| | - Barbara M.A. Schout
- Department of Urology, Alrijne Health Care Group, Leiden/Leiderdorp, The Netherlands
| | - Hossain Roshani
- Department of Urology, Haga Teaching Hospital, The Hague, The Netherlands
| | - Guido M. Kamphuis
- Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Rob C.M. Pelger
- Department of Urology, LUMC, University of Leiden, Leiden, The Netherlands
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Bower PE, Pereira J, Al-Alao O, Kott O, Velez D, Thavaseelan S, Pareek G. Indications for stent omission after ureteroscopic lithotripsy defined: A single-institution experience with cost analysis. Arab J Urol 2019; 17:206-211. [PMID: 31489236 PMCID: PMC6711146 DOI: 10.1080/2090598x.2019.1614243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 04/15/2019] [Indexed: 12/03/2022] Open
Abstract
Objectives: To report on our experience with the use of an evidence-based algorithm defining specific indications for stent omission (SO) after ureteroscopic lithotripsy (URSL), as stent placement has been associated with increased cost and morbidity and indications for SO in the setting of uncomplicated ureteroscopy have been proposed but remain vague. Patients and methods: Indications for SO were defined as per the attached figure, data from URSL procedures performed from January 2016 to September 2017 were collected. For procedures eligible for SO, preoperative and intraoperative factors were recorded including: stone burden, presence of preoperative stent, procedure time, access sheath use, and whether SO was performed. Morbidity data were reviewed including: postoperative events, patient telephone calls for bothersome symptoms, unplanned return visits, and admissions within 30 days. Results: In all, 250 URSL procedures were performed during the study period, and 106 (42.4%) were eligible for SO. SO was performed in 60 (24.0%) cases reflecting a 56.7% compliance with the algorithm. There were no readmissions or re-operations within 30 days for the SO group. Lower postoperative event rates were noted in the SO group (16.7% vs 34.8%, P = 0.03), unplanned return visits (8.3% vs 17.4%, P = 0.16) and 30-day readmission rates (0.0% vs 6.5%, P = 0.08) were also lower in the SO group, although they did not reach statistical significance. Analysis also demonstrated a protective effect of SO on unplanned return visits (odds ratio 0.43, 95% confidence interval 0.13–1.42, P = 0.17), although this was not statistically significant. No statistically significant associations were noted between postoperative events and stone burden, procedure time, or presence of preoperative stent. Conclusions: We provide an algorithm defining indications for SO. SO is safe in a significant portion of URSL procedures, and SO appears to decrease postoperative events when performed judiciously. Abbreviations: IQR: interquartile range; LUTS: lower urinary tract symptoms; OR, odds ratio; SO: stent omission; URSL: ureteroscopic lithotripsy; YAG: yttrium-aluminium-garnet
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Affiliation(s)
- Paul E Bower
- Section of Minimally Invasive Urology, Alpert Medical School, Brown University, Providence, RI, USA
| | - Jorge Pereira
- Section of Minimally Invasive Urology, Alpert Medical School, Brown University, Providence, RI, USA
| | - Osama Al-Alao
- Section of Minimally Invasive Urology, Alpert Medical School, Brown University, Providence, RI, USA
| | - Ohad Kott
- Section of Minimally Invasive Urology, Alpert Medical School, Brown University, Providence, RI, USA
| | - Danielle Velez
- Section of Minimally Invasive Urology, Alpert Medical School, Brown University, Providence, RI, USA
| | - Simone Thavaseelan
- Section of Minimally Invasive Urology, Alpert Medical School, Brown University, Providence, RI, USA
| | - Gyan Pareek
- Section of Minimally Invasive Urology, Alpert Medical School, Brown University, Providence, RI, USA
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Ordonez M, Hwang EC, Borofsky M, Bakker CJ, Gandhi S, Dahm P. Reprint - Ureteral stent vs. no ureteral stent for ureteroscopy in the management of renal and ureteral calculi: A Cochrane review. Can Urol Assoc J 2019; 14:61-68. [PMID: 31348748 DOI: 10.5489/cuaj.5957] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We aimed to assess the effects of postoperative ureteral stent placement after uncomplicated ureteroscopy. METHODS We performed a comprehensive search with no restrictions on publication language or status up to February 1, 2019. We only included randomized trials. Two review authors independently examined full-text reports, identified relevant studies, assessed the eligibility of studies for inclusion, extracted data, and assessed risk of bias. We performed statistical analyses using a random-effects model and assessed the certainty of the evidence according to GRADE. RESULTS We included 23 studies with 2656 randomized patients. Primary outcomes: It is uncertain whether stenting reduces the number of unplanned return visits (very low certainty of evidence [CoE]). Pain on the day of surgery is probably similar (mean difference [MD] 0.32; 95% confidence interval (CI) -0.13-0.78; moderate CoE). Pain on postoperative days 1-3 may show little to no difference (standardized mean difference [SMD] 0.25; 95% CI -0.32-0.82; low CoE). It is uncertain whether stented patients experience more pain on postoperative days 4-30 (very low CoE). Stenting may result in little to no difference in the need for secondary interventions (risk ratio [RR] 1.15; 95% CI 0.39-3.33; low CoE). SECONDARY OUTCOMES We are uncertain whether stenting reduces the need for narcotics and reduces ureteral stricture rates up to 90 days (very low CoE). Rates of hospital admission may be slightly reduced (RR 0.70; 95% CI 0.32-1.55; low CoE). This review was limited to patients in whom ureteroscopy was deemed 'uncomplicated.' In addition, time intervals for the grouping for the reported degree of pain were established post-hoc. The CoE for most outcomes was rated as low or very low for methodological reasons. CONCLUSIONS Findings of this review illustrate the tradeoffs of risks and benefits faced by urologists and their patients when it comes to decision-making about stent placement after uncomplicated ureteroscopy for stone disease.
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Affiliation(s)
- Maria Ordonez
- Department of Urology, University of Minnesota, Minneapolis, MN, United States
| | - Eu Chang Hwang
- Department of Urology, University of Minnesota, Minneapolis, MN, United States.,Department of Urology, Chonnam National University Medical School, Hwasun, South Korea.,Urology Section, Minneapolis VA Health Care System, Minneapolis, MN, United States
| | - Michael Borofsky
- Department of Urology, University of Minnesota, Minneapolis, MN, United States
| | - Caitlin J Bakker
- Health Sciences Libraries, University of Minnesota, Minneapolis, MN, United States
| | | | - Philipp Dahm
- Department of Urology, University of Minnesota, Minneapolis, MN, United States.,Urology Section, Minneapolis VA Health Care System, Minneapolis, MN, United States
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11
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Pereira JF, Bower P, Jung E, Parkhomenko E, Tran T, Thavaseelan S, Pareek G. Ureteral stenting practices following routine ureteroscopy: an international survey. World J Urol 2019; 37:2501-2508. [PMID: 30747279 DOI: 10.1007/s00345-019-02660-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 01/30/2019] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Stent omission after routine ureteroscopy (rtURS) is accepted by current guidelines and may result in decreased patient morbidity and treatment costs. In a value-based healthcare model, the added morbidity and cost of routine stent placement may be scrutinized. Furthermore, data are limited on urologist cost knowledge and it is effect on ureteral stent placement. As such, we seek to describe ureteral stenting practices and urologist cost knowledge amongst US and non-US-based urologists. METHODS The ureteroscopic practice patterns and cost awareness of members of the Endourological Society were surveyed using an international email listserv. Respondents were grouped by practice location (US vs non-US). Logistic regression was used to evaluate the associations of surgeon practice location with stenting practices. RESULTS 233 completed responses were received with a response rate of 13.5%. Results revealed that 55% and 71% of respondents reported ureteral stent insertion after rtURS more than 75% of the time for ureteral and renal stones, respectively. Reporting stent insertion following more than 75% of rtURS was more common among US participants for both ureteral and renal stones. Overall, reported cost knowledge was high, but lower among US participants. On multivariable analysis, US respondents were more likely to place ureteral stents after rtURS for ureteral stones more than 75% of the time when compared to those abroad (OR 3.43 p < 0.01). CONCLUSION Ureteral stenting after rtURS is over utilized in the US compared to other countries. While this phenomenon is multifactorial in nature, cost knowledge may be under recognized as a determinant of ureteral stent placement following rtURS.
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Affiliation(s)
- Jorge F Pereira
- Columbia University Division of Urology, Mount Sinai Medical Center, 4302 Alton Road, Suite 540, Miami Beach, FL, 33140, USA.
| | - Paul Bower
- Warren Alpert Medical School of Brown University, Providence, RI, USA.,Division of Urology, Rhode Island Hospital, The Miriam Hospital, Providence, RI, USA
| | - Eric Jung
- Warren Alpert Medical School of Brown University, Providence, RI, USA.,Division of Urology, Rhode Island Hospital, The Miriam Hospital, Providence, RI, USA
| | - Egor Parkhomenko
- Department of Urology, University of California, Irvine, Orange, CA, USA
| | - Timothy Tran
- Warren Alpert Medical School of Brown University, Providence, RI, USA.,Division of Urology, Rhode Island Hospital, The Miriam Hospital, Providence, RI, USA
| | - Simone Thavaseelan
- Warren Alpert Medical School of Brown University, Providence, RI, USA.,Division of Urology, Rhode Island Hospital, The Miriam Hospital, Providence, RI, USA
| | - Gyan Pareek
- Warren Alpert Medical School of Brown University, Providence, RI, USA.,Division of Urology, Rhode Island Hospital, The Miriam Hospital, Providence, RI, USA.,Minimally Invasive Urology Institute, The Miriam Hospital, Providence, RI, USA
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Ordonez M, Hwang EC, Borofsky M, Bakker CJ, Gandhi S, Dahm P. Ureteral stent versus no ureteral stent for ureteroscopy in the management of renal and ureteral calculi. Cochrane Database Syst Rev 2019; 2:CD012703. [PMID: 30726554 PMCID: PMC6365118 DOI: 10.1002/14651858.cd012703.pub2] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Ureteroscopy combined with laser stone fragmentation and basketing is a common approach for managing renal and ureteral stones. This procedure is associated with some degree of ureteral trauma. Ureteral trauma may lead to swelling, ureteral obstruction, and flank pain and may require subsequent interventions such as hospital admission or secondary ureteral stent placement. To prevent such issues, urologists often place temporary ureteral stents prophylactically, but the value of doing so remains unclear. OBJECTIVES To assess the effects of postoperative ureteral stent placement after uncomplicated ureteroscopy. SEARCH METHODS We performed a comprehensive search using multiple databases (the Cochrane Library, MEDLINE, Embase, Scopus, Google Scholar, and Web of Science), trials registries, other sources of grey literature, and conference proceedings, up to 01 February 2019. We applied no restrictions on publication language or status. SELECTION CRITERIA We included trials in which researchers randomised participants undergoing uncomplicated ureteroscopy to placement of a ureteral stent versus no ureteral stent. DATA COLLECTION AND ANALYSIS Two review authors independently classified studies and abstracted data from the included studies. We performed statistical analyses using a random-effects model. We rated the certainty of evidence (CoE) according to the GRADE approach. MAIN RESULTS Primary outcomesStenting may slightly reduce the number of unplanned return visits (16 trials with 1970 participants; very low CoE), but we are very uncertain of this finding.Pain on the day of surgery as measured on a visual analogue scale (scale 0 to 10; higher values reflect more pain) is probably similar (mean difference (MD) 0.32 higher, 95% confidence interval (CI) 0.13 lower to 0.78 higher; 4 trials with 346 participants; moderate CoE). Pain on postoperative days 1 to 3 may show little to no difference (standardised mean difference (SMD) 0.25 higher, 95% CI 0.32 lower to 0.82 higher; 8 trials with 683 participants; low CoE). On postoperative days 4 to 30, stented participants may experience more pain (8 trials with 903 participants; very low CoE), but we are very uncertain of this finding.Stenting may result in little to no difference in the need for secondary interventions (risk ratio (RR) 1.15, 95% CI 0.39 to 3.33; 10 studies with 1435 participants; low CoE); this corresponds to three more interventions per 1000 participants (95% CI 13 fewer to 48 more).Secondary outcomesStenting may reduce the need for narcotics (7 trials with 830 participants; very low CoE), but we are very uncertain of this finding.Rates of urinary tract infection (UTI) up to 90 days are probably not substantially different (RR 0.94, 95% CI 0.59 to 1.51; 10 trials with 1207 participants; moderate CoE); this corresponds to three fewer infections per 1000 participants (95% CI 23 fewer to 29 more).Ureteral stricture rates up to 90 days may be slightly reduced (14 trials with 1625 participants; very low CoE), but we are very uncertain of this finding.Rates of hospital admission may be slightly reduced (RR 0.70, 95% CI 0.32 to 1.55; 13 studies with 1647 participants; low CoE). This corresponds to 15 fewer admissions per 1000 participants (95% CI 33 fewer to 27 more). AUTHORS' CONCLUSIONS Findings of this review illustrate the trade-offs of risks and benefits faced by urologists and their patients when it comes to decision-making about stent placement after uncomplicated ureteroscopy for stone disease. We noted that both desirable and undesirable effects were small in absolute terms, with findings based mostly on low and very low CoE. The main issues reducing our confidence in research findings were study limitations (mostly risk of performance and detection bias) and imprecision. We were unable to conduct any of the preplanned subgroup analyses, in particular those based on stone size, stone location, and use of ureteral dilation, which may be important effect modifiers. Given the importance of this question, higher-quality and sufficiently large trials are needed to better inform decision-making.
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Affiliation(s)
- Maria Ordonez
- University of MinnesotaDepartment of Urology420 Delaware Street SE, MMC 394MinneapolisMinnesotaUSA
| | - Eu Chang Hwang
- Chonnam National University Medical School, Chonnam National University Hwasun HospitalDepartment of UrologyHwasunKorea, South
| | - Michael Borofsky
- University of MinnesotaDepartment of Urology420 Delaware Street SE, MMC 394MinneapolisMinnesotaUSA
| | - Caitlin J Bakker
- University of MinnesotaHealth Sciences Libraries303 Diehl Hall, 505 Essex Street SEMinneapolisMinnesotaUSA55455
| | | | - Philipp Dahm
- Minneapolis VA Health Care SystemUrology SectionOne Veterans DriveMail Code 112DMinneapolisMinnesotaUSA55417
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Du K, Wang RS, Vetter J, Paradis AG, Figenshau RS, Venkatesh R, Desai AC. Unplanned 30-Day Encounters After Ureterorenoscopy for Urolithiasis. J Endourol 2018; 32:1100-1107. [PMID: 30156428 DOI: 10.1089/end.2018.0177] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To identify avoidable predictors of postureteroscopy (URS) unplanned encounters and to minimize 30-day encounters. MATERIALS AND METHODS We performed retrospective chart review and telephone surveys on patients who underwent URS for urolithiasis between January and June 2016. Univariate and multivariable analyses evaluated for potential predictors of unplanned encounters. RESULTS Of 157 patients, there were 44 (28.0%) unplanned patient-initiated clinical phone calls, 23 (14.6%) emergency department (ED) visits, and 8 (5.1%) readmissions, with pain being the most common complaint during the encounters. Factors associated with a higher rate of phone calls include first-time stone procedure (36.6% vs 20.9%, p = 0.029), outpatient status (30.3% vs 0%, p = 0.021), intraoperative stent placement (31.2% vs 0%, p = 0.006), and stent removal at home (58.8% vs 28.8%, p = 0.014). Factors associated with increased rate of ED visits were first-time stone procedure (22.5% vs 8.1%, p = 0.011) and ureteral access sheath (UAS) usage (29.6% vs 11.8%, p = 0.018). Factors associated with a higher rate of readmissions were lower body mass index (23.9 vs 29.7, p = 0.013), bilateral procedure (20.0% vs 2.9%, p = 0.010), and UAS usage (14.8% vs 3.1%, p = 0.032). Stone burden, operative time, Charlson comorbidity index, and preoperative urinary tract infection were not significantly associated with postoperative encounters. CONCLUSIONS Pain, first-time stone treatment, presence of a ureteral stent, outpatient status, bilateral procedures, and UAS usage were common reasons for postoperative encounters after URS. Appropriate perioperative patient education and counseling and adequate pain management may minimize these encounters and improve treatment quality and patient satisfaction.
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Affiliation(s)
- Kefu Du
- 1 Division of Urologic Surgery, Washington University School of Medicine , St. Louis, Missouri
| | - Robert S Wang
- 2 Division of Urology, University of Michigan Medical School , Ann Arbor, Michigan
| | - Joel Vetter
- 1 Division of Urologic Surgery, Washington University School of Medicine , St. Louis, Missouri
| | - Alethea G Paradis
- 1 Division of Urologic Surgery, Washington University School of Medicine , St. Louis, Missouri
| | - Robert S Figenshau
- 1 Division of Urologic Surgery, Washington University School of Medicine , St. Louis, Missouri
| | - Ramakrishna Venkatesh
- 1 Division of Urologic Surgery, Washington University School of Medicine , St. Louis, Missouri
| | - Alana C Desai
- 1 Division of Urologic Surgery, Washington University School of Medicine , St. Louis, Missouri
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Doersch KM, Elmekresh A, Machen GL, El Tayeb MM. The use of a string with a stent for self-removal following ureteroscopy: A safe practice to remain. Arab J Urol 2018; 16:435-440. [PMID: 30534444 PMCID: PMC6277270 DOI: 10.1016/j.aju.2018.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 04/28/2018] [Indexed: 11/26/2022] Open
Abstract
Abstract objectives To examine the safety and effectiveness of the use of a stent with a string attached after ureteroscopy (URS) for self-removal of the stent by the patient. Patients and methods After Institutional Review Board approval, a retrospective chart review was performed concerning patients who underwent URS and received an indwelling stent with or without a string attached to the stent (94 vs 349, respectively). Amongst the string group patients received a single- or a double-arm-stringed stent (31 vs 63, respectively). Statistical analyses included chi-squared and Student’s t-tests. Results The string group consisted of 94 procedures, in which 59.6% of the patients were male with a mean (SD) age of 50.0 (16.5) years. In the no-string group, 51.3% of the 349 procedures were performed in males and the mean (SD) age was 54.9 (18.1) years. Complication rates were 12.8% in the string group and 14.0% in the no-string group (P = 0.867). In the string group, 17.0% of the patients returned to the Emergency Department, whilst 15.8% of the no-string patients returned (P = 0.753). The complication rate in the single- and double-arm groups were 12.9% and 12.7%, respectively (P > 0.910). Self-removal of stents was successful in 94.7% of patients (89/94). Conclusions The use of a stent with a string after URS appears safe and effective. Few patients had difficulty removing their stents and complication rates were similar in the groups with and without a string attached to their stents. Single- and double-arm-stringed stents have similar complication rates.
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Affiliation(s)
- Karen M Doersch
- MD/PhD Program, Texas A&M Health Sciences Center, Temple, TX, USA
| | - Amr Elmekresh
- Department of Surgery, Division of Urology, Baylor Scott and White Health, Temple, TX, USA
| | - G Luke Machen
- Department of Surgery, Division of Urology, Baylor Scott and White Health, Temple, TX, USA
| | - Marawan M El Tayeb
- Department of Surgery, Division of Urology, Baylor Scott and White Health, Temple, TX, USA
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Hamidi N, Ozturk E, Yikilmaz TN, Atmaca AF, Basar H. The effect of corticosteroid on postoperative early pain, renal colic and total analgesic consumption after uncomplicated and unstented ureteroscopy: a matched-pair analysis. World J Urol 2018; 36:979-984. [PMID: 29396787 DOI: 10.1007/s00345-018-2210-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 01/24/2018] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To evaluate the effect of corticosteroid (CS) on early postoperative pain, renal colic and total analgesic consumption after uncomplicated and unstented ureteroscopy (URS). METHODS Data of 397 patients who underwent URS and stone fragmentation for symptomatic distal ureteral stone (≤ 15 mm) were retrospectively evaluated. After exclusion, 72 patients who received methylprednisolone (Group I) after non-stenting uncomplicated URS were matched with another 72 patients who did not receive CS (Group II). Cases were matched 1:1 ratio and the matched-pair criteria were age, stone diameter, and duration of surgery. RESULTS Both groups were statistically similar in terms of mean age, operative time, stone size and preoperative pain score. However, the mean postoperative pain score was statistically significantly lower in group I than group II on the day of surgery (3.3 ± 1.7 vs. 3.9 ± 1.3, p = 0.012) and postoperative day 1 (2.8 ± 1.8 vs. 3.4 ± 1.3, p = 0.02), respectively. Renal colic episode development rate (4.2 vs. 13.2%, p = 0.036), parenteral analgesic requirement rate (18.1 vs. 33.3%, p = 0.001) and total parenteral analgesic consumption per patient (18 vs. 36mg, p = 0.009) were statistically lower in group I than group II on the day of surgery; however, there were no statistically significant differences on postoperative day 1. There were no statistically significant differences between groups in terms of ureteral stenting requirement and late unplanned urgent room visit rates. CONCLUSIONS Corticosteroid after uncomplicated URS can be offered to reduce early postoperative pain, renal colic episode and total analgesic consumption.
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Affiliation(s)
- Nurullah Hamidi
- Department of Urology, Atatürk Training and Research Hospital, Ankara, Turkey.
| | - Erdem Ozturk
- Department of Urology, Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey
| | - Taha Numan Yikilmaz
- Department of Urology, Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey
| | - Ali Fuat Atmaca
- Department of Urology, Atatürk Training and Research Hospital, Ankara Yildirim Beyazit University School of Medicine, Ankara, Turkey
| | - Halil Basar
- Department of Urology, Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey
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Dogan HS, Tekgul S. Re. 'Retrograde intrarenal surgery using ureteral access sheaths is a safe and effective treatment for renal stones in children weighing <20 kg'. J Pediatr Urol 2018; 14:60-61. [PMID: 29239802 DOI: 10.1016/j.jpurol.2017.09.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 09/29/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Hasan Serkan Dogan
- Hacettepe University, Faculty of Medicine, Department of Urology, Section of Paediatric Urology, Ankara, Turkey.
| | - Serdar Tekgul
- Hacettepe University, Faculty of Medicine, Department of Urology, Section of Paediatric Urology, Ankara, Turkey
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17
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Outcomes of ureteroscopy miniaturization on tissue damage and tissue hypoxia in a pig model. Sci Rep 2018; 8:431. [PMID: 29323197 PMCID: PMC5765032 DOI: 10.1038/s41598-017-18885-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 12/19/2017] [Indexed: 12/23/2022] Open
Abstract
Miniaturization of ureteroscopy materials is intended to decrease tissue damage. However, tissue hypoxia and the gross and microscopic effects on tissue have not been adequately assessed. We compared the gross and microscopic effects of micro-ureteroscopy (m-URS) and conventional ureteroscopy (URS) on the urinary tract. We employed 14 pigs of the Large White race. URS was performed in one of the ureters with an 8/9.8 F ureteroscope, while a 4.85 F m-URS sheath was used in the contralateral ureter. Gross assessment of ureteral wall damage and ureteral orifice damage was performed. For microscopic assessment hematoxylin-eosin staining and immunohistochemistry for detection of tissue hypoxia were conducted. Regarding the macroscopic assessment of ureteral damage, substantial and significant differences were recorded using URS (C = 0.8), but not with m-URS. Microscopic assessment after staining with hematoxylin-eosin revealed greater epithelial desquamation in the URS group (p < 0.05). Pimonidazole staining revealed greater hypoxia in the epithelial cells than in the remainder of the ureteral layers. We conclude that m-URS causes less damage to the ureteral orifice than URS. Histopathological findings show m-URS reduces ureteral epithelial damage compared with conventional ureteroscopy. Both URS and m-URS cause cellular hypoxia.
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Shariffuddin II, Teoh WH, Wahab S, Wang CY. Effect of single-dose dexmedetomidine on postoperative recovery after ambulatory ureteroscopy and ureteric stenting: a double blind randomized controlled study. BMC Anesthesiol 2018; 18:3. [PMID: 29304735 PMCID: PMC5756369 DOI: 10.1186/s12871-017-0464-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 12/18/2017] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Ambulatory surgery has recently gain popularity, as it is a good method of optimizinghospital resources utilization. To support ambulatory surgery, anaesthetic goals nowrevolve around patients' early recovery with minimal pain and nausea, expedientdischarge home and prompt resumption of activities of daily living. In this study, weevaluated the effect of a single pre-induction dose of dexmedetomidine on anaestheticrequirements, postoperative pain and clinical recovery after ambulatory ureteroscopy andureteric stenting under general anaesthesia. METHODS Sixty patients were randomised to receive IV dexmedetomidine 0.5 μg.kg-1 (Group DEX, n = 30) or IV saline (Group P, n = 30). General anaesthesia was maintained with Sevoflurane: oxygen: air, titrated to BIS 40-60. Pain intensity, sedation, rescue analgesics, nausea/vomiting and resumption of daily activities were recorded at 1 h, and postoperative day (POD) 1-5. RESULTS Group DEX patients had significant reduction in sevoflurane minimum alveolar concentration (MAC), mean (SD) DEX vs. Placebo 0.6 (0.2) vs. 0.9 (0.1), p = 0.037; reduced postoperative resting pain at 1 h (VAS 0-10) (mean (SD) 1.00 (1.84) vs. 2.63 (2.78), p = 0.004), POD 1 (mean (SD) 1.50 (1.48) vs. 2.87 (2.72), p = 0.002), POD 2 (0.53 (0.97) vs. 1.73 (1.96), p = 0.001) and POD 3 (0.30 (0.75) vs. 0.89 (1.49), p = 0.001). DEX patients also had less pain on movement POD 1 (3.00 (2.12) vs. 4.30 (3.10), p = 0.043) and POD 2 (2.10 (1.98) vs. 3.10 (2.46), p = 0.040), with higher resumption of daily activities by 48 h compared to placebo, 87% vs. 63%, p = 0.04. CONCLUSIONS We conclude that a single dose of dexmedetomidine was a useful adjuvant in reducing MAC and postoperative pain (at 1 h and POD 1-3), facilitating faster return to daily activities by 48 h. TRIAL REGISTRATION The Australian New Zealand Clinical Trials Registry (ANZCTR), ACTRN12617001120369 , 31st July 2017, retrospectively registered.
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Affiliation(s)
- I I Shariffuddin
- Department of Anaesthesia, Faculty of Medicine, University of Malaya, Lembah Pantai, 50603, Kuala Lumpur, Malaysia.
| | - W H Teoh
- Wendy Teoh Pte. Ltd, Private Anaesthesia Practice, Singapore, Singapore
| | - S Wahab
- Department of Anaesthesia, Faculty of Medicine, University of Malaya, Lembah Pantai, 50603, Kuala Lumpur, Malaysia
| | - C Y Wang
- Department of Anaesthesia, Faculty of Medicine, University of Malaya, Lembah Pantai, 50603, Kuala Lumpur, Malaysia
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Kassite I, Renaux Petel M, Chaussy Y, Eyssartier E, Alzahrani K, Sczwarc C, Villemagne T, Lardy H, Braik K, Binet A. High Pressure Balloon Dilatation of Primary Obstructive Megaureter in Children: A Multicenter Study. Front Pediatr 2018; 6:329. [PMID: 30430104 PMCID: PMC6220115 DOI: 10.3389/fped.2018.00329] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 10/15/2018] [Indexed: 11/27/2022] Open
Abstract
Aim of the Study: We described the initial experience of four referral centers in the treatment of primary obstructive megaureter (POM) in children, by high-pressure balloon dilatation (HPBD) of the ureterovesical junction with double JJ stenting. We managed a retrospective multicenter study to assess its effectiveness in long-term. Methods: We reviewed the medical records of all children who underwent HPBD for POM that require surgical treatment from May 2012 to December 2017 in four different institutions. The primary outcome measured was ureterohydronephrosis (UHN) and its degree of improvement after the procedure. Secondary outcomes were postoperative complications and resolution of preoperative symptomatology. Main Results: Forty-two ureters underwent HPBD for POM in 33 children, with a median age of 14.7 months - (range: 3 months -15 years). Ureterohydronephrosis improves in 86% of ureters after one endoscopic treatment. Three cases required a second HPBD. Four patients required surgical treatment for worsening of UHN after endoscopic treatment. The post-operative complication rate was 50% (21 ureters). In 13 cases (61%), they were related to double J stent. The median follow-up was 24 months (2 months -5 years) and all patients were symptom-free. Conclusion: We reported the first multicenter study and the largest series of children treated with HPBD, with an overall success rate of 92%. Endoscopic treatment can be a definitive treatment of POM since it avoided reimplantation in 90% of cases. Complications are mainly due to double J stent.
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Affiliation(s)
- Ibtissam Kassite
- Department of Pediatric Surgery, University Teaching Hospital of Tours, Gatien de Clocheville Hospital, Tours, France
| | - Mariette Renaux Petel
- Department of Pediatric Surgery, University Teaching Hospital of Rouen, Charles Nicolle Hospital, Rouen, France
| | - Yann Chaussy
- Department of Pediatric Surgery, University Teaching Hospital of Besançon, Jean Minjoz Hospital, Besancon, France
| | - Emilie Eyssartier
- Department of Pediatric Surgery, University Teaching Hospital of Angers, Angers, France
| | - Khalid Alzahrani
- Department of Pediatric Surgery, University Teaching Hospital of Tours, Gatien de Clocheville Hospital, Tours, France
| | - Caroline Sczwarc
- Department of Pediatric Surgery, University Teaching Hospital of Tours, Gatien de Clocheville Hospital, Tours, France
| | - Thierry Villemagne
- Department of Pediatric Surgery, University Teaching Hospital of Tours, Gatien de Clocheville Hospital, Tours, France
| | - Hubert Lardy
- Department of Pediatric Surgery, University Teaching Hospital of Tours, Gatien de Clocheville Hospital, Tours, France
| | - Karim Braik
- Department of Pediatric Surgery, University Teaching Hospital of Tours, Gatien de Clocheville Hospital, Tours, France
| | - Aurélien Binet
- Department of Pediatric Surgery, University Teaching Hospital of Tours, Gatien de Clocheville Hospital, Tours, France
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Deroy C, Rossetti D, Ragetly G, Hernandez J, Poncet C. Comparison between double-pigtail ureteral stents and ureteral bypass devices for treatment of ureterolithiasis in cats. J Am Vet Med Assoc 2017; 251:429-437. [PMID: 28763282 DOI: 10.2460/javma.251.4.429] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare the complication rates and outcomes in cats with ureteral obstruction treated by placement of double-pigtail ureteral stents or ureteral bypass (UB) devices. DESIGN Retrospective cohort study. ANIMALS Cats with unilateral or bilateral ureterolithiasis that received double-pigtail ureteral stents (30 stents in 27 cats; stent group) or UB devices (30 devices in 23 cats; UB group). PROCEDURES Medical records were reviewed to collect data on signalment, clinical signs, serum biochemical data, surgical procedure, duration of hospitalization, complications, and follow-up (≥ 6 months after placement) information. Outcomes were compared between device types. RESULTS Median durations of surgery and hospitalization were significantly longer in the stent versus UB group. Perioperative mortality rate was 18% (5/27) in the stent group and 13% (3/23) in the UB group. Median survival time was shorter in the stent versus UB group. Stent placement was associated with a greater risk of lower urinary tract-related signs, such as hematuria (52% [14/27]) and pollakiuria or stranguria (48% [13/27]). The risk of device occlusion was also greater in the stent (26% [7/27]) versus UB (4% [1/23]) group. The percentage of cats requiring additional procedures to treat complications was greater in the stent (44%; complications included uroabdomen, stent occlusion, and refractory cystitis) versus UB (9%; complications included UB occlusion and urethral obstruction) group. CONCLUSIONS AND CLINICAL RELEVANCE Although the benefits of stent placement in the treatment of ureteral obstruction in cats have been established, results suggested that cats treated with UB devices had a lower risk of complications and a longer survival time than those treated with double-pigtail ureteral stents.
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Fröhlich M, Fehr J, Sulser T, Eberli D, Mortezavi A. Extraction Strings for Ureteric Stents: Is There an Increased Risk for Urinary Tract Infections? Surg Infect (Larchmt) 2017; 18:936-940. [PMID: 28976816 DOI: 10.1089/sur.2017.165] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND To evaluate urinary tract infections associated with placement of ureteric stents, we performed a retrospective study and compared rates between patients with and patients without an extraction string attached to the ureteric stent. Indwelling ureteric stents are routinely removed by cystoscopy. If an extraction string has been connected to the stent at the time of placement, however, the removal can be performed without an invasive procedure. Concerns exist regarding the risk for an unintentional dislocation, increased stent-related discomfort, or an increase of the post-operative urinary tract infection rate. METHODS All elective transurethral ureteric stent placements performed between November 2011 and December 2012 in our department were included for this investigation. Urinary tract infection was defined according to the Centers for Disease Control and Prevention (CDC)/National Healthcare Safety Network (NHSN) surveillance definition of health-care-associated infections. Patients with an existing urinary tract infection at the time of admission were excluded from the analysis. RESULTS A total of 342 patients receiving ureteric stents were evaluated regarding post-operative urinary tract infections. Of these patients, 127 (37.1%) had an extraction string and 215 (62.9%) a stent without a string. The total urinary tract infection rate was 6.4% with no significant difference between the two groups (7.9% vs. 5.6%, p = 0.49). CONCLUSION In the present study, we did not observe an increased rate of post-operative urinary tract infections in patients with an extraction string attached to the ureteral stent. Extraction string is a good option for patients to avoid cystoscopic stent removal.
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Affiliation(s)
- Maryna Fröhlich
- 1 Department of Urology, University Hospital Zurich, University of Zurich , Zurich, Switzerland
| | - Jan Fehr
- 2 Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich , Zurich, Switzerland
| | - Tullio Sulser
- 1 Department of Urology, University Hospital Zurich, University of Zurich , Zurich, Switzerland
| | - Daniel Eberli
- 1 Department of Urology, University Hospital Zurich, University of Zurich , Zurich, Switzerland
| | - Ashkan Mortezavi
- 1 Department of Urology, University Hospital Zurich, University of Zurich , Zurich, Switzerland
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Gul Z, Alazem K, Li I, Monga M. Predicting procedural pain after ureteroscopy: does hydrodistention play a role? Int Braz J Urol 2017; 42:734-9. [PMID: 27564284 PMCID: PMC5006769 DOI: 10.1590/s1677-5538.ibju.2015.0275] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 10/15/2015] [Indexed: 11/29/2022] Open
Abstract
Purpose: To identify perioperative predictors of immediate pain after ureteroscopy, specifically evaluating the impact of hydrodistention from irrigation on pain. Materials and Methods: We retrospectively identified patients who underwent ureteroscopy for the treatment of calculi. Data recorded for these patients included their maximum pain score in the post-anesthesia care unit (PACU), average flow rate of irrigant used during the procedure, patient and stone characteristics, operative procedure, and details of patients' immediate, post-operative course. Spearman's rho was used to determine the relationship between non-parametric, continuous variables. Then, a linear regression was performed to assess which variables could predict the peak pain score. Results: A total of 131 patients were included in the study. A non-parametric correlation analysis revealed that maximum pain score was negatively correlated with being male (r = −0.18, p=0.04), age (r = −0.34, p<0.001), and post-op foley placement (r = −0.20, p=0.02) but positively correlated with the preoperative pain score (r = 0.41, p<0.001), time in the PACU (r = 0.19, p = 0.03), and the morphine equivalent dose (MED) of narcotics administered in the PACU (r = 0.67, p<0.001). On linear regression, the significant variables were age, preoperative pain score, and stent placement. For every ten-year increase in age post-operative pain score decreased by 4/10 of a point (p = 0.03). For every 1 point increase in preoperative pain score there was a 3/10 of a point increase in the maximum pain score (p = 0.01), and leaving a stent in place post-operatively was associated with a 1.6 point increase in the maximum pain score. Conclusions: Hydrodistention does not play a role in post-ureteroscopy pain. Patients who are younger, have higher preoperative pain scores, or who are stented will experience more post-operative pain after ureteroscopy.
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Affiliation(s)
- Zeynep Gul
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Kareem Alazem
- Cleveland Clinic, Glickman Urological and Kidney Institute, Cleveland, Ohio, USA
| | - Ina Li
- Cleveland Clinic, Glickman Urological and Kidney Institute, Cleveland, Ohio, USA
| | - Manoj Monga
- Cleveland Clinic, Glickman Urological and Kidney Institute, Cleveland, Ohio, USA
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Maldonado-Avila M, Garduno-Arteaga L, Jungfermann-Guzman R, Manzanilla-Garcia HA, Rosas-Nava E, Procuna-Hernandez N, Vela-Mollinedo A, Almazan-Trevino L, Guzman-Esquivel J. Efficacy of Tamsulosin, Oxybutynin, and their combination in the control of double-j stent-related lower urinary tract symptoms. Int Braz J Urol 2017; 42:487-93. [PMID: 27286111 PMCID: PMC4920565 DOI: 10.1590/s1677-5538.ibju.2015.0186] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Accepted: 08/11/2015] [Indexed: 11/22/2022] Open
Abstract
Introduction and objective Indwelling double J ureteral stents are used routinely in the resolution of ureteral obstruction caused by different etiologies. Evaluation of urinary symptoms related to double-J stent, indicate that these affect 73-90% of patients. We conducted a prospective, randomized study, to evaluate the efficacy of tamsulosin, oxybutinin and combination therapy in improving the urinary symptoms. Methods Patients who underwent ureteral stent placement after ureterolithotripsy (total 51), were randomized into three groups: Group I: Tamsulosin 0.4 mg. once per day(17 patients), Group II: Oxybutinin 5 mg. once per day (17 patients), Group III: Tamsulosin+ oxybutynin once per day (17 patients). All the groups received the drugs for three weeks and completed a Spanish validated Ureteral Stent Symptom Questionnaire (USSQ) at day 7 and 21. Results Repeated measures ANOVA showed mean urinary symptom index score was 22.3 vs. 15.5 in group three (p<0.001) at day 7 and 21 respectively. The mean work performance index was 6.6 vs 8.1 (p=0.049) favoring tamsulosin group, the mean sexual score was 0.5 vs 1.5 (p=0.03). Among additional problems the mean was 7.2 vs 6.2 (p=0.03). No significant difference was noted among pain and general health index. No side effects were reported. Conclusions Combination therapy with tamsulosin and oxybutynin improved irritative symptoms and work performance as well as sexual matters. Combination therapy should be considered for patients who complained of stent related symptoms.
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Muslumanoglu AY, Fuglsig S, Frattini A, Labate G, Nadler RB, Martov A, Wong C, de la Rosette JJMCH. Risks and Benefits of Postoperative Double-J Stent Placement After Ureteroscopy: Results from the Clinical Research Office of Endourological Society Ureteroscopy Global Study. J Endourol 2017; 31:446-451. [PMID: 28292209 DOI: 10.1089/end.2016.0827] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Double-J stent placement after stone removal by ureteroscopy (URS) is common and recommended in many cases but debatable in others. In this study, the risks and benefits of postoperative Double-J stent placement in URS stone treatment procedures undertaken in current clinical practice are examined. MATERIALS AND METHODS The Clinical Research Office of Endourological Society (CROES) URS is a prospective, observational, international multicenter study, in which patients are candidates for URS as primary treatment or after failure of prior treatment for ureteral and renal stones. Baseline, intraoperative, and postoperative data were collected. Predictors and outcomes of postoperative stent placement were analyzed by inverse probability-weighted regression adjustment of the relationship between a Double-J stent placement and outcomes (complications, readmission [including retreatment], and length of hospital stay). RESULTS Significant predictors of postoperative Double-J stent placement in URS treatment of ureteral stones were intraoperative complications, impacted stones, operation time, stone burden, age, presence of a solitary kidney, and stone-free rate. In renal stone treatment, the predictors identified included operation time, age, preoperative stent placement, anticoagulant use, presence of a solitary kidney, and intraoperative complications. In both ureteral and renal stone treatment groups, postoperative placement of a Double-J stent resulted in significantly fewer postoperative complications (p < 0.001) compared with patients who did not receive a stent. CONCLUSIONS Patient- and procedure-related variables were identified, which may enable an individualized approach to postoperative stenting, resulting in improved clinical outcomes in urologic stone treatment by URS.
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Affiliation(s)
- Ahmet Y Muslumanoglu
- 1 Department of Urology, Haseki Training and Research Hospital , Istanbul, Turkey
| | - Sven Fuglsig
- 2 Department of Urology, University Hospital of Aarhus , Skejby, Aarhus, Denmark
| | - Antonio Frattini
- 3 Department of Urology, Guastalla Hospital , Reggio Emilia, Italy
| | - Gaston Labate
- 4 UROSALUD, Urology Center , Buenos Aires, Argentina
| | - Robert B Nadler
- 5 Department of Urology, Northwestern University Feinberg School of Medicine , Chicago, Illinois
| | - Alexey Martov
- 6 Department of Urology, Moscow City Hospital No 57 , Moscow, Russia
| | - Carson Wong
- 7 Division of Urology, University Hospitals Ahuja Medical Center , Beachwood, Ohio.,8 Minimally Invasive and Robotic Surgery, SouthWest Urology, LLC , Cleveland, Ohio
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Seklehner S, Sievert KD, Lee R, Engelhardt PF, Riedl C, Kunit T. A cost analysis of stenting in uncomplicated semirigid ureteroscopic stone removal. Int Urol Nephrol 2017; 49:753-761. [PMID: 28197765 DOI: 10.1007/s11255-017-1538-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 02/04/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the outcome and the costs of stenting in uncomplicated semirigid ureteroscopic stone removal. MATERIALS AND METHODS A decision tree model was created to evaluate the economic impact of routine stenting versus non-stenting strategies in uncomplicated ureteroscopy (URS). Probabilities of complications were extracted from twelve randomized controlled trials. Stone removal costs, costs for complication management, and total costs were calculated using Treeage Pro (TreeAge Pro Healthcare version 2015, Software, Inc, Williamstown Massachusetts, USA). RESULTS Stone removal costs were higher in stented URS (€1512.25 vs. €1681.21, respectively). Complication management costs were higher in non-stented procedures. Both for complications treated conservatively (€189.43 vs. €109.67) and surgically (€49.26 vs. €24.83). When stone removal costs, costs for stent removal, and costs for complication management were considered, uncomplicated URS with stent placement yielded an overall cost per patient of €1889.15 compared to €1750.94 without stent placement. The incremental costs of stented URS were €138.25 per procedure. CONCLUSION Semirigid URS with stent placement leads to higher direct procedural costs. Costs for managing URS-related complications are higher in non-stented procedures. Overall, a standard strategy of deferring routine stenting uncomplicated ureteroscopic stone removal is more cost efficient.
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Affiliation(s)
- Stephan Seklehner
- Department of Urology, Landesklinikum Baden-Mödling, Waltersdorfer Straße 75, 2500, Baden, Austria.
- Department of Urology, Paracelsus Medical University Salzburg, Strubergasse 21, 5020, Salzburg, Austria.
| | - Karl-Dietrich Sievert
- Department of Urology, Paracelsus Medical University Salzburg, Strubergasse 21, 5020, Salzburg, Austria
| | - Richard Lee
- Department of Urology, Weill Medical College of Cornell University, New York, NY, USA
| | - Paul F Engelhardt
- Department of Urology, Landesklinikum Baden-Mödling, Waltersdorfer Straße 75, 2500, Baden, Austria
- Department of Urology, Paracelsus Medical University Salzburg, Strubergasse 21, 5020, Salzburg, Austria
| | - Claus Riedl
- Department of Urology, Landesklinikum Baden-Mödling, Waltersdorfer Straße 75, 2500, Baden, Austria
| | - Thomas Kunit
- Department of Urology, Paracelsus Medical University Salzburg, Strubergasse 21, 5020, Salzburg, Austria
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Wang H, Man L, Li G, Huang G, Liu N, Wang J. Meta-Analysis of Stenting versus Non-Stenting for the Treatment of Ureteral Stones. PLoS One 2017; 12:e0167670. [PMID: 28068364 PMCID: PMC5221881 DOI: 10.1371/journal.pone.0167670] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 11/20/2016] [Indexed: 12/23/2022] Open
Abstract
Background and aim Ureteroscopic lithotripsy (URL) and extracorporeal shock wave lithotripsy (ESWL) are two widely used methods for the treatment of ureteral stones. The need for ureteral stenting during these procedures is controversial. In this meta-analysis, we evaluated the benefits and disadvantages of ureteral stents for the treatment of ureteral stones. Methods Databases including PubMed, Embase and Cochrane library were selected for systematic review of randomized controlled trials (RCTs) comparing outcomes with or without stenting during URL and ESWL. Meta-analysis was performed using RevMan 5.3 and STATA 13.0 software. Results We identified 22 RCTs comparing stenting and non-stenting. The stented group was associated with longer operation time (WMD: 4.93; 95% CI: 2.07 to 7.84; p < 0.001), lower stone-free rate (OR: 0.55; 95% CI: 0.34 to 0.89; p = 0.01). In terms of complications, the incidence of hematuria (OR: 3.68; 95% CI: 1.86 to 7.29; p < 0.001), irritative urinary symptoms (OR: 4.40; 95% CI: 2.19 to 9.10; p < 0.001), urinary infection (OR: 2.23; 95% CI: 1.57 to 3.19; p < 0.001), and dysuria (OR: 3.90; 95% CI: 2.51 to 6.07; p < 0.001) were significantly higher in the stented group. No significant differences in visual analogue score (VAS), stricture formation, fever, or hospital stay were found between stenting and non-stenting groups. The risk of unplanned readmissions (OR: 0.63; 95% CI: 0.41 to 0.97; p = 0.04) was higher in the non-stented group. Conclusions Our analysis showed that stenting failed to improve the stone-free rate, and instead, it resulted in additional complications. However, ureteral stents are valuable in preventing unplanned re-hospitalization. Additional randomized controlled trials are still required to corroborate our findings.
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Affiliation(s)
- Hai Wang
- Department of Urology, Beijing Jishuitan Hospital, Beijing, China
- * E-mail:
| | - Libo Man
- Department of Urology, Beijing Jishuitan Hospital, Beijing, China
| | - Guizhong Li
- Department of Urology, Beijing Jishuitan Hospital, Beijing, China
| | - Guanglin Huang
- Department of Urology, Beijing Jishuitan Hospital, Beijing, China
| | - Ning Liu
- Department of Urology, Beijing Jishuitan Hospital, Beijing, China
| | - Jianwei Wang
- Department of Urology, Beijing Jishuitan Hospital, Beijing, China
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Pais VM, Smith RE, Stedina EA, Rissman CM. Does Omission of Ureteral Stents Increase Risk of Unplanned Return Visit? A Systematic Review and Meta-Analysis. J Urol 2016; 196:1458-1466. [PMID: 27287523 DOI: 10.1016/j.juro.2016.05.109] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2016] [Indexed: 01/22/2023]
Abstract
PURPOSE Post-ureteroscopy ureteral stent omission remains controversial. Although omission is associated with reduced postoperative discomfort, concern remains for early obstruction. We performed a systematic review and meta-analysis of trials to compare the risk of unplanned visits with vs without a stent following ureteroscopy for nephrolithiasis. MATERIALS AND METHODS Randomized, controlled trials and observational studies comparing post-ureteroscopic stent omission vs placement and reporting unplanned visits within 30 days were identified via a search of MEDLINE® (1946 to 2015), CENTRAL (Cochrane Central Register of Controlled Trials, 1898 to 2015), Embase® (1947 to 2015), ClinicalTrials.gov (1997 to 2015), AUA (American Urological Association) Annual Meeting abstracts (2011 to 2015) and reference lists of included articles as last updated in October 2015. Two reviewers independently extracted data and assessed methodological quality. ORs, RRs and weighted mean differences were calculated as appropriate for each outcome. RESULTS Of the initial 1,992 studies 17 in a total of 1,943 participants met inclusion criteria. Unstented patients were significantly more likely to have an unplanned medical visit compared to those who received a post-ureteroscopy stent (OR 1.63, 95% CI 1.15-2.30). Unstented patients had shorter operative time (weighted mean difference -3.19 minutes, 95% CI -5.64--0.74) and were less likely to experience dysuria (RR 0.39, 95% CI 0.25-0.62). They were also less likely to experience postoperative infection (OR 0.89, 95% CI 0.59-1.33) and pain (OR 0.64, 95% CI 0.39-1.05), although these results were not significant. CONCLUSIONS Stent omission is associated with an increased risk of unplanned medical visits despite reduced symptoms compared to those in stented patients. Patients and physicians should weigh these trade-offs when considering post-ureteroscopy stent placement.
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Affiliation(s)
- Vernon M Pais
- Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire; Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
| | - Rebecca E Smith
- Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire
| | - Elizabeth A Stedina
- Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire
| | - Cody M Rissman
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
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Zhu J, Liang Y, Chen W, Xu S, Wang Y, Hu J, He H, Zhong WD, Sun Z. Effect of alpha1-blockers on stentless ureteroscopic lithotripsy. Int Braz J Urol 2016; 42:101-6. [PMID: 27136474 PMCID: PMC4811233 DOI: 10.1590/s1677-5538.ibju.2014.0478] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 03/26/2015] [Indexed: 11/22/2022] Open
Abstract
Objective To evaluate the clinical efficiency of alpha1-adrenergic antagonists on stentless ureteroscopic lithotripsy treating uncomplicated lower ureteral stones. Materials and Methods From January 2007 to January 2013, 84 patients who have uncomplicated lower ureteral stones treated by ureteroscopic intracorporeal lithotripsy with the holmium laser were analyzed. The patients were divided into two groups, group A (44 patients received indwelled double-J stents) and group B (40 patients were treated by alpha1-adrenergic antagonists without stents). All cases of group B were treated with alpha1 blocker for 1 week. Results The mean operative time of group A was significantly longer than group B. The incidences of hematuria, flank/abdominal pain, frequency/urgency after surgery were statistically different between both groups. The stone-free rate of each group was 100%. Conclusions The effect of alpha1-adrenergic antagonists is more significant than indwelling stent after ureteroscopic lithotripsy in treating uncomplicated lower ureteral stones.
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Affiliation(s)
- Jianguo Zhu
- Department of Urology, The People's Hospital of GuiZhou Provience, Guiyang, P.R. China
| | - Yuxiang Liang
- Department of Urology, Guangdong Key Laboratory of Clinical Molecular Medicine and Diagnostics, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Weihong Chen
- Department of Urology, The People's Hospital of GuiZhou Provience, Guiyang, P.R. China
| | - Shuxiong Xu
- Department of Urology, The People's Hospital of GuiZhou Provience, Guiyang, P.R. China
| | - Yuanlin Wang
- Department of Urology, The People's Hospital of GuiZhou Provience, Guiyang, P.R. China
| | - Jianxing Hu
- Department of Urology, The People's Hospital of GuiZhou Provience, Guiyang, P.R. China
| | - Huichan He
- Department of Urology, Guangdong Key Laboratory of Clinical Molecular Medicine and Diagnostics, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Wei-de Zhong
- Department of Urology, Guangdong Key Laboratory of Clinical Molecular Medicine and Diagnostics, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Zhaolin Sun
- Department of Urology, The People's Hospital of GuiZhou Provience, Guiyang, P.R. China
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A Randomized Controlled Trial to Compare the Safety and Efficacy of Tadalafil and Tamsulosin in Relieving Double J Stent Related Symptoms. Adv Urol 2015; 2015:592175. [PMID: 26788054 PMCID: PMC4691600 DOI: 10.1155/2015/592175] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 11/17/2015] [Accepted: 11/25/2015] [Indexed: 11/18/2022] Open
Abstract
Objectives. To evaluate the safety and efficacy of Tadalafil and Tamsulosin in treating Double J stent related symptoms. Methods. In a prospective study, 161 patients with DJ related symptoms were randomized into 3 groups: Group A patients (54), Group B patients (53), and Group C patients (54). They were given Tadalafil, Tamsulosin, and placebo, respectively, at 1st week till removal of DJ stent at 3rd week. All patients completed Ureteral Stent Symptom Questionnaire (USSQ) at 1st week and at 3rd week. The statistical significant difference among groups was determined by the t-test, Kruskal-Wallis test and multivariate analysis were used to assess association of the variables within the three groups, and the level of significance was set at P < 0.05. Results. Tadalafil and Tamsulosin were comparable in relieving urinary symptoms, general health, and work performance (OR = 0.65, 1.8, and 0.92). But Tadalafil was more effective in relieving body pain, sexual problems, and additional problems than Tamsulosin (OR = 5.95, 19.25, and 2.69) and was statistically significant as P < 0.05. Conclusion. Tadalafil was as effective as Tamsulosin in relieving urinary symptom but more effective in relieving sexual symptoms and body pain.
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30
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Kawahara T, Ito H, Terao H, Uemura H, Yao M, Matsuzaki J. Ureteroscopy-assisted retrograde nephrostomy (UARN) without ureteral access sheath (UAS). Int J Surg Case Rep 2015; 10:56-8. [PMID: 25813125 PMCID: PMC4429843 DOI: 10.1016/j.ijscr.2015.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Revised: 03/06/2015] [Accepted: 03/08/2015] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION We previously described ureteroscopy assisted retrograde nephrostomy (UARN). In UARN, it is possible to continuously visualize the dilation of the ureter from puncture to insertion of the nephroaccess sheath with minimal complication. But in the course of making nephrostomy, UARN requires ureteral access sheath (UAS). UAS has a potential risk of ureteral stricture. Herein, we report the first case of UARN without the use of UAS. PRESENTATION OF CASE A 53-year-old female was referred to our hospital for treatment of her right renal stone. Because her stone burden was 27mm, we planned to perform percutaneous nephrolithotomy (PCNL) using UARN without UAS. DISCUSSION UAS facilitates a decrease in the intrarenal pressure due to irrigation, and it makes controlling the URS easier. However, in terms of the risk of ureteral stricture, unnecessary insertion of a UAS should be avoided. CONCLUSION We describe the first case of a renal stone successfully treated by PCNL using the UARN method without the use of a UAS.
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Affiliation(s)
- Takashi Kawahara
- Department of Urology, Ohguchi Higashi General Hospital, Japan; Department of Urology, Yokohama City University, Graduate School of Medicine, Japan.
| | - Hiroki Ito
- Department of Urology, Ohguchi Higashi General Hospital, Japan; Department of Urology, Yokohama City University, Graduate School of Medicine, Japan
| | - Hideyuki Terao
- Department of Urology, Ohguchi Higashi General Hospital, Japan
| | - Hiroji Uemura
- Department of Urology, Yokohama City University, Graduate School of Medicine, Japan
| | - Masahiro Yao
- Department of Urology, Yokohama City University, Graduate School of Medicine, Japan
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Capozza N, Torino G, Nappo S, Collura G, Mele E. Primary Obstructive Megaureter in Infants: Our Experience with Endoscopic Balloon Dilation and Cutting Balloon Ureterotomy. J Endourol 2015; 29:1-5. [DOI: 10.1089/end.2013.0665] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Nicola Capozza
- Surgical Unit of the Pediatric Urology, “Bambino Gesù” Children's Hospital and Research Institute, Rome, Italy
| | - Giovanni Torino
- Surgical Unit of the Pediatric Urology, “Bambino Gesù” Children's Hospital and Research Institute, Rome, Italy
| | - Simona Nappo
- Surgical Unit of the Pediatric Urology, “Bambino Gesù” Children's Hospital and Research Institute, Rome, Italy
| | - Giuseppe Collura
- Surgical Unit of the Pediatric Urology, “Bambino Gesù” Children's Hospital and Research Institute, Rome, Italy
| | - Ermelinda Mele
- Surgical Unit of the Pediatric Urology, “Bambino Gesù” Children's Hospital and Research Institute, Rome, Italy
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Althaus AB, Li K, Pattison E, Eisner B, Pais V, Steinberg P. Rate of dislodgment of ureteral stents when using an extraction string after endoscopic urological surgery. J Urol 2014; 193:2011-4. [PMID: 25541339 DOI: 10.1016/j.juro.2014.12.087] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE Ureteral stents are manufactured with an extraction string tethered to the distal end, which facilitates removal after urological surgery. However, the string may allow for stent dislodgment. We report the stent dislodgment rate in a multi-institutional series. MATERIALS AND METHODS We retrospectively reviewed the records of ureteroscopy cases at 3 academic endourology practices. Demographic and operative data were obtained as well as string use and stent dislodgment data. Categorical variables were assessed with the Fisher exact test and the Student t-test was used to assess continuous variables. RESULTS Of the 512 cases a string was used in 98 (19.1%) comprising 41 females (41.8%) and 57 males (58.2%). The stent was dislodged in 10 women and 3 men. No dislodgment occurred when a string was not used. When stratified by gender, 5.3% of men and 24.4% of women with a string experienced stent dislodgment (p = 0.013). Women were more than fourfold more likely to experience stent dislodgment than men (RR 4.6, 95% CI 1.36-15.8, p = 0.01). CONCLUSIONS Almost 15% of patients in whom a stent is placed with a string sustain stent dislodgment and most of these patients will be women. We recommend considering the risks of dislodgment in each patient who undergoes ureteroscopy with stent placement and considering string removal if the surgeon believes that dislodgment could result in adverse events such as severe colic or obstruction.
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Affiliation(s)
- Adam B Althaus
- Brigham and Women's Hospital, Boston, Massachusetts; Beth Israel Deaconess Medical Center, Boston, Massachusetts.
| | - Kai Li
- Massachusetts General Hospital, Boston, Massachusetts
| | - Erik Pattison
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Brian Eisner
- Massachusetts General Hospital, Boston, Massachusetts
| | - Vernon Pais
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
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Ureteral stenting after uncomplicated ureteroscopy for distal ureteral stones: a randomized, controlled trial. Minim Invasive Surg 2014; 2014:892890. [PMID: 25431663 PMCID: PMC4241699 DOI: 10.1155/2014/892890] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Accepted: 10/10/2014] [Indexed: 12/02/2022] Open
Abstract
Objectives. We compared outcome and complications after uncomplicated ureteroscopic treatment of distal ureteral calculi with or without the use of ureteral stents. Materials and Methods. 117 patients, prospectively divided into three groups to receive a double j stent (group 1, 42 patients), ureteral stent (group 2, 37 patients), or no stent (group 3, 38 patients), underwent ureteroscopic treatment of distal ureteral calculi. Stone characteristics, operative time, postoperative pain, lower urinary tract symptoms (LUTS), analgesia need, rehospitalization, stone-free rate, and late postoperative complications were all studied. Results. There were no significant differences in preoperative data. There was no significant difference between the three groups regarding hematuria, fever, flank pain, urinary tract infection, and rehospitalisation. At 48 hours and 1 week, frequency/urgency and dysuria were significantly less in the nonstented group. When comparing group 1 and group 3, patients with double j stents had statistically significantly more bladder pain (P = 0.003), frequency/urgency (P = 0.002), dysuria (P = 0.001), and need of analgesics (P = 0.001). All patients who underwent imaging postoperatively were without evidence of obstruction or ureteral stricture. Conclusions. Uncomplicated ureteroscopy for distal ureteral calculi without intraoperative ureteral dilation can safely be performed without placement of a ureteral stent.
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Gönülalan U, Akand M, Hasırcı E, Koşan M. An unusual complication of a double-J ureteral stent: renal parenchymal perforation in a solitary kidney. Turk J Urol 2014; 40:245-7. [PMID: 26328186 DOI: 10.5152/tud.2014.76753] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 03/20/2014] [Indexed: 11/22/2022]
Abstract
Double-J ureteral stenting is commonly used in urological practice and has various complications. We report a patient with a renal parenchymal perforation and perirenal hematoma due to a double-J ureteral stent in a solitary kidney. This complication of ureteral stents is rarely observed and is life-threatening.
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Affiliation(s)
- Umut Gönülalan
- Department of Urology, Başkent University Faculty of Medicine, Konya, Turkey
| | - Murat Akand
- Department of Urology, Selçuk University Faculty of Medicine, Konya, Turkey
| | | | - Murat Koşan
- Department of Urology, Başkent University Faculty of Medicine, Konya, Turkey
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de la Rosette J, Denstedt J, Geavlete P, Keeley F, Matsuda T, Pearle M, Preminger G, Traxer O. The clinical research office of the endourological society ureteroscopy global study: indications, complications, and outcomes in 11,885 patients. J Endourol 2013; 28:131-9. [PMID: 24147820 DOI: 10.1089/end.2013.0436] [Citation(s) in RCA: 245] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To assess the current indications for ureteroscopy (URS) treatment, outcome in terms of stone-free rate, and intra- and postoperative complications using the modified Clavien grading system. PATIENTS AND METHODS The Clinical Research Office of the Endourological Society collected prospective data as part of the URS Global Study for consecutive patients treated with URS at centers around the world for 1 year. URS was performed according to study protocol and local clinical practice guidelines. The stone size and location were recorded and postoperative outcome and complications, graded according to the modified Clavien grading system, reported. RESULTS Between January 2010 and October 2012, 11,885 patients received URS at 114 centers in 32 countries; 1852 had only renal stones, 8676 had only ureteral stones, and 1145 patients had both types of stone. Fragmentation was performed principally using a laser device (49.0%) or a pneumatic device (30.3%); no device was used in 17.9% of the patients. A high stone-free rate (85.6%) was achieved. The large majority of patients did not receive any further treatment for renal or ureter stones (89.4%). The postoperative complication rate was low (3.5%). The most frequent complication was fever (1.8%); a blood transfusion was required in 0.2% of patients. The majority of complications were Clavien grade I or II (2.8% of patients). CONCLUSION URS is an established minimal invasive treatment for urinary stones with a high success rate and low morbidity. Recent advances have expanded the indication for urinary stones, which now ranges from treatment of smaller sized distal ureter stones by semirigid URS to larger sized renal pelvis stones treated by flexible URS.
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Affiliation(s)
- Jean de la Rosette
- 1 Department of Urology, AMC University Hospital , Amsterdam, The Netherlands
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Picozzi SCM, Ricci C, Stubinski R, Casellato S, Ratti D, Macchi A, Bozzini G, Carmignani L. Is stone diameter a variable in the decision process of employing a ureteral stent in patients undergoing uncomplicated ureterorenoscopy and associated intracorporeal lithotripsy? World J Urol 2013; 31:1617-25. [PMID: 23462959 DOI: 10.1007/s00345-013-1046-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Accepted: 02/18/2013] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION A number of randomized trials and meta-analysis in patients who underwent ureteroscopic stone removal investigated the effects of placing a ureteral stent at the end of the procedure on complication rates. However, none of these investigates the stone diameter and its possible influence on complication rates and, as such, if it should be considered a possible variable in the decision process of placing or not a ureteral stent. MATERIALS AND METHODS A bibliographic search covering the period from January 1990 to March 2012 was conducted in PubMed, MEDLINE and EMBASE. This analysis is based on the fifteen remaining studies which fulfilled the predefined inclusion criteria. All statistical evaluations were performed using SAS version 9.2. and by RevMan 5.0. RESULTS A total of 1,416 patients were included. All the studies were published after 2000. Mean stone diameter ranged between 5.3 and 13.3 mm in the non-stented group and between 6.26 and 13.28 mm in the stented group. Meta-analysis showed that stone diameter was not statistically different for stented or non-stented subgroups, whereas surgical operative time was shorter for the non-stented subgroup. The effect of stone diameter, irrespectively if patients were operated with or without stents were grouped or considered separately, did not influence complications of fever, haematuria, unplanned medical visits after surgery and urinary tract infections. CONCLUSIONS Stone diameter is not a variable in the pre- or intraoperative decision process of placing or not placing a ureteral stent in patients undergoing uncomplicated ureterorenoscopy with intracorporeal lithotripsy.
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Affiliation(s)
- Stefano C M Picozzi
- Urology Department, IRCCS Policlinico San Donato, University of Milan, Via Morandi 30, 20097, San Donato Milanese, Milan, Italy,
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Early ureteral catheter removal after ureteroscopic lithotripsy using ureteral access sheath. Urolithiasis 2012; 41:31-5. [PMID: 23532420 DOI: 10.1007/s00240-012-0518-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2012] [Accepted: 12/08/2012] [Indexed: 10/27/2022]
Abstract
A ureteral access sheath (UAS) can facilitate ureteroscopy (URS) and the retrieval of stone fragments while reducing the intrarenal pressure, thereby improving irrigate flow and decreasing the length of an operation. Ureteral stenting after URS is unnecessary for uncomplicated cases. This study examined the early removal of postoperative ureteral catheterization after URS for cases that used a UAS. A total of 93 patients underwent ureteroscopic lithotripsy with the early removal of ureteral catheterization. Sixty-three of these patients underwent surgery with the use of UAS and were analyzed in this study. Postoperative hydronephrosis was assessed using ultrasonography 3 days after the operation and computed tomography 2 weeks after operation in all patients. Post-operative complications including fever, prolonged hospitalization, frequent usage of painkillers and the re-insertion of ureteral stent were also investigated. Hydronephrosis was detected 3 days after the operation in 34 patients (54.0 %) and 2 weeks after the operation in four patients (6.3 %). No hydronephrosis was detected after a 2-month follow-up in these four patients. The mean operation time in the hydronephrosis group was significantly higher at 58.9 min than in the non-hydronephrosis group at 45.5 min (p < 0.05). Post-operative fever (38 °C) was seen in one case, the frequent usage of painkillers was seen in four cases, a prolonged hospital stay was seen in five cases, and ureteral stent re-insertion was observed in one case. The early removal of ureteral catheterization can be safely performed for the patients that undergo URS with UAS.
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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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Sundaram P, Tan YH. Minimally Invasive Surgical and Medical Management of Urinary Calculi. PROCEEDINGS OF SINGAPORE HEALTHCARE 2012. [DOI: 10.1177/201010581202100205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Management of urinary calculi has changed from open pyelolithotomy and ureterolithotomy to predominantly non-invasive procedures such as extracorporeal shockwave lithotripsy (ESWL) as well as endourological such as ureterorenoscopy (URS) and percutaneous nephrolithotripsy (PCNL). Technology has advanced rapidly allowing stone disease to be treated with minimally invasive techniques that have lower morbidity than the open operations of the past. Newer semi-rigid ureteroscopes of size 7 to 9 F allow visualisation of the ureter without traumatic dilatation. There is the flexible ureteroscope developed with smaller fibre optics, the addition of the working channel that allows the use of laser fibres for stone fragmentation and a greater deflection of the tip that enables all parts of the pelvicalyceal system to be inspected for stones. New generation lithotripters for ESWL deliver shockwave to a smaller focal zone so as to minimise damage to surrounding soft tissue but as a result, there are higher failure rates. PCNL, though more invasive than ESWL and URS, is the procedure of choice for large renal stones. It is highly efficient in such situations as newer equipment to disintegrate stone and newer techniques for percutaneous access has been developed. In addition to all these minimally invasive surgical techniques, there is medical therapy available to allow the expulsion of distal ureteric stones as well as alkalinising agents to dissolve uric acid stones. Metabolic evaluation is necessary for patients with recurrent stones. Dietary adjustments may help prevent recurrent stone formation in selected patients depending on the results. With all these techniques currently available, management of urinary calculi has to be tailored according to the size, location of stone as well as patient preference.
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Affiliation(s)
| | - Yeh Hong Tan
- Department of Urology, Singapore General Hospital
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40
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Gross AJ, Netsch C. Retrograde Intrarenal Surgery (RIRS). Urolithiasis 2012. [DOI: 10.1007/978-1-4471-4387-1_50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Patel SR, Nakada SY. Ureteral Stone Management: An Overview. Urolithiasis 2012. [DOI: 10.1007/978-1-4471-4387-1_56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Tang L, Gao X, Xu B, Hou J, Zhang Z, Xu C, Wang L, Sun Y. Placement of Ureteral Stent After Uncomplicated Ureteroscopy: Do We Really Need It? Urology 2011; 78:1248-56. [DOI: 10.1016/j.urology.2011.05.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2011] [Revised: 04/15/2011] [Accepted: 05/05/2011] [Indexed: 11/28/2022]
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Pengfei S, Yutao L, Jie Y, Wuran W, Yi D, Hao Z, Jia W. The results of ureteral stenting after ureteroscopic lithotripsy for ureteral calculi: a systematic review and meta-analysis. J Urol 2011; 186:1904-9. [PMID: 21944085 DOI: 10.1016/j.juro.2011.06.066] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Indexed: 02/05/2023]
Abstract
PURPOSE We evaluated the necessity and adverse effects of routine ureteral stent placement after ureteroscopic lithotripsy for ureteral stones. MATERIALS AND METHODS A systematic search of PubMed®, Embase® and the Cochrane Library was performed to identify all randomized controlled trials. All relevant studies were on the outcomes and complications of ureteroscopic lithotripsy in the management of ureteral stones with or without a Double-J stent. The outcomes and complications included stone-free rate, operative time, lower urinary tract symptoms, hematuria, fever, urinary tract infection, pain and analgesia, unplanned medical visits and late postoperative complications. The Cochrane Collaboration Review Manager software (RevMan 5.0.2) was used for statistical analysis. RESULTS A total of 16 randomized controlled trials were enrolled for analysis and involved 1,573 patients. Of these patients 797 were in the nonstented group and 776 in the stented group. There was a statistically significant difference in mean operative time between the 2 groups. The incidence of lower urinary tract symptoms and pain was significantly higher in the stented group than in the nonstented group. Significant differences between the groups were not found in fever, urinary tract infection, need for analgesia, unplanned readmission and late postoperative complications. CONCLUSIONS This systematic review reveals the obvious disadvantages of ureteral stents after ureteroscopic lithotripsy in lower urinary tract symptoms and pain. Stents do not improve stone-free rate, fever, incidence of urinary tract infection, unplanned medical visits, requirement for analgesia and late postoperative complications. Ureteral stenting after uncomplicated ureteroscopic lithotripsy could be unnecessary.
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Affiliation(s)
- Shen Pengfei
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
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Abstract
Objectives: To review the evidence-based literature on the causes, characteristics, and options to manage double J stent-related symptoms. Methods: We performed a Medline database assessment on papers that investigated the prevalence, mechanisms, risk factors, bothersome and management of double-J stent-related symptoms. Articles in English were reviewed and summarized. Results: Stent-related symptoms have a high prevalence and may affect over 80% of patients. They include irritative voiding symptoms including frequency, urgency, dysuria, incomplete emptying; flank and suprapubic pain; incontinence, and hematuria. Assessment tools are important to determine their intensity and allow for comparisons between different points in the timeline. The Urinary Stent Symptom Questionnaire (USSQ) is the most proper tool used for this purpose. Management should be focused on the prevention and management of symptoms. In this sense, research has focused on new materials and stent designs that would be more compatible to the physiologic properties of the urinary tract and medications that can ameliorate the sensitivity and motor response of the bladder. Conclusions: Stent-related symptoms are very common in the Urological clinical setting. It is of major importance for the urologist to understand their physiopathology and to be familiar with ways to avoid or manage them.
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Affiliation(s)
- Ricardo Miyaoka
- Department of Urologic Surgery, University of Minnesota, Minneapolis, MN, USA
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Başeskioğlu B, Sofikerim M, Demirtaş A, Yenilmez A, Kaya C, Can C. Is ureteral stenting really necessary after ureteroscopic lithotripsy with balloon dilatation of ureteral orifice? A multi-institutional randomized controlled study. World J Urol 2011; 29:731-6. [PMID: 21590466 DOI: 10.1007/s00345-011-0697-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Accepted: 05/04/2011] [Indexed: 10/18/2022] Open
Abstract
PURPOSE Our aim was to evaluate the role of balloon dilatation of the ureteral orifice on the decision to stent after ureteroscopy. MATERIALS AND METHODS We prospectively enrolled 505 patients from two clinics, undergoing ureteroscopy (URS) for urolithiasis. Patients having balloon dilatation of the ureteral orifice and uncomplicated ureteroscopy were randomized to be either stented (n = 144) or nonstented (n = 142). Ureteroscopy was done with a 9.8 rigid ureteroscope. For dilatation of ureteral orifice, 18Fr-4 cm balloons were used (Uromax™, Boston Scientific, USA). Holmium laser or pneumatic devices were used for lithotripsy. In the second postoperative week, patients were asked to assess: pain, dysuria, and urgency using a 10-cm visual analog score (VAS) and unplanned visits. In each visit, urinalysis, urine culture, plain X-ray, and ultrasound examinations were performed. Six months after URS, follow-up IVU was performed to evaluate ureteral narrowing. Results for the separate clinics were not revealed until the end of study. RESULTS There were no significant differences between the two groups regarding gender, age, preoperative serum creatinine levels, stone size, stone side and location, lithotripsy type, pain, infectious complications, unplanned visits, and ureteral narrowing. However, irritative symptoms were more common in the stented group. Success rates of 97.8 and 97.2% were similar in the unstented and stented groups. CONCLUSION In uncomplicated URS, balloon dilatation of the ureteral orifice should not significantly affect the decision for or against stent placement. Avoiding stents lowers costs and gives fewer irritative symptoms.
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Meta-analysis of postoperatively stenting or not in patients underwent ureteroscopic lithotripsy. ACTA ACUST UNITED AC 2011; 40:67-77. [PMID: 21573923 DOI: 10.1007/s00240-011-0385-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2011] [Accepted: 04/26/2011] [Indexed: 02/05/2023]
Abstract
The aim of this study was to evaluate the necessity for stenting after ureteroscopic lithotripsy. We performed a systematic research of Medline, Embase, Cochrane central registration for RCTs concerning the comparison between stented and non-stented post-ureteroscopic procedures for stone removal and reference lists of the included study were also screened. 15 trials were included and data related was extracted and analyzed in meta way. No difference was detected in stone free rate and stricture formation between the two groups (P = 0.69; P = 0.67). Participants with stents had higher risk of being infected than those without, RR = 1.72, but with no difference. Stent related lower urinary symptoms were more frequently experienced by stented patients, dysuria (RR = 5.24, P = 0.003); hematuria (RR = 7.28, P = 0.001); loin voiding pain (RR = 5.24, P = 0.003). Postoperative pain score were also higher in patients with stent in the early period after surgery with mean difference 0.95 (P = 0.002). With additional time needed for the placement of stent, the operative time in stented patients were 3.36 min longer than those without stenting (P = 0.02). The additional cost for longer operative room stay, together with the sent and cystoscopic stent removed conditionally, and made the cost for stented patients much higher. No difference were detected in length of hospital stay between both groups (P = 0.22), the stented patients were even of lower rate pay unplanned hospital visit (RR = 0.81, P = 0.55). Stenting did not improve the outcome of patients who underwent ureteroscopic lithotripsy, but associated with increased complication rate. Routinely stenting after ureteroscopic procedure for stone removal was not necessary; however, it still should be reserved conditionally.
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Tanriverdi O, Yencilek F, Koyuncu H, Yencilek E, Sarica K. Emergent Stenting After Uncomplicated Ureteroscopy: Evaluation of 23 Patients. Urology 2011; 77:305-8. [DOI: 10.1016/j.urology.2010.07.472] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Revised: 06/29/2010] [Accepted: 07/19/2010] [Indexed: 10/18/2022]
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Cevik I, Dillioglugil O, Akdas A, Siegel Y. Is stent placement necessary after uncomplicated ureteroscopy for removal of impacted ureteral stones? J Endourol 2010; 24:1263-7. [PMID: 20615145 DOI: 10.1089/end.2009.0153] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND PURPOSE Ureteral stent placement after ureteroscopic lithotripsy has some advantages and disadvantages. In this randomized study, the necessity of ureteral stent placement after uncomplicated ureteroscopy for impacted ureteral stones was assessed. MATERIALS AND METHODS Between 2005 and 2007, 60 evaluable patients were equally randomized to groups with and without stents. Patients underwent ureteroscopic pneumatic lithotripsy for ureteral stones. The operation was completed with or without stent placement according to the randomization order. Excretory urography was performed 3 months after the procedure. All stents were cystoscopically removed at the third postoperative week. Sociodemographic and clinical variables (age, sex, stone location, stone size, operative time, hospital stay, narcotic and nonnarcotic analgesic use), and postoperative complications (fever, pain delaying discharge, emergency department visit, urinary retention, stent-related irritative symptoms) were evaluated. RESULTS Mean stone size was not significantly different in both groups. Mean operative time was significantly longer in the stent group: 30.5 +/- 9.6 vs 43.7 +/- 11.6 minutes. On the operation day and until postoperative day (POD) 5, narcotic (P = 0.004) and nonnarcotic analgesic (P = not significant) use was more frequent in the no-stent group. At POD 5 and later, although narcotic and nonnarcotic analgesic use were frequently necessary in the stent group, both were almost unnecessary in the no-stent patients. Stent-related irritative symptoms were overwhelmingly higher (10% vs 93%) in the stent group. Discharge was delayed (23% vs 10%) and unplanned emergency department visits (20% vs 10%) were exercised almost two times more commonly in the no-stent group. Stone-free rates were identical (n = 29/30; 97%) in both groups. CONCLUSION Routine placement of a ureteral stent is not mandatory in patients without complications after ureteroscopic lithotripsy for impacted ureteral stones. Stent placement can be argued and agreed with the patients preoperatively in the light of the data presented above.
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Menéndez N, Varea S, Penida A, Santomil F, Quezada J, Grillo C. [Diagnostic and therapeutic ureteroscopy: is dilatation of ureteral meatus always necessary?]. Actas Urol Esp 2009; 33:1000-4. [PMID: 19925761 DOI: 10.1016/s0210-4806(09)72900-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess the feasibility and safety of diagnostic or therapeutic semirigid ureteroscopy without ureteral meatus dilatation. MATERIALS AND METHODS A comparative, retrospective study was conducted of patients undergoing ureteroscopy from January 2000 to May 2008. For data analysis purposes, the population was divided into two groups based on whether ureteroscopy had been performed with (Group 1) or without (Group 2) ureteral meatus dilatation. Variables recorded included age, sex, type of procedure, surgical diagnosis, passive or active dilatation, number of stones, stone location, stone diameter, peroperative and postoperative complications, internal urinary diversion after the procedure, therapeutic success rate, operating time, and hospital stay duration. A 8-9.8 Fr Wolf semirigid ureteroscope was used. Descriptive statistics of the population and cohorts were performed, providing medians, quartiles, and limit values for non-normally distributed interval variables, and absolute and relative frequencies for categorical variables. Shapiro-Wilk's, Mann-Whitney's U, Chi-square, and Fisher's exact tests were used for statistical analysis. A value of p 2 alpha < or = 0.005 was considered statistically significant. Arcus Quickstat Biomedical 1.0 software was used. RESULTS Among the 306 ureteroscopies studied, 286 performed in 256 patients were analyzed. Median age was 50 years (16-83), 59% of patients were male, and elective ureteroscopy was performed in 183 patients (64%). Group 1: 191 ureteroscopies, Group 2: 95 ureteroscopies. Stone location: 149 in distal ureter, 60 in middle ureter, and 35 in proximal ureter. Sixty-nine percent of stones had sizes ranging from 5 and 10 mm. The overall success rate was 86.5%. There were 5 peroperative and 22 postoperative complications, with no statistically significant differences between the groups. CONCLUSIONS In selected cases, ureteroscopy may be performed without ureteral meatus dilatation with success and morbidity rates similar to when the procedure is performed with meatal dilatation.
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Elwood CN, Lange D, Nadeau R, Seney S, Summers K, Chew BH, Denstedt JD, Cadieux PA. Novel in vitro model for studying ureteric stent-induced cell injury. BJU Int 2009; 105:1318-23. [PMID: 19888977 DOI: 10.1111/j.1464-410x.2009.09001.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To develop a novel in vitro model for the study of bladder and kidney epithelial cell injury akin to stent movement, as ureteric stents are associated with urinary tract complications that can significantly add to patient morbidity. These sequelae may be linked to inflammation triggered by stent-mediated mechanical injury to the urinary tract. MATERIALS AND METHODS T24 bladder and A498 kidney cell line monolayers were damaged mechanically by segments of either Percuflex Plus (PP) or Triumph (triclosan-eluting) stents (both from Boston Scientific Corporation Inc. Natick, MA, USA) and the resulting expression profiles of several pro-inflammatory cytokines and growth factors were analysed. RESULTS After control injury using the PP stent, supernatants of both cell lines had significantly increased levels of interleukin (IL)-6, IL-8, basic fibroblast growth factor and platelet-derived growth factor BB, and A498 cells also had increased tumour necrosis factor alpha. In almost all cases, the presence of triclosan within the media abrogated the pro-inflammatory cytokine increases, while its effects on growth factors varied. CONCLUSION This study suggests that stent-related symptoms in the bladder and kidney may be partially due to a local inflammatory response to epithelial damage caused by the presence and movement of the stent. Future stent design should take these inflammatory responses, with respect to physical injury, into consideration, using either more biocompatible materials or anti-inflammatory compounds such as triclosan.
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Affiliation(s)
- Chelsea N Elwood
- Lawson Health Research Institute, University of Western Ontario, London, Canada
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