1
|
Chen CW, Liu WY, Huang LY, Chu YW. Using ensemble learning and hierarchical strategy to predict the outcomes of ESWL for upper ureteral stone treatment. Comput Biol Med 2024; 179:108904. [PMID: 39047504 DOI: 10.1016/j.compbiomed.2024.108904] [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: 04/24/2024] [Revised: 06/19/2024] [Accepted: 07/14/2024] [Indexed: 07/27/2024]
Abstract
Urinary tract stones are a common and frequently recurring medical issue. Accurately predicting the success rate after surgery can help avoid ineffective medical procedures and reduce unnecessary healthcare costs. This study collected data from patients with upper ureter stones who underwent extracorporeal shock wave lithotripsy, including cases of successful as well as unsuccessful stone removal after the first and second lithotripsy procedures, and constructed prediction systems for the outcomes of the first and second lithotripsy procedures. Features were extracted from three categories of information: patient characteristics, stone characteristics, and extracorporeal shock wave lithotripsy machine data, and additional features were created using Feature Creation. Finally, the impact of features on the models was analyzed using six methods to calculate feature importance. Our prediction model for the first lithotripsy, selected from among 43 methods and seven ensemble learning techniques, achieves an AUC of 0.91. For the second lithotripsy, the AUC reaches 0.76. The results indicate that the detailed and binary information provided by patients regarding their history of stone experiences contributes differently to the predictive accuracy of the first and second lithotripsy procedures. The prediction tool is available at https://predictor.isu.edu.tw/ks.
Collapse
Affiliation(s)
- Chi-Wei Chen
- Graduate Degree Program of Smart Healthcare & Bioinformatics, I-Shou University, Kaohsiung City, Taiwan; Department of Biomedical Engineering, I-Shou University, Kaohsiung City, Taiwan.
| | - Wayne-Young Liu
- Doctoral Program in Medical Biotechnology, National Chung Hsing University, Taichung City, Taiwan; Department of Urology, Jen-Ai Hospital, Taichung City, Taiwan.
| | - Lan-Ying Huang
- Doctoral Program in Medical Biotechnology, National Chung Hsing University, Taichung City, Taiwan.
| | - Yen-Wei Chu
- Doctoral Program in Medical Biotechnology, National Chung Hsing University, Taichung City, Taiwan; Graduate Institute of Genomics and Bioinformatics, National Chung Hsing University, Taichung City, Taiwan; Institute of Molecular Biology, National Chung Hsing University, Taichung City, Taiwan; Agricultural Biotechnology Center, National Chung Hsing University, Taichung City, Taiwan; Rong Hsing Research Center for Translational Medicine, Taichung City, Taiwan; Ph. D Program in Medical Biotechnology, National Chung Hsing University, Taichung City, Taiwan; Smart Sustainable New Agriculture Research Center (SMARTer), Taichung, 402, Taiwan.
| |
Collapse
|
2
|
Mata Alcaraz M, Laso García I, Mínguez Ojeda C, Artiles Medina A, Duque Ruiz G, Hevia Palacios M, Arias Fúnez F, Burgos Revilla FJ. Extracorporeal shock wave lithotripsy for lower calyx stones: predicting treatment success. Actas Urol Esp 2023; 47:688-693. [PMID: 37442226 DOI: 10.1016/j.acuroe.2023.07.004] [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: 04/27/2023] [Revised: 06/07/2023] [Accepted: 06/08/2023] [Indexed: 07/15/2023]
Abstract
INTRODUCTION The use of extracorporeal shock wave lithotripsy (ESWL) for lower calyx stones is associated with a high rate of residual fragments. Our aim is to analyse the effectiveness and complications of ESWL for lower calyx stones. METHODS Retrospective review of patients with lower renal calyx stones treated with ESWL between January-2014 and December-2020. Measurement of infundibular length, infundibular width and infundibulopelvic angle in lower renal pole to determine favourable anatomy. ESWL failure: fragments >3 mm detected in plain abdominal film, CT scan and/or renal ultrasound 3 months after treatment. Complications after ESWL, auxiliary procedures along with risk factors associated with perirenal haematoma were analysed. SPSS statistical software was used. RESULTS 512 patients with lower calyx stones were treated with ESWL. 80.3% of patients had a favourable anatomy. Overall stone-free rate was 70.5%. Regarding main complications after ESWL, stainstrasse was described in 5 patients and urinary tract infection in 3 patients. 10 perirenal haematomas (2%) were reported. Statistical association was found between antiplatelet treatment and the risk of perirenal haematoma (p = 0.004). Logistic binary regression proved the association between unfavourable anatomy of the lower renal pole (p = 0.000), size of the stone (p = 0.001), number of shock waves (p = 0.003), energy applied (p = 0.038) and the need for additional treatment after ESWL. CONCLUSIONS ESWL can still be considered as the initial treatment option for lower renal pole stones. The size of the stone, an unfavourable anatomy of the lower renal calyx, number of shock waves and energy applied can help predict the need for additional treatment.
Collapse
Affiliation(s)
- M Mata Alcaraz
- Servicio de Urología, Hospital Universitario Ramón y Cajal, Madrid, Spain.
| | - I Laso García
- Servicio de Urología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - C Mínguez Ojeda
- Servicio de Urología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - A Artiles Medina
- Servicio de Urología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - G Duque Ruiz
- Servicio de Urología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - M Hevia Palacios
- Servicio de Urología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - F Arias Fúnez
- Servicio de Urología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - F J Burgos Revilla
- Servicio de Urología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| |
Collapse
|
3
|
Fentoukh MK, Alqahtani AA, Salih AA, Koko AH. Unusual complication after shock wave lithotripsy (SWL) for a renal stone: A subcapsular hepatic hematoma. A case report and review of literature. Urol Case Rep 2023; 51:102604. [PMID: 38024509 PMCID: PMC10663668 DOI: 10.1016/j.eucr.2023.102604] [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: 09/18/2023] [Revised: 10/20/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Urolithiasis is a common urological condition that affects around 8 per 1000 people every year. Management depends on multiple factors varying between stone related and patient related factors. In some cases, shock wave lithotripsy (SWL), one of the most popular noninvasive and safe procedures, is required where conservative measures fail. However, it can lead to life-threatening complications. Here we present rare case of hepatic hematoma in a 57-year-old female patient following SWL for right kidney stone on the 2nd day post-SWL. The patient was managed successfully with conservative measures.
Collapse
Affiliation(s)
- Moath K. Fentoukh
- Department of Urology, Armed Forces Hospital, King Abdulaziz Air Base, Dhahran, Kingdom of Saudi Arabia
| | - Ali A. Alqahtani
- Department of Urology, Armed Forces Hospital, King Abdulaziz Air Base, Dhahran, Kingdom of Saudi Arabia
| | - Abdelwahab A. Salih
- Department of Urology, Armed Forces Hospital, King Abdulaziz Air Base, Dhahran, Kingdom of Saudi Arabia
| | - Abdelmoniem H. Koko
- Department of Urology, Armed Forces Hospital, King Abdulaziz Air Base, Dhahran, Kingdom of Saudi Arabia
| |
Collapse
|
4
|
Snicorius M, Drevinskaitė M, Miglinas M, Čekauskas A, Urbonienė V, Bandzevičiūtė R, Čeponkus J, Šablinskas V, Želvys A. A Prospective Study on the Impact of Clinical Factors and Adjusted Triple D System for Success Rate of ESWL. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1827. [PMID: 37893545 PMCID: PMC10608682 DOI: 10.3390/medicina59101827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/11/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023]
Abstract
Objective: Our study aimed to evaluate the success rate of ESWL and identify relevant treatment-specific factors affecting treatment outcomes, as well as to assess the accuracy of the updated Triple D scoring system and compare it with older systems. Material and Methods: A prospective study of 71 patients who received ESWL treatment for renal stones that were 5-15 mm in size was completed. The patient having no residual stones or residual stones lesser than 4 mm after ESWL was identified as a treatment success. Univariate and multivariate logistic regression and ROC curves were used to identify important factors for treatment outcomes. Results: Successful treatment was achieved for 66.2% of patients. The stone volume (SV), mean stone density (MD), and delivered power to the stone volume unit ratio (SMLI/SV) were defined as the most critical factors influencing ESWL success. An updated Triple D score system with a, SMLI/SV ratio could be an alternative to older systems and reach an even higher accuracy. A limitation of this study is the limited sample size due to the COVID-19 pandemic. Conclusions: Our results show that the three factors that most influence the success of ESWL are the stone size, mean stone density, and SMLI/SV ratio. Based on this, we present a simple updated triple D score system to predict ESWL success, which could be implemented in future clinical practice.
Collapse
Affiliation(s)
- Marius Snicorius
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 03225 Vilnius, Lithuania
| | - Mingailė Drevinskaitė
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 03225 Vilnius, Lithuania
| | - Marius Miglinas
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 03225 Vilnius, Lithuania
| | - Albertas Čekauskas
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 03225 Vilnius, Lithuania
| | - Vidita Urbonienė
- Institute of Chemical Physics, Faculty of Physics, Vilnius University, 10222 Vilnius, Lithuania
| | - Rimantė Bandzevičiūtė
- Institute of Chemical Physics, Faculty of Physics, Vilnius University, 10222 Vilnius, Lithuania
| | - Justinas Čeponkus
- Institute of Chemical Physics, Faculty of Physics, Vilnius University, 10222 Vilnius, Lithuania
| | - Valdas Šablinskas
- Institute of Chemical Physics, Faculty of Physics, Vilnius University, 10222 Vilnius, Lithuania
| | - Arunas Želvys
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 03225 Vilnius, Lithuania
| |
Collapse
|
5
|
Na L, Li J, Pan C, Zhan Y, Bai S. Development and validation of a predictive model for major complications after extracorporeal shockwave lithotripsy in patients with ureteral stones: based on a large prospective cohort. Urolithiasis 2023; 51:42. [PMID: 36862228 PMCID: PMC9979111 DOI: 10.1007/s00240-023-01417-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 02/20/2023] [Indexed: 03/03/2023]
Abstract
The risk factors of complications after SWL are not well characterized. Therefore, based on a large prospective cohort, we aimed to develop and validate a nomogram for predicting major complications after extracorporeal shockwave lithotripsy (SWL) in patients with ureteral stones. The development cohort included 1522 patients with ureteral stones who underwent SWL between June 2020 and August 2021 in our hospital. Five hundred and fifty-three patients with ureteral stones participated in the validation cohort from September 2020 to April 2022. The data were prospectively recorded. Backward stepwise selection was applied using the likelihood ratio test with Akaike's information criterion as the stopping rule. The efficacy of this predictive model was assessed concerning its clinical usefulness, calibration, and discrimination. Finally, 7.2% (110/1522) of patients in the development cohort and 8.7% (48/553) of those in the validation cohort suffered from major complications. We identified five predictive factors for major complications: age, gender, stone size, Hounsfield unit of stone, and hydronephrosis. This model showed good discrimination with an area under the receiver operating characteristic curves of 0.885 (0.872-0.940) and good calibration (P = 0.139). The decision curve analysis showed that the model was clinically valuable. In this large prospective cohort, we found that older age, female gender, higher Hounsfield unit, size, and grade of hydronephrosis were risk predictors of major complications after SWL. This nomogram will be helpful in preoperative risk stratification to provide individualized treatment recommendations for each patient. Furthermore, early identification and appropriate management of high-risk patients may decrease postoperative morbidity.
Collapse
Affiliation(s)
- Lei Na
- Department of Urology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, 110004 People’s Republic of China
| | - Jia Li
- Department of Urology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, 110004 People’s Republic of China
| | - Chunyu Pan
- Department of Urology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, 110004 People’s Republic of China
| | - Yunhong Zhan
- Department of Urology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, 110004 People’s Republic of China
| | - Song Bai
- Department of Urology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, 110004 People’s Republic of China
| |
Collapse
|
6
|
Juliebø-Jones P, Moen CA, Haugland JN, Gjengstø P, Æsøy MS, Beisland C, Ulvik Ø. Ureteroscopy for Stone Disease in Extremely Elderly Patients (≥85 Years): Outcomes and Lessons Learned. J Endourol 2023; 37:245-250. [PMID: 36458461 DOI: 10.1089/end.2022.0665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Introduction: The volume of surgeries including ureteroscopy (URS) performed for urolithiasis is increasing. This includes for the elderly population. The aim of this study was to evaluate the outcomes of URS in extremely elderly patients and identify any lessons that could be learned for clinical practice and treatment planning. Materials and Methods: Retrospective analysis was performed of consecutive patients aged 85 years and older undergoing URS between 2010 and 2022 at our tertiary center. Uni- and multivariable logistic regression analyses were performed to identify possible risk factors for complications. Survival analysis, stratified by age-adjusted Charlson Comorbidity index (ACCI), was performed using the Kaplan-Meier method as well as the log-rank test. Results: Sixty-four URS procedures were performed on 51 patients (mean age 88 years, range 85-97). Mean ACCI score was 7 (range 4-13) and most patients were American Society Anesthesiologists 3 (78%). Mean operative time and hospital stay were 60 minutes (range 15-120) and 2 days (range 0-6), respectively. At 3-month follow-up imaging, 92% were stone free (zero fragments). Intraoperative complication rate was 14% and in three cases (5%), early termination of the procedure was necessary. Eight patients (13%) suffered a complication before discharge. Eighteen patients (28%) had documented late complications after their surgery. The complication rate when combining early and late adverse events was 41%. One year mortality rate was 23%. Multivariable regression analysis revealed that operation time and ACCI >7 were significant predictors of complications after surgery. Survival probability was significantly worse in those patients with ACCI >7 (p = 0.0083). Conclusion: The morbidity burden of URS in the extremely elderly is higher than for other population groups. Risk should be considered carefully and implementation of ACCI can aid this process. High scores should prompt strong consideration of a conservative approach. Operation time should be kept to a minimum wherever possible.
Collapse
Affiliation(s)
- Patrick Juliebø-Jones
- Department of Urology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | | | | | - Peder Gjengstø
- Department of Urology, Haukeland University Hospital, Bergen, Norway
| | | | - Christian Beisland
- Department of Urology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Øyvind Ulvik
- Department of Urology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| |
Collapse
|
7
|
Ibrahim A, Elatreisy A, Khogeer A, Ahmadi A, Mishra S, Faisal M, Sabnis R, Aube-Peterkin M, Carrier S, Ganpule A, Desai M. Can we predict the ancillary treatments after extracorporeal shockwave lithotripsy for renal and upper ureteral stones? Arch Ital Urol Androl 2022; 94:439-442. [PMID: 36576455 DOI: 10.4081/aiua.2022.4.439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 12/05/2022] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To quantify the predictors for the ancillary treatments after extracorporeal shock wave lithotripsy (SWL) for renal and upper ureteral stones. MATERIALS AND METHODS From January 2014 to January 2017, patients undergoing SWL using an electromagnetic lithotripter machine (Compact Delta; Dornier MedTech GmbH, Wessling, Germany) for renal and upper ureteral stones ≤ 20 mm were retrospectively reviewed. All patients underwent CT urography prior to SWL. The cohort was subdivided into three groups according to stone attenuation values in Hounsfield Units (HU). Group I; HU < 500 (n = 20), group II; HU 500-1000 (n = 51) and group III; HU ≥ 1000 (n = 180). The parameters included for multivariate analysis were stone size, location, multiplicity, stone attenuation value, number of shocks and stone clearance rate by 3 months. The ancillary treatments were ureteroscopy (URS), ureteral stenting and hospital readmission for pain or fever. RESULTS A total of 251 patients were included in the study. The overall SWL success rate was 92.4%. Mean stone size was 10.9 ± 2.1, 11.6 ± 3 and 11.4 ± 3.6 mm and mean stone attenuation values were 364 ± 125, 811 ± 154 and 1285 ± 171 HU for groups I, II and III respectively. The stone clearance rates by 3 months were 96%, 92% and 88.4% for groups I, II and III respectively. On subgroup analysis, group III required ancillary treatments in 70% of patients whereas group I, II, did not require any ancillary treatments. On multivariate analysis, stone multiplicity, stone location (lower calyceal stones) and HU were independent significant predictors for the need for ancillary treatments after SWL (p values < 0.05). CONCLUSIONS Patients with stone attenuation value (HU) > 1000, multiple stones and/or lower calyceal stones have higher risk to necessitate ancillary treatments after SWL. These patients would likely benefit from upfront endoscopic lithotripsy for treating symptomatic renal or upper ureteral stones.
Collapse
Affiliation(s)
| | | | - Abdulghani Khogeer
- Department of Surgery, Faculty of Medicine, Rabigh, King Abdulaziz University, Jeddah.
| | | | | | | | | | - Melanie Aube-Peterkin
- Department of Surgery, Division of Urology, McGill University Health Center, Montreal QC.
| | - Serge Carrier
- Department of Surgery, Division of Urology, McGill University Health Center, Montreal QC.
| | | | | |
Collapse
|
8
|
Taguchi M, Yasuda K, Tsuchiya A, Kinoshita H. Usefulness of ureteroscopic lithotripsy in Izuo position for patients with difficulty opening legs. Int J Urol 2022; 29:1240-1242. [PMID: 35976717 DOI: 10.1111/iju.14969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Makoto Taguchi
- Department of Urology, Osaka Saiseikai Izuo Hospital based on Social Welfare Organization "Saiseikai" Imperial Gift Foundation Inc., Osaka, Japan.,Department of Urology and Andrology, Kansai Medical University, Osaka, Japan
| | - Kaneki Yasuda
- Department of Urology and Andrology, Kansai Medical University, Osaka, Japan
| | - Atsuyuki Tsuchiya
- Department of Orthopaedic Surgery, McSYL Tatsumi Clinic & Hospital, Osaka, Japan
| | - Hidefumi Kinoshita
- Department of Urology and Andrology, Kansai Medical University, Osaka, Japan
| |
Collapse
|
9
|
Zheng Z, Xu J, Peng L, Zhong W. Predict success of shock wave lithotripsy was still interesting and challenging. World J Urol 2022; 40:1261-1262. [PMID: 34136946 DOI: 10.1007/s00345-021-03758-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 06/07/2021] [Indexed: 12/13/2022] Open
Affiliation(s)
- Zexian Zheng
- Department of Urology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Guangdong Key Laboratory of Urology, Guangzhou, China.,Guangzhou Institute of Urology, Guangzhou, China
| | - Jiandong Xu
- Department of Urology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Guangdong Key Laboratory of Urology, Guangzhou, China.,Guangzhou Institute of Urology, Guangzhou, China
| | - Linjie Peng
- Department of Urology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Guangdong Key Laboratory of Urology, Guangzhou, China.,Guangzhou Institute of Urology, Guangzhou, China
| | - Wen Zhong
- Department of Urology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China. .,Guangdong Key Laboratory of Urology, Guangzhou, China. .,Guangzhou Institute of Urology, Guangzhou, China.
| |
Collapse
|
10
|
Wagenius M, Oddason K, Utter M, Popiolek M, Forsvall A, Lundström KJ, Linder A. Factors influencing stone-free rate of Extracorporeal Shock Wave Lithotripsy (ESWL); a cohort study. Scand J Urol 2022; 56:237-243. [DOI: 10.1080/21681805.2022.2055137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Magnus Wagenius
- Department of Clinical Sciences, Division of Infection Medicine, Lund University, Lund, Sweden
- Department of Urology Helsingborg Hospital, Helsingborg, Sweden
| | - Karl Oddason
- Department of Urology Helsingborg Hospital, Helsingborg, Sweden
| | - Maria Utter
- Department of Urology Helsingborg Hospital, Helsingborg, Sweden
| | - Marcin Popiolek
- Department or Urology, Örebro University Hospital, Örebro, Sweden
| | - Andreas Forsvall
- Department of Clinical Sciences, Division of Infection Medicine, Lund University, Lund, Sweden
- Department of Urology Helsingborg Hospital, Helsingborg, Sweden
| | - Karl-Johan Lundström
- Institution of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Adam Linder
- Department of Clinical Sciences, Division of Infection Medicine, Lund University, Lund, Sweden
| |
Collapse
|
11
|
Taguchi M, Kinoshita H, Anada N, Yasuda K, Ueno O, Matsuda T. Effectiveness and Safety of Ureteroscopic Lithotripsy in Young, Old-Old, and Oldest Old Patients. J Endourol 2022; 36:439-443. [PMID: 34714141 DOI: 10.1089/end.2021.0565] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objectives: To investigate the efficacy and safety of ureteroscopic lithotripsy (URSL) in young, old-old, and oldest old patients. Materials and Methods: We enrolled 157 patients who underwent URSL. We divided the patients into young (<65 years), old-old (65-84 years), and oldest old (≥85 years) groups and compared the safety of surgery between young vs old-old and young vs oldest old, separately. Results: In the <65 group, 65 to 85 group, and ≥85 group, respectively, the mean stone diameters were 8.9 ± 4.9, 10.8 ± 7.7, and 11.4 ± 6.3 mm; mean operative time was 76.6 ± 33.1, 86.7 ± 44.7, and 84.0 ± 44.5 min; the stone-free rates were 95.9%, 94.4%, and 96.3%; and the complication rates were 8.2%, 9.8%, and 3.7%. Conclusions: In this study, we showed the feasibility and safety of URSL for elderly people. Although oldest old (≥85 years) people had multiple comorbidities with low performance status, URSL could be performed with acceptable complication rates. Clinical Trial Registration Number: 1809-1.
Collapse
Affiliation(s)
- Makoto Taguchi
- Department of Urology, Osaka Saiseikai Izuo Hospital based on Social Welfare Organization "Saiseikai" Imperial Gift Foundation, Inc., Osaka, Japan
- Department of Urology and Andrology, Kansai Medical University, Osaka, Japan
| | - Hidefumi Kinoshita
- Department of Urology and Andrology, Kansai Medical University, Osaka, Japan
| | - Natsuki Anada
- Department of Anesthesiology, Osaka Saiseikai Izuo Hospital based on Social Welfare Organization "Saiseikai" Imperial Gift Foundation, Inc., Osaka, Japan
| | - Kaneki Yasuda
- Department of Urology, Osaka Saiseikai Izuo Hospital based on Social Welfare Organization "Saiseikai" Imperial Gift Foundation, Inc., Osaka, Japan
| | - Osamu Ueno
- Department of Anesthesiology, Osaka Saiseikai Izuo Hospital based on Social Welfare Organization "Saiseikai" Imperial Gift Foundation, Inc., Osaka, Japan
| | - Tadashi Matsuda
- Department of Urology and Andrology, Kansai Medical University, Osaka, Japan
| |
Collapse
|
12
|
Cheng W, Chiu Y, Fan Y, Chang C, Kao K. Efficacy of intravenous hydration during extracorporeal shock wave lithotripsy in improving ureteral stone treatment success rate. Int J Urol 2022; 29:548-552. [DOI: 10.1111/iju.14836] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 02/14/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Weiming Cheng
- Division of Urology Department of Surgery Taipei City Hospital, Zhongxiao Branch Taipei Taiwan
- Institute of Biopharmaceutical Science College of Life Science National Yang Ming Chiao Tung University Taipei Taiwan
- Department of Urology College of Medicine National Yang Ming Chiao Tung University Taipei Taiwan
- Program in Molecular Medicine College of Life Sciences National Yang Ming Chiao Tung University Taipei Taiwan
| | - Yi‐Chun Chiu
- Division of Urology Department of Surgery Taipei City Hospital, Heping Fuyou Branch Taipei Taiwan
- Department of Exercise and Health Sciences University of Taipei Taipei Taiwan
| | - Yu‐Hua Fan
- Department of Urology College of Medicine National Yang Ming Chiao Tung University Taipei Taiwan
- Department of Urology Taipei Veterans General Hospital Taipei Taiwan
| | - Chang‐Chi Chang
- Division of Urology Department of Surgery Taipei City Hospital, Zhongxiao Branch Taipei Taiwan
| | - Kuo‐Wei Kao
- Division of Urology Department of Surgery Taipei City Hospital, Renai Branch Taipei Taiwan
| |
Collapse
|
13
|
Sengupta S, Basu S, Ghosh K. A prospective observational study on the predictability of Triple-D score versus Quadruple-D score in the success rate of extracorporeal shock wave lithotripsy of renal stones 1–2 cm in diameter. Urol Ann 2022; 14:37-42. [PMID: 35197701 PMCID: PMC8815344 DOI: 10.4103/ua.ua_1_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 07/19/2021] [Indexed: 11/04/2022] Open
Abstract
Introduction: The aim of the study is to evaluate the clinical efficacy of Triple-D scoring system versus Quadruple-D scoring system for assessing stone-free rate (SFR) in individuals with renal stones measuring 1–2 cm in diameter after extracorporeal shock wave lithotripsy (ESWL). Materials and Methods: The study was conducted on 120 patients who presented to a tertiary care center in eastern India. Systemic random sampling technique was applied with a sampling interval of 2. Triple-D scoring system comprising of three computed tomography based metrics – stone dimension (volume), stone density (Hounsfield unit), and skin-to-stone distance (SSD) was done before ESWL. Stone location was included as an additional parameter to formulate Quadruple-D scoring system where an extra score was given for stones in the non-lower polar region. Stone-free status was assessed by plain abdominal radiography 3 weeks after ESWL. Results: In the study population, stone dimension, stone density, and stone location were positive predictors of SFR after ESWL whereas age, sex, and body mass index of the patients, laterality of the stone and SSD were not. The area under the curve of Triple-D and Quadruple-D scoring systems were 0.598 and 0.674. Conclusion: Triple-D scoring system has been successfully validated as the SFR showed a parallel increase with every positive component. The Quadruple-D scoring system with a simple addition of stone location can further facilitate the validation of Triple-D scoring by increasing SFR, keeping the calculation simple and easy to use. These findings support the incorporation of Quadruple-D scoring system over Triple-D scoring system.
Collapse
|
14
|
The effect of stone and patient characteristics in predicting extra-corporal shock wave lithotripsy success rate: A cross sectional study. Ann Med Surg (Lond) 2021; 70:102829. [PMID: 34540217 PMCID: PMC8441084 DOI: 10.1016/j.amsu.2021.102829] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/05/2021] [Accepted: 09/05/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction We determine the effect of patient characteristics (age, sex, and body mass index BMI) and stone characteristics (density, location, and size) by non-contrast computed tomography of the kidneys, ureters, and bladder (CT-KUB) in predicting the success of extracorporeal shock wave lithotripsy (ESWL) in the treatment of kidney and ureteric stones. We present this study to further enrich the knowledge of physicians towards the effect of different patient characteristics upon predicting extra-corporal shock wave lithotripsy success rates. Methods We evaluated 155 patients who received ESWL for renal and ureteric stone measuring 3–20 mm (mm), over a 3-month period. The stone size in millimeters, density in Hounsfield units (HU) and its location was determined on pre-treatment CT-KUB. ESWL was successful if post-treatment residual renal stone fragments were ≤3 mm and for ureteric stones should be totally cleared. Results The overall success of ESWL treatment was observed in 65.8% of the 155 patients. There was no significant difference seen when the effect of patients age, sex and BMI were studied with ESWL outcome with P values were 0.155, 0.101 and 0.415 respectively. Also, stone location either in the kidney or ureter has no statistically significant effect on ESWL response rate. while stone density and size determined on CT KUB have statistically significant effect on the success rate of ESWL with a P-value of 0.002 and 0.000 respectively. Conclusions This study shows that determination of stone density and stone size on CT KUB pre ESWL can help to predict the outcome of ESWL. We propose that stone density <500 HU and stone size < 5 mm are highly likely to result in successful ESWL. Previous studies have reported a wide variation of ESWL success rate ranging from 46% to 91%. Failure of ESWL results in unnecessary exposure of renal parenchyma to shock waves and complications like renal hematoma. Increasing Efforts have been made to determine factors that predict ESWL outcome and improve patients' selection.
Collapse
|
15
|
El-Sakka A, Elgamasy A, Sallam K, Soliman MG. Counter-Irrigation as a Novel Technique versus the Standard Technique in Percutaneous Nephrolithotomy: A Prospective Randomized Trial. Urol Int 2021; 106:469-475. [PMID: 34569552 DOI: 10.1159/000518372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 06/23/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This study aimed to evaluate the efficacy of our counter-irrigation technique versus the standard technique in percutaneous nephrolithotomy (PCNL) by assessment of the stone-free rate after the procedures and its safety in terms of comparing the intraoperative time, Hb deficit, blood transfusion, length of hospital stay, auxiliary procedures, and perioperative complications with that of the standard one. METHODS This prospective randomized trial was conducted on patients with renal stone 2-3 cm in diameter without contraindications to PCNL. The patients were randomized into group A in which the counter-irrigation technique has been performed and group B who were managed by the standard technique. The preoperative characteristics including demographic data and stone parameters were compared between both groups. The primary outcome was the stone-free rate assessed by noncontrast spiral CT after 3 months. The secondary outcome included intraoperative time, Hb deficit, blood transfusion, hospital stay, auxiliary procedure required, and rate of complications. RESULTS Forty-eight patients were included in this study. Overall, no significant difference was observed between both groups regarding preoperative characteristics, Hb deficit, and complication rate. Operative time was significantly shorter in group B (p = 0.001). None of our patients required blood transfusion. The stone-free rates at 3 months were significantly better in group A (95% for group A and 70% for group B, p = 0.04). CONCLUSIONS Our results indicate that our counter-irrigation technique has lower stone migration with subsequent significantly better stone-free rate versus the standard technique. We can recommend this technique as a potentially valid option for cases with large stone burden when the access to the upper calyx is feasible to minimize significant residual fragments.
Collapse
Affiliation(s)
- Ahmed El-Sakka
- Urology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | | | - Karim Sallam
- Urology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Mohamed G Soliman
- Urology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| |
Collapse
|
16
|
Rice P, Pugh M, Geraghty R, Hameed BZ, Shah M, Somani BK. Machine Learning Models for Predicting Stone-Free Status after Shockwave Lithotripsy: A Systematic Review and Meta-Analysis. Urology 2021; 156:16-22. [PMID: 33894229 DOI: 10.1016/j.urology.2021.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/21/2021] [Accepted: 04/06/2021] [Indexed: 01/04/2023]
Abstract
We performed a systematic review and meta-analysis to investigate the use of machine learning techniques for predicting stone-free rates following Shockwave Lithotripsy (SWL). Eight papers (3264 patients) were included. Two studies used decision-tree approaches, five studies utilised Artificial Neural Networks (ANN), and one study combined a variety of approaches. The summary true positive rate was 79%, summary false positive rate was 14%, and Receiver Operator Characteristic (ROC) was 0.90 for machine learning approaches. Machine learning algorithms were at least as good as standard approaches. Further prospective evidence is needed to routinely apply machine learning algorithms in clinical practice.
Collapse
|
17
|
Outcome groups and a practical tool to predict success of shock wave lithotripsy in daily clinical routine. World J Urol 2021; 39:943-951. [PMID: 32436072 DOI: 10.1007/s00345-020-03253-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 05/08/2020] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To improve outcome prediction of extracorporeal shock wave lithotripsy (SWL) by development of a model based on easily available clinical and radiographical predictors and suitable for daily clinical use. MATERIALS AND METHODS We evaluated predictive factors for SWL success in 517 consecutive patients suffering from urinary calculi who underwent SWL between 2010 and 2018. Analyses included descriptive statistics, receiver operating characteristic statistics and logistic regression. Predictive value was improved by combining parameters using model selection and recursive partitioning. RESULTS Of the 517 patients, 310 (60.0%) had a successful SWL. Best individual predictor of SWL success was mean attenuation (MAV), with an area under the curve (AUC) of 0.668, and an optimal cutpoint (OC) of 987.5 HU. The best multivariable model, including MAV, stone size, skin to stone distance (SSD), presence of an indwelling stent, and four interaction effects, yielded an AUC of 0.736. Recursive partitioning would categorize patients into three outcome groups with high (76.9%), intermediate (41%) and low (10%) success probability. High probability of SWL success (76.9%) was found for patients with a stone with MAV ≤ 987 HU or with MAV > 987 HU but stone size ≤ 11 mm and SSD (45°) ≤ 88 mm. CONCLUSION A model based on four established predictors, and provided as an Excel®-Tool, can clearly improve prediction of SWL success. In addition, patients can be classified into three defined outcome groups based on simple cutpoint combinations. Both tools improve informed decision-making in daily clinical practice and might reduce failure rates.
Collapse
|
18
|
Factors influencing extracorporeal shock wave lithotripsy efficiency for optimal patient selection. Wideochir Inne Tech Maloinwazyjne 2021; 16:409-416. [PMID: 34136039 PMCID: PMC8193744 DOI: 10.5114/wiitm.2021.103915] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 11/06/2020] [Indexed: 12/02/2022] Open
Abstract
Introduction Current literature suggests various predictors related to the stone and patient, which could influence stone fragmentation and clearance rates. Aim To establish clinical characteristics of stone disease for patients undergoing extracorporeal shockwave lithotripsy (ESWL) which may predict the success of the procedure. Material and methods One hundred and nine patients with renal stone disease diagnosed by non-contrast computed tomography (NCCT) who underwent ESWL between January 2015 and December 2019 were included in the study. Endpoints: patient being stone free (SF) or when < 4 mm fragments were detected. Age, gender, location, skin-to-stone distance, maximum stone length, stone volume, stone surface area, mean stone Hounsfield units (HU) and highest HU score were explored in uni- and multivariate regression analysis. Results Stone size revealed the highest prognostic power for ESWL failure, where OR for stone volume and stone surface area were 1.06 (1.03–1.10) and 1.04 (1.02–1.06), respectively (all p < 0.01) while a tendency was observed for skin-to-stone distance 1.02 (1.00–1.03). The amount of energy applied during the procedure to one cubic millimeter of stone volume (SMLI/stone volume) was predictive for treatment success (OR = 0.60, 95% CI: 0.41–0.87, p < 0.01). Stone volume (OR = 1.06, 95% CI: 1.00–1.14, p = 0.01) and stone surface area (OR = 1.03, 95% CI: 1.01–1.06, p = 0.02) remained as statistically significant prognostic factors for treatment failure. Conclusions Both greater stone volume and stone surface area, as well as lower power delivered per stone volume unit during the ESWL procedure, were found to be significant factors and could be useful to predict treatment failure.
Collapse
|
19
|
Ozer C, Tekin MI. Clinical results of shock wave lithotripsy treatment in elderly patients with kidney stones: Results of 1433 patients. ACTA ACUST UNITED AC 2020; 92. [PMID: 33348965 DOI: 10.4081/aiua.2020.4.350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 10/27/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE In this study, it was aimed to evaluate the efficacy and safety of SWL treatment in elderly patients with kidney stones. MATERIALS AND METHODS Data from a total of 3024 patients who underwent SWL treatment for urinary tract stone disease in three centers of our university were evaluated retrospectively. A total of 1433 patients in the adult age group treated for single kidney stones were included in the study. The patients were divided into 3 groups (18-40, 41-64 and ≥ 65) years depending on their age. Demographic data, stone parameters, stone-free rate (SFR) and clinically insignificant residual fragment (CIRF) rate, number of SWL sessions and complication rate were analyzed according to the age groups. RESULTS The mean age of the patients was 47.38 ± 13.24 years. Stone size was significantly lower in the 18-40 years age group compared to other groups (p = 0.000) and the stones were mostly located on the right side in this age group (p = 0.007). There was no significant relationship between age groups and gender, stone localization, and number of SWL sessions. The overall SFR was 66.4%. Although the SFR was lower (61.4%) and the rate of multiple sessions (27.2%) was higher in ≥ 65 years group, there was no statistically significant difference between age groups regarding SFR, CIRF, need for additional sessions, and complication rates. CONCLUSIONS Due to its similar clinical results, treatment of SWL should not be ignored as a treatment option in the geriatric patient group with kidney stones.
Collapse
Affiliation(s)
- Cevahir Ozer
- Department of Urology, Baskent University, Adana.
| | | |
Collapse
|
20
|
Chang TH, Lin WR, Tsai WK, Chiang PK, Chen M, Tseng JS, Chiu AW. Comparison of ultrasound-assisted and pure fluoroscopy-guided extracorporeal shockwave lithotripsy for renal stones. BMC Urol 2020; 20:183. [PMID: 33172476 PMCID: PMC7653739 DOI: 10.1186/s12894-020-00756-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 10/31/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In this study, we aimed to compare the efficacy and clinical outcomes of shock wave lithotripsy (SWL) for patients with renal stones using pure fluoroscopy (FS) or ultrasound-assisted (USa) localization with two lithotripters. METHODS We retrospectively identified 425 patients with renal calculi who underwent SWL with either a LiteMed LM-9200 ELMA lithotripter (209 cases), which combined ultrasound and fluoroscopic stone targeting or a Medispec EM-1000 lithotripter machine (216 cases), which used fluoroscopy for stone localization and tracking. The patient demographic data, stone-free rates, stone disintegration rates, retreatment rates and complication rates were analyzed. RESULTS The USa group had a significantly higher overall stone-free rate (43.6 vs. 28.2%, p < 0.001) and stone disintegration rate (85.6 vs. 64.3%, p < 0.001), as well as a significantly lower retreatment rate (14.8 vs. 35.6%, p < 0.001) and complication rate (1.9 vs. 5.5%, p = 0.031) compared with the FS group. This superiority remained significant in the stone size < 1 cm stratified group. In the stone size > 1 cm group, the stone-free rate (32.4 vs. 17.8%, p = 0.028), disintegration rate (89.2 vs. 54.8%, p = 0.031) and retreatment rate (21.6 vs. 53.4%, p < 0.001) were still significantly better in the USa group, however there was no significant difference in the complication rate. The most common complication was post-SWL-related flank pain. CONCLUSION SWL is a safe and non-invasive way of treating renal stones. This study compared two electromagnetic shock wave machines with different stone tracking systems. LiteMed LM-9200 ELMA lithotripter, which combined ultrasound and fluoroscopic stone targeting outperformed Medispec EM-1000 lithotripter, which used fluoroscopy for stone localization and tracking, with better stone-free rates and disintegration rates, as well as lower retreatment rates and complications with possible reduced radiation exposure.
Collapse
Affiliation(s)
- Tsung-Hsin Chang
- Department of Urology, MacKay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Taipei City, 10449, Taiwan.
| | - Wun-Rong Lin
- Department of Urology, MacKay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Taipei City, 10449, Taiwan.,Mackay Medical College, No.46, Sec. 3, Zhongzheng Rd., Sanzhi Dist., New Taipei City, 252, Taiwan
| | - Wei-Kung Tsai
- Department of Urology, MacKay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Taipei City, 10449, Taiwan.,Mackay Medical College, No.46, Sec. 3, Zhongzheng Rd., Sanzhi Dist., New Taipei City, 252, Taiwan
| | - Pai-Kai Chiang
- Department of Urology, MacKay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Taipei City, 10449, Taiwan.,Mackay Medical College, No.46, Sec. 3, Zhongzheng Rd., Sanzhi Dist., New Taipei City, 252, Taiwan
| | - Marcelo Chen
- Department of Urology, MacKay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Taipei City, 10449, Taiwan.,Mackay Medical College, No.46, Sec. 3, Zhongzheng Rd., Sanzhi Dist., New Taipei City, 252, Taiwan.,Mackay Junior College of Medicine, Beitou District, Nursing, and Management, No.92, Shengjing Road, Taipei City, 11272, Taiwan
| | - Jen-Shu Tseng
- Department of Urology, MacKay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Taipei City, 10449, Taiwan.
| | - Allen W Chiu
- Department of Urology, MacKay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Taipei City, 10449, Taiwan.,School of Medicine, National Yang-Ming University, No.145, Zhengzhou Rd., Datong Dist., Taipei City, 10341, Taiwan
| |
Collapse
|
21
|
Cui HW, Tan TK, Christiansen FE, Osther PJS, Turney BW. The utility of automated volume analysis of renal stones before and after shockwave lithotripsy treatment. Urolithiasis 2020; 49:219-226. [PMID: 32926195 PMCID: PMC8113220 DOI: 10.1007/s00240-020-01212-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 08/31/2020] [Indexed: 11/23/2022]
Abstract
This study aimed to evaluate the additional utility of an automated method of estimating volume for stones being treated with shockwave lithotripsy (SWL) using computed tomography (CT) images compared to manual measurement. Utility was assessed as the ability to accurately measure stone burden before and after SWL treatment, and whether stone volume is a better predictor of SWL outcome than stone diameter. 72 patients treated with SWL for a renal stone with available CT scans before and after treatment were included. Stone axes measurement and volume estimation using ellipsoid equations were compared to volume estimation using software using CT textural analysis (CTTA) of stone images. There was strong correlation (r > 0.8) between manual and CTTA estimated stone volume. CTTA measured stone volume showed the highest predictive value (r2 = 0.217) for successful SWL outcome on binary logistic regression analysis. Three cases that were originally classified as ‘stone-free with clinically insignificant residual fragments’ based on manual axis measurements actually had a larger stone volume based on CTTA estimation than the smallest fragments remaining for cases with an outcome of ‘not stone-free’. This study suggests objective measurement of total stone volume could improve estimation of stone burden before and after treatment. Current definitions of stone-free status based on manual measurements of residual fragment sizes are not accurate and may underestimate remaining stone burden after treatment. Future studies reporting on the efficacy of different stone treatments should consider using objective stone volume measurements based on CT image analysis as an outcome measure of stone-free state.
Collapse
Affiliation(s)
- Helen Wei Cui
- Oxford Stone Group, University of Oxford, Oxford, UK.
| | - Tze Khiang Tan
- Ninewells Hospital and Medical School, University of Dundee, Dundee, DD1 9SY, UK
| | | | - Palle Jörn Sloth Osther
- Department of Urology, Urological Research Center, Lillebaelt Hospital, University of Southern Denmark, Vejle, Denmark
| | | |
Collapse
|
22
|
Gökce Mİ, Akpinar Ç, Obaid K, Süer E, Gülpinar Ö, Bedük Y. Comparison of retrograde ureterorenoscopy (URS) and percutaneous anterograde ureteroscopy for removal of impacted upper ureteral stones >10mm in the elderly population. Int Braz J Urol 2020; 47:64-70. [PMID: 32840338 PMCID: PMC7712678 DOI: 10.1590/s1677-5538.ibju.2019.0638] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 01/16/2020] [Indexed: 12/23/2022] Open
Abstract
PURPOSE We aimed to compare the success and complication rates of the anterograde and retrograde Ureterorenoscopy (URS) for impacted upper ureteral stones in patients > 65 years of age. MATERIALS AND METHODS Data of 146 patients >65 years of age and underwent anterograde URS (n=68) in supine position or retrograde URS (n=78) for upper ureteral impacted stones>10 mm between January 2014 and September 2018 were collected prospectively. The groups were compared for success and complication rates, duration of operation, hospital stay, and ancillary procedures. RESULTS Anterograde and retrograde URS groups were similar for demographic and stone related characteristics. The success rate of the anterograde URS group was significantly higher than the retrograde URS group (97.1% vs. 78.2%, p=0.0007). The complication rates were similar for the two groups (p=0.86). Clavien grade I and II complications were observed in 3 patients in each group. The mean hemoglobin drop was 0.5 g/dL in the anterograde URS group and blood transfusion was not performed in any of the patients. The mean duration of operation was 41.2±12.5 minutes in the mini-PNL group and 59.6±15.1 minutes in the RIRS group and the difference was statistically significant (p=0.02). The median duration of hospitalization was 1 day for both groups. CONCLUSIONS Performing anterograde URS in supine position provided better success rates and similar complication rates compared to retrograde URS. Based on these results anterograde URS shall be considered as one of the primary treatment options for management of impacted upper ureteral stones in the elderly population.
Collapse
Affiliation(s)
- Mehmet İlker Gökce
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Çağri Akpinar
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Khaled Obaid
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Evren Süer
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Ömer Gülpinar
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Yaşar Bedük
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| |
Collapse
|
23
|
Hegazy M, El-Assmy A, Ali-El-Dein B, Sheir KZ. The alternating bidirectional versus the standard approach during shock wave lithotripsy for upper lumbar ureteric stones: a randomized controlled trial. World J Urol 2020; 39:247-253. [PMID: 32206888 DOI: 10.1007/s00345-020-03148-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 02/26/2020] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To compare the outcome of shock wave lithotripsy (SWL) for upper lumbar ureteric stones using the alternating bidirectional approach versus the standard approach during the first session. METHODS Our study was a randomized controlled trial including patients with single radio-opaque stone < 1 cm located in the upper lumbar ureter (from the ureteropelvic junction till the level medial to the lower margin of the kidney). SWL was conducted using electromagnetic Dornier Gemini Lithotripter. In group 1, patients were treated with the alternating under and over-table approach during the first session only and if other sessions were needed, the standard under-table approach was used. In group 2, patients were treated with the standard under-table approach during all sessions. Stone disintegration after the first session was assessed by kidney-ureter-bladder X-ray, renal ultrasonography and noncontrast computed tomography. Moreover, the incidence and severity of postoperative complications were evaluated. RESULTS Forty-eight patients in each group completed the study. Patient demographics and stone characteristics were comparable in both groups. Complete disintegration was achieved in 41.7% of patients in group 1 versus 18.8% in group 2 (P = 0.021). Stone-free rate (SFR) was 58.3% and 20.8% in group 1 and 2 respectively (P = 0.001). The mean session time was 56.42 min in group 1 versus 46.35 min in group 2 (P < 0.001). There was no significant difference in postoperative complications. CONCLUSION Stone disintegration and SFR after the first SWL session are higher when using the alternating bidirectional approach for upper lumbar ureteric stones at the expense of longer procedural duration. TRIAL REGISTRATION ClinicalTrials identifier (ID: NCT03243682), clinicaltrials.gov.
Collapse
Affiliation(s)
- Mohammed Hegazy
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
| | - Ahmed El-Assmy
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | | | - Khaled Z Sheir
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| |
Collapse
|
24
|
Cui HW, Silva MD, Mills AW, North BV, Turney BW. Predicting shockwave lithotripsy outcome for urolithiasis using clinical and stone computed tomography texture analysis variables. Sci Rep 2019; 9:14674. [PMID: 31604986 PMCID: PMC6788981 DOI: 10.1038/s41598-019-51026-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 08/14/2019] [Indexed: 11/09/2022] Open
Abstract
We aimed to develop and evaluate a statistical model, which included known pre-treatment factors and new computed tomography texture analysis (CTTA) variables, for its ability to predict the likelihood of a successful outcome after extracorporeal shockwave lithotripsy (SWL) treatment for renal and ureteric stones. Up to half of patients undergoing SWL may fail treatment. Better prediction of which cases will likely succeed SWL will help patients to make an informed decision on the most effective treatment modality for their stone. 19 pre-treatment factors for SWL success, including 6 CTTA variables, were collected from 459 SWL cases at a single centre. Univariate and multivariable analyses were performed by independent statisticians to predict the probability of a stone free (both with and without residual fragments) outcome after SWL. A multivariable model had an overall accuracy of 66% on Receiver Operator Curve (ROC) analysis to predict for successful SWL outcome. The variables most frequently chosen for the model were those which represented stone size. Although previous studies have suggested SWL can be reliably predicted using pre-treatment factors and that analysis of CT stone images may improve outcome prediction, the results from this study have not produced a useful model for SWL outcome prediction.
Collapse
Affiliation(s)
- Helen W Cui
- Oxford Stone Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom.
| | | | | | | | - Benjamin W Turney
- Oxford Stone Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| |
Collapse
|
25
|
Abstract
This comprehensive review updates the advances in extracorporeal lithotripsy, including improvements in external shockwave lithotripsy and innovations in ultrasound based lithotripsy, such as burst wave lithotripsy, ultrasonic propulsion, and histotripsy. Advances in endoscopic technology and training have changed the surgical approach to nephrolithiasis; however, improvements and innovations in extracorporeal lithotripsy maintain its status as an excellent option in appropriately selected patients.
Collapse
Affiliation(s)
- Tim Large
- Department of Urology, Indiana University, Methodist Hospital, 1801 Senate Boulevard, Suite 220, Indianapolis, IN 46202, USA
| | - Amy E Krambeck
- Department of Urology, Indiana University, Methodist Hospital, 1801 Senate Boulevard, Suite 220, Indianapolis, IN 46202, USA.
| |
Collapse
|
26
|
Reinforcement of the Triple D score with simple addition of the intrarenal location for the prediction of the stone-free rate after shockwave lithotripsy for renal stones 10-20 mm in diameter. Int Urol Nephrol 2019; 51:239-245. [PMID: 30604235 DOI: 10.1007/s11255-018-02066-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 12/24/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE We investigated the clinical efficacy of the Triple D score (TrD-S) on stone-free rate (SFR) prediction following shockwave lithotripsy (SWL) for renal stones 10-20 mm in diameter and modified the scoring system to improve outcome prediction. METHODS We retrospectively examined clinical data from the medical records of 226 consecutive patients who underwent SWL for 10-20 mm kidney stones. The TrD-S was calculated according to the cutoffs of < 150 mm3 for stone volume, < 600 Hounsfield unit for stone density, and < 12 cm for skin-to-stone distance on computed tomography. The Quadruple D score was defined as the sum of the TrD-S and stone location (0/1 point for intrarenal stone distribution at lower/non-lower poles, respectively). Complete clearance 3 months after the final SWL was considered the stone-free status. RESULTS The residual group (n = 102) had significantly older age, larger stones, higher stone density, higher lower-pole stone incidence, and lower TrD-S than the stone-free group (n = 124). In the multivariate analysis, age, TrD-S, and non-lower-pole stones independently predicted the SFR. The TrD-Ss of 0, 1, 2, and 3 points showed SFRs of 40.0%, 51.9%, 73.0%, and 100.0%, respectively. The Quadruple D scores of 0, 1, 2, 3, and 4 points showed SFRs of 0.0%, 37.9%, 54.5%, 84.4%, and 100.0%, respectively, with better prediction accuracy than the TrD-S (p = 0.01). CONCLUSIONS The TrD-S is successfully validated for use in Japanese patients with 10-20-mm renal stones. Simple addition of the stone location to the TrD-S could reinforce SFR prediction after SWL.
Collapse
|
27
|
Mannil M, von Spiczak J, Hermanns T, Poyet C, Alkadhi H, Fankhauser CD. Three-Dimensional Texture Analysis with Machine Learning Provides Incremental Predictive Information for Successful Shock Wave Lithotripsy in Patients with Kidney Stones. J Urol 2018; 200:829-836. [DOI: 10.1016/j.juro.2018.04.059] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2018] [Indexed: 10/17/2022]
Affiliation(s)
- Manoj Mannil
- Institute of Diagnostic and Interventional Radiology and Department of Urology (TH, CP, CDF), University Hospital Zurich, University of Zurich, Switzerland
| | - Jochen von Spiczak
- Institute of Diagnostic and Interventional Radiology and Department of Urology (TH, CP, CDF), University Hospital Zurich, University of Zurich, Switzerland
| | - Thomas Hermanns
- Institute of Diagnostic and Interventional Radiology and Department of Urology (TH, CP, CDF), University Hospital Zurich, University of Zurich, Switzerland
| | - Cédric Poyet
- Institute of Diagnostic and Interventional Radiology and Department of Urology (TH, CP, CDF), University Hospital Zurich, University of Zurich, Switzerland
| | - Hatem Alkadhi
- Institute of Diagnostic and Interventional Radiology and Department of Urology (TH, CP, CDF), University Hospital Zurich, University of Zurich, Switzerland
| | - Christian Daniel Fankhauser
- Institute of Diagnostic and Interventional Radiology and Department of Urology (TH, CP, CDF), University Hospital Zurich, University of Zurich, Switzerland
| |
Collapse
|
28
|
Prattley S, Voss J, Cheung S, Geraghty R, Jones P, Somani BK. Ureteroscopy and stone treatment in the elderly (≥70 years): prospective outcomes over 5- years with a review of literature. Int Braz J Urol 2018. [PMID: 29522293 PMCID: PMC6092651 DOI: 10.1590/s1677-5538.ibju.2017.0516] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Objective: To assess outcomes of ureteroscopy for treatment of stone disease in the elderly. Ureteroscopy (URS) is an increasingly popular treatment modality for urolithiasis and its applications are ever expanding with the development of newer technologies. Its feasibility and outcomes within the elderly population to our knowledge remain under-reported. Materials and Methods: We examined the patient demographics and surgical outcomes from our prospective database for patients ≥70 years who underwent URS for urolithiasis, in a 5-year period between March 2012 and December 2016. Results: A total of 110 consecutive patients underwent 121 procedures (1.1 procedure/patient) with a mean age of 77.2 years (range: 70-91 years). Stone location was in the kidney/ pelviureteric junction (PUJ) in 29%, ureter in 37% and in multiple locations in 34%. The initial and final stone free rate (SFR) was 88% and 97% respectively. While 73% were done as true day case procedures, 89% patients were discharged within 24 hours. Eleven patients (9%) underwent complications of which 10 were Clavien I/II including acute urinary retention, urinary tract infection, stent symptoms and pneumonia. One patient underwent Clavien IV complication where they needed intensive care unit admission for urosepsis but fully recovered and were discharged home subsequently. Conclusion: Ureteroscopy is a safe and effective method of managing urolithiasis in elderly patients. Although most patients are discharged within 24-hours, consideration needs to be made for patients where social circumstances can impact their discharge planning.
Collapse
Affiliation(s)
- Sarah Prattley
- University Hospital Southampton, NHS Trust, United Kingdom, UK
| | - James Voss
- University Hospital Southampton, NHS Trust, United Kingdom, UK
| | | | - Robert Geraghty
- University Hospital Southampton, NHS Trust, United Kingdom, UK
| | - Patrick Jones
- University Hospital Southampton, NHS Trust, United Kingdom, UK
| | | |
Collapse
|
29
|
Yanaral F, Ozgor F, Savun M, Agbas A, Akbulut F, Sarilar O. Shock-wave Lithotripsy for Pediatric Patients: Which Nomogram Can Better Predict Postoperative Outcomes? Urology 2018; 117:126-130. [DOI: 10.1016/j.urology.2018.03.045] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 03/19/2018] [Accepted: 03/24/2018] [Indexed: 11/25/2022]
|
30
|
Shinde S, Al Balushi Y, Hossny M, Jose S, Al Busaidy S. Factors Affecting the Outcome of Extracorporeal Shockwave Lithotripsy in Urinary Stone Treatment. Oman Med J 2018; 33:209-217. [PMID: 29896328 DOI: 10.5001/omj.2018.39] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Objectives We sought to evaluate the factors affecting the outcome of extracorporeal shockwave lithotripsy (ESWL) in urinary stone treatment. Methods We conducted a retrospective review of 235 adult patients treated with ESWL, for radiopaque renal or ureteric stones between January 2015 and December 2016. Patient's age, sex, stone size, laterality, location, density, skin-to-stone distance (SSD), and presence of double J stent were studied as potential predictors. At the end of three months, the patients were divided into success and failure groups and the significance was determined. Results Of the 235 patients (188 males and 47 females) analyzed, ESWL was successful in 79.1%. Univariate analysis of both groups revealed no significant difference in patient's age and stone laterality. Statistically significant differences in gender, stone size, stone site, stone density, SSD, and patients with stents were observed. Statistically significant factors in multivariate logistic regression analysis were sex and stent. Females had three-times higher risk for ESWL failure than males (odds ratio (OR) = 3.213; 95% confidence interval (CI): 1.194-8.645; p = 0.021) and a higher failure rate when a stent was used (OR = 6.358; 95% CI: 2.228-18.143; p = 0.001). Conclusions This study revealed that ESWL can treat renal and ureteric stones successfully with an inverse association between outcome and predictors such as stone size and density, SSD, and stent presence. These factors can help us in improving patient selection and ensure better results at lower cost.
Collapse
Affiliation(s)
- Sanjay Shinde
- Urology Department, Armed Forces Hospital, Muscat, Oman
| | | | - Medhat Hossny
- Urology Department, Armed Forces Hospital, Muscat, Oman
| | - Sachin Jose
- Planning and Studies Department, Oman Medical Specialty Board, Muscat, Oman
| | | |
Collapse
|
31
|
Chen PC, Liu YT, Hsieh JH, Wang CC. A practical formula to predict the stone-free rate of patients undergoing extracorporeal shock wave lithotripsy. UROLOGICAL SCIENCE 2017. [DOI: 10.1016/j.urols.2016.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
32
|
Kasote DM, Jagtap SD, Thapa D, Khyade MS, Russell WR. Herbal remedies for urinary stones used in India and China: A review. JOURNAL OF ETHNOPHARMACOLOGY 2017; 203:55-68. [PMID: 28344029 DOI: 10.1016/j.jep.2017.03.038] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 03/13/2017] [Accepted: 03/21/2017] [Indexed: 05/13/2023]
Abstract
ETHANOPHARMACOLOGICAL RELEVANCE The process of formation or appearance of a urinary stone anywhere in the renal tract is known as urolithiasis. It is a longstanding health problem, known to exist since early age of civilization. Records about symptoms, signs and treatment strategies of urinary stones diseases are found in the several ancient texts of traditional medicines such as Ayurveda, Traditional Chinese Medicine (TCM), Siddha and Unani. In Ayurveda, urolithiasis has been considered as one of the eight most troublesome diseases. Ayurvedic management and cure of urinary stone involves herbal formulas, alkaline liquids and surgical procedures. Whereas, TCM recommends polyherbal drugs, acupuncture and mexibustion for treatment of the urinary stones. Among these therapies, herbal remedies are in practice till today for the treatment and cure urinary stone diseases. MATERIALS AND METHODS A comprehensive review of the scientific literature about pathophysiology of urinary stones and antiurolithiatic plants was undertaken using the following bibliographic databases: MEDLINE/PubMed, Scopus, Web of Knowledge and Google Scholar. The search was conducted from publications from all years until Dec., 2015 by combination of the search terms and Boolean operators; 'urinary stone' OR 'kidney stone' AND 'plant' OR 'medicine' OR 'antiurolithiatic plants'. Outputs were restricted to those completed studies only published in English. In this review, literatures about plants which are used as diuretic and/or in treatment urinary tract infections have not also been considered. The Plant List and Royal Botanical Garden, Kew databases were used to authenticate botanical names of plants. Books and monographs published in English were used to collect information about historical records of antiurolithiatic plants. RESULTS Recent pharmacological interventions accredited ancient antiurolithiatic claims to several plants and their formulations. The majority of antiurolithiatic plants were found to either dissolve the stones or inhibit the process of urinary stone formation. Plants such as Phyllanthus niruri L. and Elymus repens (L.) Gould, as well as herbal products including 'Wu-Ling-San' formula, 'Cystone' and 'Herbmed' have been proved their utility as promising antiurolithiatic medicines in the different phases of clinical trials. In addition, some of the isolated phytochemicals such as berberine, lupeol, khelin, visnagin, 7-hydroxy-2',4',5'-trimethoxyisoflavone and 7-hydroxy-4'-methoxyisoflavone were reported to have potent antiurolithiatic activity. CONCLUSION In ancient medicinal texts, antiurolithiatic potential has been ascribed to several plants and their formulations. Present scientific studies provide scientific evidences for few of these claims however, they are insufficient to establish many of these plants and herbal formulations as therapeutic remedies for the treatment and management of urinary stones. Conversely, findings of pre-clinical and clinical studies about some plants and herbal formulations are promising, which underlines the utility of herbal remedies as alternative medicines for the treatment and management of urinary stones in the future.
Collapse
Affiliation(s)
- Deepak M Kasote
- Natural Products Group, Rowett Institute of Nutrition and Health, University of Aberdeen, Aberdeen AB21 9SB, UK; Herbal Medicine, Interactive Research School for Health Affairs (IRSHA), Bharati Vidyapeeth University, Pune Satara Road, Pune 411043, Maharashtra, India.
| | - Suresh D Jagtap
- Herbal Medicine, Interactive Research School for Health Affairs (IRSHA), Bharati Vidyapeeth University, Pune Satara Road, Pune 411043, Maharashtra, India
| | - Dinesh Thapa
- Natural Products Group, Rowett Institute of Nutrition and Health, University of Aberdeen, Aberdeen AB21 9SB, UK
| | - Mahendra S Khyade
- Department of Botany, Sangamner Nagarpalika Arts, D. J. Malpani Commerce and B.N. Sarda Science College, Sangamner 422605, Maharashtra, India
| | - Wendy R Russell
- Natural Products Group, Rowett Institute of Nutrition and Health, University of Aberdeen, Aberdeen AB21 9SB, UK
| |
Collapse
|
33
|
Chen YZ, Lin WR, Lee CC, Sun FJ, Chow YC, Tsai WK, Chiang PK, Lin TP, Chen M, Chiu AW. Comparison of safety and outcomes of shock wave lithotripsy between elderly and non-elderly patients. Clin Interv Aging 2017; 12:667-672. [PMID: 28442896 PMCID: PMC5396840 DOI: 10.2147/cia.s134750] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background This study compared the clinical outcomes of extracorporeal shock wave lithotripsy between elderly (aged $65 years) and non-elderly (aged <65 years) patients. Methods A retrospective review of medical records was performed on 483 (non-elderly: 245, elderly: 238) patients with upper urinary tract stones who underwent shock wave lithotripsy between 2007 and 2015. The demographic data, stone parameters, stone-free rate, retreatment rate, and complication rate were analyzed in both elderly and non-elderly patient groups. Results There was no significant difference between non-elderly and elderly patients in terms of stone-free rate (46.5% vs 41.1%, P>0.05) regardless of stone site or stone size and overall retreatment rate (41.6% vs 37.0%, P>0.05). Elderly patients had a higher complication rate than non-elderly patients (15.5% vs 23.5%, P=0.026). The most common complication was flank pain. Receiver operating characteristic curves predicted that elderly patients (cutoff value: 65 years of age) had a higher risk of complications and that patients with smaller stones (cutoff value: 0.8 cm) had a higher stone-free rate. Conclusion This study showed that elderly patients with upper urinary tract stones undergoing shock wave lithotripsy had comparable efficacy for stone-free rates and retreatment rates, but higher complication rates.
Collapse
Affiliation(s)
| | - Wun-Rong Lin
- Department of Urology, MacKay Memorial Hospital.,School of Medicine, MacKay Medical College
| | - Chih-Chiao Lee
- Department of Urology, MacKay Memorial Hospital.,School of Medicine, MacKay Medical College
| | - Fang-Ju Sun
- Department of Urology, MacKay Memorial Hospital.,Department of Cosmetic Applications and Management, MacKay Junior College of Medicine, Nursing and Management
| | - Yung-Chiong Chow
- Department of Urology, MacKay Memorial Hospital.,School of Medicine, MacKay Medical College
| | - Wei-Kung Tsai
- Department of Urology, MacKay Memorial Hospital.,School of Medicine, MacKay Medical College
| | - Pai-Kai Chiang
- Department of Urology, MacKay Memorial Hospital.,School of Medicine, MacKay Medical College
| | - Ting-Po Lin
- Department of Urology, MacKay Memorial Hospital.,School of Medicine, MacKay Medical College
| | - Marcelo Chen
- Department of Urology, MacKay Memorial Hospital.,School of Medicine, MacKay Medical College.,Department of Cosmetic Applications and Management, MacKay Junior College of Medicine, Nursing and Management
| | - Allen W Chiu
- Department of Urology, MacKay Memorial Hospital.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| |
Collapse
|
34
|
Ozgor F, Tosun M, Kayali Y, Savun M, Binbay M, Tepeler A. External Validation and Evaluation of Reliability and Validity of the Triple D Score to Predict Stone-Free Status After Extracorporeal Shockwave Lithotripsy. J Endourol 2017; 31:169-173. [PMID: 27889982 DOI: 10.1089/end.2016.0721] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE The Triple D scoring system is defined as novel and simple nomogram using the main parameters (skin-to-stone distance, stone density, and volume) to indicate most appropriate patients for extracorporeal shockwave lithotripsy (SWL). We aimed to evaluate the accuracy of the Triple D scoring system in predicting SWL success rates. PATIENTS AND METHODS In two tertiary academic centers, charts were retrospectively analyzed of patients who had, between January 2014 and May 2016, been treated by SWL for radiopaque kidney stones. A total of 200 patients were enrolled into the study. Parameters were calculated for each of the three specified variables. Since one point was assigned for any parameter that was less than the cutoff value, Triple D scores ranged from 0 (worst) to 3 (best). RESULTS Stone-free status was achieved in 115 patients (57.5%), and 85 patients had one or more residual fragments (42.5%). Differences in stone characteristics, including stone location, density, and volume, were statistically significant in patients whether SWL achieved stone-free status or not (p < 0.001, p < 0.001, and p < 0.001, respectively). Triple D scores were significantly higher in patients treated with SWL compared with patients in whom SWL failed (p < 0.001). Triple D scores of 0, 1, 2, and 3 correlated with stone-free rates of 41.7%, 33.7%, 69.4%, and 97%, respectively. The multivariate analyses revealed that Triple D score and stone location were identified as independent factors affecting SWL success (p < 0.001 and p = 0.008, respectively). The mean number of SWL sessions was significantly higher in patients with SWL failure (p = 0.003). CONCLUSION Our study externally validates that the Triple D scoring system is associated with SWL success in the treatment of renal and ureteral stones. Further studies are warranted to assess clinical usefulness and the accuracy of this nomogram in different patient groups.
Collapse
Affiliation(s)
- Faruk Ozgor
- 1 Department of Urology, Haseki Teaching and Research Hospital , Istanbul, Turkey
| | - Muhammed Tosun
- 2 Department of Urology, Faculty of Medicine, Bezmialem Vakif University , Istanbul, Turkey
| | - Yunus Kayali
- 2 Department of Urology, Faculty of Medicine, Bezmialem Vakif University , Istanbul, Turkey
| | - Metin Savun
- 1 Department of Urology, Haseki Teaching and Research Hospital , Istanbul, Turkey
| | - Murat Binbay
- 1 Department of Urology, Haseki Teaching and Research Hospital , Istanbul, Turkey
| | | |
Collapse
|
35
|
|
36
|
Manikandan R, Mittal JK, Dorairajan LN, Mishra AK, Sreerag KS, Verma A. Endoscopic Combined Intrarenal Surgery for Simultaneous Renal and Ureteral Stones: A Retrospective Study. J Endourol 2016; 30:1056-1061. [DOI: 10.1089/end.2016.0329] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
| | | | | | | | | | - Anil Verma
- Department of Urology, JIPMER, Puducherry, India
| |
Collapse
|
37
|
Gökce MI, Esen B, Gülpınar B, Süer E, Gülpınar Ö. External Validation of Triple D Score in an Elderly (≥65 Years) Population for Prediction of Success Following Shockwave Lithotripsy. J Endourol 2016; 30:1009-16. [PMID: 27392789 DOI: 10.1089/end.2016.0328] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Triple D score was recently developed for prediction of extracorporeal shockwave lithotripsy (SWL) outcomes. However, it has not been validated. SWL in elderly patients results in lower success and higher complication rates. We aimed at externally validating Triple D score in a population ≥65 years of age. PATIENTS AND METHODS We retrospectively analyzed the data of 182 patients ≥65 years of age who underwent SWL for renal or ureteral stones and were evaluated with non-contrast computed tomography before SWL. Stone volume (SV), skin-to-stone distance (SSD), and stone density were measured, and cutoff values were determined with receiver operator characteristic analysis. Triple D scores were calculated, and success rates were determined for each score. RESULTS Mean SV, SSD, and stone density values were significantly higher in patients with failed outcomes compared with those with successful outcomes in both renal and ureteral cases. Cutoff values of 187.5 mm(3), 10.5 cm, and 675 HU for renal stones and of 185 mm(3), 11.5 cm, and 785 HU for ureteral stones were detected. Success rates of 95.5% and 95% were detected for patients with a Triple D score of 3 in the renal and ureteral stone groups, respectively. Success rates of patients with a Triple D score of 0 were 20% and 25% in the renal and ureteral stone groups, respectively. CONCLUSIONS Triple D score correlated well with SWL outcomes in patients ≥65 years of age, and it is externally validated. Various factors may deal with cutoff levels of involved parameters. Therefore, we suggest that each institution determines its unique cutoff levels for SV, SSD, and stone density parameters and calculates the Triple D score for its patients with respect to these cutoff levels to predict the success after SWL and aid in decision making.
Collapse
Affiliation(s)
- Mehmet Ilker Gökce
- 1 Department of Urology, Ankara University School of Medicine , Ankara, Turkey
| | - Barış Esen
- 1 Department of Urology, Ankara University School of Medicine , Ankara, Turkey
| | - Başak Gülpınar
- 2 Department of Radiology, Ankara University School of Medicine , Ankara, Turkey
| | - Evren Süer
- 1 Department of Urology, Ankara University School of Medicine , Ankara, Turkey
| | - Ömer Gülpınar
- 1 Department of Urology, Ankara University School of Medicine , Ankara, Turkey
| |
Collapse
|
38
|
External validation of Resorlu–Unsal stone score as predictor of outcomes after retrograde intrarenal surgery. Int Urol Nephrol 2016; 48:1247-1252. [DOI: 10.1007/s11255-016-1311-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 04/29/2016] [Indexed: 10/21/2022]
|
39
|
Olvera-Posada D, Alenezi H, Tailly T, Dion M, Denstedt JD, Razvi H. Assessing the Magnitude of Effect of Bone Structures on Shockwave Lithotripsy Fragmentation: Results from an In Vitro Study. J Endourol 2016; 30:544-9. [PMID: 26732533 DOI: 10.1089/end.2015.0641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Several anatomic and clinical factors have been implicated in the failure rates of shock wave lithotripsy (SWL), including the attenuating effects of bony structures. We designed an in vitro model that incorporates the lumbar spine, including vertebral bodies and transverse processes along the pathway of shockwaves, to mimic the clinical scenario during SWL of upper ureteral stones. We hypothesized that the presence of bone structures in the SWL pathway significantly affects the fragmentation rate. MATERIALS AND METHODS An ordnance gelatin (OG) model was conceptualized and created to allow a pig's lumbar spine to be embedded within it. Artificial urinary calculi weighing 2 ± 0.1 g (1.2-cm diameter) were prepared using BegoStone plaster. The trial was divided into two arms: group 1 models had OG only and served as the control and group 2 models had the bone embedded in the gelatin with stone wells placed above the transverse processes. Twenty-four stones per group were subjected to SWL using the STORZ MODULITH SLX-F2 lithotripter, using the same treatment parameters. Fragments were sieved through 2- and 4-mm filters, and the fragmentation coefficients (FC) were calculated. The Mann-Whitney test was used to compare FC between the two groups. RESULTS The mean fragmentation rate of group 1 was statistically significantly higher compared with group 2 using a 4-mm sieve (43% vs 0.62%, p < 0.001) and the 2-mm filter (18% vs 0.52%, p < 0.001). CONCLUSIONS The presence of bone structures dramatically reduces the fragmentation rate of phantom stones using an OG in vitro model. The OG model is inexpensive and simple to use to simulate clinical situations during SWL.
Collapse
Affiliation(s)
- Daniel Olvera-Posada
- Division of Urology, Department of Surgery, Schulich School of Medicine & Dentistry, The University of Western Ontario , London, Ontario, Canada
| | - Husain Alenezi
- Division of Urology, Department of Surgery, Schulich School of Medicine & Dentistry, The University of Western Ontario , London, Ontario, Canada
| | - Thomas Tailly
- Division of Urology, Department of Surgery, Schulich School of Medicine & Dentistry, The University of Western Ontario , London, Ontario, Canada
| | - Marie Dion
- Division of Urology, Department of Surgery, Schulich School of Medicine & Dentistry, The University of Western Ontario , London, Ontario, Canada
| | - John D Denstedt
- Division of Urology, Department of Surgery, Schulich School of Medicine & Dentistry, The University of Western Ontario , London, Ontario, Canada
| | - Hassan Razvi
- Division of Urology, Department of Surgery, Schulich School of Medicine & Dentistry, The University of Western Ontario , London, Ontario, Canada
| |
Collapse
|
40
|
Smith HE, Bryant DA, KooNg J, Chapman RA, Lewis G. Extracorporeal shockwave lithotripsy without radiation: Ultrasound localization is as effective as fluoroscopy. Urol Ann 2016; 8:454-457. [PMID: 28057991 PMCID: PMC5100152 DOI: 10.4103/0974-7796.192104] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
CONTEXT Extracorporeal shockwave lithotripsy (SWL) is the first-line treatment for renal calculi in most cases. Recent technology has allowed lithotriptor machines to localize stones using fluoroscopy or ultrasound (US). AIM The aim of this study is to compare stone free rates (SFR) using two techniques. METHODS This is a single center retrospective cohort study. We have studied 95 patients with renal calculi undergoing first SWL treatment with localization using US (48 pts) and fluoroscopy (47 pts). SFR was defined as fragments ≤2 m at 4 weeks post procedure on x-ray or US. Patient records were reviewed. RESULTS Stone size and location, age and body mass index were comparable between groups. Stones ≤7 mm had better SFR with US 86% (18/21) compared to fluoroscopy 59% (10/17) P= 0.08. Overall the US group had similar SFR to the fluoroscopy group for stones of all sizes and locations with 60% (29/48) compared to 45% (21/47)P= 0.18. Radiation exposure was the biggest difference between techniques with a mean radiation dose (mGy/cm2) in the US group of 103 (0-233) and 2113 (241-7821) in the fluoroscopy group. Radiation use in the US group was due to the use of a single shot pre- and post-procedure, this could be reduced to zero. CONCLUSIONS Our data show equivalent outcomes using US compared to the traditional fluoroscopy localization technique. We would encourage departments to develop the use of US localization to reduce radiation exposure to patients.
Collapse
Affiliation(s)
- Hazel Elizabeth Smith
- Department of Urology, Sunderland Royal Hospital, Sunderland, SR4 7TP, United Kingdom; Department of Urology, Ninewells Hospital, Dundee, DD1 9SY, United Kingdom
| | - David Alistair Bryant
- Department of Urology, Sunderland Royal Hospital, Sunderland, SR4 7TP, United Kingdom
| | - Jenny KooNg
- Department of Urology, Sunderland Royal Hospital, Sunderland, SR4 7TP, United Kingdom
| | | | - Gareth Lewis
- Department of Urology, Sunderland Royal Hospital, Sunderland, SR4 7TP, United Kingdom
| |
Collapse
|
41
|
Ozkan B, Dogan C, Can GE, Tansu N, Erozencı A, Onal B. Does ureteral stenting matter for stone size? A retrospectıve analyses of 1361 extracorporeal shock wave lithotripsy patients. Cent European J Urol 2015; 68:358-64. [PMID: 26568882 PMCID: PMC4643708 DOI: 10.5173/ceju.2015.611] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 04/27/2015] [Accepted: 06/24/2015] [Indexed: 11/26/2022] Open
Abstract
Introduction The aim of our study was to determine the efficacy of ureteral stents for extracorporeal shock wave lithotripsy (SWL) treatment of pelvis renalis stones and to compare the results and complications in stented and non-stented patients. Material and methods Between 1995 and 2011, 1361 patients with pelvis renalis stones were treated with SWL. Patients were subdivided into three groups according to stone burden: ≤1 cm2 (group 1; n = 514), 1.1 to 2 cm2 (group 2; n = 530) and >2 cm2 (group 3; n = 317). Each group was divided into subgroups of patients who did and did not undergo ureteral stent implantation before SWL treatment. The efficacy of treatment was evaluated by determining the effectiveness quotient (EQ). Statistical analysis was performed by chi-square, Fisher's exact and Mann-Whitney U tests. Results Of the 514, 530 and 317 patients in groups 1, 2 and 3 respectively, 30 (6%), 44 (8%) and 104 (33%) patients underwent auxiliary stent implantation. Steinstrasse rates did not differ significantly between stented and non-stented patients in each group. The EQ was calculated as 62%, 33% and 70% respectively in non-stented, stented and totally for group 1. This ratio calculated as 58%, 25% and 63% for group 2 and 62%, 26% and 47% for group 3. Stone-free rates were significantly higher for non-stented than for stented patients in groups 2 and 3. Conclusions Stone free rates are significantly higher in non-stented than in stented patients with pelvis renalis stones >1 cm2, whereas steinstrasse rates are not affected.
Collapse
Affiliation(s)
- Burak Ozkan
- Acıbadem Unıversıty, Faculty of Medıcıne, Department of Urology, Istanbul, Turkey
| | - Cagatay Dogan
- Unıversıty of Istanbul, Cerrahpasa School of Medıcıne, Department of Urology, Istanbul, Turkey
| | - Gulce Ecem Can
- Unıversıty of Istanbul, Cerrahpasa School of Medıcıne, Department of Urology, Istanbul, Turkey
| | - Nejat Tansu
- Unıversıty of Istanbul, Cerrahpasa School of Medıcıne, Department of Urology, Istanbul, Turkey
| | - Ahmet Erozencı
- Unıversıty of Istanbul, Cerrahpasa School of Medıcıne, Department of Urology, Istanbul, Turkey
| | - Bulent Onal
- Unıversıty of Istanbul, Cerrahpasa School of Medıcıne, Department of Urology, Istanbul, Turkey
| |
Collapse
|
42
|
Safety and efficacy of retrograde intrarenal surgery in patients of different age groups. Actas Urol Esp 2015; 39:354-9. [PMID: 25667174 DOI: 10.1016/j.acuro.2014.06.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 06/10/2014] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To assess the efficacy and safety of retrograde intrarenal surgery (RIRS) to treat renal stones in different age groups of patients. PATIENTS AND METHODS We performed a retrospective analysis of 947 patients who underwent RIRS for renal calculi between January 2008 and January 2014. Age at RIRS was analysed both as a continuous and categorical variable and patients were categorized into three age groups; aged ≤ 15 years at surgery (group i, n=51), 16 - 60 years (group Ii, n=726) and>60 years (group iii, n=170). We compared the 3 groups with the regard to stone characteristics, operative parameters and postoperative outcomes. RESULTS The stone-free rate was 78.4% in group i, 77.5% in group ii, and 81.1% in group iii (P=.587). A multivariate logistic regression analysis showed that only stone size and stone number had significant influence on the stone-free rates after RIRS. Intraoperative complications occurred 13.7% in group i, 5.6% group ii, and 7.6% in group iii. Overall complication rates in children were higher than adult patients but the differences were not statistically significant. We found that only operation time was associated with the increased risk of intraoperative complications. Peroperative medical complications developed in 8 patients (.8%) in group ii and 2 patients (1.1%) in group iii. A 48-year-old man died from septic shock 5 days after the surgery. CONCLUSIONS RIRS was observed to be a safe and effective procedure in all age groups of patients with stone disease, therefore age should not be considered as a limiting factor.
Collapse
|
43
|
Ichiyanagi O, Nagaoka A, Izumi T, Kawamura Y, Kato T. Age-related delay in urinary stone clearance in elderly patients with solitary proximal ureteral calculi treated by extracorporeal shock wave lithotripsy. Urolithiasis 2015; 43:419-26. [PMID: 25981235 DOI: 10.1007/s00240-015-0783-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 05/06/2015] [Indexed: 11/27/2022]
Abstract
We investigated the effects of aging on the stone-free rate (SFR) after shock wave lithotripsy (SWL) for the treatment of proximal ureteral calculi. A total of 247 consecutive patients were retrospectively selected, classified into seven groups set at 10 year increments (from 20 to 90 years), and examined for SFR after SWL. According to our final analysis, 185 male and 62 female patients with an average age of 54.1 years had stones with a diameter of 11.5 mm and a density of 893.1 Hounsfield units. On average, SFR was 74.9 % at 3 months after 1.7 SWL sessions. SFR gradually reached ≥ 90 % for each age-group after 1.5-2 years. Median durations to achieve 50 % SFR were estimated to be 21 and 86 days for those in their 20 and 80 s, respectively. However, the difference between the two estimates was not significant (p = 0.064). The durations to achieve 50 % SFR for the other groups lay between these two estimates. Aging does not affect long-term SFR, but patients aged ≥ 80 years might experience delayed stone clearance within the first 12 months after SWL.
Collapse
Affiliation(s)
- Osamu Ichiyanagi
- Department of Urology, Yamagata University Faculty of Medicine, Iida-Nishi 2-2-2, Yamagata City, Yamagata Prefecture, Japan.
| | - Akira Nagaoka
- Department of Urology, Yamagata University Faculty of Medicine, Iida-Nishi 2-2-2, Yamagata City, Yamagata Prefecture, Japan
| | - Takuji Izumi
- Department of Urology, South Miyagi Medical Center, Aza-nishi 38-1, Ogawara Town, Miyagi Prefecture, Japan
| | - Yuko Kawamura
- Department of Urology, South Miyagi Medical Center, Aza-nishi 38-1, Ogawara Town, Miyagi Prefecture, Japan
| | - Tomoyuki Kato
- Department of Urology, Yamagata University Faculty of Medicine, Iida-Nishi 2-2-2, Yamagata City, Yamagata Prefecture, Japan
| |
Collapse
|
44
|
Noncontrast computed tomography factors that predict the renal stone outcome after shock wave lithotripsy. Clin Imaging 2015; 39:845-50. [PMID: 25975631 DOI: 10.1016/j.clinimag.2015.04.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Revised: 03/26/2015] [Accepted: 04/17/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Extracorporeal shock wave lithotripsy (ESWL) is a popular treatment for nephrolithiasis. We took advantage of noncontrast abdominal computed tomography (NCCT) to search the possible prognostic factors including abdominal fat distribution influencing stone-free rate. METHODS From August 2008 to August 2010, 145 patients who had renal calculus and had undergone ESWL were retrospectively reviewed. All of them received NCCT assessment before ESWL and were followed up after 1 month for stone clearance. These patients were divided into two groups: one was the stone-free group and the other was the residual-stone group. Affecting parameters included stone size, location, stone surface area, Hounsfield unit density (HU density), skin-to-stone distance (SSD), and abdominal fat area as analyzed between these two groups. RESULTS Of 145 patients, 70 were stone-free and 75 had residual stone after ESWL treatment and 1-month follow-up. From univariate analysis, stone size, HU density, SSD, and stone surface area were significant predicting factors for ESWL success. On multivariate analysis, the important factors influencing ESWL outcomes were HU density and stone surface area (odds ratio 1.002 vs. 77.18, respectively; P<.05). Abdominal fat accumulation and distribution had no significant difference between these two groups. CONCLUSION This study revealed that stone size, HU density, SSD, and stone surface area were associated with stone-free rate after ESWL treatment. Therefore, these factors could be used to assess the feasibility of ESWL before deciding the treatment strategy. Abdominal fat distribution had no significant impact on ESWL outcome for renal stones.
Collapse
|
45
|
Lai D, Chen M, He Y, Li X. Simultaneous retrograde intrarenal surgery for ipsilateral asymptomatic renal stones in patients with ureteroscopic symptomatic ureteral stone removal. BMC Urol 2015; 15:22. [PMID: 25888137 PMCID: PMC4391107 DOI: 10.1186/s12894-015-0016-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 03/11/2015] [Indexed: 11/10/2022] Open
Abstract
Background Ipsilateral asymptomatic renal stone associated with symptomatic ureteral stone is not a rare event, and the recommended treatment policy was not declared clearly. This study was conducted to compare the outcomes of simultaneous retrograde intrarenal surgery (RIRS) and ureteroscopy to ureteroscopy alone for this clinical event. Methods 415 patients with symptomatic ureteral stone and ipsilateral asymptomatic renal stones were reviewed to obtain two match groups, who were treating with simultaneous modality (group A, N = 72), or ureteroscopy alone (group B, N = 72). Matching criteria were ureteral and renal stone side, duration and location, the presence of pre-stented. Perioperative and postoperative characteristics were compared between the two groups. Results Mean stone burdens were similar between group A and B. Mean operative duration for group A and B were 72.4 ± 21.3 and 36.4 ± 10.2 min, respectively (P < 0.001). Mean hospital duration was 6.4 ± 2.9 and 5.3 ± 2.1 days in group A and B, respectively (P = 0.521). Ureteral SFR was 100% in each group. Renal SFR for RIRS was 86.1%. Complication rates in group A were higher (22.2% vs 13.9%), but the differences were not statistically significant (P = 0.358). In group A, complications were significantly less in pre-stented patients (3/25 vs 5/11, P = 0.04). Auxiliary treatment rate was significant higher in group B (69.4% vs 5.6%, P < 0.001) during follow-up (mean >18 months). Conclusions Simultaneous RIRS for ipsilateral asymptomatic renal stones in patients with ureteroscopic symptomatic ureteral stone removal can be performed safely and effectively. It promises a high SFR with lower auxiliary treatment rate, and does not lengthen hospital duration and increase complications.
Collapse
Affiliation(s)
- Dehui Lai
- Urology Department, Fifth Affiliated Hospital, Guangzhou Medical University, 621 Gangwan Road, Huangpu District, Guangzhou, Guangdong, 510700, China. .,Translational Medical Center, Minimally Invasive Technology and Product, Guangzhou Medical University, Guangzhou, Guangdong, China.
| | - Meiling Chen
- Urology Department, Fifth Affiliated Hospital, Guangzhou Medical University, 621 Gangwan Road, Huangpu District, Guangzhou, Guangdong, 510700, China.
| | - Yongzhong He
- Urology Department, Fifth Affiliated Hospital, Guangzhou Medical University, 621 Gangwan Road, Huangpu District, Guangzhou, Guangdong, 510700, China.
| | - Xun Li
- Urology Department, Fifth Affiliated Hospital, Guangzhou Medical University, 621 Gangwan Road, Huangpu District, Guangzhou, Guangdong, 510700, China. .,Translational Medical Center, Minimally Invasive Technology and Product, Guangzhou Medical University, Guangzhou, Guangdong, China.
| |
Collapse
|
46
|
Takazawa R, Kitayama S, Tsujii T. Appropriate kidney stone size for ureteroscopic lithotripsy: When to switch to a percutaneous approach. World J Nephrol 2015; 4:111-117. [PMID: 25664253 PMCID: PMC4317621 DOI: 10.5527/wjn.v4.i1.111] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 09/29/2014] [Accepted: 12/01/2014] [Indexed: 02/06/2023] Open
Abstract
Flexible ureteroscopy (fURS) has become a more effective and safer treatment for whole upper urinary tract stones. Percutaneous nephrolithotomy (PNL) is currently the first-line recommended treatment for large kidney stones ≥ 20 mm and it has an excellent stone-free rate for large kidney stones. However, its invasiveness is not negligible considering its major complication rates. Staged fURS is a practical treatment for such large kidney stones because fURS has a minimal blood transfusion risk, short hospitalization and few restrictions on daily routines. However, as the stone size becomes larger, the stone-free rate decreases, and the number of operations required increases. Therefore, in our opinion, staged fURS is a practical option for kidney stones 20 to 40 mm. Miniaturized PNL combined with fURS should be considered to be a preferred option for stones larger than 40 mm. Moreover, URS is an effective treatment for multiple upper urinary tract stones. Especially for patients with a stone burden < 20 mm, URS is a favorable option that promises a high stone-free rate after a single session either unilaterally or bilaterally. However, for patients with a stone burden ≥ 20 mm, a staged operation should be considered to achieve stone-free status.
Collapse
|
47
|
[Effectiveness of flexible ureteroscopy versus extracorporeal shock wave lithotripsy for kidney stones treatment]. Prog Urol 2015; 25:233-9. [PMID: 25640027 DOI: 10.1016/j.purol.2015.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 12/09/2014] [Accepted: 01/02/2015] [Indexed: 11/23/2022]
Abstract
Primary endpoint was to objective a better effectiveness of flexible ureteroscopy (fURS) compared to extracorporeal shock wave lithotripsy (ESWL) 3 months after treatment of a unique kidney stone from 5 to 20mm. Secondary endpoints were to evaluate effectiveness in subgroup and tolerance. We conducted a prospective comparative randomised trial between May 2012 and February 2014. A computerised tomography was done before treatment and another 3 months after treatment. Of the 30 randomised patients, 8 dropped out from the study and 4 were lost to follow-up. Median time of follow-up was 3.82 months. In per-protocol analysis, success rate was 60% for fURS group versus 28.6% for ESWL group (P=0.29). In intention to treat analysis, success rate was 77.8% in fURS group versus 53.8% in ESWL group (P=0.38). In ESWL group, 5 patients (41.7%) needed a second treatment versus none in fURS group but it was not significant. During follow-up, 1 patient in each group presented a complication. Results of this feasibility study did not allowed to conclude on superiority of a technic. A multicenter study with more important enrollment is necessary considering economic side and tolerance of these treatments.
Collapse
|
48
|
Lessons learned from the CROES percutaneous nephrolithotomy global study. World J Urol 2014; 33:223-33. [PMID: 25100624 DOI: 10.1007/s00345-014-1367-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 07/18/2014] [Indexed: 10/24/2022] Open
Abstract
PURPOSE The purpose of the study was to give an overview of the data derived from the CROES PCNL Global Study published previously in 25 articles. METHODS A comprehensive overview of the outcome of the CROES PCNL Global Study was made, analysed and compared with the current literature and guidelines. RESULTS Percutaneous nephrolithotomy (PCNL) was predominately performed in prone position. Although the supine position claims to be favourable over the prone approach, the present study showed a longer operation time and lower stone-free rate (SFR). This might be explained by differences in definition in operation time and methods in the evaluation of residual stones. Ultrasound (US)-guided access proves beneficial in lowering puncture time and radiation exposure. Renal anomalies can safely be treated by PCNL and have similar outcomes to a normal situation. In patients with a solitary kidney, however, there is a lower SFR and more bleeding. Also, severe chronic kidney disease (CKD) patients have less favourable outcome. Morbidity and complications following PCNL are dominated by fever (10.5%) and bleeding (7.8%). A matched control analysis confirmed that antibiotic prophylaxis gives a threefold lower post-operative fever rate. In a multivariate analysis, it was elegantly demonstrated that bleeding was directly related to the size of the dilatation: the larger the bore, the higher the chance for bleeding. Elderly patients are at higher risk of complications and longer hospital stay. Overall, obese patients have similar outcome as the general population; however, super-obese (BMI > 40) patients have a higher chance of more severe complications. For the first time, this database illustrated a significant relationship between results and complications of PCNL, and caseload volume. The optimal case volume per centre appears to be 120 PCNL's/year. Finally, a nomogram has been developed that enables better patient counselling and decision-making. CONCLUSION The CROES PCNL Global Study is the largest real-life study providing new insights into general and special conditions. Because of the vast number of patients included, rare conditions including renal anomalies, solitary kidneys and patient characteristics like severe CKD, super obesity and old age could be analysed. Besides this information, a nomogram was developed. And for the first time, the influence of caseload volume was established.
Collapse
|
49
|
Hussein A, Anwar A, Abol-Nasr M, Ramadan E, Shaaban A. The role of plain radiography in predicting renal stone fragmentation by shockwave lithotripsy in the era of noncontrast multidetector computed tomography. J Endourol 2014; 28:850-3. [PMID: 24568734 DOI: 10.1089/end.2014.0034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE The objective of this study is to determine if plain radiography has a role in prediction of stone fragmentation by shockwave lithotripsy (SWL). PATIENTS AND METHODS Our study included 106 patients undergoing SWL for renal stones. Based on plain radiography criteria, stones were classified according to density, homogeneity, and outline. We compared the success of SWL in fragmentation of stones with a density equal to or less than bone, nonhomogeneous stones, and stones with irregular outline to its success in stones with a density more than bone, homogeneous stones, and stones with smooth outline. RESULTS In plain radiography, stone density equal to or less than bone, nonhomogeneous stones, and stones with irregular outline showed successful SWL fragmentation in 88.8%, 91.2%, and 90.6%, respectively. Stones with a density more than bone, homogeneous stones, and stones with smooth outline showed successful SWL fragmentation in 52.9%, 52.6%, and 57.1%, respectively. CT attenuation value was significantly less in stones successfully fragmented by SWL compared with nonfragmented stone (649±169 and 1465±256, respectively). In homogeneous stones with smooth outline having a density more than bone, we found a significantly lower CT attenuation in patients with successful stone fragmentation by SWL compared with those with failed stone fragmentation (690.9±171 and 1462±212, respectively). CONCLUSION In relatively large solitary renal pelvic stones, plain radiography can predict the success of stone fragmentation by SWL. Nonhomogeneous stones with irregular outline and a density equal to or less than bone are expected to be successfully fragmented by SWL. Noncontrast CT is only needed, to predict success of SWL, in cases of homogeneous stones with smooth outline and density more than bone.
Collapse
|
50
|
Lo AHK, Au YW. Clinical audit of a new extracorporeal shockwave lithotripsy machine. SURGICAL PRACTICE 2014. [DOI: 10.1111/1744-1633.12041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - Yuk-Wa Au
- Department of Urology; St. Paul's Hospital; Hong Kong
| |
Collapse
|