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Wang W, Peng L, Di X, Gao X, Wei X. Does previous unsuccessful shockwave lithotripsy influence the outcomes of ureteroscopy?-a systematic review and meta-analysis. Transl Androl Urol 2021; 10:2122-2132. [PMID: 34159093 PMCID: PMC8185663 DOI: 10.21037/tau-21-39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background To determine whether previous unsuccessful shockwave lithotripsy (SWL) influence the outcomes of ureteroscopy (URS). Methods An exhaustive search of PubMed, EMBASE, Web of Science and Cochrane Library were conducted to find eligible studies before October 2020. Result variables consisting stone-free rate (SFR), operation time and postoperative modified Clavien grade I-IV complications were pooled utilizing RevMan 5.3. Results Seven studies with 2413 individuals were included. Pooled results revealed that the salvage URS after failed SWL was similar to URS performed primarily regarding SFR [odds ratio (OR) =0.84, P=0.15] and operation time [weighted mean difference (WMD) =6.79, P=0.19]. Additionally, no statistically significant differences concerning fever (OR: 1.36; P=0.32), hematuria (OR: 0.81; P=0.75), urinary tract infection (OR: 1.57; P=0.28), renal colic (OR: 1.94; P=0.50), ureteral perforation (OR: 1.44; P=0.46), ureteral avulsion (OR: 1.21; P=0.83), stone migration (OR: 0.92; P=0.86) and sepsis (OR: 0.46; P=0.38) were observed between salvage URS and primary URS group. Discussion The success rates and complications of URS were not impacted by previous unsuccessful SWL. The salvage URS is equally effective and safe to primary URS.
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Affiliation(s)
- Wei Wang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Liao Peng
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xingpeng Di
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiaoshuai Gao
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xin Wei
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Rashid AO, Attar A, Mohammed KS, Fakhralddin SS, Abdulla LN, Buchholz N. Direct Comparison of Pneumatic and Ho:YAG Laser Lithotripsy in the Management of Lower Ureteric Stones. Urol Int 2020; 104:765-768. [PMID: 32702701 DOI: 10.1159/000508419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 04/30/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Besides extracorporeal shockwave lithotripsy, semi-rigid ureteroscopy (URS) has become an equal therapy of choice for the treatment of most distal ureteric stones. Before the wide availability of laser lithotripsy as a tool for stone fragmentation, pneumatic lithotripsy was, and still is, widely used. In a country like Iraq, availability and affordability are the huge questions asked. Besides the capital investment for a laser machine, the pneumatic device is reusable, whereas the laser fibers are limited in their reusability. This makes pneumatic lithotripsy a more cost-effective option, at least in our setting. The question remains whether both options, compared in our setting with our limited resources, are equally effective and beneficial to our patients. PATIENTS AND METHODS Fifty patients were included in our prospective study who underwent URS for the treatment of a distal ureteric stone. Half each (n = 25) underwent pneumatic (group A) or laser lithotripsy (group B). Inclusion criteria were a single distal ureteric stone measuring 7-20 mm in largest diameter, no anatomical abnormality, age >18 years, and an unsuccessful attempt of medical expulsion therapy. Patients with signs of urinary infection and pregnant women were excluded. All patients were operated upon under spinal anesthesia. Data recorded included operation time, stone size, type of scope and lithotripter, complications, hospital stay, and stone-free rate. RESULTS Both groups did not show statistically significant differences in patient demography, stone size, operation time, complications, and stone-free rates (p > 0.05). CONCLUSION Both pneumatic and Ho:YAG laser lithotripsy are equally effective and safe in treating distal ureteric stones in our setting. If the cost and availability of laser treatment is an issue, pneumatic lithotripsy is a viable and more cost-effective option.
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Affiliation(s)
- Aso Omer Rashid
- Medical College, Sulaimani University, Sulaimani, Iraq.,U-merge Ltd. (Urology in Emerging Countries), London, United Kingdom
| | - Aree Attar
- Department of Urology, Sulaimani University Hospital, Sulaimani, Iraq
| | | | | | | | - Noor Buchholz
- U-merge Ltd. (Urology in Emerging Countries), London, United Kingdom,
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Serbetci E, Celikoyar MM, Altundag A. Sialendoscopic Pneumatic Lithotripsy for Salivary Calculi: A New Technique and a Long-term Clinical Experience. Otolaryngol Head Neck Surg 2017; 157:906-908. [DOI: 10.1177/0194599817717457] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We report our results comprising a series of 34 cases of sialolithiasis that were approached sialendoscopically with conventional instruments (ie, basket and/or forceps) and for which stone removal was unsuccessful and so were thereafter treated with pneumatic lithotripsy. Intraductal pneumatic lithotripsy was able to fragment 30 of 34 (88%) salivary calculi in total. No major complications occurred. All 30 treated glands returned to normal function without any symptoms. We believe that the success of sialendoscopy is closely related to the success of salivary stone fragmentability.
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Affiliation(s)
| | - M. Mazhar Celikoyar
- Department of Otolaryngology, Istanbul Florence Nightingale Hospital, Istanbul, Turkey
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Ibrahim AK. Reporting ureteroscopy complications using the modified clavien classification system. Urol Ann 2015; 7:53-7. [PMID: 25657545 PMCID: PMC4310118 DOI: 10.4103/0974-7796.148611] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Accepted: 08/06/2014] [Indexed: 11/20/2022] Open
Abstract
Objective: Perioperative complications are one of the surrogate indicators of surgical outcomes. However, reporting these complications need a precise grading system. Our aim is to report and grade the complications of semirigid ureteroscopy in ureteral stone management according to the modified Clavien classification system. Materials and Methods: This is a prospective study conducted From January 2012 to June 2013. All patients with ureteral stones who were indicated for semirigid URS were evaluated. All procedures were performed by the same surgeon. The data recorded including patient demographics, clinical indication, stone size and location, operative time and complications were classified according to the modified Clavien classification system. The patients were followed for 8 weeks postoperatively. Results: 148 patients included, Stone distribution was: 89 (60.1%) lower ureteral, 26 (17.6%) mid ureteral, and 33 (22.3%) upper ureteral. the mean stone size was 8.6 mm. Urgent URS done in 23% of patient. The overall stone free rate was 88.5%, the individual stone free rate for the upper, middle and lower ureter were 87.9%, 84.6%, and 89.9%, respectively. The mean operative time was 31.9 min (20-50 min.). Complications occurred in 26.35% of patients. Grade I complications occurred in 32 patients (26.1%), grade II in 9 (6.1%), grade IIIa in 7 (4.7%), grade IIIb in 8 (5.4%), grade IVa in two patient (1.35%), and grade IVb in one patient (0.7%). No grade V complication was encountered. Conclusion: Ureteroscopy becomes the vanguard interventional therapy for ureteral stones with well-established efficacy and safety. It is of paramount importance to adopt a precise structured classification system for reporting surgical complications, that should be flexible and comprehensive in order to accommodate the various and rapidly expanding surgical fields.
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Categorization of intraoperative ureteroscopy complications using modified Satava classification system. World J Urol 2013; 32:131-6. [PMID: 23504074 DOI: 10.1007/s00345-013-1054-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 03/06/2013] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVES To review our experience with ureteroscopy (URS) in the treatment of ureteral calculi and stratify intraoperative complications of URS according to the modified Satava classification system. PATIENTS AND METHODS We performed a retrospective analysis of 1,208 patients (672 males and 536 females), with a mean age of 43.1 years (range 1-78), who underwent ureteroscopic procedures for removal of ureteral stones. Intraoperative complications were recorded according to modified Satava classification system. Grade 1 complications included incidents without consequences for the patient; grade 2 complications, which are treated intraoperatively with endoscopic surgery (grade 2a) or required endoscopic re-treatment (grade 2b); and grade 3 complications included incidents requiring open or laparoscopic surgery. RESULTS The stones were completely removed in 1,067 (88.3%) patients after primary procedure by either simple extraction or after fragmentation. The overall incidence of intraoperative complications was 12.6%. The most common complications were proximal stone migration (3.9%), mucosal injury (2.8%), bleeding (1.9%), inability to reach stone (1.8%), malfunctioning or breakage of instruments (0.8%), ureteral perforation (0.8%) and ureteral avulsion (0.16%). According to modified Satava classification system, there were 4.5% grade 1; 4.4% grade 2a; 3.2% grade 2b; and 0.57% grade 3 complications. CONCLUSION We think that modified Satava classification is a quick and simple system for describing the severity of intraoperative URS complications and this grading system will facilitate a better comparison for the surgical outcomes obtained from different centers.
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Gunlusoy B, Degirmenci T, Kozacioglu Z, Arslan M, Ceylan Y, Nergiz N, Minareci S. Factors Affecting the Complications of Pneumatic Lithotripsy for the Treatment of Ureteral Stones with Different Localizations: A Multivariate Analysis of Complications. Urol Int 2013; 91:357-62. [DOI: 10.1159/000350243] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Accepted: 02/21/2013] [Indexed: 11/19/2022]
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Maghsoudi R, Amjadi M, Norizadeh D, Hassanzadeh H. Treatment of ureteral stones: A prospective randomized controlled trial on comparison of Ho:YAG laser and pneumatic lithotripsy. Indian J Urol 2011; 24:352-4. [PMID: 19468467 PMCID: PMC2684370 DOI: 10.4103/0970-1591.39549] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To study the treatment of ureteric stones by HO:YAG laser lithotripsy and pneumatic lithotripsy and to evaluate the results of the two treatment modalities to assess effectiveness and complications. MATERIALS AND METHODS Over 1-year period, a total of 79 patients with 82 ureteral stones were randomized into two groups. In group 1 (39 cases with 41 ureteral stones) ureteroscopic HO:YAG laser lithotripsy was performed using a rigid 8 Fr-ureteroscope (LL group). In group 2 (40 cases with 41 ureteral stones) pneumatic lithotripsy was performed in like manner. Efficacy safety and complications in both groups were analyzed. RESULTS A total of 79 patients with 82 calculi were treated. Two cases in LL group and one in PL group had bilateral ureteral stones. Mean stone size was 12.07 mm in LL group and 10.2 mm in PL group. Stones located in lower ureter in 30 cases on LL group and 29 cases in PL group. Proximal migration of stone occurred in 1 case on LL group and in 3 cases on PL group. Successful fragmentation occurred in 37 cases on LL group and in 30 cases on PL group. Stone-free rate after 1 month in the base of Kidney Ureter Bladder (KUB) and sonography was 95% in LL group and 80.5% in PL group. Ureteral perforation, urinoma, and urosepsis were not seen in both groups. CONCLUSION HO:YAG laser has advantages over PL in high efficacy of stone fragmentation and a low-retrograde migration of ureteral stone treatment. Other complication of ureteral stone treatment with LL and PL are the same and very rare.
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Affiliation(s)
- Robab Maghsoudi
- Department of Urology, Imam Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
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Lee JH, Woo SH, Kim ET, Kim DK, Park J. Comparison of Patient Satisfaction with Treatment Outcomes between Ureteroscopy and Shock Wave Lithotripsy for Proximal Ureteral Stones. Korean J Urol 2010; 51:788-93. [PMID: 21165201 PMCID: PMC2991578 DOI: 10.4111/kju.2010.51.11.788] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Accepted: 10/05/2010] [Indexed: 11/25/2022] Open
Abstract
Purpose We examined patient satisfaction with treatment outcomes after shock wave lithotripsy (SWL) and ureteroscopic removal of stone (URS) for proximal ureteral stones. Materials and Methods We evaluated 224 consecutive patients who underwent SWL (n=156) or URS (n=68) for a single radiopaque proximal ureteral stone. Stone-free rates, defined as no visible fragment on a plain X-ray; complications; and patient satisfaction were compared. Patient satisfaction was examined through a specifically tailored questionnaire that included overall satisfaction (5 scales) and 4 domains (pain, voiding symptoms, cost, and stone-free status). Results The stone-free rates after the first, second, and third sessions of SWL were 36.5%, 65.4%, and 84.6%, respectively. The overall stone-free rate of URS was 82.4%, which was comparable to that of the third session of SWL. Complications were similar between the two groups except for greater steinstrasse in the SWL group. Overall satisfaction and voiding symptoms, cost, and stone-free status showed no significant difference between the groups. In the pain domain, the SWL group had a relatively lower satisfaction rate than did the URS group (p=0.05). Subanalysis showed that the satisfaction rate of the URS group with stone-free status was significantly lower than that of the SWL group in patients with ≥10 mm stones (p=0.032). Conclusions Overall treatment outcomes and patient satisfaction were not significantly different between SWL and URS. However, patients undergoing URS for ≥10 mm proximal ureteral stones had lesser satisfaction with stone-free status, because of relatively lower stone-free rates due to upward stone migration. We suggest that factors regarding the subjective satisfaction of patients be included in counseling about treatment options for proximal ureteral stones.
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Affiliation(s)
- Jong-Hyun Lee
- Department of Urology, Eulji University Hospital, Eulji University College of Medicine, Daejeon, Korea
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Basiri A, Zare S, Tabibi A, Sharifiaghdas F, Aminsharifi A, Mousavi-Bahar SH, Ahmadnia H. A Multicenter, Randomized, Controlled Trial of Transureteral and Shock Wave Lithotripsy—Which is the Best Minimally Invasive Modality to Treat Distal Ureteral Calculi in Children? J Urol 2010; 184:1106-9. [DOI: 10.1016/j.juro.2010.05.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Indexed: 10/19/2022]
Affiliation(s)
- Abbas Basiri
- Urology and Nephrology Research Center (UNRC), Shahid Labbafinejad Medical Center, Shahid Beheshti University, M. C. (SBMU), Tehran, I. R. Iran
| | - Samad Zare
- Urology and Nephrology Research Center (UNRC), Shahid Labbafinejad Medical Center, Shahid Beheshti University, M. C. (SBMU), Tehran, I. R. Iran
| | - Ali Tabibi
- Urology and Nephrology Research Center (UNRC), Shahid Labbafinejad Medical Center, Shahid Beheshti University, M. C. (SBMU), Tehran, I. R. Iran
| | - Farzaneh Sharifiaghdas
- Urology and Nephrology Research Center (UNRC), Shahid Labbafinejad Medical Center, Shahid Beheshti University, M. C. (SBMU), Tehran, I. R. Iran
| | - Alireza Aminsharifi
- Urology and Nephrology Research Center (UNRC), Shahid Labbafinejad Medical Center, Shahid Beheshti University, M. C. (SBMU), Tehran, I. R. Iran
| | - Seyed Habibollah Mousavi-Bahar
- Urology and Nephrology Research Center (UNRC), Shahid Labbafinejad Medical Center, Shahid Beheshti University, M. C. (SBMU), Tehran, I. R. Iran
| | - Hassan Ahmadnia
- Urology and Nephrology Research Center (UNRC), Shahid Labbafinejad Medical Center, Shahid Beheshti University, M. C. (SBMU), Tehran, I. R. Iran
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Park WJ, Kwon JO, Oh TH. The Outcome of Laparoscopic Retroperitoneal Ureterolithotomy for the Management of Upper Ureteral Stones Larger than 10 mm: A Comparison with Rigid Ureteroscopic Removal of Stones with Lithoclast®. Korean J Urol 2009. [DOI: 10.4111/kju.2009.50.4.349] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Woo Jin Park
- Department of Urology, Masan Samsung Hospital, Sungkyunkwan University School of Medicine, Masan, Korea
| | - Jun O Kwon
- Department of Urology, Masan Samsung Hospital, Sungkyunkwan University School of Medicine, Masan, Korea
| | - Tae Hee Oh
- Department of Urology, Masan Samsung Hospital, Sungkyunkwan University School of Medicine, Masan, Korea
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11
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Urétéroscopie pour calcul du haut appareil urinaire. Prog Urol 2008; 18:912-6. [DOI: 10.1016/j.purol.2008.09.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2008] [Accepted: 09/02/2008] [Indexed: 11/22/2022]
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12
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Hamida W, Hidoussi A, Jaidane M, Slama A, Youssef A, Sorba N, Mosbah A. L’urétéroscopie rigide bilatérale au cours de la même séance opératoire. Prog Urol 2008; 18:580-5. [DOI: 10.1016/j.purol.2008.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2007] [Accepted: 06/16/2008] [Indexed: 10/21/2022]
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Predictive Factors for Intraoperative Complications in Semirigid Ureteroscopy: Analysis of 1235 Ballistic Ureterolithotripsies. Urology 2008; 72:770-4. [DOI: 10.1016/j.urology.2008.05.042] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2007] [Revised: 04/15/2008] [Accepted: 05/13/2008] [Indexed: 11/18/2022]
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Yifeng J, Shujie X, Hongbin S, Yaoting X, Jie F, Xiaoda T. Use of free peritoneal and bladder mucosal grafts as ureteral mucosa substitutes for management of avulsion of the ureteral mucosa in a dog model. J Endourol 2008; 22:729-34. [PMID: 18419218 DOI: 10.1089/end.2007.0136] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND PURPOSE Avulsion of the ureteral mucosa is one of the most serious complications of ureteroscopy and considered challenging for urologic surgeons. In this study, we developed two novel methods to reconstruct the impaired ureter. MATERIALS AND METHODS After ureteral mucosal avulsion in a canine model, ureteral reconstruction was performed in one of three ways: free tabularized peritoneal grafts (group A, n = 6); bladder mucosal grafts (group B, n = 6); or simple stenting technique (control group [n = 3]). At postoperative week 10, evaluation with intravenous urography (IVU) was followed by harvesting of reconstructed ureter segments for pathologic analysis. RESULTS IVU showed nonvisualization of the collecting system of the affected side and histologic evaluation showed imperforation or stenosis in all animals in the control group. IVU showed good visualization of the reconstructed ureter without stenosis in group A and in most animals in group B. There was a mild dilation but no obvious stenosis in one animal in group B. Microscopically, all the reconstructed ureteral lumens were uniformly lined with transitional epithelium. Extensive neovascularity was evident in the subepithelial layer with a streaming of fibroblasts toward the neomucosa. CONCLUSION Replacing the avulsed mucosa in the injured ureter with tubularized peritoneal free grafts or bladder mucosal grafts may be an optimal method to manage avulsion of the ureteral mucosa.
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Affiliation(s)
- Jing Yifeng
- Department of Urology, First Affiliated People's Hospital of Shanghai Jiao Tong University, Shanghai, China
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15
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Karadag MA, Tefekli A, Altunrende F, Tepeler A, Baykal M, Muslumanoglu AY. Is Routine Radiological Surveillance Mandatory After Uncomplicated Ureteroscopic Stone Removal? J Endourol 2008; 22:261-6. [DOI: 10.1089/end.2006.0445] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mert Ali Karadag
- Department of Urology, Haseki Teaching and Research Hospital, Istanbul, Turkey
| | - Ahmet Tefekli
- Department of Urology, Haseki Teaching and Research Hospital, Istanbul, Turkey
| | - Fatih Altunrende
- Department of Urology, Haseki Teaching and Research Hospital, Istanbul, Turkey
| | - Abdulkadir Tepeler
- Department of Urology, Haseki Teaching and Research Hospital, Istanbul, Turkey
| | - Murat Baykal
- Department of Urology, Haseki Teaching and Research Hospital, Istanbul, Turkey
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Rapoport D, Perks AE, Teichman JM. Ureteral Access Sheath Use and Stenting in Ureteroscopy: Effect on Unplanned Emergency Room Visits and Cost. J Endourol 2007; 21:993-7. [DOI: 10.1089/end.2006.0236] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Daniel Rapoport
- Division of Urology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alexandra E. Perks
- Division of Urology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Joel M.H. Teichman
- Division of Urology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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Rané A, Kommu SS, Kandaswamy SV, Rao P, Aron M, Kumar R, Gupta N. Initial clinical evaluation of a new pneumatic intracorporeal lithotripter. BJU Int 2007; 100:629-32. [PMID: 17578519 DOI: 10.1111/j.1464-410x.2007.07003.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To test the clinical efficacy of the StoneBreaker (LMA Urology, Gland, Switzerland), a novel device which is much more compact and ergonomic than other current intracorporeal pneumatic lithotripters, and more powerful, generating contact pressures of up to 2.9 MPa, thereby enabling better pneumatic fragmentation and removal of stones during percutaneous nephrostolithotomy (PCNL), ureteroscopic stone fragmentation (USF) and vesical stone lithotripsy (VL). PATIENTS AND METHODS We prospectively evaluated 102 patients, comprising 49 PCNLs, 48 USFs and 5 VLs, treated using the StoneBreaker. The stone size, position, number of shocks required to fragment the stone to effect complete clearance, and degree of retropulsion were documented in each case; any evidence of urothelial trauma was noted. RESULTS All stones were satisfactorily fragmented and all patients rendered stone-free. Very few shocks were required, and documented retropulsion was minor. There was no evidence of consequential urothelial trauma at the end of any procedure. CONCLUSION The StoneBreaker appears to be a safe, effective, robust and compact device for intracorporeal lithotripsy.
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Affiliation(s)
- Abhay Rané
- Department of Urology, East Surrey Hosptial, Redhill, Surrey, UK.
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18
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Mariani S, Matarazzo E, De Dominicis M, Capozza N, Caione P. Efficacy and safety of endoscopic treatment of ureteral stones in pediatric age. Urologia 2007. [DOI: 10.1177/039156030707400206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Ureteroscopy procedures in pediatric age are becoming more and more common thanks to the availability of smaller caliber instruments, and of improved endoscopic techniques. The efficacy of this procedure in pediatric age is still discussed nowadays. This paper aims at reviewing all cases of ureteral lithiasis treated by ureteroscopy plus intracorporeal lithotripsy (ULT), as well as verifying efficacy and safety of this procedure in pediatric age. Materials and Methods From July 2002 to May 2006, 37 patients (26 female, 11 male; mean age 7.4 years; range 2–17) were treated by ULT for ureteral stones: 30 in distal, 4 in middle and 3 in proximal ureter. Median size of stones was 7mm (range 3–13mm). Dilation of the ureteral meatus was necessary in 2 patients only. Endoscopic procedure was similar to adult patients. Outcomes were statistically compared with current literature data. Results In 36 (97.3%) out of 37 patients ULT proved successful. All patients having stones in distal (30) and middle (4) ureter were stone-free at the end of treatment. Stone migration into the kidney pelvis occurred in 1 patient with proximal ureter stones (66.7% stone-free rate): an ESWL treatment was therefore performed. 1 case only (2.7%) developed a perioperative complication (stone migration). Hematuria and flank pain in 4 patients (10.8%) were the most common reported post-operative complications. A stone-free state was confirmed at 1 and 3 months for all 36 patients. There was no evidence of ureteral strictures and/or ureteral refluxes. Conclusions Smaller caliber ureteroscopes confirmed ULT as the first-choice treatment procedure in children affected by ureteral lithiasis, thanks to its efficacy and safety.
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Affiliation(s)
- S. Mariani
- UO Chirurgia Urologica, Dipartimento Nefrologia-Urologia, Ospedale Pediatrico “Bambino Gesù”, IRCCS Roma
| | - E. Matarazzo
- UO Chirurgia Urologica, Dipartimento Nefrologia-Urologia, Ospedale Pediatrico “Bambino Gesù”, IRCCS Roma
| | - M. De Dominicis
- UO Chirurgia Urologica, Dipartimento Nefrologia-Urologia, Ospedale Pediatrico “Bambino Gesù”, IRCCS Roma
| | - N. Capozza
- UO Chirurgia Urologica, Dipartimento Nefrologia-Urologia, Ospedale Pediatrico “Bambino Gesù”, IRCCS Roma
| | - P. Caione
- UO Chirurgia Urologica, Dipartimento Nefrologia-Urologia, Ospedale Pediatrico “Bambino Gesù”, IRCCS Roma
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Tugcu V, Gürbüz G, Aras B, Gurkan L, Otunctemur A, Tasci AI. Primary ureteroscopy for distal-ureteral stones compared with ureteroscopy after failed extracorporeal lithotripsy. J Endourol 2007; 20:1025-9. [PMID: 17206896 DOI: 10.1089/end.2006.20.1025] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND PURPOSE We reviewed our experiences with ureteroscopic pneumatic lithotripsy (URS-PL) for the treatment of distal-ureteral stones and investigated whether failed extracorporeal shockwave lithotripsy (SWL) is a limiting factor for the ureteroscopic procedure. PATIENTS AND METHODS We retrospectively studied the medical records of 375 patients treated with URS-PL from January 1999 to September 2005 in our clinic. Of these patients, 213 were treated with URS-PL primarily (group 1), whereas the remaining 162 patients had undergone SWL unsuccessfully before URS-PL was performed (group 2). We used 9F or 9.5F rigid instruments and the Vibrolith (Elmed, Ankara, Turkey). RESULTS In group 1, 206 patients (96.7%) were treated successfully with URS alone, as were 155 patients (95.6%) in group 2. Impacted stones were observed in 21 patients in group 1 (9.85%) and in 57 patients in group 2 (35.1%). The average operating time was 33.19 +/- 9.039 minutes in group 1 and 57.42 +/- 8.757 minutes in group 2. The stone-free rates of the two groups were significantly different on the first postoperative day, but this difference decreased to an insignificant level at the end of the first month. CONCLUSION When SWL fails, URS-PL is as safe and effective as primary URS. Pneumatic lithotripsy also seems to be effective for impacted stones.
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Affiliation(s)
- Volkan Tugcu
- Department of Urology, Baklrkoy Training and Research Hospital, Istanbul, Turkey.
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Tunc L, Kupeli B, Senocak C, Alkibay T, Sözen S, Karaoglan U, Bozkirli I. Pneumatic lithotripsy for large ureteral stones: is it the first line treatment? Int Urol Nephrol 2007; 39:759-64. [PMID: 17318351 DOI: 10.1007/s11255-006-9084-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2006] [Accepted: 07/11/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of pneumatic lithotripsy (PL) with ureteroscopy in the treatment of large ureteral stones. METHODS We reviewed, retrospectively, the records of 156 patients (122 male, 34 female) who had ureteral calculi larger than 10 mm that were treated with PL. Of these patients, 41 (26.3%) were treated primarily with PL and 115 (73.7%) were treated secondarily after unsuccessful extracorporeal shock wave lithotripsy (SWL). The mean stone diameter was 12.87 mm (range 10-20.5 mm). Results were evaluated 3 months after treatment by excretory urography and/or ultrasonography. RESULTS The overall stone-free and fragmentation rates (FRs) were 85.2 and 92.3%, respectively. Corresponding values were 60 and 84% for upper ureteral stones, 79.5 and 89.7% for middle ureter stones and 94.5 and 95.6% for lower ureteral stones, respectively. The main complications were migration of a complete stone or of fragments (7.1%), urosepsis (4.5%) and ureteral perforation (1.3%). CONCLUSIONS Although SWL is generally accepted as the first treatment option for ureteral stones because of its non-invasive nature, PL with ureteroscopy seems to be a good alternative with the advantage of higher success rates and quick stone clearance. Especially when we take the importance of quick stone removal into account for larger ureteral stones, which are more likely to have obstruction, impaction, or infection, we believe that PL may be chosen as the first line treatment rather than SWL for stones larger than 10 mm.
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Affiliation(s)
- Lutfi Tunc
- Urology, gazi university, cukurambar mah. 38. cad. 3/21, Balgat, Ankara, 06520, Turkey.
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Hara N, Koike H, Bilim V, Takahashi K, Nishiyama T. Efficacy of Extracorporeal Shockwave Lithotripsy with Patients Rotated Supine or Rotated Prone for Treating Ureteral Stones: A Case-Control Study. J Endourol 2006; 20:170-4. [PMID: 16548722 DOI: 10.1089/end.2006.20.170] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To improve the therapeutic efficacy of extracorporeal shockwave lithotripsy (SWL) for ureteral stones by attempting semilateral/rotated approaches. There has been no study that shows the advantage of rotated positions. PATIENTS AND METHODS Two hundred forty-eight (group 1) and 156 (group 1R) patients with proximal-ureteral stones were treated by the Dornier Lithotriptor U15/50 in the supine and rotated-supine position, respectively. When residual calculi remained in the middle-distal ureter, group 1 subjects underwent subsequent sessions in the ordinary prone position, and Group 1R patients were treated in the rotated-prone position. Sixty-two (group 2) and 60 (group 2R) patients with primary middle-ureteral stones were treated in the prone and rotated- prone position, respectively, while 110 (group 3) and 98 (group 3R) patients with distal-ureteral stones were treated in the prone and rotated-prone position, respectively. RESULTS Although the stone-free rate was not different in group 1 (94.8%) and 1R (97.4%), the number of sessions required for Group 1R patients to be stonefree (mean 1.49) was less than for Group 1 patients (mean 1.74; p=0.023). Group 1R patients tolerated a higher shockwave intensity than group 1 patients for sessions in the proximal ureter (p=0.042). The stone-free rate for Groups 1 and 1R for booster sessions in the middle- distal ureter was 85.4% and 100%, respectively (p=0.059). The stone-free rate for groups 2R (95.0%) and 3R (98.0%) was higher than that for groups 2 (83.9%) and 3 (89.1%) (p=0.046; p=0.011). CONCLUSION These effortless modifications bring about a superior outcome when treating ureteral calculi with SWL.
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Affiliation(s)
- Noboru Hara
- Department of Urology, Labor Welfare Niigata Rousai Hospital, Joetsu, and Department of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Japan.
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Bibliography. Current world literature. Minimally invasive surgery in urology. Curr Opin Urol 2006; 16:112-7. [PMID: 16479214 DOI: 10.1097/01.mou.0000193398.85092.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lee YK, Park DS, Hong YK. Ureteroscopic Lithotripsy with Pneumatic Lithotriptor: 274 Cases. Korean J Urol 2006. [DOI: 10.4111/kju.2006.47.6.625] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Yong Kyu Lee
- Departments of Urology, Bundang CHA Hospital, Pochon CHA University College of Medicine, Seongnam, Korea
| | - Dong Soo Park
- Departments of Urology, Bundang CHA Hospital, Pochon CHA University College of Medicine, Seongnam, Korea
| | - Young Kwon Hong
- Departments of Urology, Bundang CHA Hospital, Pochon CHA University College of Medicine, Seongnam, Korea
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LiteratureWatch. J Endourol 2005; 19:1045-62. [PMID: 16253079 DOI: 10.1089/end.2005.19.1045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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