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Zia H, Zadeh SST, Khatami F, Aghamir SMK. Laparoscopic ureterolithotomy for large lower ureteral stone: a case series report. AFRICAN JOURNAL OF UROLOGY 2021. [DOI: 10.1186/s12301-021-00201-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Identifying the precise location of the lower ureter is crucial in not only ureteral surgeries but also the other surgeries that may cause ureteral injury. Although a variety of approaches have been applied to detect the location of the lower ureter, the majority of them had an association with several complications or be difficult to perform perfectly or be time-consuming.
Case presentation
Seven patients with distal ureteric stones of the size ranged from 2 to 3 cm. All patients entered the study after signing the informed consent, and the case report is based on CARE guidelines. After specifying the inner ring of the inguinal canal, the posterior peritoneum was opened and dissected from an area of 2 cm medial and 2 cm inferior to the inner ring. Thereafter, the stone was extracted from the precise location of them, which was identified by ureteral pinching.
Conclusion
We assumed that we were easily able to identify the site of the lower ureter through 2 cm medial and 2 cm inferior to the inner ring. The result of our study on seven patients demonstrated that this maneuver can minimize the time of surgery and no complications have been seen while this approach was applied.
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Patterns of opioid analgesic use in the U.S., 2009 to 2018. Pain 2021; 162:1060-1067. [PMID: 33021566 DOI: 10.1097/j.pain.0000000000002101] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 09/28/2020] [Indexed: 11/26/2022]
Abstract
ABSTRACT Although overall outpatient dispensing of opioid analgesic prescriptions has declined, there may still be overprescribing. Understanding how many opioid analgesic units, primarily tablets, are dispensed with the intention of shorter-vs longer-term use can inform public health interventions. We used pharmacy prescription data to estimate the number of opioid analgesic tablets dispensed annually in the U.S. We studied patterns of new use of opioid analgesics by evaluating how many opioid analgesic prescriptions and tablets were dispensed to patients with no opioid analgesic prescriptions in the previous year. Estimated opioid analgesic tablets dispensed declined from a peak of 17.8 billion in 2012 to 11.1 billion in 2018. Patients newly starting opioid analgesics declined from 47.4 million patients in 2011 to 37.1 million patients in 2017. Approximately 40% fewer tablets were dispensed within a year to patients starting in 2017 (2.4 billion) compared with 2011 (4.0 billion). In 2011, patients with ≥5 opioid analgesic prescriptions within a year were dispensed 2.2 billion tablets (55% of all tablets in our study). This declined by 52% to 1.1 billion tablets (44% of all tablets) in 2017. Tablets dispensed within a year to patients with <5 opioid analgesic prescriptions declined by 26% from 2011 to 2017. Patients with ≥5 prescriptions comprised a small and decreasing proportion of all patients newly starting therapy. However, these patients received almost half of all tablets dispensed within a year to patients in our study, despite a larger decline than tablets dispensed to patients with <5 prescriptions within a year.
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Technique, complications, and outcomes of pediatric urolithiasis management at a tertiary care hospital: evolving paradigms over the last 15 years. J Pediatr Urol 2019; 15:665.e1-665.e7. [PMID: 31648889 DOI: 10.1016/j.jpurol.2019.09.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 09/10/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Despite technological advancements, there is lack of consensus for the standard treatment modalities for pediatric urolithiasis. OBJECTIVE The primary objective was to review the management of pediatric urolithiasis over the last 15 years in terms of technical modifications, surgical outcomes, and complications. The secondary objective was to compare the efficacy and outcomes of standard percutaneous nephrolithotomy (PCNL) and mini-PCNL for renal and upper ureteric calculi. STUDY DESIGN Medical records of all patients aged <18 years who presented to the authors' tertiary care hospital in northern India between August 2003 and December 2018 were reviewed retrospectively. Before 2010, all PCNLs performed were standard PCNL, whereas after 2010, most PCNLs performed were mini-PCNL. Thus, the patients were divided into two groups: group A (patients up to 2010) and group B (patients after 2010). These were compared for the type of treatment, success rate, and complications. The outcomes of surgical management of lower ureteric and vesical calculi were also reviewed. RESULTS During this period, there were 580 children with urolithiasis (677 stone sites). There were 265 patients (321 stone sites) in group A and 315 patients (356 stone sites) in group B. The median age was seven years (range: 3-18 years). The most common location of calculus was the collecting system of the kidney (n = 398, 58.8%). A total of 175 stone sites (25.8%) were located in the ureter. Urinary bladder calculi were seen in 43 (6.4%) patients. Multiple stones were seen in 61 sites (9.0%). A total of 115 patients in group A underwent standard PCNL, whereas in group B, nine patients underwent standard PCNL and 129 underwent mini-PCNL. Group B had a significantly higher stone clearance rate for mini-PCNL (P < 0.001). Minor complications (grades 1 and 2) accounted for a majority of overall complications in both groups (87.5% in group A and 94.9% in group B). DISCUSSION Mini-PCNL is an excellent option for renal calculi in children as it offers dual advantages of improved stone clearance and reduced major complications such as bleeding. Ureteroscopic lithotripsy has been established as the standard for small lower ureteric calculi. CONCLUSION For renal and upper ureteric calculi, mini-PCNL has evolved as standard technique with a high stone-free rate and minimum complications compared with standard PCNL. Extracorporeal shockwave lithotripsy and ureteroscopic lithotripsy (URSL)/retrograde intrarenal surgery are acceptable alternatives for smaller stone burden. For lower ureteric and vesical calculi, retrograde approaches such as cystolithotripsy and URSL have now become the standard of care.
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Nour HH, Elgobashy SE, Elkholy A, Kamal AM, Roshdy MA, Elbaz AG, Riad E. Laparoscopic management of distal ureteric stones in a bilharzial ureter: Results of a single-centre prospective study. Arab J Urol 2015; 13:182-6. [PMID: 26413344 PMCID: PMC4563007 DOI: 10.1016/j.aju.2015.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 06/08/2015] [Accepted: 06/15/2015] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To determine the efficacy and safety of the laparoscopic management of an impacted distal ureteric stone in a bilharzial ureter, as bilharzial ureters are complicated by distal stricture caused by the precipitation of bilharzial ova in the distal ureter. These cases are associated with poorly functioning and grossly hydronephrotic kidneys that hinder the endoscopic manipulation of the coexistent distal high burden of, and long-standing, impacted stones. PATIENTS AND METHODS We used laparoscopic ureterolithotomy, with four trocars, to manage 51 bilharzial patients (33 men and 18 women; mean age 40.13 years) with distal ureteric stones. The ureter was opened directly over the stone and the stone was extracted. A JJ stent was inserted into the ureter, which was then closed with a 4-0 polyglactin running suture. RESULTS The mean stone size was 2.73 cm. Conversion to open surgery was required in only one patient. The mean operative duration was 92 min, the postoperative pain score was 20-60, the mean (range) number of analgesic requests after surgery was 1.72 (1-3), comprising once in 21 patients, twice in 23 and thrice in seven. The mean hospital stay was 2.74 days, and the total duration of follow-up was 7-12 months. The stone recurred in four patients and a ureteric stricture was reported in two. All patients were rendered stone-free. CONCLUSION Laparoscopy is a safe and effective minimally invasive procedure for distal ureteric stones in a bilharzial ureter with hydronephrosis.
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Affiliation(s)
- Hani H. Nour
- Urology Department, Theodor Bilharz Research Institute, Giza, Egypt
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Garg M, Singh V, Sinha RJ, Sankhwar SN, Kumar M, Kumar A, Prakash J, Kumar P, Pandey M. Prospective Randomized Comparison of Open versus Transperitoneal Laparoscopic Ureterolithotomy: Experience of a Single Center from Northern India. Curr Urol 2013; 7:83-9. [PMID: 24917764 DOI: 10.1159/000356254] [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: 04/21/2013] [Accepted: 08/08/2013] [Indexed: 11/19/2022] Open
Abstract
AIM Prospective randomized study on transperitoneal laparoscopic ureterolithotomy (TPLU) versus open ureterolithotomy (OU) for treatment of large impacted ureteric stones (≥ 1.5 cm) and assessment of overall results. MATERIAL & METHODS In a prospective study between 2010 to 2012, 30 patients underwent TPLU and 30 OU based on 1:1 randomization. The operation was indicated primarily in 44 cases or after failed shock-wave lithotripsy/ureteroscopy in 16 cases. Two groups were compared for operative time, success rate, visual pain score, analgesic requirement, hospital stay, and postoperative complications. Statistical analysis was performed with SPSS® version 16.0 using Fisher exact or Mann-Whitney U tests with p < 0.05 considered statistically significant. RESULTS The difference in visual pain score (6.2 in TPLU group vs 3.1 in OU group on day 1; 4.8 vs. 2.4 on day 2) and tramadol requirements (184.32 mg in TPLU group vs. 150.87 mg in OU group on day 1; 97.34 mg vs. 65.56 mg on day 2) were statistically significant and more in OU. Hospital stay and convalescence were significantly lower in the TPLU. However, stone removal in one attempt was similar in both the groups. CONCLUSION Although successful stone removal rates are equal in both groups, TPLU is associated significantly with less postoperative pain, less analgesic requirement, shorter hospital stay and short convalescence in comparison to OU.
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Affiliation(s)
- Manish Garg
- Department of Urology, King George Medical University, Lucknow, India
| | - Vishwajeet Singh
- Department of Urology, King George Medical University, Lucknow, India
| | - Rahul J Sinha
- Department of Urology, King George Medical University, Lucknow, India
| | - Satya N Sankhwar
- Department of Urology, King George Medical University, Lucknow, India
| | - Manoj Kumar
- Department of Urology, King George Medical University, Lucknow, India
| | - Amit Kumar
- Department of Urology, King George Medical University, Lucknow, India
| | - Jai Prakash
- Department of Urology, King George Medical University, Lucknow, India
| | - Pradeep Kumar
- Department of Urology, King George Medical University, Lucknow, India
| | - Mohit Pandey
- Department of Surgery, Era Medical College, Lucknow, India
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Tugcu V, Simsek A, Kargi T, Polat H, Aras B, Tasci AI. Retroperitoneal Laparoendoscopic Single-site Ureterolithotomy Versus Conventional Laparoscopic Ureterolithotomy. Urology 2013; 81:567-72. [DOI: 10.1016/j.urology.2012.11.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Revised: 10/23/2012] [Accepted: 11/19/2012] [Indexed: 12/18/2022]
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Al-Sayyad A. Laparoscopic transperitoneal ureterolithotomy for large ureteric stones. Urol Ann 2012; 4:34-7. [PMID: 22346099 PMCID: PMC3271448 DOI: 10.4103/0974-7796.91619] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Accepted: 04/21/2011] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To evaluate the efficacy and safety of laparoscopic transperitoneal ureterolithotomy for management of large proximal ureteric stones. MATERIALS AND METHODS Medical records of patients who underwent laparoscopic transperitoneal ureterolithotomy for proximal ureteral stones ≥2 cm were reviewed retrospectively. Patients' characteristics, stone characteristics, perioperative and follow-up data were studied. Patients with stones <2 cm in size, previous transperitoneal surgical procedure, or follow-up duration <6 months were excluded from the study. RESULTS Twelve patients (mean age = 52.9 ± 12 years) with large upper ureteric stones (mean stone largest diameter = 39 ± 13 mm) were included. Nine patients had single stone, 2 patients had two stones, and 1 patient had large impacted stone with 2 small stones floating above. Mean operative time was 107 ± 49.5 min with mean blood loss of 60.5 ± 19.2 cc. Mean total pain score was 38.4 ± 5.5 (100 point scale) and mean time till resuming oral intake was 3.6 ± 0.5 h. Mean duration of hospital stay was 2.6 ± 1.4 days and mean duration of stenting was 7.3 ± 2 weeks. Throughout a mean duration of follow-up of 14.8 ± 7.6 months, 100% stone clearance rate was achieved with no recurrence. One patient developed a ureteric stricture treated by laser endoureterotomy and stenting for 6 weeks and responded without re-stricture formation. CONCLUSION Laparoscopic transperitoneal ureterolithotomy is a safe and effective approach for selected patients with large proximal ureteric stones with reduced postoperative pain and short hospital stay, and should be considered as a treatment option for such stones.
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Affiliation(s)
- Ahmed Al-Sayyad
- Department of Urology, King Abdulaziz University, Jeddah, Saudi Arabia
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Mandhani A, Kapoor R. Laparoscopic ureterolithotomy for lower ureteric stones: Steps to make it a simple procedure. Indian J Urol 2011; 25:140-2. [PMID: 19468448 PMCID: PMC2684310 DOI: 10.4103/0970-1591.45556] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Despite advances in endoscopy and availability of holmium lithotripsy there are ureteric stones, which primarily need to be treated with laparoscopic ureterolithotomy. Literature is replete with the stone retrieval in upper ureteric stone but there are a very few reports on stones removal from ureter below the lower sacroiliac joint. Putting a double J stent before starting the procedure does not give any extra advantage; rather it takes away significant operating room time. This point of technique describes port placement strategy, proximal ureteral occlusion; stone localization, ureterotomy, stone retrieval and laparoscopic stenting are the important steps where one would like to be careful enough to complete the procedure successfully.
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Affiliation(s)
- Anil Mandhani
- Department of Urology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh-226 014, India
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Laparoscopic ureterolithotomy: minimally invasive second line treatment. Int Urol Nephrol 2010; 43:651-4. [DOI: 10.1007/s11255-010-9872-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2010] [Accepted: 11/02/2010] [Indexed: 10/18/2022]
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Farooq Qadri SJ, Khan N, Khan M. Retroperitoneal laparoscopic ureterolithotomy--a single centre 10 year experience. Int J Surg 2010; 9:160-4. [PMID: 21059419 DOI: 10.1016/j.ijsu.2010.10.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Revised: 09/23/2010] [Accepted: 10/22/2010] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The management of ureteric stones has standardized with the introduction of ureteroscopy (URS), shock wave lithotripsy(SWL) and HO:YAG laser. But still one may need to use laparoscopic ureterolithotomy for failed URS/SWL cases or as a primary procedure for large impacted stones. At centers which do not have access to expensive equipment needed in URS and SWL, laparoscopic ureterolithotomy may be used as a primary procedure. The aim of this article is to share our 10 year long experience and the lessons learnt from performing retroperitoneal laparoscopic ureterolithotomy (RLU) which we believe is the better route than transperitoneal one. METHODS From January 2000 to January 2010, 820 cases of ureteric stones were managed at our centre. RLU was performed for 126 cases. Most common indication for RLU was as a primary procedure for large impacted upper or mid ureteric stones 86(68.25%) followed by failed URS in 28(22.23%) and failed SWL in 12(9.52%) cases. RESULTS With a mean operative time of 88(45-120) min RLU was successful in 123(97.6%) cases. There was no major intra or postoperative complication. Most common complication of the procedure was the inadvertent peritoneotomy 15(11.9%). Mean hospital stay was 2.8(2-13) days and there were 3(2.38%) cases of prolonged urinary drainage which were managed conservatively. CONCLUSION RLU is a very effective minimally invasive modality of treating ureteral calculi. Unlike URS this procedure can give 100% stone clearance in one session. Its role in advanced urological centers is primarily as a salvage procedure for failed URS/SWL but in developing nations which usually do not have access to URS and SWL RLU can be used as a primary procedure for managing upper and mid ureteric stones with excellent results and with minimal resources.
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Fan T, Xian P, Yang L, Liu Y, Wei Q, Li H. Experience and learning curve of retroperitoneal laparoscopic ureterolithotomy for upper ureteral calculi. J Endourol 2010; 23:1867-70. [PMID: 19811058 DOI: 10.1089/end.2008.0536] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
PURPOSE To summarize our experience and evaluate the learning curve of retroperitoneal laparoscopic ureterolithotomy of the upper ureter. PATIENTS AND METHODS Between May 2004 and May 2007, 40 patients underwent retroperitoneal laparoscopic ureterolithotomy of the upper ureter. We divided the first and last 20 patients into group I and group II. There was no statistical difference in stone size between groups. Operative time and complications were measured as a basis for the assessment of the learning curve. RESULTS In group I, the complication rate was 15% (3/20), including two patients whose procedure was converted to open surgery because of intraoperative bleeding, and one patient who experienced urine leakage because of a displaced Double-J ureteral stent. In group II, no postoperative complications occurred, while the mean operative time was significantly shorter compared with the earlier operations (65 vs 120 min). CONCLUSION Retroperitoneal laparoscopic ureterolithotomy is safe and effective for large or impacted stones of the upper ureter. It is associated with a short learning curve in the setting of an active laparoscopic practice for selected patients.
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Affiliation(s)
- Tianyong Fan
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China.
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Almeida GL, Heldwein FL, Graziotin TM, Schmitt CS, Telöken C. Estudio prospectivo que compara laparoscopia y cirugía abierta para el tratamiento de cálculos ureterales impactados. Actas Urol Esp 2009; 33:1108-14. [DOI: 10.1016/s0210-4806(09)73189-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hruza M, Schulze M, Teber D, Gözen AS, Rassweiler JJ. Laparoscopic Techniques for Removal of Renal and Ureteral Calculi. J Endourol 2009; 23:1713-8. [PMID: 19785553 DOI: 10.1089/end.2009.1539] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Marcel Hruza
- Department of Urology, SLK-Kliniken Heilbronn GmbH, Teaching Hospital of Heidelberg University, Heilbronn, Germany
| | - Michael Schulze
- Department of Urology, SLK-Kliniken Heilbronn GmbH, Teaching Hospital of Heidelberg University, Heilbronn, Germany
| | - Dogu Teber
- Department of Urology, SLK-Kliniken Heilbronn GmbH, Teaching Hospital of Heidelberg University, Heilbronn, Germany
| | - Ali Serdar Gözen
- Department of Urology, SLK-Kliniken Heilbronn GmbH, Teaching Hospital of Heidelberg University, Heilbronn, Germany
| | - Jens Jochen Rassweiler
- Department of Urology, SLK-Kliniken Heilbronn GmbH, Teaching Hospital of Heidelberg University, Heilbronn, Germany
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Saussine C, Lechevallier E, Traxer O. Lithiase urinaire et laparoscopie. Traitement des calculs situés dans l’uretère. Prog Urol 2008; 18:943-7. [DOI: 10.1016/j.purol.2008.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2008] [Accepted: 09/02/2008] [Indexed: 10/21/2022]
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Abstract
INTRODUCTION The increasing spread and technical enhancement of endourological methods has led to displacement of the surgical therapy of renal and ureteral calculi. MATERIALS AND METHODS Based on a review of current literature, we describe indications, technique, and clinical importance of the open and laparoscopic management of urolithiasis. RESULTS In Europe and North America, the surgical therapy of urolithiasis only plays a role in cases of very large or hard stones, after failure of shock wave lithotripsy, percutaneous nephrolithotripsy, or ureteroscopic stone removal, and in cases of abnormal renal anatomy, i.e., only in a few percent of all stone therapies. However, in developing countries and emerging markets with different structure and funding of the health care system where the methods of endourology are not readily available, these techniques still have a higher importance. Particularly in Europe, laparoscopic surgery is emerging because calculi can be removed from almost all locations in the kidney and ureter using a transperitoneal or retroperitoneal access. Functional outcomes and complication rates are comparable. The benefits of laparoscopy are less postoperative pain, shorter hospital stay, faster convalescence, and better cosmetic results. CONCLUSIONS Although procedures for open and laparoscopic removal of renal and ureteral calculi are only performed in rare cases in daily urological practice, they are superior to the endourological techniques in some circumstances. Therefore, they should still be part of the urologist's skills.
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