1
|
Moretto S, Saita A, Scoffone CM, Talso M, Somani BK, Traxer O, Angerri O, Knoll T, Liatsikos E, Herrmann TRW, Ulvik Ø, Skolarikos A, Cracco CM, Keller EX, Paciotti M, Piccolini A, Uleri A, Tailly T, Carmignani L, Pietropaolo A, Corrales M, Lughezzani G, Lazzeri M, Fasulo V, De Coninck V, Arena P, Nagele U, Ferretti S, Kronenberg P, Perez-Fentes D, Osther PJ, Goumas IK, Acquati P, Ajayi L, Diana P, Casale P, Buffi NM. Ureteral stricture rate after endoscopic treatments for urolithiasis and related risk factors: systematic review and meta-analysis. World J Urol 2024; 42:234. [PMID: 38613692 DOI: 10.1007/s00345-024-04933-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 03/15/2024] [Indexed: 04/15/2024] Open
Abstract
PURPOSE We aimed to accurately determine ureteral stricture (US) rates following urolithiasis treatments and their related risk factors. METHODS We conducted a systematic review and meta-analysis following the PRISMA guidelines using databases from inception to November 2023. Studies were deemed eligible for analysis if they included ≥ 18 years old patients with urinary lithiasis (Patients) who were subjected to endoscopic treatment (Intervention) with ureteroscopy (URS), percutaneous nephrolithotomy (PCNL), or shock wave lithotripsy (SWL) (Comparator) to assess the incidence of US (Outcome) in prospective and retrospective studies (Study design). RESULTS A total of 43 studies were included. The pooled US rate was 1.3% post-SWL and 2.1% post-PCNL. The pooled rate of US post-URS was 1.9% but raised to 2.7% considering the last five years' studies and 4.9% if the stone was impacted. Moreover, the pooled US rate differed if follow-ups were under or over six months. Patients with proximal ureteral stone, preoperative hydronephrosis, intraoperative ureteral perforation, and impacted stones showed higher US risk post-endoscopic intervention with odds ratio of 1.6 (P = 0.05), 2.6 (P = 0.009), 7.1 (P < 0.001), and 7.47 (P = 0.003), respectively. CONCLUSIONS The overall US rate ranges from 0.3 to 4.9%, with an increasing trend in the last few years. It is influenced by type of treatment, stone location and impaction, preoperative hydronephrosis and intraoperative perforation. Future standardized reporting and prospective and more extended follow-up studies might contribute to a better understanding of US risks related to calculi treatment.
Collapse
Affiliation(s)
- S Moretto
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy.
| | - A Saita
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - C M Scoffone
- Department of Urology, Cottolengo Hospital, Turin, Italy
| | - M Talso
- Department of Urology, Luigi Sacco University Hospital, Milan, Italy
| | - B K Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - O Traxer
- Department of Urology, Sorbonne Université, Paris, France
| | - O Angerri
- Department of Urology, Fundació Puigvert Univ. Autonoma de Barcelona, Barcelona, Spain
| | - T Knoll
- Department of Urology, Sindelfingen Medical Center, University of Tübingen, Tübingen, Germany
| | - E Liatsikos
- Department of Urology, University Hospital of Patras, Patras, Greece
| | - T R W Herrmann
- Department of Urology, Spital Thurgau AG, Frauenfeld, Switzerland
- Hannover Medical School, Hannover, Germany
- Division of Urology, Department of Surgical Sciences, Stellenbosch University, Western Cape, South Africa
| | - Ø Ulvik
- Department of Urology, Haukeland University Hospital, Bergen, Norway
| | - A Skolarikos
- Second Department of Urology, Sismanoglio Hospital, National and Kapodistrian University of Athen, Athens, Greece
| | - C M Cracco
- Department of Urology, Cottolengo Hospital, Turin, Italy
| | - E X Keller
- Department of Urology, University Hospital Zurich, Zurich, Switzerland
| | - M Paciotti
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - A Piccolini
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - A Uleri
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - T Tailly
- Department of Urology, University Hospital Ghent, Ghent, Belgium
| | - L Carmignani
- Department of Urology, University of Milan, Milan, Italy
| | - A Pietropaolo
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - M Corrales
- Department of Urology, Sorbonne Université, Paris, France
| | - G Lughezzani
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - M Lazzeri
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - V Fasulo
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - V De Coninck
- Department of Urology, AZ Klina, Brasschaat, Belgium
| | - P Arena
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - U Nagele
- Department of Urology, General Hospital Hall in Tirol, Hall in Tirol, Austria
| | - S Ferretti
- Department of Urology, Azienda Ospedaliero-Universitaria di Modena, Baggiovara, Italy
| | - P Kronenberg
- Department of Urology, Hospital CUF Descobertas, Lisbon, Portugal
| | - D Perez-Fentes
- Department of Urology, University Hospital Complex of Santiago de Compostela, Santiago, Spain
| | - P J Osther
- Department of Urology, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - I K Goumas
- Department of Urology, Istituto Clinico Beato Matteo, Vigevano, Italy
| | - P Acquati
- Department of Urology, IRCCS Policlinico San Donato, Milan, Italy
| | - L Ajayi
- Department of Urology, Royal Free London NHS Foundation Trust, London, UK
| | - P Diana
- Department of Urology, Fundació Puigvert Univ. Autonoma de Barcelona, Barcelona, Spain
| | - P Casale
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - N M Buffi
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| |
Collapse
|
2
|
Lombardo R, Tzelves L, Geraghty R, Davis NF, Neisius A, Petřík A, Gambaro G, Türk C, Somani B, Thomas K, Skolarikos A. Follow-up of urolithiasis patients after treatment: an algorithm from the EAU Urolithiasis Panel. World J Urol 2024; 42:202. [PMID: 38546854 DOI: 10.1007/s00345-024-04872-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/08/2024] [Indexed: 04/02/2024] Open
Abstract
OBJECTIVE To develop a follow-up algorithm for urinary stone patients after definitive treatment. MATERIALS AND METHODS The panel performed a systematic review on follow-up of urinary stone patients after treatment (PROSPERO: CRD42020205739). Given the lack of comparative studies we critically evaluated the literature and reached a consensus on the follow-up scheme. RESULTS A total of 76 studies were included in the analysis, including 17 RCTs. In the stone-free general population group, 71-100% of patients are stone-free at 12 months while 29-94% remain stone-free at 36 months. We propose counselling these patients on imaging versus discharge after the first year. The stone-free rate in high-risk patients not receiving targeted medical therapy is < 40% at 36 months, a fact that supports imaging, metabolic, and treatment monitoring follow-up once a year. Patients with residual fragments ≤ 4 mm have a spontaneous expulsion rate of 18-47% and a growth rate of 10-41% at 12 months, supporting annual imaging follow-up. Patients with residual fragments > 4 mm should be considered for surgical re-intervention based on the low spontaneous expulsion rate (13% at 1 year) and high risk of recurrence. Plain film KUB and/or kidney ultrasonography based on clinicians' preference and stone characteristics is the preferred imaging follow-up. Computed tomography should be considered if patient is symptomatic or intervention is planned. CONCLUSIONS Based on evidence from the systematic review we propose, for the first time, a follow-up algorithm for patients after surgical stone treatment balancing the risks of stone recurrence against the burden of radiation from imaging studies.
Collapse
Affiliation(s)
| | - Lazaros Tzelves
- National and Kapodistrian University of Athens, Chairman of the EAU Urolithiasis Guidelines, Department of Urology, Sismanogleio Hospital, Athens, Greece
| | - Robert Geraghty
- Department of Urology, Freeman Hospital, Newcastle-Upon-Tyne, UK
- Institute of Genetic Medicine, Newcastle University, Newcastle-Upon-Tyne, UK
| | - Niall F Davis
- Department of Urology, Connolly Hospital, Blanchardstown, Dublin 15, Ireland
| | - Andreas Neisius
- Department of Urology, Hospital of the Brothers of Mercy Trier, Medical Campus University Mainz, Trier, Germany
| | - Ales Petřík
- Department of Urology, Region Hospital, Ceske Budejovice, Czech Republic
- Department of Urology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Giovanni Gambaro
- Division of Nephrology and Dialysis, Department of Medicine, University of Verona, Verona, Italy
| | - Christian Türk
- Department of Urology, Hospital of the Sisters of Charity, Vienna, Austria
- Urologische Praxis, Vienna, Austria
| | - Bhaskar Somani
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Kay Thomas
- Department of Urology, Guy's and St Thomas' Hospital, London, UK
| | - Andreas Skolarikos
- National and Kapodistrian University of Athens, Chairman of the EAU Urolithiasis Guidelines, Department of Urology, Sismanogleio Hospital, Athens, Greece.
| |
Collapse
|
3
|
Tzelves L, Geraghty R, Lombardo R, Davis NF, Petřík A, Neisius A, Gambaro G, Türk C, Thomas K, Somani B, Skolarikos A. Duration of Follow-up and Timing of Discharge from Imaging Follow-up, in Adult Patients with Urolithiasis After Surgical or Medical Intervention: A Systematic Review and Meta-analysis from the European Association of Urology Guideline Panel on Urolithiasis. Eur Urol Focus 2023; 9:188-198. [PMID: 35851252 DOI: 10.1016/j.euf.2022.06.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/31/2022] [Accepted: 06/30/2022] [Indexed: 11/20/2022]
Abstract
CONTEXT No algorithm exists for structured follow-up of urolithiasis patients. OBJECTIVE To provide a discharge time point during follow-up of urolithiasis patients after treatment. EVIDENCE ACQUISITION We performed a systematic review of PubMed/Medline, EMBASE, Cochrane Library, clinicaltrials.gov, and reference lists according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. Fifty studies were eligible. EVIDENCE SYNTHESIS From a pooled analysis of 5467 stone-free patients, we estimated that for a safety margin of 80% for remaining stone free, patients should be followed up using imaging, for at least 2 yr (radiopaque stones) or 3 yr (radiolucent stones) before being discharged. Patients should be discharged after 5 yr of no recurrence with a safety margin of 90%. Regarding residual disease, patients with fragments ≤4 mm could be offered surveillance up to 4 yr since intervention rates range between 17% and 29%, disease progression between 9% and 34%, and spontaneous passage between 21% and 34% at 49 mo. Patients with larger residual fragments should be offered further definitive intervention since intervention rates are high (24-100%). Insufficient data exist for high-risk patients, but the current literature dictates that patients who are adherent to targeted medical treatment seem to experience less stone growth or regrowth of residual fragments, and may be discharged after 36-48 mo of nonprogressive disease on imaging. CONCLUSIONS This systematic review and meta-analysis indicates that stone-free patients with radiopaque or radiolucent stones should be followed up to 2 or 3 yr, respectively. In patients with residual fragments ≤4 mm, surveillance or intervention can be advised according to patient preferences and characteristics, while for those with larger residual fragments, reintervention should be scheduled. PATIENT SUMMARY Here, we review the literature regarding follow-up of urolithiasis patients. Patients who have no stones after treatment should be seen up to 2-3 yr, those with large fragments should be reoperated, and those with small fragments could be offered surveillance with imaging.
Collapse
Affiliation(s)
- Lazaros Tzelves
- Department of Urology, Sismanogleio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Robert Geraghty
- Department of Urology, Freeman Hospital, Newcastle-upon-Tyne, UK; Institute of Genetic Medicine, Newcastle University, Newcastle-upon-Tyne, UK
| | | | - Niall F Davis
- Department of Urology, Connolly Hospital, Blanchardstown, Dublin, Ireland
| | - Ales Petřík
- Department of Urology, Region Hospital, Ceske Budejovice, Czech Republic; Department of Urology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Andreas Neisius
- Department of Urology, Hospital of the Brothers of Mercy Trier, Medical Campus University Mainz, Trier, Germany
| | - Giovanni Gambaro
- Division of Nephrology and Dialysis, Department of Medicine, University of Verona, Verona, Italy
| | - Christian Türk
- Department of Urology, Hospital of the Sisters of Charity, Vienna, Austria; Urologische Praxis, Vienna, Austria
| | - Kay Thomas
- Department of Urology, Guy's and St Thomas' Hospital, London, UK
| | - Bhaskar Somani
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Andreas Skolarikos
- Department of Urology, Sismanogleio Hospital, National and Kapodistrian University of Athens, Athens, Greece.
| |
Collapse
|
4
|
[Follow-up after urolithiasis management]. Urologe A 2022; 61:500-507. [PMID: 35381865 PMCID: PMC9072455 DOI: 10.1007/s00120-022-01816-5] [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] [Accepted: 03/08/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND Urinary stones often affect younger people. Because the risk of recurrence is high, regular follow-up is important for individuals at risk. OBJECTIVE To summarize the extent of urinary stones and the health and economic impact in the population; to provide recommendations for general and stone-specific follow-up. MATERIALS AND METHODS Analysis and discussion of publications and guideline recommendations. RESULTS The risk of recurrence after a stone attack can be high depending on the risk profile. An initial metabolic workup should be performed promptly after stone therapy. General dietary management should be intensified by stone-specific dietary management depending on the risk profile. Nutritional counseling may be helpful. Imaging after stone therapy is used to monitor the success of treatment and detect recurrences early. Since the risk of recurrence can vary greatly depending on the stone composition, not only the type of imaging but also its frequency should be adjusted accordingly. The same applies to the various stone therapies, which help determine the frequency and type of imaging follow-up. Exact guidelines and cost-effectiveness analyses of follow-up examinations after stone therapy are unfortunately missing. CONCLUSIONS Acute urolithiasis represents an excruciating experience for patients. Accordingly, their willingness to undergo metaphylaxis and follow-up shortly after the event is strong. Since the risk of recurrence after a stone attack can be very high, regular follow-up after stone therapy is essential. The frequency of follow-up should be adapted to the probability of stone recurrence.
Collapse
|
5
|
Dauw CA, Ghani KR, Qi J, Kim T, Telang J, Seifman B, Jafri M, Blix G, Hollingsworth JM. Variable Use of Postoperative Imaging Following Ureteroscopy: Results from a Statewide Quality Improvement Collaborative. Urology 2020; 136:63-69. [DOI: 10.1016/j.urology.2019.07.055] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 07/03/2019] [Accepted: 07/05/2019] [Indexed: 02/08/2023]
|
6
|
Ahn JS, Holt SK, May PC, Harper JD. National Imaging Trends after Ureteroscopic or Shock Wave Lithotripsy for Nephrolithiasis. J Urol 2017; 199:500-507. [PMID: 28941916 DOI: 10.1016/j.juro.2017.09.079] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE The study of diagnostic imaging after procedural intervention for nephrolithiasis is limited. We sought to characterize actual national imaging patterns and longitudinal trends after ureteroscopic or shock wave lithotripsy. MATERIALS AND METHODS We analyzed the MarketScan® database and identified a nationally representative sample of insured, employed patients, 17 to 64 years old who underwent ureteroscopic or shock wave lithotripsy for nephrolithiasis between 2007 and 2014. Patients were excluded from study if they lacked at least 1 year of postoperative database enrollment or underwent a repeat nephrolithiasis procedure of any type within 90 days after the initial procedure. We identified and tracked postoperative imaging modalities by medical billing codes. RESULTS We identified 101,554 patients treated with ureteroscopy, of whom 55% and 39% underwent no postoperative imaging within 3 and 12 months, respectively. Of the 101,590 patients treated with shock wave lithotripsy 23% and 16% underwent no postoperative imaging within 3 and 12 months, respectively. Abdominal x-ray was the most common imaging modality after either procedure type. Ultrasound use increased with time while computerized tomography decreased. In about 25% of ureteroscopy and shock wave lithotripsy cases at least 1 postoperative computerized tomography was done within a year. Female gender and older age were associated with higher imaging rates. Ultrasound was more commonly performed in the northeast region and in more densely populated areas. CONCLUSIONS A notable portion of patients treated with ureteroscopy and a smaller percent treated with shock wave lithotripsy do not undergo any followup imaging within 1 year. In the majority who undergo imaging abdominal x-ray is done, precluding the ability to screen for hydronephrosis or silent obstruction in almost 75% of patients treated with ureteroscopy.
Collapse
Affiliation(s)
- Justin S Ahn
- Department of Urology, University of Washington, Seattle, Washington
| | - Sarah K Holt
- Department of Urology, University of Washington, Seattle, Washington
| | - Philip C May
- Department of Urology, University of Washington, Seattle, Washington
| | - Jonathan D Harper
- Department of Urology, University of Washington, Seattle, Washington.
| |
Collapse
|
7
|
Khant SR, Chaudhari R, Kore RA, Bhagwat S, Jakhalekar RP. Low dose lignocaine + butorphanol vs. low dose bupivacaine for spinal anaesthesia in day care urological surgeries: a prospective randomized control trial. Turk J Urol 2017; 43:189-195. [PMID: 28717545 DOI: 10.5152/tud.2017.14367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 09/08/2016] [Indexed: 12/23/2022]
Abstract
OBJECTIVE A local anaesthetic with fast onset, short and reliable duration of anaesthesia may be preferable for day care urological surgeries. Low dose lignocaine is believed to act faster and to have a shorter duration of action than low dose bupivacaine. Use of lignocaine for spinal anesthesia is discouraged now a days because of rare reports of transient neurological symptoms. The purpose of this study was to compare effectiveness and safety of low dose of lignocaine + butorphanol against low dose of bupivacaine for day care urological surgeries. MATERIAL AND METHODS A prospective randomized control trial was conducted between December 2012 to November 2015. After taking ethical committe approval and patient consent, total 990 patients were randomized in two groups. Group A received 0.5 mL of 5% lignocaine (25 mg) + 0.3 mL butorphanol (0.3 mg) and group B received 1 mL of 0.5% bupivacaine (5 mg) for spinal anesthesia. Spinal anesthesia was given at the L3-L4 interspace with the patient in the sitting or lateral position. The criteria for evaluation were time till onset of sensory and motor block, duration of sensory and motor block, time till ambulation, time till fit for discharge and any complications. RESULTS Both the groups were comparable in terms of age, male to female ratio, American Society of Anesthesiologists (ASA) grade and duration surgery. Group A and Group B were statistically different in terms of mean time till onset of sensory block (120±22 sec and 274±36 sec), onset of motor block (228±34 sec and 372±41 sec), duration of sensory block (100±21 min and 230±28 min), duration of motor block (60±15 min and 152±23 min), time till ambulation (138±24 min and 292±48 min), time till fit for discharge (256±35 min and 428±46 min) respectively (<0.0001). Nausea, vomitings, hypotension, bradycarida and pruritis were less in group A compared to group B (<0.01). None of patient in any group had temporary or permanent neurological defecit. CONCLUSION Spinal anaesthesia is an effective as well as a safe modality to anaesthetize the patient for day care urological procedures. This study shows lignocaine + butorphanol is preferable over bupivacaine for spinal anesthesia for day care urological procedures. It also favours day care surgery at remote areas with lesser medical facilities. It helps to minimize requirement of medical and paramedical staff, thus further extending scope of day care urological surgeries.
Collapse
Affiliation(s)
| | - Rajeev Chaudhari
- Department of Urology And Urodynamics Centre, Rahee Health Care, Pune, India
| | - Rishikesh Arun Kore
- Department of Urology And Urodynamics Centre, Rahee Health Care, Pune, India
| | - Shirish Bhagwat
- Department of Urology And Urodynamics Centre, Rahee Health Care, Pune, India
| | | |
Collapse
|
8
|
Gökçe Mİ, Esen B, Gülpınar B, Hüseynov A, Özkidik M, Süer E. Evaluation of postoperative hydronephrosis following semirigid ureteroscopy: Incidence and predictors. Turk J Urol 2017; 43:171-175. [PMID: 28717542 DOI: 10.5152/tud.2017.80106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 10/14/2016] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Hydronephrosis developing following ureteroscopy (URS) is an important issue associated with the long-term postoperative renal functions. Studies investigating the role of postoperative imaging revealed conflicting results. In this study, we aimed to determine the incidence and predictors of hydronephrosis following semirigid URS. MATERIAL AND METHODS We evaluated the results of 455 patients who underwent U RS a nd postoperative imaging with non-contrast computed tomography (CT). Primary endpoints of the study were to determine the frequency of development of hydronephrosis and factors associated with the development of hydronephrosis. Logistic regression analysis was used to define factors effecting on the development of hydronephrosis. RESULTS Postoperative non-contrast CT revealed hydronephrosis in 81 (17.8%) patients. Stone-free status was achieved in 415 (91.2%) patients. Univariate analysis revealed history of ipsilateral URS (p=0.001), duration of operation (p=0.022), presence of multiple stones (p=0.001), and occurrence of a renal colic episode postoperatively (p=0.013) as the parameters associated with increased risk of postoperative hydronephrosis. In the multivariate analysis, history of ipsilateral URS (OR: 2.724, p=0.017) and presence of multiple stones (OR: 2.116, p=0.032) were found to be the independent prognostic markers of developing postoperative hydronephrosis. CONCLUSION Ipsilateral hydronephrosis following URS develops in a significant number of patients. In patients with history of ipsilateral hydronephrosis and multiple stones, risk of development of postoperative hydronephrosis is higher, therefore physicians should be keep these parameters in mind in the decision making process of selective imaging postoperatively.
Collapse
Affiliation(s)
- Mehmet İlker Gökçe
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Barış Esen
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Başak Gülpınar
- Department of Radiology, Ankara University School of Medicine, Ankara, Turkey
| | - Adil Hüseynov
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Mete Özkidik
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Evren Süer
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| |
Collapse
|
9
|
Bayrak O, Demirbas A, Doluoglu OG, Karakan T, Resorlu B, Kardas S, Tepeler A, Tangal S, Adanur S, Celik O. Is a contrast study really necessary prior to ureteroscopy? ACTA ACUST UNITED AC 2016; 49:e4855. [PMID: 26577846 PMCID: PMC4678656 DOI: 10.1590/1414-431x20154855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 07/23/2015] [Indexed: 11/22/2022]
Abstract
This study aimed to evaluate the effect of preoperative imaging techniques on the
success and complication rates of ureteroscopy. We performed a retrospective analysis
of 736 patients (455 males and 281 females), with a mean age of 45.5±15.2 years
(range, 1-88 years), who underwent rigid ureteroscopic procedures for removal of
ureteral stones. Patients were divided into 4 groups according to the type of imaging
modality used: group I, intravenous urography (n=116); group II, computed tomography
(n=381); group III, computed tomography and intravenous urography (n=91), and group
IV, ultrasonography and abdominal plain film (n=148). Patients’ demographics, stone
size and location, prior shock wave lithotripsy, lithotripsy technique, operation
time, success rate, and rate of intraoperative complications were compared among the
groups. There were no significant differences in success and complication rates among
the groups. The stone-free rate after primary ureteroscopy was 87.1% in group I,
88.2% in group II, 96.7% in group III, and 89.9% in group IV (P=0.093). The overall
incidence of intraoperative complications was 11.8%. According to the modified Satava
classification system, 6.1% of patients had grade 1, 5.1% had grade 2, and 0.54% had
grade 3 complications. Intraoperative complications developed in 12.1% of patients in
group I, 12.6% of patients in group II, 7.7% of patients in group III, and 12.2% of
patients in group IV (P=0.625). Our findings clearly demonstrate that ureteroscopic
treatment of ureteral stones can be safely and effectively performed with no use of
contrast study imaging, except in doubtful cases of anatomical abnormalities.
Collapse
Affiliation(s)
- O Bayrak
- Department of Urology, School of Medicine, Gazi University, Ankara, Turkey
| | - A Demirbas
- Department of Urology, Ankara Training and Research Hospital, Ankara, Turkey
| | - O G Doluoglu
- Department of Urology, Ankara Training and Research Hospital, Ankara, Turkey
| | - T Karakan
- Department of Urology, Ankara Training and Research Hospital, Ankara, Turkey
| | - B Resorlu
- Department of Urology, Ankara Training and Research Hospital, Ankara, Turkey
| | - S Kardas
- Department of Urology, Faculty of Medicine, Bezmialem University, Istanbul, Turkey
| | - A Tepeler
- Department of Urology, Faculty of Medicine, Bezmialem University, Istanbul, Turkey
| | - S Tangal
- Department of Urology, Faculty of Medicine, Ufuk University, Ankara, Turkey
| | - S Adanur
- Department of Urology, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - O Celik
- Department of Urology, Tepecik Training and Research Hospital, Izmir, Turkey
| |
Collapse
|
10
|
Kim SW, Ahn JH, Yim SU, Cho YH, Shin BS, Chung HS, Hwang EC, Yu HS, Oh KJ, Kim SO, Jung SI, Kang TW, Kwon DD, Park K. Clinical factors associated with postoperative hydronephrosis after ureteroscopic lithotripsy. Investig Clin Urol 2016; 57:343-50. [PMID: 27617316 PMCID: PMC5017563 DOI: 10.4111/icu.2016.57.5.343] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 07/04/2016] [Indexed: 12/29/2022] Open
Abstract
Purpose This study aimed to determine the predictors of ipsilateral hydronephrosis after ureteroscopic lithotripsy for ureteral calculi. Materials and Methods From January 2010 to December 2014, a total of 204 patients with ureteral calculi who underwent ureteroscopic lithotripsy were reviewed. Patients with lack of clinical data, presence of ureteral rupture, and who underwent simultaneous percutaneous nephrolithotomy (PNL) were excluded. Postoperative hydronephrosis was determined via computed tomographic scan or renal ultrasonography, at 6 months after ureteroscopic lithotripsy. Multivariable analysis was performed to determine clinical factors associated with ipsilateral hydronephrosis. Results A total of 137 patients were enrolled in this study. The mean age of the patients was 58.8±14.2 years and the mean stone size was 10.0±4.6 mm. The stone-free rate was 85.4%. Overall, 44 of the 137 patients (32.1%) had postoperative hydronephrosis. Significant differences between the hydronephrosis and nonhydronephrosis groups were noted in terms of stone location, preoperative hydronephrosis, impacted stone, operation time, and ureteral stent duration (all, p<0.05). On multivariable analysis, increasing preoperative diameter of the hydronephrotic kidney (adjusted odds ratio [OR], 1.21; 95% confidence interval [CI], 1.12–1.31; p=0.001) and impacted stone (adjusted OR, 3.01; 95% CI, 1.15–7.61; p=0.031) independently predicted the occurrence of postoperative hydronpehrosis. Conclusions Large preoperative diameter of the hydronephrotic kidney and presence of impacted stones were associated with hydronephrosis after ureteroscopic stone removal. Therefore, patients with these predictive factors undergo more intensive imaging follow-up in order to prevent renal deterioration due to postoperative hydronephrosis.
Collapse
Affiliation(s)
- Sun Woo Kim
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Ji Hoon Ahn
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Sang Un Yim
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Yang Hyun Cho
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Bo Sung Shin
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Ho Seok Chung
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Eu Chang Hwang
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Ho Song Yu
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Kyung Jin Oh
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Sun-Ouck Kim
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Seung Il Jung
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Taek Won Kang
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Dong Deuk Kwon
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Kwangsung Park
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| |
Collapse
|
11
|
Gökce MI, Telli O, Özkıdık M, Akıncı A, Hajıyev P, Soygür T, Burgu B. Evaluation of Postoperative Hydronephrosis Following Ureteroscopy in Pediatric Population: Incidence and Predictors. Urology 2016; 93:164-9. [DOI: 10.1016/j.urology.2016.02.052] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Revised: 01/20/2016] [Accepted: 02/02/2016] [Indexed: 11/17/2022]
|
12
|
Marchini GS, Vicentini FC, Monga M, Torricelli FC, Danilovic A, Brito AH, Câmara C, Srougi M, Mazzucchi E. Irreversible Renal Function Impairment Due to Silent Ureteral Stones. Urology 2016; 93:33-9. [PMID: 26968488 DOI: 10.1016/j.urology.2016.02.042] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 02/02/2016] [Accepted: 02/12/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate if renal function loss and hydronephrosis due to a silent ureteral stone might be reversed. MATERIALS AND METHODS We prospectively selected patients with silent ureteral stones between January 2006 and January 2014. A silent case was considered if there were no specific or subjective symptoms related to the ureteral stone. Patient, stone, and kidney characteristics were evaluated preoperatively, 3 and 12 months postoperatively. Renal function was accessed in the same intervals with serum creatinine (SCr), glomerular filtration rate (GFR), and (99m)Tc-dimercaptosuccinic acid. Patients without complete pre- and postoperative evaluation were excluded. Primary end point was midterm progress of global and ipsilateral renal function. Secondary end points included the evaluation of renal and collecting system anatomy from diagnosis to 12 months after treatment. Analysis of variance with repeated measures and marginal homogeneity test were used to evaluate renal function and hydronephrosis progression. RESULTS Twenty-six patients met our inclusion criteria. Mean preoperative SCr and GFR were 1.24 mg/dL and 72.5 mL/min, respectively. At initial scintigraphy, mean renal function was 33.4%. Laser ureterolithotripsy was performed in 84.6% of cases and all patients were rendered stone free. Two patients (8%) developed ureteral stenosis. There was no difference regarding SCr (P = .89), GFR (P = .48), and renal function at scintigraphy (P = .19) during follow-up. Hydronephrosis significantly improved from preoperatively to 3 months postoperatively (P < .0001), but not from 3 to 12 months (P = .065). CONCLUSION Patients with silent ureteral stones present with significant impairment of ipsilateral renal function and hydronephrosis at diagnosis. On midterm follow-up evaluation, renal function of the affected unit remains stable whereas hydronephrosis improves after treatment.
Collapse
Affiliation(s)
- Giovanni S Marchini
- Section of Endourology, Division of Urology, Hospital das Clínicas, University of Sao Paulo Medical School, Sao Paulo, Brazil; Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
| | - Fábio Carvalho Vicentini
- Section of Endourology, Division of Urology, Hospital das Clínicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Manoj Monga
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Fábio César Torricelli
- Section of Endourology, Division of Urology, Hospital das Clínicas, University of Sao Paulo Medical School, Sao Paulo, Brazil; Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Alexandre Danilovic
- Section of Endourology, Division of Urology, Hospital das Clínicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Artur Henrique Brito
- Section of Endourology, Division of Urology, Hospital das Clínicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Cesar Câmara
- Section of Endourology, Division of Urology, Hospital das Clínicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Miguel Srougi
- Section of Endourology, Division of Urology, Hospital das Clínicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Eduardo Mazzucchi
- Section of Endourology, Division of Urology, Hospital das Clínicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| |
Collapse
|
13
|
Omar M, Chaparala H, Monga M, Sivalingam S. Contemporary Imaging Practice Patterns Following Ureteroscopy for Stone Disease. J Endourol 2015; 29:1122-5. [DOI: 10.1089/end.2015.0088] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Mohamed Omar
- Department of Urology, Glickman Urological and Kidney Institute, The Cleveland Clinic, Cleveland, Ohio
| | - Hemant Chaparala
- Department of Urology, Glickman Urological and Kidney Institute, The Cleveland Clinic, Cleveland, Ohio
| | - Manoj Monga
- Department of Urology, Glickman Urological and Kidney Institute, The Cleveland Clinic, Cleveland, Ohio
| | - Sri Sivalingam
- Department of Urology, Glickman Urological and Kidney Institute, The Cleveland Clinic, Cleveland, Ohio
| |
Collapse
|
14
|
Barbour ML, Raman JD. Incidence and Predictors for Ipsilateral Hydronephrosis Following Ureteroscopic Lithotripsy. Urology 2015; 86:465-71. [PMID: 26144338 DOI: 10.1016/j.urology.2015.06.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Revised: 05/08/2015] [Accepted: 06/16/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To review our experience in using ureteroscopy (URS) with lithotripsy for renal or ureteral calculi to determine the incidence and predictors of postprocedural ipsilateral hydronephrosis. PATIENTS AND METHODS Records of 324 URS cases for renal or ureteral calculi with imaging performed 4-12 weeks postprocedure were reviewed. Ipsilateral hydronephrosis was determined by computed tomography scan or renal ultrasound. Univariate and multivariate analyses determined the factors associated with hydronephrosis. RESULTS 176 men and 148 women with a median age of 50 years were included. Median stone size was 6 mm and operative duration was 60 minutes; 30% of patients had multiple calculi; and 35% had undergone a prior ipsilateral URS. Overall, 49 of 324 patients (15%) had evidence of hydronephrosis, with 65% of these patients having symptoms and 40% requiring ancillary procedures. On multivariate analysis, increasing stone diameter (odds ratio [OR] 8.9, 95% confidence interval [CI] 1.9-23.8, P = .03), prior ipsilateral URS (OR 7.7, 95% CI 1.8-28.2, P = .006), longer operative duration (OR 6.5, 95% CI 1.8-16.3, P = .02), and renal colic symptoms (OR 48.3, 95% CI 14.7-71.4, P <.001) independently predicted hydronephrosis. Conversely, other factors including stone impaction at procedure, ureteral dilation, use of an access sheath, intraoperative perforation, or use of a stent did not associate with ipsilateral hydronephrosis. CONCLUSION In this contemporary cohort study, 15% of patients undergoing URS had evidence of ipsilateral hydronephrosis. Larger stone size, longer OR duration, prior ipsilateral URS, and recurrent colic were associated with an increased likelihood for this observation. Patients and stone cases with such characteristics likely warrant imaging modalities beyond plain radiography.
Collapse
Affiliation(s)
- Meredith L Barbour
- Division of Urology, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Jay D Raman
- Division of Urology, Penn State Milton S. Hershey Medical Center, Hershey, PA.
| |
Collapse
|
15
|
How Much is a Kidney Worth? Cost-Effectiveness of Routine Imaging After Ureteroscopy to Prevent Silent Obstruction. J Urol 2013; 189:2136-41. [DOI: 10.1016/j.juro.2012.12.059] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2012] [Indexed: 11/16/2022]
|
16
|
Fulgham PF, Assimos DG, Pearle MS, Preminger GM. Clinical effectiveness protocols for imaging in the management of ureteral calculous disease: AUA technology assessment. J Urol 2012; 189:1203-13. [PMID: 23085059 DOI: 10.1016/j.juro.2012.10.031] [Citation(s) in RCA: 190] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2012] [Indexed: 11/17/2022]
Abstract
PURPOSE This technology assessment addresses the optimal use of imaging in the evaluation and treatment of patients with suspected or documented ureteral stones. MATERIALS AND METHODS A comprehensive literature search addressing 4 guiding questions was performed for full text in English articles published between January 1990 and July 2011. The search focused on major subtopics associated with the imaging of ureteral calculi, and included specific imaging modalities used in the diagnosis and management of ureteral calculous disease such as unenhanced (noncontrast) computerized tomography, conventional radiography, ultrasound, excretory urography, magnetic resonance imaging and nuclear medicine studies. Protocols (in the form of decision tree algorithms) were developed based on this literature review and in some instances on panel opinion. The 4 questions addressed were 1) What imaging study should be performed for suspected ureteral calculous disease? 2) What information should be obtained? 3) After diagnosis of a ureteral calculus, what followup imaging should be used? 4) After treatment of a ureteral calculus, what followup imaging studies should be obtained? RESULTS Based on these protocols, noncontrast computerized tomography is recommended to establish the diagnosis in most cases, with a low energy protocol advocated if body habitus is favorable. Conventional radiography and ultrasound are endorsed for monitoring the passage of most radiopaque stones as well as for most patients undergoing stone removal. Other studies may be indicated based on imaging findings, and patient, stone and clinical factors. CONCLUSIONS The protocols generated assist the clinician in establishing the diagnosis of ureteral calculous disease, monitoring stone passage and following patients after treatment. The protocols take into account not only clinical effectiveness but also cost-effectiveness and risk/harm associated with the various imaging modalities.
Collapse
Affiliation(s)
- Pat Fox Fulgham
- Texas Health Presbyterian Hospital of Dallas, Dallas, Texas 75231, USA.
| | | | | | | |
Collapse
|
17
|
Resorlu B, Kara C, Resorlu EB, Unsal A. Effectiveness of ultrasonography in the postoperative follow-up of pediatric patients undergoing ureteroscopic stone manipulation. Pediatr Surg Int 2011; 27:1337-41. [PMID: 21953523 DOI: 10.1007/s00383-011-2979-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/12/2011] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To evaluate the effectiveness of ultrasonography and to determine whether ionizing radiation is necessary in the postoperative follow-up of children undergoing ureteroscopy. METHODS We reviewed the charts of 49 children who underwent 51 ureteroscopic procedures for ureteral calculi. Renal ultrasound and intravenous urography were performed in all patients at 3 months after surgery for postoperative evaluation. RESULTS In three cases, stones migrated to the kidney. Retrograde intrarenal surgery was performed in two patients and one patient required shockwave lithotripsy to become stone-free. Fourty-six children were completely stone-free and 3 had residual fragments on plain film in the postoperative 3 month. The sensitivity, specificity, negative and positive predictive values of ultrasonography for detecting hydronephrosis were 85.7, 100, 97.7 and 100%, respectively. Two patients under observation and three patients under medical expulsive therapy had resolution of hydronephrosis on follow-up. One patient required ureteroscopy for residual obstructing fragments. CONCLUSIONS Ultrasonography has limited accuracy for detecting residual ureteral stones, but it is a highly specific and reasonably sensitive test for detecting hydronephrosis. A combination of ultrasonography and plain film is a safe and effective imaging procedure in postoperative follow-up of children undergoing ureteroscopy.
Collapse
Affiliation(s)
- Berkan Resorlu
- Ministry of Health, Kecioren Training and Research Hospital, Ankara, Turkey.
| | | | | | | |
Collapse
|
18
|
Manger JP, Mendoza PJ, Babayan RK, Wang DS. Use of Renal Ultrasound to Detect Hydronephrosis After Ureteroscopy. J Endourol 2009; 23:1399-402. [DOI: 10.1089/end.2009.0392] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jules P. Manger
- Department of Urology, Boston University School of Medicine, Boston, Massachusetts
| | - Pierre J. Mendoza
- Department of Urology, Boston University School of Medicine, Boston, Massachusetts
| | - Richard K. Babayan
- Department of Urology, Boston University School of Medicine, Boston, Massachusetts
| | - David S. Wang
- Department of Urology, Boston University School of Medicine, Boston, Massachusetts
| |
Collapse
|
19
|
Bevan JM, Lulich JP, Albasan H, Osborne CA. Comparison of laser lithotripsy and cystotomy for the management of dogs with urolithiasis. J Am Vet Med Assoc 2009; 234:1286-94. [DOI: 10.2460/javma.234.10.1286] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
20
|
Adiyat KT, Meuleners R, Monga M. Selective Postoperative Imaging After Ureteroscopy. Urology 2009; 73:490-3; discussion 493. [DOI: 10.1016/j.urology.2008.09.064] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2008] [Revised: 07/06/2008] [Accepted: 09/02/2008] [Indexed: 10/21/2022]
|