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Davidson J, Ding Y, Chan E, Dave S, Bjazevic J, Filler G, Wang PZT. Postoperative outcomes of ureteroscopy for pediatric urolithiasis: A secondary analysis of the National Surgical Quality Improvement Program Pediatric. J Pediatr Urol 2021; 17:649.e1-649.e8. [PMID: 34162516 DOI: 10.1016/j.jpurol.2021.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 05/13/2021] [Accepted: 06/03/2021] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Incidence of pediatric urinary stone disease (PUSD) has increased over recent decades. Innovations in ureteroscopic technology has expanded the role of endourologic stone management in children. However, there is currently no consensus on the optimal use of ureteroscopy (URS) within the heterogenous PUSD population. OBJECTIVE The primary objective was to investigate the rate of 30-day unplanned readmissions in pediatric patients after URS. The secondary objective was to examine the influence of demographic, perioperative, postoperative, and reoperation variables as predictors of an increased risk of unplanned readmission in this sample. STUDY DESIGN A secondary analysis was performed on retrospectively collected data from the National Surgical Quality Improvement Program Pediatric between 2015 and 2018. Pediatric patients diagnosed with PUSD and treated with URS were identified. Patients undergoing concurrent or additional surgeries during the URS procedure were excluded. Data on demographic, perioperative, postoperative, and unplanned reoperation variables were examined for their possible influence on 30-day unplanned readmissions. Descriptive statistics were used to characterize the study cohort. Continuous and categorical variables were analyzed using independent samples t-test, one-way ANOVA with Tukey post-hoc test, and Chi-square Tests or Fisher's Exact Test, respectfully. Multivariate analysis was performed using stepwise logistic regression. RESULTS A total of 2510 patients were identified within the study period. The majority of children undergoing URS were between 12 and 18 years of age (66.1%), female (56.9%), and had renal calculi (45.2%). Of these, 162 (6.5%) experienced a 30-day unplanned readmission related to the URS procedure. The most common reasons for an unplanned readmission was urinary tract infection (31.4%), new/unresolved stone (28.3%), and postoperative pain (8.2%). Multivariate modelling showed that females (Relative Risk [RR]: 2.03; 95% Confidence Interval [95%CI]: 1.34-3.07), patients with renal stones (RR: 1.77; 95%CI: 1.10-2.83), and inpatients at the time of surgery (RR: 1.61; 95%CI: 1.03-2.51) were more at risk of an unplanned readmission within 30-days of an URS procedure. CONCLUSION This study reports on short-term unplanned readmission rates in pediatric patients who underwent an URS procedure. Further it highlights possible predictors of unplanned readmission rates within a sampling of patients from NSQIP affiliated institutions. The findings from this study can be used to guide future studies around the safe use of URS in pediatric patients.
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Affiliation(s)
- Jacob Davidson
- Division of Paediatric Surgery, Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Youshan Ding
- Faculty of Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Ernest Chan
- Division of Urology, Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Sumit Dave
- Division of Urology, Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Jennifer Bjazevic
- Division of Urology, Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Guido Filler
- Division of Paediatric Nephrology, Department of Paediatrics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Peter Zhan Tao Wang
- Division of Urology, Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.
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Ceylan Y, Ucer O, Bozkurt O, Gunlusoy B, Mertoglu O, Zumrutbas AE, Yildiz G, Irer B, Muezzinoglu T, Demir O. The effect of SWL and URS on health-related quality of life in proximal ureteral stones. MINIM INVASIV THER 2017; 27:148-152. [DOI: 10.1080/13645706.2017.1350719] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Yasin Ceylan
- Department of Urology, Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Oktay Ucer
- Department of Urology, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
| | - Ozan Bozkurt
- Department of Urology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Bulent Gunlusoy
- Department of Urology, Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Oguz Mertoglu
- Department of Urology, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Ali Ersin Zumrutbas
- Department of Urology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Guner Yildiz
- Department of Urology, Dr Suat Seren Chest Diseases and Surgery Training, Research Hospital, İzmir, Turkey
| | - Bora Irer
- Department of Urology, Esrefpaşa Hospital, Izmir, Turkey
| | - Talha Muezzinoglu
- Department of Urology, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
| | - Omer Demir
- Department of Urology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
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Canguven O, Boz M, Bulbul M, Selimoglu A, Albayrak S. Withdraw of the ureteroscope causes fragmented ureter stones to disperse. Int Braz J Urol 2014; 39:756-7; discussion 757. [PMID: 24267120 DOI: 10.1590/s1677-5538.ibju.2013.05.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 06/15/2013] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Ureteroscopy has improved from the first use of ureteroscope in the 1970' s. Although the success rate increased in the last years, new treatment techniques are being developed for impacted and large proximal ureter stones (2). Pneumatic lithotripsy has high efficiency with low complication rates. However, in case of steinstrasse and large (> 1 cm) ureter stones, fragmented small stones may obstruct insertion of a ureteroscope after initial lithotripsy. In order to triumph over this issue, multiple ureteroscopic passages and manipulations needed for extraction of these small stones by forceps or basket catheters. The overall incidence of stricture was found upto 14.2% when the fragments were removed with a grasping forceps or a basket. We present our technique to disperse small fragmented stones in order to contact non-fragmented rest stone. MATERIALS AND METHODS Ureteral lithotripsy was performed with an 8-9.8F semirigid ureteroscope using a pneumatic lithotripter (Swiss LithoClast, EMS, Nyon, Switzerland). The stone was fragmented into small pieces as small as 2-3 mm. by pneumatic lithotripter. Eventually, these fragmented stones interfered with vision and the lithotripter to get in touch with the rest stone. After fragmenting distal part of the large stone, the ureteroscope was pulled back out of ureter. While pulling back, the operating channel was closed and irrigation fluid was flowing in order not to decrease pressure behind the stones. Simultaneously, a person tilted the operating table to about 30 in reverse Trendelenburg position. When the ureteroscope was out of ureteral orifice, the operating channel was opened and irrigation fluid was stopped. This maneuver aided decreasing pressure in the bladder more rapidly in addition to feeding tube. Stone dust and antegrade fluid flow were easily seen out of the ureteral orifice. Ureteroscope was re-inserted after 30-60 seconds. While reaching the rest of the stone, small stone dust was seen at first. Bigger stones were approximately 3-5 cm distal to the original place of the stone. When the non-fragmented rest stone appeared, there were no blocking fragmented stones. Insertion of the ureteroscope was easy and we could go on with the lithotripsy procedure. CONCLUSIONS In comparison to standard position, tilting and rapid decrease in pressure by pulling back the ureteroscope made gravity and negative pressure more effective.
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Affiliation(s)
- Onder Canguven
- Urology II Clinics, Kartal Teaching and Research Hospital, Istanbul, Turkey
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Mursi K, Elsheemy MS, Morsi HA, Ali Ghaleb AK, Abdel-Razzak OM. Semi-rigid ureteroscopy for ureteric and renal pelvic calculi: Predictive factors for complications and success. Arab J Urol 2013; 11:136-41. [PMID: 26558071 PMCID: PMC4443018 DOI: 10.1016/j.aju.2013.04.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 04/19/2013] [Accepted: 04/23/2013] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To analyse and compare the effect of stone site and size, method of lithotripsy, and level of experience on the results and complications of semi-rigid ureteroscopy for ureteric and renal pelvic stones. PATIENTS AND METHODS Between April 2010 and May 2011, 90 patients underwent 95 ureteroscopies, using 7.5- and 9-F semi-rigid ureteroscopes, with or without pneumatic or laser lithotripsy. The peri-operative findings were analysed and compared. RESULTS The mean (SD) longest diameter of the stones was 11.8 (4.5) mm. Laser lithotripsy was used in 32 cases and pneumatic lithotripsy in 26. There were complications in 35 procedures in the form of colicky pain (2%), haematuria (1%), stone migration (7%), equipment failure (5%), access failure (8%), mucosal injury (7%), fever (2%) and extravasation (3%).The calculi were successfully retrieved in 75 patients (83%). The success rate was 95%, 77%, 85%, and 53% in the lower, middle, upper ureter and renal pelvis, respectively. CONCLUSIONS Upper ureteric stones can be managed safely with the semi-rigid ureteroscope. Renal pelvic stones are associated with a lower success rate, and thus they were not a primary indication for ureteroscopic intervention. The secondary ureteroscopic management of renal pelvic stones improved the results of subsequent alkalinisation or shock-wave lithotripsy if they could not be eradicated completely. The failure rate was significantly small in lower ureteric stones and stones of <10 mm. Less experience, a stone size of >15 mm and patients ⩽2 years old were associated with more complications or a lower success rate. There was no significant difference in the success or complication rate between laser and pneumatic lithotripsy.
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Affiliation(s)
- Khaled Mursi
- Department of Urology, Kasr Al-Ainy Hospitals, Cairo University, Cairo, Egypt
| | - Mohammed S Elsheemy
- Department of Urology, Kasr Al-Ainy Hospitals, Cairo University, Cairo, Egypt
| | - Hany A Morsi
- Department of Urology, Kasr Al-Ainy Hospitals, Cairo University, Cairo, Egypt
| | | | - Omar M Abdel-Razzak
- Department of Urology, Kasr Al-Ainy Hospitals, Cairo University, Cairo, Egypt
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Gunlusoy B, Degirmenci T, Arslan M, Kozacıoglu Z, Koras O, Ceylan Y, Ors B. Is bilateral ureterorenoscopy the first choice for the treatment of bilateral ureteral stones? An updated study. Urol Int 2012; 89:412-7. [PMID: 23128066 DOI: 10.1159/000342662] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Accepted: 08/07/2012] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We analyze our recent results and discuss the advantages and disadvantages of bilateral single-session ureterorenoscopy (URS) for bilateral ureteral stones. PATIENTS AND METHODS 55 patients underwent URS with pneumatic lithotripsy (PL) for bilateral stones. 61 (55.5%), 28 (25.4%) and 21 (19.1%) stones were located in the lower, middle and upper ureter, respectively. RESULTS Of the 110 stones, 99 (90.0%) were fragmented in a single procedure. The stone clearance rate was 94.5% after the second session. The stone clearance rates with regard to stone location were 71.4, 89.3 and 96.7% for the upper, middle and lower ureter, respectively. An analysis of the clearance rates based on location demonstrated that lower ureteric stones were more successfully removed than upper ureteric stones (96.7 vs.71.4%, p = 0.003). CONCLUSION Bilateral single-session URS with PL is a highly effective treatment modality for bilateral ureteral stones. The success rate of PL is affected by stone size and location.
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Affiliation(s)
- Bulent Gunlusoy
- Department of Urology, Izmir Education and Research Hospital, Izmir, Turkey.
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Kupajski M, Tkocz M, Ziaja D. Modern management of stone disease in patients with a solitary kidney. Wideochir Inne Tech Maloinwazyjne 2012; 7:1-7. [PMID: 23255993 PMCID: PMC3516964 DOI: 10.5114/wiitm.2011.25641] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2011] [Revised: 06/27/2011] [Accepted: 07/25/2011] [Indexed: 11/17/2022] Open
Abstract
Analysing the data available in the literature, contemporary methods of treatment of nephrolithiasis are limited to the methods of minimally invasive percutaneous nephrolithotomy (PCNL) and ureterorenoscopic lithotripsy (URSL), not excluding their use in the presence of developmental abnormalities and kidney impairment only. Minimally invasive methods have become standard procedures. A complement to ineffective URSL and PCNL treatment is extracorporeal shock wave lithotripsy. This is confirmed by 30 years of observation in the only treatment of kidney calculi by Alken launched in 1981 and continued by Jones et al. Before the era of endoscopic procedures (PCNL and URSL) effectively removed the only deposits in the kidney in open operations. Minimally invasive treatments are recommended for patients with localized deposits in the pelvicalyceal system or solitary kidney ureter. They are recognized as safe and effective treatment in a solitary kidney in particular in patients who have already been operated on.
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Affiliation(s)
- Maciej Kupajski
- Prof. E. Michałowski's Independent Health Care Facility, Katowice, Poland
| | - Michał Tkocz
- Prof. E. Michałowski's Independent Health Care Facility, Katowice, Poland
| | - Damian Ziaja
- Department of Vascular and General Surgery, Medical University of Silesia, Katowice, Poland
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Skolarikos AA, Papatsoris AG, Mitsogiannis IC, Chatzidarellis L, Liakouras C, Deliveliotis C. Current status of ureteroscopic treatment for urolithiasis. Int J Urol 2009; 16:713-7. [PMID: 19674169 DOI: 10.1111/j.1442-2042.2009.02364.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Intracorporeal treatment of urolithiasis is characterized by continuous technological evolution. In this review we present updated data upon the use of ureteroscopy for the management of urolithiasis. Novel digital flexible ureteroscopes are used in clinical practice. Ureteroscopic working tools are revolutionized resulting in safer and more efficient procedures. Special categories of stone patients such as pregnant women, children and patients on anticoagulation medication can now undergo uneventful ureteroscopy. Routine insertion of stents and access sheaths as well as bilateral ureteroscopy is still a controversial issue. Future perspectives include smaller and better instruments to visualize and treat a stone, while robotic ureteroscopy is becoming a fascinating reality.
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Affiliation(s)
- Andreas A Skolarikos
- Athens Medical School, 2nd Department of Urology, Sismanoglio Hospital, Athens, Greece.
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