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Huang T, Ke M, Chen C, Xu Z, Wang B, Sun P, Zhu D, Yang Q, Wu H, Xu M. Application of virtual endoscopic imaging to parapelvic cyst incision by flexible ureteroscopy: a multicenter retrospective cohort study. Minerva Urol Nephrol 2024; 76:505-512. [PMID: 38757773 DOI: 10.23736/s2724-6051.24.05486-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
BACKGROUND A three-dimensional (3D) reconstruction of the kidney, parapelvic cyst and the collecting system was conducted using the 3D Slicer software. The reconstructed image was used to form a virtual endoscope to assist flexible ureteroscopic incision and drainage was performed with a holmium laser for treating parapelvic cysts. The effectiveness of this assistive technique was assessed. METHODS This was a retrospective cohort study. The clinical information of 59 patients undergoing flexible ureteroscopic incision and drainage for parapelvic cysts in two medical centers was collected. 3D Slicer software reconstruction and virtual endoscopic imaging were performed for 28 cases. Before the operation, the best point for incision on the collecting system's mucosa was assessed by virtual endoscope imaging. Propensity score matching was adopted for the reconstructive and non-reconstructive groups. RESULTS After matching, the reconstructive group and non-reconstructive group both had 21 cases each. The operation time in the reconstructive and non-reconstructive groups was 38.81±5.01 and 51.00±18 minutes, respectively. Statistically significant differences existed between the two groups (t=7.024, P<0.001). No statistical significance was found in postoperative fever, immediate postoperative C reactive protein (CRP), length of postoperative hospital stay and cyst diameter three months after the operation. CONCLUSIONS The operator was provided with a more direct and real vision when 3D Slicer software reconstruction was adopted via virtual endoscopic imaging to assist flexible ureteroscopic parapelvic cyst incision. This helped reduce the operation time. Further follow-ups and observations are required to assess the long-term efficacy of flexible ureteroscopic parapelvic cyst incision.
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Affiliation(s)
- Ting Huang
- Department of Urology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang, China
| | - Mang Ke
- Department of Urology, Affiliated Taizhou Hospital, Wenzhou Medical University, Taizhou, Zhejiang, China
| | - Chaoqian Chen
- Department of Urology, Affiliated Taizhou Hospital, Wenzhou Medical University, Taizhou, Zhejiang, China
| | - Zekun Xu
- Department of Urology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang, China
| | - Bin Wang
- Department of Urology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang, China
| | - Peng Sun
- Department of Urology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang, China
| | - Desheng Zhu
- Department of Urology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang, China
| | - Qing Yang
- Department of Urology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang, China
| | - Haixiao Wu
- Department of Urology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang, China
| | - Min Xu
- Department of Urology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang, China -
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Abuelnaga M, Esmat M, Hatata AN, Samir YR, Arafa H, Salem MS. Clinical efficacy of mini-percutaneous nephrolithotomy versus retrograde intrarenal surgery for the management of upper urinary tract calculus (1-2.5 cm) in children ≤10 years of age. J Pediatr Urol 2024; 20:605.e1-605.e8. [PMID: 38851968 DOI: 10.1016/j.jpurol.2024.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 05/08/2024] [Accepted: 05/22/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND With improvements in endoscopic surgery, open surgical procedures for urinary system stones have cleared the path for the use of less invasive treatment modalities in patients with pediatric kidney stone disease. Extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL), and retrograde intrarenal surgery (RIRS) are among the treatment options available. OBJECTIVE To prospectively evaluate the outcomes of mini-percutaneous nephrolithotomy and retrograde intrarenal surgery (RIRS) for children ≤10 years of age with upper urinary tract calculus (1-2.5 cm). STUDY DESIGN Sixty pediatric patients with single or multiple renal stones (1-2.5 cm in diameter) were collected prospectively and equally divided into two groups to undergo RIRS or mini-PCNL. The operative and postoperative outcomes of both groups were analyzed. RESULTS The groups' mean ages and genders were comparable. The mean stone size for the RIRS group was 1.86 cm and 1.69 cm for the PCNL group (P = 0.449). The PCNL group had statistically longer mean fluoroscopy and hospitalization times. The stone-free rates (SFRs) after a single procedure were 27 (90%) in the PCNL group and 25 (83.33%) in the RIRS group (P = 0.706). The UAS was placed in 13 (43.33%) patients in the RIRS group. In the RIRS group, 14 (46.67%) children required preoperative DJ stent application to passively dilate the ureteric orifice. As regard post DJ stenting, 13 (46%) cases applied DJ in the mini PCNL group. major complications were observed in either group. Minor complication (Clavien 1-3) rates were 16.66% and 13.33% for the PCNL and RIRS groups, respectively. There were no differences found between the RIRS and mini-PCNL groups regarding operative time. The mean cost of RIRS was $703.96 and $537.03 for the mini-PCNL. CONCLUSION According to the results of this study, mini-PCNL and RIRS are effective procedures for treating renal stones in children up to 2.5 cm with comparable success and complication rates. Hospital stay, radiation exposure, and fluoroscopy time are significantly lower in RIRS than in the mini PCNL technique. Although RIRS is effective, a major disadvantage is the greater requirement for JJ stent insertion either before or after the procedure and the consequent need for a second procedure for removal.
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He M, Dong Y, Cai W, Cai J, Xie Y, Yu M, Li C, Wen L. Recent advances in the treatment of renal stones using flexible ureteroscopys. Int J Surg 2024; 110:4320-4328. [PMID: 38477158 PMCID: PMC11254199 DOI: 10.1097/js9.0000000000001345] [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: 12/21/2023] [Accepted: 03/04/2024] [Indexed: 03/14/2024]
Abstract
Upper urinary tract stones are a common urological disease that can be treated by flexible ureteroscopy (FURS) through the natural urinary tract, in addition to extracorporeal shock wave lithotripsy and percutaneous nephrolithotomy. The advantages of FURS are less trauma, faster recovery, and fewer complications, while its disadvantages include poor results of lithotripsy and stone extraction when dealing with larger stones, and prolonged operation time. Over the last two decades, the emergence of new technologies such as FURS combined with negative pressure suction, robot-assisted FURS, and artificially intelligent FURS, coupled with improvements in laser technology (the use of thulium fiber lasers and the invention of single-use flexible ureteroscopes (su-fURS) suitable for primary level application, have significantly increased the global adoption of FURS. This surge in usage holds a promising future in clinical application, benefiting a growing number of patients with renal calculi. Accompanied by changes in technical concepts and therapeutic modalities, the scope of indications for FURS is broadening, positioning it as a potential primary choice for urolithiasis treatment in the future. This review outlines the progress in employing FURS for the treatment of renal calculi in order to generate insights for further research.
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Affiliation(s)
- Min He
- School of the Second Clinical Medical College, Zhejiang Chinese Medical University
- First People’s Hospital of Fuyang
| | - Yonghui Dong
- School of the Second Clinical Medical College, Zhejiang Chinese Medical University
- Department of Urology, Affiliated Hangzhou First People’s Hospital, School of Medicine, Westlake University
| | | | - Jiale Cai
- School of the Second Clinical Medical College, Zhejiang Chinese Medical University
- First People’s Hospital of Fuyang
| | - Yaming Xie
- General Surgery, Department of Hepatobiliary and Pancreatic Surgery and Minimal Invasive Surgery, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital), Hangzhou Medical College
| | - Mingke Yu
- Zhejiang Provincial Hospital of Chinese Medicine, Hangzhou, Zhejiang Province, People’s Republic of China
| | - Changjiu Li
- Department of Urology, Affiliated Hangzhou First People’s Hospital, School of Medicine, Westlake University
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Khedekar PG, Viswaroop SB, Arul M, Gopalakrishnan G, Kandasami SV. The cost-effectiveness of reusable flexible ureteroscopes: An institutional audit. Indian J Urol 2024; 40:179-184. [PMID: 39100613 PMCID: PMC11296592 DOI: 10.4103/iju.iju_41_24] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 04/30/2024] [Accepted: 05/16/2024] [Indexed: 08/06/2024] Open
Abstract
Introduction A flexible ureteroscope (FU) is an important tool in the urologist's armamentarium. This study aims to check the durability and cost-effectiveness of conventional FU. Methods The institution registry of damaged FU over the last 7 years was reviewed. A total of 17 flexible scopes were used. The data of 13 scopes (11 Storz fiberoptic and 2 Seesheen digital) are included in this study. A total of 1905 cases were performed. The cost of scope, duration of use, number of cases done by each scope, and nature of damage were evaluated. We compared the cost-effectiveness of conventional scopes with published costs on disposable scopes. Results The mean number of cases done by fiberoptic scope was 159 (range 25-334). The total cases done by 2 digital scopes were 135 and 25. The mean life of fiberoptic and digital scopes was 17 (range 4-31) and 8 months, respectively. The mean cost of fiberoptic scope was Indian Rupee (INR) 338,951 ($4082.7221) and INR 525,000 ($6323.7138) for digital scope. The cost per case for reusable scope is calculated by dividing the mean cost of FU by the mean number of cases done. The reprocessing cost of INR 527 was then added. Thus, the average cost per procedure for fiberoptic and digital FU was INR 2658.76 and INR 7089.50, respectively. We compared this cost with a projected cost of disposable FUbased on today's market data, which ranged from INR 60,000 to 107,427. Conclusions The reusable scopes are durable, cost-effective, and an excellent option for high case-load institutions.
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Affiliation(s)
- Pranalee G. Khedekar
- Department of Urology, Vedanayagam Hospital and PG Institute, Coimbatore, Tamil Nadu, India
| | - S. Bobby Viswaroop
- Department of Urology, Vedanayagam Hospital and PG Institute, Coimbatore, Tamil Nadu, India
| | - M. Arul
- Department of Urology, Vedanayagam Hospital and PG Institute, Coimbatore, Tamil Nadu, India
| | - Ganesh Gopalakrishnan
- Department of Urology, Vedanayagam Hospital and PG Institute, Coimbatore, Tamil Nadu, India
| | - S. V. Kandasami
- Department of Urology, Vedanayagam Hospital and PG Institute, Coimbatore, Tamil Nadu, India
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Gul T, Laymon M, Alrayashi M, Abdelkareem M, Salah M. Successful treatment of staghorn stones with flexible ureteroscopy and thulium fiber laser (TFL) lithotripsy: initial experience with 32 cases. Urolithiasis 2024; 52:102. [PMID: 38937284 PMCID: PMC11211131 DOI: 10.1007/s00240-024-01598-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 06/12/2024] [Indexed: 06/29/2024]
Affiliation(s)
- Tawiz Gul
- Urology Section, Surgery Department, Hazm Mebaireek general hospital, Hamad medical corporation, Doha, Qatar.
- College of Medicine, Qatar University, Doha, Qatar.
| | - Mahmoud Laymon
- Urology and Nephrology center, Mansoura University, Mansoura, Egypt.
| | - Maged Alrayashi
- Urology Section, Surgery Department, Hazm Mebaireek general hospital, Hamad medical corporation, Doha, Qatar
| | - Mohamed Abdelkareem
- Urology Section, Surgery Department, Hazm Mebaireek general hospital, Hamad medical corporation, Doha, Qatar
| | - Morshed Salah
- Urology Section, Surgery Department, Hazm Mebaireek general hospital, Hamad medical corporation, Doha, Qatar
- College of Medicine, Qatar University, Doha, Qatar
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Juliebø‐Jones P, Gauhar V, Lim EJ, Traxer O, Madarriaga YQ, Castellani D, Fong KY, Bujons A, Ragoori D, Shrestha A, Vaddi CM, Bhatia TP, Sekerci CA, Tanidir Y, Teoh JY, Somani BK. Outcomes and considerations for retrograde intrarenal surgery (RIRS) in the setting of multiple and large renal stones (>15 mm) in children: Findings from multicentre and real-world setting. BJUI COMPASS 2024; 5:558-563. [PMID: 38873356 PMCID: PMC11168767 DOI: 10.1002/bco2.357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 02/24/2024] [Accepted: 03/10/2024] [Indexed: 06/15/2024] Open
Abstract
Purpose The aim of this study is to evaluate the outcomes of retrograde intra renal surgery (RIRS) in the setting of large or multiple stones in children (<18 years). Materials and Methods Retrospective analysis was performed of paediatric RIRS cases at nine centres worldwide over a 6-year period. Patients were divided into two groups: Group 1 had a single stone <15 mm. Group 2 had either multiple stones, maximum stone diameter of >15 mm, or both. Outcomes included stone free rate (SFR) and complications within 30 days. Results In total, 344 patients were included with 197 and 147 in Groups 1 and 2, respectively. Ureteric access sheaths were more frequently used in Group 2 (39.5% vs. 56.8%, p = 0.021). The operation time was significantly longer in Group 2 (p < 0.001). SFR after a single procedure was 84.7% in Group 1 and 63.7% in Group 2. Overall complication rates in Groups 1 and 2 were 7.6% and 33.3%, respectively. The most frequently reported complication in both groups was post-operative fever (4.4% vs. 14%, p = 0.004). The rate of Clavien I/II complications in groups 1 and 2 was 6% and 25.1%, respectively (p < 0.05). The rate of Clavien ≥ III complications in groups 1 and 2 was 1.6% and 8.1%, respectively (p < 0.05). On multivariate analysis, total operation time, stone size and multiplicity were significant predictors of residual fragments. Conclusions RIRS can be performed in paediatric cases with large and multiple stone burdens, but the complication rate is significantly higher when compared to smaller stones.
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Affiliation(s)
- Patrick Juliebø‐Jones
- Department of Clinical MedicineUniversity of BergenBergenNorway
- Department of UrologyHaukeland University HospitalBergenNorway
- Department of UrologyUniversity Hospital SouthamptonSouthamptonUK
| | - Vineet Gauhar
- Department of UrologyNg Teng Fong HospitalSingaporeSingapore
| | - Ee Jean Lim
- Department of UrologySingapore General HospitalSingaporeSingapore
| | - Olivier Traxer
- Department of Urology Hôpital TenonSorbonne UniversityParisFrance
| | | | - Daniele Castellani
- Urology Division, Azienda Ospedaliero‐Universitaria Ospedali Riuniti Di AnconaUniversità Politecnica Delle MarcheAnconaItaly
| | - Khi Yung Fong
- Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
| | - Anna Bujons
- Urology DepartmentAutonomous University of Barcelona, Fundació PuigvertBarcelonaSpain
| | - Deepak Ragoori
- Department of UrologyAsian Institute of Nephrology and Urology, Banjara HillsHyderabadIndia
| | - Anil Shrestha
- Department of Urology, National Academy of Medical SciencesBir HospitalKathmanduNepal
| | | | | | - Cagri Akin Sekerci
- Department of UrologyMarmara University School of MedicineIstanbulTurkey
| | - Yiloren Tanidir
- Department of UrologyMarmara University School of MedicineIstanbulTurkey
| | - Jeremy Yuen‐Chun Teoh
- Department of Surgery, S.H. Ho Urology CentreThe Chinese University of Hong KongSha TinHong Kong, China
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Abushamma F, Zyoud SH. Analyzing global research trends and focal points in the utilization of laser techniques for the treatment of urolithiasis from 1978 to 2022: visualization and bibliometric analysis. Urolithiasis 2024; 52:67. [PMID: 38630266 DOI: 10.1007/s00240-024-01568-1] [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: 02/09/2024] [Accepted: 04/02/2024] [Indexed: 04/19/2024]
Abstract
Laser lithotripsy is gaining global prominence and is a dynamically progressing field marked by a continual influx of new and comprehensive research each year. Recently, there has been a noticeable shift toward the adoption of various kinds of lasers, such as holmium: yttrium-aluminum-garnet (Ho:YAG) and thulium fiber (TFL) lasers. Consequently, we aim to conduct a bibliometric analysis to analyze key areas of research activity within scientific publications that center on the utilization of laser techniques in urolithiasis. A search of the literature spanning from 1978 to 2022 was carried out on 25 December 2023 using the Scopus database to explore research related to the application of laser techniques for urolithiasis treatment. Visualization analysis was performed using VOSviewer software (version 1.6.20). We examined 962 publications that met the specified criteria, 791 (82.22%) of which were original articles. The analysis of the retrieved publications indicated a consistent increase in research output from 1978 to 2022; a particularly noteworthy surge occurred after 2003. In particular, the U.S. claimed the leading position as the most productive country, contributing 211 articles (21.93%). However, India had the highest research productivity according to the adjustment index of 19.08. In the European region, 324 publications (33.68% of the total) originated from 25 countries. The Journal of Endourology contributed the most between 1978 and 2022 (n = 96, 9.98%). The most cited paper examined the effectiveness of holmium: yttrium-aluminum-garnet (Ho:YAG) lasers, while a subsequent study focused on the use of a thulium fiber laser (TFL), an emerging laser technology that has gained increased recognition. Co-occurrence analysis revealed three distinct clusters focusing on the types of laser technology, minimally invasive approaches, and success rate/postoperative complications. This comprehensive investigation delves into the global landscape of laser use for the treatment of urolithiasis. This review supports the emerging clinical concept of using various types of laser technology for urolithiasis treatment. Moreover, the hot issues that researchers should focus on based on the findings of this study are the use of different types of laser lithotripsy in view of the surgical approach, success rate and complications.
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Affiliation(s)
- Faris Abushamma
- Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine.
- Department of Urology, An-Najah National University Hospital, Nablus, 44839, Palestine.
| | - Sa'ed H Zyoud
- Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine.
- Clinical Research Center, An-Najah National University Hospital, Nablus, 44839, Palestine.
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Guo Z, Wang Z, Weng X, Tang Y, Wu D, Cheng F, Chen B, Tang H, Cui J, Gu C, Zou Q, Li Y, Gan S, Xiang S, Wang S. The safety and efficacy of Sotn ureteroscopy for renal and upper ureteral calculi: a prospective multicenter randomized controlled trial. Minerva Urol Nephrol 2024; 76:221-229. [PMID: 38742555 DOI: 10.23736/s2724-6051.24.05595-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
BACKGROUND Sotn ureteroscopy is a new lithotripsy procedure developed on the basis of ureteroscopy and includes a rigid ureteral access sheath, standard mirror, lithotripsy mirror, and Sotn perfusion aspirator. Thus, we performed a prospective multicenter randomized controlled trial comparing the safety and efficacy of Sotn ureteroscopy in the treatment of renal and upper ureteral calculi. METHODS In this study, 224 patients with renal and upper ureteral calculi were randomly divided equally into study and control groups from March 2018 to March 2022. All the patients were approved by the hospital ethics committee (proof number: ZF-2018-164-01 and ZF-2018-165-01) of the Second Affiliate Hospital of Guangzhou University of Chinese Medicine in China. The primary outcome was stone-free rate (SFR) assessed by computed tomography on the 1st day and month after treatment and operation duration. The secondary outcome was postoperative complication rate. RESULTS In total, for upper ureteral calculi, the SFR of 1 day after operation of the Sotn ureteroscopy group was significantly higher than the rigid ureteroscopy group (83.6% vs. 60%, P=0.006). Moreover, operative time (33.7±1.80 vs. 52.9±2.73 min, P<0.005) of the Sotn ureteroscopy group was significantly lower than the rigid ureteroscopy group. Additionally, the SFR of 1 day after operation and operative time for the study group (Sotn ureteroscopy combined with flexible ureteroscopy) and the control group (flexible ureteroscopy alone) were 63.2% and 36.8% (P=0.005), 65.6±4.06 and 80.3±4.91 (P=0.023), respectively. However, there were no significant differences in the SFR of 1 month after operation, success rate of ureteral access sheath placement, and postoperative complications between the two groups (P>0.05). In subgroups with stone diameters ≥1.5 cm and stone CT values ≥1000 Hounsfield units, Sotn ureteroscopy showed more advantages in terms of the SFR of 1 day after operation. Importantly, complications such as ureteral injury, sepsis, fever, and severe hematuria were not statistically different between the two groups (P>0.05). CONCLUSIONS For renal and upper ureteral calculi, Sotn ureteroscopy has the advantage of a higher SFR of 1 day after the operation and a shorter operative time, suggesting that the Sotn ureteroscopy may have further potential applications in clinics.
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Affiliation(s)
- Zhenlang Guo
- Department of Urology, The Second Affiliated Hospital of Guangzhou, University of Chinese Medicine, Guangzhou, China
| | - Zhichao Wang
- Department of Urology, The Second Affiliated Hospital of Guangzhou, University of Chinese Medicine, Guangzhou, China
| | - Xiangtao Weng
- Department of Urology, The Second Affiliated Hospital of Guangzhou, University of Chinese Medicine, Guangzhou, China
| | - Yanquan Tang
- Department of Urology, Jiangmen Wuyi Hospital of Chinese Medicine, Jiangmen, China
| | - Deneng Wu
- Department of Urology, Guilin Hospital of Chinese Traditional and Western Medicine, Guilin, China
| | - Fan Cheng
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Bin Chen
- Department of Urology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Huilong Tang
- Department of Urology, The First Affiliated Hospital of Hunan University of Chinese Medicine, Changsha, China
| | - Jinsheng Cui
- Department of Urology, Heji Hospital of Changzhi Medical College, Changzhi, China
| | - Chiming Gu
- Department of Urology, The Second Affiliated Hospital of Guangzhou, University of Chinese Medicine, Guangzhou, China
| | - Qianming Zou
- Department of Urology, The Second Affiliated Hospital of Guangzhou, University of Chinese Medicine, Guangzhou, China
| | - Yuan Li
- Department of Urology, The Second Affiliated Hospital of Guangzhou, University of Chinese Medicine, Guangzhou, China
| | - Shu Gan
- Department of Urology, The Second Affiliated Hospital of Guangzhou, University of Chinese Medicine, Guangzhou, China
| | - Songtao Xiang
- Department of Urology, The Second Affiliated Hospital of Guangzhou, University of Chinese Medicine, Guangzhou, China
| | - Shusheng Wang
- Department of Urology, The Second Affiliated Hospital of Guangzhou, University of Chinese Medicine, Guangzhou, China -
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Abdelfatah Zaza MM, Farouk Salim A, El-Mageed Salem TA, Mohammed Ezzat A, Hassan Ali M. Impact of ureteric access sheath use during flexible ureteroscopy: A comparative study on efficacy and safety. Actas Urol Esp 2024; 48:204-209. [PMID: 37838327 DOI: 10.1016/j.acuroe.2023.10.005] [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: 07/01/2023] [Revised: 08/19/2023] [Accepted: 08/21/2023] [Indexed: 10/16/2023]
Abstract
OBJECTIVES This study evaluates the impact of using an access sheath (AS) during flexible ureteroscopy (fURS) for urolithiasis treatment, focusing on outcomes such as stone-free rate, operation time, and complications. METHODS This prospective, randomized study was carried out at Badr Hospital, Helwan University, and Ain Shams University hospitals from August 2021 to August 2022. Patients were systematically randomized into two groups (fURS with AS: 33 patients and without AS: 31 patients) and underwent preoperative and postoperative assessments, including lab tests and imaging. Possible procedure-associated risks, such as failed stone access, pain, bleeding, and sepsis, were monitored. RESULTS The two groups were found to be comparable in terms of demographic characteristics or preoperative stone findings (p > 0.05 for all). However, operation duration was shorter in the No Sheath group (79.4 ± 15.3 min vs. 90.4 ± 16.7 min in the Sheath group, p = 0.008). Intraoperative complication rates, including failed access, operation termination, ureteric injury, and bleeding, were comparable in both groups (p > 0.05). Postoperative stone-free rates (78.8% vs. 71.0%, p = 0.305) and mean residual stone size (2.7 ± 3.5 mm vs. 3.1 ± 3.1 mm, p = 0.687) showed no significant differences. CONCLUSIONS The present study suggests that fURS without an access sheath may offer an efficient and equally effective option for managing upper ureteric and renal stones. However, more studies with larger sample sizes and longer follow-up periods are required to validate these findings and to establish more precise indications for this approach.
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Affiliation(s)
- M M Abdelfatah Zaza
- Departamento de Urología, Facultad de Medicina, Universidad de Helwan, El Cairo, Egypt
| | - A Farouk Salim
- Departamento de Urología, Facultad de Medicina, Universidad de Ain Shams, El Cairo, Egypt
| | - T A El-Mageed Salem
- Departamento de Urología, Facultad de Medicina, Universidad de Helwan, El Cairo, Egypt
| | - A Mohammed Ezzat
- Departamento de Urología, Facultad de Medicina, Universidad de Helwan, El Cairo, Egypt.
| | - M Hassan Ali
- Departamento de Urología, Facultad de Medicina, Universidad de Helwan, El Cairo, Egypt
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Salah M, Laymon M, Gul T, Alnawasra H, Ibrahim M, Tallai B, Ebrahim M, Alrayashi M, Abdelkareem M, Al-Ansari A. Optimizing outcome reporting after robotic flexible ureteroscopy for management of renal calculi: Introducing the concept of tetrafecta. J Robot Surg 2024; 18:128. [PMID: 38492131 PMCID: PMC10944431 DOI: 10.1007/s11701-024-01858-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 01/31/2024] [Indexed: 03/18/2024]
Abstract
Robotic flexible ureteroscopy (RFURS) has shown encouraging results in terms of stone free rate (SFR) and better ergonomics compared to conventional FURS. However, few studies have reported its outcomes. The goal of this study was to report our initial results of RFURS, furthermore we proposed a novel metrics for composite outcome reporting named tetrafecta. A retrospective analysis of electronic records of 100 patients treated with RFURS for renal stones between 2019 till 2023 was performed. Tetrafecta criteria included, complete stone removal after a single treatment session, without auxiliary procedures, absence of high-grade complications (GIII-V) and same-day hospital discharge. Mean patient age and stone size were 40.7 ± 9.2 and 11.7 ± 5.8 mm, respectively. Median stone volume was 916 (421-12,235) mm3. Twenty-eight patients had multiple renal stones. Staghorn stones were seen in 12 patients. Preoperative DJ stent was fixed in 58 patients. Median operative time and stone treatment time were 116 min (97-148) and 37 (22-69) min. The median stone treatment efficiency (STE) was 21.6 (8.9-41.6). A strong positive correlation between stone volume and STE (R = 0.8, p < 0.0001). Overall, 73 patients were stone free after the initial treatment session while tetrafecta was achieved in 70 patients. Univariate analysis showed that the stone size (p = 0.008), acute infundibulopelvic angle (p = 0.023) and preoperative stenting (p = 0.017) had significant influence on achieving tetrafecta. Multivariate analysis identified preoperative stenting (OR 0.3, 95% CI 0.1-0.8, p = 0.019) as the only independent predictor of tetrafecta achievement. A comprehensive reporting methodology for reporting outcomes of RFURS is indicated for patient counseling and comparing different techniques. Tetrafecta was achieved in 70% of cases. Presence of significant residual stones ≥ 3mm was the leading cause of missing tetrafecta. Absence of preoperative stent was the only predictor of missing tetrafecta.
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Affiliation(s)
- Morshed Salah
- Urology Section, Surgery Department, Hazm Mebaireek General Hospital, Hamad Medical Corporation, Doha, Qatar.
- Department of Surgery-Urology, College of Medicine, QU Health, Qatar University, Doha, Qatar.
| | - Mahmoud Laymon
- Urology Section, Surgery Department, Hazm Mebaireek General Hospital, Hamad Medical Corporation, Doha, Qatar
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Tawiz Gul
- Urology Section, Surgery Department, Hazm Mebaireek General Hospital, Hamad Medical Corporation, Doha, Qatar
- Department of Surgery-Urology, College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Hossameldin Alnawasra
- Urology Section, Surgery Department, Hazm Mebaireek General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Mohammed Ibrahim
- Urology Section, Surgery Department, Hazm Mebaireek General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Bela Tallai
- Urology Section, Surgery Department, Hazm Mebaireek General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Mohamed Ebrahim
- Urology Section, Surgery Department, Hazm Mebaireek General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Maged Alrayashi
- Urology Section, Surgery Department, Hazm Mebaireek General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Mohamed Abdelkareem
- Urology Section, Surgery Department, Hazm Mebaireek General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Abdulla Al-Ansari
- Urology Section, Surgery Department, Hazm Mebaireek General Hospital, Hamad Medical Corporation, Doha, Qatar
- Department of Surgery-Urology, College of Medicine, QU Health, Qatar University, Doha, Qatar
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Cinar O, Cakir H, Ozman O, Akgul M, Basatac C, Siddikoglu D, Sancak EB, Baseskioglu B, Yazici CM, Akpinar H, Onal B. Safety and Efficacy of Retrograde Intrarenal Surgery in the Solitary Kidney: A Propensity Score-Matched Analysis of the RIRSearch Study Groups' Results. J Laparoendosc Adv Surg Tech A 2024; 34:155-161. [PMID: 38153393 DOI: 10.1089/lap.2023.0408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023] Open
Abstract
Background: The aim of this study was to evaluate the efficacy and safety of retrograde intrarenal surgery (RIRS) in patients with renal calculi with solitary kidneys (SKs). Materials and Methods: In this retrospective, multicenter study, a matched case-control study was carried out using the data from 522 RIRS patients treated between 2014 and 2021. Patients' demographic data, stone characteristics, operative outcomes, perioperative and postoperative complications, and surgical success were analyzed. All patients were evaluated with noncontrast-enhanced computed tomography (NCCT) preoperatively and 1 month after the surgery. Surgical success was defined as no evidence of remaining residual fragments of <3 mm in the first-month postoperative NCCT images. The case group of 29 patients with SKs (Group 1) treated with RIRS were matched with 76 control patients (Group 2) with bilateral kidneys, who underwent unilateral RIRS by propensity score-matched (PSM) analysis. Results: After PSM analysis, the demographic and clinical data did not differ significantly between the groups. The stone burden was similar between the groups: 733.6 mm3 (range: 50.4-7565.9) versus 991.1 mm3 (range: 201.2-4380.6) (P = .09), respectively. The perioperative complication rates were 13.8% (n = 4) in Group 1 and 11.8% (n = 9) in Group 2 (P = .78). There was no statistically significant difference between the groups for postoperative complication rates (minor complications, classified as Clavien 1 or 2), (6.9% [n = 2] versus 13.2% [n = 10; P = .34]), respectively. Surgical success was 82.8% (n = 24) in Group 1 and 83.6% in Group 2 (P = .92). There was no significant difference between preoperative and postoperative glomerular filtration rate and creatinine values (P = .005). Conclusions: Our results support that RIRS is a safe and effective treatment method in SK patients with similar complication and stone-free rates compared to patients who had bilateral functional kidneys and underwent unilateral RIRS.
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Affiliation(s)
- Onder Cinar
- Department of Urology, Medicana International Samsun Hospital, Urology Clinic, Samsun, Turkey
| | - Hakan Cakir
- Department of Urology, Acibadem Hospitals Group, Acibadem Fulya Hospital, Clinic of Urology, Istanbul, Turkey
| | - Oktay Ozman
- Department of Urology, Gaziosmanpasa Training and Research Hospital, Clinic of Urology, Istanbul, Turkey
| | - Murat Akgul
- Department of Urology, Faculty of Medicine, Tekirdag Namik Kemal University, Tekirdag, Turkey
| | - Cem Basatac
- Department of Urology, Istanbul Florence Nightingale Hospital, Clinic of Urology, Istanbul, Turkey
| | - Duygu Siddikoglu
- Department of Biostatistics and Faculty of Medicine, Canakkale Onsekiz Mart University, Canakkale, Turkey
| | - Eyup Burak Sancak
- Department of Urology, Faculty of Medicine, Canakkale Onsekiz Mart University, Canakkale, Turkey
| | - Barbaros Baseskioglu
- Department of Urology, Acibadem Hospitals Group, Acibadem Eskisehir Hospital, Clinic of Urology, Eskisehir, Turkey
| | - Cenk Murat Yazici
- Department of Urology, Faculty of Medicine, Tekirdag Namik Kemal University, Tekirdag, Turkey
| | - Haluk Akpinar
- Department of Urology, Istanbul Florence Nightingale Hospital, Clinic of Urology, Istanbul, Turkey
| | - Bulent Onal
- Department of Urology, Faculty of Medicine, Istanbul University Cerrahpasa, Istanbul, Turkey
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Zeng X, Diao X, Jin S, Hu W, Bai W, Li J, Xiao B. Needle-perc-assisted endoscopic surgery (NAES) for patients with complicated solitary kidney stones: a prospective randomized study from a single center. World J Urol 2023; 41:3121-3127. [PMID: 37750960 DOI: 10.1007/s00345-023-04576-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 08/15/2023] [Indexed: 09/27/2023] Open
Abstract
PURPOSE The goal of this study is to compare traditional percutaneous nephrolithotomy (PCNL) and needle-perc-assisted endoscopic surgery (NAES) in the treatment of complicated solitary kidney stones via a single-center randomized controlled prospective study. METHODS A total of patients with complex (Guy's score II-IV) solitary kidney stones between July 2019 to June 2022 were enrolled in the study. Participants were stratified into two groups: needle-perc-assisted endoscopic surgery group (group A) and traditional PCNL group (group B). All procedures were finished by X-ray free technique. The clinical characteristics and outcomes were analyzed. RESULTS A total of 90 (44 in Group A and 46 in Group B) patients were finally included in our study. There were no statistically differences in terms of gender, age, body mass index (BMI), stone burden between two groups. The mean operative duration of Group A was significant higher than group B (95.1 ± 21.4 min vs 72.5 ± 29.5 min, p=0.02). The 1-month stone-free rate (SFR) was significant higher in Group A than B (90.9% vs 73.9%, p=0.03). A less hemoglobin drop (p=0.01), shorter postoperative in-hospital day (p=0.04), and lower severe complication (Clavien-Dindo III and above) rates (p=0.03) were observed in Group A. CONCLUSION For patients with solitary kidney stones, NAES technique provides a higher one-session SFR, a better renal function recovery and compared with traditional PCNL.
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Affiliation(s)
- Xue Zeng
- Department of Urology, Tsinghua University Affiliated Beijing Tsinghua Changgung Hospital, Tsinghua University Clinical Institute, No.168, Litang Road, Changping District, Beijing, 102218, China
| | - Xiaolin Diao
- Department of Medicine, Peking University Hospital, Beijing, 100871, China
| | - Song Jin
- Department of Urology, Tsinghua University Affiliated Beijing Tsinghua Changgung Hospital, Tsinghua University Clinical Institute, No.168, Litang Road, Changping District, Beijing, 102218, China
| | - Weiguo Hu
- Department of Urology, Tsinghua University Affiliated Beijing Tsinghua Changgung Hospital, Tsinghua University Clinical Institute, No.168, Litang Road, Changping District, Beijing, 102218, China
| | - Wenjie Bai
- Department of Urology, Tsinghua University Affiliated Beijing Tsinghua Changgung Hospital, Tsinghua University Clinical Institute, No.168, Litang Road, Changping District, Beijing, 102218, China
| | - Jianxing Li
- Department of Urology, Tsinghua University Affiliated Beijing Tsinghua Changgung Hospital, Tsinghua University Clinical Institute, No.168, Litang Road, Changping District, Beijing, 102218, China
| | - Bo Xiao
- Department of Urology, Tsinghua University Affiliated Beijing Tsinghua Changgung Hospital, Tsinghua University Clinical Institute, No.168, Litang Road, Changping District, Beijing, 102218, China.
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Comparison Between Percutaneous Nephrolithotomy and Retrograde Flexible Nephrolithotripsy in Obese Patients with 2 - 4 cm Renal Stones. Nephrourol Mon 2022. [DOI: 10.5812/numonthly-132180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Nowadays, because of remarkable advancements in retrograde intrarenal surgery (RIRS), modest attention toward this procedure as the second or alternative choice for renal stones treatment has been drawn. Objectives: In the present study, we compared RIRS and percutaneous nephrolithotomy (PCNL) outcomes in treating obese patients with 2 - 4 cm renal stones. Methods: Eighty-two patients who underwent PCNL (n = 40) and RIRS (n = 42) between June 2015 and December 2018 at the Department of Urology of Sina Hospital were enrolled in our retrospective cohort study. Results: After the first surgery session, stone-free rates for the RIRS group were 92.9% and for the PCNL group was 95% (P value = 0.52). The mean operation time for the RIRS and PCNL groups were 71.6 ± 11 and 93.3 ± 12.2, respectively (P < 0.001). The hospitalization stay for all of the PCNL group was more than 1 day (mean = 2.5 days); however, that for the majority of the RIRS group was less than 1 day (P < 0.001). The analgesic use in the RIRS group was significantly lower than in the PCNL group (9.0 ± 5.5, 61.8 ± 13.6, respectively; P < 0.001). The overall complication rates were higher in the RIRS group. However, none of them were statically significant (P > 0.05). Conclusions: According to satisfactory outcomes obtained in the RIRS groups, it can be concluded that RIRS can be applied as an alternative or even the first choice in obese patients with 2 - 4 cm renal stones.
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Tufano A, Frisenda M, Rossi A, Viscuso P, Mantica G, Bove P, Leonardi R, Calarco A. External validation of Resorlu-Unsal stone score in predicting outcomes after retrograde intrarenal surgery. Experience from a single institution. Arch Ital Urol Androl 2022; 94:311-314. [DOI: 10.4081/aiua.2022.3.311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 09/09/2022] [Indexed: 11/22/2022] Open
Abstract
Objective: Pre-operative assessment of renal stones is essential in selecting treatment options and achieving high success rates for retrograde intrarenal surgery (RIRS). Several nephrolithometric scoring systems have been developed using pre-operative clinical data and stone characteristics. Resorlu-Unsal stone score (RUSS) is composed of four different parameters, and each of them adds 1 point to the final score. One point is added in patients with stone size > 20 mm, lower calyceal stones and infundibulo-pelvic angle < 45°, stone number > 1, and abnormal anatomy, respec-tively. RUSS categorizes patients into four distinct groups and aims to predict stone-free rates (SFR) after RIRS. We externally validated RUSS and evaluated its predictive accuracy.Materials and Methods: We performed a retrospective analysis of patients who underwent RIRS for renal stones between January 2020 and December 2021. Patient age, pre-operative hydronephrosis, stone size, stone density as Hounsfield Unit(HU), operative time and RUSS were investigated as potential preoperative predictive factors for stone-free status. RUSS was applied to all patients, and the nomogram was externally vali-dated. Area under the curve (AUC) was used for clinical validity assessment.Results: The present study included a total of 79 patients. Mean patient age was 55.1 ± 15.4 years with a mean stone size was 14.2 ± 4.4 mm. Overall, 62/79 (78.4%) patients were stone free after the initial treatment. After applying RUSS, 36 (45.6%), 29 (36.7%), 10 (12.6%), and 4 (5.1%) patients had a score of 0, 1, 2, and 3, respectively. On multivariate logistic regression RUSS (OR = 0.220; 95%CI: 0.086-0.567; p = 0.002) was identified as the only predictor of postoperative stone-free status.Conclusions: RUSS is a user-friendly scoring system that may predict postoperative stone-free rate after RIRS with great effi-cacy and accuracy.
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15
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Lv G, Zhang Z, Du F, Qi W, Zhong M, Zhou Y, Zhou C, Li Y, Zhang D. Comparison of flexible ureteroscopy and mini-percutaneous nephrolithotomy in the treatment for multiple nephrolithiasis. Front Surg 2022; 9:1004432. [PMID: 36157421 PMCID: PMC9500501 DOI: 10.3389/fsurg.2022.1004432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 08/25/2022] [Indexed: 12/02/2022] Open
Abstract
Objective To compare the outcomes of flexible ureteroscopy and mini-percutaneous nephrolithotomy in the treatment for multiple nephrolithiasis in 1–2 cm size. Methods The clinical data of patients with multiple renal calculi in the range of 1–2 CM who underwent flexible ureteroscopy lithotripsy and percutaneous nephrolithotomy in Qilu Hospital of Shandong University from January 2016 to March 2021 were retrospectively collected and matched using propensity score matching. Then a subgrouping of the number of stones was performed. Patients were divided into Group A and Group B according to their stone numbers. Patients with no statistically significant differences in baseline data were matched to compare the safety and efficacy of the two procedures. Results A total of 210 patients with clinical data were collected, and the patients’ baseline data were not comparable, and 142 patients were finally included in the study after propensity score matching. There was no statistical difference in baseline data between the two groups of patients. The postoperative hospital days (3.00, 2.00 vs. 7.00, 3.00, P < 0.001), operation time (90.00, 50.00 vs. 110.00, 53.00, P = 0.018), complications (6, 6.8% vs. 14, 25.9%, P = 0.001) of patients in flexible ureteroscopy group %, P = 0.001) was significantly lower than that in the percutaneous nephrolithotomy group. There was no significant difference in stone clearance rate between the two groups (76, 86.4% vs. 42, 77.8%, P = 0.185). When the number of stones was no more than 3, the operation time (85.00, 49.00 vs. 110.00, 53.00, P = 0.005) and complications (2, 4.2% vs. 11, 29.7%, P = 0.001) of f-URS were significantly less than those of mPCNL, but when the number of stones was more than 3, there was no significant difference between the two operations. Conclusion For multiple nephrolithiasis within 1–2 CM, when the number of stones does not exceed 3, flexible ureteroscopy can achieve the same stone clearance rate as percutaneous nephrolithotomy, while having shorter post-operation days, operative time and fewer complications. When the number of stones is more than 3, there are no significant difference between two operations.
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Affiliation(s)
- Guangda Lv
- Department of Urology, Qilu Hospital of Shandong University, Jinan, China
| | - Zhiwei Zhang
- Department of Urology, Qilu Hospital of Shandong University, Jinan, China
| | - Fei Du
- Department of Urology, Yanggu People’s Hospital, Yanggu, China
| | - Wenqiang Qi
- Department of Urology, Qilu Hospital of Shandong University, Jinan, China
| | - Minglei Zhong
- Department of Urology, Qilu Hospital of Shandong University, Jinan, China
| | - Yongheng Zhou
- Department of Urology, Qilu Hospital of Shandong University, Jinan, China
| | - Changkuo Zhou
- Department of Urology, Qilu Hospital of Shandong University, Jinan, China
| | - Yan Li
- Department of Urology, Qilu Hospital of Shandong University, Jinan, China
| | - Dongqing Zhang
- Department of Urology, Qilu Hospital of Shandong University, Jinan, China
- Correspondence: Dongqing Zhang
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Bozkurt M, Seker KG. Fluoroscopy-free RIRS on the second session after ureteral stent placement. Urologia 2022; 90:130-135. [PMID: 36047537 DOI: 10.1177/03915603221114459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aim: Fluoroscopy is used in some stages of the conventional Retrograde Intrarenal Surgery (RIRS) procedure and is beneficial. On the other hand, radiation exposure is its most obvious disadvantage. As a subgroup, we aimed to show that fluoroscopy-free technique is safe and effective in patients who underwent RIRS after passive dilatation. Materials and methods: Between October 2018 and April 2020, 54 cases of second session RIRS of renal stones performed by a single surgeon were retrospectively evaluated. Patients’ demographic characteristics (age, gender), stone features (laterality, size, number, volume, and location), mean operative time, and, perioperative and postoperative complications, as well as the stone-free rate (SFR), were all retrospectively evaluated. The results were classified as stone free, clinical insignificant residual fragments (CIRF), and presence of residual stones. Complications were graded using the Clavien–Dindo classification system. We used a modified surgical technique. Results: All of complications were minor. There were no major complications (Clavien grade III–IV). The stone-free rate was 70.3% (38/54) on the first day after surgery and 83.3% (45/54) 1 month afterward, respectively. If we accept the absence of residual stone as success, we can say that it is about 91% successful in the first month. Conclusion: This technique has a high stone-free success rate and a low complication rate without the use of radiation. For surgeons experienced in endourology, we can say that the fluoroscopy-free technique is safe and effective in secondary-session RIRS cases which passive dilatation was performed by inserting a ureteral catheter before.
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Affiliation(s)
- Muammer Bozkurt
- Department of Urology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
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17
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Fu W, Dai C, Chen J, Wang L, Song T, Peng Z, Xu M, Xu L, Tang Y, Shao Y. Altered insular functional connectivity correlates to impaired vigilant attention after sleep deprivation: A resting-state functional magnetic resonance imaging study. Front Neurosci 2022; 16:889009. [PMID: 35958999 PMCID: PMC9361853 DOI: 10.3389/fnins.2022.889009] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 07/05/2022] [Indexed: 11/25/2022] Open
Abstract
Objectives This study used resting-state functional magnetic resonance imaging (rs-fMRI) scans to assess the dominant effects of 36 h total sleep deprivation (TSD) on vigilant attention and changes in the resting-state network. Materials and methods Twenty-two healthy college students were enrolled in this study. Participants underwent two rs-fMRI scans, once in rested wakefulness (RW) and once after 36 h of TSD. We used psychomotor vigilance tasks (PVT) to measure vigilant attention. The region-of-interest to region-of-interest correlation was employed to analyze the relationship within the salience network (SN) and between other networks after 36 h of TSD. Furthermore, Pearson’s correlation analysis investigated the relationship between altered insular functional connectivity and PVT performance. Results After 36 h of TSD, participants showed significantly decreased vigilant attention. Additionally, TSD induced decreased functional connectivity between the visual and parietal regions, whereas, a significant increase was observed between the anterior cingulate cortex and insula. Moreover, changes in functional connectivity in the anterior cingulate cortex and insula showed a significant positive correlation with the response time to PVT. Conclusion Our results suggest that 36 h of TSD impaired vigilant visual attention, resulting in slower reaction times. The decrease in visual-parietal functional connectivity may be related to the decrease in the reception of information in the brain. Enhanced functional connectivity of the anterior cingulate cortex with the insula revealed that the brain network compensation occurs mainly in executive function.
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Affiliation(s)
- Weiwei Fu
- School of Biomedical Engineering (Suzhou), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China
| | - Cimin Dai
- School of Psychology, Beijing Sport University, Beijing, China
| | - Jie Chen
- School of Psychology, Beijing Sport University, Beijing, China
| | - Letong Wang
- School of Psychology, Beijing Sport University, Beijing, China
| | - Tao Song
- School of Psychology, Beijing Sport University, Beijing, China
| | - Ziyi Peng
- School of Psychology, Beijing Sport University, Beijing, China
| | - Mengmeng Xu
- School of Psychology, Beijing Sport University, Beijing, China
| | - Lin Xu
- School of Psychology, Beijing Sport University, Beijing, China
| | - Yuguo Tang
- School of Biomedical Engineering (Suzhou), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China
- *Correspondence: Yuguo Tang,
| | - Yongcong Shao
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China
- School of Psychology, Beijing Sport University, Beijing, China
- Yongcong Shao,
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Datta SN, Chalokia RS, Wing KW, Patel K, Solanki R, Desai J. Ultramini-percutaneous nephrolithotomy versus retrograde intrarenal surgery in the treatment of 10-30 mm calculi: a randomized controlled trial. Urolithiasis 2022; 50:361-367. [PMID: 35107612 DOI: 10.1007/s00240-022-01304-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 01/12/2022] [Indexed: 12/14/2022]
Abstract
The surgical management of renal stones 10-30 mm is usually performed with percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS). Standard form of percutaneous nephrolithotomy has paved the way for miniaturized PCNL in many centres. We wanted to evaluate the efficacy, safety and the cost-effectiveness of ultramini-percutaneous nephrolithotomy (UMP) versus RIRS in the treatment of renal stones with stone burden 10-30 mm. Patients with renal stone burden 10-30 mm were prospectively randomized into either UMP or RIRS. The demographic data, stone characteristic, operative time and cost of the equipment were recorded. The stone free status, analgesic requirement, deterioration of the renal function and hemoglobin and the postoperative complications as per Clavein-Dindo grade were recorded. One hundred and fifty patients met inclusion criteria. Out of these 98 underwent UMP and 46 RIRS. Six withdrew the consent before the procedure. Mean stone size was comparable in either of the groups. Mean laser time and stone extraction time was significantly less for UMP compared to RIRS (41.17 min versus 73.58 min p < 0.0001). Mean consumable costs in the UMP group were considerably less at US$45.73 compared to the RIRS group at $423.11 (p < 0.0001). The stone free rates at 1 month of follow-up were 100% for UMP group and 73% for RIRS group. There were insignificant changes to mean hemoglobin and glomerular filtration rate (GFR) in all patients and the average length of the stay was similar in both the groups. The postoperative complications revealed Grade I and II rate of 10% in the UMP group and 35% in the RIRS group, respectively. We concluded that UMP to be safe, effective and more economical to the RIRS for renal stones up to 3 cm in size.Trial registered with ISRCTN registry ID ISRCTN20935105, Retrospective.
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Affiliation(s)
| | | | - K W Wing
- Department of Urology, Colchester General Hospital, Colchester, UK
| | - K Patel
- Department of Urology, Samved Hospital, Ahmedabad, India
| | - R Solanki
- Department of Urology, Samved Hospital, Ahmedabad, India
| | - Janak Desai
- Department of Urology, Samved Hospital, Ahmedabad, India.
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Deng XX, Zhang W, Fu D, Fu B. Renal Pseudoaneurysms after Flexible Ureteroscopy and Holmium Laser Lithotripsy: A Case Report. Front Surg 2022; 9:896548. [PMID: 36034371 PMCID: PMC9406514 DOI: 10.3389/fsurg.2022.896548] [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: 03/15/2022] [Accepted: 04/27/2022] [Indexed: 11/17/2022] Open
Abstract
Background Flexible ureteroscopy (FURS) and holmium laser lithotripsy is considered one of the most minimally invasive and safe surgical methods for the treatment of renal calculi. Renal pseudoaneurysm is a rare complication after FURS holmium laser lithotripsy. We report a case of renal pseudoaneurysm after FURS and holmium laser lithotripsy and review the relevant literature to analyze the possible etiology and summarize the treatment. Case presentation A 29-year-old male with a 2-year history of diabetes was admitted to the hospital because of right back pain for 5 days. A doppler ultrasound demonstrated bilateral renal calculi with bilateral mild hydronephrosis. The patient underwent one-stage right FURS and holmium laser lithotripsy and bilateral ureteral stent implantation. The urine was clear on the second day after the operation, and he was discharged from the hospital. Due to severe gross hematuria, he had to be hospitalized 28 days after the operation. A CT scan showed multiple blood clots in the right renal pelvis and bladder. An emergency blood transfusion and removal of the bladder blood clots and bilateral double J tubes were performed. His urine was clear for one week, and he was discharged from the hospital. He was hospitalized again 47 days after the operation because of fever and hematuria. A CT scan demonstrated blood clots in the bladder and right renal pelvis. Angiography showed a pseudoaneurysm in a small branch of the right renal artery, and hematuria stopped after selective renal artery embolization with microcoils. Conclusion FURS and holmium laser lithotripsy is safe, but we should be aware of the possibility of renal artery pseudoaneurysms (RAP). Through careful operation during the surgery, avoiding kidney injury, reducing intrarenal pressure and controlling the time of operation may prevent the occurrence of this complication. Vascular embolization is the first choice for the treatment of pseudoaneurysms.
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Affiliation(s)
- Xin-xi Deng
- Department of Urology, Jiu Jiang NO.1 People’s Hospital, Jiujiang, China
- Department of Urology, The First Affiliated Hospital of Nanchang University; Jiangxi Institute of Urology, Nanchang, China
| | - Wensheng Zhang
- Department of Urology, Jiu Jiang NO.1 People’s Hospital, Jiujiang, China
| | - Delai Fu
- Department of Urology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- Correspondence: Bin Fu Delai Fu
| | - Bin Fu
- Department of Urology, The First Affiliated Hospital of Nanchang University; Jiangxi Institute of Urology, Nanchang, China
- Correspondence: Bin Fu Delai Fu
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Sebaey A, Taleb AA, Elbashir S, Gomaa R, Elshazli A, Saber W. Flexible ureterorenoscopy (RIRS) vs. Mini- percutaneous nephrolithotomy (MINI-PCNL) for renal stones 20–30 mm a prospective randomized study. AFRICAN JOURNAL OF UROLOGY 2022. [DOI: 10.1186/s12301-022-00278-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
To evaluate the safety and efficacy of mini percutaneous nephrolithotomy (mini PCNL) and retrograde intrarenal surgery (RIRS) in treatment of kidney stones 20–30 mm.
Methods
A prospective randomized study of 70 patients who presented to the urology department with calyceal or renal pelvic stone of 20–30 mm between September 2017 and September 2019. Patients were randomly divided into two groups, Group A (Mini PCNL) consists of 35 patients who were treated with mini PCNL and Group B (RIRS) consists of 35 patients who were Achieving success of the technique was considered when the patient is stone-free or has radiologically insignificant residual fragments < 4 mm.
Results
The demographic data in this study were comparable in both groups. The stone size was 20.43 ± 2.2 mm in group A & 20.5 ± 2.1 in group B, with no statistical significance. Meanwhile, the operative time in group A was 59.71 ± 19.44 min and in group B was 80.43 ± 14.79 min with statistical significance difference (p value < 0.001), while Fluoroscopy time had a mean of 8.11 ± 2.05 min in group A & 5.8 ± 1.98 min in group B with statistically significant diffrence (p value < 0.001). The stone free rate (SFR) was 88.6% in mini PCNL and 82.9% in RIRS with no statistically significant difference (p value: 0.5).
Conclusion
RIRS and mini PCNL can be an effective and alternative option for treatment of renal stones 2–3 cm. Both techniques have relatively similar SFR but RIRS showed more operative time, on contrary Mini-PCNL has more operative and postoperative complications. A multicenter studies with larger numbers of patients will be more effective to confirm these results.
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21
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Kozyrakis D, Soukias G, Karagiannis D, Zarkadas A, Perikleous S, Chatzistamou SE, Katsaros I, Skriapas K, Lardas M, Mertziotis N, Kratiras Z. Prognostic factors for the safety and efficacy of retrograde laser lithotripsy: Data from a contemporary series of 155 consecutive patients with single and multiple lithiasis of the urinary tract. Exp Ther Med 2022; 23:294. [DOI: 10.3892/etm.2022.11221] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 12/17/2021] [Indexed: 11/05/2022] Open
Affiliation(s)
- Diomidis Kozyrakis
- Department of Urology, ‘Achillopoulio’ General Hospital, Volos 32222, Greece
| | - Georgios Soukias
- Department of Urology, ‘Achillopoulio’ General Hospital, Volos 32222, Greece
| | | | - Anastasios Zarkadas
- Department of Urology, ‘Achillopoulio’ General Hospital, Volos 32222, Greece
| | - Stefanos Perikleous
- Department of Urology, ‘Achillopoulio’ General Hospital, Volos 32222, Greece
| | | | - Ilias Katsaros
- Department of Urology, ‘Achillopoulio’ General Hospital, Volos 32222, Greece
| | | | - Michael Lardas
- Department of Urology, ‘Metropolitan’ General Hospital, Athens 15562, Greece
| | - Nikolaos Mertziotis
- Department of Urology, ‘Metropolitan’ General Hospital, Athens 15562, Greece
| | - Zisis Kratiras
- Department of Urology, ‘Achillopoulio’ General Hospital, Volos 32222, Greece
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22
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Calarco A, Frisenda M, Molinaro E, Lenci N. The active guidewire technique versus standard technique as different way to approach ureteral endoscopic stone treatment. Arch Ital Urol Androl 2021; 93:431-435. [PMID: 34933539 DOI: 10.4081/aiua.2021.4.431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 08/25/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND One of the greatest challenges in semi-rigid ureteroscopies, for both stones and tumors, is the control of endoscopic vision and the maintenance of low intracavitary liquid pressure. We present a comparison between two operative techniques: in the first method an ordinary guide wire (diameter 0.032'') is used for the procedure; in the second one a 5 Fr ureteral catheter replaces the guidewire (we called it "Active guidewire") Methods We compared 50 semirigid ureteroscopies (sURS) performed using the active guidewire with another 50 procedures conducted with a classic guidewire. We evaluated the difference in operating times, quality of endoscopic vision, periprocedural infections rate and stone-free rate. RESULTS The use of active guidewire has considerably reduced the standardized operating times per unit stone-volume by about 39%. Vision quality has improved considerably thanks to the continuous flow in-and-out. Consequently, periprocedural infections decreased (3% vs 30%) and the stone-free rate rose from 86% to 92%. DISCUSSION AND CONCLUSIONS Employing an "active guidewire" instead of the standard guidewire, the risk of complications related to high pressures and operating time is considerably lower, as well as better treatment quality thanks to the cleaner vision. This technique has proven to be safe as well as easy to apply, and in our belief is to be preferred whenever the ureter accepts without forcing, both the presence of the catheter and the semi-rigid 7 F ureteroscope.
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Affiliation(s)
| | - Marco Frisenda
- Department of Urology, "Cristo Re" Hospital Fondation, Rome; Department of Urology, Policlinico Umberto I, "La Sapienza" University, Rome.
| | - Emilio Molinaro
- Department of Urology, "Cristo Re" Hospital Fondation, Rome; Department of Urology, Policlinico Umberto I, "La Sapienza" University, Rome.
| | - Niccolò Lenci
- Department of Urology, "A. Gemelli" Academic Hospital, Catholic University of Sacred Heart, Rome.
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23
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Ayoub EM, Bourgi A, Alsouki J, Merhej S, Conort P. Fluoroless endourological surgery for high burden renal and proximal ureteric stones: A safe technique for experienced surgeons. Arab J Urol 2021; 19:438-444. [PMID: 34881057 PMCID: PMC8648002 DOI: 10.1080/2090598x.2021.1901357] [Citation(s) in RCA: 4] [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
Objective: To describe the feasibility of treating proximal ureteric and renal stones using flexible ureteroscopy (fURS) or a double approach (mini-percutaneous nephrolithotomy [PCNL] + fURS) without any use of radiation. Patients and methods: We retrospectively reviewed the data of all patients operated by one surgeon for retrograde endoscopic removal of renal and ureteric lithiasis performed between June 2015 and January 2019 in our institution. Patients with anatomical complexities, high-burden stone disease (diameter >20 mm), and medical comorbidities (anti-platelet drug administration) were included in our study. Outcomes analysed included complication rate, stone-free rate (SFR, defined as no residual stone >1 mm), and repeat procedure rate. Results: In all, 183 consecutive URS for proximal ureteric and renal lithiasis were conducted. C-arm fluoroscope guidance was not required, not even in the complex cases. Simultaneous ultrasonography and fURS guidance was used in patients where the mini-PCNL approach was indicated. Lead aprons were not needed by the operating room staff in any of the operations. The SFR was 91.8% after the first procedure, with no Clavien–Dindo Grade III or IV complications. Conclusion: Our present series shows clearly that the fURS and mini-PCNL approach under fURS control is a feasible and safe technique for experienced surgeons. Patients had a high SFR and no technique-related complications, with no additional risk of X-ray exposure. However, a prospective study is required to test the reproducibility of this technique. Abbreviations: GMSV: Galdakao-modified supine Valdivia; ICRP: International Commission on Radiological Protection; KUB: plain abdominal radiograph of the kidneys, ureters and bladder; OR: operating room; PCNL: percutaneous nephrolithotomy; SFR: stone-free rate; UAS: ureteric access sheath; (f)URS: (flexible) ureteroscopy; US: ultrasonography
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Affiliation(s)
- Elias M Ayoub
- Department of Urology, Hôpital Français Du Levant, Beirut, Lebanon.,Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Ali Bourgi
- Department of Urology, Hôpital Français Du Levant, Beirut, Lebanon.,Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Josee Alsouki
- Faculty of Medicine, Saint Joseph University, Beirut, Lebanon.,Department of Urology, Hôtel-Dieu De France, Beirut, Lebanon
| | - Sleiman Merhej
- Department of Urology, Hôpital Français Du Levant, Beirut, Lebanon.,Faculty of Medicine, Saint Joseph University, Beirut, Lebanon.,Department of Urology, Hôtel-Dieu De France, Beirut, Lebanon
| | - Pierre Conort
- Department of Urology, Pitié Salpêtrière, Assistance Publique - Hôpitaux De Paris, Paris, France
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24
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Maugeri O, Dalmasso E, Peretti D, Venzano F, Chiapello G, Ambruosi C, Dadone C, Bonaccorsi A, Pepe P, D'Arrigo L, Pennisi M. Stone free rate and clinical complications in patients submitted to retrograde intrarenal surgery (RIRS): Our experience in 571 consecutive cases. Arch Ital Urol Androl 2021; 93:313-317. [PMID: 34839636 DOI: 10.4081/aiua.2021.3.313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 05/07/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The purpose of this study is to report the stone free rate (SFR) and clinical complications in patients submitted to retrograde intrarenal surgery (RIRS). MATERIALS AND METHODS A total of 571 procedures of upper urinary stones treated using flexible ureteroscopy and holmium laser lithotripsy from January 2014 to February 2020 have been analyzed. Overall SFR was evaluated after 3 months following the procedure by means of a non-contrast computed tomography. Success was considered as stone-free status or ≤ 0.4 cm fragments. RESULTS The overall SFR was 92.3% in group 1 (stone size: < 1 cm), 88.3% in group 2 (stone size: > 1 ≤ 2 cm), 56.7% in group 3 (stone size: 2-3 cm) and 69.6% in group 4 (multiple stones). Post-operative complications, according to the Clavien- Dindo (CD) classification system, were recorded in 32 (5.6%) procedures. The major complications recorded were: one case of subcapsular hematoma (SRH) associated with pulmonary embolism two days after the procedure (CD Grade IIIa) treated conservatively and one case of hemorrhagic shock 2 hour with multiple renal bleedings requiring urgent nephrectomy (CD Grade IVA). CONCLUSIONS The RIRS is an effective and safe procedure with a high SFR significantly correlated with the stone size; at the same time, RIRS could be characterized by severe clinical complications that require rapid diagnosis and prompt treatment.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Pietro Pepe
- Urology Unit - Cannizzaro Hospital, Catania.
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25
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Zhang P, Han XW, Zhang X, Zhu XH, Li T, Li YS, Chen YH, Li G. Clinical Observation of UreTron Single-Probe Ultrasonic Intracorporeal Lithotripter for Ureteral Calculi. Int J Gen Med 2021; 14:4229-4237. [PMID: 34393502 PMCID: PMC8355551 DOI: 10.2147/ijgm.s325306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 07/26/2021] [Indexed: 11/23/2022] Open
Abstract
Objective The present study aimed to observe and discuss the effectiveness and safety of the UreTron single-probe ultrasonic intracorporeal lithotripter in ureteroscopic lithotripsy. Methods The clinical data of patients with unilateral solitary ureteral calculi treated with ureteroscopic lithotripsy who were hospitalized at the Department of Urology (West District) of Beijing Chaoyang Hospital between March 2016 and August 2020 were selected for retrospective analysis. The patients were divided into the UreTron group (group U) and holmium laser group (group H) according to the lithotripsy method adopted. The operation duration, length of hospital stay, stone clearance rate, proportion of patients requiring flexible ureteroscopy-assisted lithotripsy, and complications were compared between the groups. Results There was no statistical difference between the groups in terms of the general characteristics, operation duration, or length of hospital stay (P > 0.05). Regarding the stone clearance rate (group U=93.5%; group H=75%), proportion of patients requiring flexible ureteroscopy-assisted lithotripsy (group U=6.5%; group H=27.8%), and incidence of surgical complications (group U=1 case; group H=9 cases), group U was superior to group H, and the differences between the groups were statistically significant (P < 0.05). However, the differences in other complications (cardiocerebral complications and lower extremity thrombosis) were not statistically significant between the groups (P > 0.05). Conclusion The UreTron system is a new lithotripsy apparatus that is safe and effective for ureteroscopic lithotripsy and has certain advantages in terms of the stone clearance rate, proportion of patients requiring flexible ureteroscopy-assisted lithotripsy, and surgical complications, making it worthy of clinical application.
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Affiliation(s)
- Peng Zhang
- Department of Urology, Beijing Chao-Yang Hospital, Beijing, People's Republic of China
| | - Xiu-Wu Han
- Department of Urology, Beijing Chao-Yang Hospital, Beijing, People's Republic of China
| | - Xin Zhang
- Department of Urology, Beijing Chao-Yang Hospital, Beijing, People's Republic of China
| | - Xu-Hui Zhu
- Department of Urology, Beijing Chao-Yang Hospital, Beijing, People's Republic of China
| | - Tao Li
- Department of Urology, Beijing Chao-Yang Hospital, Beijing, People's Republic of China
| | - Yan-Sheng Li
- Department of Urology, Beijing Chao-Yang Hospital, Beijing, People's Republic of China
| | - Yuan-Hao Chen
- Department of Urology, Beijing Chao-Yang Hospital, Beijing, People's Republic of China
| | - Gao Li
- Department of Urology, Beijing Chao-Yang Hospital, Beijing, People's Republic of China
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26
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Xu Y, Lu Z, Lan Y, Wu D, Xiong L. Retrograde intrarenal surgery for a staghorn renal calculus in a patient with solitary kidney and urinary tract deformity: a case report. Transl Androl Urol 2021; 10:3532-3539. [PMID: 34532278 PMCID: PMC8421840 DOI: 10.21037/tau-21-192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 07/21/2021] [Indexed: 02/05/2023] Open
Abstract
Staghorn renal calculi are large, branched stones in the kidney that partially or completely fill the renal pelvis and renal calyces. Percutaneous nephrolithotomy (PCNL) is the gold standard treatment for staghorn calculi. However, we report a retrograde intrarenal surgery (RIRS) performed to treat a staghorn calculus in a patient with a solitary kidney and a deformed urinary tract. The 37-year-old male patient presented with right-sided lumbar pain. The computed tomography (CT) scan found a solitary kidney on the right side with an opaque 4.5 cm × 2.4 cm renal stone and grade I hydronephrosis. Additionally, a urinary tract deformity was observed, and it was secondary to the deformity of the pelvis caused by a previous pubis fracture, which significantly increased the risk and the difficulty of intrarenal surgery. A total number of 3 sessions of RIRS were conducted, and the patient was discharged 3 days after each session on average. The postoperative X-ray exam of the third session revealed that the renal stone was completely removed. The patient recovered well without any complications. This case demonstrates that RIRS is a safe and effective treatment of staghorn calculi with the presence of urinary tract deformation. This suggests RIRS may be of particular interest in minimizing the procedure-related damage of a solitary kidney.
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Affiliation(s)
- Yuancheng Xu
- Department of Urology, The University of Hong Kong- Shenzhen Hospital, Shenzhen, China
| | - Zhengquan Lu
- Department of Urology, The University of Hong Kong- Shenzhen Hospital, Shenzhen, China
| | - Yulong Lan
- Department of Cardiology, The Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Dan Wu
- Department of Pediatrics, The Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Lin Xiong
- Department of Urology, The University of Hong Kong- Shenzhen Hospital, Shenzhen, China
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27
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Çakıcı MÇ, Kazan Ö, Çiçek M, İplikçi A, Yıldırım A, Atış G. The effect of ideal urine culture time on urinary infections after flexible ureteroscopy: A match-pair case-control study. Int J Clin Pract 2021; 75:e14212. [PMID: 33819371 DOI: 10.1111/ijcp.14212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 03/30/2021] [Accepted: 04/02/2021] [Indexed: 11/27/2022] Open
Abstract
AIMS To investigate the effect of the ideal period (Δ-day), which is a period between the sterile urine culture and initiation of flexible ureteroscopy (f-URS), on postoperative urinary tract infections (UTI) in our tertiary referral centre. METHODS After obtaining the approval of the local ethics committee, retrospective data were collected for all f-URS procedures performed between January 2017 and March 2019. Patients that developed UTI were matched in 1:1 proportion with patients that did not develop UTI based on their demographic and stone characteristics. The group of patients with postoperative UTI was compared with the control group. RESULTS A total of 916 f-URS cases that had all required data were analysed. Sixty-eight patients with postoperative UTI were determined and a total of 136 patients were included in the study after match-pair. We found that if the Δ-day is longer than 2 weeks, the possibility of postoperative urinary infection rates increases with statistical significance (P = .006). According to our subgroup analysis, postoperative UTI was more common if the Δ-day >14 days. ROC curve analysis provided a 14.5-day period as a cut-off value of Δ-day for postoperative UTI. CONCLUSIONS The present study is the first to examine the impact of the Δ-day for f-URS on postoperative UTIs. In brief, prolonging the Δ-day, especially if Δ-day >14 days, leads to an increase in the rates of postoperative UTI. We conclude that it is preferred to either perform the f-URS in the early period after the urine culture analysis or doing the urine culture analysis shortly before the surgery.
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Affiliation(s)
- Mehmet Çağlar Çakıcı
- Department of Urology, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Özgür Kazan
- Department of Urology, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Muhammet Çiçek
- Department of Urology, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Ayberk İplikçi
- Department of Urology, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Asıf Yıldırım
- Department of Urology, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Gökhan Atış
- Department of Urology, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey
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28
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He Y, Feng YG, He J, Liang B, Jiang MD, Liu J, Kang YM, Ma LP, Zhang Q, Peng QJ, Yang T, Liu Y, Luo L, Zhang M. Effects of irrigation fluid temperature during flexible ureteroscopic holmium laser lithotripsy on postoperative fever and shivering: a randomized controlled trial. BMC Urol 2021; 21:72. [PMID: 33906652 PMCID: PMC8077842 DOI: 10.1186/s12894-021-00841-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 04/20/2021] [Indexed: 02/08/2023] Open
Abstract
Background Flexible ureteroscopic holmium laser lithotripsy is used to treat urinary tract calculi, but postoperative complications include shivering, fever and infection. To investigate the effects of irrigation fluid temperature on postoperative complications. Methods This randomized controlled trial included 120 consecutive patients undergoing flexible ureteroscopic holmium laser lithotripsy at the Urology Department, Suining Central Hospital, Sichuan, China between January 2017 and July 2019. Patients were randomized 1:1:1 into three groups (17 °C, 27 °C or 37 °C). Primary outcome was fever incidence (body temperature > 37.5 °C) within 48 h after surgery. Secondary outcomes included shivering incidence during recovery from anesthesia, white blood cell count (WBC), serum procalcitonin (PCT) and incidence of suspected infection (temperature > 38.5 °C and PCT > 0.5 µg/L). Results There were 108 patients, (17 °C group, n = 36; 27 °C group, n = 35; 37 °C group, n = 37), received flexible ureteroscopic holmium laser lithotripsy and analyzed. Age, gender distribution, body mass index, ASA grade, stone burden, preoperative creatinine, preoperative core temperature and irrigation fluid volume did not differ significantly between groups. 17 °C, 27 °C and 37 °C groups exhibited significant differences in the incidences of postoperative fever (38.9% vs. 17.1% vs. 13.5%) and shivering (22.2% vs. 5.7% vs. 2.7%) (p < 0.05 for all pairwise comparisons). There was no significant difference of WBC, PCT and incidence of suspected infection in 37 °C or 27 °C group compared with 17 °C group. One case each of flash pulmonary edema and bleeding occurred in 37 °C group. Conclusion Warming the irrigation fluid can reduce the incidence of postoperative fever and shivering, but further studies are needed to determine the optimal temperature. Trial registration The trial was registered at the Chinese Clinical Trials Registry and allocated as ChiCTR2000031683. The trial was registered on 07/04/2020 and this was a retrospective registration.
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Affiliation(s)
- Yue He
- Department of Urology, Suining Central Hospital, No. 127 Desheng W. Rd., Chuanshan District, Suining City, 629000, Sichuan Province, People's Republic of China. .,Department of Urology, Institute of Urology, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu City, 610041, Sichuan Province, People's Republic of China.
| | - You-Gang Feng
- Department of Urology, Suining Central Hospital, No. 127 Desheng W. Rd., Chuanshan District, Suining City, 629000, Sichuan Province, People's Republic of China
| | - Jun He
- Department of Urology, Suining Central Hospital, No. 127 Desheng W. Rd., Chuanshan District, Suining City, 629000, Sichuan Province, People's Republic of China
| | - Bo Liang
- Department of Urology, Suining Central Hospital, No. 127 Desheng W. Rd., Chuanshan District, Suining City, 629000, Sichuan Province, People's Republic of China
| | - Ming-Dong Jiang
- Department of Urology, Suining Central Hospital, No. 127 Desheng W. Rd., Chuanshan District, Suining City, 629000, Sichuan Province, People's Republic of China
| | - Jun Liu
- Department of Urology, Suining Central Hospital, No. 127 Desheng W. Rd., Chuanshan District, Suining City, 629000, Sichuan Province, People's Republic of China
| | - Yong-Ming Kang
- Department of Urology, Suining Central Hospital, No. 127 Desheng W. Rd., Chuanshan District, Suining City, 629000, Sichuan Province, People's Republic of China
| | - Li-Ping Ma
- Operation Room, Suining Central Hospital, No. 127 Desheng W. Rd., Chuanshan District, Suining City, 629000, Sichuan Province, People's Republic of China
| | - Qin Zhang
- Operation Room, Suining Central Hospital, No. 127 Desheng W. Rd., Chuanshan District, Suining City, 629000, Sichuan Province, People's Republic of China
| | - Qi-Jia Peng
- Operation Room, Suining Central Hospital, No. 127 Desheng W. Rd., Chuanshan District, Suining City, 629000, Sichuan Province, People's Republic of China
| | - Tao Yang
- Department of Urology, Suining Central Hospital, No. 127 Desheng W. Rd., Chuanshan District, Suining City, 629000, Sichuan Province, People's Republic of China
| | - Yao Liu
- Operation Room, Suining Central Hospital, No. 127 Desheng W. Rd., Chuanshan District, Suining City, 629000, Sichuan Province, People's Republic of China
| | - Li Luo
- Department of Anesthesiology, Suining Central Hospital, No. 127 Desheng W. Rd., Chuanshan District, Suining City, 629000, Sichuan Province, People's Republic of China
| | - Min Zhang
- Department of Anesthesiology, Suining Central Hospital, No. 127 Desheng W. Rd., Chuanshan District, Suining City, 629000, Sichuan Province, People's Republic of China
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Günseren KÖ, Demir A, Celen S, Çiçek MÇ, Kılıçarslan H. A cut-off value for the operation time and other risk factors in terms of the infection risk for flexible ureterorenoscopy. Int J Clin Pract 2021; 75:e13846. [PMID: 33222355 DOI: 10.1111/ijcp.13846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 11/16/2020] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES To investigate the operation time (OT) and ureteral access sheath (UAS) usage with the infection rates and to determine a cut-off value for OT. METHODS We retrospectively analysed the data of the patients who underwent flexible ureterorenoscopy (FURS) for renal stones larger than 20 mm between 2010 and 2019. The investigated parameters were OT, UAS using, and infection status. The data were analysed by forming two groups according to whether the OT was less than 60 minutes and more, whether the UAS was used and whether an infection occurred. In addition, independent risk factors that may affect postoperative urinary infection development were also investigated by logistic regression analysis. And, a Receiver Operating Characteristic (ROC) curve analysis was applied to determine a cut-off value in OT terms, where infection rates increase more. RESULTS A total of 575 patients were enrolled in the study. The rates of the usage of UAS and infection were greater statistically in the group for longer than 60 minutes. OT was longer statistically in the infection group than in the group without infection (94.1 ± 14.2 and 68.01 ± 23.1, for groups 1 and 2, respectively, P < .05, Table 2). OT was statistically longer in the UAS group than the unused one (79.3 ± 24.4 and 66.7 ± 22.4, for groups 1 and 2, respectively, P < .05, Table 3). ROC analyses revealed a cut-off point of 87.5 min for OT in terms of infection rate. CONCLUSION While the infection risk increases when OT exceeds 60 minutes, FURS can be safely performed up to 87.5 minutes with 89% sensitivity and 69% specificity infection risk.
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Affiliation(s)
| | - Aslan Demir
- Urology Department, Faculty of Medicine, Bezmialem Vakıf University, İstanbul, Turkey
| | - Sinan Celen
- Urology Department, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | | | - Hakan Kılıçarslan
- Urology Department, Faculty of Medicine, Uludağ University, Bursa, Turkey
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Kirecci SL, Ilgi M, Yesildal C, Yavuzsan AH, Albayrak AT, Sarica K. The impact of the pelvicalyceal anatomy characteristics on the prediction of flexible ureteroscopy outcomes. Urol Ann 2021; 13:105-110. [PMID: 34194134 PMCID: PMC8210722 DOI: 10.4103/ua.ua_19_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 09/16/2020] [Indexed: 11/04/2022] Open
Abstract
Background The anatomical architecture is a prominent factor in the outcomes of flexible ureteroscopy (FURS). Aims and Objectives The aim to regard the success of procedures based on Pelvicalyceal body that called Sampaio classification system. Materials and Methods A total of 125 FURS procedures were reviewed between December 2012 and December 2016 in our department. Seven patients were excluded from the study due to the horseshoe kidney in two cases and recurrent cystine stone configuration in five patients. The patient's renal collecting system anatomy characteristics are regarded, and they are classified into four main groups based on the mid-renal-zone anatomy assessed according to Sampaio Classification. Results Total stone-free rate (SFR) during the postoperative 1st-month evaluation was noncontrast computerized tomography 75 (63.6%). The evaluation of the SFR in all subgroup of cases based on Sampaio classification noticed easily, SFR was significantly lower in subgroup A2 (30.4%) (P = 0.00), significantly higher in subgroup B2 (P = 0.008). The comparative analysis of the operative duration defined that it was the shortest (75.3 ± 18.1 min) in Type B1 subgroup cases, and the longest (84.7 ± 25.7 min) in the Type A2 subgroup cases. Even though this duration was found to be relatively higher in Type A2 subgroup cases than the others, this difference was not statistically significant (P = 0.271). Fluoroscopy time was noted to be the shortest (11.9 ± 13.4 s) in B1 subgroup and the longest in A2 subgroup with a statistically significant different (median: 21.3 ± 30.4) (P = 0.04). While 6 (5.1%) cases had Clavien 2 and 3 (2.5%) cases, demonstrated Clavien 3a complications. Conclusion The calyceal structure of the kidney affects the SFR; therefore, a detailed classification of pelvicalyceal could improve the outcomes, decrease the rate of auxiliary procedures and prevent the complications.
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Affiliation(s)
- Sinan Levent Kirecci
- Urology Clinic, Sisli Hamidiye Etfal Research and Training Hospital, University of Health Sciences, Istanbul, Turkey
| | - Musab Ilgi
- Urology, Pediatric Urology and Uro-Oncology Clinic, KMG Klinikum Luckenwalde, Brandenburg, Germany
| | - Cumhur Yesildal
- Urology Clinic, Sisli Hamidiye Etfal Research and Training Hospital, University of Health Sciences, Istanbul, Turkey
| | - Abdullah Hizir Yavuzsan
- Urology Clinic, Sisli Hamidiye Etfal Research and Training Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ahmet Tevfik Albayrak
- Urology Clinic, Sisli Hamidiye Etfal Research and Training Hospital, University of Health Sciences, Istanbul, Turkey
| | - Kemal Sarica
- Urology Clinic, Kafkas University Medical School, Kars, Turkey
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Pan Y, Chen H, Chen H, Jin X, Zhu Y, Chen G. The feasibility of one-stage flexible ureteroscopy lithotripsy in solitary kidney patients with 1-3 cm renal stones and risk factors of renal function changes. Ren Fail 2021; 43:264-272. [PMID: 33491554 PMCID: PMC7850451 DOI: 10.1080/0886022x.2021.1872625] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Purpose To compare perioperative outcomes and long-term renal function changes between prior stenting (PS) and not prior stenting (NPS) before flexible ureteroscopy lithotripsy (f-URS) for solitary kidney patients. Methods Solitary kidney patients with 10–30 mm renal stones were enrolled in this historical control study. Perioperative parameters and complications were compared. Stone-free was defined as the absence of any residual stones on a CT scan. Renal function changes were evaluated by estimated glomerular filtration rate (eGFR) and adjusted for body surface area. A decrease in the eGFR over 20% was identified as ‘deterioration’ in renal function. The follow-up period was at least 6 months. Logistic regression was used to identify risk factors of renal function deterioration. Results Of the 76 patients included, 40 cases experienced prior stenting before f-URS. The average stone diameter was 16.8 ± 4.7 mm, ranging from 10.0 to 28.4 mm. Initial SFR was 85.0 and 83.3% in the PS and NPS groups, respectively (p = 0.842), while SFR after the second procedure was 97.5 and 94.4% (p = 0.926). Seven PS and 5 NPS patients developed complications (p = 0.666). At the postoperative 6 months, seven patients showed a deteriorated renal function. Surgical time in minutes was identified as a risk factor for renal function deterioration after the operation (OR = 1.061, 95% CI: 1.015–1.109, p = 0.009, per minute). Conclusion It appears that one-stage f-URS without PS could be feasible for 10–30 mm renal stones in solitary kidney patients, and less surgical time might be beneficial to protect renal function.
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Affiliation(s)
- Yang Pan
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Han Chen
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hualin Chen
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaoxiang Jin
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yunxiao Zhu
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Gang Chen
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Erkoc M, Bozkurt M. Comparison of Mini-Percutaneous Nephrolithotomy and Retrograde Intrarenal Surgery for Renal Pelvic Stones of 2-3 cm. J Laparoendosc Adv Surg Tech A 2020; 31:605-609. [PMID: 33316204 DOI: 10.1089/lap.2020.0860] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Backgrounds: Mini-percutaneous nephrolithotomy (M-PCNL) and retrograde intrarenal surgery (RIRS) are commonly used methods for the treatment of kidney stones. The aim of our study is to compare the effectiveness and safety of M-PCNL and RIRS for the treatment of renal pelvic stones with a diameter of 2-3 cm. Materials and Methods: The study included 250 patients, who underwent surgery for renal pelvic stones. M-PCNL and RIRS were performed on 130 and 120 patients, respectively. Age, gender, body mass index of the patients, stone size, the side of surgery, operative times, history of extracorporeal shock-wave lithotripsy, Hounsfield unit (HU) values, the length of hospital stay, stone-free rate (SFR), complication rates according to the modified Clavien system, postoperative hemoglobin loss, postoperative transfusion rates, postoperative narcotic analgesic use, and the number of secondary interventions were recorded. SFR in the postoperative first and third months were calculated. A chi-square test, Student's t-test, and the Wilcoxon test were used for statistical analyses. Results: No statistically significant differences were found in the demographic data, stone size, complication rates defined according to the modified Clavien system, HU values, and postoperative transfusion rates between the patient groups (P > .05). The success rate was statistically significantly higher regarding the postoperative first-month SFR in the M-PCNL group (P < .05). The postoperative third-month SFR after secondary interventions were similar between the groups. The examination of the postoperative hemoglobin loss and narcotic analgesic use and the length of hospital stay revealed superior results in the RIRS group (P < .05). Conclusion: M-PCNL and RIRS are effective and safe methods for the treatment of renal pelvic stones. M-PCNL is advantageous because of high SFR in the postoperative first month and the low need for secondary interventions, whereas RIRS has been found more advantageous in terms of the length of hospital stay, use of narcotic analgesics, and postoperative hemoglobin loss. Further studies on patients with multiple caliceal stones and on patients with a greater stone burden are needed.
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Affiliation(s)
- Mustafa Erkoc
- Department of Urology, Basaksehir Cam and Sakura City Hospital-Istanbul, Istanbul, Turkey
| | - Muammer Bozkurt
- Department of Urology, Basaksehir Cam and Sakura City Hospital-Istanbul, Istanbul, Turkey
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Huang JS, Xie J, Huang XJ, Yuan Q, Jiang HT, Xiao KF. Flexible ureteroscopy and laser lithotripsy for renal stones 2 cm or greater: A single institutional experience. Medicine (Baltimore) 2020; 99:e22704. [PMID: 33120764 PMCID: PMC7581148 DOI: 10.1097/md.0000000000022704] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
With improvements in endoscopy and laser technology, flexible ureteroscopy (FURS) has been a viable treatment option for large renal stones. Here, we share our experience of the FURS treatment for renal stones 2 cm or greater.We evaluated 251 consecutive patients who underwent FURS and holmium laser lithotripsy for renal stones 2 cm or greater between January 2015 and April 2019. Stone size was defined as the longest axis on non-contrast computed tomography. Data were retrospectively collected from electronic medical records. Patient demographics, stone clearance rates and perioperative complications were evaluated.There were 165 male patients and 86 female patients with an average age of 46.9 years (range 22-80 years). Mean stone size was 2.7 cm and the average number of procedures was 1.4 (range 1-5). The stone-free rate at the end of the first, second and third procedure was 61.9%, 82.9%, and 89.5%, respectively. The final stone-free rate decreased as stone size grows, and it was only 58.3% for kidney stones larger than 4 cm after an average of 2.3 procedures. The lowest clearance rates were observed in lower calyx calculi (87.2%) and multiple calyx calculi (83.5%). The overall complication rate was 15.1%, and the most common complication was postoperative fever (9.6%). One patient required blood transfusion, owing to postoperative coagulation disorders induced by urosepsis.Single or staged FURS is a practical treatment option for the renal stones sized 2 to 4 cm with acceptable efficacy and safety. Stone clearance rate of FURS treatment is mainly affected by stone size and location.
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Joshi R. Early experience of Retrograde Intrarenal Surgery for Renal stone: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc 2020; 58:465-469. [PMID: 32827006 PMCID: PMC7580390 DOI: 10.31729/jnma.4819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Introduction: Retrograde intrarenal surgery with improving skill and knowledge may be considered one of the first-line treatment options for removal of renal stones. The study is done to find the outcome of retrograde intrarenal surgery (RIRS) in patients with renal stone. Method: This descriptive cross sectional study was carried out on patients undergoing retrograde intrarenal surgery for renal stone at a tertiary care hospital December 2019 to March 2020. Ethical approval was taken from the institutional review committee (Ref. no.200120202). The Convenient sampling method was applied. Data was collected and analyzed in Statistical Package for the Social Sciences version 20.0. Point estimate at 95% confidence interval was calculated along with frequency and proportion for binary data. Results: Out of the 28 patients, the retrograde intrarenal surgery was successful in 27 (96.4%) cases. There were 16 (57.15%) females and 12 (42.86%) male patients with the mean age of 37.86±11.47 years. Most of the stones were in renal pelvis 18 (64.28%) followed by lower calyx 8(28.57%). The mean diameter of the stone was 11.47±3.33mm whereas most of the stones were on the right side 16 (57.15%). The mean hardness was 1155.21±265.34 Hounsfield units. Perioperative complications like failed access sheath placement in 2 (7.14%) cases, hematuria in 6 (21.43%) cases, fever in 6 (21.43%) cases, and septicemia in 4 (14.28%) cases. Conclusions: We found that the success rate of retrograde intrarenal surgery for the renal stone was acceptable and similar to other published studies . Retrograde intrarenal surgery is feasible for the treatment of kidney stones with acceptable complications and success rates.
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Affiliation(s)
- Robin Joshi
- Department of Urology, Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal
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Parikh KP, Jain RJ, Parikh AK. Is plasma sterilization the modality of choice of sterilization today for endourological procedures such as ureterorenoscopy and retrograde intrarenal surgery? A single-center retrospective evaluation of 198 patients. Urol Ann 2020; 12:122-127. [PMID: 32565648 PMCID: PMC7292435 DOI: 10.4103/ua.ua_61_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 11/12/2019] [Indexed: 11/17/2022] Open
Abstract
Introduction: The prevalence of infective complications among patients undergoing Retrograde Intrarenal Surgery (RIRS) for renal stone is 1.7%-18%, including fever, Systemic Inflammatory Response Syndrome (SIRS) and sepsis. The infectious complications of RIRS can be minimised by strict aseptic precautions and plasma sterilization. The Sterrad Next Generation (Sterrad NX) System, a low-temperature sterilizer represents the next generation of low-temperature hydrogen peroxide gas plasma sterilizers. This study was conducted to evaluate the efficacy of plasma sterilization among patients undergoing ureterorenoscopy (URS) and RIRS. The primary endpoint of this study was incidence of septicemia or related complications. Till date, there is no study on the incidence of infection rate in RIRS in relation to a specific mode of sterilization. Material and Methods: This is a retrospective study comprising of 198 patients undergoing URS and/or RIRS. The parameters studied were incidence of post-operative fever, Systemic Inflammatory Response Syndrome (SIRS), pyelonephritis or septicemic shock. Results: Out of 198 patients, incidence of post-operative fever was 3.5%, SIRS was 1.7%, pyelonephritis was 0.7% and septicemic shock was 0%. This is statistically significantly low septicemia rate among patients undergoing URS and /or RIRS as compared to the available literature. No health hazards of plasma sterilization were noted. No damage to the endoscopes or instruments was noted. Conclusion: Sterrad NX based on hydrogen peroxide gas plasma (HPGP) technology is highly efficacious, safe and the modality for sterilization of instruments, including heat labile instruments such as semi rigid, flexible and chip on the tip endoscopes and other EndoUrology armamentarium.
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Affiliation(s)
- Kandarp Priyakant Parikh
- Department of Genito Urinary Surgery, Minimal Access Surgery Training Institute, Shyam Urosurgical Hospital, Ahmedabad, Gujarat, India
| | - Ravi Jineshkumar Jain
- Department of Genito Urinary Surgery, Minimal Access Surgery Training Institute, Shyam Urosurgical Hospital, Ahmedabad, Gujarat, India
| | - Aditya K Parikh
- Department of Genito Urinary Surgery, Minimal Access Surgery Training Institute, Shyam Urosurgical Hospital, Ahmedabad, Gujarat, India
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Analysis of performance factors in 240 consecutive cases of robot-assisted flexible ureteroscopic stone treatment. J Robot Surg 2020; 15:265-274. [PMID: 32557097 DOI: 10.1007/s11701-020-01103-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 06/09/2020] [Indexed: 10/24/2022]
Abstract
Flexible ureteroscopy is the keystone of modern kidney stone treatment. Although a simple surgical technique achieves good clinical results and a low complication rate, there are high demands on the surgeon's dexterity and ergonomic restrictions. Robotic-assisted flexible ureteroscopy (rfURS) could overcome these limitations. After 4 years of use of rfURS at a tertiary stone center, performance factors were analyzed to define the role of rfURS in kidney stone management. A rfURS system was installed in August 2014 at the SLK Kliniken (Heilbronn, Germany). Treatment data of N = 240 consecutive patients undergoing rfURS were prospectively collected and analyzed. The patient cohort represents typical stone formers. N = 240 renal units containing 443 stones with an average stone load of 1798 mm3 were treated. Surgical parameters as well as the peri- and postoperative complications were recorded, analyzed and compared to the current data in the literature. OR time 91 min, stone treatment time 55 min, stone treatment efficacy 33 mm3/min; perioperative complications 5.4%; robot times: preparation 5 min, docking 5 min, console time to stone contact 6 min, console time 75 min; postoperative complications 6.7%; postoperative length of stay 1.5 days; stone-free rate (residuals < 2 mm) 90% and re-treatment rate 8.75%. This consecutive series represents real-life data about the utilization of rfURS. The detailed analysis of performance factors revealed the successful utilization of the first generation of robotic systems in endourologic stone surgery, and indicates that the robot performs comparably to conventional flexible URS. Optimal ergonomics maintain the surgeon's endurance in long-lasting surgeries.
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Lai D, He Y, Li X, Chen M, Zeng X. RIRS with Vacuum-Assisted Ureteral Access Sheath versus MPCNL for the Treatment of 2-4 cm Renal Stone. BIOMED RESEARCH INTERNATIONAL 2020; 2020:8052013. [PMID: 32509870 PMCID: PMC7245689 DOI: 10.1155/2020/8052013] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 04/01/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Comparison of outcomes between RIRS with vacuum-assisted ureteral access sheath (V-UAS) and MPCNL in the treatment of renal stone. MATERIALS AND METHODS 28 patients with 2-4 cm renal stone were treated using RIRS with 14/16 F V-UAS. The outcomes were compared to those who underwent MPCNL with 16 F Amplatz sheath using a matched-pair analysis in a 1 : 2 scenario. Matching criteria included stone size, location and laterality, gender, age, BMI, and degree of hydronephrosis. Patients' demographics, perioperative and postoperative characteristics, complications, stone-free rate (SFR), and auxiliary procedures were compared. RESULTS Mean operative times for the RIRS and MPCNL groups were 72.4 ± 21.3 minutes and 67.4 ± 25 minutes (P = 0.042). Postoperative pain was significantly less in the RIRS group. The initial SFR was 50% for the RIRS group and 73.2% for the MPCNL group (P = 0.035). The final SFR at postoperative three months improved to 89.3% for the RIRS group and 92.9% for the MPCNL group (P = 0.681). The auxiliary procedure rates were higher in the RIRS group (42.9% vs. 25%, P = 0.095). The overall complication rate in the RIRS group was lower, but the significant difference was not found. CONCLUSION In the treatment of 2-4 cm renal stone, using V-UAS in RIRS can improve surgical efficiency with lower postoperative early pain scores. Comparing with MPCNL, its initial SFR was more depressed, and there is still a trend towards requiring more auxiliary procedures to achieve comparable final SFR.
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Affiliation(s)
- Dehui Lai
- Urology, Fifth Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
- Minimally Invasive Technique and Product Translational Center, Guangzhou Medical University, Guangzhou, Guangdong, China
- College of Materials Science and Engineering, Key Lab of Guangdong Province for High Property and Functional Polymer Materials, South China University of Technology, Guangzhou, China
| | - Yongzhong He
- Urology, Fifth Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
- Minimally Invasive Technique and Product Translational Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Xun Li
- Urology, Fifth Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
- Minimally Invasive Technique and Product Translational Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Meiling Chen
- Urology, Fifth Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
- Minimally Invasive Technique and Product Translational Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Xingrong Zeng
- College of Materials Science and Engineering, Key Lab of Guangdong Province for High Property and Functional Polymer Materials, South China University of Technology, Guangzhou, China
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Karagöz MA, Erihan IB, Doluoğlu ÖG, Uğurlu Ç, Bağcıoğlu M, Uslu M, Sarıca K. Efficacy and safety of fURS in stones larger than 20 mm: is it still the threshold? Cent European J Urol 2020; 73:49-54. [PMID: 32395324 PMCID: PMC7203769 DOI: 10.5173/ceju.2020.0056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 12/22/2019] [Accepted: 12/27/2019] [Indexed: 11/22/2022] Open
Abstract
Introduction The aim of this article was to evaluate the safety and efficiency of flexible ureteroscopy (fURS) in the management of renal calculi larger than 20 mm. Material and methods A total of 92 cases with renal calculi were managed with fURS and divided into two groups depending on the size of the stones; <20 mm and >20 mm (Group 1 and Group 2, respectively). The groups were compared with respect to treatment-related parameters including success, complication rates, hospitalization period and need for auxiliary procedures with an emphasis on the rate of infections. Success rates were also compared in each group according to stone location. Results Overall success rates after 3 months showed that stone-free rates in both groups were 84.1% (< 20 mm) and 58.33% (>20 mm) respectively (p = 0.008). The success rates of upper/mid pole (100% vs. 80%) and pelvis stones (83.3% vs. 75%) showed no statistically significant difference (p = 0.5, p = 0.51 respectively). Success rates for stones located in the lower pole were 75% vs. 14.28% respectively (p = 0.008). The rate of infectious complications was significantly higher in cases undergoing fURS for relatively larger stones (22.9%) as compared to smaller calculi (6.8%) (p = 0.032). No complications were recorded in Group 1, while 2 cases in Group 2 (4.1%) developed ureteral stricture. Conclusions Despite the relatively low stone-free rates in lower pole stones, our current results indicate that fURS can be an effective and safe treatment alternative to PNL in larger renal stones (>20 mm) located in the pelvis and in the upper part of the calyceal system of the involved kidney.
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Affiliation(s)
- Mehmet Ali Karagöz
- Department of Urology, Kafkas University Faculty of Medicine, Kars, Turkey
| | | | | | - Çağlar Uğurlu
- Department of Urology, Kafkas University Faculty of Medicine, Kars, Turkey
| | - Murat Bağcıoğlu
- Department of Urology, Kafkas University Faculty of Medicine, Kars, Turkey
| | - Mehmet Uslu
- Department of Urology, Kafkas University Faculty of Medicine, Kars, Turkey
| | - Kemal Sarıca
- Department of Urology, Kafkas University Faculty of Medicine, Kars, Turkey
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Meng X, Cong R, Song R, Lu P, Zhang W, Wang Z. Multiple renal ruptures after flexible ureteroscopic lithotripsy with holmium laser. AME Case Rep 2020; 4:1. [PMID: 32206747 DOI: 10.21037/acr.2019.12.01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 11/20/2019] [Indexed: 11/06/2022]
Abstract
The authors present a case report of multiple renal ruptures after flexible ureteroscopic lithotripsy (FURL) with holmium laser. Multiple renal ruptures following flexible ureterorenoscopy have not been reported so far. The etiology remains unclear. We like to share this case to make urologists aware of this unusual complication and discuss possible causes and therapeutic approaches.
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Affiliation(s)
- Xianghu Meng
- Department of Urology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Rong Cong
- Department of Urology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Rijin Song
- Department of Urology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Pei Lu
- Department of Urology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Wei Zhang
- Department of Urology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Zengjun Wang
- Department of Urology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
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Birowo P, Rasyid N, Atmoko W, Sutojo B. Case Report: An occurrence of steinstrasse in retrograde intra renal surgery (RIRS) for large staghorn kidney stone: a difficult experience in managing surgical outcomes. F1000Res 2020; 9:184. [PMID: 32724559 PMCID: PMC7338919 DOI: 10.12688/f1000research.22448.2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/27/2020] [Indexed: 11/20/2022] Open
Abstract
Immediate removal of staghorn kidney stones is important to prevent life-threatening complications. With the advancement of endoscopic technology, retrograde intrarenal surgery (RIRS) is now an alternate treatment to the standard percutaneous nephrolithotomy (PCNL) for stones removal. However, when used to treat large stones (>3cm), RIRS can cause the formation steinstrasse (SS). Here, we present the case of a 68-year-old man with multiple stones in the collecting system of the right kidney after initial treatment with RIRS. After two years of multiple interventions, the SS was completely removed. To prevent this complication in patients, a detailed assessment of the stone (size, location) and renal anatomy should be completed before RIRS is performed.
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Affiliation(s)
- Ponco Birowo
- Department of Urology, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta Pusat, DKI Jakarta, 10430, Indonesia
| | - Nur Rasyid
- Department of Urology, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta Pusat, DKI Jakarta, 10430, Indonesia
| | - Widi Atmoko
- Department of Urology, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta Pusat, DKI Jakarta, 10430, Indonesia
| | - Bobby Sutojo
- Department of Urology, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta Pusat, DKI Jakarta, 10430, Indonesia
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Complications of ureteroscopy: a complete overview. World J Urol 2019; 38:2147-2166. [DOI: 10.1007/s00345-019-03012-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 11/05/2019] [Indexed: 12/18/2022] Open
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Zhu M, Wang X, Shi Z, Ding M, Fan D, Wang X, Jiang R. Comparison between retrograde intrarenal surgery and percutaneous nephrolithotripsy in the management of renal stones: A meta-analysis. Exp Ther Med 2019; 18:1366-1374. [PMID: 31363376 PMCID: PMC6614733 DOI: 10.3892/etm.2019.7710] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 04/07/2017] [Indexed: 01/21/2023] Open
Abstract
Percutaneous nephrolithotripsy (PCNL) is recommended as the first-line treatment for the management of kidney stones that are ≥2 cm in diameter. Retrograde intrarenal surgery (RIRS) has become increasingly preferred due to its high level of safety and repeatability, particularly in small stones. However, whether PCNL has superior efficacy and lower complication rates when compared with RIRS remains controversial. Therefore, the present meta-analysis was conducted to compare the clinical outcomes of patients treated with PCNL and RIRS as therapy for renal stones. Clinical trials published in PubMed, Web of Science, Excerpta Medica dataBASE (EMBASE), and the Chinese Biomedical Database (CBM) were systematically reviewed to evaluate the efficacy and safety profiles of patients with renal stones who were treated with PCNL or RIRS. Main outcomes measures included stone-free rate, operative time, hospital stay, and complication rate. Results were expressed as risk ratio (RR), or weighted mean difference (WMD) with 95% confidence intervals (CIs). Pooled estimates were calculated using a fixed-effects or random-effects model according to the heterogeneity among the studies. In total, 17 studies [4 randomized controlled trials (RCTs) and 13 cohort studies] involving 1,717 patients met the inclusion criteria, and were included in this meta-analysis. Pooled results showed that PCNL exhibited a significantly higher stone-free rate (RR=0.90, 95% CI: 0.86 to 0.95; P<0.001) but was associated with a longer hospital stay, when compared with RIRS (WMD=-2.72, 95% CI: -3.9 to -1.54; P<0.001). Operative time (WMD=7.86, 95% CI: -0.89 to 16.61; P=0.078) and complication rate (RR=0.71, 95% CI: 0.48 to 1.05; P=0.083) did not significantly differ between the groups. Subgroup analysis revealed that PCNL had a shorter operation time than RIRS in patients with stone sizes ≥2 cm (WMD=12.88, 95% CI: 4.77 to 20.99; P=0.002), and PCNL had a similar stone-free rate as RIRS when the estimates were pooled from RCTs (RR=0.88, 95% CI: 0.76 to 1.01; P=0.078). Compared with PCNL, RIRS had a significantly lower stone-free rate, shorter hospital stay, but a similar operation time and complication rate. Therefore, we propose that RIRS may be an alternative therapy to PCNL, with acceptable efficacy and complication rates for renal stones. Further large-scale, well-conducted RCTs are required to verify our findings.
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Affiliation(s)
- Ming Zhu
- Nephrology Department, First Affiliated Hospital, Huzhou Teachers College, The First People's Hospital of Huzhou, Huzhou, Zhejiang 313000, P.R. China
| | - Xiaoyi Wang
- Nephrology Department, First Affiliated Hospital, Huzhou Teachers College, The First People's Hospital of Huzhou, Huzhou, Zhejiang 313000, P.R. China
| | - Zhanqin Shi
- Nephrology Department, First Affiliated Hospital, Huzhou Teachers College, The First People's Hospital of Huzhou, Huzhou, Zhejiang 313000, P.R. China
| | - Min Ding
- Nephrology Department, First Affiliated Hospital, Huzhou Teachers College, The First People's Hospital of Huzhou, Huzhou, Zhejiang 313000, P.R. China
| | - Deyong Fan
- Nephrology Department, Huzhou Central Hospital, Huzhou, Zhejiang 313003, P.R. China
| | - Xiang Wang
- Nephrology Department, First Affiliated Hospital, Huzhou Teachers College, The First People's Hospital of Huzhou, Huzhou, Zhejiang 313000, P.R. China
| | - Rui Jiang
- Nephrology Department, Huzhou Central Hospital, Huzhou, Zhejiang 313003, P.R. China
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Mahmood SN, Toffeq H, Fakhralddin S. Sheathless and fluoroscopy-free retrograde intrarenal surgery: An attractive way of renal stone management in high-volume stone centers. Asian J Urol 2019; 7:309-317. [PMID: 32742931 PMCID: PMC7385507 DOI: 10.1016/j.ajur.2019.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 12/20/2018] [Accepted: 04/16/2019] [Indexed: 01/21/2023] Open
Abstract
Objective To evaluate the efficacy and safety of sheathless and fluoroscopy-free flexible ureterorenoscopic laser lithotripsy (FURSL) for treating renal stones. Methods Between May 2015 and May 2017, 135 patients with renal stones treated with sheathless and fluoroscopy-free FURSL were prospectively evaluated. Our technique involved a semi-rigid ureteroscopic assessment of the ureter, and the guidewire was left in situ to railroad the flexible ureteroscope. A holmium laser was used to fragment and dust the stones; fragments were neither grasped nor collected. Results The study population consisted of 135 patients including 85 males (62.96%) and 50 females (37.04%) with a mean age of 40.65 years (range: 3–70 years) were evaluated. The mean stone size was 17.23 mm (range: 8–41 mm). Complete stone-free status was achieved in 122 (90.37%) patients and clinically insignificant residual fragments (CIRF) in two (1.48%), while residual stones were still present in 11 (8.15%) patients. Postoperative complications occurred in 23 (17.4%) cases and were mostly minor, including fever in 17 (12.6%), pyelonephritis in four (3.0%), subcapsular hematoma in one (0.7%) and steinstrasse in one (0.7%). These complications were Clavien I-II, GI in 17 (12.6%) patients, GII in five (3.7%), and Clavien IIIb in one (0.7%). No major complications were observed. Stone size ≥2 cm, operative time ≥30 min, and lasing time ≥20 min were significantly associated with a higher rate of complications and lower stone-free rates upon univariate analysis (p<0.05). Conclusion Sheathless and fluoroscopy-free FURSL are effective and safe for renal stone management, especially for stones under 2 cm in diameter. This process is a feasible option for avoiding sheath complications, which can protect surgeons from the negative effects of radiation.
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Affiliation(s)
- Sarwar Noori Mahmood
- University of Sulaimani College of Medicine, Kurdistan, Iraq
- Corresponding author.
| | - Hewa Toffeq
- Sulaimania General Teaching Hospital, Sulaimania, Iraq
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Chen H, Qiu X, Du C, Xie D, Liu T, Wang G, Song L. The Comparison Study of Flexible Ureteroscopic Suctioning Lithotripsy With Intelligent Pressure Control Versus Minimally Invasive Percutaneous Suctioning Nephrolithotomy in Treating Renal Calculi of 2 to 3 cm in Size. Surg Innov 2019; 26:528-535. [PMID: 31130072 DOI: 10.1177/1553350619849782] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose. To compare the efficacy and safety of flexible ureteroscopic suctioning lithotripsy (FURS) using patented designed intelligent irrigation and suctioning intraluminal pressure-control platform and integrated pressure-measuring suctioning ureteral access sheath versus minimally invasive suctioning percutaneous nephrolithotomy (MPCNL) in treating renal calculi at 2 to 3 cm in size. Methods. Ninety-one patients who met the criteria were included in the study. Among these, 46 patients underwent transurethral flexible ureteroscopic lithotripsy and the other 45 patients underwent MPCNL. We retrospectively analyzed the clinical data for the 2 groups and parameters including stone clearance rate, complication rate, average operative time, average postoperative hospitalization duration, and average postoperative hemoglobin level decrease were compared. Results. The hospitalization time for the FURS group was 3.53 ± 1.25 days, which was statistically shorter than that of the MPCNL group, which was 6.54 ± 2.36 days. There was significantly more patients needing pain medication postoperatively in the MPCNL group with statistical difference between the 2 groups ( P = .015). Also, there was more significant hemoglobin level drop in the MPCNL group with statistical difference between the 2 groups. However, there were no statistical differences between the 2 groups on average operative time and stone clearance rate. Conclusion. Both the operative methods are safe and efficacious in treating solitary renal calculus at 2 to 3 cm in size. However, FURS has more advantages including shorter hospital stay, less complication, and less bleeding.
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Affiliation(s)
- Hua Chen
- The Affiliated Ganzhou Hospital of Nanchang University, Ganzhou, Jiangxi, China
| | - Xuanxi Qiu
- The Affiliated Ganzhou Hospital of Nanchang University, Ganzhou, Jiangxi, China
| | - Chuance Du
- The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | | | - Tairong Liu
- The Affiliated Ganzhou Hospital of Nanchang University, Ganzhou, Jiangxi, China
| | - Gongxian Wang
- The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Leming Song
- The Affiliated Ganzhou Hospital of Nanchang University, Ganzhou, Jiangxi, China
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Fernández Alcalde Á, Ruiz Hernández M, Gómez dos Santos V, Sánchez Guerrero C, Diaz Pérez D, Arias Fúnez F, Laso García I, Duque Ruiz G, Burgos Revilla F. Comparison between percutaneous nephrolithotomy and flexible ureteroscopy for the treatment of 2 and 3cm renal lithiasis. Actas Urol Esp 2019; 43:111-117. [PMID: 30528533 DOI: 10.1016/j.acuro.2018.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 08/21/2018] [Accepted: 08/31/2018] [Indexed: 10/27/2022]
Abstract
CONTEXT AND OBJECTIVES The first-line treatment for >2cm lithiasis is percutaneous nephrolithotomy (PNL), leaving flexible ureteroscopy (fURS) as a second option. In the present review, the stone-free rate and the complications of both techniques were evaluated in the treatment of 2-3cm stones. MATERIAL AND METHODS Systematic review of studies that compared both techniques. Studies that were not comparative, as well as those carried out in the pediatric population or with <2cm or>3cm stones, were excluded. Two researchers independently performed the investigation, obtaining 5 studies that made up a total of 815 patients: 252 belonged to the fURS group and 563 to the PNL group. Four studies were retrospective, and one was non-randomized prospective. RESULTS Stone-free rate ranged between 47.0% and 95.0% for the fURS and between 87.0% and 100% for the PNL. The complication rate was 8.8-29.0% in the fURS and 11.9-27.0% in the PNL. fURS required a greater number of procedures, and had a lower decrease in haemoglobin and creatinine rise compared to PNL. CONCLUSIONS The stone-free rate was higher for PNL, although the fURS could reach comparable results at the expense of performing several procedures. Both techniques have a similar frequency of complications, but the PNL has more postsurgical analytical alterations.
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Shi X, Peng Y, Li X, Wang Q, Li L, Liu M, Gao X, Sun Y. Propensity Score-Matched Analysis Comparing Retrograde Intrarenal Surgery with Percutaneous Nephrolithotomy for Large Stones in Patients with a Solitary Kidney. J Endourol 2019; 32:198-204. [PMID: 29212373 DOI: 10.1089/end.2017.0482] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To evaluate the clinical efficacy, safety, and cost of retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL) in the treatment for large renal stones in patients with a solitary kidney. PATIENTS AND METHODS In this study, 117 patients with a solitary kidney who had undergone PCNL or RIRS for renal stones larger than 2 cm between January 2010 and December 2016 were retrospectively evaluated. The patients' demographic data, clinical characteristics, and perioperative outcomes were collected through a review of their medical records. Forty-three patients treated with PCNL were compared to 43 patients treated with RIRS by propensity score-matched analysis. The stone-free rate, retreatment rate, complication rate, and efficacy quotient (EQ) were assessed in both groups. RESULTS Initial stone-free rate of the PCNL group after a single procedure was significantly higher compared with the RIRS group (74.42% vs 34.88%, p < 0.001), whereas there was no significant difference in the final stone-free rate after repeated procedures (90.70% vs 88.37%, p = 0.713). PCNL had a significantly lower retreatment rate than RIRS (16.28% vs 63.79%, p < 0.001), and the PCNL group underwent fewer procedures than the RIRS group (p < 0.001). Thus, PCNL group had a higher EQ (78.00% vs 53.52%). Although cost per procedure of PCNL was significantly higher compared with RIRS (p < 0.001), the total costs were comparable. Complication rate of RIRS was lower compared with PCNL with no statistical significance (p = 0.193), and acute kidney injury rates were also comparable (PCNL vs RIRS: 13.95% vs 6.98%, p = 0.533). CONCLUSIONS With fewer repeated surgical procedures, higher EQ, and comparable total costs, PCNL is recommended as the first choice for the treatment of large renal calculi in patients with a solitary kidney. As for specific indications such as anticoagulant drugs, RIRS is a safer choice with fewer complications and acceptable final stone-free rate.
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Affiliation(s)
- Xiaolei Shi
- 1 Department of Urology, Shanghai Changhai Hospital, Second Military Medical University , Shanghai, China
| | - Yonghan Peng
- 1 Department of Urology, Shanghai Changhai Hospital, Second Military Medical University , Shanghai, China
| | - Xiao Li
- 2 Department of Radiology, Shanghai Changhai Hospital, Second Military Medical University , Shanghai, China
| | - Qi Wang
- 1 Department of Urology, Shanghai Changhai Hospital, Second Military Medical University , Shanghai, China
| | - Ling Li
- 1 Department of Urology, Shanghai Changhai Hospital, Second Military Medical University , Shanghai, China
| | - Min Liu
- 1 Department of Urology, Shanghai Changhai Hospital, Second Military Medical University , Shanghai, China
| | - Xiaofeng Gao
- 1 Department of Urology, Shanghai Changhai Hospital, Second Military Medical University , Shanghai, China
| | - Yinghao Sun
- 1 Department of Urology, Shanghai Changhai Hospital, Second Military Medical University , Shanghai, China
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Jiao B, Lai S, Xu X, Zhang M, Diao T, Zhang G. The efficacy of flexible ureteroscopy lithotripsy and miniaturized percutaneous nephrolithotomy for the treatment of renal and proximal ureteral calculi of ≤2 cm: A retrospective study. Medicine (Baltimore) 2019; 98:e14535. [PMID: 30882621 PMCID: PMC6426591 DOI: 10.1097/md.0000000000014535] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
To assess the clinical effect of miniaturized percutaneous nephrolithotomy (MPCNL) and flexible ureteroscopy lithotripsy (FURL) for the treatment of renal and proximal ureteral calculi of ≤2 cm.A retrospective analysis was carried out on clinical data of 106 patients with kidney or upper urethral calculi. Among these patients, 58 underwent the MPCNL, and 48 received FURL. Stone-free rates, operating time, blood loss, hemoglobin drop, length of hospital stay, complications, and renal damage indexes were compared.The stone removal rates of the FURL and MPCNL groups were 81.25% versus 87.93% (p > .05). Although operating time was significantly shorter in the MPCNL group, hospital stays were significantly shorter in the FURL group. In addition, pooled analysis showed that mean estimated blood loss was significantly higher in the PCNL group but the hemoglobin decline of the FURL group and PCNL group had no significant difference. The PCNL group had no significant difference in complications compared to the FURL group. Differences on the creatinine levels and urea nitrogen levels before the operation and after the operation were not statistically significant.FURL is an effective method for treating renal stone. FURL not only had a similar stone-free rate as compared to MPCNL but also was associated with less blood loss and more favorable recovery time. However, FURL had a longer operative time.
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Affiliation(s)
- Binbin Jiao
- Peking University China-Japan Friendship School of Clinical Medicine
- Department of Urology, China-Japan Friendship Hospital, Chaoyang District
| | - Shicong Lai
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences
- Department of Urology, Beijing Hospital, Dongcheng District
| | - Xin Xu
- Department of Urology, China-Japan Friendship Hospital, Chaoyang District
| | - Meng Zhang
- Peking University China-Japan Friendship School of Clinical Medicine
- Department of Urology, China-Japan Friendship Hospital, Chaoyang District
| | - Tongxiang Diao
- Department of Urology, Beijing Hospital, Dongcheng District
| | - Guan Zhang
- Peking University China-Japan Friendship School of Clinical Medicine
- Department of Urology, China-Japan Friendship Hospital, Chaoyang District
- Graduate School of Peking Union Medical College, China-Japan Friendship Institute of Clinical Medicine, Chaoyang District, Beijing, China
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Anbarasan R, Griffin SJ, Somani BK. Outcomes and Long-Term Follow-Up with the Use of Ureteral Access Sheath for Pediatric Ureteroscopy and Stone Treatment: Results from a Tertiary Endourology Center. J Endourol 2019; 33:79-83. [PMID: 30511885 DOI: 10.1089/end.2018.0448] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE The aim of this study was to retrospectively analyze outcomes of flexible ureteroscopy and laser fragmentation (FURSL) of renal stones with the use of ureteral access sheath (UAS) in the pediatric population. MATERIALS AND METHODS We retrospectively collected data between January 2011 and January 2018 for patient demographics, stone characteristics, and outcomes in 21 children who underwent FURSL with the use of UAS. RESULTS Twenty-one patients (10 boys and 11 girls) with a mean age of 11.8 years (range: 2-16 years) underwent FURSL using an access sheath. The stone location was in the lower pole in 13 patients (62%) with 12 patients (57%) having multiple stones. A 9.5F (35 cm) Cook Flexor UAS was used in all cases. The mean and overall stone size was 12 mm (range: 5-30 mm) and 15.4 mm (range: 5-35 mm), respectively. Preoperative stent was present in 8(38%) patients, and a postoperative stent or overnight ureteric catheter was inserted in 14 patients (67%). Thirty-one procedures (average: 1.5/patient) were needed to achieve a stone-free rate of 95%. There were no procedural or long-term complications noted over a mean follow-up of 26 months (4-37 months). CONCLUSION The use of UAS in the treatment of pediatric renal stones is safe and feasible with good outcomes and without any long-term sequelae.
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Affiliation(s)
- Ravindar Anbarasan
- 1 Department of Paediatric Urology, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Stephen J Griffin
- 1 Department of Paediatric Urology, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Bhaskar K Somani
- 2 Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
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Lai D, Chen M, He Y, Li X, Wan S. Safety and efficacy of retrograde intrarenal surgery for the treatment of renal stone in solitary kidney patients. Ren Fail 2018; 40:390-394. [PMID: 30040518 PMCID: PMC6062886 DOI: 10.1080/0886022x.2018.1487861] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Purpose: We present our experience of retrograde intrarenal surgery (RIRS) for the treatment of renal stones in patients with solitary kidneys and evaluate the safety and efficacy of this treatment modality. Materials and methods: Between March 2011 and July 2015, the clinical records of 60 patients with renal stones in solitary kidneys who underwent RIRS were retrospectively reviewed. Demographic characteristics, preoperative urinary culture, blood biochemistry, stone location, and surface area were documented. The final stone-free rates (SFRs) were assessed one month after the last treatment session by computed tomography (CT). Preoperative, operative, and postoperative parameters were analyzed. Serum creatinine (Scr) and glomerular filtration rate (GFR) were measured preoperatively, one month postoperatively, and at each follow-up visit. Results: The mean stone burden was 628 ± 27.2 mm2 (range 301–1199). The mean operative time was 84.4 ± 21.3 min (range 40–115). The mean drop in postoperative hemoglobin was 0.6 ± 0.21 g/dL (range 0.1–0.7). Twelve patients (20%) required second-stage RIRS for residual stones. The SFRs after the single and second procedures were 80% and 95%, respectively. The mean preoperative Scr level was 111.6 ± 45.59 μmol/L, and the mean postoperative Scr level was 96.7 ± 34.12 μmol/L. The change was statistically significant (p = .008). The same findings were observed for GFR. The mean preoperative GFR was 65.04 ± 25.37 ml/min, and the mean postoperative GFR was 76.89 ± 27.2 ml/min (p = .023). Minor complications occurred in nine patients (15%). One patient experienced septic shock and acute renal failure due to steinstrasse. This patient required hemodialysis and percutaneous nephrostomy drainage. One patient developed perirenal abscess and was treated with percutaneous drainage. Conclusion: RIRS is a safe and effective procedure for the treatment of renal stones in patients with solitary kidneys. RIRS did not adversely affect renal function at either the short-term or the long-term follow-up.
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Affiliation(s)
- Dehui Lai
- a Department of Urology, Fifth Affiliated Hospital , Guangzhou Medical University , Guangzhou , Guangdong , China
| | - Meiling Chen
- a Department of Urology, Fifth Affiliated Hospital , Guangzhou Medical University , Guangzhou , Guangdong , China
| | - Yongzhong He
- a Department of Urology, Fifth Affiliated Hospital , Guangzhou Medical University , Guangzhou , Guangdong , China
| | - Xun Li
- a Department of Urology, Fifth Affiliated Hospital , Guangzhou Medical University , Guangzhou , Guangdong , China
| | - Shawpong Wan
- a Department of Urology, Fifth Affiliated Hospital , Guangzhou Medical University , Guangzhou , Guangdong , China
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Factors affecting infectious complications following flexible ureterorenoscopy. Urolithiasis 2018; 47:481-486. [PMID: 30448869 DOI: 10.1007/s00240-018-1098-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 11/13/2018] [Indexed: 02/08/2023]
Abstract
In the present study, we aimed to clarify predictive factors that may cause postoperative infectious complications after flexible ureterorenoscopy (f-URS). In a 4-year prospective study, charts of patients who underwent f-URS between January 2014 and January 2018 for renal stone(s) in a tertiary academic center were reviewed. A standardized f-URS procedure was performed for all patients. Post-operative infectious complications including fever, sepsis and septic shock were categorized into same group. Patients with and without infectious complications were compared in the terms of preoperative, operative and post operative characteristics. In total, 463 patients who did not face infectious complications and 31 patients who faced infectious complications were enrolled into the study. The mean age was significantly lower in patients who did face infectious complications (34.8 vs 44.7 years old, p < 0.001). On the other hand, presence of renal abnormality was significantly more common in patients with infectious complications (12.3% vs 35.5%, p < 0.001). The mean operation time was 65.3 min in patients with infectious complications and significantly longer when compared with patients who did not face infectious complication (47.8 min, p < 0.001). Stone-free rate was significantly higher in patients without infectious complications (85.3% vs 77.5, p = 0.009). Multivariate regression analysis revealed that longer operation time ≥ 60 min, presence of renal abnormality and age ≤ 40 years were predictive factors for infectious complications following f-URS. The present study has demonstrated that operation time ≥ 60 min, presence of renal abnormality and patients with ≤ 40 years were significantly associated with infectious complications following f-URS.
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