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Uğur R, Yağmur İ. Urgent ureterorenoscopy as a primary treatment for ureteral stone: why not? Urolithiasis 2024; 52:69. [PMID: 38653876 DOI: 10.1007/s00240-024-01569-0] [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: 08/30/2023] [Accepted: 04/03/2024] [Indexed: 04/25/2024]
Abstract
To evaluate the feasibility of urgent ureteroscopy (uURS) and elective ureteroscopy (eURS) in the management of patients with renal colic due to ureteral stones. Patients who were operated for ureteral stones between September 2020 and March 2022 were determined retrospectively. The patients who were operated within the first 24 h constituted the uURS group, while the patients who were operated after 24 h were classified as eURS. No limiting factors such as age, gender and concomitant disease were determined as inclusion criteria. Patients with bilateral or multiple ureteral stones, bleeding diathesis, patients requiring emergency nephrostomy or decompression with ureteral JJ stent, and pregnant women were not included. The two groups were compared in terms of stone-free rate, complications, and overall outcomes. According to the inclusion-exclusion criteria, a total of 572 patients were identified, including 142 female and 430 male patients. There were 219 patients in the first group, the uURS arm, and 353 patients in the eURS arm. The mean stone size was 8.1 ± 2.6. The stone-free rate was found to be 87.8% (502) in general, and 92 and 85% for uURS and eURS, respectively. No major intraoperative or postoperative complications were observed in any of the patients. Urgent URS can be performed effectively and safely as the primary treatment in patients with renal colic due to ureteral stones. In this way, the primary treatment of the patient is carried out, as well as the increased workload, additional examination, treatment and related morbidities are prevented.
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Affiliation(s)
- Ramazan Uğur
- Department of Urology, University of Health Sciences, Başakşehir Çam and Sakura City Hospital, Başakşehir Olympic Boulevard Road, 34480, Başakşehir, Istanbul, Turkey.
| | - İlyas Yağmur
- Department of Urology, Yenişehir, Viranşehir State Hospital, Viranşehir - Ceylanpınar Street, No:3, 63700, Viranşehir, Şanlıurfa, Turkey
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2
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Khopekar F, Nabi S, Shiva M, Stewart M, Rajendran B, Nabi G. Cost-effectiveness of quality improvement intervention to reduce time between CT-detection and ureteroscopic laser fragmentation in acute symptomatic ureteric stones management. World J Urol 2024; 42:144. [PMID: 38478078 PMCID: PMC10937764 DOI: 10.1007/s00345-023-04694-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 07/25/2023] [Indexed: 03/17/2024] Open
Abstract
OBJECTIVE To prospectively assess clinical and cost effectiveness of emergency ureteroscopic laser fragmentation of urinary stones causing symptoms or obstruction. PATIENTS AND METHODS 100 consecutive patients with an average (median) age 55.6 (57.5) years and average (median) stone size of 8.2 mm (± 7 mm) between October 2018 and December 2021 who underwent emergency ureteroscopy and laser fragmentation formed the study cohort as part of a clinical service quality improvement. Primary outcome was single procedure stone-free rate and cost-effectiveness. The secondary outcomes were complications, re-admission and re-intervention. A decision analysis model was constructed to compare the cost-effectiveness of emergency ureteroscopy with laser fragmentation (EUL) and emergency temporary stenting followed by delayed ureteroscopy with laser fragmentation (DUL) using our results and success rates for modelling. RESULTS Single procedure stone-free rates (SFR) for EUL and DUL were 85%. The re-intervention rate, re-admission and complication rates of the study cohort (EUL) were 9%, 18%, and 4%, respectively, compared to 15%, 20%, and 5%, respectively for the control cohort (DUL). The decision analysis modelling demonstrated that the EUL treatment option was more cost-efficient, averting £2868 (€3260) per patient for the UK health sector. Total cost of delayed intervention was £7783 (€8847) for DUL in contrast to £4915 (€5580) for EUL. CONCLUSIONS Implementation of quality improvement project based on a reduction in CT detection-to-laser fragmentation time interval in acute ureteric obstruction or symptoms caused by stones had similar clinical effectiveness compared to delayed ureteroscopic management, but more cost-effective.
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Affiliation(s)
| | - Soha Nabi
- University of Aberdeen, Aberdeen, UK
| | | | | | | | - Ghulam Nabi
- Ninewells Hospital, Dundee, UK.
- Division of Imaging Sciences and Technology, School of Medicine, Ninewells Hospital, Dundee, DD1 9SY, UK.
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3
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Choi Y, Lee DH, Choi YH, Choi JY, Lim JY, Bae SJ. Predictors for emergency readmission in patients with ureteral calculi: a focus on pain management and stone location. World J Urol 2024; 42:119. [PMID: 38446234 DOI: 10.1007/s00345-024-04813-9] [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: 07/25/2023] [Accepted: 01/16/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND The management of patients with ureteral calculi in the emergency department (ED) remains challenging due to high revisit rates. PURPOSE To identify predictors of revisits among patients with ureteral calculi in the ED. DESIGN, SETTING, AND PARTICIPANTS Data from patients who presented at a tertiary academic hospital in Seoul, Republic of Korea, between February 2018 and December 2019, were analyzed retrospectively. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Variables, including the respiratory rate (RR), estimated glomerular filtration rate (eGFR), duration of pain, number of analgesic doses, location of ureteral calculi, and ED length of stay (LOS) were examined using logistic regression. We also examined some additional variables included in the STONE and CHOKAI scoring systems to examine their association with revisit. RESULTS Significant predictors of revisits included the number of analgesic doses and the location of ureteral calculi. Patients who required multiple analgesic doses or those with proximal or mid-ureteral calculi were more likely to revisit the ED. Although the STONE and CHOKAI scores could predict uncomplicated ureteral calculi, we found that the CHOKAI score is a valuable tool for predicting the likelihood of patient revisits (p = 0.021). CONCLUSIONS Effective pain management and consideration of calculi location are important for predicting patient revisits. More research is required to validate findings, develop precise predictive models, and empower tailored care for high-risk patients. In patients with ureteral calculi in the ED, the number of analgesics given and stone location predict return visits. Proximal ureteral calculi on CT may require early urologic intervention to prevent pain-related revisits.
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Affiliation(s)
- Yunhyung Choi
- Department of Emergency Medicine, Chung-Ang University Gwangmyeong Hospital, College of Medicine, Seoul, Chung-Ang University, 110, Deokan-Ro, Gwangmyeong-Si, 14353, Gyeonggi-do, Republic of Korea
| | - Dong Hoon Lee
- Department of Emergency Medicine, Chung-Ang University Gwangmyeong Hospital, College of Medicine, Seoul, Chung-Ang University, 110, Deokan-Ro, Gwangmyeong-Si, 14353, Gyeonggi-do, Republic of Korea
| | - Yoon Hee Choi
- Department of Emergency Medicine, College of Medicine, Ewha Womans University Mokdong Hospital, Ewha Womans University, 1071, Anyangcheon-Ro, Yangcheon-Gu, 07985, Seoul, Republic of Korea
| | - Jae Young Choi
- Department of Urology, College of Medicine, Yeungnam University, 170, Hyeonchung-Ro, Nam-Gu, 42415, Daegu, Republic of Korea
| | - Ji Yeon Lim
- Department of Emergency Medicine, College of Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University, 260, Gonghang-Daero, Gangseo-Gu, 07804, Seoul, Republic of Korea
| | - Sung Jin Bae
- Department of Emergency Medicine, Chung-Ang University Gwangmyeong Hospital, College of Medicine, Seoul, Chung-Ang University, 110, Deokan-Ro, Gwangmyeong-Si, 14353, Gyeonggi-do, Republic of Korea.
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4
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Sabhan AH. Comparison of immediate versus post-stenting ureteroscopy for ureteral stones treatment. J Med Life 2023; 16:1745-1749. [PMID: 38585524 PMCID: PMC10994621 DOI: 10.25122/jml-2023-0199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/18/2023] [Indexed: 04/09/2024] Open
Abstract
Ureteroscopy is a highly effective treatment for ureteral stones, characterized by a high stone-free rate and a low need for re-treatment. Ureteral stent placement can improve the insertion of the ureteral access sheath and ureteroscope but may be associated with higher morbidity prior to and after ureteroscopy. The study aimed to compare immediate versus post-stenting ureteroscopy for ureteral stone treatment in terms of operative time, intra- and post-operative complications, length of hospital stay, and stone-free rate. This prospective study involved 126 patients with ureteral stones divided into two groups: the post-stenting ureteroscopy group (PS-URS), who underwent primary ureteral stenting by double J followed by delayed ureteroscopy, and the immediate ureteroscopy group (I-URS), who underwent immediate ureteroscopy without previous stenting. Sixty-six patients were included in the PS-URS group and 60 patients in the I-URS group. Results were comparable, with no significant differences between both groups. The mean operative time was 33.77±3.51 minutes for the PS-URS group and 34.60±2.01 minutes for the I-URS group. The average length of hospital stay was 0.84±2.55 days for PS-URS and 0.92±1.96 days for I-URS patients. The stone-free rate was 97% in the PS-URS group and 95% in the I-URS group. The overall complication rate was 4.5% versus 5% in the PS-URS and I-URS groups, respectively, with all complications being minor and managed effectively. Immediate ureteroscopy is a safe and relevant operative approach for ureteral stones, with comparative results for post-stenting delayed ureteroscopy.
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Affiliation(s)
- Ali Hadi Sabhan
- Department of Surgery, College of Medicine, University of Al-Qadisiyah, Al-Diwaneyah, Iraq
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5
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Meria P, Raynal G, Denis E, Plassais C, Cornet P, Gil-Jardiné C, Almeras C. 2022 Recommendations of the AFU Lithiasis Committee: Management of symptomatic urinary stones. Prog Urol 2023; 33:791-811. [PMID: 37918980 DOI: 10.1016/j.purol.2023.08.018] [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: 06/30/2023] [Revised: 07/27/2023] [Accepted: 08/01/2023] [Indexed: 11/04/2023]
Abstract
The acute situation, caused by an obstructive stone, is defined by a renal colic that may be uncomplicated, complicated, or at risk in specific conditions. Its management may be medical or require interventional treatment by extracorporeal shockwave lithotripsy, endoscopic removal, or ureteroscopy. METHODOLOGY: These recommendations were developed using two methods, the Clinical Practice Recommendations (CPR) and the ADAPTE method, in function of whether the question was considered in the European Association of Urology (EAU) recommendations (https://uroweb.org/guidelines/urolithiasis) [EAU Guidelines on urolithiasis. 2022] and whether they could be adapted to the French context.
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Affiliation(s)
- P Meria
- UroSud, clinique La Croix du Sud, Quint-Fonsegrives, France
| | - G Raynal
- Clinique Métivet, department of urology, Saint-Maur-des-Fossés, France
| | - E Denis
- Centre hospitalier Saint-Joseph Saint-Luc, Lyon, France
| | - C Plassais
- Department of Urology, Hôpitaux Universitaires Pitié-Salpêtrière, Paris, France
| | - P Cornet
- Department of General Medicine, Sorbonne University, SFMG, Paris, France
| | - C Gil-Jardiné
- Pôle Urgences adultes - SAMU, Hôpital Pellegrin, CHU de Bordeaux, SFR-SIGU, Bordeaux, France; Inserm U1219, Bordeaux Population Health Research Centre, IETO Team, Bordeaux University, ISPED, Bordeaux, France
| | - C Almeras
- UroSud, clinique La Croix du Sud, Quint-Fonsegrives, France.
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6
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Jeong JY, Cho KS, Jun DY, Moon YJ, Kang DH, Jung HD, Lee JY. Impact of Preoperative Ureteral Stenting in Retrograde Intrarenal Surgery for Urolithiasis. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59040744. [PMID: 37109702 PMCID: PMC10145251 DOI: 10.3390/medicina59040744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 03/26/2023] [Accepted: 04/05/2023] [Indexed: 04/29/2023]
Abstract
Background and Objectives: Ureteral stent insertion passively dilates the ureter. Therefore, it is sometimes used preoperatively before flexible ureterorenoscopy to make the ureter more accessible and facilitate urolithiasis passage, especially when ureteroscopic access has failed or when the ureter is expected to be tight. However, it may cause stent-related discomfort and complications. This study aimed to assess the effect of ureteral stenting prior to retrograde intrarenal surgery (RIRS). Materials and Methods: Data from patients who underwent unilateral RIRS for renal stone with the use of a ureteral access sheath from January 2016 to May 2019 were retrospectively analyzed. Patient characteristics, including age, sex, BMI, presence of hydronephrosis, and treated side, were recorded. Stone characteristics in terms of maximal stone length, modified Seoul National University Renal Stone Complexity score, and stone composition were evaluated. Surgical outcomes, including operative time, complication rate, and stone-free rate, were compared between two groups divided by whether preoperative stenting was performed. Results: Of the 260 patients enrolled in this study, 106 patients had no preoperative stenting (stentless group), and 154 patients had stenting (stenting group). Patient characteristics except for the presence of hydronephrosis and stone composition were not statistically different between the two groups. In surgical outcomes, the stone-free rate was not statistically different between the two groups (p = 0.901); however, the operation time for the stenting group was longer than that of the stentless group (44.8 ± 24.2 vs. 36.1 ± 17.6 min; p = 0.001). There were no differences in the complication rate between the two groups (p = 0.523). Conclusions: Among surgical outcomes for RIRS with a ureteral access sheath, preoperative ureteral stenting does not provide a significant advantage over non-stenting with respect to the stone-free rate and complication rate.
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Affiliation(s)
- Jae Yong Jeong
- Department of Urology, National Health Insurance Service Ilsan Hospital, Goyang 10444, Republic of Korea
| | - Kang Su Cho
- Department of Urology, Prostate Cancer Center, Gangnam Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul 06273, Republic of Korea
| | - Dae Young Jun
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Young Joon Moon
- Department of Urology, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu 41944, Republic of Korea
| | - Dong Hyuk Kang
- Department of Urology, Inha University College of Medicine, Incheon 22332, Republic of Korea
| | - Hae Do Jung
- Department of Urology, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang 10380, Republic of Korea
| | - Joo Yong Lee
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
- Center of Evidence Based Medicine, Institute of Convergence Science, Yonsei University, Seoul 03722, Republic of Korea
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Mantica G, Carrion DM, Antón-Juanilla M, Pang KH, Parodi S, Tappero S, Rodriguez-Serrano A, Crespo-Atín V, Cansino R, Scarpa RM, Nikles S, Balzarini F, Terrone C, Gomez Rivas J, Esperto F. Impact of a delayed presentation to the emergency department for acute renal colic on biochemical and clinical outcomes. Actas Urol Esp 2023; 47:41-46. [PMID: 36503815 DOI: 10.1016/j.acuroe.2021.12.013] [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: 12/08/2021] [Accepted: 12/11/2021] [Indexed: 12/14/2022]
Abstract
INTRODUCTION AND OBJECTIVE To verify the impact of delay on biochemical and clinical outcomes for patients presenting to the emergency department (ED) with acute renal colic. MATERIALS AND METHODS Data were retrospectively collected from three institutions of two European countries between 01 January and 30 April 2020. Patients who presented to the ED with unilateral or bilateral renal colic caused by urolithiasis confirmed by imaging tests during the study period were included. A presentation after 24 h since the onset of symptoms was considered a delay. Patients presenting before 24 h from the symptom onset were included in Group A, while the patients presenting after 24 h in Group B. Clinical and biochemical parameters and management were compared. RESULTS A total of 397 patients who presented to ED with confirmed urolithiasis were analyzed (Group A, n = 199; Group B, n = 198. The median (IQR) delay in presentation was 2 days (1,5-4). At presentation, no statistically significant differences were found amongst the two groups of patients regarding presenting symptoms such as fever and flank pain, and the median serum levels of creatinine, C reactive protein and white blood cells. No differences were found in terms of conservative or operative management. CONCLUSION Delay in consultation >24 h is not associated with worsening biochemical parameters and clinical outcomes. Most patients with acute loin pain do not necessarily need urgent attendance to the ED and may be managed in the outpatients.
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Affiliation(s)
- G Mantica
- Department of Urology, Policlinico San Martino Hospital, University of Genova, Genova, Italy; European Society of Residents in Urology (ESRU), Arnhem, The Netherlands
| | - D M Carrion
- European Society of Residents in Urology (ESRU), Arnhem, The Netherlands; Department of Urology, La Paz University Hospital, Madrid, Autonomous University of Madrid, Madrid, Spain
| | - M Antón-Juanilla
- Department of Urology, Cruces University Hospital, Barakaldo, Vizcaya, Spain
| | - K H Pang
- European Society of Residents in Urology (ESRU), Arnhem, The Netherlands; Department of Oncology and Metabolism, Academic Urology Unit, University of Sheffield, Sheffield, UK
| | - S Parodi
- Department of Urology, Policlinico San Martino Hospital, University of Genova, Genova, Italy
| | - S Tappero
- Department of Urology, Policlinico San Martino Hospital, University of Genova, Genova, Italy
| | - A Rodriguez-Serrano
- Department of Urology, La Paz University Hospital, Madrid, Autonomous University of Madrid, Madrid, Spain
| | - V Crespo-Atín
- Department of Urology, Cruces University Hospital, Barakaldo, Vizcaya, Spain
| | - R Cansino
- Department of Urology, La Paz University Hospital, Madrid, Autonomous University of Madrid, Madrid, Spain
| | - R M Scarpa
- Department of Urology, Campus Biomedico, University of Rome, Italy
| | - S Nikles
- European Society of Residents in Urology (ESRU), Arnhem, The Netherlands; Department of Urology, Sestre Milosrdnice University Hospital Centre, Zagreb, Croatia
| | - F Balzarini
- Department of Urology, Policlinico San Martino Hospital, University of Genova, Genova, Italy.
| | - C Terrone
- Department of Urology, Policlinico San Martino Hospital, University of Genova, Genova, Italy
| | - J Gomez Rivas
- European Society of Residents in Urology (ESRU), Arnhem, The Netherlands; Department of Urology, Hospital Clinico San Carlos, Madrid, Spain
| | - F Esperto
- European Society of Residents in Urology (ESRU), Arnhem, The Netherlands; Department of Urology, Campus Biomedico, University of Rome, Italy
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Mantica G, Carrion D, Antón-Juanilla M, Pang K, Parodi S, Tappero S, Rodriguez-Serrano A, Crespo-Atín V, Cansino R, Scarpa R, Nikles S, Balzarini F, Terrone C, Rivas JG, Esperto F. Impacto de la presentación tardía al servicio de Urgencias por cólico renal agudo en los resultados bioquímicos y clínicos. Actas Urol Esp 2023. [DOI: 10.1016/j.acuro.2021.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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9
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DiBianco JM, Conrado B, Daignault-Newton S, Witzke K, Wenzler D, Pimentel H, Ghani KR, Dauw CA. Practice patterns and outcomes of urgent versus elective ureteroscopy in a statewide surgical collaborative. World J Urol 2023; 41:221-227. [PMID: 36326915 PMCID: PMC9631605 DOI: 10.1007/s00345-022-04203-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 10/25/2022] [Indexed: 11/06/2022] Open
Abstract
PURPOSE Urgent indications for nephrolithiasis treatment include obstruction with intractable pain or renal impairment without untreated infection. Patients and hospitals may benefit from urgent primary ureteroscopy. We aimed to examine variation in urgent ureteroscopy utilization and associated outcomes. METHODS Using Reducing Operative Complications from Kidney Stones (ROCKS), we identified all ureteroscopy's between 2016 and 2019. Cases were classified by acuity (elective versus urgent). We assessed practice/urologist variation in urgent ureteroscopy performance. We characterized patients demographic, operative and outcomes data, making bivariate comparisons with elective ureteroscopy to understand implications of urgent surgery. We performed multilevel modeling to understand factors associated with unplanned healthcare encounters after urgent ureteroscopy. RESULTS 12,859 cases were identified from 33 practices and 204 urologists, 10,854 (84.4%) elective and 2005 (15.6%) urgent. Urgent ureteroscopy was performed on younger patients (53 vs 57, p < 0.001), with higher rates of ureteral stones (72.8% vs 56.8%, p < 0.001). Urgent ureteroscopy rates varied widely by practice (2-70%) and urologist (0-98%). Urgent ureteroscopy had higher stenting rates (77.4% vs 72.5%, p < 0.001), stone free rates (66% vs 58.4%, p < 0.001), and postoperative ED visits (11% vs 7.2%, p < 0.001). There were no differences in intraoperative complications or unplanned hospitalizations. Factors predictive of ED visits in urgent ureteroscopy included concomitant ureteral/renal stone location (OR = 1.53, CI = 1.05-2.23, p = 0.035). CONCLUSIONS In Michigan elective ureteroscopy is performed 5 times more frequently than urgent ureteroscopy with wide variation. Urgent ureteroscopy demonstrated low morbidity. Urgent ureteroscopy produced modestly higher stone free rates with a slightly increased frequency of unscheduled ED visits particularly for ureteral stones.
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Affiliation(s)
| | - Bronson Conrado
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | | | - Karla Witzke
- Department of Urology, University of Michigan, Midland, MI, USA
| | | | | | - Khurshid R Ghani
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Casey A Dauw
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
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Sehgal R, Abu-Ghanem Y, Fontaine C, Forster L, Goyal A, Allen D, Kucheria R, Singh P, Ellis G, Ajayi L. Primary Definitive Treatment versus Ureteric Stenting in the Management of Acute Ureteric Colic: A Cost-Effectiveness Analysis. J Pers Med 2022; 12:jpm12111773. [PMID: 36579512 PMCID: PMC9697827 DOI: 10.3390/jpm12111773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 10/23/2022] [Accepted: 10/25/2022] [Indexed: 01/01/2023] Open
Abstract
Objectives: To analyze the differences in cost-effectiveness between primary ureteroscopy and ureteric stenting in patients with ureteric calculi in the emergency setting. Patients and Methods: Patients requiring emergency intervention for a ureteric calculus at a tertiary centre were analysed between January and December 2019. The total secondary care cost included the cost of the procedure, inpatient hospital bed days, emergency department (A&E) reattendances, ancillary procedures and any secondary definitive procedure. Results: A total of 244 patients were included. Patients underwent ureteric stenting (62.3%) or primary treatment (37.7%), including primary ureteroscopy (URS) (34%) and shock wave lithotripsy (SWL) (3.6%). The total secondary care cost was more significant in the ureteric stenting group (GBP 4485.42 vs. GBP 3536.83; p = 0.65), though not statistically significant. While mean procedural costs for primary treatment were significantly higher (GBP 2605.27 vs. GBP 1729.00; p < 0.001), costs in addition to the procedure itself were significantly lower (GBP 931.57 vs. GBP 2742.35; p < 0.001) for primary treatment compared to ureteric stenting. Those undergoing ureteric stenting had a significantly higher A&E reattendance rate compared with primary treatment (25.7% vs. 10.9%, p = 0.02) and a significantly greater cost per patient related to revisits to A&E (GBP 61.05 vs. GBP 20.87; p < 0.001). Conclusion: Primary definitive treatment for patients with acute ureteric colic, although associated with higher procedural costs than ureteric stenting, infers a significant reduction in additional expenses, notably related to fewer A&E attendances. This is particularly relevant in the COVID-19 era, where it is crucial to avoid unnecessary attendances to A&E and reduce the backlog of delayed definitive procedures. Primary treatment should be considered concordance with clinical judgement and factors such as patient preference, equipment availability and operator experience.
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11
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Alsawi M, Nalagatla S, Ahmad N, Chandiramani AS, Mokool L, Nalagatla SK, Somani B, Aboumarzouk OM, Amer T. Primary versus delayed ureteroscopy for ureteric stones: A systematic review and meta-analysis. JOURNAL OF CLINICAL UROLOGY 2022. [DOI: 10.1177/20514158221088687] [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]
Abstract
Background: Ureteric colic is a major clinical and economic burden on the National Health Service. There has been a recent paradigm shift to consider definitive surgery as the primary intervention at the time of initial presentation. Objective: To systematically evaluate the outcomes of primary/emergency ureteroscopy versus delayed/elective ureteroscopy. Methods: We performed a critical review of MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials–CENTRAL, CINAHL, Clinicaltrials.gov, Google Scholar and individual urological journals in April 2020. A robust database search was performed using a combination of the terms ‘primary ureteroscopy’, ‘immediate ureteroscopy’, ‘delayed ureteroscopy’ and ‘emergency ureteroscopy’. Adult patients (> 16 years) with ureteric stones presenting as an emergency were included. Results: Twelve studies met the inclusion criteria, with 4 studies directly comparing primary/emergency to delayed/elective ureteroscopy for an acute presentation of ureteric colic. Across the studies, 1708 patients underwent primary/emergency ureteroscopy for ureteric calculi and 990 underwent delayed ureteroscopy. No significant differences in stone-free rates were found between both groups with primary/emergency achieving 85% and delayed/elective 91% ( p = 0.68). The majority of stones treated were located in the distal ureter in both groups. Overall, there were no differences in complications between the groups ( p = 0.42) or major complications (0.17). However, there were fewer minor complications in the primary URS group ( p = 0.02). Ureteral catheter or double-J stent insertion was used in 71% of delayed/elective ureteroscopy cases, compared to 46.8% of primary/emergency cases (p = 0.001). For patients undergoing primary/emergency ureteroscopy, 6.4% patients required auxiliary procedures. In the delayed/elective group, 7.6% required further definitive treatment (NS). Conclusion: Primary ureteroscopy is a safe and feasible procedure, when performed in suitable patients in the acute setting. It is associated with significantly lower stent usage, equivalent stone clearance, no increase in overall or major complications including sepsis, and fewer minor complications when compared to delayed/elective ureteroscopy. Prospective studies will do well to explore this area further but on current evidence, primary ureteroscopy is the safe procedure. Level of evidence: Not applicable
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Affiliation(s)
| | | | - Nafees Ahmad
- Department of Urology, University Hospital Monklands, UK
| | | | - Leenesh Mokool
- Department of Urology, University Hospital Monklands, UK
| | | | - Bhaskar Somani
- Department of Urology, University Hospital Southampton NHS Foundation Trust, UK
| | - Omar M Aboumarzouk
- Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Qatar
| | - Tarik Amer
- Department of Urology, University Hospital Monklands, UK
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Lin J, Lin W, Xu L, Lin T. The role of quantitative gray-scale ultrasound histogram in the differential diagnosis of infected and non-infected hydronephrosis. Clin Hemorheol Microcirc 2022; 82:295-301. [PMID: 36093689 DOI: 10.3233/ch-221414] [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: 02/05/2023]
Abstract
BACKGROUND The early detection of infected hydronephrosis is critical before lithotripsy. A feasible and noninvasive diagnostic method is of considerable clinical attention. OBJECTIVES This retrospective study was performed to find some quantitative evaluation parameters of B-mode Gray-scale ultrasound histogram analysis that might assist the early diagnosis of infected hydronephrosis and test their diagnostic efficacy. MATERIALS AND METHODS The ultrasound images and clinical data of 245 patients with hydronephrosis were retrospectively analyzed. Image J software was applied to obtain the gray-scale maps and the analysis results of the signal strength. The difference in the data between the infected and non-infected groups and the diagnostic value of the parameters were calculated. RESULTS In this retrospective study, 70 patients with infected hydronephrosis and 175 patients with non-infected hydronephrosis were enrolled. The echogenicity of internal effusion and the echogenicity ratio of infected cases were significantly higher than those of non-infected cases (p < 0.05). The cutoff values were 23.82 (AUC = 0.859) of echogenicity of internal effusion, while 0.27 (AUC = 0.832) of echogenicity ratio. CONCLUSION The quantitative evaluation of gray-scale ultrasound histogram is an objective and reliable method in differentiating infected from non-infected hydronephrosis.
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Affiliation(s)
- Jia Lin
- Department of Ultrasound, First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, P.R. China
| | - Wenqiang Lin
- Department of Ultrasound, First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, P.R. China
| | - Liang Xu
- Department of Shantou University Medical College, Shantou, Guangdong, P.R. China
| | - Teng Lin
- Department of Ultrasound, First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, P.R. China
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Lee JY, Andonian S, Bhojani N, Bjazevic J, Chew BH, De S, Elmansy H, Lantz-Powers AG, Pace KT, Schuler TD, Singal RK, Wang P, Ordon M. Canadian Urological Association guideline: Management of ureteral calculi - Abridged version. Can Urol Assoc J 2021; 15:383-393. [PMID: 34847343 PMCID: PMC8631858 DOI: 10.5489/cuaj.7652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Jason Y. Lee
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Sero Andonian
- Division of Urology, Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Naeem Bhojani
- Department of Urology, Université de Montréal, Montreal, QC, Canada
| | - Jennifer Bjazevic
- Division of Urology, Department of Surgery, Western University, London, ON, Canada
| | - Ben H. Chew
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Shubha De
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Hazem Elmansy
- Urology, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | | | - Kenneth T. Pace
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Trevor D. Schuler
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Rajiv K. Singal
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Peter Wang
- London Health Sciences Centre, Western University, London, ON, Canada
| | - Michael Ordon
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
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Kocatürk H, Bedir F, Turangezli Ö, Şebin E, Altay MS, Bedir B, Sarıca K. Time dependant functional and morphological recovery of the kidney after relief of obstruction in patients with impacted ureteral stones. ACTA ACUST UNITED AC 2021; 93:178-183. [PMID: 34286552 DOI: 10.4081/aiua.2021.2.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 05/02/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To assess the course of functional and morphological recovery of the kidney following the relief of obstruction with ureteral JJ stent in cases with unilateral impacted stones. MATERIALS AND METHODS A total of 42 adult patients who were admitted to our clinic with unilateral obstructing impacted ureteral stones requiring JJ stent placement were included in the study. The course of functional recovery was assessed by evaluating the serum creatinine levels, renal resistive index (RRI) values and urinary levels of kidney injury molecule-1, neutrophil gelatinaseassociated lipocalin as well as microalbumin before at 1 day, 1 week and 4 weeks after JJ stent placement. Course of morphologic recovery was evaluated by evaluating the degree of hydronephrosis, kidney size, perirenal straining and ureteral diameter. RESULTS Our results showed that all relevant parameters began to decrease after 24 hours and continue to normalize during 1 week evaluation; majority of these variables indicating the functional and morphological recovery were in normal range after 4 weeks. Decompression of the obstructed kidneys with JJ stent placement in patients with impacted ureteral stones was found to be effective enough with recovery of normal renal functional and morphological status after a minimum time period of 4 weeks. Morphological recovery of affected kidneys following JJ stenting was obtained with a significant difference between baseline and 1-month evaluation findings (p = 0.001, p < 001, p < 001, respectively). KIM-1 excretion began to decline to normal levels after 4 weeks (3.52 ± 0.99 ng/ml versus 2.84 ± 0.66 ng/ml, p < 0.001). The same findings were observed for the urinary excretion levels of NGAL, which normalized at the 1-month evaluation (604.55 ± 140.28 ng/ml versus 596.87 ± 80.17 ng/ml p = 0.895). Urinary microalbumin excretion levels however remained high even until 1-month follow-up with a statistically significant difference when compared with the normal excretion values (p < 0.001). There was a statistically significant difference in RRI values between baseline and 1-month follow-up findings in obstructed kidney (p < 0.001). CONCLUSIONS Elective management of the obstructing impacted ureteral stone(s) will be safer with limited risk of infective complications after functional and morphological normalization in such kidneys following 4 weeks of JJ stent placement.
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Affiliation(s)
- Hüseyin Kocatürk
- Department of Urology Health Sciences University, Erzurum Regional Training and Research Hospital, Erzurum.
| | - Fevzi Bedir
- Department of Urology Health Sciences University, Erzurum Regional Training and Research Hospital, Erzurum.
| | - Ömer Turangezli
- Department of Urology Health Sciences University, Erzurum Regional Training and Research Hospital, Erzurum.
| | - Engin Şebin
- Department of Biochemistry Health Sciences University, Erzurum Regional Training and Research Hospital, Erzurum.
| | - Mehmet Sefa Altay
- Department of Urology Health Sciences University, Erzurum Regional Training and Research Hospital, Erzurum.
| | - Banu Bedir
- Aziziye District Health Directorate, Erzurum.
| | - Kemal Sarıca
- Biruni University, Faculty of Medicine, Department of Urology, Istanbul.
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Gadzhiev NK, Akopyan GN, Tursunova FI, Afyouni AS, Korolev DO, Tsarichenko DG, Rapoport LM, Okhunov Z, Bhaskar S, Malkhasyan VA. Emergency versus elective ureteroscopy for the management of ureteral stones. Urologia 2021; 89:79-84. [PMID: 33427095 DOI: 10.1177/0391560320987163] [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] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess the safety and efficacy of emergency ureteroscopy (URS) compared with elective URS. METHODS We conducted a retrospective analysis of patients who underwent URS for isolated ureteral stones in a single center from October 2001 to February 2014. Our patient cohort was divided into two groups: an emergency URS group (Group A), which consisted of patients who underwent URS within the first 24 h of admission, and an elective or planned URS group (Group B). The URS success rate was defined as being the incidence of successful stone fragmentation and whether there was resolution of renal obstruction. RESULTS A total of 2957 patients' medical records were available for analysis. Of these, 704 (21%) comprised of emergency cases and the remaining 2253 (79%) were elective cases. Patients in Group A were younger, had a smaller BMIs, and had smaller stone sizes (p < 0.001). The URS success rate was found to be 97% in Group A and 96% in Group B (p = 0.35). Intraoperative or postoperative complication rates were not found to vary significantly between the groups (8% vs 7%, respectively, p = 0.50). The incidence of ureteral stenting was nearly twice as high if URS was performed during night hours (85% vs 45%, p < 0.001). However, ureteral stenting was more prevalent in Group B compared to Group A patients (57% vs 25%, p < 0.001), possibly as a result of the number of pre-stented patients (73%). CONCLUSIONS Emergency URS is an effective and safe option for patients with renal colic. Younger patients without pre-existing obesity and with stone sizes up to 8 mm located in the distal ureter might be a better match for emergency URS.
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Affiliation(s)
- Nariman K Gadzhiev
- Department of Urology, Pavlov First Saint Petersburg State Medical University, Saint-Petersburg, Russia
| | - Gagik N Akopyan
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Farzona I Tursunova
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Andrew S Afyouni
- Department of Urology, University of California, Irvine, CA, USA
| | - Dmitry O Korolev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Dmitry G Tsarichenko
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Leonid M Rapoport
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Zhamshid Okhunov
- Department of Urology, University of California, Irvine, CA, USA
| | - Somani Bhaskar
- Department of Urology, University Hospital Southhampton NHS Foundation Trust, Southampton, UK
| | - Vigen A Malkhasyan
- Department of Urology, A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
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Al-Terki A, Alkabbani M, Alenezi TA, Al-Shaiji TF, Al-Mousawi S, El-Nahas AR. Emergency vs elective ureteroscopy for a single ureteric stone. Arab J Urol 2020; 19:137-140. [PMID: 34104487 PMCID: PMC8158266 DOI: 10.1080/2090598x.2020.1813004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective To compare emergency with elective ureteroscopy (URS) for the treatment of a single ureteric stone. Patients and methods The files of adult patients with a single ureteric stone were retrospectively reviewed. Patients with fever or turbid urine on passage of the guidewire beside the stone underwent ureteric stenting or nephrostomy drainage. Patients who underwent URS were included and divided into two groups: the emergency (EM) Group, those who presented with persistent renal colic and underwent emergency URS within 24 h; and the elective (EL) Group, who underwent elective URS after ≥14 days of diagnosis. Patients with ureteric stents were excluded. The technique for URS was the same in both groups. Safety was defined as absence of complications. Efficacy was defined as the stone-free rate after a single URS session. Results From March 2015 to September 2018, 179 patients (107 in the EM Group and 72 in the EL Group) were included. There were significantly more hydronephrosis and smaller stones in the EM Group (P = 0.002 and P = 0.001, respectively). Laser disintegration was needed in more patients in the EL Group (83% vs 68%, P = 0.023). Post-URS ureteric stents were inserted in more patients in the EM Group (91% vs 72%, P = 0.001). Complications were comparable for both groups (4.2% for EL and 5.6% for EM, P = 0.665). Stone-free rates were also comparable (93% in the EL Group and 96% in the EM Group, P = 0.336). Conclusions Emergency URS can be as safe and effective as elective URS for the treatment of a single ureteric stone if it is performed in patients without fever or turbid urine. Abbreviations: EL Group: elective group; EM Group: emergency group; KUB: plain abdominal radiograph of the kidneys, ureters and bladder; MET: medical expulsive therapy; NCCT: non-contrast CT; SFR: stone-free rate; SWL: shockwave lithotripsy; URS: ureteroscopy
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Affiliation(s)
| | | | | | | | | | - Ahmed R El-Nahas
- Urology Unit, Al-Amiri Hospital, Kuwait City, Kuwait.,Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
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Valley ZA, Kaler KS. Acute care for renal colic in Canadian healthcare - a commentary on emergency department patient flow metrics and treatment options. Can Urol Assoc J 2020; 14:265-266. [PMID: 33626319 DOI: 10.5489/cuaj.6823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Zachary A Valley
- Department of Surgery, Section of Urology, University of Calgary, Calgary, AB, Canada
| | - Kamaljot S Kaler
- Department of Surgery, Section of Urology, University of Calgary, Calgary, AB, Canada
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18
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Nestler S, Grüne B, Schilchegger L, Neisius A, Jones J. Evaluation of stone free rates in early versus delayed primary ureteroscopy: time does matter. World J Urol 2020; 39:909-914. [PMID: 32488357 DOI: 10.1007/s00345-020-03235-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 04/28/2020] [Indexed: 11/26/2022] Open
Affiliation(s)
- Sebastian Nestler
- Department of Urology, Hochtaunus Hospital, Bad Homburg, Germany.
- Urogate, Urological Practice, Frankfurt, Germany.
| | - Britta Grüne
- Department of Urology, Hochtaunus Hospital, Bad Homburg, Germany
- Department of Urology, University Medical Center, Mannheim, Germany
| | | | - Andreas Neisius
- Department of Urology, Brüderkrankenhaus Trier, University of Mainz, Trier, Germany
| | - Jon Jones
- Department of Urology, Hochtaunus Hospital, Bad Homburg, Germany
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19
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Zhang Z, Wang X, Chen D, Peng N, Chen J, Wang Q, Yang M, Zhang Y. Minimally invasive management of acute ureteral obstruction and severe infection caused by upper urinary tract calculi. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2020; 28:125-135. [PMID: 31796723 DOI: 10.3233/xst-190576] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSETo evaluate therapeutic efficacy of two minimally invasive surgical methods in managing acute ureteral obstruction and severe infection caused by upper urinary tract calculi (UUTC).PATIENTS AND METHODSData of 47 patients diagnosed with acute upper urinary tract obstruction and severe infection caused by ureteral calculus using X-ray CT between September 2014 and January 2019 were retrospectively analyzed. All patients were treated with immediate renal drainage and, after infection and ureteral obstruction were relieved, UUTC removal. Renal drainage was performed by ultrasound-guided percutaneous nephrostomy and retrograde ureteral catheterization was performed using cystoscopy. Kidney and ureteral stones were removed; renal function and the urinary tract were examined by X-ray during follow-up.RESULTSPercutaneous nephrostomy was performed in 29 patients in a critical condition including intolerance to surgery, high-grade hydronephrosis, or failure of retrograde ureteric stent placement. In other 18 patients diagnosed with small stones (≤10 mm) and low-grade hydronephrosis, indwelling double-J ureteral stents were temporally installed by a cystoscope. Acute infection and ureteral obstruction were relieved; white blood cell counts returned to normal values within 3 to 7 days after drainage in all patients. In the second-stage treatment, percutaneous nephrolithotomy (PCNL), ureteroscopic lithotripsy, extracorporeal shock wave lithotripsy and nephrectomy were performed in 24, 10, 8 and 5 patients, respectively. No patients developed severe complication after stone removal surgery. All patients were followed up for 3 months to 4.5 years. Renal function was significantly recovered; 17/29 (59%) patients with elevated serum creatinine returned to normal and serum creatinine in 12/29 (41%) patients improved significantly after drainage, with a pre-operation level of 285±169μM vs 203±91μM post-operation (P = 0.014). Five patients were lost during follow-up.CONCLUSIONThis study demonstrated an optimal approach for relieving upper urinary tract obstruction and acute infection in which percutaneous nephrostomy drainage is preferred for patients with severe pyonephrosis, large stones (>10 mm) with high-grade hydronephrosis, steinstrasse, or failure in retrograde ureteric stent placement, while retrograde ureteral catheterization using cystoscopy is suitable for patients diagnosed with small stones (≤10 mm) and low-grade hydronephrosis.
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Affiliation(s)
- Zejian Zhang
- Department of Urology, Shenzhen Longhua District Central Hospital, The Affiliated Central Hospital of Shenzhen Longhua District, Guangdong Medical University, Shenzhen, Guangdong Province, China
| | - Xisheng Wang
- Department of Urology, Shenzhen Longhua District Central Hospital, The Affiliated Central Hospital of Shenzhen Longhua District, Guangdong Medical University, Shenzhen, Guangdong Province, China
| | - Dong Chen
- Department of Urology, Shenzhen Longhua District Central Hospital, The Affiliated Central Hospital of Shenzhen Longhua District, Guangdong Medical University, Shenzhen, Guangdong Province, China
| | - Naixiong Peng
- Department of Urology, Shenzhen Longhua District Central Hospital, The Affiliated Central Hospital of Shenzhen Longhua District, Guangdong Medical University, Shenzhen, Guangdong Province, China
| | - Jicheng Chen
- Department of Urology, Shenzhen Longhua District Central Hospital, The Affiliated Central Hospital of Shenzhen Longhua District, Guangdong Medical University, Shenzhen, Guangdong Province, China
| | - Qinjun Wang
- Department of Urology, Shenzhen Longhua District Central Hospital, The Affiliated Central Hospital of Shenzhen Longhua District, Guangdong Medical University, Shenzhen, Guangdong Province, China
| | - Minlong Yang
- Department of Urology, Shenzhen Longhua District Central Hospital, The Affiliated Central Hospital of Shenzhen Longhua District, Guangdong Medical University, Shenzhen, Guangdong Province, China
| | - Yuanyuan Zhang
- Wake Forest Institute for Regenerative Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
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Tran TY, Hernandez Bustos N, Kambadakone A, Eisner B, Pareek G. Emergency Ureteral Stone Treatment Score Predicts Outcomes of Ureteroscopic Intervention in Acute Obstructive Uropathy Secondary to Urolithiasis. J Endourol 2017. [PMID: 28637368 DOI: 10.1089/end.2017.0043] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Immediate ureteroscopic treatment for patients presenting to the emergency room with symptomatic ureterolithiasis is more commonly being utilized. Recent reports demonstrate good efficacy for emergency ureteroscopy (URS); however, preoperative predictors of treatment success have not been described. In this study, we report our multicenter experience with emergency URS and identify predictors of successful treatment. We also describe the Emergency Ureteral Stone Treatment (EUST) score, which integrates these predictors and stratifies patients into those that are likely and unlikely to have successful treatment. MATERIALS AND METHODS Laboratory and radiographic data for all patients who underwent emergency URS for acute symptomatic ureterolithiasis from 2010 to 2015 were reviewed. Statistical difference among parameters for patients who were stone free (SF) and not SF was assessed with the Student's t-test. Cutoff values for significant predictors were determined using sensitivity and specificity analysis. The EUST score was determined based on the number of cutoffs a patient was below. RESULTS Two hundred two of 247 patients (81.8%) were SF. Two complications (ureteral perforation) occurred. Stone size, duration of symptoms before presentation, and serum white blood count at presentation did not affect SF rates. 95.5% of the treatment failures were attributed to a tight ureter preventing stone access. Patients who received alpha blockers before treatment were more likely to be SF (98.0% vs 55.5%, p < 0.01). Periureteral density (PUD) was lower in SF patients (2.8 HU vs 19.6 HU, p < 0.01), whereas the increase in serum creatinine from baseline (ΔCr) was greater in non-SF patients (0.44 mg/dL vs 0.20 mg/dL, p < 0.01). EUST score of 0, 1, and 2 correlated with SF rates of 20.6%, 81.9%, and 99.2%, respectively. CONCLUSIONS Combined consideration of PUD and ΔCr with the EUST score can assist in selecting optimal candidates for immediate ureteroscopic management. Administration of alpha blockers before surgery may improve success rates by providing preoperative ureteral dilation.
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Affiliation(s)
- Timothy Y Tran
- 1 Division of Urology, Warren Alpert Medical School of Brown University , Providence, Rhode Island
| | | | - Avinash Kambadakone
- 3 Department of Radiology, Massachusetts General Hospital , Boston, Massachusetts
| | - Brian Eisner
- 2 Department of Urology, Massachusetts General Hospital , Boston, Massachusetts
| | - Gyan Pareek
- 1 Division of Urology, Warren Alpert Medical School of Brown University , Providence, Rhode Island
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Arcaniolo D, De Sio M, Rassweiler J, Nicholas J, Lima E, Carrieri G, Liatsikos E, Mirone V, Monga M, Autorino R. Emergent versus delayed lithotripsy for obstructing ureteral stones: a cumulative analysis of comparative studies. Urolithiasis 2017; 45:563-572. [DOI: 10.1007/s00240-017-0960-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 01/22/2017] [Indexed: 12/23/2022]
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Abstract
Ureteric colic is a common presentation to acute emergency services. The gold standard test for the diagnosis of acute ureteric colic is a non-contrast computer tomography of the kidneys ureters and bladder (CT KUB). Non-steroidal anti-inflammatory drugs (NSAIDs) should be used as first-line analgesia, with studies showing that there is no role for steroid or phosphodiesterase-5 inhibitors. There is emerging evidence that a high body mass index (BMI) is a risk factor. The drugs used to facilitate stone passage are known as medical expulsive therapy (MET). The most evaluated being alpha-blockers. The Spontaneous Urinary Stone Passage Enabled by Drugs (SUSPEND) trial was designed to evaluate the use of MET (tamsulosin and nifedipine). This trial showed that there was no difference with MET and placebo for the spontaneous passage of ureteric stones. There is an emerging role for the use of primary ureteroscopy in the management of non-infective ureteric stones.
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Khatami A, Rosengren K. Reduced time from diagnosis to stone-free status in patients with ureteral calculi. Int J Health Care Qual Assur 2016; 29:276-87. [PMID: 27120506 DOI: 10.1108/ijhcqa-03-2015-0028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose - The purpose of this paper is to describe an improvement project and its effects on decreasing the time from diagnosis to treatment for patients with kidney stones and to reduce the negative effects related to untreated stones at one hospital in western Sweden. Design/methodology/approach - A quantitative descriptive study based on Nolan's improvement model was used. The quality improvement effects were evaluated using statistical process control. Findings - Extracorporeal shock wave lithotripsy treatment's positive effects within 48 hours were described as efficiency (decreased waiting time) from diagnosis to treatment, even if a re-treatment was necessary. The results also showed a reduction in the usage of percutaneous nephropyelostomies as a treatment option. Research limitations/implications - This study includes data from one department at one hospital in one country. Comparative data include the time from acute radiological examination to final treatment but not total re-treatments, complications or time to up following radiological examination. However, the study was performed over one year and analyzed data from medical records in a systematic way. Practical implications - This study may inspire measuring and developing routines from diagnosis to treatment for patients who are transferred within different departments at one hospital. Social implications - By measuring the working process, resource use within a healthcare organization could be visualized. Planning and co-operation at different managerial levels are key factors for success when improvement projects are performed. Originality/value - Studies in improvement projects considering ureteral or kidney stones are generally lacking; thus, this study is important for improving the care of patients with this diagnose.
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Affiliation(s)
- Annelie Khatami
- Department of Urology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kristina Rosengren
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
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Sivalingam S, Stormont IM, Nakada SY. Contemporary Practice Patterns in the Management of Acute Obstructing Ureteral Stones. J Endourol 2015; 29:736-40. [DOI: 10.1089/end.2014.0681] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sri Sivalingam
- Department of Urology, Glickman Urological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ian M. Stormont
- Department of Urology, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin
| | - Stephen Y. Nakada
- Department of Urology, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin
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Zargar-Shoshtari K, Anderson W, Rice M. Role of emergency ureteroscopy in the management of ureteric stones: analysis of 394 cases. BJU Int 2014; 115:946-50. [PMID: 24925167 DOI: 10.1111/bju.12841] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To analyse the outcomes of emergency ureteroscopy (URS) cases performed in Auckland City Hospital. METHODS We conducted a retrospective review of all emergency URS procedures performed at Auckland City Hospital between 1 January 2010 and 31 December 2011. Data on patients, stones and procedures were collected and analysed. Emergency URS failure was defined as fragments >3 mm or the need for a repeat procedure. RESULTS A total of 499 URS procedures were identified. Of these 394 (79%) were emergency procedures. The mean (sd; range) patient age was 48 (16; 13-88) years. In all, 83% of emergency URS cases had an American Society of Anesthesiologists (ASA) score of 1 or 2, 25% of stones were >9 mm, with a mean (sd) size of 8 (4) mm, and 285 procedures (72%) were successful. These patients were younger (47 vs 51 years), were more likely to have an ASA score of 1 (103 patients in the successful treatment group vs 26 in the failed treatment group), had smaller stones (7 vs 9 mm) and were more likely to have distal stones (P < 0.05). A total of 20 complications (5%) were recorded including six false passages and three mucosal injuries, one of which required radiological intervention, and 50 patients (13%) re-presented, for pain (76%), bleeding (10%) or infection (14%). CONCLUSION We showed that emergency URS is a feasible approach for the routine management of acute ureteric colic with a low complications rate. A subgroup of younger, healthier patients may benefit the most from the procedure.
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Affiliation(s)
| | - William Anderson
- Department of Urology, Auckland City Hospital, Auckland, New Zealand
| | - Michael Rice
- Department of Urology, Auckland City Hospital, Auckland, New Zealand
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Panah A, Patel S, Bourdoumis A, Kachrilas S, Buchholz N, Masood J. Factors predicting success of emergency extracorporeal shockwave lithotripsy (eESWL) in ureteric calculi--a single centre experience from the United Kingdom (UK). Urolithiasis 2013; 41:437-41. [PMID: 23748923 PMCID: PMC7120875 DOI: 10.1007/s00240-013-0580-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 05/25/2013] [Indexed: 01/22/2023]
Abstract
Few studies show that "emergency extracorporeal shockwave lithotripsy (eESWL)" reduces the incidence of ureteroscopy in patients with ureteric calculi. We assess success of eESWL and look to study and identify factors which predict successful outcome. We retrospectively studied patients presenting with their first episode of ureteric colic undergoing eESWL (within 72 h of presentation) over a 5-year period. Patient's age, gender, stone size and location, time between presentation and ESWL, number of shock waves and ESWL sessions, and Hounsfield units (HU) were recorded. 97 patients (mean age 40 years; 76 males, 21 females) were included. 71 patients were stone free after eESWL (73.2 %) (group 1) and 26 patients failed treatment and proceeded to ureteroscopy (group 2). The two groups were well matched for age and gender. Mean stone size in group 1 and 2 was 6.4 mm and 7.7 mm, respectively, (p = 0.00141). Stone location was 34, 21, and 16 in upper, middle and lower ureter in group 1 compared to 11, 5, and 10 in group 2, respectively. Mean HU in group 1 was 480 and 612 in group 2 (p value 0.0036). In group 2, significantly, more patients received treatment after 24 h compared with group 1 (38 vs 22.5 %). The number of shock waves, maximal intensity, and ESWL sessions were not significantly different in the two groups. No complications were noted. eESWL is safe and effective in patients with ureteric colic. Stone size and Hounsfield units are important factors in predicting success. Early treatment (≤24 h) minimizes stone impaction and increases the success rate of ESWL.
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Affiliation(s)
- A Panah
- Endourology and Stone Services, Barts Health NHS Trust, London, UK
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Matani YS, Al-Ghazo MA, Al-Azab RS, Hani OB, Ghalayini IF, Hani IB. Emergency versus elective ureteroscopic treatment of ureteral stones. Can Urol Assoc J 2013; 7:E470-4. [PMID: 23914262 DOI: 10.5489/cuaj.1402] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION This retrospective study investigates the role of the emergency ureteroscopic (URS) approach in the definitive treatment of ureteric stones. METHODS We reviewed all patients admitted for ureteric stones from May 2003 to December 2010. Those who underwent URS stone treatment were selected and stratified into emergency (EMG) and elective groups (ELG). Emergency URS is defined as URS being performed within 24 hours of admission to the emergency room. The main indication for emergency treatment was refractory ureteric colic in spite of narcotic analgesia. Both groups were statistically compared in terms of their patient-, stone- and outcome-related variables. The overall success rate was defined by the clearance of the stone and/or presence of residual fragments (<3 mm) at the end of 4-week follow-up period. RESULTS In total, 903 patients were suitable for analysis with 244 and 659 patients in the EMG and ELG, respectively. Age, sex and comorbidities were comparable in both groups. Average ages were 43.4 ± 15.31 and 45.6 ± 13.24 years among EMG and ELG, respectively. Stones had an average size of 0.92 ± 0.49 (in the EMG group) and 0.96 ± 0.53 cm (in the ELG group). We found that 61.1% and 65.7% of stones were distally located in the EMG and ELG, respectively. EMG had a longer operative time (69 ± 21.03 vs. 57 ± 13.45 minutes) with comparable average hospital stays (1.9 days). Intra-operative double-J stents or ureteric catheter insertion was noted in 72.5 and 67.7% of EMG and ELG, respectively. The overall complication rates were reported in 13.1% in EMG and 14.4% in ELG. A higher rate of ureteric injuries (early and late) was documented in the EMG group (7% vs. 5.6%). Most of these injuries were minor and manageable without additional procedure and/or general anesthesia. Success was achieved in 90.6% and 91.8% of the EMG and ELG groups, respectively. CONCLUSION With recent advances in technology, the growing trend toward one-stage definitive treatment, patient acceptability and rising concerns over financial aspects, emergency URS treatment of ureteric stones is evolving as a standard initial management option.
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Affiliation(s)
- Yousef S Matani
- King Abdullah University Hospital, Department of Surgery and Urology, Jordan University of Science and Technology, Faculty of Medicine, Irbid, Jordan
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Mandal S, Singh V, Sankhwar S. Re: Netsch et al.: Impact of preoperative ureteral stenting on stone-free rates of ureteroscopy for nephroureterolithiasis: a matched-paired analysis of 286 patients (Urology 2012;80:1214-1220). Urology 2013; 81:698. [PMID: 23452813 DOI: 10.1016/j.urology.2012.11.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Revised: 11/21/2012] [Accepted: 11/22/2012] [Indexed: 11/15/2022]
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Picozzi SCM, Ricci C, Gaeta M, Casellato S, Stubinski R, Bozzini G, Pace G, Macchi A, Carmignani L. Urgent ureteroscopy as first-line treatment for ureteral stones: a meta-analysis of 681 patients. ACTA ACUST UNITED AC 2012; 40:581-6. [PMID: 22367457 DOI: 10.1007/s00240-012-0469-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2011] [Accepted: 02/04/2012] [Indexed: 11/30/2022]
Abstract
There are various recent studies on the use of ureteroscopy and debate on whether this should be the first-line treatment for patients with ureteral stones. The aim of this meta-analysis was to understand the role of this surgical procedure in the emergency setting as first-line treatment and to compare the immediate procedure with a delayed one in terms of stone-free rate and complications. A bibliographic search covering the period from January 1980 to March 2010 was conducted in PubMed, MEDLINE and EMBASE. This analysis is based on the six studies found that fulfilled the predefined inclusion criteria. A total of 681 participants were included. The number of participants in each of the studies considered ranged from 27 to 244 (mean 113). Stone-free rates were 81.9% (72.0-91.8) for the proximal ureter, 87.3% (82.6-92.0) for the mid-ureter, 94.9% (92.1-97.6) for the distal ureter and 89.5% (86.5-92.5) overall according to the logistic regression applied. These values are not statistically significantly different from those reported in the AUA and EAU guidelines. The stone diameter seems to affect the stone-free rate. An increase of the stone diameter of 1 mm beyond 8 mm corresponded to a reduction of stone-free rate of 5% (2.4-8.0) and 8.1% (3.8-12.1) for the distal and proximal ureters, respectively. There is a complete lack of information in international guidelines on the ureteroscopic management of ureteral stones in an emergency setting and the currently available results are dispersed in a few studies in the literature. The rationale for using emergency ureteroscopy is more rapid stone clearance and relief from colic pain. According to our meta-analysis, immediate ureteroscopy for ureteral stone colic seems to be a safe treatment with a high success rate. This evidence will be validated by further randomized studies, with larger series of patients.
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Affiliation(s)
- Stefano C M Picozzi
- Urology Department, IRCCS Policlinico San Donato, University of Milan, San Donato Milanese, MI, Italy.
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Editorial. Arab J Urol 2011; 9:183. [PMID: 26579293 PMCID: PMC4150586 DOI: 10.1016/j.aju.2011.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Accepted: 10/13/2011] [Indexed: 11/21/2022] Open
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