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Nam KH, Suh J, Shin JH, Chae HK, Park HK. Effect of perioperative tamsulosin on successful ureteral access sheath placement and stent-related symptom relief: A double-blinded, randomized, placebo-controlled study. Investig Clin Urol 2024; 65:342-350. [PMID: 38978214 PMCID: PMC11231658 DOI: 10.4111/icu.20240005] [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: 01/02/2024] [Revised: 03/18/2024] [Accepted: 04/23/2024] [Indexed: 07/10/2024] Open
Abstract
PURPOSE This study investigated the effect of administering tamsulosin before surgery on the successful insertion of a 12/14 French (F) ureteral access sheath (UAS) during the procedure, as well as the impact of preoperative and postoperative tamsulosin use on symptoms related to the ureteral stent. MATERIALS AND METHODS This study was a randomized, single-center, double-blinded, placebo-controlled trial involving 200 patients who underwent unilateral retrograde intrarenal surgery. Patients received either tamsulosin (0.4 mg) or placebo 1 week before surgery until stent removal. Patients were randomly assigned to one of four groups. Group 1 received tamsulosin throughout the study period. Group 2 received tamsulosin before surgery and placebo after surgery. Group 3 received placebo before surgery and tamsulosin after surgery. Group 4 received placebo before and after surgery. The USSQ (Ureteral Stent Symptom Questionnaire) was completed between postoperative days 7 and 14 immediately before stent removal. RESULTS A total of 160 patients were included in this analysis. Their mean age was 55.0±11.0 years, and 48 patients (30.0%) were female. In the group that received preoperative tamsulosin, the success rate of 12/14F UAS deployment was significantly higher than that of the preoperative placebo group (88.0 vs. 75.3%, p=0.038). Preoperative and postoperative tamsulosin did not significantly alleviate symptoms related to the ureteral stent. CONCLUSIONS Our results revealed that preoperative administration of tamsulosin improved the success of larger-sized UAS, whereas preoperative and postoperative tamsulosin use did not significantly alleviate symptoms related to ureteral stents.
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Affiliation(s)
- Kyeng Hyun Nam
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jungyo Suh
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung Hyun Shin
- Department of Urology, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Han Kyu Chae
- Department of Urology, Gangneung Asan Medical Center, University of Ulsan College of Medicine, Gangneung, Korea
| | - Hyung Keun Park
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Victor DR, Oliveira RDAPD, Melão BVLA, Coelho HGB, Barros Júnior TDP. Preoperative α1-Blockers Impact on Outcomes of Patients Undergoing Ureteroscopy with Ureteral Access Sheaths: A Systematic Review and Meta-Analysis. J Endourol 2024. [PMID: 38757611 DOI: 10.1089/end.2024.0060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024] Open
Abstract
Introduction: The use of a ureteral access sheath (UAS) during ureteroscopy (URS) has been associated with the risk for ureteral injuries. Preoperative administration of α1-blockers presents a potential mitigator of such lesions by inducing ureteral relaxation, which may also contribute to improving other surgical outcomes. Methods: A comprehensive literature search was conducted across MEDLINE, Embase, and Cochrane databases for studies comparing preoperative α1-blockers administration vs its non-use in adult patients without pre-stenting undergoing URS. Binary outcomes were evaluated using risk ratios (RRs) and odds ratios (ORs) with 95% confidence intervals (CIs). Heterogeneity was measured with the Cochran's Q test, I2 statistics, and prediction intervals (PIs). A DerSimonian and Laird random-effects model was utilized for all outcomes. Results: Eleven studies encompassing 1074 patients undergoing URS were included, of whom 522 (48.60%) received α1-blockers before the procedure. Preoperative α1-blockers were associated with a reduction in significant ureteral injuries (RR 0.30; 95% CI 0.17-0.53; I2 = 6%; PI 0.10-0.88) and an increase in mean successful UAS insertion (OR 2.14; 95% CI 1.08-4.23; I2 = 23%; PI 0.51-8.93). In patients undergoing exclusively ureteroscopy lithotripsy (URSL), the medications also reduced total complications (RR 0.62; 95% CI 0.46-0.84; I2 = 0%) and complications graded Clavien-Dindo III or higher (RR 0.16; 95% CI 0.04-0.69; I2 = 0%), but no significant difference between groups was found in the stone-free rate (RR 1.10; 95% CI 0.86-1.40; I2 = 91%; PI 0.47-2.59). Conclusion: Preoperative α1-blockers were linked to a decrease in significant ureteral injuries with UAS use and fewer complications during URSL procedures. However, their impact on the successful insertion of a UAS remains uncertain. Consideration of administering preoperative α1-blockers in non-stented adult patients undergoing URS with UAS is advisable.
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Sinanoglu O, Yildirim S, Suceken FY, Bicaklioglu F, Aydin ME, Uslu M, Arikan O, Sarica K. Bilateral ureteral stones; factors affecting treatment decision. Urolithiasis 2024; 52:76. [PMID: 38780633 DOI: 10.1007/s00240-024-01573-4] [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: 03/23/2024] [Accepted: 04/27/2024] [Indexed: 05/25/2024]
Abstract
AIM To evaluate certain factors that may affect the decision-making process for the rational management approach in cases presenting with bilateral ureteral stones. METHODS A total of 153 patients presenting with bilateral ureteral stones from 6 centers were evaluated and divided in three groups. Group 1 (n:21) Patients undergoing DJ stent insertion in one ureter and ureterorenoscopic (URS) lithotripsy for the contralateral ureteral stone. Group 2 (n:91), URS lithotripsy for both ureteral stones and Group 3 (n:41) patients undergoing bilateral DJ stent insertion. The outcomes of the procedures and the relevant patient as well as stone related factors have been comparatively evaluated in three groups. RESULTS While associated UTI rates and serum creatinine levels were significantly higher in bilateral DJ group, previous URS history was found to be significantly higher in cases undergoing bilateral URS than those undergoing bilateral DJ stenting. URS was performed significantly more often in cases with lower ureteral stones and DJ stenting seems to be more rational approach in upper ureteral stones. In patients with lower ureteral stones, larger and harder stones, endourologists tended to perform URS as the first option. CONCLUSIONS Decision making for a rational approach in cases with bilateral ureteral stones my be challenging. Our findings demonstated that serum creatinine levels, associated UTI, location and the hardness of the stone and previous ureteroscopy anamnesis could be important factors in making a decision between JJ stenting and ureteroscopic stone extraction in emergency conditions.
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Affiliation(s)
- Orhun Sinanoglu
- Department of Urology, Sancaktepe Sehit Prof Dr Ilhan Varank Training and Research Hospital, Istanbul, Turkey.
| | - Salih Yildirim
- Department of Urology, Sancaktepe Sehit Prof Dr Ilhan Varank Training and Research Hospital, Istanbul, Turkey
| | - Ferhat Yakup Suceken
- Department of Urology, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Fatih Bicaklioglu
- Department of Urology, Kartal Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | | | - Mehmet Uslu
- Department of Urology, Kafkas University Medical School, Kars, Turkey
| | - Ozgur Arikan
- Department of Urology, Istanbul Medeniyet University Goztepe Suleyman Yalcin City Hospital, Istanbul, Turkey
| | - Kemal Sarica
- Department of Urology, Sancaktepe Sehit Prof Dr Ilhan Varank Training and Research Hospital, Istanbul, Turkey
- Biruni University, Faculty of Medicine, Istanbul, Turkey
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Müller MR, Prey EM, Spachmann PJ, Goßler C, Burger M, Schnabel MJ. Ureterorenoscopic Stone Removal without Antibiotic Prophylaxis. Urol Int 2024:1-7. [PMID: 38626728 DOI: 10.1159/000538856] [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: 12/30/2023] [Accepted: 04/03/2024] [Indexed: 04/18/2024]
Abstract
INTRODUCTION The aim of this study was to assess the feasibility of sparing routine antibiotic prophylaxis in patients without preoperative urinary tract infection undergoing ureterorenoscopy (URS) for stone removal. METHODS A retrospective, monocentric study was conducted to evaluate the outcome of a modified perioperative antibiotic management strategy according to the principles of antibiotic stewardship. Patients with preoperative unremarkable urine culture received no antibiotic prophylaxis for URS stone removal (NoPAP). The NoPAP group was compared to a historic URS cohort, when antibiotic prophylaxis (PAP) was standard of care. Analysis focused on postoperative complications. RESULTS Postoperative fever occurred in 1% of the NoPAP and 2% of the PAP patients (p = 0.589). Clavien 1-3 complications did not differ between groups with 9% in the NoPAP and 6.2% in the PAP (p = 0.159). No Clavien 4-5 complications were seen. We identified a residual stone (p = 0.033) and an ASA score 3-4 (p = 0.004) as significant risk factors for postoperative fever. By sparing routine antibiotic prophylaxis, the overall antibiotic usage was reduced from 100% (PAP) to 8.3% (NoPAP). CONCLUSION Sparing a routine antibiotic prophylaxis during URS for stone removal seems feasible in patients with unremarkable preoperative urine culture for most of the patients. A prospective validation is warranted.
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Affiliation(s)
| | - Eva-Maria Prey
- Department of Urology, University of Regensburg, Caritas St. Josef Medical Center, Regensburg, Germany
| | | | - Christopher Goßler
- Department of Urology, University of Regensburg, Caritas St. Josef Medical Center, Regensburg, Germany
| | - Maximilian Burger
- Department of Urology, University of Regensburg, Caritas St. Josef Medical Center, Regensburg, Germany
| | - Marco Julius Schnabel
- Department of Urology, University of Regensburg, Caritas St. Josef Medical Center, Regensburg, Germany
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Danilovic A, Suartz CV, Torricelli FCM, Marchini GS, Batagello C, Vicentini FC, Nahas WC, Mazzucchi E. Play it safe: renal function after bilateral flexible ureteroscopy for kidney stones. World J Urol 2024; 42:226. [PMID: 38594574 DOI: 10.1007/s00345-024-04924-3] [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: 06/13/2023] [Accepted: 03/05/2024] [Indexed: 04/11/2024] Open
Abstract
PURPOSE We searched for perioperative renal function deterioration risk factors in patients that underwent bilateral flexible ureteroscopy (fURS) for kidney stones. METHODS From August 2016 to February 2020, symptomatic patients > 18 years old with bilateral kidney stones up to 20 mm in each side were prospectively studied. Serum creatinine samples were collected on admission to surgery, immediate postoperative (IPO), on POD 3, 10, and 30. Estimated glomerular filtration rate (eGFR) was calculated using Chronic Kidney Disease Epidemiology Collaboration equation (CKD-EPI) without a race coefficient. RESULTS Thirty patients underwent bilateral fURS. Comparing to preoperative eGFR, median IPO and POD3 eGFR (p < 0.001) were significantly lower, and POD10 (p = 0.092) and POD30 (p = 0.648) were similar to preoperative eGFR. During follow-up, 22/30 (73.3%), 14/30 (46.7%), and 7/30 (23.3%) of the patients presented a decrease > 10% eGFR, > 20% eGFR, and > 30% eGFR, respectively. Multivariate analysis demonstrated that lower preoperative eGFR is a risk factor for eGFR < 60 mL/min/1.73 m2, p = 0.019 [1.021-1.263; 1.136]; ASA > 1 is a risk factor for decrease of eGFR > 10%, p = 0.028 [1.25-51.13; 8.00]; longer operative time is a risk factor for decrease of eGFR > 20%, p = 0.042 [1.00-1.05; 1.028]; and operative time ≥ 120 min is a risk factor for decrease of eGFR > 30%, p = 0.026 [0.016-0.773; 0.113]. CONCLUSIONS Renal function suffers a reversible decrease after bilateral fURS. Our study suggests that adequate selection of patients and maintaining operative time < 120 min are relevant factors in preventing acute renal function deterioration following bilateral fURS.
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Affiliation(s)
- Alexandre Danilovic
- Urology, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Eneas de Carvalho Aguiar, 255, 7 and. Sala 7175, São Paulo, SP, 05403-000, Brazil.
| | - Caio Vinicius Suartz
- Urology, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Eneas de Carvalho Aguiar, 255, 7 and. Sala 7175, São Paulo, SP, 05403-000, Brazil
| | - Fabio Cesar Miranda Torricelli
- Urology, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Eneas de Carvalho Aguiar, 255, 7 and. Sala 7175, São Paulo, SP, 05403-000, Brazil
| | - Giovanni Scala Marchini
- Urology, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Eneas de Carvalho Aguiar, 255, 7 and. Sala 7175, São Paulo, SP, 05403-000, Brazil
| | - Carlos Batagello
- Urology, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Eneas de Carvalho Aguiar, 255, 7 and. Sala 7175, São Paulo, SP, 05403-000, Brazil
| | - Fabio Carvalho Vicentini
- Urology, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Eneas de Carvalho Aguiar, 255, 7 and. Sala 7175, São Paulo, SP, 05403-000, Brazil
| | - William C Nahas
- Urology, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | - Eduardo Mazzucchi
- Urology, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Eneas de Carvalho Aguiar, 255, 7 and. Sala 7175, São Paulo, SP, 05403-000, Brazil
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Lavasani SAM, Rojhani A, Cumpanas AD, Osann K, Morgan KL, Hernandez MC, McCormac A, Piedras P, Vo K, Gorgen ARH, Sharifi SHH, Gao BM, Tano ZE, Patel RM, Landman J, Clayman RV. Surgical Force: Initial Study and Clinical Implications in the Assessment of Ureteral Access Sheath Induced Injury. J Endourol 2024; 38:316-322. [PMID: 38243836 DOI: 10.1089/end.2023.0548] [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: 01/22/2024] Open
Abstract
Purpose: Ureteral access sheaths (UAS) pose the risk of severe ureteral injury. Our prior studies revealed forces ≤6 Newtons (N) prevent ureteral injury. Accordingly, we sought to define the force urologists and residents in training typically use when placing a UAS. Materials and Methods: Among urologists and urology residents attending two annual urological conferences in 2022, 121 individuals were recruited for the study. Participants inserted 12F, 14F, and 16F UAS into a male genitourinary model containing a concealed force sensor; they also provided demographic information. Analysis was completed using t-tests and Chi-square tests to identify group differences when passing a 16F sheath UAS. Participant traits associated with surpassing or remaining below a minimal force threshold were also explored through polychotomous logistic regression. Results: Participant force distributions were as follows: ≤4N (29%), >6N (45%), and >8N (32%). More years of practice were significantly associated with exerting >6N relative to forces between 4N and 6N; results for >8N relative to 4N and 8N were similar. Compared to high-volume ureteroscopists (those performing >20 ureteroscopies/month), physicians performing ≤20 ureteroscopies/month were significantly less likely to exert forces ≤4N (p = 0.017 and p = 0.041). Of those surpassing 6N and 8N, 15% and 18%, respectively, were high-volume ureteroscopists. Conclusions: Despite years of practice or volume of monthly ureteroscopic cases performed, most urologists failed to pass 16F access sheaths within the ideal range of 4N to 6N (74% of participants) or within a predefined safe range of 4N to 8N (61% of participants).
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Affiliation(s)
| | - Allen Rojhani
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Andrei D Cumpanas
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Kathryn Osann
- Division of Hematology/Oncology, Department of Medicine, University of California, Irvine, Irvine, California, USA
| | - Kalon L Morgan
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Mariah C Hernandez
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Amanda McCormac
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Paul Piedras
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Kelvin Vo
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Antonio R H Gorgen
- Department of Urology, University of California, Irvine, Orange, California, USA
| | | | - Bruce M Gao
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Zachary E Tano
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Roshan M Patel
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Jaime Landman
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Ralph V Clayman
- Department of Urology, University of California, Irvine, Orange, California, USA
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Polo R, Canós-Nebot À, Caballero-Romeu JP, Caballero P, Galán-Llopis JA, Soria F, de la Cruz-Conty JE, Tuells J. Post-Ureteroscopic Lesion Scale to determine ureteral wall damage, not so easy to employ. Actas Urol Esp 2024; 48:162-169. [PMID: 37832847 DOI: 10.1016/j.acuroe.2023.10.003] [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: 06/13/2023] [Revised: 08/13/2023] [Accepted: 08/14/2023] [Indexed: 10/15/2023]
Abstract
OBJECTIVE To analyze the level of agreement of the Post-Ureteroscopy Lesion Scale (PULS) and the consequences on its application in clinical practice with more reliable statistical data than the one used in the original work. METHODS 14 URS and 14 micro-URS were performed in 14 female porcine model. All the procedures were video recorded and an anatomopathological analysis was performed in each ureter. Sixteen urologists (9 endourologists and 7 general urologists) and 4 residents evaluated the ureteral lesions according to the PULS, with degrees 0, 1 and ≥2. The agreement was calculated with percentages, Kendall's W coefficient and the indicators Fleiss' Kappa and Krippendorff's Alpha, while the inter-rater agreement was calculated with Spearman's correlation and Cohen's Kappa. RESULTS The percent of agreement was 11.1%. The coefficients were likewise classified as low or very low, with the greatest agreement found among the inexperienced. Also, 50% of the raters did not agree with the rest. CONCLUSIONS The low inter-rater agreement, the specificity of the PULS and the clinical-pathological correlation suggests that this scale is not simple, and probably has a long learning curve.
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Affiliation(s)
- R Polo
- Servicio de Urología, Hospital Marina Baixa, Denia, Valencia, Spain
| | - À Canós-Nebot
- Servicio de Urología, Hospital General de la Universidad de Alicante, Instituto de Investigación Sanitaria y Biomédica (ISABIAL - Fundación FISABIO), Alicante, Spain
| | - J P Caballero-Romeu
- Servicio de Urología, Hospital General de la Universidad de Alicante, Instituto de Investigación Sanitaria y Biomédica (ISABIAL - Fundación FISABIO), Alicante, Spain
| | - P Caballero
- Departamento de Enfermería Comunitaria, Medicina Preventiva y Salud Pública e Historia de la Ciencia, Universidad de Alicante, Alicante, Spain.
| | - J A Galán-Llopis
- Servicio de Urología, Hospital General de la Universidad de Alicante, Instituto de Investigación Sanitaria y Biomédica (ISABIAL - Fundación FISABIO), Alicante, Spain
| | - F Soria
- Unidad de Cirugía Experimental, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - J E de la Cruz-Conty
- Departamento de Fisiología-Laboratorio del Dr. Adebiyi, Centro de Ciencias de la Salud de la Universidad de Tennessee (UTHSC), Memphis, TN, USA
| | - J Tuells
- Departamento de Enfermería Comunitaria, Medicina Preventiva y Salud Pública e Historia de la Ciencia, Universidad de Alicante, Alicante, Spain
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Sahin C, Karaca Y, Sobay R, Arikan O, Uslu M, Bicaklioglu F, Sahinler EB, Sarica K. Ureteral stricture formation after endoscopic removal of obstructing stones: could it be predicted with well-assessed radiological parameters? Urolithiasis 2024; 52:34. [PMID: 38372797 DOI: 10.1007/s00240-024-01530-1] [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: 08/21/2023] [Accepted: 01/06/2024] [Indexed: 02/20/2024]
Abstract
The possible role of well-assessed radiological parameters in the prediction of ureteral stricture formation in cases with impacted obstructive ureteral calculi has been evaluated. 46 adult patients with or without ureteral stricture formation after ureteroscopic stone management were included. In addition to stone size and some certain radiological parameters including ureteral wall thickness (UWT) of the involved ureter at the impacted stone site was also measured and noted on computed tomography (CT) images. Parameters were evaluated in two subgroups of cases, namely: Group 1: patients in whom a ureteral stricture formed after endoscopic stone removal and Group 2: patients normal ureteral anatomy without any stricture formation. The possible relationship between the UWT values and degree of hydronephrosis (HN) with subsequent stricture formation was comparatively evaluated. All of the stones were proximal ureteral calculi in both groups. Both the degree of HN and proximal ureteral diameter (PUD) parenchymal was higher in cases with stricture formation. In addition, mean parenchymal thickness was lower and mean values of UWT measurements at the stone site were 3.70 ± 0.97 mm and 2.17 ± 0.26 mm in Groups 1 and 2, respectively. A cutoff value 2.49 mm for UWT was found to be highly predictive for stricture formation. UWT value calculated at the obstructing stone site was found to be predictive enough for the likelihood of ureteral stricture formation with high sensitivity and specificity . This evaluation along with some other radiological parameters may enable the urologists to follow such cases on this aspect with necessary measures taken.
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Affiliation(s)
- Cahit Sahin
- Department of Urology, Sancaktepe Sehit Prof. Dr. Ilhan Varank Research and Training Hospital, Health Sciences University, Istanbul, Turkey.
| | - Yavuz Karaca
- Department of Urology, Sancaktepe Sehit Prof. Dr. Ilhan Varank Research and Training Hospital, Health Sciences University, Istanbul, Turkey
| | - Resul Sobay
- Department of Urology, Umraniye Research and Training Hospital, Health Sciences University, Istanbul, Turkey
| | - Ozgur Arikan
- Department of Urology, Medeniyet University Göztepe Süleyman Yalçın City Hospital, Istanbul, Turkey
| | - Mehmet Uslu
- Department of Urology, Kafkas University Health Research and Application Center, Kars, Turkey
| | - Fatih Bicaklioglu
- Department of Urology, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
| | - Emre Burak Sahinler
- Department of Urology, Sancaktepe Sehit Prof. Dr. Ilhan Varank Research and Training Hospital, Health Sciences University, Istanbul, Turkey
| | - Kemal Sarica
- Department of Urology, Sancaktepe Sehit Prof. Dr. Ilhan Varank Research and Training Hospital, Health Sciences University, Istanbul, Turkey
- Department of Urology, Medeniyet University Göztepe Süleyman Yalçın City Hospital, Istanbul, Turkey
- Department of Urology, Biruni University, Faculty of Medicine, Istanbul, Turkey
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9
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Pervaiz A, Aziz W, Ather MH. Utility of Post-ureteroscopy Lesion Scale (PULS) in Per-operative Decision-Making for the Need of Double J Stent. Cureus 2022; 14:e26166. [PMID: 35891870 PMCID: PMC9302918 DOI: 10.7759/cureus.26166] [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] [Accepted: 06/21/2022] [Indexed: 11/23/2022] Open
Abstract
Objectives: To assess the applicability of the post ureteroscopy lesion scale (PULS) as an objective measure to define the need for double J (DJ) stent placement after ureterorenoscopy (URS). Methods: Between June and December 2020 a cross-sectional study was conducted at a university hospital. All patients fulfilling the inclusion criteria undergoing URS for renal or ureteric stones were included. At the completion of procedures, the ureter was carefully inspected for injury. Lesions were classified using PULS scoring by the operating surgeon, another consultant, and the resident. The primary outcome was to validate the PULS score against the surgeon’s decision for postoperative stenting and to assess its reliability. Results: A total of 126 patients were included with a mean age of 43.42±15.3 years. The mean stone size was 9.42±3.60mm. DJ stents were placed in 81 cases (62.4%). All of the 38 (30.1%) patients with a significant residual fragment were stented. Ureteric injury of grade 1 was observed in 66 patients (52.3%), of which 22 (33%) had DJ stenting. PULS grade 2 injuries were observed in 22 patients (17.4%), and 95% were stented. With a PULS score of > 2 almost all (97.8%) were stented. Inter-rater reliability of PULS scoring was high among the consultants (Kendall’s W=0.89, p<0.005). Conclusion: DJ stent placement was observed in 33%, 95%, and 98% of patients with PULS grade 1, 2, and >2 injury respectively. In patients with no residual fragment, the need for DJ stenting can be objectively defined using the PULS scoring system as it has high specificity and good interrater reliability.
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10
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Jiang P, Afyouni AS, Brevik A, Peta A, King T, Dinh ST, Ayad M, Larson K, Limfueco L, Kosmala CM, Sharifi H, Patel RM, Landman J, Clayman R. The Impact of One Week of Pre-stenting on Porcine Ureteral Luminal Circumference. J Endourol 2022; 36:885-890. [PMID: 35044235 DOI: 10.1089/end.2021.0771] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES Larger ureteral access sheaths (UAS) have the potential to improve ureteroscopic stone removal outcomes, but are often avoided by surgeons due to concerns of ureteral injury. Using our novel UAS force sensor and previously defined force thresholds for ureteral injury, we sought to evaluate the impact of one week of stenting on the maximum safe dilation of ureteral luminal circumference. METHODS Twelve juvenile female Yorkshire pigs (24 ureters) were evaluated. The inner (i.e. luminal) circumference of each ureter was determined using Cook urethral dilators ranging from 8-24Fr in 2Fr increments, 37cm in length. Each dilator was sequentially passed while applying the UAS force sensor to measure insertion force before and after one week of stent placement. Each ureter was randomized to receive either a 4.7Fr or 7.0Fr stent (20cm). Maximum ureteral luminal circumference was defined as successful passage of the dilator to the ureteropelvic junction with <6 newtons (N) of force (the force threshold previously defined by porcine and clinical studies to avoid ureteral damage). Following passage of the largest dilator at 6N, flexible ureteroscopy was performed and a post-ureteroscopic lesion score (PULS) was recorded. RESULTS After one week of stent placement, the median ureteral luminal circumference increased to 15Fr representing a mean increase of 3.8Fr + 2.8 (p<0.001). Twenty-one (88%) of the pre-stented ureters had an increase in luminal circumference, with 12 ureters (50%) dilated to >16Fr (p=0.032), six ureters (25%) dilated to >18Fr, and in two cases a maximum size of 24Fr was recorded. The PULS grade was < 2 in all cases, indicating no high grade ureteral injuries. Laterality and stent size did not impact ureteral luminal circumference after pre-stenting (p=0.232 and p=0.337, respectively). CONCLUSIONS One week of ureteral stenting resulted in nearly a 4Fr increase in the luminal circumference of porcine ureters.
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Affiliation(s)
- Pengbo Jiang
- University of California Irvine, 8788, Urology, Orange, California, United States;
| | - Andrew S Afyouni
- University of California Irvine, 8788, Urology, Orange, California, United States;
| | - Andrew Brevik
- University of California Irvine, 8788, Urology, Orange, California, United States;
| | - Akhil Peta
- University of California Irvine, 8788, Urology, Orange, California, United States;
| | - Tori King
- University of California Irvine, 8788, Urology, Orange, California, United States;
| | - Samantha T Dinh
- University of California Irvine, 8788, Urology, Orange, California, United States;
| | - Maged Ayad
- University of California Irvine, 8788, Urology, Orange, California, United States;
| | - Krista Larson
- University of California Irvine, 8788, Urology, Orange, California, United States;
| | - Luke Limfueco
- University of California Irvine, 8788, Urology, Orange, California, United States;
| | - Christina M Kosmala
- University of California Irvine, 8788, Urology, Orange, California, United States;
| | - Hossein Sharifi
- University of California Irvine, 8788, Urology, Orange, California, United States;
| | - Roshan M Patel
- University of California Irvine, 8788, Urology, Orange, California, United States;
| | - Jaime Landman
- University of California Irvine, 8788, Urology, Orange, California, United States;
| | - Ralph Clayman
- University of California Irvine, 8788, Urology, Orange, California, United States;
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11
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Long JA, Savoie PH, Boissier R. [Management of complications of upper urinary tract trauma (kidney and ureter)]. Prog Urol 2021; 31:1014-1021. [PMID: 34814985 DOI: 10.1016/j.purol.2021.07.009] [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: 06/20/2021] [Revised: 07/10/2021] [Accepted: 07/16/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Complications of kidney and ureter trauma are directly in the field of the urologist. If they have a second place in the vital prognosis, a good knowledge of these pathologies is essential. METHODS A systematic review of the literature was carried out using the Medline database in order to identify the most relevant articles in English and French. RESULTS Urinary extravasation in the context of blunt kidney trauma has a good functional prognosis. Impaired function of the traumatized kidney is linked to vascular damage associated with grade IV and V. Non operative management is the treatment of choice with deferred management in the event of septic or painful deterioration. The lesions of the ureter are predominantly iatrogenic. While incomplete lesions can be treated endoscopically, complete lesions (stenosis or wound) require surgery. The most frequent lesions, in the distal ureter are easily treated by ureterovesical reimplantation. Large losses of substance may require ileal replacement. CONCLUSION Blunt kidney trauma causing urinary extravasation, with an excellent prognosis, are treated conservatively. Conversely, lesions of the ureter require in the majority of cases an intervention to restore continuity.
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Affiliation(s)
- J-A Long
- Centre hospitalier universitaire de Grenoble, 38043 Grenoble cedex 9, France; TIMC-IMAG, CNRS 5525, La Tronche cedex 9, France.
| | - P-H Savoie
- Hôpital d'instruction des Armées Sainte-Anne, BP 600, 83800 Toulon cedex 09, France
| | - R Boissier
- CHU de La Conception, AP-HM, 13005 Marseille, France
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12
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Bozzini G, Bevilacqua L, Besana U, Calori A, Pastore A, Romero Otero J, Macchi A, Broggini P, Breda A, Gozen A, Inzillo R, Puliatti S, Sighinolfi MC, Rocco B, Liatsikos E, Muller A, Buizza C. Ureteral access sheath-related injuries vs. post-operative infections. Is sheath insertion always needed? A prospective randomized study to understand the lights and shadows of this practice. Actas Urol Esp 2021; 45:576-581. [PMID: 34697008 DOI: 10.1016/j.acuroe.2020.11.010] [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: 04/25/2020] [Accepted: 11/25/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To compare intraoperative ureteral injuries in RIRS with UAS insertion with the rate of postoperative infections after RIRS without UAS insertion. PATIENTS AND METHODS In this randomized trial, patients who received an indication for RIRS between January 2017 and December 2017 were divided into two groups. Group A had no UAS insertion and Group B had UAS insertion. Post-Ureteroscopic Lesion Scale (PULS) grading was performed after UAS or flexible ureteroscope removal. Proximal, middle and distal ureteral lesions were evaluated and compared according to the PULS scale. Additionally, patients in both groups were followed postoperatively to assess any infective complication. RESULTS The evaluation comprised 181 patients, 89 for group A and 92 for group B. Overall stone-free rate, clinically insignificant residual fragments, and final stone-free rate were 41.4%, 53.5%, and 95%, respectively. There were 33 (37.1%) patients with ureteral lesions in group A while 42 (45.6%) patients had ureteral lesions in group B, with no significant difference. On the other hand, the overall presence of postoperative infection rate was much higher for Group A (37.1% vs 16.3% P = 0.03). CONCLUSIONS UAS insertion does not result in a higher number of ureteral injuries. UAS insertion during RIRS allows a lower rate of postoperative infections. CLINICAL TRIAL REGISTRATION NUMBER (ISRCTN REGISTRY NUMBER) 55546280.
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Affiliation(s)
- G Bozzini
- ESUT, European Section for UroTechnology EAU, Arnhem, The Netherlands; Urology Department, ASST Valle Olona, Busto Arsizio, Lombardía, Italy.
| | - L Bevilacqua
- Urology Department, Baggiovara Hospital, Módena, Italy
| | - U Besana
- Urology Department, ASST Valle Olona, Busto Arsizio, Lombardía, Italy
| | - A Calori
- Urology Department, ASST Valle Olona, Busto Arsizio, Lombardía, Italy
| | - A Pastore
- Urology Department, Università La Sapienza, Latina, Italy
| | - J Romero Otero
- Urology Department, Hospital 12 de Octubre, Madrid, Spain
| | - A Macchi
- Urology Department, INT, Milán, Italy
| | - P Broggini
- Urology Department, ASST Valle Olona, Busto Arsizio, Lombardía, Italy
| | - A Breda
- ESUT, European Section for UroTechnology EAU, Arnhem, The Netherlands; Urology Department, Fundacio Puigvert, Barcelona, Spain
| | - A Gozen
- ESUT, European Section for UroTechnology EAU, Arnhem, The Netherlands; Urology Department, University of Heidelberg, Heilbronn, Germany
| | - R Inzillo
- Urology Department, Baggiovara Hospital, Módena, Italy
| | - S Puliatti
- Urology Department, Baggiovara Hospital, Módena, Italy
| | | | - B Rocco
- ESUT, European Section for UroTechnology EAU, Arnhem, The Netherlands; Urology Department, Baggiovara Hospital, Módena, Italy
| | - E Liatsikos
- ESUT, European Section for UroTechnology EAU, Arnhem, The Netherlands; Urology Department, University of Patras, Patras, Greece
| | - A Muller
- Urology Department, Limattal Hospital, Schilieren, Switzerland
| | - C Buizza
- Urology Department, ASST Valle Olona, Busto Arsizio, Lombardía, Italy
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13
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Karani R, Arada RB, Okhunov Z, Tapiero S, Landman J, Clayman RV. Endoscopic Guided Percutaneous Nephrolithotomy. J Endourol 2021; 35:S62-S67. [PMID: 34499544 DOI: 10.1089/end.2020.0556] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Percutaneous nephrolithotomy (PCNL) is the treatment of choice for kidney stones >2 cm in size. Obtaining a nephrostomy tract to access the kidney is a key step in this procedure that ultimately determines the patient's outcome. We describe each step of the endoscopic guided approach to PCNL as performed at the University of California, Irvine. Each step of the endoscopic guided PCNL is described and depicted in the video. Surgical steps depicted in the video are from various recorded PCNL procedures from our institution. This guide outlines the indications, preoperative preparation, patient positioning, surgical steps, and postoperative care for patients undergoing PCNL using the endoscopic guided approach. Direct observation of nephrostomy puncture, tract dilation using the balloon, and passing of the Amplatz sheath allow for proper access to the kidney and lower risk of injury. By following this systematic module of endoscopic guided PCNL, a nephrostomy tract can be created and accessed under direct observation, facilitating the routine steps of PCNL.
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Affiliation(s)
- Rajiv Karani
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Raphael B Arada
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Zhamshid Okhunov
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Shlomi Tapiero
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Jaime Landman
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Ralph V Clayman
- Department of Urology, University of California, Irvine, Orange, California, USA
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14
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Danilovic A, Torricelli FCM, Marchini GS, Batagello C, Vicentini FC, Traxer O, Srougi M, Nahas WC, Mazzucchi E. Does previous standard percutaneous nephrolithotomy impair retrograde intrarenal surgery outcomes? Int Braz J Urol 2021; 47:1198-1206. [PMID: 34469672 PMCID: PMC8486447 DOI: 10.1590/s1677-5538.ibju.2021.0253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 08/01/2021] [Indexed: 01/15/2023] Open
Abstract
Purpose: The objective of this study is to evaluate the impact of a previous standard percutaneous nephrolithotomy (PCNL) on the outcomes of retrograde intrarenal surgery (RIRS). Materials and Methods: Outcomes of RIRS performed from January 2017 to January 2020 in adult patients with residual stone fragments ≤20mm after a standard PCNL (Post-PCNL) and symptomatic adult patients with kidney stones ≤20mm (Control) were prospectively studied. Stone-free rate (SFR) was evaluated on a postoperative day 90 non-contrast computed tomography. Surgical complications based on Clavien-Dindo classification during the 90 days of follow-up were recorded. Results: Outcomes of 55 patients and 57 renal units of the post-PCNL group were compared to 92 patients and 115 renal units of the control group. SFR was lower in post-PCNL group than in control (28/57, 49.1% vs. 86/115, 74.8%, p <0.001). Overall complications were more frequent in post-PCNL group (p=0.004). Infundibula strictures were identified and incised with laser in 15/57 (26.3%) renal units of the post-PCNL group. Thirteen renal units had infundibulum stricture at the site of previous percutaneous tract (13/15; 86.7%, p=0.004) and one renal unit had three infundibula strictures. Postoperative complications were not affected by the treatment of infundibula strictures (p=0.198). Conclusions: Previous standard PCNL significantly impairs the outcomes of RIRS. Infundibula strictures can be found in 26.3% of the patients with residual stone fragments after standard PCNL for large burden kidney stones. The main site of infundibulum stricture after standard PCNL is the infundibulum of the entry calyx.
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Affiliation(s)
- Alexandre Danilovic
- Departamento de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, SP, Brasil
| | - Fábio César Miranda Torricelli
- Departamento de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, SP, Brasil
| | - Giovanni Scala Marchini
- Departamento de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, SP, Brasil
| | - Carlos Batagello
- Departamento de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, SP, Brasil
| | - Fabio Carvalho Vicentini
- Departamento de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, SP, Brasil
| | - Olivier Traxer
- Sorbonne Université, GRC n 20 Lithiase Renale, AP-HP, Hôpital Tenon, F-75020 Paris, France, University, Paris, France
| | - Miguel Srougi
- Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - William C Nahas
- Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Eduardo Mazzucchi
- Departamento de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, SP, Brasil
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15
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Bozzini G, Bevilacqua L, Besana U, Calori A, Pastore A, Romero Otero J, Macchi A, Broggini P, Breda A, Gozen A, Inzillo R, Puliatti S, Sighinolfi MC, Rocco B, Liatsikos E, Muller A, Buizza C. Ureteral access sheath-related injuries vs. post-operative infections. Is sheath insertion always needed? A prospective randomized study to understand the lights and shadows of this practice. Actas Urol Esp 2021; 45:S0210-4806(21)00125-X. [PMID: 34344583 DOI: 10.1016/j.acuro.2020.11.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 10/28/2020] [Accepted: 11/25/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To compare intraoperative ureteral injuries in RIRS with UAS insertion with the rate of postoperative infections after RIRS without UAS insertion. PATIENTS AND METHODS In this randomized trial, patients who received an indication for RIRS between January 2017 and December 2017 were divided into two groups. Group A had no UAS insertion and Group B had UAS insertion. Post-Ureteroscopic Lesion Scale (PULS) grading was performed after UAS or flexible ureteroscope removal. Proximal, middle and distal ureteral lesions were evaluated and compared according to the PULS scale. Additionally, patients in both groups were followed postoperatively to assess any infective complication. RESULTS The evaluation comprised 181 patients, 89 for group A and 92 for group B. Overall stone-free rate, clinically insignificant residual fragments, and final stone-free rate were 41.4%, 53.5%, and 95%, respectively. There were 33 (37.1%) patients with ureteral lesions in group A while 42 (45.6%) patients had ureteral lesions in group B, with no significant difference. On the other hand, the overall presence of postoperative infection rate was much higher for Group A (37.1% vs 16.3% P=.03). CONCLUSIONS UAS insertion does not result in a higher number of ureteral injuries. UAS insertion during RIRS allows a lower rate of postoperative infections. Clinical Trial Registration Number (ISRCTN registry number): 55546280.
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Affiliation(s)
- G Bozzini
- ESUT, European section for UroTechnology EAU, Arnhem, Países Bajos; Urology Department, ASST Valle Olona, Busto Arsizio, Lombardía, Italia.
| | - L Bevilacqua
- Urology Department, Baggiovara Hospital, Módena, Italia
| | - U Besana
- Urology Department, ASST Valle Olona, Busto Arsizio, Lombardía, Italia
| | - A Calori
- Urology Department, ASST Valle Olona, Busto Arsizio, Lombardía, Italia
| | - A Pastore
- Urology Department, Università La Sapienza, Latina, Italia
| | - J Romero Otero
- Urology Department, Hospital 12 de Octubre, Madrid, España
| | - A Macchi
- Urology Department, INT, Milán, Italia
| | - P Broggini
- Urology Department, ASST Valle Olona, Busto Arsizio, Lombardía, Italia
| | - A Breda
- ESUT, European section for UroTechnology EAU, Arnhem, Países Bajos; Urology Department, Fundacio Puigvert, Barcelona, España
| | - A Gozen
- ESUT, European section for UroTechnology EAU, Arnhem, Países Bajos; Urology Department, University of Heidelberg, Heilbronn, Alemania
| | - R Inzillo
- Urology Department, Baggiovara Hospital, Módena, Italia
| | - S Puliatti
- Urology Department, Baggiovara Hospital, Módena, Italia
| | | | - B Rocco
- ESUT, European section for UroTechnology EAU, Arnhem, Países Bajos; Urology Department, Baggiovara Hospital, Módena, Italia
| | - E Liatsikos
- ESUT, European section for UroTechnology EAU, Arnhem, Países Bajos; Urology Department, University of Patras, Patras, Grecia
| | - A Muller
- Urology Department, Limattal Hospital, Schilieren, Suiza
| | - C Buizza
- Urology Department, ASST Valle Olona, Busto Arsizio, Lombardía, Italia
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16
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Soria F, de La Cruz JE, Budia A, Cepeda M, Álvarez S, Serrano Á, Sanchez-Margallo FM. Iatrogenic Ureteral Injury Treatment with Biodegradable Antireflux Heparin-Coated Ureteral Stent-Animal Model Comparative Study. J Endourol 2021; 35:1244-1249. [PMID: 33626973 DOI: 10.1089/end.2020.0591] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Objective: The aim is to assess the effectiveness of a biodegradable antireflux ureteral stent with heparin coating in a comparative study (BraidStent®-H) in an animal model for the treatment of iatrogenic ureteral perforation. Materials and Methods: A total of 24 female pigs underwent initial endoscopic, nephrosonographic, and contrast fluoroscopy assessment of the urinary tract. Afterward, unilateral iatrogenic perforation in proximal ureter model was performed. Then the animals were randomly assigned to Group-I, in which a double-pigtail stent was placed for 6 weeks, or Group-II, in which a BraidStent-H a biodegradable heparin-coated stent was placed. Follow-up assessments were performed at 1 and 6 weeks and 5 months. Results: In terms of therapeutic effectiveness, complete resolution was observed in 95.8% of Group-I animals and 87.5% in Group-II. No animals in Group-II showed vesicoureteral reflux (VUR) during the study; statistical significance was observed at 1 and 6 weeks versus Group-I. All stents in Group-II degraded without producing obstructive fragments and allowed distal ureteral peristalsis. Heparin coating was not efficient to reduce asymptomatic bacteriuria between groups. Pathologic assessment did not show any significance in the global score, but did in the "fibrosis in muscular layer" parameter, at the ureteral perforation healing area; Group-II showed higher healing quality. Conclusions: The biodegradable intraureteral BraidStent®-H is highly effective for the minimally invasive treatment of ureteral perforation, since it displays controlled and predictable degradation, avoiding the development of VUR as well as irritation of the bladder trigone. Unfortunately, heparin coating was not effective in avoiding stent-associated bacteriuria.
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Affiliation(s)
- Federico Soria
- Endoscopy-Endourology Department, Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain
| | - Julia E de La Cruz
- Endoscopy-Endourology Department, Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain
| | - Alberto Budia
- Urology Department, University Hospital La Fe, Valencia, Spain
| | - Marcos Cepeda
- Urology Department, University Hospital Río Hortega, Valladolid, Spain
| | - Sara Álvarez
- Urology Department, University Hospital Santiago Ramón y Cajal, Madrid, Spain
| | - Álvaro Serrano
- Urology Department, University Hospital Clínico San Carlos, Madrid, Spain
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17
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Jones P, Pietropaolo A, Chew BH, Somani BK. Atlas of scoring systems, grading tools and nomograms in Endourology: A comprehensive overview from The TOWER Endourological Society research group. J Endourol 2021; 35:1863-1882. [PMID: 33878937 DOI: 10.1089/end.2021.0124] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION With an increase in the prevalence of kidney stone disease (KSD), there has been a universal drive to develop reliable and user-friendly tools such as grading systems and predictive nomograms. An atlas of scoring systems, grading tools and nomograms in Endourology is provided in this paper. METHODS A comprehensive search of world literature was performed to identify nomograms, grading systems and classification tools in endourology related to KSD. Each of these were reviewed by the authors and have been evaluated in a narrative format with details on those which are externally validated and their respective citation count on google scholar. RESULTS A total of 54 endourological tools have been described in our atlas of endourological scoring systems, grading tools and nomograms. Of the tools, 23 (43%) are published in the last 3 years showing an increasing interest in this area. This includes 5 for percutaneous nephrolithotomy (PCNL), 6 for flexible ureteroscopy (fURS), 3 for semi-rigid URS (sURS), 9 for shockwave lithotripsy (SWL), 2 for stent encrustations, 3 for intra-operative appearance at the time of URS and 3 to classify intra-operative ureteric injury. There were 3 tools for renal colic assessment, one each for prediction of future stone event, stone classification and stone impaction and 2 for need of emergency intervention in ureteric stone. While 2 tools are related to stone recurrence, 6 are related to post-procedural complications. There are now 2 tools for simulation in endourology and 5 for patient reported outcome measures (PROMS). CONCLUSIONS A number of reliable and established tools exist currently in endourology. Each of these offers their own respective advantages and disadvantages. While nomograms and scoring systems can help in the decision making, these must be tailored to individual patients based on their specific clinical scenarios, expectations and informed consent.
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Affiliation(s)
- Patrick Jones
- Haukeland University Hospital, 60498, Urology, Bergen, Norway;
| | - Amelia Pietropaolo
- University Hospital Southampton NHS Foundation Trust, 7425, Urology, Southampton, Southampton , United Kingdom of Great Britain and Northern Ireland;
| | - Ben H Chew
- University of British Columbia, Urologic Sciences, Vancouver, British Columbia, Canada;
| | - Bhaskar K Somani
- University Hospital Southampton NHS Foundation Trust, 7425, Urology, Southampton, Southampton , United Kingdom of Great Britain and Northern Ireland.,University of Southampton, 7423, Southampton, Hampshire, United Kingdom of Great Britain and Northern Ireland;
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18
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Ureterorenoskopie. Urolithiasis 2021. [DOI: 10.1007/978-3-662-62454-8_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Zhang Z, Chen D, Deng L, Li W, Wang X, Zhang Y, Liekui F, Feloney MP, Zhang Y. Iatrogenic ureteral injury during retroperitoneal laparoscopy for large renal cysts: What we learned and a review of the literature. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2021; 29:185-196. [PMID: 33459688 DOI: 10.3233/xst-200804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE To avoid Iatrogenic ureteral injury during retroperitoneal laparoscopy for large renal cyst (diameter > 70 mm), we present two cases of iatrogenic ureteral injury and discuss their clinical courses and final outcomes. PATIENTS AND METHODS Two male patients (47 years old and 74 years old) with large left simple renal cysts underwent a retroperitoneal laparoscopic operation to treat the cysts. In the first patient, the left proximal ureter was partially transected (Grade 3) during the operation. The injury was identified intraoperatively. The transection was managed with a primary ureteroureterostomy (end to end) along with a double J ureteral stent. In the second patient, the left proximalureter was partially transected (Grade 4). However, the injury was unrecognized postoperatively for two days. After recognition of the complication, the injury was managed with an early primary ureteroureterostomy, which followed a failed attempt to place ureteral stent endoscopically. RESULTS In the first patient, a postoperative urinary leakage developed and lasted for 13 days. During long term follow-up of the first patient after the urine leak resolved, there were no reports of pain in the lumbar region or other discomfort. No recurrence of the renal cyst occurred, which was confirmed with an ultrasound at one year postoperatively. In the second patient a ureteral fistula and severe perirenal infection occurred and lasted for 86 days. The patient ultimately underwent a left nephrectomy after conservative management for this surgical complication failed. This patient developed a chronic wound infection that lasted for 3.14 months following the nephrectomy. During follow-up post nephrectomy, the patient developed stage 3B moderate chronic kidney disease (CKD) (GFR = 30 -44 ml/min). CONCLUSIONS For single large (diameter > 70 mm) renal cysts located at the lower pole of the kidney, it is recommended to not completely dissect out and mobilize the entire renal cyst for cyst decortication in order to avoid injuring the ureter. Iatrogenic ureteral injury increases the risk of readmission and serious life-threatening complications. The immediate diagnosis and proper management ureteric injury can reduce complications and long term sequalae.
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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
| | - 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
| | - Ling Deng
- Department of Urology,Shenzhen Longhua District Central Hospital,The Affiliated Central Hospital of Shenzhen Longhua District, Guangdong Medical University, Shenzhen, Guangdong Province,China
| | - Wei Li
- 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
| | - Yixiang Zhang
- Department of Urology, Shenzhen People's Hospital,The Second Clinical Medical College of Jinan University, The First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, Guangdong Province,China
| | - Fang Liekui
- Department of Urology, The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen third people's hospital, Shenzhen, Guangdong Province, China
| | - Michael P Feloney
- Department of Urology, Creighton University School of Medicine, Omaha, NE, USA
| | - Yuanyuan Zhang
- Wake Forest Institute for Regenerative Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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Schlager D, Schulte A, Schütz J, Brandenburg A, Schell C, Lamrini S, Vogel M, Teichmann HO, Miernik A. Laser-guided real-time automatic target identification for endoscopic stone lithotripsy: a two-arm in vivo porcine comparison study. World J Urol 2020; 39:2719-2726. [PMID: 32960325 PMCID: PMC8332575 DOI: 10.1007/s00345-020-03452-0] [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] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 09/10/2020] [Indexed: 12/19/2022] Open
Abstract
Introduction and objective Thermal injuries associated with Holmium laser lithotripsy of the urinary tract are an underestimated problem in stone therapy. Surgical precision relies exclusively on visual target identification when applying laser energy for stone disintegration. This study evaluates a laser system that enables target identification automatically during bladder stone lithotripsy, URS, and PCNL in a porcine animal model. Methods Holmium laser lithotripsy was performed on two domestic pigs by an experienced endourology surgeon in vivo. Human stone fragments (4–6 mm) were inserted in both ureters, renal pelvises, and bladders. Ho:YAG laser lithotripsy was conducted as a two-arm comparison study, evaluating the target identification system against common lithotripsy. We assessed the ureters’ lesions according to PULS and the other locations descriptively. Post-mortem nephroureterectomy and cystectomy specimens were examined by a pathologist. Results The sufficient disintegration of stone samples was achieved in both setups. Endoscopic examination revealed numerous lesions in the urinary tract after the commercial Holmium laser system. The extent of lesions with the feedback system was semi-quantitatively and qualitatively lower. The energy applied was significantly less, with a mean reduction of more than 30% (URS 27.1%, PCNL 52.2%, bladder stone lithotripsy 17.1%). Pathology examination revealed only superficial lesions in both animals. There was no evidence of organ perforation in either study arm. Conclusions Our study provides proof-of-concept for a laser system enabling automatic real-time target identification during lithotripsy on human urinary stones. Further studies in humans are necessary, and to objectively quantify this new system’s advantages, investigations involving a large number of cases are mandatory. Electronic supplementary material The online version of this article (10.1007/s00345-020-03452-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Daniel Schlager
- Department of Urology, Faculty of Medicine, Medical Center - University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany.
| | - Antonia Schulte
- Department of Urology, Faculty of Medicine, Medical Center - University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Jan Schütz
- Fraunhofer Institute for Physical Measurement Techniques IPM, Heidenhofstrasse 8, 79110, Freiburg, Germany
| | - Albrecht Brandenburg
- Fraunhofer Institute for Physical Measurement Techniques IPM, Heidenhofstrasse 8, 79110, Freiburg, Germany
| | - Christoph Schell
- Institute of Surgical Pathology, Faculty of Medicine, Medical Center - University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Samir Lamrini
- LISA Laser Products GmbH, Albert-Einstein-Straße 4, 37191, Katlenburg-Lindau, Germany
| | - Markus Vogel
- LISA Laser Products GmbH, Albert-Einstein-Straße 4, 37191, Katlenburg-Lindau, Germany
| | | | - Arkadiusz Miernik
- Department of Urology, Faculty of Medicine, Medical Center - University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
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Denis D, Moreno S, Velasco A, Salvadó JA. Ureteral Avulsion During Retrograde Intrarenal Surgery: When the Unexpected Happens. J Endourol Case Rep 2020; 6:177-179. [PMID: 33102721 PMCID: PMC7580639 DOI: 10.1089/cren.2020.0006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We report the case of a 49-year-old woman affected by bilateral urinary stones. Bilateral semirigid ureteroscopy was performed followed on the left side by a flexible ureteroscopy, caused by localization of the stone. Unfortunately, disinsertion of the left ureter occurred during the intervention. Open conversion was performed in the same single procedure for left ureteral reimplant. After an easy recovery, the patient was rehospitalized on day 9 postintervention for left pyelonephritis. This case report discusses the management of this rare but serious complication, including the necessity for quick thinking and decision making.
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Affiliation(s)
- David Denis
- Department of Urology, Clinica Santa Maria, Santiago, Chile
- Department of Urology, Cliniques Universitaires Saint-Luc, Bruxelles, Belgique
| | - Sergio Moreno
- Department of Urology, Clinica Santa Maria, Santiago, Chile
- Universidad Finis Terrae, Facultad de Medicina, Providencia, Región Metropolitana de Santiago, Chile
| | - Alfredo Velasco
- Department of Urology, Clinica Santa Maria, Santiago, Chile
- Universidad Finis Terrae, Facultad de Medicina, Providencia, Región Metropolitana de Santiago, Chile
| | - José A. Salvadó
- Department of Urology, Clinica Santa Maria, Santiago, Chile
- Universidad Finis Terrae, Facultad de Medicina, Providencia, Región Metropolitana de Santiago, Chile
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22
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Danilovic A, Torricelli FCM, Marchini GS, Batagello C, Vicentini FC, Traxer O, Srougi M, Nahas WC, Mazzucchi E. Prospective Evaluation of Bilateral Retrograde Intrarenal Surgery: Is It Really Safe? J Endourol 2020; 35:14-20. [PMID: 32689826 DOI: 10.1089/end.2020.0611] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: The aim of this study was to prospectively compare the outcomes of bilateral same-session retrograde intrarenal surgery (BSS RIRS) with unilateral RIRS and to compare the outcomes of first with second operated kidneys in BSS RIRS. Subjects and Methods: Consecutive symptomatic adult patients with kidney stones up to 20 mm who accepted to be treated by RIRS were prospectively studied. Stone-free rate (SFR) was evaluated by non-contrast CT for each renal unit, and surgical complications were evaluated based on Clavien-Dindo classification. Results: SFR (73.9% vs 76.1%, p = 0.830) and hospitalization time (14.43 ± 18.81 hours vs 13.00 ± 4.89 hours, p = 0.564) were similar between unilateral and BSS RIRS groups, with less consumption of disposable devices in BSS RIRS (p = 0.017). Operative time was longer in BSS RIRS (61.24 ± 26.62 minutes vs 88.65 ± 33.19 minutes, p < 0.001). Bilateral group had significant more overall complications by Clavien-Dindo classification than unilateral (15.9% vs 39.9%, p = 0.030) and more emergency room (ER) visits (11.6% vs 34.8%, p = 0.026). Moreover, although both groups temporarily increased creatinine levels, it was significantly higher in bilateral RIRS (p = 0.019). First operated kidney outcomes were similar to second operated kidney outcomes of BSS RIRS. Conclusion: Although BSS RIRS had similar SFR and consumed less disposable devices, it had a higher overall complication rate, a higher frequency of ER visits, and higher creatinine levels during follow-up than unilateral RIRS. There is no significant outcome difference between first and second operated kidneys in BSS RIRS.
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Affiliation(s)
- Alexandre Danilovic
- Department of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | | | - Giovanni Scala Marchini
- Department of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Carlos Batagello
- Department of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Fabio Carvalho Vicentini
- Department of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Olivier Traxer
- Department of Urology, Sorbonne Université, GRC n20 Lithiase Renale, AP-HP, Hôpital Tenon, Paris, France
| | - Miguel Srougi
- Department of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - William C Nahas
- Department of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Eduardo Mazzucchi
- Department of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
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Reed AM, Christensen CL, Allam CL. Duration of Ureteral Stenting Following Ureteroscopic Perforation in a Porcine Model. J Endourol 2020; 35:259-265. [PMID: 32762262 DOI: 10.1089/end.2020.0449] [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: 12/31/2022] Open
Abstract
Objectives: Ureteroscopic ureteral perforations have been reported in up to 6% of cases, with recent studies suggesting a decline to less than 2%. Ureteroscopic perforations are managed with prolonged ureteral stenting of up to 6 weeks based on historical data. We sought to evaluate the time of urothelial healing and duration of ureteral stenting following a ureteroscopic perforation in a porcine model. Materials and Methods: Part A: Ureteral perforation using a semirigid ureteroscope was performed in 37 ureters. The ureters were stented using 4.7F × 22 cm stents for 3, 7, 10, or 14 days, and retrograde pyelograms performed after stent removal. Injured ureteral segments were collected for histologic evaluation. Part B: 8 ureters had endoscopic perforation and stenting for 7 days and then survived for 4 weeks for evaluation of urinary extravasation or hydronephrosis and histologic evaluation. Results: Part A: At 3 days of ureteral stenting, there was urinary extravasation on retrograde pyelograms and gross defect in all ureters; average creatinine increased (1.55-1.75 mg/dL). Starting at 7 days, no evidence of gross urothelial defects or extravasation, and average creatinine was stable. Histologic evaluation revealed urothelial healing by 7 days with ongoing tissue healing. Granulation tissue predominated in early phase of healing. Part B: With only 7 days of ureteral stenting, no extravasation or hydronephrosis developed a month after stent removal. Conclusions: Following ureteroscopic ureteral perforation in a porcine model, the urothelium is functionally intact with 7 days of stenting. These results are sustained without complications for at least 4 weeks after stent removal. While further studies are warranted, these results challenge the current practice of maintaining ureteral stenting for several weeks following ureteral perforation during ureteroscopy.
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Affiliation(s)
- Amy M Reed
- Urology Division, Department of Surgery, Brooke Army Medical Center, JBSA-Fort Sam Houston, Texas, USA
| | | | - Christopher L Allam
- Urology Division, Department of Surgery, Brooke Army Medical Center, JBSA-Fort Sam Houston, Texas, USA
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24
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Danilovic A, Nunes E, Lipkin ME, Ferreira T, Torricelli FCM, Marchini GS, Srougi M, Nahas WC, Mazzucchi E. Low Dose Fluoroscopy During Ureteroscopy Does Not Compromise Surgical Outcomes. J Endourol 2020; 33:527-532. [PMID: 30793920 DOI: 10.1089/end.2018.0722] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: To evaluate whether reducing the dose of fluoroscopy to ¼ of standard dose during unilateral ureteroscopy for ureteral stone treatment would impact in a reduction of total radiation emitted and whether this strategy would impact operation time, stone-free rate, and complication rate. Methods: From August 2016 to August 2017, patients over 18 years submitted to ureteroscopy for ureteral stone between 5 and 20 mm were prospectively randomized for ¼ dose reduction or standard dose fluoroscopy. Patients with abnormal urinary anatomy such as horseshoe kidney, pelvic kidney, or duplex system were excluded from the study. Results: Ninety-four patients were enrolled. The fluoroscopic dose reduction strategy to ¼ of the standard dose was able to significantly reduce the cumulative radiation emitted by C-arm fluoroscopy and the dose area product (3.6 ± 4.5 mGy vs 16.2 ± 19.3 mGy, p = 0.0001 and 0.23 ± 0.52 mcGycm2 vs 1.15 ± 2.74 mcGycm2, p = 0.02, respectively). Fluoroscopy time was similar between groups (74.5 ± 84.8 seconds vs 88.3 ± 90 seconds, p = 0.44). There was no need to increase the fluoroscopy dose during any of the procedures. Surgical outcomes were not affected by fluoroscopic dose reduction strategy. Conclusion: Low dose fluoroscopy reduces the emitted radiation during ureteroscopy without compromising surgical outcomes.
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Affiliation(s)
- Alexandre Danilovic
- 1 Department of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Eduardo Nunes
- 1 Department of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Michael E Lipkin
- 2 Division of Urologic Surgery, Surgery Department, Duke University Medical Center, Durham, North Carolina
| | - Thiago Ferreira
- 1 Department of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Fabio C M Torricelli
- 1 Department of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Giovanni S Marchini
- 1 Department of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Miguel Srougi
- 1 Department of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - William C Nahas
- 1 Department of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Eduardo Mazzucchi
- 1 Department of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
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Guven S, Yigit P, Tuncel A, Karabulut İ, Sahin S, Kilic O, Balasar M, Seckiner I, Canda E, Sonmez MG, Tefik T, Boz MY, Atis G, Ergin G, Soytas M, Senel Ç, Kirac M, Kiremit MC, Akand M, Tugcu V, Erkurt B, Muslumanoglu A, Sarica K. Retrograde intrarenal surgery of renal stones: a critical multi-aspect evaluation of the outcomes by the Turkish Academy of Urology Prospective Study Group (ACUP Study). World J Urol 2020; 39:549-554. [PMID: 32347334 DOI: 10.1007/s00345-020-03210-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 04/09/2020] [Indexed: 11/26/2022] Open
Abstract
AIMS To outline and evaluate the incidence, management and follow-up of the residual fragments (RFs) following retrograde intrarenal surgery (RIRS) of renal stones by the Turkish Academy of Urology Prospective Study Group (ACUP Study). METHODS Following the ethical committee approval, 15 centers providing data regarding the incidence, management, and follow-up of RFs after RIRS were included and all relevant information was recorded into the same electronic database program ( https://acup.uroturk.org.tr/ ) created by Turkish Urology Academy for Residual Stone Study. RESULTS A total of 1112 cases underwent RIRS for renal calculi and RFs were observed in 276 cases (24.8%). Of all the parameters evaluated, our results demonstrated no statistically significant relation between preoperative DJ stenting and the presence of RFs (χ2 (1) = 158.418; p = 0.099). RFs were significantly higher in patients treated with UAS (82 patients, 29.3%) during the procedure compared to the cases who did not receive UAS (194 patients, 23.3%) (χ2 (1) = 3.999; p = 0.046). The mean period for a secondary intervention after RIRS was 28.39 (± 12.52) days. Regarding the procedures applied for RF removal, re-RIRS was the most commonly performed approach (56%). CONCLUSIONS Despite the reported safe and successful outcomes, the incidence of RFs is higher, after the RIRS procedure particularly in cases with relatively larger calculi. Such cases need to be followed in a close manner and although a second flexible ureteroscopy is the treatment of choice for fragment removal in the majority of these patients, shock wave lithotripsy and percutaneous nephrolithotomy may also be preferred in selected cases.
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Affiliation(s)
- Selcuk Guven
- Department of Urology, Istanbul Medipol University, TEM Otoyolu No. 1, Bagcilar, 34214, Istanbul, Turkey.
| | - Pakize Yigit
- Department of Medical Statistics and Medical Informatics, Istanbul Medipol University, Istanbul, Turkey
| | - Altug Tuncel
- Department of Urology, Ankara Numune Research and Training Hospital, University of Health Sciences, Ankara, Turkey
| | - İbrahim Karabulut
- Department of Urology, Erzurum Research and Training Hospital, University of Health Sciences, Erzurum, Turkey
| | - Selcuk Sahin
- Department of Urology, Bakirköy Sadi Konuk Research and Training Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ozcan Kilic
- Department of Urology, Selcuklu Medical School, Selcuk University, Konya, Turkey
| | - Mehmet Balasar
- Department of Urology, Meram Medical School, Necmettin Erbakan University, Konya, Turkey
| | - Ilker Seckiner
- Department of Urology, Gaziantep University, Gaziantep, Turkey
| | - Erdem Canda
- Department of Urology, Yıldırım Beyazit University, Ankara, Turkey
| | - Mehmet Giray Sonmez
- Department of Urology, Meram Medical School, Necmettin Erbakan University, Konya, Turkey
| | - Tzevat Tefik
- Department of Urology, Istanbul Medical School, Istanbul University, Istanbul, Turkey
| | - Mustafa Yucel Boz
- Department of Urology, Istanbul Medipol University, TEM Otoyolu No. 1, Bagcilar, 34214, Istanbul, Turkey
| | - Gokhan Atis
- Department of Urology, Goztepe Training and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Giray Ergin
- Department of Urology, Koru Hospital, Ankara, Turkey
| | - Mustafa Soytas
- Department of Urology, Bakirköy Sadi Konuk Research and Training Hospital, University of Health Sciences, Istanbul, Turkey
| | - Çagdas Senel
- Department of Urology, Ankara Numune Research and Training Hospital, University of Health Sciences, Ankara, Turkey
| | - Mustafa Kirac
- Department of Urology, Koru Hospital, Ankara, Turkey
| | | | - Murat Akand
- Department of Urology, Selcuklu Medical School, Selcuk University, Konya, Turkey
| | - Volkan Tugcu
- Department of Urology, Bakirköy Sadi Konuk Research and Training Hospital, University of Health Sciences, Istanbul, Turkey
| | - Bulent Erkurt
- Department of Urology, Istanbul Medipol University, TEM Otoyolu No. 1, Bagcilar, 34214, Istanbul, Turkey
| | - Ahmet Muslumanoglu
- Department of Urology, Bagcilar Research and Training Hospital, University of Health Sciences, Istanbul, Turkey
| | - Kemal Sarica
- Department of Urology, Biruni University, Istanbul, Turkey
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26
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Videourology Abstracts. J Endourol 2020; 34:531-534. [DOI: 10.1089/end.2020.29078.vid] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Radiation exposure during retrograde intrarenal surgery (RIRS): a prospective multicenter evaluation. World J Urol 2020; 39:217-224. [PMID: 32200411 PMCID: PMC7858553 DOI: 10.1007/s00345-020-03160-9] [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: 10/09/2019] [Accepted: 03/06/2020] [Indexed: 12/29/2022] Open
Abstract
Purpose Retrograde intrarenal surgery (RIRS) may require extensive X-ray usage. We evaluated the impact of preoperative surgeon briefing regarding the inclusion and evaluation of fluoroscopy time (FT) and dose area product (DAP) in a multicenter study on the applied X-ray usage. Methods A prospective multicenter study of 6 tertiary centers was performed. Each center recruited up to 25 prospective patients with renal stones of any size for RIRS. Prior to study´s onset, all surgeons were briefed about hazards of radiation and on strategies to avoid high doses in RIRS. Prospective procedures were compared to past procedures, as baseline data. FT was defined as the primary outcome. Secondary parameters were stone-free rate (SFR), complications according to the Clavien, SATAVA and postureteroscopic lesion scale. Results were analyzed using T test, chi-squared test, univariate analysis and confirmed in a multivariate regression model. Results 303 patients were included (145 retro- and 158 prospective). Mean FT and DAP were reduced from 130.8 s/565.8 to 77.4 s/357.8 (p < 0.05). SFR was improved from 85.5% to 93% (p < 0.05). Complications did not vary significantly. Neither stone position (p = 0.569), prestenting (p = 0.419), nor surgeons’ experience (> 100 RIRS) had a significant impact on FT. Significant univariate parameters were confirmed in a multivariate model, revealing X-ray training to be radiation protective (OR − 44, p = 0.001). Conclusions Increased surgeon awareness of X-ray exposure risks has a significant impact on FT and DAP. This “awareness effect” is a simple method to reduce radiation exposure for the patient and OR staff without the procedures´ outcome and safety being affected.
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Werthemann P, Weikert S, Enzmann T, Schostak M, Lebentrau S. A Stent for Every Stone? Prestenting Habits and Outcomes from a German Multicenter Prospective Study on the Benchmarks of Ureteroroscopic Stone Treatment (BUSTER). Urol Int 2020; 104:431-436. [DOI: 10.1159/000504682] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Accepted: 11/08/2019] [Indexed: 11/19/2022]
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Kaler KS, Lama DJ, Safiullah S, Cooper V, Valley ZA, O'Leary ML, Patel RM, Klopfer MJ, Li GP, Landman J, Clayman RV. Ureteral Access Sheath Deployment: How Much Force Is Too Much? Initial Studies with a Novel Ureteral Access Sheath Force Sensor in the Porcine Ureter. J Endourol 2019; 33:712-718. [DOI: 10.1089/end.2019.0211] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- Kamaljot S. Kaler
- Department of Urology, School of Medicine, University of California, Irvine, Orange, California
- Section of Urology, Department of Surgery, University of Calgary, Calgary, Canada
| | - Daniel J. Lama
- Department of Urology, School of Medicine, University of California, Irvine, Orange, California
| | - Shoaib Safiullah
- Department of Urology, School of Medicine, University of California, Irvine, Orange, California
| | - Vinay Cooper
- Department of Urology, School of Medicine, University of California, Irvine, Orange, California
| | - Zachary A. Valley
- Department of Urology, School of Medicine, University of California, Irvine, Orange, California
| | - Mitchell L. O'Leary
- Department of Urology, School of Medicine, University of California, Irvine, Orange, California
| | - Roshan M. Patel
- Department of Urology, School of Medicine, University of California, Irvine, Orange, California
| | - Michael J. Klopfer
- California Institute of Telecommunications and Information Technology, University of California, Irvine, Irvine, California
| | - Guann-Pyng Li
- Department of Electrical Engineering and Computer Science, University of California, Irvine, Irvine, California
| | - Jaime Landman
- Department of Urology, School of Medicine, University of California, Irvine, Orange, California
| | - Ralph V. Clayman
- Department of Urology, School of Medicine, University of California, Irvine, Orange, California
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May M, Schönthaler M, Gilfrich C, Wolff I, Peter J, Miernik A, Fritsche HM, Burger M, Schostak M, Lebentrau S. [Interrater reliability and clinical impact of the Post-Ureteroscopic Lesion Scale (PULS) grading system for ureteral lesions after ureteroscopy : Results of the German prospective multicenter BUSTER project]. Urologe A 2019; 57:172-180. [PMID: 29322235 DOI: 10.1007/s00120-017-0565-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND The Post-ureteroscopic Lesion Scale (PULS) was designed as a standardized classification system for ureteral lesions after uretero(reno)scopy (URS). This study evaluates its routine use and a possible clinical impact based on a representative patient cohort. MATERIALS AND METHODS Data of 307 patients in 14 German centers within the BUSTER project were used to test 3 hypotheses (H): PULS score shows a high interrater reliability (IRR) after independent assessment by urologic surgeon and assistance personnel (H1); PULS score is correlated with the frequency of postoperative complications during hospital stay (H2); post-URS stenting of the ureter is associated with higher PULS scores (H3). RESULTS Median age of patients was 54.4 years (interquartile range [IQR] 44.4-65.8; 65.5% male). Median diameter of index stones was 6 mm (IQR 4-8) with 117 (38.4%) pyelo-caliceal and 188 (61.6%) ureteral stones. Overall, 70 and 82.4% of patients had pre-stenting and post-URS stenting, respectively. Stone-free status was achieved in 68.7% after one URS procedure with a complication rate of 10.8% (mostly grade 1-2 according to Clavien-Dindo). PULS scores 0, 1, 2 and 3 were assessed in 40%, 52.1%, 6.9% and 1% of patients, respectively, when estimated by urologic surgeons. PULS score showed a high IRR between the urologic surgeon and assistance personnel (κ = 0.883, p < 0.001), but was not significantly correlated with complications (ρ = 0.09, p = 0.881). In contrast, a significant positive correlation was found between PULS score and post-URS stenting (ρ = 0.287, p < 0.001). A PULS score of 1 multiplied the likelihood of post-URS stenting by 3.24 (95% confidence interval 1.43-7.34; p = 0.005) as opposed to PULS score 0. CONCLUSIONS Removal of upper urinary tract stones using URS is safe and efficacious. Real-world data provided by this study confirm a high IRR of the PULS score and its clinical impact on the indication for post-URS stenting. A future prospective randomized trial should evaluate a possible standardization of post-URS stenting based on PULS score assessment.
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Affiliation(s)
- M May
- Urologische Kliniken, St. Elisabeth-Klinikum Straubing, St.-Elisabeth-Str. 23, 94315, Straubing, Deutschland.
| | - M Schönthaler
- Urologische Kliniken, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - C Gilfrich
- Urologische Kliniken, St. Elisabeth-Klinikum Straubing, St.-Elisabeth-Str. 23, 94315, Straubing, Deutschland
| | - I Wolff
- Urologische Kliniken, Carl-Thiem-Klinikum Cottbus, Cottbus, Deutschland
| | - J Peter
- Urologische Kliniken, St. Elisabeth-Klinikum Straubing, St.-Elisabeth-Str. 23, 94315, Straubing, Deutschland
| | - A Miernik
- Urologische Kliniken, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - H-M Fritsche
- Urologische Kliniken, Universitätsklinikum Regensburg, Caritas-Krankenhaus St. Josef, Regensburg, Deutschland.,Urologische Abteilung der Chirurgischen Klinik München-Bogenhausen, München, Deutschland
| | - M Burger
- Urologische Kliniken, Universitätsklinikum Regensburg, Caritas-Krankenhaus St. Josef, Regensburg, Deutschland
| | - M Schostak
- Urologische Kliniken, Universitätsklinikum Magdeburg A.ö.R., Magdeburg, Deutschland
| | - S Lebentrau
- Urologische Kliniken, Ruppiner Kliniken GmbH, Hochschulklinikum der MHB, Neuruppin, Deutschland
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Ordonez M, Hwang EC, Borofsky M, Bakker CJ, Gandhi S, Dahm P. Reprint - Ureteral stent vs. no ureteral stent for ureteroscopy in the management of renal and ureteral calculi: A Cochrane review. Can Urol Assoc J 2019; 14:61-68. [PMID: 31348748 DOI: 10.5489/cuaj.5957] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We aimed to assess the effects of postoperative ureteral stent placement after uncomplicated ureteroscopy. METHODS We performed a comprehensive search with no restrictions on publication language or status up to February 1, 2019. We only included randomized trials. Two review authors independently examined full-text reports, identified relevant studies, assessed the eligibility of studies for inclusion, extracted data, and assessed risk of bias. We performed statistical analyses using a random-effects model and assessed the certainty of the evidence according to GRADE. RESULTS We included 23 studies with 2656 randomized patients. Primary outcomes: It is uncertain whether stenting reduces the number of unplanned return visits (very low certainty of evidence [CoE]). Pain on the day of surgery is probably similar (mean difference [MD] 0.32; 95% confidence interval (CI) -0.13-0.78; moderate CoE). Pain on postoperative days 1-3 may show little to no difference (standardized mean difference [SMD] 0.25; 95% CI -0.32-0.82; low CoE). It is uncertain whether stented patients experience more pain on postoperative days 4-30 (very low CoE). Stenting may result in little to no difference in the need for secondary interventions (risk ratio [RR] 1.15; 95% CI 0.39-3.33; low CoE). SECONDARY OUTCOMES We are uncertain whether stenting reduces the need for narcotics and reduces ureteral stricture rates up to 90 days (very low CoE). Rates of hospital admission may be slightly reduced (RR 0.70; 95% CI 0.32-1.55; low CoE). This review was limited to patients in whom ureteroscopy was deemed 'uncomplicated.' In addition, time intervals for the grouping for the reported degree of pain were established post-hoc. The CoE for most outcomes was rated as low or very low for methodological reasons. CONCLUSIONS Findings of this review illustrate the tradeoffs of risks and benefits faced by urologists and their patients when it comes to decision-making about stent placement after uncomplicated ureteroscopy for stone disease.
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Affiliation(s)
- Maria Ordonez
- Department of Urology, University of Minnesota, Minneapolis, MN, United States
| | - Eu Chang Hwang
- Department of Urology, University of Minnesota, Minneapolis, MN, United States.,Department of Urology, Chonnam National University Medical School, Hwasun, South Korea.,Urology Section, Minneapolis VA Health Care System, Minneapolis, MN, United States
| | - Michael Borofsky
- Department of Urology, University of Minnesota, Minneapolis, MN, United States
| | - Caitlin J Bakker
- Health Sciences Libraries, University of Minnesota, Minneapolis, MN, United States
| | | | - Philipp Dahm
- Department of Urology, University of Minnesota, Minneapolis, MN, United States.,Urology Section, Minneapolis VA Health Care System, Minneapolis, MN, United States
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Ordonez M, Hwang EC, Borofsky M, Bakker CJ, Gandhi S, Dahm P. Ureteral stent versus no ureteral stent for ureteroscopy in the management of renal and ureteral calculi. Cochrane Database Syst Rev 2019; 2:CD012703. [PMID: 30726554 PMCID: PMC6365118 DOI: 10.1002/14651858.cd012703.pub2] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Ureteroscopy combined with laser stone fragmentation and basketing is a common approach for managing renal and ureteral stones. This procedure is associated with some degree of ureteral trauma. Ureteral trauma may lead to swelling, ureteral obstruction, and flank pain and may require subsequent interventions such as hospital admission or secondary ureteral stent placement. To prevent such issues, urologists often place temporary ureteral stents prophylactically, but the value of doing so remains unclear. OBJECTIVES To assess the effects of postoperative ureteral stent placement after uncomplicated ureteroscopy. SEARCH METHODS We performed a comprehensive search using multiple databases (the Cochrane Library, MEDLINE, Embase, Scopus, Google Scholar, and Web of Science), trials registries, other sources of grey literature, and conference proceedings, up to 01 February 2019. We applied no restrictions on publication language or status. SELECTION CRITERIA We included trials in which researchers randomised participants undergoing uncomplicated ureteroscopy to placement of a ureteral stent versus no ureteral stent. DATA COLLECTION AND ANALYSIS Two review authors independently classified studies and abstracted data from the included studies. We performed statistical analyses using a random-effects model. We rated the certainty of evidence (CoE) according to the GRADE approach. MAIN RESULTS Primary outcomesStenting may slightly reduce the number of unplanned return visits (16 trials with 1970 participants; very low CoE), but we are very uncertain of this finding.Pain on the day of surgery as measured on a visual analogue scale (scale 0 to 10; higher values reflect more pain) is probably similar (mean difference (MD) 0.32 higher, 95% confidence interval (CI) 0.13 lower to 0.78 higher; 4 trials with 346 participants; moderate CoE). Pain on postoperative days 1 to 3 may show little to no difference (standardised mean difference (SMD) 0.25 higher, 95% CI 0.32 lower to 0.82 higher; 8 trials with 683 participants; low CoE). On postoperative days 4 to 30, stented participants may experience more pain (8 trials with 903 participants; very low CoE), but we are very uncertain of this finding.Stenting may result in little to no difference in the need for secondary interventions (risk ratio (RR) 1.15, 95% CI 0.39 to 3.33; 10 studies with 1435 participants; low CoE); this corresponds to three more interventions per 1000 participants (95% CI 13 fewer to 48 more).Secondary outcomesStenting may reduce the need for narcotics (7 trials with 830 participants; very low CoE), but we are very uncertain of this finding.Rates of urinary tract infection (UTI) up to 90 days are probably not substantially different (RR 0.94, 95% CI 0.59 to 1.51; 10 trials with 1207 participants; moderate CoE); this corresponds to three fewer infections per 1000 participants (95% CI 23 fewer to 29 more).Ureteral stricture rates up to 90 days may be slightly reduced (14 trials with 1625 participants; very low CoE), but we are very uncertain of this finding.Rates of hospital admission may be slightly reduced (RR 0.70, 95% CI 0.32 to 1.55; 13 studies with 1647 participants; low CoE). This corresponds to 15 fewer admissions per 1000 participants (95% CI 33 fewer to 27 more). AUTHORS' CONCLUSIONS Findings of this review illustrate the trade-offs of risks and benefits faced by urologists and their patients when it comes to decision-making about stent placement after uncomplicated ureteroscopy for stone disease. We noted that both desirable and undesirable effects were small in absolute terms, with findings based mostly on low and very low CoE. The main issues reducing our confidence in research findings were study limitations (mostly risk of performance and detection bias) and imprecision. We were unable to conduct any of the preplanned subgroup analyses, in particular those based on stone size, stone location, and use of ureteral dilation, which may be important effect modifiers. Given the importance of this question, higher-quality and sufficiently large trials are needed to better inform decision-making.
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Affiliation(s)
- Maria Ordonez
- University of MinnesotaDepartment of Urology420 Delaware Street SE, MMC 394MinneapolisMinnesotaUSA
| | - Eu Chang Hwang
- Chonnam National University Medical School, Chonnam National University Hwasun HospitalDepartment of UrologyHwasunKorea, South
| | - Michael Borofsky
- University of MinnesotaDepartment of Urology420 Delaware Street SE, MMC 394MinneapolisMinnesotaUSA
| | - Caitlin J Bakker
- University of MinnesotaHealth Sciences Libraries303 Diehl Hall, 505 Essex Street SEMinneapolisMinnesotaUSA55455
| | | | - Philipp Dahm
- Minneapolis VA Health Care SystemUrology SectionOne Veterans DriveMail Code 112DMinneapolisMinnesotaUSA55417
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Loftus CJ, Ganesan V, Traxer O, Schold JD, Noble M, Sivalingam S, Muruve N, Monga M. Ureteral Wall Injury with Ureteral Access Sheaths: A Randomized Prospective Trial. J Endourol 2019; 34:932-936. [PMID: 30526031 DOI: 10.1089/end.2018.0603] [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: 02/03/2023] Open
Abstract
Objective: To compare two commercially available ureteral access sheaths in their ability to access the renal collecting system and assess ureteral wall trauma using a prospective, randomized trial. Patients and Methods: Ninety-five patients undergoing ureteroscopy for renal stones were randomized to Cook Flexor™ or Boston Scientific Navigator HD™ 12/14F sheaths. If the initial sheath failed to advance, an alternate sheath was attempted. The primary outcome was the difference in these access sheaths to obtain access to the upper collecting system and the postoperative ureteral injury using standardized five-point classification system. Results: The overall success rate for sheath placement was 87.4% and did not differ for sheath groups. The Navigator HD was successful in 43% of the Flexor failures and was subjectively rated as easier to place (p = 0.018). Male gender, large stone burden, longer time of sheath insertion, and a more difficult subjective rating for sheath placement were associated with high-grade (grade 2 or 3) ureteral injury. Limitations include a small sample size and absence of long-term follow-up. Conclusion: Sheaths had equal success of placement and there was no significant difference in ureteral wall injury between the two sheaths. Subjectively difficult sheath placement and longer time of placement were associated with high-grade injury, suggesting that surgeons should carry a low threshold for switching to a smaller sheath when resistance is felt or if placement time is long. Clinical Trial number: Nct03349099.
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Affiliation(s)
- Christopher J Loftus
- Department of Urology, University of Washington Medical Center, Seattle, Washington, USA
| | | | - Oliver Traxer
- Department of Urology, Hôpital Tenon, Université Pierre et Marie Curie Paris 6, Paris, France
| | - Jesse D Schold
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mark Noble
- Cleveland Clinic, Glickman Urological and Kidney Institute, Cleveland, Ohio, USA
| | - Sri Sivalingam
- Cleveland Clinic, Glickman Urological and Kidney Institute, Cleveland, Ohio, USA
| | - Nicolas Muruve
- Department of Urology, Cleveland Clinic Florida, Weston, Florida, USA
| | - Manoj Monga
- Cleveland Clinic, Glickman Urological and Kidney Institute, Cleveland, Ohio, USA
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How bothersome double-J ureteral stents are after semirigid and flexible ureteroscopy: a prospective single-institution observational study. World J Urol 2018; 37:201-207. [PMID: 29923014 DOI: 10.1007/s00345-018-2376-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 06/12/2018] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To evaluate in details the actual extent of double-J stent-related symptoms after semirigid (URS) and flexible (RIRS) ureteroscopy using a validated questionnaire. METHODS We asked to complete the Ureteric Stent Symptoms Questionnaire (USSQ) to all stone patients undergoing URS or RIRS with stent placement from 2010 to 2015. Stent-related symptoms' prevalence, severity, and impact on daily life were analyzed using descriptive statistics and five-order Likert scales. Subgroups analyses were performed. RESULTS 232 patients completed the USSQ. Stents had a deep impact on urinary symptoms (daily frequency ≥ 1 per hour 59.1%, ≥ 1 nocturnal micturition 90.1%, urgency 86.6%, burning 82.3%) that represented a problem for 88.4% of patients. 83.2% complained of pain, mostly in the kidney (67.9%) or in the bladder area (31.3%), particularly during physical activity (72.9%) and micturition (77.0%). Pain interfered with everyday life in 92.2%. General health, working, and sexual activity were also affected. 62.0% of patients would be dissatisfied (51.6% unhappy or terrible) if further ureteral stenting was proposed in future. Younger patients and females were more affected. Limitations include observational design and lack of baseline evaluation. CONCLUSIONS Ureteral stents are responsible for significant urinary symptoms and pain after semirigid and flexible ureteroscopy. They also considerably affect general health, working and sexual activity. Urologists should consider it carefully before stenting, inform patients about stent-related symptoms, and minimize stent indwelling time.
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Medical impulsive therapy (MIT): the impact of 1 week of preoperative tamsulosin on deployment of 16-French ureteral access sheaths without preoperative ureteral stent placement. World J Urol 2018; 36:2065-2071. [DOI: 10.1007/s00345-018-2336-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 05/11/2018] [Indexed: 11/27/2022] Open
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Lildal SK, Andreassen KH, Jung H, Pedersen MR, Osther PJS. Evaluation of ureteral lesions in ureterorenoscopy: impact of access sheath use. Scand J Urol 2018; 52:157-161. [DOI: 10.1080/21681805.2018.1430705] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Søren Kissow Lildal
- Urological Research Center, Department of Urology, Lillebaelt Hospital, Vejle, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Vejle, Denmark
| | - Kim Hovgaard Andreassen
- Urological Research Center, Department of Urology, Lillebaelt Hospital, Vejle, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Vejle, Denmark
| | - Helene Jung
- Urological Research Center, Department of Urology, Lillebaelt Hospital, Vejle, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Vejle, Denmark
| | - Malene Roland Pedersen
- Institute of Regional Health Research, University of Southern Denmark, Vejle, Denmark
- Department of Radiology, Lillebaelt Hospital, Vejle, Denmark
| | - Palle Jörn Sloth Osther
- Urological Research Center, Department of Urology, Lillebaelt Hospital, Vejle, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Vejle, Denmark
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Outcomes of ureteroscopy miniaturization on tissue damage and tissue hypoxia in a pig model. Sci Rep 2018; 8:431. [PMID: 29323197 PMCID: PMC5765032 DOI: 10.1038/s41598-017-18885-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 12/19/2017] [Indexed: 12/23/2022] Open
Abstract
Miniaturization of ureteroscopy materials is intended to decrease tissue damage. However, tissue hypoxia and the gross and microscopic effects on tissue have not been adequately assessed. We compared the gross and microscopic effects of micro-ureteroscopy (m-URS) and conventional ureteroscopy (URS) on the urinary tract. We employed 14 pigs of the Large White race. URS was performed in one of the ureters with an 8/9.8 F ureteroscope, while a 4.85 F m-URS sheath was used in the contralateral ureter. Gross assessment of ureteral wall damage and ureteral orifice damage was performed. For microscopic assessment hematoxylin-eosin staining and immunohistochemistry for detection of tissue hypoxia were conducted. Regarding the macroscopic assessment of ureteral damage, substantial and significant differences were recorded using URS (C = 0.8), but not with m-URS. Microscopic assessment after staining with hematoxylin-eosin revealed greater epithelial desquamation in the URS group (p < 0.05). Pimonidazole staining revealed greater hypoxia in the epithelial cells than in the remainder of the ureteral layers. We conclude that m-URS causes less damage to the ureteral orifice than URS. Histopathological findings show m-URS reduces ureteral epithelial damage compared with conventional ureteroscopy. Both URS and m-URS cause cellular hypoxia.
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Same Session Bilateral Ureteroscopy for Multiple Stones: Results from the CROES URS Global Study. J Urol 2017; 198:130-137. [DOI: 10.1016/j.juro.2017.01.074] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2017] [Indexed: 12/23/2022]
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Ordonez M, Borofsky M, Bakker CJ, Dahm P. Ureteral stent versus no ureteral stent for ureteroscopy in the management of renal and ureteral calculi. Hippokratia 2017. [DOI: 10.1002/14651858.cd012703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Maria Ordonez
- University of Minnesota; Department of Urology; 420 Delaware Street SE, MMC 394 Minneapolis Minnesota USA
| | - Michael Borofsky
- University of Minnesota; Department of Urology; 420 Delaware Street SE, MMC 394 Minneapolis Minnesota USA
| | - Caitlin J Bakker
- University of Minnesota; Health Sciences Libraries; 303 Diehl Hall, 505 Essex Street SE Minneapolis Minnesota USA 55455
| | - Philipp Dahm
- Minneapolis VA Health Care System; Urology Section; One Veterans Drive Mail Code 112D Minneapolis Minnesota USA 55417
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Somani BK, Giusti G, Sun Y, Osther PJ, Frank M, De Sio M, Turna B, de la Rosette J. Complications associated with ureterorenoscopy (URS) related to treatment of urolithiasis: the Clinical Research Office of Endourological Society URS Global study. World J Urol 2017; 35:675-681. [PMID: 27492012 PMCID: PMC5364249 DOI: 10.1007/s00345-016-1909-0] [Citation(s) in RCA: 113] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 07/25/2016] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Ureterorenoscopy (URS) is a popular and growing option for management of ureteric and renal stones. The CROES URS Global Study was set up to assess the outcomes of URS in a large worldwide cohort of patients involving multiple centres. In this paper, we analysed the database for intra-operative and post-operative complications associated with ureterorenoscopy. METHODS The CROES database was established via collaboration between 114 centres in 32 countries worldwide, and information on both intra-operative and post-operative complications was collected electronically between January 2010 and October 2012. RESULT On analysis of a total of 11,885 patients, the overall complication and stone-free rates were found to be 7.4 and 85.6 %, respectively. The intra-operative and post-operative complication rates were 4.2 and 2.6 %, respectively, and in total 5 deaths were reported in the study period. Taking into account different world economies, there were no differences in the complication rates between the developing and developed nations or between different centres from different continents. CONCLUSION Ureterorenoscopy is a safe and effective procedure for treatment of stones, the outcomes of which are broadly comparable in different parts of the world for similar patient and stone demographics.
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Affiliation(s)
- B K Somani
- Department of Urology, University Hospital Southampton, Southampton, UK
| | - G Giusti
- Department of Urology, IRCCS San Raffaele Scientific Institute, Ville Turro Division, Milan, Italy
| | - Y Sun
- Department of Urology, Changhai Hospital, Shanghai, China
| | - P J Osther
- Department of Urology, Lillebaelt Hospital, Fredericia, Denmark
| | - M Frank
- Department of Urology, City Hospital Number 40, Yekaterinburg, Russia
| | - M De Sio
- Urology Unit, Second University of Naples, Naples, Italy
| | - B Turna
- Department of Urology, Ege University School of Medicine, Izmir, Turkey
| | - J de la Rosette
- Department of Urology, AMC University Hospital, Meibergdreef 9, 1105 AZ, Amsterdam Z-O, The Netherlands.
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Caballero-Romeu JP, Galán-Llopis JA, Pérez-Fentes D, Budia-Alba A, Cepeda-Delgado M, Palmero-Marti JL, Cansino-Alcaide JR, Caballero-Pérez P, Ibarluzea-Gonzalez G. Assessment of the Effectiveness, Safety, and Reproducibility of Micro-Ureteroscopy in the Treatment of Distal Ureteral Stones in Women: A Multicenter Prospective Study. J Endourol 2016; 30:1185-1193. [PMID: 27565720 DOI: 10.1089/end.2016.0503] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE The aim of this study is to assess the effectiveness, safety, and reproducibility of the micro-ureteroscopy (m-URS) in the treatment of distal ureteral stones in women. MATERIALS AND METHODS A multicenter, prospective observational study was designed and conducted between March and December 2015. We included women having at least one stone in the distal ureter and being a candidate for surgical treatment using the 4.85F sheath of MicroPerc®. Patients with clinical criteria and/or laboratory analysis indicating sepsis or coagulation alteration were excluded. RESULTS Thirty-nine women were operated in eight hospitals. The profile of the patients was fairly homogeneous among hospitals. Only differences were found in age, preoperative stent, and the result of the previous urine culture. Immediate stone-free status was achieved in 88.2% and 100% 7 days after the procedure. 97.4% of patients did not present any complication in the postoperative period, with only one case with complication Clavien II. Postureteroscopic Lesion Scale (PULS) in 76.9% of patients did not show any injury, 20.5% had lesions grade 1, and grade 2 lesions 2.6%. As for the reproducibility of m-URS between hospitals, statistical analysis of the results showed differences between all the centers participating in the study. CONCLUSIONS m-URS is an effective, safe, and reproducible technique that minimizes surgical aggression to the ureteral anatomy. Satisfactory and comparable results to "conventional" ureteroscopy were obtained in the treatment of distal ureteral stones in women, although clinical trials are needed. The reduction of the ureteral damage may reduce secondary procedures and increase the cost-effectiveness of the procedure.
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Affiliation(s)
| | | | | | | | | | | | | | - Pablo Caballero-Pérez
- 8 Department of Community Nursing, Preventive Medicine and Public Health and History of Science Health, Faculty of Health Sciences, University of Alicante , Alicante, Spain
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Tayeb ME, Mellon MJ, Lingeman JE. Simultaneous percutaneous nephrolithotomy and early endoscopic ureteric realignment for iatrogenic ureteropelvic junction avulsion during ureteroscopy. Can Urol Assoc J 2016; 9:E882-5. [PMID: 26834898 DOI: 10.5489/cuaj.2830] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
We present a case report of successful management of ureteropelvice junction avulsion during ureteroscopy successfully managed with simultaneous percutaneous nephrolithotomy and early endoscopic ureteral realignment.
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Affiliation(s)
- Marawan El Tayeb
- Indiana University School of Medicine, Department of Urology, Indianapolis, IN
| | - Matthew J Mellon
- Indiana University School of Medicine, Department of Urology, Indianapolis, IN
| | - James E Lingeman
- Indiana University School of Medicine, Department of Urology, Indianapolis, IN
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Guzelburc V, Guven S, Boz MY, Erkurt B, Soytas M, Altay B, Albayrak S. Intraoperative Evaluation of Ureteral Access Sheath-Related Injuries Using Post-Ureteroscopic Lesion Scale. J Laparoendosc Adv Surg Tech A 2015; 26:23-6. [PMID: 26539998 DOI: 10.1089/lap.2015.0294] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE In the present study, intraoperative ureteral injuries inflicted during retrograde intrarenal surgery (RIRS) with ureteral access sheath (UAS) use were evaluated using the Post- Ureteroscopic Lesion Scale (PULS). MATERIALS AND METHODS Patients in whom a UAS was used during RIRS and for whom ureter images were video recorded during the procedure were included in the study. PULS grading was performed after UAS removal, and video sequences of all patients were viewed by a junior resident, a senior resident, and four experienced urologists and assessed according to the PULS. Ureteral lesions in distal, middle, proximal, and multiple locations were evaluated and compared according to the PULS scale. The inter-rater reliability of PULS grading among various urologists was also evaluated. RESULTS The evaluation comprised 101 patients. In 77 patients, 9.5/11.5 French UAS devices were used, and in 24 patients, 12/14 French UAS devices were used. The stone-free rate, clinical insignificant residual fragments, and final stone-free rate were 41.6%, 53.5%, and 98%, respectively. In 58.4% of the patients, no lesions were present according to PULS grading. No lesions of Grade 3 and above were found; however, there were lesions of Grade 1 and 2 in 38.6% and 2.9% of the patients, respectively. Injuries were found in the proximal ureter only and distal ureter only in 45.23% and 40.47% of the patients, respectively. Multiple injuries occurred in 5.94% of the patients (in 3.96% in the proximal and distal ureter, in 0.99% in the mid- and distal ureter, and in 0,99% in the proximal, mid-, and distal ureter). In the grading performed according to the PULS classification, there was a high accuracy among the residents and specialists. CONCLUSIONS The assessment of UAS-induced injuries using standardized intraoperative methods will help to evaluate the procedure more objectively and will guide the postoperative follow-up of patients.
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Affiliation(s)
- Vahit Guzelburc
- Department of Urology, Medical Faculty of Istanbul Medipol University , Istanbul, Turkey
| | - Selcuk Guven
- Department of Urology, Medical Faculty of Istanbul Medipol University , Istanbul, Turkey
| | - Mustafa Yucel Boz
- Department of Urology, Medical Faculty of Istanbul Medipol University , Istanbul, Turkey
| | - Bulent Erkurt
- Department of Urology, Medical Faculty of Istanbul Medipol University , Istanbul, Turkey
| | - Mustafa Soytas
- Department of Urology, Medical Faculty of Istanbul Medipol University , Istanbul, Turkey
| | - Bulent Altay
- Department of Urology, Medical Faculty of Istanbul Medipol University , Istanbul, Turkey
| | - Selami Albayrak
- Department of Urology, Medical Faculty of Istanbul Medipol University , Istanbul, Turkey
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Abstract
Background Irrigation and instrumentation during ureterorenoscopic procedures may cause increased pressure in the renal pelvis (PP) with potential harmful adverse effects. In order to assess the pressure increases during ureterorenoscopy, we measured the intraluminal renal pelvic pressure during retrograde intrarenal stone surgery (RIRS). Methods Twelve patients admitted for RIRS were included. Irrigation rate was standardized to 8 ml/min. A ureteral catheter was retrogradely placed in the renal pelvis for PP measurements. PP was measured one time per second during insertion of the Storz Flex-X2 ureteroscope and during stone treatment. Results Baseline PP was mean 10(±4.0) mmHg. During simple ureterorenoscopy, PP was mean 35(±10) mmHg. During stone management the average PP was 54(±18) mmHg and pelvic pressure peaks up to 328 mmHg occurred. In a 5-min standardized period of simple ureterorenoscopy, 83 pressure peaks >50 mmHg were measured in average per patient (range 2–238). Forced irrigation with a 20 ml syringe resulted in pressure peaks up to 288 mmHg. Conclusion Very high pelvic pressures are obtained during flexible ureterorenoscopy. Taking into consideration that the threshold for pyelovenous backflow is around 30 mmHg, it is concerning that PPs >300 mmHg are not uncommon during these procedures. Methods to monitor and lower the PP during ureterorenoscopy, therefore, are considered of importance.
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Affiliation(s)
- Helene Jung
- Department of Urology, Urological Research Center, Lillebaelt Hospital, University of Southern Denmark, Fredericia, Denmark
| | - Palle J S Osther
- Department of Urology, Urological Research Center, Lillebaelt Hospital, University of Southern Denmark, Fredericia, Denmark
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Caballero JP, Galán JA, Verges A, Amorós A, Garcia-Segui A. Micro-ureteroscopy: Initial experience in the endoscopic treatment of pelvic ureteral lithiasis. Actas Urol Esp 2015; 39:327-31. [PMID: 25443520 DOI: 10.1016/j.acuro.2014.08.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 08/22/2014] [Accepted: 08/25/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To present to report the first case of ureteral lithiasis resolved using a new endoscopic approach, which we call microureteroscopy (m-URS) and attempts to reduce the ureteral damage caused by conventional instrumentation. MATERIAL AND METHODS We selected a 53-year-old patient with a 16-mm calculus in the right distal ureter. For endoscopic access, we used a 4.8 Fr sheath from the microperc set and fragmented the stone with a 230-micron laser fiber. RESULTS Complete fragmentation of the stone was achieved. We placed a JJ catheter due to significant ureteral edema. The surgical time and postsurgical stay were 156minutes and 24hours, respectively. There were no complications, the requirements for analgesia were minimal, and the patient was free of residual stones. CONCLUSIONS The m-URS technique is feasible, simple and effective for the treatment of pelvic ureteral lithiasis in women and optimizes minimal invasion, with results that can be comparable to conventional endoscopic techniques in terms of ease of access and quality of endoscopic vision without affecting the resolution capacity. Larger studies and greater technological development is needed to define the definitive role of this procedure. Currently, its major limitations lie in the treatment of proximal ureter lithiasis and in the treatment of men. This technique could also be a viable alternative for pediatric patients.
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Affiliation(s)
- J P Caballero
- Servicio de Urología, Hospital del Vinalopó, Elche, Alicante, España.
| | - J A Galán
- Servicio de Urología, Hospital del Vinalopó, Elche, Alicante, España
| | - A Verges
- Servicio de Urología, Hospital del Vinalopó, Elche, Alicante, España
| | - A Amorós
- Servicio de Urología, Hospital del Vinalopó, Elche, Alicante, España
| | - A Garcia-Segui
- Servicio de Urología, Hospital del Vinalopó, Elche, Alicante, España
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Inoue T, Murota T, Okada S, Hamamoto S, Muguruma K, Kinoshita H, Matsuda T. Influence of Pelvicaliceal Anatomy on Stone Clearance After Flexible Ureteroscopy and Holmium Laser Lithotripsy for Large Renal Stones. J Endourol 2015; 29:998-1005. [PMID: 25879676 DOI: 10.1089/end.2015.0071] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE This study was performed to evaluate the impact of pelvicaliceal anatomy on stone clearance in patients with remnant fragments in the lower pole after flexible ureteroscopy and holmium laser lithotripsy (fURSL) for renal stones >15 mm. PATIENTS AND METHODS This retrospective study included 67 patients with radiopaque residual fragments (>2 mm) in the lower pole after fURSL for large renal stones (>15 mm). The preoperative infundibular length (IL), infundibular width (IW), infundibulopelvic angle (IPA), and caliceal pelvic height (CPH) were measured using intravenous urography. Multivariate analysis was performed to determine whether any of these measurements affected stone clearance. RESULTS Of the 67 patients, 55 (82.1%) were stone free (SF) 3 months after fURSL. The anatomic factors significantly favorable for an SF status were a short IL, broad IW, wide IPA, and low CPH. On multivariate analysis, the IPA had a significant influence on an SF status after fURSL (p=0.010). An IPA <30° was a negative risk factor (p=0.019). Postoperative complications occurred in nine patients (13.4%), including Clavien grade I complications in two patients (2.9%), grade II in six patients (8.9%), and grade IIIa in one patient (1.8%). Almost all complications were minor. CONCLUSIONS An IPA <30° is the only negative risk factor for stone clearance after fURSL for large renal stones according to our multivariate analysis. Additional studies are required to further evaluate the characteristics of the pelvicaliceal anatomy influencing stone clearance.
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Affiliation(s)
- Takaaki Inoue
- 1 Department of Urology and Stone Center, Takii Hospital, Kansai Medical University , Moriguchi City, Japan
| | - Takashi Murota
- 1 Department of Urology and Stone Center, Takii Hospital, Kansai Medical University , Moriguchi City, Japan
| | - Shinsuke Okada
- 2 Department of Urology, Gyotoku General Hospital , Ichikawa City, Japan
| | - Shuzo Hamamoto
- 3 Department of Urology, Toyota Kousei Hospital , Toyota City, Japan
| | - Kouei Muguruma
- 1 Department of Urology and Stone Center, Takii Hospital, Kansai Medical University , Moriguchi City, Japan
| | - Hidefumi Kinoshita
- 4 Department of Urology, Hirakata Hospital, Kansai Medical University , Hirakata City, Japan
| | - Tadashi Matsuda
- 4 Department of Urology, Hirakata Hospital, Kansai Medical University , Hirakata City, Japan
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Ultra-mini PCNL versus flexible ureteroscopy: a matched analysis of analgesic consumption and treatment-related patient satisfaction in patients with renal stones 10-35 mm. World J Urol 2015; 33:2131-6. [PMID: 25971205 DOI: 10.1007/s00345-015-1585-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 05/02/2015] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To compare ultra-mini PCNL (UMP) and flexible ureteroscopy (fURS) for the treatment of medium- to large-sized renal stones with a focus on patients' postsurgical cumulative analgesic consumption and treatment-related satisfaction. METHODS Twenty-five patients treated by UMP between April 2013 and October 2014 were matched to data of 25 fURS patients from an existing database. Clinical outcome parameters were recorded prospectively. Postoperative analgesic consumption was assessed using the Cumulative Analgesic Consumption Score (CACS), and satisfaction was measured with the Freiburg Index of Patient Satisfaction (FIPS) questionnaire. RESULTS Perioperative outcome parameters showed no significant differences except for mean operating times (fURS 98.52 min, UMP 130.12 min [p = 0.002]) and hospital stay (fURS 67.2 h, UMP 91.5 h [p = 0.04]). Primary stone-free rate was 96 % in fURS and 92 % in UMP. Complications Clavien grade 2 or 3 occurred in 16 % of UMP patients and in 4 % of fURS patients. Postsurgical cumulative analgesic consumption was almost identical in both groups with CACSs of 6.96 (0-15) for fURS and 6.8 (0-23) for UMP. Patients' satisfaction was high in both techniques: FIPS score in fURS 1.67 (1-3) and 1.73 (1-4) in UMP (scale 1-6). CONCLUSIONS Treatment of medium- to large-sized renal stones is safe and highly effective by both UMP and fURS. Moreover, both treatments yield comparable postsurgical analgesic requirements and high patient satisfaction scores. Patient-related factors (anatomical and stone related) and availability of technical equipment and surgical expertise appear to be the most important determining factors in treatment planning.
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Ultra-mini PCNL versus flexible ureteroscopy: a matched analysis of treatment costs (endoscopes and disposables) in patients with renal stones 10–20 mm. World J Urol 2015; 33:1601-5. [DOI: 10.1007/s00345-015-1489-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 01/09/2015] [Indexed: 12/17/2022] Open
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Singh BP, Prakash J, Sankhwar SN, Dhakad U, Sankhwar PL, Goel A, Kumar M. Retrograde intrarenal surgery vs extracorporeal shock wave lithotripsy for intermediate size inferior pole calculi: a prospective assessment of objective and subjective outcomes. Urology 2014; 83:1016-22. [PMID: 24560970 DOI: 10.1016/j.urology.2013.12.026] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 10/16/2013] [Accepted: 12/13/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To assess objective and subjective outcomes of retrograde intrarenal surgery (RIRS) and extracorporeal shock wave lithotripsy (SWL) for the treatment of intermediate size (1-2 cm) inferior calyceal (IC) stones in a prospective randomized fashion. METHODS Between March 2011 and January 2013, 70 symptomatic adults who had isolated IC stone between 10 and 20 mm underwent RIRS or SWL by computer-generated pseudorandom assignment (1:1). Success rate, mean procedure time, hospital stay, pain score on day 1 and 2 using visual analog scale, analgesic requirement after discharge, complications, retreatment rate, auxiliary procedure, and patient-reported outcomes (using self-made nonvalidated questionnaire) were compared. RESULTS Baseline parameters and mean stone size (SWL 16.45 ± 2.28 mm, RIRS 15.05 ± 3.56 mm; P = .0542) were comparable. Success rate was significantly higher after a single session of RIRS compared with 3 sessions of SWL (85% vs 54%; P = .008). Retreatment rate (65% vs 5.7%; P = .0001) and auxiliary procedure (45% vs 8%; P = .0009) were significantly higher in SWL. Pain score on postoperative day 1 and 2 was significantly higher in RIRS, but patients with SWL required significantly more analgesics afterward. Most of the complications were of Clavien grade I and/or II in both groups. Average time to return to normal activity and voiding symptoms were significantly higher in RIRS. Overall satisfaction score (2.17 ± 1.24 vs 2.82 ± 1.17; P = .026) was significantly higher in RIRS than SWL. CONCLUSION For the treatment of intermediate size IC calculi, RIRS is superior to SWL in terms of objective and subjective outcomes.
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Affiliation(s)
| | - Jai Prakash
- Department of Urology, King George Medical University, Lucknow, India.
| | | | - Urmila Dhakad
- Department of Rheumatology, King George Medical University, Lucknow, India
| | - Pushp Lata Sankhwar
- Department of Obstetrics and Gynecology, King George Medical University, Lucknow, India
| | - Apul Goel
- Department of Urology, King George Medical University, Lucknow, India
| | - Manoj Kumar
- Department of Urology, King George Medical University, Lucknow, India
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Abstract
Accurate reporting of complications is an essential component to critical appraisal and innovation in surgery and specifically with percutaneous nephrolithotomy (PCNL). We review the evolution of complication reporting for PCNL and suggest future directions for innovation. A selective review was carried out using Pubmed. Key search terms and their combinations included percutaneous, anatrophic, nephrolithotomy, PCNL, complications, Clavien, Martin score, bleeding, bowel injury, perforation, fever, sepsis. The references from relevant papers and reviews as well as AUA and EAU guidelines were also scanned for inclusion. PCNL has become the procedure of choice for large renal stones owing to decreased morbidity over alternative procedures. Both common and rare complications have been described in large case series, small randomized controlled trials, and case reports in an unstandardized form. Although these reports have provided an informative starting point, a standardized complication reporting methodology is necessary to enable appropriate comparisons between institutions, time periods, or innovations in technique. The Clavien-Dindo grading system has become widely accepted in urology and has facilitated the study of PCNL complications. Future research should focus on adaptions of this system to render it more comprehensive and applicable to PCNL.
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Affiliation(s)
- Philippe D Voilette
- Department of Surgery, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - John D Denstedt
- Department of Surgery, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada
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