1
|
Luo D, Zhang J, Xie L, Wang R, Ren H, Shang Z, Li C, Liu C. Development and validation of a predictive model for failure of ureteral access sheath placement in patients with ureteral calculi. BMC Urol 2024; 24:220. [PMID: 39385156 PMCID: PMC11462699 DOI: 10.1186/s12894-024-01606-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Accepted: 09/27/2024] [Indexed: 10/11/2024] Open
Abstract
OBJECTIVE The Ureteral Access Sheath (UAS) has notable benefits but may fail to traverse the ureter in some cases. Our objective was to develop and validate a dynamic online nomogram for patients with ureteral stones who experienced UAS placement failure during retrograde intrarenal surgery (RIRS). METHODS This study is a retrospective cohort analysis using medical records from the Second Hospital of Tianjin Medical University. We reviewed the records of patients with ureteral stones who underwent RIRS in 2022 to identify risk factors associated with UAS placement failure. Lasso combined logistic regression was utilized to identify independent risk factors associated with unsuccessful UAS placement in individuals with ureteral stones. Subsequently, a nomogram model was developed to predict the likelihood of failed UAS placement in this patient cohort. The model's performance was assessed through Receiver Operating Characteristic Curve (ROC) analysis, calibration curve assessment, and Decision Curve Analysis (DCA). RESULTS Significant independent risk factors for unsuccessful UAS placement in patients with ureteral stones included age (OR = 0.95, P < 0.001), male gender (OR = 2.15, P = 0.017), body mass index (BMI) (OR = 1.12, P < 0.001), history of stone evacuation (OR = 0.35, P = 0.014), and ureteral stone diameter (OR = 0.23, P < 0.001). A nomogram was constructed based on these variables. Model validation demonstrated an area under the ROC curve of 0.789, indicating good discrimination. The calibration curve exhibited strong agreement, and the decision curve analysis revealed a favorable net clinical benefit for the model. CONCLUSIONS Young age, male sex, high BMI, no history of stone evacuation, and small diameter of ureteral stones were independent risk factors for failure of UAS placement in patients with ureteral stones, and the dynamic nomogram established with these 5 factors was clinically effective in predicting the outcome of UAS placement.
Collapse
Affiliation(s)
- Di Luo
- Department of urology, Tianjin institute of urology, The Second Hospital of Tianjin Medical University, 23 Pingjiang Road, Hexi District, Tianjin, 300000, People's Republic of China
| | - Jingdong Zhang
- Department of urology, Tianjin institute of urology, The Second Hospital of Tianjin Medical University, 23 Pingjiang Road, Hexi District, Tianjin, 300000, People's Republic of China
| | - Linguo Xie
- Department of urology, Tianjin institute of urology, The Second Hospital of Tianjin Medical University, 23 Pingjiang Road, Hexi District, Tianjin, 300000, People's Republic of China
| | - Rui Wang
- Department of urology, Tianjin institute of urology, The Second Hospital of Tianjin Medical University, 23 Pingjiang Road, Hexi District, Tianjin, 300000, People's Republic of China
| | - Haotian Ren
- Department of urology, Tianjin institute of urology, The Second Hospital of Tianjin Medical University, 23 Pingjiang Road, Hexi District, Tianjin, 300000, People's Republic of China
| | - Zhiqun Shang
- Department of urology, Tianjin institute of urology, The Second Hospital of Tianjin Medical University, 23 Pingjiang Road, Hexi District, Tianjin, 300000, People's Republic of China
| | - Chunpeng Li
- Department of urology, Tianjin institute of urology, The Second Hospital of Tianjin Medical University, 23 Pingjiang Road, Hexi District, Tianjin, 300000, People's Republic of China
| | - Chunyu Liu
- Department of urology, Tianjin institute of urology, The Second Hospital of Tianjin Medical University, 23 Pingjiang Road, Hexi District, Tianjin, 300000, People's Republic of China.
| |
Collapse
|
2
|
Erdogan E, Kuzan TY, Burak Sahinler E, Kanberoglu AF, Uslu M, Arikan O, Sobay R, Asik A, Sarica K. Could radiological parameters help to predict the failure of ureteral access sheath placement. Urolithiasis 2024; 52:99. [PMID: 38918251 PMCID: PMC11199268 DOI: 10.1007/s00240-024-01599-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 06/20/2024] [Indexed: 06/27/2024]
Abstract
To identify the radiological parameters which may help to predict the success of ureteral access sheath (UAS) placement during retrograde intrarenal surgery (RIRS).The study included 49 patients in whom failure ureteral access sheath placement in RIRS and 49 control group patients who were successfully placement between January 2023 and December 2023. The age, gender, body mass index (BMI), non-contrast computed tomography (NCCT), and kidney ureter bladder (KUB) radiographs were compared between the two groups. Measurements of the anteroposterior (ap) diameter of the pelvic inlet, anteroposterior diameter of the pelvic outlet, interspinous distance diameter were taken from non-contrast computed tomography (NCCT), while pelvic anteroposterior diameter and pelvic lateral diameter were measured from kidney ureter bladder (KUB) radiography. There were no significant differences between the groups in age, gender, body mass index, ap pelvic inlet diameter, ap pelvic outlet, and interspinous distance diameter. However, a statistically significant difference was found between the pelvic ap diameter and pelvic lateral diameter values measured on the KUB radiography. The values for pelvic ap diameter and pelvic lateral diameter measured in the KUB radiographs can be used to predict the likelihood of UAS passage during RIRC procedures. However, further studies with larger patient groups are needed to establish a cut-off value.
Collapse
Affiliation(s)
- Erhan Erdogan
- Department of Urology, Sancaktepe Sehit Prof. Dr. Ilhan Varank Research and Training Hospital, Istanbul, Turkey.
| | - Taha Yusuf Kuzan
- Department of Urology, Sancaktepe Sehit Prof. Dr. Ilhan Varank Research and Training Hospital, Istanbul, Turkey
| | - Emre Burak Sahinler
- Department of Urology, Sancaktepe Sehit Prof. Dr. Ilhan Varank Research and Training Hospital, Istanbul, Turkey
| | - Ahmet Fatih Kanberoglu
- Department of Urology, Sancaktepe Sehit Prof. Dr. Ilhan Varank Research and Training Hospital, Istanbul, Turkey
| | - Mehmet Uslu
- Department of Urology, Health Practice and Research Hospital, Kafkas University, Kars, Turkey
| | - Ozgur Arikan
- Department of Urology, Istanbul Medeniyet University Goztepe Suleyman Yalcin City Hospital, Istanbul, Turkey
| | - Resul Sobay
- Department of Urology, Umraniye Research and Training Hospital, Istanbul, Turkey
| | - Alper Asik
- Department of Urology, Sancaktepe Sehit Prof. Dr. Ilhan Varank Research and Training Hospital, Istanbul, Turkey
| | - Kemal Sarica
- Department of Urology, Sancaktepe Sehit Prof. Dr. Ilhan Varank Research and Training Hospital, Istanbul, Turkey
- Department of Urology, Medical School, Biruni University, Istanbul, Turkey
| |
Collapse
|
3
|
John J, Wellman M, Dixon C, Kellermann T, Wisniewski P, Kopeć K, Trzciński J, Kopeć D, Ciach T, Fieggen G, Kaestner L, Lazarus J. Introducing an lsoprenaline Eluting Guidewire: Report on its Design and the Results of the Dose-Determining Pilot Study. J Endourol 2024; 38:590-597. [PMID: 38468539 DOI: 10.1089/end.2023.0745] [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: 03/13/2024] Open
Abstract
Introduction: Retrograde intrarenal surgery (RIRS) is associated with complications, many of which are related to the intrarenal pressure (IRP). We aim to describe the design of a novel isoprenaline-eluting guidewire ("IsoWire") and present the results from the first in vitro release studies and the first animal studies showing its effect on IRP. Materials and Methods: The IsoWire comprises a Nitinol core surrounded by a stainless-steel wire wound into a tight coil. The grooves created by this coil provided a reservoir for adding a hydrogel coating into which isoprenaline, a beta-agonist, was loaded. Animal studies were performed using a porcine model. For the control, IRP, heart rate (HR), and mean arterial pressure (MAP) were measured continuously for 6 minutes with a standard guidewire in place. For the experiment, the standard hydrophilic guidewire was removed, the IsoWire was inserted into the renal pelvis, and the same parameters were measured. Results: In vitro analysis of the isoprenaline release profile showed that most (63.9 ± 5.9%) of the loaded drug mass was released in the 1st minute, and almost all of the drug was released in the first 4 minutes exponentially. Porcine studies showed a 25.1% reduction in IRP in the IsoWire that released 10 μg in the 1st minute; however, there was a marked increase in HR. The average percentage reduction in IRP was 8.95% and 21.3% in the IsoWire that released 5 and 7.5 μg of isoprenaline, respectively, with no changes in HR or MAP. Conclusions: The IsoWire, which releases 5 and 7.5 μg of isoprenaline in the 1st minute, appears to be safe and effective in reducing the IRP. Further studies are needed to establish whether the isoprenaline-induced ureteral relaxation will render easier insertion of a ureteral access sheath, reduce IRP during sheathless RIRS, or even promote the practice of sheathless RIRS.
Collapse
Affiliation(s)
- Jeff John
- Division of Urology, Department of Surgery, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
- Division of Urology, Department of Surgery, Frere Hospital and Walter Sisulu University, East London, South Africa
| | - Mark Wellman
- Division of Urology, Department of Surgery, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Charné Dixon
- Division of Clinical Pharmacology, Department of Medicine, University of Stellenbosch, Cape Town, South Africa
| | - Tracy Kellermann
- Division of Clinical Pharmacology, Department of Medicine, University of Stellenbosch, Cape Town, South Africa
| | | | - Kamil Kopeć
- Department of Biotechnology and Bioprocess Engineering, Laboratory of Biomedical Engineering, Warsaw University of Technology, Warsaw, Poland
| | - Jakub Trzciński
- Department of Biotechnology and Bioprocess Engineering, Laboratory of Biomedical Engineering, Warsaw University of Technology, Warsaw, Poland
| | - Daniel Kopeć
- Department of Biotechnology and Bioprocess Engineering, Laboratory of Biomedical Engineering, Warsaw University of Technology, Warsaw, Poland
| | - Tomasz Ciach
- Department of Biotechnology and Bioprocess Engineering, Laboratory of Biomedical Engineering, Warsaw University of Technology, Warsaw, Poland
| | - Graham Fieggen
- Division of Neurosurgery, Department of Surgery, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Lisa Kaestner
- Division of Urology, Department of Surgery, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - John Lazarus
- Division of Urology, Department of Surgery, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| |
Collapse
|
4
|
Cruz JACS, Danilovic A, Vicentini FC, Brito AH, Batagello CA, Marchini GS, Torricelli FCM, Nahas WC, Mazzucchi E. Ureteral access sheath. Does it improve the results of flexible ureteroscopy? A narrative review. Int Braz J Urol 2024; 50:346-358. [PMID: 38498688 PMCID: PMC11152322 DOI: 10.1590/s1677-5538.ibju.2024.9907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 01/20/2024] [Indexed: 03/20/2024] Open
Affiliation(s)
- José Agustin Cabrera Santa Cruz
- Universidade de São Paulo – USPHospital das Clínicas da Faculdade de MedicinaSão PauloSPBrasilDivisão de Urologia - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo – USP, São Paulo, SP, Brasil
| | - Alexandre Danilovic
- Universidade de São Paulo – USPHospital das Clínicas da Faculdade de MedicinaSão PauloSPBrasilDivisão de Urologia - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo – USP, São Paulo, SP, Brasil
| | - Fabio Carvalho Vicentini
- Universidade de São Paulo – USPHospital das Clínicas da Faculdade de MedicinaSão PauloSPBrasilDivisão de Urologia - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo – USP, São Paulo, SP, Brasil
| | - Artur Henrique Brito
- Universidade de São Paulo – USPHospital das Clínicas da Faculdade de MedicinaSão PauloSPBrasilDivisão de Urologia - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo – USP, São Paulo, SP, Brasil
| | - Carlos Alfredo Batagello
- Universidade de São Paulo – USPHospital das Clínicas da Faculdade de MedicinaSão PauloSPBrasilDivisão de Urologia - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo – USP, São Paulo, SP, Brasil
| | - Giovanni Scalla Marchini
- Universidade de São Paulo – USPHospital das Clínicas da Faculdade de MedicinaSão PauloSPBrasilDivisão de Urologia - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo – USP, São Paulo, SP, Brasil
| | - Fabio César Miranda Torricelli
- Universidade de São Paulo – USPHospital das Clínicas da Faculdade de MedicinaSão PauloSPBrasilDivisão de Urologia - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo – USP, São Paulo, SP, Brasil
| | - William Carlos Nahas
- Universidade de São Paulo – USPHospital das Clínicas da Faculdade de MedicinaSão PauloSPBrasilDivisão de Urologia - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo – USP, São Paulo, SP, Brasil
| | - Eduardo Mazzucchi
- Universidade de São Paulo – USPHospital das Clínicas da Faculdade de MedicinaSão PauloSPBrasilDivisão de Urologia - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo – USP, São Paulo, SP, Brasil
| |
Collapse
|
5
|
Şahin MF, Ozman O, Cakir H, Cinar O, Akgul M, Basatac C, Simsekoglu MF, Teke K, Yazici CM, Sancak EB, Önal B, Akpinar H. Retrograde Intrarenal Surgery Learning Curves of Urology Residents Supervised by an Experienced Endourologist: An RIRSearch Study. Urol Int 2023; 107:877-885. [PMID: 37619537 DOI: 10.1159/000531517] [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: 03/18/2023] [Accepted: 06/06/2023] [Indexed: 08/26/2023]
Abstract
INTRODUCTION Although retrograde intrarenal surgery (RIRS) is being performed with increasing frequency, there are only a limited number of studies about the learning curve (LC). This study aimed to analyze the LC of RIRS for five surgeons who underwent the same training. MATERIALS AND METHODS The data of the 410 patients who underwent RIRS between April 2017 and 2022 in a single institution, which were performed consecutively by five surgeons, were analyzed. All 50 cases performed by each surgeon were included and numbered consecutively and separately, according to the date of the operation. The combined stone-free rate (SFR) was calculated for each surgeon's cases in the same row, and the LCs were created using moving average and cumulative sum (CUSUM) analyses. Separate multivariable analyses identified each period's (LC vs. beyond) characteristics. RESULTS The LCs from the combined SFRs reached a plateau after approximately 50 cases for both the CUSUM and the moving average. The effect of stone burden on SFR was more evident in the first 50 cases compared to subsequent cases in the multivariable analyses (p = 0.001 and p = 0.047, respectively). Case order and stone density were independent factors in the first 50 cases (OR: 1.02 [95% CI 1.00-1.04], p = 0.04 and OR: 0.99 [95% CI 0.99-1.00], p = 0.04) but not significant in subsequent cases (OR: 0.97 [95% CI 0.94-1.00], p = 0.1 and OR: 1.00 [95% CI 0.99-1.00], p = 0.7, respectively). Compared to single locations except the lower calyx, the unfavorable effect of the multiple-stone localization on SFR grew in strength after the 50th case (OR: 0.42 [95% CI 0.23-0.78], p = 0.01 and OR: 0.20 [95% CI 0.09-0.46], p < 0.001, respectively). CONCLUSIONS This is the first study reporting on the RIRS LCs of urology residents. While stone burden, density, and multiple-stone localization were the factors determining SFR in the learning period, after completing the LC, the effect of stone burden weakened and multiple-stone localization became stronger.
Collapse
Affiliation(s)
| | - Oktay Ozman
- Urology Clinic, Gaziosmanpasa Training and Research Hospital, Istanbul, Turkey
| | - Hakan Cakir
- Urology Clinic, Fulya Acıbadem Hospital, Istanbul, Turkey
| | - Onder Cinar
- Department of Urology, Bülent Ecevit University, Zonguldak, Turkey
| | - Murat Akgul
- Department of Urology, Tekirdağ Namık Kemal University, Tekirdağ, Turkey
| | - Cem Basatac
- Department of Urology, Group Florence Nightingale Hospitals, Istanbul, Turkey
| | | | - Kerem Teke
- Department of Urology, Kocaeli University, Kocaeli, Turkey
| | - Cenk Murat Yazici
- Department of Urology, Tekirdağ Namık Kemal University, Tekirdağ, Turkey
| | - Eyup Burak Sancak
- Department of Urology, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
| | - Bülent Önal
- Department of Urology, Cerrahpaşa Faculty of Medicine, Istanbul, Turkey
| | - Haluk Akpinar
- Urology Clinic, Fulya Acıbadem Hospital, Istanbul, Turkey
| |
Collapse
|
6
|
Waseda Y, Takazawa R, Kobayashi M, Fuse H, Tamiya T. Different failure rates of insertion of 10/12-Fr ureteral access sheaths during retrograde intrarenal surgery in patients with and without stones. Investig Clin Urol 2022; 63:433-440. [PMID: 35796140 PMCID: PMC9262494 DOI: 10.4111/icu.20220081] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 04/16/2022] [Accepted: 05/18/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose The aim of this study was to compare the failure rates of insertion of a 10/12-Fr ureteral access sheath (UAS) during retrograde intrarenal surgery (RIRS) in cases with and without stones and to analyze the risk factors for UAS insertion failure. Materials and Methods A total of 640 RIRS cases (538 with and 102 without stones) were evaluated. The primary outcome of interest was the failure rate of insertion of a 10/12-Fr UAS. Associated risk factors were assessed using univariate and multivariate logistic regression analyses. Propensity score (PS) matching and inverse probability of treatment weighting (IPTW) were used to ensure the robustness of the results. Results The overall failure rate of 10/12-Fr UAS insertion in the cases without stones was significantly higher than that in the cases with stones (39.2% vs. 7.2%; p<0.001), and was approximately 2.5 to 4 times higher after PS matching and IPTW. Multivariate logistic analyses showed that being in the group without stones and younger age were independent significant risk factors for insertion failure in both the PS-matched cohort (odds ratio [OR], 5.43; 95% confidence interval [CI], 2.16–13.6; and OR, 1.04; 95% CI, 1.01–1.07) and the IPTW-adjusted cohort (OR, 1.82; 95% CI, 1.14–2.90; and OR, 1.03; 95% CI, 1.01–1.04). Conclusions The incidence of 10/12-Fr UAS insertion failure during RIRS was higher in cases without stones than in those with stones. These results provide valuable information for surgeons to use during informed consent discussions with patients undergoing RIRS, especially patients without stones.
Collapse
Affiliation(s)
- Yuma Waseda
- Department of Urology, Kidney Stone Center, Tokyo Metropolitan Ohtsuka Hospital, Tokyo, Japan
| | - Ryoji Takazawa
- Department of Urology, Kidney Stone Center, Tokyo Metropolitan Ohtsuka Hospital, Tokyo, Japan.
| | - Masaki Kobayashi
- Department of Urology, Kidney Stone Center, Tokyo Metropolitan Ohtsuka Hospital, Tokyo, Japan
| | - Honoka Fuse
- Department of Urology, Kidney Stone Center, Tokyo Metropolitan Ohtsuka Hospital, Tokyo, Japan
| | - Takashi Tamiya
- Department of Urology, Kidney Stone Center, Tokyo Metropolitan Ohtsuka Hospital, Tokyo, Japan
| |
Collapse
|
7
|
Predicting narrow ureters before ureteroscopic lithotripsy with a neural network: a retrospective bicenter study. Urolithiasis 2022; 50:599-610. [PMID: 35737011 DOI: 10.1007/s00240-022-01341-2] [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: 04/08/2022] [Accepted: 05/30/2022] [Indexed: 10/17/2022]
Abstract
In some patients, the passage of semi-rigid ureteroscopes up the ureter is impossible due to narrow ureteral lumen. We established a neural network to predict the inability of the ureter to accommodate the semi-rigid ureteroscope and the need for active or passive dilatation using non-contrast computed tomography (CT) images. Data were collected retrospectively from two centers of 1989 eligible patients who underwent ureteroscopic lithotripsy with ureteral stones. Patients were categorized into two groups: control and narrow ureter. The network was designed and trained for predicting a narrow ureter during initial ureteroscopic lithotripsy, which integrated multi-scale features of the ureter. The predictive efficacy of neural networks DenseNet3D, ResNet3D, ResNet3D MC, and TimeSformer was compared. Furthermore, a previous ureteroscopy or a history of double-J stent placement, ureteral wall thickness and Hounsfield unit (HU) density of the ureter under the stone were compared. Model performance was assessed based on the accuracy, area under the receiver operating characteristic curve (AUC ROC), etc. The DenseNet3D-based network achieved an AUC ROC score of 0.884 and an accuracy of 85.29%, followed by the ResNet3D-based network, the ResNet3D MC-based network, and the TimeSformer-based network. The DenseNet3D-based network significantly outperformed other candidate predictors. Furthermore, the networks were validated in an external test set. Decision curve analysis showed the clinical utility of the neural network. The neural network provides an individualized preoperative prediction of narrow ureter based on non-contrast CT images, which could be employed as part of a surgical decision-making support system.
Collapse
|
8
|
Waseda Y, Takazawa R, Kobayashi M, Fuse H, Tamiya T. Risk factors and predictive model for incidence of difficult ureter during retrograde ureteroscopic lithotripsy. Int J Urol 2022; 29:542-546. [PMID: 35218070 DOI: 10.1111/iju.14835] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 02/13/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Difficult ureter can be a challenge for accessing upper urinary tract during lithotripsy. In this study, we evaluated the risk factors for the incidence of difficult ureter in retrograde ureteroscopic lithotripsy. Moreover, we aimed to develop a predictive model for the incidence of difficult ureter. METHODS We retrospectively reviewed consecutive retrograde ureteroscopic lithotripsies performed at our institution between 2009 and 2021. A total of 1010 renal units were evaluated: 449 units with renal stones only and 561 units with ureteral stones, with or without renal stones. RESULTS The overall incidence of difficult ureter was 5.9%, with a higher incidence in the renal alone stone group than in the ureteral stone group (7.8% vs 4.5%, P = 0.026). Multivariate regression analysis revealed three risk factors for the incidence of difficult ureter: absence of stone history (odds ratio 5.67, 95% confidence interval 2.40-13.4, and P < 0.001), age ≤45 years (odds ratio 3.61, 95% confidence interval 2.05-6.37, and P < 0.001), and renal stone only (odds ratio 2.11, 95% confidence interval 1.22-3.64, and P = 0.008). A simple model using these three risks enabled the stratification of the incidence rate of difficult ureter, with the incidence of high-risk cases being 12.7%. CONCLUSIONS The greatest risk factor for the incidence of difficult ureter was the absence of stone history, followed by age 45 years or younger, and having only renal stones. In high-risk cases of difficult ureter, the possibility of secondary lithotripsy should be explained to the patients.
Collapse
Affiliation(s)
- Yuma Waseda
- Department of Urology, Kidney Stone Center, Tokyo Metropolitan Ohtsuka Hospital, Toshima-ku, Tokyo, Japan
| | - Ryoji Takazawa
- Department of Urology, Kidney Stone Center, Tokyo Metropolitan Ohtsuka Hospital, Toshima-ku, Tokyo, Japan
| | - Masaki Kobayashi
- Department of Urology, Kidney Stone Center, Tokyo Metropolitan Ohtsuka Hospital, Toshima-ku, Tokyo, Japan
| | - Honoka Fuse
- Department of Urology, Kidney Stone Center, Tokyo Metropolitan Ohtsuka Hospital, Toshima-ku, Tokyo, Japan
| | - Takashi Tamiya
- Department of Urology, Kidney Stone Center, Tokyo Metropolitan Ohtsuka Hospital, Toshima-ku, Tokyo, Japan
| |
Collapse
|
9
|
Yavuzsan AH, Kirecci SL, Ilgi M, Turk S, Bursali K, Yesildal C, Albayrak AT, Demirel HC, Horasanli K. Failure of ureteral access sheath insertion in primary flexible ureteroscopy for renal stones: is there any relation with inflammation? Aktuelle Urol 2022; 53:67-74. [PMID: 34933347 DOI: 10.1055/a-1378-2495] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To investigate the relationship between failure to insert a ureteral access sheath (UAS) with inflammation and other clinical parameters in patients treated with flexible ureteroscopy for renal stones. METHODS This study included patients who underwent flexible ureteroscopy for the treatment of renal stones in our centre between 2015 and 2020. Patients who underwent any surgical procedure on the ipsilateral ureter and had a history of spontaneous stone passage were excluded. Patients were divided into two groups based on UAS insertion success (group 1) or failure (group 2). Both groups were compared with a view to clinical characteristics, preoperative neutrophil, lymphocyte, monocyte and platelet counts and ratios of these counts, all being considered inflammatory markers. A multivariate logistic regression analysis was performed to determine the independent variables affecting UAS insertion success. RESULTS There were 113 (59.1%) patients in group 1, while group 2 consisted of 78 (40.9%) patients. The rates of male gender, coronary artery disease and preoperative ipsilateral hydronephrosis were significantly higher in group 2, while platelet counts and platelet-lymphocyte ratios were significantly lower. Our analysis revealed four independent predictors for UAS insertion failure: female gender (odds ratio [OR]=2.1) increased the rate of UAS insertion success, while hydronephrosis (OR=1.6), low platelet counts and PLR increased the rate of UAS insertion failure (OR=0.99, OR=0.98, respectively). CONCLUSION Our results suggest that male gender and ipsilateral hydronephrosis are associated with increased UAS insertion failure. Although we found a relationship between relatively low platelet levels and UAS insertion failure, we think that further studies are needed to investigate this matter.
Collapse
Affiliation(s)
- Abdullah Hizir Yavuzsan
- Urology, University of Health Sciences Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Sinan Levent Kirecci
- Urology, University of Health Sciences Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Musab Ilgi
- Urologie, KMG Klinikum Luckenwalde, Luckenwalde, Germany
| | - Semih Turk
- Urology, University of Health Sciences Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Kerem Bursali
- Urology, University of Health Sciences Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Cumhur Yesildal
- Urology, University of Health Sciences Sultan 2. Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Tevfik Albayrak
- Urology, University of Health Sciences Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Huseyin Cihan Demirel
- Urology, University of Health Sciences Sisli Hamidiye Etfal Training and Research Hospital, Sisli, Turkey
| | - Kaya Horasanli
- Urology, University of Health Sciences Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| |
Collapse
|
10
|
Hu J, Yu Y, Liu W, Zhong J, Zhou X, Xi H. Identification of the Risk Factors for the Failure of Ureteral Access Sheath Placement. Int J Clin Pract 2022; 2022:7518971. [PMID: 36120665 PMCID: PMC9467721 DOI: 10.1155/2022/7518971] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/18/2022] [Accepted: 08/25/2022] [Indexed: 12/03/2022] Open
Abstract
PURPOSE Insertion of a ureteral access sheath (UAS) may fail in some patients in retrograde intrarenal surgery (RIRS), and this study aimed to seek preoperative risk factors for the failure of 12/14F UAS placement. METHODS We retrospectively analyzed 260 consecutive patients who underwent RIRS between May 2020 and March 2022 at our institution. Data on patient and stone characteristics and several computed tomography (CT)-based measurements were collected and compared between the success and failure UAS placement groups. RESULTS Twenty-nine (11.2%) patients failed to insert the UAS. Age, gender, height, weight, stone side, stone location, length of history, and computed tomography (CT)-based parameters were not significant differences between the two groups. Univariate logistic regression analyses showed sex (female/male) (odds ratio: 0.287 and 95% CI [0.107, 0.722], p=0.013), length of history 15-31 days (odds ratio: 0.315 and 95% CI [0.102, 0.974], p=0.045), length of history >31 days (odds ratio: 0.202 and 95% CI [0.051, 0.805], p=0.023), and diameter of the ipsilateral common iliac artery (odds ratio: 1.285 and 95% CI [1.018, 1.623], p=0.035) were associated with UAS placement. CONCLUSION Our study indicated that males, the short length of history, and the short diameter of the ipsilateral common iliac artery were the risk factors for the failure of UAS placement.
Collapse
Affiliation(s)
- Jieping Hu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yue Yu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Wei Liu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jialei Zhong
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xiaochen Zhou
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Haibo Xi
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| |
Collapse
|
11
|
Hu J, Yu Y, Liu W, Zhong J, Zhou X, Xi H. CT-Based Predictor for the Success of 12/14-Fr Ureteral Access Sheath Placement. Int J Clin Pract 2022; 2022:3343244. [PMID: 36415697 PMCID: PMC9646298 DOI: 10.1155/2022/3343244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/04/2022] [Accepted: 10/18/2022] [Indexed: 01/25/2023] Open
Abstract
PURPOSE Ureteral access sheaths (UAS) are widely used in retrograde intrarenal surgery (RIRS), and this study aimed to develop a model for predicting the success of UAS placement based on computed tomography. METHODS We analyzed the clinical data of 847 patients who received ureteroscopy. Data on patient and stone characteristics and several computed tomography (CT)-based measurements were collected. A nomogram predicting the success of UAS placement was developed and validated using R software. RESULTS Two hundred and forty-seven patients were identified. Twenty-five patients (10.1%) failed to pass through the UAS. A model with three factors including the short diameter of ureteral calculi, the short diameter of hydronephrosis, and the diameter of the narrowest part of the renal parenchyma was to be strongly practical and had a high area under the curve on internal validation (80.3%). Using a threshold cutoff of 92%, the sensitivity and specificity for predicting UAS placement were 0.35 and 0.92, respectively. CONCLUSION Our study provides a nomogram for predicting the success of UAS placement, and this model could help discriminate patients who are likely to suffer from failed UAS insertion; preoperative ureteral stenting is recommended according to the prediction.
Collapse
Affiliation(s)
- Jieping Hu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yue Yu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Wei Liu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jialei Zhong
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xiaochen Zhou
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Haibo Xi
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| |
Collapse
|
12
|
Fahmy A, Dawoud W, Badawy H, Youssif M, Kamal A, Elgebaly O. Optimum duration of ureteral prestenting dwelling time in children undergoing retrograde intrarenal surgery. J Pediatr Urol 2021; 17:845.e1-845.e6. [PMID: 34452828 DOI: 10.1016/j.jpurol.2021.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/25/2021] [Accepted: 08/06/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION AND OBJECTIVES Ureteral prestenting before retrograde intrarenal surgery (RIRS) causes passive dilatation of the ureter, improves stone-free rate and is associated with shorter operative time. However, the presence of a ureteric stent may increase the risk for septic complications, which accelerates with increased dwelling time duration. The aim of the present study is to explore the impact of ureteral prestenting timing in a group of children undergoing retrograde intrarenal surgery (RIRS) on perioperative outcomes and complication rates and to define the optimum duration of prestenting dwelling time. PATIENTS AND METHODS A retrospective study on 60 children aged less than 14 years, presented with upper tract urinary stones, who were subdivided into two groups: Group 1 and 2, each included 30 children who had undergone RIRS after ureteric stenting for two weeks and four weeks respectively. Success of ureteroscope introduction, operative time, stone free rate (SFR), intraoperative and postoperative complications and number of retreatment procedures after definitive RIRS were recorded and compared between the two treatment groups. RESULTS Ureteric access was successfully obtained in all children in both groups. Patients in group 1 and 2 had a SFR of 86.6% and 90%, respectively (p = 0.199). The mean operative time of group 1 and 2 were 56.5 and 52.9 min (p = 0.612). Postoperative UTI rates increased with prolonged dwelling time from 6.7% in group 1 to 30% in group 2. No patient in both groups developed high grade complications. CONCLUSIONS Increasing prestenting dwelling time from two to four weeks had no statistically significant effect on the successful ureteroscopic access nor the stone free rate in children undergoing RIRS. Reducing the ureteric stent dwelling time minimizes the rate of postoperative UTI without compromising the success of operative outcomes.
Collapse
Affiliation(s)
- Ahmed Fahmy
- Urology Department, Alexandria University, Egypt.
| | | | | | | | - Amr Kamal
- Urology Department, Alexandria University, Egypt
| | | |
Collapse
|
13
|
Fahmy O, Shsm H, Lee C, Khairul-Asri MG. Impact of Preoperative Stenting on the Outcome of Flexible Ureterorenoscopy for Upper Urinary Tract Urolithiasis: A Systematic Review and Meta-Analysis. Urol Int 2021; 106:679-687. [PMID: 34515258 DOI: 10.1159/000518160] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 06/22/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE This study aimed to investigate the effect of preoperative stenting (POS) on the perioperative outcomes of flexible ureterorenoscopy (fURS). MATERIALS AND METHODS A systematic review and meta-analysis was conducted based on the PRISMA statement. From the initially retrieved 609 reports, we excluded the ineligible studies at 2 stages. We only included studies that contained fURS patients with and without POS in the same report. Data of patients who underwent semirigid ureteroscope only were excluded from the analysis. The Newcastle-Ottawa Scale (NOS) system was applied for risk of bias assessment. RESULTS A total of 20 studies including 5,852 patients were involved. 48.5% of the patients had preoperative stent. Stone-free rate was significantly higher with prestenting; odds ratio (OR) was 1.98 (95% CI: 1.51-2.58) (Z = 5.02; p = 0.00001). It also displayed tendency toward lower complications; OR was 0.74 (95% CI: 0.52-1.05) (Z = 1.67; p = 0.09). POS significantly increased the use of ureteral access sheath; OR was 1.49 (95% CI: 1.05-2.13) (Z = 2.22; p = 0.03). Risk of bias assessment showed 13 and 7 studies with low and moderate risk, respectively. CONCLUSIONS POS clearly improves the stone-free rates after fURS. It might reduce the complications, especially ureteral injury. These findings might help solve the current debate and can be useful for urologists during patient counselling for a proper decision-making.
Collapse
Affiliation(s)
- Omar Fahmy
- Department of Urology, Universiti Putra Malaysia, Selangor, Malaysia
| | - Hadi Shsm
- Department of Urology, Royal Cornwall Hospital, Truro, United Kingdom
| | - Cks Lee
- Department of Urology, Universiti Putra Malaysia, Selangor, Malaysia
| | | |
Collapse
|
14
|
Sancak EB, Basatac C, Akgul HM, Cinar O, Ozman O, Yazıcı CM, Akpinar H. The effect of optical dilatation before retrograde intrarenal surgery on success and complications: Results of the RIRSearch group study. Int J Clin Pract 2021; 75:e14335. [PMID: 33960069 DOI: 10.1111/ijcp.14335] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 05/03/2021] [Indexed: 11/26/2022] Open
Abstract
AIM The guidelines propose optical dilatation before retrograde intrarenal surgery (RIRS), but there are currently no evidence-based studies concerning the impact of optical dilatation with semirigid ureteroscopy (sURS). The aim of this study was to evaluate the effect of optical dilatation through sURS prior to the RIRS procedure on the success and complications of RIRS. METHODS A total of 422 patients were included in the retrospective multicentre study. The patients were divided into two groups according to whether sURS was to be performed. Patients' demographics, stone parameters and operative outcomes were compared. Surgical success was defined as no or up to 3-mm residual stone fragments without the need for additional procedures. The independent predictors for surgical success were determined with a multivariable logistic regression model. RESULTS Of the 422 patients, 133 (31.5%) were in the sURS group and 289 (68.5%) were in the non-sURS group. Stone characteristics and patients' demographics were similar between the groups. Operation time in the sURS group was significantly longer (compared with the non-sURS group, P < .0001). A ureteral access sheath (UAS) could not be placed in four (3.0%) patients in the sURS group, nor in 25 (8.7%) patients in the non-sURS group (P = .03). Compared with the non-sURS group, the intraoperative complication rate was lower in the sURS group (14 [4.8%] vs 1 [0.8%], P = .04). The surgical success rate was higher in the sURS group (P = .002). Nevertheless, sURS had no independent effect on surgical success. We found two independent predictors for surgical success rate: stone number (P < .0001, OR:2.28) and failed UAS placement (P = .035, OR:3.49). CONCLUSIONS Optical dilatation with sURS before RIRS increases surgical success by raising the rate of UAS placement and reducing the rate of intraoperative complications. We suggest that this method can be routinely applied to patients who have not been passively dilated with a JJ stent.
Collapse
Affiliation(s)
- Eyup Burak Sancak
- Department of Urology, Canakkale Onsekiz Mart University Faculty of Medicine, Canakkale, Turkey
| | - Cem Basatac
- Department of Urology, Florence Nightingale Hospital, Istanbul, Turkey
| | - Hacı Murat Akgul
- Department of Urology, Tekirdag Namık Kemal Faculty of Medicine, Tekirdag, Turkey
| | - Onder Cinar
- Department of Urology, Zonguldak Bulent Ecevit University Faculty of Medicine, Zonguldak, Turkey
| | - Oktay Ozman
- Department of Urology, Istanbul Gaziosmanpasa Training and Research Hospital, Istanbul, Turkey
| | - Cenk Murat Yazıcı
- Department of Urology, Tekirdag Namık Kemal Faculty of Medicine, Tekirdag, Turkey
| | - Haluk Akpinar
- Department of Urology, Florence Nightingale Hospital, Istanbul, Turkey
| |
Collapse
|
15
|
Karakoyunlu N, Çakıcı MÇ, Sarı S, Hepşen E, Bikirov M, Kısa E, Özbal S, Özok HU, Ersoy H. Efficacy of various laser devices on lithotripsy in retrograde intrarenal surgery used to treat 1-2 cm kidney stones: A prospective randomized study. Int J Clin Pract 2021; 75:e14216. [PMID: 33864337 DOI: 10.1111/ijcp.14216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 04/05/2021] [Indexed: 11/29/2022] Open
Abstract
AIMS To compare the efficacy of different laser devices and power ranges on lithotripsy in retrograde intrarenal surgery (RIRS) for 1-2 cm kidney stones. METHODS A total of 223 participants undergoing RIRS for 1-2 cm kidney stones at our clinic between January 2015 and January 2017 were recruited for this prospective study (NCT02451319). Two hundred and four participants included in our study were randomly allocated into either ≤20 W with 20 W laser device (group 1) or ≤20 W with 30 W laser device (group 2) or >20 W with 30 W laser device (group 3). RESULTS There was no significant difference between the groups in terms of demographic and stone characteristics. Operation and fluoroscopy times were significantly longer (P = .003 and P < .001, respectively) and stone-free rate (SFR) was significantly lower in group 1 (P = .002). Complications were similar in all three groups (P = .512). However, post-operative pain scores were significantly higher in group 1 (P < .001). The multivariate analysis revealed that stone size (95% CI: 0.654-0.878, OR = 0.758, P < .001), ureteral access sheath use (95% CI: 1.003-20.725, OR = 4.560, P = .049), and lithotripsy with 30 W laser device (95% CI: 1.304-11.632, OR = 3.895, P = .015; 95% CI: 1.738-17.281, OR = 5.480, P = .004, groups 2 and 3, respectively) were independent factors predicting SFR for RIRS used in 1-2 cm kidney stones. CONCLUSION The 30 W laser device used in RIRS for 1-2 cm kidney stones had shorter operation times, higher SFRs, and lower post-operative pain scores compared with the 20 W device. The 30 W laser device is safe and more efficient in RIRS for treatment of 1-2 cm kidney stones.
Collapse
Affiliation(s)
- Nihat Karakoyunlu
- Department of Urology, Health Sciences University, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Mehmet Çağlar Çakıcı
- Department of Urology, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Sercan Sarı
- Department of Urology, Faculty of Medicine Hospital, Bozok University, Yozgat, Turkey
| | - Emre Hepşen
- Department of Urology, Yildirim Beyazit University Yenimahalle Training and Research Hospital, Ankara, Turkey
| | - Muslim Bikirov
- Department of Urology, Health Sciences University, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Erdem Kısa
- Department of Urology, Health Sciences University, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
| | - Serra Özbal
- Department of Radiology, Health Sciences University, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Hakkı Uğur Özok
- Department of Urology, Faculty of Medicine Hospital, Karabuk University, Karabük, Turkey
| | - Hamit Ersoy
- Department of Urology, Health Sciences University, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| |
Collapse
|
16
|
Wong VK, Aminoltejari K, Almutairi K, Lange D, Chew BH. Controversies associated with ureteral access sheath placement during ureteroscopy. Investig Clin Urol 2021; 61:455-463. [PMID: 32869562 PMCID: PMC7458869 DOI: 10.4111/icu.20200278] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/23/2020] [Accepted: 07/29/2020] [Indexed: 12/23/2022] Open
Abstract
The use of ureteral access sheaths (UAS) is common practice during routine flexible ureteroscopy procedures. However, debates and concerns continue amongst endourologists on routine UAS placement. UAS placement allows for multiple passages of the ureteroscope, decreases intrarenal pressure, and may improve stone-free rates. However, concerns for the UAS's effectiveness in these claimed benefits and complications related to UAS placement has been documented and investigated by many. In this review, we will discuss the controversies surrounding the placement of UAS during ureteroscopy.
Collapse
Affiliation(s)
- Victor Kf Wong
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada.
| | - Khatereh Aminoltejari
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Khaled Almutairi
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Dirk Lange
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Ben H Chew
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
17
|
Effect of Preoperative Double-J Ureteral Stenting before Flexible Ureterorenoscopy on Stone-free Rates and Complications. Curr Med Sci 2021; 41:140-144. [PMID: 33582918 DOI: 10.1007/s11596-021-2328-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 10/15/2020] [Indexed: 10/22/2022]
Abstract
The effect of preoperative Double-J (DJ) ureteral stenting before flexible ureterorenoscopy (FURS) in the treatment for urinary stones was evaluated. We retrospectively enrolled 306 consecutive patients who underwent FURS from Jan. 2014 to Dec. 2017. All the patients were classified into two groups according to whether they had DJ ureteral stenting before FURS. Baseline characteristics (age, sex, stone location, stone size, surgical success rate, operation time, stone-free rate of the first day after surgery, stone-free rate of the first month after surgery, total complication rate) were compared using Chi-square test for categorical variables and Kruskal-Wallis test for continuous variables. In total, 306 patients were included in this study. The group of DJ stenting before FURS included 203 (66.3%) patients, and non-DJ stenting before FURS was observed in 103 (33.7%) patients. The group of DJ stenting before FURS was significantly associated with a shorter operation time (53.8 vs. 59.3 min, P<0.001), a higher stone-free rate of the first day after surgery (69.0% vs. 51.5%, P=0.003). However, statistical significant differences were not found in the age, sex, stone location, stone size, surgical success rate, stone-free rate of the first month after surgery (89.2% vs. 81.6%, P=0.065) and total complication rate (5.4% vs. 9.7%, P=0.161) between the two groups. Preoperative DJ ureteral stenting before FURS could reduce the operation time and increase stone-free rate of the first day after surgery. However, it might not benefit the stone-free rate of the first month after surgery and reduce the complication rate. Preoperative DJ stenting should be not routinely performed.
Collapse
|
18
|
Gan S, Guo Z, Zou Q, Gu C, Xiang S, Li S, Ye Z, Wang S. Diagnosis accuracy of PCA3 level in patients with prostate cancer: a systematic review with meta-analysis. Int Braz J Urol 2020; 46:786-793. [PMID: 32539255 PMCID: PMC7822363 DOI: 10.1590/s1677-5538.ibju.2019.0521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 11/01/2019] [Indexed: 12/16/2022] Open
Abstract
Objective: This study aims to design a novel semirigid ureterorenoscope with irrigation and vacuum suction system and a modified ureteral access sheath (UAS) named Sotn ureterorenoscope® (Sotn=ShuoTong Medical Company) to overcome the deficiencies of the current procedure and to improve the efficiency and safety of using Sotn ureterorenoscope® for treatment of upper urinary calculi. Materials and Methods: Fifty-eight patients, comprising 31 males and 27 females, were evaluated. The medical records of 58 patients with upper urinary calculi treated with Sotn ureterorenoscope® from March 2015 to June 2017 were retrospectively reviewed at the Second Affiliate Hospital of Guangzhou University of Chinese Medicine in China. The primary outcome was stone-free rate (SFR) assessed by computed tomography on the 1st day and one month after treatment. The secondary outcome was postoperative complication rate. Results: The mean and SD of operative duration was 48.5 (10.4) min, and the mean and SD of stone size was 15.6 (5.6) mm. The primary overall SFR was 89.7% (52/58) and 100% at 1 month follow-up. Complication, which was Clavien I (minor fever managed by antipyretic therapy), was detected in 1.7% (1/58) of the patients. Conclusions: Sotn ureterorenoscope® is technically feasible, efficacious and safe for treatment of upper urinary calculi because of its advantages of high SFR and low complication rates.
Collapse
Affiliation(s)
- Shu Gan
- Department of Urology, The Second Affiliate Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhenlang Guo
- Department of Urology, The Second Affiliate Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Qianming Zou
- Department of Urology, The Second Affiliate Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Chiming Gu
- Department of Urology, The Second Affiliate Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Songtao Xiang
- Department of Urology, The Second Affiliate Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Siyi Li
- Department of Urology, The Second Affiliate Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhangqun Ye
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shusheng Wang
- Department of Urology, The Second Affiliate Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| |
Collapse
|
19
|
Subiela JD, Kanashiro A, Emiliani E, Villegas S, Sánchez-Martín FM, Millán F, Palou J, Angerri O. Systematic Review and Meta-Analysis Comparing Fluoroless Ureteroscopy and Conventional Ureteroscopy in the Management of Ureteral and Renal Stones. J Endourol 2020; 35:417-428. [PMID: 33076706 DOI: 10.1089/end.2020.0915] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Context: Stone recurrence is frequent in stone formers, and repeated diagnostic and therapeutic procedures in recurrent stone formers place patients and urologists at a significant risk of radiation-related effects. Objective: To assess the efficacy and safety of fluoroless ureteroscopy (fURS) compared with conventional ureteroscopy (cURS) in the management of ureteral and renal stones. Evidence Acquisition: A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Studies providing data on the stone-free rate (SFR), secondary procedures, operative time (OT), and complication rate for fURS and cURS were included. An overall analysis and a subgroup analysis based on the stone target (ureteral stones, renal stones, or a combination thereof) were performed. Evidence Synthesis: A total of 23 studies were included, recruiting 4029 patients. Pooled data showed that in comparison with cURS, fURS exhibited a similar SFR (odds ratio [OR]: 0.99; 95% confidence interval [CI]: 0.92 to 1.06; p = 0.709), without significant differences in overall intraoperative complication rate (OR: 0.73; 95% CI: 0.33 to 1.63; p = 0.446), overall postoperative complication rate (OR: 0.98; 95% CI: 0.59 to 1.63; p = 0.949), major postoperative complication rate (Clavien ≥3; OR: 0.46; 95% CI: 0.14 to 1.53; p = 0.205), OT (standardized mean difference [SMD]: 0.07; 95% CI: -0.15 to 0.29; p = 0.537), hospital stay (SMD: -0.12; 95% CI: -0.26 to 0.02; p = 0.084), or secondary procedures (OR: 1.20; 95% CI: 0.58 to 2.49; p = 0.616). The subgroup analysis revealed no differences in outcomes according to the stone target. We also identified a rate of conversion to the conventional technique of 5% (95% CI: 3% to 7%). Conclusions: The available data suggest that for the treatment of ureteral and renal stones, fURS offers a similar SFR to that provided by the cURS without any increase in complication rate, OT, hospital stay, or secondary procedures. Critical review of the dogmatic routine use of fluoroscopy during ureteroscopy may be warranted.
Collapse
Affiliation(s)
- José Daniel Subiela
- Department of Urology, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Andrés Kanashiro
- Department of Urology, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Estaban Emiliani
- Department of Urology, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Sergio Villegas
- Urology Service, Hospital Central Universitario Antonio María Pineda, Barquisimeto, Venezuela
| | | | - Felix Millán
- Department of Urology, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joan Palou
- Department of Urology, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Oriol Angerri
- Department of Urology, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain
| |
Collapse
|
20
|
Yuk HD, Park J, Cho SY, Sung LH, Jeong CW. The effect of preoperative ureteral stenting in retrograde Intrarenal surgery: a multicenter, propensity score-matched study. BMC Urol 2020; 20:147. [PMID: 32928162 PMCID: PMC7490880 DOI: 10.1186/s12894-020-00715-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Accepted: 09/04/2020] [Indexed: 11/10/2022] Open
Abstract
Background Stent placement before retrograde intrarenal surgery (RIRS) can theoretically expand the ureter to improve access and remove stones. The purpose of this study was to investigate the effect of preoperative ureteral stenting on access and surgery. Methods We retrospectively analyzed patients who underwent RIRS between January 2010 and December 2016 at multiple centers. The patients were divided into two groups based on whether or not a ureteral stent was inserted preoperatively. The characteristics of the stone (size, number, density, and location), the success rate of the access sheath placement, perioperative complications, operative times, hospitalization periods, the period for which the stents remained, postoperative urinary tract infection rates, stone-free rates, and additional treatment rates were analyzed. Results Overall, 727 patients were included in the study (113 were pre-stented and 614 were non-stented). The median stone size was 12.2 mm. The overall stone-free rate (SFR) was 85.8% for the pre-stented group and 83.2% for the non-stented group, showing no significant (p = 0.498) difference between the two groups. Preoperative ureteral stenting improved the success rate of sheath placement (93.8% vs. 85.3%, p = 0.023) during surgery. The access sheath size in participants in the pre-stented group showed a tendency to be larger than that in participants in the non-stented group. However, there were no differences in perioperative complications, operative times, additional treatment rates, and stone-free rates. Conclusions Although preoperative ureteral stenting did not affect operative outcomes, it increased the success rate of access sheath placement. Depending on the patient’s characteristics, preoperative ureteral stenting can be considered as an adjunctive option when access sheath insertion is considered during RIRS.
Collapse
Affiliation(s)
- Hyeong Dong Yuk
- Department of Urology, Seoul National University Hospital, 101 Daehak - ro, Jongno - gu, Seoul, 03080, Republic of Korea.
| | - Juhyun Park
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sung Yong Cho
- Department of Urology, Seoul National University Hospital, 101 Daehak - ro, Jongno - gu, Seoul, 03080, Republic of Korea
| | - Luck Hee Sung
- Department of Urology, Inje University Sanggye Paik Hospital, 1342 Dongil-ro, Nowon-gu, Seoul, 01757, South Korea
| | - Chang Wook Jeong
- Department of Urology, Seoul National University Hospital, 101 Daehak - ro, Jongno - gu, Seoul, 03080, Republic of Korea.
| |
Collapse
|
21
|
Sari S, Cakici MC, Aykac A, Baran O, Selmi V, Karakoyunlu AN. Outcomes with ureteral access sheath in retrograde intrarenal surgery: a retrospective comparative analysis. Ann Saudi Med 2020; 40:382-388. [PMID: 33007166 PMCID: PMC7532051 DOI: 10.5144/0256-4947.2020.382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Retrograde intrarenal surgery is used for treatment of urinary system stones. The ureteral access sheath (UAS) is used to decrease intrapelvic pressure, help with access of multiple instruments, and facilitate drainage and removal of the fragmented stones. OBJECTIVE Assess the effect of the UAS on the outcomes of retrograde intrarenal surgery. DESIGN A retrospective patient data review. SETTING Training and research hospital in Turkey. PATIENTS AND METHODS We reviewed the data of patients who had undergone retrograde intrarenal surgery between 2012-2019. Patients who had kidney anomalies, were <18 years old, and who had ureteral and urethral strictures were excluded from the study. The demographic characteristics, stone type, complications, intraoperative and postoperative data of the patients were reviewed. A successful outcome was defined as being stone free or having clinically insignificant residual fragments (<3 mm). The use of the UAS was compared with other procedures in terms of efficiency and safety. Factors determining UAS usage were assessed by multivariate analysis. MAIN OUTCOME MEASURES Stone free rate and complication rate in patients who underwent retrograde intrarenal surgery. SAMPLE SIZE 1808 patients met inclusion criteria. RESULTS The UAS was used in 1489 procedures, while other methods were used in 319 procedures. Operation time was 46.9 (17.3) minutes and 42.9 (19.0) minutes with other methods. Postoperative double J stent usage rates were 88.2% and 63% in the UAS and other methods, respectively. The rate of successful outcome was 88.2% and 81.2% in the UAS and other methods, respectively (P<.001). The rate of complications was similar in both groups (P=.543). In a multivariate analysis, UAS usage was directly proportional with stone size and inversely proportional with preoperative JJ stent usage CONCLUSION: The UAS can be effectively and successfully used in retrograde intrarenal surgery for treatment of urinary system stones. UAS usage should be considered for the patients who have large stones (2 cm) and do not have a preoperative double J stent. LIMITATIONS Retrospective design. CONFLICT OF INTEREST None.
Collapse
Affiliation(s)
- Sercan Sari
- From the Department of Urology, Faculty of MEdicine, Yozgat Bozok University, Yozgat, Turkey
| | - Mehmet Caglar Cakici
- From the Deparment of Urology, Faculty of Medicine, Istabbul Medeniyet University, Istanbul, Turkey
| | - Aykut Aykac
- From the Department of urology, Karabuk Universitesi Tip Fakultesi, Karabuk, Turkey
| | - Ozer Baran
- From the Department of urology, Karabuk Universitesi Tip Fakultesi, Karabuk, Turkey
| | - Volkan Selmi
- From the Department of Urology, Faculty of MEdicine, Yozgat Bozok University, Yozgat, Turkey
| | - Ahmet Nihat Karakoyunlu
- From the Department of Urology, Health Science University, Diskapi Yildrim Beyazit Training and Research Hospital, Ankara, Turkey
| |
Collapse
|
22
|
Alkhamees M, Aljuhayman A, Addar A, Ghazwani Y, Alasker A, Hamri SB. Failure of ureteral access sheath insertion in virgin ureters: A retrospective tertiary care center study. Urol Ann 2020; 12:331-334. [PMID: 33776328 PMCID: PMC7992527 DOI: 10.4103/ua.ua_94_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 06/24/2020] [Indexed: 12/02/2022] Open
Abstract
Objective: The objective of the study was to identify the failure rate of insertion of ureteral access sheath (UAS) during primary flexible ureteroscopy (FURS). Materials and Methods: This was a single-surgeon, single-tertiary care center retrospective study. All patients who underwent primary FURS for proximal ureteric or renal stones from November 2014 to May 2018 were included in the study. Patients with a stone burden of more than 20 mm were excluded from the study. A 10/12-Fr coaxial UAS (Bi-Flex, Rocamed) was used. Data collection included age, sex, body mass index (BMI), stone burden and location, previous spontaneous passage of stones, type of anesthesia, and preexisting congenital anomalies. The Chi-square test and t-test were used for the statistical analyses. Results: One hundred and twelve patients were included in the study. All patients underwent primary FURS. The failure rate of primary UAS insertion was 10.7% (n = 12). No statistically significant difference was found in age, BMI, type of anesthesia, previous history of spontaneous stone passage, and stone burden between the success and failure groups (P > 0.05). Conclusions: We believe that our study opens the door for a multicentric prospective trial. Identifying factors leading to a failed primary FURS and UAS insertion is crucial to properly counsel patients preoperatively about the number of procedures that they might need and to prevent the financial loss associated with failed UAS insertion.
Collapse
Affiliation(s)
- Mohammad Alkhamees
- Department of Urology, College of Medicine, Majmaah University, Al Majma'ah, Saudi Arabia
| | - Ahmed Aljuhayman
- Department of Urology, College of Medicine, Majmaah University, Al Majma'ah, Saudi Arabia
| | - Abdulmalik Addar
- Division of Urology, Department of Surgery, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia
| | - Yahya Ghazwani
- Division of Urology, Department of Surgery, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia.,College of Medicine, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia
| | - Ahmed Alasker
- Division of Urology, Department of Surgery, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia.,College of Medicine, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia
| | - Saeed Bin Hamri
- Division of Urology, Department of Surgery, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia
| |
Collapse
|
23
|
Lima A, Reeves T, Geraghty R, Pietropaolo A, Whitehurst L, Somani BK. Impact of ureteral access sheath on renal stone treatment: prospective comparative non-randomised outcomes over a 7-year period. World J Urol 2020; 38:1329-1333. [PMID: 31342247 PMCID: PMC7190582 DOI: 10.1007/s00345-019-02878-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 07/16/2019] [Indexed: 12/17/2022] Open
Abstract
PURPOSE To compare the outcomes (stone free rate and complications) of renal stone treatment with and without the use of ureteral access sheath (UAS). The worldwide use of UAS has risen over the last decade; however, questions still remain on the safety and outcomes with its use. We wanted to look at the role of UAS for treatment of consecutive renal stones over a 7-year period. METHODS The outcomes of flexible ureteroscopy and stone treatment (FURS) for renal stones with and without the use of UAS was prospectively compared from March 2012 to July 2018. Patients were divided into two groups: group-1 where UAS was used for stone treatment and group-2 where a UAS was not used. Data were collected prospectively on consecutive patients for demographics, stone size, location and number, pre and post-operative stent usage, operative time duration, stone free rate (SFR), length of stay and complications. RESULTS During the study period, 338 patients underwent FURS for renal stones, of which a UAS was used for 203 (60%) patients. The mean age of patients was 56 years (range 2-89 years) with a male:female ratio of 204:134. The mean cumulative stone size and the mean number of stones was 16.5 ± 10.8 mm and 11.37 ± 8.08 mm (P < 0.001), and 2.17 ± 1.99 and 1.66 ± 1.50 (P = 0.009) for groups 1 and 2 respectively. The pre and post-operative stent insertion rates were similar in the two groups. The procedural time was longer in group-1 (54.8 ± 25.8 min) compared to group-2 (41.3 ± 22.2 min) (P < 0.001). The SFR for group-1 (88%) was slightly lower than group-2 (94%) although this was not statistically significant (P = 0.07). There were no intra-operative complications in either of the groups. Post-operative complications were seen in eight patients in group-1 (7 Clavien I/II and 1 Clavien IVa) and two patients in group-2 (Clavien I) (P = 0.19). CONCLUSION The use of UAS for renal stones is safe with no intra-operative complications noted in our series. Good stone-free rates were obtained for large and multiple renal stones with a small risk of minor complications post-operatively.
Collapse
Affiliation(s)
- Ashleigh Lima
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Wessex Clinical Research Network and Simulation Lead for Urology, Tremona Road, Southampton, SO16 6YD UK
| | - Thomas Reeves
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Wessex Clinical Research Network and Simulation Lead for Urology, Tremona Road, Southampton, SO16 6YD UK
| | - Robert Geraghty
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Wessex Clinical Research Network and Simulation Lead for Urology, Tremona Road, Southampton, SO16 6YD UK
| | - Amelia Pietropaolo
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Wessex Clinical Research Network and Simulation Lead for Urology, Tremona Road, Southampton, SO16 6YD UK
| | - Lily Whitehurst
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Wessex Clinical Research Network and Simulation Lead for Urology, Tremona Road, Southampton, SO16 6YD UK
| | - Bhaskar K. Somani
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Wessex Clinical Research Network and Simulation Lead for Urology, Tremona Road, Southampton, SO16 6YD UK
| |
Collapse
|
24
|
Cho SY, Ryang SH, Lee DS. A presumptive role of lower ureteral angles in the difficulty of ureteral access sheath insertion during retrograde intrarenal surgery. Int Urol Nephrol 2020; 52:1657-1663. [DOI: 10.1007/s11255-020-02483-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 04/21/2020] [Indexed: 11/24/2022]
|
25
|
Sung LH, Cho DY. The role of preoperative ureteral stenting in retrograde intrarenal surgery in renal stone patients: a propensity score-matched study. Transl Androl Urol 2020; 9:276-283. [PMID: 32420133 PMCID: PMC7214966 DOI: 10.21037/tau.2020.03.09] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background The purpose of this study was to investigate the effect of preoperative ureteral stenting on retrograde intrarenal surgery (RIRS). Methods We retrospectively analyzed RIRS cases from October 2014 to June 2017. Patients were divided into two groups according to preoperative ureteral stent insertion. The characteristics of the patients [age, body mass index (BMI), sex, previous disease history, hemoglobin, creatinine, estimated glomerular filtration rate (eGFR)], characters of stone (size, number, density, location), ureteral access sheath (UAS) success rate, perioperative complication, operative time, hospitalization time, period with stent, postoperative urinary tract infection (UTI) rate, stone free rate (SFR), and additional treatment rate were analyzed. Results RIRS was performed for 122 patients. Seventy-three patients had preoperative ureteral stents before RIRS, while 49 patients did not have preoperative ureteral stents. The median size of the stone was 14.5 mm. Overall SFR was 87.7%. Preoperative eGFR was relatively high in patients who underwent preoperative stenting (68.18 vs. 79.01 mL/min/1.73 m2, P=0.042). Preoperative stenting led to improvement in the success rate of UAS insertion (97.3% vs. 87.8%, P=0.038) during surgery. Before and after propensity score matching revealed a significant difference in operation time when the diameter of the stone was smaller than 1 cm (P=0.019 and P=0.004). However, there was no significant difference in operation time, postoperative UTI rate, additional treatment rate, or SFR. Conclusions Preoperative ureteral stenting can facilitate UAS insertion, and reduce operation time in RIRS for stones with a diameter less than 1 cm.
Collapse
Affiliation(s)
- Luck Hee Sung
- Department of Urology, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Dae Yeon Cho
- Department of Urology, Inje University Sanggye Paik Hospital, Seoul, Korea
| |
Collapse
|
26
|
Zilberman DE, Lazarovich A, Winkler H, Kleinmann N. Practice patterns of ureteral access sheath during ureteroscopy for nephrolithiasis: a survey among endourologists worldwide. BMC Urol 2019; 19:58. [PMID: 31272430 PMCID: PMC6610981 DOI: 10.1186/s12894-019-0489-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 06/26/2019] [Indexed: 02/07/2023] Open
Abstract
Background The use of ureteral access sheath (UAS) during ureteroscopy is controversial. We aimed to explore practice patterns of UAS during ureteroscopy for nephrolithiasis among endourologists worldwide. Methods A 15-question survey was designed using the SurveyMonkey® platform. The questions covered the background and professional experience of the potential respondents, indications for UAS insertion, UAS caliber and possible complications associated with its use. The questions were anonymously tabulated in order to determine practice patterns of UAS during ureteroscopy for nephrolithiasis among endourologists. The survey was then distributed via e-mail to all the Endourological Society members. Results 216 members responded. 99.53% of the respondents practice as endourologists, 63.4% are fellowship trained and 74.4% are at least 6 years post-fellow. 73.2% practice in an academic facility. 77.3% perform at least 100 ureteroscopies annually. 46 and 76% routinely use UAS for the treatment of ureteral and kidney stones, respectively. In both cases, the 12/14 access sheath is the most common. 42% use UAS in primary ureteroscopy. 90.3% believe that a double J stent insertion is not mandatory prior to UAS insertion. 79.1% think the use of UAS does not increase postoperative complications rate, and if the latter does encounter, then most likely it is either a ureteral stricture (93.2%) or pain (48%). Conclusions UAS is commonly used by highly skilled endourologists during ureteroscopy. 12/14 UAS is mostly used. Ureteral stricture and post-operative pain are proposed as possible complications following UAS introduction, however pre-stenting is not mandatory as overall low complication rate is expected.
Collapse
Affiliation(s)
- Dorit Esther Zilberman
- Department of Urology , Chaim Sheba Medical Center, Affiliated to Sackler School of Medicine, Tel-Aviv University, Tel-Hashomer, Ramat-Gan, 52621, Tel-Aviv, Israel.
| | - Alon Lazarovich
- Department of Urology , Chaim Sheba Medical Center, Affiliated to Sackler School of Medicine, Tel-Aviv University, Tel-Hashomer, Ramat-Gan, 52621, Tel-Aviv, Israel
| | - Harry Winkler
- Department of Urology , Chaim Sheba Medical Center, Affiliated to Sackler School of Medicine, Tel-Aviv University, Tel-Hashomer, Ramat-Gan, 52621, Tel-Aviv, Israel
| | - Nir Kleinmann
- Department of Urology , Chaim Sheba Medical Center, Affiliated to Sackler School of Medicine, Tel-Aviv University, Tel-Hashomer, Ramat-Gan, 52621, Tel-Aviv, Israel
| |
Collapse
|
27
|
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.
Collapse
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
| |
Collapse
|
28
|
Yoshida T, Inoue T, Abe T, Matsuda T. Evaluation of Intrapelvic Pressure When Using Small-Sized Ureteral Access Sheaths of ≤10/12F in an Ex Vivo Porcine Kidney Model. J Endourol 2018; 32:1142-1147. [DOI: 10.1089/end.2018.0501] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Takashi Yoshida
- Department of Urology and Andrology, Kori Hospital, Kansai Medical University, Osaka, Japan
- Department of Urology and Andrology, Kansai Medical University, Osaka, Japan
| | - Takaaki Inoue
- Department of Urology and Andrology, Kansai Medical University, Osaka, Japan
| | - Taiji Abe
- Department of Nursing Unit, Kori Hospital, Kansai Medical University, Osaka, Japan
| | - Tadashi Matsuda
- Department of Urology and Andrology, Kansai Medical University, Osaka, Japan
| |
Collapse
|
29
|
Kaygısız O, Özmerdiven G, Günseren KÖ, Kılıçarslan H. Stent placement after flexible ureterorenoscopy for renal stones can improve stone-free rate on final follow-up: A retrospective single center study. ARCHIVES OF CLINICAL AND EXPERIMENTAL MEDICINE 2018. [DOI: 10.25000/acem.415835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
30
|
De Coninck V, Keller EX, Rodríguez-Monsalve M, Audouin M, Doizi S, Traxer O. Systematic review of ureteral access sheaths: facts and myths. BJU Int 2018; 122:959-969. [PMID: 29752769 DOI: 10.1111/bju.14389] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The aim of the present paper was to review the literature on all available ureteral access sheaths (UASs) with their indications, limitations, risks, advantages and disadvantages in current modern endourological practice. Two authors searched Medline, Scopus, Embase and Web of Science databases to identify studies on UASs published in English. No time period restriction was applied. All original articles reporting outcomes or innovations were included. Additional articles identified through references lists were also included. Case reports, editorials, letters, review articles and meeting abstracts were excluded. A total of 754 abstracts were screened, 176 original articles were assessed for eligibility and 83 articles were included in the review. Based on a low level of evidence, UASs increase irrigation flow during flexible ureteroscopy and decrease intrapelvic pressure and probably infectious complications. Data were controversial and sparse on the impact of UASs on multiple reinsertions and withdrawals of a ureteroscope, stone-free rates, ureteroscope protection or damage, postoperative pain, risk of ureteral strictures, and also on its cost-effectiveness. Studies on the benefit of UASs in paediatrics and in patients with a coagulopathy were inconclusive. In the absence of good randomized data, the true impact of UASs on surgery outcome remains unclear. The present review may contribute to the evidence-based decision-making process at the individual patient level regarding whether or not a UAS should be used.
Collapse
Affiliation(s)
- Vincent De Coninck
- Urology Department, Sorbonne University, Paris, France.,GRC no. 20, Urolithiasis Clinical Research Group, Assistance-Publique Hôpitaux de Paris, Tenon Hospital, Paris, France
| | - Etienne Xavier Keller
- Urology Department, Sorbonne University, Paris, France.,GRC no. 20, Urolithiasis Clinical Research Group, Assistance-Publique Hôpitaux de Paris, Tenon Hospital, Paris, France
| | - María Rodríguez-Monsalve
- Urology Department, Sorbonne University, Paris, France.,GRC no. 20, Urolithiasis Clinical Research Group, Assistance-Publique Hôpitaux de Paris, Tenon Hospital, Paris, France
| | - Marie Audouin
- Urology Department, Sorbonne University, Paris, France.,GRC no. 20, Urolithiasis Clinical Research Group, Assistance-Publique Hôpitaux de Paris, Tenon Hospital, Paris, France
| | - Steeve Doizi
- Urology Department, Sorbonne University, Paris, France.,GRC no. 20, Urolithiasis Clinical Research Group, Assistance-Publique Hôpitaux de Paris, Tenon Hospital, Paris, France
| | - Olivier Traxer
- Urology Department, Sorbonne University, Paris, France.,GRC no. 20, Urolithiasis Clinical Research Group, Assistance-Publique Hôpitaux de Paris, Tenon Hospital, Paris, France
| |
Collapse
|
31
|
Osther PJS. Risks of flexible ureterorenoscopy: pathophysiology and prevention. Urolithiasis 2017; 46:59-67. [PMID: 29151117 DOI: 10.1007/s00240-017-1018-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 11/11/2017] [Indexed: 11/26/2022]
Abstract
Currently, indications for flexible ureterorenoscopy (fURS) are expanding, mainly due to technological advancements. Although data from clinical series definitely presents fURS as a safe procedure, serious complications including sepsis and ureteral lesions do occur. These complications seem to be a result of the unique elements of fURS, ureteral access and irrigation, pushing normal upper urinary tract physiology into pathophysiological processes, including intrarenal/pyelo-veneous backflow and ureteral contractions, potentially resulting in septic, haemorrhagic and ureteral lesional complications. Knowledge on normal upper urinary tract physiology are crucial for understanding how these harmful effects of fURS may be avoided or minimized. The pathophysiology of intrarenal pressure increases and ureteral access will be discussed as a basis for understanding preventive measures. Role of antibiotics, ureteral access sheaths, safty guidewires, pain medication, prestenting and pharmacologic modulation of pyeloureteral dynamics are reviewed from a pathophysiological perspective.
Collapse
Affiliation(s)
- Palle J S Osther
- Urological Research Center, Department of Urology, Lillebaelt Hospital, Beridderbakken 4, 7100, Vejle, Denmark.
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Vejle, Denmark.
| |
Collapse
|
32
|
ŞAHİNKANAT T, EKERBİÇER HÇ. 30 mm’den Küçük Renal Pelvis Taşlarının Üreteroskopik Tedavisi. KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNIVERSITESI TIP FAKÜLTESI DERGISI 2017. [DOI: 10.17517/ksutfd.302093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
|
33
|
Pharmacological Relaxation of the Ureter When Using Ureteral Access Sheaths during Ureterorenoscopy: A Randomized Feasibility Study in a Porcine Model. Adv Urol 2016; 2016:8064648. [PMID: 27840637 PMCID: PMC5093247 DOI: 10.1155/2016/8064648] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Accepted: 10/04/2016] [Indexed: 11/17/2022] Open
Abstract
Objective. High intraluminal pressure during ureterorenoscopy (URS) increases risk of infectious and haemorrhagic complications. Intrarenal pressure may be reduced by the use of ureteral access sheaths (UASs), which on the other hand may cause ureteral damage. We have previously shown that the β-agonist isoproterenol (ISO), when administered topically in the irrigation fluid, is able to inhibit ureteral muscle tone and lower intrarenal pressure during URS. The aim of this study was to examine the effect of ISO on the success rate of UAS insertion in a porcine model. Materials and Methods. 22 pigs in which a UAS could not initially be placed were randomized to endoluminal irrigation with either ISO (0.1 μg/mL) or saline before a new insertion trial. Subsequently, it was registered whether the UAS could be passed without resistance. During extraction of the sheath, any ureteral lesions were characterized ureteroscopically using the PULS classification system. Surgeons were blinded to randomization. Results. In the ISO group, the observed effect of irrigation was 63% successful UAS insertions, compared to 27% in the saline group. No serious lesions (<PULS grade 2) were observed in the ISO group. Conclusions. Endoluminal irrigation with ISO may facilitate UAS insertion and potentially decrease UAS related ureteral lesions.
Collapse
|
34
|
Abstract
PURPOSE OF REVIEW Indications for ureterorenoscopy are expanding without hard scientific evidence to support its efficacy. Therefore, it is extremely important to focus on potential harmful effects of the procedure itself. This review explores how physiology of the upper urinary tract reacts to ureterorenoscopy, potentially translating into harmful effects, and how such pathophysiological processes may be minimized. RECENT FINDINGS Complications to ureterorenoscopy and postoperative pain seem to be related to intrarenal pressure and/or access. Mean intrarenal pressures in the range of 60-100 mmHg during ureterorenoscopy without access sheaths have been measured, thus by far exceeding the threshold for intrarenal backflow, potentially resulting in septic complications. Intrarenal pressure may be reduced by use of ureteral access sheaths, which, however, may cause ureteral damage due to the limited size of the ureter and strain-induced ureteral contractions (peristalsis). Different receptor types modulate this peristaltic activity. β-receptor agonists have been investigated in animal and human trials for the purpose of relaxing the ureter. In randomized, placebo-controlled trials in pigs and humans, usage of the β-receptor agonist isoproterenol in the irrigation fluid has shown a potential for reducing both intrarenal pressure and ureteral tone during ureterorenoscopy. SUMMARY Upper urinary tract physiology has unique features that may be pushed into pathophysiological processes by the unique elements of ureterorenoscopy: access and irrigation. Pharmacological ureteral relaxation during ureterorenoscopy deserves further attention with regard to reducing complications and postoperative pain.
Collapse
|
35
|
Abstract
PURPOSE OF REVIEW Ureteral access sheath (UAS) became increasingly popular worldwide. However, the safety of its routine use remains controversial. The aim of the current revision is to provide a systematic review on the benefits and disadvantages of the UAS. RECENT FINDINGS A systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. Two reviewers independently searched the literature, finally identifying 20 articles valuable for this review. The use of UAS demonstrated several advantages to facilitate retrograde intrarenal access, lower intrarenal pressure, protect the ureter, protect the scope, and expedite stone extraction. Despite this, there is also some evidence that UAS use may be associated with acute ureteral injury and long-term complications, apparently related to maneuvers for UAS insertion and mucosal or deeper layers of injury and ischemia. Furthermore, there are still pending questions on the possible increase in stone-free rates, and decrease in operative time and costs. SUMMARY Although the use of UAS is associated with some risk and limiting factors, it appears from this systematic review that its use is common and safe for the retrograde intrarenal access. Therefore, UAS is highly recommended for the treatment of upper tract disease by means of retrograde intrarenal surgery.
Collapse
|
36
|
Manzo BO, Bertacchi M, Lozada E, Rasguido A, Aleman E, Cabrera M, Rodríguez A, Manzo G, Sánchez H, Blasco J. Current practice in Latin America of flexible ureterorenoscopy with laser for treating kidney stones. Actas Urol Esp 2016; 40:229-36. [PMID: 26672677 DOI: 10.1016/j.acuro.2015.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 11/02/2015] [Accepted: 11/02/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The use of flexible ureterorenoscopy for treating kidney stones has increased in recent years, with considerable worldwide variation in the surgical technique and indications. OBJECTIVES To determine the current practice, technique variations, use and indications of flexible ureterorenoscopy for treating kidney stones in Latin American. METHODS We sent (by email and web link) an anonymous questionnaire with 30 questions on flexible ureterorenoscopy for treating kidney stones to Latin American urologists from January 2015 to July 2015. We collected the responses through the Survey Monkey system. RESULTS A total of 283 urologists in 15 Latin American countries participated (response rate, 10.8%); 254 answered the questionnaire completely; 52.8% were urologists from Mexico and 11% were from Argentina; 11.8% of the responders stated that they performed >100 cases per year; 15.2% considered ureterorenoscopy as the treatment of choice for stones >2cm, and 19.6% performed ureterorenoscopy in single stages for calculi measuring >2.5cm. Some 78.4% use fluoroscopy, 69.1% use a ureteral sheath in all cases, 55.8% place double-J catheters at the end of surgery, 37.3% considered a stone-free state to be 0 fragments, and 41.2% use plain radiography to assess the stone-free condition. CONCLUSIONS Most participating urologists consider flexible ureterorenoscopy as the first-choice treatment for stones <2cm; a small percentage of these urologists perform >100 ureterorenoscopies per year. More than half of the urologists routinely used fluoroscopy and ureteral access sheath; the most common method for determining the stone-free state is plain abdominal radiography.
Collapse
Affiliation(s)
- B O Manzo
- Hospital Regional de Alta Especialidad del Bajío, León Gto, México.
| | - M Bertacchi
- Servicio de Urología, Central de las Fuerzas Armadas, Montevideo, Uruguay
| | - E Lozada
- Hospital Regional de Alta Especialidad del Bajío, León Gto, México
| | - A Rasguido
- Centro Urológico Dr. Ricardo Rasguido, Tucumán, Argentina
| | - E Aleman
- Sociedad Panameña de Urología, Panamá, Panamá
| | - M Cabrera
- Hospital Universitario de la Samaritana-Universidad del Rosario, Bogota, Colombia
| | - A Rodríguez
- Centro Urológico del Cibao, Santiago, República Dominicana
| | - G Manzo
- Hospital Regional de Alta Especialidad del Bajío, León Gto, México
| | - H Sánchez
- Hospital Regional de Alta Especialidad del Bajío, León Gto, México
| | - J Blasco
- Central del Instituto de Previsión Social H.C.I.P.S, Asunción, Paraguay
| |
Collapse
|
37
|
Karabulut I, Keskin E, Bedir F, Yilmazel FK, Ziypak T, Doluoglu OG, Resorlu B, Germiyanoglu C. Rigid Ureteroscope Aided Insertion of Ureteral Access Sheath in Retrograde Intrarenal Surgery. Urology 2016; 91:222-5. [DOI: 10.1016/j.urology.2016.02.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 01/24/2016] [Accepted: 02/08/2016] [Indexed: 10/22/2022]
|
38
|
Liao W, Xiong Y, Yang S, Song C, Liu L, Meng L. Efficacy and functional outcome of flexible ureteroscopy for renal stones in patients with a solitary kidney. SURGICAL PRACTICE 2016. [DOI: 10.1111/1744-1633.12155] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Wenbiao Liao
- Department of Urology; Renmin Hospital of Wuhan University; Wuhan China
| | - Yunhe Xiong
- Department of Urology; Renmin Hospital of Wuhan University; Wuhan China
| | - Sixing Yang
- Department of Urology; Renmin Hospital of Wuhan University; Wuhan China
| | - Chao Song
- Department of Urology; Renmin Hospital of Wuhan University; Wuhan China
| | - Lingqi Liu
- Department of Urology; Renmin Hospital of Wuhan University; Wuhan China
| | - Lingchao Meng
- Department of Urology; Renmin Hospital of Wuhan University; Wuhan China
| |
Collapse
|
39
|
Cho SY, Jeong H, Cho MC, Park J, Son H. Current status of minimally invasive surgery for treatment of renal stones and tumors using a flexible ureteroscopy. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2016. [DOI: 10.5124/jkma.2016.59.6.459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Sung Yong Cho
- Department of Urology, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Hyeon Jeong
- Department of Urology, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Min Chul Cho
- Department of Urology, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Juhyun Park
- Department of Urology, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Hwancheol Son
- Department of Urology, SMG-SNU Boramae Medical Center, Seoul, Korea
| |
Collapse
|
40
|
Kaplan AG, Lipkin ME, Scales CD, Preminger GM. Use of ureteral access sheaths in ureteroscopy. Nat Rev Urol 2015; 13:135-40. [PMID: 26597613 DOI: 10.1038/nrurol.2015.271] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The ureteral access sheath (UAS) facilitates the use of flexible ureteroscopy, enabling improved minimally invasive management of complex upper urinary tract diseases. The UAS, which comes in a variety of diameters and lengths, is passed in a retrograde fashion, aided by a hydrophilic coating and other features designed to confer smooth passage into the ureter with sufficient resistance to kinking and buckling. Use of a UAS has the advantage of enabling repeated passage of the ureteroscope while minimizing damage to the ureter, thus improving the flow of irrigation fluid and visualization within the urethra with reductions in operative times, which improves both the effectiveness of the surgery and reduces the costs. Placement of the UAS carries an increased risk of ureteral wall ischaemia and injury to the mucosal or muscular layers of the ureter, and a theoretically increased risk of ureteral strictures. A ureteral stent is typically placed after ureteroscopy with a UAS. Endourologists have found several additional practical uses of a UAS, such as the percutaneous treatment of patients with ureteral stones, and solutions to other endourological challenges.
Collapse
Affiliation(s)
- Adam G Kaplan
- Comprehensive Kidney Stone Center at Duke University Medical Center, Duke University, DUMC Box 3167, Durham, North Carolina 27710, USA
| | - Michael E Lipkin
- Comprehensive Kidney Stone Center at Duke University Medical Center, Duke University, DUMC Box 3167, Durham, North Carolina 27710, USA
| | - Charles D Scales
- Comprehensive Kidney Stone Center at Duke University Medical Center, Duke University, DUMC Box 3167, Durham, North Carolina 27710, USA
| | - Glenn M Preminger
- Comprehensive Kidney Stone Center at Duke University Medical Center, Duke University, DUMC Box 3167, Durham, North Carolina 27710, USA
| |
Collapse
|
41
|
Viers BR, Viers LD, Hull NC, Hanson TJ, Mehta RA, Bergstralh EJ, Vrtiska TJ, Krambeck AE. The Difficult Ureter: Clinical and Radiographic Characteristics Associated With Upper Urinary Tract Access at the Time of Ureteroscopic Stone Treatment. Urology 2015; 86:878-84. [DOI: 10.1016/j.urology.2015.08.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 08/10/2015] [Accepted: 08/10/2015] [Indexed: 11/28/2022]
|
42
|
Cho SY. Current status of flexible ureteroscopy in urology. Korean J Urol 2015; 56:680-8. [PMID: 26495068 PMCID: PMC4610894 DOI: 10.4111/kju.2015.56.10.680] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 08/21/2015] [Indexed: 12/23/2022] Open
Abstract
Retrograde intrarenal surgery (RIRS) is being performed for the surgical management of upper urinary tract pathology. With the development of surgical instruments with improved deflection mechanisms, visuality, and durability, the role of RIRS has expanded to the treatment of urinary calculi located in the upper urinary tract, which compensates for the shortcomings of shock wave lithotripsy and percutaneous nephrolithotomy. RIRS can be considered a conservative treatment of upper urinary tract urothelial cancer (UTUC) or for postoperative surveillance after radical treatment of UTUC under an intensive surveillance program. RIRS has a steep learning curve and various surgical techniques can be used. The choice of instruments during RIRS should be based on increased surgical efficiency, decreased complications, and improved cost-benefit ratio.
Collapse
Affiliation(s)
- Sung Yong Cho
- Department of Urology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| |
Collapse
|
43
|
Breda A, Emiliani E, Millán F, Scoffone CM, Knoll T, Osther PJS, Liatsikos E. The new concept of ureteral access sheath with guidewire disengagement: One wire does it all. World J Urol 2015; 34:603-6. [PMID: 26245745 DOI: 10.1007/s00345-015-1638-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Accepted: 07/07/2015] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To prospectively evaluate the new Flexor©Parallel™ Rapid Release™ (Cook(®), Bloomington, IN, USA) access sheath (UAS) which allows the use of a single wire to serve as both safety and working guide. MATERIALS AND METHODS Between June and September 2014, adult patients from five European centers who underwent flexible ureteroscopy (fURS) for therapeutic and diagnostic purposes were included. The 12/14Fr Flexor©Parallel™ UAS was evaluated. Data were collected and examined by both univariate and multivariate analyses. The UAS material and usage characteristics were rated per case by the surgeons on a scale from very bad to very good. RESULTS In total, 134 UASs were used in 67 male and 67 female patients. Fifty percent of ureters (67 patients) were pre-stented. Ninety percent of the procedures were therapeutic. The overall successful insertion rate was 94 %. Pre-stenting status was the only independent factor for a successful access sheath insertion: 98.5 % of the pre-stented patients had a successful UAS placement vs. 82 % of non-pre-stented (p = 0.001, C.I. 95 %: 1.2). Evaluation of the material and radiopacity was considered very good in over 90 % of cases. Release of the guidewire, hydrophilic coating, gliding of the endoscope and repeatability were considered very good in over 80 %. There were two (1.4 %) UAS malfunctions and one submucosal lesion reported. CONCLUSIONS The use of the Flexor©Parallel™ Rapid Release™ (Cook(®), Bloomington, IN, USA) with usage of a single guidewire in a prospective multicentric scenario was clinically applicable in the majority of cases. Pre-stenting increased the chance of a successful insertion from 82 to 98.5 %.
Collapse
Affiliation(s)
- Alberto Breda
- Department of Urology, Fundació Puigvert, Universitat Autonoma de Barcelona, Barcelona, Spain.
| | - Esteban Emiliani
- Department of Urology, Fundació Puigvert, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Felix Millán
- Department of Urology, Fundació Puigvert, Universitat Autonoma de Barcelona, Barcelona, Spain
| | | | - Thomas Knoll
- Department of Urology, Klinikum Sindelfingen, University of Tübingen, Tübingen, Germany
| | - Palle J S Osther
- Department of Urology, Lillebaelt Hospital, University of Southern Denmark, Fredericia, Denmark
| | | |
Collapse
|
44
|
Peng Y, Xu B, Zhang W, Li L, Liu M, Gao X, Sun Y. Retrograde intrarenal surgery for the treatment of renal stones: is fluoroscopy-free technique achievable? Urolithiasis 2015; 43:265-70. [PMID: 25749889 DOI: 10.1007/s00240-015-0760-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Accepted: 02/18/2015] [Indexed: 11/24/2022]
Abstract
The aim of this study was to present the safety and efficacy of retrograde intrarenal surgery (RIRS) procedures that minimize the intraoperative radiation exposure. The totally endoscopy-guided RIRS technique included the following steps: (a) preoperative assessment of pelvicaliceal system anatomy and stone characteristics, (b) thorough evaluation of the ureters by rigid ureteroscopy, (c) a step-wise approach of introducing the ureteral sheath, (d) gathering stones in the more accessible renal calyx before fragmenting them, and (e) a modified holmium laser technique. The RIRS procedures performed by a single surgeon between October 2012 and October 2013 in consecutive patients with renal stones were retrospectively reviewed. The mean stone size was 1.4 ± 0.4 (range 0.8-2.0) cm. The median operative time was 74.5 min. Fluoroscopy was only used in one patient who had a double collecting system with two ureters. The stone-free status was achieved in 134 (95.7%) patients one month after surgery. Five (3.6%) patients had minor complications, including hematuria and fever. No major intraoperative complication was observed. We believe that with appropriate preparation, RIRS without fluoroscopic guidance can be safely and efficiently performed by experienced urologists in selected patients with renal stones.
Collapse
Affiliation(s)
- Yonghan Peng
- Department of Urology, Changhai Hospital, The Second Military Medical University, No.168 Changhai Road, Shanghai, 200433, People's Republic of China
| | | | | | | | | | | | | |
Collapse
|