1
|
Huang X, He X, Zhai Q, Song L, Du C, Deng X. Ureteroscopic lithotripsy with pressure-measuring ureteral access sheath for large ureteral stones. MINIM INVASIV THER 2024; 33:157-162. [PMID: 38258834 DOI: 10.1080/13645706.2024.2306813] [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: 10/30/2023] [Accepted: 12/30/2023] [Indexed: 01/24/2024]
Abstract
INTRODUCTION To evaluate the safety and efficacy of ureteroscopic lithotripsy with pressure-measuring ureteral access sheath (PM-UAS) for large ureteral stones. MATERIAL AND METHODS A total of 258 consecutive patients with large ureteral stones ≥15 mm was enrolled. They were treated by ureteroscopic lithotripsy with PM-UAS in the oblique supine lithotomy position. The technology can precisely monitor and automatically control cavity pressure. The cavity pressure control value was set at -15 mmHg∼-5 mmHg. The cavity pressure limit value was set at 30 mmHg. Infusion flow rate was set at 100-200 ml/min. Postoperative data such as stone-free rate and complications were analyzed. RESULTS PM-UAS was successfully implanted in 225 patients at one stage. Eighteen cases of patients who had failed the first surgery were successfully treated with a second operation. Fifty-one cases with stones migrating up to the kidney were converted to flexible lithotripsy. The other 15 cases were converted to percutaneous nephrolithotomy due to significant ureteral stenosis. The operative time was 49.5 ± 11.2 min. The stone-free rates after one month and three months were 87.2% (212/243) and 94.2% (229/243), respectively. Complications from grade I to II were observed in 25(10.3%) patients. No other complications from grade III to V were noted. CONCLUSION The ureteroscopic lithotripsy with PM-UAS is safe and efficacious for large ureteral stones.
Collapse
Affiliation(s)
- Xin Huang
- Department of Urology, Ganzhou People's Hospital, Ganzhou, Jiangxi, China
| | - Xiaolong He
- Department of Urology, Ganzhou People's Hospital, Ganzhou, Jiangxi, China
| | - Qiliang Zhai
- Department of Urology, Ganzhou People's Hospital, Ganzhou, Jiangxi, China
| | - Leming Song
- Department of Urology, Ganzhou People's Hospital, Ganzhou, Jiangxi, China
| | - Chuance Du
- Department of Urology, Ganzhou People's Hospital, Ganzhou, Jiangxi, China
| | - Xiaolin Deng
- Department of Urology, Ganzhou People's Hospital, Ganzhou, Jiangxi, China
| |
Collapse
|
2
|
Yuming Z, Lei Y, Qiliang Z, Xin H, Jin K, Song L, Xiaolin D. Rigid ureteroscopic lithotripsy with a pressure-controlling ureteral access sheath for complex steinstrasse. BMC Urol 2024; 24:112. [PMID: 38807114 PMCID: PMC11131169 DOI: 10.1186/s12894-024-01501-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 05/20/2024] [Indexed: 05/30/2024] Open
Abstract
OBJECTIVE To evaluate the safety and efficacy of rigid ureteroscopic lithotripsy with a pressure-controlling ureteral access sheath (PC-UAS) for complex steinstrasse. METHODS Thirty-one consecutive patients (male: 18; female: 13) with steinstrasse were enrolled, six of whom had concurrent kidney stones. The mean cumulative stone size was 2.7 ± 1.3 cm. The patients were treated with rigid ureteroscopic lithotripsy using a PC-UAS. The cavity pressure parameters were set as follows: control value at -15 mmHg to -2 mmHg, warning value at 20 mmHg, and limit value at 30 mmHg. The infusion flow rate was set at 150-200 ml/min. A holmium laser (550 μm) was used to powderize the stone at 2.0-2.5 J/pulse with a frequency of 20-30 pulses/s. Analyses included cavity pressure, operative time, stone-free rates, and complications. RESULTS Among the 31 patients, 29 were successfully treated with PC-UAS, with nine requiring adjunctive flexible ureteroscopy for stone migration to the kidney. Two procedures were converted to percutaneous nephrolithotomies due to failure of sheath placement. The cavity pressure of all 29 patients was well-maintained below 20 mmHg, with clear vision. The mean operative time was 48.2 ± 17.7 min. No complications, such as ureteral perforation, mucosal avulsion, or hemorrhage, occurred. Two cases of Clavien-Dindo grade I complications occurred. No major complications (Clavien-Dindo grade II-V) occurred. The mean postoperative hospitalization time was 1.7 days. The stone-free rates 1 day and 1 month after surgery were 93.1% and 96.6%, respectively. One patient with residual stones underwent extracorporeal shockwaves. CONCLUSIONS Rigid ureteroscopic lithotripsy with PC-UAS can effectively control the cavity pressure, shorten the operation time, and improve the efficiency of broken stones, thus reducing the complication rate.
Collapse
Affiliation(s)
- Zhong Yuming
- Department of Urology, Ganzhou People's Hospital, 17 Hongqi Avenue, Ganzhou, 341000, Jiangxi, China
| | - Yao Lei
- Department of Urology, Ganzhou People's Hospital, 17 Hongqi Avenue, Ganzhou, 341000, Jiangxi, China
| | - Zhai Qiliang
- Department of Urology, Ganzhou People's Hospital, 17 Hongqi Avenue, Ganzhou, 341000, Jiangxi, China
| | - Huang Xin
- Department of Urology, Ganzhou People's Hospital, 17 Hongqi Avenue, Ganzhou, 341000, Jiangxi, China
| | - Kuang Jin
- Department of Urology, Ganzhou People's Hospital, 17 Hongqi Avenue, Ganzhou, 341000, Jiangxi, China
| | - Leming Song
- Department of Urology, Ganzhou People's Hospital, 17 Hongqi Avenue, Ganzhou, 341000, Jiangxi, China
| | - Deng Xiaolin
- Department of Urology, Ganzhou People's Hospital, 17 Hongqi Avenue, Ganzhou, 341000, Jiangxi, China.
| |
Collapse
|
3
|
Deng X, Chen Y, Zhai Q, Song L, Du C, Tan W. Fluid absorption during flexible ureteroscopy with intelligent control of renal pelvic pressure: a randomized controlled trial. World J Urol 2024; 42:331. [PMID: 38758400 DOI: 10.1007/s00345-024-05036-8] [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: 11/26/2023] [Accepted: 05/08/2024] [Indexed: 05/18/2024] Open
Abstract
PURPOSE To investigate fluid absorption and its influencing factors during flexible ureteroscopy with intelligent control of renal pelvic pressure (RPP). METHODS A total of 80 patients with upper urinary tract calculi underwent flexible ureteroscopy with intelligent control of RPP by pressure-measuring ureteral access sheath and were randomly divided into four groups. The RPP of Groups A, B, and C were set at - 5, 0 and 5 mmHg, respectively. Conventional flexible ureteroscopy with uncontrolled pressure served as control Group D. The perfusion flow rate was set at 100 ml/min in the four groups, with 20 patients in each group. The fluid absorption was measured by 1% ethanol every 10 min. Operation time, stone-free rate, and complications were recorded. RESULT Seventy-three patients were finally included in the RCT. The general and preoperative data of the patients were comparable between the groups. The fluid absorption of Groups A, B, and C was significantly less than that of Group D (P < 0.01). Fluid absorption and operation time were positively correlated, and the correlation coefficients R were 0.864, 0.896, 0.918, and 0.947, respectively (P < 0.01). The fluid absorption of patients with vomiting, fever and ureteral injury was greater than that of patients without complications in the four groups (P < 0.01). In different groups, fluid absorption was greater in patients with ureteral injury Post-Ureteroscopic Lesion Scale (PULS) 1-3 than in noninjured patients (P < 0.01). CONCLUSION Flexible ureteroscopy with intelligent control of RPP effectively reduces the absorption of perfusion fluid. Operation time and ureteral injury are also key factors affecting perfusion fluid absorption. REGISTRATION NUMBER AND DATE NCT05201599; August 11, 2021.
Collapse
Affiliation(s)
- Xiaolin Deng
- Department of Urology, Ganzhou Hospital-Nanfang Hospital, Southern Medical University, 17 Hongqi Avenue, Ganzhou City, 341000, Jiangxi Province, People's Republic of China
- Jiangxi Inventor Technology Company Limited, Jiangxi, China
| | - Yijian Chen
- Department of Urology, Ganzhou Hospital-Nanfang Hospital, Southern Medical University, 17 Hongqi Avenue, Ganzhou City, 341000, Jiangxi Province, People's Republic of China
| | - Qiliang Zhai
- Department of Urology, Ganzhou Hospital-Nanfang Hospital, Southern Medical University, 17 Hongqi Avenue, Ganzhou City, 341000, Jiangxi Province, People's Republic of China
| | - Leming Song
- Department of Urology, Ganzhou Hospital-Nanfang Hospital, Southern Medical University, 17 Hongqi Avenue, Ganzhou City, 341000, Jiangxi Province, People's Republic of China
- Jiangxi Inventor Technology Company Limited, Jiangxi, China
| | - Chuance Du
- Department of Urology, Ganzhou Hospital-Nanfang Hospital, Southern Medical University, 17 Hongqi Avenue, Ganzhou City, 341000, Jiangxi Province, People's Republic of China
| | - Wanlong Tan
- Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, Guangdong, China.
| |
Collapse
|
4
|
Yuen SKK, Traxer O, Wroclawski ML, Gadzhiev N, Chai CA, Lim EJ, Giulioni C, De Stefano V, Nedbal C, Maggi M, Sarica K, Castellani D, Somani B, Gauhar V. Scoping Review of Experimental and Clinical Evidence and Its Influence on Development of the Suction Ureteral Access Sheath. Diagnostics (Basel) 2024; 14:1034. [PMID: 38786332 PMCID: PMC11120421 DOI: 10.3390/diagnostics14101034] [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: 04/24/2024] [Revised: 05/10/2024] [Accepted: 05/13/2024] [Indexed: 05/25/2024] Open
Abstract
The ureteral access sheath (UAS) has been a boon and a bane in flexible ureteroscopy (FURS), with its merits and demerits well established. Its design and dimensions were instrumental in reshaping the way flexible scopes were used and were key adjuncts to establishing retrograde intrarenal surgery (RIRS) as a standard of care in the endourological management of renal stones. With the ever-changing landscape of RIRS over the decades shaped by technological advancements in lasers and flexible scopes, the UAS has also continuously evolved. The utility of suction in endourology has recently changed the way RIRS is performed and is a game changer for FURS outcomes. With strong clinical and experimental evidence to support its use, the UAS has undergone a transformative change in the recent past, with its ability to monitor intrarenal pressure and provide a superior vacuum-cleaner effect that improves the trifecta of RIRS, namely an improved single-stage stone-free rate (SFR), minimise complications, and reduce reinterventions. Our comprehensive review outlines the key clinical and experimental evidence and traces the developments that were key to modifying the traditional UAS into a flexible and navigable suction ureteric access sheath (FANS) and highlights how the design and modifications, in turn, influence the ability to push the boundaries of RIRS.
Collapse
Affiliation(s)
- Steffi Kar Kei Yuen
- SH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Olivier Traxer
- Department of Urology AP-HP, Sorbonne University, Tenon Hospital, 75020 Paris, France;
| | - Marcelo Langer Wroclawski
- Hospital Israelita Albert Einstein, São Paulo 05652-900, Brazil;
- BP—A Beneficência Portuguesa de São Paulo, São Paulo 01451-010, Brazil
| | - Nariman Gadzhiev
- Urology Department, Saint-Petersburg State University Hospital, 197342 St. Petersburg, Russia;
| | - Chu Ann Chai
- Urology Unit, Surgery Department, University Malaya Medical Center, Petaling Jaya 50603, Malaysia;
| | - Ee Jean Lim
- Department of Urology, Singapore General Hospital, Singapore 169608, Singapore;
| | - Carlo Giulioni
- Department of Urology, Casa di Cura Villa Igea, 60127 Ancona, Italy;
| | - Virgilio De Stefano
- Urology Unit, Azienda Ospedaliero Universitaria delle Marche, 60121 Ancona, Italy; (V.D.S.); (C.N.); (D.C.)
| | - Carlotta Nedbal
- Urology Unit, Azienda Ospedaliero Universitaria delle Marche, 60121 Ancona, Italy; (V.D.S.); (C.N.); (D.C.)
- Urology Unit, ASST Fatebenefratelli Sacco, 20131 Milano, Italy
| | - Martina Maggi
- Department of Maternal Infant and Urological Sciences, Sapienza University of Rome, 00185 Rome, Italy;
| | - Kemal Sarica
- Department of Urology, Biruni University, 34015 Istanbul, Turkey;
| | - Daniele Castellani
- Urology Unit, Azienda Ospedaliero Universitaria delle Marche, 60121 Ancona, Italy; (V.D.S.); (C.N.); (D.C.)
| | - Bhaskar Somani
- Department of Urology, University Hospitals Southampton, NHS Trust, Southampton SO16 6YD, UK;
| | - Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital, Singapore 126817, Singapore
| |
Collapse
|
5
|
Geavlete P, Multescu R, Mares C, Buzescu B, Iordache V, Geavlete B. Retrograde Intrarenal Surgery for Lithiasis Using Suctioning Devices: A Shift in Paradigm? J Clin Med 2024; 13:2493. [PMID: 38731026 PMCID: PMC11084153 DOI: 10.3390/jcm13092493] [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: 03/03/2024] [Revised: 04/12/2024] [Accepted: 04/20/2024] [Indexed: 05/13/2024] Open
Abstract
New suction endoscopes, ureteral access sheaths (UAS) and catheters aim to improve the efficacy of flexible ureteroscopy and optimize its safety. Suction UAS with non-flexible tips have shown promising results, especially in maintaining low intrarenal pressure, but also in removing small debris and reducing the "snow globe" effect. In addition, suctioning UAS with a flexible tip offers the advantage of being able to be navigated through the pyelocaliceal system to where the laser lithotripsy is performed. It can also remove small stone fragments when the flexible ureteroscope is retracted, using the Venturi effect. Direct in-scope suction (DISS) involves aspirating dust and small stone debris through the working channel of a flexible ureteroscope, thus regulating intrarenal pressure and improving visibility. Steerable aspiration catheters are other devices designed to increase stone clearance of the pyelocaliceal system. They are inserted under fluoroscopic guidance into every calyx after retraction of the flexible ureteroscope, alternating irrigation and aspiration to remove dust and small gravels. Combining flexible-tip suction UAS and the DISS technique may offer some advantages worth evaluating. The advantage of using these instruments to achieve a low intrarenal pressure was demonstrated. The true practical impact on the long-term stone-free status is a matter requiring further studies.
Collapse
Affiliation(s)
- Petrisor Geavlete
- Department of Urology, “Saint John” Emergency Clinical Hospital, 042122 Bucharest, Romania; (P.G.); (V.I.); (B.G.)
- Faculty of General Medicine, University of Medicine and Pharmacy, ‘Carol Davila’ Bucharest, 050474 Bucharest, Romania
| | - Razvan Multescu
- Department of Urology, “Saint John” Emergency Clinical Hospital, 042122 Bucharest, Romania; (P.G.); (V.I.); (B.G.)
| | - Cristian Mares
- Department of Urology, “Saint John” Emergency Clinical Hospital, 042122 Bucharest, Romania; (P.G.); (V.I.); (B.G.)
- Faculty of General Medicine, University of Medicine and Pharmacy, ‘Carol Davila’ Bucharest, 050474 Bucharest, Romania
| | - Bogdan Buzescu
- Department of Urology, “Saint John” Emergency Clinical Hospital, 042122 Bucharest, Romania; (P.G.); (V.I.); (B.G.)
- Faculty of General Medicine, University of Medicine and Pharmacy, ‘Carol Davila’ Bucharest, 050474 Bucharest, Romania
| | - Valentin Iordache
- Department of Urology, “Saint John” Emergency Clinical Hospital, 042122 Bucharest, Romania; (P.G.); (V.I.); (B.G.)
| | - Bogdan Geavlete
- Department of Urology, “Saint John” Emergency Clinical Hospital, 042122 Bucharest, Romania; (P.G.); (V.I.); (B.G.)
- Faculty of General Medicine, University of Medicine and Pharmacy, ‘Carol Davila’ Bucharest, 050474 Bucharest, Romania
| |
Collapse
|
6
|
Wang L, Zhou Z, Gao P, Yang Y, Ding Q, Wu Z. Comparison of traditional and suctioning ureteral access sheath during retrograde intrarenal surgery in the treatment of renal calculi. Langenbecks Arch Surg 2024; 409:81. [PMID: 38430305 DOI: 10.1007/s00423-024-03275-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 02/27/2024] [Indexed: 03/03/2024]
Abstract
PURPOSE This study aims to compare the efficiency and clinical outcomes between the suctioning ureteral access sheath (UAS) group and the traditional UAS group during retrograde intrarenal surgery (RIRS) for kidney stones and explore the impact of suctioning UAS on postoperative infectious complications. METHODS We retrospectively reviewed the clinical data of 162 patients with kidney stones who underwent RIRS with a traditional UAS (n = 74) or a suctioning UAS (n = 71) between March 2021 and May 2023. RESULTS The mean operative time in suctioning UAS group (39.03 ± 18.01 s) was significantly shorter than that (49.73 ± 20.77 s) in the traditional UAS group (P = 0.037). The mean postoperative hospital stay was significantly shorter in the suctioning UAS group (1.57 ± 0.82d) compared with the traditional UAS group (2.30 ± 1.6 2 d) (P = 0.032). The instant SFRs were significantly higher in the suctioning UAS group (88.73%) than in the traditional UAS group (75.68%) (P = 0.040). The overall SFR in suctioning UAS group (92.96%) was slightly higher than the traditional UAS group (85.14%). The incidence of overall complications was significantly higher in the traditional UAS group (35.14%) than in the suctioning UAS group (16.90%) (P = 0.013). In multivariate analysis, female patients (OR 0.053, P = 0.018), positive urine WBC (OR 10.382, P = 0.034), operative time > 60 min (OR 20.231, P = 0.032), and the application of traditional UAS (OR 0.042, P = 0.017) were independent risk factors associated with infectious complications. CONCLUSION We demonstrated that suctioning UAS provided a higher instant SFR and fewer postoperative infectious complications during RIRS, and patients with predictable risk factors for infectious complications could potentially benefit from the use of the suctioning UAS.
Collapse
Affiliation(s)
- Lujia Wang
- Department of Urology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Rd, Shanghai, 200040, People's Republic of China
- Clinical Research Center of Urolithiasis, Shanghai Medical College, Fudan University, Shanghai, 200040, People's Republic of China
| | - Zijian Zhou
- Department of Urology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Rd, Shanghai, 200040, People's Republic of China
- Clinical Research Center of Urolithiasis, Shanghai Medical College, Fudan University, Shanghai, 200040, People's Republic of China
| | - Peng Gao
- Department of Urology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Rd, Shanghai, 200040, People's Republic of China
- Clinical Research Center of Urolithiasis, Shanghai Medical College, Fudan University, Shanghai, 200040, People's Republic of China
| | - Yuanyuan Yang
- Department of Urology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Rd, Shanghai, 200040, People's Republic of China
- Clinical Research Center of Urolithiasis, Shanghai Medical College, Fudan University, Shanghai, 200040, People's Republic of China
| | - Qiang Ding
- Department of Urology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Rd, Shanghai, 200040, People's Republic of China
- Clinical Research Center of Urolithiasis, Shanghai Medical College, Fudan University, Shanghai, 200040, People's Republic of China
| | - Zhong Wu
- Department of Urology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Rd, Shanghai, 200040, People's Republic of China.
- Clinical Research Center of Urolithiasis, Shanghai Medical College, Fudan University, Shanghai, 200040, People's Republic of China.
| |
Collapse
|
7
|
Cui D, Ma Q, Xie S, Wang G, Li G, Chen G. Comparison of the effectiveness of two adjustable negative pressure ureteral access sheaths combined with flex ureteroscopy for ≤ 2 cm renal stones. Sci Rep 2024; 14:4745. [PMID: 38413652 PMCID: PMC10899199 DOI: 10.1038/s41598-024-55333-w] [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: 11/21/2023] [Accepted: 02/22/2024] [Indexed: 02/29/2024] Open
Abstract
To compare the safety and effectiveness of the combination of intelligent intrarenal pressure control platforms (IPCP) and flexible ureteral access sheath (FUAS) combined with retrograde intrarenal surgery (RIRS) for the treatment of renal stones less than 2 cm. We retrospectively collected 383 patients with renal stones who underwent RIRS in our department from June 2022 to October 2023. Inclusion criteria: stone length or the sum of multiple stone lengths ≤ 2 cm. Finally, 99 cases were included and divided into an IPCP group (n = 40) and FUAS group (n = 59) based on surgical methods. The main endpoint was the stone-free rate (SFR) at third months after surgery, with no residual stones or stone fragments less than 2 mm defined as stone clearance. The secondary endpoints were surgical time and perioperative complications, including fever, sepsis, septic shock, and perirenal hematoma. There was no statistically significant difference in general information between the two groups, including age, gender, body mass index, comorbidities, stone side, stone location, stone length, urine bacterial culture, and hydronephrosis. The operation time for IPCP group and FUAS group was 56.83 ± 21.33 vs 55.47 ± 19.69 min (p = 0.747). The SFR of IPCP group and FUAS group on the first postoperative day was 75.00% vs 91.50% (p = 0.024). The SFR was 90.00% vs 94.90% in the third month (p = 0.349).In IPCP group, there were 11 cases with stones located in the lower renal calyces and 17 cases in FUAS group. The SFR of the two groups on the first day and third months after surgery were 45.50% vs 88.20% (p = 0.014) and 63.60% vs 94.10% (p = 0.040), respectively, with statistical differences. For kidney stones ≤ 2 cm, there was no difference in SFR and the incidence of infection-related complications between IPCP and FUAS combined with RIRS, both of which were superior to T-RIRS. For lower renal caliceal stones, FUAS has a higher SFR compared to IPCP.
Collapse
Affiliation(s)
- Deheng Cui
- Department of Urology, The Second Hospital of Longyan, Longyan, 364000, Fujian, China
| | - Qinghong Ma
- Department of Urology, The Second Hospital of Longyan, Longyan, 364000, Fujian, China
| | - Shengbiao Xie
- Department of Urology, The Second Hospital of Longyan, Longyan, 364000, Fujian, China
| | - Guangzhi Wang
- Department of Urology, The Second Hospital of Longyan, Longyan, 364000, Fujian, China
| | - Guanghai Li
- Department of Urology, The Second Hospital of Longyan, Longyan, 364000, Fujian, China.
| | - Guoqiang Chen
- Department of Urology, The Second Hospital of Longyan, Longyan, 364000, Fujian, China.
| |
Collapse
|
8
|
He X, Huang X, Zhai Q, Song L, Deng X. Retrograde intrarenal surgery with intelligent control of renal pelvic pressure for staghorn calculi: a case report. Front Med (Lausanne) 2024; 11:1321184. [PMID: 38327711 PMCID: PMC10847286 DOI: 10.3389/fmed.2024.1321184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 01/05/2024] [Indexed: 02/09/2024] Open
Abstract
Percutaneous nephrolithotomy is the gold standard treatment for staghorn calculi. However, this study reviews a case of an almost complete removal of staghorn calculi following one session of retrograde intrarenal surgery with intelligent control of renal pelvic pressure (RIRS-ICP). A 45 years-old female patient with an 8.3 × 4.5 cm complete staghorn stone was infected with Proteus mirabilis. Two sensitive antibiotics, piperacillin tazobactam and etimicin, were administered for 3 days. Semirigid 7/8.4 Fr ureteroscope was used to treat the renal pelvis and upper calyceal calculi for 57 min. A 550 μm holmium laser fiber with 2.0 J × 30 Hz was set. Next, a disposable flexible ureteroscope of 8.4 Fr was used to address residual middle and lower calyx stones for 94 min. A 200 μm holmium laser fiber with 1.0 J × 30 Hz was set. The renal pelvis pressure was controlled within 15 mmHg. A 2 mm CT scan on the first postoperative day showed inferior caliceal residue of approximately 1.0 × 0.6 cm. No complications occurred. This suggests that RIRS-ICP is a safe and effective treatment for staghorn calculi.
Collapse
Affiliation(s)
| | | | | | | | - Xiaolin Deng
- Department of Urology, The Affiliated Ganzhou Hospital of Nanchang University, Ganzhou, China
| |
Collapse
|
9
|
Jahrreiss V, Nedbal C, Castellani D, Gauhar V, Seitz C, Zeng G, Juliebø-Jones P, Keller E, Tzelves L, Geraghty R, Rangarajan K, Traxer O, Philip J, Skolarikos A, Kallidonis P, Bres-Niewada E, Somani B. Is suction the future of endourology? Overview from EAU Section of Urolithiasis. Ther Adv Urol 2024; 16:17562872241232275. [PMID: 38405421 PMCID: PMC10893777 DOI: 10.1177/17562872241232275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 01/23/2024] [Indexed: 02/27/2024] Open
Affiliation(s)
- Victoria Jahrreiss
- Department of Urology, Medical University of Vienna, Vienna, Austria
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
- EAU Section of Urolithiasis
| | - Carlotta Nedbal
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Urology Unit, Azienda Ospedaliero-Universitaria Delle Marche, Università Politecnica Delle Marche, Ancona, Italy
| | - Daniele Castellani
- Urology Unit, Azienda Ospedaliero-Universitaria Delle Marche, Università Politecnica Delle Marche, Ancona, Italy
| | - Vineet Gauhar
- EAU Section on Urolithiasis
- Department of Urology, Ng Teng Fong General Hospital, National University Health System, Singapore, Singapore
| | - Christian Seitz
- Department of Urology, Medical University of Vienna, Vienna, Austria
- EAU Section on Urolithiasis
| | - Guohua Zeng
- Guangdong Key Laboratory of Urology, Department of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | | | - Etienne Keller
- EAU Section on Urolithiasis
- Department of Urology, University Hospital Zurich, University of Zurich, Zürich, Switzerland
| | - Lazaros Tzelves
- Second Department of Urology, Sismanoglio General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Rob Geraghty
- Department of Urology, Freeman Hospital, Newcastle upon Tyne, UK
| | - Karan Rangarajan
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Olivier Traxer
- Department of Urology, AP-HP, Tenon Hospital, Sorbonne University, Paris, France
| | - Joe Philip
- Bristol Urological Institute, Southmead Hospital, Westbury on Trym, Bristol, UK
| | - Andreas Skolarikos
- Second Department of Urology, Sismanoglio General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Ewa Bres-Niewada
- EAU Section on Urolithiasis
- Department of Urology, Roefler Memorial Hospital, Pruszków, Poland
- Faculty of Medicine, Lazarski University, Warsaw, Poland
| | - Bhaskar Somani
- University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK
- EAU Section of Urolithiasis
| |
Collapse
|
10
|
Pauchard F, Bhojani N, Chew B, Ventimiglia E. How to measure intra-renal pressure during flexible URS: Historical background, technological innovations and future perspectives. Actas Urol Esp 2024; 48:42-51. [PMID: 37832846 DOI: 10.1016/j.acuroe.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 09/01/2023] [Indexed: 10/15/2023]
Abstract
INTRODUCTION High intrarenal pressure (IRP) is a potential risk factor for infectious complications related to URS. Methods to lower IRP have been described. However, it is still not possible to assess live IRP values during URS. The objective of this study was to perform a systematic review of the literature regarding endoscopic methods to measure IRP during URS. METHODS A systematic search and review of Medline, PubMed and Scopus was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta Analysis (PRISMA) checklist and a narrative synthesis of the study results was performed. RESULTS A total of 19 articles were included in the review. Four non invasive (i.e. endoscopic) methods to measure IRP were reported: ureteral catheter, sensor wire, pressure sensor proximal to an irrigation system and a novel ureteral access sheath that integrates suction, irrigation, and IRP measurement. CONCLUSIONS We provide here a comprehensive overview of the reported clinical measuring systems of IRP during URS. The ideal system has not been developed yet, but urologists will be able to measure IRP during their daily practice soon. The implications of having this type of data during surgery remains unknown. Systems that could integrate irrigation, suction, IRP and temperature seems to be ideal.
Collapse
Affiliation(s)
- F Pauchard
- Servicio de Urología, Hospital Naval Almirante Nef, Viña del Mar, Chile
| | - N Bhojani
- División de Urología, Universidad de Montreal, Montreal, QC, Canada
| | - B Chew
- Departamento de Ciencias Urológicas, Universidad de British Columbia, Vancouver, BC, Canada
| | - E Ventimiglia
- División de Oncología Experimental/Unidad de Urología, Instituto de Investigación Urológica (URI), IRCCS Hospital San Raffaele, Milán, Italy.
| |
Collapse
|
11
|
Chen YJ, Liu SW, Deng XL, Liang JX, Huang YS, Zhou W, Yang HB. The effect and safety assessment of monitoring ethanol concentration in exhaled breath combined with intelligent control of renal pelvic pressure on the absorption of perfusion fluid during flexible ureteroscopic lithotripsy. Int Urol Nephrol 2024; 56:45-53. [PMID: 37676386 DOI: 10.1007/s11255-023-03776-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 08/29/2023] [Indexed: 09/08/2023]
Abstract
PURPOSE Previously, we designed a ureteral access sheath with the capability of renal pelvic pressure (RPP) measurement and a medical perfusion and aspiration platform, allowing for the intelligent control of RPP. However, the effect of different RPP levels on perfusion fluid absorption remains unclear. This randomized controlled trial aimed to investigate the effects of exhaled ethanol concentration monitoring and intelligent pressure control on perfusion fluid absorption during flexible ureteroscopic lithotripsy. METHODS Eighty patients scheduled for flexible ureteroscopic lithotripsy were randomly divided into four groups. In groups A, B, and C, the RPPs were set at 0, - 5, and - 10 mmHg, respectively. Group D was regarded as the controls with unfixed RPP. Isotonic saline containing 1% ethanol was used as the irrigation fluid, with an average irrigation flow rate of 100 mL/min. The primary outcome of this study was the absorption of perfusion fluid that was calculated based on the exhaled ethanol concentration. The secondary outcomes included duration of operation and amounts of perfusion fluid used. Postoperative complications, pre- and postoperative renal function, infection markers, and blood gas analysis were also recorded for safety assessment. RESULTS In all, 76 patients were involved in this study, whose demographic characteristics and preoperative conditions were comparable among groups. Under the same perfusion flow rate, the groups with fixed RPP exhibited reduced absorption of perfusion fluid, duration of operation, and perfusion volume. In particular, the lowest values were observed in group C (RPP = - 10 mmHg). In contrast to the unfixed RPP group, no considerable difference were observed in levels of BUN, Scr, WBC, CRP, and blood gas values among the fixed RPP groups. Moreover, postoperative complications showed no significant difference among groups. CONCLUSION In flexible ureteroscopic lithotripsy, the groups with fixed RPP had less absorption of perfusion fluid and perfusion volume, shorter duration of surgery, and higher safety than the unfixed group.
Collapse
Affiliation(s)
- Yi-Jian Chen
- Department of Anaesthesiology, Ganzhou People's Hospital, Ganzhou, 341000, Jiangxi, China.
| | - Shi-Wen Liu
- Department of Anaesthesiology, Ganzhou People's Hospital, Ganzhou, 341000, Jiangxi, China
| | - Xiao-Lin Deng
- Department of Urology, Ganzhou People's Hospital, Ganzhou, 341000, Jiangxi, China
| | - Jie-Xian Liang
- Special Needs Medical Unit, Ganzhou People's Hospital, Ganzhou, 341000, Jiangxi, China
| | - Yi-Sheng Huang
- Department of Anaesthesiology, Ganzhou People's Hospital, Ganzhou, 341000, Jiangxi, China
| | - Wen Zhou
- Department of Anaesthesiology, Ganzhou People's Hospital, Ganzhou, 341000, Jiangxi, China
| | - Hong-Biao Yang
- Department of Anaesthesiology, Ganzhou People's Hospital, Ganzhou, 341000, Jiangxi, China
| |
Collapse
|
12
|
Zhang Z, Xie T, Li F, Wang X, Liu F, Jiang B, Zou X, Zhang G, Yuan Y, Xiao R, Wu G, Qian B. Comparison of traditional and novel tip-flexible suctioning ureteral access sheath combined with flexible ureteroscope to treat unilateral renal calculi. World J Urol 2023; 41:3619-3627. [PMID: 37821778 PMCID: PMC10693513 DOI: 10.1007/s00345-023-04648-w] [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: 05/19/2023] [Accepted: 09/21/2023] [Indexed: 10/13/2023] Open
Abstract
OBJECTIVES To compare the safety and efficacy of novel tip-flexible suctioning ureteral access sheath (NTFS-UAS) and traditional ureteral access sheath (T-UAS) combined with flexible ureteroscope for treating unilateral renal calculi. MATERIALS AND METHODS The clinical data of 214 patients with unilateral renal calculi treated by NTFS-UAS (n = 102) and T-UAS (n = 112) combined with flexible ureteroscope from August 2021 to April 2022 were analyzed retrospectively. Demographic characteristics, stone-related parameters, operative time, stone-free rates (SFR), hospitalization time and complication rate (CR) were analyzed. RESULT No significant difference was observed between the two groups in terms of demographic characteristics, stone-related parameters, intraoperative CR, and hospitalization time. The operative time of NTFS-UAS group was significantly shorter than T-UAS group (55.25 ± 11.42 min vs. 59.36 ± 15.59 min; P = 0.028). The NTFS-UAS group obtained significantly higher SFR on 1 day postoperatively (86.3% vs. 75.0%; P = 0.038), and higher SFR on 30 days postoperatively than T-UAS group (91.2% vs. 81.3%; P = 0.037). The hemoglobin loss of NTFS-UAS group (- 0.54 ± 0.69 g/dl) was significantly lower than T-UAS group (- 0.83 ± 0.66 g/dl; P = 0.002). There was a significantly lower incidence of overall CR (11.8% vs. 22.3%; P = 0.041), and infectious CR (8.8% vs. 18.8%; P = 0.037) in the NTFS-UAS group. CONCLUSION Compared to T-UAS combined with flexible ureteroscope for treating unilateral renal calculi, NTFS-UAS had superiority in higher SFR on 1 day and 30 days postoperatively. Shorter operation time, lower hemoglobin loss, lower incidences of overall and infectious CR were observed in NTFS-UAS group. REGISTRATION NUMBER AND DATE ChiCTR2300070210; April 5, 2023.
Collapse
Affiliation(s)
- Zhaolin Zhang
- Department of Urology, First Affiliated Hospital of Gannan Medical University, No. 128, Jinling Road, Ganzhou, 341000, Jiangxi, China
- Jiangxi Stone Prevention Engineering Technology Research Center, Ganzhou, 341000, Jiang Xi, China
| | - Tianpeng Xie
- Department of Urology, First Affiliated Hospital of Gannan Medical University, No. 128, Jinling Road, Ganzhou, 341000, Jiangxi, China
- Jiangxi Stone Prevention Engineering Technology Research Center, Ganzhou, 341000, Jiang Xi, China
| | - Fangzhi Li
- First Clinical Medical College, Gannan Medical University, Ganzhou, 341000, Jiang Xi, China
| | - Xiaoning Wang
- Department of Urology, First Affiliated Hospital of Gannan Medical University, No. 128, Jinling Road, Ganzhou, 341000, Jiangxi, China.
- Jiangxi Stone Prevention Engineering Technology Research Center, Ganzhou, 341000, Jiang Xi, China.
| | - Folin Liu
- Department of Urology, First Affiliated Hospital of Gannan Medical University, No. 128, Jinling Road, Ganzhou, 341000, Jiangxi, China
- Jiangxi Stone Prevention Engineering Technology Research Center, Ganzhou, 341000, Jiang Xi, China
| | - Bo Jiang
- Department of Urology, First Affiliated Hospital of Gannan Medical University, No. 128, Jinling Road, Ganzhou, 341000, Jiangxi, China
- Jiangxi Stone Prevention Engineering Technology Research Center, Ganzhou, 341000, Jiang Xi, China
| | - Xiaofeng Zou
- Department of Urology, First Affiliated Hospital of Gannan Medical University, No. 128, Jinling Road, Ganzhou, 341000, Jiangxi, China
- Jiangxi Stone Prevention Engineering Technology Research Center, Ganzhou, 341000, Jiang Xi, China
| | - Guoxi Zhang
- Department of Urology, First Affiliated Hospital of Gannan Medical University, No. 128, Jinling Road, Ganzhou, 341000, Jiangxi, China
- Jiangxi Stone Prevention Engineering Technology Research Center, Ganzhou, 341000, Jiang Xi, China
| | - Yuanhu Yuan
- Department of Urology, First Affiliated Hospital of Gannan Medical University, No. 128, Jinling Road, Ganzhou, 341000, Jiangxi, China
- Jiangxi Stone Prevention Engineering Technology Research Center, Ganzhou, 341000, Jiang Xi, China
| | - Rihai Xiao
- Department of Urology, First Affiliated Hospital of Gannan Medical University, No. 128, Jinling Road, Ganzhou, 341000, Jiangxi, China
- Jiangxi Stone Prevention Engineering Technology Research Center, Ganzhou, 341000, Jiang Xi, China
| | - Gengqing Wu
- Department of Urology, First Affiliated Hospital of Gannan Medical University, No. 128, Jinling Road, Ganzhou, 341000, Jiangxi, China
- Jiangxi Stone Prevention Engineering Technology Research Center, Ganzhou, 341000, Jiang Xi, China
| | - Biao Qian
- Department of Urology, First Affiliated Hospital of Gannan Medical University, No. 128, Jinling Road, Ganzhou, 341000, Jiangxi, China
- Jiangxi Stone Prevention Engineering Technology Research Center, Ganzhou, 341000, Jiang Xi, China
| |
Collapse
|
13
|
Zhai Q, Zhang J, Wei Q, Zeng M, Song L, Zhang Y, Maheremu M, Luo M, Xu Z, Fan D. Clinical application of novel integrated suctioning semi-rigid ureteroscopic lithotripsy. MINIM INVASIV THER 2023; 32:314-322. [PMID: 37366228 DOI: 10.1080/13645706.2023.2225599] [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: 10/20/2022] [Accepted: 06/02/2023] [Indexed: 06/28/2023]
Abstract
INTRODUCTION Urinary calculi are frequently encountered in urology. Traditionally, the lack of a perfect water injection and drainage system means the observation field is affected during ureteroscopy. Here, we explored the effect and clinical value of a new integrated suctioning semi-rigid ureteroscopic lithotripsy (URSL) for treating ureteral calculi. MATERIAL AND METHODS A total of 180 patients were successfully enrolled in this study (60 in each group). Group A included patients who underwent a traditional semi-rigid URSL, group B included patients who underwent a suctioning semi-rigid URSL with a sheath being connected to a vacuum device, and group C included patients who underwent a new type of suctioning integrated rigid URSL with a novel designed ureteroscope. RESULTS In total, 164 cases of URSL were completed in one stage. Compared with group A, group C had a higher stone-clearance rate at 30 days postoperatively, shorter operation time, and fewer hospitalization days (p < .05); compared with group B, group C had a higher one-stage operation success rate, shorter operation time, and fewer hospitalization days (p < .05). CONCLUSIONS Comparatively, the new suctioning integrated semi-rigid URSL is advantageous for treating upper urinary calculi, considering the reduced operation time, length of hospital stay, and low invasiveness.
Collapse
Affiliation(s)
- Qiliang Zhai
- Department of Urology, The Affiliated Ganzhou Hospital of Nanchang University, Ganzhou People's Hospital, Ganzhou, Jiangxi, China
| | - Jianqiang Zhang
- Department of Urology, Ruikang Hospital, Guangxi University of Traditional Chinese Medicine, Nanning, Guangxi, China
- Integrated Chinese and Western Medicine Clinical Research Center for Kidney Disease, Nanning, Guangxi, China
| | - Qiang Wei
- Department of Urology, The Affiliated Ganzhou Hospital of Nanchang University, Ganzhou People's Hospital, Ganzhou, Jiangxi, China
- Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou, Guandong, China
| | - Min Zeng
- Department of Urology, The Affiliated Ganzhou Hospital of Nanchang University, Ganzhou People's Hospital, Ganzhou, Jiangxi, China
| | - Leming Song
- Department of Urology, The Affiliated Ganzhou Hospital of Nanchang University, Ganzhou People's Hospital, Ganzhou, Jiangxi, China
| | - Yifan Zhang
- Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou, Guandong, China
| | - Maierhaba Maheremu
- Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou, Guandong, China
| | - Mayao Luo
- Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou, Guandong, China
| | - Zhuofan Xu
- Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou, Guandong, China
| | - Difu Fan
- Department of Urology, The Affiliated Ganzhou Hospital of Nanchang University, Ganzhou People's Hospital, Ganzhou, Jiangxi, China
| |
Collapse
|
14
|
Gauhar V, Traxer O, Castellani D, Ragoori D, Heng CT, Chew BH, Somani BK, Bin Hamri S. A Feasibility Study on Clinical Utility, Efficacy and Limitations of 2 Types of Flexible and Navigable Suction Ureteral Access Sheaths in Retrograde Intrarenal Surgery for Renal Stones. Urology 2023; 178:173-179. [PMID: 37328010 DOI: 10.1016/j.urology.2023.05.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/24/2023] [Accepted: 05/30/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE To evaluate stone-free rate, device maneuverability, and complications after retrograde intrarenal surgery (RIRS) using 2 different sizes of flexible and navigable suction ureteral access sheaths (FANS). METHODS A retrospective analysis was performed for patients who underwent RIRS for renal stones of any size, number, and location between November 2021 and October 2022. Group 1 had FANS of 12 French. Group 2 had FANS of 10 French. Both sheaths have a Y-shaped suction channel. Tip of 10 French FANS has 20% more flexibility. Lithotripsy was achieved using either thulium fiber or high-power holmium lasers. A 5-point Likert scale was used to assess the performance of each sheath. RESULTS There were 16 patients in Group 1 and 15 patients in Group 2. Baseline demographics and stone parameters were similar. Four patients in Group 2 had the same session bilateral RIRS. Sheath insertion was successful in all renal units but one. Ten French FANS had a higher percentage of excellent scores for ease of use, manipulation, and visibility. Neither of the sheaths had an average or difficult rating for all evaluation scales. A fornix rupture requiring prolonged stenting occurred in group 2. All patients were discharged within 24 hours of surgery. One patient in each group visited the emergency department (analgesic treatment). There were no infectious complications. At 3 months, a computed tomography scan showed that the absence of residual fragments >2 mm was significantly higher in Group 2 (94.7% vs 68.8%, P = 0.01). CONCLUSION The 10 Fr FANS showed a higher stone-free rate. There was no infectious complication using both sheaths.
Collapse
Affiliation(s)
- Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Olivier Traxer
- Department of Urology AP-HP, Sorbonne University, Tenon Hospital, Paris, France
| | - Daniele Castellani
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy.
| | - Deepak Ragoori
- Department of Urology, Asian Institute of Nephrology & Urology, Irram Manzil Colony, Hyderabad, Telangana, India
| | - Chin Tiong Heng
- Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Ben H Chew
- Department of Urology, University of British Columbia, Vancouver, Canada
| | - Bhaskar K Somani
- Department of Urology, University Hospitals Southampton, NHS Trust, Southampton, UK
| | - Saeed Bin Hamri
- Division of Urology, Department of Surgery, Ministry of the National Guard Health Affairs, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| |
Collapse
|
15
|
Solano C, Chicaud M, Kutchukian S, Candela L, Corrales M, Panthier F, Doizi S, Traxer O. Optimizing Outcomes in Flexible Ureteroscopy: A Narrative Review of Suction Techniques. J Clin Med 2023; 12:jcm12082815. [PMID: 37109152 PMCID: PMC10146070 DOI: 10.3390/jcm12082815] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 04/04/2023] [Accepted: 04/08/2023] [Indexed: 04/29/2023] Open
Abstract
OBJECTIVE The aim of this review is to summarize the existing suction systems in flexible ureteroscopy (fURS) and to evaluate their effectiveness and safety. METHODS A narrative review was performed using the Pubmed and Web of Science Core Collection (WoSCC) databases. Additionally, we conducted a search on the Twitter platform. Studies including suctions systems in fURS were included. Editorials, letters and studies reporting intervention with semirigid ureteroscopy, PCNL and mPCNL were excluded. RESULTS A total of 12 studies were included in this review. These studies comprised one in vitro study, one ex vivo study, one experimental study and eight cohort studies. The Pubmed and WoSCC searches identified three suction techniques (Irrigation/Suctioning system with control of pressure, suction ureteral access sheath (sUAS) and direct in scope suction (DISS)), and the Twitter search identified four of them. The overall results showed that suction is an effective and safe technique that improves stone-free rates, reduces operative time and limits complication rates after fURS. CONCLUSIONS The use of suctioning during common endourological procedures has been shown to improve safety and efficacy in several indications. However, randomized controlled trials are needed to confirm this.
Collapse
Affiliation(s)
- Catalina Solano
- GRC n 20, Groupe de Recherche Clinique sur la Lithiasis Urinaire, Hôpital Tenon, Sorbonne Université, 75020 Paris, France
- Department of Endourology, Uroclin S.A.S., Medellín 50011, Colombia
| | - Marie Chicaud
- Department of Urology, Limoges University Hospital, 2 Avenue Martin Luther King, 87000 Limoges, France
| | - Stessy Kutchukian
- Department of Urology, Poitiers University Hospital, 2 Rue de la Milétrie, 86000 Poitiers, France
| | - Luigi Candela
- GRC n 20, Groupe de Recherche Clinique sur la Lithiasis Urinaire, Hôpital Tenon, Sorbonne Université, 75020 Paris, France
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, 20100 Milan, Italy
| | - Mariela Corrales
- GRC n 20, Groupe de Recherche Clinique sur la Lithiasis Urinaire, Hôpital Tenon, Sorbonne Université, 75020 Paris, France
| | - Frédéric Panthier
- GRC n 20, Groupe de Recherche Clinique sur la Lithiasis Urinaire, Hôpital Tenon, Sorbonne Université, 75020 Paris, France
| | - Steeve Doizi
- GRC n 20, Groupe de Recherche Clinique sur la Lithiasis Urinaire, Hôpital Tenon, Sorbonne Université, 75020 Paris, France
| | - Olivier Traxer
- GRC n 20, Groupe de Recherche Clinique sur la Lithiasis Urinaire, Hôpital Tenon, Sorbonne Université, 75020 Paris, France
| |
Collapse
|
16
|
Zhong Y, Xie D, Luo C, Liao X, Liu T, Deng X, Zhu L, Song L. Clinical application of flexible ureteroscopic sheath with controllable intraluminal pressure in treating ureteral stones. Asian J Urol 2023; 10:166-171. [PMID: 36942124 PMCID: PMC10023535 DOI: 10.1016/j.ajur.2021.08.007] [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: 08/02/2020] [Revised: 10/12/2021] [Accepted: 11/24/2021] [Indexed: 11/27/2022] Open
Abstract
Objective The purpose of the study was to assess the clinical efficacy and safety of a combined perfusion suction platform with pressure feedback control function and an ureteroscopic suction sheath that can measure the ureteropelvic pressure in implementing lithotripsies. Methods Fifty-two patients who underwent lithotripsy under intelligent monitoring of ureteral intraluminal pressure from June 2016 to January 2018 were retrospectively recruited. The inclusion standard was stone diameter >1.5 cm but <2.5 cm. After the 12/14 Fr suction sheath was placed, manometer interface and suction interface of the sheath were connected to the platform via the pressure sensor and suction tube, respectively. The ureteroscope was connected to the platform perfusion pump, and the crushed stones were aspirated out under negative pressure. Results According to the location of the stone, 21 (40.4%) cases were classified as upper ureteral stones, 19 (36.5%) were midureteral stones, and 12 (23.1%) were lower ureteral stones. Forty-seven patients underwent successful primary sheath placement and lithotripsy with a mean operative time of 34.5 (standard deviation 18.3) min. Retrograde stone migration did not occur. There were eight patients with hematuria postoperatively. Serious complication was 1.9% with one case of ureteral perforation. Stone clearance was 95.7% at Day 1-2 postoperatively, and 100% at Day 30 postoperatively. Conclusion Ureteroscopic lithotripsy with intelligent pressure control using our device improved the efficiency of the lithotripsy and rate of stone clearance. The safety of the operation can be ensured. It is worth popularization and application in clinical practice.
Collapse
Affiliation(s)
- Yuming Zhong
- Department of Urology, The Affiliated Ganzhou Hospital of Nanchang University, Ganzhou, Jiangxi, China
| | | | - Chunxiang Luo
- Department of Urology, The Affiliated Ganzhou Hospital of Nanchang University, Ganzhou, Jiangxi, China
- Liaobu Township Community Health Service Center, Dongguan, Guangdong, China
| | - Xiaohui Liao
- Department of Urology, The Affiliated Ganzhou Hospital of Nanchang University, Ganzhou, Jiangxi, China
- Gan County District Dermatology Institute, Ganzhou, Jiangxi, China
| | - Tairong Liu
- Department of Urology, The Affiliated Ganzhou Hospital of Nanchang University, Ganzhou, Jiangxi, China
| | - Xiaoling Deng
- Department of Urology, The Affiliated Ganzhou Hospital of Nanchang University, Ganzhou, Jiangxi, China
| | - Lunfeng Zhu
- Department of Urology, The Affiliated Ganzhou Hospital of Nanchang University, Ganzhou, Jiangxi, China
| | - Leming Song
- Department of Urology, The Affiliated Ganzhou Hospital of Nanchang University, Ganzhou, Jiangxi, China
- Corresponding author.
| |
Collapse
|
17
|
Quhal F, Zeng G, Seitz C. Current evidence for suction in endourological procedures: comprehensive review of literature. Curr Opin Urol 2023; 33:77-83. [PMID: 36336907 DOI: 10.1097/mou.0000000000001061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
PURPOSE OF REVIEW To identify the latest advances on the utilization of suctioning devices in the surgical treatment of urinary stones. RECENT FINDINGS Advances are being made to incorporate suction and pressure control capabilities in percutaneous and ureteroscopic lithotripsy. Multiple retrospective studies and few prospective studies have shown that suctioning with minimally invasive percutaneous nephrolithotomy, commonly referred to as Super MiniPerc, can lead to better stone-free rates (SFR) and shorter operative time with lower incidence of infectious complications. Suctioning during retrograde intrarenal surgery (RIRS) has mainly been achieved through suctioning ureteral access sheath. Here as well, the incorporation of suction improved the SFR, but most importantly, reduced the risk of postoperative infectious complications. SUMMARY Theoretically suction in endourological procedures could facilitate stone debris removal and could reduce intrarenal pressure at the same time allowing for increased irrigation flow potentially decreasing operation time and infectious complications. These claims are supported in contemporary clinical studies, reporting superior SFR and reduced postoperative infectious complications in both percutaneous nephrolithotomy and RIRS.
Collapse
Affiliation(s)
- Fahad Quhal
- Department of Urology, Medical University of Vienna, Vienna, Austria
- Department of Urology, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Guohua Zeng
- Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, and Guangdong Key Laboratory of Urology, Guangzhou, China
| | - Christian Seitz
- Department of Urology, Medical University of Vienna, Vienna, Austria
- European Urolithiasis Society (EULIS), Arnhem, The Netherlands
| |
Collapse
|
18
|
Zeng G, Traxer O, Zhong W, Osther P, Pearle MS, Preminger GM, Mazzon G, Seitz C, Geavlete P, Fiori C, Ghani KR, Chew BH, Git KA, Vicentini FC, Papatsoris A, Brehmer M, Martinez JL, Cheng J, Cheng F, Gao X, Gadzhiev N, Pietropaolo A, Proietti S, Ye Z, Sarica K. International Alliance of Urolithiasis guideline on retrograde intrarenal surgery. BJU Int 2023; 131:153-164. [PMID: 35733358 PMCID: PMC10084014 DOI: 10.1111/bju.15836] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES To set out the second in a series of guidelines on the treatment of urolithiasis by the International Alliance of Urolithiasis that concerns retrograde intrarenal surgery (RIRS), with the aim of providing a clinical framework for urologists performing RIRS. MATERIALS AND METHODS After a comprehensive search of RIRS-related literature published between 1 January 1964 and 1 October 2021 from the PubMed database, systematic review and assessment were performed to inform a series of recommendations, which were graded using modified GRADE methodology. Additionally, quality of evidence was classified using a modification of the Oxford Centre for Evidence-Based Medicine Levels of Evidence system. Finally, related comments were provided. RESULTS A total of 36 recommendations were developed and graded that covered the following topics: indications and contraindications; preoperative imaging; preoperative ureteric stenting; preoperative medications; peri-operative antibiotics; management of antithrombotic therapy; anaesthesia; patient positioning; equipment; lithotripsy; exit strategy; and complications. CONCLUSION The series of recommendations regarding RIRS, along with the related commentary and supporting documentation, offered here should help provide safe and effective performance of RIRS.
Collapse
Affiliation(s)
- Guohua Zeng
- Department of Urology, Guangdong Key Laboratory of UrologyFirst Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
| | - Olivier Traxer
- GRC Urolithiasis No. 20, Sorbonne UniversityTenon HospitalParisFrance
| | - Wen Zhong
- Department of Urology, Guangdong Key Laboratory of UrologyFirst Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
| | - Palle Osther
- Department of Urology, Vejle Hospital‐a part of Lillebaelt HospitalUniversity Hospital of Southern DenmarkVejleDenmark
| | | | - Glenn M Preminger
- Division of Urologic SurgeryDuke University Medical CenterDurhamNCUSA
| | | | - Christian Seitz
- Department of Urology, Comprehensive Cancer Center, Vienna General HospitalMedical University of ViennaViennaAustria
| | - Petrisor Geavlete
- Sanador HospitalBucharestRomania
- Department of UrologySf. Ioan Emergency Clinical HospitalBucharestRomania
| | - Cristian Fiori
- Division of Urology, Department of OncologyUniversity of TurinTurinItaly
| | | | - Ben H. Chew
- Department of Urologic SciencesUniversity of British ColumbiaVancouverBCCanada
| | - Kah Ann Git
- Department of UrologyPantai HospitalPenangMalaysia
| | - Fabio Carvalho Vicentini
- Departamento de Urologia, Faculdade de Medicina da Universidade de São Paulo – FMUSPHospital das ClínicasSão PauloBrazil
| | - Athanasios Papatsoris
- 2nd Department of Urology, School of Medicine, Sismanoglio HospitalNational and Kapodistrian University of AthensAthensGreece
| | - Marianne Brehmer
- Division of Urology, Department of Clinical Sciences, Karolinska InstitutetDanderyd HospitalStockholmSweden
| | | | - Jiwen Cheng
- Department of UrologyThe First Affiliated Hospital of Guangxi Medical UniversityNanningChina
| | - Fan Cheng
- Department of UrologyRenmin Hospital of Wuhan UniversityWuhanChina
| | - Xiaofeng Gao
- Department of UrologyChanghai HospitalShanghaiChina
| | - Nariman Gadzhiev
- Department of UrologySaint‐Petersburg State University HospitalSaint‐PetersburgRussia
| | | | | | - Zhangqun Ye
- Department of Urology, Tongji Medical College, Tongji HospitalHuazhong University of Science and TechnologyWuhanChina
| | - Kemal Sarica
- Department of Urology, Medical SchoolBiruni UniversityIstanbulTurkey
| |
Collapse
|
19
|
Bragaru M, Multescu R, Georgescu D, Bulai C, Ene C, Popescu R, Geavlete P, Geavlete B. Single-use versus conventional reusable flexible ureteroscopes - an evaluation of the functional parameters. J Med Life 2023; 16:10-15. [PMID: 36873117 PMCID: PMC9979166 DOI: 10.25122/jml-2022-0269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 12/27/2022] [Indexed: 03/07/2023] Open
Abstract
The purpose of single-use flexible ureteroscopes (su-fURS) was to overcome the limitations of conventional reusable ureteroscopes in terms of maneuverability and maintenance. We aimed to perform a systematic literature review on available su-fURS performance versus conventional reusable fURS focusing on clinical data. A systematic research using Pubmed was performed evaluating single-use fURS and reusable fURS in urinary tract stone disease, including prospective assessments and case series. This review aimed to provide an overview of single-use and disposable flexible ureteroscopes and to examine and compare their capabilities (deflection, irrigation, optical properties). We included 11 studies, where the single-use fURS were compared to the reusable fURS. The studies with single-use ureteroscopes included data on LithoVue (Boston Scientific), The Uscope UE3022 (Pusen, Zhuhai, China), NeoFlex-Flexible, (Neoscope Inc San Jose, CA), 23 YC-FR-A (Shaogang). For reusable ureteroscopes, data were included on three models, two digital (Karl Storz Flex-XC and Olympus URF-Vo) and one fiber optic (Wolf-Cobra). There were no significant differences in stone-free rate, procedure duration, or functional capabilities between single-use fURS and reusable fURS. The systematic literature review analyzed operative time, functional capabilities, stone-free rates, and postoperative complications of the ureteroscopes, and a special chapter about renal abnormalities to emphasize that they are a good choice having a high proportion of stone-free rates and few risks, particularly in treating difficult-to-access calculi. Single-use fURS demonstrate a comparable efficacy with reusable fURS in resolving renal lithiasis. Further studies on clinical efficacy are needed to determine whether single-use fURS will reliably replace its reusable counterpart.
Collapse
Affiliation(s)
- Marius Bragaru
- Urology Department, Sf. Ioan Emergency Clinical Hospital, Bucharest, Romania.,3 Department, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Razvan Multescu
- Urology Department, Sf. Ioan Emergency Clinical Hospital, Bucharest, Romania
| | - Dragos Georgescu
- Urology Department, Sf. Ioan Emergency Clinical Hospital, Bucharest, Romania.,3 Department, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Cătălin Bulai
- Urology Department, Sf. Ioan Emergency Clinical Hospital, Bucharest, Romania.,3 Department, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Cosmin Ene
- Urology Department, Sf. Ioan Emergency Clinical Hospital, Bucharest, Romania.,3 Department, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Razvan Popescu
- Urology Department, Sf. Ioan Emergency Clinical Hospital, Bucharest, Romania.,3 Department, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Petrişor Geavlete
- Urology Department, Sf. Ioan Emergency Clinical Hospital, Bucharest, Romania.,3 Department, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Bogdan Geavlete
- Urology Department, Sf. Ioan Emergency Clinical Hospital, Bucharest, Romania.,3 Department, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| |
Collapse
|
20
|
Gao X, Zhang Z, Li X, Cai W, Zheng B, Lu Y, Zhao H, You J, Zheng G, Bao W, Lai Y, Lv Y. High stone-free rate immediately after suctioning flexible ureteroscopy with Intelligent pressure-control in treating upper urinary tract calculi. BMC Urol 2022; 22:180. [DOI: 10.1186/s12894-022-01126-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 10/20/2022] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The retrospective observational study aimed to evaluate the safety and efficacy of suctioning flexible ureteroscopy with Intelligent pressure-control (SFUI) on treating upper urinary tract calculi in a large cohort.
Methods
Between July 2020 and August 2021, 278 patients with upper urinary tract calculi who underwent SFUI in our hospital were enrolled. Outcomes were stone-free rate (SFR) in one session and one-month after SFUI treatment, and complications scored by the Clavien-Dindo classification.
Results
A total of 310 kidneys underwent SFUI were included. The median surgery time was 75 min (ranged 60–110 min). One session and one-month SFRs were 80.65% and 82.26%, respectively. The one-session SFR was ≧ 87% in patients with Guy’s stone score of Grade I among stone size < 40 mm. Risk factors for unsuccessful stone-free in one session were stone history (adjusted odds ratio (aOR): 2.39, 95% confidence interval (CI): 1.21–4.73), stone size of 40–49 mm (aOR: 4.37, 95% CI: 1.16–16.45), Guy’s stone score ≧ Grade II (Grade II, aOR: 3.54, 95% CI: 1.18–10.59; Grade III, aOR: 10.95, 95% CI: 2.65–45.25). The incidence of Clavien-Dindo grade II-III complication was 3.26%. Complication is associated with Guy’s stone score III (aOR: 22.36, 95% CI: 1.81–276.36).
Conclusion
SFUI shows good safety and efficiency on treating upper urinary tract calculi. Patients with stone size < 40 mm or Guy’s stone score of Grade I have a high chance to reach stone-free after SFUI treatment.
Collapse
|
21
|
De Coninck V, Somani B, Sener ET, Emiliani E, Corrales M, Juliebø-Jones P, Pietropaolo A, Mykoniatis I, Zeeshan Hameed BM, Esperto F, Proietti S, Traxer O, Keller EX. Ureteral Access Sheaths and Its Use in the Future: A Comprehensive Update Based on a Literature Review. J Clin Med 2022; 11:jcm11175128. [PMID: 36079058 PMCID: PMC9456781 DOI: 10.3390/jcm11175128] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 08/27/2022] [Accepted: 08/29/2022] [Indexed: 11/21/2022] Open
Abstract
Ureteral access sheaths (UASs) are part of urologist’s armamentarium when performing retrograde intrarenal surgery (RIRS). Recently, the world of RIRS has changed dramatically with the development of three game-changers: thulium fiber laser (TFL), smaller size single use digital flexible ureterosopes and intraoperative intrarenal pressure (IRP) measurement devices. We aimed to clarify the impact of UASs on IRP, complications and SFRs and put its indications in perspective of these three major technological improvements. A systematic review of the literature using the Medline, Scopus and Web of Science databases was performed by two authors and relevant studies were selected according to PRISMA guidelines. Recent studies showed that using a UAS lowers IRP and intrarenal temperature by increasing irrigation outflow during RIRS. Data on the impact of a UAS on SFRs, postoperative pain, risk of infectious complications, risk of ureteral strictures and risk of bladder recurrence of urothelial carcinoma after diagnostic RIRS were inconclusive. Prestenting for at least one week resulted in ureteral enlargement, while the influence of pre-operative administration of alpha-blockers was unclear. Since TFL, smaller single use digital ureteroscopes and devices with integrated pressure-measuring and aspiration technology seemed to increase SFRs and decrease pressure and temperature related complications, indications on the use of a UAS may decrease in the near future.
Collapse
Affiliation(s)
- Vincent De Coninck
- Department of Urology, AZ Klina, 2930 Brasschaat, Belgium
- Young Academic Urologists (YAU), Urolithiasis & Endourology Working Party, 6846 Arnhem, The Netherlands
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), 75020 Paris, France
- Correspondence: ; Tel.: +32-3-650-50-56
| | - Bhaskar Somani
- Department of Urology, University Hospital Southampton, Southampton SO16 6YD, UK
| | - Emre Tarik Sener
- Young Academic Urologists (YAU), Urolithiasis & Endourology Working Party, 6846 Arnhem, The Netherlands
- Department of Urology, Marmara University School of Medicine, Istanbul 34854, Turkey
| | - Esteban Emiliani
- Young Academic Urologists (YAU), Urolithiasis & Endourology Working Party, 6846 Arnhem, The Netherlands
- Department of Urology, Fundacio Puigvert, Autonomous University of Barcelona, 08025 Barcelona, Spain
| | - Mariela Corrales
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), 75020 Paris, France
- Service d’Urologie, AP-HP, Hôpital Tenon, Sorbonne Université, 75020 Paris, France
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020 Paris, France
| | - Patrick Juliebø-Jones
- Department of Urology, Haukeland University Hospital, N-5021 Bergen, Norway
- Department of Clinical Medicine, University of Bergen, N-5021 Bergen, Norway
| | - Amelia Pietropaolo
- Young Academic Urologists (YAU), Urolithiasis & Endourology Working Party, 6846 Arnhem, The Netherlands
- Department of Urology, University Hospital Southampton, Southampton SO16 6YD, UK
| | - Ioannis Mykoniatis
- Young Academic Urologists (YAU), Urolithiasis & Endourology Working Party, 6846 Arnhem, The Netherlands
- Department of Urology, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Belthangady M. Zeeshan Hameed
- Young Academic Urologists (YAU), Urolithiasis & Endourology Working Party, 6846 Arnhem, The Netherlands
- Department of Urology, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal 576104, India
| | - Francesco Esperto
- Young Academic Urologists (YAU), Urolithiasis & Endourology Working Party, 6846 Arnhem, The Netherlands
- Department of Urology, Campus Bio-Medico University, 00128 Rome, Italy
- Unit of Urology, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
| | - Silvia Proietti
- Department of Urology, IRCCS San Raffaele Hospital, 20132 Milan, Italy
| | - Olivier Traxer
- Service d’Urologie, AP-HP, Hôpital Tenon, Sorbonne Université, 75020 Paris, France
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020 Paris, France
| | - Etienne Xavier Keller
- Young Academic Urologists (YAU), Urolithiasis & Endourology Working Party, 6846 Arnhem, The Netherlands
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), 75020 Paris, France
- Department of Urology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| |
Collapse
|
22
|
Juliebø-Jones P, Keller EX, Haugland JN, Æsøy MS, Beisland C, Somani BK, Ulvik Ø. Advances in Ureteroscopy: New technologies and current innovations in the era of Tailored Endourological Stone Treatment (TEST). JOURNAL OF CLINICAL UROLOGY 2022. [DOI: 10.1177/20514158221115986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Ureteroscopy has undergone many advances in recent decades. As a result, it is able to treat an increasing range of patient groups including special populations such as pregnancy, anomalous kidneys and extremes of age. Such advances include Holmium laser, high-power systems and pulse modulation. Thulium fibre laser is a more recent introduction to clinical practice. Ureteroscopes have also been improved alongside vision and optics. This article provides an up-to-date guide to these topics as well as disposable scopes, pressure control and developments in operating planning and patient aftercare. These advances allow for a custom strategy to be applied to the individual patient in what we describe using a new term: Tailored endourological stone treatment (TEST). Level of evidence: 5
Collapse
Affiliation(s)
- Patrick Juliebø-Jones
- Department of Urology, Haukeland University Hospital, Norway
- Department of Clinical Medicine, University of Bergen, Norway
| | - Etienne Xavier Keller
- Department of Urology, University Hospital Zurich, University of Zurich, Switzerland
| | | | | | - Christian Beisland
- Department of Urology, Haukeland University Hospital, Norway
- Department of Clinical Medicine, University of Bergen, Norway
| | | | - Øyvind Ulvik
- Department of Clinical Medicine, University of Bergen, Norway
| |
Collapse
|
23
|
Qian X, Liu C, Hong S, Xu J, Qian C, Zhu J, Wang S, Zhang J. Application of Suctioning Ureteral Access Sheath during Flexible Ureteroscopy for Renal Stones Decreases the Risk of Postoperative Systemic Inflammatory Response Syndrome. Int J Clin Pract 2022; 2022:9354714. [PMID: 35685551 PMCID: PMC9159138 DOI: 10.1155/2022/9354714] [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: 12/10/2021] [Revised: 01/04/2022] [Accepted: 01/10/2022] [Indexed: 12/05/2022] Open
Abstract
Purpose To clarify the efficiency and outcomes of suctioning ureteral access sheath (UAS) during flexible ureteroscopic lithotripsy (fURL) for the management of renal stones. Methods Between January 2017 and January 2019, a total of 444 patients with renal stones undergoing fURL were divided into suctioning UAS and nonsuctioning UAS groups. The outcomes of patients in both groups were compared using a matched-pair analysis (1 : 1 scenario). Furthermore, a directed acyclic graph (DAG) was drawn to guide the multivariate logistic regression model and analyze the protective effect of suctioning UAS on the incidence of postoperative systemic inflammatory response syndrome (SIRS). Results Before propensity score matching, significant differences were observed between the two groups in blood white cell counts, urine white cell counts, preoperative fever, preoperative indwelling stents, and laterality (P < 0.05). Eighty-one patients in the suctioning UAS group were successfully matched with 81 patients in the nonsuctioning group. The stone-free rate (SFR) on postoperative day 1 after fURL in the suctioning group was higher than that in the nonsuctioning group (86.4% vs. 71.6%; P=0.034), whereas it was comparable between the two groups 1 month after the surgery (88.9% vs. 82.7%; P=0.368). The incidence of postoperative fever or SIRS was lower in the suctioning group (fever: 3.70% vs. 14.8%; P=0.030; SIRS: 1.23% vs. 12.3%; P=0.012). However, the operative duration was similar in both groups (mean (SD)) (72.9 (28.1) min vs. 80.0 (29.5) min; P=0.121). The result of the multivariate logistic regression model guided by DAG revealed that the application of nonsuctioning UAS (odds ratio: 5.28 [1.38-35.07], P=0.034) during fURL was associated with postoperative SIRS. Conclusions The application of suctioning UAS during fURL was associated with higher SFR on day 1 after surgery and a lower incidence of postoperative fever or SIRS.
Collapse
Affiliation(s)
- Xiaoyuan Qian
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chenqian Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Senyuan Hong
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jinzhou Xu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Can Qian
- Department of Traditional Chinese Medicine and Rheumatology, Southwest Hospital, Army Military Medical University, Chongqing, China
| | - Jianning Zhu
- The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Shaogang Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiaqiao Zhang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| |
Collapse
|
24
|
Lai L, Zhang W, Zheng F, Wang T, Bai P, Liu Z, Zheng J, Shao Z, Duan B, Wang H, Xing J, Chen H, Huang Y, Chen B. Comparison of the Efficacy of ShuoTong Ureteroscopy and Simple Flexible Ureteroscopy in the Treatment of Unilateral Upper Ureteral Calculi. Front Surg 2021; 8:707022. [PMID: 34646858 PMCID: PMC8503526 DOI: 10.3389/fsurg.2021.707022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 08/26/2021] [Indexed: 11/13/2022] Open
Abstract
Background: ShuoTong ureteroscopy (Sotn-ureteroscopy, ST-URS), a new lithotripsy operation method developed on the basis of ureteroscopy, is widely used to treat ureteral stones in China. Its composition includes rigid ureteral access sheath, standard mirror, lithotripsy mirror, and ShuoTong perfusion aspirator (ST-APM). Here, we compared the efficacy and safety of the ST-URS and the flexible ureteroscope (F-URS) holmium laser lithotripsy in the treatment of unilateral upper ureteral calculi. Methods: Retrospective analysis was conducted on the clinical data of 280 patients who met the inclusion 1) urinary tract CT was diagnosed with unilateral single upper ureteral calculi above the L4 lumbar spine; 2) patient age was from 18 to 80 years old; 3) patients were informed and consented to this study; and 4) patients were approved by the hospital ethics committee (proof number: KY-2019-020) and the exclusion criteria for unilateral upper ureteral calculi in the First Affiliated Hospital of Xiamen University from January 2018 to November 2020, and they were divided into the ST-URS group and the flexible ureteroscopy (F-URS) group. Results: The stone-free rate of 1 day after operation of the ST-URS group was significantly higher than the F-URS group (63.71 vs. 34.62%, P < 0.0001). The operative time (38.45 vs. 46.18 min, P = 0.005) and hospitalization cost (27,203 vs. 33,220 Yuan, P < 0.0001) of the ST-URS group were significantly lower than the F-URS group. There were no significant differences in the success rate of ureteral access sheath placement, operative blood loss, stone-free rate of 1 month after operation, postoperative complications, postoperative hospital stay, and postoperative visual analog scale (VAS) pain score between the two groups (P > 0.05). In subgroups of a diameter of calculi ≥ 1.5 cm, calculi CT numerical value ≥ 1,000 Hounsfield unit and the preoperative hydronephrosis range ≥ 3.0 cm, ST-URS shows more advantages in the operative time, stone-free rate of 1 day after the operation, the hospitalization cost, and the incidence of postoperative complications. Conclusion: In unilateral upper ureteral stones treated with a holmium laser, compared with the simple F-URS, the ST-URS has a shorter operative time, lower hospitalization cost, and a higher stone-free rate of 1 day after the operation, suggesting that the ST-URS could be more widely applied in clinics.
Collapse
Affiliation(s)
- Longhui Lai
- The Key Laboratory of Urinary Tract Tumors and Calculi, Department of Urology Surgery, The First Affiliated Hospital, School of Medicine, Xiamen University, Xiamen, China.,The School of Clinical Medicine, Fujian Medical University, Fuzhou, China
| | - Wenzhao Zhang
- The Key Laboratory of Urinary Tract Tumors and Calculi, Department of Urology Surgery, The First Affiliated Hospital, School of Medicine, Xiamen University, Xiamen, China.,The School of Clinical Medicine, Fujian Medical University, Fuzhou, China
| | - Fangjian Zheng
- The Key Laboratory of Urinary Tract Tumors and Calculi, Department of Urology Surgery, The First Affiliated Hospital, School of Medicine, Xiamen University, Xiamen, China
| | - Tao Wang
- The Key Laboratory of Urinary Tract Tumors and Calculi, Department of Urology Surgery, The First Affiliated Hospital, School of Medicine, Xiamen University, Xiamen, China
| | - Peide Bai
- The Key Laboratory of Urinary Tract Tumors and Calculi, Department of Urology Surgery, The First Affiliated Hospital, School of Medicine, Xiamen University, Xiamen, China
| | - Zhengsheng Liu
- The Key Laboratory of Urinary Tract Tumors and Calculi, Department of Urology Surgery, The First Affiliated Hospital, School of Medicine, Xiamen University, Xiamen, China
| | - Jiaxin Zheng
- The Key Laboratory of Urinary Tract Tumors and Calculi, Department of Urology Surgery, The First Affiliated Hospital, School of Medicine, Xiamen University, Xiamen, China
| | - Zhiqiang Shao
- Xiamen University Laboratory Animal Center, Xiamen University, Xiamen, China
| | - Bo Duan
- The Key Laboratory of Urinary Tract Tumors and Calculi, Department of Urology Surgery, The First Affiliated Hospital, School of Medicine, Xiamen University, Xiamen, China
| | - Huiqiang Wang
- The Key Laboratory of Urinary Tract Tumors and Calculi, Department of Urology Surgery, The First Affiliated Hospital, School of Medicine, Xiamen University, Xiamen, China
| | - Jinchun Xing
- The Key Laboratory of Urinary Tract Tumors and Calculi, Department of Urology Surgery, The First Affiliated Hospital, School of Medicine, Xiamen University, Xiamen, China.,The School of Clinical Medicine, Fujian Medical University, Fuzhou, China
| | - Huixin Chen
- Department of Urology Surgery, Zhangzhou Hospital of Traditional Chinese Medicine, Zhangzhou, China
| | - Yushan Huang
- Department of Urology Surgery, Anxi County Hospital of Traditional Chinese Medicine, Quanzhou, China
| | - Bin Chen
- The Key Laboratory of Urinary Tract Tumors and Calculi, Department of Urology Surgery, The First Affiliated Hospital, School of Medicine, Xiamen University, Xiamen, China.,The School of Clinical Medicine, Fujian Medical University, Fuzhou, China
| |
Collapse
|
25
|
Mao C, Peng C, Li S, Chen L, You M, Fang K, Xiang S, Su Y. Quantitative evaluation of upper urinary tract pump function in pigs with acute unilateral lower ureteral obstruction by 640-slice dynamic volume CT. BMC Urol 2021; 21:118. [PMID: 34474669 PMCID: PMC8414779 DOI: 10.1186/s12894-021-00887-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 08/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is a challenging problem to differentiate obstructive hydronephrosis from noninvasive evaluation of renal pelvis and ureteral motility in patients. The purpose of this study was to explore the value of 640-slice dynamic volume CT (DVCT) in the quantitative measurement of upper urinary tract (UUT) pump function after acute unilateral lower ureteral obstruction in pigs. METHODS In this study, a perfusion pig model was constructed by constant pressure perfusion testing of the renal pelvis and left nephrostomy. The perfusion and pressure measuring devices were connected to create a state of no obstruction and acute obstruction of the lower part of the left ureter. After successful modelling, continuous dynamic volume scanning of the bilateral renal excretion phase was performed with 640-slice DVCT, and pump functions of the renal pelvis and part of the upper ureter were calculated and analysed. No obstruction or acute obstruction of the lower part of the left ureter was observed. Pump functions of the renal pelvis and part of the upper ureter were determined. RESULTS The results showed that after LUUT fistulostomy, the time difference between the average UUT volume and positive volume value increased gradually, and the calculated flow velocity decreased, which was significantly different from that of the RUUT. The volume difference of the LUUT increased significantly in mild obstruction. In the bilateral control, the volume change rate of the LUUT increased with mild obstruction and decreased with severe obstruction, and there was a significant difference between the left and right sides. CONCLUSION The continuous dynamic volume scan and measurement of 640-slice DVCT can obtain five pump function datasets of UUT in pigs with acute lower ureteral obstruction.
Collapse
Affiliation(s)
- Chongwen Mao
- Department of Radiology, The Fourth Affiliated Hospital of Kunming Medical University, #176 Qingnian Road, Kunming, 650021, Yunnan, China
| | - Cong Peng
- Department of Radiology, The Central Hospital of Wuhan, The Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Song Li
- Department of Urology, The Fourth Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Liling Chen
- Department of Clinical Skills Center, The Kunming Medical University, Kunming, Yunnan, China
| | - Mengjing You
- Department of Radiology, The Fourth Affiliated Hospital of Kunming Medical University, #176 Qingnian Road, Kunming, 650021, Yunnan, China
| | - Kewei Fang
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Shutian Xiang
- Department of Radiology, The Fourth Affiliated Hospital of Kunming Medical University, #176 Qingnian Road, Kunming, 650021, Yunnan, China
| | - Yunshan Su
- Department of Radiology, The Fourth Affiliated Hospital of Kunming Medical University, #176 Qingnian Road, Kunming, 650021, Yunnan, China.
| |
Collapse
|
26
|
Shu X, Hua P, Xie L. An irrigation system for noninvasively estimating intrarenal pressure during flexible ureteroscopy. Int J Med Robot 2021; 17:e2306. [PMID: 34260148 DOI: 10.1002/rcs.2306] [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: 03/28/2021] [Revised: 07/04/2021] [Accepted: 07/08/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND High intrarenal pressure (IRP) during flexible ureteroscopy (FURS) may lead to severe complications. Reported methods for measuring IRP are often inconvenient to use, expensive and involve instruments that occupy the narrow ureter. METHODS We proposed an irrigation system, which can noninvasively estimate IRP based on the principle of fluid mechanics. To determine the feasibility of our system, we conducted irrigation experiments on a kidney phantom and a porcine kidney. The estimated IRPs were compared with the ground truth IRPs. RESULTS When no surgical instrument was inserted into the flexible ureteroscope's working channel, our system can estimate IRP with high accuracy. When a surgical instrument was inserted, our system can approximately estimate the level of IRP. CONCLUSIONS Our proposed irrigation system can noninvasively estimate IRP, presenting a new thought for clinical practice. In future studies, in vivo experiments are needed to further validate and improve the system.
Collapse
Affiliation(s)
- Xiongpeng Shu
- Institute of Forming Technology & Equipment, Shanghai Jiao Tong University, Shanghai, China
| | - Peng Hua
- Institute of Forming Technology & Equipment, Shanghai Jiao Tong University, Shanghai, China
| | - Le Xie
- Institute of Forming Technology & Equipment, Shanghai Jiao Tong University, Shanghai, China.,Institute of Medical Robotics, Shanghai Jiao Tong University, Shanghai, China
| |
Collapse
|
27
|
Bahaee J, Plott J, Ghani KR. Single-use flexible ureteroscopes: how to choose and what is around the corner? Curr Opin Urol 2021; 31:87-94. [PMID: 33399370 DOI: 10.1097/mou.0000000000000852] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The pace of technology development with single-use endoscopy has led to a range of disposable ureteroscopes. We review the development of single-use scopes, deconstruct the basic design and functional characteristics of available devices, and discuss future directions for next-generation platforms. RECENT FINDINGS Currently available devices are differentiated on the basis of several core features. The optical, deflection and irrigation characteristics are marginally different with no device clearly superior in every category. Studies comparing single-use ureteroscopes in patients linked to outcomes are limited. The incorporation of next-generation technologies into these platforms include sensors to monitor intrarenal pressure and temperature, suction of fluid and fragments, and computer vision for artificial intelligence. SUMMARY Each ureteroscope has specific features that may be advantageous in different circumstances. Single-use devices could transform the ureteroscope from a visual conduit to a transformative surgical instrument that improves outcomes and reduces complications.
Collapse
Affiliation(s)
| | - Jeffrey Plott
- Coulter Program, Department of Biomedical Engineering, University of Michigan
| | - Khurshid R Ghani
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| |
Collapse
|
28
|
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
|
29
|
Abstract
PURPOSE OF REVIEW Equipment used in endourology is constantly evolving due to increasing incidence of urolithiasis. Suctioning has been used mainly in PCNL in conjunction with ultrasonic and ballistic devices for stone removal. Recently technological advances permitted the use of suctioning in more endourological techniques. This review aims to summarize the literature regarding these advancements and analyze the upcoming results. RECENT FINDINGS Several centers have conducted experimental and clinical studies on suctioning use during PCNL, mPCNL, and ureteroscopy and concluded that it is an effective and safe adjustment that improves stone-free rates and limits complication rates after these procedures. Suctioning use during common endourological procedures led to improved safety and efficacy among several indications. Due to the observational nature and small sample size of many studies, larger RCTs are needed to make safe conclusions.
Collapse
Affiliation(s)
- Lazaros Tzelves
- 2nd Department of Urology, National and Kapodistrian University of Athens, Sismanogleion Hospital, Athens, Greece
| | - Andreas Skolarikos
- 2nd Department of Urology, National and Kapodistrian University of Athens, Sismanogleion Hospital, Athens, Greece.
| |
Collapse
|
30
|
Mazzucchi E. Editorial Comment: Novel semirigid ureterorenoscope with irrigation and vacuum suction system: introduction and initial experience for management of upper urinary calculi. Int Braz J Urol 2020; 46:794-795. [PMID: 32648418 PMCID: PMC7822383 DOI: 10.1590/s1677-5538.ibju.2019.0521.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Eduardo Mazzucchi
- Departamento de Endourologia, Divisão de Urologia, Faculdade de Medicina de São Paulo da Universidade de São Paulo, SP, Brasil
| |
Collapse
|
31
|
Patel RM, Jefferson FA, Owyong M, Hofmann M, Ayad ML, Osann K, Okhunov Z, Landman J, Clayman RV. Characterization of intracalyceal pressure during ureteroscopy. World J Urol 2020; 39:883-889. [PMID: 32462302 DOI: 10.1007/s00345-020-03259-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 05/13/2020] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To provide the first report of measuring intracalyceal pressures during ureteroscopy (URS). METHODS A prospective single-center clinical study using a cardiac pressure guidewire to measure intracalyceal pressure during flexible URS was performed. Eight patients (45 calyces) undergoing URS for nephrolithiasis were included. A Verrata® pressure guide wire was passed through the working channel of a dual lumen flexible ureteroscope and into the calyces while irrigation was maintained at 150 mmHg. Pressure was measured in the renal pelvis, upper pole, interpolar, and lower pole calyces both with and without a ureteral access sheath (UAS). The pressure in each location with and without a UAS was compared. The correlation between calyceal pressure and infundibular dimensions (width, length) was determined. RESULTS Intracalyceal pressure was significantly lower in each region when a UAS was used. Compared to patients with a 12/14Fr UAS, those with a 14/16Fr UAS had significantly lower pressure in the interpolar (25.3 ± 13.1 vs. 44.0 ± 27.5 mmHg, p = 0.03) and lower pole (16.2 ± 3.5 vs. 49.2 ± 40.3 mmHg, p = 0.004) calyces. Interpolar calyceal pressure in the presence of a UAS was significantly higher than the renal pelvis pressure (RPP) (30.8 ± 19.6 vs. 17.9 ± 11.0 mmHg, p = 0.004). CONCLUSIONS During flexible URS, RPP strongly correlates with, but does not uniformly represent, the intracalyceal pressure. With a 14/16Fr UAS and an inflow pressure of 150 mmHg, RPP and intracalyceal pressure never exceed the threshold for renal backflow.
Collapse
Affiliation(s)
- Roshan M Patel
- Department of Urology, University of California, 333 City Blvd. West, Suite 2100, Irvine, Orange, CA, 92868, USA.
| | - Francis A Jefferson
- Department of Urology, University of California, 333 City Blvd. West, Suite 2100, Irvine, Orange, CA, 92868, USA
| | - Michael Owyong
- Department of Urology, University of California, 333 City Blvd. West, Suite 2100, Irvine, Orange, CA, 92868, USA
| | - Martin Hofmann
- Department of Urology, University of California, 333 City Blvd. West, Suite 2100, Irvine, Orange, CA, 92868, USA
| | - Maged L Ayad
- Department of Urology, University of California, 333 City Blvd. West, Suite 2100, Irvine, Orange, CA, 92868, USA
| | - Kathryn Osann
- Department of Urology, University of California, 333 City Blvd. West, Suite 2100, Irvine, Orange, CA, 92868, USA
| | - Zhamshid Okhunov
- Department of Urology, University of California, 333 City Blvd. West, Suite 2100, Irvine, Orange, CA, 92868, USA
| | - Jaime Landman
- Department of Urology, University of California, 333 City Blvd. West, Suite 2100, Irvine, Orange, CA, 92868, USA
| | - Ralph V Clayman
- Department of Urology, University of California, 333 City Blvd. West, Suite 2100, Irvine, Orange, CA, 92868, USA
| |
Collapse
|
32
|
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: 13] [Impact Index Per Article: 3.3] [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
|
33
|
Keller EX, De Coninck V, Doizi S, Traxer O. The role of ureteroscopy for treatment of staghorn calculi: A systematic review. Asian J Urol 2019; 7:110-115. [PMID: 32257803 PMCID: PMC7096690 DOI: 10.1016/j.ajur.2019.10.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 09/16/2019] [Accepted: 10/16/2019] [Indexed: 11/24/2022] Open
Abstract
Objective To define the role of ureteroscopy for treatment of staghorn calculi. Methods A systematic review was conducted using the Scopus and Medline databases. Original articles and systematic reviews were selected according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Only studies relating to the role of ureteroscopy for treatment of staghorn calculi were included. Results In five studies on ureteroscopic monotherapy, stone-free rate (SFR) ranged from 33% to 93%, with a maximum four ureteroscopy sessions per patient and no major complications. Endoscopic combined intrarenal surgery (ECIRS) was compared with percutaneous nephrolithotomy (PNL) in two studies and reached significantly higher SFR (88%-91% vs. 59%-65%) and lower operative times (84-110 min vs. 105-129 min). The role of salvage ureteroscopy for residual stones after primary PNL has been highlighted by two studies with a final SFR of 83%-89%. One study reported on the feasibility of ureteroscopy for ureteral stones and same-session PNL for contralateral staghorn calculi, with a SFR of 92%. Conclusion Ureteroscopy plays a pivotal role in the setting of a combined approach to staghorn calculi. Ureteroscopy is also particularly suitable for clearance of residual stones. In specific cases, ureteroscopy may become the sole applicable therapeutic option to staghorn calculi. Technological advances and refinement of techniques suggest a major role of ureteroscopy for staghorn calculi treatment in close future.
Collapse
Affiliation(s)
- Etienne Xavier Keller
- Sorbonne Université, Service d'Urologie, AP-HP, Hôpital Tenon, F-75020, Paris, France.,Sorbonne Université, GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, F-75020, Paris, France.,Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Vincent De Coninck
- Sorbonne Université, Service d'Urologie, AP-HP, Hôpital Tenon, F-75020, Paris, France.,Sorbonne Université, GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, F-75020, Paris, France.,Department of Urology, AZ Klina, Brasschaat, Belgium
| | - Steeve Doizi
- Sorbonne Université, Service d'Urologie, AP-HP, Hôpital Tenon, F-75020, Paris, France.,Sorbonne Université, GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, F-75020, Paris, France
| | - Olivier Traxer
- Sorbonne Université, Service d'Urologie, AP-HP, Hôpital Tenon, F-75020, Paris, France.,Sorbonne Université, GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, F-75020, Paris, France
| |
Collapse
|
34
|
Li K, Liao Z, Lin T, Li Z, He W, Liu C, Huang Y, Zhou J, Huang J, Xu K. A Novel Semirigid Ureterorenoscope with Vacuum Suctioning System for Management of Single Proximal Ureteral and Renal Pelvic Stones: An Initial Experience. J Endourol 2019; 32:1154-1159. [PMID: 30398381 DOI: 10.1089/end.2018.0565] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION A novel semirigid ureterorenoscope, named the Sotn ureterorenoscope, was designed with a vacuum suction system. The present study aimed to evaluate the feasibility and safety of using the Sotn ureterorenoscope to manage single proximal ureteral or renal pelvic stones. PATIENTS AND METHODS Data were retrospectively collected from consecutive patients treated with a Sotn ureterorenoscope between February 2010 and August 2015 at Sun Yat-sen Memorial Hospital of Sun Yat-sen University and Jiangmen Wuyi Traditional Chinese Medicine Hospital in China. The primary outcome was the primary stone-free rate (SFR) in 1 month. The secondary outcomes were the final SFR and the perioperative complication rate. RESULTS A total of 386 patients were evaluated, including 240 males and 146 females. The median (interquartile range [IR]) age was 50 (40-59) years. There were 96 and 290 stones located in the renal pelvis and proximal ureter, respectively. The median (IR) operative time and console time for all patients were 40 (30-70) and 20 (12-38) minutes, respectively. The primary overall SFR was 86.5%, whereas the SFRs for stones with a diameter of ≤1, 1 to 2, and 2 to 3 cm were 95.7%, 86.9%, and 69.0%, respectively. Complications occurred in 90 patients (23.3%); these complications were classified as Clavien-Dindo grades 1 to 2 (minor) in 79 (20.5%) patients, and grades 3 to 4 (major) in 11 (2.8%). CONCLUSIONS The novel semirigid Sotn ureterorenoscope featuring a vacuum suction system is effective and safe for managing proximal ureteral and renal pelvic stones.
Collapse
Affiliation(s)
- Kaiwen Li
- 1 Department of Urology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University ; and Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangzhou, China
| | - Zhijian Liao
- 2 Department of Urology, Jiangmen Wuyi Traditional Chinese Medicine Hospital , Jiangmen, China
| | - Tianxin Lin
- 1 Department of Urology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University ; and Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangzhou, China
| | - Zhuohang Li
- 1 Department of Urology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University ; and Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangzhou, China
| | - Wang He
- 1 Department of Urology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University ; and Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangzhou, China
| | - Cheng Liu
- 1 Department of Urology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University ; and Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangzhou, China
| | - Yuleng Huang
- 1 Department of Urology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University ; and Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangzhou, China
| | - Junhong Zhou
- 2 Department of Urology, Jiangmen Wuyi Traditional Chinese Medicine Hospital , Jiangmen, China
| | - Jian Huang
- 1 Department of Urology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University ; and Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangzhou, China
| | - Kewei Xu
- 1 Department of Urology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University ; and Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangzhou, China
| |
Collapse
|
35
|
[Role of pressure and temperature in ureterorenoscopy and percutaneous nephrolitholapaxy : Pressure and temperature changes during stone treatment]. Urologe A 2019; 58:1289-1297. [PMID: 31501985 DOI: 10.1007/s00120-019-01034-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Ureterorenoscopy and percutaneous nephrolitholapaxy are minimally invasive procedures and are the standard procedures for the treatment of kidney stones and ureteral calculi. To achieve an adequate view, in both methods an optimal and sufficient irrigation flow is necessary. The intrarenal pressure is influenced by the irrigation pressure and irrigation volume and has to be controlled. Pathologically elevated intrarenal pressure can lead to irreversible damage of the kidneys. Lasers are frequently used for stone fragmentation. It has been shown in studies that the laser energy can lead to an increase in the temperature and that thermal effects can also damage the kidneys. This article provides the surgeon with an overview about the effects of temperature and pressure changes during ureterorenoscopy and percutaneous nephrolitholapaxy and how damages can be avoided.
Collapse
|
36
|
Tonyali S. How to prevent infectious complications following flexible ureteroscopy? World J Urol 2019; 38:1813-1814. [DOI: 10.1007/s00345-019-02908-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 08/09/2019] [Indexed: 11/30/2022] Open
|
37
|
Khaleel SS, Borofsky MS. Innovations in Disposable Technologies for Stone Management. Urol Clin North Am 2019; 46:175-184. [DOI: 10.1016/j.ucl.2018.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
38
|
A study on the clinical application of a patented perfusion and suctioning platform and ureteral access sheath in the treatment of large ureteral stones below L4 level. Int Urol Nephrol 2018; 51:207-213. [PMID: 30536191 PMCID: PMC6394455 DOI: 10.1007/s11255-018-2049-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 12/04/2018] [Indexed: 11/30/2022]
Abstract
Purpose The purpose of the study was to evaluate the efficacy and safety of a patented perfusion and suctioning platform and ureteral access sheath in the treatment of large ureteral stones (≥ 1.5 cm) below L4 level. Methods We recruited 122 patients with large ureteral stones below L4 level at our hospital from December 2014 to June 2017. The patients were randomly divided into the study and control groups. Multiple operative and perioperative parameters were compared between the two groups. Results The study group had shorter operation time, less cases of postoperative fever, lower serum levels of PCT, IL-6 and BET within 24 h after surgery, as well as less number of cases receiving secondary surgery than the control group. Moreover, the former had a significantly higher stone clearance rate than the latter (P < 0.05; t-test or χ2 test). Conclusions The patented perfusion and suctioning platform and ureteral access sheath are safe and effective in treating large ureteral stones (≥ 1.5 cm) below L4 level.
Collapse
|
39
|
Peng G, Song L, Xie D, Huang J, Zhong Y, Tan W, Deng X. Suctioning flexible ureteroscopic lithotripsy in the oblique supine lithotomy position and supine lithotomy position: a comparative retrospective study. MINERVA UROL NEFROL 2018; 70:612-616. [DOI: 10.23736/s0393-2249.18.03144-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
40
|
Tonyali S. Suctioning ureteral access sheath use in flexible ureteroscopy might decrease operation time and prevent infectious complications. World J Urol 2018; 37:393-394. [PMID: 30259124 DOI: 10.1007/s00345-018-2510-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 09/24/2018] [Indexed: 11/26/2022] Open
Affiliation(s)
- Senol Tonyali
- Department of Urology, Turkiye Yuksek Ihtisas Training and Research Hospital, University of Health Sciences, 06230, Altındag, Ankara, Turkey.
| |
Collapse
|
41
|
Zhu Z, Cui Y, Zeng F, Li Y, Chen Z, Hequn C. Comparison of suctioning and traditional ureteral access sheath during flexible ureteroscopy in the treatment of renal stones. World J Urol 2018; 37:921-929. [PMID: 30120500 DOI: 10.1007/s00345-018-2455-8] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 08/14/2018] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To compare the efficiency and safety of suctioning ureteral access sheath (UAS) and traditional UAS during flexible ureteroscopy (FURS) for treatment of renal stones. METHODS Between January 2015 and December 2017, 165 patients who had renal stones successfully underwent FURS with suctioning UAS created by connecting a channel on the tail of the suctioning UAS to a vacuum device. The outcomes of these patients were compared with those of 165 patients undergoing FURS with traditional UAS using a 1:1 scenario matched-pair analysis. The matching parameters were age, gender and stone burden. RESULTS The baseline characteristics were homogeneous between the two groups. The suctioning UAS group had significantly higher SFR one day postoperatively (82.4% vs. 71.5%; P = 0.02), but SFR 1 month postoperatively was comparable in the two groups (P = 0.13). The incidence of overall complications was significantly higher in the traditional UAS group (24.8% vs 11.5%; P < 0.001). Regarding individual complications, the traditional UAS group was associated with a significantly higher incidence of fever (13.9% vs 5.5%; P = 0.009) and urosepsis requiring only additional antibiotics (6.7% vs 1.8%; P = 0.029). No significant difference was noted in the incidence of septic shock, hematuria, steinstrasse or ureteral stricture. The suctioning UAS group had significantly shorter operative time (49.7 + 16.3 min vs. 57.0 ± 14.0 min; P < 0.001). CONCLUSIONS Compared to traditional UAS during FURS for treating renal stones, suctioning UAS had the advantages of higher SFR 1 day postoperatively, a lower incidence of infectious complications and a shorter operative time. Further well-designed studies are required to confirm the results.
Collapse
Affiliation(s)
- Zewu Zhu
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
| | - Yu Cui
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
| | - Feng Zeng
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
| | - Yang Li
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
| | - Zhiyong Chen
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
| | - Chen Hequn
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China.
| |
Collapse
|
42
|
Lama DJ, Owyong M, Parkhomenko E, Patel RM, Landman J, Clayman RV. Fluid Dynamic Analysis of Hand-Pump Infuser and UROMAT Endoscopic Automatic System for Irrigation Through a Flexible Ureteroscope. J Endourol 2018; 32:431-436. [DOI: 10.1089/end.2017.0811] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Daniel J. Lama
- Department of Urology, School of Medicine, University of California, Irvine, Orange, California
| | - Michael Owyong
- Department of Urology, School of Medicine, University of California, Irvine, Orange, California
| | - Egor Parkhomenko
- Department of Urology, School of Medicine, University of California, Irvine, Orange, California
| | - Roshan M. Patel
- Department of Urology, School of Medicine, University of California, Irvine, Orange, California
| | - Jaime Landman
- Department of Urology, School of Medicine, University of California, Irvine, Orange, California
| | - Ralph V. Clayman
- Department of Urology, School of Medicine, University of California, Irvine, Orange, California
| |
Collapse
|
43
|
Huang J, Xie D, Xiong R, Deng X, Huang C, Fan D, Peng Z, Qin W, Zeng M, Song L. The Application of Suctioning Flexible Ureteroscopy With Intelligent Pressure Control in Treating Upper Urinary Tract Calculi on Patients With a Solitary Kidney. Urology 2018; 111:44-47. [DOI: 10.1016/j.urology.2017.07.042] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 07/14/2017] [Accepted: 07/28/2017] [Indexed: 11/27/2022]
|