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Lin H, Lin H, Liu C, Lin T, He Y, Shen Z, Ruan M. Clinical study of UMP and RIRS in 1.0-2.0 cm diameter renal/upper ureteral calculi. World J Urol 2024; 42:376. [PMID: 38869843 DOI: 10.1007/s00345-024-05076-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 05/23/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND The purpose of this study was to compare the efficacy and safety of Ultra-mini-percutaneous nephrolithotomy (UMP) and Retrograde intrarenal surgery (RIRS) for renal/upper ureteral calculi in 1.0-2.0 cm diameter. METHODS From October 2017 to October 2022, the surgical treatment of patients with renal/upper ureteral calculi in 1.0-2.0 cm diameter who were admitted to our hospital was retrospectively analyzed. They were divided into two groups, the UMP group (sixty-two cases) and the RIRS group (one hundred and nine cases), according to the different surgical methods. Baseline data includes general information, stone size, location, CT value, hydronephrosis, creatinine level, etc. RESULTS: Intraoperative blood loss was 33.6 ± 8.5 ml in the UMP group was significantly more than 4.3 ± 0.7 ml in the RIRS group (P < 0.05). Intraoperative renal pelvis pressure of UMP group 10.5 ± 1.3 mmHg was significantly lower than RIRS group 23.6 ± 5.6 mmHg (P < 0.05). The incidence of postoperative infection was higher in the RIRS group (thirteen cases [11.93%]), and one case ([1.61%]) in the UMP group (P < 0.05). Routine CT scans on the second day and two months after surgery showed that the stone clearance rates in the UMP group were 87.1% and 93.5%, respectively, higher than those in the RIRS group (69.7% and 79.8%, respectively; P < 0.05). CONCLUSION UMP has the advantage of a higher stone-free rate but a higher risk of injury and bleeding. The advantages of RIRS include less trauma, less bleeding, and faster recovery, but lower stone-free rates and a higher risk of infection.
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Affiliation(s)
- Haili Lin
- Department of Urology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian, China
| | - Huiying Lin
- Department of Neurology, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Chenyu Liu
- Department of Urology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian, China
| | - Tianqi Lin
- Department of Urology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian, China
| | - Yongxin He
- Department of Urology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian, China
| | - Zaixiong Shen
- Department of Urology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian, China
| | - Minyi Ruan
- Department of Science and Education, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian, China.
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Wombwell A, Lobo N, Khan MS, Thurairaja R. Ileal conduit obstruction secondary to tethering of the small bowel anastomosis to the pubic bone. BMJ Case Rep 2024; 17:e258418. [PMID: 38182174 PMCID: PMC10773287 DOI: 10.1136/bcr-2023-258418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2024] Open
Abstract
We present the case of a late 60s male who presented to hospital 3 years postradical cystectomy and ileal conduit diversion with polyuria and acute kidney injury. CT of the kidneys, ureters and bladder (KUB) revealed mild hydronephrosis of a solitary left kidney and a 3-cm calculus in the ileal conduit. The patient subsequently underwent a laparotomy which revealed the cause of obstruction to be tethering of the small bowel anastomosis to the pubic bone. The conduit was excised with the calculus in situ and a new conduit was fashioned. The patient recovered from surgery without complication, and his kidney function improved.
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Affiliation(s)
- Amy Wombwell
- Urology, Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Niyati Lobo
- Urology, Guy's and St Thomas' Hospitals NHS Trust, London, UK
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Zhou C, Yin G, Jiang Z, Tan J, Huang K, Yuan P. Mini-percutaneous nephrolithotomy versus retrograde intrarenal surgery for the treatment of 10-20-mm kidney stones in patients with ileal conduit: a comparative study. Minerva Urol Nephrol 2023; 75:616-624. [PMID: 37728497 DOI: 10.23736/s2724-6051.23.05394-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
BACKGROUND Both mini-percutaneous nephrolithotomy (mPNL) and retrograde intrarenal surgery (RIRS) are two major strategies for the endourological management of kidney stones. In the current study, we aimed to compare the efficacy and safety of mPNL and RIRS for the treatment of 10-20 mm kidney stones in patients with ileal conduit. METHODS Patients with a history of bladder cancer and ileal conduit who had undergone mPNL or RIRS for unilateral kidney stones 10-20 mm in size between January 2015 and June 2022 were retrospectively included. Baseline characteristics and perioperative outcomes were analyzed and compared between mPNL and RIRS. RESULTS The failure rate of the initial surgery was 2.5% and 18.9% for mPNL and RIRS, respectively (P=0.025). In total, 39 and 30 patients were finally included in the mPNL and RIRS groups. One-session stone-free rate (SFR) was higher in the mPNL group than the RIRS group (97.4% vs. 66.7%, P=0.002). However, there was no statistically significant difference between the two groups with regard to operation time, postoperative hospitalization, complications according to Clavien-Dindo classification, as well as the change in hemoglobin, creatinine, procalcitonin, and pain Visual Analogue Scale Score before and after the surgery. Moreover, Results were consistent across subgroup analyses in patients stratified by years (2015-2018 and 2019-2022). CONCLUSIONS Both mPNL and RIRS were feasible and safe for the treatment of 10-20 mm kidney stones in patients with ileal conduit. However, mPNL achieved superior SFR outcomes with a similar incidence of complications, and it might be a sensible alternative for selected patients.
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Affiliation(s)
- Chuanchi Zhou
- Department of Urology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Guangming Yin
- Department of Urology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Zhiqiang Jiang
- Department of Urology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Jing Tan
- Department of Urology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Kai Huang
- Department of Urology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Peng Yuan
- Department of Urology, The Third Xiangya Hospital, Central South University, Changsha, China -
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Xu S, Wang XN, Wang ZJ, Zhang TW, Zhang YH, Cao YC, Jiao W. Migrated Hem-o-Lok clips in the neobladder with giant stone formation: a case report. BMC Urol 2023; 23:52. [PMID: 36997995 PMCID: PMC10061752 DOI: 10.1186/s12894-023-01223-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 03/21/2023] [Indexed: 04/01/2023] Open
Abstract
INTRODUCTION Neobladder urolithiasis is a rare but important delaying complication of orthotopic urinary diversion. We report a case of Hem-o-Lok (HOLC) migration into the neobladder with giant stone formation after orthotopic neobladder cystectomy. CASE REPORT We report a case of a 57-year-old man with frequent urination and occasional discharge of stones 3 years after a laparoscopic orthotopic neobladder cystectomy. Computed tomography revealed a large round 3.5 cm calculus. An endoscopic neocystolitholapaxy was performed, and a Hem-o-Lok was found in the center of the stone. CONCLUSION We described the case presentation, treatment and analysis of etiology of stone formation to avoid such complication.
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Affiliation(s)
- Shang Xu
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong Province, China
| | - Xin-Ning Wang
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong Province, China
| | - Zi-Jie Wang
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong Province, China
| | - Tian-Wei Zhang
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong Province, China
| | - Yu-Hao Zhang
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong Province, China
| | - Yuan-Chao Cao
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong Province, China
| | - Wei Jiao
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong Province, China.
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Gu J, He Z, Li H, Liu Y, Wang H, Huang Y, Ding M. A giant neobladder stone with insignificant symptoms: A case report and literature review. Front Surg 2023; 10:1105146. [PMID: 36874453 PMCID: PMC9977997 DOI: 10.3389/fsurg.2023.1105146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 01/20/2023] [Indexed: 02/18/2023] Open
Abstract
Background Giant neobladder lithiasis after orthotopic bladder replacement is an infrequent but important long-term complication, which should be diagnosed and treated early. If left untreated, it may eventually lead to irreversible acute kidney injury and seriously affect the quality of life of patients. Here, we present a rare case of a patient who presented with a massive neobladder stone after radical cystectomy done with orthotopic neobladder construction, followed by a challenging stone extraction process. Case presentation A 70-year-old female patient presented with a massive neobladder stone 14 years after radical cystectomy done with orthotopic neobladder construction. A computed tomography scan showed a large elliptic stone. The patient underwent suprapubic cystolithotomy surgery, which removed her giant-sized stone in the neobladder. The size of the bladder stone that was removed was 13 cm × 11.5 cm × 9 cm, with a total weight of 903 g. To date, the follow-up time of treatment is 4 months, and in our patient, no pain, urinary tract infections, or other abnormalities suggestive of fistula were found. Conclusion Imaging examination is useful for detecting neobladder lithiasis occurring after orthotopic neobladder construction. Our experience demonstrates that open cystolithotomy is an appropriate therapeutic method for treating the late-stage complication of a giant neobladder stone.
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Affiliation(s)
- Jun Gu
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Zexi He
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Haihao Li
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yijie Liu
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Haifeng Wang
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yinglong Huang
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Mingxia Ding
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
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Complications of Pediatric Bladder Reconstruction in the Adult Patient. CURRENT BLADDER DYSFUNCTION REPORTS 2020. [DOI: 10.1007/s11884-020-00584-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Nethala D, Martin C, Tabib C, Griffiths L, Hall S. Massive Neobladder Stones in Postcystectomy Patient Lost to Follow Up. Urology 2020; 139:e10-e11. [DOI: 10.1016/j.urology.2020.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 01/13/2020] [Accepted: 01/17/2020] [Indexed: 10/25/2022]
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Tafuri A, Porcaro AB, Ashrafi AN, Cerruto MA, Amigoni N, Mariotto A, Sebben M, Marcer A, Bassi S, Medina LG, Cacciamani GE, Baccaglini W, Winter M, Verratti V, Monaco C, Migliorini F, Siracusano S, Artibani W. Multiple stones in neobladder: Case report and literature review. Urologia 2019; 86:216-219. [PMID: 31116696 DOI: 10.1177/0391560319850427] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Neobladder urolithiasis is a rare but important long-term complication of orthotopic urinary diversion. It may be asymptomatic and can be discovered as an incidental finding on a radiological investigation. However, when symptoms occur, they may include lower abdominal pain, dysuria, hematuria, and lower urinary tract symptoms. CASE DESCRIPTION We report the case of a 63-year-old male patient with irritative lower urinary tract symptoms, lower abdominal fullness, urinary incontinence, fecaluria, and urinary loss from the left inguinal fold 12 years after a radical cystoprostatectomy with a orthotopic neobladder. Computed tomography scan and urethrocystography showed a distended pouch with multiple large stones, an enterovesical fistula, and neovesicocutaneous fistula. The fistulae were successfully managed conservatively with the placement of a Foley catheter. After 3 months, open cystolithotomy was performed and approximately 50 stones with dimensions varying from 5 mm to 5 cm, with a total weight of 890 g, were removed. After a 1-year follow-up, the patient did not report pain, urinary tract infections, or symptoms suggestive of fistula and imaging evaluation confirmed no recurrence of neobladder stones. CONCLUSION Neobladder stones may present with various symptoms. Our patient had irritative lower urinary tract symptoms, lower abdominal fullness, urinary incontinence, fecaluria, and urinary loss from the left inguinal fold 12 years after a radical cystoprostatectomy with a orthotopic neobladder. Our experience demonstrates that open cystolithotomy is an effective intervention for the removal of large stones in neobladder.
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Affiliation(s)
- Alessandro Tafuri
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy.,Catherine & Joseph Aresty Institute of Urology, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | - Antonio B Porcaro
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Akbar N Ashrafi
- Catherine & Joseph Aresty Institute of Urology, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | - Maria Angela Cerruto
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Nelia Amigoni
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Arianna Mariotto
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Marco Sebben
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Anna Marcer
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Silvia Bassi
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Luis G Medina
- Catherine & Joseph Aresty Institute of Urology, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | - Giovanni E Cacciamani
- Catherine & Joseph Aresty Institute of Urology, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | - Willy Baccaglini
- Catherine & Joseph Aresty Institute of Urology, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA.,Departamento de Urologia, Faculdade de Medicina do ABC, Santo André, Brazil
| | - Matthew Winter
- Catherine & Joseph Aresty Institute of Urology, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | - Vittore Verratti
- Department of Psychological Sciences, Health and Territory, 'G. d'Annunzio' University-Chieti-Pescara, Chieti, Italy
| | - Carmelo Monaco
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Filippo Migliorini
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Salvatore Siracusano
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Walter Artibani
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
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Abstract
Urinary diversion (UD) with an intestinal segment has significant risks of short- and long-term complications. With modern reporting criteria, understanding of the true prevalence and spectrum of these complications has improved. Methods to minimize early postoperative complications include enhanced recovery pathways, restricted intraoperative fluid protocols, and referral to high-volume centers. With long-term follow-up after UD, the risk of complications steadily rises. Late surgical complications include ureterointestinal anastomotic strictures, urolithiasis, and stomal issues. Patients with UDs require close surveillance to monitor for anatomic, infectious, and metabolic complications and surgeons who perform UD should be aware of the risk and timing of postoperative complications.
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10
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Jesse E, Mahdy A. Surgical management of large pouch stone in continent urinary diversion. Int Urogynecol J 2017; 29:165-166. [PMID: 28948306 DOI: 10.1007/s00192-017-3469-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 08/21/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Erin Jesse
- Division of Urology, Department of Surgery, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, OH, 45267, USA
| | - Ayman Mahdy
- Division of Urology, Department of Surgery, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, OH, 45267, USA.
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