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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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Juliebø-Jones P, Antoniou V, Moen CA, Gjengstø P, Æsøy MS, Beisland C, Somani BK, Ulvik Ø. Ureteroscopy in Patients with Urinary Diversion: Outcomes and Lessons Learned from Two European Centres. EUR UROL SUPPL 2023; 50:85-90. [PMID: 37101777 PMCID: PMC10123421 DOI: 10.1016/j.euros.2023.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2023] [Indexed: 03/05/2023] Open
Abstract
Background Ureteroscopy (URS) in patients with urinary diversion is technically challenging. Common difficulties include anastomotic strictures, tortuosity, and failure to cannulate the ureteric orifice. There are few studies reporting outcomes in this special population. Objective Our aim was to report outcomes at two tertiary centres in Europe. Design setting and participants A multicentre retrospective cohort study was conducted between 2010 and 2022. Intervention URS (antegrade and retrograde) procedures carried out in patients with urinary diversions. Outcome measurements and statistical analysis Outcomes of interest included success at cannulating the ureteric orifice, stone-free rate (SFR), and complications. A logistic regression analysis was performed to identify potential predictors for success at cannulating the ureteric orifice and success at completing the intended procedure in a single session. Results and limitations Fifty patients underwent 72 URS procedures, with most (86%) undergoing a retrograde approach. The majority (82%) of patients had undergone ileal conduit. Wallace was the commonest anastomosis type (64%). Ureteric anastomosis was cannulated successfully in 81% of cases. The most common reason for cannulation failure was the inability to identify the ureteric orifice (11%). A multivariable analysis revealed that an endourologist performing the case was associated with a significantly greater likelihood of cannulation success compared with consultants (odds ratio 25.9, p < 0.001). The mean operative time and hospital stay were 49 min (range: 11-126) and 1 d (range: 0-10), respectively. SFRs were 75% (zero fragments) and 81% (residual fragments ≤2 mm). No intraoperative complications were recorded. The overall postoperative complication rate was 6%. This study is limited by its retrospective status. Conclusions Endourological experience increases the likelihood of successful ureteric cannulation and procedural success. A low complication rate can be achieved despite this being a population with often multiple comorbidities. Patient summary Patients with previous bladder reconstructive surgery can undergo ureteroscopy with good outcomes. Surgeon experience increases the likelihood of treatment success.
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Affiliation(s)
- Patrick Juliebø-Jones
- Department of Urology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Corresponding author. Department of Urology, Haukeland University Hospital, Bergen, Norway. Tel. +47 55 97 50 00.
| | - Vaki Antoniou
- Department of Urology. University Hospital Southampton, Southampton, UK
| | | | - Peder Gjengstø
- Department of Urology, Haukeland University Hospital, Bergen, Norway
| | - Mathias S. Æsøy
- Department of Urology, Haukeland University Hospital, Bergen, Norway
| | - Christian Beisland
- Department of Urology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Bhaskar K. Somani
- Department of Urology. University Hospital Southampton, Southampton, UK
| | - Øyvind Ulvik
- Department of Urology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
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Tuong MNE, Prillaman GE, Culp SH, Nelson M, Krupski TL, Isharwal S. India Ink Tattooing of Ureteroenteric Anastomoses. Tomography 2023; 9:449-458. [PMID: 36960996 PMCID: PMC10037650 DOI: 10.3390/tomography9020037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 01/31/2023] [Accepted: 02/15/2023] [Indexed: 02/25/2023] Open
Abstract
While upper tract access through the insensate conduit following urinary diversion takes less time and incurs fewer costs than percutaneous kidney access does for the treatment of ureter and kidney pathology, endoscopic ureteroenteric anastomoses (UEA) identification can be difficult. We injected India Ink into the bowel mucosa near the UEA during ileal conduit diversion (IC) to determine the safety and feasibility of ink tattooing. Patients undergoing IC were prospectively randomized to receive ink or normal saline (NS) injections. The injections were placed 1 cm from UEA in a triangular configuration, and loopogram exams and looposcopy were performed to identify reflux (UR), UEA, the tattooing site and strictures in 10 and 11 patients randomized with respect to ink and NS injections, respectively. Ink patients were older (72 vs. 61 years old, p = 0.04) and had a higher Charlson Comorbidity Index (5 vs. 2, p = 0.01). Looposcopy was performed in three ink and four NS patients. Visualization of UEA was achieved in 100% of the ink and 75% of the NS patients (p = 0.26). The ink ureteroenteric anastomotic stricture (UEAS) rate was higher (N = 3 vs. N = 1) and six patients vs. one patients underwent surgery, respectively, for UEAS (p = 0.31). The study was halted early due to safety concerns. Our pilot study demonstrates that ink can be well visualized following injection near UEA during IC. However, the ink cohort had more UEAS than previously cited in the literature and our prior institutional UEAS rate of 6%. While this study sample is small, the higher incidence of UEAS after ink injection led us to question the utility and safety of ink injection following IC.
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Affiliation(s)
- Mei N E Tuong
- Department of Urology, University of Virginia Health System, Charlottesville, VA 22903, USA
| | - Grace E Prillaman
- School of Medicine, University of Virginia, Charlottesville, VA 22903, USA
| | - Stephen H Culp
- Department of Urology, University of Virginia Health System, Charlottesville, VA 22903, USA
| | - Marc Nelson
- Uropartners, Glenview Illinois, Chicago, IL 60007, USA
| | - Tracey L Krupski
- Department of Urology, University of Virginia Health System, Charlottesville, VA 22903, USA
| | - Sumit Isharwal
- Department of Urology, University of Virginia Health System, Charlottesville, VA 22903, USA
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Panach-Navarrete J, Negueroles-García M, Martínez-Jabaloyas JM. Retrograde endoureterotomy as a treatment option for impacted calculus in the ureterointestinal junction. Urologia 2021; 89:585-588. [PMID: 34519244 DOI: 10.1177/03915603211046167] [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: 11/16/2022]
Abstract
INTRODUCTION In patients with a history of radical cystectomy and with intestinal diversion, urolithiasis in the upper urinary tract is a frequent event. MATERIAL AND METHODS We describe for the first time a case of retrograde endoureterotomy used to treat a calculus proximal to the ureterointestinal junction. RESULTS This technique is of interest when antegrade access is not possible. In our example, after passing the guidewire percutaneously, and externalize it through the stoma, the left meatus was reached with a resectoscope inserted through the ileal duct. After the use of a balloon to prevent migration of the calculus, a retrograde endoureterotomy was performed with a Collins knife and the stone removed. The patient's progress was satisfactory. CONCLUSION Endoscopic management of calculi in patients with intestinal diversion can be performed with different approaches. We recommend retrograde endoureterotomy as a feasible treatment option for the removal of impacted calculi at the ureterointestinal junction.
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Affiliation(s)
- Jorge Panach-Navarrete
- Department of Urology, University Clinic Hospital of Valencia; INCLIVA, Institute for Health Research; Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain
| | - María Negueroles-García
- Department of Urology, University Clinic Hospital of Valencia; INCLIVA, Institute for Health Research; Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain
| | - José María Martínez-Jabaloyas
- Department of Urology, University Clinic Hospital of Valencia; INCLIVA, Institute for Health Research; Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain
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Fonseca R, Santos JC, Lopes FA, Peyroteo I, Silva A, Gaspar FP, Mota RL. Endourological approach in patients with anatomical urinary tract challenges. JOURNAL OF CLINICAL UROLOGY 2021. [DOI: 10.1177/20514158211007733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: This article reports our experience managing neoplasms, stenosis and urolithiasis in patients with anatomical variations of the urinary system, using an endourological approach, either with an antegrade access or with combined access. Patients and methods: A retrospective review was performed using medical records of all patients who underwent percutaneous endourological treatment at our institution between 2014 and 2019. Those with such urinary anatomical variations were selected. Results: Out of 185 patients, 10 were identified. The study group included patients with urinary diversion, renal transplantation and congenital anomalies. Patients were divided into two sets, A and B, based on the presence or absence of urolithiasis, respectively. In set A, the median operative time was 213 minutes (standard deviation ( SD)=65.91 minutes). Only one patient had lithiasis in the first postoperative evaluation. Two patients had postoperative complications graded ⩾II in the Clavien–Dindo classification. Regarding set B, the median operation time was 75 minutes ( SD=66.89 minutes). Two patients had postoperative complications graded ⩾II in the Clavien–Dindo classification. Conclusions: Patients with anatomical tract challenges currently have a longer life expectancy and are therefore prone to urological complications in their unusual structures. Treatment of urological complications is essential, and minimal invasive procedures should be considered to resolve them and to reduce morbidity. Level of evidence: Not applicable.
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Affiliation(s)
- Rita Fonseca
- Department of Urology, Centro Hospitalar de Lisboa Ocidental EPE, Portugal
| | - José C Santos
- Department of Urology, Centro Hospitalar de Lisboa Ocidental EPE, Portugal
| | - Filipe A Lopes
- Department of Urology, Centro Hospitalar de Lisboa Ocidental EPE, Portugal
| | - Inês Peyroteo
- Department of Urology, Instituto Português de Oncologia de Lisboa Francisco Gentil EPE, Portugal
| | - Andreia Silva
- Department of Urology, Centro Hospitalar de Lisboa Ocidental EPE, Portugal
| | - Frederico P Gaspar
- Department of Urology, Centro Hospitalar de Lisboa Ocidental EPE, Portugal
| | - Renato L Mota
- Department of Urology, Centro Hospitalar de Lisboa Ocidental EPE, Portugal
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Abt D. Steinleiden bei anatomischen Besonderheiten. Urolithiasis 2021. [DOI: 10.1007/978-3-662-62454-8_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ye YL, Liang HT, Tan L, Zheng X, Xiong D, Xiao KH, Qin ZK. Conservative treatment for urinary fistula following ileal conduit urinary diversion: a simple method. BMC Urol 2019; 19:131. [PMID: 31823766 PMCID: PMC6905099 DOI: 10.1186/s12894-019-0564-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 12/01/2019] [Indexed: 12/19/2022] Open
Abstract
Background The presence of urinary fistula after ileal conduit urinary diversion is a challenging complication, and this study investigated the role of the intra-conduit negative pressure system (NPS) in the presence of urinary fistula following ileal conduit (IC) urinary diversion as a conservative treatment. Methods Using the intra-conduit NPS, a minor drainage tube was placed within a silicon tube to suck urine from the conduit with consistent negative pressure. Patients with urinary fistula following IC from August 2012 to July 2017 were recorded, and the clinical characteristics and outcome were retrospectively analyzed. Results The intra-conduit NPS was used as a primarily conservative treatment for 13 patients who suffered from urinary fistula and presented with a large amount of abdominal/pelvic drainage without other significant morbidities. The median age was 60 years old (42–74 years), and 7patients were male. The median duration between the IC operation and the presence of urinary fistula was 15 days (2–28 days), and elevated creatinine levels were detected in the abdominal/pelvic drainage with a median level of 2114 μmol/L (636–388 μmol/L). A significant decrease in abdominal/pelvic drainage was identified in 12 patients. The median time that the NPS was used was 9 days (7–11 days). The other patient did not show any improvements after 2 days of observation and then underwent open surgery. With ureteral stenting, 2 abdominal drainage tubes and the intra-conduit NPS were placed during operation, no urine leakage was observed in the abdominal/pelvic field, and the patient was cured in 9 days. With a median follow-up of 22 months, no fistula recurrence or hydronephrosis was detected. Conclusion The intra-conduit negative pressure system is a feasible and promising way to cure urinary fistula following ileal conduit urinary diversion. Because this procedure is a mini-invasive and simple approach, it might represent an alternative in selected patients.
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Affiliation(s)
- Yun-Lin Ye
- Department of Urology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, Guangdong, China
| | - Hai-Tao Liang
- Department of Urology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, Guangdong, China
| | - Lei Tan
- Department of Urology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, Guangdong, China.,Department of Urology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Guangdong, China
| | - Xia Zheng
- Department of Urology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, Guangdong, China
| | - Dan Xiong
- Department of Urology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, Guangdong, China.,Medical Laboratory of The Third affiliated Hospital of Shenzhen University, Shenzhen, 518000, Guangdong, China
| | - Kang-Hua Xiao
- Department of Urology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, Guangdong, China
| | - Zi-Ke Qin
- Department of Urology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, Guangdong, China.
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