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Fernandez N, Ellison JS, Wang Z, Huang J, Chu DI, Sturm R, Stec AA, Hsi RS, Wu W, Nelson C, Ching C, Augelli B, Lorenzo M, Bi-Karchin J, Tasian GE. Surgeon, and Institution Characteristics Associated Surgical Preferences in the Pediatric KIDney Stone Care Improvement Network. Urology 2024; 187:64-70. [PMID: 38458327 DOI: 10.1016/j.urology.2024.02.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 01/26/2024] [Accepted: 02/27/2024] [Indexed: 03/10/2024]
Abstract
OBJECTIVE To reveal barriers and opportunities to implement evidence for the management of pediatric kidney stone disease, we determined surgeon and institutional factors associated with preferences for the type of surgical intervention for kidney and ureteral stones. METHODS We conducted a cross-sectional study of urologists participating in the Pediatric KIDney Stone Care Improvement Network (PKIDS) trial. Questionnaires ascertained strengths of urologists' preferences for types of surgery as well as characteristics of participating urologists and institutions. The outcome was the strength of preferences for ureteroscopy, shockwave lithotripsy, and percutaneous nephrolithotomy for four scenarios for which two alternative procedures are recommended by the AUA guidelines: (1) 2 cm kidney stone, (2) 9 mm proximal ureteral stone, (3) 1.5 cm lower pole kidney stone, (4) 1 cm nonlower pole kidney stone. Principal component analysis was performed to identify unique clusters of factors that explain surgical preferences. RESULTS One hundred forty-eight urologists at 29 sites completed surveys. Stated preferences were highly skewed except for the choice between ureteroscopy and percutaneous nephrolithotomy for a 1.5 cm kidney stone. Shockwave lithotripsy ownership and local practice patterns most frequently associated with the strength of surgeons' preferences for the type of surgery. Principal component analysis revealed that three clusters of stone, patient, and heterogenous characteristics explained 30% of the variance in preferences. CONCLUSION There is wide variation in the strengths of preferences for surgical interventions supported by current guidelines that are partially explained by surgeon and institutional characteristics. These results reveal opportunities to develop strategies for guidelines that consider real-world drivers of care.
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Affiliation(s)
- Nicolas Fernandez
- Department of Surgery, Division of Urology, Seattle Children's Hospital, Seattle, WA
| | | | - Zi Wang
- Department of Biostatistics, Epidemiology, and Informatics; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Jing Huang
- Department of Biostatistics, Epidemiology, and Informatics; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - David I Chu
- Ann & Robert H. Lurie Children's Hospital of Chicago, Division of Urology. Chicago, IL
| | - Renea Sturm
- Mattel Children's Hospital, Department of Urology, University of California, Los Angeles, CA
| | - Andrew A Stec
- Division of Urology, Nemours Children's Health, Jacksonville, FL
| | - Ryan S Hsi
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
| | - Wayland Wu
- Division Pediatric Urology, Cohen Children's Medical Center of New York, Zucker School of Medicine at Hofstra/Northwell, Long Island, NY
| | - Caleb Nelson
- Department of Urology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Christina Ching
- Kidney and Urinary Tract Center, Department of Pediatric Urology, Nationwide Children's Hospital, Columbus, OH
| | - Brian Augelli
- Department of Surgery, Division of Urology, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Matt Lorenzo
- Department of Surgery, Division of Urology, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Jing Bi-Karchin
- Department of Surgery, Division of Urology, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Gregory E Tasian
- Department of Biostatistics, Epidemiology, and Informatics; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Department of Surgery, Division of Urology, The Children's Hospital of Philadelphia, Philadelphia, PA.
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Campbell P, Mudd B, Craig K, Daugherty M, Vanderbrink B, DeFoor W, Minevich E, Reddy P, Strine A. One and done: Feasibility and Safety of Primary Ureteroscopy in a Pediatric Population. J Pediatr Urol 2024; 20:224.e1-224.e7. [PMID: 37957074 DOI: 10.1016/j.jpurol.2023.10.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/24/2023] [Accepted: 10/27/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Pediatric urolithiasis has been increasing at rate of 4-10 % annually in the United States, most notably within adolescents and females. A significant number of patients will require surgical management of their stones. Primary ureteroscopy (URS) affords the opportunity to treat stones under a single anesthetic with lower re-treatment rates or anatomical and stone characteristic limitations compared to shockwave lithotripsy. Previous studies evaluating primary URS have been largely underpowered, are limited by stone location, and/or are not representative of the stone population in the United States. OBJECTIVES Primary study outcomes were the success of primary URS and patient characteristics associated with success. Secondary outcomes were the stone-free rate (SFR), 30-day emergency department (ED) visits, 30-day readmissions, and complications. METHODS We performed a retrospective cohort study of patients less than 18 years of age from 2011 to 2023 who underwent primary URS. Patients were excluded if a ureteral stent was placed prior to URS or diagnostic URS was performed. A successful primary URS was considered if access to the ureter was obtained and treatment of the stone(s) completed. In failed primary URS, a ureteral stent was placed for staged management. RESULTS A total of 196 patients were included and primary URS was performed or attempted on 224 renal units. The median age was 15.8 (IQR 13.4-16.9) years and median follow up 8.4 (IQR 1.1-24.6) months. The success rate of primary URS was 79 %. No significant characteristics were appreciated for successful primary URS based on: overall age, <14 vs > 14 years of age, sex, body mass index, history of stones, history of endourologic procedures, preoperative alpha blockade, location of stone(s), multiple stones, type of URS, or acute treatment. In successful primary URS, the SFR was 88 % with stone size (p = 0.0001) the only predictor of having residual stones. The 30-day ED rate was 21.4 %, 30-day unplanned readmission rate was 12.5 %, and complication rate was 7.5 %. No long-term complications were appreciated. DISCUSSION Our success of primary URS compares favorably to previously published literature. Our SFR rate, 30-day ED visits, 30-day unplanned readmission, and complication rates are similar to other studies. Limitations of the study are its retrospective design, selection bias, and intermediate follow-up. CONCLUSIONS Primary URS can be completed safely in the majority of pediatric patients without any patient characteristics associated with success. We advocate for primary URS when possible due to the excellent SFR and potential of treating stones under a single anesthetic.
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Affiliation(s)
- Paul Campbell
- Cincinnati Children's Hospital Medical Center, Department of Urology, Cincinnati, OH, 3333 Burnet Avenue, Cincinnati, OH 45229, USA.
| | - Brandon Mudd
- University of Cincinnati, Department of Urology, Cincinnati, OH, 231 Albert Sabin Way, Cincinnati, OH 45267, USA.
| | - Kiersten Craig
- Cincinnati Children's Hospital Medical Center, Department of Urology, Cincinnati, OH, 3333 Burnet Avenue, Cincinnati, OH 45229, USA.
| | - Michael Daugherty
- Cincinnati Children's Hospital Medical Center, Department of Urology, Cincinnati, OH, 3333 Burnet Avenue, Cincinnati, OH 45229, USA.
| | - Brian Vanderbrink
- Cincinnati Children's Hospital Medical Center, Department of Urology, Cincinnati, OH, 3333 Burnet Avenue, Cincinnati, OH 45229, USA.
| | - William DeFoor
- Cincinnati Children's Hospital Medical Center, Department of Urology, Cincinnati, OH, 3333 Burnet Avenue, Cincinnati, OH 45229, USA.
| | - Eugene Minevich
- Cincinnati Children's Hospital Medical Center, Department of Urology, Cincinnati, OH, 3333 Burnet Avenue, Cincinnati, OH 45229, USA.
| | - Pramod Reddy
- Cincinnati Children's Hospital Medical Center, Department of Urology, Cincinnati, OH, 3333 Burnet Avenue, Cincinnati, OH 45229, USA.
| | - Andrew Strine
- Cincinnati Children's Hospital Medical Center, Department of Urology, Cincinnati, OH, 3333 Burnet Avenue, Cincinnati, OH 45229, USA.
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Gabrigna Berto F, Wang P, McClure JA, Bjazevic J, Golomb D, Filler G, Diaz-Gonzalez de Ferris M, Welk B, Razvi H, Dave S. A population-based retrospective cohort study of surgical trends and outcomes of pediatric urolithiasis in Ontario, Canada (2002-2019). J Pediatr Urol 2023; 19:784-791. [PMID: 37739819 DOI: 10.1016/j.jpurol.2023.08.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 08/06/2023] [Accepted: 08/31/2023] [Indexed: 09/24/2023]
Abstract
INTRODUCTION The worldwide incidence of pediatric urinary stone disease (PUSD) is increasing. However, there is no commensurate data on whether this translates to an increasing need for surgical intervention for PUSD, given the role of conservative management. OBJECTIVE We aimed to evaluate the trends and outcomes of clinically significant PUSD, using administrative databases to identify patients surgically treated for PUSD. STUDY DESIGN This retrospective population-based cohort study assessed the incidence and trends of surgically treated PUSD and outcomes in Ontario, Canada in patients <18 years of age who underwent their first PUSD procedure between 2002 and 2019 utilizing administrative databases held at the Institute of Clinical Evaluative Sciences (ICES). We assessed the incidence of surgically treated PUSD, demographics, initial surgical treatment and imaging modality, and risk factors for repeat intervention within 5 years. Statistical analyses summarized demographics, surgical trends, and logistic regression was used to identify risk factors for repeat surgical intervention. RESULTS We identified 1149 patients (mean age 11.3 years), with 59.6% older than 12 years. There was a decrease in the number of PUSD procedures performed per year that was close to statistical significance (p = 0.059) and a trend towards increased utilization of ureteroscopy (URS) compared with Shockwave Lithotripsy (SWL). In addition, there was a significant increase in the proportion of females surgically treated with PUSD (p = 0.001). In the 706 patients followed for 5 years, 17.7% underwent a repeat procedure within 6 months, while 20.4% underwent a repeat procedure from 6-months to 5 years. Renal stone location (OR 2.79, 95% confidence interval (CI) 1.62-4.80, p = 0.0002) and index SWL (OR 1.66, 95% CI 1.20-2.31, p = 0.0025) were risk factors for repeat surgical intervention within the first 6-months. There was an increasing utilization of ultrasound (US) compared to computerized tomography (CT) (p = 0.0008). DISCUSSION Despite the literature reporting increasing PUSD incidence, we observed a non-significant decrease in the number of surgical PUSD procedures performed. Exclusion of those treated conservatively may explain our results. The increase in the proportion of females treated reflects the narrowing gender gap in stone disease. A trend towards increased URS utilization was observed and re-intervention rates were similar to previous studies. CONCLUSION The overall rate of surgically treated PUSD did not show an increasing trend in Ontario, Canada from 2002 to 2019. URS was the most common surgical treatment modality, with a corresponding decline in SWL rates. PUSD was associated with a high surgical re-intervention rate within 6 months.
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Affiliation(s)
| | - Peter Wang
- Department of Surgery, Division of Urology, Western University, London, Ontario, Canada; Division of Pediatric Surgery and Division of Urology, Western University, London, Ontario, Canada
| | - J Andrew McClure
- Department of Surgery, London Health Sciences Centre, London, Ontario, Canada
| | - Jennifer Bjazevic
- Department of Surgery, Division of Urology, Western University, London, Ontario, Canada
| | - Dor Golomb
- Urology Department, Assuta Ashdod Hospital, Ashdod, Israel
| | - Guido Filler
- Department of Pediatrics, Division of Pediatric Nephrology, Western University, London, Ontario, Canada
| | | | - Blayne Welk
- Department of Surgery, Division of Urology, Western University, London, Ontario, Canada
| | - Hassan Razvi
- Department of Surgery, Division of Urology, Western University, London, Ontario, Canada
| | - Sumit Dave
- Department of Surgery, Division of Urology, Western University, London, Ontario, Canada; Division of Pediatric Surgery and Division of Urology, Western University, London, Ontario, Canada.
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Zimmermann P, Kraemer S, Pardey N, Bassler S, Stahmeyer JT, Lacher M, Zeidler J. Management of Children and Adolescents with Chest Trauma in Pediatric and Non-Pediatric Departments—A Claims Data Analysis. CHILDREN 2023; 10:children10030512. [PMID: 36980070 PMCID: PMC10047084 DOI: 10.3390/children10030512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/27/2023] [Accepted: 03/03/2023] [Indexed: 03/08/2023]
Abstract
Background: To investigate the management of children and adolescents with isolated and combined chest trauma in pediatric (PD) and non-pediatric departments (non-PD). Methods: Anonymized claims data were provided by two large German statutory health insurance funds, covering 6.3 million clients over a 10-year period (2010–2019). Data were extracted for patients who had an inpatient ICD diagnosis of section S20–S29 (injuries to the thorax) and were ≤18 years of age. Demographic and clinical data were analyzed. Results: A total of 4064 children and adolescents with chest trauma were included (mean age 12.0 ± 5.0 years; 55% male). In 1928 cases (47.4%), treatment was provided at PD. Patients admitted to PD underwent CT imaging less frequently (8.1%; non-PD: 23.1%; p < 0.0001). Children with a chest drain treated at university/maximum care hospitals (UM) showed more injuries involving multiple body regions compared with non-UM (25.8% vs. 4.5%; p = 0.0061) without a difference in the length of hospital stay. Conclusion: Children and adolescents with chest trauma are treated almost equally often in pediatric and adult departments. CT is significantly less frequently used in pediatric departments. Patients with a chest drain treated at a UM showed more concomitant injuries without a longer hospital stay. However, the clinical validity of this finding is questionable.
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Affiliation(s)
- Peter Zimmermann
- Department of Pediatric Surgery, University of Leipzig, 04103 Leipzig, Germany
- Correspondence:
| | - Sebastian Kraemer
- Section of Thoracic Surgery, Department of Visceral-, Transplant-, Thoracic and Vascular Surgery, University of Leipzig, 04103 Leipzig, Germany
| | - Nicolas Pardey
- Center for Health Economics Research Hannover (CHERH), 30159 Hannover, Germany
| | - Stefan Bassler
- AOK PLUS-Die Gesundheitskasse fuer Sachsen und Thueringen, 01067 Dresden, Germany
| | - Jona T. Stahmeyer
- AOK-Die Gesundheitskasse fuer Niedersachsen, 30519 Hannover, Germany
| | - Martin Lacher
- Department of Pediatric Surgery, University of Leipzig, 04103 Leipzig, Germany
| | - Jan Zeidler
- Center for Health Economics Research Hannover (CHERH), 30159 Hannover, Germany
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Changing Trends in Surgical Management of Nephrolithiasis among Young Adults: A 15-Year Population-Based Study. J Pers Med 2022; 12:jpm12081345. [PMID: 36013296 PMCID: PMC9410135 DOI: 10.3390/jpm12081345] [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: 06/24/2022] [Revised: 08/13/2022] [Accepted: 08/18/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Increases in obesity and diabetes rates among all ages have led to a greater prevalence of nephrolithiasis worldwide. We aimed to explore the changing trends in surgical management of nephrolithiasis in young adults over a 15 year period. Methods: We reviewed medical records of military personnel for information on the diagnosis and care of nephrolithiasis before and during active service between 2007−2021, divided into three 5 year periods: 2007−2011, 2012−2016, and 2017−2021. Demographic, clinical, radiological, and surgical data were retrieved for the analysis of changing trends. Results: The records of 1,117,692 recruits yielded 7383 (0.66%) with stone-related surgeries, of whom 1885 were operated during military service. Their median age was 19.6 years (interquartile range [IQR] 16.8−21.2), 829 (70%) were males, and the cohort’s median body mass index was 23.6 (IQR 17.3−26.1). There was a dramatic decline in shock wave lithotripsy (SWL) prevalence (35.1%, 10.4%, and 4.4%, respectively) with a continually increasing prevalence of ureteroscopy (URS)/retrograde intrarenal surgery (RIRS) (62.7%, 88.5%, and 94.6%, p = 0.01). Percutaneous nephrolithotomy (PCNL) procedures have become nearly extinct over time (0.8% in 2017−2021). The number of median-sized stones treated by URS/RIRS increased (7.5 mm, 8.2 mm, and 9.7 mm, p = 0.044), but not those treated by SWL/PCNL. The median length of medical leave for URS/RIRS and PCNL decreased significantly (7 vs. 4 days, p = 0.05 and 10 vs. 6 days, p = 0.036, respectively), with no comparable change for SWL. There was a substantial decline in ancillary procedures in the URS/RIRS groups (9%, 6.8%, and 3.1%, p < 0.01), but not in the SWL/PCNL groups. Conclusions: Advancements in technology and surgical training are leading to the extinction of SWL and the adoption of URS/RIRS as the new standard of care for nephrolithiasis among young adults.
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MADENDERE SERDAR, Değer MD, Aktoz T. Global Web Trends Analysis of Minimally Invasive Urinary Stone Treatment in the Last Decade and during the COVID-19 Pandemic. J Endourol 2022; 36:1271-1276. [DOI: 10.1089/end.2022.0086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | - Tevfik Aktoz
- Trakya University Faculty of Medicine, 64058, Urology, Edirne, Turkey
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Kaygısız O, Yeni S, Turan L, Cicek MC, Coskun B, Kilicarslan H. Ureterorenoscopic lithotripsy for pediatric kidney stones using Holmium: YAG laser devices: 15 W versus 30 W. J Endourol 2022; 36:916-920. [PMID: 35166132 DOI: 10.1089/end.2021.0922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction We aimed to compare the effectiveness of 15Watt (W) and 30 W Holmium: yttrium-aluminum-garnet (Ho: YAG) laser devices used in the treatment of pediatric kidney stones. Methods: Eighty-six consecutive pediatric patients who underwent retrograde intrarenal surgery between February 2010 and August 2020 were enrolled in the study. After exclusion criteria, the data of 79 children were evaluated retrospectively. Patients were divided into two groups according to the laser device power 15W (Group 15: N=30) and 30W (Group 30: N=49). The groups were compared according to demographic, stone feature, and clinical efficacy. Results The age, gender, height, weight, stone characteristics were similar between the groups. The mean operation time was shorter in Group 30. The stone-free rate after the first RIRS session (SF1) was 66.7% in Group 15 and 83.3% in Group 30. SF1 rate after the first RIRS procedure for 20 mm or larger kidney stones was found 0% in Group 15 and 62.5% in Group 30. However, there was no statistically significant difference between the two groups in terms of stone-free rate. Conclusion: In pediatric kidney stone treatment, 30 W Ho:YAG laser devices should be preferred as they shorten the operation time compared to 15 W devices and provide final stone-free with fewer procedures, especially in large kidney stones.
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Affiliation(s)
- Onur Kaygısız
- Bursa Uludağ University, Faculty of Medicine, Urology, Bursa, Turkey;
| | - Sezgin Yeni
- Bursa Uludag University, 37523, Bursa Uludag University Faculty of Medicine Hospital, Department of Urology, Bursa, Turkey, 16059;
| | - Levent Turan
- Bursa Uludağ University, Faculty of Medicine, Urology, Bursa, Turkey;
| | | | - Burhan Coskun
- Bursa Uludag University, Faculty of Medicine, urology, Bursa, Turkey;
| | - Hakan Kilicarslan
- Bursa Uludag University, Faculty of Medicine, Urology, Bursa, Turkey;
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McGee LM, Sack BS, Wan J, Kraft KH. The effect of preoperative tamsulosin on ureteroscopic access in school-aged children. J Pediatr Urol 2021; 17:795.e1-795.e6. [PMID: 34544632 DOI: 10.1016/j.jpurol.2021.08.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 06/02/2021] [Accepted: 08/23/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Flexible ureteroscopes are not tailored for pediatric ureteral size and may not pass at first attempt into the pediatric ureter. Administration of tamsulosin preoperatively in adults has been shown to facilitate ureteral access sheath placement. Several studies have shown tamsulosin to be safe and effective when utilized for medical expulsive therapy in pediatric patients, but its utility for preoperative ureteral dilation has not been studied to date. OBJECTIVE We hypothesized that preoperative tamsulosin reduces failed ureteroscopic access in children. MATERIALS AND METHODS We conducted a retrospective review of patients aged 0-18 years undergoing flexible ureteroscopy (URS) from 2014 to 2019 at a single institution. Patients were divided into those taking 0.4 mg of tamsulosin daily for at least 1 week prior to surgery and those not taking tamsulosin. The primary outcome was failure to pass a 7.95 Fr flexible ureteroscope on initial attempt, requiring stent placement and staged management. Patients undergoing URS or stent placement within the prior year, requiring semi-rigid URS, or with genitourinary anomalies were excluded. RESULTS AND DISCUSSION A total of 49 patients met inclusion criteria. The tamsulosin group (n = 13) and non-tamsulosin group (n = 36) were similar with respect to demographic data. The percentage of prepubertal patients was 53% vs 33% (p = 0.19). The tamsulosin group had lower failed URS (38% vs 61%, p = 0.20). When stratified by age, both prepubertal and postpubertal patients in the tamsulosin group had lower failed URS (43% vs 67%, p = 0.67 and 33% vs 58%, p = 0.38). These clinically significant results suggest initial passage of a flexible ureteroscope is more successful in pediatric patients on preoperative tamsulosin. This study was largely limited by its low power and flaws inherent to its retrospective design. CONCLUSION Our results have implications for prescribing tamsulosin preoperatively to reduce multiple procedures and anesthetics in children. Adequately powered prospective trials are warranted to confirm preoperative tamsulosin reduces failed first-attempt flexible URS in children.
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Affiliation(s)
- Lauren M McGee
- Department of Urology, Oregon Health & Science University, Portland, OR, USA.
| | - Bryan S Sack
- Department of Urology, University of Michigan, Ann Arbor, MI, USA.
| | - Julian Wan
- Department of Urology, University of Michigan, Ann Arbor, MI, USA.
| | - Kate H Kraft
- Department of Urology, University of Michigan, Ann Arbor, MI, USA.
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Tonyali S. YouTube: A good source for retrograde intrarenal surgery? Investig Clin Urol 2021; 62:180-185. [PMID: 33660445 PMCID: PMC7940848 DOI: 10.4111/icu.20200314] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/10/2020] [Accepted: 09/07/2020] [Indexed: 11/29/2022] Open
Abstract
Purpose To evaluate the quality of videos for retrograde intrarenal surgery (RIRS) on YouTube (Google, LLC) from the perspective of both patients and physicians. Materials and Methods All videos longer than 2 minutes returned by the YouTube search engine in response to the keyword search “retrograde intrarenal surgery” were included in this study. The quality of content was analyzed by using the validated Journal of the American Medical Association Benchmark Score (JAMAS) and the Global Quality Score (GQS). Two surgeons developed the RIRS Scoring System (RIRSSS) to evaluate the technical quality of the videos. A video power index (VPI) was used to score the popularity of the videos. Results A total of 63 videos with a median of 389 views were included in the present study. Forty-three videos (68.3%) were provided by health care professionals and 53 videos (84.1%) included technical aspects about RIRS. The median (interquartile range) GQS, JAMAS, RIRSSS, and VPI scores were 2 (1–3), 1 (1–2), 2 (1–5), and 0.41 (0.08–1.29), respectively. Videos with audio had significantly higher GQS and RIRSSS scores than did with videos with no audio (p<0.001, p=0.039, respectively). The GQS of videos providing general information about RIRS was higher, whereas RIRSSS scores were higher for videos detailing technical aspects (p=0.027, p=0.038, respectively). Conclusions The quality of YouTube videos containing information about RIRS evaluated in this study was very low. It is necessary for health care organizations to prepare online materials and upload these materials to popular social media platforms to convey accurate information to patients.
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Affiliation(s)
- Senol Tonyali
- Department of Urology, Istanbul University Faculty of Medicine, Istanbul, Turkey.
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Guler Y, Erbin A. Comparison of extracorporeal shockwave lithotripsy and retrograde intrarenal surgery in the treatment of renal pelvic and proximal ureteral stones ≤2 cm in children. Indian J Urol 2020; 36:282-287. [PMID: 33376264 PMCID: PMC7759164 DOI: 10.4103/iju.iju_116_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 06/23/2020] [Accepted: 07/16/2020] [Indexed: 12/17/2022] Open
Abstract
Introduction: We aimed to compare extracorporeal shockwave lithotripsy (ESWL) and retrograde intrarenal surgery (RIRS) in pediatric patients with ≤2 cm renal pelvis and proximal ureteral stones. Methods: Medical records of 165 pediatric patients who underwent shockwave lithotripsy (SWL) or RIRS for upper urinary system stones up to 2 cm between January 2014 and December 2018 were retrospectively reviewed. After exclusions, the remaining 130 patients included 73 in the SWL group and 57 in the RIRS group. The groups were compared for demographic features, stone characteristics, operative data, success, and complications. Results: The mean stone volume was 308 ± 85 (54–800) and 336 ± 96 (60–720) mm3 in SWL and RIRS groups, respectively (P = 0.46). There were no significant differences in success rates (60% vs. 70%, SWL and RIRS), auxiliary treatment rates (16.4% vs. 14%), and complication rates (26% vs. 24.5%). The number of active procedural sessions and number of anesthesia sessions was higher in the RIRS group (P < 0.001 and P < 0.001, respectively), while the procedural time and anesthesia time were higher in the SWL group (P < 0.001 and P < 0.001, respectively). Stone size was found to be an independent success predictive factor for both the treatment modalities. Conclusions: Both SWL and RIRS have similar success, complication, and auxiliary treatment rates. RIRS was superior in terms of total procedure and anesthesia durations, while SWL was superior in terms of numbers of anesthesia sessions and active procedure sessions. As both have similar success rates, the more minimally invasive SWL should be chosen for pediatric upper urinary system stones of less than 2 cm size.
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Affiliation(s)
- Yavuz Guler
- Department of Urology, Private Safa Hospital, Istanbul, Turkey
| | - Akif Erbin
- Department of Urology, Haseki Traning and Research Hospital, Istanbul, Turkey
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Guven S, Yigit P, Tuncel A, Karabulut İ, Sahin S, Kilic O, Balasar M, Seckiner I, Canda E, Sonmez MG, Tefik T, Boz MY, Atis G, Ergin G, Soytas M, Senel Ç, Kirac M, Kiremit MC, Akand M, Tugcu V, Erkurt B, Muslumanoglu A, Sarica K. Retrograde intrarenal surgery of renal stones: a critical multi-aspect evaluation of the outcomes by the Turkish Academy of Urology Prospective Study Group (ACUP Study). World J Urol 2020; 39:549-554. [PMID: 32347334 DOI: 10.1007/s00345-020-03210-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 04/09/2020] [Indexed: 11/26/2022] Open
Abstract
AIMS To outline and evaluate the incidence, management and follow-up of the residual fragments (RFs) following retrograde intrarenal surgery (RIRS) of renal stones by the Turkish Academy of Urology Prospective Study Group (ACUP Study). METHODS Following the ethical committee approval, 15 centers providing data regarding the incidence, management, and follow-up of RFs after RIRS were included and all relevant information was recorded into the same electronic database program ( https://acup.uroturk.org.tr/ ) created by Turkish Urology Academy for Residual Stone Study. RESULTS A total of 1112 cases underwent RIRS for renal calculi and RFs were observed in 276 cases (24.8%). Of all the parameters evaluated, our results demonstrated no statistically significant relation between preoperative DJ stenting and the presence of RFs (χ2 (1) = 158.418; p = 0.099). RFs were significantly higher in patients treated with UAS (82 patients, 29.3%) during the procedure compared to the cases who did not receive UAS (194 patients, 23.3%) (χ2 (1) = 3.999; p = 0.046). The mean period for a secondary intervention after RIRS was 28.39 (± 12.52) days. Regarding the procedures applied for RF removal, re-RIRS was the most commonly performed approach (56%). CONCLUSIONS Despite the reported safe and successful outcomes, the incidence of RFs is higher, after the RIRS procedure particularly in cases with relatively larger calculi. Such cases need to be followed in a close manner and although a second flexible ureteroscopy is the treatment of choice for fragment removal in the majority of these patients, shock wave lithotripsy and percutaneous nephrolithotomy may also be preferred in selected cases.
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Affiliation(s)
- Selcuk Guven
- Department of Urology, Istanbul Medipol University, TEM Otoyolu No. 1, Bagcilar, 34214, Istanbul, Turkey.
| | - Pakize Yigit
- Department of Medical Statistics and Medical Informatics, Istanbul Medipol University, Istanbul, Turkey
| | - Altug Tuncel
- Department of Urology, Ankara Numune Research and Training Hospital, University of Health Sciences, Ankara, Turkey
| | - İbrahim Karabulut
- Department of Urology, Erzurum Research and Training Hospital, University of Health Sciences, Erzurum, Turkey
| | - Selcuk Sahin
- Department of Urology, Bakirköy Sadi Konuk Research and Training Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ozcan Kilic
- Department of Urology, Selcuklu Medical School, Selcuk University, Konya, Turkey
| | - Mehmet Balasar
- Department of Urology, Meram Medical School, Necmettin Erbakan University, Konya, Turkey
| | - Ilker Seckiner
- Department of Urology, Gaziantep University, Gaziantep, Turkey
| | - Erdem Canda
- Department of Urology, Yıldırım Beyazit University, Ankara, Turkey
| | - Mehmet Giray Sonmez
- Department of Urology, Meram Medical School, Necmettin Erbakan University, Konya, Turkey
| | - Tzevat Tefik
- Department of Urology, Istanbul Medical School, Istanbul University, Istanbul, Turkey
| | - Mustafa Yucel Boz
- Department of Urology, Istanbul Medipol University, TEM Otoyolu No. 1, Bagcilar, 34214, Istanbul, Turkey
| | - Gokhan Atis
- Department of Urology, Goztepe Training and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Giray Ergin
- Department of Urology, Koru Hospital, Ankara, Turkey
| | - Mustafa Soytas
- Department of Urology, Bakirköy Sadi Konuk Research and Training Hospital, University of Health Sciences, Istanbul, Turkey
| | - Çagdas Senel
- Department of Urology, Ankara Numune Research and Training Hospital, University of Health Sciences, Ankara, Turkey
| | - Mustafa Kirac
- Department of Urology, Koru Hospital, Ankara, Turkey
| | | | - Murat Akand
- Department of Urology, Selcuklu Medical School, Selcuk University, Konya, Turkey
| | - Volkan Tugcu
- Department of Urology, Bakirköy Sadi Konuk Research and Training Hospital, University of Health Sciences, Istanbul, Turkey
| | - Bulent Erkurt
- Department of Urology, Istanbul Medipol University, TEM Otoyolu No. 1, Bagcilar, 34214, Istanbul, Turkey
| | - Ahmet Muslumanoglu
- Department of Urology, Bagcilar Research and Training Hospital, University of Health Sciences, Istanbul, Turkey
| | - Kemal Sarica
- Department of Urology, Biruni University, Istanbul, Turkey
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