Editorial Comment on: "Systematic Review and Meta-Analysis Comparing Fluoroless Ureteroscopy and Conventional Ureteroscopy in the Management of Ureteral and Renal Stones" by Subiela et al

The application of new type ureteroscope and traditional linear ureteroscope in ureteric stone patients

OBJECTIVE

A ureteric stone is a type of urinary tract stone that is found within the ureter. While most cases can be managed with conservative treatment or minimally invasive surgery, these methods often cause significant pain for the patient. Interestingly, a new type of ureteroscope has shown considerable promise in treating patients with ureteric stones, and this study aims to explore its clinical application.

METHODS

A total of 120 patients with ureteric stones were recruited from our hospitals between January 1, 2023, and December 31, 2023. These patients were randomly assigned to either the control group, which received the traditional straight ureteroscope, or the experimental group, which was treated with the new type of ureteroscope. Both groups provided general data and blood samples for further analysis. A logistic regression analysis was conducted to examine the factors influencing infection following surgery in patients with ureteric stones, including preoperative CRP greater than 8 mg/L, postoperative CRP greater than 8 mg/L, preoperative white blood cell count (> 109/L), postoperative white blood cell count (> 109/L), preoperative urinalysis count greater than 28 (/ul), postoperative urinalysis count greater than 28 (/ul), and urine routine leukocyte count.

RESULTS

The findings indicated no significant differences between the observation group and the control group regarding preoperative demographic, participants general data (P > 0.05). Postoperative CRP > 8 mg/L, white blood cell count > 10 × 109/L, urinalysis count > 28/µL, and urine leukocyte count significantly decreased in the experimental group compared to the control group (P < 0.05). Binary logistic regression showed that postoperative CRP > 8 mg/L (OR = 7.03), white blood cell count > 109/L (OR = 3.86), urinalysis count > 28/µL (OR = 2.83), and urine leukocyte count (OR = 1.004) were predictive factors for ureteric stones. Preoperative values showed no significant difference (P > 0.05).

CONCLUSIONS

The binary logistic regression analysis identified Postoperative CRP > 8 mg/L, white blood cell count > 10 × 109/L, urinalysis count > 28/µL, and urine leukocyte count as significant predictors of postoperative infections. Our research findings indicate that the new ureteroscope has significant advantages over traditional ureteroscopes in terms of ease of entry into the ureteral lumen, stone fragmentation angle during surgery, surgical field of view, surgical operability, and reducing the risk of postoperative potential infections. These characteristics demonstrate that the new ureteroscope has significant potential in clinical applications, warranting further promotion and use.

Flexible Ureteroscopy and Nephroscopy for Stone Removal in Patients with Multiple Renal Calculi

Objective

Renal calculi are a common type of urological calculi and are associated with morbidity. This study was aimed at exploring the effect of flexible ureteroscopy and nephroscopy on stone removal in patients with multiple renal calculi.

Method

This randomized controlled trial included a total of 78 cases with multiple renal calculi in our hospital. The patients were randomly divided into the study and control groups and treated with flexible ureteroscopy and percutaneous nephrolithotomy with pneumatic ballistics, respectively. The surgery condition, levels of prostaglandin F2α (PGF2α), prostaglandin E2 (PGE2), keratocyte growth factor (KGF), renal function indices, and the incidence of complications were analyzed before and after surgery in the two groups.

Result

The operation time, the postoperative analgesia pump application time, one-time stone removal rate, the intraoperative blood loss, and hospital stay of the study group were significantly lower than those of the control group. Postsurgery, the levels of PGE2, PGF2α, and KGF in the study group were significantly lower than those in the control group. The serum levels of SCR, BUN, and NGAL in the study group were significantly lower than those in the control group. In addition, the incidence complications in the study group were significantly lower.

Conclusion

Flexible ureteroscopy and laser lithotripsy under nephroscopy were equally effective against multiple renal calculi. Flexible ureteroscopy reduced surgical trauma without affecting renal function and had a low incidence of complications.