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Xie F, Deng S, Fei K, Xu H, Zhang H. Nomogram to predict the risk of adverse outcomes in patients with residual stones following percutaneous nephrolithotomy. Int Braz J Urol 2023; 49:599-607. [PMID: 37390125 PMCID: PMC10482460 DOI: 10.1590/s1677-5538.ibju.2023.0111] [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: 03/10/2023] [Accepted: 05/28/2023] [Indexed: 07/02/2023] Open
Abstract
PURPOSE To investigate the risk factors associated with adverse outcomes in patients with residual stones after percutaneous nephrolithotomy (PCNL) and to establish a nomogram to predict the probability of adverse outcomes based on these risk factors. METHODS We conducted a retrospective review of 233 patients who underwent PCNL for upper urinary tract calculi and had postoperative residual stones. The patients were divided into two groups according to whether adverse outcomes occurred, and the risk factors for adverse outcomes were explored by univariate and multivariate analyses. Finally, we created a nomogram for predicting the risk of adverse outcomes in patients with residual stones after PCNL. RESULTS In this study, adverse outcomes occurred in 125 (53.6%) patients. Multivariate logistic regression analysis indicated that the independent risk factors for adverse outcomes were the diameter of the postoperative residual stones (P < 0.001), a positive urine culture (P = 0.022), and previous stone surgery (P = 0.004). The above independent risk factors were used as variables to construct the nomogram. The nomogram model was internally validated. The calculated concordance index was 0.772. The Hosmer-Lemeshow goodness-of-fit test was performed (P > 0.05). The area under the ROC curve of this model was 0.772. CONCLUSIONS Larger diameter of residual stones, positive urine culture, and previous stone surgery were significant predictors associated with adverse outcomes in patients with residual stones after PCNL. Our nomogram could help to assess the risk of adverse outcomes quickly and effectively in patients with residual stones after PCNL.
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Affiliation(s)
- Feng Xie
- University of South ChinaThe First Affiliated HospitalHengyang Medical SchoolHengyangHunanChinaDepartment of Urology, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China
- The First Hospital of ChangshaEmergency DepartmentChangshaHunanChinaEmergency Department, The First Hospital of Changsha, Changsha, Hunan, China
| | - Shidong Deng
- University of South ChinaThe First Affiliated HospitalHengyang Medical SchoolHengyangHunanChinaDepartment of Urology, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Kuilin Fei
- Central South UniversityXiangya HospitalDepartment of ObstetricsChangshaHunanChinaDepartment of Obstetrics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Hanfeng Xu
- University of South ChinaThe First Affiliated HospitalHengyang Medical SchoolHengyangHunanChinaDepartment of Urology, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Huihui Zhang
- University of South ChinaThe First Affiliated HospitalHengyang Medical SchoolHengyangHunanChinaDepartment of Urology, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China
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Application of Box-Behnken Design in the Preparation, Optimization, and In-Vivo Pharmacokinetic Evaluation of Oral Tadalafil-Loaded Niosomal Film. Pharmaceutics 2023; 15:pharmaceutics15010173. [PMID: 36678802 PMCID: PMC9861327 DOI: 10.3390/pharmaceutics15010173] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/28/2022] [Accepted: 12/28/2022] [Indexed: 01/06/2023] Open
Abstract
Benign prostatic hyperplasia (BPH) affects about 90% of men whose ages are over 65. Tadalafil, a selective PDE-5 inhibitor, was approved by FDA for BPH, however, its poor aqueous solubility and bioavailability are considered major drawbacks. This work intended to develop and evaluate oral fast dissolving film containing tadalafil-loaded niosomes for those who cannot receive the oral dosage form. Niosomes were statistically optimized by Box-Behnken experimental design and loaded into a polymeric oral film. Niosomes were assessed for their vesicular size, uniformity, and zeta potential. The thickness, content uniformity, folding endurance, tensile strength, disintegration time, and surface morphology were evaluated for the prepared polymeric film. The optimized niosomes revealed high entrapment efficiency (99.78 ± 2.132%) and the film was smooth with good flexibility and convenient thickness (110 ± 10 µm). A fast release of tadalafil was achieved within 5 min significantly faster than the niosomes-free drug film. The in-vivo bioavailability in rats established that the optimized niosomal film enhanced tadalafil systemic absorption, with higher peak concentration (Cmax = 0.63 ± 0.03 µg/mL), shorter Tmax value (0.66-fold), and relative bioavailability of 118.4% compared to the marketed tablet. These results propose that the oral film of tadalafil-loaded niosomes is a suitable therapeutic application that can be passed with ease to geriatric patients who suffer from BPH.
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Yang T, Wu C, Dai L, Hu Z, Song R, Meng X, Shi H. Effect of different targeted calyxes on the treatment of multi-site calculi in the postural drainage lithotripsy system. Front Med (Lausanne) 2022; 9:1050118. [PMID: 36874949 PMCID: PMC9978150 DOI: 10.3389/fmed.2022.1050118] [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: 09/26/2022] [Accepted: 12/05/2022] [Indexed: 02/18/2023] Open
Abstract
Objectives We developed a postural drainage lithotripsy system (PDLS) that can provide an individualized inversion and overturning angle and uses gravity to remove residual fragments (RFs). This study aimed to evaluate the effect of different targeted calyces on treating multi-site stones in PDLS. Methods A total of 20 stones with different sizes and diameters of 0-4 mm were placed in the kidney model through ureteroscopy, and 20 stones were evenly scattered in the middle calyx and the lower calyx of the model. The ventral-middle calyx, the dorsal-middle calyx, the ventral-lower calyx, and the dorsal-lower calyx were used as the targeted calyx of PDLS to treat multi-site stones. During treatment, if the stone moved from the starting position of the renal calyx to the ureteropelvic junction, it was recorded as "passing through." The clearance rate was recorded, and the efficacy of different targeted calyxes in the treatment of multiple-site calyx was compared. Each model was treated with four different targeted calyxes, and 20 models were tested 80 times. Results When the lower calyx was the targeted calyx, the total stone clearance rate was higher than when the middle calyx was the locating calyx (94.5 vs. 64%, P = 0.000), and the result was statistically significant. Conclusions Choosing the lower calyx as the targeted calyx, we can obtain a better stone clearance rate. However, there is no significant difference between the ventral lower calyx and the dorsal lower calyx.
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Affiliation(s)
- Tao Yang
- Wujin Hospital Affiliated Jiangsu University, Changzhou, China.,The Wujin Clinical College of Xuzhou Medical University, Changzhou, China.,The Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou Second People's Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, China
| | - Chong Wu
- The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Liangliang Dai
- Wujin Hospital Affiliated Jiangsu University, Changzhou, China.,The Wujin Clinical College of Xuzhou Medical University, Changzhou, China.,The Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou Second People's Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, China
| | - Zhixiong Hu
- Wujin Hospital Affiliated Jiangsu University, Changzhou, China.,The Wujin Clinical College of Xuzhou Medical University, Changzhou, China.,The Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou Second People's Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, China
| | - Rijin Song
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xianghu Meng
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Honglei Shi
- Wujin Hospital Affiliated Jiangsu University, Changzhou, China.,The Wujin Clinical College of Xuzhou Medical University, Changzhou, China.,The Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou Second People's Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, China
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Jiang P, Brevik A, Clayman RV. The Life and Death of Percutaneous Stone Removal: "Looking Back-Looking Forward". Urol Clin North Am 2021; 49:119-128. [PMID: 34776046 DOI: 10.1016/j.ucl.2021.07.010] [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: 10/20/2022]
Abstract
Although percutaneous nephrolithotomy (PCNL) is less morbid than open surgery, it still carries risks of significant complications as well as injury to the renal parenchyma. Flexible ureteroscopic stone removal, although causes no appreciable damage to the renal parenchyma, has limitations, most notably, a lower stone-free rate than PCNL. Advances in our knowledge regarding ureteral physiology combined with technical developments applied to ureteral access sheath deployment and size may well propel retrograde intrarenal surgery to the forefront of kidney stone removal, regardless of stone size or location.
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Affiliation(s)
- Pengbo Jiang
- Department of Urology, University of California - Irvine, 333 City Boulevard West, Suite 2100, Orange, CA 92868, USA.
| | - Andrew Brevik
- Department of Urology, University of California - Irvine, 333 City Boulevard West, Suite 2100, Orange, CA 92868, USA
| | - Ralph V Clayman
- Department of Urology, University of California - Irvine, 333 City Boulevard West, Suite 2100, Orange, CA 92868, USA
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Hausmann T, Becker B, Gross AJ, Netsch C, Rosenbaum CM. Novel Biocompatible Adhesive to Remove Stone Dust: Usability Trial in a Kidney Model. J Endourol 2021; 35:1223-1228. [PMID: 33559523 DOI: 10.1089/end.2020.0748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Introduction and Objective: "Clinically insignificant residual fragments" are an independent predictive factor for recurrence of nephrolithiasis. To improve the stone-free rates (SFR), we tested the viability of a novel bioadhesive system for intrarenal embedding and retrieval of residual fragments <1 mm in a kidney model. Materials and Methods: All procedures were performed in a standardized setting, including a kidney model (Kidney module right, Samed GmbH, Dresden) in a plastic basin filled with water. We used a Viper URF flexible ureterorenoscope (fURS) (6.6/8F, Richard Wolf, Knittlingen). A mean amount of 138 mg (standard deviation [SD] ±32.2 mg) of sand grains (range, 0.2-0.8 mm) was inserted in renal calices of the kidney model. We assessed the extraction efficacy of fURS using the bioadhesive system. In total, eight different surgeons performed each one trial, respectively. The endoscopic and macroscopic SFR, the level of the surgeons' experience, and the overall time of stone retrieval were evaluated. Additionally, a survey of the participants was conducted, to assess the contentment with this novel system. Results: The extraction of the sand grains was only possible using the bioadhesive system, otherwise they were too small sized to grab with a retrieval basket. The total SFR was 84% (SD ±11.7%). The operation time (p = 0.052) and the percentage of extracted sand grains (p = 0.194) were not significantly different between experienced and less experienced surgeons. All participants stated that it was a promising technique, which they could imagine using on a daily basis. Conclusions: The bioadhesive system improves the SFR with fragments from 0.2 to 0.8 mm (0% vs 84%). Also, the performance of this operation is not dependent on the surgeon's experience level. This method might improve the SFR in difficult anatomic conditions, that is, lower calices or anomalous kidneys.
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Affiliation(s)
- Teresa Hausmann
- Department of Urology, Asklepios Clinic Barmbek (Institution to Which this Work Is Attributed), Hamburg, Germany
| | - Benedikt Becker
- Department of Urology, Asklepios Clinic Barmbek (Institution to Which this Work Is Attributed), Hamburg, Germany
| | - Andreas J Gross
- Department of Urology, Asklepios Clinic Barmbek (Institution to Which this Work Is Attributed), Hamburg, Germany
| | - Christopher Netsch
- Department of Urology, Asklepios Clinic Barmbek (Institution to Which this Work Is Attributed), Hamburg, Germany
| | - Clemens M Rosenbaum
- Department of Urology, Asklepios Clinic Barmbek (Institution to Which this Work Is Attributed), Hamburg, Germany.,Department of Urology, University Clinic Hamburg-Eppendorf, Hamburg, Germany
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