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Stankovic M, Wolff L, Wieder T, Mendes J, Schumacher B. MAGnetic REtriaval Device for Minimally Invasive Ureter Stent Removal. J Endourol 2024. [PMID: 38780804 DOI: 10.1089/end.2024.0042] [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: 05/25/2024] Open
Abstract
Purpose: To assess the effectiveness and pain intensity associated with magnetic ureteral stent removal using a retriever, without the aid of ultrasound guidance. Methods: We prospectively enrolled 100 patients who underwent retrograde rigid and flexible ureterorenoscopy with or without laser lithotripsy for ureteronephrolithiasis treatment from September 2021 to June 2023. These patients were assigned in two groups. Group 1 underwent the traditional ureteral stent insertion, while Group 2 underwent magnetic ureteral stent insertion. Both insertion and removal times were documented. The indwelling time for ureteral stents was 14 days. One group underwent stent removal via flexible cystoscopy using grasping forceps and the other group using just a magnetic retriever, without the aid of ultrasound guidance. The numeric pain rating scale, recommendation rate, and a standardized self-answered ureter stent symptoms questionnaire (USSQ) were obtained directly after stent removal. Results: Both groups presented comparable characteristics in factors such as age, body mass index, history of stone treatments, procedure type, and complication rates during and post-surgery. Time taken for ureteral stent insertion did not differ significantly between the groups (131.2 seconds for Group 1 vs 159.1 seconds for Group 2). However, the stent removal time (152.1 seconds for Group 1 vs 35.4 seconds for Group 2) and pain intensity (6 for Group 1 vs 2 for Group 2) were significantly lower for Group 2. Furthermore, five out of the six sections of the USSQ showed significantly better results for Group 2. Conclusions: The use of magnetic ureteral stents, as a safe and efficient alternative to conventional ureteral stents, not only eliminates the need for cystoscopy but also conserves resources and reduces patient discomfort.
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Affiliation(s)
- Mladen Stankovic
- Department of Urology, Salem Hospital, Academic Hospital, University of Heidelberg, Heidelberg, Germany
| | - Laura Wolff
- Department of Urology, Salem Hospital, Academic Hospital, University of Heidelberg, Heidelberg, Germany
| | - Teresa Wieder
- Department of Urology, Salem Hospital, Academic Hospital, University of Heidelberg, Heidelberg, Germany
| | - Joao Mendes
- Department of Urology, Salem Hospital, Academic Hospital, University of Heidelberg, Heidelberg, Germany
| | - Bastian Schumacher
- Department of Urology, Salem Hospital, Academic Hospital, University of Heidelberg, Heidelberg, Germany
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Damavand RS, Esmaeili S, Bateni BH, Tavakoli AA, Kazemnezhad E. Comparing the effect of peri-operative antibiotic prophylaxis only with continuous low-dose antibiotic treatment on the incidence of urinary tract infection and stent related-symptoms in patients undergoing Double-J (DJ) stent insertion following transurethral lithotripsy (TUL). World J Urol 2023; 41:3027-3032. [PMID: 37775547 DOI: 10.1007/s00345-023-04585-8] [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: 04/20/2023] [Accepted: 08/19/2023] [Indexed: 10/01/2023] Open
Abstract
PURPOSE There are some controversial data about the peri operative use of antibiotics after double-J (DJ) insertion. This study aimed to compare the rates of urinary tract infections (UTI) and stent-related symptoms (SRSs) in patients who received only perioperative antibiotic prophylaxis and those given continuous low-dose antibiotic therapy for the entire stent-indwelling time following transurethral lithotripsy (TUL). METHODS In this randomized clinical trial 178 patients received intravenous antibiotic prophylaxis (ciprofloxacin 400 mg) before the TUL and then randomly divided into two groups to either receive no antibiotic treatment after procedure (group A, 90 patients) or to additionally receive a continuous low-dose antibiotic treatment with one ciprofloxacin 500 mg every 12 h for 3 days and then ciprofloxacin 250 mg once daily for the entire stent-indwelling time (group B, 88 patients). The rates of UTIs, SRSs and incidence of drug side-effects were evaluated in groups. RESULTS A total of 7 patients had positive urine culture [group A: 4 (4.4%) vs. group B: 3 (3.4%); P = 0.722]. Only 1 patient in group B had febrile UTI in the mean duration of indwelling stent in situ. The rate of SRSs was 92.2% and 89.8% in Group A and B, respectively, with no significant difference (P = 0.609). A total of 4 patients in Group B complained of gastrointestinal side effects of ciprofloxacin. CONCLUSION Continuous low-dose antibiotic treatment has no role in reducing the incidence of UTIs and SRSs during the indwelling time of ureteral stents compared with the peri-operative antibiotic prophylaxis only.
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Affiliation(s)
- Reza Shahrokhi Damavand
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Samaneh Esmaeili
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Bahador Heidari Bateni
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
| | - Ardalan Akhavan Tavakoli
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Ehsan Kazemnezhad
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
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Li J, Gauhar V, Lim EJ, Dmitriy S, Vladimir O, Dmitriy G, Igor S, Gadzhiev N. Safety and effectiveness of magnetic ureteric stent removal under ultrasound control: a randomized single center trial. World J Urol 2023; 41:2889-2896. [PMID: 37243718 DOI: 10.1007/s00345-023-04437-5] [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: 01/15/2023] [Accepted: 05/12/2023] [Indexed: 05/29/2023] Open
Abstract
PURPOSE To assess the safety and effectiveness of magnetic ureteric stent removal with a special magnet retriever under ultrasound guidance. METHODS A total of 60 male patients, who underwent ureteroscopy from October 2020 to March 2022, were prospectively enrolled and randomized into two groups. Group A patients underwent conventional double-J (DJ) stent insertion and subsequent stent removal via flexible cystoscopy. Group B patients underwent stent insertion using magnetic ureteric stent [Blackstar, Urotech (Achenmühle, Germany)] and stents were removed using a special magnet retriever under ultrasound guidance. Stents were left in situ for 30 days in both groups. All patients had follow-ups with a ureter stent symptoms questionnaire at 3- and 30-days post stent insertion. Visual analog scale (VAS) was assessed immediately after stent removal. RESULTS Stent removal time (142.5 s vs 142.5 s, group A vs group B, p < 0.0001) and VAS scores (4 vs 1, group A vs group B, p = 0.0008) were significantly lower in Group B. There were no statistically significant differences between both groups in the "urinary symptoms" (p = 0.3471) and "sexual matters" (p = 0.6126) in the USSQ domains. There was marginal statistical significance favoring Group A in the "body pain" (p = 0.0303), "general health score" (p = 0.0072), "additional problems" (p = 0.0142), and "work performance" (p < 0.0001) domains. CONCLUSIONS Magnetic ureteric stent can be considered as a safe and efficient alternative to conventional DJ stent. This approach avoids the need for cystoscopy, saving resources while minimizing patient discomfort.
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Affiliation(s)
- Jingqiu Li
- Department of Urology, Singapore General Hospital, Singapore, Singapore
| | - Vineet Gauhar
- Department of Urology, Ng Teng Feng General Hospital, Singapore, Singapore
| | - Ee Jean Lim
- Department of Urology, Singapore General Hospital, Singapore, Singapore
| | - Shkarupa Dmitriy
- Department of Urology, Saint Petersburg State University Hospital, Str. Optikov 38, B1, App 35, Saint Petersburg, 197342, Russia
| | - Obidnyak Vladimir
- Department of Urology, Pavlov First St. Petersburg State Medical University, Saint Petersburg State University Hospital, Saint Petersburg, Russia
| | - Gorelov Dmitriy
- Department of Urology, Pavlov First St. Petersburg State Medical University, Saint Petersburg State University Hospital, Saint Petersburg, Russia
| | - Semeniakin Igor
- Department of Urology, Joint Stock Company "Medsi Group", Moscow, Russia
| | - Nariman Gadzhiev
- Department of Urology, Saint Petersburg State University Hospital, Str. Optikov 38, B1, App 35, Saint Petersburg, 197342, Russia.
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Tulone G, Costanzo A, Pavan N, Giaimo R, Claps F, Fasciana TMA, Giammanco A, Bartoletti R, Simonato A. Analysis of Bacterial Stent Colonization: The Role of Urine and Device Microbiological Cultures. Antibiotics (Basel) 2023; 12:1512. [PMID: 37887213 PMCID: PMC10604538 DOI: 10.3390/antibiotics12101512] [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: 07/06/2023] [Revised: 09/25/2023] [Accepted: 09/30/2023] [Indexed: 10/28/2023] Open
Abstract
In this study, we explored the incidence of double J (JJ) contamination of patients who underwent an endourological procedure for urinary stones and ureteral stenosis. We developed a prospective study between January 2019 and December 2021. Ninety-seven patients, 54 male and 43 female, were enrolled. Urine culture was taken during four steps: before stent insertion, a sample from selective renal pelvis catheterization, a sample two days after the JJ insertion and finally, after the stent removal procedure. At the time of the stent removal, 1 cm of proximal and distal ends were cut off and placed in the culture for bacterial evaluation. Cohen's kappa coefficient value (k) and concordance rates of microbiological culture results were evaluated. The study group comprised 56% of male patients. Proximal and distal stent cultures were positive in 81 and 78 patients. The concordance rate of microbiological cultures between proximal and distal double J stent is 88% (k 0.6). The most common pathogens isolated from urine and stent cultures were Enterococcus spp. in 52 cases and Klebsiella spp. in 27 cases.
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Affiliation(s)
- Gabriele Tulone
- Urology Section, Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, 90100 Palermo, Italy; (G.T.); (A.C.); (R.G.); (A.S.)
| | - Angela Costanzo
- Urology Section, Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, 90100 Palermo, Italy; (G.T.); (A.C.); (R.G.); (A.S.)
| | - Nicola Pavan
- Urology Section, Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, 90100 Palermo, Italy; (G.T.); (A.C.); (R.G.); (A.S.)
| | - Rosa Giaimo
- Urology Section, Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, 90100 Palermo, Italy; (G.T.); (A.C.); (R.G.); (A.S.)
| | - Francesco Claps
- Urology Clinic, Department of Medical, Surgical and Health Sciences, University of Trieste, 34127 Trieste, Italy;
| | - Teresa Maria Assunta Fasciana
- Department of Health Promotion, Maternal-Childhood, Internal Medicine of Excellence “G. D’Allesandro”, University of Palermo, 90127 Palermo, Italy; (T.M.A.F.); (A.G.)
| | - Anna Giammanco
- Department of Health Promotion, Maternal-Childhood, Internal Medicine of Excellence “G. D’Allesandro”, University of Palermo, 90127 Palermo, Italy; (T.M.A.F.); (A.G.)
| | - Riccardo Bartoletti
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy;
| | - Alchiede Simonato
- Urology Section, Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, 90100 Palermo, Italy; (G.T.); (A.C.); (R.G.); (A.S.)
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Clapp B, Marrero K, Corbett J, Sharma I, Hage K, Vierkant RA, McKenzie T, Davis SS, Ghanem OM. Effect of operative times in bariatric surgery on outcomes: a matched analysis of the MBSAQIP database. Surg Endosc 2023:10.1007/s00464-023-09927-6. [PMID: 36752855 DOI: 10.1007/s00464-023-09927-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 01/28/2023] [Indexed: 02/09/2023]
Abstract
BACKGROUND The implications of operative time (OT) have been studied in different surgical specialties, showing a correlation with higher incidence rates of postoperative complications. However, the impact of OT on bariatric surgery complications is not well elucidated. METHODS A retrospective review of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database between 2015 and 2019 was performed. A total of 358,382 SG patients and 123,357 RYGB patients were included. The median OT was 68 min (10-720) and 113 min (10-640) for the sleeve gastrectomy (SG) group and the Roux-en-Y gastric bypass group, respectively. The groups were subdivided into two subgroups based on OT in comparison to the median time of each group. The subgroups were compared for surgical complications and outcomes. To reduce selection bias and risk of confounders, we performed a propensity score matching (PSM) for 22 variables. RESULTS In the PSM-matched cohort, 18,915 SG and 6,495 RYGB patients were included in each subgroup. The SG cohort showed higher rates of Clavien-Dindo Class 1, 2, 3a, 4, and 5 complications as well as higher rates of readmission, reoperation, and reintervention in the longer OT group before matching. After PSM, the subgroup with longer times continued to have higher rates of Clavien-Dindo Class 2 complications and higher rates of readmission and reoperation. Similarly, there were higher rates of all Clavien-Dindo class complications as well as readmission, reoperation, and reintervention in the RYGB group with higher OT. After PSM, there were still higher rates of Clavien-Dindo Class 3a complications as well as readmission and reintervention in the RYGB subgroup with prolonged OT. CONCLUSION In both SG and RYGB, longer OT was associated with increased rates of complications as well as readmission, reoperation, and reintervention. Surgeons should be cognizant of the increased rates of complications when operative times are longer.
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Affiliation(s)
- Benjamin Clapp
- Department of Surgery, Texas Tech HSC Paul Foster School of Medicine, El Paso, TX, USA
| | - Katie Marrero
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - John Corbett
- Department of Surgery, Texas Tech HSC Paul Foster School of Medicine, El Paso, TX, USA
| | - Ishna Sharma
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Karl Hage
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | | | | | - Scott S Davis
- Division of General and GI Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Omar M Ghanem
- Department of Surgery, Mayo Clinic, Rochester, MN, USA. .,Endocrine and Metabolic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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Hori S, Otsuki H, Fujio K, Nakajima K, Mitsui Y. Impact of eliminating urethral catheterization following ureterorenoscopic lithotripsy. Int J Urol 2022; 29:337-342. [PMID: 35028967 DOI: 10.1111/iju.14782] [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: 07/20/2021] [Revised: 12/14/2021] [Accepted: 12/19/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To show that elimination of a urethral catheter in ureterorenoscopic lithotripsy cases is not disadvantageous. METHODS We reviewed 164 non-catheterized patients (experimental group) and 656 catheterized patients (control group) with renal or ureteral stones treated at our institution. Inclusion criteria were initial operation, patient age 18 to 75 years, no dysuria, and no preoperative febrile urinary tract infection due to calculi. The primary areas of evaluation were patient background, stone characteristics, perioperative factors, and postoperative evaluation results. RESULTS The proportion of women was significantly lower (24.4% vs 37.2%; P = 0.01) and the proportion of multiple stone cases was significantly higher (34.9% vs 19.2%; P < 0.001) in the experimental as compared to the control group, while there were no significant differences for patient background or stone characteristics. The percentages of short-term preoperative stent insertion (72.0% vs 33.0%; P = 0.009) and negative preoperative urine culture cases (58.0% vs 23.0%; P < 0.001) were significantly higher in the experimental than in the control group, with no differences regarding other perioperative factors. There was no significant difference for complete stone clearance rate between the groups (P = 0.339), while only one patient underwent re-catheterization and there were no cases of urinary retention. Interestingly, the rate of postoperative febrile urinary tract infection was significantly lower (P = 0.024) in the experimental (5.7%) than in the control (9.0%) group. CONCLUSION Postoperative urethral catheterization can be eliminated in low-risk ureterorenoscopic lithotripsy cases, although additional studies are needed.
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Affiliation(s)
- Shunsuke Hori
- Department of Urology, Toho University Faculty of Medicine, Tokyo, Japan.,Department of Urology, Abiko Toho Hospital, Chiba, Japan
| | - Hideo Otsuki
- Department of Urology, Abiko Toho Hospital, Chiba, Japan
| | - Kei Fujio
- Department of Urology, Abiko Toho Hospital, Chiba, Japan
| | - Koichi Nakajima
- Department of Urology, Toho University Faculty of Medicine, Tokyo, Japan
| | - Yozo Mitsui
- Department of Urology, Toho University Faculty of Medicine, Tokyo, Japan
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Post-Ureteroscopy Infections Are Linked to Pre-Operative Stent Dwell Time over Two Months: Outcomes of Three European Endourology Centres. J Clin Med 2022; 11:jcm11020310. [PMID: 35054005 PMCID: PMC8777996 DOI: 10.3390/jcm11020310] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 12/15/2021] [Accepted: 01/07/2022] [Indexed: 12/25/2022] Open
Abstract
Background: The aim of this study is to investigate outcomes of pre-operative stent dwell time on infectious complications following ureteroscopy and stone treatment to identify a time cut-off. Material and Methods: Three tertiary referral centres in Europe retrospectively collected outcomes of ureteroscopy and laser fragmentation (URSL) for all patients with pre-operative indwelling ureteric stents over a period of up to 5 years. Data was collected on patient details, stone demographics, stent dwell time, complications and stone free rate (SFR). Matching for age, sex, operative time, stone size and post-operative stent insertion. To examine for a threshold effect, monthly cut-offs were used to compare post-ureteroscopic febrile UTIs. Binomial logistic regression was used (SPSS v.24) with a significance level set at 0.0036. The risk ratio (RR) with a 95% confidence interval (CI) and the number needed to harm (NNH) are reported. Results: There were 467 patients with a pre-operative stent for analysis. These patients (n = 315) were matched to non-stented controls after excluding 152 patients to achieve adequate matching. There was a significant difference in rates of post-ureteroscopic febrile UTI between stented vs non-stented patients (RR = 2.67, 95% CI: 1.10–6.48, p = 0.03). On adjustment, a dwell time of more than two months was associated with an increased risk of post-ureteroscopic febrile UTI (RR = 3.94, 95% CI: 1.30–12.01, p = 0.02), this increased risk rose with longer dwell time. At stent time longer than four months was associated with a significantly increased risk of post-ureteroscopic febrile UTI (5% vs. 15%, RR = 3.09, 95% CI: 1.56–6.10, p = 0.001), with the number needed to harm at 10. Conclusions: Overall infectious complication rates from URSL are low. The risk of post-operative UTI after four months of dwell time is nearly tripled compared to less than four months.
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The development and application of a triage system for urolithiasis during COVID-19. World J Urol 2021; 40:577-583. [PMID: 34762172 PMCID: PMC8581286 DOI: 10.1007/s00345-021-03871-7] [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: 04/25/2021] [Accepted: 10/26/2021] [Indexed: 12/03/2022] Open
Abstract
Purpose To balance epidemic prevention with the therapeutic needs of patients with urolithiasis during the COVID-19 pandemic, we developed a triage system to guide medical staff in making priority decisions. Methods The study began with a review of the literature to propose a theoretical framework. Then, focus groups were assembled to develop, supplement, refine and form a consensus on the indications of the triage system. Finally, the system was implemented in the clinic. The validity and reliability of the system were tested by a content validity index and the interrater reliability kappa coefficient. Changes in patient characteristics and waiting time before and after the epidemic were compared. Results The theoretical framework was based on disease pathophysiology, including obstruction, infection, kidney dysfunction, and other symptoms. With this guide, a 28-item triage system with categories of T1–5 (low priority to urgent) was developed. The content validity index and the interrater reliability coefficient were 0.833 and 0.812, respectively. During clinical application, although the total number of patients remained steady, the proportion of T1 decreased significantly; even though the overall waiting time of patients did not change significantly, it increased for T1 and decreased for T2–4 in 2020 compared with 2019 (P < 0.05). Conclusion This triage tool based on the dimensions of obstruction, infection, kidney dysfunction, and other symptoms has good psychometric properties and significant utility for prioritizing patients with urolithiasis during times of crisis. With this system, patients of moderate to high priority were treated promptly during the COVID-19 pandemic. Supplementary Information The online version contains supplementary material available at 10.1007/s00345-021-03871-7.
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