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Lin CB, Chuang SH, Shih HJ, Pan Y. Utilization of Ureteral Access Sheath in Retrograde Intrarenal Surgery: A Systematic Review and Meta-Analysis. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1084. [PMID: 39064513 PMCID: PMC11278831 DOI: 10.3390/medicina60071084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2024] [Revised: 06/23/2024] [Accepted: 06/29/2024] [Indexed: 07/28/2024]
Abstract
Background and Objectives: This paper evaluates the efficacy and safety of ureteral access sheath (UAS) utilization in retrograde intrarenal surgery (RIRS). Materials and Methods: We searched PubMed, Embase, and the Cochrane Library up to 30 August 2023. The inclusion criteria comprised English-language original studies on RIRS with or without UAS in humans. The primary outcome was SFR, while the secondary outcomes included intraoperative and postoperative complications, the lengths of the operation and the hospitalization period, and the duration of the fluoroscopy. Subgroup analyses and a sensitivity analysis were performed. Publication bias was assessed using funnel plots and Egger's regression tests. Dichotomous variables were analyzed using odds ratios (ORs) with 95% confidence intervals (CIs), while mean differences (MDs) were employed for continuous variables. Results: We included 22 studies in our analysis. These spanned 2001 to 2023, involving 12,993 patients and 13,293 procedures. No significant difference in SFR was observed between the UAS and non-UAS groups (OR = 0.90, 95% CI 0.63-1.30, p = 0.59). Intraoperative (OR = 1.13, 95% CI 0.75-1.69, p = 0.5) and postoperative complications (OR = 1.29, 95% CI 0.89-1.87, p = 0.18) did not significantly differ between the groups. UAS usage increased operation times (MD = 8.30, 95% CI 2.51-14.10, p = 0.005) and fluoroscopy times (MD = 5.73, 95% CI 4.55-6.90, p < 0.001). No publication bias was detected for any outcome. Conclusions: In RIRS, UAS usage did not significantly affect SFR, complications, or hospitalization time. However, it increased operation time and fluoroscopy time. Routine UAS usage is not supported, and decisions should be patient-specific. Further studies with larger sample sizes and standardized assessments are needed to refine UAS utilization in RIRS.
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Affiliation(s)
- Chi-Bo Lin
- Divisions of Urology, Department of Surgery, Changhua Christian Hospital, Changhua 500, Taiwan;
| | - Shu-Han Chuang
- Division of General Practice, Department of Medical Education, Changhua Christian Hospital, Changhua 500, Taiwan;
| | - Hung-Jen Shih
- Divisions of Urology, Department of Surgery, Changhua Christian Hospital, Changhua 500, Taiwan;
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 402, Taiwan
- Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Yueh Pan
- Divisions of Urology, Department of Surgery, Changhua Christian Hospital, Changhua 500, Taiwan;
- Ph.D. Program in Translational Medicine, National Chung Hsing University, Taichung 402, Taiwan
- Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung 402, Taiwan
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He M, Dong Y, Cai W, Cai J, Xie Y, Yu M, Li C, Wen L. Recent advances in the treatment of renal stones using flexible ureteroscopys. Int J Surg 2024; 110:4320-4328. [PMID: 38477158 PMCID: PMC11254199 DOI: 10.1097/js9.0000000000001345] [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: 12/21/2023] [Accepted: 03/04/2024] [Indexed: 03/14/2024]
Abstract
Upper urinary tract stones are a common urological disease that can be treated by flexible ureteroscopy (FURS) through the natural urinary tract, in addition to extracorporeal shock wave lithotripsy and percutaneous nephrolithotomy. The advantages of FURS are less trauma, faster recovery, and fewer complications, while its disadvantages include poor results of lithotripsy and stone extraction when dealing with larger stones, and prolonged operation time. Over the last two decades, the emergence of new technologies such as FURS combined with negative pressure suction, robot-assisted FURS, and artificially intelligent FURS, coupled with improvements in laser technology (the use of thulium fiber lasers and the invention of single-use flexible ureteroscopes (su-fURS) suitable for primary level application, have significantly increased the global adoption of FURS. This surge in usage holds a promising future in clinical application, benefiting a growing number of patients with renal calculi. Accompanied by changes in technical concepts and therapeutic modalities, the scope of indications for FURS is broadening, positioning it as a potential primary choice for urolithiasis treatment in the future. This review outlines the progress in employing FURS for the treatment of renal calculi in order to generate insights for further research.
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Affiliation(s)
- Min He
- School of the Second Clinical Medical College, Zhejiang Chinese Medical University
- First People’s Hospital of Fuyang
| | - Yonghui Dong
- School of the Second Clinical Medical College, Zhejiang Chinese Medical University
- Department of Urology, Affiliated Hangzhou First People’s Hospital, School of Medicine, Westlake University
| | | | - Jiale Cai
- School of the Second Clinical Medical College, Zhejiang Chinese Medical University
- First People’s Hospital of Fuyang
| | - Yaming Xie
- General Surgery, Department of Hepatobiliary and Pancreatic Surgery and Minimal Invasive Surgery, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital), Hangzhou Medical College
| | - Mingke Yu
- Zhejiang Provincial Hospital of Chinese Medicine, Hangzhou, Zhejiang Province, People’s Republic of China
| | - Changjiu Li
- Department of Urology, Affiliated Hangzhou First People’s Hospital, School of Medicine, Westlake University
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Juliebø‐Jones P, Gauhar V, Lim EJ, Traxer O, Madarriaga YQ, Castellani D, Fong KY, Bujons A, Ragoori D, Shrestha A, Vaddi CM, Bhatia TP, Sekerci CA, Tanidir Y, Teoh JY, Somani BK. Outcomes and considerations for retrograde intrarenal surgery (RIRS) in the setting of multiple and large renal stones (>15 mm) in children: Findings from multicentre and real-world setting. BJUI COMPASS 2024; 5:558-563. [PMID: 38873356 PMCID: PMC11168767 DOI: 10.1002/bco2.357] [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: 01/30/2024] [Revised: 02/24/2024] [Accepted: 03/10/2024] [Indexed: 06/15/2024] Open
Abstract
Purpose The aim of this study is to evaluate the outcomes of retrograde intra renal surgery (RIRS) in the setting of large or multiple stones in children (<18 years). Materials and Methods Retrospective analysis was performed of paediatric RIRS cases at nine centres worldwide over a 6-year period. Patients were divided into two groups: Group 1 had a single stone <15 mm. Group 2 had either multiple stones, maximum stone diameter of >15 mm, or both. Outcomes included stone free rate (SFR) and complications within 30 days. Results In total, 344 patients were included with 197 and 147 in Groups 1 and 2, respectively. Ureteric access sheaths were more frequently used in Group 2 (39.5% vs. 56.8%, p = 0.021). The operation time was significantly longer in Group 2 (p < 0.001). SFR after a single procedure was 84.7% in Group 1 and 63.7% in Group 2. Overall complication rates in Groups 1 and 2 were 7.6% and 33.3%, respectively. The most frequently reported complication in both groups was post-operative fever (4.4% vs. 14%, p = 0.004). The rate of Clavien I/II complications in groups 1 and 2 was 6% and 25.1%, respectively (p < 0.05). The rate of Clavien ≥ III complications in groups 1 and 2 was 1.6% and 8.1%, respectively (p < 0.05). On multivariate analysis, total operation time, stone size and multiplicity were significant predictors of residual fragments. Conclusions RIRS can be performed in paediatric cases with large and multiple stone burdens, but the complication rate is significantly higher when compared to smaller stones.
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Affiliation(s)
- Patrick Juliebø‐Jones
- Department of Clinical MedicineUniversity of BergenBergenNorway
- Department of UrologyHaukeland University HospitalBergenNorway
- Department of UrologyUniversity Hospital SouthamptonSouthamptonUK
| | - Vineet Gauhar
- Department of UrologyNg Teng Fong HospitalSingaporeSingapore
| | - Ee Jean Lim
- Department of UrologySingapore General HospitalSingaporeSingapore
| | - Olivier Traxer
- Department of Urology Hôpital TenonSorbonne UniversityParisFrance
| | | | - Daniele Castellani
- Urology Division, Azienda Ospedaliero‐Universitaria Ospedali Riuniti Di AnconaUniversità Politecnica Delle MarcheAnconaItaly
| | - Khi Yung Fong
- Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
| | - Anna Bujons
- Urology DepartmentAutonomous University of Barcelona, Fundació PuigvertBarcelonaSpain
| | - Deepak Ragoori
- Department of UrologyAsian Institute of Nephrology and Urology, Banjara HillsHyderabadIndia
| | - Anil Shrestha
- Department of Urology, National Academy of Medical SciencesBir HospitalKathmanduNepal
| | | | | | - Cagri Akin Sekerci
- Department of UrologyMarmara University School of MedicineIstanbulTurkey
| | - Yiloren Tanidir
- Department of UrologyMarmara University School of MedicineIstanbulTurkey
| | - Jeremy Yuen‐Chun Teoh
- Department of Surgery, S.H. Ho Urology CentreThe Chinese University of Hong KongSha TinHong Kong, China
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Tanidir Y, Sekerci CA, Bujons A, Castellani D, Ferretti S, Gatti C, Campobasso D, Quiroz Y, Teoh JYC, Pietropaolo A, Ragoori D, Bhatia TP, Vaddi CM, Shrestha A, Lim EJ, Fong KY, Sinha MM, Griffin S, Sarica K, Somani BK, Traxer O, Gauhar V. The Utility and Safety of Ureteral Access Sheath During Retrograde Intrarenal Surgery in Children. Urology 2024; 187:71-77. [PMID: 38432431 DOI: 10.1016/j.urology.2024.02.041] [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: 11/30/2023] [Revised: 01/15/2024] [Accepted: 02/28/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVE To compare retrograde intrarenal surgery (RIRS) with and without ureteral access sheath (UAS) in different pediatric age groups. METHODS The data of RIRS for kidney stone in children were obtained from 9 institutions. Demographic characteristics of patients and stones, intraoperative and postoperative results were recorded. While analyzing the data, patients who underwent RIRS without UAS (group 1) (n = 195) and RIRS with UAS (group 2) (n = 194) were compared. RESULTS Group 1 was found to be young, thin, and short (P <.001, P = .021, P <.001), but there was no gender difference and similar symptoms were present except hematuria, which was predominant in group 2 (10.6% vs 17.3%, P <.001). Group 1 had smaller stone diameter (9.91 ± 4.46 vs 11.59 ± 4.85 mm, P = .001), shorter operation time (P = .040), less stenting (35.7% vs 72.7%, P = .003). Re-intervention rates and stone-free rates (SFR) were similar between groups (P = .5 and P = .374). However, group 1 had significantly high re-RIRS (P = .009). SFR had a positive correlation with smaller stone size and thulium fiber laser usage compared to holmium fiber laser (HFL) (P <.001 and P = .020), but multivariate analysis revealed only large stone size as a risk factor for residual fragments (P = .001). CONCLUSION RIRS can be performed safely in children with and without UAS. In children of smaller size or younger age (<5 years), limited use of UAS was observed. UAS may be of greater utility in stones larger than 1 cm, regardless of the age, and using smaller diameter UAS and ureteroscopes can decrease the complications.
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Affiliation(s)
- Yiloren Tanidir
- Department of Urology, Marmara University School of Medicine, Istanbul, Turkey.
| | - Cagri Akin Sekerci
- Division of Pediatric Urology, Department of Urology, Marmara University School of Medicine, Istanbul, Turkey.
| | - Anna Bujons
- Urology Department, Autonomous University of Barcelona, Fundació Puigvert, Barcelona, Spain.
| | - Daniele Castellani
- Urology Division, Azienda Ospedaliero-Universitaria Ospedali Riuniti Di Ancona, Università Politecnica Delle Marche, Ancona, Italy.
| | - Stefania Ferretti
- Urology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy.
| | - Claudia Gatti
- Pediatric Surgery Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy.
| | - Davide Campobasso
- Urology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy.
| | - Yesica Quiroz
- Urology Department, Autonomous University of Barcelona, Fundació Puigvert, Barcelona, Spain.
| | - Jeremy Yuen-Chun Teoh
- Department of Surgery, S.H. Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, China.
| | - Amelia Pietropaolo
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
| | - Deepak Ragoori
- Department of Urology, Asian Institute of Nephrology and Urology, Banjara Hills, Hyderabad, Telangana, India.
| | - Tanuj Paul Bhatia
- Department of Urology, Sarvodaya Healthcare, Faridabad, Haryana, India.
| | - Chandra Mohan Vaddi
- Department of Urology, Preeti Urology and Kidney Hospital, Hyderabad, Telangana, India.
| | - Anil Shrestha
- Department of Urology, National Academy of Medical Sciences, Bir Hospital, Kanti Path, Kathmandu, Nepal.
| | - Ee Jean Lim
- Department of Urology, Singapore General Hospital, Singapore, Singapore.
| | - Khi Yung Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
| | - Mriganka Mani Sinha
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
| | - Stephen Griffin
- School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom.
| | - Kemal Sarica
- Department of Urology, Biruni University, Istanbul, Turkey.
| | - Bhaskar Kumar Somani
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
| | - Olivier Traxer
- Department of Urology Hôpital Tenon, Sorbonne University, Paris, France.
| | - Vineet Gauhar
- Department of Urology, Ng Teng Fong Hospital, Singapore, Singapore.
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Tuoheti KB, Wang XH, Wang T, Wang YZ, Wu ZH, Liu TZ. Clinical Efficacy Evaluation of a Novel Negative Pressure Ureteroscopic Lithotripsy for Ureteral Stones. Urology 2024; 187:1-5. [PMID: 38373576 DOI: 10.1016/j.urology.2023.12.031] [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: 09/06/2023] [Revised: 11/13/2023] [Accepted: 12/14/2023] [Indexed: 02/21/2024]
Abstract
OBJECTIVE To evaluate the clinical efficacy of a novel negative pressure ureteroscopic lithotripsy (NP-URL) compared to standard ureteroscopic lithotripsy (S-URL) for treating ureteral stones. METHODS A total of 284 patients diagnosed with ureteral stones and who underwent ureteroscopic lithotripsy between December 2020 and May 2022 at our hospital were included in the study. Among them, 146 cases underwent NP-URL and 138 cases underwent S-URL. The negative pressure device used in NP-URL consists of a 5F ureteric catheter and a tee joint. We evaluated the operative duration, stone-free rate, incidence of postoperative complications, stone retropulsion rate, and adjunct procedure rate between the two groups. RESULTS The mean operative duration was significantly shorter in the NP-URL group compared to the S-URL group (30.17 ± 5.84 minutes vs 34.84 ± 6.62 minutes; P<.05). Additionally, the NP-URL group had a lower incidence of postoperative fever (1.4% vs 8.7%; P<.05), reduced stone retropulsion rate (3.4% vs 11.6%; P<.05), and a statistically lower rate of adjunct procedures (5.5% vs 14.5%, P<.05). The NP-URL group also demonstrated a higher primary stone-free rate (91.8% vs 81.9%; P<.05). However, there was no significant difference in the final stone-free rate between the NP-URL and S-URL groups (P>.05). CONCLUSION NP-URL potentially reduces operative duration, significantly decreases the incidence of postoperative complications, and achieves better primary stone-free rates compared to S-URL.
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Affiliation(s)
- Kuer-Ban Tuoheti
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xing-Huan Wang
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Ting Wang
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yong-Zhi Wang
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Zhong-Hua Wu
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China.
| | - Tong-Zu Liu
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
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Tung YH, Li WM, Juan YS, Huang TY, Wang YC, Yeh HC, Lee HY. New infundibulopelvic angle measurement method can predict stone-free rates following retrograde intrarenal surgery. Sci Rep 2024; 14:9891. [PMID: 38688919 PMCID: PMC11061286 DOI: 10.1038/s41598-024-60248-7] [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: 01/22/2024] [Accepted: 04/20/2024] [Indexed: 05/02/2024] Open
Abstract
To enhance the accuracy of predicting stone-free rates after retrograde intrarenal surgery, we devised a novel approach to assess the renal infundibulopelvic angle. We conducted a retrospective review of patient records for those who underwent retrograde intrarenal surgery for renal stones between April 2018 and August 2019. Patient demographics, stone characteristics, and perioperative data were recorded. Subsequently, we introduced a modified angle measurement called the pelvic stone angle and evaluated its predictive performance for stone-free rates by comparing it with the traditional method in scoring systems. A total of 43 individuals were included in this study. Notable differences in stone burden and Hounsfield unit measurements were found between stone-free and non-stone-free patients. The pelvic stone angle demonstrated a good model fit when used in scoring systems, performing equally well as the conventional approach. The area under the receiver operating characteristic curve for the R.I.R.S. scoring system using the pelvic stone angle and the conventional approach did not show a significant difference. In conclusion, the predictive ability of the pelvic stone angle for stone-free rates was comparable to the old measurement method. Moreover, scoring systems using the pelvic stone angle exhibited a better model fit than those using the conventional approach.
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Affiliation(s)
- Yu-Hung Tung
- Department of Urology, Kaohsiung Medical University Hospital, No. 100, Shih-Chuan 1st Road, Sanmin Dist., Kao-hsiung, 80708, Taiwan
| | - Wei-Ming Li
- Department of Urology, Kaohsiung Medical University Hospital, No. 100, Shih-Chuan 1st Road, Sanmin Dist., Kao-hsiung, 80708, Taiwan
- Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kao-hsiung, Taiwan
- Department of Urology, Ministry of Health and Welfare Pingtung Hospital, Pingtung, Taiwan
- Department of Urology, Kaohsiung Medical University Gang-Shan Hospital, Kao-hsiung, Taiwan
| | - Yung-Shun Juan
- Department of Urology, Kaohsiung Medical University Hospital, No. 100, Shih-Chuan 1st Road, Sanmin Dist., Kao-hsiung, 80708, Taiwan
- Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kao-hsiung, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kao-hsiung, Taiwan
| | - Tsung-Yi Huang
- Department of Urology, Kaohsiung Medical University Hospital, No. 100, Shih-Chuan 1st Road, Sanmin Dist., Kao-hsiung, 80708, Taiwan
| | - Yen-Chun Wang
- Department of Urology, Kaohsiung Medical University Hospital, No. 100, Shih-Chuan 1st Road, Sanmin Dist., Kao-hsiung, 80708, Taiwan
| | - Hsin-Chih Yeh
- Department of Urology, Kaohsiung Medical University Hospital, No. 100, Shih-Chuan 1st Road, Sanmin Dist., Kao-hsiung, 80708, Taiwan
- Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kao-hsiung, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kao-hsiung, Taiwan
- Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kao-hsiung, Taiwan
| | - Hsiang-Ying Lee
- Department of Urology, Kaohsiung Medical University Hospital, No. 100, Shih-Chuan 1st Road, Sanmin Dist., Kao-hsiung, 80708, Taiwan.
- Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kao-hsiung, Taiwan.
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kao-hsiung, Taiwan.
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Devos B, Vanderbruggen W, Claessens M, Duchateau A, Hente R, Keller EX, Pietropaolo A, Van Cleynenbreugel B, De Coninck V. Risk factors of early infectious complications after ureterorenoscopy for stone disease: a prospective study. World J Urol 2024; 42:277. [PMID: 38691160 DOI: 10.1007/s00345-024-04983-6] [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: 12/19/2023] [Accepted: 03/25/2024] [Indexed: 05/03/2024] Open
Abstract
PURPOSE To prospectively evaluate the rate and associated risk factors of early infectious complications after ureterorenoscopy for urolithiasis. METHODS After ethical committee approval, 400 therapeutic retrograde ureterorenoscopy procedures between August 3, 2020 and November 24, 2021 were included for analysis in a single-center study. Postoperative infection was defined as an afebrile urinary tract infection, fever (≥ 38 °C) with pyuria (≥ 300 WBC/μL) or proven urinary pathogen, and urosepsis. The primary outcome was the rate of infectious complications after ureterorenoscopy. Secondary outcomes were the perioperative factors that increased the risk of infectious complications within 30 days of surgery using univariate and multivariate logistic regression analysis. RESULTS Twenty-nine of four hundred (7.3%) patients developed an infectious complication within 30 days after ureterorenoscopy. Ten (2.5%) patients developed an afebrile urinary tract infection, eight (2.0%) developed fever with pyuria, five (1.3%) febrile urinary tract infection, and six (1.5%) urosepsis. On univariate analysis, preoperative stent-type JFil® pigtail suture stent was significantly associated with the dependent variable (p < 0.001). On multivariate logistic regression analysis, older age (OR 1.035; 95% CI 1.006-1.070; p = 0.02) was found to be significantly associated with developing a postoperative infectious complication. CONCLUSIONS A 7.3% rate of postoperative infectious complications and 1.5% urosepsis rate were observed after therapeutic ureterorenoscopy, without the need of intensive care admission. The only significant risk factors were preoperative stent type (JFil® pigtail suture stent) on univariate analysis, and older age on multivariate logistic regression analysis. Further multicentric prospective observational data are needed in this field.
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Affiliation(s)
- Brecht Devos
- Faculty of Medicine, University Hospitals Leuven, Louvain, Belgium
| | | | - Marc Claessens
- Department of Urology, AZ Klina, Augustijnslei 100, 2930, Brasschaat, Belgium
| | - Aline Duchateau
- Department of Urology, AZ Klina, Augustijnslei 100, 2930, Brasschaat, Belgium
| | - Robert Hente
- Department of Urology, AZ Klina, Augustijnslei 100, 2930, Brasschaat, Belgium
| | - Etienne Xavier Keller
- Young Academic Urologists (YAU), Urolithiasis & Endourology Working Party, 6846, Arnhem, Netherlands
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Amelia Pietropaolo
- Young Academic Urologists (YAU), Urolithiasis & Endourology Working Party, 6846, Arnhem, Netherlands
- Department of Urology, University Hospital Southampton, Southampton, UK
| | - Ben Van Cleynenbreugel
- Faculty of Medicine, University Hospitals Leuven, Louvain, Belgium
- Department of Development and Regeneration, KU Leuven, Louvain, Belgium
| | - Vincent De Coninck
- Department of Urology, AZ Klina, Augustijnslei 100, 2930, Brasschaat, Belgium.
- Young Academic Urologists (YAU), Urolithiasis & Endourology Working Party, 6846, Arnhem, Netherlands.
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Tsaturyan A, Keller EX, Peteinaris A, Gabriel FC, Pietropaolo A, Ballesta Martinez B, Tatanis V, Ventimiglia E, Esperto F, Sener TE, De Coninck V, Emiliani E, Hameed BMZ, Talso M, Mykoniatis I, Tzelves L, Kallidonis P. Fluid dynamics within renal cavities during endoscopic stone surgery: does the position of the flexible ureteroscope and ureteral access sheath affect the outflow rate? World J Urol 2024; 42:240. [PMID: 38630158 DOI: 10.1007/s00345-024-04926-1] [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: 11/30/2023] [Accepted: 03/06/2024] [Indexed: 04/19/2024] Open
Abstract
PURPOSE To evaluate the impact of ureteroscope position within renal cavities as well as different locations of the tip of the ureteral access sheath (UAS) on fluid dynamics during retrograde intrarenal surgery (RIRS). MATERIALS AND METHODS A prospective observational clinical study was performed. Measurements with a flexible ureteroscope placed in the upper, middle and lower calyces were obtained with the tip of the UAS placed either 2 cm below the pyelo-ureteric junction (PUJ), or at the level of the iliac crest. RESULTS 74 patients were included. The outflow rates from the middle and upper calyxes were statistically significantly higher compared to the lower calyx, both with the UAS close to the pyelo-ureteric junction and at the iliac crest. When the UAS was withdrawn and positioned at the level of the iliac crest, a significant decrease in outflow rates from the upper (40.1 ± 4.3 ml/min vs 35.8 ± 4.1 ml/min) and middle calyces (40.6 ± 4.0 ml/min vs 36.8 ± 4.6 ml/min) and an increase in the outflow from the lower calyx (28.5 ± 3.3 ml/min vs 33.7 ± 5.7 ml/min) were noted. CONCLUSIONS Our study showed that higher fluid outflow rates are observed from upper and middle calyces compared to lower calyx. This was true when the UAS was positioned 2 cm below the PUJ and at the iliac crest. Significant worsening of fluid dynamics from upper and middle calyces was observed when the UAS was placed distally at the level of the iliac crest. While the difference was statistically significant, the absolute change was not significant. In contrast, for lower calyces, a statistically significant improvement was documented.
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Affiliation(s)
- Arman Tsaturyan
- Department of Urology, Erebouni Medical Center, 0087, Yerevan, Armenia.
- EAU Young Academic Urologists (YAU) Urolithiasis and Endourology Working Group Arnhem, NL-6803, Arnhem, The Netherlands.
| | - Etienne X Keller
- EAU Young Academic Urologists (YAU) Urolithiasis and Endourology Working Group Arnhem, NL-6803, Arnhem, The Netherlands
- Department of Urology, University Hospital Zurich, University of Zurich, 8006, Zurich, Switzerland
| | | | - Faria-Costa Gabriel
- Department of Urology, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal
- Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Amelia Pietropaolo
- EAU Young Academic Urologists (YAU) Urolithiasis and Endourology Working Group Arnhem, NL-6803, Arnhem, The Netherlands
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK
| | | | | | - Eugenio Ventimiglia
- EAU Young Academic Urologists (YAU) Urolithiasis and Endourology Working Group Arnhem, NL-6803, Arnhem, The Netherlands
- Division of Experimental Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, 20132, Milan, Italy
| | - Francesco Esperto
- EAU Young Academic Urologists (YAU) Urolithiasis and Endourology Working Group Arnhem, NL-6803, Arnhem, The Netherlands
- Department of Urology, Campus Biomedico University of Rome, 00128, Rome, Italy
| | - Tarik Emre Sener
- EAU Young Academic Urologists (YAU) Urolithiasis and Endourology Working Group Arnhem, NL-6803, Arnhem, The Netherlands
- Department of Urology, Marmara University School of Medicine, 34854, Istanbul, Turkey
| | - Vincent De Coninck
- EAU Young Academic Urologists (YAU) Urolithiasis and Endourology Working Group Arnhem, NL-6803, Arnhem, The Netherlands
- Department of Urology, AZ Klina, 2930, Brasschaat, Belgium
| | - Esteban Emiliani
- EAU Young Academic Urologists (YAU) Urolithiasis and Endourology Working Group Arnhem, NL-6803, Arnhem, The Netherlands
- Department of Urology, Fundacio Puigvert, Autonomous University of Barcelona, 08193, Barcelona, Spain
| | - B M Zeeshan Hameed
- EAU Young Academic Urologists (YAU) Urolithiasis and Endourology Working Group Arnhem, NL-6803, Arnhem, The Netherlands
- Department of Urology, Father Muller Medical College, Mangalore, Karnataka, 575002, India
| | - Michele Talso
- EAU Young Academic Urologists (YAU) Urolithiasis and Endourology Working Group Arnhem, NL-6803, Arnhem, The Netherlands
- Department of Urology, ASST Fatebenefratelli Sacco, Luigi Sacco University Hospital, Via Giovanni Battista Grassi, 74, 20157, Milan, Italy
| | - Ioannis Mykoniatis
- EAU Young Academic Urologists (YAU) Urolithiasis and Endourology Working Group Arnhem, NL-6803, Arnhem, The Netherlands
- Department of Urology, Aristotle University of Thessaloniki, 541 24, Thessaloniki, Greece
| | - Lazaros Tzelves
- EAU Young Academic Urologists (YAU) Urolithiasis and Endourology Working Group Arnhem, NL-6803, Arnhem, The Netherlands
- Institute of Urology, University College Hospital London, London, NW1 2BU, UK
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9
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Teke K, Çakir H, Siddikoğlu D, Özman O, Başataç C, Akgül HM, Çinar Ö, Şimşekoğlu MF, Tuna MB, Sancak EB, Yazici CM, Akpinar H, Önal B. Is Psoas Muscle Mass Associated with Failure of Ureteral Access Sheath Insertion and Complications from Retrograde Intrarenal Surgery? A Case-Control Study from RIRSearch group. J Laparoendosc Adv Surg Tech A 2024; 34:329-338. [PMID: 38422189 DOI: 10.1089/lap.2023.0512] [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] [Indexed: 03/02/2024] Open
Abstract
Objective: To investigate the association between psoas muscle mass (PMM) and failure of ureteral access sheath (UAS) insertion and complications from retrograde intrarenal surgery (RIRS). Materials and Methods: A multicenter retrospective case-control study was conducted that included patients who underwent RIRS despite failure of UAS insertion (Cohort 1) and confounder-matched control patients who underwent RIRS after successful UAS insertion (Cohort 2). For morphometric analysis of PMM, ipsilateral psoas muscle areas (iPMAs) were measured using the coreslicer.com webkit. After comparing demographic, clinical, and complication rates and iPMAs between cohorts, gender-specific median iPMAs were also determined to further subdivide patients in each cohort as either low iPMAs or high iPMAs. Thereafter, patients were also compared in terms of RIRS complications. Results: Cohort 1 included 86 patients whereas Cohort 2 consisted of 124 matched cases. The median (interquartile range) iPMAs were similar between the cohorts: Cohort 1, 11.05 (6.82-14.44) cm2 versus 11.12 (6.97-13.69) cm2 for Cohort 2 (P ˃ .05). There was a significant inverse relationship between iPMAs with age (r = -0.222) and Charlson comorbidity index (r = -0.180) for all patients (P ˂ .05). Perioperative and postoperative complication rates were 8.1% and 16.3% for Cohort 1 and 6.5% and 21% for Cohort 2, respectively. The complication rates were not statistically different between patients with high iPMAs and those with low iPMAs, in male or female patients (P > .05). Conclusions: These results show that failure of UAS was not associated with PMM. Furthermore, since the complication rates were similar between patients with high PMM and low PMM, RIRS may be a reliable treatment choice for sarcopenic patients as well as in nonsarcopenic patients.
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Affiliation(s)
- Kerem Teke
- Department of Urology, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Hakan Çakir
- Department of Urology, Fulya Acıbadem Hospital, İstanbul, Turkey
| | - Duygu Siddikoğlu
- Department of Biostatistics and Çanakkale Onsekiz Mart University, Çanakkale, Turkey
| | - Oktay Özman
- Department of Urology, Bahçelievler Memorial Hospital, İstanbul, Turkey
| | - Cem Başataç
- Department of Urology, Group Florence Nightingale Hospitals, İstanbul, Turkey
| | - Hacı Murat Akgül
- Department of Urology, Tekirdağ Namık Kemal University, Tekirdağ, Turkey
| | - Önder Çinar
- Department of Urology, MEDICANA International, Samsun, Turkey
| | | | | | - Eyüp Burak Sancak
- Department of Urology, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
| | - Cenk Murat Yazici
- Department of Urology, Tekirdağ Namık Kemal University, Tekirdağ, Turkey
| | - Haluk Akpinar
- Department of Urology, Group Florence Nightingale Hospitals, İstanbul, Turkey
| | - Bülent Önal
- Department of Urology, Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
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10
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Edison E, Mazzon G, Arumuham V, Choong S. Prevention of complications in endourological management of stones: What are the basic measures needed before, during, and after interventions? Asian J Urol 2024; 11:180-190. [PMID: 38680580 PMCID: PMC11053336 DOI: 10.1016/j.ajur.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 04/17/2023] [Indexed: 05/01/2024] Open
Abstract
Objective This narrative review aims to describe measures to minimise the risk of complications during percutaneous nephrolithotomy (PCNL), ureteroscopy, and retrograde intrarenal surgery. Methods A literature search was conducted from the PubMed/PMC database for papers published within the last 10 years (January 2012 to December 2022). Search terms included "ureteroscopy", "retrograde intrarenal surgery", "PCNL", "percutaneous nephrolithotomy", "complications", "sepsis", "infection", "bleed", "haemorrhage", and "hemorrhage". Key papers were identified and included meta-analyses, systematic reviews, guidelines, and primary research. The references of these papers were searched to identify any further relevant papers not included above. Results The evidence is assimilated with the opinions of the authors to provide recommendations. Best practice pathways for patient care in the pre-operative, intra-operative, and post-operative periods are described, including the identification and management of residual stones. Key complications (sepsis and stent issues) that are relevant for any endourological procedure are then be discussed. Operation-specific considerations are then explored. Key measures for PCNL include optimising access to minimise the chance of bleeding or visceral injury. The role of endoscopic combined intrarenal surgery in this regard is discussed. Key measures for ureteroscopy and retrograde intrarenal surgery include planning and technique to minimise the risk of ureteric injury. The role of anaesthetic assessment is discussed. The importance of specific comorbidities on each step of the pathway is highlighted as examples. Conclusion This review demonstrates that the principles of meticulous planning, interdisciplinary teamworking, and good operative technique can minimise the risk of complications in endourology.
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Affiliation(s)
- Eric Edison
- Department of Urology, University College Hospital London, London, UK
| | - Giorgio Mazzon
- Department of Urology, San Bassiano Hospital, Vicenza, Italy
| | - Vimoshan Arumuham
- Department of Urology, University College Hospital London, London, UK
| | - Simon Choong
- Department of Urology, University College Hospital London, London, UK
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11
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O'Meara S, Cunnane EM, Croghan SM, Cunnane CV, Walsh MT, O'Brien FJ, Davis NF. Mechanical characteristics of the ureter and clinical implications. Nat Rev Urol 2024; 21:197-213. [PMID: 38102385 DOI: 10.1038/s41585-023-00831-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2023] [Indexed: 12/17/2023]
Abstract
The ureteric wall is a complex multi-layered structure. The ureter shows variation in passive mechanical properties, histological morphology and insertion forces along the anatomical length. Ureter mechanical properties also vary depending on the direction of tensile testing and the anatomical region tested. Compliance is greatest in the proximal ureter and lower in the distal ureter, which contributes to the role of the ureter as a high-resistance sphincter. Similar to other human tissues, the ureteric wall remodels with age, resulting in changes to the mechanical properties. The passive mechanical properties of the ureter vary between species, and variation in tissue storage and testing methods limits comparison across some studies. Knowledge of the morphological and mechanical properties of the ureteric wall can aid in understanding urine transport and safety thresholds in surgical techniques. Indeed, various factors alter the forces required to insert access sheaths or scopes into the ureter, including sheath diameter, safety wires and medications. Future studies on human ureteric tissue both in vivo and ex vivo are required to understand the mechanical properties of the ureter and how forces influence these properties. Testing of instrument insertion forces in humans with a focus on defining safe upper limits and techniques to reduce trauma are also needed. Last, evaluation of dilatation limits in the mid and proximal ureter and clarification of tensile strength anisotropy in human specimens are necessary.
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Affiliation(s)
- Sorcha O'Meara
- Department of Surgery, Royal College of Surgeons of Ireland (RCSI), Dublin, Ireland.
- Department of Urology, Blackrock Clinic, Blackrock, Co., Dublin, Ireland.
| | - Eoghan M Cunnane
- Biomaterials Cluster, Bernal Institute, University of Limerick, Limerick, Ireland
- School of Engineering, University of Limerick, Limerick, Ireland
| | - Stefanie M Croghan
- Department of Surgery, Royal College of Surgeons of Ireland (RCSI), Dublin, Ireland
- Department of Urology, Blackrock Clinic, Blackrock, Co., Dublin, Ireland
| | - Connor V Cunnane
- Biomaterials Cluster, Bernal Institute, University of Limerick, Limerick, Ireland
- School of Engineering, University of Limerick, Limerick, Ireland
| | - Michael T Walsh
- Biomaterials Cluster, Bernal Institute, University of Limerick, Limerick, Ireland
- School of Engineering, University of Limerick, Limerick, Ireland
| | - Fergal J O'Brien
- Tissue Engineering Research Group, Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
- Trinity Centre for Biomedical Engineering, Trinity College Dublin, Dublin, Ireland
- Advanced Materials and Bioengineering Research Centre (AMBER), RCSI and TCD, Dublin, Ireland
| | - Niall F Davis
- Department of Surgery, Royal College of Surgeons of Ireland (RCSI), Dublin, Ireland
- Department of Urology, Blackrock Clinic, Blackrock, Co., Dublin, Ireland
- Department of Urology and Transplant Surgery, Beaumont Hospital, Dublin, Ireland
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12
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Raj K K, Adiga K P, Chandni Clara D'souza R, B N, Upadhyaya R. Prospective Evaluation of Risk Factors Responsible for Infection Following Retrograde Intrarenal Surgery. Cureus 2024; 16:e59420. [PMID: 38826593 PMCID: PMC11140228 DOI: 10.7759/cureus.59420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2024] [Indexed: 06/04/2024] Open
Abstract
OBJECTIVE The study aimed to identify the various risk factors for infective complications following retrograde intrarenal surgery (RIRS). MATERIALS AND METHODS The study was conducted over one year, and the incidence of infectious complications after RIRS was calculated. Patients were divided into two groups based on the presence and absence of infective complications and were compared in terms of preoperative and operative characteristics. The complications were assessed and graded according to the Modified Clavien classification system (MCCS). The Fisher's exact test, Student's t-test, and Mann-Whitney U test were used for univariate analysis. Multivariate logistic regression analysis was used to identify independent risk factors for postoperative urinary tract infection (UTI). RESULTS Out of 165 patients in the study, 27 (16.7%) patients developed UTI within one month of undergoing RIRS. The most frequent complication was fever, which occurred in 13 (7.8%) patients. When stratified by MCCS, 13 were grade I, nine were grade II, four were grade III, and one was a grade IV complication. High stone burden, concomitant diabetes mellitus, and multiple renal stones were identified as substantial risk factors for postoperative UTI in univariate analysis. On multivariate analysis, preoperative UTI and prolonged operative time were found to have a significant association with postoperative UTI. CONCLUSION The present study demonstrated that preoperative UTI and prolonged operative time are independent factors responsible for postoperative UTI. Large stone burden, stone multiplicity, and diabetes mellitus contribute to a higher risk for UTI following RIRS.
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Affiliation(s)
- Kishan Raj K
- Urology, Father Muller Medical College and Hospital, Mangalore, IND
| | - Prashant Adiga K
- Urology, Father Muller Medical College and Hospital, Mangalore, IND
| | | | - Nandakishore B
- Urology, Father Muller Medical College and Hospital, Mangalore, IND
| | - Rajani Upadhyaya
- Obstetrics and Gynaecology, Kasturba Medical College, Manipal, Udupi, IND
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13
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Juliebø‐Jones P, Somani BK, Mykoniatis I, Hameed BMZ, Tzelves L, Æsøy MS, Gjengstø P, Moen CA, Beisland C, Ulvik Ø. Adverse events related to accessory devices used during ureteroscopy: Findings from a 10-year analysis of the Manufacturer and User Facility Device Experience (MAUDE) database. BJUI COMPASS 2024; 5:70-75. [PMID: 38179023 PMCID: PMC10764172 DOI: 10.1002/bco2.274] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 05/27/2023] [Accepted: 07/05/2023] [Indexed: 01/06/2024] Open
Abstract
Objectives The objective of this study was to evaluate adverse events and device events related to accessories used during ureteroscopy (URS). Materials and methods Analysis was performed of the records available in the Manufacturer and User Facility Device Experience database in the United States. Information was collected on characteristics of problem, timing, manufacturer verdict, successful completion of planned surgery, prolonged anaesthesia and injury to patient or staff. Results Five-hundred seventy-one events related to URS accessories were recorded. These were associated with the following devices: baskets (n = 347), access sheath (n = 86), guidewires (n = 78), balloon dilators (n = 27), ARDs (n = 17) and ureteral catheters (n = 16). Of the events, 12.7% resulted in patient injuries. Forty-eight per cent of the events resulted in prolonged anaesthesia, but the planned surgery was successfully completed in 78.4% of all cases. Collectively, the manufacturers accepted responsibility due to actual device failure in only 0.5% of cases. Common problems for baskets were failure to deploy (39.5%) and complete detachment of basket head (34.6%) and partial breakage of the basket head (12.4%). Of the basket group, 4.3% required open or percutaneous surgery to remove stuck basket. Full break of the body of the access sheath occurred in 41.9% and complete ureteral avulsion in 3.5%. For balloon dilators, there was a burst in 37% of cases. Broken guidewires were associated with 11.5% requiring repeat intervention for retrieval and 6.4% required JJ stent due to perforation to the collecting system. No injuries to operating staff were recorded with accessory usage. Conclusion Accessories used during URS are fragile. Potential for serious injury does exist as a direct result of their use. Surgeons should familiarise themselves with these events and how they can be prevented.
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Affiliation(s)
- Patrick Juliebø‐Jones
- Department of UrologyHaukeland University HospitalBergenNorway
- Department of Clinical MedicineUniversity of BergenBergenNorway
- EAU YAU Urolithiasis GroupArnhemNetherlands
| | | | - Ioannis Mykoniatis
- EAU YAU Urolithiasis GroupArnhemNetherlands
- School of Medicine, Department of Urology, Faculty of Health SciencesAristotle University of ThessalonikiThessalonikiGreece
| | - B. M. Zeeshan Hameed
- EAU YAU Urolithiasis GroupArnhemNetherlands
- Department of UrologyFather Muller Medical CollegeMangaloreKarnatakaIndia
| | - Lazaros Tzelves
- EAU YAU Urolithiasis GroupArnhemNetherlands
- Second Department of UrologyNational and Kapodistrian University of Athens, Sismanogleio General HospitalAthensGreece
| | - Mathias S. Æsøy
- Department of UrologyHaukeland University HospitalBergenNorway
| | - Peder Gjengstø
- Department of UrologyHaukeland University HospitalBergenNorway
| | | | - Christian Beisland
- Department of UrologyHaukeland University HospitalBergenNorway
- Department of Clinical MedicineUniversity of BergenBergenNorway
| | - Øyvind Ulvik
- Department of UrologyHaukeland University HospitalBergenNorway
- Department of Clinical MedicineUniversity of BergenBergenNorway
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14
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Özman O, Akgül HM, Başataç C, Çınar Ö, Sancak EB, Yazıcı CM, Önal B, Akpınar H. Multi-aspect analysis of ureteral access sheath usage in retrograde intrarenal surgery: A RIRSearch group study. Asian J Urol 2024; 11:80-85. [PMID: 38312818 PMCID: PMC10837649 DOI: 10.1016/j.ajur.2021.11.004] [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: 05/24/2021] [Accepted: 08/29/2021] [Indexed: 10/19/2022] Open
Abstract
Objective To evaluate the effect of ureteral access sheath (UAS) use and calibration change on stone-free rate and complications of retrograde intrarenal surgery (RIRS). Methods Data from 568 patients undergoing RIRS for kidney or upper ureteral stones were retrospectively included. Firstly, patients were compared after 1:1 propensity score matching, according to UAS usage during RIRS (UAS used [+] 87 and UAS non-used [-] 87 patients). Then all UAS+ patients (n=481) were subdivided according to UAS calibration: 9.5-11.5 Fr, 10-12 Fr, 11-13 Fr, and 13-15 Fr. Primary outcomes of the study were the success and complications of RIRS. Results Stone-free rate of UAS+ patients (86.2%) was significantly higher than UAS- patients (70.1%) after propensity score matching (p=0.01). Stone-free rate increased with higher caliber UAS (9.5-11.5 Fr: 66.7%; 10-12 Fr: 87.0%; 11-13 Fr: 90.6%; 13-15 Fr: 100%; p<0.001). Postoperative complications of UAS+ patients (11.5%) were significantly lower than UAS- patients (27.6%) (p=0.01). Complications (8.7%) with 9.5-11.5 Fr UAS was lower than thicker UAS (17.2%) but was not statistically significant (p=0.09). UAS usage was an independent factor predicting stone-free status or peri- and post-operative complications (odds ratio [OR] 3.654, 95% confidence interval [CI] 1.314-10.162; OR 4.443, 95% CI 1.350-14.552; OR 4.107, 95% CI 1.366-12.344, respectively). Conclusion Use of UAS in RIRS may increase stone-free rates, which also increase with higher caliber UAS. UAS usage may reduce complications; however, complications seemingly increase with higher UAS calibration.
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Affiliation(s)
- Oktay Özman
- Gaziosmanpasa Training and Research Hospital, Urology Clinic, İstanbul, Turkey
| | - Hacı M Akgül
- Tekirdağ Namık Kemal University, School of Medicine, Department of Urology, Tekirdağ, Turkey
| | - Cem Başataç
- Group Florence Nightingale Hospitals, Department of Urology, İstanbul, Turkey
| | - Önder Çınar
- Zonguldak Bulent Ecevit University, School of Medicine, Department of Urology, Zonguldak, Turkey
| | - Eyüp B Sancak
- Çanakkale Onsekiz Mart University, School of Medicine, Department of Urology, Çanakkale, Turkey
| | - Cenk M Yazıcı
- Tekirdağ Namık Kemal University, School of Medicine, Department of Urology, Tekirdağ, Turkey
| | - Bülent Önal
- İstanbul University-Cerrahpaşa, Cerrahpaşa Medical Faculty, Department of Urology, İstanbul, Turkey
| | - Haluk Akpınar
- Group Florence Nightingale Hospitals, Department of Urology, İstanbul, Turkey
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15
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Abouelgreed TA, Elhelaly MA, El-Agamy ESI, Ahmed R, Haggag YM, Abdelwadood M, Abdelkader SF, Ali SS, Aboelsoud NM, Alassal MF, Bashir GA, Gharib T. Effect of preoperative ureteral stenting on the surgical outcomes of patients with 1-2 cm renal stones managed by retrograde intrarenal surgery using a ureteral access sheath. Arch Ital Urol Androl 2023; 95:12102. [PMID: 38193223 DOI: 10.4081/aiua.2023.12102] [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: 11/16/2023] [Accepted: 12/02/2023] [Indexed: 01/10/2024] Open
Abstract
OBJECTIVE To assess the surgical results of patients who underwent retrograde intrarenal surgery (RIRS) using a ureteral access sheath (UAS) for management of renal stones sized 1-2 cm compared between patients who did and did not undergo preoperative ureteral stenting. MATERIALS AND METHODS This prospective study included 83 patients (aged ≥ 20 years) who underwent RIRS from July 2021 to January 2023. All patients had renal calculi (stone size: 1-2 cm) located within the pelvicalyceal system. 43 and 40 patients were allocated to the non-prestent (group A) and prestent (group B), respectively. Patient baseline characteristics, renal stone details, operative data, stone-free rate (SFR) at 4 weeks and 6 months, and perioperative complications were compared between groups. RESULTS The baseline characteristics of all patients were comparable across the groups. Four weeks after surgery, the overall stone-free rate (SFR) stood at 62.65%. In the non-prestent and prestent groups, the SFRs were 58.12% and 67.5%, respectively (p = 0.89). By the sixth month post-surgery, the overall SFR rose to 80.72%. In the non-prestent and prestent groups, the SFRs were 76.74% and 85%, respectively (p = 0.081). No notable differences emerged in other variables, including perioperative complications, between the two groups. CONCLUSIONS The SFR showed no significant difference between the prestenting and non-prestenting groups at the 4-week and 6-month postoperative marks. Additionally, there were no substantial differences in complications during surgery and recovery between the groups. Notably, the SFR increased from 4 weeks to 6 months without any additional procedures in either group.
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Affiliation(s)
- Tamer A Abouelgreed
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt; Gulf medical university, Ajman.
| | | | | | - Rasha Ahmed
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo.
| | - Yasser M Haggag
- Department of Urology, Faculty of Medicine, Al-Azhar University, Asyut.
| | - M Abdelwadood
- Department of Urology, Faculty of Medicine, Ain Shams University, Cairo.
| | - Salma F Abdelkader
- Department of Radiology, Faculty of Medicine Ain Shams University, Cairo.
| | - Sameh S Ali
- Department of Radiology, Sheikh Khalifa general Hospital, UAQ.
| | - Naglaa M Aboelsoud
- Department of Radiology, Faculty of Medicine, Al-Azhar University, Cairo.
| | - Mosab F Alassal
- Department of Vascular Surgery, Saudi German Hospital, Ajman.
| | - Gehad A Bashir
- Department of Urology, Sheikh Khalifa Medical City, Abu Dhabi.
| | - Tarek Gharib
- Department of Urology, Faculty of medicine, Benha University, Benha.
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16
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Emiliani E, Sanz-Gómez I, Somani B, Tailly T, Castellani D, Traxer O, Yuen-Chun Teoh J, Chew B, Ong Lay Keat W, Chai CA, Bin-Hamri S, Shrestha A, Soehabali B, Angerri O, Gauhar V. Does gender influence retrograde intrarenal surgery (RIRS) outcomes? Data from the Flexible Ureteroscopy Outcomes Registry (FLEXOR). Actas Urol Esp 2023; 47:581-587. [PMID: 37369300 DOI: 10.1016/j.acuroe.2023.06.008] [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: 04/11/2023] [Accepted: 04/17/2023] [Indexed: 06/29/2023]
Abstract
INTRODUCTION AND OBJECTIVES As well established flexible ureteroscopy (RIRS). There is still no evidence if gender can have any influence on the outcomes and complication when performing. This study aims to evaluate the role that gender has in performing flexible ureteroscopy from a large series of patients. METHODS This study retrospectively analyzed patients who underwent RIRS for renal stones from January 2018 to August 2021 within the multicentric FLEXOR registry. Demographics, stone characteristics, perioperative findings, results and complications were analyzed and compared between gender groups. RESULTS A total of 6669 patients were included, 66.1% were male and 33.9% were female. Stone characteristics was comparable between groups. Female patients had significant higher fever and positive urine culture rates (12% vs. 8% and 37% vs. 34%). Also, females had a slight longer hospital stay (3.8 vs. 3.5 days; P < 0.001) and more residual fragments after the procedure (23.03% vs. 20.97 (P = 0.032). Overall complications were slightly significantly higher in women (15.74% vs. 14% (P = 0.042)) mainly at the expense of fever rates (6.9% vs. 5.7%) whereas the risk of sepsis was similar in both groups. A multivariate analysis showed that larger stone size, multiple and lower pole stones seem to have a negative impact in the incidence of residual stones and complications. CONCLUSION Our real life global study reflects that female gender may have a correlation with a slightly increased residual fragment rate and overall low grade complications. However, women can safely be treated with RIRS with no increased the rate of sepsis with appropriate care.
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Affiliation(s)
- E Emiliani
- Servicio de Urología, Fundación Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain.
| | - I Sanz-Gómez
- Servicio de Urología, Fundación Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - B Somani
- Servicio de Urología, Hospital Universitario de Southampton, NHS Trust, Southampton, United Kingdom
| | - T Tailly
- Servicio de Urología, Hospital Universitario de Gante, Gante, Belgium
| | - D Castellani
- Servicio de Urología, Azienda Ospedaliero-Universitaria delle Marche, Universidad Politécnica Marche, Ancona, Italy
| | - O Traxer
- Servicio de Urología, Universidad de La Sorbona, Hospital Tenon (AP-HP), París, France
| | - J Yuen-Chun Teoh
- Servicio de Cirugía, Clínica de Urología S.H. Ho, Facultad de Medicina, Universidad China de Hong Kong, Hong Kong, China
| | - B Chew
- Departamento de Urología, Universidad de British Columbia, Vancouver, Canada
| | - W Ong Lay Keat
- Servicio de Urología, Hospital General de Penang, Georgetown, Malaysia
| | - C A Chai
- Departamento de Urología, Universidad de Malaya, Kuala Lumpur, Malaysia
| | - Saeed Bin-Hamri
- Servicio de Urología, King Abdulaziz National Guard Medical City, Riad, Saudi Arabia
| | - A Shrestha
- Servicio de Urología, Hospital Bir, Academia Nacional de Ciencias Médicas, Katmandú, Nepal
| | - B Soehabali
- Departamento de Urología, Facultad de Medicina, Universidad de Mulawarman, Hospital Abdul Wahab Sjahranie, Samarinda, Indonesia
| | - O Angerri
- Servicio de Urología, Fundación Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - V Gauhar
- Servicio de Urología, Hospital General Ng Teng Fong, Singapur, Singapore
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Juliebø-Jones P, Keller EX, De Coninck V, Uguzova S, Tzelves L, Æsøy MS, Beisland C, Somani BK, Ulvik Ø. Controversies in ureteroscopy: lasers, scopes, ureteral access sheaths, practice patterns and beyond. Front Surg 2023; 10:1274583. [PMID: 37780913 PMCID: PMC10533910 DOI: 10.3389/fsurg.2023.1274583] [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: 08/08/2023] [Accepted: 09/04/2023] [Indexed: 10/03/2023] Open
Abstract
Ureteroscopy has become an increasingly popular surgical intervention for conditions such as urinary stone disease. As new technologies and techniques become available, debate regarding their proper use has risen. This includes the role of single use ureteroscopes, optimal laser for stone lithotripsy, basketing versus dusting, the impact of ureteral access sheath, the need for safety guidewire, fluoroscopy free URS, imaging and follow up practices are all areas which have generated a lot of debate. This review serves to evaluate each of these issues and provide a balanced conclusion to guide the clinician in their practice.
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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
- EAU Young Academic urology Urolithiasis Group, Arnhem, Netherlands
| | - Etienne Xavier Keller
- EAU Young Academic urology Urolithiasis Group, Arnhem, Netherlands
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Vincent De Coninck
- EAU Young Academic urology Urolithiasis Group, Arnhem, Netherlands
- Department of Urology, AZ Klina, Brasschaat, Belgium
| | - Sabine Uguzova
- Department of Urology, Royal Preston Hospital, Preston, United Kingdom
| | - Lazaros Tzelves
- EAU Young Academic urology Urolithiasis Group, Arnhem, Netherlands
- 2nd Department of Urology, Sismanogleion Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Mathias Sørstrand Æsøy
- Department of Urology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, 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, Southampton General Hospital, Southampton, United Kingdom
| | - Øyvind Ulvik
- Department of Urology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
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Mao L, Li Z, Wen J, Xu J, Zheng Z, Zhong W. Effect of bladder emptying status on the ureteral access sheath insertion resistance and following ureteral injury in RIRS: a prospective randomized controlled trial in academic hospital. World J Urol 2023; 41:2535-2540. [PMID: 37450006 DOI: 10.1007/s00345-023-04477-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 05/31/2023] [Indexed: 07/18/2023] Open
Abstract
PURPOSE To evaluate the effect of bladder emptying status on the ureteral access sheath (UAS) insertion resistance and following ureteral injury. METHODS Eighty patients were enrolled and randomly divided into bladder emptying group and control group before UAS placement. A digital force gauge (Imada Z2-50N) was used to measure the resistance during the UAS insertion. The ureteral injury was evaluated and graded with Post-Ureteroscopic Lesion Scale (PULS) system at the end of procedure. The mean resistance, maximum resistance in different ureteral segments, and ureteral injury were compared between the two groups. RESULTS The mean resistance (3.12 ± 0.49 vs. 4.28 ± 0.52 N, P < 0.001), maximum resistance in the whole procedure (5.17 ± 0.72 vs. 6.39 ± 0.96 N, P < 0.001) and distal ureter (3.07 ± 0.75 vs. 6.18 ± 1.17 N, P < 0.001) in the bladder emptying group were significantly lower when compared to the control group. In subgroup analysis, the similar result was also noted in patients with BMI ≥ 25 when compared to patients with BMI < 25, while there was no significant difference between men and women, age ≥ 50 years versus age < 50 years. The incidence of PULS 1-2 ureteral injury in the bladder emptying group was lower than the control group (35% vs. 55%, P = 0.045). The ureteral injury in distal ureteral was less frequently noted in bladder emptying group than the control group (22.5% vs. 55%, P = 0.006); however, there was no significant difference in middle and upper ureter (P > 0.05). CONCLUSION Emptying the bladder before UAS insertion can effectively reduce the UAS insertion resistance and the risk of distal ureteral injury in RIRS.
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Affiliation(s)
- Leiyafang Mao
- Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510230, China
| | - Zhifeng Li
- Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510230, China
| | - Junjun Wen
- Department of Urology, Dongxihu District People's Hospital, Wuhan, 431700, China
| | - Jiandong Xu
- Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510230, China
| | - Zexian Zheng
- Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510230, China
| | - Wen Zhong
- Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510230, China.
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Yoshida T, Ohe C, Nakamoto T, Kinoshita H. Learning from the past and present to change the future: Endoscopic management of upper urinary tract urothelial carcinoma. Int J Urol 2023; 30:634-647. [PMID: 37294007 DOI: 10.1111/iju.15208] [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: 02/25/2023] [Accepted: 05/09/2023] [Indexed: 06/10/2023]
Abstract
Current guidelines recommend endoscopic management (EM) for patients with low-risk upper urinary tract urothelial carcinoma, as well as those with an imperative indication. However, regardless of the tumor risk, radical nephroureterectomy is still mainly performed worldwide despite the benefits of EM, such as renal function maintenance, no hemodialysis requirement, and treatment cost reduction. This might be explained by the association of EM with a high risk of local recurrence and progression. Furthermore, the need for rigorous patient selection and close surveillance following EM may be relevant. Nevertheless, recent developments in diagnostic modalities, pathological evaluation, surgical devices and techniques, and intracavitary regimens have been reported, which may contribute to improved risk stratification and treatments with superior oncological outcomes. In this review, considering recent advances in endourology and oncology, we propose novel treatment strategies for optimal EM.
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Affiliation(s)
- Takashi Yoshida
- Department of Urology and Andrology, Kansai Medical University, Osaka, Japan
- Corporate Sponsored Research Programs for Multicellular Interactions in Cancer, Kansai Medical University, Osaka, Japan
| | - Chisato Ohe
- Corporate Sponsored Research Programs for Multicellular Interactions in Cancer, Kansai Medical University, Osaka, Japan
- Department of Pathology, Kansai Medical University, Osaka, Japan
| | - Takahiro Nakamoto
- Department of Urology and Andrology, Kansai Medical University, Osaka, Japan
- Department of Pathology, Kansai Medical University, Osaka, Japan
| | - Hidefumi Kinoshita
- Department of Urology and Andrology, Kansai Medical University, Osaka, Japan
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20
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Huettenbrink C, Schaldach J, Hitzl W, Shamlou A, Ell J, Pahernik S. Different ureteral access sheaths sizes for retrograde intrarenal surgery. World J Urol 2023; 41:1913-1919. [PMID: 37222780 DOI: 10.1007/s00345-023-04423-x] [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: 10/11/2022] [Accepted: 04/27/2023] [Indexed: 05/25/2023] Open
Abstract
PURPOSE There is a trend toward miniaturization in endourological stone therapy. Good visibility, intrarenal pressures and temperature control should be ensured by ureteral sheaths. In the context of the present study, 10/12 Charr. sheaths and 12/14 Charr. sheaths for flexible ureterorenoscopy were investigated regarding stone-free rate, complication rate and efficacy for laser lithotripsy. METHODS From January 2020 to January 2022, 100 patients each with kidney stone up to 1.5 cm in diameter were included in the study. Use of a 12/14 Charr. vs. 10/12 Charr. ureteral sheath for flexible ureterorenoscopy was compared. Perioperative data, stone size, volume and density, laser energy, laser duration, stone-free rates and complications based on Clavien-Dindo classification were retrospectively analyzed. RESULTS For both groups of ureteral access sheaths, there were no differences in median surgery duration (10/12 Charr: 29 min (7-105 min) vs. 12/14 Charr: 34 min (9-95 min); p = 0.33), overall complication rate (p = 0.61) and hospitalization (p = 0.155). There were no differences in stone-free rates (97.9% vs. 92.7%, p = 0.37). Laser lithotripsy duration usingholmium laser was 1.9 min (0.1-10.8 min) vs. 3.8 min (0.2-20.7 min) (p < 0.01) and applied laser energy was 3.1 J (0.15 J-10.29 J) vs. 6.8 J (1.07 J-26.77 J) (p < 0.01) for 12/14 Charr. sheaths and 10/12 Charr. sheaths, respectively. CONCLUSION In terms of stone-free rates, there are no differences between the 10/12 and 12/14 Charr. ureteral access sheaths. The laser duration and energy was increased with 10/12 Charr. sheaths without showing increased risk for clinical complications like trauma or inflammation.
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Affiliation(s)
- Clemens Huettenbrink
- Department of Urology, Nuremberg General Hospital, Paracelsus Medical University, Prof. Ernst-Nathan Strasse 1, 90419, Nuremberg, Germany.
| | - Julia Schaldach
- Department of Urology, Nuremberg General Hospital, Paracelsus Medical University, Prof. Ernst-Nathan Strasse 1, 90419, Nuremberg, Germany
| | - Wolfgang Hitzl
- Research and Innovation Management (RIM), Biostatistics and Publication of Clinical Trial Studies Paracelsus Medical University, Salzburg, Austria
- Department of Ophthalmology and Optometry, Paracelsus Medical University Salzburg, Salzburg, Austria
- Research Program Experimental Ophthalmology and Glaucoma Research, Paracelsus, Medical University Salzburg, Salzburg, Austria
| | - Aida Shamlou
- Department of Urology, Nuremberg General Hospital, Paracelsus Medical University, Prof. Ernst-Nathan Strasse 1, 90419, Nuremberg, Germany
| | - Jascha Ell
- Department of Urology, Nuremberg General Hospital, Paracelsus Medical University, Prof. Ernst-Nathan Strasse 1, 90419, Nuremberg, Germany
| | - Sascha Pahernik
- Department of Urology, Nuremberg General Hospital, Paracelsus Medical University, Prof. Ernst-Nathan Strasse 1, 90419, Nuremberg, Germany
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21
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Özman O, Çınar Ö, Çakır H, Başataç C, Akgül HM, Demirbilek M, Sancak EB, Yazıcı CM, Başeskioğlu B, Önal B, Akpınar H. Is It a Good Strategy to Proceed a Retrograde Intrarenal Surgery Session Sheathless After Ureteral Access Sheath Insertion Failure? A RIRSearch Study. J Endourol 2023; 37:747-752. [PMID: 37021344 DOI: 10.1089/end.2022.0599] [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] [Indexed: 04/07/2023] Open
Abstract
Objectives: To complement our previous findings regarding effect of ureteral access sheath (UAS) use, we checked RIRSearch database for patients who operated without using UAS. The aim of the study was to understand these new data better by comparing outcomes of retrograde intrarenal surgery (RIRS) that continued sheathless after a failed UAS insertion vs those planned and completed sheathless. Materials and Methods: Data of 195 patients who underwent sheathless RIRS for kidney and/or ureteral stones between 2011 and 2021 were retrieved from the database. Patients divided into two groups: cases who were planned and completed sheathless (n = 110, Group 1) and those who proceeded without UAS after insertion failure (n = 85, Group 2). After propensity score matching (PSM), each group consisted of 76 patients. Results: After PSM, stone-free rate for Group 1 (90.8%) was significantly higher than stone-free rate of Group 2 (76.3%) in sheathless RIRS (p = 0.02). Also postoperative complication rate was significantly lower in Group 1 (10.5%) than in Group 2 (27.6%) (p = 0.007). In Group 2, median operating time was longer (60 minutes, interquartile range [IQR]: 40-80) and more unplanned auxilliary procedure (22.4%) was needed than Group 1 (45 minutes, IQR: 40-50 and 3.9%) (both p = 0.001). Stone burden (odds ratio [OR]: 1.002, p = 0.019) and stone density (OR: 1.002, p = 0.003) were associated with high risk of residual stones after RIRS. Higher hydronephrosis grades were associated with increased stone-free rates (OR: 0.588 for residual stone risk, p = 0.024). Cases who completed sheathless by dusting all available stones, as planned preoperatively, were more likely to have stone-free status after RIRS than those who proceeded sheathless after UAS insertion failure (OR: 2.645, p = 0.024). Conclusions: Operation course after UAS insertion failure may be more challenging. In cases who performed without using UAS, surgeons who proceed with procedure sheathless after UAS insertion failure may more frequently run into complications and may fail achieving stone-free status compared with sheathless-planned cases.
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Affiliation(s)
- Oktay Özman
- Department of Urology, Gaziosmanpasa Training and Research Hospital, Urology Clinic, İstanbul, Turkey
- Department of Urology, Antoni van Leeuwenhoek Hospital, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Önder Çınar
- Department of Urology, School of Medicine, Zonguldak Bulent Ecevit University, Zonguldak, Turkey
| | - Hakan Çakır
- Department of Urology, Fulya Acıbadem Hospital, Urology Clinic, İstanbul, Turkey
| | - Cem Başataç
- Department of Urology, Group Florence Nightingale Hospitals, İstanbul, Turkey
| | - Hacı Murat Akgül
- Department of Urology, School of Medicine, Tekirdağ Namık Kemal University, Tekirdağ, Turkey
| | - Muhammet Demirbilek
- Department of Urology, Cerrahpaşa Medical Faculty, İstanbul University-Cerrahpaşa, İstanbul, Turkey
- Department of Urology, School of Medicine, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
| | - Eyüp Burak Sancak
- Department of Urology, School of Medicine, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
| | - Cenk Murat Yazıcı
- Department of Urology, School of Medicine, Tekirdağ Namık Kemal University, Tekirdağ, Turkey
| | - Barbaros Başeskioğlu
- Department of Urology, Eskişehir Acıbadem Hospital, Urology Clinic, Eskişehir, Turkey
| | - Bülent Önal
- Department of Urology, Cerrahpaşa Medical Faculty, İstanbul University-Cerrahpaşa, İstanbul, Turkey
- Department of Urology, School of Medicine, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
| | - Haluk Akpınar
- Department of Urology, Group Florence Nightingale Hospitals, İstanbul, Turkey
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22
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Elsaqa M, Hyder Z, Thai K, Dowd K, El Mekresh A, Wagner K, Patel B, Lowry P, El Tayeb MM. Comparison of commonly utilized ureteral access sheaths: A prospective randomized trial. Arch Ital Urol Androl 2023. [PMID: 37278382 DOI: 10.4081/aiua.2023.11149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 01/22/2023] [Indexed: 06/07/2023] Open
Abstract
OBJECTIVE We aimed to evaluate and compare the functional characteristics, safety profile and effectiveness of two commonly used ureteral access sheaths (UAS) during flexible ureteroscopy. METHODS After institutional review board approval, patients with proximal ureteral or kidney stones requiring flexible ureteroscopy and UAS were prospectively randomized to group I or group II according to the type of access sheath used. Primary outcome was incidence of intraoperative complications. RESULTS Eighty-eight patients were enrolled in the study, 44 patients in each group. Sheath size 12/14 FR was used in both cohorts. Median (IQR) stone size was 10 mm (7-13.5) and 10.5 mm (7.37-14) in group I and II respectively (p = 0.915). Nineteen and twenty patients, in group I and II respectively, were pre-stented. Subjective resistance with insertion of the UAS was observed in 9 and 11 patients in group I and II respectively (p = 0.61) while failed insertion was encountered in one patient in group I. Traxer grade 1 ureteral injury was noted in 5 and 6 patients in group I and II respectively while grade 3 injury was seen in 1 patient for both cohorts (p = 0.338). There was less resistance for UAS placement in pre-stented patients (p = 0.0202) but without significant difference in ureteric injury incidence (p = 0.175). Emergency department visits were encountered in 7 (group I) and 5 patients (group II) (p = 0.534). CONCLUSIONS The studied UASs were comparable regarding safety and efficacy in the current study. Pre-stented and dilated ureters had less resistance to insertion although this was not reflected on incidence of ureteric injury.
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Affiliation(s)
- Mohamed Elsaqa
- Baylor Scott & White Medical Center, Temple, TX; Alexandria University Faculty of Medicine, Alexandria, Egypt.
| | - Zain Hyder
- Baylor Scott & White Medical Center, Temple, TX.
| | - Kim Thai
- Baylor Scott & White Medical Center, Temple, TX.
| | | | | | | | - Belur Patel
- Baylor Scott & White Medical Center, Temple.
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Hughes T, Tzelves L, Somani BK. Cystine Stones: Developments in Minimally Invasive Surgery and Their Impact on Morbidity and Stone Clearance. Res Rep Urol 2023; 15:175-185. [PMID: 37303487 PMCID: PMC10254682 DOI: 10.2147/rru.s381190] [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: 03/19/2023] [Accepted: 05/31/2023] [Indexed: 06/13/2023] Open
Abstract
Cystinuria is a rare genetic condition that is responsible for cystine stones. Besides stone recurrence, patients with cystine stones have reduced health-related quality of life, increased rates of chronic kidney disease and hypertension. Although lifestyle measures, medical therapy and close follow up are essential to reduce and monitor cystine stone recurrences, surgical intervention is frequently needed for most cystinuria patients. Shock wave lithotripsy, ureteroscopy, percutaneous nephrolithotomy and active surveillance all have a role, and technological advances in endourology are vital in achieving a stone-free status and to prevent recurrences. The complexity of managing cystine stones necessitates a multidisciplinary team discussion, patient involvement and an individualised approach in a specialist centre for optimum management. Thulium fibre laser and virtual reality may have an increasing role in the future of cystine stone management.
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Affiliation(s)
- Thomas Hughes
- Department of Urology, Warwick Hospital, Warwick, UK
| | - Lazaros Tzelves
- Department of Urology, Sismanogleio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Bhaskar K Somani
- Department of Urology, University Hospital Southampton, Southampton, UK
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Assantachai K, Srinualnad S, Leewansangtong S, Taweemonkongsap T, Liangkobkit K, Chotikawanich E. Surgical outcomes of patients who underwent retrograde intrarenal surgery using a ureteral access sheath to manage kidney stones sized 1-2 cm compared between patients who did and did not undergo preoperative ureteral stenting. Heliyon 2023; 9:e15801. [PMID: 37305517 PMCID: PMC10256857 DOI: 10.1016/j.heliyon.2023.e15801] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 04/19/2023] [Accepted: 04/21/2023] [Indexed: 06/13/2023] Open
Abstract
Objective To investigate the surgical outcomes of patients who underwent retrograde intrarenal surgery (RIRS) using a ureteral access sheath (UAS) to manage kidney stones sized 1-2 cm compared between patients who did and did not undergo preoperative ureteral prestenting. Materials and methods This retrospective cohort study included 166 patients (aged ≥18 years) who underwent RIRS at Siriraj Hospital (Bangkok, Thailand) during February 2015-February 2020. All patients had renal calculi (stone size: 1-2 cm) located within the pelvicalyceal system. 80 and 86 patients were allocated to the prestent and non-prestent groups, respectively. Patient baseline characteristics, renal stone details, operative equipment, stone-free rate (SFR) at 2 weeks and 6 months, and perioperative complications were compared between groups. Results All patient baseline characteristics were similar between groups. At 2 weeks after surgery, the overall SFR was 65.1%, and the SFRs in the prestent and non-prestent groups were 73.4% and 59.5%, respectively (p = 0.09). At 6 months after surgery, the overall SFR was 80.1%, and the SFRs in the prestent and non-prestent groups were 90.7% and 79.3%, respectively (p = 0.08). The incidence of perioperative complications was not significantly different between groups. Conclusions There was no significant difference in the SFR between the presenting and non-prestenting groups at both the 2-week and 6-month postoperative time points. There was also no significant difference in intraoperative and postoperative complications between groups. The SFR was higher at 6 months than at 2 weeks in both groups with no additional procedure.
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Affiliation(s)
| | | | | | | | | | - Ekkarin Chotikawanich
- Corresponding author. Ekkarin Chotikawanich, MD. Division of Urology, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University.
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25
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Kim GH, Jung G, Suh J, Park J, Cho SY. A Newly Developed Hematuria Grading System May Predict the Status of Stone-Free and Acute Pyelonephritis of Minimally Invasive Renal Stone Surgery. J Clin Med 2023; 12:jcm12082820. [PMID: 37109157 PMCID: PMC10142515 DOI: 10.3390/jcm12082820] [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: 02/21/2023] [Revised: 04/06/2023] [Accepted: 04/07/2023] [Indexed: 04/29/2023] Open
Abstract
OBJECTIVES The aim of this study was to evaluate the level of hematuria and the presence of clots during retrograde intrarenal surgery (RIRS) and miniaturized percutaneous nephrolithotomy (mPCNL) to predict surgical outcomes. MATERIALS AND METHODS The data of patients who underwent RIRS and mPCNL were analyzed separately. A hematuria grading (HG) system was classified into five grades based on the presence of blood clots and any visible stones according to the irrigation settings. Inter-observer reliability of the grading system was assessed using intra-class correlation and Spearman's rho. RESULTS The HG system showed high agreement among examiners, with high intra-class reliability and a strong correlation between RIRS and mPCNL groups. The stone density of the Houns-field unit was the most important factor in determining the hematuria across the development and validation groups of RIRS and mPCNL patients. Multivariate logistic regression analysis showed that the HG system was a significant predictor for remnant stones in the PCNL group and the probability of acute pyelonephritis or sepsis in the RIRS group. The high hematuria group showed lower basketing difficulty with the basket with a blue marker instrument than with others. CONCLUSIONS The new HG system shows excellent inter-observer reliability and a correlation with a gradual increase in stone density and surgical difficulty.
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Affiliation(s)
- Gyeong Hun Kim
- Department of Urology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| | - Gyoohwan Jung
- Department of Urology, Hanyang University Seoul Hospital, 222-1, Wangsimni-ro, Seongdong-gu, Seoul 04763, Republic of Korea
| | - Jungyo Suh
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
| | - Juhyun Park
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
| | - Sung Yong Cho
- Department of Urology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
- Department of Urology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
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26
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Xiang Y, Yan T, Fu M, Quan K, Shu J, Wang R. The regular use of calcium channel blockers before flexible URS appears to facilitate primary UAS insertion: a retrospective study in a single center. Int Urol Nephrol 2023; 55:547-551. [PMID: 36450869 DOI: 10.1007/s11255-022-03426-8] [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: 09/26/2022] [Accepted: 11/21/2022] [Indexed: 12/05/2022]
Abstract
PURPOSE To evaluate the effect of regular use of CCB before flexible URS for successful primary UAS insertion. MATERIALS AND METHODS We retrospectively analyzed 209 patients who underwent flexible ureteroscopy (URS) for upper urinary tract calculi between Jan 2021 and Dec 2021. Patients were divided into two groups based on whether calcium channel blockers (CCB) were used (n = 72) or not (n = 137). The following parameters were collected: age, sex, height and weight, BMI, stone location, stone burden, number of stones, operation time, hospital stay, hospital readmission, post-operative fever, post-operative SIRS rate, Clavien-Dindo grade, hospitalization costs, successful primary UAS insertion. We compared the two groups using Student's t test, Mann-Whitney U test and χ2 test for quantitative and categorical variables, respectively. A logistic regression model was used to identify predictive factors of UAS successful primary insertion. RESULTS Compared with the non-CCB group, the CCB group had a higher successful primary UAS insertion rate (97.2% vs.85.4%, p = 0.008), and a lower hospital readmission rate (2.8% vs.12.4%, p = 0.021). In multivariate analyses, the regular use of CCB was the only predictive factor of successful primary UAS insertion rate (OR 6.32, 95% CI 1.41-28.29, p = 0.016). CONCLUSION The regular use of calcium channel blockers (CCB) before flexible URS appears to facilitate ureteral access sheaths (UAS) primary insertion.
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Affiliation(s)
- Yechen Xiang
- Department of Urology, The First People's Hospital of Huaihua, University of South China, No. 144 Jinxi South Road, Huaihua, 418000, Hunan, China.
| | - Tingshuai Yan
- Department of Urology, The First People's Hospital of Huaihua, University of South China, No. 144 Jinxi South Road, Huaihua, 418000, Hunan, China
| | - Maoling Fu
- Department of Urology, The First People's Hospital of Huaihua, University of South China, No. 144 Jinxi South Road, Huaihua, 418000, Hunan, China
| | - Keli Quan
- Department of Urology, The First People's Hospital of Huaihua, University of South China, No. 144 Jinxi South Road, Huaihua, 418000, Hunan, China
| | - Jianping Shu
- Department of Urology, The First People's Hospital of Huaihua, University of South China, No. 144 Jinxi South Road, Huaihua, 418000, Hunan, China
| | - Ruoyu Wang
- Department of Urology, The First People's Hospital of Huaihua, University of South China, No. 144 Jinxi South Road, Huaihua, 418000, Hunan, China
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27
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Lildal SK, Hansen ESS, Laustsen C, Nørregaard R, Bertelsen LB, Madsen K, Rasmussen CW, Osther PJS, Jung H. Gadolinium-enhanced MRI visualizing backflow at increasing intra-renal pressure in a porcine model. PLoS One 2023; 18:e0281676. [PMID: 36795705 PMCID: PMC9934347 DOI: 10.1371/journal.pone.0281676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 01/27/2023] [Indexed: 02/17/2023] Open
Abstract
INTRODUCTION Intrarenal backflow (IRB) is known to occur at increased intrarenal pressure (IRP). Irrigation during ureteroscopy increases IRP. Complications such as sepsis is more frequent after prolonged high-pressure ureteroscopy. We evaluated a new method to document and visualize intrarenal backflow as a function of IRP and time in a pig model. METHODS Studies were performed on five female pigs. A ureteral catheter was placed in the renal pelvis and connected to a Gadolinium/ saline solution 3 ml/L for irrigation. An occlusion balloon-catheter was left inflated at the uretero-pelvic junction and connected to a pressure monitor. Irrigation was successively regulated to maintain steady IRP levels at 10, 20, 30, 40 and 50 mmHg. MRI of the kidneys was performed at 5-minute intervals. PCR and immunoassay analyses were executed on the harvested kidneys to detect potential changes in inflammatory markers. RESULTS MRI showed backflow of Gadolinium into the kidney cortex in all cases. The mean time to first visual damage was 15 minutes and the mean registered pressure at first visual damage was 21 mmHg. On the final MRI the mean percentage of IRB affected kidney was 66% after irrigation with a mean maximum pressure of 43 mmHg for a mean duration of 70 minutes. Immunoassay analyses showed increased MCP-1 mRNA expression in the treated kidneys compared to contralateral control kidneys. CONCLUSIONS Gadolinium enhanced MRI provided detailed information about IRB that has not previously been documented. IRB occurs at even very low pressures, and these findings are in conflict with the general consensus that keeping IRP below 30-35 mmHg eliminates the risk of post-operative infection and sepsis. Moreover, the level of IRB was documented to be a function of both IRP and time. The results of this study emphasize the importance of keeping IRP and OR time low during ureteroscopy.
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Affiliation(s)
| | | | - Christoffer Laustsen
- Department of Clinical Medicine, MR Research Centre, Aarhus University, Aarhus, Denmark
| | - Rikke Nørregaard
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lotte Bonde Bertelsen
- Department of Clinical Medicine, MR Research Centre, Aarhus University, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Kirsten Madsen
- Department of Clinical Pathology, Odense University Hospital, Odense, Denmark
| | - Camilla W. Rasmussen
- Department of Clinical Medicine, MR Research Centre, Aarhus University, Aarhus, Denmark
| | - Palle Jörn Sloth Osther
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Department of Urology, Vejle Hospital–a part of Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Helene Jung
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Department of Urology, Vejle Hospital–a part of Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
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A nomogram for predicting postoperative urosepsis following retrograde intrarenal surgery in upper urinary calculi patients with negative preoperative urine culture. Sci Rep 2023; 13:2123. [PMID: 36747018 PMCID: PMC9902470 DOI: 10.1038/s41598-023-29352-y] [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: 11/03/2022] [Accepted: 02/02/2023] [Indexed: 02/08/2023] Open
Abstract
Retrograde intrarenal surgery (RIRS) is one of the main surgical methods for upper urinary calculi, but severe complications of infection may occur after surgery. This study aimed to establish and validate a preoperative nomogram for predicting postoperative urosepsis following retrograde intrarenal surgery to treat upper urinary calculus in patients with a negative preoperative urine culture. We retrospectively recruited 1767 patients with negative preoperative urine cultures who underwent retrograde intrarenal surgery to treat upper urinary calculi from January 2017 to April 2022. The independent risk factors for urosepsis include a solitary kidney, positive urine nitrite, operative time ≥ 75 min, history of recurrent urinary tract infections, and history of diabetes were identified by univariate analysis and multivariate binary logistic regression analysis, which construct a nomogram. The receiver operating characteristic curve of the nomogram for predicting urosepsis was 0.887 in the training cohort and 0.864 in the validation cohort, respectively. The calibration curve and decision curve analysis demonstrated great consistency and clinical utility of the nomogram. Therefore, the nomogram combining preoperative independent risk factors can predict the probability of a postoperative urosepsis following retrograde intrarenal surgery in patients with a negative preoperative urine culture, which could help urologists take preventive measures in advance after surgery to avoid more serious complications of infection.
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Göger YE, Özkent MS, Kılınç MT, Erol E, Taşkapu HH. Influencing factors of acute kidney injury following retrograde intrarenal surgery. World J Urol 2023; 41:857-864. [PMID: 36719465 DOI: 10.1007/s00345-023-04301-6] [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: 09/20/2022] [Accepted: 01/17/2023] [Indexed: 02/01/2023] Open
Abstract
PURPOSE To investigate the influencing factors of acute kidney injury (AKI) following retrograde intrarenal surgery (RIRS). METHODS The data of patients who underwent RIRS for kidney stones between January 2018 and June 2022 at two tertiary centers were retrospectively analyzed. Demographic data of patients were obtained. According to kidney disease: Improving Global Outcomes (KDIGO) criteria, those with and without AKI were divided into two groups. Preoperative, intraoperative, and postoperative predictive factors of patients were investigated between the groups. In addition, the influencing factors of AKI were examined by multivariate analysis. RESULTS This study included 295 (35.7%) women and 532 (64.3%) men. The mean age was 50.03 ± 15.4 years (range 18-89), and mean stone size was 15.5 ± 6.1 mm (range 6-47). Overall, 672 of patients (81.3%) were stone-free after the initial treatment. According to KDIGO, 110 of patients (13.3%) had AKI during the postoperative period. Univariate analysis showed that stone size (P = .003), previous stone surgery (P = .010), renal malformations (P = .017), high operative time (P = < .001), high preoperative creatinine value (P = .036), intraoperative complications (P = .018), and postoperative urinary tract infection (P = .003) had significant influence on the AKI after RIRS. Multivariate analysis excluded previous stone surgery, high preoperative creatinine value, renal malformations, and intraoperative complications from the logistic regression model, whereas other factors maintained their statistically significant effect on AKI, indicating that they were independent predictors. CONCLUSIONS Stone size, operative time, postoperative urinary tract infection, and diabetes mellitus are significant predictors of AKI. During RIRS, urologists should consider the factors that increase the risk of AKI and evaluate the treatment outcomes based on these factors.
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Affiliation(s)
- Yunus Emre Göger
- Department of Urology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | | | | | - Eren Erol
- Department of Urology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Hakan Hakkı Taşkapu
- Department of Urology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
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Gauhar V, Chai CA, Chew BH, Singh A, Castellani D, Tailly T, Emiliani E, Keat WOL, Ragoori D, Lakmichi MA, Teoh JYC, Traxer O, Somani BK. RIRS with disposable or reusable scopes: does it make a difference? Results from the multicenter FLEXOR study. Ther Adv Urol 2023; 15:17562872231158072. [PMID: 36923302 PMCID: PMC10009018 DOI: 10.1177/17562872231158072] [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: 12/12/2022] [Accepted: 01/31/2023] [Indexed: 03/16/2023] Open
Abstract
Introduction With several single-use ureteroscopes now available, our aim was to analyze and compare data obtained globally from high-volume centers using both disposable and reusable flexible ureteroscopes and see if indeed in real-world practice either scope has a distinct advantage. Methods Retrospective analysis was performed on the FLEXOR registry, which was created as a TOWER group (Team of Worldwide Endourological Researchers, research wing of the Endourological Society) endeavor. Patients who underwent retrograde intrarenal surgery (RIRS) for renal stones from January 2018 to August 2021 were enrolled from 20 centers globally. A total of 6663 patients whose data were available for analysis were divided into Group 1 (Reusable scopes, 4808 patients) versus Group 2 (Disposable scopes, 1855 patients). Results The age and gender distribution were similar in both groups. The mean stone size was 11.8 mm and 9.6 mm in Groups 2 and 1, respectively (p < 0.001). Group 2 had more patients with >2 cm stones, lower pole stones and of higher Hounsfield unit. Thulium fiber laser (TFL) was used more in Group 2 (p < 0.001). Patients in Group 2 had a slightly higher stone-free rate (SFR) (78.22%) and a lower number of residual fragments (RFs) compared with Group 1 (p < 0.001). The need for further treatments for RF and overall complications was comparable between groups. On multivariate analysis, overall complications were more likely to occur in elderly patients, larger stone size, lower pole stones, and were also more when using disposable scopes with longer operative time. RFs were significantly higher (p < 0.001) for lower pole, larger, harder, multiple stones and in elderly. Conclusion Our real-world practice observations suggest that urologists choose disposable scopes for bigger, lower pole, and harder stones, and it does indeed help in improving the single-stage SFR if used correctly, with the appropriate lasers and lasing techniques in expert hands.
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Affiliation(s)
- Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital, Singapore
| | - Chu Ann Chai
- Urology Unit, Department of Surgery, University of Malaya, Kuala Lumpur, Malaysia
| | - Ben H Chew
- Department of Urology, University of British Columbia, Vancouver, BC, Canada
| | | | - Daniele Castellani
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
| | - Thomas Tailly
- Department of Urology, University Hospital of Ghent, Ghent, Belgium
| | - Esteban Emiliani
- Urology Department, Fundación Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain
| | | | | | - Mohamed Amine Lakmichi
- Department of Urology, University Hospital Mohammed the VIth of Marrakesh, Marrakesh, Morocco
| | - Jeremy Yuen-Chun Teoh
- S.H. Ho Urology Centre, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Olivier Traxer
- Department of Urology, AP-HP, Tenon Hospital, Sorbonne University, Paris, France
| | - Bhaskar Kumar Somani
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
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Juliebø-Jones P, Keller EX, Tzelves L, Beisland C, Somani BK, Gjengstø P, Æsøy MS, Ulvik Ø. Paediatric kidney stone surgery: state-of-the-art review. Ther Adv Urol 2023; 15:17562872231159541. [PMID: 36950219 PMCID: PMC10026105 DOI: 10.1177/17562872231159541] [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: 09/07/2022] [Accepted: 02/07/2023] [Indexed: 03/24/2023] Open
Abstract
While urolithiasis in children is rare, the global incidence is rising, and the volume of minimally invasive surgeries being performed reflects this. There have been many developments in the technology, which have supported the advancement of these interventions. However, innovation of this kind has also resulted in wide-ranging practice patterns and debate regarding how they should be best implemented. This is in addition to the extra challenges faced when treating stone disease in children where the patient population often has a higher number of comorbidities and for example, the need to avoid risk such as ionising exposure is higher. The overall result is a number of challenges and controversies surrounding many facets of paediatric stone surgery such as imaging choice, follow-up and different treatment options, for example, medical expulsive therapy, shockwave lithotripsy, ureteroscopy, and percutaneous nephrolithotomy. This article provides an overview of the current status of paediatric stone surgery and discussion on the key topics of debate.
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Affiliation(s)
| | - Etienne Xavier Keller
- Department of Urology, University Hospital
Zurich, University of Zurich, Zurich, Switzerland EAU YAU Urolithiasis
Group, Arnhem, The Netherlands
| | - Lazaros Tzelves
- Second Department of Urology, National and
Kapodistrian University of Athens, Sismanogleio General Hospital, Athens,
Greece EAU YAU Urolithiasis Group, Arnhem, The Netherlands
| | - Christian Beisland
- Department of Urology, Haukeland University
Hospital, Bergen, NorwayDepartment of Clinical Medicine, University of
Bergen, Bergen, Norway
| | - Bhaskar K Somani
- Department of Urology, University Hospital
Southampton, Southampton, UK
| | - Peder Gjengstø
- Department of Urology, Haukeland University
Hospital, Bergen, Norway
| | | | - Øyvind Ulvik
- Haukeland University Hospital, Bergen,
NorwayDepartment of Clinical Medicine, University of Bergen, Bergen,
Norway
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Faria-Costa G, Tsaturyan A, Peteinaris A, Faitatziadis S, Liatsikos E, Kallidonis P. Determinants of outflow rate through the ureteral access sheath during flexible ureteroscopy: an experimental in vivo study in an anesthetized porcine model. Urolithiasis 2022; 51:18. [PMID: 36534198 DOI: 10.1007/s00240-022-01377-4] [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: 07/18/2022] [Accepted: 11/02/2022] [Indexed: 12/23/2022]
Abstract
To evaluate the effect of different ureteroscope positions, saline pumping frequency, laser fiber diameter and ureteral access sheath (UAS) on outflow rate during flexible ureteroscopy (fURS). This study was performed in an anesthetized porcine model. The fURS setup included a manual pumping system, a 9.5 Fr single used-digital flexible ureteroscope and a ureteral access sheath (UAS). Outflow was collected and measured from the UAS during 1 min in all experimental settings. The evaluated variables were the position of the ureteroscope, the pumping frequency (2 s, 3 s or 5 s), the diameter of the used UAS (12/14 Fr or 14/16 Fr) and laser fiber (200 μm or a 272 μm). Ureteroscope position in the lower calyx was associated with significantly lower outflow rate (p < 0.05). The use of the 14/16 Fr UAS resulted in improved flow in the renal pelvis and upper calyx (p < 0.05) but not in the lower calyx. The use of a 200 μm laser fiber only improved flow in the upper calyx and when a 14/16 Fr UAS was being used. Pumping frequency did not show a significant correlation with outflow rate. The ureteroscope positioning and UAS size were important determinants of outflow rate through the UAS during fURS, while laser fiber diameter had a limited effect. In the lower calyx the outflow was minimal and was not improved by using a larger UAS.
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Affiliation(s)
- Gabriel Faria-Costa
- Department of Urology, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal
- Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Arman Tsaturyan
- Department of Urology, University of Patras Medical School, Rio, 26500, Patras, Greece.
| | - Angelis Peteinaris
- Department of Urology, University of Patras Medical School, Rio, 26500, Patras, Greece
| | - Solon Faitatziadis
- Department of Urology, University of Patras Medical School, Rio, 26500, Patras, Greece
| | - Evangelos Liatsikos
- Department of Urology, University of Patras Medical School, Rio, 26500, Patras, Greece
- Department of Urology, Medical University of Vienna, Vienna, Austria
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Panagiotis Kallidonis
- Department of Urology, University of Patras Medical School, Rio, 26500, Patras, Greece
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Quiroz Y, Somani BK, Tanidir Y, Tekgul S, Silay S, Castellani D, Lim EJ, Fong KY, Garcia Rojo E, Corrales M, Hameed BMZ, Llorens E, Teoh JYC, Dogan HS, Traxer O, Bujons Tur A, Gauhar V. Retrograde Intrarenal Surgery in Children: Evolution, Current Status, and Future Trends. J Endourol 2022; 36:1511-1521. [PMID: 35972727 DOI: 10.1089/end.2022.0160] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Introduction: Incidence of urolithiasis in children has increased in recent years and with technological advancements and miniaturization of surgical instruments, pediatric urologists have acquired an impressive arsenal for their treatment. Retrograde intrarenal surgery (RIRS) has gained widespread popularity as it is a natural extension of semirigid ureteroscopy and can be done through natural orifice minimizing the morbidity of percutaneous access. The aim of this narrative review is to describe how RIRS has evolved over the decades in children and if the age-related anatomical difference impacts reported outcomes especially stone-free rate (SFR) and complications. Materials and Methods: An electronic literature search from inception to October 15, 2021 was performed using Medical Subject Heading terms in several combinations on PubMed, EMBASE, and Web of Science without language restrictions. A total of 2022 articles were founded and 165 articles were full-text screening. Finally, 2 pediatric urologists included 51 articles that summarize the available literature regarding the development and use of RIRS in children. Results: RIRS as of today is well established as a superior modality for all stones in all locations compared with extracorporeal shockwave lithotripsy both in children and adults. The passive dilation has decreased the need of active ureteral dilation, but the need to perform prestenting is not defined yet. Regarding the use of the ureteral access sheath, the literature tends to lean toward its placement in most cases, but we do not know its long-term effects over the growth of children. Finally, the SFR has increased as the experience of pediatric urologists increases, as well as the number of complications has decreased. Conclusion: RIRS in pediatrics has crossed many milestones, yet many areas need further research and larger data are required to make RIRS the procedure of choice for renal stone management in children across all age groups.
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Affiliation(s)
- Yesica Quiroz
- Department of Urology, Division of Pediatric Urology, Fundació Puigvert, Barcelona, Spain
| | - Bhaskar Kumar Somani
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Yiloren Tanidir
- Department of Urology, Marmara University School of Medicine, Istanbul, Turkey
| | - Serdar Tekgul
- Division of Pediatric Urology, Department of Urology, Medical School, Hacettepe University, Ankara, Turkey
| | - Selcuk Silay
- Department of Urology, Istanbul Biruni University, Istanbul Medeniyet University, Istanbul Memorial Hospital, Istanbul, Turkey
| | - Daniele Castellani
- Department of Urology, Division of Urology, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Università Politecnica delle Marche, Ancona, Italy
| | - Ee Jean Lim
- Department of Urology, Singapore General Hospital, Singapore, Singapore
| | - Khi Yung Fong
- Department of Urology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Esther Garcia Rojo
- Department of Urology, Hospital Universitario HM Sanchinarro, HM Hospitales, Madrid, Spain
| | - Mariela Corrales
- Department of Urology, Hôpital Tenon, Sorbonne University, Paris, France
| | - B M Zeeshan Hameed
- Department of Urology, Father Muller Medical College Mangalore, Karnataka, India
| | - Erika Llorens
- Department of Urology, Division of Pediatric Urology, Fundació Puigvert, Barcelona, Spain
| | - Jeremy Yuen-Chun Teoh
- S.H. Ho Urology Center, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Hasan Serkan Dogan
- Division of Pediatric Urology, Department of Urology, Medical School, Hacettepe University, Ankara, Turkey
| | - Olivier Traxer
- Department of Urology, Hôpital Tenon, Sorbonne University, Paris, France
| | - Anna Bujons Tur
- Department of Urology, Division of Pediatric Urology, Fundació Puigvert, Barcelona, Spain
| | - Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital, NUHS, Singapore, Singapore
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Chen Y, Zheng L, Lin L, Li C, Gao L, Ke L, Kuang R, Chen J. A novel flexible vacuum-assisted ureteric access sheath in retrograde intrarenal surgery. BJU Int 2022; 130:586-588. [PMID: 35986898 PMCID: PMC9826103 DOI: 10.1111/bju.15873] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Yujun Chen
- Nanchang University Medical CollegeNanchangChina
| | - Liangliang Zheng
- Department of UrologyJiangxi Provincial People's HospitalNanchangChina
| | - Longhui Lin
- Department of UrologyJiangxi Provincial People's HospitalNanchangChina
| | - Chen Li
- Department of UrologyJiangxi Provincial People's HospitalNanchangChina
| | - Liang Gao
- Department of UrologyJiangxi Provincial People's HospitalNanchangChina
| | - Longlong Ke
- Department of UrologyJiangxi Provincial People's HospitalNanchangChina
| | - Renrui Kuang
- Department of UrologyJiangxi Provincial People's HospitalNanchangChina
| | - Jie Chen
- Department of UrologyJiangxi Provincial People's HospitalNanchangChina
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Neuzillet Y, Seisen T, Traxer O, Allory Y, Audenet F, Leon P, Loriot Y, Pradère B, Roumiguié M, Xylinas E, Masson-Lecomte A, Roupret M. French AFU Cancer Committee Guidelines - Update 2022-2024: Upper urinary tract urothelial cancer (UTUC). Prog Urol 2022; 32:1164-1194. [PMID: 36400481 DOI: 10.1016/j.purol.2022.08.003] [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: 07/05/2022] [Accepted: 08/01/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The aim was to propose an update of the French Urology Association Cancer Committee (ccAFU) Recommendations on the management of upper urinary tract urothelial carcinomas (UUT-UC). METHODS A systematic Medline search was performed between 2020 and 2022, taking account of the diagnosis, treatment options and follow-up of UUT-UC, while evaluating the references with their levels of evidence. RESULTS The diagnosis of this rare pathology is based on CTU acquisition during excretion and flexible ureterorenoscopy with histological biopsies. Radical nephroureterectomy (RNU) remains the gold standard for surgical treatment. Nevertheless conservative treatment can be discussed for low risk lesions: tumour of low-grade, with no infiltration on imaging, unifocal<2cm, eligible for full treatment therefore requiring close endoscopic surveillance by flexible ureteroscopy in compliant patients. After RNU, postoperative instillation of chemotherapy is recommended to reduce the risk of recurrence in the bladder. Adjuvant chemotherapy has shown clinical benefits compared to surveillance after RNU for tumours (pT2-T4 N0-3 M0). CONCLUSION These updated recommendations should contribute to improving not only patients' level of care, but also the diagnosis and decision-making concerning treatment for UUT-UC.
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Affiliation(s)
- Y Neuzillet
- Service d'urologie, hôpital Foch, Université Paris Saclay, Suresnes, France.
| | - T Seisen
- Sorbonne Université, GRC 5 Predictive Onco-Uro, AP-HP, Urologie, Hôpital Pitié-Salpetrière, 75013 Paris, France
| | - O Traxer
- Sorbonne Université, GRC#20 Lithiase Urinaire et EndoUrologie, AP-HP, Urologie, Hôpital Tenon, 75020 Paris, France
| | - Y Allory
- Service d'anatomopathologie, Institut Curie, Université Paris Saclay, Saint-Cloud, France
| | - F Audenet
- Service d'urologie, Hôpital européen Georges-Pompidou AP-HP Centre, Université Paris Cité, Paris, France
| | - P Leon
- Service d'urologie, clinique Pasteur, Royan, France
| | - Y Loriot
- Service d'oncologie médicale, Institut Gustave-Roussy, Villejuif, France
| | - B Pradère
- Service d'urologie UROSUD, Clinique Croix Du Sud, 31130 Quint-Fonsegrives, France
| | - M Roumiguié
- Service d'urologie, CHU de Toulouse, UPS, Université de Toulouse, Toulouse, France
| | - E Xylinas
- Service d'urologie, Hôpital Bichat-Claude Bernard AP-HP, Université Paris Cité, Paris, France
| | - A Masson-Lecomte
- Service d'urologie, Hôpital Saint-Louis AP-HP, Université Paris Cité, Paris, France
| | - M Roupret
- Sorbonne Université, GRC 5 Predictive Onco-Uro, AP-HP, Urologie, Hôpital Pitié-Salpetrière, 75013 Paris, France
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Complications en endo-urologie : urétéroscopie et néphrolithotomie percutanée. Prog Urol 2022; 32:966-976. [DOI: 10.1016/j.purol.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 09/05/2022] [Indexed: 11/20/2022]
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Ripa F, Tokas T, Griffin S, Ferretti S, Bujons Tur A, Somani BK. Role of Pediatric Ureteral Access Sheath and Outcomes Related to Flexible Ureteroscopy and Laser Stone Fragmentation: A Systematic Review of Literature. EUR UROL SUPPL 2022; 45:90-98. [PMID: 36267473 PMCID: PMC9576810 DOI: 10.1016/j.euros.2022.09.012] [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] [Accepted: 09/18/2022] [Indexed: 11/17/2022] Open
Abstract
Context Flexible ureteroscopy and laser lithotripsy (FURSL) represent a good treatment option for pediatric urolithiasis. Scarce evidence is available about the safety and efficacy of the concomitant use of a ureteral access sheath (UAS) in the setting of pediatric ureteroscopy (URS). Objective To acquire all the available evidence on UAS usage in pediatric FURSL, focusing on intra- and postoperative complications and stone-free rates (SFRs). Evidence acquisition We performed a systematic literature research using PubMed/MEDLINE, Embase, and Scopus databases. The inclusion criteria were cohorts of pediatric patients <18 yr old, submitted to URS for FURSL, reporting on more than ten cases of UAS placement. The primary outcomes were prestenting rates, operating time, ureteric stent placement rates after surgery, rates and grades of complications, ureteral injuries, and overall SFR. A total of 22 articles were selected. Evidence synthesis In total, 26 intraoperative and 130 postoperative complications following URS with UAS placement were reported (1.8% and 9.18% of the overall procedures, respectively). According to the Clavien-Dindo classification, 32 were classified as Clavien I, 29 as Clavien II, 43 as Clavien I or II, six as Clavien III, and one as Clavien IV. Twenty-one cases of ureteral injuries (1.59%) were noted in the whole cohort; most of them were ureteral perforation or extravasation, and were treated with a temporary indwelling ureteric stent. The overall SFR after a single URS procedure was 76.92%; after at least a second procedure, it was 84.9%. Conclusions FURSL is a safe and effective treatment option for pediatric urolithiasis. UAS use was associated with a low rate of ureteric injuries, mostly treated and resolved with a temporary indwelling ureteric stent. Patient summary We performed a systematic literature research on the utilization of a UAS during ureteroscopy for stone treatment in pediatric patients. We assessed the outcomes related to the rates of intra- and postoperative complications and the rates of efficacy of the procedure in the clearance of stones. The evidence shows a low rate and grade of complications associated with UAS placement and good stone-free outcomes. A ureteric injury may occur in 1.6% of cases, but it is usually managed and resolved with a temporary indwelling ureteric stent.
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Affiliation(s)
- Francesco Ripa
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Theodoros Tokas
- Department of Urology and Andrology, General Hospital Hall in Tirol, Hall in Tirol, Austria,Training and Research in Urological Surgery and Technology (T.R.U.S.T.) Group
| | - Stephen Griffin
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | | | - Bhaskar K. Somani
- University Hospital Southampton NHS Foundation Trust, Southampton, UK,Corresponding author. University Hospital Southampton NHS Trust, Southampton, UK. Tel. +44 02381206873.
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Corrales M, Sierra A, Doizi S, Traxer O. Risk of Sepsis in Retrograde Intrarenal Surgery: A Systematic Review of the Literature. EUR UROL SUPPL 2022; 44:84-91. [PMID: 36071820 PMCID: PMC9442387 DOI: 10.1016/j.euros.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2022] [Indexed: 10/31/2022] Open
Abstract
Context Objective Evidence acquisition Evidence synthesis Conclusions Patient summary
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Chua ME, Kim JK, Ming JM, De Cotiis KN, Yang SS, Rickard M, Lorenzo AJ, Dos Santos J. Scoping review of recent evidence on the management of pediatric urolithiasis: summary of meta-analyses, systematic reviews and relevant randomized controlled trials. Pediatr Surg Int 2022; 38:1349-1361. [PMID: 35939126 DOI: 10.1007/s00383-022-05190-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/13/2022] [Indexed: 11/25/2022]
Abstract
This scoping review aimed to evaluate and summarize the recent 10 year pediatric urolithiasis literature with a particular focus on systematic reviews, randomized-controlled trials (RCT) and meta-analysis. The systematic literature search performed on September 1, 2021, restricted to the recent 10 years, focused on pediatric urolithiasis that are RCTs, meta-analysis and systematic reviews. The summarized literature included etiology, diagnostics, medical and surgical management. GRADE criteria are used to evaluate and standardize the reporting of evidence quality. A total of 33 relevant articles were included. The recent high-level studies included topics of genetic and diet association with pediatric stone formation, diagnostic assessment, medical management intervention including medical dissolution and expulsion therapy. The study extended to include the efficacy and safety of extracorporeal lithotripsy, percutaneous nephrolithotomy and retrograde intrarenal surgery. However, evidence quality was ranked "very-low" or "low". Based on the GRADE criteria downgrading of the quality level was due to heterogeneity and low precision. A majority of the RCTs were categorized as having a "high" to "uncertain" risk of bias. The relevant RCTs, meta-analyses and systematic reviews within the past decade are of low quality. Consequently, the research provided no clear evidence-based recommendations for managing pediatric urolithiasis. More rigorous research and high-quality studies are needed to determine the best practices.
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Affiliation(s)
- Michael E Chua
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada.
- Department of Surgery, University of Toronto, Toronto, ON, Canada.
- Institute of Urology, St. Luke's Medical Center, Quezon City, Philippines.
| | - Jin Kyu Kim
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Jessica M Ming
- Department of Urology, University of New Mexico, Albuquerque, NM, USA
| | - Keara N De Cotiis
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- Department of Urology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Stephen S Yang
- Division of Urology, Buddhist Tzu Chi General Hospital, New Taipei Branch, New Taipei City, Taiwan
| | - Mandy Rickard
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Armando J Lorenzo
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Joana Dos Santos
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
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De Coninck V, Somani B, Sener ET, Emiliani E, Corrales M, Juliebø-Jones P, Pietropaolo A, Mykoniatis I, Zeeshan Hameed BM, Esperto F, Proietti S, Traxer O, Keller EX. Ureteral Access Sheaths and Its Use in the Future: A Comprehensive Update Based on a Literature Review. J Clin Med 2022; 11:jcm11175128. [PMID: 36079058 PMCID: PMC9456781 DOI: 10.3390/jcm11175128] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 08/27/2022] [Accepted: 08/29/2022] [Indexed: 11/21/2022] Open
Abstract
Ureteral access sheaths (UASs) are part of urologist’s armamentarium when performing retrograde intrarenal surgery (RIRS). Recently, the world of RIRS has changed dramatically with the development of three game-changers: thulium fiber laser (TFL), smaller size single use digital flexible ureterosopes and intraoperative intrarenal pressure (IRP) measurement devices. We aimed to clarify the impact of UASs on IRP, complications and SFRs and put its indications in perspective of these three major technological improvements. A systematic review of the literature using the Medline, Scopus and Web of Science databases was performed by two authors and relevant studies were selected according to PRISMA guidelines. Recent studies showed that using a UAS lowers IRP and intrarenal temperature by increasing irrigation outflow during RIRS. Data on the impact of a UAS on SFRs, postoperative pain, risk of infectious complications, risk of ureteral strictures and risk of bladder recurrence of urothelial carcinoma after diagnostic RIRS were inconclusive. Prestenting for at least one week resulted in ureteral enlargement, while the influence of pre-operative administration of alpha-blockers was unclear. Since TFL, smaller single use digital ureteroscopes and devices with integrated pressure-measuring and aspiration technology seemed to increase SFRs and decrease pressure and temperature related complications, indications on the use of a UAS may decrease in the near future.
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Affiliation(s)
- Vincent De Coninck
- Department of Urology, AZ Klina, 2930 Brasschaat, Belgium
- Young Academic Urologists (YAU), Urolithiasis & Endourology Working Party, 6846 Arnhem, The Netherlands
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), 75020 Paris, France
- Correspondence: ; Tel.: +32-3-650-50-56
| | - Bhaskar Somani
- Department of Urology, University Hospital Southampton, Southampton SO16 6YD, UK
| | - Emre Tarik Sener
- Young Academic Urologists (YAU), Urolithiasis & Endourology Working Party, 6846 Arnhem, The Netherlands
- Department of Urology, Marmara University School of Medicine, Istanbul 34854, Turkey
| | - Esteban Emiliani
- Young Academic Urologists (YAU), Urolithiasis & Endourology Working Party, 6846 Arnhem, The Netherlands
- Department of Urology, Fundacio Puigvert, Autonomous University of Barcelona, 08025 Barcelona, Spain
| | - Mariela Corrales
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), 75020 Paris, France
- Service d’Urologie, AP-HP, Hôpital Tenon, Sorbonne Université, 75020 Paris, France
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020 Paris, France
| | - Patrick Juliebø-Jones
- Department of Urology, Haukeland University Hospital, N-5021 Bergen, Norway
- Department of Clinical Medicine, University of Bergen, N-5021 Bergen, Norway
| | - Amelia Pietropaolo
- Young Academic Urologists (YAU), Urolithiasis & Endourology Working Party, 6846 Arnhem, The Netherlands
- Department of Urology, University Hospital Southampton, Southampton SO16 6YD, UK
| | - Ioannis Mykoniatis
- Young Academic Urologists (YAU), Urolithiasis & Endourology Working Party, 6846 Arnhem, The Netherlands
- Department of Urology, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Belthangady M. Zeeshan Hameed
- Young Academic Urologists (YAU), Urolithiasis & Endourology Working Party, 6846 Arnhem, The Netherlands
- Department of Urology, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal 576104, India
| | - Francesco Esperto
- Young Academic Urologists (YAU), Urolithiasis & Endourology Working Party, 6846 Arnhem, The Netherlands
- Department of Urology, Campus Bio-Medico University, 00128 Rome, Italy
- Unit of Urology, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
| | - Silvia Proietti
- Department of Urology, IRCCS San Raffaele Hospital, 20132 Milan, Italy
| | - Olivier Traxer
- Service d’Urologie, AP-HP, Hôpital Tenon, Sorbonne Université, 75020 Paris, France
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020 Paris, France
| | - Etienne Xavier Keller
- Young Academic Urologists (YAU), Urolithiasis & Endourology Working Party, 6846 Arnhem, The Netherlands
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), 75020 Paris, France
- Department of Urology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
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Juliebø-Jones P, Keller EX, Haugland JN, Æsøy MS, Beisland C, Somani BK, Ulvik Ø. Advances in Ureteroscopy: New technologies and current innovations in the era of Tailored Endourological Stone Treatment (TEST). JOURNAL OF CLINICAL UROLOGY 2022. [DOI: 10.1177/20514158221115986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Ureteroscopy has undergone many advances in recent decades. As a result, it is able to treat an increasing range of patient groups including special populations such as pregnancy, anomalous kidneys and extremes of age. Such advances include Holmium laser, high-power systems and pulse modulation. Thulium fibre laser is a more recent introduction to clinical practice. Ureteroscopes have also been improved alongside vision and optics. This article provides an up-to-date guide to these topics as well as disposable scopes, pressure control and developments in operating planning and patient aftercare. These advances allow for a custom strategy to be applied to the individual patient in what we describe using a new term: Tailored endourological stone treatment (TEST). Level of evidence: 5
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Affiliation(s)
- Patrick Juliebø-Jones
- Department of Urology, Haukeland University Hospital, Norway
- Department of Clinical Medicine, University of Bergen, Norway
| | - Etienne Xavier Keller
- Department of Urology, University Hospital Zurich, University of Zurich, Switzerland
| | | | | | - Christian Beisland
- Department of Urology, Haukeland University Hospital, Norway
- Department of Clinical Medicine, University of Bergen, Norway
| | | | - Øyvind Ulvik
- Department of Clinical Medicine, University of Bergen, Norway
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Wu ZH, Wang YZ, Liu TZ, Wang XH, Zhang C, Zhang WB, Zheng H, Zhang YG. Comparison of vacuum suction ureteroscopic laser lithotripsy and traditional ureteroscopic laser lithotripsy for impacted upper ureteral stones. World J Urol 2022; 40:2347-2352. [PMID: 35849171 DOI: 10.1007/s00345-022-04075-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 06/09/2022] [Indexed: 01/24/2023] Open
Abstract
PURPOSE To compare a novel vacuum suction ureteroscopic laser lithotripsy (VS-URS) with traditional ureteroscopic laser lithotripsy (T-URS) for impacted upper ureteral stones and to better define the potential benefits of VS-URS. METHODS Between May 2019 and March 2021, 158 patients with impacted upper ureteral stones underwent ureteroscopic holmium-YAG laser lithotripsy. Of these, 76 underwent VS-URS and 82 underwent T-URS. In VS-URS procedures, the vacuum suction device is composed of a 5F ureteral catheter and a tee joint. The ureteral catheter is linked to the vacuum aspirator by the sidearm of the tee joint, and a 200 μm fiber is inserted through the tee joint and the ureteral catheter into the stone site for lithotripsy. RESULTS When compared to the T-URS group, the VS-URS group had a shorter mean operation time (38.18 ± 6.37 min vs. 46.65 ± 5.66 min; P = 0.000), lower fever rate (3.9% vs. 14.6%; P < 0.022), less stone retropulsion (5.3% vs. 18.3%; P = 0.012), lower extra management rate (6.58% vs. 21.95%; P = 0.006), and a higher stone-free rate of the first postoperative day (88.2% vs. 72.0%; P = 0.011). There were no significant differences in stone-free rates 1 month after surgery between groups (94.7% vs. 92.7%; P = 0.748). CONCLUSIONS VS-URS is an effective modality for impacted upper ureteral stones, and has a shorter operating time, lower fever rate, less stone retropulsion, and a higher primary stone-free rate compared with T-URS.
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Affiliation(s)
- Zhong-Hua Wu
- Department of Urology, Zhongnan Hospital of Wuhan University, Donghu Road #169, Wuchang District, Wuhan, 430071, Hubei, China.
| | - Yong-Zhi Wang
- Department of Urology, Zhongnan Hospital of Wuhan University, Donghu Road #169, Wuchang District, Wuhan, 430071, Hubei, China
| | - Tong-Zu Liu
- Department of Urology, Zhongnan Hospital of Wuhan University, Donghu Road #169, Wuchang District, Wuhan, 430071, Hubei, China
| | - Xing-Huan Wang
- Department of Urology, Zhongnan Hospital of Wuhan University, Donghu Road #169, Wuchang District, Wuhan, 430071, Hubei, China
| | - Ci Zhang
- Department of Urology, Zhongnan Hospital of Wuhan University, Donghu Road #169, Wuchang District, Wuhan, 430071, Hubei, China
| | - Wei-Bing Zhang
- Department of Urology, Zhongnan Hospital of Wuhan University, Donghu Road #169, Wuchang District, Wuhan, 430071, Hubei, China
| | - Hang Zheng
- Department of Urology, Zhongnan Hospital of Wuhan University, Donghu Road #169, Wuchang District, Wuhan, 430071, Hubei, China
| | - Yin-Gao Zhang
- Department of Urology, Zhongnan Hospital of Wuhan University, Donghu Road #169, Wuchang District, Wuhan, 430071, Hubei, China
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Cristallo C, Santillán D, Tobia I, Tirapegui FI, Daels FP, González MS. Flexible ureteroscopy without ureteral access sheath. Actas Urol Esp 2022; 46:354-360. [PMID: 35260371 DOI: 10.1016/j.acuroe.2021.12.006] [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: 01/19/2021] [Revised: 03/09/2021] [Accepted: 04/18/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Ureteral access sheath (UAS) is widely used in flexible ureteroscopy and laser lithotripsy (FURS) based on better stone-free rates, lower intrarenal pressure and fewer complications. However, it also rises surgical costs and may injure the ureteral wall. The main objective of our study is to compare safety and efficacy of FURS with and without UAS to evaluate whether its use is justified in all cases. MATERIALS AND METHODS We performed a retrospective observational analytic study based on a prospective database. A total of 241 consecutive patients who underwent FURS for upper ureter and renal stones between January 2018 and May 2020 were included for analysis and divided into two groups upon UAS use. We compared demographic data, stone characteristics, prestenting, operative time, need for ureteral stent, postoperative urinary tract infection, renal colic and need for ancillary procedures. RESULTS A total of 198 patients (82.2%) were included in the group without UAS. Operative time was significantly shorter in the group of patients without UAS than those with UAS (64.6 minutes ± 29.5 vs. 89.9 minutes ± 2.8 respectively; p 0.010). Both groups had similar rates of colic pain and urinary tract infection. Ancillary procedures were more frequent in the UAS group (37.2 vs. 21.2%; p 0.026), but significance was lost in multivariate assessment. CONCLUSION FURS without UAS seems to be as safe as FURS with UAS but requires less ancillary procedures. An additional advantage is shorter operative time.
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Affiliation(s)
- C Cristallo
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - D Santillán
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - I Tobia
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - F I Tirapegui
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - F P Daels
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - M S González
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Lazarus J, Kaestner L. Novel syphon ureteric access sheath has the potential to improve renal pressures and irrigant flow. BJU Int 2022; 129:642-647. [PMID: 34496125 DOI: 10.1111/bju.15593] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/15/2021] [Accepted: 08/30/2021] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To describe a novel syphoning ureteric access sheath (UAS) intended for use during flexible ureterorenoscopy (URS). We aimed to assess if in vitro it could reduce intrarenal pressure (IRP) and increase irrigant flow compared to traditional UASs. MATERIALS AND METHODS A validated phantom kidney with fibre optic pressure sensing capabilities was used to assess the IRP. Standardised 80 cmH2 O irrigation via a ureterorenoscope was instilled through traditional UASs (11/13 and 12/14 F) and compared to the novel 11/13-F syphoning UAS. The measured minute volume, calculated hourly flow volume, and steady state IRP were compared. RESULTS The traditional 11/13 and 12/14-F UASs had statistically poorer irrigant flow than the novel syphoning UAS, at 19.3 vs 29.3 mL/min (P < 0.001) and 22.7 vs 29.3 mL/min (P = 0.002), respectively. The steady state IRP was 20 mmHg for the traditional 11/13 F and 13 mmHg for the 12/14 F compared to 0 mmHg for the novel UAS. CONCLUSION The described novel UAS is different from traditional devices by incorporating a syphon mechanism. Our in vitro assessment demonstrates that the novel UAS holds clinical potential to reduce IRP while allowing a significant increase in irrigant flow compared to larger diameter traditional UASs.
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Affiliation(s)
- John Lazarus
- Division of Urology, Groote Schuur Hospital, Cape Town, South Africa
| | - Lisa Kaestner
- Division of Urology, Groote Schuur Hospital, Cape Town, South Africa
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Aykanat C, Balci M, Senel C, Ozercan AY, Coser S, Aslan Y, Guzel O, Asfuroglu A, Karabulut E, Tuncel A. The Impact of Ureteral Access Sheath Size on Perioperative Parameters and Postoperative Ureteral Stricture in Retrograde Intrarenal Surgery. J Endourol 2022; 36:1013-1017. [PMID: 35229631 DOI: 10.1089/end.2021.0751] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To investigate the effect of the diameter of UAS used during RIRS on operative parameters, perioperative ureteral injury, and ureteral stricture development. MATERIAL AND METHOD The study was designed as a prospective randomized controlled trial and included 320 patients who underwent RIRS. The patients were divided into two groups according to UAS diameter (9.5/11.5 Fr (Group 1) and 12/14 Fr (Group 2)) were used during the operation. At the end of the operation, ureteral injury was checked visually using semi-rigid ureterorenoscopy and classified according to the ureter injury scale. In the postoperative first year, the control CT urography images used to newly developed ureteral dilation. RESULTS There was no statistical difference between the two groups in terms of patient and stone characteristics, operative time, postoperative stone-free rate, and postoperative infection development parameters. In Group 1, 30 (18.8%) of the patients had low-grade and 8 (5%) of the patients had high-grade ureteral injury while in Group 2, 44 (27.5%) had low-grade and 19 (11.9%) had high-grade ureteral injury (p=0.013). In the postoperative period, ureteral stricture was found in 5 (1.6%) patients, of whom 4 (2.5%) were in Group 2 and 1 (0.6%) (p=0.371). CONCLUSION The results of our study showed that the use of a 12/14 Fr UAS in patients who are not previously stented, increases the risk of high grade ureteral injuries, however, despite this increase there is no difference in ureteral stricture formation.
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Affiliation(s)
| | - Melih Balci
- Ankara Numune Training and Research Hospital, 64134, Urology, Talatpasa Blv, Ankara, Turkey, 06100;
| | - Cagdas Senel
- numune eğitim ve araştırma hastanesi b blok 3.kat üroloji a kliniğiAnkara, Turkey, 06100;
| | | | | | | | | | | | - Erdem Karabulut
- Hacettepe University Faculty of Medicine, 64005, Biostatistics, Ankara, Ankara, Turkey;
| | - Altug Tuncel
- Ankara Numune Research and Training Hospital, urology, Sihhiye, Ankara, Turkey, 06120.,Turkey;
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Gallegos H, Bravo JC, Sepúlveda F, Astroza GM. Intrarenal temperature measurement associated with holmium laser intracorporeal lithotripsy in an ex vivo model. Cent European J Urol 2022; 74:588-594. [PMID: 35083081 PMCID: PMC8771124 DOI: 10.5173/ceju.2021.0092] [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: 03/30/2021] [Revised: 10/10/2021] [Accepted: 10/10/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction The aim of this article was to quantify the effect of the use of holmium laser during intracorporeal lithotripsy in an ex vivo model. Material and methods A simulated model for laser nephro-lithotripsy was designed. Two ex vivo porcine kidneys were used. Electronic thermometer electrodes were inserted on the upper calyx. Intracorporeal lithotripsy was simulated with a holmium laser. Intrarenal temperature was recorded both at the beginning and after one minute of laser use with delta temperature (DT) defined as the difference between them. Measurements were made at different irrigation heights (30, 40, and 50 cm H2O), frequency (Hz), and laser energy (J) in addition to the presence or absence of the access sheath. Analysis of factors associated with temperature change was performed. Results Thirty-eight observations were recorded. The measurement without the use of access sheath showed an average DT of 4.9, 5.1, and 6.5°C for 5, 10, and 15 Hz, respectively; however, with a sheath, DTs were 0.2, 0.5, and 1.5°C. In terms of energy, mean DTs of 4.3, 6.1, 5.2, and 13.9°C for 0.5, 0.8, 1.0, and 1.5 J were recorded; in contrast, with a sheath, averages of 0.4, 0.5, 0.5, and 3.8°C, respectively were noted. In the adjusted model, energy, frequency, and use of sheath and water height were significant. Conclusions The configuration of the laser significantly modifies the intrarenal temperature and height of the bladder irrigation. The use of an access sheath provides lower intrarenal temperatures regardless of laser configuration and water height.
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Affiliation(s)
- Héctor Gallegos
- Graduate School, Faculty of Medicine, Catholic University of Chile, Santiago, Chile
| | - Juan Cristóbal Bravo
- Graduate School, Faculty of Medicine, Catholic University of Chile, Santiago, Chile
| | - Francisca Sepúlveda
- Graduate School, Faculty of Medicine, Catholic University of Chile, Santiago, Chile
| | - Gastón M Astroza
- Department of Urology, School of Medicine, Catholic University of Chile, Santiago, Chile
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Law YXT, Teoh JYC, Castellani D, Lim EJ, Chan EOT, Wroclawski M, Pirola GM, Giulioni C, Rubilotta E, Gubbioti M, Scarcella S, Chew BH, Traxer O, Somani BK, Gauhar V. Role of pre-operative ureteral stent on outcomes of retrograde intra-renal surgery (RIRS): systematic review and meta-analysis of 3831 patients and comparison of Asian and non-Asian cohorts. World J Urol 2022; 40:1377-1389. [PMID: 35072738 DOI: 10.1007/s00345-022-03935-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 01/07/2022] [Indexed: 12/27/2022] Open
Abstract
PURPOSE To evaluate the outcomes of pre-stented (PS) versus non-pre-stented (NPS) patients who have undergone retrograde intrarenal surgery (RIRS) for renal calculi with subgroup analysis of Asian and non-Asian cohorts. METHODS Protocol is registered in PROSPERO, CRD42021261123. Eligible studies identified from four electronic databases. Meta-analysis was done to enumerate the outcomes of RIRS in between PS and NPS. Secondary sub-analysis was done to look for differences in outcomes in Asian and non-Asian cohorts. RESULTS Fourteen studies involving 3831 patients (4 prospective, 10 retrospective studies) were included. PS patients experienced higher success rates of ureteral access sheath (UAS) insertion than NPS (RR 1.09, 95% CI 1.05-1.13, p < 0.00001). PS patients had lower risk of ureteral injuries from UAS placement (RR 0.69, 95% CI 0.50-0.96, p = 0.03). No significant differences in intra- and postoperative complications between two groups were found. Stone-free rate (SFR) outcomes for residual fragment (RF) cut-off of < 1 mm and < 4 mm favoured the PS patients (RR 1.10, 95% CI 1.04-1.17, p = 0.002 for < 4 mm, RR1.10, 95% CI 1.02-1.19, p = 0.02 for < 1 mm). In the subgroup analysis, PS Asian patients had similar SFR as NPS patients for SFR(< 4 mm) but non-Asian population showed better outcomes in the PS patients for SFR(< 4 mm) (RR 1.31, 95% CI 1.13-1.52, p = 0.0005). CONCLUSIONS This meta-analysis suggests that pre-stenting results in a higher success for UAS placement, minimising intraoperative ureteric injury, with higher overall SFR for any RF cut-off in PS cohorts. In non-Asian cohort, significant differences occurred at SFR < 4 mm but not for SFR < 1 mm. No difference was seen in our Asian cohort for any SFR cut-off in both PS and NPS patients.
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Affiliation(s)
- Y X T Law
- Department of Urology, National University Hospital, National University Health System, Singapore, Singapore.
| | - J Y C Teoh
- S.H. Ho Urology Centre, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - D Castellani
- Urology Division, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Università Politecnica Delle Marche, Ancona, Italy
| | - E J Lim
- Department of Urology, Singapore General Hospital, Singapore, Singapore
| | - E O T Chan
- S.H. Ho Urology Centre, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - M Wroclawski
- Department of Urology, Hospital Israelita Albert Einstein, São Paulo, Brazil.,BP-a Beneficência Portuguesa de São Paulo, São Paulo, Brazil
| | - G M Pirola
- Department of Urology, San Donato Hospital, Arezzo, Italy
| | - C Giulioni
- Urology Division, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Università Politecnica Delle Marche, Ancona, Italy
| | - E Rubilotta
- Department of Urology, A.O.U.I. Verona University, Verona, Italy
| | - M Gubbioti
- Department of Urology, San Donato Hospital, Arezzo, Italy
| | - S Scarcella
- Urology Division, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Università Politecnica Delle Marche, Ancona, Italy
| | - B H Chew
- Department of Urologic Sciences, University of British Columbia, Vancouver, Canada
| | - O Traxer
- Service d'Urologie, Sorbonne Université, Paris, France.,Service d'Urologie, AP-HP, Hôpital Tenon, Paris, France
| | - B K Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - V Gauhar
- Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore
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Cristallo C, Santillán D, Tobia I, Tirapegui F, Daels F, González M. Ureteroscopia flexible sin vaina de acceso ureteral. Actas Urol Esp 2022. [DOI: 10.1016/j.acuro.2021.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Raskolnikov D, Harper JD. When the sheath hits the fan: an argument against the routine use of ureteral access sheaths. J Endourol 2021; 36:584-587. [PMID: 34963314 DOI: 10.1089/end.2021.0860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Dima Raskolnikov
- University of Washington School of Medicine, 12353, Department of Urology, 1959 NE Pacific St, Box 356510, Seattle, Washington, United States, 98195-6340;
| | - Jonathan D Harper
- University of Washington School of Medicine, 12353, Department of Urology, Seattle, Washington, United States;
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Affiliation(s)
- Nadya E York
- Auckland City Hospital, 58991, Urology, Auckland, Auckland, New Zealand;
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