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Cinar O, Cakir H, Ozman O, Akgul M, Basatac C, Siddikoglu D, Sancak EB, Baseskioglu B, Yazici CM, Akpinar H, Onal B. Safety and Efficacy of Retrograde Intrarenal Surgery in the Solitary Kidney: A Propensity Score-Matched Analysis of the RIRSearch Study Groups' Results. J Laparoendosc Adv Surg Tech A 2024; 34:155-161. [PMID: 38153393 DOI: 10.1089/lap.2023.0408] [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: 12/29/2023] Open
Abstract
Background: The aim of this study was to evaluate the efficacy and safety of retrograde intrarenal surgery (RIRS) in patients with renal calculi with solitary kidneys (SKs). Materials and Methods: In this retrospective, multicenter study, a matched case-control study was carried out using the data from 522 RIRS patients treated between 2014 and 2021. Patients' demographic data, stone characteristics, operative outcomes, perioperative and postoperative complications, and surgical success were analyzed. All patients were evaluated with noncontrast-enhanced computed tomography (NCCT) preoperatively and 1 month after the surgery. Surgical success was defined as no evidence of remaining residual fragments of <3 mm in the first-month postoperative NCCT images. The case group of 29 patients with SKs (Group 1) treated with RIRS were matched with 76 control patients (Group 2) with bilateral kidneys, who underwent unilateral RIRS by propensity score-matched (PSM) analysis. Results: After PSM analysis, the demographic and clinical data did not differ significantly between the groups. The stone burden was similar between the groups: 733.6 mm3 (range: 50.4-7565.9) versus 991.1 mm3 (range: 201.2-4380.6) (P = .09), respectively. The perioperative complication rates were 13.8% (n = 4) in Group 1 and 11.8% (n = 9) in Group 2 (P = .78). There was no statistically significant difference between the groups for postoperative complication rates (minor complications, classified as Clavien 1 or 2), (6.9% [n = 2] versus 13.2% [n = 10; P = .34]), respectively. Surgical success was 82.8% (n = 24) in Group 1 and 83.6% in Group 2 (P = .92). There was no significant difference between preoperative and postoperative glomerular filtration rate and creatinine values (P = .005). Conclusions: Our results support that RIRS is a safe and effective treatment method in SK patients with similar complication and stone-free rates compared to patients who had bilateral functional kidneys and underwent unilateral RIRS.
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Affiliation(s)
- Onder Cinar
- Department of Urology, Medicana International Samsun Hospital, Urology Clinic, Samsun, Turkey
| | - Hakan Cakir
- Department of Urology, Acibadem Hospitals Group, Acibadem Fulya Hospital, Clinic of Urology, Istanbul, Turkey
| | - Oktay Ozman
- Department of Urology, Gaziosmanpasa Training and Research Hospital, Clinic of Urology, Istanbul, Turkey
| | - Murat Akgul
- Department of Urology, Faculty of Medicine, Tekirdag Namik Kemal University, Tekirdag, Turkey
| | - Cem Basatac
- Department of Urology, Istanbul Florence Nightingale Hospital, Clinic of Urology, Istanbul, Turkey
| | - Duygu Siddikoglu
- Department of Biostatistics and Faculty of Medicine, Canakkale Onsekiz Mart University, Canakkale, Turkey
| | - Eyup Burak Sancak
- Department of Urology, Faculty of Medicine, Canakkale Onsekiz Mart University, Canakkale, Turkey
| | - Barbaros Baseskioglu
- Department of Urology, Acibadem Hospitals Group, Acibadem Eskisehir Hospital, Clinic of Urology, Eskisehir, Turkey
| | - Cenk Murat Yazici
- Department of Urology, Faculty of Medicine, Tekirdag Namik Kemal University, Tekirdag, Turkey
| | - Haluk Akpinar
- Department of Urology, Istanbul Florence Nightingale Hospital, Clinic of Urology, Istanbul, Turkey
| | - Bulent Onal
- Department of Urology, Faculty of Medicine, Istanbul University Cerrahpasa, Istanbul, Turkey
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Zeng X, Diao X, Jin S, Hu W, Bai W, Li J, Xiao B. Needle-perc-assisted endoscopic surgery (NAES) for patients with complicated solitary kidney stones: a prospective randomized study from a single center. World J Urol 2023; 41:3121-3127. [PMID: 37750960 DOI: 10.1007/s00345-023-04576-9] [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: 04/18/2023] [Accepted: 08/15/2023] [Indexed: 09/27/2023] Open
Abstract
PURPOSE The goal of this study is to compare traditional percutaneous nephrolithotomy (PCNL) and needle-perc-assisted endoscopic surgery (NAES) in the treatment of complicated solitary kidney stones via a single-center randomized controlled prospective study. METHODS A total of patients with complex (Guy's score II-IV) solitary kidney stones between July 2019 to June 2022 were enrolled in the study. Participants were stratified into two groups: needle-perc-assisted endoscopic surgery group (group A) and traditional PCNL group (group B). All procedures were finished by X-ray free technique. The clinical characteristics and outcomes were analyzed. RESULTS A total of 90 (44 in Group A and 46 in Group B) patients were finally included in our study. There were no statistically differences in terms of gender, age, body mass index (BMI), stone burden between two groups. The mean operative duration of Group A was significant higher than group B (95.1 ± 21.4 min vs 72.5 ± 29.5 min, p=0.02). The 1-month stone-free rate (SFR) was significant higher in Group A than B (90.9% vs 73.9%, p=0.03). A less hemoglobin drop (p=0.01), shorter postoperative in-hospital day (p=0.04), and lower severe complication (Clavien-Dindo III and above) rates (p=0.03) were observed in Group A. CONCLUSION For patients with solitary kidney stones, NAES technique provides a higher one-session SFR, a better renal function recovery and compared with traditional PCNL.
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Affiliation(s)
- Xue Zeng
- Department of Urology, Tsinghua University Affiliated Beijing Tsinghua Changgung Hospital, Tsinghua University Clinical Institute, No.168, Litang Road, Changping District, Beijing, 102218, China
| | - Xiaolin Diao
- Department of Medicine, Peking University Hospital, Beijing, 100871, China
| | - Song Jin
- Department of Urology, Tsinghua University Affiliated Beijing Tsinghua Changgung Hospital, Tsinghua University Clinical Institute, No.168, Litang Road, Changping District, Beijing, 102218, China
| | - Weiguo Hu
- Department of Urology, Tsinghua University Affiliated Beijing Tsinghua Changgung Hospital, Tsinghua University Clinical Institute, No.168, Litang Road, Changping District, Beijing, 102218, China
| | - Wenjie Bai
- Department of Urology, Tsinghua University Affiliated Beijing Tsinghua Changgung Hospital, Tsinghua University Clinical Institute, No.168, Litang Road, Changping District, Beijing, 102218, China
| | - Jianxing Li
- Department of Urology, Tsinghua University Affiliated Beijing Tsinghua Changgung Hospital, Tsinghua University Clinical Institute, No.168, Litang Road, Changping District, Beijing, 102218, China
| | - Bo Xiao
- Department of Urology, Tsinghua University Affiliated Beijing Tsinghua Changgung Hospital, Tsinghua University Clinical Institute, No.168, Litang Road, Changping District, Beijing, 102218, China.
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Determining the safety and effectiveness of percutaneous nephrolithotomy and retrograde intrarenal surgery in treating nephrolithiasis in patients with solitary kidneys. Urolithiasis 2022; 51:2. [DOI: 10.1007/s00240-022-01386-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 11/17/2022] [Indexed: 12/03/2022]
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Mahmood SN, Babarasul MH, Fakhralddin SS, Tawfeeq HM. Retrograde intrarenal surgery for the treatment of renal stones in patients with a solitary kidney: Does access sheath matter? AFRICAN JOURNAL OF UROLOGY 2021. [DOI: 10.1186/s12301-021-00133-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Treating renal stones in patients with a solitary functioning kidney is challenging. The present study was aimed to assess the competence and safety of retrograde intrarenal surgery (RIRS) for the treatment of renal stones in a solitary kidney.
Methods
Between August of 2017 and August of 2019, 25 ensuing patients with a solitary kidney and renal calculi and who were treated with RIRS were prospectively enlisted in the study. All patients were assessed by non-contrast computed tomography before surgery. Stone-free status was determined if there were no residual fragments. The final stone-free rates (SFRs) were assessed 3 months after the last treatment session by plain X-ray KUB and ultrasonography. Patient demographics, perioperative and postoperative outcomes were prospectively evaluated. Serum creatinine levels and glomerular filtration rate (GFR) pre-procedure and during follow-up were correlated.
Results
Twenty-five patients underwent 26 procedures. The mean patient age was 42.81 ± 12.3 (range 22–67) years. The mean stone size was 18.23 ± 6.27 mm (range 9–25 mm) and the mean operative time was 46.15 ± 15.34 min (range 25–100 min). A ureteral access sheath (UAS) was used in five (19.2%) pre-stented patients. One patient (3.8%) required the second stage RIRS for residual stones. The SFR after the initial and final procedures, the SFR was 84% and 92%, respectively.
The mean serum creatinine levels were significantly reduced post-surgery compared to preoperative levels (1.76 ± 1.21 mg/dL; 1.37 ± 0.60 mg/dL; p value 0.001) while GFR not encounter any significant variation post-surgery (63.04 ± 33.16 ml/min) compared to preoperative rates (61.12 ± 34.76 ml/min, p value 0.502). Minor complications classified as Clavien I or II developed in 5 patients (20%). Clavien IIIb, a major complication, developed in one (4%) patient, which was caused by steinstrasse and necessitated emergency surgical intervention.
Conclusion
Renal stones in a solitary kidney can be managed using RIRS safely and effectively with and without the use of UAS, without compromising renal function.
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Kati B, Pelit ES, Demir M, Yagmur I, Tuncekin A, Ciftci H. Do we have a limit for retrograde intrarenal surgery for solitary kidney stone? Arch Ital Urol Androl 2021; 93:318-322. [PMID: 34839637 DOI: 10.4081/aiua.2021.3.318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 06/27/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The management of urolithiasis in patients with a solitary kidney is challenging for urologists. This study aimed to evaluate the safety of retrograde intrarenal surgery (RIRS) in the treatment of stones in patients with solitary kidney and to reply to the question if there is any limit for this surgery. METHODS Between January 2016 and December 2019, we enrolled 52 patients who had a solitary kidney and underwent RIRS. We collected data on preoperative patient characteristics, stone dimensions, and postoperative outcomes. Stone size, duration of operation, duration of fluoroscopy, type of anesthesia, and degree of surgical complication were evaluated retrospectively. Surgeries performed in less and more than 60 minutes and with and without complications were compared. RESULTS A total of 52 patients with a kidney stone and a solitary kidney were evaluated. The mean stone size was 14 ± 0.4 cm and surgical success rate was 87.3%. In our study, 13 patients (24.5%) had grade 1 minor complications, and none required a blood transfusion. The mean operation time was 51.9 ± 17.3 minutes. The postoperative creatinine value increased in 6 patients. The duration of operation in the group with complications was significantly higher than that in the group without complications. In patients who underwent an operation lasting ≥ 60 minutes, stone size, fluoroscopy time, and complication rate were significantly higher than in patients who underwent an operation lasting ≤ 60 minutes. CONCLUSION Our opinion is to be careful in patients with a solitary kidney with a big stone and we recommend assigning these procedure to experienced hands for not exceeding 60 minutes in one session.
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Affiliation(s)
- Bulent Kati
- Harran University, Faculty of Medicine, Urology Department, Sanliurfa.
| | - Eyyup Sabri Pelit
- Harran University, Faculty of Medicine, Urology Department, Sanliurfa.
| | - Mehmet Demir
- Harran University, Faculty of Medicine, Urology Department, Sanliurfa.
| | - Ismail Yagmur
- Harran University, Faculty of Medicine, Urology Department, Sanliurfa.
| | - Adem Tuncekin
- Harran University, Faculty of Medicine, Urology Department, Sanliurfa.
| | - Halil Ciftci
- Harran University, Faculty of Medicine, Urology Department, Sanliurfa.
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Xu Y, Lu Z, Lan Y, Wu D, Xiong L. Retrograde intrarenal surgery for a staghorn renal calculus in a patient with solitary kidney and urinary tract deformity: a case report. Transl Androl Urol 2021; 10:3532-3539. [PMID: 34532278 PMCID: PMC8421840 DOI: 10.21037/tau-21-192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 07/21/2021] [Indexed: 02/05/2023] Open
Abstract
Staghorn renal calculi are large, branched stones in the kidney that partially or completely fill the renal pelvis and renal calyces. Percutaneous nephrolithotomy (PCNL) is the gold standard treatment for staghorn calculi. However, we report a retrograde intrarenal surgery (RIRS) performed to treat a staghorn calculus in a patient with a solitary kidney and a deformed urinary tract. The 37-year-old male patient presented with right-sided lumbar pain. The computed tomography (CT) scan found a solitary kidney on the right side with an opaque 4.5 cm × 2.4 cm renal stone and grade I hydronephrosis. Additionally, a urinary tract deformity was observed, and it was secondary to the deformity of the pelvis caused by a previous pubis fracture, which significantly increased the risk and the difficulty of intrarenal surgery. A total number of 3 sessions of RIRS were conducted, and the patient was discharged 3 days after each session on average. The postoperative X-ray exam of the third session revealed that the renal stone was completely removed. The patient recovered well without any complications. This case demonstrates that RIRS is a safe and effective treatment of staghorn calculi with the presence of urinary tract deformation. This suggests RIRS may be of particular interest in minimizing the procedure-related damage of a solitary kidney.
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Affiliation(s)
- Yuancheng Xu
- Department of Urology, The University of Hong Kong- Shenzhen Hospital, Shenzhen, China
| | - Zhengquan Lu
- Department of Urology, The University of Hong Kong- Shenzhen Hospital, Shenzhen, China
| | - Yulong Lan
- Department of Cardiology, The Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Dan Wu
- Department of Pediatrics, The Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Lin Xiong
- Department of Urology, The University of Hong Kong- Shenzhen Hospital, Shenzhen, China
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Pan Y, Chen H, Chen H, Jin X, Zhu Y, Chen G. The feasibility of one-stage flexible ureteroscopy lithotripsy in solitary kidney patients with 1-3 cm renal stones and risk factors of renal function changes. Ren Fail 2021; 43:264-272. [PMID: 33491554 PMCID: PMC7850451 DOI: 10.1080/0886022x.2021.1872625] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Purpose To compare perioperative outcomes and long-term renal function changes between prior stenting (PS) and not prior stenting (NPS) before flexible ureteroscopy lithotripsy (f-URS) for solitary kidney patients. Methods Solitary kidney patients with 10–30 mm renal stones were enrolled in this historical control study. Perioperative parameters and complications were compared. Stone-free was defined as the absence of any residual stones on a CT scan. Renal function changes were evaluated by estimated glomerular filtration rate (eGFR) and adjusted for body surface area. A decrease in the eGFR over 20% was identified as ‘deterioration’ in renal function. The follow-up period was at least 6 months. Logistic regression was used to identify risk factors of renal function deterioration. Results Of the 76 patients included, 40 cases experienced prior stenting before f-URS. The average stone diameter was 16.8 ± 4.7 mm, ranging from 10.0 to 28.4 mm. Initial SFR was 85.0 and 83.3% in the PS and NPS groups, respectively (p = 0.842), while SFR after the second procedure was 97.5 and 94.4% (p = 0.926). Seven PS and 5 NPS patients developed complications (p = 0.666). At the postoperative 6 months, seven patients showed a deteriorated renal function. Surgical time in minutes was identified as a risk factor for renal function deterioration after the operation (OR = 1.061, 95% CI: 1.015–1.109, p = 0.009, per minute). Conclusion It appears that one-stage f-URS without PS could be feasible for 10–30 mm renal stones in solitary kidney patients, and less surgical time might be beneficial to protect renal function.
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Affiliation(s)
- Yang Pan
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Han Chen
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hualin Chen
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaoxiang Jin
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yunxiao Zhu
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Gang Chen
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Ababacar TA, Youssef AL, Badreeddine A, Meryem B, Maaroufi M, Imane K. [Embolization of a false arterial aneurysm in a patient living with one kidney: about a rare complication of percutaneous nephrolithotomy]. Pan Afr Med J 2020; 35:60. [PMID: 32537064 PMCID: PMC7250218 DOI: 10.11604/pamj.2020.35.60.14626] [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: 12/17/2017] [Accepted: 01/16/2019] [Indexed: 11/23/2022] Open
Abstract
La néphrolithotomie percutanée s’accompagne d’un risque de complications en particulier hémorragiques, qui en fait une technique potentiellement invasive. Nous rapportons le cas d’une patiente de 70 ans, traitée auparavant pour néphrolithotomie percutanée d’une lithiase sur un rein unique gauche. Une hématurie persistante de moyenne abondance est apparue il y a 2 mois et demi, et qui a motivé à la réalisation d’une tomodensitométrie découvrant un faux anévrisme intra rénal polaire inférieur, d’origine iatrogène. Il a nécessité une embolisation sélective efficace à la colle biologique.
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Affiliation(s)
- Traore Abdoulaye Ababacar
- Service de Radiologie du Centre Hospitalier Universitaire Hassan II Fès, Université Sidi Mohammed Ben Abdellah, Faculté de Médecine et de Pharmacie de Fès, Fès, Maroc
| | - Alaoui Lamrani Youssef
- Service de Radiologie du Centre Hospitalier Universitaire Hassan II Fès, Université Sidi Mohammed Ben Abdellah, Faculté de Médecine et de Pharmacie de Fès, Fès, Maroc
| | - Alami Badreeddine
- Service de Radiologie du Centre Hospitalier Universitaire Hassan II Fès, Université Sidi Mohammed Ben Abdellah, Faculté de Médecine et de Pharmacie de Fès, Fès, Maroc
| | - Boubbou Meryem
- Service de Radiologie du Centre Hospitalier Universitaire Hassan II Fès, Université Sidi Mohammed Ben Abdellah, Faculté de Médecine et de Pharmacie de Fès, Fès, Maroc
| | - Maaroufi Maaroufi
- Service de Radiologie du Centre Hospitalier Universitaire Hassan II Fès, Université Sidi Mohammed Ben Abdellah, Faculté de Médecine et de Pharmacie de Fès, Fès, Maroc
| | - Kamaoui Imane
- Service de Radiologie du Centre Hospitalier Universitaire Mohammed VI Oujda, Oujda, Maroc
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Pietropaolo A, Reeves T, Aboumarzouk O, Kallidonis P, Ozsoy M, Skolarikos A, Tailly T, Liatsikos E, Traxer O, Somani BK. Endourologic Management (PCNL, URS, SWL) of Stones in Solitary Kidney: A Systematic Review from European Association of Urologists Young Academic Urologists and Uro-Technology Groups. J Endourol 2019; 34:7-17. [PMID: 31456421 DOI: 10.1089/end.2019.0455] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Introduction: Urolithiasis in solitary kidney (SK) presents significant management dilemma as any insult to the kidney or its drainage can lead to significant morbidity. The treatment options include shock wave lithotripsy (SWL), percutaneous nephrolithotomy (PCNL), and ureteroscopy (URS). Our aim was to conduct a systematic review of literature on all available endourologic techniques reporting on the management of stones in an SK. Materials and Methods: We conducted a systematic review according to the Cochrane and PRISMA checklist for all English-language articles from inception to December 2018. All studies with a minimum of 10 patients that reported on endourologic management (SWL, PCNL, or URS) were included. Data were extracted for patient and stone demographics, outcomes including stone-free rate (SFR), adverse events, and renal function. Results: After an initial search of 553 articles, 27 were included for the final review (10 PCNL, 1 mini-PCNL, 9 URS, 1 SWL, and 6 comparative studies). The choice of treatment seemed to be based on stone size, with PCNL, URS, and SWL offered for mean stone sizes between 25-50, 10-28, and 12-15 mm, respectively. PCNL, URS, and SWL were reported in 1445, 792, and 186 patients, respectively, with a final SFR of 67%-97.7%, 43%-100%, and 73%-80% and a complication rate of 26.4%, 15%, and 16.7% across the three groups. The renal function deterioration was reported in 4/16 PCNL studies and in 1/15 URS studies, while it remained unaffected in the SWL study. Conclusions: Our review shows a rise of endourologic techniques in the management of stones in SK. Although PCNL was used for larger stones, it had a higher risk of major complications, including blood transfusion. While a good SFR was obtained for patients irrespective of the treatment modality, the selected intervention needs to be balanced with its safety profile and the need for ancillary procedures.
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Affiliation(s)
- Amelia Pietropaolo
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, United Kingdom
| | - Thomas Reeves
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, United Kingdom
| | - Omar Aboumarzouk
- Department of Urology, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | | | - Mehmet Ozsoy
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Andreas Skolarikos
- 2nd Department of Urology, University of Athens, Sismanoglio Hospital, Athens, Greece
| | - Thomas Tailly
- Department of Urology, University Hospitals Ghent, Ghent, Belgium
| | | | - Olivier Traxer
- Tenon Hospital, Pierre and Marie Curie University, Paris, France
| | - Bhaskar Kumar Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, United Kingdom
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Pietropaolo A, Jones P, Whitehurst L, Rai BP, Geraghty R, Somani BK. Efficacy and Safety of Ureteroscopy for Stone Disease in a Solitary Kidney: Findings From a Systematic Review. Urology 2018; 119:17-22. [DOI: 10.1016/j.urology.2018.03.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 02/10/2018] [Accepted: 03/24/2018] [Indexed: 12/22/2022]
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A new prediction model for operative time of flexible ureteroscopy with lithotripsy for the treatment of renal stones. PLoS One 2018; 13:e0192597. [PMID: 29438410 PMCID: PMC5811000 DOI: 10.1371/journal.pone.0192597] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 01/28/2018] [Indexed: 11/25/2022] Open
Abstract
This study aimed to develop a prediction model for the operative time of flexible ureteroscopy (fURS) for renal stones. We retrospectively evaluated patients with renal stones who had been treated successfully and had stone-free status determined by non-contrast computed tomography (NCCT) 3 months after fURS and holmium laser lithotripsy between December 2009 and September 2014 at a single institute. Correlations between possible factors and the operative time were analyzed using Spearman’s correlation coefficients and a multivariate linear regression model. The P value < 0.1 was used for entry of variables into the model and for keeping the variables in the model. Internal validation was performed using 10,000 bootstrap resamples. Flexible URS was performed in 472 patients, and 316 patients were considered to have stone-free status and were enrolled in this study. Spearman’s correlation coefficients showed a significant positive relationship between the operation time and stone volume (ρ = 0.417, p < 0.001), and between the operation time and maximum Hounsfield units (ρ = 0.323, p < 0.001). A multivariate assessment with forced entry and stepwise selection revealed six factors to predict the operative time of fURS: preoperative stenting, stone volume, maximum Hounsfield unit, surgeon experience, sex, and sheath diameter. Based on this finding, we developed a model to predict operative time of fURS. The coefficient of determination (R2) in this model was 0.319; the mean R2 value for the prediction model was 0.320 ± 0.049. To our knowledge, this is the first report of a model for predicting the operative time of fURS treatment of renal stones. The model may be used to reliably predict operative time preoperatively based on patient characteristics and the surgeons’ experience, plan staged URS, and avoid surgical complications.
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Bai Y, Wang X, Yang Y, Han P, Wang J. Percutaneous nephrolithotomy versus retrograde intrarenal surgery for the treatment of kidney stones up to 2 cm in patients with solitary kidney: a single centre experience. BMC Urol 2017; 17:9. [PMID: 28100225 PMCID: PMC5241927 DOI: 10.1186/s12894-017-0200-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 01/10/2017] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND To compare the treatment outcomes between percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS) for the management of stones larger than 2 cm in patients with solitary kidney. METHODS One hundred sixteen patients with a solitary kidney who underwent RIRS (n = 56) or PCNL (n = 60) for large renal stones (>2 cm) between Jan 2010 and Nov 2015 have been considered. The patients' characteristics, stone characteristics, operative time, incidence of complications, hospital stay, and stone-free rates (SFR) have been evaluated. RESULTS SFRs after one session were 19.6% and 35.7% for RIRS and PCNL respectively (p = 0.047), but the SFR at 3 months follow-up comparable in both groups (82.1% vs. 88.3%, p = 0.346). The calculated mean operative time for RIRS was longer (p < 0.001), but the mean postoperatively hospital stay was statistically significantly shorter (p < 0.001) and average drop in hemoglobin level was less (p = 0.040). PCNL showed a higher complication rate, although this difference was not statistically significant. CONCLUSIONS Satisfactory stone clearance can be achieved with multi-session RIRS in the treatment of renal stones larger than 2 cm in patients with solitary kidney. RIRS can be considered as an alternative to PCNL in selected cases.
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Affiliation(s)
- Yunjin Bai
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoming Wang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Yubo Yang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Ping Han
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Jia Wang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China.
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Jones P, Aboumarzouk OM, Rai BP, Somani BK. Percutaneous Nephrolithotomy for Stones in Solitary Kidney: Evidence From a Systematic Review. Urology 2016; 103:12-18. [PMID: 27856206 DOI: 10.1016/j.urology.2016.10.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 09/14/2016] [Accepted: 10/14/2016] [Indexed: 01/30/2023]
Abstract
Stones in solitary kidney represent a management dilemma for the endourologist. The advantage of bilateral fully functioning kidneys is not present. Therefore, any insult to either the solitary kidney itself or drainage system can lead to significant morbidity. Key clinical objectives include maximum preservation of existing renal function, high stone clearance, and minimizing post-procedure complications. To date, there exists no Level 1 evidence on this subject. This systematic review serves to evaluate the safety and efficacy of percutaneous nephrolithomy for patients (adults only) with stones in a solitary kidney.
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Affiliation(s)
- Patrick Jones
- Department of Urology, Royal Blackburn Hospital, UK.
| | | | - Bhavan Prasad Rai
- Royal College of Surgeons Fellow in Robotic Surgery, The Lister Hospital, Stevenage, UK
| | - Bhaskar K Somani
- Department of Urology, University Hospital Southampton, Southampton, UK
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15
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Yuruk E. Editorial Comment to Retrograde intrarenal surgery for urinary stone disease in patients with solitary kidney: A retrospective analysis of the efficacy and safety. Int J Urol 2015; 23:74. [PMID: 26458957 DOI: 10.1111/iju.12990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Emrah Yuruk
- Department of Urology, Bagcilar Training and Research Hospital, Istanbul, Turkey.
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