1
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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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2
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Yu Y, Chen Y, Zhou X, Li X, Liu W, Cheng X, Chen L, Yang H, Wang G, Xi H. Comparison of novel flexible and traditional ureteral access sheath in retrograde intrarenal surgery. World J Urol 2024; 42:7. [PMID: 38175210 PMCID: PMC10766707 DOI: 10.1007/s00345-023-04697-1] [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: 01/17/2023] [Accepted: 10/10/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVES To compare the efficiency and safety of a novel flexible ureteral access sheath (f-UAS) and traditional ureteral access sheath (UAS) during retrograde intrarenal surgery (RIRS). PATIENTS AND METHODS Between January 2022 and September 2022, a total of 152 consecutive cases with renal stones underwent RIRS with the f-UAS. Their outcomes were compared with those of another 152 consecutive cases undergoing RIRS with traditional UAS using a 1:1 scenario matched-pair analysis, with matching parameters including age and stone size. The f-UAS is a novel UAS with a 10-cm-long tube at the tip that can follow the bends of flexible ureteroscope (f-URS). RESULTS Baseline characteristics were found to be similar between the two groups. The f-UAS group demonstrated significantly higher SFR (76.3% vs. 7.2%; P < 0.001) at 1 day postoperatively and a higher clearance rate of stone volume (98.11% vs. 91.78%; P < 0.001). The f-UAS group also had lower total complications rate (9.9% vs. 22.4%; P = 0.003), lower incidence of fever (5.9% vs 11.9%; P = 0.001), shorter operative times (56.5 min vs. 59.9 min; P = 0.047), and lower usage rate of baskets (17.1% vs. 100%; P < 0.001). There was no significant difference in SFR at 1 month postoperatively (P = 0.627) and in the length of postoperative hospital stay between the two groups (P = 0.225). CONCLUSION Compared to the traditional UAS during RIRS, the f-UAS showed several advantages, including higher SFR at 1 day postoperatively, shorter operative times, lower incidence of complications, and less use of basket.
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Affiliation(s)
- Yue Yu
- Department of Urology, The 1st Affiliated Hospital, Jiangxi Medical College, Nanchang University, 17 YongWai Street Surgery Building, 17th Floor, Nanchang, 330006, Jiangxi, China
| | - Yujun Chen
- Department of Urology, The 1st Affiliated Hospital, Jiangxi Medical College, Nanchang University, 17 YongWai Street Surgery Building, 17th Floor, Nanchang, 330006, Jiangxi, China
| | - Xiaochen Zhou
- Department of Urology, The 1st Affiliated Hospital, Jiangxi Medical College, Nanchang University, 17 YongWai Street Surgery Building, 17th Floor, Nanchang, 330006, Jiangxi, China
| | - Xunwen Li
- Department of Urology, The 1st Affiliated Hospital, Jiangxi Medical College, Nanchang University, 17 YongWai Street Surgery Building, 17th Floor, Nanchang, 330006, Jiangxi, China
| | - Wei Liu
- Department of Urology, The 1st Affiliated Hospital, Jiangxi Medical College, Nanchang University, 17 YongWai Street Surgery Building, 17th Floor, Nanchang, 330006, Jiangxi, China
| | - Xiaofeng Cheng
- Department of Urology, The 1st Affiliated Hospital, Jiangxi Medical College, Nanchang University, 17 YongWai Street Surgery Building, 17th Floor, Nanchang, 330006, Jiangxi, China
| | - Luyao Chen
- Department of Urology, The 1st Affiliated Hospital, Jiangxi Medical College, Nanchang University, 17 YongWai Street Surgery Building, 17th Floor, Nanchang, 330006, Jiangxi, China
| | - Heng Yang
- Department of Urology, The 1st Affiliated Hospital, Jiangxi Medical College, Nanchang University, 17 YongWai Street Surgery Building, 17th Floor, Nanchang, 330006, Jiangxi, China
| | - Gongxian Wang
- Department of Urology, The 1st Affiliated Hospital, Jiangxi Medical College, Nanchang University, 17 YongWai Street Surgery Building, 17th Floor, Nanchang, 330006, Jiangxi, China.
| | - Haibo Xi
- Department of Urology, The 1st Affiliated Hospital, Jiangxi Medical College, Nanchang University, 17 YongWai Street Surgery Building, 17th Floor, Nanchang, 330006, Jiangxi, China.
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3
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Kaneko K, Yasuda M, Fukuuchi T, Yamaoka N, Takahashi K, Mawatari KI, Isotani S, Horie S, Nakagawa T. Plasma levels and urinary excretion of protein Z in patients with urolithiasis. Int J Urol 2023; 30:1188-1193. [PMID: 37602692 DOI: 10.1111/iju.15277] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 08/02/2023] [Indexed: 08/22/2023]
Abstract
OBJECTIVES Protein Z (PZ) is a γ-carboxyglutamic acid protein present in plasma that is involved in blood coagulation. Detailed analysis of urinary stones from patients with urolithiasis has revealed that PZ is often found in urinary stones composed of calcium oxalate monohydrate. In this study, we compared blood and urinary PZ concentrations between healthy individuals and patients with urolithiasis. METHODS Plasma and urine were collected from healthy individuals and patients with urolithiasis who provided informed consent. PZ was detected as a urinary stone matrix protein in some of the patients. PZ was quantified by ELISA, creatinine was measured by the enzymatic method, and the total protein concentration was measured by the Bradford method. RESULTS The plasma PZ level was 2.54 ± 1.02 μg/mL in healthy individuals and that in urolithiasis patients classified by stone history were from 1.16 ± 0.77 to 3.73 ± 1.09 μg/mL, which was not significantly different. The urinary excretion of PZ (PZ/creatinine) was also not different in patients with urolithiasis and in healthy individuals (from 54.1 ± 40.9 to 95.4 ± 69.4 ng/mg vs. 73.3 ± 36.0 ng/mg). A positive correlation was found between the plasma PZ level and creatinine-corrected urinary PZ concentration (r = 0.46). CONCLUSIONS Both the plasma level and urinary excretion of PZ in urolithiasis patients were not significantly different with normal individuals. PZ detected in urinary stones as a matrix protein is thought to be incorporated into urinary stones regardless of blood and urine levels of PZ.
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Affiliation(s)
- Kiyoko Kaneko
- Faculty of Pharmaceutical Sciences, Teikyo Heisei University, Tokyo, Japan
- The Laboratory of Biomedical and Analytical Sciences, Faculty of Pharma Sciences, Teikyo University, Tokyo, Japan
| | - Makoto Yasuda
- The Laboratory of Analytical Biochemistry, Faculty of Pharma Sciences, Teikyo University, Tokyo, Japan
| | - Tomoko Fukuuchi
- The Laboratory of Biomedical and Analytical Sciences, Faculty of Pharma Sciences, Teikyo University, Tokyo, Japan
| | - Noriko Yamaoka
- The Laboratory of Biomedical and Analytical Sciences, Faculty of Pharma Sciences, Teikyo University, Tokyo, Japan
| | - Kei Takahashi
- The Laboratory of Biomedical and Analytical Sciences, Faculty of Pharma Sciences, Teikyo University, Tokyo, Japan
| | - Ken-Ichi Mawatari
- The Laboratory of Analytical Biochemistry, Faculty of Pharma Sciences, Teikyo University, Tokyo, Japan
| | - Shuji Isotani
- Department of Urology, Juntendo University School of Medicine, Tokyo, Japan
| | - Shigeo Horie
- Department of Urology, Juntendo University School of Medicine, Tokyo, Japan
| | - Tohru Nakagawa
- Department of Urology, Teikyo University School of Medicine, Tokyo, Japan
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Shrestha A, Adhikari B, Panthier F, Baidya S, Gauhar V, Traxer O. Flexible ureteroscopy for lower pole calculus: is it still a challenge? World J Urol 2023; 41:3345-3353. [PMID: 37728745 DOI: 10.1007/s00345-023-04606-6] [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: 07/29/2023] [Accepted: 08/28/2023] [Indexed: 09/21/2023] Open
Abstract
PURPOSE Flexible ureteroscopy (fURS) is steadily gaining popularity in the management of renal calculi, including those located in the lower pole (LP). Due to difficulty in accessing to the LP of kidney in minority of cases with fURS and reports of lower stone-free rate (SFR), it is still considered as a challenge in selected cases. The purpose of the review was to analyze the various aspects of fURS for LP stones. METHODS An extensive review of the recent literature was done including different factors such as anatomy, preoperative stenting, stone size, flexible scopes, types of lasers, laser fibers, suction, relocation, stone-free rates, and complications. RESULTS The significance of various lower pole anatomical measurements remain a subject of debate and requires standardization. Recent improvements in fURS such as single-use digital scopes with better vision and flexibility, high power laser, thulium fiber laser, smaller laser fiber, and accessories have significantly contributed to make flexible ureteroscopy more effective and safer in the management of LP stone. The utilization of thulium fiber lasers in conjunction with various suction devices is being recognized and can significantly improve SFR. CONCLUSIONS With the significant advancement of various aspects of fURS, this treatment modality has shown remarkable efficacy and gaining widespread acceptance in management of LP kidney stones. These developments have made the fURS of LP stones less challenging.
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Affiliation(s)
- Anil Shrestha
- National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal.
- B&B Hospital, Lalitpur, Nepal.
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5
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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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6
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Kwok JL, De Coninck V, Pietropaolo A, Juliebø-Jones P, Ventimiglia E, Tailly T, Alexander Schmid F, Hunziker M, Poyet C, Traxer O, Eberli D, Keller EX. Instrumental dead space and proximal working channel connector design in flexible ureteroscopy: a new concept. Ther Adv Urol 2023; 15:17562872231179332. [PMID: 37377944 PMCID: PMC10291398 DOI: 10.1177/17562872231179332] [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: 02/28/2023] [Accepted: 05/15/2023] [Indexed: 06/29/2023] Open
Abstract
Objective The objective of this study was to evaluate a new concept in flexible ureteroscopy: instrumental dead space (IDS). For this purpose, various proximal working channel connector designs, as well as the impact of ancillary devices occupying the working channel were evaluated in currently available flexible ureteroscopes. Design and methods IDS was defined as the volume of saline irrigation needed to inject at the proximal connector for delivery at the distal working channel tip. Because IDS is related to working channel diameter and length, proximal connector design, as well as occupation of working channel by ancillary devices, these parameters were also reviewed. Results IDS significantly varied between flexible ureteroscope models, ranging from 1.1 ml for the Pusen bare scopes, to 2.3 ml for Olympus scopes with their 4-way connector (p < 0.001). Proximal connector designs showed a high degree of variability in the number of available Luer locks, valves, seals, angles, and rotative characteristics. The measured length of the working channel of bare scopes ranged between 739 and 854 mm and significantly correlated with measured IDS (R2 = 0.82, p < 0.001). The coupling of scopes with an alternative ancillary proximal connector and the insertion of ancillary devices into the working channel significantly reduced IDS (mean IDS reduction of 0.1 to 0.5 ml; p < 0.001). Conclusions IDS appears as a new parameter that should be considered for future applications of flexible ureteroscopes. A low IDS seems desirable for several clinical applications. The main factors impacting IDS are working channel and proximal connector design, as well as ancillary devices inserted into the working channel. Future studies should clarify how reducing IDS may affect irrigation flow, intrarenal pressure, and direct in-scope suction, as well as evaluate the most desirable proximal connector design properties.
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Affiliation(s)
- Jia-Lun Kwok
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Urology, Tan Tock Seng Hospital, Singapore
| | - Vincent De Coninck
- Department of Urology, AZ Klina, Brasschaat, Belgium
- Endourology & Urolithiasis Working Group, Young Academic Urologists (YAU), Arnhem, The Netherlands
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
| | - Amelia Pietropaolo
- Department of Urology, University Hospital Southampton, Southampton, UK
- Endourology & Urolithiasis Working Group, Young Academic Urologists (YAU), Arnhem, The Netherlands
| | - Patrick Juliebø-Jones
- Department of Urology, Haukeland University Hospital, Bergen, Norway
- Endourology & Urolithiasis Working Group, Young Academic Urologists (YAU), Arnhem, The Netherlands
| | - Eugenio Ventimiglia
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
- Endourology & Urolithiasis Working Group, Young Academic Urologists (YAU), Arnhem, The Netherlands
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
| | - Thomas Tailly
- Department of Urology, University Hospital Ghent, Ghent, Belgium
- Endourology & Urolithiasis Working Group, Young Academic Urologists (YAU), Arnhem, The Netherlands
| | | | - Manuela Hunziker
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Cédric Poyet
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Olivier Traxer
- Sorbonne Université, GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, F-75020, Paris, France
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
| | - Daniel Eberli
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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7
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Retrograde intrarenal lithotripsy in completely bedridden children with severe physical disabilities. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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8
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Inoue T, Hamamoto S, Okada S, Yamamichi F, Fujita M, Tominaga K, Fujisawa M. Primary impact of simultaneous use of double devices through one-working channel when performing flexible ureteroscope with ureteral access sheath for single ureteral stone: In bench and retrospective clinical study. Int J Urol 2022; 29:1163-1169. [PMID: 35710688 DOI: 10.1111/iju.14957] [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: 01/25/2022] [Accepted: 05/26/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This study aimed to compare the simultaneous use of two devices versus a single device through a single working channel in flexible ureteroscopy using a ureteral access sheath for single ureteral stones. METHODS In a bench study, the time to (i) set laser fiber, (ii) exchange laser fiber and nitinol basket through working channel, and (iii) pull out the device from working channel were measured 10 times in each step. In a clinical study, 156 patients who underwent flexible ureteroscopy with a ureteral access sheath for a ureteral stone in middle and upper ureter between April 2019 and November 2021 were assessed. One device was used at a time for 79 patients (S-Group) and two were simultaneously used for 77 (D-Group). Surgical outcomes and complications were compared. RESULTS In the bench study, the mean time to change from laser fiber to basket and from basket to laser fiber through the working channel were 26.1 ± 3.7 s and 23.6 ± 2.0 s (p = 0.084), respectively, which were significantly longer than the laser setup time (p < 0.001). In the clinical study, although the stone-free rate was not significantly different between the groups (S-Group 89.8%, D-Group 93.5%; p = 0.412), the median operation time was significantly shorter (p < 0.001) and the rate of postoperative stenting was significantly lower (p = 0.002) in the D-Group. There were no significant between-group differences in intra- and post-operative complications. CONCLUSION The simultaneous use of two devices through a single working channel is safe and could help save the time needed to exchange the laser fiber and nitinol basket.
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Affiliation(s)
- Takaaki Inoue
- Department of Urology and Stone Center, Hara Genitourinary Hospital, Kobe City, Hyogo, Japan.,Division of Urology, Department of Surgery Related, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Shuzo Hamamoto
- Department of Urology, Medical School, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Shinsuke Okada
- Department of Urology, Gyotoku General Hospital, Ichikawa, Chiba, Japan
| | - Fukashi Yamamichi
- Department of Urology and Stone Center, Hara Genitourinary Hospital, Kobe City, Hyogo, Japan
| | - Masaichiro Fujita
- Department of Urology and Stone Center, Hara Genitourinary Hospital, Kobe City, Hyogo, Japan
| | - Koki Tominaga
- Department of Urology and Stone Center, Hara Genitourinary Hospital, Kobe City, Hyogo, Japan
| | - Masato Fujisawa
- Division of Urology, Department of Surgery Related, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
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9
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Yamashita S, Inoue T, Kohjimoto Y, Hara I. Comprehensive endoscopic management of impacted ureteral stones: Literature review and expert opinions. Int J Urol 2022; 29:799-806. [PMID: 35475562 DOI: 10.1111/iju.14908] [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: 12/09/2021] [Accepted: 04/10/2022] [Indexed: 11/30/2022]
Abstract
Treatment of urolithiasis, a benign disease, requires high efficacy and safety. Endoscopic treatment of impacted ureteral stones remains a challenging procedure for urologists, despite recent remarkable advances in surgical technology in treatment of urolithiasis. The success rate of endoscopic treatment in patients with impacted stones is reported to be lower than that in patients with nonimpacted stones. Moreover, the presence of stone impaction is associated with high rates of intraoperative and postoperative complications. The best management for patients with impacted ureteral stones should therefore be devised based on the latest knowledge and techniques. The present review focuses on the preoperative prediction of stone impaction, the safest and most effective endoscopic surgical procedures, and the most appropriate management for postoperative ureteral strictures. We overview comprehensive endoscopic management for impacted ureteral stones based on literature review and expert opinions.
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Affiliation(s)
| | - Takaaki Inoue
- Department of Urology, Hara Genitourinary Hospital, Kobe, Japan.,Department of Urology, Kobe University, Kobe, Japan
| | - Yasuo Kohjimoto
- Department of Urology, Wakayama Medical University, Wakayama, Japan
| | - Isao Hara
- Department of Urology, Wakayama Medical University, Wakayama, Japan
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10
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Yang XC, Luo NQ, Wei HY, Liu TX. Autonomous irrigation system improvement and extension. Asian J Surg 2022; 45:828-829. [PMID: 34969571 DOI: 10.1016/j.asjsur.2021.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 12/17/2021] [Indexed: 11/02/2022] Open
Affiliation(s)
- Xiao-Chun Yang
- Department of Urology, Gansu Provincial Hospital, Lanzhou, Gansu, 73000, China
| | - Neng-Qin Luo
- Department of Urology, Gansu Provincial Hospital, Lanzhou, Gansu, 73000, China
| | - Hong-Yan Wei
- Department of Urology, Qingshui County Hospital, Tianshui, Gansu, 741400, China
| | - Tian-Xiang Liu
- Department of Oncological Surgery, Gansu Provincial Hospital, Lanzhou, Gansu, 73000, China.
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11
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Grinholtz D, Kamkoum H, Capretti C, Traxer O, Doizi S. Comparison of irrigation flows between different irrigation methods for flexible ureteroscopy: An in vitro study. Prog Urol 2022; 32:616-622. [PMID: 35027282 DOI: 10.1016/j.purol.2021.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 10/12/2021] [Accepted: 10/21/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To compare the irrigation flows between different irrigation methods for f-URS. METHODS We compared the automatic irrigation system Endoflow II to gravity-based irrigation, and gravity-based irrigation with pressure cuff. Irrigation pressures were set at 40 and 100cmH2O. A LithoVue f-URS with a 3.6Fr working channel was used for the experiments. The f-URS was placed in straight alignment without active deflection on the operating table. For each irrigation pressure level, we evaluated the influence of the occupation of the working channel of the f-URS with an empty working channel, a 272μm laser fiber, a 1.9Fr nitinol basket. The outflow from f-URS was measured by the volume of irrigation fluid collected using a graduated glass at 1min, 2min, 3min and 5min. RESULTS Irrigations flows remained constant over the time for the Endoflow II and the gravity-based irrigation methods regardless of the irrigation pressure and setting. For the pressure cuff method, the irrigation flow remained constant only when the working channel was occupied either by the nitinol basket or the laser fiber. Irrigation flow with the Endoflow II were constantly higher than gravity-based irrigation methods. Irrigation flow significantly increased with increased irrigation pressure. In the presence of any instruments at any irrigation pressure, the flow decreased as the size of the instrument in the working channel increased. CONCLUSIONS Automatic irrigation system Endoflow II provided higher irrigation flows than gravity-based irrigation methods. The irrigation flow decreased as the size of the instrument in the working channel increased. Further studies conducted in vivo are needed to investigate if the differences found between irrigation methods result in higher intrarenal pressure during procedures. LEVEL OF PROOF 4.
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Affiliation(s)
- D Grinholtz
- Sorbonne Université, GRC n̊20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, 75020 Paris, France; Sorbonne Université, Service d'Urologie, AP-HP, Hôpital Tenon, 75020 Paris, France.
| | - H Kamkoum
- Sorbonne Université, GRC n̊20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, 75020 Paris, France; Sorbonne Université, Service d'Urologie, AP-HP, Hôpital Tenon, 75020 Paris, France.
| | - C Capretti
- Sorbonne Université, GRC n̊20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, 75020 Paris, France; Sorbonne Université, Service d'Urologie, AP-HP, Hôpital Tenon, 75020 Paris, France.
| | - O Traxer
- Sorbonne Université, GRC n̊20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, 75020 Paris, France; Sorbonne Université, Service d'Urologie, AP-HP, Hôpital Tenon, 75020 Paris, France.
| | - S Doizi
- Sorbonne Université, GRC n̊20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, 75020 Paris, France; Sorbonne Université, Service d'Urologie, AP-HP, Hôpital Tenon, 75020 Paris, France.
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12
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Khusid JA, Hordines JC, Sadiq AS, Atallah WM, Gupta M. Prevention and Management of Infectious Complications of Retrograde Intrarenal Surgery. Front Surg 2021; 8:718583. [PMID: 34434958 PMCID: PMC8381273 DOI: 10.3389/fsurg.2021.718583] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 07/14/2021] [Indexed: 01/11/2023] Open
Abstract
Kidney stone disease (KSD) is a commonly encountered ailment in urologic practice. Urinary tract infection (UTI) is commonly associated with KSD, both as an etiology (e.g., struvite and carbonate apatite stones), and as a complication (i.e., obstructive pyelonephritis and post-operative UTI). Indeed, a significant portion of the economic burden of KSD is skewed toward stones associated with infection. UTI is the most common post-operative complication related to stone intervention with progression to urosepsis as a rare but serious consequence. Risk for infection is influenced by a variety of factors including co-morbid conditions, anatomic abnormalities, prior surgical procedures, and local anti-microbial susceptibility. Understanding these risks and the proper steps to mitigate them is an essential component in reducing post-operative morbidity and mortality. Retrograde intrarenal surgery is routinely used for the treatment of KSD. The objective of this review article is to examine the current literature and guidelines for the prevention and management of stone-related infectious complications associated with retrograde intrarenal surgery. Special attention will be given to the incidence, etiology, and antibiotic prophylaxis choice in the management of stone-related infections. Intraoperative risk mitigation techniques will be discussed in conjunction with the management of post-operative infections. Antibiotic stewardship and the potential benefits of reduced empiric antibiotic treatment will also be discussed.
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Affiliation(s)
- Johnathan A Khusid
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - John C Hordines
- Department of Urology, SUNY Downstate College of Medicine, Brooklyn, NY, United States
| | - Areeba S Sadiq
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - William M Atallah
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Mantu Gupta
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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Alnadhari I, Ali O, Abdeljaleel O, Sampige VRP, Shamsodini A, Salah M. Ergonomics and Surgeon Comfort During Flexible Ureteroscopy. Res Rep Urol 2021; 13:415-424. [PMID: 34235098 PMCID: PMC8254182 DOI: 10.2147/rru.s317347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 06/05/2021] [Indexed: 11/23/2022] Open
Abstract
The technological advancements of flexible ureteroscopy (FURS) and its accessories have resulted in broadening its indications to include the management of complex renal stones, with long operative time. The surgeon's understanding about the ergonomics of the ureteroscopes and their cognizance of the operation theatre layout helps to improve their performance, including the surgical outcomes. This paper will describe the ergonomics that are involved in conducting FURS which in turn will aid in developing a more conducive surgical environment for the surgeon during the procedure, based on scientific literature review and expert opinions in high-volume centres. Proper surgeon position, well-arranged operation theatre layout, monitor and pedal position, anaesthesia type, and surgical team are important factors to decrease musculoskeletal strains for surgeons and increase work efficiency. Different types of flexible ureteroscope have different characters and knowing these special characters leads to better ergonomics during surgery. Robotic-assisted FURS have shown good safety and ergonomics in clinical application.
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Affiliation(s)
- Ibrahim Alnadhari
- Urology Section, Department of Surgery, Al Wakra Hospital, Hamad Medical Corporation, Al Wakra, Qatar
| | - Omar Ali
- Urology Section, Department of Surgery, Al Wakra Hospital, Hamad Medical Corporation, Al Wakra, Qatar
| | - Osama Abdeljaleel
- Urology Section, Department of Surgery, Al Wakra Hospital, Hamad Medical Corporation, Al Wakra, Qatar
| | | | - Ahmad Shamsodini
- Urology Section, Department of Surgery, Al Wakra Hospital, Hamad Medical Corporation, Al Wakra, Qatar
| | - Morshed Salah
- Urology Section, Department of Surgery, Hazm Mebaireek General Hospital, Hamad Medical Corporation, Doha, Qatar
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14
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Doizi S. Intrarenal Pressure: What Is Acceptable for Flexible Ureteroscopy and Percutaneous Nephrolithotomy? Eur Urol Focus 2021; 7:31-33. [PMID: 33547026 DOI: 10.1016/j.euf.2021.01.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 12/31/2020] [Accepted: 01/08/2021] [Indexed: 11/28/2022]
Abstract
The factors that can reduce intrarenal pressure during flexible ureteroscopy and percutaneous nephrolithotomy have been identified as low irrigation pressure, use of a ureteral access sheath or operating sheath appropriate fothe diameter of the endoscope, and occupation of the working channel in the case of flexible ureteroscopy.
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Affiliation(s)
- Steeve Doizi
- Sorbonne Université, GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, F-75020 Paris, France; Sorbonne Université, Service d'Urologie, AP-HP, Hôpital Tenon, F-75020 Paris, France.
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15
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Inoue T, Okada S, Hamamoto S, Fujisawa M. Retrograde intrarenal surgery: Past, present, and future. Investig Clin Urol 2021; 62:121-135. [PMID: 33660439 PMCID: PMC7940851 DOI: 10.4111/icu.20200526] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/09/2020] [Accepted: 12/10/2020] [Indexed: 12/18/2022] Open
Abstract
With the recent technological advancements in endourology, retrograde intrarenal surgery has become a more popular procedure for treatment of urolithiasis. Furthermore, since the introduction of new laser systems and advanced flexible ureteroscopy with miniaturized ureteroscopes, the treatment indications for retrograde intrarenal surgery have expanded to include not only larger renal stones of >2 cm but also upper urinary tract urothelial carcinoma, ureteral stricture, and idiopathic renal hematuria. Clinicians must keep up with these trends and make good use of these technologies in the rapidly changing field of endourology. Simultaneously, we must consider the risk of various complications including thermal injury due to laser use, ureteral injury caused by the ureteral access sheath, and radiation exposure during retrograde intrarenal surgery with fluoroscopic guidance. This review focuses on the past, present, and future of retrograde intrarenal surgery and provides many topics and clinical options for urologists to consider.
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Affiliation(s)
- Takaaki Inoue
- Department of Urology and Stone Center, Hara Genitourinary Hospital, Kobe, Hyogo, Japan.,Department of Urology, Kobe University, Kobe, Hyogo, Japan.
| | - Shinsuke Okada
- Department of Urology, Gyotoku General Hospital, Ichikawa, Chiba, Japan
| | - Shuzo Hamamoto
- Department of Urology, Medical School, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
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