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Preoperative estimate of natural ureteral length based on computed tomography and/or plain radiography. Sci Rep 2021; 11:12202. [PMID: 34108557 PMCID: PMC8190263 DOI: 10.1038/s41598-021-91658-6] [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] [Received: 12/26/2020] [Accepted: 05/26/2021] [Indexed: 11/23/2022] Open
Abstract
To predict natural ureter lengths based on clinical images. We reviewed our image database of patients who underwent multiphasic computed tomography urography from January 2019 to April 2020. Natural ureteral length (ULCTU) was measured using a three-dimensional curved multiplanar reformation technique. Patient parameters including age, height, and height of the lumbar spine, the index of ureteral length using kidney/ureter/bladder (KUB) radiographs (C-P and C-PS) and computed tomography (ULCT) were collected. ULCTU correlated most strongly with ULCT. R square and adjusted R square values from multivariate regression were 0.686 and 0.678 (left side) and 0.516 and 0.503 (right side), respectively. ULCTU could be estimated by the regression model in three different scenarios as follows:ULCT + C-PULCTUL = 0.405 \documentclass[12pt]{minimal}
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We provide equations to predict ULCTU based on CT, KUB or CT plus KUB for different clinical scenarios. The formula based on CT plus KUB provided the most accurate estimation, while the others had lower validation values but could still meet clinical needs.
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Jayasimha S, Nagasubramanian S, Jayanth E ST, Muthukrishna Pandian R, J C, Kumar S. Management of proximal migration of double-J stents after Anderson-Hynes pyeloplasty in children. J Pediatr Urol 2021; 17:399.e1-399.e7. [PMID: 33622628 DOI: 10.1016/j.jpurol.2021.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/12/2021] [Accepted: 02/03/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Proximal migration of double J stents after pediatric pyeloplasty is rare. Although retrograde removal of migrated stents is more common, the small calibre of the pediatric ureter may necessitate antegrade retrieval. Many techniques are described for the same in adults however, pediatric literature is sparse. We aim to describe the management of proximally displaced stents after pediatric pyeloplasty. MATERIALS AND METHODS This retrospective study included all children (<17 years age) who underwent retrieval of proximally displaced DJ stents after pyeloplasty between 2007 and 2019 at a single institution. The retrograde technique employed ureteroscopic retrieval with a grasper while in the antegrade technique, an access sheath was placed percutaneously into a calyx and Nephroscopic retrieval was performed. RESULTS There were 8 children (6 boys and 2 girls) of which 4 were infants. Median age was 3.5 (0.5-12) years and median follow-up was 7.5 (4-47) months. Two children had been referred with displaced stents after pyeloplasty from other centres. The incidence of proximal stent migration was 6/1644 (0.4%). Open pyeloplasty had been performed in seven while one child had undergone laparoscopic pyeloplasty. The lower coil of the migrated stent was in the renal pelvis in 6 (complete) and ureter in 2 (partial migration). Those with partial migration underwent successful ureteroscopic retrieval. Three infants required Antegrade stent removal while ureteroscopic retrieval was successful in an older child with complete stent migration. Nephrectomy for loss of function and redo pyeloplasty for pelvi-ureteric stricture was performed in one each. One child had self-limiting fever (Clavien 1) after stent removal. All had normal drainage on renogram after 6 months. The cause of proximal stent migration was likely to be an inadequate lower coil (<180°) in 5 children and a capacious pelvis with narrow ureter in one infant. The cause could not be ascertained in two children who were referred from other centres. The management algorithm for retrieval of proximally migrated DJ stents, is depicted in Fig. 3. CONCLUSIONS Proximal migration of DJ stent after pyeloplasty is a rare complication which may be safely managed with a stepwise approach using both Antegrade and retrograde techniques. Accurate stent length, adequate distal coil and appropriate placement are essential to avoid stent migration.
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Affiliation(s)
- Sudhindra Jayasimha
- Department of Urology, Christian Medical College, Vellore, Tamilnadu, 632004, India.
| | | | | | | | - Chandrasingh J
- Department of Urology, Christian Medical College, Vellore, Tamilnadu, 632004, India.
| | - Santosh Kumar
- Department of Urology, Christian Medical College, Vellore, Tamilnadu, 632004, India.
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Huang IS, Tsai CH, Chen WJ, Cheng WM, Chiang CY, Kao WT, Huang EH, Huang W. Measuring individual ureteral length using computed tomography urography to determine the appropriate lengths of ureteral stents. UROLOGICAL SCIENCE 2021. [DOI: 10.4103/uros.uros_68_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Jung SI, Park HS, Yu MH, Kim YJ, Lee H, Choi WS, Park HK, Kim HG, Paick SH. Korean ureter length: A computed tomography-based study. Investig Clin Urol 2020; 61:291-296. [PMID: 32377605 PMCID: PMC7189102 DOI: 10.4111/icu.2020.61.3.291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 01/12/2020] [Indexed: 11/19/2022] Open
Abstract
Purpose We measured ureter length in healthy Koreans using reformatted computed tomography (ULCT) and found ways to indirectly estimate ureter length by measuring LLCT, the length between the ureteropelvic junction and the ureterovesical junction, and standing and sitting height. Materials and Methods A total of 508 ureters of 254 healthy patients (median age, 55.0 years; 148 males and 106 females) were included in this retrospective study. ULCT, LLCT, and sitting and standing body height were measured. Results The mean left and right ULCT were 25.2±2.2 and 25.0±2.2 cm, respectively. The mean left and right LLCT were 21.1±1.8 and 20.3±1.9 cm, respectively. Standing and sitting body height were 164.1±8.9 and 88.3±4.3 cm, respectively. Height was significantly correlated with ULCT, but this relation was not linear (r2=0.064 standing height, 0.062 sitting height). However, LLCT showed a significant linear correlation with ULCT (r2=0.485). ULCT can be estimated indirectly by the following equation: ULCT=0.823×LLCT+8.093. Conclusions We could measure the ureteral length of healthy Koreans by ULCT. ULCT could be estimated indirectly by LLCT and standing and sitting height. Of these variables, LLCT provided the most accurate estimate of ureteral length.
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Affiliation(s)
- Sung Il Jung
- Department of Radiology, Konkuk University Medical Center, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Korea
| | - Hee Sun Park
- Department of Radiology, Konkuk University Medical Center, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Korea
| | - Mi Hye Yu
- Department of Radiology, Konkuk University Medical Center, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Korea
| | - Young Jun Kim
- Department of Radiology, Konkuk University Medical Center, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Korea
| | - Hyunjin Lee
- Department of Computed Tomography, Konkuk University Medical Center, Seoul, Korea
| | - Woo Suk Choi
- Department of Urology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Hyong Keun Park
- Department of Urology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Hyeong Gon Kim
- Department of Urology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Sung Hyun Paick
- Department of Urology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
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Forzini T, Demouron M, Uhl M, Mesureur S, Renard C, Klein C, Haraux E. Computed tomograpy evaluation of ureteral length in children. J Pediatr Urol 2019; 15:555.e1-555.e5. [PMID: 31324475 DOI: 10.1016/j.jpurol.2019.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 06/15/2019] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Although ureteral length (UL) is highly variable in children, reliable data on this topic are scarce. During urinary tract surgery, the use of an inappropriately dimensioned ureteral stent is associated with adverse effects. This study aimed to evaluate UL as a function of the child's age, using contrast-enhanced computed tomography (CT) of the abdomen and pelvis, and to calculate a new equation for predicting UL (and thus the optimal length of ureteral stents) in children. MATERIAL AND METHODS A retrospective, single-centre study of children (younger than 16 years) who are free of abdominal mass syndrome and severe scoliosis was conducted. After three-dimensional reconstruction of the CT data, the ureter was measured between the ureteropelvic junction and ureterovesical junction by two observers. The lengths of the right and left ureters were analyzed by age, with at least 10 CT measurements per age class. RESULTS The mean ULs on the right and left were, respectively, 9.7 and 9.91 cm before the age of 1 year, 20.10 and 21.08 cm at the age of 7 and 26.55 and 27.46 cm at the age of 16. The interobserver reproducibility of UL determination was high (intraclass correlation coefficient [95% confidence interval]: 0.97 [0.94-0.99]). On the basis of these results, the length of the double-J catheter should be equal to the child's age +12 cm (Table 1). CONCLUSION Computed tomography measurement of the UL in healthy children is reproducible and reliable and enabled the estimation of the UL by age group. This knowledge should facilitate the choice of the stent used in ureteral surgery. To confirm the study results, the stent size suggested here should be evaluated in routine practice.
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Affiliation(s)
- T Forzini
- Department of Urology and Transplantation, Amiens University Hospital, Amiens, France
| | - M Demouron
- Department of Visceral Surgery, Amiens University Hospital, Amiens, France
| | - M Uhl
- Department of Urology and Transplantation, Amiens University Hospital, Amiens, France
| | - S Mesureur
- Department of Pediatric Surgery, Amiens University Hospital, Amiens, France
| | - C Renard
- Department of Radiology, Amiens University Hospital, Amiens, France
| | - C Klein
- Department of Pediatric Surgery, Amiens University Hospital, Amiens, France
| | - E Haraux
- Department of Pediatric Surgery, Amiens University Hospital, Amiens, France; PeriTox - UMI 01, UFR de Médecine, Jules Verne University of Picardy, Amiens, France.
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Mansouri A, Tostivint V, Rouvellat P, Roumiguié M, Gamé X, Huyghe E, Rischmann P, Thanwerdas J, Malavaud P. [Is the ureteral length associated with the patient's size?]. Prog Urol 2019; 29:127-132. [PMID: 30709777 DOI: 10.1016/j.purol.2018.12.004] [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: 08/31/2016] [Revised: 08/26/2018] [Accepted: 12/12/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To assess the relation between the ureteral length and the patients' size. PATIENTS AND METHOD Prospective study made between September 2012 and May 2014, on 87 patients with 42 men and 45 women, in whom the ureteral measure was performed during the various procedures that require the use of a pigtail stent. The average age of the population was 53 years old (±15.9) with an average height of 168.3cm (±8.4). This has been achieved through ureteral catheter combining fluoroscopy and endoscopy. RESULTS The ureteral average length was 23.5cm (±2.33). The ureteral average length was 23.8cm (±2.18) for man and 23.2cm (±2.44) for women. In this population, there were a positive correlation between the size of the patients and the length of the ureters (r=0.75; P=0.01). However, this correlation was not found in all subgroups, particularly among women (r=0.16; P=0.30) and on the right side of men (r=0.34; P=0.12). This correlation was still true for the left side in the men's group (r=0.50; P=0.02). CONCLUSION In this study, there is a positive correlation between the patients' size and the ureteral length. But this correlation is not found in some subgroups. It is better to perform in vivo the ureteral measurement to have the precise length in order to set up a pigtail stent adapted to the patient. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- A Mansouri
- Service d'urologie, hôpital Jean-Rougier, 46000 Cahors, France.
| | - V Tostivint
- Service d'urologie, d'andrologie et de transplantation rénale, CHU Rangueil, 31059 Toulouse, France
| | - P Rouvellat
- Service d'urologie, d'andrologie et de transplantation rénale, CHU Rangueil, 31059 Toulouse, France
| | - M Roumiguié
- Service d'urologie, d'andrologie et de transplantation rénale, CHU Rangueil, 31059 Toulouse, France
| | - X Gamé
- Service d'urologie, d'andrologie et de transplantation rénale, CHU Rangueil, 31059 Toulouse, France
| | - E Huyghe
- Service d'urologie, d'andrologie et de transplantation rénale, CHU Rangueil, 31059 Toulouse, France
| | - P Rischmann
- Service d'urologie, d'andrologie et de transplantation rénale, CHU Rangueil, 31059 Toulouse, France
| | - J Thanwerdas
- Service d'urologie, hôpital Jean-Rougier, 46000 Cahors, France
| | - P Malavaud
- Service d'urologie, d'andrologie et de transplantation rénale, CHU Rangueil, 31059 Toulouse, France
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Linder BJ, Occhino JA. Cystoscopic ureteral stent placement: techniques and tips. Int Urogynecol J 2018; 30:163-165. [PMID: 30220023 DOI: 10.1007/s00192-018-3762-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 08/31/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS We present a video demonstrating technical considerations and tips for cystoscopic placement of external, lighted, and internal ureteral stents. METHODS Cystoscopic ureteral stent placement is useful in cases where difficult pelvic periureter dissection is expected or encountered. In this video, we review cystoscopy basics, our approach to various types of retrograde stent placement, and performing retrograde pyelograms. Traditional external ureteral stent and lighted stent placement for prophylactic purposes are discussed, with attention to understanding stent markings, appropriate resistance, and steps for externalization. Internal, double-J ureteral stent placement with the use of fluoroscopy is initiated with placement of a guidewire. An open-ended ureteral catheter is advanced over the wire in the pelvic portion of the ureter, and a retrograde pyelogram is performed. The wire is reintroduced and the stent advanced to the renal pelvis under fluoroscopy. The proximal curl is confirmed to be in the appropriate position with fluoroscopy. The string attached to the stent is then cut and removed, the guidewire is removed, and the stent is deployed with the distal curl in the bladder. CONCLUSIONS This video reviews key steps for cystoscopic ureteral stent placement in a prophylactic setting, cases of challenging anatomy, or ureteral injury.
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Affiliation(s)
- Brian J Linder
- Department of Urology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA. .,Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA.
| | - John A Occhino
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
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Barrett K, Ghiculete D, Sowerby RJ, Farcas M, Pace KT, Honey RJD. Intraoperative Radiographic Determination of Ureteral Length as a Method of Determining Ideal Stent Length. J Endourol 2017; 31:S101-S105. [PMID: 28306331 DOI: 10.1089/end.2016.0709] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Accurate determination of ureteral length (UL) and appropriate stent length remains a challenge. The objective of this study was to describe an intraoperative technique to measure UL and determine appropriate stent length, and to compare this technique with other methods of determining appropriate stent length. METHODS Patients undergoing ureteroscopy requiring postoperative stenting and who had a preoperative CT were prospectively identified. Gender, age, height, body mass index, L1 to L5 lumbar height on CT, and surgeon's estimate of UL were recorded. UL was measured using four methods: direct measurement with a ureteral catheter, ureteropelvic junction (UPJ) to ureterovesical junction distance on axial and coronal CT, and using a novel intraoperative radiographic technique. Radiographic measurement was performed using a radiographic nipple marker affixed to the skin over the ureteral orifice (UO) and an angiographic catheter with radiopaque markings at 1 cm intervals. UL was the distance from the UPJ to the marker at the UO measured using the catheter markers. Correlation between direct measurement and the recorded variables and methods of ureteral measurement were calculated. Stent length was chosen based on radiographic measurement. Stents were deemed of appropriate length if they showed a proximal coil in the renal pelvis and a distal coil in the bladder without crossing midline. RESULTS Twenty-five ureters from 23 patients were included. Radiographically measured UL was strongly correlated with direct measurement. (r = 0.873, p < 0.01). Coronal and axial CT ULs were significantly associated with direct measurement (p < 0.05). Height, lumbar height, and surgeon's estimate of UL were not. Stents were deemed of appropriate length in 23/25 cases (92%). CONCLUSIONS This new method for radiographic UL measurement is strongly correlated with directly measured UL. A length of stent chosen based on radiographic UL resulted in an appropriate stent length.
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Affiliation(s)
- Keith Barrett
- Division of Urology, St. Michael's Hospital, University of Toronto , Toronto, Ontario
| | - Daniela Ghiculete
- Division of Urology, St. Michael's Hospital, University of Toronto , Toronto, Ontario
| | - Robert J Sowerby
- Division of Urology, St. Michael's Hospital, University of Toronto , Toronto, Ontario
| | - Monica Farcas
- Division of Urology, St. Michael's Hospital, University of Toronto , Toronto, Ontario
| | - Kenneth T Pace
- Division of Urology, St. Michael's Hospital, University of Toronto , Toronto, Ontario
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Kawahara T, Sakamaki K, Ito H, Kuroda S, Terao H, Makiyama K, Uemura H, Yao M, Miyamoto H, Matsuzaki J. Developing a preoperative predictive model for ureteral length for ureteral stent insertion. BMC Urol 2016; 16:70. [PMID: 27903253 PMCID: PMC5131421 DOI: 10.1186/s12894-016-0189-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 11/22/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ureteral stenting has been a fundamental part of various urological procedures. Selecting a ureteral stent of optimal length is important for decreasing the incidence of stent migration and complications. The aim of the present study was to develop and internally validate a model for predicting the ureteral length for ureteral stent insertion. METHODS This study included a total of 127 patients whose ureters had previously been assessed by both intravenous urography (IVU) and CT scan. The actual ureteral length was determined by direct measurement using a 5-Fr ureteral catheter. Multiple linear regression analysis with backward selection was used to model the relationship between the factors analyzed and actual ureteral length. Bootstrapping was used to internally validate the predictive model. RESULTS Patients all of whom had stone disease included 76 men (59.8%) and 51 women (40.2%), with the median and mean (± SD) ages of 60 and 58.7 (±14.2) years. In these patients, 53 (41.7%) right and 74 (58.3%) left ureters were analyzed. The median and mean (± SD) actual ureteral lengths were 24.0 and 23.3 (±2.0) cm, respectively. Using the bootstrap methods for internal validation, the correlation coefficient (R2) was 0.57 ± 0.07. CONCLUSION We have developed a predictive model, for the first time, which predicts ureteral length using the following five preoperative characteristics: age, side, sex, IVU measurement, and CT calculation. This predictive model can be used to reliably predict ureteral length based on clinical and radiological factors and may thus be a useful tool to help determining the optimal length of ureteral stent.
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Affiliation(s)
- Takashi Kawahara
- Department of Urology, Yokohama City University, Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 2360004, Japan. .,Department of Urology, Ohguchi Higashi General Hospital, Yokohama, Japan.
| | - Kentaro Sakamaki
- Departments of Biostatistics, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Hiroki Ito
- Department of Urology, Yokohama City University, Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 2360004, Japan.,Department of Urology, Ohguchi Higashi General Hospital, Yokohama, Japan
| | - Shinnosuke Kuroda
- Department of Urology, Ohguchi Higashi General Hospital, Yokohama, Japan
| | - Hideyuki Terao
- Department of Urology, Ohguchi Higashi General Hospital, Yokohama, Japan
| | - Kazuhide Makiyama
- Department of Urology, Yokohama City University, Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 2360004, Japan
| | - Hiroji Uemura
- Department of Urology, Yokohama City University, Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 2360004, Japan
| | - Masahiro Yao
- Department of Urology, Yokohama City University, Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 2360004, Japan
| | - Hiroshi Miyamoto
- Departments of Pathology and Urology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Junichi Matsuzaki
- Department of Urology, Ohguchi Higashi General Hospital, Yokohama, Japan
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Barrett K, Foell K, Lantz A, Ordon M, Lee JY, Pace KT, Honey RJD. Best Stent Length Predicted by Simple CT Measurement Rather than Patient Height. J Endourol 2016; 30:1029-32. [PMID: 27338649 DOI: 10.1089/end.2016.0105] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Ureteral stent length is important, as stents that are too long might worsen symptoms and too short are at higher risk of migration. The purpose of this study was to determine if patient or radiologic parameters correlate with directly measured ureteral length and if directly measured ureteral length predicts proper stent positioning. METHODS During stent placement, ureteral length (ureteropelvic junction to ureterovesical junction distance) was directly measured by endoscopically viewing a ureteral catheter (with 1-cm marking) emanating from the ureteral orifice. A 22, 24, or 26 cm stent was chosen to be closest to the measured ureteral length. For ureters >26 cm, a 26 cm stent was chosen. Ends of an "ideally positioned" stent were fully curled in the renal pelvis and bladder, without crossing the bladder midline. Rates of ideal stent position were compared between patients with matching stent and ureteral lengths and those with stent lengths differing by ≥1 cm (mismatched). The measured ureteral length was correlated with patient height, L1-L5 height, and length measured on CT. RESULTS Fifty-nine ureters from 57 patients were included. Height was reasonably correlated with L1-L5 height (Spearman correlation coefficient [rho] = 0.79), although both were poorly correlated with directly measured ureteral length (rho = 0.18 for height and 0.32 for lumbar height). Ureteral lengths measured on CT correlated well with direct measurement (rho = 0.63 for axial cuts and rho = 0.64 for coronal cuts). Matched stent length was associated with higher rates of ideal stent position than mismatched (100% vs 70.9%, p = 0.006). CONCLUSIONS CT measurements, rather than height, correlate well with measured length and could be used to choose the appropriate stent length. Stents matching directly measured ureteral lengths are associated with high rates of ideal stent position.
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Affiliation(s)
- Keith Barrett
- 1 Division of Urology, St. Michael's Hospital, University of Toronto , Toronto, Canada
| | | | - Andrea Lantz
- 3 Department of Urology, Dalhousie University , Halifax, Canada
| | - Michael Ordon
- 1 Division of Urology, St. Michael's Hospital, University of Toronto , Toronto, Canada
| | - Jason Y Lee
- 1 Division of Urology, St. Michael's Hospital, University of Toronto , Toronto, Canada
| | - Kenneth T Pace
- 1 Division of Urology, St. Michael's Hospital, University of Toronto , Toronto, Canada
| | - R John D'A Honey
- 1 Division of Urology, St. Michael's Hospital, University of Toronto , Toronto, Canada
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Acelam PA. Verification of relationships between anthropometric variables among ureteral stents recipients and ureteric lengths: a challenge for Vitruvian-da Vinci theory. Res Rep Urol 2015; 7:117-24. [PMID: 26317082 PMCID: PMC4540172 DOI: 10.2147/rru.s87860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective To determine and verify how anthropometric variables correlate to ureteric lengths and how well statistical models approximate the actual ureteric lengths. Materials and methods In this work, 129 charts of endourological patients (71 females and 58 males) were studied retrospectively. Data were gathered from various research centers from North and South America. Continuous data were studied using descriptive statistics. Anthropometric variables (age, body surface area, body weight, obesity, and stature) were utilized as predictors of ureteric lengths. Linear regressions and correlations were used for studying relationships between the predictors and the outcome variables (ureteric lengths); P-value was set at 0.05. To assess how well statistical models were capable of predicting the actual ureteric lengths, percentages (or ratios of matched to mismatched results) were employed. Results The results of the study show that anthropometric variables do not correlate well to ureteric lengths. Statistical models can partially estimate ureteric lengths. Out of the five anthropometric variables studied, three of them: body frame, stature, and weight, each with a P<0.0001, were significant. Two of the variables: age (R2=0.01; P=0.20) and obesity (R2=0.03; P=0.06), were found to be poor estimators of ureteric lengths. None of the predictors reached the expected (match:above:below) ratio of 1:0:0 to qualify as reliable predictors of ureteric lengths. Conclusion There is not sufficient evidence to conclude that anthropometric variables can reliably predict ureteric lengths. These variables appear to lack adequate specificity as they failed to reach the expected (match:above:below) ratio of 1:0:0. Consequently, selections of ureteral stents continue to remain a challenge. However, height (R2=0.68) with the (match:above:below) ratio of 3:3:4 appears suited for use as estimator, but on the basis of decision rule. Additional research is recommended for stent improvements and ureteric length determinations.
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Affiliation(s)
- Philip A Acelam
- Walden University, College of Health Sciences, Minneapolis, MN, USA
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De S, Monga M, Knudsen B. Office-based stone management. Urol Clin North Am 2013; 40:481-95. [PMID: 24182971 DOI: 10.1016/j.ucl.2013.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
As hospital resources are becoming strained, ambulatory surgical centers and day hospitals are being increasingly utilized. For the urologist, a working knowledge of local anesthetics and conscious sedation protocols are important, as many surgical kidney-stone procedures can be performed without general anesthetic. With any anesthesia, the key goal is to maximize patient comfort while minimizing respiratory depression and avoiding prolonged sedation. When using these medications, a working knowledge of emergency reversal, ventilation (bag mask/laryngeal mask airway/intubation), and cardiopulmonary resuscitation is recommended.
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Affiliation(s)
- Shubha De
- Endourology, The Cleveland Clinic, 9500 Euclid Avenue, Q10-1, Cleveland, OH 44195, USA
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