1
|
Tang X, Wu S, Li Z, Wang D, Lei C, Liu T, Wang X, Li S. Comparison of Thulium Fiber Laser versus Holmium laser in ureteroscopic lithotripsy: a Meta-analysis and systematic review. BMC Urol 2024; 24:44. [PMID: 38374098 PMCID: PMC10875760 DOI: 10.1186/s12894-024-01419-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 01/29/2024] [Indexed: 02/21/2024] Open
Abstract
OBJECTIVES To compare the efficacy and safety of thulium fiber laser (TFL) to holmium: YAG (Ho: YAG) laser in ureteroscopic lithotripsy for urolithiasis. METHODS PubMed, Web of Science, Embase, CENTRAL, SinoMed, CNKI database, VIP and Wanfang Database were systematically searched for all relevant clinical trials until September 2023. References were explored to identify the relevant articles. Meta-analysis was carried out for the retrieved studies using RevMan5.4.1 software, and the risk ratio, mean difference and 95% confidence interval were expressed. Statistical significance was set at p < 0.05. The main outcomes of this meta-analysis were stone-free rate (SFR), perioperative outcomes and intraoperative or postoperative complications. RESULTS Thirteen studies, including 1394 patients, were included. According to the results of pooled analysis, TFL was associated with significantly higher stone-free rate (SFR) [0.52, 95% CI (0.32, 0.85), P = 0.009], shorter operation time [-5.47, 95% CI (-8.86, -2.08), P = 0.002], and less stone migration [0.17, 95% CI (0.06, 0.50), P = 0.001]. However, there was no significant difference in terms of the laser time, duration of hospital stay, drop of hemoglobin level, total energy, postoperative ureteral stenting, the incidence of intraoperative complications or postoperative complications between TFL and Ho: YAGs. CONCLUSION The findings of this study demonstrated several advantages of TFL in terms of higher SFR, shorter operative time and less stone migration. TRIAL REGISTRATION The protocol of this systematic review was listed in PROSPERO ( www.crd.york.ac.uk/PROSPERO ) (Protocol number: CRD42022362550).
Collapse
Affiliation(s)
- Xiaoyu Tang
- Department of Urology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, China
- Department of Biological Repositories, Cancer Precision Diagnosis and Treatment and Translational Medicine Hubei Engineering Research Center, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Shaojie Wu
- Department of Urology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, China
| | - Zhilong Li
- Department of Urology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, China
| | - Du Wang
- The Institute of Technological Sciences, Wuhan University, Wuhan, 430072, China
| | - Cheng Lei
- The Institute of Technological Sciences, Wuhan University, Wuhan, 430072, China
| | - Tongzu Liu
- Department of Urology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, China
| | - Xinghuan Wang
- Department of Urology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, China.
| | - Sheng Li
- Department of Urology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, China.
- Department of Biological Repositories, Cancer Precision Diagnosis and Treatment and Translational Medicine Hubei Engineering Research Center, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.
| |
Collapse
|
2
|
Xu M, Han X, Zhu J, Sun C, Tao W, Xue B. The study of double-J stent free mode of flexible ureteroscopy and laser lithotripsy: a single centre experience. J Int Med Res 2023; 51:3000605231161214. [PMID: 36994856 PMCID: PMC10068976 DOI: 10.1177/03000605231161214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 02/15/2023] [Indexed: 03/31/2023] Open
Abstract
OBJECTIVE To evaluate the effectiveness and safety of flexible ureteroscopy in the treatment of kidney and upper ureteral calculi under double-J stent free mode. METHODS Data from patients who underwent flexible ureteroscopy and laser lithotripsy between February 2018 and September 2021 were retrospectively and analysed. Cases were grouped according to pre- or postoperative use of the double-J stent (6 Fr): Post-F group (preoperative double-J stent but no postoperative double-J stent); Pre-F group (no preoperative stenting but with postoperative double-J stent); and Routine group (preoperative and postoperative double-J stenting). RESULTS A total of 554 patients (390 male and 164 female) were included. The mean operation time was similar between the three groups, with no statistically significant difference. Incidence of grade 0-1 ureteral injury was significantly higher in the Pre-F group versus other groups, but there were no significant between-group differences in other operation-related complications. During follow-up, stent-associated complications were observed in the Pre-F and Routine groups, but not in the Post-F group. Stone clearance rates were similar between all groups at 1, 3 and 6 months following surgery. CONCLUSIONS Flexible ureteroscopy using double-J stent free mode was found to be safe, feasible and effective in treating renal and upper ureteral calculi.
Collapse
Affiliation(s)
- Ming Xu
- Department of Urology, The Second Affiliated Hospital of Soochow
University, Suzhou, China
| | - Xiaoyun Han
- Department of Neurology, Suzhou Xiangcheng People Hospital,
Suzhou, China
| | - Jin Zhu
- Department of Urology, The Second Affiliated Hospital of Soochow
University, Suzhou, China
| | - Chuanyang Sun
- Department of Urology, The Second Affiliated Hospital of Soochow
University, Suzhou, China
| | - Wei Tao
- Department of Urology, The Second Affiliated Hospital of Soochow
University, Suzhou, China
| | - Boxin Xue
- Department of Urology, The Second Affiliated Hospital of Soochow
University, Suzhou, China
| |
Collapse
|
3
|
Bulbul E, Tutar O, Gultekin MH, Ilki Y, Citgez S, Onal B. The association between ureteral wall thickness and need for additional procedures after primary ureteroscopy in patients with ureteral stones above the iliac crest. Aktuelle Urol 2023; 54:37-43. [PMID: 36473485 DOI: 10.1055/a-1840-0682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE To examine the parameters affecting the need for additional procedures in the primary ureteroscopy treatment in patients with ureteral stones above the iliac crest level. METHODS Seventy-one patients were included in the study who were ≥ 18 years old and had undergone ureteroscopy (URS) for ureteral stones above the iliac crest level between 2018-2020 and had a non-contrast-enhanced abdominal computed tomography before the procedures were included in the study. Patients and stone characteristics were prospectively collected. The results were evaluated six weeks after URS. The absence of any residual fragment was thought to indicate stone-free status. The patients with failure were referred for the additional procedures. RESULTS The median patient age was 51 years [interquartile range (IQR): 18-66]. The median transverse stone diameter was 9.5 mm (IQR: 7.1-11.4), and the median ureteral wall thickness (UWT) was 5.8 mm (IQR: 4.3-6.5). In the univariate analysis, UWT (p < 0.001), presence of multiple stones (p = 0.008), and stone length (p = 0.022) affected stone-free status. The multivariate analysis revealed UWT as the only independent factor affecting the need for additional procedures after URS (p = 0.028). In the receiver operating characteristic curve analysis, the best threshold value for UWT according to the outcomes was identified as 5.8 mm. CONCLUSION Ureteral wall thickness was the only independent parameter determining the need for additional procedures and affecting the treatment outcomes after the URS procedure.
Collapse
Affiliation(s)
- Emre Bulbul
- Department of Urology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Onur Tutar
- Department of Radiology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Mehmet Hamza Gultekin
- Department of Urology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Yavuz Ilki
- Department of Urology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Sinharib Citgez
- Department of Urology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Bulent Onal
- Department of Urology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| |
Collapse
|
4
|
Martínez-Corral M, Núñez-Otero J, Fernández-Baltar C, Masid-Gómez A, Valiño-Hortas C, Pérez-Fentes D. Resultados iniciales del tratamiento endourológico de la litiasis renoureteral mediante ureteroscopia flexible y cirugía percutánea en régimen de cirugía mayor ambulatoria en un centro de tercer nivel. Actas Urol Esp 2022. [DOI: 10.1016/j.acuro.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
5
|
Martínez-Corral ME, Núñez-Otero JJ, Fernández-Baltar C, Masid-Gómez A, Valiño-Hortas C, Pérez-Fentes D. Initial results of endourological treatment of renoureteral lithiasis by means of flexible ureteroscopy and percutaneous surgery in an outpatient procedure in a tertiary care center. ACTAS UROLÓGICAS ESPAÑOLAS (ENGLISH EDITION) 2022; 47:15-21. [PMID: 37078842 DOI: 10.1016/j.acuroe.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 09/09/2022] [Accepted: 09/12/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Urinary lithiasis is a prevalent disease with a high socioeconomic impact, where endourological surgery has shown excellent results with minimal complications. For its part, outpatient surgery is an efficient, safe and quality care model. We present our experience in the outpatient endourological treatment of lithiasis and a review of the main series. MATERIAL AND METHODS Prospective analysis of 85 flexible or percutaneous procedures for the treatment of lithiasis, carried out in our center between January 2021 and April 2022. The main objective was to analyze the rate of unplanned admission and the success and incidence of complications as secondary objectives. The patients were selected following the inclusion criteria of the care process. RESULTS The mean age was 56 ± 14 years. Urine culture was positive in 13.9% of the patients, 38% had a pre-surgical double-J catheter. Median stone surface was 55 mm 2 (961 ± 323 Hounsfield Units). 73 flexible and 12 percutaneous procedures were performed. 8 patients required immediate unplanned admission and another 2 during the first month. 94% were stone-free at the third month. No intraoperative complications were detected, although 16.5% of the patients presented some type of postoperative complication. CONCLUSION In our experience, with a strict selection of patients and following a care process with multidisciplinary participation, endourological procedures are feasible and safe in the outpatient setting. Periodic monitoring of the results is essential for the sake of a constant improvement of the process.
Collapse
Affiliation(s)
- M E Martínez-Corral
- Unidad de Endourología y Litiasis, Servicio de Urología, Complejo Hospitalario Universitario de Santiago de Compostela, A Coruña, Spain.
| | - J J Núñez-Otero
- Unidad de Endourología y Litiasis, Servicio de Urología, Complejo Hospitalario Universitario de Santiago de Compostela, A Coruña, Spain
| | - C Fernández-Baltar
- Unidad de Endourología y Litiasis, Servicio de Urología, Complejo Hospitalario Universitario de Santiago de Compostela, A Coruña, Spain
| | - A Masid-Gómez
- Unidad de Cirugía Ambulatoria, Servicio de Anestesia y Reanimación, Complejo Hospitalario Universitario de Santiago de Compostela, A Coruña, Spain
| | - C Valiño-Hortas
- Unidad de Cirugía Ambulatoria, Servicio de Anestesia y Reanimación, Complejo Hospitalario Universitario de Santiago de Compostela, A Coruña, Spain
| | - D Pérez-Fentes
- Unidad de Endourología y Litiasis, Servicio de Urología, Complejo Hospitalario Universitario de Santiago de Compostela, A Coruña, Spain
| |
Collapse
|
6
|
Baboudjian M, Negre T, Van Hove A, McManus R, Lechevallier E, Gondran-Tellier B, Boissier R. A multi-institutional experience of Micro-percutaneous Nephrolithotomy (MicroPERC) for renal stones: Results and feasibility of day case surgery. Prog Urol 2022; 32:435-441. [DOI: 10.1016/j.purol.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/26/2022] [Accepted: 02/03/2022] [Indexed: 10/18/2022]
|
7
|
Johnson BA, Akhtar A, Crivelli J, Steinberg RL, Sasaki J, Street A, Antonelli JA, Pearle MS. Impact of an Enhanced Recovery After Surgery Protocol on Unplanned Patient Encounters in the Early Postoperative Period After Ureteroscopy. J Endourol 2022; 36:298-302. [PMID: 34569278 DOI: 10.1089/end.2021.0435] [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] [Indexed: 12/20/2022] Open
Abstract
Introduction: Ureteroscopy (URS) is associated with substantial patient-perceived morbidity. To improve the patient experience, we developed an enhanced recovery after surgery (ERAS) protocol for URS. We sought to determine if an ERAS protocol could reduce unplanned patient-initiated encounters. Materials and Methods: The ERAS protocol involves the preoperative administration of four medications to patients undergoing URS. We reviewed data on 100 consecutive patients undergoing URS with ureteral stent placement between April 2018 and August 2018. All unplanned postoperative encounters, including phone calls and electronic medical record messages, unplanned urology outpatient visits, emergency department (ED) visits, and re-admissions within 30 days of surgery, were recorded. A control group of patients undergoing URS between July 2013 and November 2014 served as a comparison group. Propensity score matching was performed. Statistical analysis included Mann-Whitney U test, Student's t-test, and Fischer's exact test. Univariable and multivariable (MVA) analyses were performed. Results: Using propensity score matching, 71 pre-ERAS (median age 57 years, interquartile range [IQR] 44-65) and 71 post-ERAS (median age 56 years, IQR 47-68) patients were compared. Although ED visits and postoperative readmissions were comparable between the two groups, significantly more unplanned phone calls/messages occurred in the pre-ERAS group than in the post-ERAS group (71 vs 27, respectively, p < 0.001). MVA regression analysis identified the ERAS protocol as a significant independent predictor of fewer patient calls (odds ratio 0.24, 95% confidence interval 0.12-0.50, p < 0.001). Conclusions: Analysis of an ERAS protocol for patients undergoing URS showed a reduction in unplanned patient-initiated communication, with implementation of the protocol. ClinicalTrials.gov: NCT04112160.
Collapse
Affiliation(s)
- Brett A Johnson
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Abdulhadi Akhtar
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Joseph Crivelli
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ryan L Steinberg
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jun Sasaki
- Department of Anesthesiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Austin Street
- Department of Anesthesiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jodi A Antonelli
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Margaret S Pearle
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Charles and Jane Pak Center for Mineral Metabolism, Dallas, Texas, USA
| |
Collapse
|
8
|
Cai H, Wu X, Chen X, Chen W. Comparison of the effects of general, spinal and epidural anesthesia on ureter access and surgical outcomes during flexible ureterorenoscopy for transurethral single stone removal surgeries: a monocentric retrospective study. Ann Med 2021; 53:2110-2119. [PMID: 34779319 PMCID: PMC8592613 DOI: 10.1080/07853890.2021.1998596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 10/19/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND In ureterorenoscopy, anaesthesiologists are preferring regional anaesthesia to avoid postoperative complications, while surgeons are preferring general anaesthesia to avoid ureteral trauma. China has not published its guidelines and not referring to the European Association of Urology guidelines. The objectives of study were to evaluate the effects of general, spinal, and epidural anaesthesia on ureter access and surgical outcomes of ureterorenoscopy. METHODS Charts of a total of 392 patients with the American Society of Anaesthesiologists grade I or II, and underwent flexible ureterorenoscopy for removal of the proximal, middle, or distal ureteral single stone under general anaesthesia (GA group; n = 145) or spinal anaesthesia (SA group; n = 131) or epidural anaesthesia (EA group; n = 116) were reviewed retrospectively. RESULTS The dilatation time for patients of GA group was fewer than those of SA (104.01 ± 12.77 sec/patient vs. 130.55 ± 22.53 sec/patient, p < .0001, q = 17.0350) and EA (104.01 ± 12.77 sec/patient vs. 147.03 ± 18.76 sec/patient, p < .0001, q = 26.7240) groups. The time to reach to stone for patients of GA group was fewer than those of SA (126.68 ± 12.59 sec/patient vs. 137.60 ± 17.84 sec/patient, p < .0001, q = 8.4510) and EA (126.68 ± 12.59 sec/patient vs. 149.44 ± 14.85 sec/patient, p < .0001, q = 17.0350) groups. The lithotripsy time (p = .359), operation time (p = .449), intraoperative complications (p = .058), and length of hospital stays (p = .057) of patients were same among groups. Visual analog scale pain scores of patients of the GA group found higher among groups. General anaesthesia caused nausea and vomiting. CONCLUSIONS This study suggests general anaesthesia for flexible ureterorenoscopy if there is no contraindication.KEY MESSAGEGeneral anaesthesia facilitates early dilatation of ureters and access to the stone.No strong correlation of the anaesthesia method of choice with lithotripsy time, operation time, intraoperative complications, stone-free conditions, and length of hospital stays.Epidural and spinal anaesthesia have advantages of fewer postoperative pain and better postoperative outcomes for flexible ureterorenoscopy.
Collapse
Affiliation(s)
- Haoliang Cai
- Department of Anesthesiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiaohui Wu
- Department of Anesthesiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xi Chen
- Department of Anesthesiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wenting Chen
- Department of Anesthesiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| |
Collapse
|
9
|
Adoumadji K, Bras Da Silva C, Vega Toro P, Uk P, Barre P, Ravery V. [A long distance between home and hospital does not bother ambulatory surgery for ureteroscopy in French Guyana]. Prog Urol 2021; 31:340-347. [PMID: 33531219 DOI: 10.1016/j.purol.2020.11.013] [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: 08/06/2020] [Revised: 10/16/2020] [Accepted: 11/26/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION French Guyana is 83,500 km2 wide (equivalent to 1/6 of France). Communes are distant. Public urology is set in Kourou only. These particularities led to develop ambulatory urological surgery including for patients living far away from the reference centre. We report our experience with patient ureteroscopy (URS). MATERIAL The study is retrospective (2018-2019), and includes 125 patients. Among these patients, 19.2% live in Kourou, 71.1% live 40 to 100km from the hospital and 9.7% beyond 100km. Every patient had an outpatient procedure for rigid and/or flexible URS to treat stone disease, including in lower calyx [LC] (38.4%). Ambulatory surgery was also proposed to the patients living away with the usual restrictions. Complications, results and switch to conventional hospitalisation (CH) were studied. RESULTS Mean stone size was 10,5mm (4-30), stone density was 1030 UH (470-1700). The postoperative complication rate was 4%. There were 90.4% 'stone free' patients (85.4% for LC). One patient was rehospitalised within 48hours for acute flank pain and 9 patients had a switch of ambulatory to CH: 6 for discharge too late and 3 for complication (fever and/or pain). Distance between home and hospital was linked neither to complication rate, nor to switch to CH. CONCLUSION Ambulatory URS is possible without further complications in selected patients living beyond 100km from the hospital, because of a specific organisation and an appropriate training of the caregivers involved in postoperative patient care. LEVEL OF PROOF 3.
Collapse
Affiliation(s)
- K Adoumadji
- Service d'urologie, centre hospitalier de Kourou, BP 703, avenue Léopold-Héder, 97387 Kourou, Guyane française
| | - C Bras Da Silva
- Service d'urologie, centre hospitalier de Kourou, BP 703, avenue Léopold-Héder, 97387 Kourou, Guyane française
| | - P Vega Toro
- Service d'urologie, centre hospitalier de Kourou, BP 703, avenue Léopold-Héder, 97387 Kourou, Guyane française
| | - P Uk
- Service d'urologie, centre hospitalier de Kourou, BP 703, avenue Léopold-Héder, 97387 Kourou, Guyane française
| | - P Barre
- Service d'urologie, centre hospitalier de Kourou, BP 703, avenue Léopold-Héder, 97387 Kourou, Guyane française
| | - V Ravery
- Service d'urologie, centre hospitalier de Kourou, BP 703, avenue Léopold-Héder, 97387 Kourou, Guyane française.
| |
Collapse
|
10
|
Al Darrab R, Addar AM, Al Shohaib I, Ghazwani Y. Trends of upper urinary tract stone management in a high volume stone center in Saudi Arabia, 12 years analysis. Urol Ann 2020; 12:128-131. [PMID: 32565649 PMCID: PMC7292426 DOI: 10.4103/ua.ua_49_19] [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: 10/23/2019] [Accepted: 11/22/2019] [Indexed: 11/23/2022] Open
Abstract
Introduction: Urolithiasis is a common urological problem globally with tremendous health and economic burden. In Saudi Arabia, an estimation has shown that the risk of developing a stone episode is 50% higher than that in Western countries. About 20% of males would experience at least one episode by 70 years of age. The introduction of minimally invasive and noninvasive methods such as shockwave lithotripsy (SWL), ureteroscopy (URS), and percutaneous nephrolithotripsy (PCNL) has driven the urologists to more complex decision-making with a noted variance in management options. Objectives and Methods: The objective of the study was to observe the trend of upper urinary tract stone management in our institution in the past 12 years. Methods: Charts of patients who underwent upper urinary tract lithotripsy procedures of any kind were reviewed. The information obtained included, patient's age, surgeon, surgery type, stone size, stone location, and duration of surgery. Analysis: The data obtained were from 2006 to 2016. Excel sheets used for the collection of data and SPSS software was used for analysis. Results: The results showed that the majority of the patients were males accounting for 65%. ESWL was the predominant approach from 2006 to 2010. In 2006, ESWL accounted for 77.7% of the cases, 76% in 2007, 70% in 2008, 64% in 2009, and 62% in 2010. However, in 2011, the rates dropped to almost 18% and URS rates have increased from a few cases per year to 64%. The frequency of URS continued to rise through the years until 2015 where URS rates reached 75%. During the 12-year period, URS is the most common upper tract procedure conducted when compared to ESWL and PCNL, accounting for 63%, 16%, and 20%, respectively. Conclusion: In our institution, the frequency of URS rose over the years being the most abundant procedure done. ESWL rates have decreased over the years.
Collapse
Affiliation(s)
- Rakan Al Darrab
- Division of Urology, King Abdullah International Medical Research Center, College of Medicine, King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abdulmalik M Addar
- Division of Urology, King Abdullah International Medical Research Center, College of Medicine, King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | | | - Yahay Ghazwani
- Division of Urology, King Abdullah International Medical Research Center, College of Medicine, King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| |
Collapse
|
11
|
Diagnosis, management, and follow-up of upper tract urothelial carcinoma: an interdisciplinary collaboration between urology and radiology. Abdom Radiol (NY) 2019; 44:3893-3905. [PMID: 31701194 DOI: 10.1007/s00261-019-02293-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Upper tract urothelial carcinoma (UTUC) is a common and lethal malignancy. Patients diagnosed with this illness often face invasive workups, morbid therapies, and prolonged post-operative surveillance. UTUC represents approximately 5-10% of urothelial malignancies in the United States and affect 4600-7800 new patients annually. Various environmental exposures as well as smoking have been implicated in the development of UTUC. The diagnosis and workup of UTUC relies on heavily on imaging studies, a close working relationship between Urologists and Radiologists, and invasive procedures such as ureteroscopy. Treatments range from renal-sparing endoscopic surgery to radical extirpative surgery depending on the specific clinical situation. Follow-up is crucial as UTUC has a high recurrence rate. Here we review the epidemiology, diagnosis, management strategies, and follow-up of UTUC from an interdisciplinary perspective.
Collapse
|
12
|
Selmi V, Sarı S, Çakıcı MÇ, Özdemir H, Kartal İG, Özok HU, İmamoğlu MA. Does Previous Failed Shockwave Lithotripsy Treatment Have an Influence on Retrograde Intrarenal Surgery Outcome? J Laparoendosc Adv Surg Tech A 2018; 29:627-630. [PMID: 30418090 DOI: 10.1089/lap.2018.0487] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: The prevalence of urolithiasis is nearly 20% and patients with urolithiasis constitute an essential part of the patients referred to the urology clinic. Many parameters should be considered for the management of renal stones and authors recommend extracorporeal shockwave lithotripsy (SWL), retrograde intrarenal surgery (RIRS), and percutaneous nephrolithotripsy (PNL), as treatment options. Among these techniques, SWL does not require general anesthesia, has 89% success rate for renal pelvic stones: 83% for upper caliceal stones, 84% for middle caliceal stones, and 68% for lower caliceal stones. In this study, we aimed to investigate whether the previously failed SWL treatment affects RIRS outcome. Methods: Patients who underwent RIRS for kidney stones between January 2012 and December 2017 in Diskapi Yildirim Beyazit Training and Research Hospital were reviewed retrospectively. Patients treated with primary RIRS (186 patients) were classified as Group 1. The outcomes of these patients were compared with those of 186 patients who underwent RIRS after failed SWL treatment using matched-pair analysis, and these patients were classified as Group 2. Results: The procedure success was defined as the sum of the stone-free and clinically insignificant residual fragments (CIRFs); final success rates were 90.3% and 91.9%, respectively. If we compare the final success rates, there was no statistically significant difference between both groups (P = .584). Conclusions: As a result, there is no negative effect of the previous unsuccessful SWL treatment on the RIRS success. Patients with CIRF should be followed up more carefully in terms of becoming symptomatic.
Collapse
Affiliation(s)
- Volkan Selmi
- 1 Department of Urology, Faculty of Medicine, Bozok University, Yozgat, Turkey
| | - Sercan Sarı
- 1 Department of Urology, Faculty of Medicine, Bozok University, Yozgat, Turkey
| | - Mehmet Çağlar Çakıcı
- 2 Department of Urology, Goztepe Training and Research Hospital, Faculty of Medicine, Medeniyet University, İstanbul, Turkey
| | - Harun Özdemir
- 3 Department of Urology, Avcılar State Hospital, İstanbul, Turkey
| | - İbrahim Güven Kartal
- 4 Department of Urology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Hakkı Uğur Özok
- 5 Department of Urology, Faculty of Medicine, Karabük University, Karabük, Turkey
| | | |
Collapse
|
13
|
Julien C, Laroche J, Deledalle FX, Brocq FX, Fournier R, Rivière P, Lechevallier E, Savoie PH. [Result of treatment of urinary lithiasis for professional aptitude]. Prog Urol 2018; 28:329-335. [PMID: 29705059 DOI: 10.1016/j.purol.2018.03.003] [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: 12/18/2016] [Revised: 02/11/2018] [Accepted: 03/15/2018] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Military people are inapt for presence of urinary stones. In this specific population, the treatment of stones is even more aggressive than for the general population without recommendation. The final decision about aptitude is the responsibility of the military doctor. Whereas, ureteroscopy has its place there and must done by any urologist. METHODS The purpose of this study was to estimate the results of treatments by ureteroscopy in this population. Success was defined by the complete absence of fragment visualized in the imaging of control operating comment and so the end of the inaptitude time. RESULTS Between 2009 and 2016, forty-two were treated for ureteral or renal calculi. The population comprises of 93% men, 35 years old on average. The stones were mainly multiple (more 2) and the medium size is 5mm; sixteen (42.9%) was at the left and eight (19%) was bilateral. In 78.8% (78) of the cases there was a stone in renal position whose 50% (39) still at the lower calyx. In total, 5% of the patients were stone-free in 2 sessions on average. The average deadline of inaptitude of the initial consultation in the resumption of work was of 6 months. In 4% of the cases there was a complication operating rank 4. CONCLUSION This study confirms the feasibility, the weak harmlessness of ureteroscopy and the lesser deadline of inaptitude. Every urologist can treat this specific population. The patient must be informed and accept the treatment because of excluding referential. LEVEL OF EVIDENCE 4.
Collapse
Affiliation(s)
- C Julien
- Service d'urologie, hôpital d'Instruction des Armées Sainte-Anne, BP 600, 83800 Toulon cedex 09, France.
| | - J Laroche
- Service d'urologie, hôpital d'Instruction des Armées Sainte-Anne, BP 600, 83800 Toulon cedex 09, France
| | - F-X Deledalle
- Service d'urologie, hôpital d'Instruction des Armées Sainte-Anne, BP 600, 83800 Toulon cedex 09, France
| | - F-X Brocq
- Centre d'expertise médicale du personnel naviguant (CEMPN) de Toulon, H.I.A Ste-Anne, CEMPN, BP 600, 83800 Toulon cedex 9, France
| | - R Fournier
- Service d'urologie, hôpital d'Instruction des Armées Sainte-Anne, BP 600, 83800 Toulon cedex 09, France
| | - P Rivière
- Service d'urologie, hôpital d'Instruction des Armées Sainte-Anne, BP 600, 83800 Toulon cedex 09, France
| | - E Lechevallier
- Service d'urologie, hôpital de La Conception, 147, boulevard Baille, 13005 Marseille, France
| | - P-H Savoie
- Service d'urologie, hôpital d'Instruction des Armées Sainte-Anne, BP 600, 83800 Toulon cedex 09, France
| |
Collapse
|
14
|
Ghosh A, Oliver R, Way C, White L, Somani BK. Results of day-case ureterorenoscopy (DC-URS) for stone disease: prospective outcomes over 4.5 years. World J Urol 2017; 35:1757-1764. [PMID: 28620694 PMCID: PMC5649591 DOI: 10.1007/s00345-017-2061-1] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 06/08/2017] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To investigate the prospective outcomes of day-case ureterorenoscopy (DC-URS) for stone disease. With the rising prevalence of stone disease in the face of finite resources, there is increasing pressure to undertake procedures as a day case avoiding in-patient stay. There are a limited number of studies reporting on the feasibility of ureteroscopy as a day-case procedure. This study aimed to investigate the prospective outcomes and predictors precluding to DC-URS for stone disease in patients treated in our university teaching hospital. MATERIALS AND METHODS Between March 2012 and July 2016, consecutive cases of adult stone ureteroscopy performed or supervised by a single surgeon were recorded in a prospective database. Patients underwent pre-operative counselling in a specialist stone clinic and were admitted to a dedicated 'Surgical day unit' on the day of surgery. A standardised anaesthetic protocol was adhered to in all cases. Data on patient demographics, stone parameters, pre-operative assessment, operative details, length of stay, stone-free rate and complication rates were collected and analysed. RESULTS A total of 544 consecutive adult ureteroscopy for stone disease were conducted over the study period with a day-case rate of 77.7%. Thirty-nine percent of failed day-case ureteroscopy were due to late completion of ureteroscopy and due to associated social circumstances of patients. The mean stone size, operating time duration and post-operative stent insertion rates for DC-URS patients were 14 mm, 46 min and 96.5%, respectively. Post-operatively, the mean stone-free rate (SFR), unplanned re-admissions and complications for DC-URS patients were 95, 4 and 4%, respectively. A higher failure of DC-URS was related to patient's age (p = 0.003), positive pre-operative urine culture (p < 0.001), elevated pre-operative serum creatinine (p < 0.001) and higher mean operating time (p < 0.02). CONCLUSION Based on our results, a day-case ureteroscopy rate of nearly 78% can be achieved. With its acceptable complication rate, and low re-admission rates, DC-URS is a safe and feasible option in a majority of patients with stone disease.
Collapse
Affiliation(s)
- Anngona Ghosh
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, SO16 6YD UK
| | - Rachel Oliver
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, SO16 6YD UK
| | - Carolyn Way
- Department of Anaesthetics, University Hospital Southampton NHS Trust, Southampton, SO16 6YD UK
| | - Lucy White
- Department of Anaesthetics, University Hospital Southampton NHS Trust, Southampton, SO16 6YD UK
| | - Bhaskar K. Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, SO16 6YD UK
| |
Collapse
|
15
|
Bosquet E, Peyronnet B, Mathieu R, Khene ZE, Pradere B, Manunta A, Vincendeau S, Guille F, Bensalah K, Verhoest G. [Safety and feasibility of outpatient flexible ureteroscopy for urinary stones: A retrospective single-center study]. Prog Urol 2017; 27:1043-1049. [PMID: 28869170 DOI: 10.1016/j.purol.2017.07.246] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 06/16/2017] [Accepted: 07/22/2017] [Indexed: 12/23/2022]
Abstract
AIM Management of urolithiasis has changed over the past decades. Outpatient surgery has become a major issue for healthcare systems. The aim of this study was to assess the feasibility of outpatient flexible ureteroscopy. METHODS A single-center retrospective study has been conducted including all patients who underwent an outpatient flexible ureteroscopy between January 2012 and December 2013. Failure of outpatient management was defined as length of hospital stay>12 hours or readmission within 48 hours after discharge. Univariate analysis was performed to seek for predictors of failure of outpatient management. RESULTS One hundred and fifty-seven patients who underwent a total of 174 procedures were included. They were mostly men (57.5 %), with a mean body mass index of 25.2kg/m2 (±4.3). The stones were mostly unique (64.3 %), with a mean size of 14.2mm (±11.2). Eighty patients had a double J stent preoperatively (46.5 %), and mean operative time was 64.2 minutes (±34.1). An ureteral access sheath was used in 39 procedures (22.4 %). A double J stent was left postoperatively in 103 patients (59.1 %). In total, 165 procedures (94.8 %) were performed successfully as outpatient surgery. On postoperative imaging, the stone-free rate was 69.5 %. Postoperative complications occurred in 3.4 % of cases and were mostly minor (i.e. Clavien 1-2; 83.3 %). Predictive factors of failed outpatient management were male gender (P=0.04), BMI (P=0.03), and anticoagulants intake (P=0.003). CONCLUSION Outpatient flexible ureteroscopy for urinary stones is feasible and its low failure and complications rate may allow a wider spread of its use. LEVEL OF EVIDENCE 4.
Collapse
Affiliation(s)
- E Bosquet
- Service d'urologie, CHU de Rennes, 35000 Rennes, France
| | - B Peyronnet
- Service d'urologie, CHU de Rennes, 35000 Rennes, France.
| | - R Mathieu
- Service d'urologie, CHU de Rennes, 35000 Rennes, France
| | - Z-E Khene
- Service d'urologie, CHU de Rennes, 35000 Rennes, France
| | - B Pradere
- Service d'urologie, CHU de Rennes, 35000 Rennes, France
| | - A Manunta
- Service d'urologie, CHU de Rennes, 35000 Rennes, France
| | - S Vincendeau
- Service d'urologie, CHU de Rennes, 35000 Rennes, France
| | - F Guille
- Service d'urologie, CHU de Rennes, 35000 Rennes, France
| | - K Bensalah
- Service d'urologie, CHU de Rennes, 35000 Rennes, France
| | - G Verhoest
- Service d'urologie, CHU de Rennes, 35000 Rennes, France
| |
Collapse
|