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Wu W, Zhang J, Yi R, Li X, Yu X. Cost-effectiveness of anti-retropulsive devices varies according to the locations of proximal ureteral stones: a retrospective cohort study. BMC Urol 2022; 22:43. [PMID: 35331199 PMCID: PMC8952225 DOI: 10.1186/s12894-022-00995-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 03/14/2022] [Indexed: 12/23/2022] Open
Abstract
Background Anti-retropulsive devices are often used to prevent stone migration in the treatment of proximal ureteral calculi. They are helpful. However, in the meantime, they also add extra expenses. This study was carried out to investigate the best criteria for treating proximal ureteral stones with anti-retropulsive devices. Methods Data from all patients who underwent ureteroscopic holmium: YAG laser lithotripsy for solitary upper ureteral stones in 2018 were collected. Patients who encountered stone retropulsion during the process of inserting the ureteroscope were excluded. Patients were divided into either group URS or group URS + ARD depending on whether the anti-retropulsive device was used. Then, the stone-free rate, expenses and other criteria were compared between groups according to stone location. Stone-free was defined as no stones present. Results For stones located ≤ 30 mm from the ureteropelvic junction (UPJ), the stone-free rates for the URS group were 80% and 80% at one day and one month after the operation, respectively. Those for the URS + ARD group were 71.4% and 78.6% at one day and one month, respectively. For stones located 31–90 mm from the UPJ, the stone-free rates were 84.7% and 84.7% for the URS group and 89.6% and 95.5% for the URS + ARD group at one day and one month, respectively. A statistically significant difference occurred at one month. For stones located > 90 mm from the UPJ, the two groups were both stone free. In the URS + ARD group, expenses were higher. In addition, the mean diameter of residual stones derived from stones located at 31–90 mm from the UPJ was statistically smaller, and 4 of 7 residual stones passed spontaneously within one month, which was obviously more than that in other locations and the URS group. Other outcomes, including operation time and postoperative stay, showed no significant difference between the groups. Conclusion Anti-retropulsive devices are indeed helpful, but they might be cost-effective for stones located solely in the middle part of the upper ureter, not for those too close to or far from the ureteropelvic junction. Supplementary Information The online version contains supplementary material available at 10.1186/s12894-022-00995-9.
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Affiliation(s)
- Weisong Wu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiaqiao Zhang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Rixiati Yi
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xianmiu Li
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiao Yu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Çeçen K. Cost-effectiveness of using stone cone, balloon dilator, stone basket, and entrapment device in ureteroscopic laser lithotripsy for ureteric stones. J Int Med Res 2021; 49:3000605211061043. [PMID: 34898311 PMCID: PMC8671668 DOI: 10.1177/03000605211061043] [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] [Indexed: 11/23/2022] Open
Abstract
Objective To evaluate the costs and stone-free rates of ureteroscopic laser lithotripsy (ULL) performed with and without auxiliary equipment and to compare first-time ULL with total treatment. Methods One hundred patients who underwent first-time ULL without the use of auxiliary equipment because its unavailability comprised the no-device ULL (ndULL) group. Additionally, 100 patients who underwent first-time ULL with the use of auxiliary equipment when necessary comprised the device ULL (dULL) group. Results In the ndULL and dULL groups, the stone-free rates after first-time ULL were 72% and 94% and the mean cost was US $1037 ± 15.10 and US $1452 ± 19.80 per case, respectively, with a statistically significant difference. The stone-free rates at the end of treatment were 98% and 99%, respectively, without a statistically significant difference. When secondary treatment costs were added to the first ULL costs after failed treatment, the mean total cost was US $1625 ± 12.60 in the ndULL group and US $1566 ± 11.01 in the dULL group without a statistically significant difference. Conclusions The stone-free rates and costs after first-time ULL were significantly different between the groups. However, after total treatment, there was no statistically significant difference between the two groups.
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Affiliation(s)
- Kürşat Çeçen
- University of Health Sciences, Derince Training and Research Hospital, Department of Urology, Kocaeli, Turkey
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Zhang P, Han XW, Zhang X, Zhu XH, Li T, Li YS, Chen YH, Li G. Clinical Observation of UreTron Single-Probe Ultrasonic Intracorporeal Lithotripter for Ureteral Calculi. Int J Gen Med 2021; 14:4229-4237. [PMID: 34393502 PMCID: PMC8355551 DOI: 10.2147/ijgm.s325306] [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: 06/18/2021] [Accepted: 07/26/2021] [Indexed: 11/23/2022] Open
Abstract
Objective The present study aimed to observe and discuss the effectiveness and safety of the UreTron single-probe ultrasonic intracorporeal lithotripter in ureteroscopic lithotripsy. Methods The clinical data of patients with unilateral solitary ureteral calculi treated with ureteroscopic lithotripsy who were hospitalized at the Department of Urology (West District) of Beijing Chaoyang Hospital between March 2016 and August 2020 were selected for retrospective analysis. The patients were divided into the UreTron group (group U) and holmium laser group (group H) according to the lithotripsy method adopted. The operation duration, length of hospital stay, stone clearance rate, proportion of patients requiring flexible ureteroscopy-assisted lithotripsy, and complications were compared between the groups. Results There was no statistical difference between the groups in terms of the general characteristics, operation duration, or length of hospital stay (P > 0.05). Regarding the stone clearance rate (group U=93.5%; group H=75%), proportion of patients requiring flexible ureteroscopy-assisted lithotripsy (group U=6.5%; group H=27.8%), and incidence of surgical complications (group U=1 case; group H=9 cases), group U was superior to group H, and the differences between the groups were statistically significant (P < 0.05). However, the differences in other complications (cardiocerebral complications and lower extremity thrombosis) were not statistically significant between the groups (P > 0.05). Conclusion The UreTron system is a new lithotripsy apparatus that is safe and effective for ureteroscopic lithotripsy and has certain advantages in terms of the stone clearance rate, proportion of patients requiring flexible ureteroscopy-assisted lithotripsy, and surgical complications, making it worthy of clinical application.
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Affiliation(s)
- Peng Zhang
- Department of Urology, Beijing Chao-Yang Hospital, Beijing, People's Republic of China
| | - Xiu-Wu Han
- Department of Urology, Beijing Chao-Yang Hospital, Beijing, People's Republic of China
| | - Xin Zhang
- Department of Urology, Beijing Chao-Yang Hospital, Beijing, People's Republic of China
| | - Xu-Hui Zhu
- Department of Urology, Beijing Chao-Yang Hospital, Beijing, People's Republic of China
| | - Tao Li
- Department of Urology, Beijing Chao-Yang Hospital, Beijing, People's Republic of China
| | - Yan-Sheng Li
- Department of Urology, Beijing Chao-Yang Hospital, Beijing, People's Republic of China
| | - Yuan-Hao Chen
- Department of Urology, Beijing Chao-Yang Hospital, Beijing, People's Republic of China
| | - Gao Li
- Department of Urology, Beijing Chao-Yang Hospital, Beijing, People's Republic of China
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Allameh F, Razzaghi M, Abedi AR, Dadpour M. The Learning Curves for Laser Application in Urology Procedures: Review of the Literature. J Lasers Med Sci 2020; 11:S8-S15. [PMID: 33995963 DOI: 10.34172/jlms.2020.s2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Introduction: Currently, a laser is a popular technology in urological surgeries. The important laserrelated issue is the time when a surgeon reaches an acceptable level of safety and efficacy using laser technology. Methods: In this review, we aimed to assess the learning curves of three types of surgeries in urology, including photoselective vaporization of the prostate (PVP), holmium laser enucleation of the prostate (HoLEP) and retrograde intra-renal surgeries (RIRSs). Here, we searched Medline, Web of Science, Google Scholar, EMBASE, and Scopus for such keywords as Urology, laser, laser vaporization, prostate, nephrolithiasis, benign prostatic hyperplasia (BPH), and learning curve. Results: We evaluated 14 studies about PVP, 17 about RIRS, and 29 studies about HoLEP. Also, we separately discussed the learning curves of these three kinds of surgeries in detail. Conclusion: All the urologists, even expert surgeons, should attend a formal training course and have a skilled tutor present at their first cases.
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Affiliation(s)
- Farzad Allameh
- Laser Application in Medical Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Razzaghi
- Laser Application in Medical Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Center of Excellence in Training Laser Application in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Reza Abedi
- Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Dadpour
- Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Teymourian H, Ghiasy S, Tayebi-Azar A, Razzaghi M, Sadri G, Ansari Djafari A, Hojjati SA, Poury M, Shahabi V, Javanmard B. The Effect of Propofol on the Success Rate of Transurethral Lithotripsy by Holmium Laser: A Randomized Clinical Trial. J Lasers Med Sci 2020; 11:305-309. [PMID: 32802292 DOI: 10.34172/jlms.2020.51] [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: 11/09/2022]
Abstract
Introduction: Urinary stone disease is the third most common affliction of the urinary tract that has been associated with an increasing incidence. Over decades, great advances have been made in the minimally invasive treatment of urinary stones. Recently, transurethral lithotripsy (TUL) by holmium laser was introduced as a possible therapeutic option. This study evaluated the effect of propofol on the success rate of TUL by holmium laser. Methods: A double-blind randomized controlled trial was conducted on 180 patients to investigate the effect of propofol on the success and complication rate of TUL by holmium laser. The enrolled patients were divided into two groups: the first group received sodium thiopental (n=89) while the second group received propofol (n=91). The two groups were compared in terms of the fluctuations of systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), operation time, future stone-free rate (SFR), stone migration, post-operative fever, and ureteral complications such as perforation and mucosal damage. Other developed complications were also recorded. After data gathering, statistical analysis was performed with SPSS version 21. Results: the patients' data such as age, sex, stone diameter, stone laterality, duration of stone impaction, primary SBP, DBP and HR were not significantly different between the two groups (P>0.05). TUL and anesthesia duration, first-minute and fifth-minute SBP and DBP, and also changes of HR were significantly lower in the propofol group compared with the sodium thiopental group (P <0.001). Moreover, SFR of TUL was more evident in the propofol group. Ureteral mucosal damage was significantly less in the propofol group. Conclusion: Propofol was associated with a higher reduction in SBP and DBP, decreased duration of TUL, fewer fluctuations in HR, and an increased success rate of stone removal by TUL with holmium laser.
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Affiliation(s)
- Houman Teymourian
- Department of Anesthesiology and Critical Care, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saleh Ghiasy
- Department of Urology, Shohada-e-Tajrish Hospital, Shahid Beheshti University Of Medical Sciences, Tehran, Iran.,Laser Application in Medical Sciences Research Center, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Tayebi-Azar
- Nephrology and Kidney transplant Research Center, Urmia University of Medical Sciences, Urmia, Iran
| | - Mohammadreza Razzaghi
- Department of Urology, Shohada-e-Tajrish Hospital, Shahid Beheshti University Of Medical Sciences, Tehran, Iran
| | - Ghazal Sadri
- Resident of Radiology, Department of Radiology, Iran University of Medical Sciences, Tehran, Iran
| | - Anahita Ansari Djafari
- Department of Urology, Shohada-e-Tajrish Hospital, Shahid Beheshti University Of Medical Sciences, Tehran, Iran
| | - Seyyed Ali Hojjati
- Department of Urology, Shohada-e-Tajrish Hospital, Shahid Beheshti University Of Medical Sciences, Tehran, Iran
| | - Mohammad Poury
- Clinical Research Development Center, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Vahid Shahabi
- Department of Urology, Shohada-e-Tajrish Hospital, Shahid Beheshti University Of Medical Sciences, Tehran, Iran
| | - Babak Javanmard
- Department of Urology, Shohada-e-Tajrish Hospital, Shahid Beheshti University Of Medical Sciences, Tehran, Iran
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