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Wang W, Gao X, Peng L, Jin T. Ureteroscopy Is Equally Efficient and Safe in Obese and Morbidly Obese Patients: A Systematic Review and Meta-Analysis. Front Surg 2022; 9:736641. [PMID: 35252322 PMCID: PMC8894321 DOI: 10.3389/fsurg.2022.736641] [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: 08/04/2021] [Accepted: 01/20/2022] [Indexed: 11/30/2022] Open
Abstract
Background Ureteroscopy (URS) has been established as an effective treatment for stones in obese patients (OP). However, recent studies found that the efficacy of the procedure may be lower in patients with higher body mass index (BMI). In the current study, we aim to determine if obesity might influence the effectiveness and safety of URS. Methods In May 2021, a comprehensive search was conducted in the PubMed, EMBASE, Web of Science, Cochrane Library, and ClinicalTrials.gov to find eligible studies. Stone-free rate (SFR), operative time, length of stay, and complication rate were assessed utilizing RevMan 5.3. Results Thirteen studies involving 4,583 normal-weight patients (NWP), 2,465 OP, and 291 morbidly OP (MOP) were included. Pooled results showed that statistically similar SFR existed between OP and NWP [odds ratio (OR): 1.09; 95% CI: 0.79, 1.52; p = 0.59], and between MOP and NWP (OR: 1.03; 95% CI: 0.46, 2.31; p = 0.95). The operation time was similar between OP and NWP [mean difference (MD): −2.27; 95% CI: −8.98, 4.43; p = 0.51], and between MOP and NWP (MD: 4.85; 95% CI: −5.78, 15.47; p = 0.37). In addition, no significant difference regarding length of stay existed between OP and NWP (MD: −0.07; 95% CI: −0.20, 0.07; p = 0.33), and between MOP and NWP (MD: −0.06; 95% CI: −0.25, 0.14; p = 0.58). Furthermore, we observed similar minor complication rate between OP and NWP (OR: 1.04; 95% CI: 0.81, 1.32; p = 0.78), and between MOP and NWP (OR: 1.29; 95% CI: 0.80, 2.08; p = 0.30). The differences concerning major complication rate between OP and NWP (OR: 0.97; 95% CI: 0.39, 2.43; p = 0.95), and between MOP and NWP (OR: 2.01; 95% CI: 0.55, 7.30; p = 0.29) were also not significant. Conclusions Our study demonstrated that URS performed in MOP and OP appears to have the same efficacy and safety as well as in NWP group.
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Park HS, Gong MK, Yoon CY, Moon DG, Cheon J, Choi YD. Computed Tomography-Based Novel Prediction Model for the Outcome of Shockwave Lithotripsy in Proximal Ureteral Stones. J Endourol 2016; 30:810-6. [DOI: 10.1089/end.2016.0056] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Hong Seok Park
- Department of Urology, College of Medicine, Korea University, Seoul, Korea
| | - Mi Kyung Gong
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Cheol Yong Yoon
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Du Geon Moon
- Department of Urology, College of Medicine, Korea University, Seoul, Korea
| | - Jun Cheon
- Department of Urology, College of Medicine, Korea University, Seoul, Korea
| | - Young Deuk Choi
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
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Badran YA, Abdelaziz AS, Shehab MA, Mohamed HAD, Emara AAA, Elnabtity AMA, Ghanem MM, ELHelaly HAA. Is scoring system of computed tomography based metric parameters can accurately predicts shock wave lithotripsy stone-free rates and aid in the development of treatment strategies? Urol Ann 2016; 8:197-202. [PMID: 27141192 PMCID: PMC4839239 DOI: 10.4103/0974-7796.164842] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: The objective was to determine the predicting success of shock wave lithotripsy (SWL) using a combination of computed tomography based metric parameters to improve the treatment plan. Patients and Methods: Consecutive 180 patients with symptomatic upper urinary tract calculi 20 mm or less were enrolled in our study underwent extracorporeal SWL were divided into two main groups, according to the stone size, Group A (92 patients with stone ≤10 mm) and Group B (88 patients with stone >10 mm). Both groups were evaluated, according to the skin to stone distance (SSD) and Hounsfield units (≤500, 500–1000 and >1000 HU). Results: Both groups were comparable in baseline data and stone characteristics. About 92.3% of Group A rendered stone-free, whereas 77.2% were stone-free in Group B (P = 0.001). Furthermore, in both group SWL success rates was a significantly higher for stones with lower attenuation <830 HU than with stones >830 HU (P < 0.034). SSD were statistically differences in SWL outcome (P < 0.02). Simultaneous consideration of three parameters stone size, stone attenuation value, and SSD; we found that stone-free rate (SFR) was 100% for stone attenuation value <830 HU for stone <10 mm or >10 mm but total number SWL sessions and shock waves required for the larger stone group were higher than in the smaller group (P < 0.01). Furthermore, SFR was 83.3% and 37.5% for stone <10 mm, mean HU >830, SSD 90 mm and SSD >120 mm, respectively. On the other hand, SFR was 52.6% and 28.57% for stone >10 mm, mean HU >830, SSD <90 mm and SSD >120 mm, respectively. Conclusion: Stone size, stone density (HU), and SSD is simple to calculate and can be reported by radiologists to applying combined score help to augment predictive power of SWL, reduce cost, and improving of treatment strategies.
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Ishii H, Couzins M, Aboumarzouk O, Biyani CS, Somani BK. Outcomes of Systematic Review of Ureteroscopy for Stone Disease in the Obese and Morbidly Obese Population. J Endourol 2015; 30:135-45. [PMID: 26415049 DOI: 10.1089/end.2015.0547] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE With a rising incidence of obesity and urolithiasis, we wanted to look at the outcomes of ureteroscopy (URS) for stone management in this group of patients. METHODS We did a systematic review of literature in accordance with Cochrane review and preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines on all English language articles between 1990 and June 2015 for URS and stone treatment in obese patients. Data were retrieved for patient and stone demographics, outcomes of URS, complications, and follow-up. RESULTS Fifteen studies (835 patients) were identified with a mean age of 49 years and a mean body mass index (BMI) of 40.5 kg/m(2). The overall stone size was 14.2 mm (range: 3-72 mm) with almost a third of the stones in the lower pole. The initial and final stone-free rate (SFR) was 76.9% and 82.5%, respectively, with an overall complication rate of 9.3% (n = 78). Except one patient with myocardial infarction, all other complications were Clavien grade I-III. The complication rate for morbidly obese patients (17.6%) was twice that of the obese patients (8.4%), although they were all graded as Clavien I or II. CONCLUSION URS and stone fragmentation are safe and efficient treatment methods in obese patients with a good SFR and a relatively low complication rate, although the complications tend to be higher in the morbidly obese patients.
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Affiliation(s)
- Hiro Ishii
- 1 Department of Urology, University Hospital Southampton NHS Foundation Trust , Southampton, United Kingdom
| | - Mike Couzins
- 1 Department of Urology, University Hospital Southampton NHS Foundation Trust , Southampton, United Kingdom
| | - Omar Aboumarzouk
- 2 Department of Urology, University of Wales NHS Trust , Cardiff, United Kingdom
| | | | - Bhaskar K Somani
- 1 Department of Urology, University Hospital Southampton NHS Foundation Trust , Southampton, United Kingdom
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Kuroda S, Ito H, Sakamaki K, Tabei T, Kawahara T, Terao H, Fujikawa A, Makiyama K, Yao M, Matsuzaki J. Development and Internal Validation of a Classification System for Predicting Success Rates After Endoscopic Combined Intrarenal Surgery in the Modified Valdivia Position for Large Renal Stones. Urology 2015; 86:697-702. [DOI: 10.1016/j.urology.2015.07.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 06/28/2015] [Accepted: 07/02/2015] [Indexed: 11/16/2022]
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Alenezi H, Denstedt JD. Flexible ureteroscopy: Technological advancements, current indications and outcomes in the treatment of urolithiasis. Asian J Urol 2015; 2:133-141. [PMID: 29264133 PMCID: PMC5730717 DOI: 10.1016/j.ajur.2015.06.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 06/09/2015] [Indexed: 01/14/2023] Open
Abstract
The last 3 decades have witnessed great improvements in the technology and clinical applications of many minimally invasive procedures in the urological field. Flexible ureteroscopy (fURS) has advanced considerably to become a widely utilized diagnostic and therapeutic tool for multiple upper urinary tract pathologies. The most common indication for fURS is the treatment of upper urinary tract stones with the aid of Holmium:Yttrium Aluminium Garnet (YAG) laser lithotripsy. Advancements in endoscope technologies and operative techniques have lead to a broader application of fURS in the management of urolithiasis to include larger and more complex stones. fURS has proved to be an effective and safe procedure with few contraindications. Continued progression in fURS may increase its clinical applicability and supplant other procedures as the first line treatment option for urolithiasis.
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Affiliation(s)
- Husain Alenezi
- Division of Urology, Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - John D Denstedt
- Division of Urology, Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
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Giusti G, Proietti S, Peschechera R, Taverna G, Sortino G, Cindolo L, Graziotti P. Sky is no limit for ureteroscopy: extending the indications and special circumstances. World J Urol 2014; 33:257-73. [DOI: 10.1007/s00345-014-1345-y] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 05/14/2014] [Indexed: 12/19/2022] Open
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Geavlete P, Multescu R, Geavlete B. Pushing the boundaries of ureteroscopy: current status and future perspectives. Nat Rev Urol 2014; 11:373-82. [PMID: 24890883 DOI: 10.1038/nrurol.2014.118] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Substantial advances in ureteroscopy have resulted in the incorporation of this procedure into routine urological practice in many centres worldwide. Subsequently, an abundance of clinical data and technological progression have enabled the development of novel solutions that have increased the efficacy of ureteroscopy, and reduced associated morbidity and costs. In addition the indications for this retrograde approach have been expanded, and pyelocalyceal diverticulum, infundibular stenosis, urolithiasis in pregnant women or in patients with urinary diversions, as well as upper urinary tract tumours can now be managed using this methodology. New endoscopes are continuously developed, with different manufacturers choosing various technical solutions to further increase the efficacy and safety-and sometimes decrease costs-of ureteroscopy, including miniaturization, inclusion of digital optical systems and dual working channels, and the introduction of disposable apparatus. The holmium laser, currently the most-versatile energy source available, enables tissue incision, tumour ablation, and intracorporeal lithotripsy. Modern ancillary instruments are diverse, flexible, and durable, and novel devices used in daily clinical practice can minimize ascendant migration of stone fragments and, therefore, decrease the failure rate of the retrograde ureteroscopic approach. However, the peak of ureteroscopy evolution seems to remain distant, with further improvement of endoscopes and ancillary instruments, and robot-assisted ureteroscopy representing only some of the areas in which future developments are possible.
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Affiliation(s)
- Petrisor Geavlete
- Urological Department, Saint John Emergency Clinical Hospital, Vitan Barzesti 13, Bucharest 042122, Romania
| | - Razvan Multescu
- Urological Department, Saint John Emergency Clinical Hospital, Vitan Barzesti 13, Bucharest 042122, Romania
| | - Bogdan Geavlete
- Urological Department, Saint John Emergency Clinical Hospital, Vitan Barzesti 13, Bucharest 042122, Romania
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