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Constantinou BT, Benedicto BC, Porto BC, Belkovsky M, Passerotti CC, Artifon EL, Otoch JP, da Cruz JA. PCNL vs. two staged RIRS for kidney stones greater than 20 mm: systematic review, meta-analysis, and trial sequential analysis. Minerva Urol Nephrol 2024; 76:31-41. [PMID: 38426420 DOI: 10.23736/s2724-6051.23.05577-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
INTRODUCTION Percutaneous nephrolithotomy (PCNL) is considered the gold standard treatment for kidney stones greater than 20 mm. However, retrograde intrarenal surgery (RIRS) may achieve the same stone-free rate with repeated procedures, and potentially fewer complications. This study aimed to compare the efficacy and safety of PCNL and two-staged RIRS. EVIDENCE ACQUISITION We conducted a systematic search in PubMed, Embase, Scopus, Cochrane, and Web of Science for studies comparing PCNL and RIRS for kidney stones greater than 20mm. The primary outcome is stone-free rate (SFR) of PCNL and RIRS (repeated once if needed). Secondary outcomes were SFR of PCNL versus RIRS (single procedure), operative time, hospital stay, need for auxiliary procedures, and complications. We performed a subgroup analysis for randomized trials, non-randomized trials, and patients with solitary kidney. We performed a trial sequential analysis for the main outcome. EVIDENCE SYNTHESIS We included 31 articles, with 1987 patients in the PCNL and 1724 patients in RIRS. We confirmed the traditional result that after a single procedure PCNL has a higher SFR. We also found that comparing the SFR of PCNL and RIRS, repeated up to two times if needed, no difference in SFR was observed. Surprisingly, only 26% (CI95 23%-28%) of the patients required a second RIRS. In the trial sequential analysis, the last point of the z-curve was within futility borders. We observed that PCNL has a higher incidence of complications (RR=1.51; CI95 1.24, 1.83; P<0.0001; I2=28%), specifically CD2 (RR=1.82; CI95 1.30, 2.54; P=0.0004; I2=26%) and longer hospital stay (MD 2.57; 2.18, 2.96; P<0.00001; I2-98%). No difference was observed regarding operative time. CONCLUSIONS RIRS repeated up to two times is equivalent to PCNL in terms of the SFR and may have the same safety.
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Affiliation(s)
| | | | - Breno C Porto
- Department of Surgical Technique and Experimental Surgery, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Mikhael Belkovsky
- Department of Surgical Technique and Experimental Surgery, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Carlo C Passerotti
- Department of Surgical Technique and Experimental Surgery, University of São Paulo School of Medicine, São Paulo, Brazil
- German Hospital Oswaldo Cruz, Specialized Center for Urology, São Paulo, Brazil
| | - Everson L Artifon
- Department of Surgical Technique and Experimental Surgery, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Jose P Otoch
- Department of Surgical Technique and Experimental Surgery, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Jose A da Cruz
- Ninth of July University (UNINOVE), São Paulo, Brazil -
- Department of Surgical Technique and Experimental Surgery, University of São Paulo School of Medicine, São Paulo, Brazil
- German Hospital Oswaldo Cruz, Specialized Center for Urology, São Paulo, Brazil
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Single-use flexible ureteroscopes: Comparative in vitro analysis of four scopes. Asian J Urol 2023; 10:64-69. [PMID: 36721687 PMCID: PMC9875117 DOI: 10.1016/j.ajur.2022.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 03/22/2021] [Accepted: 08/23/2021] [Indexed: 02/03/2023] Open
Abstract
Objective Single-use flexible ureteroscopes (fURSs) have recently been introduced by different companies. Goal of this in-vitro study was to compare four fURSs. Methods We performed in vitro analysis of Uscope 7.5 Fr and Uscope 9.5 Fr (Pusen Ltd., Zhuhai, China), LithoVue 9.5 Fr (LithoVue™, Boston Scientific, MA, USA), and Indoscope 9.5 Fr (Bioradmedisys™, Pune, India). Optical characteristics (image resolution, color representation, and luminosity) were compared at various distances of 10 mm, 20 mm, and 50 mm. Deflection and irrigation were evaluated with and without accessories. Results Color perception was comparable for all scopes at 10 mm (p<0.05), while Lithovue 9.5 Fr was comparable with Indoscope 9.5 Fr at the distances of 20 mm and 50 mm. Both scopes were statistically better than both Uscopes at the distances of 20 mm and 50 mm. Image resolution powers were comparable amongst all fURSs at the distances of 10 mm and 20 mm (3.56 line pairs per millimeter [lp/mm]). However, Indoscope (3.56 lp/mm) was superior to LithoVue and Uscope scopes (3.17 lp/mm) at the distance of 50 mm. Luminosity at the distance of 10 mm was comparable for LithoVue and Uscope 9.5 Fr. However, at the distances of 20 mm and 50 mm, LithoVue had the highest luminosity while Uscope 7.5 Fr had the lowest one. Indoscope had lower luminosity than other 9.5 Fr scopes at all distances. With empty working channel and 200 μm laser fiber, Indoscope had the maximum deflection (285°). With basket, Uscope 7.5 Fr had the maximum loss of deflection (30°) while Indoscope had no deflection loss. With empty working channel, all scopes had comparable irrigation flow rates in both deflected and undeflected state. Similarly, with 200 μm laser or basket, irrigation flow rates were comparable in all scopes. Conclusion Color representation was equivalent for Indoscope and LithoVue, while being better than Uscope 7.5 Fr and Uscope 9.5 Fr. Image resolution was comparable in all scopes at the distances of 10 mm and 20 mm. Beyond the distance of 10 mm, luminosity of LithoVue was the highest and that of Uscope 7.5 Fr was the lowest. Deflection loss was the minimum with Indoscope and the maximum with 7.5 Fr Uscope. Under all scenarios, irrigation flow rates were comparable in all scopes.
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Sahan M, Yarimoglu S, Polat S, Nart B, Koras O, Bozkurt IH, Degirmenci T. A novel nomogram and a simple scoring system for urinary leakage after percutaneous nephrolithotomy. Int Braz J Urol 2022; 48:817-827. [PMID: 35839435 PMCID: PMC9388186 DOI: 10.1590/s1677-5538.ibju.2022.0091] [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: 02/18/2022] [Accepted: 05/03/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction: The present study aimed to investigate the factors of prolonged urinary leakage (PUL) after percutaneous nephrolithotomy (PCNL) and develop a new and simple scoring system to predict it. Patients and Methods: We retrospectively reviewed patients with renal stones who underwent PCNL at the University of Health Sciences Izmir Bozyaka Training and Research Hospital between April 2011 and January 2020. The patients were divided into two groups according to the presence of PUL, and their preoperative and perioperative data were compared. A multivariate regression analysis was applied to examine the relationship between perioperative descriptors and PUL, and a nomogram was developed using significant predictors. Then, the individual components of the nomogram were assigned points to form a scoring system. Results: There were 92 and 840 patients in the groups with and without PUL, respectively. The results of the univariate logistic regression analysis showed that hydronephrosis grade, parenchymal thickness, duration of nephroscopy, and duration of nephrostomy catheter were significantly associated with PUL. Subsequently, a multivariate regression analysis was carried out with these four factors as possible independent risk factors of PUL after PCNL. Based on the results of this analysis, a nomogram prediction model was developed with an area under the curve value of 0.811, which was consequently used to develop a new simple score system consisting of three characteristics: parenchymal thickness (1–5 points), duration of nephroscopy (1–3 points), and hydronephrosis grade (1–3 points). Conclusion: A novel scoring system is a useful tool for predicting PUL in patients who have undergone percutaneous nephrolithotomy.
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Affiliation(s)
- Murat Sahan
- Department of Urology, HSU Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Serkan Yarimoglu
- Department of Urology, HSU Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Salih Polat
- Department of Urology, Amasya University Faculty of Medicine, Amasya, Turkey
| | - Bilal Nart
- Department of Urology, HSU Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Omer Koras
- Department of Urology, Hatay University Faculty of Medicine, Hatay, Turkey
| | - Ibrahim Halil Bozkurt
- Department of Urology, HSU Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Tansu Degirmenci
- Department of Urology, HSU Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
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Sebaey A, Taleb AA, Elbashir S, Gomaa R, Elshazli A, Saber W. Flexible ureterorenoscopy (RIRS) vs. Mini- percutaneous nephrolithotomy (MINI-PCNL) for renal stones 20–30 mm a prospective randomized study. AFRICAN JOURNAL OF UROLOGY 2022. [DOI: 10.1186/s12301-022-00278-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
To evaluate the safety and efficacy of mini percutaneous nephrolithotomy (mini PCNL) and retrograde intrarenal surgery (RIRS) in treatment of kidney stones 20–30 mm.
Methods
A prospective randomized study of 70 patients who presented to the urology department with calyceal or renal pelvic stone of 20–30 mm between September 2017 and September 2019. Patients were randomly divided into two groups, Group A (Mini PCNL) consists of 35 patients who were treated with mini PCNL and Group B (RIRS) consists of 35 patients who were Achieving success of the technique was considered when the patient is stone-free or has radiologically insignificant residual fragments < 4 mm.
Results
The demographic data in this study were comparable in both groups. The stone size was 20.43 ± 2.2 mm in group A & 20.5 ± 2.1 in group B, with no statistical significance. Meanwhile, the operative time in group A was 59.71 ± 19.44 min and in group B was 80.43 ± 14.79 min with statistical significance difference (p value < 0.001), while Fluoroscopy time had a mean of 8.11 ± 2.05 min in group A & 5.8 ± 1.98 min in group B with statistically significant diffrence (p value < 0.001). The stone free rate (SFR) was 88.6% in mini PCNL and 82.9% in RIRS with no statistically significant difference (p value: 0.5).
Conclusion
RIRS and mini PCNL can be an effective and alternative option for treatment of renal stones 2–3 cm. Both techniques have relatively similar SFR but RIRS showed more operative time, on contrary Mini-PCNL has more operative and postoperative complications. A multicenter studies with larger numbers of patients will be more effective to confirm these results.
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Comparison stone-free rate and effects on quality of life of percutaneous nephrolithotomy and retrograde intrarenal surgery for treatment of renal pelvis stone (2–4 cm). Curr Urol 2021; 16:5-8. [PMID: 35633857 PMCID: PMC9132185 DOI: 10.1097/cu9.0000000000000071] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 07/02/2020] [Indexed: 11/25/2022] Open
Abstract
Objectives: The aim of our study was to compare the effects on quality of life (QoL) and stone-free rate (SFR) of percutaneous nephrolithotomy (PNL) and retrograde intrarenal surgery (RIRS) in patients with renal stones 2-4cm. Materials and methods: A total of 102 patients with renal pelvis stones were enrolled in this prospective controlled study, of which 52 were performed RIRS and 50 with PNL. The QoL was evaluated by using Short From-36 pre- and post-operatively. Also, the surgical data of all patients during and after the operations were compared between the 2 groups. Results: The mean age, body mass index, stone size and density of the patients in the 2 groups were statistically similar (p > 0.05). The SFR of PNL and RIRS were found 94% (47/50) and 73% (38/52), respectively (p < 0.01). There were no statistically differences between operation times, minor complication rates and Short From-36 scores of the 2 groups. Hospitalization times were 1.13 ± 0.34days for RIRS and 2.9 ± 5.7days for PNL (p < 0.05). While the blood transfusion rate of PNL group was 8% (4/50), none patient was made blood transfusion in RIRS. Conclusions: The results of our study show that the blood transfusion rates and hospitalization times of RIRS group are significantly lower than PNL for management of renal pelvis stone 2-4cm. Despite these advantages of RIRS, the SFR is significantly lower than PNL for these stones. The effects on QoL of the both interventions before and after surgery were similar.
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Yıldızhan M, Balcı M, Asil E, Kızılkan Y, Aslan Y, Özden C, Tuncel A. Comparison of percutaneous nephrolithotomy and retrograde intrarenal surgery outcomes for kidney stones larger than 2 cm from Guy's stone scoring system perspective. Int J Clin Pract 2021; 75:e14956. [PMID: 34614286 DOI: 10.1111/ijcp.14956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/13/2021] [Accepted: 10/02/2021] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To compare surgical outcomes of percutaneous nephrolithotomy (PNL) and retrograde intrarenal surgeries (RIRS) as a result of kidney stones larger than 2 cm, together with Guy's stone scores (GSS). MATERIALS AND METHODS The data of 811 patients with stone sizes 2-6 cm were operated using PNL (n = 361) and RIRS (n = 450) reviewed retrospectively. GSS were graded 1, 2, 3 or 4 according to the computed tomography findings. Stone-free rate (SFR), operation times, length of hospital stay (LOHS) and Clavien complications (CC) were recorded. RESULTS Although mean operative times were significantly longer in the RIRS group than the PNL group in GSS grades 1, 2 and 3 (P < .001), it was similar between the two groups in GSS grade 4 (P = .186). SFRs in the PNL and RIRS group were 90.3% and 58.4% on post-operative 10th day (P < .001), and it raised up to 95.3% and 81.6% after secondary interventions (P < .001). Significantly higher SFRs observed in the PNL group in GSS grades 1, 2 and 3 categories. On postoperative 10th day, the SFRs were similar in both GSS grade 4 categories (P = .06). LOHS was longer in the PNL group (P < .001). Although LOHS was significantly longer only in GSS grade 3 (P = .043) and GSS grade 4 (P < .001) in the PNL group, it was similar in GSS grade 1 and 2 between groups. Clavien complications increased in line with GSS in the PNL group (P < .001), but the difference did not differ between GSS grade 3 and 4. CONCLUSION SF of PNL in a single session and short operation time seems to be significant especially in GSS grades 1, 2 and 3 category stones. Although the number of patients in the GSS 4 group is very small to claim this, RIRS might be considered as an alternative to PNL in a special group of patients such as GSS grade 4 because of its lower complication rates and shorter LOHS.
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Affiliation(s)
| | - Melih Balcı
- Department of Urology, Ankara City Hospital, Ankara, Turkey
- Department of Urology Affiliated with Ankara City Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Erem Asil
- Department of Urology, Ankara City Hospital, Ankara, Turkey
| | | | - Yılmaz Aslan
- Department of Urology Affiliated with Ankara City Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Cüneyt Özden
- Department of Urology Affiliated with Ankara City Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Altuğ Tuncel
- Department of Urology Affiliated with Ankara City Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
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Alam R, Matlaga BR, Alam A, Winoker JS. Contemporary considerations in the management and treatment of lower pole stones. Int Braz J Urol 2021; 47:957-968. [PMID: 33861542 PMCID: PMC8321457 DOI: 10.1590/s1677-5538.ibju.2021.0010] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 01/05/2021] [Indexed: 12/23/2022] Open
Abstract
The presence of lower pole stones poses a unique challenge due to the anatomical considerations involved in their management and treatment. Considerable research has been performed to determine the optimal strategy when faced with this highly relevant clinical scenario. Standard options for management include observation, shock wave lithotripsy, retrograde intrarenal surgery, or percutaneous nephrolithotomy. Indeed, each approach confers a distinct set of risks and benefits, which must be placed into the context of patient preference and expected outcomes. The current state of practice reflects a combination of lessons learned from managing calculi not only in the lower pole, but also from other locations within the kidney as well.
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Affiliation(s)
- Ridwan Alam
- Johns Hopkins University School of MedicineJames Buchanan Brady Urological InstituteDepartment of UrologyBaltimoreUSADepartment of Urology, James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Brian R. Matlaga
- Johns Hopkins University School of MedicineJames Buchanan Brady Urological InstituteDepartment of UrologyBaltimoreUSADepartment of Urology, James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Ayman Alam
- Johns Hopkins University School of MedicineJames Buchanan Brady Urological InstituteDepartment of UrologyBaltimoreUSADepartment of Urology, James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Jared S. Winoker
- Johns Hopkins University School of MedicineJames Buchanan Brady Urological InstituteDepartment of UrologyBaltimoreUSADepartment of Urology, James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, USA
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Yarimoglu S, Sahan M, Polat S, Koras O, Erdemoglu O, Degirmenci T. The comparison of perioperative outcomes between percutaneous nephrolithotomy and retrograde intrarenal surgery in elderly patients. Int J Clin Pract 2021; 75:e14221. [PMID: 33871135 DOI: 10.1111/ijcp.14221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/01/2021] [Accepted: 04/12/2021] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES In this study, we aimed to compare the outcomes and complication rates of percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS) in elderly patients. MATERIALS AND METHODS Between April 2011 and January 2020, patients who underwent PCNL and RIRS for renal stone in elderly patients were retrospectively evaluated. The two groups' perioperative values, stone-free rates and complication rates were compared. Post-operative complications were noted according to the Clavien scoring system. RESULTS There were 89 and 72 patients in the PCNL and RIRS group respectively. The median age was 67 years in both the groups (P = .192). The stone size were 22.2 ± 3.5 mm and 19.9 ± 7.1 mm in the PCNL and RIRS group, respectively (P = .082). Stone-free rates were significantly higher in PCNL group (P = .021, P = .034). Also we found that overall complication and major complication rates were significantly higher in PCNL group (P = .016, P = .029). CONCLUSION Despite there was higher stone clearance in PCNL, the complication rates were higher compared with RIRS. So RIRS might be a safe alternative treatment method to PCNL in older patients.
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Affiliation(s)
- Serkan Yarimoglu
- Department of Urology, HSU Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Murat Sahan
- Department of Urology, HSU Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Salih Polat
- Department of Urology, Faculty of Medicine, Amasya University, Amasya, Turkey
| | - Omer Koras
- Department of Urology, Faculty of Medicine, Hatay University, Hatay, Turkey
| | - Onur Erdemoglu
- Department of Urology, HSU Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Tansu Degirmenci
- Department of Urology, HSU Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
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Kirecci SL, Ilgi M, Yesildal C, Yavuzsan AH, Albayrak AT, Sarica K. The impact of the pelvicalyceal anatomy characteristics on the prediction of flexible ureteroscopy outcomes. Urol Ann 2021; 13:105-110. [PMID: 34194134 PMCID: PMC8210722 DOI: 10.4103/ua.ua_19_20] [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: 03/04/2020] [Accepted: 09/16/2020] [Indexed: 11/04/2022] Open
Abstract
Background The anatomical architecture is a prominent factor in the outcomes of flexible ureteroscopy (FURS). Aims and Objectives The aim to regard the success of procedures based on Pelvicalyceal body that called Sampaio classification system. Materials and Methods A total of 125 FURS procedures were reviewed between December 2012 and December 2016 in our department. Seven patients were excluded from the study due to the horseshoe kidney in two cases and recurrent cystine stone configuration in five patients. The patient's renal collecting system anatomy characteristics are regarded, and they are classified into four main groups based on the mid-renal-zone anatomy assessed according to Sampaio Classification. Results Total stone-free rate (SFR) during the postoperative 1st-month evaluation was noncontrast computerized tomography 75 (63.6%). The evaluation of the SFR in all subgroup of cases based on Sampaio classification noticed easily, SFR was significantly lower in subgroup A2 (30.4%) (P = 0.00), significantly higher in subgroup B2 (P = 0.008). The comparative analysis of the operative duration defined that it was the shortest (75.3 ± 18.1 min) in Type B1 subgroup cases, and the longest (84.7 ± 25.7 min) in the Type A2 subgroup cases. Even though this duration was found to be relatively higher in Type A2 subgroup cases than the others, this difference was not statistically significant (P = 0.271). Fluoroscopy time was noted to be the shortest (11.9 ± 13.4 s) in B1 subgroup and the longest in A2 subgroup with a statistically significant different (median: 21.3 ± 30.4) (P = 0.04). While 6 (5.1%) cases had Clavien 2 and 3 (2.5%) cases, demonstrated Clavien 3a complications. Conclusion The calyceal structure of the kidney affects the SFR; therefore, a detailed classification of pelvicalyceal could improve the outcomes, decrease the rate of auxiliary procedures and prevent the complications.
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Affiliation(s)
- Sinan Levent Kirecci
- Urology Clinic, Sisli Hamidiye Etfal Research and Training Hospital, University of Health Sciences, Istanbul, Turkey
| | - Musab Ilgi
- Urology, Pediatric Urology and Uro-Oncology Clinic, KMG Klinikum Luckenwalde, Brandenburg, Germany
| | - Cumhur Yesildal
- Urology Clinic, Sisli Hamidiye Etfal Research and Training Hospital, University of Health Sciences, Istanbul, Turkey
| | - Abdullah Hizir Yavuzsan
- Urology Clinic, Sisli Hamidiye Etfal Research and Training Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ahmet Tevfik Albayrak
- Urology Clinic, Sisli Hamidiye Etfal Research and Training Hospital, University of Health Sciences, Istanbul, Turkey
| | - Kemal Sarica
- Urology Clinic, Kafkas University Medical School, Kars, Turkey
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Kim CH, Chung DY, Rha KH, Lee JY, Lee SH. Effectiveness of Percutaneous Nephrolithotomy, Retrograde Intrarenal Surgery, and Extracorporeal Shock Wave Lithotripsy for Treatment of Renal Stones: A Systematic Review and Meta-Analysis. MEDICINA (KAUNAS, LITHUANIA) 2020. [PMID: 33396839 DOI: 10.3390/medicina56100537,october13,2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Background and objectives: To perform a updated systematic review and meta-analysis comparing effectiveness of percutaneous nephrolithotomy (PCNL), retrograde intrarenal surgery (RIRS), and extracorporeal shock wave lithotripsy (ESWL) for treatment of renal stones (RS). Materials and Methods: A total of 37 studies were included in this systematic review and meta-analysis about effectiveness to treat RS. Endpoints were stone-free rates (SFR), incidence of auxiliary procedure, retreatment, and complications. We also conducted a sub-analysis of ≥2 cm stones. Results: First, PCNL had the highest SFR than others regardless of stone sizes and RIRS showed a higher SFR than ESWL in <2 cm stones. Second, auxiliary procedures were higher in ESWL than others, and it did not differ between PCNL and RIRS. Finally, in <2 cm stones, the retreatment rate of ESWL was higher than others. RIRS required significantly more retreatment procedures than PCNL in ≥2 cm stones. Complication was higher in PCNL than others, but there was no statistically significant difference in complications between RIRS and PCNL in ≥2 cm stones. For ≥2 cm stones, PCNL had the highest SFR, and auxiliary procedures and retreatment rates were significantly lower than others. Conclusions: We suggest that PCNL is a safe and effective treatment, especially for large RS.
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Affiliation(s)
- Chan Hee Kim
- Department of Nursing Science, College of Nursing, Gachon University, Incheon 22212, Korea
| | - Doo Yong Chung
- Department of Urology, Inha University School of Medicine, Incheon 22212, Korea
| | - Koon Ho Rha
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Joo Yong Lee
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul 03722, Korea
- Center of Evidence Based Medicine, Institute of Convergence Science, Yonsei University, Seoul 03722, Korea
| | - Seon Heui Lee
- Department of Nursing Science, College of Nursing, Gachon University, Incheon 22212, Korea
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Kim CH, Chung DY, Rha KH, Lee JY, Lee SH. Effectiveness of Percutaneous Nephrolithotomy, Retrograde Intrarenal Surgery, and Extracorporeal Shock Wave Lithotripsy for Treatment of Renal Stones: A Systematic Review and Meta-Analysis. MEDICINA (KAUNAS, LITHUANIA) 2020; 57:26. [PMID: 33396839 PMCID: PMC7823824 DOI: 10.3390/medicina57010026] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/21/2020] [Accepted: 12/26/2020] [Indexed: 12/16/2022]
Abstract
Background and objectives: To perform a updated systematic review and meta-analysis comparing effectiveness of percutaneous nephrolithotomy (PCNL), retrograde intrarenal surgery (RIRS), and extracorporeal shock wave lithotripsy (ESWL) for treatment of renal stones (RS). Materials and Methods: A total of 37 studies were included in this systematic review and meta-analysis about effectiveness to treat RS. Endpoints were stone-free rates (SFR), incidence of auxiliary procedure, retreatment, and complications. We also conducted a sub-analysis of ≥2 cm stones. Results: First, PCNL had the highest SFR than others regardless of stone sizes and RIRS showed a higher SFR than ESWL in <2 cm stones. Second, auxiliary procedures were higher in ESWL than others, and it did not differ between PCNL and RIRS. Finally, in <2 cm stones, the retreatment rate of ESWL was higher than others. RIRS required significantly more retreatment procedures than PCNL in ≥2 cm stones. Complication was higher in PCNL than others, but there was no statistically significant difference in complications between RIRS and PCNL in ≥2 cm stones. For ≥2 cm stones, PCNL had the highest SFR, and auxiliary procedures and retreatment rates were significantly lower than others. Conclusions: We suggest that PCNL is a safe and effective treatment, especially for large RS.
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Affiliation(s)
- Chan Hee Kim
- Department of Nursing Science, College of Nursing, Gachon University, Incheon 22212, Korea;
| | - Doo Yong Chung
- Department of Urology, Inha University School of Medicine, Incheon 22212, Korea;
| | - Koon Ho Rha
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul 03722, Korea;
| | - Joo Yong Lee
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul 03722, Korea;
- Center of Evidence Based Medicine, Institute of Convergence Science, Yonsei University, Seoul 03722, Korea
| | - Seon Heui Lee
- Department of Nursing Science, College of Nursing, Gachon University, Incheon 22212, Korea;
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Barone B, Crocetto F, Vitale R, Di Domenico D, Caputo V, Romano F, De Luca L, Bada M, Imbimbo C, Prezioso D. Retrograde intra renal surgery versus percutaneous nephrolithotomy for renal stones >2 cm. A systematic review and meta-analysis. MINERVA UROL NEFROL 2020; 72:441-450. [DOI: 10.23736/s0393-2249.20.03721-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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13
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Dragos LB, Somani BK, Keller EX, De Coninck VMJ, Herrero MRM, Kamphuis GM, Bres-Niewada E, Sener ET, Doizi S, Wiseman OJ, Traxer O. Characteristics of current digital single-use flexible ureteroscopes versus their reusable counterparts: an in-vitro comparative analysis. Transl Androl Urol 2019; 8:S359-S370. [PMID: 31656742 DOI: 10.21037/tau.2019.09.17] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background Single-use flexible ureterorenoscopes (fURSs) have been recently introduced aiming to offer solutions to the sterilization, fragility and cost issues of the reusable fURSs. In order to be a viable alternative, the single-use scopes must prove similar capabilities when compared to their reusable counterparts. The goal of our in-vitro study was to compare the current reusable and single-use digital fURSs regarding their deflection, irrigation and vision characteristics. Methods We compared in-vitro 4 single-use fURSs-LithoVue™ (Boston Scientific, Marlborough, Massachusetts, USA), Uscope™ (Zhuhai Pusen Medical Technology Co. Ltd., Zhuhai, Guangdong Province, China), NeoFlex™ (NeoScope Inc, San Jose, California, USA) and ShaoGang™ (YouCare Technology Co. Ltd., Wuhan, China) versus 4 reusable fURSs-FLEX-Xc (Karl Storz SE & Co KG, Tuttlingen, Germany), URF-V2 (Olympus, Shinjuku, Tokyo, Japan), COBRA vision and BOA vision (Richard Wolf GmbH, Knittlingen, Germany). Deflection and irrigation abilities were evaluated with different instruments inserted through the working channel: laser fibres (200/273/365 µm), retrieval baskets (1.5/1.9/2.2 Fr), guide wires [polytetrafluoroethylene (PTFE) 0.038 inch, nitinol 0.035 inch] and a biopsy forceps. A scoring system was designed to compare the deflection impairment. Saline at different heights (40/80 cm) was used for irrigation. The flow was measured with the tip of the fURS initially straight and then fully deflected. The vision characteristics were evaluated (field of view, depth of field, image resolution, distortion and colour representation) using specific target models. Results Overall, the single-use fURSs had superior in-vitro deflection abilities than the reusable fURSs, in most settings. The highest score was achieved by NeoFlex™ and the lowest by ShaoGang™. PTFE guide wire had most impact on deflection for all fURSs. The 200 µm laser fibre had the lowest impact on deflection for the single-use fURSs. The 1.5 Fr basket caused the least deflection impairment on reusable fURSs. At the end of the tests, deflection loss was noted in most of the single-use fURSs, while none of the reusable fURSs presented deflection impairment. ShaoGang™ had the highest irrigation flow. Increasing the size of the instruments occupying the working channel led to decrease of irrigation flow in all fURSs. The impact of maximal deflection on irrigation flow was very low for all fURSs. When instruments were occupying the working channel, the single-use fURSs had slightly better in-vitro irrigation flow than the reusable fURSs. The field of view was comparable for all fURSs, with LithoVue™ showing a slight advantage. Depth of field and colour reproducibility were almost similar for all fURSs. ShaoGang™ and Uscope™ had the lowest resolution. FLEX Xc had the highest image distortion while LithoVue™ had the lowest. Partial field of view impairment was not for Uscope™ and ShaoGang™. Conclusions In-vitro, there are differences in technical characteristics of fURSs. It appears that single-use fURSs deflect better than their reusable counterparts. Irrespective of deflection, the irrigation flow of the single-use fURSs was slightly superior to the flow of the reusable fURSs. Overall, reusable fURSs had better vision characteristics than single-use fURSs. Further in-vivo studies might be necessary to confirm these findings.
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Affiliation(s)
- Laurian B Dragos
- Urology Department, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,Urology Department, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania.,PETRA - Progress in Endourology, Technology and Research Association, Paris, France
| | - Bhaskar K Somani
- PETRA - Progress in Endourology, Technology and Research Association, Paris, France.,Urology Department, University Hospital Southampton NHS Trust, Southampton, UK
| | | | | | | | - Guido M Kamphuis
- PETRA - Progress in Endourology, Technology and Research Association, Paris, France.,Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Ewa Bres-Niewada
- Urology Department, Medical University of Warsaw, Warsaw, Poland
| | - Emre T Sener
- PETRA - Progress in Endourology, Technology and Research Association, Paris, France.,Urology Department, Marmara University School of Medicine, Istanbul, Turkey
| | - Steeve Doizi
- PETRA - Progress in Endourology, Technology and Research Association, Paris, France.,Urology Department, Tenon Hospital, Paris, France.,Urology Department, Sorbonne University, Paris, France
| | - Oliver J Wiseman
- Urology Department, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Olivier Traxer
- PETRA - Progress in Endourology, Technology and Research Association, Paris, France.,Urology Department, Tenon Hospital, Paris, France.,Urology Department, Sorbonne University, Paris, France
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Chung DY, Kang DH, Cho KS, Jeong WS, Jung HD, Kwon JK, Lee SH, Lee JY. Comparison of stone-free rates following shock wave lithotripsy, percutaneous nephrolithotomy, and retrograde intrarenal surgery for treatment of renal stones: A systematic review and network meta-analysis. PLoS One 2019; 14:e0211316. [PMID: 30789937 PMCID: PMC6383992 DOI: 10.1371/journal.pone.0211316] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 01/13/2019] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES To perform a systematic review and network meta-analysis comparing stone-free rates following retrograde intrarenal surgery (RIRS), extracorporeal shock wave lithotripsy (SWL), and percutaneous nephrolithotomy (PCNL) treatments of renal stones. MATERIALS AND METHODS Clinical trials comparing RIRS, SWL, and PCNL for treatment of renal stones were identified from electronic databases. Stone-free rates for the procedures were compared by qualitative and quantitative syntheses (meta-analyses). Outcome variables are shown as risk ratios (ORs) with 95% credible intervals (CIs). RESULTS A total of 35 studies were included in this network meta-analysis of success and stone-free rates following three different treatments of renal stones. Six studies compared PCNL versus SWL, ten studies compared PCNL versus RIRS, fourteen studies compared RIRS versus SWL, and five studies compared PCNL, SWL, and RIRS. The quality scores within subscales were relatively low-risk. Network meta-analyses indicated that stone-free rates of RIRS (OR 0.38; 95% CI 0.22-0.64) and SWL (OR 0.12; 95% CI 0.067-0.19) were lower than that of PCNL. In addition, stone-free rate of SWL was lower than that of RIRS (OR 0.31; 95% CI 0.20-0.47). Stone free rate of PCNL was also superior to RIRS in subgroup analyses including ≥ 2 cm stone (OR 4.680; 95% CI 2.873-8.106), lower pole stone (OR 1.984; 95% CI 1.043-2.849), and randomized studies (OR 2.219; 95% CI 1.348-4.009). In rank-probability test, PCNL was ranked as No. 1 and SWL was ranked as No. 3. CONCLUSIONS PCNL showed the highest success and stone-free rate in the surgical treatment of renal stones. In contrast, SWL had the lowest success and stone-free rate.
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Affiliation(s)
- Doo Yong Chung
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Hyuk Kang
- Department of Urology, Inha University School of Medicine, Incheon, Korea
| | - Kang Su Cho
- Department of Urology, Gangnam Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Won Sik Jeong
- Department of Urology, Kwangju Christian Hospital, Gwangju, Korea
| | - Hae Do Jung
- Department of Urology, Yongin Severance Hospital, Yonsei University Health System, Yongin, Korea
| | - Jong Kyou Kwon
- Department of Urology, Severance Check-Up, Yonsei University Health System, Seoul, Korea
| | - Seon Heui Lee
- Department of Nursing Science, Gachon University College of Nursing, Incheon, Korea
| | - Joo Yong Lee
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
- * E-mail:
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Alazaby H, Khalil M, Omar R, Mohey A, Gharib T, Abo-Taleb A, El-Barky E. Outcome of retrograde flexible ureterorenoscopy and laser lithotripsy for treatment of multiple renal stones. AFRICAN JOURNAL OF UROLOGY 2018. [DOI: 10.1016/j.afju.2018.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Selmi V, Nalbant I, Ozturk U, Tuygun C, Goktug HNG, Imamoglu MA. Comparison of Retrograde Intrarenal Surgery and Percutaneous Nephrolithotomy Methods in Treatment of Upper Calyceal Stones of 10–20 mm. J Laparoendosc Adv Surg Tech A 2017; 27:1293-1298. [DOI: 10.1089/lap.2016.0634] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Volkan Selmi
- Igdır State Hospital, Urology Clinic, Igdır, Turkey
| | - Ismail Nalbant
- Medical Faculty, Urology Clinic, Ordu University, Ordu, Turkey
| | - Ufuk Ozturk
- Diskapi Yildirim Beyazit Training and Research Hospital, Urology Clinic, Ankara, Turkey
| | - Can Tuygun
- Diskapi Yildirim Beyazit Training and Research Hospital, Urology Clinic, Ankara, Turkey
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Moore SL, Bres-Niewada E, Cook P, Wells H, Somani BK. Optimal management of lower pole stones: the direction of future travel. Cent European J Urol 2016; 69:274-279. [PMID: 27729994 PMCID: PMC5057048 DOI: 10.5173/ceju.2016.819] [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] [Received: 03/22/2016] [Revised: 04/15/2016] [Accepted: 06/13/2016] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Kidney stone disease is increasing worldwide with its most common location being in the lower pole. A clear strategy for effective management of these stones is essential in the light of ever increasing choice, effectiveness, and complications of different treatment options. MATERIAL AND METHODS This review identifies the latest and clinically relevant publications focused on optimal management of lower pole stones. RESULTS We present an up-to-date European Association of Urology and American Urological Association algorithm for lower pole stones, risks and benefits of different treatments, and changing landscape with the miniaturization of percutaneous stone treatments. CONCLUSIONS Available literature seems to be deficient on quality of life, patient centered decision making, and cost analysis of optimal management with no defined standard of 'stone free rate', all of which are critical in any surgical consultation and outcome analysis.
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Affiliation(s)
- Sacha L Moore
- Department of Urology, University Hospital Southampton NHS Trust, United Kingdom
| | - Ewa Bres-Niewada
- Department of Urology, Medical University of Warsaw, Warsaw, Poland
| | - Paul Cook
- Department of Biochemical Pathology, University Hospital Southampton NHS Trust, United Kingdom
| | - Hannah Wells
- Department of Urology, University Hospital Southampton NHS Trust, United Kingdom
| | - Bhaskar K Somani
- Department of Urology, University Hospital Southampton NHS Trust, United Kingdom
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