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Gharib TM, Abdel-Al I, Elatreisy A, Faisal M, Shalkamy O, El-Dakhakhny AS. Evaluation of ultrathin semirigid ureteroscopy in terms of efficiency and cost compared to flexible ureteroscopy in treating proximal ureteric stones: a prospective randomized multicenter study. World J Urol 2023; 41:2527-2534. [PMID: 37477684 DOI: 10.1007/s00345-023-04507-8] [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: 11/02/2022] [Accepted: 06/29/2023] [Indexed: 07/22/2023] Open
Abstract
PURPOSE To investigate the outcome and cost-effectiveness of ultrathin 6-7.5-Fr semirigid ureteroscopy in treating proximal ureteric stones compared to flexible ureteroscopy. METHODS Two hundred and twenty patients with a solitary proximal ureteric stone were eligible for ureteroscopy (stone size = 1-2 cm). Patients were randomly subdivided into two groups: Group I included 105 patients who underwent ultrathin semirigid ureteroscopy and group II included 115 patients who underwent flexible ureteroscopy. Both groups were compared regarding successful stone access, operation time, reoperation rates, the financial cost to stone-free, complications, and stone clearance at 4 and 8 weeks. RESULTS Groups I and II had no significant differences regarding patient demographics, stone criteria, and hospitalization time. In contrast, the mean operative time was significantly longer in group II (p < 0.001). The overall scope-to-stone access rate was 89.5%. It was 87.6% compared to 91.3% (p = 0.32), while the stone-free rate was 81.9% versus 87.8% (p = 0.22) for groups I and II, respectively. Intraoperative and postoperative complications were statistically insignificant between the study groups. The cost/person in Egyptian pounds was 8619 ± 350 in group I, compared to 17,620 ± 280 in group II (p < 0.001); similarly, the cost to attain the stone-free rate was 8950 ± 720 in group I compared to 17,950 ± 500 in group II. CONCLUSION Ultrathin semirigid ureteroscopy is safe, durable, and considered a cost-effective method for treating upper ureteric calculi compared to the flexible ureteroscopy and could be considered a first treatment option in developing countries.
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Affiliation(s)
- Tarek Mohamed Gharib
- Urology Department, Faculty of Medicine, Benha University, Benha, Egypt
- Urology Department, Najran Armed Force Hospital, Najran, Saudi Arabia
| | - Ibrahim Abdel-Al
- Urology Department, Faculty of Medicine, Al-Azhar University, Assiut Branch, Asyût, 71511, Egypt.
| | - Adel Elatreisy
- Urology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Mahmoud Faisal
- Urology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Osama Shalkamy
- Urology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
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Mares C, Geavlete P, Ene C, Iordache V, Geavlete B. Semirigid vs Flexible Ureteroscopy in the Management of Ureteral Stones - Review. MAEDICA 2023; 18:490-497. [PMID: 38023749 PMCID: PMC10674128 DOI: 10.26574/maedica.2023.18.3.490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
Ureteral stones are a major clinical problem in urology that require effective and safe therapeutic options. Semirigid and flexible ureteroscopy ar two well-established procedures for treating these stones. The present review provides an outline of the advantages and disadvantages of these approaches. Semirigid ureteroscopy, which uses a rigid straight instrument, provides excellent stone visualisation and successful fragmentation. It is especially useful for proximal and bigger stones, frequently resulting in high stone-free rates and reduced procedure times. Nonetheless, its stiffness can make it difficult to navigate the delicate ureteral anatomy and increase the risk of mucosal injury. On the other hand, flexible ureteroscopy employs a more adjustable flexible scope, allowing access to complicated ureteral configurations while reducing the risk of ureteral trauma. It excels at treating distal and difficult stones but has a lower efficacy with larger stones and often requires longer procedure times. The choice between semirigid and flexible ureteroscopy is determined by patient-specific factors such as stone characteristics or anatomical considerations and the surgeon's skill. A customised approach that uses the capabilities of both treatments as needed can improve stone management outcomes while reducing potential problems. The continued advancement of technology and methodological modifications is predicted to improve the field of ureteroscopic stone management.
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Affiliation(s)
- C Mares
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- "Saint John" Emergency Clinical Hospital, Department of Urology, Bucharest, Romania
| | - P Geavlete
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- "Saint John" Emergency Clinical Hospital, Department of Urology, Bucharest, Romania
- Sanador Hospital, Bucharest, Romania
| | - C Ene
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- "Saint John" Emergency Clinical Hospital, Department of Urology, Bucharest, Romania
| | - V Iordache
- "Saint John" Emergency Clinical Hospital, Department of Urology, Bucharest, Romania
| | - B Geavlete
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- "Saint John" Emergency Clinical Hospital, Department of Urology, Bucharest, Romania
- Sanador Hospital, Bucharest, Romania
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Natal Alvarez F, Martín Martín S, Torrecilla García-Ripoll JR, Díaz Romero JM, Calleja Escudero J, Bedate Núñez M, Soto Rodríguez JL, Lara Pérez FM, Ruano Mayo A, Zamora Horcajada A, Cuéllar Martín LA, Muñoz Moreno MF, Cortiñas González JR. Endourological treatment for lumbar ureteral stones. What are the benefits of flexible ureterorenoscopy? Actas Urol Esp 2021; 45:569-575. [PMID: 34690104 DOI: 10.1016/j.acuroe.2021.06.009] [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: 05/16/2020] [Accepted: 06/27/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION AND OBJECTIVES Currently, there are no established criteria regarding treatment for lumbar ureteral stones. The objective of this work is to present our results in the endourological treatment of this pathology, analyzing the variables associated with the use of the flexible ureterorenoscope. MATERIAL AND METHODS Retrospective review of 103 patients who underwent retrograde URS with semi-rigid or flexible ureterorenoscope. Proximal location: L2-L3. Medial location: L4-L5. Semirigid URS was the initial treatment, with conversion to flexible URS when it was required to complete the procedure. Success was defined as absence of residual fragments (6 weeks). Demographic, surgical, immediate postoperative variables, and those related to the stone, were analyzed. Their correlation with the use of the flexible ureterorenoscope was evaluated. RESULTS Mean age: 57.2 years (SD 15.6); there were 73 men (70.9%). Stone size: 8 mm (range 4-30; IQR 4.5). Proximal location: 58 (56.3%). Previous JJ: 44.7%. Previous nephrostomy: 10.7%. Semirigid URS with conversion to flexible URS: 51 (49.5%). Impacted stones: 28.2%. Intraoperative complications: 2 (1.9%). Postoperative JJ: 84.5%. Immediate postoperative complications: 23 (22.3%) (Clavien-Dindo I-II: 91.3%). Postoperative ureteral stricture: 5.8%. Success: 88.4%. Residual fragments: 12 (11.7%). Spontaneous passage: 6 (50%). Greater performance of flexible URS in proximal ureteral stones (p = 0.001) of more than 11 mm (p = 0.02) in univariate analysis, and in proximal stones [OR 3.5; 1.5-8.1; p = 0.004] in multivariate analysis. CONCLUSIONS Endourological treatment obtained a high success rate in our sample. Size greater than 11 mm and proximal ureteral location in univariate and multivariate analysis, respectively, behaved as predictors of flexible URS.
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Affiliation(s)
- F Natal Alvarez
- Servicio de Urología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
| | - S Martín Martín
- Servicio de Urología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | - J M Díaz Romero
- Servicio de Urología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - J Calleja Escudero
- Servicio de Urología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - M Bedate Núñez
- Servicio de Urología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - J L Soto Rodríguez
- Servicio de Urología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - F M Lara Pérez
- Servicio de Urología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - A Ruano Mayo
- Servicio de Urología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - A Zamora Horcajada
- Servicio de Urología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - L A Cuéllar Martín
- Servicio de Urología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - M F Muñoz Moreno
- Unidad de Apoyo a la Investigación, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - J R Cortiñas González
- Servicio de Urología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
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Where is it logical to break-up a ureter stone with endoscopic surgery? JOURNAL OF SURGERY AND MEDICINE 2021. [DOI: 10.28982/josam.958608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Natal Alvarez F, Martín Martín S, Torrecilla García-Ripoll JR, Díaz Romero JM, Calleja Escudero J, Bedate Núñez M, Soto Rodríguez JL, Lara Pérez FM, Ruano Mayo A, Zamora Horcajada A, Cuéllar Martín LA, Muñoz Moreno MF, Cortiñas González JR. Endourological treatment for lumbar ureteral stones. What are the benefits of flexible ureterorenoscopy? Actas Urol Esp 2021; 45:S0210-4806(21)00126-1. [PMID: 34344584 DOI: 10.1016/j.acuro.2021.06.003] [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: 05/16/2020] [Revised: 05/19/2021] [Accepted: 06/27/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION AND OBJECTIVES Currently, there are no established criteria regarding treatment for lumbar ureteral stones. The objective of this work is to present our results in the endourological treatment of this pathology, analyzing the variables associated with the use of the flexible ureterorenoscope. MATERIAL AND METHODS Retrospective review of 103 patients who underwent retrograde URS with semi-rigid or flexible ureterorenoscope. Proximal location: L2-L3. Medial location: L4-L5. Semirigid URS was the initial treatment, with conversion to flexible URS when it was required to complete the procedure. Success was defined as absence of residual fragments (6 weeks). Demographic, surgical, immediate postoperative variables, and those related to the stone, were analyzed. Their correlation with the use of the flexible ureterorenoscope was evaluated. RESULTS Mean age: 57.2 years (SD 15.6); there were 73 men (70.9%). Stone size: 8mm (range 4-30; IQR 4.5). Proximal location: 58 (56.3%). Previous JJ: 44.7%. Previous nephrostomy: 10.7%. Semirigid URS with conversion to flexible URS: 51 (49.5%). Impacted stones: 28.2%. Intraoperative complications: 2 (1.9%). Postoperative JJ: 84.5%. Immediate postoperative complications: 23 (22.3%) (Clavien-Dindo I-II: 91.3%). Postoperative ureteral stricture: 5.8%. Success: 88.4%. Residual fragments: 12 (11.7%). Spontaneous passage: 6 (50%). Greater performance of flexible URS in proximal ureteral stones (P=0.001) of more than 11mm (P=0.02) in univariate analysis, and in proximal stones [OR 3.5; 1.5-8.1; P=0.004] in multivariate analysis. CONCLUSIONS Endourological treatment obtained a high success rate in our sample. Size greater than 11mm and proximal ureteral location in univariate and multivariate analysis, respectively, behaved as predictors of flexible URS.
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Affiliation(s)
- F Natal Alvarez
- Servicio de Urología, Hospital Clínico Universitario de Valladolid, Valladolid, España.
| | - S Martín Martín
- Servicio de Urología, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | | | - J M Díaz Romero
- Servicio de Urología, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - J Calleja Escudero
- Servicio de Urología, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - M Bedate Núñez
- Servicio de Urología, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - J L Soto Rodríguez
- Servicio de Urología, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - F M Lara Pérez
- Servicio de Urología, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - A Ruano Mayo
- Servicio de Urología, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - A Zamora Horcajada
- Servicio de Urología, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - L A Cuéllar Martín
- Servicio de Urología, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - M F Muñoz Moreno
- Unidad de Apoyo a la Investigación, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - J R Cortiñas González
- Servicio de Urología, Hospital Clínico Universitario de Valladolid, Valladolid, España
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Omar M, Garabawey ME, Sayedahmed K, Aboutaleb H, Noureldin Y. The utility of instruments and disposables during endourologic practice among Egyptian urologists. JOURNAL OF CLINICAL UROLOGY 2021. [DOI: 10.1177/20514158211024070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: We aimed to investigate the prevalence of utilization of different endourological instruments and disposables among Egyptian urologists and to see how availability could affect the deviation from the universal standards that might result in reduced patient safety. Patients and method: We surveyed members of the Egyptian Urological Association by a questionnaire evaluating the importance of different instruments and disposables used during ureteroscopy and percutaneous nephrolithotomy. All responses were collected by a commercially available Internet-based survey host ( www.surveymonkey.com ) over 8 weeks. Results: One hundred and fifty-two responses were received. For ureteroscopy, the most mandatory instruments and disposables included the C-arm device (83%), Dormia basket (61%), ureteral stone forceps (58%), pneumatic lithotripter (50%), and regular PTFE guide wire (49%). The instruments and disposables described as optional included 4.5 Fr ureteroscope (74%), flexible ureteroscope (70%), and hydrophilic guidewire (67%). For percutaneous nephrolithotomy, the most mandatory instruments and disposables were pneumatic lithotripter (78%), Alken metal dilator (75%), fascial dilator (45%), and regular PTFE guidewire (42%); while instruments and disposables described as optional included flexible cystoscope (70%), hydrophilic guidewire (67%), balloon dilator (57%), and laser machine (52%). Conclusion: The prevalence of the utilization of newly introduced instruments and disposables is low among Egyptian urologists.
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Affiliation(s)
- Mohamed Omar
- Department of Urology, Menoufia University, Egypt
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Danilovic A. Editorial Comment: The Impact of Ureteral Access Sheath Use on the Development of Abnormal Postoperative Upper Tract Imaging after Ureteroscopy. Int Braz J Urol 2021; 47:460-461. [PMID: 33284553 PMCID: PMC7857740 DOI: 10.1590/s1677-5538.ibju.2021.02.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Alexandre Danilovic
- Serviço de Urologia, Hospital das Clínicas da Faculdade de Medicina da USP - HCFMUSP, São Paulo, SP, Brasil
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Elgebaly OF, Abdeldaeim H, Abouyoussif T, Fahmy AM, Edris F, Zahran A, Assem A. 'Boxing in the corner': A modified retrograde approach for the management of proximal ureteric stones of 1-2 cm. Arab J Urol 2021; 19:141-146. [PMID: 34104488 PMCID: PMC8158186 DOI: 10.1080/2090598x.2021.1881421] [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: 11/16/2022] Open
Abstract
Objectives: To study a modification to the conventional retrograde ureteroscopic approach for treating proximal ureteric stones of 1–2 cm; we intentionally push the stone from the proximal ureter into a favourable calyx then the flexible ureteroscope is used to fragment the trapped stone using laser lithotripsy (‘boxing in the corner’). Patients and methods: The study was conducted in a randomised prospective manner and included 100 patients who presented with a single proximal ureteric stone of 1–2 cm. We randomised the patients into two equal groups: Group A (50 patients) underwent the conventional retrograde technique (CRT) and Group B (50 patients) underwent the modified retrograde technique (MRT) with the primary intention of relocating the stone into a favourable calyx. Intended relocation of the proximal ureteric stone in the MRT group was achieved in a stepwise manner. All intraoperative parameters and postoperative outcomes were recorded and compared between the two groups. Results: There was no statistical significant difference in terms of the patients’ demographics and stone criteria between the two groups. The stone-free rate (SFR) was significantly higher in Group B (92%) compared to Group A (78%) (P = 0.049). Fluoroscopy time was significantly longer in Group B (P < 0.001), while operative time, lithotripsy time and hospital stay were comparable. There was no difference between the groups regarding complications. Conclusion: The MRT was found to be safe and more effective than the CRT for treating proximal ureteric stones of 1–2 cm, with a significantly higher SFR. Abbreviations CONSORT: Consolidated Standards of Reporting Trials; ESWL: extracorporeal shockwave lithotripsy; fURS: flexible ureteroscope; NCCT: non-contrast CT; SFR: stone-free rate; YAG: yttrium-aluminium-garnet
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Affiliation(s)
- Omar Farid Elgebaly
- Department of Urology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Hussein Abdeldaeim
- Department of Urology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Tamer Abouyoussif
- Department of Urology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Ahmed Mahmoud Fahmy
- Department of Urology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Faisal Edris
- Department of Urology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Abdelrahman Zahran
- Department of Urology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Akram Assem
- Department of Urology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Selmi V, Sarı S, Caniklioğlu M, Öztekin Ü, Taspinar MS, Işıkay L. Effect of Endoscopic Ureteral Stone Treatment on Kidney Function. Cureus 2021; 13:e12883. [PMID: 33633912 PMCID: PMC7901160 DOI: 10.7759/cureus.12883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2021] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Ureteral stones may have an influence on kidney functions due to postrenal obstruction or urinary infections. Urgent decompression or stone removal is necessary and recommended to prevent further complications in case of severe conditions such as anuria and urosepsis. Although it is believed that ureteral stone removal would result in renal function improvement, there are still unclear points on whether ureteroscopy (URS) can provide benefit as expected and has some adverse effects. In this study, we aimed to evaluate the alteration of kidney functions of patients who undergo rigid or flexible URS for ureteral stones and find if there are any influencing factors on kidney function alteration. MATERIALS AND METHOD We analyzed 126 patients who underwent retrograde intrarenal surgery (RIRS) for renal stones between May 2018 and February 2020 prospectively. The estimated glomerular filtration rate (eGFR) was calculated on the day before the surgery, by modification of diet in renal disease (MDRD) formula. The calculation was repeated and saved three times during follow-up for the same patient; on the day after the operation, on the postoperative 30th day, and the postoperative 90th day. Then, we evaluated the renal function by comparing eGFR and assessed the predicting factors affecting the kidney function. RESULTS Preoperative mean eGFR was 82.28 ± 25.20 mL/min/1.73 m2 for the study group. Mean eGFR was calculated 90.92 ± 22.97 mL/min/1.73 m2 on the first postoperative day, and 94.54 ± 21.95 mL/min/1.73 m2 on the third-month follow-up. The mean change in eGFR was 8.63 ± 16.68 mL/min/1.73 m2 in the early period and 12.26 ± 21.09 mL/min/1.73 m2 in the long-term follow-up period. Fifty-one patients improved on chronic kidney disease (CKD) stage, and 13 deteriorated in three months follow-up. CONCLUSION Removing the stone and relieving the obstruction by ureteroscopic treatment have an alteration on eGFR. Although eGFR improves in the short-term follow-up, amelioration is evident in long-term follow-up, especially in female patients. The other predictive factors for eGFR improvement after URS are the presence of ureteral obstruction and high preoperative serum creatinine levels.
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Affiliation(s)
- Volkan Selmi
- Urology, Yozgat Bozok University, Faculty of Medicine, Yozgat, TUR
| | - Sercan Sarı
- Urology, Yozgat Bozok University, Faculty of Medicine, Yozgat, TUR
| | | | | | | | - Levent Işıkay
- Urology, Yozgat Bozok University, Faculty of Medicine, Yozgat, TUR
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Outcomes of loco-regional anaesthesia in ureteroscopy for stone disease: a systematic review. Curr Opin Urol 2020; 30:726-734. [PMID: 32657841 DOI: 10.1097/mou.0000000000000791] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE OF REVIEW Routine ureteroscopy (URS) for stone disease is performed under a general anaesthesia. However, controversy exists on the role of loco-regional anaesthesia and the outcomes associated with it. Here we review the challenges, outcomes and complications of loco-regional anaesthesia for URS. A Cochrane style review was performed in accordance with the preferred reporting items for systematic reviews and meta-analyses guidelines to evaluate the outcomes of loco-reginal anaesthesia for URS in stone disease, including all English language articles from January 1980 and December 2019. RECENT FINDINGS Twenty-one studies (1843 procedures) with a mean age of 46 years and a male : female ratio of 1.2 : 1 underwent URS under loco-regional anaesthesia. The mean stone size was 9 mm (range:4-21 mm) and except five papers, all other papers included stones in the ureter of which the majority were in the distal ureter. The conversion to general anaesthesia was needed in 2.7% patients (range 1-21%) across studies, with a stone free rate of 48-100%. The complication rate varied from 1.4 to 36%. Although the intraoperative complications included ureteric injury (n = 21) or perforation (n = 4), the postoperative complications included fever (n = 37), urinary tract infection (n = 20), haematuria (n = 4), urosepsis (n = 4) and others (n = 7). SUMMARY The present systematic review shows that local anaesthetic URS is a potential alternative to general anaesthetic URS in carefully selected patients. Randomised controlled trials with subgroup analysis are required to further assess whether loco-regional anaesthesia URS is noninferior to general anaesthesia URS and might help determine if the former approach should become more widespread.
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Jayaprakash SP, Thangarasu M, Jain N, Bafna S, Paul R. In situ Management of Large Upper Ureteric Calculus by Mini-Percutaneous Nephrolithotomy in the Era of Retrograde Intrarenal Surgery. Res Rep Urol 2020; 12:633-638. [PMID: 33330143 PMCID: PMC7735938 DOI: 10.2147/rru.s280454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 11/09/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose The aim of the study is to demonstrate the ease and success of in situ management of large upper ureteric stones with mini percutaneous nephrolithotomy (PCNL). Methods This was a prospective observational study conducted in the Department of Urology between January 2018 and June 2019. All patients underwent standard prone mini PCNL with 15Fr amplatz with 80 cases of fluoroscopic and 12 cases of ultrasound guided access. In three cases of tortuous ureters, wire was passed via retrograde catheter and retrieved via amplatz to straighten the ureter. Calculi fragmented with laser. Results A total of 77 patients were included in this study, 62 unilateral and 15 bilateral cases (92 renal units). The mean age was 45.4±13.7 years (range 17–71), male to female ratio was 61:16, the disease laterality (left: right) was 28:34. The mean stone size was 17.6±1.4 mm. Mean operative time was 22.4±1.5 min. 88% patients were discharged as day care. Complication rate was 6.5%, three patients had transient fever and two patients had distal migration of small fragments and they were extracted at the time of DJ stent removal by rigid ureteroscopy (100%). Conclusion We conclude that it is easy and effective to deal with large upper ureteric calculus when it is in a fixed position. In situ management of large upper ureteric calculus by mini-PCNL can be done safely and effectively as it is a fast procedure, prevents unnecessary manoeuvres, less complication rates and has good stone clearance rates.
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Topaktaş R, Altin S, Aydin C, Akkoç A, Ürkmez A, Aydin ZB. Is spinal anesthesia an alternative and feasible method for proximal ureteral stone treatment? Cent European J Urol 2020; 73:336-341. [PMID: 33133662 PMCID: PMC7587490 DOI: 10.5173/ceju.2020.0049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/11/2020] [Accepted: 06/14/2020] [Indexed: 11/22/2022] Open
Abstract
Introduction We investigated the clinical, operational, and pain parameters of patients who underwent semirigid ureterorenoscopy (sURS) under spinal anesthesia (SA) and general anesthesia (GA) for proximal ureter stones. Material and methods Patients treated with sURS after diagnosis of proximal ureter stones between January 2014 and May 2017 were reviewed retrospectively. The patients were divided into two groups (the SA group and the GA group) based on the type of anesthesia used. Perioperative variables and operation results were evaluated and compared. Success was defined as the patient being stone-free as observed on low-dose non-contrast computed tomography performed in the first month postoperatively. Results The SA and GA groups had 40 and 32 patients, respectively. There were no statistically significant differences between the groups in terms of age (p = 0.593), gender (p = 0.910), average stone size (p = 0.056), side (p = 0.958), or density (p = 0.337). Based on the Clavien classification system, complication rates between the two groups were similar. The postoperative visual pain scale in the SA group was statistically significantly lower (p <0.05) than in the GA group. Success rates in the SA and GA groups were found to be 90% (36/40) and 93.7% (30/32), respectively, with no significant difference between the groups (p = 0.819). Conclusions Ureterorenoscopy, which is performed for proximal ureter stone treatment in adult patients, is a reliable surgical method that can be performed under both SA and GA. SA offers the advantage of reduced postoperative pain as compared to GA.
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Affiliation(s)
- Ramazan Topaktaş
- Department of Urology, Haydarpaşa Numune Training and Research Hospital, Istanbul, Turkey
| | - Selçuk Altin
- Department of Urology, Necip Fazil Training and Research Hospital, Kahramanmaraş, Turkey
| | - Cemil Aydin
- Department of Urology, Hitit University Çorum Erol Olçok Training and Research Hospital, Çorum, Turkey
| | - Ali Akkoç
- Department of Urology, Faculty of Medicine, Alanya Alaaddin Keykubat University, Alanya, Turkey
| | - Ahmet Ürkmez
- Department of Urology, Haydarpaşa Numune Training and Research Hospital, Istanbul, Turkey
| | - Zeynep Banu Aydin
- Department of Radiology, Hitit University Çorum Erol Olçok Training and Research Hospital, Çorum, Turkey
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Lane J, Whitehurst L, Hameed BMZ, Tokas T, Somani BK. Correlation of Operative Time with Outcomes of Ureteroscopy and Stone Treatment: a Systematic Review of Literature. Curr Urol Rep 2020; 21:17. [PMID: 32211985 DOI: 10.1007/s11934-020-0970-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE OF REVIEW To present the latest evidence related to the impact of increased operative times in retrograde intrarenal surgery and identify possible important factors that can facilitate ureteroscopy procedures. RECENT FINDINGS Ureteroscopy constitutes the mainstay treatment of renal stones and is characterized by a huge variation in techniques and instrumentation. It has been suggested that increased operative times can mitigate the outcomes of the procedures by increasing complication rates. Nevertheless, little is known about the time limits, above which complications are likely to occur. Furthermore, complication rates in different procedure durations have not yet been assessed. Prolonged operative times are linked to increased complication rates in ureteroscopy. Stone complexity, patient risk factors, surgeon experience, bilateral surgery, and instrumentation constitute important factors that can hamper or facilitate a procedure and should be taken into account beforehand. Keeping procedural times below 90 min can dissuade potential predicaments and achieve improved stone-free rates.
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Affiliation(s)
- Jenni Lane
- University Hospital Southampton NHS Trust, Southampton, UK
| | | | | | - Theodoros Tokas
- Department of Urology and Andrology, General Hospital Hall in Tirol, Hall in Tirol, Austria
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Whitehurst L, Pietropaolo A, Geraghty R, Kyriakides R, Somani BK. Factors affecting operative time during ureteroscopy and stone treatment and its effect on outcomes: retrospective results over 6.5 years. Ther Adv Urol 2020; 12:1756287220934403. [PMID: 32636935 PMCID: PMC7313327 DOI: 10.1177/1756287220934403] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 05/26/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND We aimed to evaluate operative time with the outcomes of ureteroscopy (URS) and investigate the relationship between these factors, and assess if longer operative times were associated with a higher risk of complications. METHODS We retrospectively audited consecutive cases of URS done between March 2012 and June 2018. Data were collected for operative times, patient demographics, stone parameters, stent insertions, use of ureteric access sheath, length of stay, stone-free rate (SFR) and complications. Statistical analysis was performed using IBM SPSS version 24. RESULTS Over 6.5 years, 736 patients with a male:female ratio of 1.8:1 and a mean age of 54.7 years (range: 2-91 years), underwent 860 URS and stone treatment procedures. The mean operative time was 43.5 min (range: 8-160 min), with a stone size of 12.3 mm (range: 3-100 mm) and access sheath was used in 35.8%. The initial and final SFR was 86% and 92.5%, respectively, and 85.6% (n = 736) patients were discharged the same day of procedure. Treatment of multiple renal stones, ureteric and renal stones, large stones, use of access sheath and post-operative stent were all associated with longer operative times (p <0.001). Patients who were stone free and those having day-case procedures had shorter operative times (p <0.001). There were 27 (3.2%) Clavien I/II complications and 8 (0.9%) Clavien ⩾III complications. Clavien score ⩾III (p = 0.028) and infectious complications (p <0.001) had significantly longer operative times. CONCLUSION Patients with shorter operative times have a higher chance of being discharged home the same day without a post-operative stent. Higher operative times are associated with high-grade, especially infection-related, complications.
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Affiliation(s)
- Lily Whitehurst
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Amelia Pietropaolo
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Robert Geraghty
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Rena Kyriakides
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Bhaskar K. Somani
- Department of Urology, University Hospital Southampton NHS Trust, Tremona Road, Southampton SO16 6YD, UK
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Alhunaidi O, Ahmad AA, El-Nahas AR, Akroof B, Alamiri A, Al-Ajrawi F, Al-Terki A, El-Shazly M. Impact of case volume per year on flexible Ureteroscopy practice: an internet based survey. BMC Urol 2019; 19:134. [PMID: 31852477 PMCID: PMC6921597 DOI: 10.1186/s12894-019-0568-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 12/12/2019] [Indexed: 11/20/2022] Open
Abstract
Background To report current worldwide variation in techniques and clinical practice of flexible ureteroscopy (FURS) among endourologists of different case volumes per year. Methods Two invitations to complete an internet survey were emailed to Endourological Society members. Some of survey questions asked about indications of using FURS for renal and upper ureteral stones. Others were concerned with clinical practice of FURS (such as preoperative stenting, use of ureteral access sheath (UAS) and safety guidewire, technique of Laser lithotripsy and fragment retrieval, and post-FURS stenting. Responders were distributed into two groups; high-volume (> 100 cases/year) and low-volume surgeons (< 100 cases/year) and data were compared between both groups. Results Responses were received from 146 endourologists all over the world (62 high-volume and 84 low-volume). FURS for intrarenal stone > 20 mm was used by 61% of high-volume surgeons compared with 28.6% for low-volume (P < 0.001). Semirigid URS was used for upper ureteric stones in 68% among high-volume group and 82% in low-volume group (P = 0.044). UAS was used by 62% in low-volume group and 69% in high volume group (P = 0.516). Laser stone dusting was preferred by 63% in low-volume group versus 45% by high-volume (P = 0.031). More responders in low-volume group preferred to leave the stent for 6 weeks (P = 0.042). Conclusions The use of FURS for treating upper tract calculi has expanded by high volume endourologists to include large renal stones > 20 mm. Low-volume surgeons prefer to use semi-rigid URS for treatment of upper ureteral stones, to apply Laser stone dusting and maintain ureteral stents for longer periods.
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Affiliation(s)
- Omar Alhunaidi
- Urology Department, Al-Amiri hospital, Kuwait City, Kuwait
| | | | - Ahmed R El-Nahas
- Urology Department, Al-Amiri hospital, Kuwait City, Kuwait. .,Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
| | - Bader Akroof
- Urology Department, Al-Amiri hospital, Kuwait City, Kuwait
| | - Ali Alamiri
- Urology Department, Al-Amiri hospital, Kuwait City, Kuwait
| | - Feras Al-Ajrawi
- Urology Department, Al-Farwaniya hospital, Sabah Al Nasser, Kuwait
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Özkaya F, Sertkaya Z, Karabulut İ, Aksoy Y. The effect of using ureteral access sheath for treatment of impacted ureteral stones at mid-upper part with flexible ureterorenoscopy: a randomized prospective study. MINERVA UROL NEFROL 2019; 71:413-420. [PMID: 31144488 DOI: 10.23736/s0393-2249.19.03356-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The number of the studies made on the efficacy of flexible ureteroscopy (FURS) with ureteral access sheath (UAS) for impacted ureteral stones is limited. The aim of our study was to compare the efficacy and reliability of FURS in treatment of mid-upper impacted ureteral stones in cases where access is used or not. METHODS Between January 2017 and June 2018, 131 adult patients who applied to our clinic with complaints of mid-upper impacted ureteral stones. Patients were randomized as group 1 (without UAS) and group 2 (with UAS) by means of a draw and assessed in terms of demographic features, stone size, stone localization, hydronephrosis grade, operation time, scope time, the need for additional surgery, hospitalization time and complications. RESULTS The mean age of the patients in group 1 was 45.01 years (19-76) and was 37.01 years (16-80) in group 2. Mean stone size was 9.04 mm2 and 9.77 mm2 in group 1 and 2, respectively. Additional treatment was required for 26 (42.6%) patients in group 1 and 8 (11.4%) in group 2. No major intraoperative and postoperative complications developed in both groups. Although bleeding as a postoperative complication rate was similar, fever (>38° C) and urinary tract infection were higher in group 1 than in group 2. CONCLUSIONS In the treatment of mid-upper impacted ureteral stones, using UAS during the application of FURS is an advantageous procedure due to shorter operation time, fever intraoperative stone migrations and the need for additional surgery, less postoperative infection.
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Affiliation(s)
- Fatih Özkaya
- Department of Urology, Faculty of Medicine, Ataturk University, Erzurum, Turkey -
| | - Zülfü Sertkaya
- Department of Urology, Dicle Memorial Hospital, Diyarbakır, Turkey
| | - İbrahim Karabulut
- Department of Urology, Erzurum Regional Training and Research Hospital, Health Science University, Erzurum, Turkey
| | - Yılmaz Aksoy
- Department of Urology, Faculty of Medicine, Ataturk University, Erzurum, Turkey
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Çitamak B, Mammadov E, Kahraman O, Ceylan T, Doğan HS, Tekgül S. Semi-Rigid Ureteroscopy Should Not Be the First Option for Proximal Ureteral Stones in Children. J Endourol 2018; 32:1028-1032. [DOI: 10.1089/end.2017.0925] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Burak Çitamak
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Emin Mammadov
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Oğuzhan Kahraman
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Taner Ceylan
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Hasan Serkan Doğan
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Serdar Tekgül
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
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Zhou R, Han C, Hao L, Chen B, Zang G, Fan T, Zhou J, Dong Y, Ma W, Pang K. Ureteroscopic lithotripsy in the Trendelenburg position for extracting obstructive upper ureteral obstruction stones: a prospective, randomized, comparative trial. Scand J Urol 2018; 52:291-295. [PMID: 30334631 DOI: 10.1080/21681805.2018.1492966] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To introduce a new position for ureteroscopic holmium laser lithotripsy for patients with upper ureteral calculi. MATERIALS AND METHODS Between June 2014 and May 2017, 192 patients were enrolled in this study. Patients were randomly assigned to one of two groups: group A, ureteroscopic lithotripsy (URSL) in the Trendelenburg position; or group B, URSL in the standard position. Baseline information, including gender, age, body mass index (BMI), stone side, stone size and hydronephrosis grade, was collected and determined preoperatively. Stone-free rate (SFR) was evaluated 3 weeks after surgery and was defined by the absence of residual stones or the presence of residual stones <2 mm in diameter. Operation time, hospital stay, stone migration, operative complications and SFR were assessed and compared between the two groups. RESULTS There were no statistically significant differences in gender, age, BMI, stone side, stone size, serum creatinine or hydronephrosis grade between the two groups (all p > 0.05). There were no significant differences in the postoperative hospital stay or postoperative complications between the two groups (all p > 0.05), but the differences in operative time, stone migration and SFR between the two groups were statistically significant (p < 0.05). CONCLUSION This study introduced a new position for ureteroscopic holmium laser lithotripsy for patients with upper ureteral calculi. The Trendelenburg position can improve the SFR and may provide an optional surgical method for treating upper ureteral calculi.
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Affiliation(s)
- Rongsheng Zhou
- a Department of Urology , Xuzhou Central Hospital , Xuzhou , PR China
| | - Conghui Han
- a Department of Urology , Xuzhou Central Hospital , Xuzhou , PR China
| | - Lin Hao
- a Department of Urology , Xuzhou Central Hospital , Xuzhou , PR China
| | - Bo Chen
- a Department of Urology , Xuzhou Central Hospital , Xuzhou , PR China
| | - Guanghui Zang
- a Department of Urology , Xuzhou Central Hospital , Xuzhou , PR China
| | - Tao Fan
- a Department of Urology , Xuzhou Central Hospital , Xuzhou , PR China
| | - Jiahe Zhou
- a Department of Urology , Xuzhou Central Hospital , Xuzhou , PR China
| | - Yang Dong
- a Department of Urology , Xuzhou Central Hospital , Xuzhou , PR China
| | - Weiming Ma
- a Department of Urology , Xuzhou Central Hospital , Xuzhou , PR China
| | - Kun Pang
- a Department of Urology , Xuzhou Central Hospital , Xuzhou , PR China
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Bres-Niewada E, Dybowski B, Zapała P, Poletajew S, Miązek-Zapała N, Michałek I, Radziszewski P. A stone pushed back to the collecting system - long therapeutic path in centers with limited access to flexible instruments. Cent European J Urol 2018; 71:186-189. [PMID: 30038808 PMCID: PMC6051363 DOI: 10.5173/ceju.2018.1716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 05/13/2018] [Accepted: 05/21/2018] [Indexed: 12/23/2022] Open
Abstract
Introduction Availability of flexible ureteroscopes is still limited in many countries and centers. Under such circumstances treating small stones pushed from the ureter to the kidney that pose a risk of symptomatic recurrence is controversial as it may require a number of surgical procedures to remove. The aim of this study was to assess the type and number of procedures used to treat stones relocated from the ureter to the collecting system in a high volume urological center with limited access to flexible instruments. Materials and methods Patients treated for ureteral stones in years 2013–2016 were retrospectively reviewed. All procedures performed after stone relocation were counted. Final stone status was determined by ultrasonography and radiography. Results Out of 75 patients with a stone relocated to the collecting system full follow-up was available for 66. In three patients (4%) the stone remained in the collecting system untreated. Seven patients (11%) passed their stones spontaneously. Active treatment was successful in 45 (68%), while it failed in 11 (17%) patients. Extracorporeal shock wave lithotripsy was used 132 times, semi-rigid ureteroscopy 21 times and percutaneous nephrolithotripsy 22 times – 175 procedures altogether (2.6 procedures/patient + accessory procedures such as JJ removal). Shockwave lithotripsy was effective in 7/41 patients, semi-rigid ureteroscopy in 18/21 and percutaneous nephrolithotripsy in 22/22 patients. Conclusions Treating small stones relocated from the ureter to the collecting system in centers not equipped with flexible endoscopes is inefficient, time-consuming or too invasive. Cost-effectiveness analysis should follow this study to obtain evidence for public health payers to change their policies.
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Affiliation(s)
- Ewa Bres-Niewada
- Medical University of Warsaw, Department of Urology, Warsaw, Poland
| | - Bartosz Dybowski
- Medical University of Warsaw, Department of Urology, Warsaw, Poland
| | - Piotr Zapała
- Medical University of Warsaw, Department of Urology, Warsaw, Poland
| | | | | | - Irmina Michałek
- Medical University of Warsaw, Department of Urology, Warsaw, Poland
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Iqbal N, Malik Y, Nadeem U, Khalid M, Pirzada A, Majeed M, Malik HA, Akhter S. Comparison of ureteroscopic pneumatic lithotripsy and extracorporeal shock wave lithotripsy for the management of proximal ureteral stones: A single center experience. Turk J Urol 2018; 44:221-227. [PMID: 29733796 PMCID: PMC5937642 DOI: 10.5152/tud.2018.41848] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 02/23/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate and compare the effectiveness of ureteroscopic (URS) pneumatic lithotripsy versus extracorporeal shock wave lithotripsy (ESWL) in the management of the proximal ureteral stones in terms of stone- free rates, complications and costs involved. MATERIAL AND METHODS We included 200 patients in Group 1 who underwent ESWL and 200 patients in Group 2 who underwent URS intervention. We used Modulith SL X lithotripter 3rd generation Storz medical for ESWL group while Swiss pneumatic lithoclast was used to break the stone in the URS group. Stone-free status was defined as stone fragment of less than 4 mm on follow- up kidney ureter and bladder X-ray after 3 months of procedure. SPSS version 16 was used for statistical analysis. RESULTS The mean age in ESWL and URS groups were 39.21±13.36, and 43.13±13.65 years respectively. Mean stone size was 10.47±3.7 mm (ESWL) and 13.6±6.6 mm (URS). Stone- free rate after single procedure was (125/200 patients) 62.5% for ESWL and (168/200 patients) 84% for URS group (p=0.001). Complications included post procedure sepsis in 3 (1.5%) patient of ESWL, while 7 (3.5%) patients of URS groups. Steinstrasse was seen in 4 (2%) patients of ESWL group. No mortality was seen in both groups. Mean costs for ESWL were US $320±50 while US $1100±150 for URS group (p=0.001). CONCLUSION The stone-free rates after single procedure were significantly higher for the URS group while the complication rates were comparable in both groups. Treatment costs were significantly lower for the ESWL group.
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Affiliation(s)
- Nadeem Iqbal
- Department of Urology, Shifa International Hospital Islamabad, Islamabad, Pakistan
| | | | | | | | | | - Mehr Majeed
- Shifa College of Medicine, Islamabad, Pakistan
| | | | - Saeed Akhter
- Department of Urology, Shifa International Hospital Islamabad, Islamabad, Pakistan
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Kallidonis P, Ntasiotis P, Knoll T, Sarica K, Papatsoris A, Somani BK, Greco F, Aboumarzouk OM, Álvarez-Maestro M, Sanguedolce F. Minimally Invasive Surgical Ureterolithotomy Versus Ureteroscopic Lithotripsy for Large Ureteric Stones: A Systematic Review and Meta-analysis of the Literature. Eur Urol Focus 2017; 3:554-566. [PMID: 28753887 DOI: 10.1016/j.euf.2017.04.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Revised: 03/28/2017] [Accepted: 04/07/2017] [Indexed: 11/26/2022]
Abstract
CONTEXT The management of large ureteric stones represents a technical and clinical challenge. OBJECTIVE To investigate the safety and efficacy of minimally invasive surgical ureterolithotomy (MISU) in comparison with ureteroscopic lithotripsy (URS) for the treatment of large ureteric stones. EVIDENCE ACQUISITION The Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guidelines were followed for the conduction of the study, which was registered in the PROSPERO database. Search string was "(laparoscop* OR retroperito* OR robot*) AND ureterolitho*"; database scope included PubMed, SCOPUS, Cochrane, and EMBASE. Primary end points were the stone-free (SFR) and complications rates. Secondary end points included operative time and hospital stay. Subgroup analyses were performed for stones 1-2 and >2cm, as well as different lithotripters and ureteroscopes. Meta-analysis and forest-plot diagrams were performed with the RevMan 5.3.5 software. EVIDENCE SYNTHESIS After screening 673 publications, seven randomized controlled trials were eligible to be included in the meta-analysis. A total of 778 patients were pooled after the elimination of the dropouts. No robotic cohorts were found. Only upper ureteral stones were treated in the included studies. The SFR at discharge and 3 mo was higher with MISU with odds ratios of 6.30 (95% confidence interval [CI]: 3.05, 13.01; I2=0%) and 5.34 (95% CI: 2.41, 8.81; I2=0%), respectively. The most common complications for MISU and URS were conversion to open surgery and stone migration to the renal pelvis, respectively. Favorable results in terms of operative time were observed in the case of URS with a mean difference of 29.5min (95% CI: 14.74, 44.26; I2=98%). Hospitalization time was favorable in the case of URS with a mean difference of 2.08 days (95% CI: 0.96, 3.20; I2=99%). CONCLUSIONS This meta-analysis showed a significantly higher SFR at discharge and 3 mo for MISU in comparison with URS when upper ureteral stones were treated. Operative and hospitalization time favored URS over MISU. PATIENT SUMMARY The current study investigated the literature on the minimally invasive management of large ureteric stones. The available evidence shows that both ureteroscopic lithotripsy and minimally invasive surgical ureterolithotomy could be considered for the treatment of these stones with similar results. The selection of the approach should be based on the advantages and disadvantages of each technique.
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Affiliation(s)
| | | | - Thomas Knoll
- Department of Urology, Klinikum Sindelfingen-Böblingen, University of Tübingen, Sindelfingen, Germany
| | - Kemal Sarica
- Department of Urology, Dr Lufti Kirdar Kartal Research and Training Hospital, Istanbul, Turkey
| | | | - Bhaskar K Somani
- Department of Urology, University Hospital Southampton, Southampton, Wessex, UK
| | - Francesco Greco
- Department of Urology and Minimal Invasive Surgery, Romolo Hospital, Crotone, Italy
| | | | | | - Francesco Sanguedolce
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Spain; Department of Urology, King's College London, King's College Hospital, UK
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