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Huang X, He X, Zhai Q, Song L, Du C, Deng X. Ureteroscopic lithotripsy with pressure-measuring ureteral access sheath for large ureteral stones. MINIM INVASIV THER 2024; 33:157-162. [PMID: 38258834 DOI: 10.1080/13645706.2024.2306813] [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: 10/30/2023] [Accepted: 12/30/2023] [Indexed: 01/24/2024]
Abstract
INTRODUCTION To evaluate the safety and efficacy of ureteroscopic lithotripsy with pressure-measuring ureteral access sheath (PM-UAS) for large ureteral stones. MATERIAL AND METHODS A total of 258 consecutive patients with large ureteral stones ≥15 mm was enrolled. They were treated by ureteroscopic lithotripsy with PM-UAS in the oblique supine lithotomy position. The technology can precisely monitor and automatically control cavity pressure. The cavity pressure control value was set at -15 mmHg∼-5 mmHg. The cavity pressure limit value was set at 30 mmHg. Infusion flow rate was set at 100-200 ml/min. Postoperative data such as stone-free rate and complications were analyzed. RESULTS PM-UAS was successfully implanted in 225 patients at one stage. Eighteen cases of patients who had failed the first surgery were successfully treated with a second operation. Fifty-one cases with stones migrating up to the kidney were converted to flexible lithotripsy. The other 15 cases were converted to percutaneous nephrolithotomy due to significant ureteral stenosis. The operative time was 49.5 ± 11.2 min. The stone-free rates after one month and three months were 87.2% (212/243) and 94.2% (229/243), respectively. Complications from grade I to II were observed in 25(10.3%) patients. No other complications from grade III to V were noted. CONCLUSION The ureteroscopic lithotripsy with PM-UAS is safe and efficacious for large ureteral stones.
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Affiliation(s)
- Xin Huang
- Department of Urology, Ganzhou People's Hospital, Ganzhou, Jiangxi, China
| | - Xiaolong He
- Department of Urology, Ganzhou People's Hospital, Ganzhou, Jiangxi, China
| | - Qiliang Zhai
- Department of Urology, Ganzhou People's Hospital, Ganzhou, Jiangxi, China
| | - Leming Song
- Department of Urology, Ganzhou People's Hospital, Ganzhou, Jiangxi, China
| | - Chuance Du
- Department of Urology, Ganzhou People's Hospital, Ganzhou, Jiangxi, China
| | - Xiaolin Deng
- Department of Urology, Ganzhou People's Hospital, Ganzhou, Jiangxi, China
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Comparison of laparoscopic ureterolithotomy and retrograde lithotripsy in the treatment of proximal ureteral stones. ACTA BIOMEDICA SCIENTIFICA 2022. [DOI: 10.29413/abs.2022-7.4.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The current approach in the surgical treatment of ureteral calculi involves the use of endourological procedures such as retrograde ureteroscopy with lithotripsy or percutaneous antegrade lithotripsy in the proximal ureter. Ureterolithotomy as a treatment method is of an auxiliary nature and is used when endourological intervention is impossible or in case of intraoperative collisions during access conversion. However, there are several comparative studies on lithotripsy and lithotomy.The aim. Comparative analysis of the outcomes of laparoscopic lithotomy and retrograde lithotripsy in the surgical treatment of proximal ureteral calculi, as well as the search for predictors of prolonged disability.Materials and methods. A prospective randomized multicenter study included 53 patients with an established diagnosis of ureterolithiasis who were treated in the period 2018–2021 in urological hospitals in Irkutsk. All patients were divided into two comparison groups: Lithotomy group (group 1; n = 30) and Lithotripsy group (group 2; n = 23).Results. When analyzing the results of the study, it was found that the level of complications of class II–III according to Clavien – Dindo was statistically comparable in both groups (p > 0.05). However, in absolute and relative terms, the prevalence of this indicator was noted during retrograde ureterolithotripsy. According to hard endpoints (reoperation, presence of residual stones or migration during the operation), 29 (96.6 %) patients of group 1 and 17 (73.4 %) patients of group 2 (p = 0.514) were successfully operated on.Conclusion. Laparoscopic ureterolithotomy may be offered to patients with large proximal ureteral stones as an alternative treatment option with better residual stone freedom but generally similar overall outcomes and complication rates.
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Huang Z, Yang T, Shao L, Yang B, Wang G, Li P, Yang S, Li J. Comparison of Transperitoneal and Retroperitoneal Laparoscopic Ureterolithotomy: A Meta-Analysis. Urol Int 2022:1-7. [DOI: 10.1159/000522103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 04/30/2021] [Indexed: 11/19/2022]
Abstract
<b><i>Purpose:</i></b> The aim of this study was to evaluate the efficacy and safety of transperitoneal and retroperitoneal laparoscopic ureterolithotomy (TLU and RLU). <b><i>Materials and Methods:</i></b> We undertook a literature search PubMed, Embase, and the Cochrane Library. Search date will range from inception to January 1, 2020. The final article results will be analyzed using StataSE 12 software. This meta-analysis was reported according to PRISMA guidelines, and a protocol was registered in PROSPERO (CRD42020160906). <b><i>Results:</i></b> Eleven articles eventually met the requirements, involving a total of 609 patients. The final result shows the operative time (Std. Mean Difference [SMD] = 0.58; 95% CI 0.36–0.80; <i>p</i> < 0.01), hospital stay (SMD = 0.26; 95% CI 0.02–0.49; <i>p</i> = 0.031), and the complication of paralytic ileus (risk difference = 0.11; 95% CI 0.05–0.17; <i>p</i> < 0.01) are significant difference between TLU and RLU, and TLU are higher or longer. <b><i>Conclusions:</i></b> Our meta-analysis suggests that if there are no other constraints, it is better to choose RLU. And more clinical trial data are needed to confirm this conclusion.
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The reasons of unsatisfactory results of extracorporeal shock wave lithotripsy in patients with ureterolithiasis. EUREKA: HEALTH SCIENCES 2021. [DOI: 10.21303/2504-5679.2021.001797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The article dedicate to the problem of failure of extracorporeal shockwave lithotripsy in patients with ureterolithiasis and reveal the changes which appear in the ureter in the location of the stone.The aim. Analysis of the results of treatment in patients, suffering ureteric stones, using the ureterolithotripsy procedure after failure extracorporeal shockwave lithotripsy.
Materials and methods. In 137 patients with ureteric stones, whom ureterolithotripsy procedure after failure extracorporeal shockwave lithotripsy was conducted, the symptoms of the disease, the diagnostic methods value, efficacy of surgical treatment and reasons of the failure of previous method of treatment were analyzed.
Results. In 135 patients endoscopic removal of stones has been succeeded, in 2 patients because of total obliteration of the ureter, uretero-ureteral anastomosis has been performed. If the symptoms, with are characteristic of ureterolithiasis, persists up to one week stones don’t cause significant macroscopic changes to the ureter wall. If the stone persists in the ureter longer than a week we identified local appearing of oedema. Long–term (more than two months) ureteric stone persistence increase the risk of intramucosal “ingrowth” of the calculi greatly.
Conclusion. The URS and ESWL are high effective and minimal invasive methods of surgical intervention for patients with ureterolithiasis, guaranteeing high level of postoperative “stone free rate”. Prolongation of the stone insertion time in the ureter causes the ureteric wall changes, complicating performance of minimal invasive interventions (ureterolithotripsy and extracorporeal shock–wave lithotripsy) and reduce its efficacy.
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Sharma G, Pareek T, Tyagi S, Kaundal P, Yadav AK, Thummala Y, Devana SK. Comparison of efficacy and safety of various management options for large upper ureteric stones a systematic review and network meta-analysis. Sci Rep 2021; 11:11811. [PMID: 34083725 PMCID: PMC8175352 DOI: 10.1038/s41598-021-91364-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 05/24/2021] [Indexed: 12/23/2022] Open
Abstract
To compare the safety and efficacy of various surgical modalities to manage large (> 1 cm) upper ureter stones. Systematic literature search was conducted to include all randomized studies comparing various treatment options for large (> 1 cm) upper ureteric stones. This review included 13 randomized studies with 1871 patients. Laparoscopic ureterolithotomy (LUL) and percutaneous nephrolithotomy (PNL) were superior to ureteroscopy (URS) and shockwave lithotripsy (SWL) for stone-free rates and need for auxiliary treatments. LUL and PNL were equally effective for stone-free rates and the need for auxiliary treatments. According to SUCRA values for stone-free rates and the need for auxiliary treatments, LUL was the best, followed by PNL. For the duration of surgery, there was no significant difference among all the techniques on network analyses, and SWL was the best according to SUCRA values. Length of hospital stay was significantly shorter for URS than LUL and PNL from network analysis, but there was no significant difference for the rest of the comparisons. Overall complications were similar in all the groups. According to the CINeMa approach, the confidence rating ranged from “very low” to “moderate” for various comparisons. LUL followed by PNL is the most efficacious treatment modality for upper ureteric stones compared to SWL and URS in terms of stone-free rates. However, due to the poor quality of included studies, further high-quality randomized studies are needed.
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Affiliation(s)
- Gopal Sharma
- Department of Urology, Advanced Urology Center, Postgraduate Institute of Medical Education and Research (PGIMER), Level II, B Block, Sector 12, Chandigarh, 160012, India
| | - Tarun Pareek
- Department of Urology, Advanced Urology Center, Postgraduate Institute of Medical Education and Research (PGIMER), Level II, B Block, Sector 12, Chandigarh, 160012, India
| | - Shantanu Tyagi
- Department of Urology, Advanced Urology Center, Postgraduate Institute of Medical Education and Research (PGIMER), Level II, B Block, Sector 12, Chandigarh, 160012, India
| | - Pawan Kaundal
- Department of Urology, Advanced Urology Center, Postgraduate Institute of Medical Education and Research (PGIMER), Level II, B Block, Sector 12, Chandigarh, 160012, India
| | - Anuj Kumar Yadav
- Department of Urology, Advanced Urology Center, Postgraduate Institute of Medical Education and Research (PGIMER), Level II, B Block, Sector 12, Chandigarh, 160012, India
| | - Yashasvi Thummala
- Department of Urology, Advanced Urology Center, Postgraduate Institute of Medical Education and Research (PGIMER), Level II, B Block, Sector 12, Chandigarh, 160012, India
| | - Sudheer Kumar Devana
- Department of Urology, Advanced Urology Center, Postgraduate Institute of Medical Education and Research (PGIMER), Level II, B Block, Sector 12, Chandigarh, 160012, India.
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Abdel Raheem A, Alowidah I, Hagras A, Gameel T, Ghaith A, Elghiaty A, Althakafi S, Al-Mousa M, Alturki M. Laparoscopic ureterolithotomy for large proximal ureteric stones: Surgical technique, outcomes and literature review. Asian J Endosc Surg 2021; 14:241-249. [PMID: 32875735 DOI: 10.1111/ases.12861] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/17/2020] [Accepted: 08/16/2020] [Indexed: 12/23/2022]
Abstract
INTRODUCTION We evaluated the efficacy and safety of laparoscopic ureterolithotomy (LPU) for the treatment of large proximal ureteric stone. METHODS A retrospective multicenter analysis for patients with solitary impacted proximal ureteric stone ≥15 mm who underwent LPU from 2016 to 2019 was performed. Primary outcome was to estimate the stone-free rate (SFR). SFR was defined as absence of residual stones on postoperative computed tomography scan. Secondary outcome was to assess the perioperative outcomes, as well as to review literature data of randomized controlled trials and meta-analyses comparing LPU to other treatment options. RESULTS Forty-four patients were included in our study. Mean stone size was 22.9 ± 5.8 mm and median follow-up was 14 months. Three patients had previous abdominal surgery, one patient had severe degree of scoliosis and six patients failed primary therapy. All stones were extracted successfully (SFR = 100%) without need of auxiliary treatments. Mean operative time and estimated blood loss were 86.6 ± 14.1 minutes. and 11.9 ± 14.7 mL, respectively. No intraoperative complications or conversion to open surgery were reported. No major postoperative complications (≥grade 3) were reported. Mean length of hospital stay was 2 ± 0.8 days. CONCLUSIONS For treatment of large ureteric stones, our study showed that LPU achieves 100% stone-free status. When performed by well-trained laparoscopic surgeons, it is safe and has no major perioperative complications. According to our results and literature data, when counseling patients with large impacted proximal ureteral stones, LPU should be advised as the procedure that has the higher SFR, lower auxiliary treatments, and comparable complication rates to other treatments.
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Affiliation(s)
- Ali Abdel Raheem
- Department of Urology, King Saud Medical City, Riyadh, Saudi Arabia.,Department of Urology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Ibrahim Alowidah
- Department of Urology, King Saud Medical City, Riyadh, Saudi Arabia
| | - Ayman Hagras
- Department of Urology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Tarek Gameel
- Department of Urology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Ahmed Ghaith
- Department of Urology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Ahmed Elghiaty
- Department of Urology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Sultan Althakafi
- Department of Urology, King Saud Medical City, Riyadh, Saudi Arabia
| | | | - Mohammed Alturki
- Department of Urology, King Saud Medical City, Riyadh, Saudi Arabia
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Comparison of mini-percutaneous nephrolithotomy and retroperitoneal laparoscopic ureterolithotomy for treatment of impacted proximal ureteral stones greater than 15 mm. Chin Med J (Engl) 2021; 134:1209-1214. [PMID: 33813518 PMCID: PMC8143756 DOI: 10.1097/cm9.0000000000001417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The optimal treatment for large impacted proximal ureteral stones remains controversial. The aim of this study was to evaluate the efficacy, safety, and potential complications of mini-percutaneous nephrolithotomy (MPCNL) and retroperitoneal laparoscopic ureterolithotomy (RPLU) in the treatment of impacted proximal ureteral stones with size greater than 15 mm. METHODS A total of 268 patients with impacted proximal ureteral stones greater than 15 mm who received MPCNL or RPLU procedures were enrolled consecutively between January 2014 and January 2019. Data on surgical outcomes and complications were collected and analyzed. RESULTS Demographic and ureteral stone characteristics found between these two groups were not significantly different. The surgical success rate (139/142, 97.9% vs. 121/126, 96.0%, P = 0.595) and stone-free rate after 1 month (139/142, 97.9% vs. 119/126, 94.4%, P = 0.245) of RPLU group were marginally higher than that of the MPCNL group, but there was no significant difference. There was no significant difference in the drop of hemoglobin between the two groups (0.8 ± 0.6 vs. 0.4 ± 0. 2 g/dL, P = 0.621). The mean operative time (68.2 ± 12.5 vs. 87.2 ± 16.8 min, P = 0.041), post-operative analgesics usage (2/121, 1.7% vs. 13/139, 9.4%, P = 0.017), length of hospital stay after surgery (2.2 ± 0.6 vs. 4.8 ± 0.9 days, P < 0.001), double J stent time (3.2 ± 0.5 vs. 3.9 ± 0.8 days, P = 0.027), time of catheterization (1.1 ± 0.3 vs. 3.5 ± 0.5 days, P < 0.001), and time of drainage tube (2.3 ± 0.3 vs. 4.6 ± 0.6 days, P < 0.001) of MPCNL group were significantly shorter than that of the RPLU group. The complication rate was similar between the two groups (20/121, 16.5% vs. 31/139, 22.3%, P = 0.242). CONCLUSIONS MPCNL and RPLU have similar surgical success and stone clearance in treating impacted proximal ureteral stones greater than 15 mm, while patients undergoing MPCNL had a lower post-operative pain rate and a faster recovery.
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Chen H, Zhu Z, Cui Y, Li Y, Chen Z, Yang Z, Zeng F. Suctioning semirigid ureteroscopic lithotomy versus minimally invasive percutaneous nephrolithotomy for large upper ureteral stones: a retrospective study. Transl Androl Urol 2021; 10:1056-1063. [PMID: 33850740 PMCID: PMC8039583 DOI: 10.21037/tau-20-1218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background To compare the safety and validity of a suctioning semirigid ureteroscopic lithotomy (Sotn-URSL) and minimally percutaneous nephrolithotomy (mPCNL) in treating upper ureteral stone larger than 15 mm. Methods Between February 2018 and December 2019, 97 patients who had upper ureteral stone >15 mm were consecutively included in this study. Forty-six patients underwent Sotn-URSL and 51 underwent mPCNL by the same surgeon. The following parameters were retrospectively assessed: patient and stone characteristics, surgical details, perioperative outcomes, and stone-free rates (SFRs). Results No significant difference was observed in two groups for patient and stone characteristics, except that mPCNL group had a higher incidence of severe hydronephrosis (19.6% vs. 41.2%, P=0.021). Sotn-URSL group was similar to mPCNL group in terms of the mean duration of surgery (50.5±5.9 vs. 52.9±8.0 min, P=0.106) and the SFR after 1 month (91.3% vs. 98%, P=0.187). The hospital stay after surgery of Sotn-URSL group was significant shorter than mPCNL group (1.4±0.6 vs. 2.3±0.7 days, P<0.001), and postoperative complications in Sotn-URSL group was less, especially postoperative pain (P=0.044). Conclusions Both mPCNL and Sotn-URSL are suitable for upper ureteral stones with a diameter of >15 mm. Nevertheless, further well-designed studies with long-term follow-up are needed to confirmed the results.
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Affiliation(s)
- Hequn Chen
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Zewu Zhu
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Yu Cui
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Yang Li
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Zhiyong Chen
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Zhongqing Yang
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Feng Zeng
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
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Taguchi K, Hamamoto S, Osaga S, Sugino T, Unno R, Ando R, Okada A, Yasui T. Comparison of antegrade and retrograde ureterolithotripsy for proximal ureteral stones: a systematic review and meta-analysis. Transl Androl Urol 2021; 10:1179-1191. [PMID: 33850753 PMCID: PMC8039618 DOI: 10.21037/tau-20-1296] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background Antegrade percutaneous ureterolithotripsy (URSL) could be a treatment option for large and/or impacted proximal ureteral stones, which are difficult to treat. To review the current approach and treatment outcomes and to compare the efficacy of retrograde and antegrade URSL for large proximal ureteral stones, we evaluated the unique perspectives of both surgical modalities. Methods This systematic literature review and meta-analysis was performed in July 2020. Articles on human studies and treatment of ureteral stones with URSL were extracted from the PubMed, MEDLINE, Embase, Cochrane Library, Scopus, and the Japan Medical Abstracts Society databases without any language restrictions. The risks of bias for randomized controlled trials (RCTs) and non-randomized controlled trials (non-RCTs) were assessed using the Cochrane risk of tool and the Risk of Bias in Non-randomized Studies- of Interventions tool, respectively. Results A total of 10 studies, including seven RCTs and three non-RCTs, were selected for the analysis; 433 and 420 cases underwent retrograde and antegrade URSL, respectively. The stone-free rate (SFR) was significantly higher in antegrade URSL than in retrograde URSL (SFR ratio: 1.17, 95% CI: 1.12-1.22; P<0.001), while the hospital stay was significantly longer in antegrade URSL than in retrograde URSL (standardized mean difference: 2.56, 95% CI: 0.67-4.46; P=0.008). There were no significant differences in the operation time and the overall complication rate between the two approaches. Conclusions Despite the heterogeneity of data and bias limitations, this latest evidence reflects real practice data, which may be useful for decision making.
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Affiliation(s)
- Kazumi Taguchi
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Shuzo Hamamoto
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Satoshi Osaga
- Clinical Research Management Center, Nagoya City University, Nagoya, Japan
| | - Teruaki Sugino
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Rei Unno
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Ryosuke Ando
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Atsushi Okada
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Takahiro Yasui
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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Wang Y, Chang X, Li J, Han Z. Efficacy and safety of various surgical treatments for proximal ureteral stone ≥10mm: A systematic review and network meta-analysis. Int Braz J Urol 2021; 46:902-926. [PMID: 32459455 PMCID: PMC7527111 DOI: 10.1590/s1677-5538.ibju.2019.0550] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 12/08/2019] [Indexed: 12/23/2022] Open
Abstract
Purpose Various surgical options are available for large proximal ureteral stones, such as extracorporeal shock wave lithotripsy (ESWL), ureteroscopic lithotripsy (URSL), percutaneous nephrolithotomy (PCNL) and laparoscopic ureterolithotomy (LU). However, the best option remains controversial. Therefore, we conducted a network meta-analysis comparing various surgical treatments for proximal ureteral stones ≥10mm to address current research deficiencies. Materials and methods We searched PubMed, Ovid, Scopus (up to June 2019), as well as citation lists to identify eligible comparative studies. All clinical studies including patients comparing surgical treatments for proximal ureteral stones ≥10mm were included. A standard network meta-analysis was performed with Stata SE 14 (Stata Corp, College Station, TX, USA) software to generate comparative statistics. The quality was assessed with level of evidence according to the Oxford Centre for Evidence-based Medicine and risk of bias with the Cochrane Collaboration’s Review Manager (RevMan) 5.3 software. Results A total of 25 studies including 2.888 patients were included in this network meta-analysis. Network meta-analyses indicated that LU and PCNL had better stone-free rates and auxiliary procedures. PCNL could result in major complications and severe bleeding. In initial stone-free rate, final stone-free rate, and auxiliary procedures results, SUCRA ranking was: LU> PCNL> URSL> ESWL. In Clavien Dindo score ≥3 complications, SUCRA ranking was: LU> ESWL> URSL> PCNL. In fever, SUCRA ranking was: ESWL> LU> URSL> PCNL. In transfusion, SUCRA ranking was: LU> URSL> ESWL> PCNL. In Cluster analysis, LU had the highest advantages and acceptable side effects. Considering the traumatic nature of PCNL, it should not be an option over URSL. ESWL had the lowest advantages. Conclusions LU have the potential to be considered as the first treatment choice of proximal ureteral stone ≥10mm.
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Affiliation(s)
- Yaxuan Wang
- Department of Urology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xueliang Chang
- Department of Urology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jingdong Li
- Department of Urology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhenwei Han
- Department of Urology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
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Affiliation(s)
- Fábio C M Torricelli
- Divisão de Urologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
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Lai S, Jiao B, Diao T, Seery S, Hu M, Wang M, Hou H, Wang J, Zhang G, Liu M. Optimal management of large proximal ureteral stones (>10 mm): A systematic review and meta-analysis of 12 randomized controlled trials. Int J Surg 2020; 80:205-217. [PMID: 32622059 DOI: 10.1016/j.ijsu.2020.06.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 06/10/2020] [Accepted: 06/13/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To develop an evidence base to guide clinicians treating adults with large proximal ureteral stones (LPUS) greater than 10 mm. METHODS A systematic search of PubMed, EMBASE, and Cochrane Library was conducted to identify randomized controlled trials (RCT) concerning different LPUS management techniques including laparoscopic ureterolithotomy (LU), percutaneous nephrolithotomy (PCNL) and ureteroscopic lithotripsy (URL) up until March 2020. We followed the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement when searching and determining inclusion. All included articles were quality assessed and the data analyses were conducted with Review Manager (5.3). RESULTS 12 RCTs involving 1416 patients met our eligibility criteria and were analyzed. Of these participants, 44.6% (n = 632) underwent URL, 25.5% (n = 361) PCNL, and 29.9% (n = 423) LU. Pooled analysis revealed that URL had a significantly lower stone-free rate (SFR) compared to PCNL and LU (both with p < 0.05). URL had a significantly higher ureteral injury rate compared to LU (Relative risk (RR) = 5.27, 95% confidence interval (CI) 1.52 to 18.22, p = 0.009) and PCNL (RR = 4.11, 95% CI 1.03 to 16.34, p = 0.04). However, no significant differences were found between PCNL and LU in terms of SFR or overall complications, both with p > 0.05. URL initially costs less than PCNL (Weighted mean difference (WMD) -597.35US$, 95% CI -823.10 to -371.60, p < 0.00001), but being less effective creates greater demand for repeat or ancillary treatments compared to LU (RR 15.65, 95% CI 2.11-116.12, p = 0.007) and PCNL (RR 8.86; 95% CI 3.19-24.60; p < 0.00001). CONCLUSIONS Both PCNL and LU appear more effective and safer than URL for LPUS; although, LU has higher risk of urine leakage and is more likely incur trauma which requires additional support. However, caution must be taken because this recommendation is based upon a very limited number of clinical studies, and even fewer comparing flexible ureteroscopic technologies. Further prospective real-world studies or RCTs comparing flexible URL, LU and PCNL are required, as well as an in depth analysis of the hidden costs involved in unsuccessful URL treatments.
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Affiliation(s)
- Shicong Lai
- Department of Urology, Beijing Hospital, Beijing, 100730, China; National Center of Gerontology, Beijing, 100730, China; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China; Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Binbin Jiao
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China; Department of Urology, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Tongxiang Diao
- Department of Urology, Beijing Hospital, Beijing, 100730, China; National Center of Gerontology, Beijing, 100730, China; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China; Peking University Fifth School of Clinical Medicine, China
| | - Samuel Seery
- School of Humanities and Social Sciences, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Maolin Hu
- Department of Urology, Beijing Hospital, Beijing, 100730, China; National Center of Gerontology, Beijing, 100730, China; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China; Peking University Fifth School of Clinical Medicine, China
| | - Miao Wang
- Department of Urology, Beijing Hospital, Beijing, 100730, China; National Center of Gerontology, Beijing, 100730, China; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China; Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Huimin Hou
- Department of Urology, Beijing Hospital, Beijing, 100730, China; National Center of Gerontology, Beijing, 100730, China; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Jianye Wang
- Department of Urology, Beijing Hospital, Beijing, 100730, China; National Center of Gerontology, Beijing, 100730, China; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China; Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China.
| | - Guan Zhang
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China; Department of Urology, China-Japan Friendship Hospital, Beijing, 100029, China.
| | - Ming Liu
- Department of Urology, Beijing Hospital, Beijing, 100730, China; National Center of Gerontology, Beijing, 100730, China; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China; Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China.
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Ali AI, Abdel-Karim AM, Abd El Latif AA, Eldakhakhny A, Galal EM, Anwar AZ, El-Hawy MM, Fathelbab TKH, Elbadry MS, Elsharkawy MS, Tawfiek ER. Stone-free rate after semirigid ureteroscopy with holmium laser lithotripsy versus laparoscopic ureterolithotomy for upper ureteral calculi: a multicenter study. AFRICAN JOURNAL OF UROLOGY 2019. [DOI: 10.1186/s12301-019-0003-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Different treatment options were used to treat upper ureteral calculi. The aim of our study is to compare the stone-free rate and postoperative outcomes between semirigid ureteroscope with holmium laser lithotripsy and laparoscopic ureterolithotomy for the management of large solitary upper ureteral stones. Sixty-seven patients with a solitary upper ureteral stone who had LU or semirigid ureteroscopy in the period between January 2014 and March 2017 were included in our study. Out of the sixty-seven patients, 37 patients had semirigid ureteroscopy and holmium laser lithotripsy (Group A) and 30 patients had laparoscopic ureterolithotomy (Group B). Both groups were compared regarding operative time, intraoperative complications, need for auxiliary procedures, hospital stays, postoperative complications and stone-free rate.
Results
The mean stone size was 1.84 ± 0.12 cm in Group A and 1.79 ± 0.17 cm in Group B, P value = 0.2. The mean operative time was 61.5 ± 3.5 min in Group A and 63 ± 4.2 min in Group B, P value = 0.13. Stone migration was recorded in five cases (14%) in Group A while no cases in Group B had stone migration. Flexible ureteroscope was used as an auxiliary measure in five patients (14%) in Group A at the same session. No auxiliary measures were used in the LU group.
Conclusion
The stone-free rates after semirigid URS and laser lithotripsy are comparable to those following LU, especially when flexible URS is used to manage migrating stone fragments at the same session.
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Li J, Chang X, Wang Y, Han Z. Laparoscopic ureterolithotomy versus ureteroscopic laser lithotripsy for large proximal ureteral stones: a systematic review and meta-analysis. MINERVA UROL NEFROL 2019; 72:30-37. [PMID: 31692305 DOI: 10.23736/s0393-2249.19.03557-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION To review current studies and conduct a meta-analysis on the topic of laparoscopic ureterolithotomy (LU) versus ureteroscopic lithotripsy (URSL) with holmium laser for large proximal ureteral stones. EVIDENCE ACQUISITION A systematic research of PubMed, Ovid, Scopus (up to March 2019), and citation lists was performed to identify eligible comparative studies. All studies comparing LU versus URSL with holmium laser in proximal ureteral stones were included. Statistical analyses were performed using the Cochrane Collaboration's Review Manager (RevMan) 5.3 software. EVIDENCE SYNTHESIS Overall, seven studies were included in analysis involving 884 patients (LU 387; URSL 497). Our meta-analysis showed that LU group had bigger stone size than URSL group (WMD 0.19 cm; P=0.001). LU group was associated with longer operative time (WMD 36.29 min; P<0.001), and length of hospital stay (WMD 1.24 d; P=0.04). However, LU group showed better initial stone-free rate (OR 11.03; P<0.001), and final stone-free rate (OR 22.37; P<0.001). There were no significant differences in all complications (RR 1.06; P=0.76). While, LU group had fewer Clavien Dindo score ≥3 complications (RR 0.21; P=0.002), fewer ureteral stricture (RR 0.26; P=0.04), and lower need of auxiliary procedures (RR 0.09; P<0.001) compared with URSL group. CONCLUSIONS LU could provide a higher stone-free rate and fewer severe complications compared with URSL with holmium laser for large proximal ureteral stones. More importantly, LU could also reduce the postoperative ureteral stricture rate.
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Affiliation(s)
- Jingdong Li
- Department of Urology, the 2nd Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xueliang Chang
- Department of Urology, the 2nd Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yaxuan Wang
- Department of Urology, the 2nd Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhenwei Han
- Department of Urology, the 2nd Hospital of Hebei Medical University, Shijiazhuang, China -
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Choi JD, Seo SI, Kwon J, Kim BS. Laparoscopic Ureterolithotomy vs Ureteroscopic Lithotripsy for Large Ureteral Stones. JSLS 2019; 23:JSLS.2019.00008. [PMID: 31223226 PMCID: PMC6565372 DOI: 10.4293/jsls.2019.00008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background and Objectives: The purpose of this study was to compare two methods (transperitoneal laparoscopic ureterolithotomy [TLU] and a combination of ureteroscopic lithotripsy [UL] with retrograde intrarenal surgery [RIRS]) designed for the treatment of large proximal ureteral calculi so that their associated complications and stone-free rates could be assessed. Methods: A total of 100 patients from three different hospitals who were diagnosed with large upper ureteral stones (≥15 mm) were treated via TLU (n = 48) or UL-RIRS (n = 52). They were treated between March 2012 and May 2014. The study compared the complications, success rate, patient characteristics, and the operation time between the two groups. Results: The immediate stone clearance rate after a single session was higher in the TLU group than in the UL-RIRS group (100% vs 73.1%, P = .005). However, there was no significant difference in the stone-free rates between the two groups three months after the last procedure was performed (100% vs 96.1%, P = .655). Regarding patients with a history of early-failure extracorporeal shock-wave lithotripsy, there was no significant difference in the stone-free rate between the two groups three months after the last procedure (100% vs 94.4%, P > .05). Further, overall complication rates between the groups were not statistically different (P = .261). Conclusion: This study demonstrates that TLU is an effective and safe procedure to treat large impacted upper ureteral stones. When compared to UL-RIRS, TLU showed equivalent efficacy and safety, though there were failed first-line treatments.
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Affiliation(s)
- Jae Duck Choi
- Department of Urology, Eulji General Hospital, Eulji University School of Medicine, Seoul, South Korea
| | - Seong Il Seo
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Joonbeom Kwon
- Department of Urology, Daegu Fatima Hospital, Daegu, South Korea
| | - Bum Soo Kim
- Department of Urology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
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16
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Hu H, Xu L, Wang S, Yu X, Yang H, Peng E, Cui L, Li C. Ureteral stricture formation after removal of proximal ureteral stone: retroperitoneal laparoscopic ureterolithotomy versus ureteroscopy with holmium: YAG laser lithotripsy. PeerJ 2017; 5:e3483. [PMID: 28674654 PMCID: PMC5494178 DOI: 10.7717/peerj.3483] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 05/31/2017] [Indexed: 12/23/2022] Open
Abstract
Objective To compare the risk of postoperative ureteral stricture formation following retroperitoneal laparoscopic ureterolithotomy (RPLU) and ureteroscopy with holmium: YAG laser lithotripsy (URSL) in patients with proximal ureteral stones. Materials and Methods We retrospectively reviewed the medical records of patients who underwent RPLU or URSL for proximal ureteral stones between April 2011 and May 2015. Patients were allocated into URSL group or RPLU group and the outcomes were compared. Results A total of 201 patients who underwent 209 procedures including 159 URSL and 50 RPLU with a median follow-up of 30 months were included. No significant difference was observed among the two groups in most baseline parameters, while the stone size was significantly larger in the RPLU group (11.37 ± 2.97 vs 14.04 ± 4.38 mm, p = 0.000). Patients in RPLU group had markedly longer operative time (p = 0.000) and longer postoperative hospital stay (p = 0.000). The initial and one-month stone-free rates were significantly higher in the RPLU group (78.6% vs 100%, p = 0.000 and 82.4% vs 100%, p = 0.001, respectively). Patients in the RPLU had a higher complication rate (18.0% vs 9.4%, p = 0.098) and lower ureteral stricture rate (2.5% vs 2.0%, p = 1.000), while the difference was not significant. Further logistic regression model identified RPLU and female sex as independent risk factors for postoperative complication (Odds Ratio[OR] = 3.57, p = 0.035 and OR = 3.57, p = 0.025, respectively); however, URSL was not an independent risk factor for the formation of postoperative ureteral stricture after adjusting confounding variables (OR = 0.90, p = 0.935). Conclusion RPLU and URSL have similar postoperative ureteral stricture formation risks. RPLU can provide significantly higher stone clearance rate, but relates with more postoperative complications.
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Affiliation(s)
- Henglong Hu
- Department and Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Lu Xu
- Department and Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Shaogang Wang
- Department and Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Xiao Yu
- Department and Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Huan Yang
- Department and Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Ejun Peng
- Department and Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Lei Cui
- Department and Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Cong Li
- Department and Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
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Wang Y, Zhong B, Yang X, Wang G, Hou P, Meng J. Comparison of the efficacy and safety of URSL, RPLU, and MPCNL for treatment of large upper impacted ureteral stones: a randomized controlled trial. BMC Urol 2017; 17:50. [PMID: 28662708 PMCID: PMC5492714 DOI: 10.1186/s12894-017-0236-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 06/12/2017] [Indexed: 12/11/2022] Open
Abstract
Background There are three minimally invasive methods for the management of large upper impacted ureteral stones: mini-percutaneous nephrolithotomy (MPCNL), transurethral ureteroscope lithotripsy (URSL), and retroperitoneal laparoscopic ureterolithotomy (RPLU). This study aimed to compare MPCNL, URSL, and RPLU, and to evaluate which one is the best choice for large upper impacted ureteral stones. Methods Between January 2012 and December 2015, at the Department of Urology, Huai’an First People’s Hospital, 150 consecutively enrolled patients with a large upper impacted ureteral stone (>15 mm) were included. The patients were randomly divided (1:1:1) into the MPCNL, URSL, and RPLU groups. The primary endpoint was success of stone removal measured 1 month postoperatively and the secondary endpoints were intraoperative and postoperative parameters and complications. Results Fifteen patients needed auxiliary ESWL after URSL, and 3 patients after MPCNL, but none after RPLU. The stone clearance rate was 96% (48/50) in the MPCNL group and 72% (33/46) in the URSL group. In the RPLU group the stones were completely removed and the stone clearance rate was 100% (48/48) (P = 0.021 vs. URSL; P = 0.083 vs. MPCNL). Operation-related complications were similar among the three groups (all P > 0.05). Hospital stay was shorter in the URSL group compared with MPCNL (P = 0.003). Operation time was the shortest with URSL and the longest with MPCNL (all P < 0.05). Conclusions MPCNL and RPUL are more suitable for upper ureteral impacted stones of >15 mm. URSL could be considered if the patient is not suitable for general anesthesia, or the patient requests transurethral uretroscopic surgery. Trial registration This study was registered with the Chinese Clinical Trial Registry (Registration number: ChiCTR-INR-17011507; Registration date: 2017–5-22).
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Affiliation(s)
- Yunyan Wang
- Department of Urology, Huai'an First People's Hospital, Nanjing Medical University, No. 6 West Beijing Road, Huai'an, Jiangsu, 223300, China
| | - Bing Zhong
- Department of Urology, Huai'an First People's Hospital, Nanjing Medical University, No. 6 West Beijing Road, Huai'an, Jiangsu, 223300, China
| | - Xiaosong Yang
- Department of Urology, Huai'an First People's Hospital, Nanjing Medical University, No. 6 West Beijing Road, Huai'an, Jiangsu, 223300, China
| | - Gongcheng Wang
- Department of Urology, Huai'an First People's Hospital, Nanjing Medical University, No. 6 West Beijing Road, Huai'an, Jiangsu, 223300, China
| | - Peijin Hou
- Department of Urology, Huai'an First People's Hospital, Nanjing Medical University, No. 6 West Beijing Road, Huai'an, Jiangsu, 223300, China
| | - Junsong Meng
- Department of Urology, Huai'an First People's Hospital, Nanjing Medical University, No. 6 West Beijing Road, Huai'an, Jiangsu, 223300, China.
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Kim JY, Kang SH, Cheon J, Lee JG, Kim JJ, Kang SG. The usefulness of flexible cystoscopy for preventing double-J stent malposition after laparoscopic ureterolithotomy. BMC Urol 2017; 17:44. [PMID: 28619091 PMCID: PMC5472879 DOI: 10.1186/s12894-017-0232-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 06/01/2017] [Indexed: 12/23/2022] Open
Abstract
Background The aim of this study was to evaluate the role of flexible cystoscopy in preventing malpositioning of the ureteral stent after laparoscopic ureterolithotomy in male patients. Methods From April 2009 to June 2015, 97 male patients with stones >1.8 cm in the upper ureter underwent intracorporeal double-J stenting of the ureter after laparoscopic ureterolithotomy performed by four different surgeons. In the last 50 patients who underwent laparoscopic ureterolithotomy flexible cystoscopy was performed through the urethral route to confirm the position of the double-J stent, while in the first 47 correct positioning of the stent was confirmed through postoperative KUB. The demographic data and perioperative outcomes were reviewed retrospectively. Penalized logistic regression analysis was used to evaluate the effects of flexible cystoscopy. Results Upward malpositioning of the ureteral stent was found in 9 of the 47 (19.1%) patients who underwent surgery without flexible cystoscopy. Among the 50 most recent patients who underwent surgery with flexible cystoscopy through the urethral route, upward malpositioning was observed in 10 (20%) patients. The factors preventing upward malpositioning of the double-J catheter in multivariate analysis were surgeon (p = 0.039) and use of flexible cystoscopy (p = 0.008). Conclusion Flexible cystoscopy is a simple, safe, quick, and effective method to identify and correct malpositioning of double-J stents, especially in male patients. Trial registration This study was registered with ClinicalTrials.gov Registry on May 11, 2017 (retrospective registration) with a trial registration number of NCT03150446. Electronic supplementary material The online version of this article (doi:10.1186/s12894-017-0232-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jae-Yoon Kim
- Department of Urology, Korea University College of Medicine, 73 Inchon-Ro, Sungbuk-gu, Seoul, 136-705, Republic of Korea
| | - Seok-Ho Kang
- Department of Urology, Korea University College of Medicine, 73 Inchon-Ro, Sungbuk-gu, Seoul, 136-705, Republic of Korea
| | - Jun Cheon
- Department of Urology, Korea University College of Medicine, 73 Inchon-Ro, Sungbuk-gu, Seoul, 136-705, Republic of Korea
| | - Jeong-Gu Lee
- Department of Urology, Korea University College of Medicine, 73 Inchon-Ro, Sungbuk-gu, Seoul, 136-705, Republic of Korea
| | - Je-Jong Kim
- Department of Urology, Korea University College of Medicine, 73 Inchon-Ro, Sungbuk-gu, Seoul, 136-705, Republic of Korea
| | - Sung-Gu Kang
- Department of Urology, Korea University College of Medicine, 73 Inchon-Ro, Sungbuk-gu, Seoul, 136-705, Republic of Korea.
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Gao ZM, Gao S, Qu HC, Li K, Li N, Liu CL, Zhu XW, Liu YL, Wang P, Zheng XH. Minimally invasive percutaneous nephrolithotomy improves stone-free rates for impacted proximal ureteral stones: A systematic review and meta-analysis. PLoS One 2017; 12:e0171230. [PMID: 28152097 PMCID: PMC5289591 DOI: 10.1371/journal.pone.0171230] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Accepted: 01/17/2017] [Indexed: 01/06/2023] Open
Abstract
Background Urinary stones are common medical disorders and the treatment of impacted proximal ureteral stones (IPUS) is still a challenge for urologists. The aim of this study was to compare the efficacy and safety of minimally invasive percutaneous nephrolithotomy (MI-PCNL) and ureteroscopic lithotripsy (URL) in the treatment of IPUS via a meta-analysis. Methods We collected studies using PubMed, Embase, and Cochrane Library from 1978 to November 2016 and analyzed them using Stata 12.0 and RevMan 5.3. Odds ratios (ORs) and standard mean difference (SMD) were calculated for binary and continuous variables respectively, accompanied with 95% confidence intervals (CIs). All study procedures followed the PRISMA guidelines. Results Five prospective studies were included in our meta-analysis, with 242 MI-PCNL and 256 URL cases. MI-PCNL was associated with a longer postoperative hospital stay than URL (SMD, 3.14; 95% CI, 1.27 to 5.55). However, no significant difference was observed in operative time (SMD, -0.38; 95% CI, -3.15 to 2.38). In addition, MI-PCNL had higher initial (OR, 11.12; 95% CI, 5.56 to 22.24) and overall stone-free rates (OR, 8.70; 95% CI, 3.23 to 23.45) than URL, along with lower possibilities of surgical conversion (OR, 0.11; 95% CI, 0.03 to 0.49) and postoperative shock wave lithotripsy (OR, 0.06; 95% CI, 0.02 to 0.18). Regarding complications, no significant differences were observed between MI-PCNL and URL (OR, 1.39; 95% CI, 0.93 to 2.10), except for hematuria (OR, 4.80; 95% CI, 1.45 to 15.94). Conclusions MI-PCNL is optimal and should be considered as the preferred treatment method for IPUS, as it has better efficacy and a safety profile similar to that of URL. However, further high quality studies with larger sample size are required in future.
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Affiliation(s)
- Zi-Ming Gao
- Department of Urological Surgery, Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning, P.R. China
| | - Shan Gao
- Department of Gynecology and Obstetrics, Shengjing Hospital of China Medical University, Shenyang, Liaoning, P.R. China
| | - Hong-Chen Qu
- Department of Urological Surgery, Liaoning Cancer Hospital/China Medical University Cancer Hospital, Shenyang, Liaoning, P.R. China
| | - Kai Li
- Department of Oncology Surgery, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, P.R. China
| | - Ning Li
- Department of Urological Surgery, Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning, P.R. China
| | - Chun-Lai Liu
- Department of Urological Surgery, Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning, P.R. China
| | - Xing-Wang Zhu
- Department of Urological Surgery, Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning, P.R. China
| | - Yi-Li Liu
- Department of Urological Surgery, Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning, P.R. China
| | - Ping Wang
- Department of Urological Surgery, Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning, P.R. China
- * E-mail: (XHZ); (PW)
| | - Xiao-Hua Zheng
- Department of Cardre Ward, No. 202 Hospital of People’s Liberation Army, Shenyang, Liaoning, P.R. China
- * E-mail: (XHZ); (PW)
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