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Ilias D, Passerotti CC, Pontes Junior J, Fakhouri F, Faria STDR, Maximiano LF, Otoch JP, DA-Cruz JAS. Learning curve of semi-rigid ureteroscopy for small calculi: how many cases are necessary? Rev Col Bras Cir 2022; 49:e20222693. [PMID: 36228197 PMCID: PMC10578800 DOI: 10.1590/0100-6991e-20222693-en] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 06/04/2022] [Indexed: 06/16/2023] Open
Abstract
INTRODUCTION semi-rigid ureteroscopy is the procedure of choice for the treatment of ureterolithiasis, but it requires a learning curve to be performed safely. OBJECTIVE To describe an estimate of the learning curve for performing semi-rigid ureterorenolithotripsy in patients with small-sized ureterolithiasis and to estimate the minimum number of procedures necessary to safely perform the surgical procedure. METHODS this is a prospective study evaluating the learning curve of a resident of urology in the first 60 semirigid ureteroscopies in patients with ureterolithiasis up to 1cm. The patients were divided into three groups: Group I one to twenty surgeries, Group II twenty one to forty surgeries and Group III forty one to sixty surgeries. The surgeries were recorded and analyzed by two urologists experienced in endourology. A qualitative analysis was performed based on a previously validated tool and a quantitative analysis. RESULTS all qualitative variables had significant variation between Groups I and II (p<0.001), and between Groups I and III (p<0.001). There was a difference in time to access the ureter, passage of a double J catheter and total operative time between Groups I and II (p<0.001) and Groups I and III (p<0.001). CONCLUSION after 40 cases there seems to be little increase in both quantitative as well as qualitative evaluation in surgical performance for performing semi-rigid ureterolithotripsy safely in calculations up to 1cm.
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Affiliation(s)
- Daniel Ilias
- - Hospital Alemão Oswaldo Cruz, Centro Especializado em Urologia - São Paulo - SP - Brasil
| | | | - José Pontes Junior
- - Hospital Alemão Oswaldo Cruz, Centro Especializado em Urologia - São Paulo - SP - Brasil
| | - Felipe Fakhouri
- - Hospital Alemão Oswaldo Cruz, Centro Especializado em Urologia - São Paulo - SP - Brasil
| | - Sabrina Thalita Dos Reis Faria
- - Faculdade de Medicina da Universidade de São Paulo, Departamento de Técnica Cirúrgica e Cirurgia Experimental - São Paulo - SP - Brasil
| | - Linda Ferreira Maximiano
- - Faculdade de Medicina da Universidade de São Paulo, Departamento de Técnica Cirúrgica e Cirurgia Experimental - São Paulo - SP - Brasil
- - Universidade de São Paulo, Hospital Universitário - São Paulo - SP - Brasil
| | - José Pinhata Otoch
- - Faculdade de Medicina da Universidade de São Paulo, Departamento de Técnica Cirúrgica e Cirurgia Experimental - São Paulo - SP - Brasil
- - Universidade de São Paulo, Hospital Universitário - São Paulo - SP - Brasil
| | - Jose Arnaldo Shiomi DA-Cruz
- - Hospital Alemão Oswaldo Cruz, Centro Especializado em Urologia - São Paulo - SP - Brasil
- - Faculdade de Medicina da Universidade de São Paulo, Departamento de Técnica Cirúrgica e Cirurgia Experimental - São Paulo - SP - Brasil
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ILIAS DANIEL, PASSEROTTI CARLOCAMARGO, PONTES JUNIOR JOSÉ, FAKHOURI FELIPE, FARIA SABRINATHALITADOSREIS, MAXIMIANO LINDAFERREIRA, OTOCH JOSÉPINHATA, DA-CRUZ JOSEARNALDOSHIOMI. Curva de aprendizado em ureteroscopia semi-rígida em cálculos de pequenas dimensões: quantos casos são necessários? Rev Col Bras Cir 2022. [DOI: 10.1590/0100-6991e-20222693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
RESUMO Introdução: ureteroscopia semi-rígida é o procedimento de escolha para o tratamento da ureterolitíase, mas necessita de uma curva de aprendizado para ser executada com segurança. Objetivo: descrever uma estimativa da curva de aprendizado para realização da ureterorrenolitotripsia semi-rígida em pacientes com ureterolitíase de pequena dimensão e estimar o número mínimo de procedimentos necessários para realizar o procedimento cirúrgico com segurança. Métodos: trata-se de um estudo prospectivo avaliando a curva de aprendizado de um residente de urologia nas primeiras 60 ureteroscopias semi-rígidas em pacientes com ureterolitíase até 1cm. Os pacientes foram divididos em três grupos: Grupo I uma a vinte cirurgias, Grupo II vinte e uma a quarenta cirurgias e Grupo III quarenta e uma a sessenta cirurgias. As cirurgias foram gravadas e analisadas por dois urologistas experientes em endourologia. Foi feita uma análise qualitativa baseada em uma ferramenta previamente validada e uma análise quantitativa. Resultados: todas as variáveis qualitativas tiveram variação significativa entre os Grupos I e II (p<0.001), e entre os Grupos I e III (p<0.001). Houve diferença no tempo para acesso ao ureter, passagem de cateter duplo J e tempo operatório total entre os Grupos I e II (p<0.001) e nos Grupos I e III (p<0.001). Conclusão: após 40 casos parece haver pouco incremento tanto na avaliação quantitativa bem como na avaliação qualitativa em performance cirúrgica para a realização de ureterolitotripsia semi-rígida com segurança em cálculos de até 1cm.
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Miernik A, Sievert KD, Herrmann TRW, Netsch C, Rassweiler JJ, Leyh H, Westphal J, Bachmann A, Häcker A, Homberg R, Klein JT, Olbert PJ, Schoeb DS, Gross AJ. [Surgical positioning techniques in urology : Tips and tricks]. Urologe A 2017; 56:1193-1206. [PMID: 28762032 DOI: 10.1007/s00120-017-0467-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Correct positioning of patients during preoperative preparations is essential for success of the intervention to avoid any positioning trauma and to provide the best access to the targeted structures. The appropriate positioning (and optimal performance) means that complications are avoided and also makes an essential contribution to the smooth course of the surgical intervention. A correct position is essential particularly in urology because the organs assigned to the discipline of urology are anatomically mostly difficult to reach. A further important function of the correct positioning technique is the avoidance of injuries to the patient. This article summarizes the most common positioning techniques in urological interventions with special emphasis on the explanation of practical advice, helpful tips and possible complications that can enable even junior surgeons to correctly perform the appropriate positioning technique.
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Affiliation(s)
- A Miernik
- Medizinische Fakultät, Klinik für Urologie, Universitätsklinikum Freiburg, Hugstetterstr. 55, 79106, Freiburg, Deutschland.
| | - K-D Sievert
- Urologische Klinik und Poliklinik, Universitätsmedizin Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Deutschland
| | - T R W Herrmann
- Klinik für Urologie und Urologische Onkologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - C Netsch
- Abteilung für Urologie, Asklepios Klinik Barmbek, Rübenkamp 220, 22291, Hamburg, Deutschland
| | - J J Rassweiler
- Klinik für Urologie, SLK-Kliniken Heilbronn GmbH, Am Gesundbrunnen 20-26, 74078, Heilbronn, Deutschland
| | - H Leyh
- Klinik für Urologie, Klinikum Garmisch-Partenkirchen, Auenstr. 6, 82467, Garmisch-Partenkirchen, Deutschland
| | - J Westphal
- Klinik für Urologie und Kinderurologie, Krankenhaus Maria Hilf der Alexianer GmbH, Dießemer Bruch 81, 47805, Krefeld, Deutschland
| | - A Bachmann
- alta uro AG, Centralbahnpl. 6, 4051, Basel, Schweiz
| | - A Häcker
- Klinik für Urologie, Haus 28, Universitätsklinikum Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
| | - R Homberg
- Klinik für Urologie, Kinderurologie und Uro-Gynäkologie, St. Barbara-Klinik Hamm-Heessen, Am Heessener Wald 1, 59073, Hamm, Deutschland
| | - J-T Klein
- Klinik für Urologie und Kinderurologie, Universitätsklinikum Ulm, Prittwitzstr.43, 89075, Ulm, Deutschland
| | - P J Olbert
- BRIXSANA private clinic, Julius-Durst-Str. 28, 39042, Brixen, Italien
| | - D S Schoeb
- Medizinische Fakultät, Klinik für Urologie, Universitätsklinikum Freiburg, Hugstetterstr. 55, 79106, Freiburg, Deutschland
| | - A J Gross
- Abteilung für Urologie, Asklepios Klinik Barmbek, Rübenkamp 220, 22291, Hamburg, Deutschland
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Update of the ICUD-SIU consultation on stone technology behind ureteroscopy. World J Urol 2017; 35:1353-1359. [DOI: 10.1007/s00345-017-2073-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 07/12/2017] [Indexed: 10/19/2022] Open
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A comparison of antegrade percutaneous and laparoscopic approaches in the treatment of proximal ureteral stones. BIOMED RESEARCH INTERNATIONAL 2014; 2014:691946. [PMID: 25295266 PMCID: PMC4177728 DOI: 10.1155/2014/691946] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 08/21/2014] [Indexed: 11/26/2022]
Abstract
Purpose. To compare the effectiveness and safety of retroperitoneal laparoscopic ureterolithotomy (RLU) and percutaneous antegrade ureteroscopy (PAU) in which we use semirigid ureteroscopy in the treatment of proximal ureteral stones. Methods. Fifty-eight patients with large, impacted stones who had a history of failed shock wave lithotripsy (SWL) and, retrograde ureterorenoscopy (URS) were included in the study between April 2007 and April 2014. Thirty-seven PAU and twenty-one RLU procedures were applied. Stone-free rates, operation times, duration of hospital stay, and follow-up duration were analyzed. Results. Overall stone-free rate was 100% for both groups. There was no significant difference between both groups with respect to postoperative duration of hospital stay and urinary leakage of more than 2 days. PAU group had a greater amount of blood loss (mean hemoglobin drops for PAU group and RLU group were 1.6 ± 1.1 g/dL versus 0.5 ± 0.3 g/dL, resp.; P = 0.022). RLU group had longer operation time (for PAU group and RLU group 80.1 ± 44.6 min versus 102.1 ± 45.5 min, resp.; P = 0.039). Conclusions. Both PAU and RLU appear to be comparable in the treatment of proximal ureteral stones when the history is notable for a failed retrograde approach or SWL. The decision should be based on surgical expertise and availability of surgical equipment.
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Lucio J, Korkes F, Lopes-Neto AC, Silva EG, Mattos MHE, Pompeo ACL. Steinstrasse predictive factors and outcomes after extracorporeal shockwave lithotripsy. Int Braz J Urol 2012; 37:477-82. [PMID: 21888699 DOI: 10.1590/s1677-55382011000400006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2011] [Indexed: 11/22/2022] Open
Abstract
PURPOSE Urinary stone disease is a common medical problem. Extracorporeal shockwave lithotripsy (SWL) has been applied with high success and low complication rates. Steinstrasse (SS) is a possible complication after SWL. The aim of the present study was to prospectively evaluate the factors and outcomes associated with SS after SWL. MATERIALS AND METHODS We have prospectively evaluated 265 SWL sessions (2005-2009). Two lithotriptors were used randomly: Siemens Lithostar and Dornier Compact S. All patients had imaging exams after 30 and 90 days or according to symptoms. RESULTS SS was observed in 14 (5.3%) out of 265 SWL procedures (n = 175 patients, 51.5% women/48.5% men, mean ± SD age = 46.3 ± 15.5 years). SS was more common after SWL for pelviureteral calculi rather than caliceal stones (p = 0.036). There was a trend toward more occurrences of SS after SWL for larger stone area (> 200 mm², p = 0.072). Preoperative ureteral stent didn't prevent SS. SWL machine, intensity, number of pulses and frequency were not associated with SS formation. Post-SWL pain, fever and gravel elimination were factors associated with SS (p = 0.021; p = 0.011; p = 0.078). When SS occurred, treatment modalities included Medical Expulsive Therapy (MET), ureteroscopy and SWL. CONCLUSIONS Steinstrasse is an uncommon event after SWL and seems to occur more frequently with larger pelviureteral stones. Impaction of stones is more frequent in the middle ureter. All patients should be followed after SWL, but SS should be specially suspected if there is macroscopic gravel elimination, flank pain and/or fever. When SS occurs, treatment should be promptly introduced, including medical expulsive therapy, surgical approach or SWL in selected cases. Further prospective studies are awaited to evaluated preventive measures for SS occurrence.
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Affiliation(s)
- Jarques Lucio
- Division of Urology, ABC Medical School, Santo André, SP, Brazil
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Zaidi Z, Alam Z. Endourological Approaches to Renal and Ureteric Calculi in Children. Urolithiasis 2012. [DOI: 10.1007/978-1-4471-4387-1_83] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Lopes Neto AC, Korkes F, Silva JL, Amarante RDM, Mattos MHE, Tobias-Machado M, Pompeo ACL. Prospective randomized study of treatment of large proximal ureteral stones: extracorporeal shock wave lithotripsy versus ureterolithotripsy versus laparoscopy. J Urol 2011; 187:164-8. [PMID: 22100003 DOI: 10.1016/j.juro.2011.09.054] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Indexed: 11/25/2022]
Abstract
PURPOSE The best treatment modalities for large proximal ureteral stones are controversial, and include extracorporeal shock wave lithotripsy, ureterolithotripsy, percutaneous nephrolithotripsy, laparoscopic ureterolithotomy and open surgery. To the best of our knowledge extracorporeal shock wave lithotripsy, semirigid ureterolithotripsy and laparoscopic ureterolithotomy have not been previously compared for the treatment of large proximal ureteral stones. Therefore, we compared these modalities for the treatment of large proximal ureteral stones. MATERIALS AND METHODS A total of 48 patients with large proximal ureteral stones (greater than 1 cm) were prospectively randomized and enrolled in the study at a single institution between 2008 and 2010. Eligible patients were assigned to extracorporeal shock wave lithotripsy, semirigid ureterolithotripsy or laparoscopic ureterolithotomy. RESULTS Extracorporeal shock wave lithotripsy had a 35.7% success rate, semirigid ureterolithotripsy 62.5% and laparoscopic ureterolithotomy 93.3%. Stone-free rates showed a statistically significant difference among the groups (p = 0.005). Patients treated with laparoscopic ureterolithotomy vs semirigid ureterolithotripsy vs extracorporeal shock wave lithotripsy required fewer treatment sessions (mean ± SD 1.9 ± 0.3 vs 2.2 ± 0.6 vs 2.9 ± 1.4, p = 0.027). Neither major nor long-term complications were observed. CONCLUSIONS Proximal ureteral stone treatment requires multiple procedures until complete stone-free status is achieved. Laparoscopic ureterolithotomy is associated with higher success rates and fewer surgical procedures, but with more postoperative pain, longer procedures and a longer hospital stay. Although it is associated with the highest success rates for large proximal ureteral calculi, laparoscopic ureterolithotomy remains a salvage, second line procedure, and it seems more advantageous than open ureterolithotomy. At less well equipped centers, where semirigid ureterolithotripsy or extracorporeal shock wave lithotripsy is not available, it remains a good treatment option.
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Korkes F, Lopes-Neto AC, Mattos MHE, Pompeo ACL, Wroclawski ER. Patient position and semi-rigid ureteroscopy outcomes. Int Braz J Urol 2009; 35:542-7; discussion 548-50. [DOI: 10.1590/s1677-55382009000500005] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2009] [Indexed: 11/22/2022] Open
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