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Sighinolfi MC, Calcagnile T, Ticonosco M, Kaleci S, DI Bari S, Assumma S, Sarchi L, Panio E, Ferrari R, Piro A, Ragusa A, Ciarlariello S, DA Silva RD, LA Rocca R, Illiano E, Paladini A, Persico F, Giraudo D, DE Marzo E, Grisanti R, Mantica G, Emiliani E, Madonia M, Salvetti M, Bassi P, Montanari E, Bove P, Simonato A, Averch TD, Porpiglia F, Calarco A, Bruschetta S, Manferrari F, Daels FP, Cerruto MA, Antonelli A, Mazzon G, Celia A, Simeone C, Zaramella S, Saita A, Costantini E, Mearini E, DE Dominicis M, Mirone V, Kim FJ, Ferretti S, Puliatti S, Rocco B, Micali S. External validation of a nomogram for outcome prediction in management of medium-sized (1-2 cm) kidney stones. Minerva Urol Nephrol 2024; 76:484-490. [PMID: 38727672 DOI: 10.23736/s2724-6051.24.05672-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2024]
Abstract
BACKGROUND Stone nomogram by Micali et al., able topredict treatment failure of shock-wave lithotripsy (SWL), retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PNL) in the management of single 1-2 cm renal stones, was developed on 2605 patients and showed a high predictive accuracy, with an area under ROC curve of 0.793 at internal validation. The aim of the present study is to externally validate the model to assess whether it displayed a satisfactory predictive performance if applied to different populations. METHODS External validation was retrospectively performed on 3025 patients who underwent an active stone treatment from December 2010 to June 2021 in 26 centers from four countries (Italy, USA, Spain, Argentina). Collected variables included: age, gender, previous renal surgery, preoperative urine culture, hydronephrosis, stone side, site, density, skin-to-stone distance. Treatment failure was the defined outcome (residual fragments >4 mm at three months CT-scan). RESULTS Model discrimination in external validation datasets showed an area under ROC curve of 0.66 (95% 0.59-0.68) with adequate calibration. The retrospective fashion of the study and the lack of generalizability of the tool towards populations from Asia, Africa or Oceania represent limitations of the current analysis. CONCLUSIONS According to the current findings, Micali's nomogram can be used for treatment prediction after SWL, RIRS and PNL; however, a lower discrimination performance than the one at internal validation should be acknowledged, reflecting geographical, temporal and domain limitation of external validation studies. Further prospective evaluation is required to refine and improve the nomogram findings and to validate its clinical value.
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Affiliation(s)
| | - Tommaso Calcagnile
- Department of Urology, ASST Santi Paolo e Carlo, Milan, Italy
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Marco Ticonosco
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Shaniko Kaleci
- Clinical and Experimental Medicine (CEM), Department of Surgical, Medical, Dental and Morphological Sciences with Interest in Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefano DI Bari
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Simone Assumma
- Department of Urology, ASST Santi Paolo e Carlo, Milan, Italy
| | - Luca Sarchi
- Department of Urology, ASST Santi Paolo e Carlo, Milan, Italy
| | - Enrico Panio
- Department of Urology, ASST Santi Paolo e Carlo, Milan, Italy
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Riccardo Ferrari
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Adele Piro
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Alberto Ragusa
- Department of Urology, Campus Biomedico University of Rome, Rome, Italy
| | - Silvia Ciarlariello
- Department of Urology, Morgagni-Pierantoni Hospital, Forlì, Forlì-Cesena, Italy
| | | | - Roberto LA Rocca
- Department of Urology, University of Naples Federico II, Naples, Italy
| | - Ester Illiano
- Department of Urology, University of Naples Federico II, Naples, Italy
| | | | - Francesco Persico
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Davide Giraudo
- Department of Urology, Ospedale degli Infermi, Biella, Italy
| | - Enrico DE Marzo
- Department of Urology, Regional Health Care and Social Agency Civil Hospitals of Brescia, Brescia, Italy
| | - Riccardo Grisanti
- Department of Urology, Nuovo Ospedale Civile, Sassuolo, Modena, Italy
| | | | - Esteban Emiliani
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Massimo Madonia
- Department of Urology, Urologic Clinic, University Hospital of Sassari, Sassari, Italy
| | - Michele Salvetti
- Department of Urology, Azienda ULSS8 Berica, Arzignano, Vicenza, Italy
| | | | | | - Pierluigi Bove
- Department of Urology, San Carlo of Nancy Hospital, Rome, Italy
| | - Alchiede Simonato
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy
| | - Timothy D Averch
- Department of Urology, Prisma Health Midlands, Columbia, SC, USA
| | - Francesco Porpiglia
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | | | | | | | - Francisco P Daels
- Department of Urology, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Maria A Cerruto
- Department of Urology, Integrated University Hospital of Verona, Verona, Italy
| | | | - Giorgio Mazzon
- Department of Urology, Civil Hospital of Bassano, Bassano del Grappa, Vicenza, Italy
| | - Antonio Celia
- Department of Urology, Civil Hospital of Bassano, Bassano del Grappa, Vicenza, Italy
| | - Claudio Simeone
- Department of Urology, University of Brescia, Brescia, Italy
| | | | - Alberto Saita
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | | | - Ettore Mearini
- Department of Urology, University of Perugia, Perugia, Italy
| | | | - Vincenzo Mirone
- Department of Urology, University of Naples Federico II, Naples, Italy
| | - Fernando J Kim
- Department of Urology, Denver Health Medical Center, Denver, CO, USA
| | - Stefania Ferretti
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefano Puliatti
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Bernardo Rocco
- Department of Urology, ASST Santi Paolo e Carlo, Milan, Italy
| | - Salvatore Micali
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy -
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Chien YC, Chen PH, Chang YJ. Impact of frailty on perioperative outcomes following percutaneous nephrolithotomy in older persons: evidence from the US Nationwide Inpatient Sample. Urolithiasis 2024; 52:95. [PMID: 38896137 PMCID: PMC11186895 DOI: 10.1007/s00240-024-01595-y] [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: 05/22/2024] [Accepted: 06/08/2024] [Indexed: 06/21/2024]
Abstract
To evaluate the impact of frailty on perioperative outcomes of older patients undergoing PCNL, utilizing the US Nationwide Inpatient Sample (NIS) database. Data of hospitalized patients ≥ 60 years who received PCNL were extracted from the 2010 to 2020 NIS database, and included demographics, clinical, and hospital-related information. Patients were assigned to low (< 5), medium (5-15), and high frailty risk (> 15) groups based on the hospital frailty risk score (HFRS). Associations between frailty risk and perioperative outcomes including total hospital cost were determined using population-weighted linear and logistic regression analyses. Data of 30,829 hospitalized patients were analyzed (mean age 72.5 years; 55% male; 78% white). Multivariable analyses revealed that compared to low frailty risk, increased frailty risk was significantly associated with elevated in-hospital mortality (adjusted odds ratio (aOR) = 10.70, 95% confidence interval (CI): 6.38-18.62), higher incidence of unfavorable discharge (aOR = 5.09, 95% CI: 4.43-5.86), prolonged hospital length of stay (LOS; aOR = 7.67, 95% CI: 6.38-9.22), increased transfusion risk (aOR = 8.05, 95% CI: 6.55-9.90), increased total hospital costs (adjusted Beta = 37.61, 95% CI: 36.39-38.83), and greater risk of complications (aOR = 8.52, 95% CI: 7.69-9.45). Frailty is a significant prognostic indicator of adverse perioperative outcomes in older patients undergoing PCNL, underscoring importance of recognizing and managing frailty in older patients.
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Affiliation(s)
- You-Chiuan Chien
- Department of Mechanical Engineering, Chung Yuan Christian University, Chung Li District, No. 200, Zhongbei Rd., Zhongli Dist, Taoyuan, 320314, Taiwan (R.O.C.)
- Tai-An Hospital, Taichung, 401007, Taiwan
| | - Pao-Hwa Chen
- Department of Surgery, Division of Urology, Changhua Christian Hospital, 135, Nanxiao St, Changhua, Changhua, 500209, Taiwan
| | - Yaw-Jen Chang
- Department of Mechanical Engineering, Chung Yuan Christian University, Chung Li District, No. 200, Zhongbei Rd., Zhongli Dist, Taoyuan, 320314, Taiwan (R.O.C.).
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Campobasso D, Panizzi M, Bellini V, Ferretti S, Amparore D, Castellani D, Fiori C, Puliatti S, Pietropaolo A, Somani BK, Micali S, Porpiglia F, Maestroni UV, Bignami EG. Application of AI in urolithiasis risk of infection: a scoping review. Minerva Urol Nephrol 2024; 76:295-302. [PMID: 38920010 DOI: 10.23736/s2724-6051.24.05686-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
INTRODUCTION Artificial intelligence and machine learning are the new frontier in urology; they can assist the diagnostic work-up and in prognostication bring superior to the existing nomograms. Infectious events and in particular the septic risk, are one of the most common and in some cases life threatening complication in patients with urolithiasis. We performed a scoping review to provide an overview of the current application of AI in prediction the infectious complications in patients affected by urolithiasis. EVIDENCE ACQUISITION A systematic scoping review of the literature was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses for Scoping Reviews (PRISMA-ScR) guidelines by screening Medline, PubMed, and Embase to detect pertinent studies. EVIDENCE SYNTHESIS A total of 467 articles were found, of which nine met the inclusion criteria and were considered. All studies are retrospective and published between 2021 and 2023. Only two studies performed an external validation of the described models. The main event considered is urosepsis in four articles, urinary tract infection in two articles and diagnosis of infection stones in three articles. Different AI models were trained, each of which exploited several types and numbers of variables. All studies reveal good performance. Random forest and artificial neural networks seem to have higher AUC, specificity and sensibility and perform better than the traditional statistical analysis. CONCLUSIONS Further prospective and multi-institutional studies with external validation are needed to better clarify which variables and AI models should be integrated in our clinical practice to predict infectious events.
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Affiliation(s)
| | - Matteo Panizzi
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Valentina Bellini
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Stefania Ferretti
- Department of Urology, University of Modena e Reggio Emilia, Modena, Italy
| | - Daniele Amparore
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Daniele Castellani
- Department of Urology, Azienda Ospedaliera Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
| | - Cristian Fiori
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Stefano Puliatti
- Department of Urology, University of Modena e Reggio Emilia, Modena, Italy
| | - Amelia Pietropaolo
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Bhaskar K Somani
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Salvatore Micali
- Department of Urology, University of Modena e Reggio Emilia, Modena, Italy
| | - Francesco Porpiglia
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | | | - Elena G Bignami
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Parma, Italy
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Ortega Polledo LE, Mantica G, Carrión DM, Khelif A, Subiela Henríquez JD, González Padilla DA, Sanchís Bonet Á, Tamayo Ruiz JC, García Rico E, Alonso Gregorio S, Gómez Rivas J, Esperto F, Scoffone CM, Cracco CM, Checcucci E. Endourological panorama and current state of training in endourology among European teaching hospitals. Minerva Urol Nephrol 2024; 76:5-8. [PMID: 38093619 DOI: 10.23736/s2724-6051.23.05646-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Affiliation(s)
- Luis E Ortega Polledo
- Department of Urology, Prince of Asturias University Hospital, University of Alcalá, Madrid, Spain -
- Institute of Urology, Hospital Universitario San Francisco de Asís, Alfonso X El Sabio University, Madrid, Spain -
- European Society of Residents in Urology (ESRU), Arnhem, the Netherlands -
| | - Guglielmo Mantica
- European Society of Residents in Urology (ESRU), Arnhem, the Netherlands
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy
| | - Diego M Carrión
- European Society of Residents in Urology (ESRU), Arnhem, the Netherlands
- Department of Urology, Torrejón University Hospital, Francisco de Vitoria University, Madrid, Spain
| | - Adrian Khelif
- European Society of Residents in Urology (ESRU), Arnhem, the Netherlands
- Centre Hospitalier Inter Régional Edith Cavel (CHIREC), Braine-l'Alleud, Belgium
| | - José D Subiela Henríquez
- European Society of Residents in Urology (ESRU), Arnhem, the Netherlands
- Department of Urology, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Hospital Universitario Ramón y Cajal, University of Alcalá, Madrid, Spain
| | - Daniel A González Padilla
- European Society of Residents in Urology (ESRU), Arnhem, the Netherlands
- Department of Urology, Clínica Universidad de Navarra (CUN), Madrid, Spain
| | - Ángeles Sanchís Bonet
- Department of Urology, Prince of Asturias University Hospital, University of Alcalá, Madrid, Spain
| | - Juan C Tamayo Ruiz
- Department of Urology, Prince of Asturias University Hospital, University of Alcalá, Madrid, Spain
| | - Eduardo García Rico
- Institute of Urology, Hospital Universitario San Francisco de Asís, Alfonso X El Sabio University, Madrid, Spain
- Department of Urology, Torrejón University Hospital, Francisco de Vitoria University, Madrid, Spain
| | - Sergio Alonso Gregorio
- Institute of Urology, Hospital Universitario San Francisco de Asís, Alfonso X El Sabio University, Madrid, Spain
| | - Juan Gómez Rivas
- European Society of Residents in Urology (ESRU), Arnhem, the Netherlands
- Department of Urology, Hospital Clinico San Carlos, Madrid, Spain
| | - Francesco Esperto
- European Society of Residents in Urology (ESRU), Arnhem, the Netherlands
- Department of Urology, Campus Bio-Medico University, Rome, Italy
| | | | | | - Enrico Checcucci
- European Society of Residents in Urology (ESRU), Arnhem, the Netherlands
- Department of Surgery, FPO-IRCCS Candiolo Cancer Institute, Candiolo, Turin, Italy
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5
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Fiori C, Cossu M, Poggio M, Quarà A, Di Dio M, De Luca S, Checcucci E, Manfredi M, Amparore D, Porpiglia F. Initial experience with robot-assisted ureteroscopy with Ily® Robot. Minerva Urol Nephrol 2023; 75:761-765. [PMID: 38126287 DOI: 10.23736/s2724-6051.23.05572-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
The aim of this study is to present the first Italian experience with robotic-assisted retrograde intrarenal surgery (rRIRS) using the Ily® platform. Procedures were performed for renal stones using the Ily® Robot (STERLAB, Vallauris, France), which is a ureteroscope holder with multiple degrees of freedom that can be controlled remotely through a wireless controller. In March 2023, consecutive patients with indications for rRIRS were included in the study. Demographic variables and stone characteristics were collected, and standard perioperative data were assessed. The one-month stone-free rate (SFR, i.e. no residual fragments) was evaluated using ultrasound. All participating surgeons filled out a Surgeons' Satisfaction Questionnaire (SSQ) based on a Likert-type scale. The questionnaire focused on: 1) ease of use; 2) ergonomics during renal cavity exploration; 3) stability during stone fragmentation. Among the patients, one had bilateral stones, while two had stones on the right side. The mean stone size was 13 mm. The average operative time was 70 minutes and the mean docking time was three minutes. No perioperative complications were recorded, and all patients were discharged on the first postoperative day. The one-month SFR was 100%. The SSQ scores were as follows: 1) ease of use: 4/5; 2) ergonomics: 5/5; 3) stability during stone fragmentation: 5/5. Based on the initial experience, the results indicate the feasibility, safety, and effectiveness of rRIRS. The ergonomic efficiency of the system was highly appreciated by the surgeons. While a cost-effectiveness analysis within clinical trials is necessary, rRIRS shows the potential for a more sustainable future for endoscopists and an improved workplace environment.
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Affiliation(s)
- Cristian Fiori
- Department of Oncology, University of Turin, Turin, Italy -
- Division of Urology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy -
| | - Marco Cossu
- Division of Urology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | | | - Alberto Quarà
- Division of Urology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Michele Di Dio
- Department of Surgery, Division of Urology, SS Annunziata Hospital, Cosenza, Italy
| | - Stefano De Luca
- Division of Urology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | | | - Matteo Manfredi
- Department of Oncology, University of Turin, Turin, Italy
- Division of Urology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Daniele Amparore
- Department of Oncology, University of Turin, Turin, Italy
- Division of Urology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Francesco Porpiglia
- Department of Oncology, University of Turin, Turin, Italy
- Division of Urology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
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Salciccia S, Maggi M, Frisenda M, Finistauri Guacci L, Hoxha S, Licari LC, Viscuso P, Gentilucci A, Del Giudice F, DE Berardinis E, Cattarino S, Mariotti G, Tufano A, DE Dominicis M, Ricciuti GP, Sciarra A, Penniston KL, Moriconi M. Translation and validation of the Italian version of the Wisconsin Stone Quality of Life Questionnaire (I-WISQOL) for assessing quality of life in patients with urolithiasis. Minerva Urol Nephrol 2023; 75:501-507. [PMID: 37067185 DOI: 10.23736/s2724-6051.23.04882-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
BACKGROUND Urolithiasis is a chronic condition, and it has been associated with a significant negative impact on patients' health-related quality of life (HRQOL). Several tools to assess patients' HRQOL have been validated in Italian, however disease-specific HRQOL instruments are still lacking. We aimed to develop and validate the Italian version of the WISQOL (I-WISQOL) in patients with urolithiasis. METHODS The Italian version of the WISQOL was developed in a multistep process involving primary translation, back-translation, and pilot testing among a group of patients (N.=10). Patients presenting with urolithiasis were prospectively recruited from the outpatient stone clinics and completed both questionnaire WISQOL and SF-36. Demographic information, as well as medical and surgical data, were obtained through an interview. Internal consistency of the I-WISQOL was obtained with Cronbach's α. Correlation of total scores of the I-WISQOL and SF36 was assessed to determine convergent validity using Spearman Rho. Correlations between clinical variables and results from the I-WISQOL were analyzed to descriptively assess the association of interest. RESULTS A total of 93 participants were evaluated and completed the Italian version of the I-WISQOL. The I-WISQOL demonstrated excellent internal consistency (Cronbach's α 0.95) and good convergent validity with the validated SF-36 (Spearman Rho r=0.70, P<0.001). Using ANOVA analysis, a significant decline in WISQOL Score was noted with the increasing number of renal colics (P=0.0543), ER visits (P=0.037), number of inpatient hospitalization (P=0.025). At multivariate analysis, worse WISQOL total score was predicted by a greater number of renal colic events (ß=-4.92 [-8.81-1.04], P=0.014) and by a greater number inpatient hospitalization (ß=-7.31 [-14.35 -0.26], P=0.042). CONCLUSIONS The I-WISQOL is an internally consistent and valid instrument to assess HRQOL in Italian-speaking patients with kidney stones. Its use in clinical practice should be implemented in order to tailor the management of each patient.
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Affiliation(s)
- Stefano Salciccia
- Department of Maternal-Infant and Urological Sciences, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy -
| | - Martina Maggi
- Department of Maternal-Infant and Urological Sciences, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy
| | - Marco Frisenda
- Department of Maternal-Infant and Urological Sciences, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy
| | - Lucia Finistauri Guacci
- Department of Maternal-Infant and Urological Sciences, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy
| | - Sanie Hoxha
- Department of Maternal-Infant and Urological Sciences, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy
| | - Leslie C Licari
- Department of Maternal-Infant and Urological Sciences, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy
| | - Pietro Viscuso
- Department of Maternal-Infant and Urological Sciences, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy
| | | | - Francesco Del Giudice
- Department of Maternal-Infant and Urological Sciences, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy
| | - Ettore DE Berardinis
- Department of Maternal-Infant and Urological Sciences, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy
| | - Susanna Cattarino
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Gianna Mariotti
- Department of Maternal-Infant and Urological Sciences, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy
| | - Antonio Tufano
- Department of Maternal-Infant and Urological Sciences, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy
| | | | - Gian P Ricciuti
- Department of Maternal-Infant and Urological Sciences, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy
| | - Alessandro Sciarra
- Department of Maternal-Infant and Urological Sciences, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy
| | - Kristina L Penniston
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Martina Moriconi
- Department of Maternal-Infant and Urological Sciences, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy
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7
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Chua ME, Kim JK, Ming JM, De Cotiis KN, Yang SS, Rickard M, Lorenzo AJ, Dos Santos J. Scoping review of recent evidence on the management of pediatric urolithiasis: summary of meta-analyses, systematic reviews and relevant randomized controlled trials. Pediatr Surg Int 2022; 38:1349-1361. [PMID: 35939126 DOI: 10.1007/s00383-022-05190-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/13/2022] [Indexed: 11/25/2022]
Abstract
This scoping review aimed to evaluate and summarize the recent 10 year pediatric urolithiasis literature with a particular focus on systematic reviews, randomized-controlled trials (RCT) and meta-analysis. The systematic literature search performed on September 1, 2021, restricted to the recent 10 years, focused on pediatric urolithiasis that are RCTs, meta-analysis and systematic reviews. The summarized literature included etiology, diagnostics, medical and surgical management. GRADE criteria are used to evaluate and standardize the reporting of evidence quality. A total of 33 relevant articles were included. The recent high-level studies included topics of genetic and diet association with pediatric stone formation, diagnostic assessment, medical management intervention including medical dissolution and expulsion therapy. The study extended to include the efficacy and safety of extracorporeal lithotripsy, percutaneous nephrolithotomy and retrograde intrarenal surgery. However, evidence quality was ranked "very-low" or "low". Based on the GRADE criteria downgrading of the quality level was due to heterogeneity and low precision. A majority of the RCTs were categorized as having a "high" to "uncertain" risk of bias. The relevant RCTs, meta-analyses and systematic reviews within the past decade are of low quality. Consequently, the research provided no clear evidence-based recommendations for managing pediatric urolithiasis. More rigorous research and high-quality studies are needed to determine the best practices.
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Affiliation(s)
- Michael E Chua
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada.
- Department of Surgery, University of Toronto, Toronto, ON, Canada.
- Institute of Urology, St. Luke's Medical Center, Quezon City, Philippines.
| | - Jin Kyu Kim
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Jessica M Ming
- Department of Urology, University of New Mexico, Albuquerque, NM, USA
| | - Keara N De Cotiis
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- Department of Urology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Stephen S Yang
- Division of Urology, Buddhist Tzu Chi General Hospital, New Taipei Branch, New Taipei City, Taiwan
| | - Mandy Rickard
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Armando J Lorenzo
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Joana Dos Santos
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
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Lin F, Li B, Rao T, Ruan Y, Yu W, Cheng F, Larré S. Presence of a Novel Anatomical Structure May Cause Bleeding When Using the Calyx Access in Mini-Percutaneous Nephrolithotomy. Front Surg 2022; 9:942147. [PMID: 35800114 PMCID: PMC9253458 DOI: 10.3389/fsurg.2022.942147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 06/06/2022] [Indexed: 11/13/2022] Open
Abstract
Background Fused renal pyramid (FRP) is a kidney anatomical structure which was first identified by us. The vascular anatomy of FRP exhibits different from that of the normal renal pyramid (NRP), manifested by the distribution of the ectopic interlobar arteries in FRP. In this study, we analyzed the effect of FRPs on bleeding when using calyx access in mini-percutaneous nephrolithotomy (PCNL). Patients and Methods Overall, 633 patients who underwent ultrasound-guided single-tract mini-PCNL were divided into two groups according to the puncture method used: in group A, puncture was performed through the axial direction of the renal calyx, the line from the apex of the fornix to the center of the neck plane under B-mode ultrasound guidance; and in group B, Doppler ultrasound-guided axillary puncture through calyces corresponding to NRPs when the plane of renal column blood vessels on both sides was selected or calyx puncture through the hypovascular area of the FRPs. Relevant demographic and clinical data were retrospectively analyzed. Results The two groups exhibited similar baseline characteristics. No significant differences were found in hemoglobin reduction, puncture site, tract size, postoperative creatinine level, or stone-free rate between the two groups (P > 0.05). Blood transfusion and embolization rates in group B were significantly lower than those in group A (P = 0.03 and 0.045, respectively). No differences were found between the two groups in terms of persistent pain, hydrothorax, fever, subcapsular hematoma, and urosepsis (P > 0.05). The overall complication rate was not significantly different between the two groups (P = 0.505). Conclusions FRP is a non-negligible anatomical structure that may cause hemorrhage when using calyx access. Doppler ultrasound can identify ectopic blood vessels in FRPs to reduce bleeding during calyx access in mini-PCNL procedures.
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Affiliation(s)
- Fangyou Lin
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Bojun Li
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Ting Rao
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yuan Ruan
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Weimin Yu
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, China
- Correspondence: Fan Cheng Weimin Yu
| | - Fan Cheng
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, China
- Correspondence: Fan Cheng Weimin Yu
| | - Stéphane Larré
- Department of Urology, Robert Debré Teaching Hospital, University of Reims, Reims, France
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Mykoniatis I, Pietropaolo A, Pyrgidis N, Tishukov M, Anastasiadis A, Jones P, Keller EX, Talso M, Tailly T, Kalidonis P. Mini percutaneous nephrolithotomy versus standard percutaneous nephrolithotomy for the management of renal stones over 2 cm: a systematic review and meta-analysis of randomized controlled trials. Minerva Urol Nephrol 2022; 74:409-417. [PMID: 35147386 DOI: 10.23736/s2724-6051.22.04678-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Standard percutaneous nephrolithotomy (sPCNL) is recommended for renal stones over 2cm. Mini percutaneous nephrolithotomy (mPCNL) has also emerged as a promising technique in this setting. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing the safety and efficacy of sPCNL to mPCNL for the management of renal stones over 2cm. EVIDENCE ACQUISITION We systematically searched PubMed, Cochrane Library and Scopus databases until April 2021 and sources of grey literature for relevant RCTs. We performed a meta-analysis of odds ratios (ORs) to compare bleeding or other complications and stone-free rate (SFR) between sPCNL and mPCNL. Similarly, we undertook a metaanalysis of weighted mean differences for the mean operative and hospitalization time between the two techniques (PROSPERO: CRD42021241860). EVIDENCE SYNTHESIS Pooled data from 8 RCTs (2535 patients) were available for analysis. sPCNL was associated with a higher hemoglobin drop (0.59g/dl, 95%CI: 0.4-0.77, I2=93%), higher likelihood of postoperative blood transfusion (OR: 2.58, 95%CI: 1.03-6.45, I2=30%) and longer hospital stay (0.75 days, 95%CI: 0.45-1.05, I2=73%) compared to mPCNL. No significant differences were demonstrated in SFR (OR: 0.92, 95%CI: 0.74-1.16, I2=0%) and mean operative time (4.05 minutes, 95%CI: -9.45-1.37, I2=91%) after sPCNL versus mPCNL. Similarly, no significant differences were observed for postoperative fever, pain and Clavien-Dindo complications. CONCLUSIONS mPCNL represents a safe and effective technique and may be also recommended as a first-line treatment modality for well-selected patients with renal stones over 2cm. Still, further high-quality RCTs on the field are mandatory, since the overall level of evidence is low.
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Affiliation(s)
- Ioannis Mykoniatis
- Department of Urology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece - g_mikoniatis @hotmail.com
| | - Amelia Pietropaolo
- Department of Urology, University of Hospital Southampton NHS Trust, Southampton, UK
| | - Nikolaos Pyrgidis
- Department of Urology, Martha-Maria Hospital Nuremberg, Nuremberg, Germany
| | - Maksim Tishukov
- Department of Urology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anastasios Anastasiadis
- Department of Urology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Patrick Jones
- Department of Urology, Haukeland University Hospital, Bergen, Norway
| | - Etienne X Keller
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Michele Talso
- Department of Urology, ASST Fatebenefratelli-Sacco, Luigi Sacco University Hospital, Milan, Italy
| | - Thomas Tailly
- Department of Urology, University Hospital Ghent, Ghent, Belgium
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