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Nizzardo M, Albo G, Ripa F, Zino E, De Lorenzis E, Boeri L, Longo F, Montanari E, Zanetti SP. Assessment of Effectiveness and Safety of Aspiration-Assisted Nephrostomic Access Sheaths in PCNL and Intrarenal Pressures Evaluation: A Systematic Review of the Literature. J Clin Med 2024; 13:2558. [PMID: 38731086 PMCID: PMC11084567 DOI: 10.3390/jcm13092558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 04/18/2024] [Accepted: 04/24/2024] [Indexed: 05/13/2024] Open
Abstract
Background: Different suction-assisted nephrostomic sheaths have been developed for percutaneous nephrolithotomy (PCNL). Objectives: (1) To examine PCNL techniques performed with different aspiration-assisted sheaths (Clear Petra® sheath, Superperc, SuperminiPCNL, and a miniPCNL patented sheath), with specific regard to effectiveness and safety outcomes in adult and paediatric patients; (2) to extrapolate intrarenal pressure (IRP) data during these procedures. Methods: A systematic literature search was performed in accordance with PRISMA guidelines. Relevant articles up to 8 February 2024 were included. Results: Twenty-five studies were selected, thirteen retrospective and twelve prospective. The use of four different aspirating sheaths for miniPCNL was reported: Clear Petra® sheath, Superperc, SuperminiPCNL, and a miniPCNL patented sheath. Stone free rates (SFRs) across techniques ranged from 71.3% to 100%, and complication rates from 1.5% to 38.9%. Infectious complication rates varied from 0 to 27.8% and bleeding complication rates from 0 to 8.9%. Most complications were low grade ones. The trend among studies comparing aspiration- and non-aspiration-assisted miniPCNL was towards equivalent or better SFRs and lower overall infectious and bleeding complication rates in suction techniques. Operation time was consistently lower in suction procedures, with a mean shortening of the procedural time of 19 min. Seven studies reported IRP values during suction miniPCNL. Two studies reported satisfactory SFRs and adequate safety profiles in paediatric patient cohorts. Conclusions: MiniPCNL with aspirating sheaths appears to be safe and effective in both adult and paediatric patients. A trend towards a reduction of overall infectious and bleeding complications with respect to non-suction procedures is evident, with comparable or better SFRs and consistently shorter operative times. The IRP profile seems to be safe with the aid of aspirating sheaths. However, high quality evidence on this topic is still lacking.
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Affiliation(s)
- Marco Nizzardo
- Department of Urology, IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Giancarlo Albo
- Department of Urology, IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Francesco Ripa
- Department of Urology, Whittington Health NHS Trust, London N19 5NF, UK
| | - Ester Zino
- Department of Urology, IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Elisa De Lorenzis
- Department of Urology, IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Luca Boeri
- Department of Urology, IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Fabrizio Longo
- Department of Urology, IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Emanuele Montanari
- Department of Urology, IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Stefano Paolo Zanetti
- Department of Urology, IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
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Abushamma F, Zyoud SH. Analyzing global research trends and focal points in the utilization of laser techniques for the treatment of urolithiasis from 1978 to 2022: visualization and bibliometric analysis. Urolithiasis 2024; 52:67. [PMID: 38630266 DOI: 10.1007/s00240-024-01568-1] [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: 02/09/2024] [Accepted: 04/02/2024] [Indexed: 04/19/2024]
Abstract
Laser lithotripsy is gaining global prominence and is a dynamically progressing field marked by a continual influx of new and comprehensive research each year. Recently, there has been a noticeable shift toward the adoption of various kinds of lasers, such as holmium: yttrium-aluminum-garnet (Ho:YAG) and thulium fiber (TFL) lasers. Consequently, we aim to conduct a bibliometric analysis to analyze key areas of research activity within scientific publications that center on the utilization of laser techniques in urolithiasis. A search of the literature spanning from 1978 to 2022 was carried out on 25 December 2023 using the Scopus database to explore research related to the application of laser techniques for urolithiasis treatment. Visualization analysis was performed using VOSviewer software (version 1.6.20). We examined 962 publications that met the specified criteria, 791 (82.22%) of which were original articles. The analysis of the retrieved publications indicated a consistent increase in research output from 1978 to 2022; a particularly noteworthy surge occurred after 2003. In particular, the U.S. claimed the leading position as the most productive country, contributing 211 articles (21.93%). However, India had the highest research productivity according to the adjustment index of 19.08. In the European region, 324 publications (33.68% of the total) originated from 25 countries. The Journal of Endourology contributed the most between 1978 and 2022 (n = 96, 9.98%). The most cited paper examined the effectiveness of holmium: yttrium-aluminum-garnet (Ho:YAG) lasers, while a subsequent study focused on the use of a thulium fiber laser (TFL), an emerging laser technology that has gained increased recognition. Co-occurrence analysis revealed three distinct clusters focusing on the types of laser technology, minimally invasive approaches, and success rate/postoperative complications. This comprehensive investigation delves into the global landscape of laser use for the treatment of urolithiasis. This review supports the emerging clinical concept of using various types of laser technology for urolithiasis treatment. Moreover, the hot issues that researchers should focus on based on the findings of this study are the use of different types of laser lithotripsy in view of the surgical approach, success rate and complications.
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Affiliation(s)
- Faris Abushamma
- Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine.
- Department of Urology, An-Najah National University Hospital, Nablus, 44839, Palestine.
| | - Sa'ed H Zyoud
- Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine.
- Clinical Research Center, An-Najah National University Hospital, Nablus, 44839, Palestine.
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Zou XC, Luo CW, Yuan RM, Jin MN, Zeng T, Chao HC. Develop a radiomics-based machine learning model to predict the stone-free rate post-percutaneous nephrolithotomy. Urolithiasis 2024; 52:64. [PMID: 38613668 DOI: 10.1007/s00240-024-01562-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 03/21/2024] [Indexed: 04/15/2024]
Abstract
Radiomics and machine learning have been extensively utilized in the realm of urinary stones, particularly in forecasting stone treatment outcomes. The objective of this study was to integrate clinical variables and radiomic features to develop a machine learning model for predicting the stone-free rate (SFR) following percutaneous nephrolithotomy (PCNL). A total of 212 eligible patients who underwent PCNL surgery at the Second Affiliated Hospital of Nanchang University were included in a retrospective analysis. Preoperative clinical variables and non-contrast-enhanced CT images of all patients were collected, and radiomic features were extracted after delineating the stone ROI. Univariate analysis was conducted to identify clinical variables strongly correlated with the stone-free rate after PCNL, and the least absolute shrinkage and selection operator algorithm (lasso regression) was utilized to screen radiomic features. Four supervised machine learning algorithms, including Logistic Regression, Random Forest (RF), Extreme Gradient Boosting (XGBoost), and Gradient Boosting Decision Tree (GBDT), were employed. The clinical variables with strong correlation and screened radiomic features were integrated into the four machine learning algorithms to construct a prediction model, and the receiver operating curve was plotted. The area under the receiver operating curve (AUC), the accuracy rate, the specificity, etc., were used to evaluate the predictive performance of the four models. After analyzing postoperative statistics, the stone-free rate following the procedure was found to be 70.3% (n = 149). Among the various clinical variables examined, factors, such as stone number, stone diameter, stone CT value, stone location, and history of stone surgery, were identified as statistically significant in relation to the stone-free rate after PCNL. A total of 121 radiomic features were extracted, and through lasso regression, 7 features most closely associated with the stone-free rate post-PCNL were identified. The predictive accuracy of different models (Logistic Regression, RF, XGBoost, and GBDT) for determining the stone-free rate after PCNL was evaluated, yielding accuracies of 78.1%, 76.6%, 75.0%, and 73.4%, respectively. The corresponding area under the curve AUC (95%CI) were 0.85 (0.83-0.89), 0.81 (0.76-0.85), 0.82 (0.78-0.85), and 0.77 (0.73-0.81), positioning these models among the top performers in logistic regression prediction. In terms of predictive importance scores, the key factors identified by the logistic regression model were number of stone, zone percentage, stone diameter, and surface area. Similarly, the RF model highlighted number of stone, stone CT value, stone diameter, and surface area as the top predictors. Among the four machine learning models, the logistic regression model demonstrated the highest accuracy and discrimination ability in predicting the stone-free rate following PCNL. In comparison to XGBoost and GBDT, RF also exhibited superior accuracy and a certain level of discrimination ability. However, based on the performance of all four models, logistic regression is more likely to aid in clinical decision-making by assisting clinicians in diagnosing PCNL in patients. This enables us to effectively predict the presence of residual stones post-surgery and ultimately select patients who are suitable candidates for PCNL.
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Affiliation(s)
- Xin Chang Zou
- Department of Urology, Second Affiliated Hospital of Nanchang University, Nanchang, 330008, China
| | - Cheng Wei Luo
- Department of Urology, Second Affiliated Hospital of Nanchang University, Nanchang, 330008, China
| | | | - Meng Ni Jin
- Department of Imaging, Second Affiliated Hospital of Nanchang University, Nanchang, 330008, China
| | - Tao Zeng
- Department of Urology, Second Affiliated Hospital of Nanchang University, Nanchang, 330008, China.
| | - Hai Chao Chao
- Department of Urology, Second Affiliated Hospital of Nanchang University, Nanchang, 330008, China
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Edison E, Mazzon G, Arumuham V, Choong S. Prevention of complications in endourological management of stones: What are the basic measures needed before, during, and after interventions? Asian J Urol 2024; 11:180-190. [PMID: 38680580 PMCID: PMC11053336 DOI: 10.1016/j.ajur.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 04/17/2023] [Indexed: 05/01/2024] Open
Abstract
Objective This narrative review aims to describe measures to minimise the risk of complications during percutaneous nephrolithotomy (PCNL), ureteroscopy, and retrograde intrarenal surgery. Methods A literature search was conducted from the PubMed/PMC database for papers published within the last 10 years (January 2012 to December 2022). Search terms included "ureteroscopy", "retrograde intrarenal surgery", "PCNL", "percutaneous nephrolithotomy", "complications", "sepsis", "infection", "bleed", "haemorrhage", and "hemorrhage". Key papers were identified and included meta-analyses, systematic reviews, guidelines, and primary research. The references of these papers were searched to identify any further relevant papers not included above. Results The evidence is assimilated with the opinions of the authors to provide recommendations. Best practice pathways for patient care in the pre-operative, intra-operative, and post-operative periods are described, including the identification and management of residual stones. Key complications (sepsis and stent issues) that are relevant for any endourological procedure are then be discussed. Operation-specific considerations are then explored. Key measures for PCNL include optimising access to minimise the chance of bleeding or visceral injury. The role of endoscopic combined intrarenal surgery in this regard is discussed. Key measures for ureteroscopy and retrograde intrarenal surgery include planning and technique to minimise the risk of ureteric injury. The role of anaesthetic assessment is discussed. The importance of specific comorbidities on each step of the pathway is highlighted as examples. Conclusion This review demonstrates that the principles of meticulous planning, interdisciplinary teamworking, and good operative technique can minimise the risk of complications in endourology.
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Affiliation(s)
- Eric Edison
- Department of Urology, University College Hospital London, London, UK
| | - Giorgio Mazzon
- Department of Urology, San Bassiano Hospital, Vicenza, Italy
| | - Vimoshan Arumuham
- Department of Urology, University College Hospital London, London, UK
| | - Simon Choong
- Department of Urology, University College Hospital London, London, UK
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Nizzardo M, Zanetti SP, Marmiroli A, Lucignani G, Turetti M, Silvani C, Gadda F, Longo F, De Lorenzis E, Albo G, Salonia A, Montanari E, Boeri L. Transient ureteral obstruction after mini-percutaneous nephrolithotomy is associated with stone volume and location: results from a single-center, real-life study. World J Urol 2024; 42:146. [PMID: 38478085 PMCID: PMC10937798 DOI: 10.1007/s00345-024-04832-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 01/16/2024] [Indexed: 03/17/2024] Open
Abstract
PURPOSE To evaluate the rate of and predictors of ureteral obstruction after mini-percutaneous nephrolithotomy (mPCNL) for kidney stones. METHODS We analyzed data from 263 consecutive patients who underwent mPCNL at a single tertiary referral academic between 01/2016 and 11/2022. Patient's demographics, stone characteristics, and operative data were collected. A nephrostomy tube was placed as the only exit strategy in each procedure. On postoperative day 2, an antegrade pyelography was performed to assess ureteral canalization. The nephrostomy tube was removed if ureteral canalization was successful. Descriptive statistics and logistic regression models were used to identify factors associated with a lack of ureteral canalization. RESULTS Overall, median (IQR) age and stone volume were 56 (47-65) years and 1.7 (0.8-4.2) cm3, respectively. Of 263, 55 (20.9%) patients showed ureteral obstruction during pyelography. Patients without ureteral canalization had larger stone volume (p < 0.001), longer operative time (p < 0.01), and higher rate of stones in the renal pelvis (p < 0.01) than those with normal pyelography. Length of stay was longer (p < 0.01), and postoperative complications (p = 0.03) were more frequent in patients without ureteral canalization. Multivariable logistic regression analysis revealed that stone volume (OR 1.1, p = 0.02) and stone located in the renal pelvis (OR 2.2, p = 0.04) were independent predictors of transient ureteral obstruction, after accounting for operative time. CONCLUSION One out of five patients showed transient ureteral obstruction after mPCNL. Patients with a higher stone burden and with stones in the renal pelvis are at higher risk of inadequate ureteral canalization. Internal drainage might be considered in these cases to avoid potential complications.
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Affiliation(s)
- Marco Nizzardo
- Department of Urology, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Stefano Paolo Zanetti
- Department of Urology, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Andrea Marmiroli
- Department of Urology, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Gianpaolo Lucignani
- Department of Urology, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Matteo Turetti
- Department of Urology, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Carlo Silvani
- Department of Urology, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Franco Gadda
- Department of Urology, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Fabrizio Longo
- Department of Urology, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Elisa De Lorenzis
- Department of Urology, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Giancarlo Albo
- Department of Urology, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy.
- Department of Clinical Sciences and Community Health, University of Milan, Via Della Commenda 15, 20122, Milan, Italy.
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
| | - Emanuele Montanari
- Department of Urology, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Via Della Commenda 15, 20122, Milan, Italy
| | - Luca Boeri
- Department of Urology, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
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Hu H, Yan Q, Tang X, Lai S, Qin Z, Xu T, Zhang H, Hu H. A novel model of urosepsis in mice developed by ureteral ligation and injection of Escherichia coli into the renal pelvis. Heliyon 2024; 10:e25522. [PMID: 38327418 PMCID: PMC10847998 DOI: 10.1016/j.heliyon.2024.e25522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 01/25/2024] [Accepted: 01/29/2024] [Indexed: 02/09/2024] Open
Abstract
Despite extensive investigations, urosepsis remains a life-threatening and high-mortality illness. The absence of widely acknowledged animal models for urosepsis prompted this investigation with the objective of formulating a replicable murine model. Eighty-four adult male C57BL/6J mice were arbitrarily distributed into three cohorts based on the concentration of the Escherichia coli (E. coli) solution administered into the renal pelvis: Sham, Low-grade sepsis (1.0 × 108 cfu/mL), and High-grade sepsis (1.0 × 109 cfu/mL). By fabricating a glass needle with a 100 μm outer diameter, bacterial leakage during renal pelvic injection was minimized. After the ureteral ligation, the mice were injected with this needle into the right renal pelvis (normal saline or E. coli solution, 1 ml/kg). Ten days post after E. coli injection, the mortality rates for the Low-grade sepsis and High-grade sepsis groups stood at 30 % and 100 %, respectively. Post-successful modeling, mice in the urosepsis cohort exhibited a noteworthy reduction in activity, body temperature, and white blood cell count within a 2-h timeframe. At the 24-h mark post-modeling, mice afflicted with urosepsis displayed compromised coagulation functionality. Concurrently, multiple organ dysfunction was confirmed as evidenced by markedly elevated levels of inflammatory factors (IL-6 and TNF-α) in four distinct organs (heart, lung, liver, and kidney). This study confirmed the feasibility of establishing a standardized mouse model of urosepsis by ureteral ligation and E. coli injection into the renal pelvis. A primary drawback of this model resides in the mice's diminished blood volume, rendering continuous blood extraction at multiple intervals challenging.
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Affiliation(s)
- Haopu Hu
- Department of Urology, Peking University People's Hospital, Beijing, China
| | - Qiuxia Yan
- Department of Urology, Huizhou First People's Hospital, Huizhou, Guangdong, China
| | - Xinwei Tang
- Department of Urology, Peking University People's Hospital, Beijing, China
| | - Shicong Lai
- Department of Urology, Peking University People's Hospital, Beijing, China
| | - Ziyu Qin
- State Key Laboratory of Vascular Homeostasis and Remodeling, The lnstitute of Cardiovascular Sciences, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China
| | - Tao Xu
- Department of Urology, Peking University People's Hospital, Beijing, China
| | - Hong Zhang
- State Key Laboratory of Vascular Homeostasis and Remodeling, The lnstitute of Cardiovascular Sciences, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China
| | - Hao Hu
- Department of Urology, Peking University People's Hospital, Beijing, China
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Huang C, Yang K, Gao W, Gu Y, Zhu HJ, Li X. Ileal ureter replacement and ileocystoplasty for the treatment of bilateral ureteral strictures and bladder contracture: technique and outcomes. Minerva Urol Nephrol 2024; 76:97-109. [PMID: 38426424 DOI: 10.23736/s2724-6051.23.05492-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
BACKGROUND The aim of this study was to explore the feasibility of ileal ureter replacement and ileocystoplasty for the treatment of bilateral long-segment ureteral strictures combined with bladder contracture. METHODS A retrospective review of clinical data from seven patients who underwent bilateral Ileal Ureter Replacement and ileocystoplasty from April 2019 to February 2023 was conducted. The surgeries were performed using open, laparoscopic, and robot-assisted laparoscopic approaches. Baseline characteristics, perioperative, and mid-term results of the patients were collected. Follow-up period of 3-28 months. A detailed description of the technique was reported. RESULTS The mean age of the patients was 52.86±6.06 years. The average duration of surgery was 365±28.54 minutes, and the estimated intraoperative blood loss was 357.14±184.06 mL. The mean length of harvested ileum was 37.86±8.40 cm. The preoperative serum creatinine level was 88.02±18.05 μmol/L, postoperative day 1 creatinine level was 90.7±12.93μmol/L, postoperative 3-month creatinine level was 93.77±33.34 μmol/L, and the mean creatinine level at the last follow-up was 94.89±27.89μmol/L. The postoperative bladder capacity was 249.43±32.50 mL on average. The average length of hospital stay was 26.57±15.46 days. No complications of Clavien-Dindo grade 3 or higher were observed. During the follow-up period, no patients experienced deterioration of renal function after surgery. CONCLUSIONS Bilateral ileal ureter replacement and ileocystoplasty are effective surgical technique for the treatment of bilateral long-segment ureteral strictures combined with bladder contracture caused by radiation therapy.
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Affiliation(s)
- Chen Huang
- Department of Urology, Jian Gong Hospital, Beijing, China
| | - Kunlin Yang
- Department of Urology, Peking University First Hospital, Beijing, China
| | - Wenzhi Gao
- Department of Urology, Miyun Hospital, Peking University First Hospital, Beijing, China
| | - Yaming Gu
- Department of Urology, Miyun Hospital, Peking University First Hospital, Beijing, China
| | - Hong J Zhu
- Department of Urology, Jian Gong Hospital, Beijing, China
| | - Xuesong Li
- Department of Urology, Peking University First Hospital, Beijing, China -
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Della Corte M, Cerchia E, Fiori C, Mandaletti M, Ruggiero E, Porpiglia F, Catti M, Gerocarni Nappo S. JJ stent dislodgement in the distal ureter: how to recover it in preschool children? Minerva Urol Nephrol 2024; 76:116-119. [PMID: 38015551 DOI: 10.23736/s2724-6051.23.05550-7] [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: 11/29/2023]
Abstract
Double-J ureteral stents are usually placed after various urological procedures. The dislodgement of their distal ringlet is a rare complication, whose retrieval is arduous in younger children, due to the small ureteral caliber. We propose our innovative endoscopic approach to recover the dislodged JJ stent. Under 8-9.8 Ch cystoscopy, the ureteral meatus is gently cannulated with a 00.18″ guidewire, then a balloon catheter Passeo 18 3-4 mm (Biotronik, Lake Oswego, OR, USA) is coaxially inserted. A pneumatic dilatation of the vesical-ureteral junction is performed up to 8 atmospheres for 5 minutes under direct vision. Consequently, the ureteral meatus allows the cystoscope passage, and the JJ-stent can be recovered thanks to endoscopic grasping forceps. A mono-J stent is then left in place for 24 hours. Four patients aged 8 months - 4 years have been successfully treated with this approach after that JJ migration was found intraoperatively or during ultrasonography. No intra- or postoperative complications occurred. Postoperative hospital stay was prolonged for one day. During 29.5 medium follow-up no clinical or ultrasonographic signs of vesical-ureteral reflux ensued. Our cystoscopic approach is effective and safe to ensure a prompt endoscopic JJ retrieval without changing neither surgical approach nor the anesthesiological support. We believe that all the pediatric urology centers should know the procedure and have small size balloon catheter available.
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Affiliation(s)
- Marcello Della Corte
- School of Medicine, Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy -
- Division of Pediatric Urology, Department of Pediatrics and Pediatric Specialties, Regina Margherita Children's Hospital, Turin, Italy -
| | - Elisa Cerchia
- Division of Pediatric Urology, Department of Pediatrics and Pediatric Specialties, Regina Margherita Children's Hospital, Turin, Italy
| | - Cristian Fiori
- School of Medicine, Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Martina Mandaletti
- School of Medicine, Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
- Division of Pediatric Urology, Department of Pediatrics and Pediatric Specialties, Regina Margherita Children's Hospital, Turin, Italy
| | - Elena Ruggiero
- Division of Pediatric Urology, Department of Pediatrics and Pediatric Specialties, Regina Margherita Children's Hospital, Turin, Italy
| | - Francesco Porpiglia
- School of Medicine, Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Massimo Catti
- Division of Pediatric Urology, Department of Pediatrics and Pediatric Specialties, Regina Margherita Children's Hospital, Turin, Italy
| | - Simona Gerocarni Nappo
- Division of Pediatric Urology, Department of Pediatrics and Pediatric Specialties, Regina Margherita Children's Hospital, Turin, Italy
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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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10
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Melchionna A, Choong S, Arumuham V, Mazzon G. Comment on: "Mini-percutaneous nephrolithotomy versus retrograde intrarenal surgery for the treatment of 10-20-mm kidney stones in patients with ileal conduit: a comparative study". Minerva Urol Nephrol 2023; 75:783-785. [PMID: 38126293 DOI: 10.23736/s2724-6051.23.05639-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Affiliation(s)
- Alberto Melchionna
- Institute of Urology, University College Hospitals of London, London, UK
| | - Simon Choong
- Institute of Urology, University College Hospitals of London, London, UK
| | - Vimoshan Arumuham
- Institute of Urology, University College Hospitals of London, London, UK
| | - Giorgio Mazzon
- Institute of Urology, University College Hospitals of London, London, UK -
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11
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Mazzon G, Choong S, Zhu W, Zeng G. Comment on: "Influence of pre-stenting on RIRS outcomes. Inferences from patients of the Global Multicentre Flexible Ureteroscopy Outcome (FLEXOR) Registry". Minerva Urol Nephrol 2023; 75:656-657. [PMID: 37728500 DOI: 10.23736/s2724-6051.23.05531-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Affiliation(s)
- Giorgio Mazzon
- Department of Urology, Guandong Key Laboratories, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China -
| | - Simon Choong
- Institute of Urology, University College Hospitals of London, London, UK
| | - Wei Zhu
- Department of Urology, Guandong Key Laboratories, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Guohua Zeng
- Department of Urology, Guandong Key Laboratories, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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12
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Bosio A, Alessandria E, Vitiello F, Vercelli E, Micai L, Gozzo C, Bisconti A, Gontero P. One hundred and one pigtail suture stents after ureteroscopy: focus on insertion, removal and complications. Minerva Urol Nephrol 2023; 75:555-558. [PMID: 37199531 DOI: 10.23736/s2724-6051.23.05162-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Affiliation(s)
- Andrea Bosio
- Department of Urology, Molinette University Hospital, Città della Salute e della Scienza, Turin, Italy -
| | - Eugenio Alessandria
- Department of Urology, Molinette University Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Federico Vitiello
- Department of Urology, Molinette University Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Eugenia Vercelli
- Department of Urology, Molinette University Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Luca Micai
- Department of Urology, Molinette University Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Claudia Gozzo
- Department of Urology, Molinette University Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Alessandro Bisconti
- Department of Urology, Molinette University Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Paolo Gontero
- Department of Urology, Molinette University Hospital, Città della Salute e della Scienza, Turin, Italy
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13
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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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14
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Chai CA, Teoh YC, Tailly T, Emiliani E, Inoue T, Tanidir Y, Gadzhiev N, Bin Hamri S, Ong WL, Shrestha A, Ragoori D, Lakmichi MA, Gorelov D, Soebhali B, Vaddi CM, Bhatia TP, Desai D, Durai P, Heng CT, Chew B, Castellani D, Somani B, Traxer O, Gauhar V. Influence of pre-stenting on RIRS outcomes. Inferences from patients of the Global Multicentre Flexible Ureteroscopy Outcome Registry (FLEXOR). Minerva Urol Nephrol 2023; 75:493-500. [PMID: 37293816 DOI: 10.23736/s2724-6051.23.05239-4] [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: 06/10/2023]
Abstract
BACKGROUND Retrograde Intrarenal Surgery (RIRS) is recommended as an alternative to percutaneous nephrolithotomy for stones up to 2 cm. Pre-stenting before RIRS remains controversial with various studies differing in outcomes and recommendations. We aim to understand how pre-stenting influences surgical outcomes. METHODS A number of 6579 patients from the TOWER group registry were divided into pre-stented (group 1) and non-pre-stented groups (group 2). Patients aged ≥18 years old, with normal calyceal anatomy were enrolled. Patients with ureteric stones, anomalous kidneys, bilateral stones, planned for ECIRS were excluded. RESULTS Patients are homogeneously distributed in both groups (3112 vs. 3467). The predominant indication for pre-stenting was symptom relief. Overall stone size was comparable, whilst group 1 had a significantly more multiple (1419 vs. 1283, P<0.001) and lower-pole (LP) stones (1503 vs. 1411, P<0.001). The mean operative time for group 2 was significantly longer (68.17 vs. 58.92, P<0.001). Stone size, LP stones, age, recurrence and multiple stones are contributing factors for residual fragments at the multivariable analysis. The incidence of postoperative day 1 fever and sepsis was significantly higher in group 2, indicating that pre-stenting is associated with a lower risk of post-RIRS infection and a lower overall complications rate (13.62% vs. 15.89%) (P<0.001). CONCLUSIONS RIRS without pre-stenting can be considered safe without significant morbidity. Multiple, lower-pole and large stone is a significant contributor towards residual fragments. Patients who were not pre-stented had significantly higher but low-grade complications, especially for lower pole and large volume stones. While we do not advocate routine pre-stenting, a tailored approach for these patients should include proper counselling regarding pre-stenting.
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Affiliation(s)
- Chu-Ann Chai
- Unit of Urology, Department of Surgery, University Malaya Medical Center, Kuala Lumpur, Malaysia -
| | - Yuen-Chun Teoh
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Thomas Tailly
- Department of Urology, University Hospital of Ghent, Ghent, Belgium
| | - Esteban Emiliani
- Puigvert Foundation, Autonomous University of Barcelona, Barcelona, Spain
| | - Takaaki Inoue
- Hara Genitourinary Private Hospital, University of Kobe, Kobe, Japan
| | - Yiloren Tanidir
- Department of Urology, School of Medicine, Marmara University, Istanbul, Türkiye
| | - Nariman Gadzhiev
- Department of Urology, Saint Petersburg State University Hospital, Saint Petersburg, Russia
| | - Saeed Bin Hamri
- Division of Urology, Department of Surgery, Ministry of the National Guard Health Affairs, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia
| | - William L Ong
- Department of Urology, Penang General Hospital, Penang, Malaysia
| | - Anil Shrestha
- National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
| | - Deepak Ragoori
- Asian Institute of Nephrology and Urology, Hyderabad, India
| | - Mohamed A Lakmichi
- Department of Urology, University Hospital Mohammed VI of Marrakesh, Cadi Ayyad University, Marrakesh, Morocco
| | - Dmitry Gorelov
- Department of Endourology, Saint-Petersburg State Medical University, Saint-Petersburg, Russia
| | - Boyke Soebhali
- Faculty of Medicine, Abdul Wahab Sjahranie Hospital, Mulawarman University, Mulawarman, Indonesia
| | - Chandra M Vaddi
- Department of Urology, Preeti Urology and Kidney Hospital, Hyderabad, India
| | - Tanuj P Bhatia
- Department of Urology, Sarvodaya Healthcare, Faridabad, Haryana, India
| | - Devang Desai
- Department of Urology, Toowoomba Base Hospital, Toowoomba, Australia
| | - Pradeep Durai
- Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Chin-Tiong Heng
- Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Ben Chew
- Department of Urology, University of British Columbia, Vancouver, BC, Canada
| | - Daniele Castellani
- AOU Ospedali Riuniti di Ancona, Università Politecnica delle Marche, Ancona, Italy
| | - Bhaskar Somani
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Olivier Traxer
- Department of Urology, GRC Urolithiasis, Tenon Hospital, Sorbonne University, Paris, France
| | - Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore
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15
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Solano C, Chicaud M, Kutchukian S, Candela L, Corrales M, Panthier F, Doizi S, Traxer O. Optimizing Outcomes in Flexible Ureteroscopy: A Narrative Review of Suction Techniques. J Clin Med 2023; 12:jcm12082815. [PMID: 37109152 PMCID: PMC10146070 DOI: 10.3390/jcm12082815] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 04/04/2023] [Accepted: 04/08/2023] [Indexed: 04/29/2023] Open
Abstract
OBJECTIVE The aim of this review is to summarize the existing suction systems in flexible ureteroscopy (fURS) and to evaluate their effectiveness and safety. METHODS A narrative review was performed using the Pubmed and Web of Science Core Collection (WoSCC) databases. Additionally, we conducted a search on the Twitter platform. Studies including suctions systems in fURS were included. Editorials, letters and studies reporting intervention with semirigid ureteroscopy, PCNL and mPCNL were excluded. RESULTS A total of 12 studies were included in this review. These studies comprised one in vitro study, one ex vivo study, one experimental study and eight cohort studies. The Pubmed and WoSCC searches identified three suction techniques (Irrigation/Suctioning system with control of pressure, suction ureteral access sheath (sUAS) and direct in scope suction (DISS)), and the Twitter search identified four of them. The overall results showed that suction is an effective and safe technique that improves stone-free rates, reduces operative time and limits complication rates after fURS. CONCLUSIONS The use of suctioning during common endourological procedures has been shown to improve safety and efficacy in several indications. However, randomized controlled trials are needed to confirm this.
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Affiliation(s)
- Catalina Solano
- GRC n 20, Groupe de Recherche Clinique sur la Lithiasis Urinaire, Hôpital Tenon, Sorbonne Université, 75020 Paris, France
- Department of Endourology, Uroclin S.A.S., Medellín 50011, Colombia
| | - Marie Chicaud
- Department of Urology, Limoges University Hospital, 2 Avenue Martin Luther King, 87000 Limoges, France
| | - Stessy Kutchukian
- Department of Urology, Poitiers University Hospital, 2 Rue de la Milétrie, 86000 Poitiers, France
| | - Luigi Candela
- GRC n 20, Groupe de Recherche Clinique sur la Lithiasis Urinaire, Hôpital Tenon, Sorbonne Université, 75020 Paris, France
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, 20100 Milan, Italy
| | - Mariela Corrales
- GRC n 20, Groupe de Recherche Clinique sur la Lithiasis Urinaire, Hôpital Tenon, Sorbonne Université, 75020 Paris, France
| | - Frédéric Panthier
- GRC n 20, Groupe de Recherche Clinique sur la Lithiasis Urinaire, Hôpital Tenon, Sorbonne Université, 75020 Paris, France
| | - Steeve Doizi
- GRC n 20, Groupe de Recherche Clinique sur la Lithiasis Urinaire, Hôpital Tenon, Sorbonne Université, 75020 Paris, France
| | - Olivier Traxer
- GRC n 20, Groupe de Recherche Clinique sur la Lithiasis Urinaire, Hôpital Tenon, Sorbonne Université, 75020 Paris, France
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16
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Fu X, Li J, Zheng Y, Chen X. Intraoperative disappearance of ureteral calculi. Asian J Surg 2023:S1015-9584(23)00386-X. [PMID: 36990819 DOI: 10.1016/j.asjsur.2023.03.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 03/15/2023] [Indexed: 03/30/2023] Open
Affiliation(s)
- Xing Fu
- Department of Urology, Xinjin District People's Hospital, Chengdu, 611430, China
| | - Jinxian Li
- Department of Urology, Xinjin District People's Hospital, Chengdu, 611430, China
| | - Yang Zheng
- Robotic Minimally Invasive Surgery Center, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital & Affiliated Hospital of the University of Electronic Science and Technology of China, Chengdu, 610072, China; School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610051, China
| | - Xu Chen
- Department of Urology, Xinjin District People's Hospital, Chengdu, 611430, China.
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17
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Zeng G, Traxer O, Zhong W, Osther P, Pearle MS, Preminger GM, Mazzon G, Seitz C, Geavlete P, Fiori C, Ghani KR, Chew BH, Git KA, Vicentini FC, Papatsoris A, Brehmer M, Martinez JL, Cheng J, Cheng F, Gao X, Gadzhiev N, Pietropaolo A, Proietti S, Ye Z, Sarica K. International Alliance of Urolithiasis guideline on retrograde intrarenal surgery. BJU Int 2023; 131:153-164. [PMID: 35733358 PMCID: PMC10084014 DOI: 10.1111/bju.15836] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES To set out the second in a series of guidelines on the treatment of urolithiasis by the International Alliance of Urolithiasis that concerns retrograde intrarenal surgery (RIRS), with the aim of providing a clinical framework for urologists performing RIRS. MATERIALS AND METHODS After a comprehensive search of RIRS-related literature published between 1 January 1964 and 1 October 2021 from the PubMed database, systematic review and assessment were performed to inform a series of recommendations, which were graded using modified GRADE methodology. Additionally, quality of evidence was classified using a modification of the Oxford Centre for Evidence-Based Medicine Levels of Evidence system. Finally, related comments were provided. RESULTS A total of 36 recommendations were developed and graded that covered the following topics: indications and contraindications; preoperative imaging; preoperative ureteric stenting; preoperative medications; peri-operative antibiotics; management of antithrombotic therapy; anaesthesia; patient positioning; equipment; lithotripsy; exit strategy; and complications. CONCLUSION The series of recommendations regarding RIRS, along with the related commentary and supporting documentation, offered here should help provide safe and effective performance of RIRS.
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Affiliation(s)
- Guohua Zeng
- Department of Urology, Guangdong Key Laboratory of Urology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Olivier Traxer
- GRC Urolithiasis No. 20, Sorbonne University, Tenon Hospital, Paris, France
| | - Wen Zhong
- Department of Urology, Guangdong Key Laboratory of Urology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Palle Osther
- Department of Urology, Vejle Hospital-a part of Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | | | - Glenn M Preminger
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Giorgio Mazzon
- Department of Urology, San Bassiano Hospital, Vicenza, Italy
| | - Christian Seitz
- Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Petrisor Geavlete
- Sanador Hospital, Bucharest, Romania.,Department of Urology, Sf. Ioan Emergency Clinical Hospital, Bucharest, Romania
| | - Cristian Fiori
- Division of Urology, Department of Oncology, University of Turin, Turin, Italy
| | - Khurshid R Ghani
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Ben H Chew
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Kah Ann Git
- Department of Urology, Pantai Hospital, Penang, Malaysia
| | - Fabio Carvalho Vicentini
- Departamento de Urologia, Faculdade de Medicina da Universidade de São Paulo - FMUSP, Hospital das Clínicas, São Paulo, Brazil
| | - Athanasios Papatsoris
- 2nd Department of Urology, School of Medicine, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Marianne Brehmer
- Division of Urology, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Juan Lopez Martinez
- Department of Urology, Clinic Hospital, University of Barcelona, Barcelona, Spain
| | - Jiwen Cheng
- Department of Urology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Fan Cheng
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xiaofeng Gao
- Department of Urology, Changhai Hospital, Shanghai, China
| | - Nariman Gadzhiev
- Department of Urology, Saint-Petersburg State University Hospital, Saint-Petersburg, Russia
| | | | - Silvia Proietti
- Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Zhangqun Ye
- Department of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Kemal Sarica
- Department of Urology, Medical School, Biruni University, Istanbul, Turkey
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18
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Comparison of Flexible Ureteroscope Performance between Reusable and Single-Use Models. J Clin Med 2023; 12:jcm12031093. [PMID: 36769740 PMCID: PMC9917814 DOI: 10.3390/jcm12031093] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 01/25/2023] [Accepted: 01/26/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Single-use flexible ureteroscopes for urinary retention have been developed in recent years as an alternative to reusable ureteroscopes in order to eliminate the risk of cross-infections and to solve the primary limitations of traditional reusable flexible ureteroscopes for urinary retention. METHODS In this study, we evaluated and contrasted three of the most recent types of flexible ureteroscopes, including two digital reusable versions (Olympus URF-V and Olympus URF-V2) and one single-use model (Pusen Medi-calUscope UE3022), in both ex vivo and in vivo scenarios. The influence of a variety of instruments on the flow of irrigation and its deflection was investigated ex vivo. In the in vivo investigation, a total of 40 patients were treated with retrograde fURS utilizing URF-V, 20 patients were treated with URF-V2, and 20 patients were treated with single-use fURS. The visibility and maneuverability of each fURS were evaluated by the same urologist during the procedures, and the results were compared. RESULTS Intraoperatively, we compared the image quality of reusable (URF-V and URF-V2) and single-use fURS USCOPE UE3022 cameras and found that there was no statistically significant difference between the two types of camera. The score for maneuverability was the same (4.2) regardless of whether we used the UscopeUE3022 or the URF-V2, but it was significantly lower (3.8, p = 0.03) when we utilized the URF-V. Irrigation was about the same when utilizing reused scopes, whereas employing a single-use scope was more than fifty percent more effective. CONCLUSIONS The findings of our research indicate that reusable and single-use fURs have visibility and maneuverability characteristics that are at least comparable to one another. The possibilities of the single-use type in terms of irrigation flow and deflection are superior.
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19
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Ventimiglia E, Quadrini F, Pauchard F, Villa L, Candela L, Proietti S, Giusti G, Pietropaolo A, Somani BK, Goumas IK, Salonia A, Doizi S, Traxer O. Pattern of key opinion leaders talks at major international urological meetings reflects the main differences in flexible ureteroscopy and PCNL diffusion. World J Urol 2023; 41:229-233. [PMID: 36445371 DOI: 10.1007/s00345-022-04209-7] [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: 07/11/2022] [Accepted: 11/01/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To analyze the pattern of speaker activity related to both flexible ureteroscopy (fURS) and percutaneous nephrolithotomy (PCNL) during plenary sessions at the main (endo)urological international meetings over the last 10 years. METHODS We reviewed the meeting programs of the main endourological international meetings (EAU, AUA, WCE, and SIU) during 2011-2019. We detected all invited speakers at plenary sessions regarding fURS or PCNL. The proportion of fURS and PCNL talks was evaluated yearly during the study period. In order to analyze plenary session speaker composition, we estimated and compared the mean number of talks per speaker according to surgical technique. We also analyzed possible differences in age distribution according to the topic of the talk as well as the presence of young (i.e., < 45 years) speakers. Data were analyzed using descriptive statistics. RESULTS During the last 10 years, a total of 498 plenary talks were found. Of those, 260 (52.2%), 211 (42.4%), and 27 (5.4%) discussed PCNL, fURS, or both, respectively. PCNL was more frequently discussed at the beginning and the end of the study period. Mean [SD] number of talks per speaker was higher for PCNL (2.9 [3.4] vs 1.6 [1.4], p < 0.001), meaning that a wider variety of speakers was invited to give fURS talks. Speakers discussing fURS were younger (median [interquartile range, IQR] age 48 [44-56] vs 52 [47-60] years, p < 0.001), and a higher proportion of young speakers was observed in the fURS group (26% vs 15% p < 0.001). PCNL speakers were more commonly discussing fURS than fURS speakers discussing PCNL (23% vs 17%, p = 0.43). CONCLUSIONS We found a wider variety of speakers at fURS plenary sessions as compared to PCNL ones. It is easier and quicker to become an internationally recognized expert in the field of fURS rather than PCNL. PCNL speakers were able to master fURS more frequently than the other way around.
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Affiliation(s)
- Eugenio Ventimiglia
- Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, GRC n°20, 75020, Paris, France
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, 4 rue de la Chine, 75020, Paris, France
- Division of Experimental Oncology/Unit of Urology, URI-Urological Research Institute, IRCCS Ospedale San Raffaele, 20132, Milan, Italy
| | - Francesca Quadrini
- Department of Urology, Ausl Bologna-Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy
| | - Felipe Pauchard
- Department of Urology, Hospital Carlos Van Buren, Valparaiso, Chile
| | - Luca Villa
- Division of Experimental Oncology/Unit of Urology, URI-Urological Research Institute, IRCCS Ospedale San Raffaele, 20132, Milan, Italy
| | - Luigi Candela
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, 4 rue de la Chine, 75020, Paris, France
- Division of Experimental Oncology/Unit of Urology, URI-Urological Research Institute, IRCCS Ospedale San Raffaele, 20132, Milan, Italy
- Vita-Salute San Raffaele University, 20132, Milan, Italy
| | - Silvia Proietti
- Department of Urology, European Training Center in Endourology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Guido Giusti
- Department of Urology, European Training Center in Endourology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Amelia Pietropaolo
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - Bhaskar K Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | | | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology, URI-Urological Research Institute, IRCCS Ospedale San Raffaele, 20132, Milan, Italy
- Vita-Salute San Raffaele University, 20132, Milan, Italy
| | - Steeve Doizi
- Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, GRC n°20, 75020, Paris, France
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, 4 rue de la Chine, 75020, Paris, France
| | - Olivier Traxer
- Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, GRC n°20, 75020, Paris, France.
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, 4 rue de la Chine, 75020, Paris, France.
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20
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Said DF, Ferreira DB, Hayek KKRE, Perrella R, Mota PKV, Cohen DJ, Batagello CA, Murta CB, Claro JFDA, Vicentini FC. Factors associated with complications after percutaneous nephrolithotomy: an analysis of 1,066 cases. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:e20221089. [PMID: 37194795 DOI: 10.1590/1806-9282.20221089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 02/23/2023] [Indexed: 05/18/2023]
Abstract
OBJECTIVE The aim of this study was to identify predictive factors for complications after percutaneous nephrolithotomy. METHODS We prospectively analyzed patients who underwent percutaneous nephrolithotomy from June 2011 to October 2018. The association of preoperative and intraoperative factors with the presence of complications was assessed using univariate and multivariate analyses. The significance level was set at p<0.05. RESULTS A total of 1,066 surgeries were evaluated, and the overall complication rate was 14.9%. In all, 105 (9.8%) surgeries were performed in the prone position, and 961 (90.2%) were performed in the supine position. Univariate analysis demonstrated that surgical position, upper pole puncture, surgical time, number of tracts, and Guys Stone Score were associated with complications. In multivariate analyses, prone position (odds ratio [OR] 2.10; p=0.003), surgical time ≥90 min (OR 1.76; p=0.014), upper pole puncture (OR 2.48; p<0.001), and Guys Stone Score 3 or 4 (OR 1.90; p=0.033) were independent predictive factors for complications after percutaneous nephrolithotomy. CONCLUSION Performing percutaneous nephrolithotomy in the supine position, in under 90 min, and avoiding upper pole punctures may reduce complications during the treatment of large kidney stones.
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Affiliation(s)
- Danniel Frade Said
- Hospital de Transplantes Dr. Euryclides de Jesus Zerbini, Division of Urology - São Paulo (SP), Brazil
| | - Daniel Beltrame Ferreira
- Hospital de Transplantes Dr. Euryclides de Jesus Zerbini, Division of Urology - São Paulo (SP), Brazil
| | | | - Rodrigo Perrella
- Hospital de Transplantes Dr. Euryclides de Jesus Zerbini, Division of Urology - São Paulo (SP), Brazil
| | | | - David Jacques Cohen
- Hospital de Transplantes Dr. Euryclides de Jesus Zerbini, Division of Urology - São Paulo (SP), Brazil
| | - Carlos Alfredo Batagello
- Hospital de Transplantes Dr. Euryclides de Jesus Zerbini, Division of Urology - São Paulo (SP), Brazil
| | - Claudio Bovolenta Murta
- Hospital de Transplantes Dr. Euryclides de Jesus Zerbini, Division of Urology - São Paulo (SP), Brazil
| | | | - Fabio Carvalho Vicentini
- Hospital de Transplantes Dr. Euryclides de Jesus Zerbini, Division of Urology - São Paulo (SP), Brazil
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21
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Lim EJ, Teoh JY, Fong KY, Emiliani E, Gadzhiev N, Gorelov D, Tanidir Y, Sepulveda F, Al-Terki A, Khadgi S, Mahajan A, Ragoori D, Ramalingam G, Mohan VC, Ganpule AP, Kumar S, Castellani D, Monga M, Scoffone C, Vincentini FC, Traxer O, Somani BK, Gauhar V. Propensity score-matched analysis comparing retrograde intrarenal surgery with percutaneous nephrolithotomy in anomalous kidneys. Minerva Urol Nephrol 2022; 74:738-746. [PMID: 35147385 DOI: 10.23736/s2724-6051.22.04664-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: 01/14/2023]
Abstract
BACKGROUND Endourologic interventions for urolithiasis in patients with anomalous kidneys can be challenging, and comparisons between these interventions are not well studied. We aim to compare the safety, outcomes and complications of retrograde intrarenal surgery (RIRS) versus percutaneous nephrolithotomy (PCNL) in patients with urolithiasis in anomalous kidneys. METHODS A propensity score-matched pair analysis (PSM) was performed on pooled patient data from 20 centers. 569 patients with anomalous kidneys (horseshoe kidney [HSK], ectopic kidney, malrotated kidney) and urolithiasis who received either PCNL or RIRS as the primary modality of intervention from 2010 to 2020 were analyzed. Patients were matched based on calculated propensity scores by a regression model using age, sex, comorbidities, stone size, and renal anomaly type as co-variates. Multivariate logistic regression of factors (mode of treatment [PCNL or RIRS], comorbidities, stone size) and their effects on outcomes of stone-free rate (SFR), need to abandon surgery due to intraoperative difficulty, postoperative hematuria and sepsis and were analyzed when applicable. RESULTS After PSM, there were a total of 127 pairs in each group. Overall, PCNL conferred a higher SFR compared to RIRS (OR=3.69, 95% CI 1.91-7.46, P<0.001), particularly in HSK (OR=3.33, 95% CI 1.22-9.99, P=0.023), and ectopic kidneys (OR=18.10, 95% CI 3.62-147.63, P=0.002), with no significant difference in malrotated kidneys. There was no significant difference in postoperative sepsis observed. Surgery was abandoned more often in RIRS than PCNL (6.3% vs. 0%, P=0.014). Although PSM provides a robust analysis due to baseline differences in the unmatched cohorts, this study was limited by an inevitable degree of selection bias. CONCLUSIONS While both modalities are safe and efficacious, PCNL yields better SFR than RIRS in patients with anomalous kidneys, with no difference in postoperative sepsis rates. Patients may benefit from personalized management best carried out in high volume endourology centers.
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Affiliation(s)
- Ee J Lim
- Department of Urology, Singapore General Hospital, Singapore -
| | - Jeremy Y Teoh
- S.H. Ho Urology Center, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Khi Y Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Esteban Emiliani
- Department of Urology, Fundación Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Nariman Gadzhiev
- Department of Urology, Saint-Petersburg State University Hospital, Saint-Petersburg, Russia
| | - Dmitry Gorelov
- Department of Endourology, Saint-Petersburg State Medical University Hospital, Saint-Petersburg, Russia
| | - Yiloren Tanidir
- Department of Urology, Marmara University School of Medicine, Istanbul, Turkey
| | - Fabio Sepulveda
- Department of Urology, Brigadeiro Hospital, São Paulo, Brazil
| | - Abdullatif Al-Terki
- Section of Urology, Department of Surgery, Al-Amiri Hospital, Kuwait City, Kuwait
| | | | | | - Deepak Ragoori
- Department of Urology, Asian Institute of Nephrology and Urology, Banjara Hills, India
| | | | - Vaddi C Mohan
- Department of Urology, Preeti Urology and Kidney Hospital, Hyderabad, India
| | - Arvind P Ganpule
- Department of Urology, Urology Muljibhai Patel Urological Hospital, Nadiad, Gujarat
| | | | - Daniele Castellani
- Urology Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Polytechnic University of Marche, Ancona, Italy
| | - Manoj Monga
- Department of Urology, University of California, San Diego, CA, USA
| | | | | | - Olivier Traxer
- Sorbonne University, Department of Urology, Tenon Hospital, Paris, France
| | - Bhaskar K Somani
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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22
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Zeng G, Zhong W, Mazzon G, Choong S, Pearle M, Agrawal M, Scoffone CM, Fiori C, Gökce MI, Lam W, Petkova K, Sabuncu K, Gadzhiev N, Pietropaolo A, Emiliani E, Sarica K. International Alliance of Urolithiasis (IAU) Guideline on percutaneous nephrolithotomy. Minerva Urol Nephrol 2022; 74:653-668. [PMID: 35099162 DOI: 10.23736/s2724-6051.22.04752-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
The International Alliance of Urolithiasis (IAU) would like to release the latest guideline on percutaneous nephrolithotomy (PCNL) and to provide a clinical framework for surgeons performing PCNLs. These recommendations were collected and appraised from a systematic review and assessment of the literature covering all aspects of PCNLs from the PubMed database between January 1, 1976, and July 31, 2021. Each generated recommendation was graded using a modified GRADE methodology. The quality of the evidence was graded using a classification system modified from the Oxford Center for Evidence-Based Medicine Levels of Evidence. Forty-seven recommendations were summarized and graded, which covered the following issues, indications and contraindications, stone complexity evaluation, preoperative imaging, antibiotic strategy, management of antithrombotic therapy, anesthesia, position, puncture, tracts, dilation, lithotripsy, intraoperative evaluation of residual stones, exit strategy, postoperative imaging and stone-free status evaluation, complications. The present guideline on PCNL was the first in the IAU series of urolithiasis management guidelines. The recommendations, tips and tricks across the PCNL procedures would provide adequate guidance for urologists performing PCNLs to ensure safety and efficiency in PCNLs.
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Affiliation(s)
- Guohua Zeng
- Department of Urology, Guangdong Key Laboratory of Urology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wen Zhong
- Department of Urology, Guangdong Key Laboratory of Urology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Giorgio Mazzon
- Department of Urology, San Bassiano Hospital, Vicenza, Italy
| | - Simon Choong
- University College Hospital of London, Institute of Urology, London, UK
| | - Margaret Pearle
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Madhu Agrawal
- Department of Urology, Center for Minimally Invasive Endourology, Global Rainbow Healthcare, Agra, India
| | | | - Cristian Fiori
- Department of Urology, San Luigi Hospital, University of Turin, Turin, Italy
| | - Mehmet I Gökce
- Department of Urology, Faculty of Medicine, University of Ankara, Ankara, Turkey
| | - Wayne Lam
- Division of Urology, Queen Mary Hospital, Hong Kong, China
| | - Kremena Petkova
- Military Medical Academy, Department of Urology and Nephrology, Sofia, Bulgaria
| | - Kubilay Sabuncu
- Department of Urology, Karacabey State Hospital, Karacabey-Bursa, Turkey
| | - Nariman Gadzhiev
- Department of Urology, Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia
| | - Amelia Pietropaolo
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - Esteban Emiliani
- Department of Urology, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Kemal Sarica
- Medical School, Department of Urology, Biruni University, Istanbul, Turkey -
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23
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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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24
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Yap LC, Hogan D, Patterson K, McGuinness G, O'Connor C, Sharfi A, Hennessey DB. Intrarenal pressures during percutaneous nephrolithotomy: a porcine kidney model. Scand J Urol 2022; 56:251-254. [PMID: 35546115 DOI: 10.1080/21681805.2022.2073387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Increased intrarenal pressure during endoscopic lithotripsy is associated with increased adverse outcomes. The objective of this study was to evaluate the effect of various devices on IRP during percutaneous intrarenal surgery in ex vivo porcine kidney models. METHODS Whole intact porcine urinary tracts were harvested. Intrarenal pressure was measured using cystometrometry software. Intrarenal pressure during PCNL was recorded using variations of percutaneous access sheath size, irrigation height of 100 cm and 60 cm, use of a ureteric catheter and use of suction. The primary outcome was absolute IRP measurements. Secondary outcomes were comparisons of IRP between techniques. RESULTS Using a 30 Fr vs 26 Fr access sheath and 26 Fr nephroscope the mean pressure at an irrigation height of 60 cm was significantly lower than 100 cm (p = 0.0013 vs p < 0.0001, respectively). Pressure's during mini-PCNL were significantly higher than conventional PCNL in all variations. Using the 16.5 Fr access sheath and 12 Fr nephroscope produced a significantly lower pressure at a 60 cm irrigation height than 100 cm (p = 0.0010). IRP was significantly lower with a ureteric catheter in place vs no ureteric catheter at 100 cm (p = 0.0015) and at 60 cm (p = 0.0040). CONCLUSIONS Using standard PCNL tract sizes intrarenal pressure varied significantly depending on the height of the irrigation fluid. Mini-PCNL is at higher risk of pathological pressure, however, the use of a ureteric catheter significantly decreased pressure. To maintain safe IRP during PCNL urologists should be aware of these significant variations.
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Affiliation(s)
- Lee Chien Yap
- Department of Urology, Mercy University Hospital, Cork, Ireland
| | - Donnacha Hogan
- Department of Urology, Mercy University Hospital, Cork, Ireland
| | | | | | | | - Ashraf Sharfi
- Department of Urology, Mercy University Hospital, Cork, Ireland
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25
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Campi R, Grosso AA, Lane BR, DE Cobelli O, Sanguedolce F, Hatzichristodoulou G, Antonelli A, Noyes S, DI Maida F, Mari A, Rodriguez-Faba O, Keeley FX, Langenhuijsen J, Musi G, Klatte T, Roscigno M, Akdogan B, Furlan M, Karakoyunlu N, Marszalek M, Capitanio U, Volpe A, Brookman-May S, Gschwend JE, Smaldone MC, Uzzo RG, Kutikov A, Minervini A. Impact of Trifecta definition on rates and predictors of "successful" robotic partial nephrectomy for localized renal masses: results from the Surface-Intermediate-Base Margin Score International Consortium. Minerva Urol Nephrol 2022; 74:186-193. [PMID: 35345387 DOI: 10.23736/s2724-6051.21.04601-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Over the years, five different Trifecta score definitions have been proposed to optimize the framing of "success" in partial nephrectomy (PN) field. However, such classifications rely on different metrics. The aim of the present study was to explore how the success rate of robotic PN, as well as its drivers, vary according to the currently available definitions of Trifecta. METHODS Data from consecutive patients with cT1-2N0M0 renal masses treated with robotic PN at 16 referral centers from September 2014 to March 2015 were prospectively collected. Trifecta rate was defined for each of the currently available definitions. Multivariable logistic regression analysis was used to evaluate possible predictors of "Trifecta failure" according to the different adopted formulation. RESULTS Overall, 289 patients met the inclusion criteria. Among the definitions, Trifecta rates ranged between 66.4% and 85.9%. Multivariable analysis showed that predictors for "Trifecta failure" were mainly tumor-related (i.e. tumor's nephrometry) for those Trifecta scores relying on WIT as a surrogate metric for postoperative renal function deterioration (definitions 1,2), while mainly surgery-related (i.e. ischemia time and excision strategy) for those including the percentage change in postoperative eGFR as the functional cornerstone of Trifecta (definitions 3-5). CONCLUSIONS There was large variability in rates and predictors of "unsuccessful PN" when using different Trifecta scores. Further research is needed to improve the value of the Trifecta metrics, integrating them into routine patient counseling and standardized assessment of surgical quality across institutions.
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Affiliation(s)
- Riccardo Campi
- Department of Urology, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Antonio A Grosso
- Department of Urology, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Brian R Lane
- Department of Urology, Spectrum Health Medical Group, Grand Rapids, MI, USA
| | - Ottavio DE Cobelli
- Department of Urology, European Institute of Oncology (IEO), University of Milan, Milan, Italy
| | - Francesco Sanguedolce
- Bristol Urological Institute, Southmead Hospital, Bristol, UK.,Unit of Uro-Oncology, Puigvert Foundation, Barcelona, Spain
| | - Georgios Hatzichristodoulou
- Department of Urology, Technical University of Munich, University Hospital Klinikum Rechts Der Isar, Munich, Germany.,Department of Urology and Pediatric Urology, Julius-Maximilians-University of Würzburg, Würzburg, Germany
| | | | - Sabrina Noyes
- Department of Urology, Spectrum Health Medical Group, Grand Rapids, MI, USA
| | - Fabrizio DI Maida
- Department of Urology, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Andrea Mari
- Department of Urology, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | - Frank X Keeley
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | - Johan Langenhuijsen
- Department of Urology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | - Gennaro Musi
- Department of Urology, European Institute of Oncology (IEO), University of Milan, Milan, Italy
| | - Tobias Klatte
- Department of Urology, Royal Bournemouth Hospital, Bournemouth, UK.,Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Marco Roscigno
- Department of Urology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Bulent Akdogan
- Department of Urology, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Maria Furlan
- Department of Urology, University of Brescia, Brescia, Italy
| | - Nihat Karakoyunlu
- Department of Urology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Martin Marszalek
- Department of Urology and Andrology, Donauspital, Austria.,Department of Urology, Graz Medical University, Graz, Austria
| | - Umberto Capitanio
- Division of Experimental Oncology, Unit of Urology, Urological Research Institute (URI), IRCCS San Raffaele Hospital, Milan, Italy
| | - Alessandro Volpe
- Department of Urology, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Sabine Brookman-May
- Department of Urology, Campus Grosshadern, Ludwig-Maximilians University (LMU) Munich, Germany.,Janssen Pharma Research and Development, Los Angeles, CA, USA
| | - Jürgen E Gschwend
- Department of Urology, Technical University of Munich, University Hospital Klinikum Rechts Der Isar, Munich, Germany
| | - Marc C Smaldone
- Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Robert G Uzzo
- Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Alexander Kutikov
- Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Andrea Minervini
- Department of Urology, University of Florence, Florence, Italy - .,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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26
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Bosio A, Alessandria E, Pizzuto G, Lauretta I, Vitiello F, Vercelli E, Biancone L, Gontero P. Stent-related symptoms in transplanted patients: milder, but detectable. Minerva Urol Nephrol 2022; 74:504-507. [PMID: 35195384 DOI: 10.23736/s2724-6051.22.04878-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Andrea Bosio
- Department of Urology, Città della Salute e della Scienza Molinette University Hospital, Turin, Italy -
| | - Eugenio Alessandria
- Department of Urology, Città della Salute e della Scienza Molinette University Hospital, Turin, Italy
| | - Giuseppe Pizzuto
- Department of Urology, Città della Salute e della Scienza Molinette University Hospital, Turin, Italy
| | - Itria Lauretta
- Department of Nephrology and Renal Transplantation, Città della Salute e della Scienza Molinette University Hospital, Turin, Italy
| | - Federico Vitiello
- Department of Urology, Città della Salute e della Scienza Molinette University Hospital, Turin, Italy
| | - Eugenia Vercelli
- Department of Urology, Città della Salute e della Scienza Molinette University Hospital, Turin, Italy
| | - Luigi Biancone
- Department of Nephrology and Renal Transplantation, Città della Salute e della Scienza Molinette University Hospital, Turin, Italy
| | - Paolo Gontero
- Department of Urology, Città della Salute e della Scienza Molinette University Hospital, Turin, Italy
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27
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Ratajczak JM, Hladun T, Krenz B, Bromber K, Salagierski M, Marczak M. Can We Identify Patients in Danger of Complications in Retrograde Intrarenal Surgery?-A Retrospective Risk Factors Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031114. [PMID: 35162137 PMCID: PMC8834554 DOI: 10.3390/ijerph19031114] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/14/2022] [Accepted: 01/18/2022] [Indexed: 01/27/2023]
Abstract
Retrograde intrarenal surgery (RIRS) is an innovative and effective method of kidney stones treatment, as it had great influence on the development of endoscopy in urology. The increasing prevalence of urolithiasis together with the rapid development of endourology leads to a rise in the number of procedures related to the disease. Flexible ureteroscopy is constantly being improved, especially regarding the effectiveness and safety of the procedure. The purpose of this study is to evaluate intraoperative and early post-operative complications of RIRS in the treatment of kidney stones. A retrospective analysis of medical records was performed. A series was comprised of 207 consecutive operations performed from 2017 to 2020. Complications occurred in 19.3% (n = 40) of patients. Occurrence according to the Clavien-Dindo scale was: 11.1% for grade I, 5.8% for grade II and 2.4% for grade IV. Infectious complications included SIRS (5.3%, n = 11) and sepsis (2.4%, n = 5). Statistical analysis revealed a correlation between acute post-operative infections and positive midstream urine culture, history of chronic or recurrent urinary tract infections, and increased body mass index (BMI). Furthermore, a significant correlation was observed between pain requiring the use of opioids with BMI over 25. Consequently, history of urinary tract infections, positive pre-operative urine culture, and increased BMI are considered risk factors and require appropriate management.
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Affiliation(s)
- Jakub Marek Ratajczak
- Department of Management and Logistics in Health Care, Medical University of Lodz, 90-647 Lodz, Poland;
- Urology Department, Regional Specialized Hospital in Nowa Sól, 67-100 Nowa Sól, Poland; (T.H.); (B.K.); (K.B.)
- Correspondence:
| | - Taras Hladun
- Urology Department, Regional Specialized Hospital in Nowa Sól, 67-100 Nowa Sól, Poland; (T.H.); (B.K.); (K.B.)
| | - Bartosz Krenz
- Urology Department, Regional Specialized Hospital in Nowa Sól, 67-100 Nowa Sól, Poland; (T.H.); (B.K.); (K.B.)
| | - Krzysztof Bromber
- Urology Department, Regional Specialized Hospital in Nowa Sól, 67-100 Nowa Sól, Poland; (T.H.); (B.K.); (K.B.)
| | - Maciej Salagierski
- Department of Urology, Collegium Medicum, University of Zielona Góra, 65-046 Zielona Góra, Poland;
| | - Michał Marczak
- Department of Management and Logistics in Health Care, Medical University of Lodz, 90-647 Lodz, Poland;
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Manfredi C, Arcaniolo D, Spatafora P, Crocerossa F, Fusco F, Verze P, Fiori C, Damiano R, Cindolo L, DE Sio M, Otero JR. Emerging minimally invasive transurethral treatments for benign prostatic hyperplasia: a systematic review with meta-analysis of functional outcomes and description of complications. Minerva Urol Nephrol 2021; 74:389-399. [PMID: 34308611 DOI: 10.23736/s2724-6051.21.04530-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Several minimally invasive surgical procedures have been proposed as alternative therapies for benign prostatic hyperplasia (BPH). The present systematic review aimed to describe the functional outcomes and complications of emerging minimally invasive transurethral treatments for BPH. EVIDENCE ACQUISITION A comprehensive bibliographic search on the MEDLINE and Cochrane Library databases was conducted. No chronological restriction was applied. Retrospective and prospective primary studies were included. A meta-analysis of IPSS, IPSS-QoL, Qmax, and PVR was performed. Data on adverse events were presented narratively. EVIDENCE SYNTHESIS A total of 18 studies were included. Thirteen papers were eligible for the meta-analysis. iTIND, Rezūm, and Aquablation were associated with a significant improvement in IPSS (p<0.001), IPSS-QoL (p<0.001), and Qmax (p<0.001) compared to baseline. A significant reduction of PVR from baseline was found with Rezūm (p<0.001) and Aquablation (p<0.001) but not iTIND (p=0.22). A significant difference in IPSS, IPSS-QoL, and Qmax was shown in favor of Aquablation compared to Rezūm and iTIND (p<0.001). Rezūm and iTIND were mainly associated with mild to moderate adverse effects. Hematuria or bleeding was reported in all studies regarding Aquablation (0.8%-26%), the need for transfusion or intervention for bleeding varied between 1.8% and 9%. CONCLUSIONS Aquablation, Rezūm, and iTIND significantly improve urinary functional outcomes compared to baseline; however, Aquablation would seem to lead to better functional results compared to the other procedures. Rezūm and iTIND appear to have an excellent safety profile, while Aquablation would seem to expose patients to a nonnegligible risk of bleeding.
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Affiliation(s)
- Celeste Manfredi
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy -
| | - Davide Arcaniolo
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Pietro Spatafora
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Fabio Crocerossa
- Department of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Ferdinando Fusco
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Paolo Verze
- Department of Medicine, Surgery, Dentistry Scuola Medica Salernitana, University of, Salerno, Salerno, Italy
| | - Cristian Fiori
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Rocco Damiano
- Department of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Luca Cindolo
- Department of Urology, Villa Stuart Private Hospital, Rome, Italy
| | - Marco DE Sio
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Javier R Otero
- Department of Urology, Hospital Universitario 12 Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.,Unit of Urology, HM Hospitales, Montepríncipe, Puerta del Sur, Sanchinarro, Madrid, Spain
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