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Zhu W, Liu S, Cao J, Wang H, Liang H, Jiang K, Cui Y, Chai CA, Sahinler EB, Aquino A, Mazzon G, Zhong W, Zhao Z, Zhang L, Ding J, Wang Q, Wang Y, Chen KW, Liu Y, Choong S, Sarica K, Zeng G. Tip bendable suction ureteral access sheath versus traditional sheath in retrograde intrarenal stone surgery: an international multicentre, randomized, parallel group, superiority study. EClinicalMedicine 2024; 74:102724. [PMID: 39070176 PMCID: PMC11277316 DOI: 10.1016/j.eclinm.2024.102724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 06/21/2024] [Accepted: 06/21/2024] [Indexed: 07/30/2024] Open
Abstract
Background Retrograde intrarenal surgery (RIRS) is the main treatments for upper urinary tract stones. The Ureteral Access Sheath (UAS) serves as a supplementary tool, facilitating direct kidney access during RIRS. High quality of evidence comparing tip bendable suction ureteral access sheath (S-UAS) with traditional UAS in RIRS for the treatment of renal and ureteral stones is lacking. The purpose of the study is to compare the efficacy and safety of S-UAS with traditional UAS in RIRS for the treatment of renal or ureteral stones ≤30 mm. Methods An international, multicenter, and superiority randomized controlled trial included 320 intention-to-treat patients across 8 medical centers in China, the Philippines, Malaysia and Turkey from August 2023 to February 2024. The inclusion criteria were patients ≥18 years old with renal or ureteral stones ≤30 mm. RIRS was performed using either S-UAS or traditional UAS. The primary outcome was the immediately stone-free rate (SFR). Secondary outcomes included SFR 3 months after operation, operating time, hospital stay, auxiliary procedures, complications (using the Clavien-Dindo grading system), and improvement in the Quality of Life (QoL) score. Differences between proportions [risk difference (RD)]/means [mean difference (MD)] and 95% confidence intervals (CI) were presented. This study is registered at ClinicalTrials.gov: NCT05952635. Findings The S-UAS group demonstrated a significantly higher immediately SFR (81.3% versus 49.4%; RD 31.9%; 95% CI 22.5%-41.7%; p = 0.004) compared to the traditional UAS group, as determined by the one-side superiority test. Additionally, the S-UAS group exhibited a higher SFR at 3 months post-operation (87.5% versus 70.0%; RD 17.5%; 95% CI 8.7%-26.3%; p < 0.001), lower postoperative fever rate (RD -11.9%; 95% CI -18.7% to -4.9%; p < 0.001), reduced use of stone baskets (RD -70.6%; 95% CI -77.8% to -63.5%; p < 0.001), and better QoL improvement (MD 7.25; 95% CI 2.21-12.29; p = 0.005). No statistically significant differences were observed in operation time, hospital stay, or the need for second-stage RIRS. Interpretation In RIRS for upper urinary tract stones ≤30 mm, S-UAS exhibited superior performance compared to traditional UAS, demonstrating higher SFR, reduced postoperative fever rate, and improved QoL outcomes. S-UAS emerges as a prudent and advantageous alternative to traditional UAS for RIRS. Funding National Natural Science Foundation of China and Guangdong Province, and Zhejiang Medicine and Health Program.
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Affiliation(s)
- Wei Zhu
- Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Shusheng Liu
- Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Jianwei Cao
- Department of Urology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Hao Wang
- Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Hui Liang
- Department of Urology, Xinchang County Hospital of Traditional Chinese Medicine, Shaoxing, Zhejiang, China
| | - Kehua Jiang
- Department of Urology, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China
| | - Yu Cui
- Department of Urology, Xiangya Hospital Central South University, Changsha, Hunan, China
| | - Chu Ann Chai
- Urology Unit, Department of Surgery, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Emre Burak Sahinler
- Department of Urology, Prof. Dr. Ilhan Varank Research and Training Hospital, Istanbul, Turkey
| | - Albert Aquino
- Department of Urology, Jose R. Reyes Memorial Medical Center, Manila, Philippines
| | - Giorgio Mazzon
- Institute of Urology, University College Hospitals of London, London, United Kingdom
| | - Wen Zhong
- Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Zhijian Zhao
- Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Lin Zhang
- Department of Urology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Jie Ding
- Department of Urology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Qing Wang
- Department of Urology, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China
| | - Yizhou Wang
- Department of Urology, Xiangya Hospital Central South University, Changsha, Hunan, China
| | | | - Yongda Liu
- Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Simon Choong
- Institute of Urology, University College Hospitals of London, London, United Kingdom
| | - Kemal Sarica
- Department of Urology, Prof. Dr. Ilhan Varank Research and Training Hospital, Istanbul, Turkey
| | - Guohua Zeng
- Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
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Huang R, Chen JC, Zhou YQ, Wang JJ, Hui CC, Jiang MJ, Xu C. Relocation of lower pole renal stones helps improve the stone-free rate during flexible ureteroscopy with a low complication rate. World J Urol 2024; 42:30. [PMID: 38217719 PMCID: PMC10787685 DOI: 10.1007/s00345-023-04703-6] [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: 03/25/2023] [Accepted: 09/06/2023] [Indexed: 01/15/2024] Open
Abstract
OBJECTIVE To compare the efficacy and safety of relocating the lower pole stones to a favorable pole during flexible ureteroscopy with in situ lithotripsy for the treatment of 10-20 mm lower pole stone (LPS). METHODS This study was a prospective analysis of patient outcomes who underwent an FURS procedure for the treatment of 10-20 mm lower pole renal stones from January 2020 to November 2022. The patients were randomized into a relocation group or in situ group. The LPSs were relocated into a calyx, during lithotripsy in the relocation group was performed, whereas the in situ group underwent FURS without relocation. All the procedures were performed by the same surgeon. The patients' demographic data, stone characteristics, perioperative parameters and outcomes, stone-free rate (SFR), complications, and overall costs were assessed retrospectively. RESULTS A total of 90 patients were enrolled and analyzed in this study (45 per group) with no significant differences between the two groups in terms of age, gender, BMI, diabetes, hypertension, stone size, number, laterality, composition, and density. The mean operation time, total energy consumption, postoperative stay, and complications were similar between the groups. Both groups had similar SFR at 1 day postoperative follow-up (p = 0.091), while the relocation group achieved significantly higher SFR 3 months later (97.8% vs 84.4%, p = 0.026). The relocation group also had a significantly higher WisQol score than the in situ group (126.98 vs 110.18, p < 0.001). CONCLUSION A satisfactory SFR with a relatively low complication rate was achieved by the relocation technique during the FURS procedure.
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Affiliation(s)
- Ru Huang
- Department of Urology, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, 215200, China
| | - Jian-Chun Chen
- Department of Urology, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, 215200, China
| | - Yong-Qiang Zhou
- Department of Urology, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, 215200, China
| | - Jin-Jin Wang
- Department of Radiology, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, 215200, China
| | - Chu-Chu Hui
- Department of Ultrasound, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, 215200, China
| | - Min-Jun Jiang
- Department of Urology, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, 215200, China.
| | - Chen Xu
- Department of Urology, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, 215200, China.
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Esperto F, Pietropaolo A, Emiliani E, De Coninck V, Tailly T, Keller EX, Talso M, Tonyali S, Sener ET, Zeeshan Hameed BM, Tzelves L, Ventimiglia E, Juliebø-Jones P, Faiella E, Mykoniatis I, Tsaturyan A, Scarpa RM. Quality of life of patients with stone disease: timing, planning, strategies, and prevention of a systemic pathology. Minerva Urol Nephrol 2023; 75:422-424. [PMID: 37314814 DOI: 10.23736/s2724-6051.23.05435-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Francesco Esperto
- Department of Urology, Campus Biomedico University of Rome, Rome, Italy -
| | - Amelia Pietropaolo
- Department of Urology, University Hospital of Southampton NHS Foundation Trust, Southampton, UK
| | - Esteban Emiliani
- Department of Urology, Puigvert Foundation, Autonomous University of Barcelona, Barcelona, Spain
| | | | - Thomas Tailly
- Department of Urology, University Hospital of Ghent, Ghent, Belgium
| | - Etienne X Keller
- Department of Urology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Michele Talso
- Department of Urology, ASST Fatebenefratelli-Sacco, Luigi Sacco University Hospital, Milan, Italy
| | - Senol Tonyali
- Department of Urology, Istanbul School of Medicine, University of Istanbul, Istanbul, Türkiye
| | - Emre T Sener
- Department of Urology, Marmara University School of Medicine, Istanbul, Türkiye
| | | | - Lazaros Tzelves
- Department of Urology, University College of London Hospital, London, UK
| | - Eugenio Ventimiglia
- Division of Experimental Oncology, Unit of Urology, Urological Research Institute, IRCCS San Raffaele Hospital, Milan, Italy
| | - Patrick Juliebø-Jones
- Department of Urology, Haukeland University Hospital, Norway University, Bergen, Norway
| | - Eliodoro Faiella
- Department of Radiology, Campus Biomedico University of Rome, Rome, Italy
| | - Ioannis Mykoniatis
- Department of Urology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Arman Tsaturyan
- Department of Urology, Erebouni Medical Center, Yerevan, Armenia
| | - Roberto M Scarpa
- Department of Urology, Campus Biomedico University of Rome, Rome, Italy
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Mazzon G, Serafin E, Ferretti S, Claps F, Zhong W, Fiori C, Celentano G, Guarino GG, Zamengo D, Piasentin A, Creta M, Longo N, Dordoni R, Pavan N, Brancelli C, Cerruto MA, Antonelli A, Celia A. Validation of the Italian version of wisconsin stone quality of life (WISQOL): a prospective Italian multicenter study. Urolithiasis 2022; 51:7. [PMID: 36459218 PMCID: PMC9716497 DOI: 10.1007/s00240-022-01382-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 11/05/2022] [Indexed: 12/05/2022]
Abstract
Urolithiasis is a worldwide spread condition that affects patients' Health-Related Quality of Life (HRQOL), which measurement is an important tool for routine clinical and research practice. Disease-specific HRQOL measures demonstrated to perform better in assessing the effects of specific conditions. A disease-specific questionnaire for kidney stones, the WISQOL, has been validated in different languages, but an Italian version is still missing. Our aim is to produce and validate the Italian version of WISQOL (IT-WISQOL). Patients undergoing any elective treatment for upper urinary tract stones were enrolled. A multi-step process with forward- and back-translation was used to translate WISQOL into Italian. Patients were evaluated within 15 days pre-operatively and then at 30-, 90 days post-operatively and administered both IT-WISQOL and SF-36v2. Post-operative data such as 30 days postoperative complications, late stone-related events, successful status, and stone complexity were collected. Cronbach's α was used to evaluate the internal consistency of IT-WISQOL, while Spearman's rho was used for item and inter-domain correlations and IT-WISQOL with SF-36v2 correlation. We found excellent internal consistency across all domains (α ≥ 0.88), particularly when the total score is considered (α = 0.960). Test-retest reliability showed excellent results for the total questionnaire (Pearson correlation value: 0.85). The Inter-domain association ranged from 0.497 to 0.786. Convergent validity was confirmed by a good correlation with subdomains of the SF-36v2 measures. IT-WISQOL is a reliable tool to measure HRQOL in stone patients. It shows analog characteristics if compared to English WISQOL.
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Affiliation(s)
- Giorgio Mazzon
- Department of Urology, San Bassiano Hospital, Bassano del Grappa, Vicenza, Italy.
| | - Emanuele Serafin
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | | | - Francesco Claps
- Urology Clinic, Department of Medical, Surgical and Health Science, University of Trieste, Trieste, Italy
| | - Wen Zhong
- Department of Urology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Cristian Fiori
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Giuseppe Celentano
- Department of Neurosciences, Sciences and Odontostomatology, Urology Unit, University of Naples "Federico II", Naples, Italy
| | | | - Davide Zamengo
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Andrea Piasentin
- Urology Clinic, Department of Medical, Surgical and Health Science, University of Trieste, Trieste, Italy
| | - Massimiliano Creta
- Department of Neurosciences, Sciences and Odontostomatology, Urology Unit, University of Naples "Federico II", Naples, Italy
| | - Nicola Longo
- Department of Neurosciences, Sciences and Odontostomatology, Urology Unit, University of Naples "Federico II", Naples, Italy
| | - Roberta Dordoni
- Department of Urology, University Hospital of Parma, Parma, Italy
| | - Nicola Pavan
- Urology Clinic, Department of Medical, Surgical and Health Science, University of Trieste, Trieste, Italy
| | - Claudio Brancelli
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Maria Angela Cerruto
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Alessandro Antonelli
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Antonio Celia
- Department of Urology, San Bassiano Hospital, Bassano del Grappa, Vicenza, Italy
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