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Gao J, Zhang M, Tang J, Wang R, Chen Y, Fang Z, Zhong H. Flexible ureteroscopic incision and drainage or laparoscopic unroofing for the parapelvic renal cysts: A systematic review and meta‑analysis. Exp Ther Med 2024; 28:347. [PMID: 39006451 PMCID: PMC11240875 DOI: 10.3892/etm.2024.12636] [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: 04/12/2023] [Accepted: 02/16/2024] [Indexed: 07/16/2024] Open
Abstract
The aim of the present study was to compare flexible ureteroscopy and laparoscopy in the treatment of peripelvic renal cysts, so as to determine the best treatment method for patients with peripelvic renal cysts. A systematic search of the PubMed, EMBASE, Cochrane Library, CONAHL, Clinicaltrials.gov, Google Scholar, CNKI and WanFang DATA databases was conducted for articles published over 22 years (December 1980-December 2022) using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. By searching the database, a total of 594 studies were found, of which eight were analyzed as evidence. A total of 394 patients were included in the present study. Of these, 193 were treated laparoscopically and 201 were treated by flexible ureteroscopy. In terms of analysis results, radiation reexamination after laparoscopic therapy had a higher success rate. Ureteroscopy has advantages in the time spent in the operation, the amount of blood lost during the operation, the time to recover the anal exhaust after the operation and the length of postoperative hospital stay. There were no significant difference in postoperative recurrence or complications between the two surgical methods. After comprehensive analysis, it was considered that flexible ureteroscopy has more advantages in the treatment of peripelvic renal cyst, which is mainly manifested in the duration of operation, the total amount of blood loss during operation, the interval of recovery of anal exhaust after operation and the total length of postoperative hospital stay. It is worth further exploration and promotion.
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Affiliation(s)
- Jianguo Gao
- Department of Urology, The First Affiliated Hospital of Huzhou Normal College, Huzhou, Zhejiang 313000, P.R. China
- Department of Urology, The First Hospital of Huzhou, Huzhou, Zhejiang 313000, P.R. China
- Huzhou Key Laboratory of Precise Diagnosis and Treatment of Urinary Tumors, Huzhou, Zhejiang 313000, P.R. China
| | - Meng Zhang
- Department of Urology, The First Affiliated Hospital of Huzhou Normal College, Huzhou, Zhejiang 313000, P.R. China
- Department of Urology, The First Hospital of Huzhou, Huzhou, Zhejiang 313000, P.R. China
| | - Jianer Tang
- Department of Urology, The First Affiliated Hospital of Huzhou Normal College, Huzhou, Zhejiang 313000, P.R. China
- Department of Urology, The First Hospital of Huzhou, Huzhou, Zhejiang 313000, P.R. China
- Huzhou Key Laboratory of Precise Diagnosis and Treatment of Urinary Tumors, Huzhou, Zhejiang 313000, P.R. China
| | - Rongjiang Wang
- Department of Urology, The First Affiliated Hospital of Huzhou Normal College, Huzhou, Zhejiang 313000, P.R. China
- Department of Urology, The First Hospital of Huzhou, Huzhou, Zhejiang 313000, P.R. China
- Huzhou Key Laboratory of Precise Diagnosis and Treatment of Urinary Tumors, Huzhou, Zhejiang 313000, P.R. China
| | - Yu Chen
- Department of Urology, The First Affiliated Hospital of Huzhou Normal College, Huzhou, Zhejiang 313000, P.R. China
- Department of Urology, The First Hospital of Huzhou, Huzhou, Zhejiang 313000, P.R. China
- Huzhou Key Laboratory of Precise Diagnosis and Treatment of Urinary Tumors, Huzhou, Zhejiang 313000, P.R. China
| | - Zhihai Fang
- Department of Urology, The First Affiliated Hospital of Huzhou Normal College, Huzhou, Zhejiang 313000, P.R. China
- Department of Urology, The First Hospital of Huzhou, Huzhou, Zhejiang 313000, P.R. China
| | - Huan Zhong
- Department of Urology, The First Affiliated Hospital of Huzhou Normal College, Huzhou, Zhejiang 313000, P.R. China
- Department of Urology, The First Hospital of Huzhou, Huzhou, Zhejiang 313000, P.R. China
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Huang T, Ke M, Chen C, Xu Z, Wang B, Sun P, Zhu D, Yang Q, Wu H, Xu M. Application of virtual endoscopic imaging to parapelvic cyst incision by flexible ureteroscopy: a multicenter retrospective cohort study. Minerva Urol Nephrol 2024; 76:505-512. [PMID: 38757773 DOI: 10.23736/s2724-6051.24.05486-7] [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: 05/18/2024]
Abstract
BACKGROUND A three-dimensional (3D) reconstruction of the kidney, parapelvic cyst and the collecting system was conducted using the 3D Slicer software. The reconstructed image was used to form a virtual endoscope to assist flexible ureteroscopic incision and drainage was performed with a holmium laser for treating parapelvic cysts. The effectiveness of this assistive technique was assessed. METHODS This was a retrospective cohort study. The clinical information of 59 patients undergoing flexible ureteroscopic incision and drainage for parapelvic cysts in two medical centers was collected. 3D Slicer software reconstruction and virtual endoscopic imaging were performed for 28 cases. Before the operation, the best point for incision on the collecting system's mucosa was assessed by virtual endoscope imaging. Propensity score matching was adopted for the reconstructive and non-reconstructive groups. RESULTS After matching, the reconstructive group and non-reconstructive group both had 21 cases each. The operation time in the reconstructive and non-reconstructive groups was 38.81±5.01 and 51.00±18 minutes, respectively. Statistically significant differences existed between the two groups (t=7.024, P<0.001). No statistical significance was found in postoperative fever, immediate postoperative C reactive protein (CRP), length of postoperative hospital stay and cyst diameter three months after the operation. CONCLUSIONS The operator was provided with a more direct and real vision when 3D Slicer software reconstruction was adopted via virtual endoscopic imaging to assist flexible ureteroscopic parapelvic cyst incision. This helped reduce the operation time. Further follow-ups and observations are required to assess the long-term efficacy of flexible ureteroscopic parapelvic cyst incision.
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Affiliation(s)
- Ting Huang
- Department of Urology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang, China
| | - Mang Ke
- Department of Urology, Affiliated Taizhou Hospital, Wenzhou Medical University, Taizhou, Zhejiang, China
| | - Chaoqian Chen
- Department of Urology, Affiliated Taizhou Hospital, Wenzhou Medical University, Taizhou, Zhejiang, China
| | - Zekun Xu
- Department of Urology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang, China
| | - Bin Wang
- Department of Urology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang, China
| | - Peng Sun
- Department of Urology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang, China
| | - Desheng Zhu
- Department of Urology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang, China
| | - Qing Yang
- Department of Urology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang, China
| | - Haixiao Wu
- Department of Urology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang, China
| | - Min Xu
- Department of Urology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang, China -
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Liu M, Xiao R, Pan Q, Yin Y, Wang L. Ultrasound-guided percutaneous intracystic deroofing is effective in the treatment of simple renal cysts. Am J Transl Res 2023; 15:5469-5476. [PMID: 37692955 PMCID: PMC10492059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 08/10/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVE To investigate the efficacy and safety of ultrasound-guided percutaneous intracystic deroofing for the treatment of simple renal cysts. METHODS A retrospective study was conducted to analyze the clinical data of 46 patients with dorsal exophytic simple renal cysts treated at the First Affiliated Hospital of Nanchang University between February 2017 and June 2022. The patients were divided into two groups according to the surgical method, with 20 cases undergoing ultrasound-guided percutaneous intracystic deroofing being assigned to the observation group and 26 cases treated by retroperitoneal laparoscopic renal cyst removal included in the control group. The operation time, blood loss, postoperative catheterization time, postoperative drainage tube indwelling time, postoperative hospital stay, and complications were compared. RESULTS None of the 46 patients converted to open surgery. The observation group showed significantly less blood loss, shorter operation time, drainage tube drainage time, postoperative hospital stay, and indwelling catheter time than the control group (all P<0.05). The two procedures had a success rate of 100%. There were no statistical significances in K+, Na+, or serum creatinine between the two groups (all P>0.05). All patients were followed up (3 to 6 months) after surgery, and no cyst recurrence was found by imaging examination. CONCLUSIONS Ultrasound-guided percutaneous intracystic deroofing of renal cysts is worthy of clinical application in the treatment of simple renal cysts due to its significant advantages such as short operation time, less trauma, quick recovery, safety, effectiveness, and low cost.
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Affiliation(s)
- Mei Liu
- Department of Anesthesiology, The First Affiliated Hospital of Nanchang UniversityNanchang 330006, Jiangxi, China
| | - Ruihai Xiao
- Hospita of Nanchang UniversityNanchang 330006, Jiangxi, China
| | - Qiufeng Pan
- Department of Urology, The First Affiliated Hospital of Nanchang UniversityNanchang 330006, Jiangxi, China
| | - Yingqun Yin
- Hospita of Nanchang UniversityNanchang 330006, Jiangxi, China
| | - Longwang Wang
- Department of Urology, The First Affiliated Hospital of Nanchang UniversityNanchang 330006, Jiangxi, China
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Huang T, Yang Q, Wu H, Zhu D, Hu Y, Xu M. Clinical efficacy of intraoperative real time ultrasound-assisted flexible ureteroscopic holmium laser incision and internal drainage in the treatment of parapelvic cysts. BMC Surg 2022; 22:315. [PMID: 35964028 PMCID: PMC9375338 DOI: 10.1186/s12893-022-01763-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 08/05/2022] [Indexed: 11/10/2022] Open
Abstract
Objective This study aims to investigate the efficacy and safety of intraoperative real time ultrasound-assisted flexible ureteroscopic holmium laser incision and internal drainage in the treatment of parapelvic cysts, and to review recently published relevant literature. Method This is a retrospective study in which the clinical data of 47 patients who underwent flexible ureteroscopic holmium laser incision and internal drainage of parapelvic cysts in our center from March 2017 to March 2021 were retrospectively analyzed. A literature search was conducted to review and summarize relevant reports on endoscopic treatment of parapelvic cysts published in the past 10 years. Results Among 47 patients with parapelvic cysts who underwent flexible ureteroscopic holmium laser incision and internal drainage, 12 (25.53%) cases had a typical cyst wall bulging into the collecting system under flexible ureteroscope. As the cyst wall was thin and translucent in these cases, ultrasound was not used during the operation. The cysts of the remaining 35 patients were located with the aid of intraoperative real time ultrasound, and all underwent successful operation. No serious surgical complications occurred after surgery. The patients were followed up for 12–24 months after operation. The cyst in one case was observed larger than its original size before operation, so recurrence was considered. In another two cases, the diameters of the cysts were more than half of their original diameters before operation. Thus, the efficacy was poor in the three cases. For the remaining 44 cases, there was no obvious cyst observed or the diameter of the cysts was less than half their preoperative level. Conclusion The approach of ultrasound-assisted flexible ureteroscopic holmium laser incision and internal drainage in the treatment of parapelvic cysts is safe and effective, which helps to solve the problem of localization of atypical parapelvic cysts on endoscopic findings.
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Affiliation(s)
- Ting Huang
- Department of Urology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, 321000, China
| | - Qing Yang
- Department of Urology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, 321000, China
| | - Haixiao Wu
- Department of Urology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, 321000, China
| | - Desheng Zhu
- Department of Urology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, 321000, China
| | - Yang Hu
- Department of Urology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, 321000, China
| | - Min Xu
- Department of Urology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, 321000, China.
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Zhang H, Xu H, Fei K, Guo D, Duan Y. The safety and efficiency of a 1470 nm laser in obtaining tract hemostasis in tubeless percutaneous nephrolithotomy: a retrospective cross-sectional study. BMC Urol 2022; 22:94. [PMID: 35780099 PMCID: PMC9250247 DOI: 10.1186/s12894-022-01046-z] [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: 04/20/2022] [Accepted: 06/27/2022] [Indexed: 11/29/2022] Open
Abstract
Objective It is challenging to perform a tubeless percutaneous nephrolithotomy (PNL) in patients with tract bleeding. The present study was designed to study the safety and efficacy of the 1470 nm laser for hemostatic completion in tubeless PNL patients with tract bleeding. Patients and Methods Between January 2020 and October 2021, 120 patients were retrospectively included and divided into two groups. The hemostasis group included 60 patients receiving tubeless PNL, in which a 1470 nm laser was used to manage tract bleeding. The other group included 60 patients receiving tubeless PNL in which the hemostasis procedure was not performed, serving as the control group. The differences in the patients’ demographic characteristics, procedural information, and posttreatment outcomes between the two groups were statistically compared. Results The differences associated with sex, age, weight, body mass index, urine culture, stone burden, calyx of puncture, degree of hydronephrosis and comorbidities between the two groups were not statistically significant. Compared with the control group, the hemostasis group showed greatly reduced blood loss (0.61 ± 0.31 vs. 0.85 ± 0.46 g/dL) and decreased postoperative hospitalization duration (2.83 ± 0.81 vs. 4.45 ± 0.91 days). The differences in operative time, stone-free rate, Visual Analogue Score and postoperative complications between the two groups were not statistically significant. In the subgroup analysis, the obese patients and patients with moderate to severe hydronephrosis in the hemostasis group also showed a significantly less blood loss (0.51 ± 0.22 vs. 0.83 ± 0.48 g/dL; 0.54 ± 0.27 vs. 0.85 ± 0.47 g/dL, respectively) and shorter length of postoperative hospitalization (2.62 ± 0.51 vs. 4.47 ± 1.19 days; 2.97 ± 0.63 vs. 4.41 ± 0.91 days, respectively) than those in the control group. Conclusions Our results demonstrated that 1470 nm laser is a safe, feasible and effective method to obtain tract hemostasis in tubeless PNL.
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Affiliation(s)
- Huihui Zhang
- Department of Urology, Hengyang Medical School, The First Affiliated Hospital, University of South China, 69 Chuanshan Road, Hengyang, 421001, Hunan, People's Republic of China.,Institute of Hospital Administration, University of South China, Hengyang, 421001, Hunan, People's Republic of China
| | - Hanfeng Xu
- Department of Urology, Hengyang Medical School, The First Affiliated Hospital, University of South China, 69 Chuanshan Road, Hengyang, 421001, Hunan, People's Republic of China
| | - Kuilin Fei
- Department of Obstetrics, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, People's Republic of China
| | - Dayong Guo
- Department of Urology, Hengyang Medical School, The First Affiliated Hospital, University of South China, 69 Chuanshan Road, Hengyang, 421001, Hunan, People's Republic of China
| | - Youjun Duan
- Department of Urology, Hengyang Medical School, The First Affiliated Hospital, University of South China, 69 Chuanshan Road, Hengyang, 421001, Hunan, People's Republic of China.
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Yan KW, Tian XF, Meng N, Liu WZ, Lu ZM, Guo MT, Xiao B. Flexible ureteroscopy with ultrasound guidance for the treatment of parapelvic renal cysts: A complementary approach for locating the cystic wall. BMC Urol 2022; 22:7. [PMID: 35073883 PMCID: PMC8785450 DOI: 10.1186/s12894-022-00960-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 01/18/2022] [Indexed: 12/26/2022] Open
Abstract
Background Flexible ureteroscopic incision and drainage is a relatively new surgical method for treating parapelvic cysts. Considering that the intraoperative localization of the cyst may fail with a flexible ureteroscope, we use an innovative ultrasound-guided method to locate the cystic wall during flexible ureteroscopic surgery. Methods We retrospectively reviewed 17 consecutive cases of parapelvic renal cysts treated by ultrasound-guided flexible ureteroscopy between March 2017 and May 2020. The differences between the simple flexible ureteroscopic technique and ultrasound-guided flexible ureteroscopic technique were compared. The surgical procedures, postoperative complications, results and patient follow-ups were evaluated. Results The cyst wall was seen clearly in 10 patients with ureteroscopic vision. Another 7 patients underwent ultrasound-guided flexible ureteroscopic surgery since it was difficult to identify the cyst wall. The mean operative time was 25.9 ± 8.7 min and 37.1 ± 10.1 min for the conventional and modified techniques, respectively (P = 0.004); the mean time to search for cysts was 17.6 ± 5.8 min and 26.5 ± 8.4 min, respectively (P = 0.002); and the mean incision time was 7.1 ± 4.9 min and 12.1 ± 5.6 min, respectively (P = 0.000). All of the patients were followed-up for 12 months, and no serious complications or recurrence were observed. Conclusions We demonstrated that it is feasible and safe to treat parapelvic renal cysts by ultrasound-guided flexible ureteroscopic incision and drainage. The small sample size and need for further studies were the limitations of our work. Supplementary Information The online version contains supplementary material available at 10.1186/s12894-022-00960-6.
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