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Geavlete B, Mareș C, Popescu RI, Mulțescu R, Ene C, Geavlete P. Unfavorable factors in accessing the pelvicalyceal system during retrograde flexible ureteroscopy (fURS). J Med Life 2023; 16:372-380. [PMID: 37168298 PMCID: PMC10165511 DOI: 10.25122/jml-2023-0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 02/28/2023] [Indexed: 05/13/2023] Open
Abstract
Flexible ureteroscopy (fURS) is a well-established procedure for treating multiple upper-urinary tract pathologies, particularly renoureteral lithiasis. Endoscopes have undergone significant advancements, including miniaturization, improved optics, and increased maneuverability. In addition, advancements in accessory instruments, such as the performance of laser fibers, guidewires, and extraction probes, have played a significant role in improving the overall performance of flexible ureteroscopy procedures. However, despite these advancements, unique circumstances can make achieving optimum results during flexible ureteroscopy challenging. These include congenital renal anomalies (horseshoe kidneys, ectopic kidneys, rotation anomalies), as well as the unique intrarenal anatomy (infundibulopelvic angle, infundibular length) or the specifications of the endoscope in terms of maneuverability (active and passive deflection). This review explored challenging scenarios during flexible ureteroscopy procedures in the pyelocaliceal system.
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Affiliation(s)
- Bogdan Geavlete
- Sanador Hospital, Bucharest, Romania
- Department of Urology, Emergency Clinical Hospital Sf. Ioan, Bucharest, Romania
| | - Cristian Mareș
- Department of Urology, Emergency Clinical Hospital Sf. Ioan, Bucharest, Romania
- Corresponding Author: Cristian Mareș, Department of Urology, Emergency Clinical Hospital Sf. Ioan, Bucharest, Romania. E-mail:
| | | | - Răzvan Mulțescu
- Sanador Hospital, Bucharest, Romania
- Department of Urology, Emergency Clinical Hospital Sf. Ioan, Bucharest, Romania
| | - Cosmin Ene
- Department of Urology, Emergency Clinical Hospital Sf. Ioan, Bucharest, Romania
| | - Petrișor Geavlete
- Sanador Hospital, Bucharest, Romania
- Department of Urology, Emergency Clinical Hospital Sf. Ioan, Bucharest, Romania
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Mille E, El-Khoury E, Haddad M, Pinol J, Charbonnier M, Gastaldi P, Dariel A, Merrot T, Faure A. Comparison of single-use flexible ureteroscopes with a reusable ureteroscope for the management of paediatric urolithiasis. J Pediatr Urol 2023:S1477-5131(23)00017-7. [PMID: 36746718 DOI: 10.1016/j.jpurol.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 01/09/2023] [Accepted: 01/12/2023] [Indexed: 01/20/2023]
Abstract
INTRODUCTION To compare the efficacy, side effects, and cost-effectiveness between a single-use digital flexible ureteroscope and a reusable flexible ureteroscope in the treatment of paediatric renal stones. METHODS This analytic, case-control, monocentric study included all patients undergoing flexible ureterosopies for stone treatment. Between April 2016 and February 2019, a reusable (Flex-XC®, Karl Storz) flexible ureteroscope was used (control group), whereas a single-use (Uscope®, PUSEN Medical©) flexible ureteroscope was used in all procedures from March 2019 to April 2021. Clinical and procedural outcomes, operative times, complication rates, hospital stay, and costs per procedure were evaluated. RESULTS Forty-three cases using a reusable flexible ureteroscope and thirty-nine using a single-use flexible ureteroscope were included in the study. Demographic patient characteristics, stone burden, location and composition, preoperative presence of a double-J stent, procedural outcomes, mean length of postoperative hospital stay, and complications (4.6% versus 5%, p = 0.81) were comparable between the two groups. Median operative duration for stone removal was 93 min (20-170) with reusable versus 81 min (55-107) with the single-use scope (p = 0.18). Scope failure occurred four times with the reusable scope and in no case with the single-use. The total cost per procedure associated with the use of single-use scopes (798 Euros) was lower than a reusable scope (1483.23 Euros). DISCUSSION Single-use flexible ureteroscopes were created to bypass the problems incurred when reusable scopes were damaged and therefore not available for use in surgical procedures. Single-use flexible ureteroscopes are always immediately available and ready to be used, even in urgent cases, as they typically do not require maintenance or sterilization. Compared with their reusable counterparts, single-use flexible ureteroscopes have similar digital performance (270°), image quality and we found no difference in the success and complication rates. Cost analysis of a reusable flexible ureteroscope must consider the purchase price, maintenance and repair costs, and decontamination costs (including handling, detergent, bacterial culture, transportation, and storage costs). In contrast, only purchase price is included in cost analysis for single-use flexible ureteroscopes. Our study suggests that single-use flexible ureteroscopes may be associated with lower costs per procedure than their reusable counterparts. CONCLUSION Single-use flexible ureteroscopes are an interesting alternative to their reusable counterparts, particularly in terms of material resource management. Cost analyses conducted using a low volume of cases representative of a paediatric urology division favour the use of single-use ureteroscopes.
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Affiliation(s)
- Eva Mille
- Aix-Marseille Université, APHM, CHU Hopital La Timone Enfants, Paediatric Surgery Department, 13385, Marseille, France
| | - Eliane El-Khoury
- Aix-Marseille Université, APHM, CHU Hopital La Timone Enfants, Paediatric Surgery Department, 13385, Marseille, France
| | - Mirna Haddad
- Aix-Marseille Université, APHM, CHU Hopital La Timone Enfants, Paediatric Surgery Department, 13385, Marseille, France
| | - Jessica Pinol
- Aix-Marseille Université, APHM, CHU Hopital La Timone Enfants, Paediatric Surgery Department, 13385, Marseille, France
| | - Matthieu Charbonnier
- Aix-Marseille Université, APHM, CHU Hopital La Timone Enfants, Paediatric Surgery Department, 13385, Marseille, France
| | - Pauline Gastaldi
- Aix-Marseille Université, APHM, CHU Hopital La Timone Enfants, Paediatric Surgery Department, 13385, Marseille, France
| | - Anne Dariel
- Aix-Marseille Université, APHM, CHU Hopital La Timone Enfants, Paediatric Surgery Department, 13385, Marseille, France
| | - Thierry Merrot
- Aix-Marseille Université, APHM, CHU Hopital La Timone Enfants, Paediatric Surgery Department, 13385, Marseille, France
| | - Alice Faure
- Aix-Marseille Université, APHM, CHU Hopital La Timone Enfants, Paediatric Surgery Department, 13385, Marseille, France.
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Miller CS, Whiles BB, Ito WE, Machen E, Thompson JA, Duchene DA, Neff DA, Molina WR. Image Distortion During Flexible Ureteroscopy: A Laboratory Model Comparing Super Pulsed Thulium Fiber Laser vs High-Power Ho:YAG Laser. J Endourol 2023; 37:99-104. [PMID: 36106599 PMCID: PMC10623464 DOI: 10.1089/end.2022.0195] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Purpose: Digital ureteroscopes employ "chip-on-the-tip" technology that allows for significant improvement in image resolution. However, image distortion often occurs during laser lithotripsy owing to acoustic wave production. We sought to compare image distortion using different laser power settings and distances from the laser fiber tip to the scope for the Super Pulsed Thulium Fiber (SPTF) laser and high-power Holmium:YAG (Ho:YAG) laser. Materials and Methods: Ureteroscopy was simulated using a silicon kidney-ureter-bladder model fitted with a 12F/14F access sheath and the Lithovue™ (Boston Scientific), disposable digital flexible ureteroscope. At defined laser parameters (10, 20, 30 and 40 W, short pulse), a 200-μm laser fiber was slowly retracted toward the tip of the ureteroscope during laser activation. Image distortion was identified, and distance from the laser tip to the scope tip was determined. Data from the two lasers were compared utilizing t-tests. Results: After controlling for frequency, power, and laser mode, utilizing 1.0 J of energy was significantly associated with less feedback than 0.5 J (-0.091 mm, p ≤ 0.05). Increased power was associated with larger feedback distance (0.016 mm, p ≤ 0.05); however, increase in frequency did not have a significant effect (-0.001 mm, p = 0.39). The SPFT laser had significantly less feedback when compared with all Holmium laser modes. Conclusions: Increased total power results in image distortion occurring at greater distances from the tip of the ureteroscope during laser activation. Image distortion occurs further from the ureteroscope with Ho:YAG laser than with SPTF fibers at the same laser settings. In clinical practice, the tip of the laser fiber should be kept further away from the tip of the scope during ureteroscopy as the power increases as well as when utilizing the Ho:YAG system compared with the SPTF laser platform. The SPTF laser may have a better safety profile in terms of potential scope damage.
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Affiliation(s)
- Caleb S. Miller
- Department of Urology, The University of Kansas Health System, Kansas City, Kansas, USA
| | - Bristol B. Whiles
- Department of Urology, The University of Kansas Health System, Kansas City, Kansas, USA
| | - Willian E. Ito
- Department of Urology, The University of Kansas Health System, Kansas City, Kansas, USA
| | - Edward Machen
- University of Kansas, School of Medicine, Kansas City, Kansas, USA
| | - Jeffrey A. Thompson
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - David A. Duchene
- Department of Urology, The University of Kansas Health System, Kansas City, Kansas, USA
| | - Donald A. Neff
- Department of Urology, The University of Kansas Health System, Kansas City, Kansas, USA
| | - Wilson R. Molina
- Department of Urology, The University of Kansas Health System, Kansas City, Kansas, USA
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Mahmood SN, Toffeq H, Fakhralddin S. Sheathless and fluoroscopy-free retrograde intrarenal surgery: An attractive way of renal stone management in high-volume stone centers. Asian J Urol 2019; 7:309-317. [PMID: 32742931 PMCID: PMC7385507 DOI: 10.1016/j.ajur.2019.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 12/20/2018] [Accepted: 04/16/2019] [Indexed: 01/21/2023] Open
Abstract
Objective To evaluate the efficacy and safety of sheathless and fluoroscopy-free flexible ureterorenoscopic laser lithotripsy (FURSL) for treating renal stones. Methods Between May 2015 and May 2017, 135 patients with renal stones treated with sheathless and fluoroscopy-free FURSL were prospectively evaluated. Our technique involved a semi-rigid ureteroscopic assessment of the ureter, and the guidewire was left in situ to railroad the flexible ureteroscope. A holmium laser was used to fragment and dust the stones; fragments were neither grasped nor collected. Results The study population consisted of 135 patients including 85 males (62.96%) and 50 females (37.04%) with a mean age of 40.65 years (range: 3–70 years) were evaluated. The mean stone size was 17.23 mm (range: 8–41 mm). Complete stone-free status was achieved in 122 (90.37%) patients and clinically insignificant residual fragments (CIRF) in two (1.48%), while residual stones were still present in 11 (8.15%) patients. Postoperative complications occurred in 23 (17.4%) cases and were mostly minor, including fever in 17 (12.6%), pyelonephritis in four (3.0%), subcapsular hematoma in one (0.7%) and steinstrasse in one (0.7%). These complications were Clavien I-II, GI in 17 (12.6%) patients, GII in five (3.7%), and Clavien IIIb in one (0.7%). No major complications were observed. Stone size ≥2 cm, operative time ≥30 min, and lasing time ≥20 min were significantly associated with a higher rate of complications and lower stone-free rates upon univariate analysis (p<0.05). Conclusion Sheathless and fluoroscopy-free FURSL are effective and safe for renal stone management, especially for stones under 2 cm in diameter. This process is a feasible option for avoiding sheath complications, which can protect surgeons from the negative effects of radiation.
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Affiliation(s)
- Sarwar Noori Mahmood
- University of Sulaimani College of Medicine, Kurdistan, Iraq
- Corresponding author.
| | - Hewa Toffeq
- Sulaimania General Teaching Hospital, Sulaimania, Iraq
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Lin CC, Wu LSH, Huang SS, Lin CF, Chen WH, Wu CT. Surgical technique to achieve high durability of flexible ureteroscopes: A single hospital experience. Biomed J 2019; 41:385-390. [PMID: 30709581 PMCID: PMC6362256 DOI: 10.1016/j.bj.2018.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 08/04/2018] [Accepted: 10/05/2018] [Indexed: 11/30/2022] Open
Abstract
Background To describe a novel operative technique resulting in extended durability and improved ease of use of current flexible ureteroscopes (FURS). A surgical method employing a modified technique of using an Olympus digital flexible URF-V ureteroscope was developed. Methods We retrospectively studied 546 patients who underwent retrograde intrarenal surgery (RIRS) using this modified approach performed by a single surgeon at our hospital, and investigated the outcome and durability of the ureteroscope. Results Through the study period, the URF-V ureteroscope required repair five times in total. During factory maintenance, distal working channel damage was noted twice, and outer bending rubber damage was noted once. The most recent two repairs were required due to laser penetration. Despite the damage and repairs, the deflection system was almost entirely intact after high-frequency use. The durability of FURS determines the efficacy of RIRS for renal stones. Conclusion In this report, we described our modified upside-down technique for manipulation of FURS under unequal dual deflection in order to preserve the deflection apparatus, which yielded a greatly prolonged durability. Additionally, the use of mimic drive turning decreased the time needed to train urologists.
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Affiliation(s)
- Cheng-Chia Lin
- Department of Urology, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Lawrence Shih-Hsin Wu
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
| | - Shian-Shiang Huang
- Department of Urology, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Cheng-Feng Lin
- Department of Urology, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Wen-Hsiang Chen
- Department of Urology, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Chun-Te Wu
- Department of Urology, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan.
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Carlos EC, Li J, Young BJ, Radvak D, Wollin DA, Winship BB, Simmons WN, Preminger GM, Lipkin ME. Let's Get to the Point: Comparing Insertion Characteristics and Scope Damage of Flat-Tip and Ball-Tip Holmium Laser Fibers. J Endourol 2018; 33:22-26. [PMID: 29943662 DOI: 10.1089/end.2018.0229] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION A ball-tip holmium laser fiber (TracTip; Boston Scientific) has been developed to theoretically reduce damaging friction forces generated within a ureteroscope working channel. We compared the insertional forces and damage with a ureteroscope inner lining when inserting standard flat-tip and ball-tip laser fibers. MATERIALS AND METHODS A standard ureteroscope channel liner was placed in a 3D-printed plastic mold. Molds were created at four angles of deflection (30°, 45°, 90°, and 180°) with a 1 cm radius of curvature. New 200 μm ball-tip (TracTip; Boston Scientific) and 200 μm flat-tip (Flexiva; Boston Scientific) laser fibers were advanced through the liner using a stage controller. A strain gauge was used to measure force required for insertion. Each fiber was passed 600 times at each angle of deflection. The ureteroscope liner was changed every 150 passes. Leak testing was performed every 50 passes or when the insertional force increased significantly to assess damage to the liner. RESULTS At all deflection angles, the average insertional force was significantly lower with the ball-tip laser fibers compared with flat-tip laser fibers (p < 0.001). All trials with the ball-tip lasers were completed at each angle without any leaks. Two of four trials using flat-tip fibers at 45° deflection caused liner leaks (at 91 and 114 passes). At 90° deflection, all flat-tip trials caused liner leaks on first pass. The 180° trials could not physically be completed with the flat-tip laser fiber. Within the flat- and ball-tip groups, an increasing amount of force was needed to pass the fiber as the degree of deflection increased (p < 0.001). CONCLUSIONS The ball-tip holmium laser fiber can be safely passed through a deflected ureteroscope without causing liner perforation. The standard flat-tip fiber requires greater insertion force at all angles and can cause the ureteroscope liner to leak if it is deflected 45° or more.
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Affiliation(s)
- Evan C Carlos
- 1 Division of Urology, Duke University Medical Center , Durham, North Carolina
| | - Jingqiu Li
- 2 National University of Singapore, Duke-NUS Medical School , Singapore, Singapore
| | - Brian J Young
- 1 Division of Urology, Duke University Medical Center , Durham, North Carolina
| | - Daniela Radvak
- 3 Department of Mechanical Engineering and Materials Science, Duke University , Durham, North Carolina
| | - Daniel A Wollin
- 1 Division of Urology, Duke University Medical Center , Durham, North Carolina
| | - Brenton B Winship
- 1 Division of Urology, Duke University Medical Center , Durham, North Carolina
| | - Walter Neal Simmons
- 3 Department of Mechanical Engineering and Materials Science, Duke University , Durham, North Carolina
| | - Glenn M Preminger
- 1 Division of Urology, Duke University Medical Center , Durham, North Carolina
| | - Michael E Lipkin
- 1 Division of Urology, Duke University Medical Center , Durham, North Carolina
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Oğuz U, Şahin T, Şenocak Ç, Özyuvalı E, Bozkurt ÖF, Reşorlu B, Ünsal A. Factors associated with postoperative pain after retrograde intrarenal surgery for kidney stones. Turk J Urol 2017; 43:303-308. [PMID: 28861302 DOI: 10.5152/tud.2017.58997] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 01/20/2017] [Indexed: 12/28/2022]
Abstract
OBJECTIVE We aimed to investigate factors related to early postoperative pain after retrograde intrarenal surgery (RIRS). MATERIAL AND METHODS A prospective data analysis of 250 patients who underwent RIRS due to kidney stones was performed. Postoperative pain was evaluated in all patients by using visual analogue scale (VAS). Patients with severe pain (VAS score ≥7) were separated and included in Group I (n=46). While patients without pain or with insignificant pain were included in Group II (n=204). The impact of patient-related (age, gender, renal anomalies, shock wave lithotripsy history, preoperative hydronephrosis) stone-related (stone number, side, size, location and opacity) and operation-related (preoperative and postoperative ureteral J-stenting, ureteral injury, postoperative bleeding and fever, stone-free rates, size of access sheath, and sheath indwelling time) factors on early stage postoperative pain (if any) were investigated. RESULTS Female gender increased the risk for pain 3.6-fold (p<0.05). One millimeter increase in stone diameter increased the risk for postoperative pain 1.15-fold. Prolonged sheath time was another important factor which increased the risk for pain (p<0.05). Patients with high residual fragments were also prone to early postoperative pain. CONCLUSION According to our results, patient-, stone-and operation-related factors associated with postoperative pain after RIRS were female gender, stone size and sheath time.
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Affiliation(s)
- Ural Oğuz
- Department of Urology, Giresun University School of Medicine, Giresun, Turkey
| | - Tolga Şahin
- Clinic of Urology, Keçiören Training and Research Hospital, Ankara, Turkey
| | - Çağrı Şenocak
- Clinic of Urology, Keçiören Training and Research Hospital, Ankara, Turkey
| | - Ekrem Özyuvalı
- Clinic of Urology, Keçiören Training and Research Hospital, Ankara, Turkey
| | - Ömer Faruk Bozkurt
- Clinic of Urology, Keçiören Training and Research Hospital, Ankara, Turkey
| | - Berkan Reşorlu
- Depertment of Urology, Ondokuz Mayıs University School of Medicine, Samsun, Turkey
| | - Ali Ünsal
- Department of Urology, Gazi University School of Medicine, Ankara, Turkey
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Talari HF, Monfaredi R, Wilson E, Blum E, Bayne C, Peters C, Zhang A, Cleary K. Robotically assisted ureteroscopy for kidney exploration. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2017; 10135. [PMID: 29731536 DOI: 10.1117/12.2253862] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Ureteroscopy is a minimally invasive procedure for diagnosis and treatment of a wide range of urinary tract pathologies. It is most commonly performed in the diagnostic work-up of hematuria and the diagnosis and treatment of upper urinary tract malignancies and calculi. Ergonomic and visualization challenges as well as radiation exposure are limitations to conventional ureteroscopy. For example, for diagnostic tumor inspection, the urologist has to maneuver the ureteroscope through each of the 6 to 12 calyces in the kidney under fluoroscopy to ensure complete surveillance. Therefore, we have been developing a robotic system to "power drive" a flexible fiber-optic ureteroscope with 3D tip tracking and pre-operative image overlay. Our goal is to provide the urologist precise control of the ureteroscope tip with less radiation exposure. Our prototype system allows control of the three degrees of freedom of the ureteroscope via brushless motors and a joystick interface. The robot provides a steady platform for controlling the ureteroscope. Furthermore, the robot design facilitates a quick "snap-in" of the ureteroscope, thus allowing the ureteroscope to be mounted midway through the procedure. We have completed the mechanical system and the controlling software and begun evaluation using a kidney phantom. We put MRI-compatible fiducials on the phantom and obtained MR images. We registered these images with the robot using an electromagnetic tracking system and paired-point registration. The system is described and initial evaluation results are given in this paper.
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Affiliation(s)
- Hadi F Talari
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Health System, Washington, DC, USA
| | - Reza Monfaredi
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Health System, Washington, DC, USA
| | - Emmanuel Wilson
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Health System, Washington, DC, USA
| | - Emily Blum
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Health System, Washington, DC, USA
| | - Christopher Bayne
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Health System, Washington, DC, USA
| | - Craig Peters
- Children's Health, UT Southwestern, Dallas, Texas, USA
| | - Anlin Zhang
- Department of Precision Engineering, Tianjin, China
| | - Kevin Cleary
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Health System, Washington, DC, USA
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Bhirud PH, Toal PV. A different fibre-optic device for double lumen tube position confirmation! Indian J Anaesth 2016; 60:298-300. [PMID: 27141122 PMCID: PMC4840819 DOI: 10.4103/0019-5049.179476] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Pritee H Bhirud
- Department of Anaesthesia, BARC Hospital, Mumbai, Maharashtra, India
| | - Pratibha V Toal
- Department of Anaesthesia, BARC Hospital, Mumbai, Maharashtra, India
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Alenezi H, Denstedt JD. Flexible ureteroscopy: Technological advancements, current indications and outcomes in the treatment of urolithiasis. Asian J Urol 2015; 2:133-141. [PMID: 29264133 PMCID: PMC5730717 DOI: 10.1016/j.ajur.2015.06.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 06/09/2015] [Indexed: 01/14/2023] Open
Abstract
The last 3 decades have witnessed great improvements in the technology and clinical applications of many minimally invasive procedures in the urological field. Flexible ureteroscopy (fURS) has advanced considerably to become a widely utilized diagnostic and therapeutic tool for multiple upper urinary tract pathologies. The most common indication for fURS is the treatment of upper urinary tract stones with the aid of Holmium:Yttrium Aluminium Garnet (YAG) laser lithotripsy. Advancements in endoscope technologies and operative techniques have lead to a broader application of fURS in the management of urolithiasis to include larger and more complex stones. fURS has proved to be an effective and safe procedure with few contraindications. Continued progression in fURS may increase its clinical applicability and supplant other procedures as the first line treatment option for urolithiasis.
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Affiliation(s)
- Husain Alenezi
- Division of Urology, Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - John D Denstedt
- Division of Urology, Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
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Chapman R, Somani B, Robertson A, Healy S, Kata S. Decreasing Cost of Flexible Ureterorenoscopy: Single-use Laser Fiber Cost Analysis. Urology 2014; 83:1003-5. [DOI: 10.1016/j.urology.2013.12.019] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 11/04/2013] [Accepted: 12/13/2013] [Indexed: 11/25/2022]
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12
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Oguz U, Resorlu B, Ozyuvali E, Bozkurt OF, Senocak C, Unsal A. Categorizing intraoperative complications of retrograde intrarenal surgery. Urol Int 2014; 92:164-8. [PMID: 24503707 DOI: 10.1159/000354623] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 07/24/2013] [Indexed: 01/05/2023]
Abstract
PURPOSE To review our intraoperative complications of retrograde intrarenal surgery (RIRS) for kidney calculi and stratify these complications according to the modified Satava classification system (SCS). PATIENTS AND METHODS 230 patients (119 males, 111 females) who underwent RIRS because of kidney calculi were analyzed. We documented and stratified the intraoperative complications according to the modified SCS. There are four grades for this classification: grade 1 complications include events without consequences for patients; grade 2a complications include events that could be treated with endoscopic surgery intraoperatively; grade 2b complications include events which were treated with endoscopic treatment in another session, and grade 3 describes the events requiring laparoscopic or open surgery. RESULTS Mean age was 39.1 years (range 1-78). The stone-free rate after one session was 81%. Intraoperative complications were recorded in 30.4% of the patients. According to the modified SCS, grade 1 complications were documented in 15.9%, grade 2a complications were documented in 5.6%, and grade 2b complications were documented in 8.9% of the patients. Grade 3 complications were not detected in any of the patients. CONCLUSION In our opinion, the modified SCS can facilitate patients to understand the safety of this surgery and can make it easier to compare the results of different institutes and surgeons.
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Affiliation(s)
- Ural Oguz
- Department of Urology, Kecioren Training and Research Hospital, Ankara, Turkey
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13
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Pasquel SG, Agnew D, Nelson N, Kruger JM, Sonea I, Schott HC. Ureteropyeloscopic anatomy of the renal pelvis of the horse. Equine Vet J 2013:31-8. [DOI: 10.1111/evj.12167] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 08/02/2013] [Indexed: 11/29/2022]
Affiliation(s)
- S. G. Pasquel
- Department of Large Animal Clinical Sciences; Michigan State University; East Lansing USA
| | - D. Agnew
- Department of Pathobiology and Diagnostic Investigation; Michigan State University; East Lansing USA
| | - N. Nelson
- Department of Small Animal Clinical Sciences; College of Veterinary Medicine; Michigan State University; East Lansing USA
| | - J. M. Kruger
- Department of Small Animal Clinical Sciences; College of Veterinary Medicine; Michigan State University; East Lansing USA
| | - I. Sonea
- Department of Pathobiology and Diagnostic Investigation; Michigan State University; East Lansing USA
| | - H. C. Schott
- Department of Large Animal Clinical Sciences; Michigan State University; East Lansing USA
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14
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Bagley DH, Healy KA, Kleinmann N. Ureteroscopic treatment of larger renal calculi (>2 cm). Arab J Urol 2012; 10:296-300. [PMID: 26558040 PMCID: PMC4442915 DOI: 10.1016/j.aju.2012.05.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Revised: 05/10/2012] [Accepted: 05/14/2012] [Indexed: 11/26/2022] Open
Abstract
Objectives To evaluate the current status of ureteroscopic lithotripsy (UL) for treating renal calculi of >2 cm, as advances in flexible ureteroscope design, accessory instrumentation and lithotrites have revolutionised the treatment of urinary calculi. While previously reserved for ureteric and small renal calculi, UL has gained an increasing role in the selective management of larger renal stone burdens. Methods We searched the available databases, including PubMed, Google Scholar, and Scopus, for relevant reports in English, and the article bibliographies to identify additional relevant articles. Keywords included ureteroscopy, lithotripsy, renal calculi, and calculi >2 cm. Retrieved articles were reviewed to consider the number of patients, mean stone size, success rates, indications and complications. Results In all, nine studies (417 patients) were eligible for inclusion. After one, two or three procedures the mean (range) success rates were 68.2 (23–84)%, 87.1 (79–91)% and 94.4 (90.1–96.7)%, respectively. Overall, the success rate was >90% with a mean of 1.2–2.3 procedures per patient. The overall complication rate was 10.3%, including six (1.4%) intraoperative and 37 (8.9%) postoperative complications, most of which were minor. The most common indications for UL were a failed previous treatment (46%), comorbidities (18.2%), and technical and anatomical factors (12.3%). Conclusions UL is safe and effective for treating large renal calculi. While several procedures might be required for total stone clearance, UL should be considered a standard approach in the urologist’s options treating renal calculi of >2 cm.
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Affiliation(s)
- Demetrius H Bagley
- Department of Urology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Kelly A Healy
- Department of Urology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Nir Kleinmann
- Department of Urology, Thomas Jefferson University, Philadelphia, PA, USA
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15
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Warmerdam GJJ, De Laet K, Wijn RPWF, Wijn PFF. Treatment options for active removal of renal stones. J Med Eng Technol 2012; 36:147-55. [DOI: 10.3109/03091902.2012.660797] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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16
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Optimization of 64-MDCT Urography: Effect of Dual-Phase Imaging With Furosemide on Collecting System Opacification and Radiation Dose. AJR Am J Roentgenol 2011; 197:W882-6. [DOI: 10.2214/ajr.11.6965] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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17
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Doddamani D, Sinha T, Talwar R. Efficacy of flexible fibreoptic ureteroscopy and Holmium laser in retrograde intrarenal surgery for calyceal calculi. Med J Armed Forces India 2011; 67:217-20. [PMID: 27365809 PMCID: PMC4920886 DOI: 10.1016/s0377-1237(11)60044-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Accepted: 03/31/2011] [Indexed: 11/23/2022] Open
Affiliation(s)
- D Doddamani
- Classified Specialist (Surgery and Urology), MH, Jalandhar Cantt
| | - Tapan Sinha
- Addl DGAFMS (MR), O/o DGAFMS, Ministry of Defence, 'M' Block, New Delhi - 01
| | - Raghav Talwar
- Classified Specialist (Surgery and Urology), AH, (R & R), Delhi Cantt. - 10
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