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Çil G, Yilmaz M, Sahin Y, Ulus İ, Canıtez İO, Şahin S, Sabuncu A, Semercioz A, Muslumanoglu AY. Does prior PCNL affect RIRS? A retrospective analysis of a single center data. Int Urol Nephrol 2024; 56:3187-3191. [PMID: 38713416 DOI: 10.1007/s11255-024-04071-z] [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: 02/22/2024] [Accepted: 04/27/2024] [Indexed: 05/08/2024]
Abstract
PURPOSE The aim of this study is to investigate the results and safety of retrograde intrarenal surgery (RIRS) in patients who have previously undergone percutaneous nephrolithotomy (PCNL). METHODS A retrospective analysis included patients who underwent RIRS for kidney stones between August 2018 and April 2023. Group 1 comprised 396 patients who underwent primary RIRS, while Group 2 included 231 individuals who had RIRS after previous PCNL. Evaluation parameters included preoperative characteristics, stone attributes, operative details, treatment outcomes, stone-free status, and complications. Statistical analysis utilized Student's t test, Mann-Whitney U test, and Pearson Chi-square test (p < 0.05). RESULTS The mean age, body mass index, stone number, mean stone burden, and SFS were not statistically different between the groups. Lower pole stones were identified in 144 patients in Group 1 and 88 patients in Group 2 (p = 0.315). In Group 1 and Group 2, the mean operation time and fluoroscopy time were 65.23 ± 18.1 min, 81.32 ± 14.3 min, 26.34 ± 8.31 s, 46.61 ± 7.6 s, respectively, showing statistically significant differences between the groups (p = 0.013, p < 0.001, respectively). Infundibulum stenosis was identified and treated with a laser in 12% of Group 2 cases. Complications occurred in 12 patients in Group 1 and 14 patients in Group 2 (p = 0.136). CONCLUSION A history of PCNL may contribute to extended operation times and increased fluoroscopy exposure in subsequent RIRS without significantly affecting postoperative SFS or complication rates.
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Affiliation(s)
- Gökhan Çil
- Department of Urology, University of Health Sciences, Bagcilar Training and Research Hospital, 34200, Istanbul, Turkey.
| | - Mehmet Yilmaz
- Department of Urology, University of Health Sciences, Bagcilar Training and Research Hospital, 34200, Istanbul, Turkey
| | - Yusuf Sahin
- Department of Urology, University of Health Sciences, Bagcilar Training and Research Hospital, 34200, Istanbul, Turkey
| | - İsmail Ulus
- Department of Urology, University of Health Sciences, Bagcilar Training and Research Hospital, 34200, Istanbul, Turkey
| | - İbrahim Ogulcan Canıtez
- Department of Urology, University of Health Sciences, Bagcilar Training and Research Hospital, 34200, Istanbul, Turkey
| | - Sergen Şahin
- Department of Urology, University of Health Sciences, Bagcilar Training and Research Hospital, 34200, Istanbul, Turkey
| | - Asilhan Sabuncu
- Department of Urology, University of Health Sciences, Bagcilar Training and Research Hospital, 34200, Istanbul, Turkey
| | - Atilla Semercioz
- Department of Urology, University of Health Sciences, Bagcilar Training and Research Hospital, 34200, Istanbul, Turkey
| | - Ahmet Yaser Muslumanoglu
- Department of Urology, University of Health Sciences, Bagcilar Training and Research Hospital, 34200, Istanbul, Turkey
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Xiong L, Kwan KJS, Wei GG, Xu X, Lu ZQ. Postoperative Renal Abscess Following Tip-Flexible Suctioning Ureteral Access Sheath and Digital Ureteroscopic Lithotripsy: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2024; 25:e944782. [PMID: 39152632 PMCID: PMC11334673 DOI: 10.12659/ajcr.944782] [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: 04/10/2024] [Revised: 07/05/2024] [Accepted: 06/14/2024] [Indexed: 08/19/2024]
Abstract
BACKGROUND The tip-flexible suctioning ureteral access sheath (TFS-UAS) can be bent under flexible ureteroscopes, which facilitates removal of renal stone segments by irrigation and suctioning effects. Small-scale comparative studies found it safer and more efficacious than traditional UAS. However, complications such as renal abscess were not documented after TFS-UAS combined with digital FURS. CASE REPORT A 57-year-old woman had right lumbar pain that persisted for 1 year. A plain computed tomography (CT) scan revealed multiple renal pelvicalyceal stones (maximum diameter 20×9 mm). She was admitted to undergo elective surgery with a TFS-UAS combined with digital flexible ureteroscopic lithotripsy. The operation was deemed successful and she was given postoperative antibiotics for 2 days before discharge. Eight postoperative days later, she was admitted to the emergency department due to high fever (39.6°C). Plain CT revealed intact double-J stents and no abnormalities. She was readmitted to the urological department to receive antibiotic therapy, which progressed to septic shock (blood pressure 80/50 mmHg) and required immediate transfer to the intensive care unit. Contrast-enhanced CT revealed a right renal abscess. She was promptly resuscitated and given stronger antibiotics. She recovered well and was discharged with 2-week oral levofloxacin treatment. Follow-up ultrasound found no renal abscess. CONCLUSIONS While TFS-UAS with digital FURs is an effective approach for multiple renal stones, there is a risk of postoperative renal abscess, possibly due to altered intrarenal pressure.
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Affiliation(s)
- Lin Xiong
- Department of Urology, The University of Hong Kong – Shenzhen Hospital, Shenzhen, Guangdong, PR China
| | - Kristine Joy Shan Kwan
- Department of General Surgery, The University of Hong Kong – Shenzhen Hospital, Shenzhen, Guangdong, PR China
- Department of Vascular Surgery, Fudan University Pudong Medical Center, Shanghai Key Laboratory of Vascular Lesions Regulation and Remodeling, Shanghai, PR China
| | - Geng-Geng Wei
- Department of Urology, The University of Hong Kong – Shenzhen Hospital, Shenzhen, Guangdong, PR China
| | - Xiang Xu
- Department of Urology, The University of Hong Kong – Shenzhen Hospital, Shenzhen, Guangdong, PR China
| | - Zhen-Quan Lu
- Department of Urology, The University of Hong Kong – Shenzhen Hospital, Shenzhen, Guangdong, PR China
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Devos B, Vanderbruggen W, Claessens M, Duchateau A, Hente R, Keller EX, Pietropaolo A, Van Cleynenbreugel B, De Coninck V. Risk factors of early infectious complications after ureterorenoscopy for stone disease: a prospective study. World J Urol 2024; 42:277. [PMID: 38691160 DOI: 10.1007/s00345-024-04983-6] [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: 12/19/2023] [Accepted: 03/25/2024] [Indexed: 05/03/2024] Open
Abstract
PURPOSE To prospectively evaluate the rate and associated risk factors of early infectious complications after ureterorenoscopy for urolithiasis. METHODS After ethical committee approval, 400 therapeutic retrograde ureterorenoscopy procedures between August 3, 2020 and November 24, 2021 were included for analysis in a single-center study. Postoperative infection was defined as an afebrile urinary tract infection, fever (≥ 38 °C) with pyuria (≥ 300 WBC/μL) or proven urinary pathogen, and urosepsis. The primary outcome was the rate of infectious complications after ureterorenoscopy. Secondary outcomes were the perioperative factors that increased the risk of infectious complications within 30 days of surgery using univariate and multivariate logistic regression analysis. RESULTS Twenty-nine of four hundred (7.3%) patients developed an infectious complication within 30 days after ureterorenoscopy. Ten (2.5%) patients developed an afebrile urinary tract infection, eight (2.0%) developed fever with pyuria, five (1.3%) febrile urinary tract infection, and six (1.5%) urosepsis. On univariate analysis, preoperative stent-type JFil® pigtail suture stent was significantly associated with the dependent variable (p < 0.001). On multivariate logistic regression analysis, older age (OR 1.035; 95% CI 1.006-1.070; p = 0.02) was found to be significantly associated with developing a postoperative infectious complication. CONCLUSIONS A 7.3% rate of postoperative infectious complications and 1.5% urosepsis rate were observed after therapeutic ureterorenoscopy, without the need of intensive care admission. The only significant risk factors were preoperative stent type (JFil® pigtail suture stent) on univariate analysis, and older age on multivariate logistic regression analysis. Further multicentric prospective observational data are needed in this field.
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Affiliation(s)
- Brecht Devos
- Faculty of Medicine, University Hospitals Leuven, Louvain, Belgium
| | | | - Marc Claessens
- Department of Urology, AZ Klina, Augustijnslei 100, 2930, Brasschaat, Belgium
| | - Aline Duchateau
- Department of Urology, AZ Klina, Augustijnslei 100, 2930, Brasschaat, Belgium
| | - Robert Hente
- Department of Urology, AZ Klina, Augustijnslei 100, 2930, Brasschaat, Belgium
| | - Etienne Xavier Keller
- Young Academic Urologists (YAU), Urolithiasis & Endourology Working Party, 6846, Arnhem, Netherlands
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Amelia Pietropaolo
- Young Academic Urologists (YAU), Urolithiasis & Endourology Working Party, 6846, Arnhem, Netherlands
- Department of Urology, University Hospital Southampton, Southampton, UK
| | - Ben Van Cleynenbreugel
- Faculty of Medicine, University Hospitals Leuven, Louvain, Belgium
- Department of Development and Regeneration, KU Leuven, Louvain, Belgium
| | - Vincent De Coninck
- Department of Urology, AZ Klina, Augustijnslei 100, 2930, Brasschaat, Belgium.
- Young Academic Urologists (YAU), Urolithiasis & Endourology Working Party, 6846, Arnhem, Netherlands.
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EL-Nahas AR, Elhammadi MG, Abolazm AE, Laymon MN, Tawfiek ER, El-Shazly M, Elshal AM, Elbaz R, Shehab El-Din AB, Shoma AM. Trifecta in flexible ureteroscopy for treatment of renal and upper ureteral calculi: A multicenter study. Arab J Urol 2024; 22:166-170. [PMID: 38818257 PMCID: PMC11136456 DOI: 10.1080/20905998.2024.2325784] [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: 02/13/2024] [Accepted: 02/27/2024] [Indexed: 06/01/2024] Open
Abstract
Purpose To determine predictors for missing trifecta in patients who underwent flexible ureteroscopy (FURS) for treatment of renal and upper ureteric calculi. Patients and Methods The data of adult patients with renal or upper ureteral stones who underwent FURS from June 2021 through December 2022 were retrospectively reviewed. Stone-free status (no residual stones > 3 mm) was evaluated after 3 months with non-contrast CT. Modified Clavien classification was used to grade complications. A stone-free status after a single intervention of FURS without complications was defined as trifecta. Patients were divided into two groups (trifecta and non-trifecta). Risk factors for missing trifecta were compared between both groups using univariate and multivariate analyses. Results Three hundred twenty-three patients with mean age 48.9 ± 13 years and mean stone length 16 ± 5.9 mm were included. The trifecta criteria were applicable for 250 patients (71%). On multivariate analysis, risk factors for missing trifecta were stone multiplicity (OR: 3.326, 95%CI: 1.933-5.725) and non-experienced surgeons (OR: 1.819, 95%CI: 1.027-3.220). Conclusions Multiple stones and performance of FURS by non-experienced surgeons are the independent risk factors for missing trifecta of FURS.
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Affiliation(s)
- Ahmed R. EL-Nahas
- Department of Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Moustafa G. Elhammadi
- Department of Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Ahmed E. Abolazm
- Department of Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Mahmoud N. Laymon
- Department of Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | | | | | - Ahmed M. Elshal
- Department of Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Ramy Elbaz
- Department of Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Ahmed B. Shehab El-Din
- Department of Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Ahmed M. Shoma
- Department of Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
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Mbaeri TU, Amos Onu O, Odo C, Victor Nwadi U. Ureteroscopy and Holmium:YAG Laser Lithotripsy For Upper Tract Stones in a New Urology Centre: Our Initial Experience. Niger Med J 2023; 64:259-266. [PMID: 38898971 PMCID: PMC11185812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024] Open
Abstract
Background To demonstrate the outcome of our initial experience in the management of upper tract stones with ureteroscopy and Holmium: YAG laser lithotripsy. Methodology The data of thirty-two patients who had ureteroscopy and laser lithotripsy for upper urinary tract stones at a private urology centre in Awka, Anambra State Nigeria from September 2020 to June 2022 (20months) were retrospectively studied. Their sociodemographic data, clinical symptoms, the location and size of the stones, preoperative and postoperative stent use, hospital stay, complications, and stone-clearance rates were analyzed. Results A total of 32 procedures were performed on 32 patients. The mean age of the patients was 44.7 ± 12.2 years. The mean stone size was 15.4 ± 6.7mm with a range of 8.0-39mm, and Hounsfield unit ranging from 233-906. The stones were on the right tract, left tract, and bilateral in 46.9%, 43.7%, and 9.4% of the cases respectively. The patients had a mean length of hospital stay of 3.31 ± 1.45 days. The stone clearance rate was 90.3%. 53.1% of the patients had postoperative complications with 40.6% of these being post-operative fever which resolved with antibiotics. There was treatment failure in one patient due to the inability to scope the ureter on account of ureteral stricture. Conclusion Ureteroscopy and laser lithotripsy are safe and effective options in the management of upper tract stones with the advantages of being performed via a natural orifice, being less painful, with reduced risk of severe bleeding, irreversible loss of renal parenchyma, as well as a short hospital stay.
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Affiliation(s)
- Timothy Uzoma Mbaeri
- Division of Urology, Department of Surgery, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - Onyekachi Amos Onu
- Division of Urology, Department of Surgery, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - Chinonso Odo
- Division of Urology, Department of Surgery, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - Uchenna Victor Nwadi
- Division of Urology, Department of Surgery, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
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Commentary: Outcomes and lessons learnt from practice of retrograde intrarenal surgery (RIRS) in a paediatric setting of various age groups: a global study across 8 centres. World J Urol 2022; 40:1595-1596. [PMID: 35249121 DOI: 10.1007/s00345-022-03981-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 02/28/2022] [Indexed: 12/13/2022] Open
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