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Lepine HL, Vicentini FC, Mazzucchi E, Molina WR, Marchini GS, Torricelli FC, Batagello CA, Danilovic A, Nahas WC. Intraoperative computed tomography for detection of residual stones in endourology procedures: systematic review and meta-analysis. Int Braz J Urol 2024; 50:250-260. [PMID: 38598828 DOI: 10.1590/s1677-5538.ibju.2024.0092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 03/04/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Success rates in endourological procedures, notably percutaneous nephrolithotomy (PCNL) and ureteroscopy (URS), have demonstrated suboptimal outcomes, leading to more reinterventions and radiation exposure. Recently, the use of intraoperative computed tomography (ICT) scans has been hypothesized as a promising solution for improving outcomes in endourology procedures. With this considered, we conducted a comprehensive systematic review and meta-analysis encompassing all available studies that evaluate the impact of the use of intraoperative CT scans on surgical outcomes compared to conventional fluoroscopic-guided procedures. METHODS This systematic review was conducted in accordance with PRISMA guidelines. Multiple databases were systematically searched up to December of 2023. This study aimed to directly compare the use of an ICT scan with the standard non-ICT-guided procedure. The primary endpoint of interest was success rate, and the secondary endpoints were complications and reintervention rates, while radiation exposure was also evaluated. Data extraction and quality assessment were performed following Cochrane recommendations. Data was presented as an Odds ratio with 95%CI across trials and a random-effects model was selected for pooling of data. RESULTS A comprehensive search yielded 533 studies, resulting in the selection of 3 cohorts including 327 patients (103 ICT vs 224 in non-ICT). Primary outcome was significantly higher in the experimental group versus the control group (84.5% vs 41.4% respectively, 307 patients; 95% CI [3.61, 12.72]; p<0.00001; I2=0). Reintervention rates also decreased from 32.6% in the control to 12.6% in the ICT group (OR 0.34; 95%CI [0.12,0.94]; p =0.04; I2= 48%), whereas complication rates did not exhibit significant differences. Radiation exposure was also significantly reduced in two of the included studies. CONCLUSION This meta-analysis highlights a favorable outcome with intraoperative CT scan use in PCNL procedures, showing a considerable increase in SFR when compared to standard fluoroscopy and nephroscopy. Despite limited studies, our synthesis underscores the potential of ICT scans to significantly reduce residual stones and their consequences for endourology patients, as reinterventions and follow-up ionizing radiation studies.
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Affiliation(s)
- Henrique L Lepine
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Fabio C Vicentini
- Departamento de Urologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Eduardo Mazzucchi
- Departamento de Urologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Wilson R Molina
- Department of Urology, Endourology Section, University of Kansas, Kansas City, KS, USA
| | - Giovanni S Marchini
- Departamento de Urologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Fabio C Torricelli
- Departamento de Urologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Carlos A Batagello
- Departamento de Urologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Alexandre Danilovic
- Departamento de Urologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - William C Nahas
- Departamento de Urologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
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Botelho Y, Marchini GS, Monga M, Torricelli FC, Danilovic A, Vicentini FC, Batagello CA, Srougi M, Nahas WC, Mazzucchi E. Prone split-leg endoscopic-guided percutaneous nephrolithotomy: the surgeons perspective with A Gopro® view. Int Braz J Urol 2021; 47:680-681. [PMID: 33621024 PMCID: PMC7993946 DOI: 10.1590/s1677-5538.ibju.2020.0524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 08/26/2020] [Indexed: 11/24/2022] Open
Abstract
Introduction: To demonstrate the entire surgeon's point of view of a prone split-leg (PSL) endoscopic guided percutaneous nephrolithotomy (ePCNL) recorded with a GoPro® camera for standardization of the essential technical steps towards a successful procedure (1). Materials and methods: A 40y.o female patient presented with right flank pain for three years. She had previously been submitted to shock wave lithotripsy without success. Non-contrast computed tomography (NCCT) revealed a 2cm stone in the renal pelvis with 1400HU and stone-to-skin distance of 11cm (Guy's Stone Score 1). PCNL approach was chosen for providing higher chances of stone-free after a single procedure. Informed consent was obtained. The PSL ePCNL was uneventful with a single access in a mid-pole. The surgeon had a Full HD GoPro Hero 4® camera mounted on his head, controlled by the surgical staff with a remote control. All essential surgical steps were recorded. Results: Operative time was 90 minutes. Hemoglobin drop was 0.7g/dL. The post-operative NCCT scan was stone-free. The patient was discharged 24h after surgery. Kidney stent was left with a string and removed after 5days. The camera worked properly and didn't cause any kind of discomfort to the surgeon. The quality of the recorded movie was excellent. Conclusion: By recording the surgeon's perspective of an endoscopic urological procedure, we were able to provide a comprehensive understanding of the surgical technique by assembling the endoscopic, fluoroscopic, and operative field views. The GoPro® camera proved to be an interesting tool to document surgical procedures without compromising outcomes and has great potential for educational purposes.
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Affiliation(s)
- Yuri Botelho
- Seção de Endourologia, Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
| | - Giovanni Scala Marchini
- Seção de Endourologia, Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
| | - Manoj Monga
- University of California, San Diego, California, USA
| | - Fabio C Torricelli
- Seção de Endourologia, Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
| | - Alexandre Danilovic
- Seção de Endourologia, Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
| | - Fabio C Vicentini
- Seção de Endourologia, Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
| | - Carlos A Batagello
- Seção de Endourologia, Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
| | - Miguel Srougi
- Seção de Endourologia, Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
| | - William C Nahas
- Seção de Endourologia, Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
| | - Eduardo Mazzucchi
- Seção de Endourologia, Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
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Torricelli FC, Reichard C, Monga M. Urolithiasis in complicated inflammatory bowel disease: a comprehensive analysis of urine profile and stone composition. Int Urol Nephrol 2020; 53:205-209. [PMID: 32915375 DOI: 10.1007/s11255-020-02649-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 09/08/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE To evaluate the impact of extensive surgery on urine profile, serum exams and stone composition of complicated IBD patients. METHODS Patients with IBD and a history of total proctocolectomy (TPC) with fecal diversion (end ileostomy or ileal pouch anal anastomosis-IPAA) were selected. Only patients with at least one complete 24-h urine profile were included. A case-control study was performed selecting patients with kidney stone disease in a random way who had also at least on complete 24-h urine profile. Case and controls were matched for age, gender, and body mass index (BMI). Groups were compared to urine profile, serum exams and stone composition. RESULTS Sixty-eight patients were enrolled in this study, 34 patients with IBD who underwent TPC and had diagnosis of kidney stones and 34 matched patients with only kidney stones. IBD patients had a significantly lower urine volume, urine citrate and urine sodium. Regarding serum exams, only serum bicarbonate was statistically significant lower. In both groups, calcium oxalate stone was the most common. CONCLUSION Patients with IBD with TPC and kidney stones have a low urine volume and low urine citrate as main risk factors for kidney stone formation. As seen in the general population, calcium oxalate is the most common stone composition.
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Affiliation(s)
- Fabio C Torricelli
- Department of Urology, University of Sao Paulo Medical School, São Paulo, SP, Brazil
| | - Chad Reichard
- Department of Urology, University of Indiana, Indianapolis, IN, USA
| | - Manoj Monga
- Department of Urology, University of California, 200 W. Arbor Drive, MC8897, San Diego, CA, 92103-8897, USA.
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Srougi V, Torricelli FC, Andrade HS, Arap MA, Mitre AI, Mazzucchi E, Duarte RJ, Srougi M. Retroperitoneoscopic ureterolithotomy to treat large ureteral stones in the proximal ureter. Int Braz J Urol 2020; 46:1106. [PMID: 32822143 PMCID: PMC7527105 DOI: 10.1590/s1677-5538.ibju.2019.0272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 11/20/2019] [Indexed: 11/19/2022] Open
Abstract
Introduction Retroperitoneoscopic ureterolithotomy emerged as an option for the extraction of large stones in the proximal ureter, offering short convalescence and low rates of residual fragments. Materials and methods We describe the case of a 50-year-old male, who presented at our emergency department with right flank pain for 15 days without fever. He had a past medical history of nephrolithiasis. A non-contrast computed tomography (NCCT) evidenced a stone with 1.5cm and 1200HU in the right proximal ureter associated with ipsilateral hydronephrosis. A retroperitoneoscopic ureterolithotomy was planned. Results The surgery was performed under general anesthesia, with the patient in 90o left lateral decubitus. Retroperitoneal space was created with blunt finger dissection. Three ports were used and the operative time was 60 minutes. Foley catheter was removed the morning after the procedure and the drain 8 hours later. The patient was discharged in the first postoperative day. Double J catheter withdrawal was done 4 weeks after surgery. No intraoperative or postoperative (90-days) complications were recorded. Control NCCT demonstrated the complete removal of the ureteral stone. Conclusion The retroperitoneoscopic approach is an effective alternative to treat large proximal ureteral stones.
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Affiliation(s)
- Victor Srougi
- Hospital das ClínicasUniversidade de São PauloFaculdade de MedicinaSPBrasil Divisão de Urologia, Hospital das Clínicas, Universidade de São Paulo, Faculdade de Medicina, SP, Brasil
| | - Fabio C. Torricelli
- Hospital das ClínicasUniversidade de São PauloFaculdade de MedicinaSPBrasil Divisão de Urologia, Hospital das Clínicas, Universidade de São Paulo, Faculdade de Medicina, SP, Brasil
| | - Hiury S. Andrade
- Hospital das ClínicasUniversidade de São PauloFaculdade de MedicinaSPBrasil Divisão de Urologia, Hospital das Clínicas, Universidade de São Paulo, Faculdade de Medicina, SP, Brasil
| | - Marco A. Arap
- Hospital das ClínicasUniversidade de São PauloFaculdade de MedicinaSPBrasil Divisão de Urologia, Hospital das Clínicas, Universidade de São Paulo, Faculdade de Medicina, SP, Brasil
| | - Anuar I. Mitre
- Hospital das ClínicasUniversidade de São PauloFaculdade de MedicinaSPBrasil Divisão de Urologia, Hospital das Clínicas, Universidade de São Paulo, Faculdade de Medicina, SP, Brasil
| | - Eduardo Mazzucchi
- Hospital das ClínicasUniversidade de São PauloFaculdade de MedicinaSPBrasil Divisão de Urologia, Hospital das Clínicas, Universidade de São Paulo, Faculdade de Medicina, SP, Brasil
| | - Ricardo J. Duarte
- Hospital das ClínicasUniversidade de São PauloFaculdade de MedicinaSPBrasil Divisão de Urologia, Hospital das Clínicas, Universidade de São Paulo, Faculdade de Medicina, SP, Brasil
| | - Miguel Srougi
- Hospital das ClínicasUniversidade de São PauloFaculdade de MedicinaSPBrasil Divisão de Urologia, Hospital das Clínicas, Universidade de São Paulo, Faculdade de Medicina, SP, Brasil
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Reis ST, Leite KRM, Marchini GS, Guimarães RM, Viana NI, Pimenta RCA, Torricelli FC, Danilovic A, Vicentini FC, Nahas WC, Srougi M, Mazzucchi E. Polymorphism in the PBX1 gene is related to cystinuria in Brazilian families. J Cell Mol Med 2019; 23:1593-1597. [PMID: 30450686 PMCID: PMC6349145 DOI: 10.1111/jcmm.13981] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 10/02/2018] [Indexed: 11/27/2022] Open
Abstract
The aim of our study was to determine regions of loss of heterozygosity, copy number variation analysis, and single nucleotide polymorphisms (SNPs) in Brazilian patients with cystinuria. A linkage study was performed using DNA samples from six patients with cystinuria and six healthy individuals. Genotyping was done with the Genome-Wide Human SNP 6.0 arrays (Affymetrix, Inc., Santa Clara, CA, USA). For validation, SNPs were genotyped using a TaqMan® SNP Genotyping Assay Kit. The homozygote polymorphic genotype of SNP rs17383719 in the gene PBX1 was more frequent (P = 0.015) in cystinuric patients. The presence of the polymorphic allele for this SNP increased the chance of cystinuria by 3.0-fold (P = 0.036). Pre-B-cell leukaemia transcription factor 1 (PBX1) was overexpressed 3.3-fold in patients with cystinuria. However, when we compared the gene expression findings with the genotyping, patients with a polymorphic homozygote genotype had underexpression of PBX1, while patients with a heterozygote or wild-type homozygote genotype had overexpression of PBX1. There is a 3-fold increase in the risk of the development of cystinuria among individuals with this particular SNP in the PBX1 gene. We postulate that the presence of this SNP alters the expression of PBX1, thus affecting the renal absorption of cystine and other amino acids, predisposing to nephrolithiasis.
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Affiliation(s)
- Sabrina T. Reis
- Laboratory of Medical Investigation (LIM55)Division of UrologyUniversity of Sao Paulo Medical SchoolSao PauloBrazil
- Endourology and Stone Disease SectionDivision of UrologyUniversity of Sao Paulo Medical SchoolSao PauloBrazil
| | - Katia R. M. Leite
- Laboratory of Medical Investigation (LIM55)Division of UrologyUniversity of Sao Paulo Medical SchoolSao PauloBrazil
| | - Giovanni S. Marchini
- Endourology and Stone Disease SectionDivision of UrologyUniversity of Sao Paulo Medical SchoolSao PauloBrazil
| | - Ronaldo M. Guimarães
- Endourology and Stone Disease SectionDivision of UrologyUniversity of Sao Paulo Medical SchoolSao PauloBrazil
| | - Nayara I. Viana
- Laboratory of Medical Investigation (LIM55)Division of UrologyUniversity of Sao Paulo Medical SchoolSao PauloBrazil
| | - Ruan C. A. Pimenta
- Laboratory of Medical Investigation (LIM55)Division of UrologyUniversity of Sao Paulo Medical SchoolSao PauloBrazil
| | - Fabio C. Torricelli
- Endourology and Stone Disease SectionDivision of UrologyUniversity of Sao Paulo Medical SchoolSao PauloBrazil
| | - Alexandre Danilovic
- Endourology and Stone Disease SectionDivision of UrologyUniversity of Sao Paulo Medical SchoolSao PauloBrazil
| | - Fábio Carvalho Vicentini
- Endourology and Stone Disease SectionDivision of UrologyUniversity of Sao Paulo Medical SchoolSao PauloBrazil
| | - William Carlos Nahas
- Laboratory of Medical Investigation (LIM55)Division of UrologyUniversity of Sao Paulo Medical SchoolSao PauloBrazil
| | - Miguel Srougi
- Laboratory of Medical Investigation (LIM55)Division of UrologyUniversity of Sao Paulo Medical SchoolSao PauloBrazil
| | - Eduardo Mazzucchi
- Endourology and Stone Disease SectionDivision of UrologyUniversity of Sao Paulo Medical SchoolSao PauloBrazil
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Srougi V, Moscardi PR, Marchini GS, Berjeaut RH, Torricelli FC, Mesquita JL, Srougi M, Mazzucchi E. Septic Shock Following Surgical Decompression of Obstructing Ureteral Stones: A Prospective Analysis. J Endourol 2018; 32:446-450. [DOI: 10.1089/end.2017.0896] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Victor Srougi
- Division of Urology, Hospital das Clínicas de São Paulo, University of São Paulo Medical School, São Paulo, Brazil
| | - Paulo R. Moscardi
- Division of Urology, Hospital das Clínicas de São Paulo, University of São Paulo Medical School, São Paulo, Brazil
| | - Giovanni S. Marchini
- Division of Urology, Hospital das Clínicas de São Paulo, University of São Paulo Medical School, São Paulo, Brazil
| | - Ricardo Haidar Berjeaut
- Division of Urology, Hospital das Clínicas de São Paulo, University of São Paulo Medical School, São Paulo, Brazil
| | - Fabio C. Torricelli
- Division of Urology, Hospital das Clínicas de São Paulo, University of São Paulo Medical School, São Paulo, Brazil
| | - Jose L.B. Mesquita
- Division of Urology, Hospital das Clínicas de São Paulo, University of São Paulo Medical School, São Paulo, Brazil
| | - Miguel Srougi
- Division of Urology, Hospital das Clínicas de São Paulo, University of São Paulo Medical School, São Paulo, Brazil
| | - Eduardo Mazzucchi
- Division of Urology, Hospital das Clínicas de São Paulo, University of São Paulo Medical School, São Paulo, Brazil
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Torricelli FC, Marchini GS, Pedro RN, Monga M. Ureteroscopy for management of stone disease: an up to date on surgical technique and disposable devices. MINERVA UROL NEFROL 2016; 68:516-526. [PMID: 27441593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The surgical management of urinary stone disease developed substantially over the past decades and advanced minimally invasive techniques have been successfully introduced into clinical practice. Retrograde ureteroscopy and ureterorrenoscopy have become the first-line option for treatment of ureteral and renal stones worldwide with high success rates allied with a low morbidity profile. In this review, we will discuss some key points in ureteroscopy for stone disease, such as the access to upper urinary tract, including balloon and catheter dilation; how to choose and use some disposable devices (hydrophilic versus PTFE guide wires, ureteral catheters, and laser fiber setting); and lastly present and compare different techniques for kidney or ureteral stone treatment (dusting versus basketing).
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De S, Autorino R, Kim FJ, Zargar H, Laydner H, Balsamo R, Torricelli FC, Di Palma C, Molina WR, Monga M, De Sio M. Percutaneous nephrolithotomy versus retrograde intrarenal surgery: a systematic review and meta-analysis. Eur Urol 2014; 67:125-137. [PMID: 25064687 DOI: 10.1016/j.eururo.2014.07.003] [Citation(s) in RCA: 199] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 07/03/2014] [Indexed: 10/25/2022]
Abstract
CONTEXT Recent advances in technology have led to the implementation of mini- and micro-percutaneous nephrolithotomy (PCNL) as well as retrograde intrarenal surgery (RIRS) in the management of kidney stones. OBJECTIVE To provide a systematic review and meta-analysis of studies comparing RIRS with PCNL techniques for the treatment of kidney stones. EVIDENCE ACQUISITION A systematic literature review was performed in March 2014 using the PubMed, Scopus, and Web of Science databases to identify relevant studies. Article selection proceeded according to the search strategy based on Preferred Reporting Items for Systematic Reviews and Meta-analysis criteria. A subgroup analysis was performed comparing standard PCNL and minimally invasive percutaneous procedures (MIPPs) including mini-PCNL and micro-PCNL with RIRS, separately. EVIDENCE SYNTHESIS Two randomised and eight nonrandomised studies were analysed. PCNL techniques provided a significantly higher stone-free rate (weighted mean difference [WMD]: 2.19; 95% confidence interval [CI], 1.53-3.13; p<0.00001) but also higher complication rates (odds ratio [OR]: 1.61; 95% CI, 1.11-2.35; p<0.01) and a larger postoperative decrease in haemoglobin levels (WMD: 0.87; 95% CI, 0.51-1.22; p<0.00001). In contrast, RIRS led to a shorter hospital stay (WMD: 1.28; 95% CI, 0.79-1.77; p<0.0001). At subgroup analysis, RIRS provided a significantly higher stone-free rate than MIPPs (WMD: 1.70; 95% CI, 1.07-2.70; p=0.03) but less than standard PCNL (OR: 4.32; 95% CI, 1.99-9.37; p=0.0002). Hospital stay was shorter for RIRS compared with both MIPPs (WMD: 1.11; 95% CI, 0.39-1.83; p=0.003) and standard PCNL (WMD: 1.84 d; 95% CI, 0.64-3.04; p=0.003). CONCLUSIONS PCNL is associated with higher stone-free rates at the expense of higher complication rates, blood loss, and admission times. Standard PCNL offers stone-free rates superior to those of RIRS, whereas RIRS provides higher stone free rates than MIPPs. Given the added morbidity and lower efficacy of MIPPs, RIRS should be considered standard therapy for stones <2 cm until appropriate randomised studies are performed. When flexible instruments are not available, standard PCNL should be considered due to the lower efficacy of MIPPs. PATIENT SUMMARY We searched the literature for studies comparing new minimally invasive techniques for the treatment of kidney stones. The analysis of 10 available studies shows that treatment can be tailored to the patient by balancing the advantages and disadvantages of each technique.
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Affiliation(s)
- Shuba De
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Riccardo Autorino
- Urology Service, Second University of Naples, Naples, Italy; Urology Institute, University Hospitals Case Medical Center, Cleveland, OH, USA.
| | - Fernando J Kim
- Department of Urology, Denver Health Medical Center, Denver, CO, USA
| | - Homayoun Zargar
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Humberto Laydner
- Urology Institute, University Hospitals Case Medical Center, Cleveland, OH, USA
| | | | - Fabio C Torricelli
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA; Division of Urology, Hospital das Clinicas, University of São Paulo, São Paulo, São Paulo, Brazil
| | | | - Wilson R Molina
- Department of Urology, Denver Health Medical Center, Denver, CO, USA
| | - Manoj Monga
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Marco De Sio
- Urology Service, Second University of Naples, Naples, Italy
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Falci R, Torricelli FC, Antonopoulos IM, Piovesan AC, Kanashiro H, Saito F, Ebaid GX, Nahas WC. Single center experience with elective surgical patients as living kidney donors. Transplant Proc 2012. [PMID: 23194997 DOI: 10.1016/j.transproceed.2012.02.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE To report a single center experience with elective surgical patients as living kidney donors. METHODS We retrospectively analyzed a prospective database of 458 living kidney donors from September 2005 to May 2011. Fifteen (3.2%) of them were elective surgical patients simultaneously undergoing living donor nephrectomy. We reviewed age, gender, operative time, intraoperative blood transfusion, intra- and postoperative complications, as well as length of hospital stay. Recipients were evaluated for delayed graft function. Four hundred forty-three patients undergoing living donor nephrectomy alone composed the control group. RESULTS Among the elective surgical patients group, the mean (range) operative time was 155 (90 to 310) minutes and mean (range) length of hospital stay was 3 (2 to 9) days. One (6.7%) recipient displayed delayed graft function. Among the regular living kidney donors group, the mean (range) operative time was 100 (70 to 150) minutes, mean (range) length of hospital stay was 3 (2 to 5) days, and delayed graft function was observed in 5.6% of recipients. Only operative time (P = .03) was significantly different between the groups. CONCLUSIONS Elective surgical patients are potential donors who may be treated at the same time as the living donor nephrectomy.
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Affiliation(s)
- R Falci
- Renal Transplantation Unit, Division of Urology, Department of Surgery, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
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