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Moretto S, Saita A, Scoffone CM, Talso M, Somani BK, Traxer O, Angerri O, Knoll T, Liatsikos E, Herrmann TRW, Ulvik Ø, Skolarikos A, Cracco CM, Keller EX, Paciotti M, Piccolini A, Uleri A, Tailly T, Carmignani L, Pietropaolo A, Corrales M, Lughezzani G, Lazzeri M, Fasulo V, De Coninck V, Arena P, Nagele U, Ferretti S, Kronenberg P, Perez-Fentes D, Osther PJ, Goumas IK, Acquati P, Ajayi L, Diana P, Casale P, Buffi NM. Ureteral stricture rate after endoscopic treatments for urolithiasis and related risk factors: systematic review and meta-analysis. World J Urol 2024; 42:234. [PMID: 38613692 DOI: 10.1007/s00345-024-04933-2] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 03/15/2024] [Indexed: 04/15/2024] Open
Abstract
PURPOSE We aimed to accurately determine ureteral stricture (US) rates following urolithiasis treatments and their related risk factors. METHODS We conducted a systematic review and meta-analysis following the PRISMA guidelines using databases from inception to November 2023. Studies were deemed eligible for analysis if they included ≥ 18 years old patients with urinary lithiasis (Patients) who were subjected to endoscopic treatment (Intervention) with ureteroscopy (URS), percutaneous nephrolithotomy (PCNL), or shock wave lithotripsy (SWL) (Comparator) to assess the incidence of US (Outcome) in prospective and retrospective studies (Study design). RESULTS A total of 43 studies were included. The pooled US rate was 1.3% post-SWL and 2.1% post-PCNL. The pooled rate of US post-URS was 1.9% but raised to 2.7% considering the last five years' studies and 4.9% if the stone was impacted. Moreover, the pooled US rate differed if follow-ups were under or over six months. Patients with proximal ureteral stone, preoperative hydronephrosis, intraoperative ureteral perforation, and impacted stones showed higher US risk post-endoscopic intervention with odds ratio of 1.6 (P = 0.05), 2.6 (P = 0.009), 7.1 (P < 0.001), and 7.47 (P = 0.003), respectively. CONCLUSIONS The overall US rate ranges from 0.3 to 4.9%, with an increasing trend in the last few years. It is influenced by type of treatment, stone location and impaction, preoperative hydronephrosis and intraoperative perforation. Future standardized reporting and prospective and more extended follow-up studies might contribute to a better understanding of US risks related to calculi treatment.
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Affiliation(s)
- S Moretto
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy.
| | - A Saita
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - C M Scoffone
- Department of Urology, Cottolengo Hospital, Turin, Italy
| | - M Talso
- Department of Urology, Luigi Sacco University Hospital, Milan, Italy
| | - B K Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - O Traxer
- Department of Urology, Sorbonne Université, Paris, France
| | - O Angerri
- Department of Urology, Fundació Puigvert Univ. Autonoma de Barcelona, Barcelona, Spain
| | - T Knoll
- Department of Urology, Sindelfingen Medical Center, University of Tübingen, Tübingen, Germany
| | - E Liatsikos
- Department of Urology, University Hospital of Patras, Patras, Greece
| | - T R W Herrmann
- Department of Urology, Spital Thurgau AG, Frauenfeld, Switzerland
- Hannover Medical School, Hannover, Germany
- Division of Urology, Department of Surgical Sciences, Stellenbosch University, Western Cape, South Africa
| | - Ø Ulvik
- Department of Urology, Haukeland University Hospital, Bergen, Norway
| | - A Skolarikos
- Second Department of Urology, Sismanoglio Hospital, National and Kapodistrian University of Athen, Athens, Greece
| | - C M Cracco
- Department of Urology, Cottolengo Hospital, Turin, Italy
| | - E X Keller
- Department of Urology, University Hospital Zurich, Zurich, Switzerland
| | - M Paciotti
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - A Piccolini
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - A Uleri
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - T Tailly
- Department of Urology, University Hospital Ghent, Ghent, Belgium
| | - L Carmignani
- Department of Urology, University of Milan, Milan, Italy
| | - A Pietropaolo
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - M Corrales
- Department of Urology, Sorbonne Université, Paris, France
| | - G Lughezzani
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - M Lazzeri
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - V Fasulo
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - V De Coninck
- Department of Urology, AZ Klina, Brasschaat, Belgium
| | - P Arena
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - U Nagele
- Department of Urology, General Hospital Hall in Tirol, Hall in Tirol, Austria
| | - S Ferretti
- Department of Urology, Azienda Ospedaliero-Universitaria di Modena, Baggiovara, Italy
| | - P Kronenberg
- Department of Urology, Hospital CUF Descobertas, Lisbon, Portugal
| | - D Perez-Fentes
- Department of Urology, University Hospital Complex of Santiago de Compostela, Santiago, Spain
| | - P J Osther
- Department of Urology, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - I K Goumas
- Department of Urology, Istituto Clinico Beato Matteo, Vigevano, Italy
| | - P Acquati
- Department of Urology, IRCCS Policlinico San Donato, Milan, Italy
| | - L Ajayi
- Department of Urology, Royal Free London NHS Foundation Trust, London, UK
| | - P Diana
- Department of Urology, Fundació Puigvert Univ. Autonoma de Barcelona, Barcelona, Spain
| | - P Casale
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - N M Buffi
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
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Angerri O, Gracia S, Rousaud F, Kanashiro A, Emiliani E. Entering into 2.0 cystinuric management with a medical digital tool to monitor urine pH: a prospective, randomized study. Actas Urol Esp 2023; 47:560-565. [PMID: 37086842 DOI: 10.1016/j.acuroe.2023.04.004] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 02/17/2023] [Accepted: 02/20/2023] [Indexed: 04/24/2023]
Abstract
BACKGROUND AND OBJECTIVES Individuals with cystinuria can experiment recurrent lithiasis events due to the relative insolubility of cystine at physiological urine pH, resulting in renal function decline. The Lit-Control® pH Meter is a medical device that accurately allows urine pH self-monitoring. The main objective of this study was to compare the usability of the Lit-Control® pH Meter with the reactive strips for self-monitoring of urinary pH at home by patients with cystinuria, and their overall satisfaction with each tool. PATIENTS AND METHODS We included 28 patients (9 females and 19 males, age 19-76 years), who were randomly assigned to monitor their urine pH with reactive strips (n = 17) or the Lit-Control® pH-meter (n = 11). RESULTS After six months of use, the satisfaction with the two methods was similarly high, but the patients rated (0-10 scale) the pH meter better in terms of ease of learning (mean ± SD, 8.11 ± 0.60 vs. 7.06 ± 1.18; P = 0.038), ease to prepare (8.22 ± 0.67 vs. 7.25 ± 1.18; P = 0.034), and ease of use (8.22 ± 0.67 vs. 7.25 ± 1.39; P = 0.062). Overall, patients did not reach the alkalinization goals (pH between 7.0 and 8.0). CONCLUSIONS The Lit-Control® pH Meter demonstrated to be an easy-to-use device that can facilitate urinary pH control by cystinuric patients. A prospective study is warranted to assess the correlation between urine pH monitoring, a treat to target approach, and the recurrence of cystine stones.
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Affiliation(s)
- O Angerri
- Department of Urology, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - S Gracia
- Department of Laboratory and Biochemistry, Fundació Puigvert, Universitat Autònoma de Barcelona, Spain
| | - F Rousaud
- Department of Urology, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - A Kanashiro
- Department of Urology, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - E Emiliani
- Department of Urology, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain
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Emiliani E, Sanz-Gómez I, Somani B, Tailly T, Castellani D, Traxer O, Yuen-Chun Teoh J, Chew B, Ong Lay Keat W, Chai CA, Bin-Hamri S, Shrestha A, Soehabali B, Angerri O, Gauhar V. Does gender influence retrograde intrarenal surgery (RIRS) outcomes? Data from the Flexible Ureteroscopy Outcomes Registry (FLEXOR). Actas Urol Esp 2023; 47:581-587. [PMID: 37369300 DOI: 10.1016/j.acuroe.2023.06.008] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 04/17/2023] [Indexed: 06/29/2023]
Abstract
INTRODUCTION AND OBJECTIVES As well established flexible ureteroscopy (RIRS). There is still no evidence if gender can have any influence on the outcomes and complication when performing. This study aims to evaluate the role that gender has in performing flexible ureteroscopy from a large series of patients. METHODS This study retrospectively analyzed patients who underwent RIRS for renal stones from January 2018 to August 2021 within the multicentric FLEXOR registry. Demographics, stone characteristics, perioperative findings, results and complications were analyzed and compared between gender groups. RESULTS A total of 6669 patients were included, 66.1% were male and 33.9% were female. Stone characteristics was comparable between groups. Female patients had significant higher fever and positive urine culture rates (12% vs. 8% and 37% vs. 34%). Also, females had a slight longer hospital stay (3.8 vs. 3.5 days; P < 0.001) and more residual fragments after the procedure (23.03% vs. 20.97 (P = 0.032). Overall complications were slightly significantly higher in women (15.74% vs. 14% (P = 0.042)) mainly at the expense of fever rates (6.9% vs. 5.7%) whereas the risk of sepsis was similar in both groups. A multivariate analysis showed that larger stone size, multiple and lower pole stones seem to have a negative impact in the incidence of residual stones and complications. CONCLUSION Our real life global study reflects that female gender may have a correlation with a slightly increased residual fragment rate and overall low grade complications. However, women can safely be treated with RIRS with no increased the rate of sepsis with appropriate care.
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Affiliation(s)
- E Emiliani
- Servicio de Urología, Fundación Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain.
| | - I Sanz-Gómez
- Servicio de Urología, Fundación Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - B Somani
- Servicio de Urología, Hospital Universitario de Southampton, NHS Trust, Southampton, United Kingdom
| | - T Tailly
- Servicio de Urología, Hospital Universitario de Gante, Gante, Belgium
| | - D Castellani
- Servicio de Urología, Azienda Ospedaliero-Universitaria delle Marche, Universidad Politécnica Marche, Ancona, Italy
| | - O Traxer
- Servicio de Urología, Universidad de La Sorbona, Hospital Tenon (AP-HP), París, France
| | - J Yuen-Chun Teoh
- Servicio de Cirugía, Clínica de Urología S.H. Ho, Facultad de Medicina, Universidad China de Hong Kong, Hong Kong, China
| | - B Chew
- Departamento de Urología, Universidad de British Columbia, Vancouver, Canada
| | - W Ong Lay Keat
- Servicio de Urología, Hospital General de Penang, Georgetown, Malaysia
| | - C A Chai
- Departamento de Urología, Universidad de Malaya, Kuala Lumpur, Malaysia
| | - Saeed Bin-Hamri
- Servicio de Urología, King Abdulaziz National Guard Medical City, Riad, Saudi Arabia
| | - A Shrestha
- Servicio de Urología, Hospital Bir, Academia Nacional de Ciencias Médicas, Katmandú, Nepal
| | - B Soehabali
- Departamento de Urología, Facultad de Medicina, Universidad de Mulawarman, Hospital Abdul Wahab Sjahranie, Samarinda, Indonesia
| | - O Angerri
- Servicio de Urología, Fundación Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - V Gauhar
- Servicio de Urología, Hospital General Ng Teng Fong, Singapur, Singapore
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Sanz I, Gauhar V, Somani B, Tailly T, Castellani D, Traxer O, Teoh J, Chew B, Lay Keat W, Ann C, Bin Hamri S, Shrestha A, Soehabali B, Angerri O, Emiliani E. Does gender have any influence on RIRS outcomes? Data from the FLEXible ureteroscopy Outcomes Registry (FLEXOR). Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01247-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Bravo Balado A, Fontanet S, Skolarikos A, Gozen A, Somani B, Traxer O, Papatsoris A, Ruiz Martínez A, Talso M, Villa L, Pietropaolo A, Tonyali S, Keller E, Tailly T, Kallidonis P, Sener E, Nagele U, De Coninck V, Esperto F, Hameed B, Kanashiro A, Angerri O, Emiliani E. Trends in radiation protection use and radiation exposure of European endourologists: an ESUT-YAU Endourology Group prospective trial. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00834-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Emiliani E, Territo A, Calderón Cortez J, Meneghetti I, Subiela J, Basile G, Angerri O, Palou J J, Breda A. Evaluación de la dinámica de la temperatura intrarrenal con el uso de láseres holmio y tulio YAG en un modelo ex vivo de riñón porcino. Actas Urol Esp 2022. [DOI: 10.1016/j.acuro.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Emiliani E, Territo A, Calderón Cortez J, Meneghetti I, Subiela J, Basile G, Angerri O, Palou J J, Breda A. Assessment of intrarenal temperature dynamics when using holmium and thulium: YAG lasers in an ex vivo porcine kidney model. Actas Urológicas Españolas (English Edition) 2022; 47:159-164. [PMID: 37013354 DOI: 10.1016/j.acuroe.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AIM To measure the temperature dynamics at the renal surface and within the urinary tract when using Ho:YAG and Tm:YAG lasers for tissue ablation. MATERIALS AND METHODS Porcine kidneys were used. Both types of lasers with different configurations and fiber sizes were used through a flexible ureteroscope. The temperature at the renal surface was recorded using a thermal camera while the intrarenal temperature was measured using two thermal probes, the first one at the ureteropelvic junction and the second one at the calyx used for lasering. Temperature was determined at 0.5-1-3-5 and 10 min. RESULTS Recordings at the ureteropelvic junction and calyx revealed significant increases when using Tm:YAG with the 273 μm (10 W to 50 W) (p ≤ 0.02) and 550 μm (10 W) fiber (p = 0.04). With Ho:YAG there was a significant increase when using 273 μm (at 10 W and 20 W) (p ≤ 0.03) and 365 μm (10 W) fibers (p = 0.04). Regarding fiber size there was a significant difference when using Tm:YAG (at 20 W and 40 W) (p < 0.05). The thermal camera recorded a mean increase of 8 °C in the UPJ while the remaining areas of the kidney did not undergo significant changes. CONCLUSIONS Temperature changes were greater when using the Ho:YAG laser with respect to Tm:YAG at similar power settings for tissue ablation. The greatest temperature increase was recorded at the UPJ from where the heat dissipated throughout the kidney.
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Bravo-Balado A, Emiliani E, Kanashiro AK, Balañà J, Fontanet S, Skolarikos A, Sánchez-Martín F, Millán F, Angerri O. Radiation exposure using lead-lined versus regular latex surgical gloves during endourological procedures: A single-center prospective comparative study. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00343-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Fontaine C, Birks T, Ferreiro C, Torrecilla C, Vigués F, Angerri O, Emiliani E, Breda A, Ajayi L. Percutaneous nephrolithotomy in the transplant kidney - a prospective 20 year multicentre experience. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33278-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Martinez C, Angerri O, Territo A, Vanacore D, Saitta G, Talle M, Caillabet A, Meneghetti I, Bevilacqua G, Montaño B, Giron I, Palou J, Breda A. Dual thulium-holmium laser ablation by percutaneous approach of upper tract urinary carcinoma in a solitary kidney: An imperative case. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)34229-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Manzo BO, Gómez F, Figueroa A, Sánchez HM, Leal M, Emiliani E, Sánchez FJ, Angerri O. A New Simplified Biplanar (0-90°) Fluoroscopic Puncture Technique for Percutaneous Nephrolithotomy. Reducing Fluoroscopy Without Ultrasound. Initial Experience and Outcomes. Urology 2020; 140:165-170. [DOI: 10.1016/j.urology.2020.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/25/2020] [Accepted: 03/04/2020] [Indexed: 10/24/2022]
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Emiliani E, Kanashiro A, Chi T, Pérez-Fentes DA, Manzo BO, Angerri O, Somani BK. Fluoroless Endourological Surgery for Stone Disease: a Review of the Literature—Tips and Tricks. Curr Urol Rep 2020; 21:27. [DOI: 10.1007/s11934-020-00979-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Emiliani E, Motta GL, Llorens E, Quiróz Y, Kanashiro AK, Angerri O, Palou J, Bujons A. Totally fluoroless retrograde intrarenal surgery technique in prestented patients: tips and tricks. J Pediatr Urol 2019; 15:570-573. [PMID: 31362862 DOI: 10.1016/j.jpurol.2019.06.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 06/14/2019] [Indexed: 10/26/2022]
Abstract
Treatment of urolithiasis has evolved greatly as retrograde intrarenal surgery (RIRS) has gained popularity nowadays being a gold standard therapy for renal stones up to 2 cm. Endourological procedures are traditionally fluoroscopic guided; thus, an increasing concern is the harm of radiation exposure, especially in the pediatric population. Therefore, performing fluoroless RIRS should be a feasible option for pediatric urologists. Herein, we describe the technique of totally fluoroless RIRS in presented patients and the tips to avoid radiation use at most.
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Affiliation(s)
- E Emiliani
- Urolithiasis Division, Fundació Puigvert, Barcelona, Spain
| | - G L Motta
- Pediatric Urology Division, Fundació Puigvert, Barcelona, Spain; Urology Division, Universidade Federal de Santa Maria, Santa Maria, Brazil
| | - E Llorens
- Pediatric Urology Division, Fundació Puigvert, Barcelona, Spain
| | - Y Quiróz
- Pediatric Urology Division, Fundació Puigvert, Barcelona, Spain
| | - A K Kanashiro
- Urolithiasis Division, Fundació Puigvert, Barcelona, Spain
| | - O Angerri
- Urolithiasis Division, Fundació Puigvert, Barcelona, Spain
| | - J Palou
- Urology Department, Fundació Puigvert, Barcelona, Spain
| | - A Bujons
- Pediatric Urology Division, Fundació Puigvert, Barcelona, Spain.
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Bujons A, Saldaña L, Caffaratti J, Garat JM, Angerri O, Villavicencio H. Can endoscopic balloon dilation for primary obstructive megaureter be effective in a long-term follow-up? J Pediatr Urol 2015; 11:37.e1-6. [PMID: 25748631 DOI: 10.1016/j.jpurol.2014.09.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 09/22/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Ureteral tapering and reimplantation is an established treatment for persistent or progressive primary obstructive megaureter (POM) but may result in complications and morbidity. Use of a less invasive technique involving endoscopic balloon dilation appears very interesting. OBJECTIVE The objective of this report is to determine if endoscopic balloon dilation for POM is effective in the long term as well as to assess complications of the procedure. MATERIAL AND METHODS A retrospective review was done on 19 patients and 20 ureters treated with the endoscopic balloon dilation by POM from June 2000 to February 2010. Surgery was performed solely in those cases in which there was persistence of obstruction in the renogram along with one or all of the following conditions: impairment of the differential renal function <40%, worsening of the renal pelvic dilation, febrile UTI in spite of antibiotic prophylaxis or renal calculi. The patients comprised 16 boys and 3 girls with a mean age at surgery of 17 months (range 1-44 months). Ten cases were left sided, eight right sided, and one bilateral. Under endoscopic and fluoroscopic guidance, a 3-5 Fr dilating balloon was inflated to 12-14 atm, or until disappearance of the stenotic obstructive area. A double J stent was positioned and withdrawn 2 months later. Follow-up recorded the presence of symptoms, number of reintervention procedures registered, and included renal ultrasound and MAG-3 renogram. RESULTS There were no perioperative complications. Eighteen ureters showed a non-obstructive pattern on MAG-3 renogram after the first endoscopic dilation, representing a 90% success rate. One case required a second dilation, which proved successful and two cases of recurrent lithiasis required ureterotomy without instances of obstruction. 2 patients had a febrile UTI and a vesicoureteral reflux was diagnosed in one. Renal function was preserved in 95% of patients. The mean follow-up was 6.9 years (range 3.9-13.3 years). One patient was lost after the procedure. DISCUSSION In an era of minimally invasive techniques, the search for less invasive procedures for treatment of POM has resulted in a variety of surgical options. Angulo et al., in 1998 and our group described the first POM treatment with endoscopic balloon dilation, which is believed to be a definitive, less invasive, and safe treatment. Furthermore, should an endoscopic approach fail, reimplant surgery can be performed. Few publications have reported short series with good results in the short and medium term. Torino et al. presented five cases in children aged less than 1 year, none of these showed evidence of obstruction. García-Aparicio et al. presented a series of 13 patients treated with a success rate of 84.6%. Christman et al. added laser incision in cases of narrowed ureteral segment 2-3 cm long and used double stenting. Good outcomes were presented in 71%. Romero et al. reported improvement of drainage within the first 18 months after treatment in 69% of patients. The potential de novo onset of vesicoureteral reflux may be the source of some controversy. We consider that dilation does not significantly alter the antireflux mechanism. In VCUG is not systematically performed because it is an invasive test. This restricts the conclusions that can be drawn from our findings. Nevertheless, some groups continue to systematically perform VCUG. CONCLUSIONS Endoscopic balloon dilation for POM is a safe, feasible, and less invasive procedure that shows good outcomes on long-term follow-up. However, multicenter studies and prospective trials should be encouraged to provide more definitive evidence on its benefits.
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Affiliation(s)
- A Bujons
- Pediatric Urology Department, Fundació Puigvert, Barcelona, Spain.
| | - L Saldaña
- Pediatric Urology Department, Fundació Puigvert, Barcelona, Spain
| | - J Caffaratti
- Pediatric Urology Department, Fundació Puigvert, Barcelona, Spain
| | - J M Garat
- Pediatric Urology Department, Fundació Puigvert, Barcelona, Spain
| | - O Angerri
- Pediatric Urology Department, Fundació Puigvert, Barcelona, Spain
| | - H Villavicencio
- Pediatric Urology Department, Fundació Puigvert, Barcelona, Spain
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Sánchez-Martín FM, Hostalot AM, Santillana JM, Angerri O, Millán F, Villavicencio H. Extraction of a bladder stone in a child as described by the renaissance physician Cristóbal Méndez. Actas Urol Esp 2014; 38:476-82. [PMID: 24630425 DOI: 10.1016/j.acuro.2014.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 01/03/2014] [Accepted: 02/02/2014] [Indexed: 11/30/2022]
Abstract
INTRODUCTION in his Libro del exercicio y de sus provechos (Book of exercise and profits), the Spanish Renaissance physician Christopher Mendez (1500-1553) describes extracting a bulk stone from the bladder of a child younger than 5 years in the land of colonial Mexico. This is the first description of a surgical procedure in America. MATERIAL AND METHODS Biographical data were collected on Christopher Mendez. The electronic facsimile of the Book of exercise and profits was read. The historical aspects of perineal lithotomy and etiology of bladder stones were analyzed. RESULTS In chapter seven of the third treatise (page 120), Mendez speaks about the removal of a bladder stone in a boy named «Villaseñor». It uses the word «open» to describe the procedure, corresponding to a lithotomy more than a necropsy. It attributes the etiology of excess movements after ingestion and suggests a possible hereditary etiology. DISCUSSION Perineal lithotomy was a common practice in ancient times for children due to the high incidence of bladder stones. The technique was very invasive and was improved over the centuries. CONCLUSIONS The surgery described by Mendez for the child called Villaseñor most likely corresponds to a perineal lithotomy. A congenital cause could play a role in its etiology.
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Affiliation(s)
| | - A M Hostalot
- Unidad de Pediatría, CAP Plana Lledó, ICS, Mollet, Barcelona, España
| | - J M Santillana
- Servicio de Urología, Fundacio Puigvert, Barcelona, España
| | - O Angerri
- Servicio de Urología, Fundacio Puigvert, Barcelona, España
| | - F Millán
- Servicio de Urología, Fundacio Puigvert, Barcelona, España
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Millán F, Gracia S, Sánchez-Martín F, Angerri O, Rousaud F, Villavicencio H. [A new approach to urinary stone analysis according to the combination of the components: experience with 7949 cases]. Actas Urol Esp 2011; 35:138-43. [PMID: 21349601 DOI: 10.1016/j.acuro.2010.10.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2010] [Accepted: 10/12/2010] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To evaluate a new approach to urinary stone analysis according to the combination of the components. MATERIALS AND METHODS A total of 7949 stones were analysed and their main components and combinations of components were classified according to gender and age. Statistical analysis was performed using the chi-square test. RESULTS Calcium oxalate monohydrate (COM) was the most frequent component in both males (39%) and females (37.4%), followed by calcium oxalate dihydrate (COD) (28%) and uric acid (URI) (14.6%) in males and by phosphate (PHO) (22.2%) and COD (19.6%) in females (p=0.0001). In young people, COD and PHO were the most frequent components in males and females respectively (p=0.0001). In older patients, COM and URI (in that order) were the most frequent components in both genders (p=0.0001). COM is oxalate dependent and is related to diets with a high oxalate content and low water intake. The progressive increase in URI with age is related mainly to overweight and metabolic syndrome. Regarding the combinations of components, the most frequent were COM (26.3%), COD+Apatite (APA) (15.5%), URI (10%) and COM+COD (7.5%) (p=0.0001). CONCLUSIONS This study reports not only the composition of stones but also the main combinations of components according to age and gender. The results prove that stone composition is related to the changes in dietary habits and life-style that occur over a lifetime, and the morphological structure of stones is indicative of the aetiopathogenic mechanisms.
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Millán F, Gracia S, Sánchez-Martín F, Angerri O, Rousaud F, Villavicencio H. Un nuevo enfoque en el análisis de la litiasis urinaria en función de la combinación de sus componentes: experiencia con 7.949 casos. Actas Urol Esp 2011. [DOI: 10.4321/s0210-48062011000300003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Millán F, Gracia S, Sánchez-Martín F, Angerri O, Rousaud F, Villavicencio H. A new approach to urinary stone analysis acccording to the combination of the components: experience with 7,949 cases. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/s2173-5786(11)70037-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Audi L, Fernández-Cancio M, Carrascosa A, Andaluz P, Torán N, Piró C, Vilaró E, Vicens-Calvet E, Gussinyé M, Albisu MA, Yeste D, Clemente M, Hernández de la Calle I, Del Campo M, Vendrell T, Blanco A, Martínez-Mora J, Granada ML, Salinas I, Forn J, Calaf J, Angerri O, Martínez-Sopena MJ, Del Valle J, García E, Gracia-Bouthelier R, Lapunzina P, Mayayo E, Labarta JI, Lledó G, Sánchez Del Pozo J, Arroyo J, Pérez-Aytes A, Beneyto M, Segura A, Borrás V, Gabau E, Caimarí M, Rodríguez A, Martínez-Aedo MJ, Carrera M, Castaño L, Andrade M, Bermúdez de la Vega JA. Novel (60%) and recurrent (40%) androgen receptor gene mutations in a series of 59 patients with a 46,XY disorder of sex development. J Clin Endocrinol Metab 2010; 95:1876-88. [PMID: 20150575 DOI: 10.1210/jc.2009-2146] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Androgen receptor (AR) gene mutations are the most frequent cause of 46,XY disorders of sex development (DSD) and are associated with a variety of phenotypes, ranging from phenotypic women [complete androgen insensitivity syndrome (CAIS)] to milder degrees of undervirilization (partial form or PAIS) or men with only infertility (mild form or MAIS). OBJECTIVE The aim of the study was to characterize the contribution of the AR gene to the molecular cause of 46,XY DSD in a series of Spanish patients. SETTING We studied a series of 133 index patients with 46,XY DSD in whom gonads were differentiated as testes, with phenotypes including varying degrees of undervirilization, and in whom the AR gene was the first candidate for a molecular analysis. METHODS The AR gene was sequenced (exons 1 to 8 with intronic flanking regions) in all patients and in family members of 61% of AR-mutated gene patients. RESULTS AR gene mutations were found in 59 individuals (44.4% of index patients), of whom 46 (78%) were CAIS and 13 (22%) PAIS. Fifty-seven different mutations were found: 21.0% located in exon 1, 15.8% in exons 2 and 3, 57.9% in exons 4-8, and 5.3% intronic. Twenty-three mutations (40.4%) had been previously described and 34 (59.6%) were novel. CONCLUSIONS AR gene mutation is the most frequent cause of 46,XY DSD, with a clearly higher frequency in the complete phenotype. Mutations spread along the whole coding sequence, including exon 1. This series shows that 60% of mutations detected during the period 2002-2009 were novel.
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Affiliation(s)
- L Audi
- Unidad Investigación Endocrinología Pediátrica, Institut de Recerca, Hospital Vall d'Hebron, Paseo Vall d'Hebron 119, 08035 Barcelona, Spain.
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Martínez-Rodríguez R, Gutiérrez-Ruiz C, Rodríguez-Escovar F, Angerri O, Sarquella Geli J, Villavicencio Mavrich H. Hematoma espontáneo paracavernoso. Actas Urol Esp 2007. [DOI: 10.4321/s0210-48062007000700014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Martinez-Rodríguez RH, Gutiérrez-Ruiz C, Rodríguez-Escovar F, Angerri O, Sarquella Geli J, Villavicencio Mavrich H. Hematoma espontáneo paracavernoso. Actas Urol Esp 2007; 31:781-2. [PMID: 17902474 DOI: 10.1016/s0210-4806(07)73722-1] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We report a case of spontaneous, perineal haematoma depending on corpora cavernosa but without injury of them. No erectile dysfunction was associated. Not traumatic injury was known. Etiopathology, diagnosis and treatment are analyses.
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Rosales A, Salvador J, De Graeve N, Angerri O, Villavicencio H. Clamping of the Renal Artery in Laparoscopic Partial Nephrectomy: An Old Device for a New Technique. Eur Urol 2005; 47:98-101. [PMID: 15582256 DOI: 10.1016/j.eururo.2004.08.021] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2004] [Indexed: 11/20/2022]
Abstract
OBJECTIVE We describe our experience with the transient clamping of the renal artery during laparoscopic partial nephrectomy for renal cancer with a double loop clamping device, inspired by the Rumel tourniquet. The silastic rubber loop is positioned around the renal artery and clinched, thus achieving arterial occlusion. METHODS From November 2002 until July 2004, fourteen consecutive patients (mean age of 58 +/- 11.6 years) underwent laparoscopic transperitoneal partial nephrectomy using the silastic rubber clamping device, eight of them on the right side and six on the left side. Hemorrhage of the renal defect was controlled with bipolar electrocoagulation, argon beam coagulation, laparoscopic sutures, surgical and fibrin glue. RESULTS : The mean surgical time was 198.92 +/- 39.95 min for a mean tumour size of 2.9 +/- 2.32 cm and a mean blood loss of 104.57 +/- 77.69 ml. The clamping device was easily and successfully positioned around the renal artery in 2.05 +/- 0.45 min and the mean warm ischemic time was 25.21 +/- 6.07 min. CONCLUSIONS The clamping device procures successful atraumatic occlusion of the renal artery during laparoscopic partial nephrectomy without the need for an additional port. As such, it could be considered as an alternative for the laparoscopic bulldog and Satinsky clamp.
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Affiliation(s)
- A Rosales
- Urology Department, Fundació Puigvert, C/ Cartagena, 340, 08025 Barcelona, Spain.
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