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Collura G, D'Ippolito G, Lopes Mandes AL, Innocenzi M, Del Prete L, Mele E, Barneschi AC, Castagnetti M. Vacuum-assisted Mini-percutaneous Nephrolithotomy for 2-3-cm Renal Stones: A Comparative Study with Retrograde Intra-renal Surgery. J Pediatr Surg 2024; 59:412-415. [PMID: 37973416 DOI: 10.1016/j.jpedsurg.2023.10.051] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 10/18/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE To compare vacuum-assisted percutaneous nephrolithotomy (VAmini-PCNL) with retrograde intra-renal surgery (RIRS) for the treatment of renal stones measuring 2-3 cm in diameter. MATERIAL AND METHODS This retrospective study included children receiving treatment for pyelocalyceal stones of 2-3 cm in diameter from November 2018 to September 2022. Consecutive patients undergoing VAmini-PCNL after 2020 were compared with a historically matched group undergoing RIRS. VAmini-PCNL was performed using a 12-Ch nephroscope through a 16-Ch vacuum ClearPetra access sheet. RIRS was performed using a flexible ureteroscope through a ureteral sheath. The endpoints included the need for pre-stenting, duration of surgery, complications, stone-free rate (SFR), and need for secondary procedures. RESULTS The patients were grouped into two with 15 patients for each group. VAmini-PCNL group was not different from the RIRS one for age at surgery [median (range) 6.6 (1-12)years vs. 7.7 (1.5-14)years], and stone diameter [median (range) 2.4 (2.0-2.9)cm vs. 2.3 (2.1-2.8)cm] and density [median (range) 577.5 (421-1068) vs. 541.5 (462-927) Hunsfield Units]. Pre-stenting was necessary in five RIRS patients (33 %). The median duration of surgery was 85.3 (76-112)min for VAmini-PCNL vs. 150.6 (132-167)min for RIRS, p = 0.00001. No major complications were observed. The SFR was 100 % after VAmini-PCNL and 60 % after RIRS, p = 0.02. All residual fragments were removed with a second RIRS. CONCLUSION VAmini-PCNL was feasible and safe in children aged >1 year. It allowed for a significantly higher SFR despite a significantly shorter operative time than RIRS, which also requires pre-stenting in one-third of patients and a second RIRS in 40 % of cases. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Giuseppe Collura
- Paediatric Urology Unit, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy.
| | | | - Ana Ludy Lopes Mandes
- Paediatric Urology Unit, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy
| | - Michele Innocenzi
- Paediatric Urology Unit, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy
| | - Laura Del Prete
- Paediatric Urology Unit, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy
| | - Ermelinda Mele
- Paediatric Urology Unit, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy
| | | | - Marco Castagnetti
- Paediatric Urology Unit, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy
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Giulioni C, Castellani D, Somani BK, Chew BH, Tailly T, Keat WOL, Teoh JYC, Emiliani E, Chai CA, Galosi AB, Ragoori D, Tanidir Y, Hamri SB, Gadzhiev N, Traxer O, Gauhar V. The efficacy of retrograde intra-renal surgery (RIRS) for lower pole stones: results from 2946 patients. World J Urol 2023; 41:1407-1413. [PMID: 36930255 DOI: 10.1007/s00345-023-04363-6] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 02/27/2023] [Indexed: 03/18/2023] Open
Abstract
PURPOSE To evaluate the perioperative outcomes of retrograde intra-renal surgery (RIRS) for lower pole stones (LPS) and factors affecting stone-free rate (SFR). METHODS Data from 20 centers were retrospectively reviewed. Inclusion criteria were adult patients, normal renal anatomy, and LPS. Exclusion criteria were bilateral surgery, concomitant surgery for ureteral stones. SFR was defined as a single residual fragment (RF) ≤ 2 mm and evaluated 3-months after surgery. A multivariable logistic regression analysis was performed to assess factors associated with RF. Statistical significance was set at p value < 0.05. RESULTS 2946 patients were included. Mean age and stone size were 49.9 years 10.19 mm, with multiple LPS in 61.1% of cases. Total operation and laser time were 63.89 ± 37.65 and 17.34 ± 18.39 min, respectively. Mean hospital stay was 3.55 days. Hematuria requiring blood transfusion and fever/urinary infections requiring prolonged antibiotics occurred in 6.1% and 169 5.7% of cases, while sepsis with intensive-care admission in 1.1% of patients. On multivariate analysis, Multiple stones (OR 1.380), stone size (OR 1.865), and reusable ureteroscopes (OR 1.414) were significantly associated with RF, while Thulium fiber laser (TFL) (OR 0.341) and pre-stenting (OR 0.750) were less likely associated with RF. CONCLUSIONS RIRS showed safety and efficacy for LPS with a mean diameter of 10 mm. This procedure can achieve a satisfactory SFR in pre-stented patients with a single and smaller stone, particularly with TFL use.
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Affiliation(s)
- Carlo Giulioni
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Polytechnic University of Marche, Ancona, Italy. .,Department of Urology, Polytechnic University of Marche, 71 Conca Street, 60126, Ancona, Italy.
| | - Daniele Castellani
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Polytechnic University of Marche, Ancona, Italy
| | - Bhaskar Kumar Somani
- Department of Urology, University Hospitals Southampton, NHS Trust, Southampton, UK
| | - Ben Hall Chew
- Department of Urology, University of British Columbia, Vancouver, Canada
| | - Thomas Tailly
- Department of Urology, University Hospital of Ghent, Ghent, Belgium
| | | | - Jeremy Yuen-Chun Teoh
- Department of Surgery, Faculty of Medicine, S.H. Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, China
| | - Esteban Emiliani
- Urology Department, Fundación Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Chu Ann Chai
- Department of Surgery, Urology Unit, University Malaya, Kuala Lumpur, Malaysia
| | - Andrea Benedetto Galosi
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Polytechnic University of Marche, Ancona, Italy
| | - Deepak Ragoori
- Department of Urology, Asian Institute of Nephrology and Urology, Irram Manzil Colony, Hyderabad, Telangana, India
| | - Yiloren Tanidir
- Department of Urology, Marmara University School of Medicine, Istanbul, Turkey
| | - Saeed Bin Hamri
- Division of Urology, Department of Surgery, Ministry of the National Guard Health Affairs, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Nariman Gadzhiev
- Endourology Department, Saint-Petersburg State Medical University, Saint-Petersburg, Russia
| | - Olivier Traxer
- Department of Urology AP-HP, Sorbonne University, Tenon Hospital, Paris, France
| | - Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore
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Golomb D, Goldberg H, Tapiero S, Stabholz Y, Lotan P, Darawsha AE, Holland R, Ehrlich Y, Lifshitz D. Retrograde intrarenal surgery for lower pole stones utilizing stone displacement technique yields excellent results. Asian J Urol 2023; 10:58-63. [PMID: 36721691 PMCID: PMC9875154 DOI: 10.1016/j.ajur.2021.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 12/22/2020] [Accepted: 06/25/2021] [Indexed: 02/03/2023] Open
Abstract
Objective To evaluate the long-term stone-free rate (SFR) of retrograde intra-renal surgery (RIRS) in the treatment of lower pole renal calculi using only basket relocation and identify independent predictors of stone-free status. Methods All consecutive patients undergoing RIRS lower pole renal calculi at a single high-volume tertiary center were analyzed retrospectively. Lower pole stones were relocated to the upper pole, where laser lithotripsy was performed. All patients were followed up in the clinic following the surgery and yearly thereafter. The stone-free status was assessed with a combination of an abdominal ultrasound and abdominal X-ray, or an abdominal non-contrast computed tomography if the stones were known to be radiolucent. Results A total of 480 consecutive patients who underwent RIRS for treatment of lower pole renal calculi, between January 2012 and December 2018, were analyzed from a prospectively maintained database of 3000 ureteroscopies. With a median follow-up time of 18.6 months, the mean SFR was 94.8%. The procedures were unsuccessful in 26 (5.4%) patients due to unreachable stones. The median stone size of the unreachable stones was 12 mm (range 10-30 mm). Multivariable logistic regression analysis revealed two predictors of SFR for lower pole stones: a small cumulative stone burden (odds ratio [OR]: 0.903, 95% confidence interval [CI]: 0.867-0.941, p<0.0001) and preoperative ureteral stent insertion (OR: 0.515, 95% CI: 0.318-0.835, p=0.007). Conclusion The long-term SFR of RIRS for the treatment of lower pole stones with basket displacement with appropriate patient selection is high.
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Affiliation(s)
- Dor Golomb
- Department of Urology, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel,Corresponding author.
| | - Hanan Goldberg
- Department of Urology, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel,Department of Urology, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Shlomi Tapiero
- Department of Urology, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yariv Stabholz
- Department of Urology, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Paz Lotan
- Department of Urology, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Abd Elhalim Darawsha
- Department of Urology, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ronen Holland
- Department of Urology, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaron Ehrlich
- Department of Urology, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Lifshitz
- Department of Urology, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Quiroz Madarriaga Y, Badenes Gallardo A, Llorens de Knecht E, Motta Lang G, Palou Redorta J, Bujons Tur A. Can cystinuria decrease the effectiveness of RIRS with high-power ho:yag laser in children? Outcomes from a tertiary endourology referral center. Urolithiasis 2022; 50:229-234. [PMID: 35084538 DOI: 10.1007/s00240-022-01301-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 09/04/2021] [Accepted: 01/08/2022] [Indexed: 11/26/2022]
Abstract
Cystinuria, which is the cause of cystine urolithiasis, accounts for 2-6% of all urinary stones in children, has a low prevalence with a high recurrence rate, making this metabolic disorder a therapeutic challenge in pediatric population. The aim of this work is evaluate the efficacy and safety of retrograde intra-renal surgery (RIRS) in pediatric patients with cystinuria and kidney stones smaller than 2 cm. Prospective study of 64 stones treated in 22 retrograde intra-renal surgeries (RIRS) in cystinuric pediatric patients with renal or proximal ureteral stones less than 2 cm. Average age of 9.5 years. The following data were analyzed: demographics, stone characteristics and surgical data with intra- and postoperative complications. Location of the stones was 68.7% in the calyces, 20.3% in the renal pelvis, and 9.3% in the ureteropelvic junction; 41% of cases had multiple locations. The average cystinuria level before the procedure was 825 mg/dL. The anatomy of 73% of the interventions increased the difficulty of flexible ureteroscopy and decreased stone free rates, because distorted renal anatomy was present: sclerosis of the pelvis or infundibulum, abnormal calyceal dilations, or excluded calyces. Intraoperative complications occurred in 18.2% of the procedures. Reno-vesical ultrasound was performed in all patients in the first postoperative month, with an SFR of 59%. Cystinuric patients are a challenge for pediatric urologists, decreasing the effectiveness of RIRS. However, it could be better treatment than SWL and with fewer complications than PCNL in the pediatric population with this disease.
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Affiliation(s)
| | | | - Erika Llorens de Knecht
- Urology Department, Fundació Puigvert, Carrer de Cartagena, 340-350, 08025, Barcelona, Spain
| | - Guilherme Motta Lang
- Urology Department, Fundació Puigvert, Carrer de Cartagena, 340-350, 08025, Barcelona, Spain
| | - Joan Palou Redorta
- Urology Department, Fundació Puigvert, Carrer de Cartagena, 340-350, 08025, Barcelona, Spain
| | - Anna Bujons Tur
- Urology Department, Fundació Puigvert, Carrer de Cartagena, 340-350, 08025, Barcelona, Spain
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Law YXT, Teoh JYC, Castellani D, Lim EJ, Chan EOT, Wroclawski M, Pirola GM, Giulioni C, Rubilotta E, Gubbioti M, Scarcella S, Chew BH, Traxer O, Somani BK, Gauhar V. Role of pre-operative ureteral stent on outcomes of retrograde intra-renal surgery (RIRS): systematic review and meta-analysis of 3831 patients and comparison of Asian and non-Asian cohorts. World J Urol 2022; 40:1377-1389. [PMID: 35072738 DOI: 10.1007/s00345-022-03935-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 12/13/2021] [Accepted: 01/07/2022] [Indexed: 12/27/2022] Open
Abstract
PURPOSE To evaluate the outcomes of pre-stented (PS) versus non-pre-stented (NPS) patients who have undergone retrograde intrarenal surgery (RIRS) for renal calculi with subgroup analysis of Asian and non-Asian cohorts. METHODS Protocol is registered in PROSPERO, CRD42021261123. Eligible studies identified from four electronic databases. Meta-analysis was done to enumerate the outcomes of RIRS in between PS and NPS. Secondary sub-analysis was done to look for differences in outcomes in Asian and non-Asian cohorts. RESULTS Fourteen studies involving 3831 patients (4 prospective, 10 retrospective studies) were included. PS patients experienced higher success rates of ureteral access sheath (UAS) insertion than NPS (RR 1.09, 95% CI 1.05-1.13, p < 0.00001). PS patients had lower risk of ureteral injuries from UAS placement (RR 0.69, 95% CI 0.50-0.96, p = 0.03). No significant differences in intra- and postoperative complications between two groups were found. Stone-free rate (SFR) outcomes for residual fragment (RF) cut-off of < 1 mm and < 4 mm favoured the PS patients (RR 1.10, 95% CI 1.04-1.17, p = 0.002 for < 4 mm, RR1.10, 95% CI 1.02-1.19, p = 0.02 for < 1 mm). In the subgroup analysis, PS Asian patients had similar SFR as NPS patients for SFR(< 4 mm) but non-Asian population showed better outcomes in the PS patients for SFR(< 4 mm) (RR 1.31, 95% CI 1.13-1.52, p = 0.0005). CONCLUSIONS This meta-analysis suggests that pre-stenting results in a higher success for UAS placement, minimising intraoperative ureteric injury, with higher overall SFR for any RF cut-off in PS cohorts. In non-Asian cohort, significant differences occurred at SFR < 4 mm but not for SFR < 1 mm. No difference was seen in our Asian cohort for any SFR cut-off in both PS and NPS patients.
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Affiliation(s)
- Y X T Law
- Department of Urology, National University Hospital, National University Health System, Singapore, Singapore.
| | - J Y C Teoh
- S.H. Ho Urology Centre, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - D Castellani
- Urology Division, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Università Politecnica Delle Marche, Ancona, Italy
| | - E J Lim
- Department of Urology, Singapore General Hospital, Singapore, Singapore
| | - E O T Chan
- S.H. Ho Urology Centre, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - M Wroclawski
- Department of Urology, Hospital Israelita Albert Einstein, São Paulo, Brazil.,BP-a Beneficência Portuguesa de São Paulo, São Paulo, Brazil
| | - G M Pirola
- Department of Urology, San Donato Hospital, Arezzo, Italy
| | - C Giulioni
- Urology Division, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Università Politecnica Delle Marche, Ancona, Italy
| | - E Rubilotta
- Department of Urology, A.O.U.I. Verona University, Verona, Italy
| | - M Gubbioti
- Department of Urology, San Donato Hospital, Arezzo, Italy
| | - S Scarcella
- Urology Division, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Università Politecnica Delle Marche, Ancona, Italy
| | - B H Chew
- Department of Urologic Sciences, University of British Columbia, Vancouver, Canada
| | - O Traxer
- Service d'Urologie, Sorbonne Université, Paris, France.,Service d'Urologie, AP-HP, Hôpital Tenon, Paris, France
| | - B K Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - V Gauhar
- Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore
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Olivero A, Ball L, Fontaneto C, Mantica G, Bottino P, Pelosi P, Terrone C. Spinal versus general anesthesia during retrograde intra-renal surgery: A propensity score matching analysis. Curr Urol 2021; 15:106-10. [PMID: 34168529 DOI: 10.1097/CU9.0000000000000014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 11/08/2019] [Indexed: 11/08/2022] Open
Abstract
Background: The indications for retrograde intra-renal surgery (RIRS) have greatly increased, however, there is still no consensus on the use of spinal anesthesia (SA) during this procedure. The aim of this study was to evaluate the comparability of surgical conditions and outcomes with RIRS performed under SA versus general anesthesia (GA) for renal stones. Materials and methods: This was a prospective, observational study in patients scheduled for RIRS in a single teaching hospital in Italy. Inclusion criteria were age >18 years and the presence of single or multiple renal stones. We recorded information concerning the site of lithiasis, the number of calculi, total stone burden, and the presence of concomitant ureteral stones or hydronephrosis. A propensity score-matched analysis was performed to evaluate the results in terms of surgical outcome, intraoperative and postoperative complications, and analgesia demand balanced for confounding factors. Patients were followed-up until day 90 from discharge. Results: We included 120 patients, the propensity score-matched cohort included 40 patients in the SA and 40 in the GA groups. The stone-free rate was 67.5% in the GA group and 70.0% in the SA group (p = 0.81). The use of auxiliary procedures within 90 days did not differ between groups (25.0% vs. 22.5%, p = 0.79). No cases of conversion from SA to GA were recorded. We did not find any differences in intraoperative bleedings, perforations, and abortions. Complication rates were similar in the 2 groups (10.0% in GA vs. 5.0% in SA, p = 0.64). Conclusions: In our cohort, RIRS performed under SA and GA was equivalent in terms of surgical results and complications.
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Saita A, Villa L, Persico F, Lughezzani G, Prezioso D, Casale P. In-vitro and in-vivo new evidence for Flexor® Vue™ deflecting endoscopic system use: optimization of the stone free rate (SFR) after flexible ureteroscopy and Ho:YAG laser lithotripsy. Urolithiasis 2020; 49:239-245. [PMID: 33005998 DOI: 10.1007/s00240-020-01215-5] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 09/19/2020] [Indexed: 11/29/2022]
Abstract
To test in-vitro and in-vivo the Flexor® Vue™ deflecting endoscopic system (FVDES) as a new technology able to improve the removal of residual intrarenal fragments.This is an observational prospective "proof of concept" study performed in patients with renal calculi treated with flexible ureteroscopy and Ho:YAG laser lithotripsy (f-URS) in Humanitas Research Hospital (Rozzano, Italy). We assessed feasibility, efficacy and safety of FVDES as an in-vivo tool for removing residual fragments after f-URS. The stone-free rate (SFR) at 30 days post-operatively was evaluated using CT. An in-vitro model was developed to evaluate the FVDES when used for this purpose.Eleven patients (M/F ratio: 7/4, mean age 63.5 ± 8.3) were treated. The stones were located in the lower calyces and the renal pelvis in 3 and 8 patients, respectively. Mean stone size was 18 ± 3.2 mm. The procedure with FVDES was feasible and effective in all the patients. Mean operative time was 82 ± 13.7 min and median hospitalization was of 1.5 days. The SFR after 90 days was 81% (9/11). We reported no relevant complications (Clavien-Dindo > 2); one patient had fever and was treated with antibiotics. The experimental in-vitro model demonstrated the efficacy of FVDES, allowing the removal of about 90% of fragments.Our study showed that FVDES is effective when used as a tool for retrieval of residual fragments at the end of f-URS. This technology could ensure a complete cleaning of the intrarenal collecting system and represent a safe alternative to basketing.
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Affiliation(s)
- Alberto Saita
- Department of Urology, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Luca Villa
- Division of Experimental Oncology/Unit of Urology URI, Ospedale San Raffaele IRCCS, Milan, Italy
| | - Francesco Persico
- Department of Urology, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy. .,Department of Neurosciences, Sciences of Reproduction, and Odontostomatology, University of Naples Federico II, Naples, Italy.
| | - Giovanni Lughezzani
- Department of Urology, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy
| | - Domenico Prezioso
- Department of Neurosciences, Sciences of Reproduction, and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Paolo Casale
- Department of Urology, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
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Sen H, Seckiner I, Bayrak O, Dogan K, Erturhan S. A comparison of micro-PERC and retrograde intrarenal surgery results in pediatric patients with renal stones. J Pediatr Urol 2017; 13:619.e1-619.e5. [PMID: 28679474 DOI: 10.1016/j.jpurol.2017.04.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 04/02/2017] [Indexed: 11/17/2022]
Abstract
INTRODUCTION With advancements in endoscopic surgery, open surgical techniques for urinary system stones have paved the way for the application of less invasive treatment modalities in patients with pediatric kidney stone disease. These treatment options include extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL), and retrograde intrarenal surgery (RIRS). OBJECTIVE We aimed to compare the efficacy and safety of RIRS and micro-PCNL techniques in the surgical treatment of kidney stones in pediatric patients. STUDY DESIGN A total of 48 pediatric patients, who underwent RIRS or micro-PERC for pediatric kidney stone disease, were retrospectively analyzed. Urinalysis, urine culture, serum creatinine (Cr), blood urea nitrogen (BUN), calcium, phosphorus, parathyroid hormone, 24-hour urine sample, complete blood count (CBC), urinary system X-ray, kidney ureter bladder (KUB), and urinary system ultrasonography (USG) test results were evaluated prior to the procedure. Intravenous pyelography (IVP), non-contrast computed tomography (CT), and renal scintigraphy evaluations were also performed, if necessary. The patients were divided into two groups: micro-PERC group (n = 25) and RIRS group (n = 23). Data relating to the duration of the operation, duration of fluoroscopy, length of hospitalization, complication rates, and stone-free rates were recorded. RESULTS The mean ages of the micro-PERC and RIRS groups were 4 ± 2.3 and 10.9 ± 3 years, respectively (p = 0.001). However, the mean stone sizes were 12.2 ± 2.8 and 13.7 ± 3.5 mm, respectively (p > 0.05). The mean duration of operation was 75.1 ± 18.9 min in the micro-PERC group and 62.3 ± 15.3 min in the RIRS group (p > 0.05). In addition, the mean duration of fluoroscopy was 115 ± 35.4 s in the micro-PERC group and 39.9 ± 15.3 s in the RIRS group. The stone-free rates in the micro-PERC and RIRS groups following the procedure were reported to be 84% (21/25) and 82.6% (19/23), respectively (p > 0.05). In terms of the degree of preoperative hydronephrosis between the groups, the rates of mild and moderate-severe disease were 76% (19 out of 25) and 24% (6 out of 25), and 69.5% (16 out of 23) and 30.4% (7 out of 23) in the micro-PERC and RIRS groups, respectively. CONCLUSION In recent years, technological developments in minimally invasive procedures, such as micro-PERC and RIRS, have facilitated choices made by urologists in the effective and safe first-line treatment in pediatric patients.
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Affiliation(s)
- Haluk Sen
- Department of Urology, School of Medicine, Gaziantep University, Gaziantep, Turkey.
| | - Ilker Seckiner
- Department of Urology, School of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Omer Bayrak
- Department of Urology, School of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Kazim Dogan
- Department of Urology, School of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Sakip Erturhan
- Department of Urology, School of Medicine, Gaziantep University, Gaziantep, Turkey
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9
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Zhang J, Xu C, He D, Lu Y, Hu H, Qin B, Wang Y, Wang Q, Li C, Wang S, Liu J. Flexible ureteroscopy for renal stone without preoperative ureteral stenting shows good prognosis. PeerJ 2016; 4:e2728. [PMID: 27917317 PMCID: PMC5131619 DOI: 10.7717/peerj.2728] [Citation(s) in RCA: 15] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 10/27/2016] [Indexed: 12/02/2022] Open
Abstract
Purpose To clarify the outcome of flexible ureteroscopy (fURS) for management of renal calculi without preoperative stenting. Methods A total of 171 patients who received 176 fURS procedures for unilateral renal stones were reviewed. All procedures were divided into two groups depending on whether they received ureteral stenting preoperatively. Baseline characteristics of patients, stone burden, operation time, stone-free rates, and complications were compared between both groups. Results Successful primary access to the renal pelvis was achieved in 104 of 114 (91.2%) patients without preoperative stenting, while all procedures with preoperative stenting (n = 62) were successfully performed. A total of 156 procedures were included for further data analysis (56 procedures in stenting group and 100 in non-stenting group). No significant differences was found regardless of a preoperative stent placement in terms of stone-free rate (73.2% with stenting vs. 71.0% without, P = 0.854), operative time (70.4 ± 32.8 with stenting vs. 70.2 ± 32.1 without, P = 0.969). Conclusions fURS for management of renal stone without preoperative ureteral stenting are associated with well outcome in short term follow-up. Our study may help patients and doctors to decide if an optional stent is placed or not.
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Affiliation(s)
- Jiaqiao Zhang
- Department and Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , People's Republic of China
| | - Chuou Xu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , People's Republic of China
| | - Deng He
- Department and Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , People's Republic of China
| | - Yuchao Lu
- Department and Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , People's Republic of China
| | - Henglong Hu
- Department and Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , People's Republic of China
| | - Baolong Qin
- Department and Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , People's Republic of China
| | - Yufeng Wang
- Department and Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , People's Republic of China
| | - Qing Wang
- Department and Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , People's Republic of China
| | - Cong Li
- Department and Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , People's Republic of China
| | - Shaogang Wang
- Department and Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , People's Republic of China
| | - Jihong Liu
- Department and Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , People's Republic of China
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