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Koterazawa S, Takahashi T, Somiya S, Ito K, Haitani T, Kanno T, Higashi Y, Yamada H, Imamura M. Ureteroscopy for urolithiasis in bedridden patients: it is feasible and acceptable. World J Urol 2024; 42:272. [PMID: 38683217 DOI: 10.1007/s00345-024-04895-5] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 02/21/2024] [Indexed: 05/01/2024] Open
Abstract
PURPOSE To investigate the safety of transurethral ureteroscopy (URS) for urolithiasis in bedridden patients and to identify bedridden patient-specific risk factors for postoperative complications. METHODS The patients who underwent URS for urolithiasis were divided into bedridden patients and good performance status (PS) patients, and the groups were compared regarding their clinical characteristics and postoperative complications. A multivariable logistic regression analysis was performed to evaluate independent predictors of postoperative febrile urinary tract infection (fUTI). RESULTS A total of 1626 patients were included, 276 in the bedridden patient group, and 1350 in the good PS patient group. The bedridden patient group had a significantly higher age and higher proportion of females and had multiple comorbidities. In 77 patients (27.9%), 88 postoperative complications developed for the bedridden patient group. Clavien-Dindo grade III or IV complications were observed in only 8 patients. No grade V complications were observed. The most common complication was fUTI. The frequency of fUTI with grade III or IV for the bedridden patient group (2.2%) was higher compared with the good PS patient group (0.5%), but the difference was not statistically significant (p = 0.13). Bedridden patient-specific risk factors for fUTI included female sex, diabetes mellitus, cerebrovascular comorbidities, lower extremity contracture, and prolonged operative time. CONCLUSION URS for urolithiasis is a feasible and acceptable procedure in bedridden patients, despite the moderate rate of postoperative complications. The identified risk factors provide a framework for risk stratification and individualized care in this unique patient population.
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Affiliation(s)
- Shigeki Koterazawa
- Department of Urology, Ijinkai Takeda General Hospital, 28-1 Moriminami-Cho, Ishida Fushimi-Ku, Kyoto, 601-1495, Japan
| | - Toshifumi Takahashi
- Department of Urology, Ijinkai Takeda General Hospital, 28-1 Moriminami-Cho, Ishida Fushimi-Ku, Kyoto, 601-1495, Japan
| | - Shinya Somiya
- Department of Urology, Ijinkai Takeda General Hospital, 28-1 Moriminami-Cho, Ishida Fushimi-Ku, Kyoto, 601-1495, Japan
| | - Katsuhiro Ito
- Department of Urology, Ijinkai Takeda General Hospital, 28-1 Moriminami-Cho, Ishida Fushimi-Ku, Kyoto, 601-1495, Japan
| | - Takao Haitani
- Department of Urology, Ijinkai Takeda General Hospital, 28-1 Moriminami-Cho, Ishida Fushimi-Ku, Kyoto, 601-1495, Japan
| | - Toru Kanno
- Department of Urology, Ijinkai Takeda General Hospital, 28-1 Moriminami-Cho, Ishida Fushimi-Ku, Kyoto, 601-1495, Japan
| | - Yoshihito Higashi
- Department of Urology, Ijinkai Takeda General Hospital, 28-1 Moriminami-Cho, Ishida Fushimi-Ku, Kyoto, 601-1495, Japan
| | - Hitoshi Yamada
- Department of Urology, Ijinkai Takeda General Hospital, 28-1 Moriminami-Cho, Ishida Fushimi-Ku, Kyoto, 601-1495, Japan
| | - Masaaki Imamura
- Department of Urology, Ijinkai Takeda General Hospital, 28-1 Moriminami-Cho, Ishida Fushimi-Ku, Kyoto, 601-1495, Japan.
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Zou XC, Luo CW, Yuan RM, Jin MN, Zeng T, Chao HC. Develop a radiomics-based machine learning model to predict the stone-free rate post-percutaneous nephrolithotomy. Urolithiasis 2024; 52:64. [PMID: 38613668 DOI: 10.1007/s00240-024-01562-7] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 03/21/2024] [Indexed: 04/15/2024]
Abstract
Radiomics and machine learning have been extensively utilized in the realm of urinary stones, particularly in forecasting stone treatment outcomes. The objective of this study was to integrate clinical variables and radiomic features to develop a machine learning model for predicting the stone-free rate (SFR) following percutaneous nephrolithotomy (PCNL). A total of 212 eligible patients who underwent PCNL surgery at the Second Affiliated Hospital of Nanchang University were included in a retrospective analysis. Preoperative clinical variables and non-contrast-enhanced CT images of all patients were collected, and radiomic features were extracted after delineating the stone ROI. Univariate analysis was conducted to identify clinical variables strongly correlated with the stone-free rate after PCNL, and the least absolute shrinkage and selection operator algorithm (lasso regression) was utilized to screen radiomic features. Four supervised machine learning algorithms, including Logistic Regression, Random Forest (RF), Extreme Gradient Boosting (XGBoost), and Gradient Boosting Decision Tree (GBDT), were employed. The clinical variables with strong correlation and screened radiomic features were integrated into the four machine learning algorithms to construct a prediction model, and the receiver operating curve was plotted. The area under the receiver operating curve (AUC), the accuracy rate, the specificity, etc., were used to evaluate the predictive performance of the four models. After analyzing postoperative statistics, the stone-free rate following the procedure was found to be 70.3% (n = 149). Among the various clinical variables examined, factors, such as stone number, stone diameter, stone CT value, stone location, and history of stone surgery, were identified as statistically significant in relation to the stone-free rate after PCNL. A total of 121 radiomic features were extracted, and through lasso regression, 7 features most closely associated with the stone-free rate post-PCNL were identified. The predictive accuracy of different models (Logistic Regression, RF, XGBoost, and GBDT) for determining the stone-free rate after PCNL was evaluated, yielding accuracies of 78.1%, 76.6%, 75.0%, and 73.4%, respectively. The corresponding area under the curve AUC (95%CI) were 0.85 (0.83-0.89), 0.81 (0.76-0.85), 0.82 (0.78-0.85), and 0.77 (0.73-0.81), positioning these models among the top performers in logistic regression prediction. In terms of predictive importance scores, the key factors identified by the logistic regression model were number of stone, zone percentage, stone diameter, and surface area. Similarly, the RF model highlighted number of stone, stone CT value, stone diameter, and surface area as the top predictors. Among the four machine learning models, the logistic regression model demonstrated the highest accuracy and discrimination ability in predicting the stone-free rate following PCNL. In comparison to XGBoost and GBDT, RF also exhibited superior accuracy and a certain level of discrimination ability. However, based on the performance of all four models, logistic regression is more likely to aid in clinical decision-making by assisting clinicians in diagnosing PCNL in patients. This enables us to effectively predict the presence of residual stones post-surgery and ultimately select patients who are suitable candidates for PCNL.
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Affiliation(s)
- Xin Chang Zou
- Department of Urology, Second Affiliated Hospital of Nanchang University, Nanchang, 330008, China
| | - Cheng Wei Luo
- Department of Urology, Second Affiliated Hospital of Nanchang University, Nanchang, 330008, China
| | | | - Meng Ni Jin
- Department of Imaging, Second Affiliated Hospital of Nanchang University, Nanchang, 330008, China
| | - Tao Zeng
- Department of Urology, Second Affiliated Hospital of Nanchang University, Nanchang, 330008, China.
| | - Hai Chao Chao
- Department of Urology, Second Affiliated Hospital of Nanchang University, Nanchang, 330008, China
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Abdelfatah Zaza MM, Farouk Salim A, El-Mageed Salem TA, Mohammed Ezzat A, Hassan Ali M. Impact of ureteric access sheath use during flexible ureteroscopy: A comparative study on efficacy and safety. Actas Urol Esp 2024; 48:204-209. [PMID: 37838327 DOI: 10.1016/j.acuroe.2023.10.005] [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: 07/01/2023] [Revised: 08/19/2023] [Accepted: 08/21/2023] [Indexed: 10/16/2023]
Abstract
OBJECTIVES This study evaluates the impact of using an access sheath (AS) during flexible ureteroscopy (fURS) for urolithiasis treatment, focusing on outcomes such as stone-free rate, operation time, and complications. METHODS This prospective, randomized study was carried out at Badr Hospital, Helwan University, and Ain Shams University hospitals from August 2021 to August 2022. Patients were systematically randomized into two groups (fURS with AS: 33 patients and without AS: 31 patients) and underwent preoperative and postoperative assessments, including lab tests and imaging. Possible procedure-associated risks, such as failed stone access, pain, bleeding, and sepsis, were monitored. RESULTS The two groups were found to be comparable in terms of demographic characteristics or preoperative stone findings (p > 0.05 for all). However, operation duration was shorter in the No Sheath group (79.4 ± 15.3 min vs. 90.4 ± 16.7 min in the Sheath group, p = 0.008). Intraoperative complication rates, including failed access, operation termination, ureteric injury, and bleeding, were comparable in both groups (p > 0.05). Postoperative stone-free rates (78.8% vs. 71.0%, p = 0.305) and mean residual stone size (2.7 ± 3.5 mm vs. 3.1 ± 3.1 mm, p = 0.687) showed no significant differences. CONCLUSIONS The present study suggests that fURS without an access sheath may offer an efficient and equally effective option for managing upper ureteric and renal stones. However, more studies with larger sample sizes and longer follow-up periods are required to validate these findings and to establish more precise indications for this approach.
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Affiliation(s)
- M M Abdelfatah Zaza
- Departamento de Urología, Facultad de Medicina, Universidad de Helwan, El Cairo, Egypt
| | - A Farouk Salim
- Departamento de Urología, Facultad de Medicina, Universidad de Ain Shams, El Cairo, Egypt
| | - T A El-Mageed Salem
- Departamento de Urología, Facultad de Medicina, Universidad de Helwan, El Cairo, Egypt
| | - A Mohammed Ezzat
- Departamento de Urología, Facultad de Medicina, Universidad de Helwan, El Cairo, Egypt.
| | - M Hassan Ali
- Departamento de Urología, Facultad de Medicina, Universidad de Helwan, El Cairo, Egypt
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Li D, Chen L, Lun X, Xu C, Wang K, Wang X, Bi Y, Lu J, Xia S, Wang Y, Shao Y. Actively extracting kidney stones combined dusting technique can improve SFR of moderate-complexity kidney stones in fURL. Int Urol Nephrol 2024:10.1007/s11255-024-03995-w. [PMID: 38489144 DOI: 10.1007/s11255-024-03995-w] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 02/15/2024] [Indexed: 03/17/2024]
Abstract
PURPOSE To evaluate the necessity and effectiveness of actively extracting kidney stones with different complexity that have been visually dusted in flexible ureteroscopic lithotripsy (fURL). METHODS We retrospectively reviewed the medical records of patients who underwent fURL with dusting technique in established hospitals. A total of 535 cases were divided into the dusting group or the dusting plus basketing group according to the use of stone basket. Their characteristics and operative parameters were collected and analyzed. We used the R.I.R.S. scoring system to classify the complexity of kidney stones and divided these kidney stones into three subgroups, namely, mild-, moderate-, and severe-complexity group. And then, the effectiveness of stone basket in these subgroups was analyzed. RESULTS Although using a stone basket significantly reduced re-operation rate (17.8% in dusting group versus 10.2% in dusting plus basketing group, p = 0.013), no significant difference on stone-free rate (SFR) and overall incidence of complications were noticed between groups. After we classified the complexity of kidney stones using the R.I.R.S. scoring system, we found a stone basket was helpful to improve SFR in kidney stones with moderate-complexity that had been visually dusted in fURL (73.5% in dusting group versus 87.3% in dusting plus basketing group, p = 0.002) but had limited influence on SFR in mild (93.8% in dusting group versus 92.6% in dusting plus basketing group, p = 0.783) or severe (28.5% in dusting group versus 34.0% in dusting plus basketing group, p = 0.598)-complexity kidney stones. CONCLUSION The use of stone basket should be encouraged in moderate-complexity kidney stones which can be visually dusted in fURL.
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Affiliation(s)
- Deng Li
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100, Haining Road, Hongkou District, Shanghai, 200080, China
- Shanghai Municipal Hospital Urology Specialist Alliance, No. 100, Haining Road, Hongkou District, Shanghai, 200080, China
| | - Lei Chen
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100, Haining Road, Hongkou District, Shanghai, 200080, China
| | - Xiaolu Lun
- Department of Urology, Weifang Traditional Chinese Hospital, Shandong University of Traditional Chinese Medicine, No. 1055, Weizhou Road, Kuiwen District, Shandong, 261000, China
| | - Chaoliang Xu
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100, Haining Road, Hongkou District, Shanghai, 200080, China
| | - Kai Wang
- Department of Urology, Weifang Traditional Chinese Hospital, Shandong University of Traditional Chinese Medicine, No. 1055, Weizhou Road, Kuiwen District, Shandong, 261000, China
| | - Xiaolong Wang
- Department of Urology, Weifang Traditional Chinese Hospital, Shandong University of Traditional Chinese Medicine, No. 1055, Weizhou Road, Kuiwen District, Shandong, 261000, China
| | - Yuhang Bi
- Department of Urology, Weifang Traditional Chinese Hospital, Shandong University of Traditional Chinese Medicine, No. 1055, Weizhou Road, Kuiwen District, Shandong, 261000, China
| | - Jun Lu
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100, Haining Road, Hongkou District, Shanghai, 200080, China
- Shanghai Municipal Hospital Urology Specialist Alliance, No. 100, Haining Road, Hongkou District, Shanghai, 200080, China
| | - Shujie Xia
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100, Haining Road, Hongkou District, Shanghai, 200080, China
- Shanghai Municipal Hospital Urology Specialist Alliance, No. 100, Haining Road, Hongkou District, Shanghai, 200080, China
| | - Yongchuan Wang
- Department of Urology, Weifang Traditional Chinese Hospital, Shandong University of Traditional Chinese Medicine, No. 1055, Weizhou Road, Kuiwen District, Shandong, 261000, China.
| | - Yi Shao
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100, Haining Road, Hongkou District, Shanghai, 200080, China.
- Shanghai Municipal Hospital Urology Specialist Alliance, No. 100, Haining Road, Hongkou District, Shanghai, 200080, China.
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Yucel C, Ozbilen MH, Bildirici C, Dumanli E, Akbay EK, Yoldas M, Sueluzgen T, Keskin MZ. Effects of hydronephrosis on the surgical outcomes of fluoroscopically guided supine percutaneous nephrolithotomy. Int Urol Nephrol 2024:10.1007/s11255-024-03969-y. [PMID: 38431533 DOI: 10.1007/s11255-024-03969-y] [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: 12/26/2023] [Accepted: 01/26/2024] [Indexed: 03/05/2024]
Abstract
PURPOSE To evaluate the effect of hydronephrosis on operation success and the development of complications in supine percutaneous nephrolithotomy (PCNL). METHODS A total 259 patients were included in the study who underwent supine PCNL in our clinic between September 2019 and November 2023. The patients were divided into four groups: normal, mild, moderate and severe, according to their preoperative hydronephrosis degrees. Demographic data, kidney stone characteristics, clinical aspects, surgical findings, and postoperative complications were compared across groups. RESULTS In terms of American Society of Anesthesiologists score, stone-free rate, operation time, fluoroscopy time, and Clavien-Dindo classification grades, a statistically significant difference was found between the hydronephrosis groups. The stone-free rate in the normal, mild, moderate, and severe groups was 86.6, 82.5, 76.0, and 61.5, respectively. The severe hydronephrosis group varied statistically substantially from the other hydronephrosis groups in terms of stone-free rate, according to the post-hoc analysis. In terms of Clavien-Dindo classification grades, the severe hydronephrosis group varied statistically significantly from the normal and mild hydronephrosis groups (p values 0.04, 0.02, respectively). In terms of Clavien-Dindo classification grades, no statistically significant difference was seen between the severe and moderate hydronephrosis groups (p = 0.085). CONCLUSION The findings of this study demonstrated that the existence of hydronephrosis was a predictive factor for the occurrence of complications and decreased the success rate of supine PCNL. Furthermore, univariate and multivariate analyses showed that the presence of hydronephrosis was a predictive factor for PCNL success and the development of complications.
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Affiliation(s)
- Cem Yucel
- Department of Urology, Health Sciences University Tepecik Training and Research Hospital, Yenişehir Mah, Gaziler Cad. No:468 Konak, Izmir, Turkey.
| | | | | | - Enes Dumanli
- Department of Urology, Health Sciences University Tepecik Training and Research Hospital, Yenişehir Mah, Gaziler Cad. No:468 Konak, Izmir, Turkey
| | - Esat Kaan Akbay
- Department of Urology, Health Sciences University Tepecik Training and Research Hospital, Yenişehir Mah, Gaziler Cad. No:468 Konak, Izmir, Turkey
| | - Mehmet Yoldas
- Department of Urology, Health Sciences University Tepecik Training and Research Hospital, Yenişehir Mah, Gaziler Cad. No:468 Konak, Izmir, Turkey
| | - Tufan Sueluzgen
- Department of Urology, Health Sciences University Tepecik Training and Research Hospital, Yenişehir Mah, Gaziler Cad. No:468 Konak, Izmir, Turkey
| | - Mehmet Zeynel Keskin
- Department of Urology, Health Sciences University Tepecik Training and Research Hospital, Yenişehir Mah, Gaziler Cad. No:468 Konak, Izmir, Turkey
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Uleri A, Farré A, Izquierdo P, Angerri O, Kanashiro A, Balaña J, Gauhar V, Castellani D, Sanchez-Martin F, Monga M, Serrano A, Gupta M, Baboudjian M, Gallioli A, Breda A, Emiliani E. Thulium Fiber Laser Versus Holmium:Yttrium Aluminum Garnet for Lithotripsy: A Systematic Review and Meta-analysis. Eur Urol 2024:S0302-2838(24)00012-5. [PMID: 38290963 DOI: 10.1016/j.eururo.2024.01.011] [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: 08/01/2023] [Revised: 12/17/2023] [Accepted: 01/14/2024] [Indexed: 02/01/2024]
Abstract
CONTEXT Thulium fiber laser (TFL) emerged as a competitor of holmium:yttrium aluminum garnet (Ho:YAG) laser for the treatment of urinary stones. OBJECTIVE To compare the efficacy between Ho:YAG and TFL for laser lithotripsy of renal and ureteral stones. EVIDENCE ACQUISITION A literature search was conducted using PubMed/Medline, Embase, and Web of Science databases to identify reports published until May 2023. The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed to identify eligible studies. The primary outcome was to compare the stone-free rate (SFR) between Ho:YAG and TFL for laser lithotripsy. EVIDENCE SYNTHESIS Eleven studies met our inclusion criteria, and data from 1286 and 880 patients who underwent, respectively, Ho:YAG and TFL laser lithotripsy were reviewed. Most studies included ureteroscopy (URS) and retrograde intrarenal surgeries as procedures, two included percutaneous nephrolithotomy, and one included URS exclusively. Only two studies reported results in pediatric patients. TFL was associated with a higher SFR (odds ratio [OR] 1.84, 95% confidence interval [CI]: 1.06-3.20; p = 0.031) when no residual fragment is considered, but not when SFR refers to the presence of fragments <3 mm (OR 2.48, 95% CI: 0.98-6.29; p = 0.055) or when only Ho:YAG with MOSES is considered (p = 0.068). According to the stones' location, TFL was associated with higher SFRs than Ho:YAG for renal (OR 3.14, 95% CI: 1.69-5.86; p < 0.001) but not for ureteral (p = 0.8) stones. TFL was associated with a lower intraoperative complication rate (OR 0.34, 95% CI: 0.19-0.63; p < 0.001). No difference was found in major (p = 0.4) or overall (p = 0.4) complication rate, operative time (p = 0.051), and laser time (p = 0.9). CONCLUSIONS TFL is a promising laser for the treatment of urinary stones with some advantages over Ho:YAG. Further high-quality studies are needed to confirm these findings and optimize the surgical settings. PATIENT SUMMARY The use of thulium fiber laser rather than holmium:yttrium aluminum garnet permits to reach a higher stone-free rate in stones located in the kidney rather than in the ureter.
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Affiliation(s)
- Alessandro Uleri
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain.
| | - Alba Farré
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Paula Izquierdo
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Oriol Angerri
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Andrés Kanashiro
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Josep Balaña
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Vineet Gauhar
- Division of Urology, Ng Teng Fong General Hospital, National University Health System, Singapore, Singapore
| | - Daniele Castellani
- Urology Division, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Polytechnic University Le Marche, Ancona, Italy
| | | | - Manoj Monga
- Department of Urology, University of California-San Diego, San Diego, CA, USA
| | - Adolfo Serrano
- Department of Urology, Universidad de los Andes School of Medicine, Hospital Universitario Fundación Santa Fe de Bogotá, Bogota, Colombia
| | - Mantu Gupta
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michael Baboudjian
- Department of Urology, North Academic Hospital, AP-HM, Marseille, France
| | - Andrea Gallioli
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Alberto Breda
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Esteban Emiliani
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
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Hu L, Zhang N, Zhang X, Liang H, Fan Y, Chen J. Laparoscopic pyelotomy combined with ultrasonic lithotripsy via a nephroscope for the treatment of complex renal stones. Urolithiasis 2024; 52:22. [PMID: 38189842 DOI: 10.1007/s00240-023-01522-7] [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: 09/23/2023] [Accepted: 12/08/2023] [Indexed: 01/09/2024]
Abstract
The purpose of the study was to introduce a novel surgical approach of combining laparoscopic pyelotomy with ultrasonic lithotripsy via a nephroscope for the treatment of complex renal stones. Between May 2021 and April 2023, 32 patients underwent laparoscopic pyelotomy combined with ultrasonic lithotripsy via a nephroscope and their perioperative variables were retrospectively collected and outcomes were assessed. Dissection and incision of the anterior renal pelvis wall was performed via a laparoscope. A 19.5 F nephroscope was introduced into the renal pelvis through a laparoscopic trocar from the incision. Stones were fragmented and sucked out using a 3.3 mm ultrasonic probe placed through the nephroscope. All operations were completed successfully and the stone-free rate at 3 days after operation was 87.5% (28/32). Four (12.5%, 4/32) patients with staghorn stones had a small residual stone in the lower calyx after operation and did not require reintervention. No patient required perioperative transfusion and four (12.5%, 4/32) patients with struvite stones developed postoperative fever, which was successfully treated with intravenous antibiotics. The mean follow-up time was 14.0 ± 7.2 months, with no patient developing long-term complications. This approach offers a safe and effective treatment option for complex renal stones, as the method exhibits a high clearance rate with few complications.
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Affiliation(s)
- Liyong Hu
- Department of Urology, Qilu Hospital of Shandong University, Lixia District, 107 Wenhua West Road, Jinan, Shandong, China
- Jinan Third People's Hospital, Licheng District, Jinan, Shandong, China
| | - Nianzhao Zhang
- Department of Urology, Qilu Hospital of Shandong University, Lixia District, 107 Wenhua West Road, Jinan, Shandong, China
| | - Xiaoyi Zhang
- Department of Urology, Qilu Hospital of Shandong University, Lixia District, 107 Wenhua West Road, Jinan, Shandong, China
| | - Hao Liang
- Department of Urology, Qilu Hospital of Shandong University, Lixia District, 107 Wenhua West Road, Jinan, Shandong, China
| | - Yidong Fan
- Department of Urology, Qilu Hospital of Shandong University, Lixia District, 107 Wenhua West Road, Jinan, Shandong, China
| | - Jun Chen
- Department of Urology, Qilu Hospital of Shandong University, Lixia District, 107 Wenhua West Road, Jinan, Shandong, China.
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Yu Y, Chen Y, Zhou X, Li X, Liu W, Cheng X, Chen L, Yang H, Wang G, Xi H. Comparison of novel flexible and traditional ureteral access sheath in retrograde intrarenal surgery. World J Urol 2024; 42:7. [PMID: 38175210 PMCID: PMC10766707 DOI: 10.1007/s00345-023-04697-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 10/10/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVES To compare the efficiency and safety of a novel flexible ureteral access sheath (f-UAS) and traditional ureteral access sheath (UAS) during retrograde intrarenal surgery (RIRS). PATIENTS AND METHODS Between January 2022 and September 2022, a total of 152 consecutive cases with renal stones underwent RIRS with the f-UAS. Their outcomes were compared with those of another 152 consecutive cases undergoing RIRS with traditional UAS using a 1:1 scenario matched-pair analysis, with matching parameters including age and stone size. The f-UAS is a novel UAS with a 10-cm-long tube at the tip that can follow the bends of flexible ureteroscope (f-URS). RESULTS Baseline characteristics were found to be similar between the two groups. The f-UAS group demonstrated significantly higher SFR (76.3% vs. 7.2%; P < 0.001) at 1 day postoperatively and a higher clearance rate of stone volume (98.11% vs. 91.78%; P < 0.001). The f-UAS group also had lower total complications rate (9.9% vs. 22.4%; P = 0.003), lower incidence of fever (5.9% vs 11.9%; P = 0.001), shorter operative times (56.5 min vs. 59.9 min; P = 0.047), and lower usage rate of baskets (17.1% vs. 100%; P < 0.001). There was no significant difference in SFR at 1 month postoperatively (P = 0.627) and in the length of postoperative hospital stay between the two groups (P = 0.225). CONCLUSION Compared to the traditional UAS during RIRS, the f-UAS showed several advantages, including higher SFR at 1 day postoperatively, shorter operative times, lower incidence of complications, and less use of basket.
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Affiliation(s)
- Yue Yu
- Department of Urology, The 1st Affiliated Hospital, Jiangxi Medical College, Nanchang University, 17 YongWai Street Surgery Building, 17th Floor, Nanchang, 330006, Jiangxi, China
| | - Yujun Chen
- Department of Urology, The 1st Affiliated Hospital, Jiangxi Medical College, Nanchang University, 17 YongWai Street Surgery Building, 17th Floor, Nanchang, 330006, Jiangxi, China
| | - Xiaochen Zhou
- Department of Urology, The 1st Affiliated Hospital, Jiangxi Medical College, Nanchang University, 17 YongWai Street Surgery Building, 17th Floor, Nanchang, 330006, Jiangxi, China
| | - Xunwen Li
- Department of Urology, The 1st Affiliated Hospital, Jiangxi Medical College, Nanchang University, 17 YongWai Street Surgery Building, 17th Floor, Nanchang, 330006, Jiangxi, China
| | - Wei Liu
- Department of Urology, The 1st Affiliated Hospital, Jiangxi Medical College, Nanchang University, 17 YongWai Street Surgery Building, 17th Floor, Nanchang, 330006, Jiangxi, China
| | - Xiaofeng Cheng
- Department of Urology, The 1st Affiliated Hospital, Jiangxi Medical College, Nanchang University, 17 YongWai Street Surgery Building, 17th Floor, Nanchang, 330006, Jiangxi, China
| | - Luyao Chen
- Department of Urology, The 1st Affiliated Hospital, Jiangxi Medical College, Nanchang University, 17 YongWai Street Surgery Building, 17th Floor, Nanchang, 330006, Jiangxi, China
| | - Heng Yang
- Department of Urology, The 1st Affiliated Hospital, Jiangxi Medical College, Nanchang University, 17 YongWai Street Surgery Building, 17th Floor, Nanchang, 330006, Jiangxi, China
| | - Gongxian Wang
- Department of Urology, The 1st Affiliated Hospital, Jiangxi Medical College, Nanchang University, 17 YongWai Street Surgery Building, 17th Floor, Nanchang, 330006, Jiangxi, China.
| | - Haibo Xi
- Department of Urology, The 1st Affiliated Hospital, Jiangxi Medical College, Nanchang University, 17 YongWai Street Surgery Building, 17th Floor, Nanchang, 330006, Jiangxi, China.
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9
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Giulioni C, Castellani D, Traxer O, Gadzhiev N, Pirola GM, Tanidir Y, da Silva RD, Glover X, Giusti G, Proietti S, Mulawkar PM, De Stefano V, Cormio A, Teoh JYC, Galosi AB, Somani BK, Emiliani E, Gauhar V. Experimental and clinical applications and outcomes of using different forms of suction in retrograde intrarenal surgery. Results from a systematic review. Actas Urol Esp 2024; 48:57-70. [PMID: 37302691 DOI: 10.1016/j.acuroe.2023.06.001] [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: 01/25/2023] [Accepted: 02/24/2023] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To identify the latest advances in suction devices and evaluate their effect in Retrograde intrarenal surgery (RIRS) and ureteroscopy for stones. BASIC PROCEDURES A systematic literature search was performed on 4th January 2023 using Scopus, PubMed, and EMBASE. Only English papers were included; both pediatric and adult studies were accepted. Duplicate studies, case reports, letters to the editor, and meeting abstracts were excluded. MAIN FINDINGS Twenty-one papers were selected. Several methods have been proposed for suction use in RIRS, such as through the ureteral access sheath or directly to the scope. Artificial intelligence can also regulate this system, monitoring pressure and perfusion flow values. All the proposed techniques showed satisfactory perioperative results for operative time, stone-free rate (SFR), and residual fragments. Moreover, the reduction of intrarenal pressure (induced by aspiration) was also associated with a lower infection rate. Even the studies that considered kidney stones with a diameter of 20 mm or higher reported higher SFR and reduced postoperative complications. However, the lack of well-defined settings for suction pressure and fluid flow prevents the standardization of the procedure. CONCLUSION Aspiration device in the surgical treatment of urinary stones favours a higher SFR, reducing infectious complications, as supported by the included studies. RIRS with a suction system provided to be a natural successor to the traditional technique, regulating intrarenal pressure and aspirating fine dust.
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Affiliation(s)
- C Giulioni
- Servicio de Urología, Azienda Ospedaliero-Universitaria delle Marche, Universidad Politécnica Marche, Ancona, Italy.
| | - 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
| | - N Gadzhiev
- Servicio de Endourología, Universidad Médica Estatal de San Petersburgo, Saint-Petersburgo, Russia
| | - G M Pirola
- Servicio de Urología, Hospital San Giuseppe, Grupo MultiMedica, Milán, Italy
| | - Y Tanidir
- Departamento de Urología, Facultad de Medicina, Universidad de Marmara, Estambul, Turkey
| | - R D da Silva
- Departamento de Urología, Facultad de Medicina, Universidad de Colorado, United States
| | - X Glover
- Departamento de Urología, Facultad de Medicina, Universidad de Colorado, United States
| | - G Giusti
- Centro Europeo de Entrenamiento en Endourología, Hospital San Raffaele IRCCS, Milán, Italy
| | - S Proietti
- Centro Europeo de Entrenamiento en Endourología, Hospital San Raffaele IRCCS, Milán, Italy
| | - P M Mulawkar
- Servicio de Urología, Hospital Superespecializado de Tirthankar, Akola, India; Universidad de Edimburgo, Edimburgo, United Kingdom
| | - V De Stefano
- Servicio de Urología, Azienda Ospedaliero-Universitaria delle Marche, Universidad Politécnica Marche, Ancona, Italy
| | - A Cormio
- Servicio de Urología, Azienda Ospedaliero-Universitaria delle Marche, Universidad Politécnica Marche, Ancona, Italy
| | - J Y-C Teoh
- Clínica de Urología S.H. Ho, Servicio de Cirugía, Facultad de Medicina, Universidad China de Hong Kong, Hong Kong, China
| | - A B Galosi
- Servicio de Urología, Azienda Ospedaliero-Universitaria delle Marche, Universidad Politécnica Marche, Ancona, Italy
| | - B K Somani
- Servicio de Urología, Hospital Universitario de Southampton, NHS Trust, Southampton, United Kingdom
| | - E Emiliani
- 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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10
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Mata Alcaraz M, Laso García I, Mínguez Ojeda C, Artiles Medina A, Duque Ruiz G, Hevia Palacios M, Arias Fúnez F, Burgos Revilla FJ. Extracorporeal shock wave lithotripsy for lower calyx stones: predicting treatment success. Actas Urol Esp 2023; 47:688-693. [PMID: 37442226 DOI: 10.1016/j.acuroe.2023.07.004] [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: 04/27/2023] [Revised: 06/07/2023] [Accepted: 06/08/2023] [Indexed: 07/15/2023]
Abstract
INTRODUCTION The use of extracorporeal shock wave lithotripsy (ESWL) for lower calyx stones is associated with a high rate of residual fragments. Our aim is to analyse the effectiveness and complications of ESWL for lower calyx stones. METHODS Retrospective review of patients with lower renal calyx stones treated with ESWL between January-2014 and December-2020. Measurement of infundibular length, infundibular width and infundibulopelvic angle in lower renal pole to determine favourable anatomy. ESWL failure: fragments >3 mm detected in plain abdominal film, CT scan and/or renal ultrasound 3 months after treatment. Complications after ESWL, auxiliary procedures along with risk factors associated with perirenal haematoma were analysed. SPSS statistical software was used. RESULTS 512 patients with lower calyx stones were treated with ESWL. 80.3% of patients had a favourable anatomy. Overall stone-free rate was 70.5%. Regarding main complications after ESWL, stainstrasse was described in 5 patients and urinary tract infection in 3 patients. 10 perirenal haematomas (2%) were reported. Statistical association was found between antiplatelet treatment and the risk of perirenal haematoma (p = 0.004). Logistic binary regression proved the association between unfavourable anatomy of the lower renal pole (p = 0.000), size of the stone (p = 0.001), number of shock waves (p = 0.003), energy applied (p = 0.038) and the need for additional treatment after ESWL. CONCLUSIONS ESWL can still be considered as the initial treatment option for lower renal pole stones. The size of the stone, an unfavourable anatomy of the lower renal calyx, number of shock waves and energy applied can help predict the need for additional treatment.
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Affiliation(s)
- M Mata Alcaraz
- Servicio de Urología, Hospital Universitario Ramón y Cajal, Madrid, Spain.
| | - I Laso García
- Servicio de Urología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - C Mínguez Ojeda
- Servicio de Urología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - A Artiles Medina
- Servicio de Urología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - G Duque Ruiz
- Servicio de Urología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - M Hevia Palacios
- Servicio de Urología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - F Arias Fúnez
- Servicio de Urología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - F J Burgos Revilla
- Servicio de Urología, Hospital Universitario Ramón y Cajal, Madrid, Spain
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11
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Qiu M, Zhang T, Zhang Y, Liang T, Chen J, Gao H. Physical Techniques to Remove Residual Stone Fragments in the Urinary System. Urol Int 2023; 108:9-19. [PMID: 38008076 PMCID: PMC10836958 DOI: 10.1159/000535298] [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: 07/17/2023] [Accepted: 10/26/2023] [Indexed: 11/28/2023]
Abstract
BACKGROUND Although significant progress has been made in treatment techniques for renal and ureteral calculi, residual fragments (RF) persisting long after treatment pose a serious threat to patients' health. A variety of novel physical techniques and extraction devices are currently being developed to promote the removal of RF from the urinary system, and a series of in vivo experiments have demonstrated their safety and efficacy. SUMMARY External physical vibration lithecbole, magnetic extraction, biocompatible stone adhesive-based methods, and ultrasonic propulsion technologies are examples of innovative therapies that can promote the clearance of RF and improve the stone-free rate. In conclusion, the physical treatment of these RF needs to be optimized and improved. They are a promising technique for improving the efficiency of endovascular urology, and further in vivo studies are needed to confirm their safety and efficacy. KEY MESSAGES We have summarized the literature on removal of RF by physical methods in recent years, especially the new progress.
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Affiliation(s)
- Minhua Qiu
- Graduate School, Guangxi University of Chinese Medicine, Nanning, China
| | - Ting Zhang
- Graduate School, Guangxi University of Chinese Medicine, Nanning, China
- Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, Nanning, China
| | - Yingying Zhang
- Graduate School, Guangxi University of Chinese Medicine, Nanning, China
- Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, Nanning, China
| | - Taisheng Liang
- Graduate School, Guangxi University of Chinese Medicine, Nanning, China
- Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, Nanning, China
| | - Jibing Chen
- Graduate School, Guangxi University of Chinese Medicine, Nanning, China
- Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, Nanning, China
| | - Hongjun Gao
- Graduate School, Guangxi University of Chinese Medicine, Nanning, China
- Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, Nanning, China
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12
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Huang J, Yang Y, Xie H, Fu Z, Zhu F, Xie L, Liu C. Vacuum-assisted dedusting lithotripsy in the treatment of kidney and proximal ureteral stones less than 3 cm in size. World J Urol 2023; 41:3097-3103. [PMID: 37698634 DOI: 10.1007/s00345-023-04595-6] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 08/23/2023] [Indexed: 09/13/2023] Open
Abstract
PURPOSE This study aimed to compare the outcomes of vacuum-assisted dedusting lithotripsy (VADL) using flexible vacuum-assisted ureteral access sheath (FV-UAS) versus traditional flexible ureteroscopic lithotripsy (fURL) in patients with kidney or proximal ureteral calculi less than 3 cm in size. METHODS A total of 371 patients who successfully underwent fURL treatment were enrolled. These patients were divided into traditional fURL group and VADL group. Outcomes of both groups were compared using 1:1 propensity score-matched analysis. Stratified analyses based on stone size and location were also conducted. RESULTS Finally, 103 well-matched patients in each group were identified. No septic shock or death occurred. The immediate stone-free rate (SFR) and follow-up SFR of VADL group were significantly higher (78.6% vs. 50.5%, p < 0.001; 94.2%% vs. 75.7%, p < 0.001). No difference was observed in postoperative fever rate (2.9% vs. 3.9%, p = 1.000) and duration of lithotripsy (37.7 ± 20.1 min vs. 40.3 ± 18.9 min, p = 0.235). For patients with stones ≤ 2 cm in size, the immediate SFR and follow-up SFR in VADL group were higher (86.7% vs. 60.6%, p < 0.001; 96.0% vs. 83.1%, p = 0.010). The same trend was observed in the 2-3 cm subgroup (57.1% vs. 28.1%, p = 0.023; 89.3% vs. 59.4%, p = 0.009). Although the in situ fragmentation strategy was employed more frequently in VADL group for lower pole stones, the SFR was still higher. Subgroup analyses did not reveal any significant differences in either infectious complications or duration of lithotripsy. CONCLUSION VADL technique can significantly improve the postoperative SFR for the patients with kidney or proximal ureteral stones less than 3 cm in size treated by flexible ureteroscope.
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Affiliation(s)
- Junkai Huang
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, No.23 Pingjiang Road, Hexi District,, Tianjin, 300211, People's Republic of China
| | - Yu Yang
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, No.23 Pingjiang Road, Hexi District,, Tianjin, 300211, People's Republic of China
| | - Haijie Xie
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, No.23 Pingjiang Road, Hexi District,, Tianjin, 300211, People's Republic of China
| | - Zhihao Fu
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, No.23 Pingjiang Road, Hexi District,, Tianjin, 300211, People's Republic of China
| | - Fu Zhu
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, No.23 Pingjiang Road, Hexi District,, Tianjin, 300211, People's Republic of China
| | - Linguo Xie
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, No.23 Pingjiang Road, Hexi District,, Tianjin, 300211, People's Republic of China
| | - Chunyu Liu
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, No.23 Pingjiang Road, Hexi District,, Tianjin, 300211, People's Republic of China.
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13
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Hartung FO, Müller KJ, Herrmann J, Grüne B, Michel MS, Rassweiler-Seyfried MC. Comparison of endoscopic versus CT assessment of stone-free status after percutaneous nephrolithotomy (PCNL). Urolithiasis 2023; 51:120. [PMID: 37801124 PMCID: PMC10558392 DOI: 10.1007/s00240-023-01495-7] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 09/20/2023] [Indexed: 10/07/2023]
Abstract
This study is aimed to determine whether postoperative low dose computed tomography (LDCT) imaging is necessary after percutaneous nephrolithotomy (PCNL), or the surgeon's intraoperative assessment of residual fragments (RF) is sufficient and avoidance of postoperative imaging with reduction of radiation exposure can be achieved. Data of all 610 patients who underwent PCNL in prone position in our institution from February 2009 to September 2020 was collected. Parameters such as age, gender, BMI, ASA-Classification, stone related parameters and the surgeon's assessment of stone-free status were analyzed. The LDCT performed postoperatively was compared to the intraoperative assessment of the surgeon regarding RF. The mean age of patients was 52.82 years; the mean BMI was 28.18 kg/m2. In 418 cases, the surgeon made a clear statement about the presence of RF and postoperative LDCT was carried out. The discrepancy between the two methods (surgeon´s assessment vs. LDCT) was significant at p < 0.0001. The sensitivity, specificity, positive and negative predictive value of the surgeon when assessing RF were 24.05%, 99.45%, 98.28% and 50%. Stone free rate (SFR) after primary PCNL was 45.57%. The overall SFR at discharge was 96.23%. Although the surgeon´s assessment of RF was reliable, postoperative LDCT imaging should still be performed if endoscopic stone clearance is suspected due to the high false negative rate and the low negative predictive value. The optimal timing of postoperative imaging following PCNL remains unclear.
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Affiliation(s)
- F. O. Hartung
- Department of Urology and Urologic Surgery, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - K. J. Müller
- Department of Urology and Urologic Surgery, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - J. Herrmann
- Department of Urology and Urologic Surgery, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - B. Grüne
- Department of Urology and Urologic Surgery, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - M. S. Michel
- Department of Urology and Urologic Surgery, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - M. C. Rassweiler-Seyfried
- Department of Urology and Urologic Surgery, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
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14
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Perez D, Neeman BB, Dotan D, Raisin G, Chertin B, Kafka I. Ultrasound-guided percutaneous nephrolithotomy (PCNL) success rates in patients with elevated body mass index: a comparative study. Urolithiasis 2023; 51:111. [PMID: 37688633 DOI: 10.1007/s00240-023-01485-9] [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: 02/11/2023] [Accepted: 08/22/2023] [Indexed: 09/11/2023]
Abstract
Percutaneous nephrolithotomy (PCNL) is considered gold standard treatment of renal stones larger than 20 mm. Several studies have shown that ultrasound guidance during this procedure is more effective and safer than fluoroscopy. A higher body mass index (BMI) can make ultrasound-guided renal access more difficult and unsuccessful. We present a prospective analysis and comparison of ultrasound-guided PCNL in patients with normal and increased body mass index. We performed a prospective comparison of patients who underwent ultrasound-guided PCNL to remove renal stones by a single surgeon between 2020 and 2022. Patients with BMIs greater than 30 (mean 33.87-obese) were compared to those with BMIs less than 30 (mean 25.69-non-obese). Demographic, perioperative, and follow-up data were collected, analyzed, and included in this study. Total of 98 consecutive patients, with 49 patients in each group were analyzed. No statistically significant differences were observed in terms of stone volume (P = 0.085), stone density (P = 0.5590), location of renal access (P = 0.108), surgery duration (P = 0.38), blood loss (P = 0.54), or laboratory changes after surgery (P = 0.60). 87.76% of obese patients were stone free per CT scan at follow-up, compared to 73.47% of normal-weight patients (P = 0.1238). According to Clavien-Dindo classification, six patients in the non-obese group experienced grade II (10%) and grade III (2%) complications, as opposed to six patients in the obese group with grade I (2%), grade II (6%), and grade III (2%) complications. There was no significant correlation between body mass index and the success or safety of ultrasound-guided PCNL. Although more challenging, a higher BMI should not be an impediment to performing this approach. This method is safe, with no increased incidence of postoperative complications or compromise in stone-free status postoperatively and can diminish or avoid both patient's and medical team's exposure to ionizing radiation.
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Affiliation(s)
- Dolev Perez
- Department of Urology, Shaare Zedek Medical Center, P.O.B 3235, 91031, Jerusalem, Israel.
| | - Binyamin B Neeman
- Department of Urology, Shaare Zedek Medical Center, P.O.B 3235, 91031, Jerusalem, Israel
| | - David Dotan
- Department of Urology, Shaare Zedek Medical Center, P.O.B 3235, 91031, Jerusalem, Israel
| | - Galiya Raisin
- Department of Urology, Shaare Zedek Medical Center, P.O.B 3235, 91031, Jerusalem, Israel
| | - Boris Chertin
- Department of Urology, Shaare Zedek Medical Center, P.O.B 3235, 91031, Jerusalem, Israel
| | - Ilan Kafka
- Department of Urology, Shaare Zedek Medical Center, P.O.B 3235, 91031, Jerusalem, Israel
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Şahin MF, Ozman O, Cakir H, Cinar O, Akgul M, Basatac C, Simsekoglu MF, Teke K, Yazici CM, Sancak EB, Önal B, Akpinar H. Retrograde Intrarenal Surgery Learning Curves of Urology Residents Supervised by an Experienced Endourologist: An RIRSearch Study. Urol Int 2023; 107:877-885. [PMID: 37619537 DOI: 10.1159/000531517] [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: 03/18/2023] [Accepted: 06/06/2023] [Indexed: 08/26/2023]
Abstract
INTRODUCTION Although retrograde intrarenal surgery (RIRS) is being performed with increasing frequency, there are only a limited number of studies about the learning curve (LC). This study aimed to analyze the LC of RIRS for five surgeons who underwent the same training. MATERIALS AND METHODS The data of the 410 patients who underwent RIRS between April 2017 and 2022 in a single institution, which were performed consecutively by five surgeons, were analyzed. All 50 cases performed by each surgeon were included and numbered consecutively and separately, according to the date of the operation. The combined stone-free rate (SFR) was calculated for each surgeon's cases in the same row, and the LCs were created using moving average and cumulative sum (CUSUM) analyses. Separate multivariable analyses identified each period's (LC vs. beyond) characteristics. RESULTS The LCs from the combined SFRs reached a plateau after approximately 50 cases for both the CUSUM and the moving average. The effect of stone burden on SFR was more evident in the first 50 cases compared to subsequent cases in the multivariable analyses (p = 0.001 and p = 0.047, respectively). Case order and stone density were independent factors in the first 50 cases (OR: 1.02 [95% CI 1.00-1.04], p = 0.04 and OR: 0.99 [95% CI 0.99-1.00], p = 0.04) but not significant in subsequent cases (OR: 0.97 [95% CI 0.94-1.00], p = 0.1 and OR: 1.00 [95% CI 0.99-1.00], p = 0.7, respectively). Compared to single locations except the lower calyx, the unfavorable effect of the multiple-stone localization on SFR grew in strength after the 50th case (OR: 0.42 [95% CI 0.23-0.78], p = 0.01 and OR: 0.20 [95% CI 0.09-0.46], p < 0.001, respectively). CONCLUSIONS This is the first study reporting on the RIRS LCs of urology residents. While stone burden, density, and multiple-stone localization were the factors determining SFR in the learning period, after completing the LC, the effect of stone burden weakened and multiple-stone localization became stronger.
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Affiliation(s)
| | - Oktay Ozman
- Urology Clinic, Gaziosmanpasa Training and Research Hospital, Istanbul, Turkey
| | - Hakan Cakir
- Urology Clinic, Fulya Acıbadem Hospital, Istanbul, Turkey
| | - Onder Cinar
- Department of Urology, Bülent Ecevit University, Zonguldak, Turkey
| | - Murat Akgul
- Department of Urology, Tekirdağ Namık Kemal University, Tekirdağ, Turkey
| | - Cem Basatac
- Department of Urology, Group Florence Nightingale Hospitals, Istanbul, Turkey
| | | | - Kerem Teke
- Department of Urology, Kocaeli University, Kocaeli, Turkey
| | - Cenk Murat Yazici
- Department of Urology, Tekirdağ Namık Kemal University, Tekirdağ, Turkey
| | - Eyup Burak Sancak
- Department of Urology, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
| | - Bülent Önal
- Department of Urology, Cerrahpaşa Faculty of Medicine, Istanbul, Turkey
| | - Haluk Akpinar
- Urology Clinic, Fulya Acıbadem Hospital, Istanbul, Turkey
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16
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Faddan AA, Najieb O, Gadelkareem RA. Predictors of stone-free rate after a single-session extracorporeal shockwave lithotripsy for a single kidney stone measuring 10 to 20 mm: A private center experience. Curr Urol 2023; 17:30-35. [PMID: 37692133 PMCID: PMC10487291 DOI: 10.1097/cu9.0000000000000152] [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: 11/19/2021] [Accepted: 02/08/2022] [Indexed: 02/07/2023] Open
Abstract
Background Despite the continuous update of guidelines for the management of kidney stones, the ability to predict a successful response to extracorporeal shockwave lithotripsy (SWL) remains a topic of research. This is due to the need to refine the decision making in the context of technological advancements and current pandemics. This study aimed to determine the predictors of stone-free rate (SFR) after single-session SWL in adult patients with a single kidney stone 10 to 20 mm in diameter. Materials and methods A retrospective review of the records of patients with a single kidney stone 10 to 20 mm in diameter was performed at a private SWL center from December 2019 to February 2021. Univariate and multivariate analyses were performed for stone- and patient-related factors, using the Student t and Mann-Whitney U tests for the quantitative variables and the Fisher exact and Pearson correlation tests for the qualitative variables. Results A total of 138 patients were eligible for this study, including 92 men and 46 women. The mean age was 38.6 ± 12.4 years, and the mean body mass index (BMI) was 25.9 ± 3.4 kg/m2. Four weeks after SWL, 120 patients (87%) were free of stones, and 18 (13%) needed further treatment. Univariate analyses showed that SFR was negatively correlated with increased BMI (p = 0.0001), maximum stone length (p = 0.0001), transverse diameter of the stone (p = 0.0001), number of shocks per session (p = 0.052), and Hounsfield unit (HU) (p = 0.0001). Multivariate analysis revealed that HU (p = 0.009), maximum stone length (p = 0.01), BMI (p = 0.000), and presence of double-J stent (p = 0.034) were independent risk factors for failure of single-session SWL in the treatment of kidney stones 10 to 20 mm in diameter. The estimated average cost per case was USD 450.5. Conclusions Increased HU, maximum stone length, BMI, and presence of double-J stents were independent risk factors for low SFR after single-session SWL for a kidney stone 10 to 20 mm in diameter. The cost of SWL remains an advantage in the private sector.
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Affiliation(s)
- Amr A. Faddan
- Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Osama Najieb
- Health Insurance Hospital, Ministry of Health, Mallawy, Egypt
| | - Rabea A. Gadelkareem
- Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt
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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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18
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Sigdel B, Shrestha S, Maskey P. Predicting the outcome of mini percutaneous nephrolithotomy using STONE nephrolithometry score-a single-center experience. Urolithiasis 2022; 51:14. [PMID: 36495320 DOI: 10.1007/s00240-022-01379-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 03/09/2022] [Accepted: 11/02/2022] [Indexed: 12/13/2022]
Abstract
To predict stone-free and complication rates following mini-percutaneous nephrolithotomy (m-PCNL) using STONE nephrolithometry score, this prospective observational study was conducted in the Department of Surgery, Urology Unit, Patan Hospital. All the patients undergoing m-PCNL were included. The cases were performed in the prone position, a single tract less than 18 French was made, and pneumatic lithotripsy was done. Stone-free rates were assessed with plain X-ray kidney, ureter, and bladder (X-ray KUB) on the first post-operative day or at 15 days follow-up. Complications within 30 days were graded using modified Clavien grading. A total of 106 patients were included in the final analysis. The overall stone-free rate was 83%. Among the individual variables, only staghorn calculus was associated with residual stone (p = 0.007). Patients who were rendered stone-free had statistically significantly lower STONE scores than those with residual stone (p < 0.001). The complication rate was 23%, and the majority were Clavien grade I complications. A higher STONE score had a greater risk of having complications but was not statistically significant (p = 0.11). STONE nephrolithometry score can predict stone complexity pre-operatively and subsequent stone-free status and thus, helps in pre-operative surgical planning and counseling for possible outcomes following m-PCNL.
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Affiliation(s)
- Bidhan Sigdel
- Department of Surgery, Urology Unit, Patan Academy of Health Sciences, Patan Hospital, Lalitpur, Nepal.
| | - Samir Shrestha
- Department of Surgery, Urology Unit, Patan Academy of Health Sciences, Patan Hospital, Lalitpur, Nepal
| | - Pukar Maskey
- Department of Surgery, Urology Unit, Patan Academy of Health Sciences, Patan Hospital, Lalitpur, Nepal
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19
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Gu J, Luo S, Jiang L, Hu D, Zhao G, Tang W. Novel scoring system combined with a virtual reality technique for the preoperative evaluation of the stone-free status after flexible ureteroscopy: the H.L.P.E.S. score. BMC Urol 2022; 22:161. [PMID: 36209157 PMCID: PMC9547458 DOI: 10.1186/s12894-022-01108-2] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 09/21/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE The original S.O.L.V.E. scoring system was modified using virtual reality technology, and a new H.L.P.E.S scoring system was constructed to improve the accuracy of predicting the stone-free rate after flexible ureteroscopy. METHODS We retrospectively analyzed clinical and virtual reality data of 150 patients with renal calculi who underwent flexible ureteroscopy at the First Affiliated Hospital of Chongqing Medical University, Chongqing, China, from September 2019 to January 2022. Factors affecting the stone-free rate were evaluated in univariate and multiple logical regression analyses. Factors were divided by cut-off value under the receiver-operating characteristic curve and scored accordingly to a well-known international scoring system. Area under the curve predicted the stone-free rate. The accuracy and superiority of the stone-free rate after flexible ureterorenoscopy was compared between this scoring system and the S.O.L.V.E, R.I.R.S, T.O.HO, and RUSS scores. RESULTS Multiple logistic regression showed that the stone surface area, renal pelvis volume, and length of the calyces funnel were correlated with stone-free rate (P < 0.01, P = 0.021, P = 0.019, respectively). The H.L.P.E.S. score included stone surface area (1-2 points), renal pelvis volume (1-2 points), length of calyces funnel (1-2 points), pelvic calyceal height (1-2 points), and essence of stone (1-2 points). The area under the receiver-operating characteristic curve of H.L.P.E.S. score was 0.927, which was higher than the S.O.L.V.E., R.I.R.S., T.O.HO, and RUSS scores. CONCLUSION H.L.P.E.S. scoring can effectively predict the stone-free rate after flexible ureteroscopy for renal calculi and is superior to other scoring systems.
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Affiliation(s)
- Jianglin Gu
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shengjun Luo
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Li Jiang
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Daixing Hu
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Guozhi Zhao
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wei Tang
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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20
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Wan C, Wang D, Xiang J, Yang B, Xu J, Zhou G, Zhou Y, Zhao Y, Zhong J, Liu J. Comparison of postoperative outcomes of mini percutaneous nephrolithotomy and standard percutaneous nephrolithotomy: a meta-analysis. Urolithiasis 2022; 50:523-533. [PMID: 35953608 PMCID: PMC9467966 DOI: 10.1007/s00240-022-01349-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 07/10/2022] [Accepted: 07/25/2022] [Indexed: 12/02/2022]
Abstract
Our study was aimed to evaluate the postoperative outcomes of Mini Percutaneous Nephrolithotomy (Mini-PCNL) and Standard Percutaneous Nephrolithotomy (Standard-PCNL) to determine the optimum option for patients with renal calculi. For publications published between January 2010 and April 2021, a comprehensive search of the PubMed, Cochrane Library, Web of Science, and EMBASE databases was done. The literatures were chosen based on the criteria for inclusion and exclusion. After the data were retrieved and the quality was assessed, the meta-analysis was performed using Review Manager Software (RevMan 5.4.1, Cochrane Collaboration, Oxford, UK). We selected 20 trials with a total of 4953 people out of 322 studies. There were 2567 patients treated with Mini-PCNL and 2386 patients treated with Standard-PCNL. Meta-analysis results showed no difference in stone-free rates (SFR, P = 0.93), fever (P = 0.83), and postoperative pain (VAS score) (P = 0.21) between Mini-PCNL and Standard-PCNL. Patients in the Mini-PCNL group experienced shorter hospital stay (P < 0.0001), less hemoglobin drop (P < 0.00001), less blood transfusion (P < 0.00001), higher postoperative tubeless (P = 0.0002), and fewer complications including bleeding (P = 0.01), perforation (P = 0.03), and leakage (P = 0.01). Compared with Standard-PCNL, operative time was longer in the Mini-PCNL group (P = 0.0005). Mini-PCNL had a shorter hospital stay, less hemoglobin drop, less blood transfusion, greater postoperative tubeless, fewer complications, and a longer operational time when compared to Standard-PCNL. SFR, fever, and postoperative pain were similar in both of them. Mini-PCNL may be a superior option for patients with proper size renal calculi.
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Affiliation(s)
- Chuanping Wan
- grid.415444.40000 0004 1800 0367Department of Urology, The Second Affiliated Hospital of Kunming Medical University, 374 Dianmian Avenue, Wuhua District, Kunming, 650101 NO China
| | - Daoqi Wang
- grid.415444.40000 0004 1800 0367Department of Urology, The Second Affiliated Hospital of Kunming Medical University, 374 Dianmian Avenue, Wuhua District, Kunming, 650101 NO China
| | - Jiajia Xiang
- Department of Anesthesiology, 920Th Hospital of Joint Logistics Support Force, PLA, Kunming, Yunnan People’s Republic of China
| | - Bin Yang
- grid.415444.40000 0004 1800 0367Department of Urology, The Second Affiliated Hospital of Kunming Medical University, 374 Dianmian Avenue, Wuhua District, Kunming, 650101 NO China
| | - Jinming Xu
- grid.415444.40000 0004 1800 0367Department of Urology, The Second Affiliated Hospital of Kunming Medical University, 374 Dianmian Avenue, Wuhua District, Kunming, 650101 NO China
| | - Guiming Zhou
- grid.415444.40000 0004 1800 0367Department of Urology, The Second Affiliated Hospital of Kunming Medical University, 374 Dianmian Avenue, Wuhua District, Kunming, 650101 NO China
| | - Yuan Zhou
- grid.415444.40000 0004 1800 0367Department of Urology, The Second Affiliated Hospital of Kunming Medical University, 374 Dianmian Avenue, Wuhua District, Kunming, 650101 NO China
| | - Yuan Zhao
- grid.415444.40000 0004 1800 0367Department of Urology, The Second Affiliated Hospital of Kunming Medical University, 374 Dianmian Avenue, Wuhua District, Kunming, 650101 NO China
| | - Jiao Zhong
- grid.415444.40000 0004 1800 0367Department of Urology, The Second Affiliated Hospital of Kunming Medical University, 374 Dianmian Avenue, Wuhua District, Kunming, 650101 NO China
| | - Jianhe Liu
- grid.415444.40000 0004 1800 0367Department of Urology, The Second Affiliated Hospital of Kunming Medical University, 374 Dianmian Avenue, Wuhua District, Kunming, 650101 NO China
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21
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Perri D, Berti L, Pacchetti A, Morini E, Maltagliati M, Besana U, Pastore AL, Romero-Otero J, Saredi G, Centrella D, Sighinolfi MC, Rocco B, Micali S, Broggini P, Boldini M, Mazzoleni F, Bozzini G. A comparison among RIRS and MiniPerc for renal stones between 10 and 20 mm using thulium fiber laser (Fiber Dust): a randomized controlled trial. World J Urol 2022; 40:2555-2560. [PMID: 36029330 DOI: 10.1007/s00345-022-04133-w] [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: 05/21/2022] [Accepted: 08/11/2022] [Indexed: 11/25/2022] Open
Abstract
PURPOSE We performed a prospective randomized comparison among Retrograde IntraRenal Surgery (RIRS) and MiniPerc (MP) for stones between 10 and 20 mm to evaluate outcomes with the same laser device: Fiber Dust. METHODS Patients with a single renal stone between 10 and 20 mm were randomized to RIRS (Group A) versus MP (Group B). Exclusion criteria were age < 18 or > 75, presence of acute infection, coagulation impairments, cardiovascular or pulmonary comorbidities. In both groups, the Fiber Dust laser was used. A CT scan after 3 months was performed. A negative CT scan or asymptomatic patients with stone fragments < 3 mm and a negative urinary culture were the criteria to assess the stone-free status. A statistical analysis was carried out to assess success, complication and retreatment rates and need for auxiliary treatments. RESULTS Between January 2021 and January 2022, 186 patients were enrolled (90 in Group A and 96 in Group B). Mean stone size was 15.8 mm and 14.9 mm in Group A and B, respectively (p = 0.23). The overall stone-free rate (SFR) was 73.3% for Group A and 84.4% for Group B. A higher SFR was reached for upper calyceal stones in Group A (90.4%) lower calyceal stones in Group B (91.6%). Retreatment rate (p = 0.31) and auxiliary procedure rate (p = 0.18) were comparable. Complication rate was 5.5% and 5.2% for Groups A and B, respectively. CONCLUSIONS RIRS and MP are both effective to obtain a postoperative SFR with Fiber Dust. According to the stone position one treatment is superior to the other one.
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Affiliation(s)
- Davide Perri
- Division of Urology, Sant'Anna Hospital, San Fermo della Battaglia, Italy.
| | - Lorenzo Berti
- Division of Urology, ASST Valle Olona, Busto Arsizio Hospital, Busto Arsizio, Italy
| | - Andrea Pacchetti
- Division of Urology, Sant'Anna Hospital, San Fermo della Battaglia, Italy
| | - Elena Morini
- Division of Urology, Sant'Anna Hospital, San Fermo della Battaglia, Italy
| | - Matteo Maltagliati
- Division of Urology, ASST Valle Olona, Busto Arsizio Hospital, Busto Arsizio, Italy
| | - Umberto Besana
- Division of Urology, Sant'Anna Hospital, San Fermo della Battaglia, Italy
| | - Antonio Luigi Pastore
- Division of Urology, Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Latina, Italy
| | | | - Giovanni Saredi
- Division of Urology, ASST Valle Olona, Busto Arsizio Hospital, Busto Arsizio, Italy
| | | | | | | | - Salvatore Micali
- Division of Urology, Modena and Reggio Emilia University, Modena, Italy
| | - Paolo Broggini
- Division of Urology, Clinica Sant'Anna, Lugano, Switzerland
| | - Marco Boldini
- Division of Urology, Clinica Sant'Anna, Lugano, Switzerland
| | - Federica Mazzoleni
- Division of Urology, Sant'Anna Hospital, San Fermo della Battaglia, Italy
| | - Giorgio Bozzini
- Division of Urology, Sant'Anna Hospital, San Fermo della Battaglia, Italy
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22
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Jannello LMI, Turetti M, Silvani C, Galbiati G, Garbagnati S, Pozzi E, Malfatto M, Zanetti SP, Longo F, De Lorenzis E, Albo G, Salonia A, Montanari E, Boeri L. Urologists are optimistic surgeons: prevalence and predictors of discordance between intraoperative stone-free rate and cross-sectional imaging evaluation after vacuum-assisted mini-percutaneous nephrolithotomy. World J Urol 2022; 40:2331-2338. [PMID: 35831471 PMCID: PMC9427905 DOI: 10.1007/s00345-022-04091-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 04/30/2022] [Accepted: 06/30/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose To assess how accurate are urologists in predicting stone-free status (SFS) after vacuum-assisted mini-PCNL (vamPCNL) compared to computed tomography (CT) and clinical predictors of discordant SFS. Methods Data from 235 patients who underwent vamPCNL were analysed. Patient’s demographics, stones’ characteristics and operative data were recorded. SFS was evaluated intraoperatively by the treating urologist (iSFS) and with non-contrast CT 3 months after vamPCNL (ctSFS). SFS was defined as no residual stones. Stone complexity was scored with the Guy’s score. Descriptive statistics and logistic regression models were used to identify clinical factors associated with discordant SFS (namely iSFS not confirmed at CT). Results iSFS and ctSFS were 88.5% and 65.5%, respectively, with 54 (23%) cases resulting in discordant evaluation of SFS between the surgeon and CT imaging. Patients with discordant SFS had larger stone volume (p < 0.001), higher rate of multiple stones (p = 0.03) and higher rate of multiple calyceal groups affected by stones (p < 0.001) than those with concordant SFS. The use of flexible ureteroscopes to look for residual stones after lithotripsy was more frequently reported in cases with concordant SFS (p = 0.001). Multivariable logistic regression analysis revealed that stones in > 2 calyceal groups (OR 10.2, p < 0.001), Guy’s score II (OR 5.8, p < 0.01) and not using flexible ureteroscopes after lithotripsy (OR 2.9, p = 0.02) were independent predictors of discordant SFS. Conclusion One out of five patients is erroneously considered SF after vamPCNL. Urologist should carefully evaluate patients with multiple calyceal stones and consider using flexible ureteroscopes to complete lapaxy of migrated fragments in order to improve their prediction of SFS.
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Affiliation(s)
- Letizia Maria Ippolita Jannello
- Department of Urology, Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via della Commenda 15, 20122, Milan, Italy
| | - Matteo Turetti
- Department of Urology, Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via della Commenda 15, 20122, Milan, Italy
| | - Carlo Silvani
- Department of Urology, Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via della Commenda 15, 20122, Milan, Italy
| | - Gilda Galbiati
- Department of Urology, Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via della Commenda 15, 20122, Milan, Italy
| | - Susanna Garbagnati
- Department of Urology, Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via della Commenda 15, 20122, Milan, Italy
| | - Efrem Pozzi
- Department of Urology, Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via della Commenda 15, 20122, Milan, Italy
| | - Matteo Malfatto
- Department of Urology, Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via della Commenda 15, 20122, Milan, Italy
| | - Stefano Paolo Zanetti
- Department of Urology, Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via della Commenda 15, 20122, Milan, Italy
| | - Fabrizio Longo
- Department of Urology, Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via della Commenda 15, 20122, Milan, Italy
| | - Elisa De Lorenzis
- Department of Urology, Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via della Commenda 15, 20122, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Giancarlo Albo
- Department of Urology, Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via della Commenda 15, 20122, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology, URIIRCCS Ospedale San RaffaeleUniversity Vita-Salute San Raffaele, Milan, Italy
| | - Emanuele Montanari
- Department of Urology, Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via della Commenda 15, 20122, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Luca Boeri
- Department of Urology, Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via della Commenda 15, 20122, Milan, Italy.
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Ulvik Ø, Æsøy MS, Juliebø-Jones P, Gjengstø P, Beisland C. Thulium Fibre Laser versus Holmium:YAG for Ureteroscopic Lithotripsy: Outcomes from a Prospective Randomised Clinical Trial. Eur Urol 2022; 82:73-79. [PMID: 35300888 DOI: 10.1016/j.eururo.2022.02.027] [Citation(s) in RCA: 57] [Impact Index Per Article: 28.5] [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: 11/02/2021] [Revised: 02/15/2022] [Accepted: 02/25/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Holmium:yttrium-aluminium-garnet (Ho:YAG) laser is the gold standard for ureterorenoscopic (URS) lithotripsy. Thulium fibre laser (TFL) has recently been introduced as a new technology and may challenge Ho:YAG as the preferred laser owing to favourable properties as demonstrated in preclinical studies. OBJECTIVE To evaluate and compare outcomes after URS lithotripsy with Ho:YAG and TFL. DESIGN, SETTING, AND PARTICIPANTS In a prospective randomised trial, patients aged ≥18 yr with ureteral and/or renal stones (≥5 mm) scheduled to undergo day-case URS lithotripsy were invited to participate. In total, 120 consecutively admitted patients with signed consent were included for randomisation. INTERVENTION URS lithotripsy with Ho:YAG or TFL. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary outcome was the stone-free rate (SFR) assessed on noncontrast computed tomography at 3-mo follow-up. Secondary outcomes were the operative time and complications. Outcomes were compared between the groups using the t test and χ2 test. RESULTS AND LIMITATIONS After a single session, the SFR was 67% in the Ho:YAG group and 92% in the TFL group, p = 0.001. For ureteral stones, the SFR was 100% in both groups, and for renal stones; 49% (Ho:YAG) and 86% (TFL), p = 0.001. Operative time was shorter using TFL (49 min) compared to Ho:YAG (57 min), p = 0.008. Bleeding that impaired the endoscopic view was the most frequent intraoperative adverse event and occurred in 13 patients (22%) in the Ho:YAG group and three (5%) in the TFL group, p = 0.014. CONCLUSIONS In this study, significantly more patients with renal stones achieved stone-free status and fewer experienced intraoperative complications using TFL compared to Ho:YAG. TFL is the emerging laser of choice for stone lithotripsy. PATIENT SUMMARY We compared outcomes after ureterorenoscopic treatment of kidney and ureteral stones using two different lasers. Our results show that the new thulium fibre laser technology is superior to the current standard laser (holmium:YAG) in clearing kidney stones and reducing operative complications.
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Affiliation(s)
- Øyvind Ulvik
- Department of Urology, Helse Bergen HF, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway.
| | | | - Patrick Juliebø-Jones
- Department of Urology, Helse Bergen HF, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Peder Gjengstø
- Department of Urology, Helse Bergen HF, Haukeland University Hospital, Bergen, Norway
| | - Christian Beisland
- Department of Urology, Helse Bergen HF, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
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24
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Chen ZH, Lee KH, Tseng WH, Su CC, Hsieh KL, Lim CY, Huang SK. Comparison of mini endoscopic combined intrarenal surgery and multitract minimally invasive percutaneous nephrolithotomy specifically for kidney staghorn stones: a single-centre experience. BMC Urol 2022; 22:93. [PMID: 35773639 PMCID: PMC9248084 DOI: 10.1186/s12894-022-01030-7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 05/17/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Staghorn stones require surgical treatment to prevent serious complications. Multitract percutaneous nephrolithotomy (PNL) causes great renal parenchymal injury and blood loss. One-stage endoscopic combined intrarenal surgery (ECIRS) entails the combined use of antegrade nephroscope and retrograde flexible ureteroscope to clear the staghorn stone, which may overcome the limitations of multitract PNL. We aimed to compare the perioperative outcomes of mini ECIRS and multitract minimally invasive PNL in staghorn stone management. METHODS This was a retrospective single-center study of patients with staghorn stones who underwent ECIRS (n = 17) or multitract minimally invasive PNL (n = 17) between January 2018 and September 2021. RESULTS There was a significant between-group difference with respect to Guy's stone score. Stone size, stone burden (ECIRS group, 21.41 cm3; multitract minimally invasive PNL group, 20.88 cm3 [P = 0.94]), and degree of hydronephrosis were comparable in the two groups. There was no significant between-group difference with respect to one-step or final stone-free rates. The mean operative time was also not significantly different between the groups (ECIRS group, 140 min; multitract minimally invasive PNL group, 183 min [P = 0.63]). ECIRS was associated with significantly lesser postoperative pain (visual analog scale; ECIRS group: 0; multitract minimally invasive PNL group: 2.7 [P < 0.001]). Hemoglobin loss, postoperative blood transfusion rate, complications, and length of hospital stay were comparable in the two groups. CONCLUSION Both mini ECIRS and multitract minimally invasive PNL were effective and safe for the management of renal staghorn stones with comparable operation time and stone-free rate, and complications. ECIRS was associated with less severe postoperative pain.
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Affiliation(s)
- Zhi-Hao Chen
- Division of Urology, Department of Surgery, Chi Mei Medical Center, No. 901, Zhonghua Rd. Yongkang Dist., Tainan City, 71004 Taiwan, R.O.C
| | - Kau-Han Lee
- Division of Urology, Department of Surgery, Chi Mei Medical Center, No. 901, Zhonghua Rd. Yongkang Dist., Tainan City, 71004 Taiwan, R.O.C
| | - Wen-Hsin Tseng
- Division of Urology, Department of Surgery, Chi Mei Medical Center, No. 901, Zhonghua Rd. Yongkang Dist., Tainan City, 71004 Taiwan, R.O.C
| | - Chia-Cheng Su
- Division of Urology, Department of Surgery, Chi Mei Medical Center, No. 901, Zhonghua Rd. Yongkang Dist., Tainan City, 71004 Taiwan, R.O.C
| | - Kun-Lin Hsieh
- Division of Urology, Department of Surgery, Chi Mei Medical Center, No. 901, Zhonghua Rd. Yongkang Dist., Tainan City, 71004 Taiwan, R.O.C
| | - Chye-Yang Lim
- Division of Urology, Department of Surgery, Chi Mei Medical Center, No. 901, Zhonghua Rd. Yongkang Dist., Tainan City, 71004 Taiwan, R.O.C
| | - Steven K. Huang
- Division of Urology, Department of Surgery, Chi Mei Medical Center, No. 901, Zhonghua Rd. Yongkang Dist., Tainan City, 71004 Taiwan, R.O.C
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Ibis MA, Gokce MI, Babayigit M, Yitgin Y, Karagoz MA, Boyuk A, Verep S, Turan S, Tefik T, Kiremit MC, Sonmez MG, Ergul R, Guven S, Sarica K. Could retrograde intrarenal surgery be a safe and effective alternative to mini-percutaneous nephrolithotomy ın the management of relatively large (20-30 mm) stones? A critical evaluation. Int Urol Nephrol 2022; 54:2141-2148. [PMID: 35763186 DOI: 10.1007/s11255-022-03255-9] [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: 02/12/2022] [Accepted: 05/11/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE To compare the outcomes of mini-percutaneous nephrolithotomy (mPCNL) and retrograde intrarenal surgery (RIRS) in patients with renal stones sizing 2-3 cm. METHODS A total of 566 patients from 6 institutions who underwent mPCNL (n = 440) and RIRS (n = 126) procedures were enrolled in our study. The retrospective patient cohort was reviewed and compared. Binary logistic regression analysis was performed to determine factors predicting success in the RIRS group. RESULTS The stone-free rates were 91.1 and 77% for the mPCNL and RIRS groups, respectively (p < 0.001). The auxiliary procedure rates were 4.5 and 39.7% in the mPCNL and RIRS groups, respectively (p < 0.001). Mean values of hemoglobin decrease, fluoroscopy time, and hospitalization time were significantly higher in the mPCNL group (p < 0.001). While the Clavien grade 1-2 complication rates were 10.9 and 34.1% (p < 0.001) in two groups, these values were 2.7 and 1.6% (p = 0.539), respectively, for Clavien grade 3-4 complication rates. Although three patients in the mPCNL group received blood transfusions, none of the patients in the RIRS groups were transfused. The stone location and stone density parameters were found to be the independent predictive factors for RIRS success. CONCLUSIONS mPCNL provided a higher stone-free rate, less need for the auxiliary procedure, and lower complication rates compared to RIRS in patients with 2-3 cm stones. Blood loss, radiation exposure, and a hospital stay of mPCNL can be significantly reduced with the RIRS technique in selected patients.
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Affiliation(s)
- Muhammed Arif Ibis
- Department of Urology, University of Health Sciences, Ataturk Sanatoryum Training and Research Hospital, Ankara, 06380, Turkey.
| | - Mehmet Ilker Gokce
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Muammer Babayigit
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Yasin Yitgin
- Department of Urology, Istinye University School of Medicine, Istanbul, Turkey
| | - Mehmet Ali Karagoz
- Department of Urology, University of Health Sciences, Cemil Tascıoglu City Hospital Training and Research Hospital, Prof. Dr, Istanbul, Turkey
| | - Abubekir Boyuk
- Department of Urology, Private Istanbul Medivita Ethica Hospital, Istanbul, Turkey
| | - Samed Verep
- Department of Urology, University of Health Sciences, Van Training and Research Hospital, Van, Turkey
| | - Serdar Turan
- Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Tzevat Tefik
- Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Murat Can Kiremit
- Department of Urology, School of Medicine, Koc University, Istanbul, Turkey
| | | | - Rifat Ergul
- Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Selcuk Guven
- Department of Urology, NEÜ Meram Medicine Faculty, Konya, Turkey
| | - Kemal Sarica
- Department of Urology, Biruni University School of Medicine, Istanbul, Turkey
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Zhang J, Li B, Li G, Yang Z, Ye N, Liu Y, Zhuo H, Hong J. Rigid ureteroscopic lithotripsy in the lateral decubitus position for upper urinary tract stones. BMC Urol 2022; 22:24. [PMID: 35197025 PMCID: PMC8867793 DOI: 10.1186/s12894-022-00977-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 05/17/2021] [Accepted: 02/11/2022] [Indexed: 11/20/2022] Open
Abstract
Background The current study aimed to assess a novel ureteroscopic technique developed for treating upper urinary calculi based on a specially designed lateral decubitus body position that could avoid stone loss by adjusting to the effects of gravity. Methods This retrospective study examined patients with upper urinary calculi who were surgically treated from November 2008 to January 2020, using a new body position and a rigid ureteroscope. Clinical outcomes, stone-free rates, operative times and complications were evaluated, and factors that could influence treatment success were determined. Results In total, 1080 patients were included, and 1145 operations were performed. The maximum calculus diameters were 11.22 ± 5.01 mm. Operative times were 48.60 ± 27.44 min. A total of 1042 cases were successfully treated, with a stone-free rate of 91.00%. Multivariate analysis showed that female sex (OR = 2.135, 95% CI 1.332–3.422, P = 0.002), thin scope standby (OR = 1.643, 95% CI 1.074–2.514, P = 0.022), laser lithotripsy (OR = 5.087, 95% CI 2.400–10.785, P = 0.000) and stone size (OR = 0.946, 95% CI 0.912–0.981, P = 0.003) were independently associated with stone-free outcomes. In total, 2 ureteral perforations, 2 ureteric avulsions and 4 urosepsis cases were observed, but were all cured without sequelae. Conclusions Ureteroscopic lithotripsy in the lateral decubitus position is a safe and effective technique for treating upper urinary tract calculi, especially upper ureteral calculi.
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Affiliation(s)
- Jinqing Zhang
- Department of Urology, Affiliated Xiaolan Hospital, Southern Medical University, Zhongshan, Guangdong, China.
| | - Binbin Li
- Department of Urology, Affiliated Foshan Hospital of SUN Yat-Sen University, The First People's Hospital of Foshan, Foshan, Guangdong, China
| | - Gang Li
- Department of Urology, Affiliated Xiaolan Hospital, Southern Medical University, Zhongshan, Guangdong, China
| | - Zengshi Yang
- Department of Urology, Affiliated Xiaolan Hospital, Southern Medical University, Zhongshan, Guangdong, China
| | - Ning Ye
- Department of Urology, Affiliated Xiaolan Hospital, Southern Medical University, Zhongshan, Guangdong, China
| | - Yihao Liu
- Department of Urology, Hospital of Traditional Chinese Medicine of Zhongshan, Zhongshan, Guangdong, China
| | - Hongbing Zhuo
- Department of Urology, Affiliated Xiaolan Hospital, Southern Medical University, Zhongshan, Guangdong, China
| | - Jingfan Hong
- Department of Urology, Dongguan Kanghua Hospital, Dongguan, Guangdong, China
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Peng L, Zheng Z, Xu J, Zhong W. Retrograde intrarenal surgery in lateral position for lower pole stone: an initial experience from Single Academic Hospital. Urolithiasis 2022. [PMID: 35048132 DOI: 10.1007/s00240-021-01297-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 12/02/2021] [Indexed: 10/19/2022]
Abstract
Retrograde intrarenal surgery (RIRS) was generally challenging in management of lower pole stone (LPS) since the unfavorable anatomy. Theoretically, LPS was prone to fall out and down to renal pelvis when patients turned to lateral position, thus to facilitate lithotripsy. The aim of the present study was to report our initial experience of RIRS in lateral position for LPS. From January 2020 to February 2021, 21 patients with LPS received RIRS in lateral position. The intraoperative finding, operation time, complications and stone-free rate (SFR) were recorded and analyzed. The mean stone size was 16.7 ± 2.4 mm, multiple stones in lower pole were noted in 38.1% (8/21) cases. The mean infundibular-pelvic angle (IPA) was 35.2 ± 6.9°, IPA less than 30° was noted in six cases (28.6%, 6/21). Mean operation time was 43.5 ± 6.3 min. Obvious stone fragments dropping from the lower calyx to renal pelvis during the lithotripsy were noted in 17 cases (81.0%). Only one case (4.8%) suffered postoperative fever (Clavien I), no severe complication (> Clavien II) was noted. Hospital stay was 1.1 ± 0.3 days, the SFR in postoperative 1 month was 85.7%. LPS was prone to fall out and down to renal pelvis when patients in lateral position, thus to facilitate the lithotripsy. RIRS in lateral position was feasible for the management of LPS; however, RCT with large sample was required to certify our initial finding.
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Tang QL, Wang DJ, Zhou S, Tao RZ. Mirabegron in medical expulsive therapy for distal ureteral stones: a prospective, randomized, controlled study. World J Urol 2021; 39:4465-4470. [PMID: 34241685 DOI: 10.1007/s00345-021-03772-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 02/16/2021] [Accepted: 06/11/2021] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To observe the efficacy and safety of Mirabegron in patients with distal, ureteral stones ≤ 10 mm. PATIENTS AND METHODS A total of 90 patients with distal ureteral stones ≤ 10 mm were prospectively randomized into two groups. Forty-five cases in the study group and 45 cases as control. The stone-free rates (SFRs) and renal colic episodes between two groups were compared at the 1st, 2nd and 4th week end by imaging examinations. RESULT All of 90 patients were randomly assigned to two groups. In patients with ≤ 5 mm stones, the SFRs in the 1st week (63.6% vs. 33.3%, P = 0.040), the 2nd week (86.4% vs. 54.2%, P = 0.018), and the 4th week (90.9% vs. 66.7%, P = 0.046) after treatment were all significantly higher than that in the control group by the stratification analysis of stone size. Even though SFRs were all higher for patients with > 5 mm stones in study group, there was no statistically significant difference (All P > 0.05). In terms of renal colic episodes, the frequency of occurrence of the study group was significantly lower than that of the control group and need less antalgic. CONCLUSIONS The MET with Mirabegron has a significant role in improve SFR for the patients with distal ureteral stones ≤ 5 mm and no effect in > 5 mm stones. Furthermore, Mirabegron reduces the need for antalgic in ≤ 10 mm stones with low incidence of adverse effects.
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Affiliation(s)
- Qing-Lai Tang
- Nanjing Jiangning Hospital, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, China
| | - Du-Jian Wang
- Nanjing Jiangning Hospital, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, China
| | - Shuang Zhou
- Nanjing Jiangning Hospital, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, China
| | - Rong-Zhen Tao
- Nanjing Jiangning Hospital, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, China.
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Schoenthaler M, Hein S, Wilhelm K, Pohlmann PF, Praus F, Walther T, Schmoor C, Gratzke C, Miernik A. Feasibility of an Updated Randomised Controlled Trial on Surgical Urolithiasis Treatments: The Pilot Trial for the German Endoscopic versus Shock Wave Therapy Study (GESS). Eur Urol Focus 2021; 8:271-275. [PMID: 33500235 DOI: 10.1016/j.euf.2021.01.001] [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: 10/16/2020] [Revised: 12/15/2020] [Accepted: 01/06/2021] [Indexed: 11/28/2022]
Abstract
Data comparing treatments for urolithiasis are often outdated, with inconsistent results or poor methodological and reporting quality. We report a pilot study in preparation for a larger multicentre randomised controlled trial (RCT) comparing shockwave therapy and ureteroscopy in patients with a single urinary stone of ≤20 mm in the upper urinary tract. Primary objectives included screening completeness, patients' willingness to participate, their remaining in the study, the suitability of the eligibility criteria, and the acceptability of the outcome measures. Screened individuals not invited to participate were those with no indication for active treatment among referred patients (n = 166), those who staff failed to screen (n = 99), and patients not meeting the inclusion criterion of a single stone (n = 422). Of the 176 patients invited, 116 refused to participate. Ultimately, we were able to recruit 60 patients within 34 mo. All patients underwent their allocated treatments. This pilot trial provides an in-depth analysis of the feasibility of an RCT on surgical treatments for upper urinary tract urolithiasis in a highly regulated health care system. The study procedures and outcome measures proved acceptable and feasible. On the basis of these data, we propose a pragmatic, multicentre RCT to deliver updated, high-level evidence on the efficacy of currently available treatments for urolithiasis. PATIENT SUMMARY: We performed a small pilot trial comparing current treatments in urolithiasis. We were able to prove the feasibility of a larger multi-institutional trial with regard to the time needed to recruit an adequate number of patients and the acceptability of the treatments and outcome measures.
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Affiliation(s)
- Martin Schoenthaler
- Department of Urology, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Simon Hein
- Department of Urology, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Konrad Wilhelm
- Department of Urology, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Philippe-Fabian Pohlmann
- Department of Urology, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Friederike Praus
- Department of Urology, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Tabea Walther
- Department of Urology, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Claudia Schmoor
- Clinical Trials Unit, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christian Gratzke
- Department of Urology, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Arkadiusz Miernik
- Department of Urology, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Micali S, Sighinolfi MC, Iseppi A, Morini E, Calcagnile T, Benedetti M, Ticonosco M, Kaleci S, Bevilacqua L, Puliatti S, De Nunzio C, Arada R, Chiancone F, Campobasso D, Eissa A, Bonfante G, Simonetti E, Cotugno M, Galli R, Curti P, Schips L, Ditonno P, Villa L, Ferretti S, Bergamaschi F, Bozzini G, Zoeir A, Sherbiny AE, Frattini A, Fedelini P, Okhunov Z, Tubaro A, Landman J, Bianchi G, Rocco B. Initial Experience and Evaluation of a Nomogram for Outcome Prediction in Management of Medium-sized (1-2 cm) Kidney Stones. Eur Urol Focus 2021; 8:276-282. [PMID: 33419709 DOI: 10.1016/j.euf.2020.12.012] [Citation(s) in RCA: 3] [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: 10/12/2020] [Revised: 11/18/2020] [Accepted: 12/18/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND The gold standard treatment for solitary medium-sized (1-2 cm) renal stones is not defined by recent guidelines, since management modalities including shockwave lithotripsy (SWL), retrograde intrarenal surgery (RIRS), and percutaneous nephrolithotomy (PNL) are recommended. Improved ability to predict patient outcomes would aid in patients' counseling and decision-making. OBJECTIVE To develop a nomogram predicting treatment failure, based on preoperative clinical variables, to be used in the preplanning setting. DESIGN, SETTING, AND PARTICIPANTS We recruited 2605 patients from 14 centers and carried out a multicenter retrospective analysis of 699 SWL, 1290 RIRS, and 616 PN L procedures performed as first-line treatment for 1-2-cm kidney stones. The variables evaluated included age, gender, previous renal surgery, body mass index, stone size, location, stone density, skin-to-stone distance, presence of urinary tract infections (UTIs), and hydronephrosis. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Multivariate logistic regression was fitted to predict treatment failure, defined as the presence of residual fragments >4 mm. A nomogram was developed based on the coefficients of the logit function. RESULTS AND LIMITATIONS A total of 2431 (93.3%) patients were stone free; 174 (6.7%) treatment failures were recorded and considered the event to be predicted. On univariate analysis, type of procedure, preoperative hydronephrosis, stone density, stone location, and laterality turned out to be statistically significant. Skin-to-stone distance, UTIs, and previous renal surgery were predictors of failure on multivariate analysis. Each variable was given a score based on statistical relevance. The main limitation of the current study is its retrospective nature. CONCLUSIONS This nomogram provides a prediction of treatment failure and need of reintervention for medium-sized kidney stones. External validation is needed to determine its reproducibility and validity. PATIENT SUMMARY We developed a preoperative model of treatment outcomes for 1-2-cm kidney stones. Its application may assist urologists to counsel patients with regard to stone management modality.
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Affiliation(s)
- Salvatore Micali
- Department of Urology, Azienda Ospedaliero-Universitaria, Urological Residency School Network, University of Modena & Reggio Emilia, Modena, Italy
| | - Maria Chiara Sighinolfi
- Department of Urology, Azienda Ospedaliero-Universitaria, Urological Residency School Network, University of Modena & Reggio Emilia, Modena, Italy.
| | - Andrea Iseppi
- Department of Urology, Azienda Ospedaliero-Universitaria, Urological Residency School Network, University of Modena & Reggio Emilia, Modena, Italy
| | - Elena Morini
- Department of Urology, Azienda Ospedaliero-Universitaria, Urological Residency School Network, University of Modena & Reggio Emilia, Modena, Italy
| | - Tommaso Calcagnile
- Department of Urology, Azienda Ospedaliero-Universitaria, Urological Residency School Network, University of Modena & Reggio Emilia, Modena, Italy
| | - Mattia Benedetti
- Department of Urology, Azienda Ospedaliero-Universitaria, Urological Residency School Network, University of Modena & Reggio Emilia, Modena, Italy
| | - Marco Ticonosco
- Department of Urology, Azienda Ospedaliero-Universitaria, Urological Residency School Network, University of Modena & Reggio Emilia, Modena, Italy
| | - Shaniko Kaleci
- Clinical and experimental medicine (CEM), Department of Surgical, Medical, Dental and Morphological Sciences with Interest in Transplant, Oncology and Regenerative Medicine, University of Modena & Reggio Emilia, Modena, Italy
| | - Luigi Bevilacqua
- Department of Urology, Azienda Ospedaliero-Universitaria, Urological Residency School Network, University of Modena & Reggio Emilia, Modena, Italy
| | - Stefano Puliatti
- Department of Urology, Azienda Ospedaliero-Universitaria, Urological Residency School Network, University of Modena & Reggio Emilia, Modena, Italy
| | - Cosimo De Nunzio
- Department of Urology, Ospedale Sant'Andrea, "La Sapienza" University, Rome, Italy
| | - Raphael Arada
- Department of Urology, University of California, Irvine, Orange, CA, USA
| | | | - Davide Campobasso
- Department of Urology, Ospedale Civile di Guastalla, Urological Residency School Network, University of Modena & Reggio Emilia, Guastalla, Italy
| | - Ahmed Eissa
- Department of Urology, Tanta University, Tanta, Egypt
| | - Giulia Bonfante
- Department of Urology, Azienda Ospedaliero-Universitaria, Urological Residency School Network, University of Modena & Reggio Emilia, Modena, Italy
| | - Elisa Simonetti
- Department of Urology, Ospedale Maggiore, Urological Residency School Network, University of Modena & Reggio Emilia, Parma, Italy
| | - Michele Cotugno
- Department of Urology, Ospedale di Vaio, Urological Residency School Network, University of Modena & Reggio Emilia, Fidenza, Italy
| | - Riccardo Galli
- Department of Urology, Policlinico San Pietro, Ponte San Pietro, Italy
| | - Pierpaolo Curti
- Department of Urology, Ospedale Mater Salutis, Legnago, Italy
| | - Luigi Schips
- Department of Urology, Ospedale SS. Annunziata, Chieti, Italy
| | | | - Luca Villa
- Department of Urology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Stefania Ferretti
- Department of Urology, Ospedale Maggiore, Urological Residency School Network, University of Modena & Reggio Emilia, Parma, Italy
| | - Franco Bergamaschi
- Department of Urology, Arcispedale S. Maria Nuova, Urological Residency School Network, University of Modena & Reggio Emilia, Reggio Emilia, Italy
| | - Giorgio Bozzini
- Department of Urology, ASST Valle Olona, Urological Residency School Network, University of Modena & Reggio Emilia, Busto Arsizio, Varese, Italy
| | - Ahmed Zoeir
- Department of Urology, Tanta University, Tanta, Egypt
| | | | - Antonio Frattini
- Department of Urology, Ospedale Civile di Guastalla, Urological Residency School Network, University of Modena & Reggio Emilia, Guastalla, Italy
| | - Paolo Fedelini
- Department of Urology, AORN Antonio Cardarelli, Naples, Italy
| | - Zhamshid Okhunov
- Department of Urology, University of California, Irvine, Orange, CA, USA
| | - Andrea Tubaro
- Department of Urology, Ospedale Sant'Andrea, "La Sapienza" University, Rome, Italy
| | - Jaime Landman
- Department of Urology, University of California, Irvine, Orange, CA, USA
| | - Giampaolo Bianchi
- Department of Urology, Azienda Ospedaliero-Universitaria, Urological Residency School Network, University of Modena & Reggio Emilia, Modena, Italy
| | - Bernardo Rocco
- Department of Urology, Azienda Ospedaliero-Universitaria, Urological Residency School Network, University of Modena & Reggio Emilia, Modena, Italy
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Washino S, Hayase T, Miyagawa T, Arai Y. Association between time to lithotripsy and stone-free rate in patients with ureteral stones undergoing shock wave lithotripsy. Urolithiasis 2021; 49:351-358. [PMID: 33386902 PMCID: PMC7778408 DOI: 10.1007/s00240-020-01232-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 07/26/2020] [Accepted: 11/18/2020] [Indexed: 11/15/2022]
Abstract
Early shock wave lithotripsy is associated with higher stone-free rate compared to delayed treatment of ureteral stones, but may constitute overtreatment because ureteral stones can pass spontaneously. We studied the association between time to treatment and stone-free rate in patients with ureteral stones to determine optimal shock wave lithotripsy timing. We retrospectively analyzed 537 patients undergoing shock wave lithotripsy for ureteral stones. Patients were divided into five groups according to time from onset of symptoms to lithotripsy—urgent (0–3 days), early (4–30 days), late (31–60 days), long-delayed lithotripsy (≥ 61 days), and asymptomatic. Stone-free rates were compared among groups. Mean age and stone size were 55.6 ± 13.1 years and 7.48 ± 3.29 mm, respectively. Mean number of shock wave lithotripsy sessions and stone-free rate were 1.37 and 91.6%, respectively, in the overall population. Stone-free rates were 95.2%, 96.8%, 91.3%, 86.3%, and 82.7% in urgent, early, late, long-delayed lithotripsy, and asymptomatic groups, respectively. Long-delayed lithotripsy and asymptomatic groups had significantly more lithotripsy sessions and lower stone-free rate, compared to urgent and early lithotripsy groups. In multivariate analysis, time to lithotripsy [long-delayed lithotripsy (odds ratio: 0.273, p = 0.004) and asymptomatic nature (odds ratio: 0.236, p = 0.002)] and age (odds ratio: 0.959, p = 0.003) independently affected stone-free rate. In conclusion, time to lithotripsy is a strong predictive factor for stone-free status following shock wave lithotripsy. Urgent shock wave lithotripsy did not improve stone-free rate if performed within 1 month. However, time to shock wave lithotripsy > 2 months reduced likelihood of stone-free status.
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Affiliation(s)
- Satoshi Washino
- The Department of Urology, Nishi-Omiya Hospital, Saitama, Japan. .,The Department of Urology, Jichi Medical University Saitama Medical Center, 1-847 Amanuma-cho, Omiya-ku, Saitama, 330-8503, Japan.
| | - Takanori Hayase
- The Department of Urology, Jichi Medical University Saitama Medical Center, 1-847 Amanuma-cho, Omiya-ku, Saitama, 330-8503, Japan
| | - Tomoaki Miyagawa
- The Department of Urology, Jichi Medical University Saitama Medical Center, 1-847 Amanuma-cho, Omiya-ku, Saitama, 330-8503, Japan
| | - Yoshiaki Arai
- The Department of Urology, Nishi-Omiya Hospital, Saitama, Japan
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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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Komeya M, Odaka H, Watanabe T, Kiuchi H, Ogawa T, Yao M, Matsuzaki J. Gap between UAS and ureteroscope predicts renal stone-free rate after flexible ureteroscopy with the fragmentation technique. World J Urol 2020; 39:2733-2739. [PMID: 32986134 DOI: 10.1007/s00345-020-03459-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 05/08/2020] [Accepted: 09/10/2020] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To assess the effect of our new classification on surgical outcomes after flexible ureteroscopy (fURS) for kidney stones. METHODS We retrospectively examined 128 patients after single renal fURS procedures performed using ureteral access sheaths (UASs) with the fragmentation technique. Based on the gap (calculated by subtracting the ureteroscope diameter from the UAS diameter), enrolled patients were divided into three groups: small (< 0.6 mm), medium (0.6 to < 1.2 mm), and large space groups (≥ 1.2 mm). Stone-free (SF) status was defined as either complete absence of stones (SF) or the presence of stones < 4 mm in diameter on non-contrast computed tomography (NCCT). RESULTS The SF rate was significantly lower in the small space group (50% in small, 97.9% in medium, 89.2% in large; p = 0.001). Perioperative complications over Clavien-Dindo Grade I were observed in 16.7%, 4.2%, and 8.1% of patients, respectively (p = 0.452). The ratio of stone volume and operative time (efficiency of stone removal) was significantly higher in the large space group compared to the small and medium space groups (0.009 ± 0.003 ml/min, 0.013 ± 0.005 ml/min, 0.027 ± 0.012 ml/min, respectively; p < 0.001). CONCLUSION Our findings that gaps > 0.6 mm (1.8 Fr), including the combination of a 9.5-Fr UAS and a small caliber ureteroscope, improve SF rates, and larger gaps facilitate stone removal efficiency providing the basis for future development of clinical protocols aimed at improving outcomes.
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Affiliation(s)
- Mitsuru Komeya
- Department of Urology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan. .,Department of Urology, Yokohama City University Medical Center, 4-57 Urafune, Minami-ku, Yokohama, Kanagawa, 223-0024, Japan.
| | - Hisakazu Odaka
- Department of Urology, Ohguchi East General Hospital, 2-19-1 Irie, Kanagawa-ku, Yokohama, Kanagawa, 221-0014, Japan
| | - Takahiko Watanabe
- Department of Urology, Ohguchi East General Hospital, 2-19-1 Irie, Kanagawa-ku, Yokohama, Kanagawa, 221-0014, Japan
| | - Hirokazu Kiuchi
- Department of Urology, Ohguchi East General Hospital, 2-19-1 Irie, Kanagawa-ku, Yokohama, Kanagawa, 221-0014, Japan
| | - Takehiko Ogawa
- Department of Urology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Masahiro Yao
- Department of Urology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Junichi Matsuzaki
- Department of Urology, Ohguchi East General Hospital, 2-19-1 Irie, Kanagawa-ku, Yokohama, Kanagawa, 221-0014, Japan
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Abstract
PURPOSE OF REVIEW Equipment used in endourology is constantly evolving due to increasing incidence of urolithiasis. Suctioning has been used mainly in PCNL in conjunction with ultrasonic and ballistic devices for stone removal. Recently technological advances permitted the use of suctioning in more endourological techniques. This review aims to summarize the literature regarding these advancements and analyze the upcoming results. RECENT FINDINGS Several centers have conducted experimental and clinical studies on suctioning use during PCNL, mPCNL, and ureteroscopy and concluded that it is an effective and safe adjustment that improves stone-free rates and limits complication rates after these procedures. Suctioning use during common endourological procedures led to improved safety and efficacy among several indications. Due to the observational nature and small sample size of many studies, larger RCTs are needed to make safe conclusions.
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Affiliation(s)
- Lazaros Tzelves
- 2nd Department of Urology, National and Kapodistrian University of Athens, Sismanogleion Hospital, Athens, Greece
| | - Andreas Skolarikos
- 2nd Department of Urology, National and Kapodistrian University of Athens, Sismanogleion Hospital, Athens, Greece.
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Lai S, Jiao B, Jiang Z, Liu J, Seery S, Chen X, Jin B, Ma X, Liu M, Wang J. Comparing different kidney stone scoring systems for predicting percutaneous nephrolithotomy outcomes: A multicenter retrospective cohort study. Int J Surg 2020; 81:55-60. [PMID: 32738550 DOI: 10.1016/j.ijsu.2020.07.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 04/10/2020] [Revised: 06/26/2020] [Accepted: 07/06/2020] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To compare the predictive performance of five previously described scoring systems (i.e., S.T.O.N.E., Guy's, Clinical Research Office of the Endourological Society (CROES), the Seoul National University Renal Stone Complexity (S-RESC) and the new Stone Kidney Size (SKS) score) for postoperative outcomes regarding stone-free rate (SFR) and complications in adult patients. METHODS Data from 349 patients who underwent percutaneous nephrolithotomy (PCNL) in three urology departments were analyzed. SKS, S.T.O.N.E., S-ReSC, CROES and Guy's nephrolithometry scoring systems were used to retrospectively calculate predictions for each patient. Univariate and multivariate analyses were performed to evaluate factors associated with SFR and complication rates. Receiver operating characteristic (ROC) curves were generated and areas under curves (AUC) were compared to identify the method with the highest predictive value. RESULTS Median SKS, S.T.O.N.E., S-ReSC, CROES and Guy's scores were 4, 7, 3, 170.8 and 2, respectively. Overall, SFR was 67.0% (234/349) with a complications rate of 36.7% (128/349). AUCs of each method for predicting stone-free status, highlighted reasonable predictive capabilities with 0.709, 0.806, 0 0.869, 0.207, and 0.735, respectively; however, the S-ReSC scoring system had the best discriminative performance. According to multivariate logistic regression and AUC results, none were effectively capable of predicting complications. CONCLUSIONS All scoring systems correlated significantly with stone-free status; although, S-ReSC appears to have the greatest predictive ability. This method is also relatively easy to implement and highly reproducible. However, none of the methods analyzed are able to accurately predict postoperative complications.
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Affiliation(s)
- Shicong Lai
- Department of Urology, Beijing Hospital; National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China; Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Binbin Jiao
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China; Department of Urology, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Zhaoqiang Jiang
- Department of Urology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan, 450003, China
| | - Jianyong Liu
- Department of Urology, Beijing Hospital; National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China; Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Samuel Seery
- School of Humanities and Social Sciences, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Xin Chen
- Department of Urology, Beijing Hospital; National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Bin Jin
- Department of Urology, Beijing Hospital; National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Xiaomeng Ma
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Ming Liu
- Department of Urology, Beijing Hospital; National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China; Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China.
| | - Jianye Wang
- Department of Urology, Beijing Hospital; National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China; Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China.
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Bozzini G, Aydogan TB, Müller A, Sighinolfi MC, Besana U, Calori A, Lorenzo B, Govorov A, Pushkar DY, Pini G, Pastore AL, Romero-Otero J, Rocco B, Buizza C. A comparison among PCNL, Miniperc and Ultraminiperc for lower calyceal stones between 1 and 2 cm: a prospective, comparative, multicenter and randomised study. BMC Urol 2020; 20:67. [PMID: 32522171 PMCID: PMC7288549 DOI: 10.1186/s12894-020-00636-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 02/17/2020] [Accepted: 05/28/2020] [Indexed: 11/10/2022] Open
Abstract
Background Conventional Percutaneous Lithotripsy (PCNL) has been an effective, successful and easy approach for especially > 1 cm sized calyceal stones however risks of complications and nephron loss are inevitable. Our aim is to compare the efficacy and safety of PCNL, MiniPerc (MP) and UltraMiniPerc (UMP) for lower calyceal stones between 1 and 2 cm with a multicenter prospective randomized study. Methods Between January 2015 and June 2018, 132 consecutive patients with single lower calyceal stone were enrolled. Patients were randomized in three groups; A: PCNL; B: MP; C: UMP. 44 patients for the Group A, 47 for Group B and 41 for Group C. Exclusion criterias were the presence of coagulation impairments, age of < 18 or > 75, presence of infection or serious comorbidities. Patients were controlled with computerized tomography scan after 3 months. A negative CT or an asymptomatic patient with stone fragments < 3 mm size were the criteria to assess the stone-free status. Patient characteristics, stone free rates (SFR) s, complications and re-treatment rates were analyzed. Results The mean stone size were 16.38, 16.82 and 15.23 mm respectively in Group A, B and C(p = 0.34). The overall SFR was significantly higher in Group A (86.3%) and B (82.9%) as compared to Group C (78%)(p < 0.05). The re-treatment rate was significantly higher in Group C (12.1%) and complication rates was higher in Group A (13.6%) as compared to others(p < 0.05). The hospitalization was significantly shorter in Group C compared to Group A (p = 0.04). Conclusions PCNL and MP showed higher efficacy than UMP to obtain a better SFR. Auxiliary and re-treatment rates were higher in UMP. On the other hand for such this kind of stones PCNL had more complications. Overall evaluation favors MP as a better indication in stones 1–2 cm size.
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Affiliation(s)
- Giorgio Bozzini
- Department of Urology, ASST Valle Olona Busto Arsizio, Varese, Italy
| | | | | | | | - Umberto Besana
- Department of Urology, ASST Valle Olona Busto Arsizio, Varese, Italy
| | - Alberto Calori
- Department of Urology, ASST Valle Olona Busto Arsizio, Varese, Italy
| | - Berti Lorenzo
- Department of Urology, ASST Valle Olona Busto Arsizio, Varese, Italy
| | - Alexander Govorov
- Department of Urology, A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - Dmitry Y Pushkar
- Department of Urology, A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | | | | | | | - Bernardo Rocco
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Carlo Buizza
- Department of Urology, ASST Valle Olona Busto Arsizio, Varese, Italy
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Omer Rashid A, Khalid H, Friad G, Hamed RY, Buchholz N. Guy's Stone Score as a Predictor for Stone-Free Rate and Complications in Percutaneous Nephrolithotomy: A Single-Center Report from a Stone Belt Country. Urol Int 2020; 104:746-751. [PMID: 32485709 DOI: 10.1159/000506211] [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: 11/20/2019] [Accepted: 01/27/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To evaluate Guy's Stone Score (GSS) as a grading system for the complexity of renal calculi before percutaneous nephrolithotomy (PCNL) and as a predictor for stone-free rate (SFR) and potential complications in the setting of a developing country with many cases of advanced complex stone disease. PATIENTS AND METHODS We performed a prospective study on 115 patients with renal stones who had PCNL between August 2017 and October 2018. Stone complexity was classified according to GSS using preoperative imaging. The rates of perioperative complications were assessed using the Clavien grading system, and the SFR was assessed in the 3rd postoperative week by abdominal X-ray and renal ultrasound. The χ2 and one-way ANOVA tests were used for statistical analysis. A p value ≤0.05 was considered significant. RESULTS The study included 115 patients (77 males) with a mean age of 50.2 (±13.3) years. Cases were classified according to GSS into 4 grades; there were 24 (20.9%) grade I, 48 (41.7%) grade II, 25 (21.7%) grade III, and 18 (15.7%) grade IV cases. There was a significant inverse correlation between GSS grade and SFR (p < 0.001). The rate of complications using the Clavien grading system were significantly higher in GSS grades III and IV (p = 0.002). So were the rates of blood transfusion, the need for >1 access tract, and the duration of hospitalization. CONCLUSION GSS is a simple and easily reproducible system to classify the complexity of renal stones. In our setting, it also proved an excellent tool to predict SFR, perioperative complications, and associated ancillary procedures. Ultimately, it can help surgeons and, above all, patients to make a more informed decision about their surgery.
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Affiliation(s)
| | - Huthiem Khalid
- Department of Urology, Sulaimany University Hospital, Sulaimany, Iraq
| | - Goran Friad
- Department of Urology, Shar Teaching Hospital, Sulaimany, Iraq.,U-merge Ltd., London, United Kingdom
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Yavuz A, Kilinc MF, Bayar G. Outcomes of different minimally invasive techniques in lower calyceal stones of 1 to 2 centimeters: A prospective, randomized study. ARCH ESP UROL 2020; 73:307-315. [PMID: 32379066] [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] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To compare efficiency, safety and full cost of lower retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PNL) types for the treatment of lower calyceal stones between 1 and 2 cm in size. METHODS This was a prospective, randomized study. In all, 175 patients were randomly divided into five groups of 35 patients each: Group A was managed by RIRS, Group B by micro PNL, Group C by ultra-mini PNL, Group D by mini PNL, and Group E by standard PNL. Operating and fluoroscopy time, length of hospital stay, stone-free rates (SFR), complications, secondar y ureterolithotripsy and cost were compared between groups. RESULTS: A total of 168 patients were included in the final analysis. The SFR was 76%, 77%, 90.1%, 94.1% and 94%; median length of hospital stay 1, 1.5, 2, 2, and 3 days was for RIRS, micro, ultra-mini, mini, and standard PNL, respectively (p<0.001). The mean costs of the procedures per case were $1,250, $962,$695, $632, and $619, and the mean return to daily activities time was 3.9, 4.5, 6.5, 9.3, and 13.5 days for RIRS, micro, ultra-mini, mini,and standard PNL, respectively (p<0.001). CONCLUSIONS SFR of treatment of lower calyceal stone was higher in ultra-mini, mini and standard PNL than micro PNL and RIRS. Moreover, patients should be informed about the results of all different procedures ; with increasing of the invasiveness of treatment, cost of the procedure decrease; but the hospital stay and return to daily activity interval increase.
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Affiliation(s)
- Abdulmecit Yavuz
- Urology Department. Iskenderun Gelisim Private Hospital. Istanbul. Turkey
| | | | - Goksel Bayar
- Urology Department. Martyr Prof Dr Ilhan Varank Sancaktepe Training and Research Hospital. Istanbul. Turkey
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Asi T, Dogan HS, Altan M, Bozaci AC, Ceylan T, Asci A, Tekgul S. Shockwave lithotripsy for kidney stones as a first-line therapy in children younger than 2 years. J Pediatr Urol 2020; 16:193.e1-193.e6. [PMID: 32037146 DOI: 10.1016/j.jpurol.2020.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 09/08/2019] [Accepted: 01/02/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND The incidence of urolithiasis in children has risen worldwide over the last decades with geographical varieties. As pediatric patients begin forming stones earlier in life, they have high risk of recurrence. Extracorporeal shockwave lithotripsy (SWL) is a non-invasive treatment modality that is preferred in the management of pediatric stones. Reports about the safety and efficacy of SWL in patients younger than 24 months are scarce in the literature. OBJECTIVE The aim of the study was to evaluate the effectiveness and safety of SWL in patients younger than 24 months. The authors also aimed to assess the validity of the Dogan nomogram in predicting stone-free rates. STUDY DESIGN Between January 2009 and March 2019, data of 247 patients younger than 24 months at the time of SWL were retrospectively collected. Analysis was performed on 260 renal units. Success was considered in patients who were completely free of stones after the first session. RESULTS AND DISCUSSION The female/male ratio was 103/157, with a median age of 15 (5-24) months, a median stone size of 8 (3-30) mm and a median follow-up period of 7 (3-20) months. Multiple stones and lower calyx stones were observed in 19.6% (51/260) and 23.4% (61/260) of patients, respectively. Complications were detected in 5.8% (15/260) of patients (9 with steinstrasse, 3 with UTI, 2 with vomiting, 1 with hematuria). After the first session, 56.9% (148/260) of patients were stone-free. Forty-six of the failed 112 first sessions underwent second session. A total of 5 patients had a third session. The efficacy quotient was 57%. On univariate analysis, younger age (≤16 months), single stone, small stone size (<10 mm), and non-lower pole location were significant predictors of stone clearance. On multivariate analysis, younger age (=<16 months) and single stone remained significant. The Dogan nomogram score lower than 150 was found to be a good cutoff point to predict better stone clearance (Table). CONCLUSION Shockwave lithotripsy is a safe and effective treatment modality in patients younger than 24 months and could be the first option in this particular age-group in whom the other endourological modalities are not always applicable. The Dogan nomogram is reliable in predicting the stone-free rate in this age-group.
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Affiliation(s)
- Tariq Asi
- Department of Urology, Hacettepe University, Faculty of Medicine, Ankara, Turkey.
| | - Hasan Serkan Dogan
- Department of Urology, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Mesut Altan
- Department of Urology, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Ali Cansu Bozaci
- Department of Urology, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Taner Ceylan
- Department of Urology, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Ahmet Asci
- Department of Urology, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Serdar Tekgul
- Department of Urology, Hacettepe University, Faculty of Medicine, Ankara, Turkey
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Jiao B, Luo Z, Xu X, Zhang M, Zhang G. Minimally invasive percutaneous nephrolithotomy versus retrograde intrarenal surgery in surgical management of upper urinary stones - A systematic review with meta-analysis. Int J Surg 2019; 71:1-11. [PMID: 31521837 DOI: 10.1016/j.ijsu.2019.09.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 06/19/2019] [Revised: 08/14/2019] [Accepted: 09/09/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The purpose of this study was to retrospectively assess the efficacy and safety of minimally invasive nephrolithotomy (MPCNL) versus retrograde intrarenal surgery (RIRS) in the management of upper urinary stones. METHODS A comprehensive literature review of articles that investigated the efficacy and safety of MPCNL and RIRS was conducted by systematically searching PubMed, EMBASE, and Cochrane Library in March 2019. Two reviewers searched the literature, independently extracted the data and evaluated the quality of the data according to the inclusion and exclusion criteria. A meta-analysis was performed by using Review Manager 5.3 software. RESULTS Eight randomized controlled trials (RCTs) involving 725 patients with upper urinary stones were analysed based on the inclusion criteria. While MPCNL has a better clinical efficacy than RIRS with respect to the stone-free rate (SFR) [RR = 1.11, 95% CI (1.05-1.17), p = 0.0005], MPCNL has a higher incidence of haematoma [RR = 3.09, 95% CI (1.44-6.66), p = 0.004] and longer hospitalization time [MD = 0.89 day, 95% CI (0.07-1.72), p = 0.04]. In addition, no significant difference in operative time [MD = 2.46 min, 95% CI (-17.99 to 22.92), p = 0.81] and postoperative pain score [MD = 0.74, 95% CI (-0.45 to 1.94), p = 0.22] were observed between the two methods. Overall, the evidence was insufficient to suggest a statistically significant difference in the adverse event profile for MPCNL compared with RIRS. CONCLUSIONS Our data suggest that MPCNL is an effective method for treating upper urinary stones, especially lower calyceal stones that are 1-2 cm in size. Compared to RIRS, MPCNL is associated with a longer hospital stay time and a higher incidence of haematoma. In addition, both methods have proven to be safe. Nevertheless, the findings should be further confirmed through well-designed prospective RCTs with a larger patient series.
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Affiliation(s)
- Binbin Jiao
- Peking University China-Japan Friendship School of Clinical Medicine, Yinghuadong Road, Chaoyang District, Beijing, 100029, China; Department of Urology, China-Japan Friendship Hospital, Yinghuadong Road, Chaoyang District, Beijing, 100029, China; Graduate School of Peking Union Medical College, China-Japan Friendship Institute of Clinical Medicine, Yinghuadong Road, Chaoyang District, Beijing, 100029, China.
| | - Zhenkai Luo
- Peking University China-Japan Friendship School of Clinical Medicine, Yinghuadong Road, Chaoyang District, Beijing, 100029, China; Department of Urology, China-Japan Friendship Hospital, Yinghuadong Road, Chaoyang District, Beijing, 100029, China.
| | - Xin Xu
- Department of Urology, China-Japan Friendship Hospital, Yinghuadong Road, Chaoyang District, Beijing, 100029, China.
| | - Meng Zhang
- Peking University China-Japan Friendship School of Clinical Medicine, Yinghuadong Road, Chaoyang District, Beijing, 100029, China; Department of Urology, China-Japan Friendship Hospital, Yinghuadong Road, Chaoyang District, Beijing, 100029, China.
| | - Guan Zhang
- Peking University China-Japan Friendship School of Clinical Medicine, Yinghuadong Road, Chaoyang District, Beijing, 100029, China; Department of Urology, China-Japan Friendship Hospital, Yinghuadong Road, Chaoyang District, Beijing, 100029, China; Graduate School of Peking Union Medical College, China-Japan Friendship Institute of Clinical Medicine, Yinghuadong Road, Chaoyang District, Beijing, 100029, China.
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May M, Schönthaler M, Gilfrich C, Wolff I, Peter J, Miernik A, Fritsche HM, Burger M, Schostak M, Lebentrau S. [Interrater reliability and clinical impact of the Post-Ureteroscopic Lesion Scale (PULS) grading system for ureteral lesions after ureteroscopy : Results of the German prospective multicenter BUSTER project]. Urologe A 2019; 57:172-180. [PMID: 29322235 DOI: 10.1007/s00120-017-0565-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND The Post-ureteroscopic Lesion Scale (PULS) was designed as a standardized classification system for ureteral lesions after uretero(reno)scopy (URS). This study evaluates its routine use and a possible clinical impact based on a representative patient cohort. MATERIALS AND METHODS Data of 307 patients in 14 German centers within the BUSTER project were used to test 3 hypotheses (H): PULS score shows a high interrater reliability (IRR) after independent assessment by urologic surgeon and assistance personnel (H1); PULS score is correlated with the frequency of postoperative complications during hospital stay (H2); post-URS stenting of the ureter is associated with higher PULS scores (H3). RESULTS Median age of patients was 54.4 years (interquartile range [IQR] 44.4-65.8; 65.5% male). Median diameter of index stones was 6 mm (IQR 4-8) with 117 (38.4%) pyelo-caliceal and 188 (61.6%) ureteral stones. Overall, 70 and 82.4% of patients had pre-stenting and post-URS stenting, respectively. Stone-free status was achieved in 68.7% after one URS procedure with a complication rate of 10.8% (mostly grade 1-2 according to Clavien-Dindo). PULS scores 0, 1, 2 and 3 were assessed in 40%, 52.1%, 6.9% and 1% of patients, respectively, when estimated by urologic surgeons. PULS score showed a high IRR between the urologic surgeon and assistance personnel (κ = 0.883, p < 0.001), but was not significantly correlated with complications (ρ = 0.09, p = 0.881). In contrast, a significant positive correlation was found between PULS score and post-URS stenting (ρ = 0.287, p < 0.001). A PULS score of 1 multiplied the likelihood of post-URS stenting by 3.24 (95% confidence interval 1.43-7.34; p = 0.005) as opposed to PULS score 0. CONCLUSIONS Removal of upper urinary tract stones using URS is safe and efficacious. Real-world data provided by this study confirm a high IRR of the PULS score and its clinical impact on the indication for post-URS stenting. A future prospective randomized trial should evaluate a possible standardization of post-URS stenting based on PULS score assessment.
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Affiliation(s)
- M May
- Urologische Kliniken, St. Elisabeth-Klinikum Straubing, St.-Elisabeth-Str. 23, 94315, Straubing, Deutschland.
| | - M Schönthaler
- Urologische Kliniken, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - C Gilfrich
- Urologische Kliniken, St. Elisabeth-Klinikum Straubing, St.-Elisabeth-Str. 23, 94315, Straubing, Deutschland
| | - I Wolff
- Urologische Kliniken, Carl-Thiem-Klinikum Cottbus, Cottbus, Deutschland
| | - J Peter
- Urologische Kliniken, St. Elisabeth-Klinikum Straubing, St.-Elisabeth-Str. 23, 94315, Straubing, Deutschland
| | - A Miernik
- Urologische Kliniken, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - H-M Fritsche
- Urologische Kliniken, Universitätsklinikum Regensburg, Caritas-Krankenhaus St. Josef, Regensburg, Deutschland.,Urologische Abteilung der Chirurgischen Klinik München-Bogenhausen, München, Deutschland
| | - M Burger
- Urologische Kliniken, Universitätsklinikum Regensburg, Caritas-Krankenhaus St. Josef, Regensburg, Deutschland
| | - M Schostak
- Urologische Kliniken, Universitätsklinikum Magdeburg A.ö.R., Magdeburg, Deutschland
| | - S Lebentrau
- Urologische Kliniken, Ruppiner Kliniken GmbH, Hochschulklinikum der MHB, Neuruppin, Deutschland
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Wilhelm K, Hahn O, Schoenthaler M, Hein S, Neubauer J, Schnabel M, Neisius A. Stone-Free Rate after Treating Kidney Stones Exceeding 10 mm via Flexible Ureteroscopy: Can Endoscopic Assessment Replace Low-Dose Computed Tomography Control? Urol Int 2019; 103:326-330. [PMID: 31394535 DOI: 10.1159/000502264] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 04/10/2019] [Accepted: 07/21/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION It is unclear whether endoscopic assessment of the stone-free rate after flexible ureteroscopy (fURS) is as effective as assessment with low-dose computed tomography (CT) scan. METHODS Prospective documentation of patients with kidney stones > 10 mm diameter from 2 different centers (Freiburg, Regensburg), who underwent fURS and were declared to be endoscopically completely stone-free. Low-dose CT control performed 4-8 weeks postoperatively. RESULTS/CONCLUSION Thirty-eight patients were treated between October 2015 and August 2016 (12 F, 26 M). Average age was 55.9 years (range 19-82, SD 17.24), and body mass index was 29.7 kg/m2 (range 23.5-42.5, SD 4.37). There were 2.0 (range 1-7, SD 1.55) stones with a mean diameter of 15 mm (range 10-40, SD 6.78) per kidney. Mean surgery time was 74 min (range 38-124, SD 24.28), and lithotripsy was necessary in 33 cases. CT was performed 5.4 weeks afterwards (range 4-8, SD 1.43). One patient had a 2 mm residual which was extracted by URS. Strictly speaking, endoluminal stone removal control failed in only that patient, yielding a negative predictive value of 97%. A routine postoperative CT scan would thus appear unnecessary in the case of negative endoscopic control for residual fragments and should be avoided to reduce radiation exposure. Further investigations with larger patient populations are necessary.
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Affiliation(s)
- Konrad Wilhelm
- Clinic of Urology, Medical Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany,
| | - Oliver Hahn
- Department of Urology, University Medical Center Göttingen, Göttingen, Germany
| | - Martin Schoenthaler
- Clinic of Urology, Medical Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Simon Hein
- Clinic of Urology, Medical Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Jakob Neubauer
- Department of Radiology, Medical Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Marco Schnabel
- Department of Urology, University of Regensburg, Caritas St. Josef Medical Center, Regensburg, Germany
| | - Andreas Neisius
- Department of Urology, Brüderkrankenhaus Trier, University of Mainz, Trier, Germany
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Kokov D, Manka L, Beck A, Winter A, Gerullis H, Karakiewicz PI, Hammerer P, Schiffmann J. Only Size Matters in Stone Patients: Computed Tomography Controlled Stone-Free Rates after Mini-Percutaneous Nephrolithotomy. Urol Int 2019; 103:166-171. [PMID: 30844789 DOI: 10.1159/000497442] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 11/20/2018] [Accepted: 02/04/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To examine and predicting stone-free rates (SFRs) after minimally invasive-percutaneous nephrolithotomy (mini-PNL) based on computed tomography (CT), instead of X-ray or ultrasound control. PATIENTS AND METHODS We identified 146 mini-PNL patients with pre- and postoperative CT scans. Patient and stone characteristics were assessed. Stone-free status was defined as ≤3 mm residual fragment after mini-PNL according to postsurgery CT scan. Multivariable logistic regression analyses predicted stone-free status after mini-PNL. RESULTS Overall, 62 (42.5%) patients achieved stone-free status after mini-PNL. In multivariable analyses, stone size was the only independent predictor for stone-free status (OR 0.9; p = 0.02). Patients with stones > 20 mm were less likely to achieve stone-free status, than those harboring stones 10-20 mm (OR 0.3; p = 0.009). SFRs according to stone size categories (< 10, 10-20, and > 20 mm) were 33.3, 50.5, and 25%. Body mass index (BMI) and stone density (Houndsfield units) were no independent predictors for stone-free status after mini-PNL. CONCLUSIONS We report lower SFRs than expected. Stone size was the only independent predictor for stone-free status after mini-PNL. Patients with larger stones need to be informed about high risk of additional interventions. High BMI and high stone density do not represent a barrier for stone-free status after mini-PNL.
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Affiliation(s)
- Dmitriy Kokov
- Department of Urology, Academic Hospital Braunschweig, Braunschweig, Germany
| | - Lukas Manka
- Department of Urology, Academic Hospital Braunschweig, Braunschweig, Germany
| | - Andreas Beck
- Department of Urology, Academic Hospital Braunschweig, Braunschweig, Germany
| | - Alexander Winter
- University Hospital for Urology, Klinikum Oldenburg, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Holger Gerullis
- University Hospital for Urology, Klinikum Oldenburg, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Québec, Canada.,Department of Urology, University of Montreal Health Center, Montreal, Québec, Canada
| | - Peter Hammerer
- Department of Urology, Academic Hospital Braunschweig, Braunschweig, Germany
| | - Jonas Schiffmann
- University Hospital for Urology, Klinikum Oldenburg, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany,
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Tao RZ, Tang QL, Zhou S, Jia CP, Lv JL. External physical vibration lithecbole facilitating the expulsion of upper ureteric stones 1.0-2.0 cm after extracorporeal shock wave lithotripsy: a prospective randomized trial. Urolithiasis 2020; 48:71-7. [PMID: 30488093 DOI: 10.1007/s00240-018-1100-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 11/26/2018] [Indexed: 11/17/2022]
Abstract
To observe the efficacy and safety of External Physical Vibration Lithecbole (EPVL) in patients with upper ureteric stones 1.0–2.0 cm after extracorporeal shock wave lithotripsy (ESWL). A total of 271 patients with upper ureteric stones 1.0–2.0 cm were prospectively randomized into two groups. One hundred and twenty-seven cases in the treatment group accepted EPVL therapy and 144 cases as control after ESWL. The stone expulsion status and stone-free rates (SFRs) between two groups were compared at the 1st, 2nd and 4th weekends by imaging examinations. All of 271 patients were randomly assigned to two groups, of which 127 patients were included in the treatment group and 144 in the control group. EPVL was successful in assisting the discharge of stone fragments. The rate of stone expulsion at day 1 in the treatment group was significantly higher than in the control group (79.5% vs. 64.6%, P = 0.006). The SFRs of the 1st weekend (76.3% vs. 61.8%, P = 0.010), the 2nd weekend (88.2% vs. 77.1%, P = 0.017) and the 4th weekend (92.1% vs. 84.0%, P = 0.042) in the treatment group were all significantly higher than that in the control group. However, no statistical significance was found in complications between the two groups (P > 0.05). Furthermore, in the treatment group the patients were treated a mean 4.3 sessions of EPVL. EPVL and ESWL are ideal complementary partners in the treatment of upper ureteric stones 1.0–2.0 cm, satisfying both high SFR and low complication. This method is safe and reproducible in clinical practice, and it also needs large-scale multicenter prospective studies further to prove the above conclusions.
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Wolff I, Lebentrau S, Miernik A, Ecke T, Gilfrich C, Hoschke B, Schostak M, May M. Impact of surgeon's experience on outcome parameters following ureterorenoscopic stone removal. Urolithiasis 2018; 47:473-479. [PMID: 29974193 DOI: 10.1007/s00240-018-1073-7] [Citation(s) in RCA: 8] [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: 03/15/2018] [Accepted: 06/25/2018] [Indexed: 10/28/2022]
Abstract
Within the BUSTER trial, we analyzed the surgeon's amount of experience and other parameters associated with URS procedures regarding the stone-free rate, complication rate, and operative time. Patient characteristics and surgical details on 307 URS procedures were prospectively documented according to a standardized study protocol at 14 German centers 01-04/2015. Surgeon's experience was correlated to clinical characteristics, and its impact on the stone-free rate, complication rate, and operative time subjected to multivariate analysis. 76 (25%), 66 (21%) and 165 (54%) of 307 URS procedures were carried out by residents, young specialists, and experienced specialists (> 5 years after board certification), respectively. Median stone size was 6 mm, median operative time 35 min. A ureteral stent was placed at the end of 82% of procedures. Stone-free rate and stone-free rate including minimal residual stone fragments (adequate for spontaneous clearance) following URS were 69 and 91%, respectively. No complications were documented during the hospital stays of 89% of patients (Clavien-Dindo grade 0). According to multivariate analysis, experienced specialists achieved a 2.2-fold higher stone-free rate compared to residents (p = 0.038), but used post-URS stenting 2.6-fold more frequently (p = 0.023). Surgeon's experience had no significant impact on the complication rate. We observed no differences in this study's main endpoints, namely the stone-free and complication rates, between residents and young specialists, but experienced specialists' stone-free rate was significantly higher. During this cross-sectional study, 75% of URS procedures were performed by specialists. The experienced specialists' more than two-fold higher stone-free rate compared to residents' justifies ongoing efforts to establish structured URS training programs.
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Affiliation(s)
- I Wolff
- Klinik für Urologie und Neuro-Urologie, Unfallkrankenhaus Berlin, Warener Str. 7, 12683, Berlin, Germany. .,Urologische Klinik, Carl-Thiem-Klinikum Cottbus gGmbH, Cottbus, Germany.
| | - S Lebentrau
- Klinik für Urologie und Kinderurologie, Brandenburg Medical School, Ruppiner Kliniken GmbH, Neuruppin, Germany
| | - A Miernik
- Klinik für Urologie, Universitätsklinikum Freiburg, Freiburg, Germany
| | - T Ecke
- Klinik für Urologie, Helios Klinikum Bad Saarow, Bad Saarow, Germany
| | - C Gilfrich
- Klinik für Urologie, Klinikum St. Elisabeth Straubing GmbH, Straubing, Germany
| | - B Hoschke
- Urologische Klinik, Carl-Thiem-Klinikum Cottbus gGmbH, Cottbus, Germany
| | - M Schostak
- Universitätsklinik für Urologie und Kinderurologie, Universitätsklinikum Magdeburg A.ö.R., Magdeburg, Germany
| | - M May
- Klinik für Urologie, Klinikum St. Elisabeth Straubing GmbH, Straubing, Germany
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46
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Atalay HA, Canat L, Bayraktarlı R, Alkan I, Can O, Altunrende F. Evaluation of stone volume distribution in renal collecting system as a predictor of stone-free rate after percutaneous nephrolithotomy: a retrospective single-center study. Urolithiasis 2017. [PMID: 28646306 DOI: 10.1007/s00240-017-0995-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
We analyzed our stone-free rates of PNL with regard to stone burden and its ratio to the renal collecting system volume. Data of 164 patients who underwent PNL were analyzed retrospectively. Volume segmentation of renal collecting system and stones were done using 3D segmentation software with the images obtained from CT data. Analyzed stone volume (ASV) and renal collecting system volume (RCSV) were measured and the ASV-to-RCSV ratio was calculated after the creation of a 3D surface volume rendering of renal stones and the collecting system. Univariate and multivariate statistical analyses were performed to determine factors affecting stone-free rates; also we assessed the predictive accuracy of the ASV-to-RCSV ratio using the receiving operating curve (ROC) and AUC. The stone-free rate of PNL monotherapy was 53% (164 procedures).The ASV-to-RCSV ratio and calyx number with stones were the most influential predictors of stone-free status (OR 4.15, 95% CI 2.24-7.24, <0.001, OR 2.62, 95% CI 1.38-4.97, p < 0.001, respectively). Other factors associated with the stone-free rate were maximum stone size (p < 0.029), stone surface area (p < 0.010), and stone burden volume (p < 0.001). Predictive accuracy of the ASV-to-RCSV ratio was AUC 0.76. Stone burden volume distribution in the renal collecting system, which is calculated using the 3D volume segmentation method, is a significant determinant of the stone-free rate before PCNL surgery. It could be used as a single guide variable by the clinician before renal stone surgery to predict extra requirements for stone clearance.
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Affiliation(s)
- Hasan Anıl Atalay
- Department of Urology, Okmeydanı Training and Research Hospital, Atakoy 5.Kısım, A/9, D: 75, 19 Mayıs street, Bakırköy, Istanbul, Turkey.
| | - Lutfi Canat
- Department of Urology, Okmeydanı Training and Research Hospital, Atakoy 5.Kısım, A/9, D: 75, 19 Mayıs street, Bakırköy, Istanbul, Turkey
| | - Recep Bayraktarlı
- Department of Radiology, Okmeydanı Training and Research Hospital, Sisli, 34750, Istanbul, Turkey
| | - Ilter Alkan
- Department of Urology, Okmeydanı Training and Research Hospital, Atakoy 5.Kısım, A/9, D: 75, 19 Mayıs street, Bakırköy, Istanbul, Turkey
| | - Osman Can
- Department of Urology, Okmeydanı Training and Research Hospital, Atakoy 5.Kısım, A/9, D: 75, 19 Mayıs street, Bakırköy, Istanbul, Turkey
| | - Fatih Altunrende
- Department of Urology, Okmeydanı Training and Research Hospital, Atakoy 5.Kısım, A/9, D: 75, 19 Mayıs street, Bakırköy, Istanbul, Turkey
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47
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Zhou X, Sun X, Chen X, Gong X, Yang Y, Chen C, Yao Q. Effect of Obesity on Outcomes of Percutaneous Nephrolithotomy in Renal Stone Management: A Systematic Review and Meta-Analysis. Urol Int 2017; 98:382-390. [PMID: 28152527 DOI: 10.1159/000455162] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 12/13/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Percutaneous nephrolithotomy (PCNL) has been widely used to treat renal stones. The application of PCNL in obese patients results in the emergence of a number of challenges. This study compared the effect of obesity on the outcomes of PCNL in kidney stone treatment. METHODS Eligible studies were searched in PubMed, Web of Science, and Cochrane Library databases. Data were analyzed using RevMan statistical software, weighted mean differences, ORs, and 95% CIs were calculated. RESULTS Seven studies involving 2,720 normal-weight, 1,686 obese, and 286 super-obese individuals were included in this meta-analysis. A pooled analysis of safety revealed that no obvious differences in terms of complication rates after treatment existed between obese and normal-weight individuals (OR 0.97, 95% CI 0.80-1.16, p = 0.73), and between super-obese and normal-weight individuals (OR 0.88, 95% CI 0.61-1.27, p = 0.49). A pooled analysis of effectiveness revealed that no obvious difference in terms of stone-free rate after treatment existed between obese and normal-weight individuals (OR 0.98, 95% CI 0.84-1.15, p = 0.79), and between super-obese and normal-weight individuals (OR 1.20, 95% CI 0.88-1.63, p = 0.25). Moreover, no obvious differences in terms of length of hospital stay after treatment existed between super-obese and normal-weight individuals (95% CI -0.15 to 0.37, p = 0.39). Additionally, no obvious differences in terms of operation time existed between obese and normal-weight individuals (95% CI -3.36 to 1.17, p = 0.34). However, the operation time was longer among super-obese individuals than among normal-weight individuals (95% CI -22.64 to -1.40, p = 0.03), and the length of hospital stay was shorter among obese patients than among normal-weight patients (95% CI 0.04-0.34, p = 0.01). No publication bias was observed in this work. CONCLUSION The PCNL performed in normal-weight, obese, and super-obese individuals for kidney stone treatment showed similar outcomes, except that operation time was longer among super-obese individuals and the hospital stay was shorter in obese individuals than in other groups. Thus, PCNL is a safe and efficacious treatment for renal stones in patients of all sizes.
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Affiliation(s)
- Xiangjun Zhou
- Department of Urology, Taihe Hospital, Hubei University of Medicine, Shiyan, China
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48
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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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Rabah DM, Mabrouki MS, Farhat KH, Seida MA, Arafa MA, Talic RF. Comparison of escalating, constant, and reduction energy output in ESWL for renal stones: multi-arm prospective randomized study. Urolithiasis 2016; 45:311-316. [PMID: 27687681 DOI: 10.1007/s00240-016-0912-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 08/10/2016] [Indexed: 11/29/2022]
Abstract
This study was designed to find out the optimized energy delivery strategy in Shock Wave Lithotripsy (SWL) that yield to the best stone-free rate (SFR). In this clinical trial, 150 consecutive patients were randomized into three groups: (a) Dose escalation, 1500 SW at 18 kV, followed by 1500 SW at 20 kV then 1500 SW at 22 kV. (b) Constant dose, 4500 SW at 20 kV. All patients undergo plain X-ray film of the urinary tract at day 1, 14, and 90 to assess stone-free rate (SFR) which was defined as no stones or painless fragments less than 4 mm. (c) Dose reduction, 1500 SW at 22 kV, followed by 1500 SW at 20 kV and then 1500 SW at 18 kV. The three treatment groups were comparable in terms of age, sex, stone size and distribution of the kidneys, and the need for Double J stent use. On day 90, the SFR achieved was 82, 90, and 84 % in the escalating, constant, and reduction energy groups, respectively. However, this rate was not statistically significant (x 2 = 1.38, p level = 0.28). At a slow rate of 60 shocks, there was no difference in stone-free rate between different voltages at 1, 14, and 90 days. Our randomized clinical trial showed no statistically significant difference in SFR between the three groups while using the slow SWL rate. Our trial is the first randomized trial comparing the three strategies. As such, a dose adjustment strategy while delivering SWL in slow rate was not recommended.
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Affiliation(s)
- Danny M Rabah
- Surgery Department, Cancer Research Chair, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohamed S Mabrouki
- Surgery Department, Cancer Research Chair, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Karim H Farhat
- Cancer Research Chair, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
| | | | - Mostafa A Arafa
- Cancer Research Chair, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Riyadh F Talic
- Surgery Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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50
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Giusti G, Proietti S, Villa L, Cloutier J, Rosso M, Gadda GM, Doizi S, Suardi N, Montorsi F, Gaboardi F, Traxer O. Current Standard Technique for Modern Flexible Ureteroscopy: Tips and Tricks. Eur Urol 2016; 70:188-194. [PMID: 27086502 DOI: 10.1016/j.eururo.2016.03.035] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 03/31/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Thanks to advancements in the endoscopic armamentarium, flexible ureteroscopy (fURS) has become a viable and attractive option for the treatment of renal stones because of its high stone-free rates (SFRs) and low morbidity. OBJECTIVE To describe our surgical technique for fURS, step-by-step, for the treatment of renal stones and to assess its effectiveness and safety. DESIGN, SETTING, AND PARTICIPANTS A retrospective analysis of 316 consecutive patients who underwent fURS for renal stones at our institution between March 2014 and September 2015 was performed. SURGICAL PROCEDURE Ureteroscopy and laser lithotripsy using a standardized technique with last-generation flexible ureteroscopes. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Clinical data were collected in a dedicated database. Intraoperative and postoperative outcomes were assessed. A descriptive statistical analysis was performed. RESULTS AND LIMITATIONS The mean overall stone size was 16.5 ± 7.9mm. Ureteral access sheath placement was possible in 287 patients (90.8%). At 1-mo follow-up, the overall primary SFR was 79.1%; the secondary and tertiary SFRs were 89.5% and 91.5%, respectively. The mean operative time was 72.6 ± 27.5min. The mean number of procedures was 1.27. Complications were reported in 92 patients (29.1%) overall, with Clavien grade 1 in 55 patients (17.4%), grade 2 in 30 patients (9.5%), grade 3 in 6 patients (1.9%), grade 4 in 1 patient (0.3%), and grade 5 in none. The main limitation of the study was the retrospective nature. CONCLUSIONS The fURS procedure is safe and effective for the treatment of renal stones. A staged procedure is necessary to achieve stone-free status with large calculi. PATIENT SUMMARY Flexible ureteroscopy is an effective treatment with low complication rates for the majority of renal stones. Both the modern highly technological armamentarium and surgical know-how should be available.
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Affiliation(s)
- Guido Giusti
- Urology Department, IRCCS San Raffaele Scientific Institute, Ville Turro Division, Milan, Italy.
| | - Silvia Proietti
- Urology Department, IRCCS San Raffaele Scientific Institute, Ville Turro Division, Milan, Italy; Urology Department, Tenon Hospital, Pierre and Marie Curie University, Paris, France
| | - Luca Villa
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Urology Department, Tenon Hospital, Pierre and Marie Curie University, Paris, France
| | - Jonathan Cloutier
- Urology Department, Tenon Hospital, Pierre and Marie Curie University, Paris, France
| | - Marco Rosso
- Urology Department, IRCCS San Raffaele Scientific Institute, Ville Turro Division, Milan, Italy
| | - Giulio Maria Gadda
- Urology Department, IRCCS San Raffaele Scientific Institute, Ville Turro Division, Milan, Italy
| | - Steeve Doizi
- Urology Department, Tenon Hospital, Pierre and Marie Curie University, Paris, France
| | - Nazareno Suardi
- Urology Department, IRCCS San Raffaele Scientific Institute, Ville Turro Division, Milan, Italy
| | - Francesco Montorsi
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Franco Gaboardi
- Urology Department, IRCCS San Raffaele Scientific Institute, Ville Turro Division, Milan, Italy
| | - Olivier Traxer
- Urology Department, Tenon Hospital, Pierre and Marie Curie University, Paris, France
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