1
|
Scoffone CM, Cracco CM. 'Case of the Month' from the Department of Urology, Cottolengo Hospital, Torino, Italy: endoscopic combined intrarenal surgery (ECIRS) for a partial staghorn renal stone, one-step solution using a new percutaneous basket. BJU Int 2024. [PMID: 38623030 DOI: 10.1111/bju.16372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
|
2
|
John J, Wellman M, Dixon C, Kellermann T, Wisniewski P, Kopeć K, Trzciński J, Kopeć D, Ciach T, Fieggen G, Kaestner L, Lazarus J. Introducing an lsoprenaline Eluting Guidewire: Report on its Design and the Results of the Dose-Determining Pilot Study. J Endourol 2024. [PMID: 38468539 DOI: 10.1089/end.2023.0745] [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] [Indexed: 03/13/2024] Open
Abstract
Introduction: Retrograde intrarenal surgery (RIRS) is associated with complications, many of which are related to the intrarenal pressure (IRP). We aim to describe the design of a novel isoprenaline-eluting guidewire ("IsoWire") and present the results from the first in vitro release studies and the first animal studies showing its effect on IRP. Materials and Methods: The IsoWire comprises a Nitinol core surrounded by a stainless-steel wire wound into a tight coil. The grooves created by this coil provided a reservoir for adding a hydrogel coating into which isoprenaline, a beta-agonist, was loaded. Animal studies were performed using a porcine model. For the control, IRP, heart rate (HR), and mean arterial pressure (MAP) were measured continuously for 6 minutes with a standard guidewire in place. For the experiment, the standard hydrophilic guidewire was removed, the IsoWire was inserted into the renal pelvis, and the same parameters were measured. Results: In vitro analysis of the isoprenaline release profile showed that most (63.9 ± 5.9%) of the loaded drug mass was released in the 1st minute, and almost all of the drug was released in the first 4 minutes exponentially. Porcine studies showed a 25.1% reduction in IRP in the IsoWire that released 10 μg in the 1st minute; however, there was a marked increase in HR. The average percentage reduction in IRP was 8.95% and 21.3% in the IsoWire that released 5 and 7.5 μg of isoprenaline, respectively, with no changes in HR or MAP. Conclusions: The IsoWire, which releases 5 and 7.5 μg of isoprenaline in the 1st minute, appears to be safe and effective in reducing the IRP. Further studies are needed to establish whether the isoprenaline-induced ureteral relaxation will render easier insertion of a ureteral access sheath, reduce IRP during sheathless RIRS, or even promote the practice of sheathless RIRS.
Collapse
Affiliation(s)
- Jeff John
- Division of Urology, Department of Surgery, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
- Division of Urology, Department of Surgery, Frere Hospital and Walter Sisulu University, East London, South Africa
| | - Mark Wellman
- Division of Urology, Department of Surgery, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Charné Dixon
- Division of Clinical Pharmacology, Department of Medicine, University of Stellenbosch, Cape Town, South Africa
| | - Tracy Kellermann
- Division of Clinical Pharmacology, Department of Medicine, University of Stellenbosch, Cape Town, South Africa
| | | | - Kamil Kopeć
- Department of Biotechnology and Bioprocess Engineering, Laboratory of Biomedical Engineering, Warsaw University of Technology, Warsaw, Poland
| | - Jakub Trzciński
- Department of Biotechnology and Bioprocess Engineering, Laboratory of Biomedical Engineering, Warsaw University of Technology, Warsaw, Poland
| | - Daniel Kopeć
- Department of Biotechnology and Bioprocess Engineering, Laboratory of Biomedical Engineering, Warsaw University of Technology, Warsaw, Poland
| | - Tomasz Ciach
- Department of Biotechnology and Bioprocess Engineering, Laboratory of Biomedical Engineering, Warsaw University of Technology, Warsaw, Poland
| | - Graham Fieggen
- Division of Neurosurgery, Department of Surgery, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Lisa Kaestner
- Division of Urology, Department of Surgery, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - John Lazarus
- Division of Urology, Department of Surgery, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| |
Collapse
|
3
|
Chen Y, Xi H, Yu Y, Cheng X, Yang H, Deng W, Liu W, Wang G, Zhou X. Flexible ureteroscopy with novel flexible ureteral access sheath versus mini-percutaneous nephrolithotomy for treatment of 2-3 cm renal stones. Int J Urol 2024; 31:281-286. [PMID: 38017651 DOI: 10.1111/iju.15347] [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: 05/14/2023] [Accepted: 11/10/2023] [Indexed: 11/30/2023]
Abstract
OBJECTIVES To assess and compare the effectiveness and safety of flexible ureteroscopy (f-URS) with a novel flexible ureteral access sheath (f-UAS) versus mini-percutaneous nephrolithotripsy (mini-PCNL) in treating 2-3 cm renal stones. METHODS Retrospectively analyzed consecutive cases that underwent f-URS with f-UAS (12/14 Fr) from January 29, 2022, to November 30, 2022. Consecutive cases that underwent mini-PCNL (18 Fr) from June 5, 2021, to January 26, 2022, were selected as controls. The f-UAS is a novel device with a 10 cm anterior tip that passively bends along with the f-URS to enter the renal calyx. We analyzed demographic characteristics, stone parameters, operative time, stone-free rates (SFR), hospitalization time, and complication. RESULTS A total of 96 consecutive cases that underwent f-URS with f-UAS and 96 consecutive cases that underwent mini-PCNL were included in the study. There were no significant differences between the two groups in terms of operative time (p = 0.06), stone volume clearance (p = 0.533) and complete SFR (p = 0.266) on the first postoperative day or residual Stone after 1 month (p = 0.407). We observed a significantly shorter postoperative hospital stay (1.4 days vs. 2.1 days; p < 0.001) and a lower decrease in hemoglobin levels (0.39 g/dL vs. 0.68 g/dL; p < 0.001) in the f-UAS group. The mini-PCNL group had a significantly higher overall complication rate (13.5%) compared with the f-UAS group (5.2%; p = 0.048). CONCLUSIONS In the treatment of 2-3 cm renal stones, f-URS with a novel f-UAS may provide a superior alternative to mini-PCNL, potentially challenging its established status.
Collapse
Affiliation(s)
- Yujun Chen
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Haibo Xi
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yue Yu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xiaofeng Cheng
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Heng Yang
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Wen Deng
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Wei Liu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Gongxian Wang
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xiaochen Zhou
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| |
Collapse
|
4
|
Gokce MI, Mazzon G, Nguyen D, Perez BM, Ibis MA, Zeng G, Sarica K. Navigating Entire Collecting System During Supine Percutaneous Nephrolithotomy: Is Rigid Nephroscopy Enough? A Prospective Study by International Alliance of Urolithiasis Supine Percutaneous Nephrolithotomy Working Group. J Laparoendosc Adv Surg Tech A 2024. [PMID: 38364181 DOI: 10.1089/lap.2024.0025] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024] Open
Abstract
Background: During percutaneous nephrolithotomy (PCNL), accessibility to the entire collecting system is crucial to check the presence of any residual stone fragments. In this study, we aimed to identify the rate of accessibility of all caliceal cavities using lower-, middle- and, upper-pole punctures and the eventual benefit of simultaneous utilization of retrograde/antegrade flexible nephroscopy. Materials and Methods: Data of patients undergone supine PCNL in five different institutions were collected prospectively. Access status to other poles of the kidney with a rigid nephroscope, antegrade access status to the other poles of the kidney with a flexible nephroscope, or retrograde access with a flexible ureterorenoscope were all evaluated together with detection of residual fragments. Access status to the other poles of the kidney with anterograde and retrograde approaches were compared. Results: Data of 226 patients were analyzed and stone-free status was achieved in 207 (91.6%) of the patients. The entire collecting system could be successfully approached by a rigid nephroscope in 50% of the cases through middle-pole puncture. This rate was significantly higher than that of lower-pole puncture (37.1%) and upper-pole puncture (28.1%) (P = .035). The successful approach to the entire collecting system with retrograde ureterorenoscopy was possible in 97.6% of the cases, while the successful approach was possible in 48 of the 60 cases (80%) with the retrograde approach (P < .0001). Conclusions: During PCNL, evaluation of the entire collecting system with rigid nephroscopy is not possible in a significant portion of the patients. We believe that the application of flexible nephroscopy, particularly via retrograde approach improves the stone-free rates.
Collapse
Affiliation(s)
- Mehmet Ilker Gokce
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Giorgio Mazzon
- Department of Urology, aulss7 Pedemontana, San Bassiano Hospital, Bassano del Grappa, Italy
| | - Dong Nguyen
- Department of Urology, Binh Dan Hospital, SaiGon, Viet Nam
| | - Braulio Manzo Perez
- Endourology Department, Hospital Regional de Alta Especialidad del Bajío, León, Gto, México
| | - Muhammed Arif Ibis
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Guohua Zeng
- Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangdong, China
| | - Kemal Sarica
- Department of Urology, Health Sciences University Sancaktepe Ilhan Varank Training and Education Hospital, Istanbul, Turkey
| |
Collapse
|
5
|
Gelikman DG, Ibanez KR, Reed AM, Hsi RS, Nimmagadda N, Miller NL. Factors Affecting Holmium Laser Efficiency: Comparison of Laryngeal Mask Airway and Endotracheal Intubation During Ureteroscopy for Renal Stones. J Endourol 2024; 38:8-15. [PMID: 37933898 PMCID: PMC10794822 DOI: 10.1089/end.2023.0294] [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] [Indexed: 11/08/2023] Open
Abstract
Introduction: Holmium laser lithotripsy is a standard energy source used for treatment of kidney stones during flexible ureteroscopy. Efficiency of laser surgery may be affected by patient and operator characteristics or perioperative management. Here, we sought to examine intraoperative data from patients undergoing high frequency dusting with high-powered holmium laser lithotripsy to evaluate surgical and demographic factors associated with lasing efficiency (LE). Methods: A total of 82 intraoperative reports were analyzed from an ongoing laser lithotripsy clinical trial evaluating the Lumenis Pulse™ 120H holmium laser with renal stones up to 20 mm in diameter with and without Moses 2.0 technology. For each case, the total pause time between lasing activations was corrected to remove lengthy pauses and divided by the total lasing time to calculate an efficiency percentage. This was then compared with patient demographics, anesthesia administration, stone burden, postoperative complications, and stone-free rates using both univariate and multivariate analyses. Results: Of the 82 included patients, 36 received endotracheal tube (ETT) intubation and 46 had a laryngeal mask airway (LMA). Patients with ETT had significantly higher LE (78.7%) compared to those with an LMA (73.3%) in our univariate analysis (p < 0.01) as well as in the multivariate model that adjusted for maximum stone size, number of stones, stone density, and patient body mass index (p < 0.05). There was also significantly higher mean LE in patients with no postoperative complications (76.3%) compared to those with any grade (I-V) Clavien-Dindo complication within 30 days after surgery (70.0%) (p < 0.05). Conclusions: Flexible ureteroscopy and laser lithotripsy cases with higher LE are associated with lower rates of postoperative complications. The data also support the use of ETT over LMA to improve overall LE; however, this remains one consideration among many for choosing anesthesia administration. Clinical Trial Registration number: NCT04505956.
Collapse
Affiliation(s)
- David G. Gelikman
- University of Central Florida College of Medicine, Orlando, Florida, USA
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kristen R. Ibanez
- University of Central Florida College of Medicine, Orlando, Florida, USA
| | - Amy M. Reed
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ryan S. Hsi
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Naren Nimmagadda
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Brady Urological Institute, Johns Hopkins University, Baltimore, Maryland, USA
| | - Nicole L. Miller
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| |
Collapse
|
6
|
Anderson S, Patterson K, Skolarikos A, Somani B, Bolton DM, Davis NF. Perspectives on technology: to use or to reuse, that is the endoscopic question-a systematic review of single-use endoscopes. BJU Int 2024; 133:14-24. [PMID: 37838621 DOI: 10.1111/bju.16206] [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] [Indexed: 10/16/2023]
Abstract
OBJECTIVE To compare clinical outcomes of single-use endoscopes with those of reusable endoscopes to better define their role within urology. METHODS A systematic search of electronic databases was performed. All studies comparing the clinical outcomes of participants undergoing urological procedures with single-use endoscopes to those of participants treated with reusable endoscopes were included. Results are reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement. RESULTS Twenty-one studies in 3943 participants were identified. Six different single-use flexible ureteroscopes and two different single-use flexible cystoscopes were assessed. There were no differences in mean postoperative infection rates (4.0% vs 4.4%; P = 0.87) or overall complication rates (11.5% vs 11.9%; P = 0.88) between single-use and reusable endoscopes. For patients undergoing flexible ureteroscopy there were no differences in operating time (mean difference -0.05 min; P = 0.96), length of hospital stay (LOS; mean difference 0.06 days; P = 0.18) or stone-free rate (SFR; 74% vs 74.3%; P = 0.54) between the single-use and reusable flexible ureteroscope groups. CONCLUSION This study is the largest to compare the clinical outcomes of single-use endoscopes to those of reusable endoscopes within urology, and demonstrated no difference in LOS, complication rate or SFR, with a shorter operating time associated with single-use flexible cystoscope use. It also highlights that the cost efficiency and environmental impact of single-use endoscopes is largely dependent on the caseload and reprocessing facilities available within a given institution. Urologists can therefore feel confident that whether they choose to 'use' or to 'reuse' based on the financial and environmental implications, they can do so without negatively impacting patient outcomes.
Collapse
Affiliation(s)
- Steven Anderson
- Department of Urology, Beaumont Hospital, Dublin, Ireland
- Department of Surgical Affairs, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | | | - Andreas Skolarikos
- Department of Urology, National and Kapodistrian University of Athens, Athens, Greece
| | - Bhaskar Somani
- Department of Urology, University Hospital Southampton, Southampton, UK
| | - Damien M Bolton
- Department of Urology, Austin Hospital, Melbourne, VIC, Australia
| | - Niall F Davis
- Department of Urology, Beaumont Hospital, Dublin, Ireland
- Department of Surgical Affairs, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| |
Collapse
|
7
|
Guliev B G, Talyshinsky A E, Agagyulov M U, Andrianov A A. [Safety and efficiency of retrograde intrarenal surgery without X-ray guidance]. Urologiia 2023:38-43. [PMID: 38156681] [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] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
INTRODUCTION The main stages of flexible ureteroscopy in patients with renal stones are usually performed under X-ray guidance. Long-term exposure of ionizing radiation can have negative effects on the patients with nephrolithiasis and the operating team. AIM To study the results of retrograde intrarenal surgery (RIRS) without fluoroscopic guidance. MATERIALS AND METHODS The results of flexible ureteroscopy (fURS) without X-ray-guidance in 76 patients were analyzed. There were 46 (53.3%) men and 30 (46.7%) women. The average age was 50.4+/-14.6 years. All patients underwent laboratory tests and non-contrast-enhanced computed tomography to determine the size and density of the stone. In all cases, preoperative ureteral stenting was performed. The average stone size was 10.5+/-4.2 mm. First, ureteroscopy with a rigid endoscope was done to assess the ureter and determine the depth of the introducing ureteral access sheath. After removing the ureteroscope along the guidewire, a ureteral access sheath was put at this distance. An inspection of the collecting system and laser fragmentation of kidney stones were performed using a flexible ureteroscope. In 64 (84.2%) patients, a 4.7 Ch stent was put at the end of the procedure, while in the remaining 12 (15.8%) patients, a ureteral catheter was left for 1-2 days. The operation time, stone-free rate, and the number of intra- and postoperative complications were studied. RESULTS All fURS were successful and performed without X-ray guidance. The average operation time was 42.5+/-8.0 minutes. After the first session, stone-free rate was 92.1% (70/76). In 6 (7.9%) cases, residual stones were found, which were completely removed after the second session. Intraoperative complications, namely perforation of the upper calyx by the distal end of the ureteral access sheath, were observed in 2 (2.6%) patients, which did not require any additional interventions. Postoperative complications occurred in 10 (13.2%) patients, including fever in 6 (7.9%) and hematuria in 4 (5.3%) cases. There were no serious complications, such as ureteral perforation or sepsis, and no blood transfusion was performed. CONCLUSION Flexible ureteroscopy with laser lithotripsy can be performed safely and effectively without X-ray guidance.
Collapse
Affiliation(s)
- G Guliev B
- Department of urology of North-Western State Medical University named after I.I. Mechnikov, Saint Petersburg, Russia
- Center of Urology with robot-assisted surgery of City Mariinsky hospital, Saint Petersburg, Russia
| | - E Talyshinsky A
- Department of urology of North-Western State Medical University named after I.I. Mechnikov, Saint Petersburg, Russia
- Center of Urology with robot-assisted surgery of City Mariinsky hospital, Saint Petersburg, Russia
| | - U Agagyulov M
- Department of urology of North-Western State Medical University named after I.I. Mechnikov, Saint Petersburg, Russia
- Center of Urology with robot-assisted surgery of City Mariinsky hospital, Saint Petersburg, Russia
| | - A Andrianov A
- Department of urology of North-Western State Medical University named after I.I. Mechnikov, Saint Petersburg, Russia
- Center of Urology with robot-assisted surgery of City Mariinsky hospital, Saint Petersburg, Russia
| |
Collapse
|
8
|
Tu WC, Zhang XL, Wang J, Huang BX, Zhang DG, Wang DW. Influence of stone load on the outcome of same-session flexible ureteroscopy for bilateral upper urinary tract stones: a multicenter retrospective study. Front Med (Lausanne) 2023; 10:1163371. [PMID: 38034526 PMCID: PMC10684712 DOI: 10.3389/fmed.2023.1163371] [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: 02/10/2023] [Accepted: 10/12/2023] [Indexed: 12/02/2023] Open
Abstract
Purpose This study aimed to evaluate the efficacy and safety of same-session flexible ureteroscopy (fURS) for the treatment of bilateral upper urinary tract stones and to examine the influence of stone load on the outcome of same-session fURS, stratifying by total diameter of stones (TDS) ≤30 mm vs. >30 mm. Patients and methods We retrospectively reviewed all cases of same-session fURS performed for bilateral upper urinary tract stones at four institutions between January 2017 and September 2020. All patients were divided into two groups based on TDS, ≤30 mm and >30 mm. Data on patient demographics, stone characteristics, surgical results, and complications were collected and analyzed for differences between the two groups. Stone-free rate (SFR) was defined as patients endoscopically stone-free or with radiological fragments <2 mm of each renal unit. Results A total of 121 patients with bilateral upper urinary tract stones underwent same-session fURS, consisting of 73 patients in the TDS ≤ 30 mm group and 48 patients in the TDS > 30 mm group. The mean bilateral stone size was 28.2 ± 12.2 mm (range: 9.1-38.4 mm), with a mean operating time of 97.1 ± 39.6 min (range: 19-220 min). The SFR was 54.5% after the first fURS, and SFR increased to 97.5% after re-fURS for residual stones. The operation time for the TDS > 30 mm group was longer than that of the TDS ≤ 30 mm group (85.1 ± 36.5 vs. 115.4 ± 37.4 min, p < 0.001). The SFR after the first fURS was significantly lower in the TDS > 30 mm group than in the TDS ≤ 30 mm group (25.0% vs. 73.9%, p < 0.001). Although there was no statistically significant difference in overall SFR between the two groups (93.7% vs. 100%, p = 0.060), the rate of re-fURS for residual stones was higher in the TDS > 30 mm group than in the TDS ≤ 30 mm group (75% vs. 26%, p < 0.001). There were no significant differences in length of hospital stay (LOS) (2.2 ± 0.7 vs. 2.3 ± 1.0, p = 0.329) or complication rate (10.9% vs. 14.6%, p = 0.582) between the two groups. Conclusion The results suggested that same-session fURS can be effectively performed with a low complication rate. A higher SFR after the first fURS can be achieved in the case of bilateral upper urinary tract stones with TDS ≤ 30 mm, and priority should be given to same-session fURS.
Collapse
Affiliation(s)
- Wei-Chao Tu
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xin-Le Zhang
- Department of Urology, Kunshan Integrated Traditional Chinese and Western Medicine Hospital, Suzhou, Jiangsu, China
| | - Jun Wang
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bao-Xing Huang
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ding-Guo Zhang
- Department of Urology, Shanghai Pudong New Area People's Hospital, Shanghai, China
| | - Da-Wei Wang
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| |
Collapse
|
9
|
Elbakary M, Alruwaili S. Utilization of Flexible Ureteroscopy in Renal Stones Management in Pediatrics: Single Tertiary Center Experience. Glob Pediatr Health 2023; 10:2333794X231199637. [PMID: 37809363 PMCID: PMC10559721 DOI: 10.1177/2333794x231199637] [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: 07/10/2023] [Revised: 08/12/2023] [Accepted: 08/21/2023] [Indexed: 10/10/2023] Open
Abstract
Objectives. To assess the effectiveness and safety of flexible ureteroscopy in children treated at our center during the last 5 years. Methods. Retrospectively, we have studied 41 children that suffered 51 stone episodes, and FURS for renal calculi <2 cm. Preoperative, operative, and postoperative data were gathered. Results. The mean age of the 41 kids who experienced 51 stone episodes was 9.6 [2.8] years (4.2-16 years). The mean stone diameter was 12.8 [3.3] mm (6-20 mm). The mean operative time was 79.9 [19.9] minutes. The mean hospital stay was 27.6 [12.9] hours. The SFR after the first session was 64.7% and 80.4% after the second session. The overall complications had been recorded in 25 cases (49%) with low morbidity (Clavien grade I-III). Conclusions. Pediatric FURS is a minimally invasive option with a high SFR and a low percentage of high-grade complications in the management of pediatric renal stones.
Collapse
Affiliation(s)
- Mohamed Elbakary
- King Fahd Specialized Hospital, Tabuk, Saudi Arabia
- Tanta University Hospital, Tanta, Egypt
| | | |
Collapse
|
10
|
Jou K, Barrera N, Gallegos Koyner FJ, Chamay S, Nieto A, Ali MM. Uncommon Complications of Cystoscopy: Presentations of Concurrent Perirenal Hematoma and Candida albicans Sepsis. Cureus 2023; 15:e46602. [PMID: 37933348 PMCID: PMC10625845 DOI: 10.7759/cureus.46602] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 10/03/2023] [Indexed: 11/08/2023] Open
Abstract
Subcapsular hematoma (SRH) or perirenal hematoma (PRH) can be seen after trauma, interventional radiological procedures, urological procedures, anticoagulant medications, coagulation disorders, infections, and spontaneously in some patients. Within the urological procedures, PRH can occur after percutaneous nephrolithotomy and extracorporeal shortwave lithotripsy but has only been reported a few times after cystoscopy/ureteroscopy. Here, we present the case of PRH as a complication from cystoscopy with retrograde pyelography in a patient with underlying chronic kidney disease (CKD) and an extensive surgical history for nephrolithiasis. In addition to this, our patient had a further complication of sepsis by Candida albicans, of which the source is proven to be urinary, and it appears that the fungemia was triggered during the procedure as well. The diagnosis was confirmed by abdominal computed tomography (CT), and PRH was proven to resolve with conservative management on repeat imaging months later.
Collapse
Affiliation(s)
- Katerina Jou
- Department of Internal Medicine, St. Barnabas Hospital Health System, New York City, USA
- Department of Clinical Medicine, City University of New York (CUNY) School of Medicine, New York City, USA
| | - Nelson Barrera
- Department of Internal Medicine, St. Barnabas Hospital Health System, New York City, USA
| | | | - Salomon Chamay
- Department of Internal Medicine, St. Barnabas Hospital Health System, New York City, USA
| | - Alejandro Nieto
- Department of Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
| | - Mahmoud M Ali
- Department of Internal Medicine, St. Barnabas Hospital Health System, New York City, USA
| |
Collapse
|
11
|
Cozma C, Geavlete P, Multescu R, Georgescu D, Bragaru M, Geavlete B. Combined semirigid and flexible ureterorenoscopy for the treatment of large renal stones. J Med Life 2023; 16:1364-1368. [PMID: 38107720 PMCID: PMC10719790 DOI: 10.25122/jml-2023-0236] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 08/25/2023] [Indexed: 12/19/2023] Open
Abstract
Ureteroscopy is recognized as a minimally invasive and readily accessible method with low morbidity, favorable outcomes, and rapid post-interventional recovery. Recent advancements in rigid and flexible ureteroscopes have enhanced their efficiency, durability, and capability to accommodate accessory instruments. In this retrospective analysis, we evaluated 75 consecutive patients with large renal stones (stone burden between 2 and 4 cm) treated using a combination of semirigid and flexible ureteroscopy between January 1, 2020, and December 31, 2021. Stone properties and anatomical information were collected from the image archives derived from computed tomography (CT) and/or KUD radiography. Multiple ureteroscopy sessions were required for bigger stones. The length of the hospital stay, operation time, stone-free rate, preoperative and postoperative complications, and complication rates were examined. The average age of the patients was 52.7 years, with a mean stone burden of 31.45 mm. Most stones were in the renal pelvis, followed by the upper calyx. The average operative time was 56.2 minutes. After the initial ureteroscopy session, the stone clearance rate was 76%, which increased to 92% after two ureteroscopy sessions. Complication rates were evaluated using the Clavien-Dindo modified system, with an overall complication rate of 18.4%. Most of the complications were Clavien Grades I and II, with no grade V complication encountered. Large renal stones can be treated by combining semirigid and flexible ureteroscopy to reduce the operative time and protect the flexible ureteroscope.
Collapse
Affiliation(s)
- Cosmin Cozma
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Department of Urology, Sf. Ioan Emergency Clinical Hospital, Bucharest, Romania
| | - Petrisor Geavlete
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Department of Urology, Sf. Ioan Emergency Clinical Hospital, Bucharest, Romania
| | - Razvan Multescu
- Department of Urology, Sf. Ioan Emergency Clinical Hospital, Bucharest, Romania
| | - Dragos Georgescu
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Department of Urology, Sf. Ioan Emergency Clinical Hospital, Bucharest, Romania
| | - Marius Bragaru
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Department of Urology, Sf. Ioan Emergency Clinical Hospital, Bucharest, Romania
| | - Bogdan Geavlete
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Department of Urology, Sf. Ioan Emergency Clinical Hospital, Bucharest, Romania
| |
Collapse
|
12
|
Faria-Costa G, Tsaturyan A, Peteinaris A, Pagonis K, Faitatziadis S, Gkeka K, Natsos A, Anaplioti I, Obaidat M, Vrettos T, Liatsikos E, Kallidonis P. Location of ureteral access sheath in the ureter. Does it affect the fluid flow in different calyces? Cent European J Urol 2023; 76:233-238. [PMID: 38045785 PMCID: PMC10690379 DOI: 10.5173/ceju.2023.03] [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: 01/03/2023] [Revised: 05/16/2023] [Accepted: 07/02/2023] [Indexed: 12/05/2023] Open
Abstract
Introduction The aim of this study was to evaluate outflow variation in different locations of the pyelocaliceal system with the use of different ureteral access sheath (UAS) sizes and different UAS positioning. Material and methods The experimental setup included an anaesthetised porcine model, a 7.5-Fr ureteroscope with a 200-μm laser fibre inserted in the working channel, a hand-held pumping irrigating system, and UAS of different sizes, namely: 9.5/11.5 Fr, 12/14 Fr, and 14/16 Fr. Each UAS was placed just below the ureteropelvic junction (UPJ) or in the mid-ureter. The ureteroscope was placed in the renal pelvis, upper and lower calyces, and outflow measurements were obtained with 3-second interval pumping for one minute in every experimental setup. Results The UAS positioning in the mid-ureter was associated with significantly higher outflow rates in the lower calyx (p = 0.041). While the UAS was below the UPJ, we observed a trend of lower outflow rate in the lower calyx, which was completely inverted when the UAS was in the mid-ureter. Increasing the UAS size from 9.5/11.5 Fr to 12/14 Fr led to a significant increase in outflow in the renal pelvis and upper calyx (p = 0.007), but not in the lower calyx. A further increase to 14/16 Fr did not produce increased flow. Conclusions Different locations of the pyelocaliceal system have different fluid mechanics during fURS. In the renal pelvis and upper calyx increasing the diameter of the UAS improved the outflow, whereas in the lower calyx the position of the UAS seems to be the most relevant factor. These variables should be considered when performing fURS, especially with high-power laser lithotripsy.
Collapse
Affiliation(s)
- Gabriel Faria-Costa
- Department of Urology, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal
- Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | | | | | | | | | | | | | | | | | - Theofanis Vrettos
- Department of Anaesthesiology and ICU, University of Patras, Patras, Greece
| | - Evangelos Liatsikos
- Department of Urology, University of Patras, Patras, Greece
- Department of Urology, Medical University of Vienna, Vienna, Austria
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | | |
Collapse
|
13
|
Yang L, Yin Z, Liu H, Wu X. Initial Experience of Simultaneous Combined use of Percutaneous Nephrolithotomy and Flexible Ureteroscopy in Complex Renal Calculi: A Novel Surgical Technique of 'Through-Through' Approach. Surg Innov 2023; 30:428-431. [PMID: 36971506 DOI: 10.1177/15533506231165827] [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] [Indexed: 08/06/2023]
Abstract
BACKGROUND For complex branched renal calculi, the endoscopic combined intrarenal surgery (ECIRS) is worldwide prevalent. This study aimed to present a novel surgical technique of percutaneous nephrolithotomy combined with antegrade flexible ureteroscopy which is named 'Through-through' approach. METHODS We retrospectively analyzed the data of 68 patients with complex renal calculi who underwent combined PNL and flexible ureteroscopy surgery using 'Through-through' approach at our center between August 2019 and December 2021. The 'Through-through' approach to surgery was indicated in residual calyceal calculi that neither rigid nephroscope nor retrograde flexible ureteroscope could reach. The brief procedure of this technique involved determining the direction of targeted calyces with the nephroscope first, followed by putting flexible ureteroscope into the targeted calyx through the nephroscope instrument channel and basketing or dusting residual calculi through the flexible ureteroscope instrument channel. RESULTS The mean maximum stone diameter was 4.0 ± 0.4 cm. The mean operative duration was 100.1 ± 18.0 minutes, and mean hemoglobin loss was 21.4 ± 5.1 g/L. In all 68 patients, calculi were cleared in 62 patients, and the stone free rate was 91.2%. Five patients underwent further surgery after 2 weeks because of significant residual calculi. One patient that had a 6 mm residual stone chose observational follow-up. Ten patients emerged with postoperative fever but did not progress to uroseptic shock. There were no Clavien grade ≥ III complications, and none of the patients required blood transfusion. CONCLUSION The 'Through-through' approach is safe, feasible and effective for complex renal calculi patients. It is a complementary solution to the failed endoscopic combined intrarenal surgery.
Collapse
Affiliation(s)
- Lei Yang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhikang Yin
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hang Liu
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaohou Wu
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| |
Collapse
|
14
|
Geavlete B, Mareș C, Popescu RI, Mulțescu R, Ene C, Geavlete P. Unfavorable factors in accessing the pelvicalyceal system during retrograde flexible ureteroscopy (fURS). J Med Life 2023; 16:372-380. [PMID: 37168298 PMCID: PMC10165511 DOI: 10.25122/jml-2023-0005] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 02/28/2023] [Indexed: 05/13/2023] Open
Abstract
Flexible ureteroscopy (fURS) is a well-established procedure for treating multiple upper-urinary tract pathologies, particularly renoureteral lithiasis. Endoscopes have undergone significant advancements, including miniaturization, improved optics, and increased maneuverability. In addition, advancements in accessory instruments, such as the performance of laser fibers, guidewires, and extraction probes, have played a significant role in improving the overall performance of flexible ureteroscopy procedures. However, despite these advancements, unique circumstances can make achieving optimum results during flexible ureteroscopy challenging. These include congenital renal anomalies (horseshoe kidneys, ectopic kidneys, rotation anomalies), as well as the unique intrarenal anatomy (infundibulopelvic angle, infundibular length) or the specifications of the endoscope in terms of maneuverability (active and passive deflection). This review explored challenging scenarios during flexible ureteroscopy procedures in the pyelocaliceal system.
Collapse
Affiliation(s)
- Bogdan Geavlete
- Sanador Hospital, Bucharest, Romania
- Department of Urology, Emergency Clinical Hospital Sf. Ioan, Bucharest, Romania
| | - Cristian Mareș
- Department of Urology, Emergency Clinical Hospital Sf. Ioan, Bucharest, Romania
- Corresponding Author: Cristian Mareș, Department of Urology, Emergency Clinical Hospital Sf. Ioan, Bucharest, Romania. E-mail:
| | | | - Răzvan Mulțescu
- Sanador Hospital, Bucharest, Romania
- Department of Urology, Emergency Clinical Hospital Sf. Ioan, Bucharest, Romania
| | - Cosmin Ene
- Department of Urology, Emergency Clinical Hospital Sf. Ioan, Bucharest, Romania
| | - Petrișor Geavlete
- Sanador Hospital, Bucharest, Romania
- Department of Urology, Emergency Clinical Hospital Sf. Ioan, Bucharest, Romania
| |
Collapse
|
15
|
Zhao J, Wang S, Wang J, Li J, Cui L, Li J. Design and experiment of a 3-DoF master device with a 2-DoF parallel mechanism for flexible ureteroscopy. Int J Med Robot 2023; 19:e2459. [PMID: 36098624 DOI: 10.1002/rcs.2459] [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: 06/13/2022] [Revised: 08/19/2022] [Accepted: 08/20/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Traditional commercial master devices and specialied serial master devices meet insufficient workspace, low intuitiveness, low stiffness, and poor accuracy during master-slave mapping for robot-assisted flexible ureteroscopy (FURS). METHODS This paper presents a 3-DoF master device for FURS. A 2-DoF parallel mechanism was designed and utilised in the master device for higher stiffness based on requirements analysis. A Back Propagation Neural Network was built for the forward kinematics of the parallel mechanism during master-slave mapping. Analysis of mechanical characteristics was carried out for the usability of the master device. A contrast experiment on the phantom was conducted to evaluate the performance between the proposed master device and a previous one. RESULTS The completion time for each trial of the proposed master devices is shorter than that of the previous master serial device. Meanwhile, the proposed device provides a more comfortable operating style than the previous one. CONCLUSIONS The proposed 3-DoF configuration for the master device is with more intuitive performance. A better comfort level indicates its usability in clinical applications.
Collapse
Affiliation(s)
- Jianchang Zhao
- Key Laboratory of Mechanism Theory and Equipment Design, Ministry of Education, Tianjin, China.,Institute of Medical Robotics and Intelligent Systems of Tianjin University, Tianjin, China
| | - Shuxin Wang
- Key Laboratory of Mechanism Theory and Equipment Design, Ministry of Education, Tianjin, China.,Institute of Medical Robotics and Intelligent Systems of Tianjin University, Tianjin, China
| | - Jiatong Wang
- Key Laboratory of Mechanism Theory and Equipment Design, Ministry of Education, Tianjin, China.,Institute of Medical Robotics and Intelligent Systems of Tianjin University, Tianjin, China
| | - Jinhua Li
- Key Laboratory of Mechanism Theory and Equipment Design, Ministry of Education, Tianjin, China.,Institute of Medical Robotics and Intelligent Systems of Tianjin University, Tianjin, China
| | - Liang Cui
- Urology Department of Civil Aviation General Hospital, Beijing, China
| | - Jianmin Li
- Key Laboratory of Mechanism Theory and Equipment Design, Ministry of Education, Tianjin, China.,Institute of Medical Robotics and Intelligent Systems of Tianjin University, Tianjin, China
| |
Collapse
|
16
|
Zeng G, Traxer O, Zhong W, Osther P, Pearle MS, Preminger GM, Mazzon G, Seitz C, Geavlete P, Fiori C, Ghani KR, Chew BH, Git KA, Vicentini FC, Papatsoris A, Brehmer M, Martinez JL, Cheng J, Cheng F, Gao X, Gadzhiev N, Pietropaolo A, Proietti S, Ye Z, Sarica K. International Alliance of Urolithiasis guideline on retrograde intrarenal surgery. BJU Int 2023; 131:153-164. [PMID: 35733358 PMCID: PMC10084014 DOI: 10.1111/bju.15836] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES To set out the second in a series of guidelines on the treatment of urolithiasis by the International Alliance of Urolithiasis that concerns retrograde intrarenal surgery (RIRS), with the aim of providing a clinical framework for urologists performing RIRS. MATERIALS AND METHODS After a comprehensive search of RIRS-related literature published between 1 January 1964 and 1 October 2021 from the PubMed database, systematic review and assessment were performed to inform a series of recommendations, which were graded using modified GRADE methodology. Additionally, quality of evidence was classified using a modification of the Oxford Centre for Evidence-Based Medicine Levels of Evidence system. Finally, related comments were provided. RESULTS A total of 36 recommendations were developed and graded that covered the following topics: indications and contraindications; preoperative imaging; preoperative ureteric stenting; preoperative medications; peri-operative antibiotics; management of antithrombotic therapy; anaesthesia; patient positioning; equipment; lithotripsy; exit strategy; and complications. CONCLUSION The series of recommendations regarding RIRS, along with the related commentary and supporting documentation, offered here should help provide safe and effective performance of RIRS.
Collapse
Affiliation(s)
- Guohua Zeng
- Department of Urology, Guangdong Key Laboratory of Urology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Olivier Traxer
- GRC Urolithiasis No. 20, Sorbonne University, Tenon Hospital, Paris, France
| | - Wen Zhong
- Department of Urology, Guangdong Key Laboratory of Urology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Palle Osther
- Department of Urology, Vejle Hospital-a part of Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | | | - Glenn M Preminger
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Giorgio Mazzon
- Department of Urology, San Bassiano Hospital, Vicenza, Italy
| | - Christian Seitz
- Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Petrisor Geavlete
- Sanador Hospital, Bucharest, Romania.,Department of Urology, Sf. Ioan Emergency Clinical Hospital, Bucharest, Romania
| | - Cristian Fiori
- Division of Urology, Department of Oncology, University of Turin, Turin, Italy
| | - Khurshid R Ghani
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Ben H Chew
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Kah Ann Git
- Department of Urology, Pantai Hospital, Penang, Malaysia
| | - Fabio Carvalho Vicentini
- Departamento de Urologia, Faculdade de Medicina da Universidade de São Paulo - FMUSP, Hospital das Clínicas, São Paulo, Brazil
| | - Athanasios Papatsoris
- 2nd Department of Urology, School of Medicine, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Marianne Brehmer
- Division of Urology, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Juan Lopez Martinez
- Department of Urology, Clinic Hospital, University of Barcelona, Barcelona, Spain
| | - Jiwen Cheng
- Department of Urology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Fan Cheng
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xiaofeng Gao
- Department of Urology, Changhai Hospital, Shanghai, China
| | - Nariman Gadzhiev
- Department of Urology, Saint-Petersburg State University Hospital, Saint-Petersburg, Russia
| | | | - Silvia Proietti
- Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Zhangqun Ye
- Department of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Kemal Sarica
- Department of Urology, Medical School, Biruni University, Istanbul, Turkey
| |
Collapse
|
17
|
Lv G, Zhou Y, Qi W, Zhong M, Li R, Zhu Y. Comparison of flexible ureteroscopy in the treatment of 1-2 cm single nephrolithiasis and multiple nephrolithiasis. Front Surg 2023; 10:1114206. [PMID: 36793313 PMCID: PMC9922881 DOI: 10.3389/fsurg.2023.1114206] [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: 12/02/2022] [Accepted: 01/11/2023] [Indexed: 01/31/2023] Open
Abstract
Objective To compare the efficacy of flexible ureteroscopy for single urinary stones with that of multiple urinary stones. Methods A retrospective study was conducted on patients who underwent flexible ureteroscopy in Qilu Hospital of Shandong University from January 2016 to March 2021. Propensity score matching was used to match patients with no statistical difference in preoperative clinical data, and they were divided into solitary calculi and multiple calculi two groups. The postoperative hospital days, operation time, complications and stone free rate were compared between the two groups. And multiple stones were divided into high group (S-ReSc > 4) and non-high group (S-ReSc ≤ 4) for analysis. Results 313 patients were counted. After propensity score matching, 198 patients were finally included in the study. There were 99 cases in the solitary stone group and the multiple stone group. There were no significant differences in postoperative hospital days, complications and stone free rate between the two groups. The operation time of patients with solitary stone group was significantly shorter than that of patients with multiple stones (65.00 min, 45.00 min VS 90.00 min, 50.00 min, P < 0.001). The SFR of high group in the multiple stones group was significantly lower than that in the non-high group (7, 58.3% VS 78, 89.7%, P = 0.013). Conclusion Despite the longer operation time, flexible ureteroscopy has similar outcomes in the treatment of multiple (S-Rec ≤ 4) compared to solitary calculi. Although, this doesn't apply when S-ReSc > 4.
Collapse
Affiliation(s)
- Guangda Lv
- Department of Urology, Qilu Hospital of Shandong University, Jinan, China
| | - Yongheng Zhou
- Department of Urology, Qilu Hospital of Shandong University, Jinan, China
| | - Wenqiang Qi
- Department of Urology, Qilu Hospital of Shandong University, Jinan, China
| | - Minglei Zhong
- Department of Urology, Qilu Hospital of Shandong University, Jinan, China
| | - Rongyang Li
- Department of Thoracic Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Yaofeng Zhu
- Department of Urology, Qilu Hospital of Shandong University, Jinan, China,Correspondence: Yaofeng Zhu
| |
Collapse
|
18
|
Bragaru M, Multescu R, Geavlete P, Popescu R, Geavlete B. Comparison of Flexible Ureteroscope Performance between Reusable and Single-Use Models. J Clin Med 2023; 12. [PMID: 36769740 DOI: 10.3390/jcm12031093] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 01/25/2023] [Accepted: 01/26/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Single-use flexible ureteroscopes for urinary retention have been developed in recent years as an alternative to reusable ureteroscopes in order to eliminate the risk of cross-infections and to solve the primary limitations of traditional reusable flexible ureteroscopes for urinary retention. METHODS In this study, we evaluated and contrasted three of the most recent types of flexible ureteroscopes, including two digital reusable versions (Olympus URF-V and Olympus URF-V2) and one single-use model (Pusen Medi-calUscope UE3022), in both ex vivo and in vivo scenarios. The influence of a variety of instruments on the flow of irrigation and its deflection was investigated ex vivo. In the in vivo investigation, a total of 40 patients were treated with retrograde fURS utilizing URF-V, 20 patients were treated with URF-V2, and 20 patients were treated with single-use fURS. The visibility and maneuverability of each fURS were evaluated by the same urologist during the procedures, and the results were compared. RESULTS Intraoperatively, we compared the image quality of reusable (URF-V and URF-V2) and single-use fURS USCOPE UE3022 cameras and found that there was no statistically significant difference between the two types of camera. The score for maneuverability was the same (4.2) regardless of whether we used the UscopeUE3022 or the URF-V2, but it was significantly lower (3.8, p = 0.03) when we utilized the URF-V. Irrigation was about the same when utilizing reused scopes, whereas employing a single-use scope was more than fifty percent more effective. CONCLUSIONS The findings of our research indicate that reusable and single-use fURs have visibility and maneuverability characteristics that are at least comparable to one another. The possibilities of the single-use type in terms of irrigation flow and deflection are superior.
Collapse
|
19
|
Cosmin C, Georgescu DA, Geavlete P, Popescu RI, Geavlete B. Comparison between Retrograde Flexible Ureteroscopy and Percutaneous Nephrolithotomy for the Treatment of Renal Stones of 2-4 cm. Medicina (Kaunas) 2023; 59. [PMID: 36676748 DOI: 10.3390/medicina59010124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/01/2023] [Accepted: 01/04/2023] [Indexed: 01/11/2023]
Abstract
Background and objectives: Renal stones are widespread, with a lifetime prevalence of 10% in adults. Flexible ureteroscopy enables urologists to treat lower calyx stones or even complex renal stones through the natural orifice and achieve an acceptable stone-free rate. Hence, we analyzed the effectiveness and safety of FURS versus PCNL in treating renal stones between 20 and 40 mm in diameter. Materials and methods: We retrospectively analyzed 250 consecutive patients with large renal solitary stones (stone burden between 2 and 4 cm) from 1 January 2019 to 31 December 2020. The patients were divided into two groups: group 1 (125 patients), in which the patients were treated by a retrograde flexible ureteroscopic approach, and group 2 (125 patients), in which we used percutaneous nephrolithotomy. Stone characteristics and anatomical data were observed based on the computed tomography (CT) and/or KUB (Kidney-ureter-Bladder) radiography imaging archive. Results: The mean stone burden was 26.38 ± 4.453 mm in group 1 and 29.44 ± 4.817 mm in group 2. The stone-free rate after the first ureteroscopy was higher for the PNL(percutaneous nephrolithotomy) group (90.4%) than the F-URS group (68%). After two sessions of ureteroscopy, the SFR was 88.8% in the first group, and after three procedures, the SFR rose to 95.2%. The overall complication rate was higher in group 1 than in group 2 (18.4% vs. 16.8%), but without statistical relevance (p > 0.5). Furthermore, we encountered more grade III and IV complications in the PNL group (8.8% vs. 4.8%, p < 0.05). Conclusion: Flexible ureteroscopy proves to be efficient in treating renal stones over 2 cm. However, the patients must be informed that more than one procedure might be necessary to overcome the entire stone burden.
Collapse
|
20
|
Gauhar V, Castellani D, Chew BH, Smith D, Chai CA, Fong KY, Teoh JYC, Traxer O, Somani BK, Tailly T. Does unenhanced computerized tomography as imaging standard post-retrograde intrarenal surgery paradoxically reduce stone-free rate and increase additional treatment for residual fragments? Outcomes from 5395 patients in the FLEXOR study by the TOWER group. Ther Adv Urol 2023; 15:17562872231198629. [PMID: 37701535 PMCID: PMC10493056 DOI: 10.1177/17562872231198629] [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: 06/28/2023] [Accepted: 08/14/2023] [Indexed: 09/14/2023] Open
Abstract
Background Assessment of residual fragments (RFs) is a key step after treatment of kidney stones. Objective To evaluate differences in RFs estimation based on unenhanced computerized tomography (CT) versus X-rays/ultrasound after retrograde intrarenal surgery (RIRS) for kidney stones. Design A retrospective analysis of data from 20 centers of adult patients who had RIRS was done (January 2018-August 2021). Methods Exclusion criteria: ureteric stones, anomalous kidneys, bilateral renal stones. Patients were divided into two groups (group 1: CT; group 2: plain X-rays or combination of X-rays/ultrasound within 3 months after RIRS). Clinically significant RFs (CSRFs) were considered RFs ⩾ 4 mm. One-to-one propensity score matching for age, gender, and stone characteristics was performed. Multivariable logistic regression analysis was performed to evaluate independent predictors of CSRFs. Results A total of 5395 patients were included (1748 in group 1; 3647 in group 2). After matching, 608 patients from each group with comparable baseline and stone characteristics were included. CSRFs were diagnosed in 1132 patients in the overall cohort (21.0%). Post-operative CT reported a significantly higher number of patients with RFs ⩾ 4 mm, before (35.7% versus 13.9%, p < 0.001) and after matching (43.1% versus 23.9%, p < 0.001). Only 21.8% of patients in the matched cohort had an ancillary procedure post-RIRS which was significantly higher in group 1 (74.8% versus 47.6%, p < 0.001). Age [OR 1.015 95% confidence interval (CI) 1.009-1.020, p < 0.001], stone size (OR 1.028 95% CI 1.017-1.040, p < 0.001), multiple stones (OR 1.171 95% CI 1.025-1.339, p = 0.021), lower pole stone (OR 1.853 95% CI 1.557-2.204, p < 0.001) and the use of post-operative CT scan (OR 5.9883 95% CI 5.094-7.037, p < 0.001) had significantly higher odds of having CSRFs. Conclusions CT is the only reliable imaging to assess the burden of RFs following RIRS and urologist should consider at least one CT scan to determine the same and definitely plan reintervention only based on CT rather than ultrasound and X-ray combination.
Collapse
Affiliation(s)
- Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Daniele Castellani
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Via Conca 71, Ancona 60126, Italy
| | - Ben Hall Chew
- Department of Urology, University of British Columbia, Vancouver, BC, Canada
| | - Daron Smith
- Institute of Urology, University College Hospital London, London, UK
| | - Chu Ann Chai
- Urology Unit, Department of Surgery, University of Malaya, Kuala Lumpur, Malaysia
| | - Khi Yung Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jeremy Yuen-Chun Teoh
- S.H. Ho Urology Centre, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Olivier Traxer
- Department of Urology AP-HP, Sorbonne University, Tenon Hospital, Paris, France
| | - Bhaskar Kumar Somani
- Department of Urology, University Hospitals Southampton, NHS Trust, Southampton, UK
| | - Thomas Tailly
- Department of Urology, University Hospital of Ghent, Ghent, Belgium
| |
Collapse
|
21
|
Inoue T, Hamamoto S, Okada S, Yamamichi F, Fujita M, Tominaga K, Tobe Y, Fujisawa M. Single-Session Impact of High-Power Laser with Moses Technology for Lower Pole Stones in Retrograde Intrarenal Surgery: Retrospective Study. J Clin Med 2022; 12. [PMID: 36615101 DOI: 10.3390/jcm12010301] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 11/29/2022] [Accepted: 12/27/2022] [Indexed: 01/03/2023] Open
Abstract
Background: This study aimed to evaluate the efficacy of a high-power holmium laser with Moses technology (MT) for the treatment of lower pole stones during retrograde intrarenal surgery (RIRS). Methods: Herein, 305 patients with lower pole stones who underwent RIRS using a high-power holmium laser with MT were retrospectively classified into the stone-free (SF) and non-SF groups. We measured the stone burden, stone volume, stone hardness, pre- or post-operative stent placement, infundibulopelvic angle (IPA), infundibular width (IW), infundibular length (IL), and calyceal pelvic height in terms of pelvicalyceal anatomy using retrograde pyelograms and evaluated the predictive factors of postoperative SF. Results: A total of 173 (56.7%) and 229 (75.1%) patients achieved a SF status on postoperative day one and at one month, respectively. Operation time in the SF group was shorter than that in the non-SF group (51.0 vs. 74.5 min). There were no significant differences in postoperative complications between the SF and non-SF groups. Significantly predictive risk factors in postoperative SF included total stone volume (odds ratio (OR), 1.056; 95% CI, 1.015-1.099; p = 0.007), IPA (OR, 0.970; 95% CI, 0.956-0.993; p = 0.009), and IW (OR, 0.295; 95% CI, 0.121-0.718; p = 0.007). The cut-off values of stone volume, IPA, and IW were 515.2 mm3, 46.8°, and 7.75 mm, respectively. Conclusions: A high-power holmium laser with MT in lower pole stones is a valuable option for positive outcomes and patient's safety. Larger stone volume, acute IPA, and narrow IW were negative predictors related to postoperative SF status.
Collapse
|
22
|
Pan SY, Huang CP, Chen WC, Chen YH, Chou EC. Percutaneous Nephrolithotomy Combined Antegrade Flexible Ureteroscope for Complete Staghorn Stones: A Case Report of a New Concept of Stone Surgery. Medicina (Kaunas) 2022; 59:35. [PMID: 36676659 DOI: 10.3390/medicina59010035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/14/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022]
Abstract
Percutaneous nephrolithotomy (PCNL) is the treatment of choice for staghorn stones. However, residual stones in calyces remain a challenge due to the limited angle which makes the approach difficult. The new operative technique of endoscopic combined intrarenal surgery (ECIRS), which integrates the advantages of PCNL and retrograde intrarenal surgery (RIRS), was developed to overcome this difficulty. However, two experienced urologists are required to perform ECIRS, and the patient has to be placed in the Galdakao-modified supine Valdivia position or modified prone split-leg position which cannot be achieved in the elderly or patients with ankylosing arthritis, as it may cause harm due to abnormal traction of the joints. In addition, it is difficult for surgeons to create an ideal access tract to perform PCNL in this position. We report the case of a 72-year-old female patient with left staghorn stone. We performed RIRS first and then placed the patient in the decubitus position for PCNL with antegrade flexible ureteroscopy. This method allows patients to be placed in an easier position, with the use of flexible ureteroscopy through a nephroscope to find previously unreachable stones. Moreover, in addition to the more comfortable position both for surgeons and patients, this procedure can also deal with large complex renal stones as with ECIRS. We also created a brand-new definition for stone clearance rate, namely, stone reduction efficiency (SRE). There was a high stone reduction efficiency of 12.64 (mm2/min) in our patient, and no complications occurred. We suggest that this procedure is an ideal alternative treatment for a huge staghorn stone instead of PCNL or ECIRS.
Collapse
|
23
|
Gauhar V, Traxer O, Cho SY, Teoh JY, Sierra A, Gauhar V, Sarica K, Somani B, Castellani D. Robotic Retrograde Intrarenal Surgery: A Journey from "Back to the Future". J Clin Med 2022; 11:5488. [PMID: 36143135 DOI: 10.3390/jcm11185488] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 08/19/2022] [Revised: 09/12/2022] [Accepted: 09/16/2022] [Indexed: 12/12/2022] Open
Abstract
The introduction of robotics has revolutionized surgery. Robotic platforms have also recently been introduced in clinical practice specifically for flexible ureteroscopy. In this paper, we look at the robotic platforms currently available for flexible ureteroscopy, describing their advantages and limitations. The following robotic platforms are discussed: Roboflex Avicenna®, EasyUretero®, and ILY® robot. Finally, potential future advancements in this field are presented.
Collapse
|
24
|
Geavlete B, Mareș C, Mulțescu R, Georgescu D, Geavlete P. Hybrid flexible ureteroscopy strategy in the management of renal stones - a narrative review. J Med Life 2022; 15:919-926. [PMID: 36188640 PMCID: PMC9514813 DOI: 10.25122/jml-2022-0110] [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: 03/11/2022] [Accepted: 05/02/2022] [Indexed: 11/21/2022] Open
Abstract
The introduction of single-use flexible ureteroscopes (suFURSs) in daily practice tends to overcome the main limitations of reusable ureteroscopes (reFURSs), in terms of high acquisition costs, maintenance, breakages and repairing costs, reprocessing and sterilization, as retrograde intrarenal surgery (RIRS) is promoted as first-line treatment of renal stones in most cases. A hybrid strategy implies having both instruments in the armamentarium of endourology and choosing the best strategy for cost-efficiency and protecting expensive reusable instruments in selected high-risk for breakage cases such as large stones of the inferior calyx, a steep infundibulopelvic angle or narrow infundibulum, or abnormal anatomy as in horseshoe and ectopic kidney. In terms of safety and efficiency, data present suFURSs as a safe alternative considering operating time, stone-free, and complication rates. An important aspect is highlighted by several authors about reusable instrument disinfection as various pathogens are still detected after proper sterilization. This comprehensive narrative review aims to analyze available data comparing suFURSs and reFURSs, considering economic, technical, and operative aspects of the two types of instruments, as well as the strategy of adopting a hybrid approach to selecting the most appropriate flexible ureteroscope in each case.
Collapse
Affiliation(s)
- Bogdan Geavlete
- Department of Urology, Sanador Hospital, Bucharest, Romania
- Department of Urology, Emergency Clinical Hospital Sfântul Ioan, Bucharest, Romania
| | - Cristian Mareș
- Department of Urology, Emergency Clinical Hospital Sfântul Ioan, Bucharest, Romania
| | - Răzvan Mulțescu
- Department of Urology, Sanador Hospital, Bucharest, Romania
- Department of Urology, Emergency Clinical Hospital Sfântul Ioan, Bucharest, Romania
| | - Dragoș Georgescu
- Department of Urology, Sanador Hospital, Bucharest, Romania
- Department of Urology, Emergency Clinical Hospital Sfântul Ioan, Bucharest, Romania
| | - Petrișor Geavlete
- Department of Urology, Sanador Hospital, Bucharest, Romania
- Department of Urology, Emergency Clinical Hospital Sfântul Ioan, Bucharest, Romania
| |
Collapse
|
25
|
Geavlete B, Popescu RI, Multescu R, Iordache V, Popa GA, Georgescu D, Geavlete P. Bilateral same-session flexible ureteroscopy for renal stones: a feasible method. J Med Life 2022; 15:284-291. [PMID: 35419108 PMCID: PMC8999109 DOI: 10.25122/jml-2021-0385] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 01/13/2022] [Indexed: 11/18/2022] Open
Abstract
A staged ureteroscopic procedure is generally preferred to treat bilateral renal stones. In this study, we evaluated the feasibility of bilateral same-session flexible ureteroscopy (BS-fURS) in renal stones. A total of 81 patients underwent bilateral BS-fURS between March 2014 and March 2021 for bilateral renal stones. The mean stone burden per patient was 17±4 (range 7-27 mm). The average stone density was 1240 HU (970 to 1510). We used 4 types of ureteroscopes: Olympus URF-V2 (34 cases), Storz Flex X2 (30 cases), single-use PUSEN PU 3022 (12 cases), and single-use PUSEN - PU 3033A (5 cases). We specifically set our Holmium laser for dusting, pop-corning, and fragmenting. We found 31 calcium oxalate monohydrate cases, 11 calcium oxalate dehydrate cases, 17 uric acid cases, and 22 magnesium ammonium phosphate cases. The mean operating time was 77 min. (range 52 to 85) for both renal units. The SFRs were evaluated between 1 and 3 months with computed tomography (fragments >3 mm were defined as residual). Double J stenting (6Fr.) was applied bilaterally in 8 cases (9.87%) and unilateral in 34 cases (41.97%). The overall SFRs after 1 and 2 procedures were 81.48% (66/81 cases) and 92.59% (75/81 cases), respectively. Postoperative complications after an overall 96 procedures were Clavien I-II (18.75%) and Clavien III (3.12%). Urinary tract infections were observed in 13 cases (16.04%) without any case of urosepsis. Our experience suggested some BS-fURS advantages as a single anesthetic session and potentially reduced cost associated with treatment. BS-fURS seem feasible, especially for medium-sized bilateral renal stones in high-volume centers.
Collapse
Affiliation(s)
- Bogdan Geavlete
- Department of Urology, Sanador Hospital, Bucharest, Romania,Department of Urology, Sf. Ioan Clinical Emergency Hospital, Bucharest, Romania
| | - Razvan-Ionut Popescu
- Department of Urology, Sf. Ioan Clinical Emergency Hospital, Bucharest, Romania,Corresponding Author: Razvan-Ionut Popescu, Department of Urology, Sf. Ioan Clinical Emergency Hospital, Bucharest, Romania. E-mail:
| | - Razvan Multescu
- Department of Urology, Sanador Hospital, Bucharest, Romania,Department of Urology, Sf. Ioan Clinical Emergency Hospital, Bucharest, Romania
| | - Valentin Iordache
- Department of Urology, Sanador Hospital, Bucharest, Romania,Department of Urology, Sf. Ioan Clinical Emergency Hospital, Bucharest, Romania
| | - Gelu-Adrian Popa
- Department of Radiology and Medical Imaging, Sf. Ioan Clinical Emergency Hospital, Bucharest, Romania
| | - Dragos Georgescu
- Department of Urology, Sanador Hospital, Bucharest, Romania,Department of Urology, Sf. Ioan Clinical Emergency Hospital, Bucharest, Romania
| | - Petrisor Geavlete
- Department of Urology, Sanador Hospital, Bucharest, Romania,Department of Urology, Sf. Ioan Clinical Emergency Hospital, Bucharest, Romania
| |
Collapse
|
26
|
Tao W, Ming X, Zang Y, Zhu J, Zhang Y, Sun C, Xue B. The clinical outcomes of flexible ureteroscopy and laser lithotripsy (FURSL) for treatment of the upper urinary tract calculi. J Xray Sci Technol 2022; 30:123-133. [PMID: 34719474 DOI: 10.3233/xst-210992] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE To evaluate efficacy and safety of flexible ureteroscopy and laser lithotripsy (FURSL) for treatment of the upper urinary tract calculi. METHODS We retrospectively analyzed 784 patients who underwent FURSL between January 2015 and October 2020 in our unit. All patients were preoperatively evaluated with urine analysis, serum biochemistry, urinary ultrasonography, non-contrast computed tomography and intravenous urography. The procedure was considered as successful in patients with complete stone disappearance or fragments < 4 mm on B ultrasound or computed tomography. The operative parameters, postoperative outcomes and complications were recorded and analyzed respectively. RESULTS The average operative time and postoperative hospital stay were 46.9±15.8 min and 1.2±1.1 days, respectively, among 784 patients. In addition, 746 patients were followed up and 38 patients were lost. In these patients, 700 (93.8%) cases met the stone removal criteria and 46 cases (6.2%) did not meet the stone removal criteria who need further treatment. The stone free rate (SFR) is 92.5%after 1-3 months and SFR of middle and upper calyceal calculi was higher than that of lower calyceal calculi significantly. The most common complications were fever (58/784, 7.4%), gross hematuria (540/784, 68.9%) and lpsilateral low back pain (47/784, 6.0%). The incidence rate of serious complication was 1.28%(10/784), including 5 cases of septic shock and 5 cases of subcapsular hematoma, which were cured after active treatment. CONCLUSION FURSL is a reliable treatment for small and medium calculi patients of upper urinary tract. The curative effect of stone removal is clear. The complications are few and the safety is high. However, there are certain limitations to the efficacy in treating larger stone and lower calyceal calculi.
Collapse
Affiliation(s)
- Wei Tao
- Department of Urology, the Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Xu Ming
- Department of Urology, the Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yachen Zang
- Department of Urology, the Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Jin Zhu
- Department of Urology, the Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yuanyuan Zhang
- Institute for Regenerative Medicine, Wake Forest University, Winston-Salem, NC, USA
| | - Chuanyang Sun
- Department of Urology, the Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Boxin Xue
- Department of Urology, the Second Affiliated Hospital of Soochow University, Suzhou, China
| |
Collapse
|
27
|
Yi X, Cao D, You P, Xiong X, Zheng X, Jin T, Peng G, Xu H, Liao D, Wei Q, Li H, Yang L, Ai J. Comparison of the Efficacy and Safety of Extracorporeal Shock Wave Lithotripsy and Flexible Ureteroscopy for Treatment of Urolithiasis in Horseshoe Kidney Patients: A Systematic Review and Meta-Analysis. Front Surg 2021; 8:726233. [PMID: 34760915 PMCID: PMC8572974 DOI: 10.3389/fsurg.2021.726233] [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: 06/16/2021] [Accepted: 09/20/2021] [Indexed: 02/05/2023] Open
Abstract
Background: Urolithiasis is the most common complication of horseshoe kidney (HK), which can be treated by extracorporeal shock wave lithotripsy (ESWL), flexible ureteroscopy (FURS), and percutaneous nephrolithotomy (PCNL). When comparing treatments of ESWL and FURS, it is unclear which is more efficient and safe. The objective of this study was to compare the efficacy and safety of FURS and SWL for the treatment of urolithiasis in HK patients. Methods: A systematic search of the Web of Science, PubMed, and EMBASE was performed in February 2021. Newcastle-Ottawa Scale (NOS) was used to assess the risk of bias in each study. Results: Five studies published between 2008 and 2018 were synthesized in the present meta-analysis. The study revealed that FURS compared with SWL had greater initial and overall stone-free rates (SFRs). Risk ratios (RRs) were 2.46 (P < 0.00001) in initial SFRs, 1.36 (P = 0.02) in overall SFRs. No differences were found in the retreatment ratio, RRs were 0.49 (P = 0.43). In addition, no major complications were encountered, and all the complications were mild to moderate. Conclusion: The study demonstrated that FURS and SWL are effective and safe treatments for patients with HK with stones (<20 mm). Moreover, FURS has greater clearance rates and lower complication rates than SWL.
Collapse
Affiliation(s)
- Xianyanling Yi
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Dehong Cao
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Pinghong You
- Department of Urology, People's Hospital of Deyang City, Deyang, China
| | - Xingyu Xiong
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaonan Zheng
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Tao Jin
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Ge Peng
- Department of Endocrinology and Metabolism, West China Hospital of Sichuan University, Chengdu, China
| | - Hang Xu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Dazhou Liao
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Qiang Wei
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Hong Li
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Lu Yang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Jianzhong Ai
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
28
|
Dybowski B, Bres-Niewada E, Rzeszutko M, Tkaczyk A, Woźniak B, Wójcik M, Znajdek Z. Risk factors for infectious complications after retrograde intrarenal surgery - a systematic review and narrative synthesis. Cent European J Urol 2021; 74:437-445. [PMID: 34729234 PMCID: PMC8552946 DOI: 10.5173/ceju.2021.250] [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: 07/20/2021] [Revised: 08/06/2021] [Accepted: 08/07/2021] [Indexed: 01/03/2023] Open
Abstract
Introduction Infectious complications are among the most frequent and significant complications in retrograde intrarenal lithotripsy. To date, review articles have covered complications after a ureteroscopy, but not after retrograde intrarenal surgery (RIRS), specifically. Because the complications and risk factors are different for a ureteroscopy and RIRS, we aimed to identify variables related to the occurrence of infectious complications post-RIRS. Material and methods This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. We included original studies that described 100 or more procedures published in 2014–2021. We extracted data and performed a narrative synthesis to explore and interpret differences between the studies. Results We selected 17 studies for analysis, including 10 from 2019–2021. Infectious complications after RIRS were observed in 2.8–7.5% of patients (mean 7.1%). We found seven independent risk factors associated with infectious complications after RIRS: long operative time, recent history of positive urine culture or urinary tract infection or antibiotic use, pyuria/nitrites, small caliber of ureteral access sheath, struvite stone, high irrigation rate, and comorbidities. Conclusions If an increased rate of infectious complications is found at a RIRS center, countermeasures should include restrictions on operative time and irrigation rate, and consideration of larger access sheaths, especially for patients with abnormal urine results or with struvite stones or with a history of urinary tract infection or co-morbidities.
Collapse
Affiliation(s)
- Bartosz Dybowski
- Department of Urology, Roefler Memorial Hospital, Pruszków, Poland.,Faculty of Medicine, Lazarski University, Warsaw, Poland
| | - Ewa Bres-Niewada
- Department of Urology, Roefler Memorial Hospital, Pruszków, Poland.,Faculty of Medicine, Lazarski University, Warsaw, Poland
| | | | | | - Barbara Woźniak
- Department of Urology, Roefler Memorial Hospital, Pruszków, Poland
| | - Marta Wójcik
- Department of Urology, Roefler Memorial Hospital, Pruszków, Poland
| | - Zuzanna Znajdek
- Department of Urology, Roefler Memorial Hospital, Pruszków, Poland
| |
Collapse
|
29
|
Feng D, Wei W. Providing Several Skills to Treat Complex Infectious Stones of Solitary Kidney in a Patient Failed to Undergo Percutaneous Nephrolithotomy: A Case Report. Front Surg 2021; 8:743813. [PMID: 34660684 PMCID: PMC8511699 DOI: 10.3389/fsurg.2021.743813] [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: 07/19/2021] [Accepted: 08/30/2021] [Indexed: 02/05/2023] Open
Abstract
Conservative treatment is closely associated with renal deterioration for patients with renal staghorn stones. It is well-recognized that percutaneous nephrolithotomy (PCNL) is recommended as the first-line treatment of renal stones larger than 2 cm due to its higher stone clearance and cost-effectiveness when compared with other treatment alternatives, such as shockwave lithotripsy and flexible ureteroscopy (FURS). Besides, our findings indicated that miniaturized PCNL could be served as an alternative to PCNL with a higher stone-free rate and a lower hemorrhage risk. Despite the higher cost-effectiveness of PCNL, the management of staghorn stones are still controversial in some special situations, such as a solitary kidney. Herein, we present a case with complex infectious stones of a right-sided solitary kidney, complaining of persistent pain in the right waist. The rarity of this case is that it is difficult to encounter these cotton-like staghorn stones which are clinically resistant to holmium laser lithotripsy, and the particularity is that the patient with solitary kidney failed to undergo PCNL. We found that the combination of intermittently high-frequency oscillation and flexible ureteroscopy forceps might contribute to treat the complex infectious stones in a patient with solitary kidney. Our surgical experience might be beneficial to such patients undergoing flexible ureteroscopy in clinical practice.
Collapse
Affiliation(s)
- Dechao Feng
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Wuran Wei
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
30
|
Lai L, Zhang W, Zheng F, Wang T, Bai P, Liu Z, Zheng J, Shao Z, Duan B, Wang H, Xing J, Chen H, Huang Y, Chen B. Comparison of the Efficacy of ShuoTong Ureteroscopy and Simple Flexible Ureteroscopy in the Treatment of Unilateral Upper Ureteral Calculi. Front Surg 2021; 8:707022. [PMID: 34646858 PMCID: PMC8503526 DOI: 10.3389/fsurg.2021.707022] [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: 05/08/2021] [Accepted: 08/26/2021] [Indexed: 11/13/2022] Open
Abstract
Background: ShuoTong ureteroscopy (Sotn-ureteroscopy, ST-URS), a new lithotripsy operation method developed on the basis of ureteroscopy, is widely used to treat ureteral stones in China. Its composition includes rigid ureteral access sheath, standard mirror, lithotripsy mirror, and ShuoTong perfusion aspirator (ST-APM). Here, we compared the efficacy and safety of the ST-URS and the flexible ureteroscope (F-URS) holmium laser lithotripsy in the treatment of unilateral upper ureteral calculi. Methods: Retrospective analysis was conducted on the clinical data of 280 patients who met the inclusion 1) urinary tract CT was diagnosed with unilateral single upper ureteral calculi above the L4 lumbar spine; 2) patient age was from 18 to 80 years old; 3) patients were informed and consented to this study; and 4) patients were approved by the hospital ethics committee (proof number: KY-2019-020) and the exclusion criteria for unilateral upper ureteral calculi in the First Affiliated Hospital of Xiamen University from January 2018 to November 2020, and they were divided into the ST-URS group and the flexible ureteroscopy (F-URS) group. Results: The stone-free rate of 1 day after operation of the ST-URS group was significantly higher than the F-URS group (63.71 vs. 34.62%, P < 0.0001). The operative time (38.45 vs. 46.18 min, P = 0.005) and hospitalization cost (27,203 vs. 33,220 Yuan, P < 0.0001) of the ST-URS group were significantly lower than the F-URS group. There were no significant differences in the success rate of ureteral access sheath placement, operative blood loss, stone-free rate of 1 month after operation, postoperative complications, postoperative hospital stay, and postoperative visual analog scale (VAS) pain score between the two groups (P > 0.05). In subgroups of a diameter of calculi ≥ 1.5 cm, calculi CT numerical value ≥ 1,000 Hounsfield unit and the preoperative hydronephrosis range ≥ 3.0 cm, ST-URS shows more advantages in the operative time, stone-free rate of 1 day after the operation, the hospitalization cost, and the incidence of postoperative complications. Conclusion: In unilateral upper ureteral stones treated with a holmium laser, compared with the simple F-URS, the ST-URS has a shorter operative time, lower hospitalization cost, and a higher stone-free rate of 1 day after the operation, suggesting that the ST-URS could be more widely applied in clinics.
Collapse
Affiliation(s)
- Longhui Lai
- The Key Laboratory of Urinary Tract Tumors and Calculi, Department of Urology Surgery, The First Affiliated Hospital, School of Medicine, Xiamen University, Xiamen, China.,The School of Clinical Medicine, Fujian Medical University, Fuzhou, China
| | - Wenzhao Zhang
- The Key Laboratory of Urinary Tract Tumors and Calculi, Department of Urology Surgery, The First Affiliated Hospital, School of Medicine, Xiamen University, Xiamen, China.,The School of Clinical Medicine, Fujian Medical University, Fuzhou, China
| | - Fangjian Zheng
- The Key Laboratory of Urinary Tract Tumors and Calculi, Department of Urology Surgery, The First Affiliated Hospital, School of Medicine, Xiamen University, Xiamen, China
| | - Tao Wang
- The Key Laboratory of Urinary Tract Tumors and Calculi, Department of Urology Surgery, The First Affiliated Hospital, School of Medicine, Xiamen University, Xiamen, China
| | - Peide Bai
- The Key Laboratory of Urinary Tract Tumors and Calculi, Department of Urology Surgery, The First Affiliated Hospital, School of Medicine, Xiamen University, Xiamen, China
| | - Zhengsheng Liu
- The Key Laboratory of Urinary Tract Tumors and Calculi, Department of Urology Surgery, The First Affiliated Hospital, School of Medicine, Xiamen University, Xiamen, China
| | - Jiaxin Zheng
- The Key Laboratory of Urinary Tract Tumors and Calculi, Department of Urology Surgery, The First Affiliated Hospital, School of Medicine, Xiamen University, Xiamen, China
| | - Zhiqiang Shao
- Xiamen University Laboratory Animal Center, Xiamen University, Xiamen, China
| | - Bo Duan
- The Key Laboratory of Urinary Tract Tumors and Calculi, Department of Urology Surgery, The First Affiliated Hospital, School of Medicine, Xiamen University, Xiamen, China
| | - Huiqiang Wang
- The Key Laboratory of Urinary Tract Tumors and Calculi, Department of Urology Surgery, The First Affiliated Hospital, School of Medicine, Xiamen University, Xiamen, China
| | - Jinchun Xing
- The Key Laboratory of Urinary Tract Tumors and Calculi, Department of Urology Surgery, The First Affiliated Hospital, School of Medicine, Xiamen University, Xiamen, China.,The School of Clinical Medicine, Fujian Medical University, Fuzhou, China
| | - Huixin Chen
- Department of Urology Surgery, Zhangzhou Hospital of Traditional Chinese Medicine, Zhangzhou, China
| | - Yushan Huang
- Department of Urology Surgery, Anxi County Hospital of Traditional Chinese Medicine, Quanzhou, China
| | - Bin Chen
- The Key Laboratory of Urinary Tract Tumors and Calculi, Department of Urology Surgery, The First Affiliated Hospital, School of Medicine, Xiamen University, Xiamen, China.,The School of Clinical Medicine, Fujian Medical University, Fuzhou, China
| |
Collapse
|
31
|
Geavlete B, Cozma C, Geavlete P. The "no-touch" technique in the flexible ureteroscopic approach of renal stones. J Med Life 2021; 14:481-486. [PMID: 34621370 PMCID: PMC8485380 DOI: 10.25122/jml-2021-0217] [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: 06/20/2021] [Accepted: 08/03/2021] [Indexed: 12/23/2022] Open
Abstract
Large meta-analyses demonstrated that ureteral access sheaths (UAS) have specific complications during and after flexible ureteroscopy (fURS). The present study focused on the technical aspects, advantages, drawbacks, and limitations of the latest "no-touch" technique (NTT) in the flexible ureteroscopic therapeutic approach of renal stones. A total of 288 patients with a single pyelocaliceal stone (largest diameter between 11 and 29 mm) underwent fURS: 144 using the 12/14 Fr UAS (group 1) and 144 without UAS (group 2). For NTT, we used four types of ureteroscopes: Olympus URF-V2 (8.5 Fr) - 33 cases, Storz Flex X2 (8.4 Fr) - 60 cases, single-use PUSEN PU 3022 (9.5 Fr) - 37 cases, and single-use PUSEN - PU 3033A (7.5 Fr) - 14 cases. For group 1, we used the Olympus URF-V2 ureteroscope in 44 cases, the Storz Flex X2 in 58 cases, and the single-use PUSEN PU 3022 in 42 cases. We compared the operative time, hospitalization periods, and complications. Successful access sheath insertion was noted in 83.3% of cases from group 1, and successful ureteroscope insertion was noted in 90.9% of cases from group 2. The average operative time was slightly higher in group 1 vs. group 2 (47 vs. 39 min). Stone-free rates (SFRs) were overall lower in group 2 (76.3% vs. 86.8%) at 1 month. At 3 months, we did not find a significant difference between these two groups. Superficial mucosal ureteral wall lesions were found in 38.8% of patients from group 1 and 4.1% from group 2. Hospitalization periods were longer in group 1 vs. group 2 (21 vs. 29 hours, respectively). The single-use 7.5 Fr ureteroscope should receive a special mention: the insertion was simple, we did not encounter any mucosal ureteral wall lesions, and all patients were discharged on the same day. Despite the clear advantages of routine UAS usage, there are many adverse events for the patient. Larger diameter sheaths involve a greater risk of ureteral wall injury. NTT seems to improve peri- and postoperative safety while preserving therapeutic efficiency. The new 7.5 Fr ureteroscopes appear to optimize surgical efficiency and diminish complications in the flexible ureteroscopic treatment of renal stones.
Collapse
Affiliation(s)
- Bogdan Geavlete
- Sanador Hospital, Bucharest, Romania.,Department of Urology, Sf. Ioan Emergency Clinical Hospital, Bucharest, Romania
| | - Cosmin Cozma
- Department of Urology, Sf. Ioan Emergency Clinical Hospital, Bucharest, Romania
| | - Petrisor Geavlete
- Sanador Hospital, Bucharest, Romania.,Department of Urology, Sf. Ioan Emergency Clinical Hospital, Bucharest, Romania
| |
Collapse
|
32
|
Abstract
The aim of this article is to illustrate a step-by-step guide to flexible ureteroscopy (URS) for treatment of upper urinary tract calculus. Preoperative evaluation of the patient with focus on comorbidities is paramount for the type of stone procedure to be performed. In this article, the steps of operating room setup, patient positioning, gaining access to the upper urinary tract, flexible URS, laser lithotripsy, basket extraction of stone fragments, and placement of a ureteral stent are described. The importance of clearance of the ureter before flexible URS in the case of pre-existing ureteral stone is also described.
Collapse
Affiliation(s)
- Garen Abedi
- Department of Urology, University of California, San Diego, La Jolla, California, USA
| | - Manoj Monga
- Department of Urology, University of California, San Diego, La Jolla, California, USA
| |
Collapse
|
33
|
Alnadhari I, Ali O, Abdeljaleel O, Sampige VRP, Shamsodini A, Salah M. Ergonomics and Surgeon Comfort During Flexible Ureteroscopy. Res Rep Urol 2021; 13:415-424. [PMID: 34235098 PMCID: PMC8254182 DOI: 10.2147/rru.s317347] [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: 04/24/2021] [Accepted: 06/05/2021] [Indexed: 11/23/2022] Open
Abstract
The technological advancements of flexible ureteroscopy (FURS) and its accessories have resulted in broadening its indications to include the management of complex renal stones, with long operative time. The surgeon's understanding about the ergonomics of the ureteroscopes and their cognizance of the operation theatre layout helps to improve their performance, including the surgical outcomes. This paper will describe the ergonomics that are involved in conducting FURS which in turn will aid in developing a more conducive surgical environment for the surgeon during the procedure, based on scientific literature review and expert opinions in high-volume centres. Proper surgeon position, well-arranged operation theatre layout, monitor and pedal position, anaesthesia type, and surgical team are important factors to decrease musculoskeletal strains for surgeons and increase work efficiency. Different types of flexible ureteroscope have different characters and knowing these special characters leads to better ergonomics during surgery. Robotic-assisted FURS have shown good safety and ergonomics in clinical application.
Collapse
Affiliation(s)
- Ibrahim Alnadhari
- Urology Section, Department of Surgery, Al Wakra Hospital, Hamad Medical Corporation, Al Wakra, Qatar
| | - Omar Ali
- Urology Section, Department of Surgery, Al Wakra Hospital, Hamad Medical Corporation, Al Wakra, Qatar
| | - Osama Abdeljaleel
- Urology Section, Department of Surgery, Al Wakra Hospital, Hamad Medical Corporation, Al Wakra, Qatar
| | | | - Ahmad Shamsodini
- Urology Section, Department of Surgery, Al Wakra Hospital, Hamad Medical Corporation, Al Wakra, Qatar
| | - Morshed Salah
- Urology Section, Department of Surgery, Hazm Mebaireek General Hospital, Hamad Medical Corporation, Doha, Qatar
| |
Collapse
|
34
|
Fu Z, Jin Z, Zhang C, Dai Y, Gao X, Wang Z, Li L, Ding G, Hu H, Wang P, Ye X. Visual-electromagnetic system: A novel fusion-based monocular localization, reconstruction, and measurement for flexible ureteroscopy. Int J Med Robot 2021; 17:e2274. [PMID: 33960604 DOI: 10.1002/rcs.2274] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 02/16/2021] [Accepted: 05/03/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND During flexible ureteroscopy (FURS), surgeons may lose orientation due to intrarenal structural similarities and complex shape of the pyelocaliceal cavity. Decision-making required after initially misjudging stone size will also increase the operative time and risk of severe complications. METHODS A intraoperative navigation system based on electromagnetic tracking (EMT) and simultaneous localization and mapping (SLAM) was proposed to track the tip of the ureteroscope and reconstruct a dense intrarenal three-dimensional (3D) map. Furthermore, the contour lines of stones were segmented to measure the size. RESULTS Our system was evaluated on a kidney phantom, achieving an absolute trajectory accuracy root mean square error (RMSE) of 0.6 mm. The median error of the longitudinal and transversal measurements was 0.061 and 0.074 mm, respectively. The in vivo experiment also demonstrated the effectiveness. CONCLUSION The proposed system worked effectively in tracking and measurement. Further, this system can be extended to other surgical applications involving cavities, branches and intelligent robotic surgery.
Collapse
Affiliation(s)
- Zuoming Fu
- Biosensor National Special Laboratory, Key Laboratory of Biomedical Engineering of Ministry of Education, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Ziyi Jin
- Biosensor National Special Laboratory, Key Laboratory of Biomedical Engineering of Ministry of Education, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Chongan Zhang
- Biosensor National Special Laboratory, Key Laboratory of Biomedical Engineering of Ministry of Education, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Yu Dai
- College of Artificial Intelligence, Nankai University, Tianjin, China
| | - Xiaofeng Gao
- Department of Urology, Changhai Hospital, Shanghai, China
| | - Zeyu Wang
- Department of Urology, Changhai Hospital, Shanghai, China
| | - Ling Li
- Department of Urology, Changhai Hospital, Shanghai, China
| | - Guoqing Ding
- Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Haiyi Hu
- Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Peng Wang
- Biosensor National Special Laboratory, Key Laboratory of Biomedical Engineering of Ministry of Education, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Xuesong Ye
- Biosensor National Special Laboratory, Key Laboratory of Biomedical Engineering of Ministry of Education, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| |
Collapse
|
35
|
Van Compernolle D, Veys R, Elshout PJ, Beysens M, Van Haute C, De Groote L, Tailly T. Reusable, Single-Use, or Both: A Cost Efficiency Analysis of Flexible Ureterorenoscopes After 983 Cases. J Endourol 2021; 35:1454-1459. [PMID: 33775101 DOI: 10.1089/end.2021.0006] [Citation(s) in RCA: 4] [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] [Indexed: 01/07/2023] Open
Abstract
Objectives: To determine which flexible ureterorenoscopy program would be most cost-efficient in our center, a cost efficiency analysis and a formula to assess cost efficiency feasibility of a hybrid model were performed. Methods: Total cost per case of reusable flexible ureterorenoscopes (rfURS) was retrospectively calculated and compared with two single-use flexible ureterorenoscopes (sufURS) marketed. A mathematical formula was developed from our data to identify the necessary increase of use of rfURS (NIU-rfURS) to be cost-efficient in a hybrid system utilizing sufURS for only high-risk-of-breakage cases. Results: In 57 months, 983 procedures were performed using 4 digital rfURS (Flex-XC; Storz), necessitating 45 repairs, with a total repair cost of €256.809. Including the capital investment of €24.000 per scope and €60 per sterilization cycle, the cost per case averaged €419 after 983 cases. Consistently using sufURS would have cost 55% to 127% more (respectively, Uscope PU3022® and Lithovue® at €650 and €950 manufacturer suggested retail price). On a per case analysis, the cost was initially extremely high, but declined to reach a plateau around €480 after ∼400 cases. After 155 or 274 procedures, a rfURS program appeared more cost-efficient than consistently using Lithovue or Uscope PU3022, respectively. Based on our data and formula, if we would hypothetically use Uscope PU3022 or Lithovue for 15% of the cases, the NIU-rfURS is, respectively, 28% or 74% (∼6 or 16 cases). The NIU-rfURS increases exponentially with an increased use of sufURS. Conclusion: Consistently using rfURS is more cost-efficient than the constant use of sufURS after 155 to 274 cases. We describe the first mathematical formula that allows a calculation and feasibility assessment of using both reusable and disposable fURS. To identify whether a hybrid system may be a feasible cost-efficient alternative to a rfURS-only program, any center can calculate the NIU-rfURS by entering center-specific data in the formula.
Collapse
Affiliation(s)
| | - Ralf Veys
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | | | - Matthias Beysens
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Carl Van Haute
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | | | - Thomas Tailly
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| |
Collapse
|
36
|
Gerber RC, Best SL, Hedican SP, Nakada SY. Flexible Ureteroscopy as the New Standard for the Management of Renal Transplant Urolithiasis <15 mm: A Single-Center Experience. J Endourol 2021; 35:1443-1447. [PMID: 33691495 DOI: 10.1089/end.2020.0473] [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] [Indexed: 11/12/2022] Open
Abstract
Objectives: To determine the safety and efficacy of flexible ureteroscopy in the treatment of transplant urolithiasis. Materials and Methods: We reviewed a single-center series of 2652 patients who underwent surgical treatment for nephrolithiasis at our institution from 2009 to the present day to identify all patients undergoing ureteroscopy for treatment of transplant lithiasis. Results: We identified 18 patients who underwent ureteroscopy for treatment of urolithiasis within the transplanted kidney or ureter. The majority of the procedures were performed using a retrograde approach with flexible ureteroscopy, with one patient undergoing antegrade ureteroscopy and two patients requiring semirigid ureteroscopy. Holmium:yttrium-aluminum-garnet laser lithotripsy was utilized in all but one case, which was performed using basket extraction. There were no intraoperative complications reported. Four patients had small stone fragments on postoperative imaging, three of which were observed. One patient required repeat ureteroscopy for persistent distal ureteral stone. Conclusion: Retrograde ureteroscopy is a feasible, safe, and effective intervention for the treatment of transplant lithiasis. Minimal intraoperative or postoperative complications were reported, and only one patient required additional intervention for residual stone burden.
Collapse
Affiliation(s)
- Rebecca C Gerber
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Sara L Best
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Sean P Hedican
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Stephen Y Nakada
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| |
Collapse
|
37
|
Okada S, Hamamoto S, Inoue T, Minagawa S, Morikawa H, Matsuda T, Miura H. One- versus two-surgeon active stone retrieval procedures for flexible ureteroscopy: An off-site simulator comparative study. Int J Urol 2021; 28:665-671. [PMID: 33709482 DOI: 10.1111/iju.14534] [Citation(s) in RCA: 4] [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: 07/05/2020] [Accepted: 01/31/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To evaluate the efficacy of the one-surgeon basketing technique compared to the conventional two-surgeon method for flexible ureteroscopy. METHODS Seven urologists (three trained and four less-trained surgeons) extracted three renal stones using each technique with an off-site simulator. We analyzed the task completion time, the number of times the basket forceps were opened and closed, and unexpected events during stone-catching, for both techniques. RESULTS There was no significant difference in the total task completion time between the one-surgeon (102.0 [interquartile range 63.5-164.0] s) and two-surgeon (99.5 [interquartile range 75.0-145.3] s) techniques. However, the time it took the trained surgeons to extract all stones was significantly shorter with the one-surgeon than with the two-surgeon technique (19.0 [interquartile range 18.0-20.0] s vs 34.0 [interquartile range 25.0-40.0] s; P = 0.049). Among the less-trained surgeons, the opposite effect was observed, but this difference was not statistically significant (96.5 [interquartile range 61.0-134.5] s vs 64.0 [interquartile range 51.5-77.0] s; P = 0.489). The number of times the forceps were opened and closed during stone-catching was significantly lower with the one-surgeon technique than with the two-surgeon technique (5.0 [interquartile range 4.0-5.0] times vs 9.0 [interquartile range 6.0-14.5] times; P = 0.018). CONCLUSIONS The one-surgeon technique can offer comparable efficacy to the two-surgeon technique. If surgeons are sufficiently trained, a one-surgeon basketing technique for performing flexible ureteroscopy might become a new technical modality for extracting renal stones.
Collapse
Affiliation(s)
- Shinsuke Okada
- Department of Urology, Gyotoku General Hospital, Chiba, Japan
| | - Shuzo Hamamoto
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Takaaki Inoue
- Department of Urology, Hara Genitourinary Hospital, Hyogo, Japan
| | - Shingo Minagawa
- Department of Urology, Gyotoku General Hospital, Chiba, Japan
| | | | - Tadashi Matsuda
- Department of Urology and Andrology, Kansai Medical University, Osaka, Japan
| | - Hiroyasu Miura
- Department of Urology, Hachinohe Koyo Clinic, Aomori, Japan
| | | |
Collapse
|
38
|
Danilovic A, Torricelli FCM, Marchini GS, Batagello C, Vicentini FC, Traxer O, Srougi M, Nahas WC, Mazzucchi E. Residual Stone Fragments After Percutaneous Nephrolithotomy: Shockwave Lithotripsy vs Retrograde Intrarenal Surgery. J Endourol 2021; 35:609-614. [PMID: 33096975 DOI: 10.1089/end.2020.0868] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Despite technology incorporation to percutaneous nephrolithotomy (PCNL), residual stone fragments (RSFs) may still persist after PCNL and need to be addressed to avoid regrowth or ureteral obstruction. The objective of this study was to compare the outcomes of retrograde intrarenal surgery (RIRS) to extracorporeal shockwave lithotripsy (SWL) for treating patients with RSFs after a previous standard PCNL. Materials and Methods: Adult patients with RSF after a standard PCNL submitted to RIRS or SWL in our Institution from January 2017 to January 2020 were retrospectively studied. Stone-free rate (SFR) was evaluated on postoperative day (POD) 90 by noncontrast CT (NCCT) or ultrasound and kidney, ureter, and bladder radiograph (KUB) for each renal unit. Surgical complications based on Clavien-Dindo classification during the 90 days of follow-up were recorded. Sample size was calculated for a power of 80% and a significance level of 0.05, assuming SFR of 20% for SWL and 50% for RIRS. Results: Thirty-three patients treated by SWL were compared with 36 patients treated by RIRS. Hospitalization time was longer in the RIRS group (4.18 vs 12.33 hours, p = 0.001). SFR and success rate were lower in SWL than RIRS group (24.2% vs 58.3%, p = 0.007 and 30.3% vs 72.2%, p = 0.004, respectively), using POD 90 NCCT in 81.8% and ultrasound and KUB in 18.2% of the SWL group and using POD 90 NCCT in 100% of the RIRS group. Minor complications (Clavien-Dindo < III) occurred in 11 of 36 (30.6%) patients submitted to RIRS and in 2 of 33 (6.1%) patients submitted to SWL group (p = 0.025). Two patients (6.1%) of the SWL group had Clavien-Dindo IIIb complication owing to Steinstrasse and were submitted to ureteroscopy. Emergency room visits were similar between groups (6.1% vs 8.3%, p = 1.0). Conclusions: RIRS has better SFR, higher minor complications, and lower major complications than SWL for the treatment of RSFs after standard PCNL.
Collapse
Affiliation(s)
- Alexandre Danilovic
- Department of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | | | - Giovanni Scala Marchini
- Department of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Carlos Batagello
- Department of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Fabio Carvalho Vicentini
- Department of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Olivier Traxer
- Sorbonne Université, GRC n 20 Lithiase Renale, AP-HP, Hôpital Tenon, Paris, France
| | - Miguel Srougi
- Department of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - William C Nahas
- Department of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Eduardo Mazzucchi
- Department of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| |
Collapse
|
39
|
Rapoport LM, Gazimiev MA, Korolev DO, Tsarichenko DG, Svetikova YUA, Enikeev ME, Akopyan GN, Chinenov DV, Taratkin MS, Enikeev DV. [ Flexible ureteroscopy for lower pole renal stones: novel superpulse thulium (TM) fiber laser lithotripsy]. Urologiia 2020:89-92. [PMID: 33427418] [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] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION The SuperPulse Thulium (Tm) fiber laser (wavelength of 1.94 m) has been recently introduced as a directed-energy source for urology. Preclinical studies have shown a significant potential of the SuperPulse Tm fiber laser (SP TFL) for lithotripsy. However, clinical reports of using SP TFL to treat urolithiasis are still few and limited. Of special interest are challenging cases, e.g., lower pole stones, when extreme deflection of the instrument is required. OBJECTIVE To evaluate the effectiveness of the SuperPulse Tm fiber laser in the management of lower pole small calyceal stones during flexible ureteroscopy (F-URS). METHOD s. The SuperPulse Tm fiber laser device (Urolase 2, IRE Polus, Fryazino, Russia) has been cleared for clinical use by the Ministry of Health of Russian Federation. Study protocol has been approved by the Ethical Review Committee. Between January 2018 and February 2019, 130 patients with kidney stones have undergone Thulium fiber laser lithotripsy during F-URS. We retrospectively analyzed 15 of this patients with a single radiopaque lower pole calculus that were included in the present study. Stone size, stone density, lithotripsy time (from the first to last footswitch press) and "lasering" (laser emission) time were measured. The SP TFL was used for stone disintegration with different settings in dusting and fragmentation modes (0.1 - 4J, 7-300Hz, 6-40W) via a fiber with a 200-m core diameter. Low dose CT scanning was performed on POD 90 to assess SFR. RESULTS Stone size ranged from 4 to 17 mm and stone density varied from 350 to 1459 HU. The average lithotripsy time was 12 min (3-30 min). The average "lasering" time was 1.3 min (0.4-2.5 min) and the mean hospital stay was 1.1+/-0.3 days. In all cases we reached the lower pole stone containing calyx with a laser fiber. The complication rates were evaluated by using the Clavien-Dindo grading system and did not exceed GII (6.6%). SFR on POD 90 was achieved in 86.6% of cases. CONCLUSIONS F-URS with SuperPulse Tm fiber laser is safe and effective option in the management of lower pole small calyceal stones. The possibility of using small laser fibers gives better instrument deflection which make possible to reach lower pole calyceal stones even with acute lower pole infundibulopelvic angle (IPA).
Collapse
Affiliation(s)
- L M Rapoport
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - M A Gazimiev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - D O Korolev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - D G Tsarichenko
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Y U A Svetikova
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - M E Enikeev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - G N Akopyan
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - D V Chinenov
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - M S Taratkin
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - D V Enikeev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| |
Collapse
|
40
|
Chang H, Jhan J, Huang T. Distal ureteral stone in an ileal conduit: A case treated by antegrade flexible ureteroscopic lithotripsy. Clin Case Rep 2020; 8:2809-2812. [PMID: 33363827 PMCID: PMC7752608 DOI: 10.1002/ccr3.3180] [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: 02/25/2020] [Accepted: 06/29/2020] [Indexed: 11/24/2022] Open
Abstract
Antegrade flexible URSL is a minimal invasive option for treating distal ureteral stones in patient after urinary diversion.
Collapse
Affiliation(s)
- Hao‐Han Chang
- Department of UrologyKaohsiung Medical University HospitalKaohsiungTaiwan
- Kaohsiung Medical UniversityKaohsiungTaiwan
| | - Jhen‐Hao Jhan
- Kaohsiung Medical UniversityKaohsiungTaiwan
- Department of UrologyKaohsiung Municipal Siaogang HospitalKaohsiungTaiwan
| | - Tsung‐Yi Huang
- Department of UrologyKaohsiung Medical University HospitalKaohsiungTaiwan
| |
Collapse
|
41
|
Cracco CM, Scoffone CM. Endoscopic combined intrarenal surgery (ECIRS) - Tips and tricks to improve outcomes: A systematic review. Turk J Urol 2020; 46:S46-S57. [PMID: 32877638 PMCID: PMC7731958 DOI: 10.5152/tud.2020.20282] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [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: 06/24/2020] [Accepted: 07/06/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE This study aimed at assessing current efficacy and safety of endoscopic combined intrarenal surgery (ECIRS) for the treatment of large and/or complex urolithiasis and identifying relevant tips and tricks able to improve its outcomes, mainly deriving from the adjunct of retrograde flexible ureteroscopy to the traditional antegrade approach of percutaneous nephrolithotomy (PNL). MATERIAL AND METHODS A systematic review was conducted using relevant databases (Ovid Medline, PubMed, Scopus, and Web of Sciences), employing "ECIRS" as the search term in all cases, and then adding "endoscopic combined intrarenal surgery" and "flexible ureteroscopy AND percutaneous nephrolithotomy" as search terms for PubMed and Scopus. Original articles and systematic reviews were selected according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Additionally, the reference lists of the selected publications were checked manually. RESULTS A total of 14 studies were selected for analysis: two systematic reviews, one randomized controlled trial, five nonrandomized comparative studies, three prospective case series, and three retrospective case series. ECIRS achieves high stone-free rates and rather low/low Clavien-Dindo grade complication rates, confirming the role of retrograde ureteroscopy in the maximization of its efficacy and safety. A narrative synthesis of the most recognized tips and tricks of ECIRS is provided. CONCLUSION The contribution of retrograde flexible ureteroscopy during PNL is essential. It plays a dual role, both diagnostic and active, allowing tailoring of the procedure to the patient, urolithiasis, and anatomy of the collecting system and optimization of the PNL efficacy and safety. This is ECIRS: an updated, complete, and versatile version of PNL.
Collapse
|
42
|
Huang JS, Xie J, Huang XJ, Yuan Q, Jiang HT, Xiao KF. Flexible ureteroscopy and laser lithotripsy for renal stones 2 cm or greater: A single institutional experience. Medicine (Baltimore) 2020; 99:e22704. [PMID: 33120764 PMCID: PMC7581148 DOI: 10.1097/md.0000000000022704] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
With improvements in endoscopy and laser technology, flexible ureteroscopy (FURS) has been a viable treatment option for large renal stones. Here, we share our experience of the FURS treatment for renal stones 2 cm or greater.We evaluated 251 consecutive patients who underwent FURS and holmium laser lithotripsy for renal stones 2 cm or greater between January 2015 and April 2019. Stone size was defined as the longest axis on non-contrast computed tomography. Data were retrospectively collected from electronic medical records. Patient demographics, stone clearance rates and perioperative complications were evaluated.There were 165 male patients and 86 female patients with an average age of 46.9 years (range 22-80 years). Mean stone size was 2.7 cm and the average number of procedures was 1.4 (range 1-5). The stone-free rate at the end of the first, second and third procedure was 61.9%, 82.9%, and 89.5%, respectively. The final stone-free rate decreased as stone size grows, and it was only 58.3% for kidney stones larger than 4 cm after an average of 2.3 procedures. The lowest clearance rates were observed in lower calyx calculi (87.2%) and multiple calyx calculi (83.5%). The overall complication rate was 15.1%, and the most common complication was postoperative fever (9.6%). One patient required blood transfusion, owing to postoperative coagulation disorders induced by urosepsis.Single or staged FURS is a practical treatment option for the renal stones sized 2 to 4 cm with acceptable efficacy and safety. Stone clearance rate of FURS treatment is mainly affected by stone size and location.
Collapse
|
43
|
Xun Y, Chen M, Liang P, Tripathi P, Deng H, Zhou Z, Xie Q, Li C, Wang S, Li Z, Hu D, Kamel I. A Novel Clinical-Radiomics Model Pre-operatively Predicted the Stone-Free Rate of Flexible Ureteroscopy Strategy in Kidney Stone Patients. Front Med (Lausanne) 2020; 7:576925. [PMID: 33178719 PMCID: PMC7593485 DOI: 10.3389/fmed.2020.576925] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 09/11/2020] [Indexed: 12/23/2022] Open
Abstract
Purpose: The purpose of the study is to develop and validate a novel clinical–radiomics nomogram model for pre-operatively predicting the stone-free rate of flexible ureteroscopy (fURS) in kidney stone patients. Patients and Methods: Altogether, 2,129 fURS cases with kidney stones were retrospectively analyzed, and 264 patients with a solitary kidney stone were included in a further study. For lower calyx calculi, a radiomics model was generated in a primary cohort of 99 patients who underwent non-contrast-enhanced computed tomography (NCCT). Radiomics feature selection and signature building were conducted by using the least absolute shrinkage and selection operator (LASSO) method. Multivariate logistic regression analysis was employed to build a model incorporating radiomics and potential clinical factors. Model performance was evaluated by its discrimination, calibration, and clinical utility. The model was internally validated in 43 patients. Results: The overall success rate of fURS was 72%, while the stone-free rate (SFR) for lower calyx calculi and non-lower calyx calculi was 56.3 and 90.16%, respectively. On multivariate logistic regression analysis of the primary cohort, independent predictors for SFR were radiomics signature, stone volume, operator experience, and hydronephrosis level, which were all selected into the nomogram. The area under the curve (AUC) of clinical–radiomics model was 0.949 and 0.947 in the primary and validation cohorts, respectively. Moreover, the calibration curve showed a satisfactory predictive accuracy, and the decision curve analysis indicated that the nomogram has superior clinical application value. Conclusion: In this novel clinical–radiomics model, the radiomics scores, stone volume, hydronephrosis level, and operator experience were crucial for the flexible ureteroscopy strategy.
Collapse
Affiliation(s)
- Yang Xun
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Mingzhen Chen
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ping Liang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Pratik Tripathi
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huchuan Deng
- College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, China
| | - Ziling Zhou
- College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, China
| | - Qingguo Xie
- College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, China
| | - Cong Li
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shaogang Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhen Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Daoyu Hu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ihab Kamel
- Russell H. Morgan Department of Radiology and Radiological Science, the Johns Hopkins Medical Institutions, Baltimore, MD, United States
| |
Collapse
|
44
|
Abstract
We report the case of a 49-year-old woman affected by bilateral urinary stones. Bilateral semirigid ureteroscopy was performed followed on the left side by a flexible ureteroscopy, caused by localization of the stone. Unfortunately, disinsertion of the left ureter occurred during the intervention. Open conversion was performed in the same single procedure for left ureteral reimplant. After an easy recovery, the patient was rehospitalized on day 9 postintervention for left pyelonephritis. This case report discusses the management of this rare but serious complication, including the necessity for quick thinking and decision making.
Collapse
Affiliation(s)
- David Denis
- Department of Urology, Clinica Santa Maria, Santiago, Chile
- Department of Urology, Cliniques Universitaires Saint-Luc, Bruxelles, Belgique
| | - Sergio Moreno
- Department of Urology, Clinica Santa Maria, Santiago, Chile
- Universidad Finis Terrae, Facultad de Medicina, Providencia, Región Metropolitana de Santiago, Chile
| | - Alfredo Velasco
- Department of Urology, Clinica Santa Maria, Santiago, Chile
- Universidad Finis Terrae, Facultad de Medicina, Providencia, Región Metropolitana de Santiago, Chile
| | - José A. Salvadó
- Department of Urology, Clinica Santa Maria, Santiago, Chile
- Universidad Finis Terrae, Facultad de Medicina, Providencia, Región Metropolitana de Santiago, Chile
| |
Collapse
|
45
|
Reicherz A, Maas V, Wenzel P, Dahlkamp L, Palisaar J, von Bodman C, Noldus J, Bach P. Transient stent placement versus tubeless procedure after ureteroscopy retrograde surgery stone extraction (Fast Track Stent study 2): A randomized prospective evaluation. Int J Urol 2020; 27:749-754. [PMID: 32974894 DOI: 10.1111/iju.14291] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 05/18/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine whether in pre-stented patients undergoing ureteroscopic stone removal (ureteroscopy retrograde surgery) a tubeless procedure provides a better outcome compared with short-term (6 h) ureteral stenting using an external ureteral catheter. METHODS In this single academic center study (Fast Track Stent study 2), carried out between May 2016 and April 2018, 121 patients with renal or ureteral calculi were initially treated with double-J insertion. Before secondary ureteroscopy retrograde surgery, patients were prospectively randomized into two groups: tubeless versus ureteral catheter insertion for 6 h after ureteroscopy retrograde surgery. Exclusion criteria were acute urinary tract infection, solitary kidney or stone diameter >25 mm. Study end-points were stent-related symptoms assessed by a validated questionnaire (ureteral stent symptom questionnaire), administered both before and 4 weeks after surgery. Numerical ureteral stent symptom questionnaire scores were compared using the Mann-Whitney-U-test. The level of significance was defined as P < 0.05. RESULTS Ureteroscopy retrograde surgery procedures carried out by 13 surgeons resulted in >90% stone removal in all patients (n = 121), with a mean operation time of 19.9 versus 18.0 min for ureteral catheter versus tubeless, respectively (P = 0.37). Patient groups did not differ significantly in their ureteral stent symptom questionnaire scores (urinary index P = 0.24; pain index P = 0.35). Patients showed a significant preference for tubeless procedure over ureteral catheter reinsertion (Question GQ P < 0.0001). The reintervention rate was 13.3% for the tubeless procedure (n = 8) and 1.6% for the ureteral catheter group (n = 1), respectively (P = 0.034). CONCLUSIONS Short-term ureteral catheter and no stent insertion after ureteroscopy retrograde surgery stone extraction in pre-stented patients result in comparable quality of life. However, the reintervention rate is higher for tubeless procedures.
Collapse
Affiliation(s)
- Alina Reicherz
- Department of Urology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Verena Maas
- Department of Urology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Patricia Wenzel
- Department of Urology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Lisa Dahlkamp
- Department of Urology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Jüri Palisaar
- Department of Urology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | | | - Joachim Noldus
- Department of Urology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Peter Bach
- Department of Urology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| |
Collapse
|
46
|
Karagöz MA, Erihan IB, Doluoğlu ÖG, Uğurlu Ç, Bağcıoğlu M, Uslu M, Sarıca K. Efficacy and safety of fURS in stones larger than 20 mm: is it still the threshold? Cent European J Urol 2020; 73:49-54. [PMID: 32395324 PMCID: PMC7203769 DOI: 10.5173/ceju.2020.0056] [Citation(s) in RCA: 2] [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: 11/03/2019] [Revised: 12/22/2019] [Accepted: 12/27/2019] [Indexed: 11/22/2022] Open
Abstract
Introduction The aim of this article was to evaluate the safety and efficiency of flexible ureteroscopy (fURS) in the management of renal calculi larger than 20 mm. Material and methods A total of 92 cases with renal calculi were managed with fURS and divided into two groups depending on the size of the stones; <20 mm and >20 mm (Group 1 and Group 2, respectively). The groups were compared with respect to treatment-related parameters including success, complication rates, hospitalization period and need for auxiliary procedures with an emphasis on the rate of infections. Success rates were also compared in each group according to stone location. Results Overall success rates after 3 months showed that stone-free rates in both groups were 84.1% (< 20 mm) and 58.33% (>20 mm) respectively (p = 0.008). The success rates of upper/mid pole (100% vs. 80%) and pelvis stones (83.3% vs. 75%) showed no statistically significant difference (p = 0.5, p = 0.51 respectively). Success rates for stones located in the lower pole were 75% vs. 14.28% respectively (p = 0.008). The rate of infectious complications was significantly higher in cases undergoing fURS for relatively larger stones (22.9%) as compared to smaller calculi (6.8%) (p = 0.032). No complications were recorded in Group 1, while 2 cases in Group 2 (4.1%) developed ureteral stricture. Conclusions Despite the relatively low stone-free rates in lower pole stones, our current results indicate that fURS can be an effective and safe treatment alternative to PNL in larger renal stones (>20 mm) located in the pelvis and in the upper part of the calyceal system of the involved kidney.
Collapse
Affiliation(s)
- Mehmet Ali Karagöz
- Department of Urology, Kafkas University Faculty of Medicine, Kars, Turkey
| | | | | | - Çağlar Uğurlu
- Department of Urology, Kafkas University Faculty of Medicine, Kars, Turkey
| | - Murat Bağcıoğlu
- Department of Urology, Kafkas University Faculty of Medicine, Kars, Turkey
| | - Mehmet Uslu
- Department of Urology, Kafkas University Faculty of Medicine, Kars, Turkey
| | - Kemal Sarıca
- Department of Urology, Kafkas University Faculty of Medicine, Kars, Turkey
| |
Collapse
|
47
|
Meng X, Cong R, Song R, Lu P, Zhang W, Wang Z. Multiple renal ruptures after flexible ureteroscopic lithotripsy with holmium laser. AME Case Rep 2020; 4:1. [PMID: 32206747 DOI: 10.21037/acr.2019.12.01] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 11/20/2019] [Indexed: 11/06/2022]
Abstract
The authors present a case report of multiple renal ruptures after flexible ureteroscopic lithotripsy (FURL) with holmium laser. Multiple renal ruptures following flexible ureterorenoscopy have not been reported so far. The etiology remains unclear. We like to share this case to make urologists aware of this unusual complication and discuss possible causes and therapeutic approaches.
Collapse
Affiliation(s)
- Xianghu Meng
- Department of Urology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Rong Cong
- Department of Urology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Rijin Song
- Department of Urology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Pei Lu
- Department of Urology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Wei Zhang
- Department of Urology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Zengjun Wang
- Department of Urology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| |
Collapse
|
48
|
Wang KY, Hu JS, Fang L, Zhang DX, Li Q, Ng DM, Haleem M, Xie GH, Ma Q. Advantages of retrograde flexible ureteroscopy in determining the etiology of painless hematuria originating from the upper urinary tract. Exp Ther Med 2020; 19:2627-2631. [PMID: 32256743 PMCID: PMC7086279 DOI: 10.3892/etm.2020.8482] [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: 05/18/2019] [Accepted: 11/29/2019] [Indexed: 01/07/2023] Open
Abstract
The present study investigated the use of retrograde flexible ureteroscopy (RFU) in the discrimination of the etiology of hematuria that originates from the upper urinary tract (UUT). The present study collected retrospective data for patients who presented with hematuria and cystoscopy-detected bleeding from the UUT between June 2006 and August 2018 in Ningbo First Hospital. All patients accepted RFU to determine the etiology of hematuria. Data regarding imaging examinations, surgery, pathology and complications were also collected and analyzed. In total, 65 patients (males, 38; females, 27) with a mean age of 63 years underwent RFU to determine the etiology of hematuria originating from the UUT. Using RFU, UUT tumors were found in 29 cases. Stones, polyps and atypical hyperplasia were found in two cases, and a definite diagnosis was not found in three cases. There were 17 cases without obvious abnormalities and nine cases were unable to undergo RFU due to ureteral stenosis. In patients who could not be diagnosed by imaging examination, 34.4% (11/32) were diagnosed with urothelial carcinoma by RFU, and these results were also confirmed by postoperative pathology. In the present study, no patient had severe complications after RFU. The present results suggested RFU may be used as a sensitive method to diagnose UUT tumors (78.4%; 29/37) and has strong specificity. RFU could be performed as a routine examination for patients with hematuria from the UUT.
Collapse
Affiliation(s)
- Kai-Yun Wang
- Translational Research Laboratory for Urology, The Key Laboratory of Ningbo City, Ningbo First Hospital, The Affiliated Hospital of Ningbo University, Ningbo, Zhejiang 315010, P.R. China.,School of Medicine, Ningbo University, Ningbo, Zhejiang 315000, P.R. China
| | - Jia-Sheng Hu
- Department of Urology, Ningbo First Hospital, The Affiliated Hospital of Ningbo University, Ningbo, Zhejiang 315010, P.R. China
| | - Li Fang
- Department of Urology, Ningbo First Hospital, The Affiliated Hospital of Ningbo University, Ningbo, Zhejiang 315010, P.R. China
| | - Dong-Xu Zhang
- Department of Urology, Ningbo First Hospital, The Affiliated Hospital of Ningbo University, Ningbo, Zhejiang 315010, P.R. China
| | - Qiang Li
- Department of Urology, Ningbo First Hospital, The Affiliated Hospital of Ningbo University, Ningbo, Zhejiang 315010, P.R. China
| | - Derry Minyao Ng
- School of Medicine, Ningbo University, Ningbo, Zhejiang 315000, P.R. China
| | - Maria Haleem
- School of Medicine, Ningbo University, Ningbo, Zhejiang 315000, P.R. China
| | - Guo-Hai Xie
- Department of Urology, Ningbo First Hospital, The Affiliated Hospital of Ningbo University, Ningbo, Zhejiang 315010, P.R. China
| | - Qi Ma
- Translational Research Laboratory for Urology, The Key Laboratory of Ningbo City, Ningbo First Hospital, The Affiliated Hospital of Ningbo University, Ningbo, Zhejiang 315010, P.R. China.,Comprehensive Urogenital Cancer Center, Ningbo First Hospital, The Affiliated Hospital of Ningbo University, Ningbo, Zhejiang 315010, P.R. China
| |
Collapse
|
49
|
Abstract
Objective To investigate the feasibility and effectiveness of flexible ureteroscopy (fURS) without fluoroscopy during the treatment of renal stones. Patients and methods Between April 2013 and August 2018, 744 patients’ data were evaluated retrospectively. Of these, 576 patients were included in the study. All fURS were performed by experienced surgeons. All procedures were planned with zero-dose fluoroscopy. But, if fluoroscopy was necessary for any reasons, these patients were excluded from the study. Demographic data, perioperative parameters, stone-free rate (SFR), and complication rates were recorded. Results Of the patients planned for fluoroless fURS (ffURS), the procedure was successfully achieved in 96.7% (557/576 patients), as 19 patients required fluoroscopy during the procedure for various reasons. In the patients included in the study, the mean (SD) stone size was 11.6 (5.2) mm and the mean (SD) operating time was 39.4 (8.2) min. After the first session of ffURS, the SFR was 83.3% (achieved in 464 patients). Second and third sessions of ffURS were performed in 32 (5.7%) and seven (1.2%) patients, respectively. Overall, the complication rate was 11.8% and all complications were minor (Clavien–Dindo Grade I or II). Conclusions The ffURS technique seems to be a safe and effective treatment compared to conventional fURS in patients with renal stones. This procedure should be performed in experienced centers, where fluoroscopy can be considered not to be mandatory during fURS. Abbreviations CIRF clinically insignificant residual fragment; CT: computed tomography; EAU: European Association of Urology; (f)fURS: (fluoroless) flexible ureteroscopy; FT: fluoroscopy time; KUB: plain abdominal radiograph of the kidneys, ureters and bladder; mSv: millisievert; PCNL: percutaneous nephrolithotomy; pps: pulse-per-second; rem: roentgen equivalent man; PUJ: pelvi-ureteric junction; SFR: stone-free rate
Collapse
Affiliation(s)
- Mustafa Kirac
- Department of Urology, Koru Ankara Hospital, Yuksek Ihtisas University, Ankara, Turkey
| | - Burak Kopru
- Department of Urology, Koru Ankara Hospital, Yuksek Ihtisas University, Ankara, Turkey
| | - Giray Ergin
- Department of Urology, Koru Ankara Hospital, Yuksek Ihtisas University, Ankara, Turkey
| | - Yusuf Kibar
- Department of Urology, Koru Ankara Hospital, Yuksek Ihtisas University, Ankara, Turkey
| | - Hasan Biri
- Department of Urology, Koru Ankara Hospital, Yuksek Ihtisas University, Ankara, Turkey
| |
Collapse
|
50
|
Erdoğan A, Keskin E, Altun A. Percutaneous nephrolithotomy versus flexible ureteroscopy in terms of cost-effectiveness in patients with 10-30 mm renal stones. Urologia 2019; 87:41-46. [PMID: 31545662 DOI: 10.1177/0391560319876805] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Kidney stones are one of the most common urological problems. When deciding on the method of treatment for this common disease, the cost of the procedure should also be taken into consideration. MATERIALS AND METHODS We performed a retrospective analysis of 55 patients who underwent percutaneous nephrolithotomy and 75 patients who underwent retrograde intrarenal surgery between January 2016 and November 2018. Until operative success was achieved, all additional surgical procedures, extracorporeal shock wave lithotripsy procedures, and interventional procedures required to resolve complications were recorded. Total cost was compared between the percutaneous nephrolithotomy and retrograde intrarenal surgery groups. RESULTS No significant difference was found between the percutaneous nephrolithotomy and retrograde intrarenal surgery groups in terms of gender, mean age, stone side, stone localization and stone surface area. The total cost of 55 patients that underwent percutaneous nephrolithotomy was calculated as US$14.766 after the first operation, and the total cost of 75 patients that underwent retrograde intrarenal surgery was determined to be US$46.627. The mean cost per patient was calculated US$320 ± US$186 for percutaneous nephrolithotomy and US$749 ± US$242 for retrograde intrarenal surgery (p < 0.001). CONCLUSIONS Percutaneous nephrolithotomy is a lower-cost and successful method in the surgical treatment of 1-3 cm stones, but the serious complications involved in this operation should be kept in mind.
Collapse
Affiliation(s)
- Abdullah Erdoğan
- Urology Department, Faculty of Medicine, Erzincan University, Erzincan, Turkey
| | - Ercüment Keskin
- Urology Department, Faculty of Medicine, Erzincan University, Erzincan, Turkey
| | - Abdulsemet Altun
- Urology Department, Faculty of Medicine, Erzincan University, Erzincan, Turkey
| |
Collapse
|