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Assimos DG. Urolithiasis/Endourology. J Urol 2024; 211:727-729. [PMID: 38329078 DOI: 10.1097/ju.0000000000003809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 11/27/2023] [Indexed: 02/09/2024]
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Devos B, Vanderbruggen W, Claessens M, Duchateau A, Hente R, Keller EX, Pietropaolo A, Van Cleynenbreugel B, De Coninck V. Risk factors of early infectious complications after ureterorenoscopy for stone disease: a prospective study. World J Urol 2024; 42:277. [PMID: 38691160 DOI: 10.1007/s00345-024-04983-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 03/25/2024] [Indexed: 05/03/2024] Open
Abstract
PURPOSE To prospectively evaluate the rate and associated risk factors of early infectious complications after ureterorenoscopy for urolithiasis. METHODS After ethical committee approval, 400 therapeutic retrograde ureterorenoscopy procedures between August 3, 2020 and November 24, 2021 were included for analysis in a single-center study. Postoperative infection was defined as an afebrile urinary tract infection, fever (≥ 38 °C) with pyuria (≥ 300 WBC/μL) or proven urinary pathogen, and urosepsis. The primary outcome was the rate of infectious complications after ureterorenoscopy. Secondary outcomes were the perioperative factors that increased the risk of infectious complications within 30 days of surgery using univariate and multivariate logistic regression analysis. RESULTS Twenty-nine of four hundred (7.3%) patients developed an infectious complication within 30 days after ureterorenoscopy. Ten (2.5%) patients developed an afebrile urinary tract infection, eight (2.0%) developed fever with pyuria, five (1.3%) febrile urinary tract infection, and six (1.5%) urosepsis. On univariate analysis, preoperative stent-type JFil® pigtail suture stent was significantly associated with the dependent variable (p < 0.001). On multivariate logistic regression analysis, older age (OR 1.035; 95% CI 1.006-1.070; p = 0.02) was found to be significantly associated with developing a postoperative infectious complication. CONCLUSIONS A 7.3% rate of postoperative infectious complications and 1.5% urosepsis rate were observed after therapeutic ureterorenoscopy, without the need of intensive care admission. The only significant risk factors were preoperative stent type (JFil® pigtail suture stent) on univariate analysis, and older age on multivariate logistic regression analysis. Further multicentric prospective observational data are needed in this field.
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Affiliation(s)
- Brecht Devos
- Faculty of Medicine, University Hospitals Leuven, Louvain, Belgium
| | | | - Marc Claessens
- Department of Urology, AZ Klina, Augustijnslei 100, 2930, Brasschaat, Belgium
| | - Aline Duchateau
- Department of Urology, AZ Klina, Augustijnslei 100, 2930, Brasschaat, Belgium
| | - Robert Hente
- Department of Urology, AZ Klina, Augustijnslei 100, 2930, Brasschaat, Belgium
| | - Etienne Xavier Keller
- Young Academic Urologists (YAU), Urolithiasis & Endourology Working Party, 6846, Arnhem, Netherlands
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Amelia Pietropaolo
- Young Academic Urologists (YAU), Urolithiasis & Endourology Working Party, 6846, Arnhem, Netherlands
- Department of Urology, University Hospital Southampton, Southampton, UK
| | - Ben Van Cleynenbreugel
- Faculty of Medicine, University Hospitals Leuven, Louvain, Belgium
- Department of Development and Regeneration, KU Leuven, Louvain, Belgium
| | - Vincent De Coninck
- Department of Urology, AZ Klina, Augustijnslei 100, 2930, Brasschaat, Belgium.
- Young Academic Urologists (YAU), Urolithiasis & Endourology Working Party, 6846, Arnhem, Netherlands.
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Koterazawa S, Takahashi T, Somiya S, Ito K, Haitani T, Kanno T, Higashi Y, Yamada H, Imamura M. Ureteroscopy for urolithiasis in bedridden patients: it is feasible and acceptable. World J Urol 2024; 42:272. [PMID: 38683217 DOI: 10.1007/s00345-024-04895-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 02/21/2024] [Indexed: 05/01/2024] Open
Abstract
PURPOSE To investigate the safety of transurethral ureteroscopy (URS) for urolithiasis in bedridden patients and to identify bedridden patient-specific risk factors for postoperative complications. METHODS The patients who underwent URS for urolithiasis were divided into bedridden patients and good performance status (PS) patients, and the groups were compared regarding their clinical characteristics and postoperative complications. A multivariable logistic regression analysis was performed to evaluate independent predictors of postoperative febrile urinary tract infection (fUTI). RESULTS A total of 1626 patients were included, 276 in the bedridden patient group, and 1350 in the good PS patient group. The bedridden patient group had a significantly higher age and higher proportion of females and had multiple comorbidities. In 77 patients (27.9%), 88 postoperative complications developed for the bedridden patient group. Clavien-Dindo grade III or IV complications were observed in only 8 patients. No grade V complications were observed. The most common complication was fUTI. The frequency of fUTI with grade III or IV for the bedridden patient group (2.2%) was higher compared with the good PS patient group (0.5%), but the difference was not statistically significant (p = 0.13). Bedridden patient-specific risk factors for fUTI included female sex, diabetes mellitus, cerebrovascular comorbidities, lower extremity contracture, and prolonged operative time. CONCLUSION URS for urolithiasis is a feasible and acceptable procedure in bedridden patients, despite the moderate rate of postoperative complications. The identified risk factors provide a framework for risk stratification and individualized care in this unique patient population.
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Affiliation(s)
- Shigeki Koterazawa
- Department of Urology, Ijinkai Takeda General Hospital, 28-1 Moriminami-Cho, Ishida Fushimi-Ku, Kyoto, 601-1495, Japan
| | - Toshifumi Takahashi
- Department of Urology, Ijinkai Takeda General Hospital, 28-1 Moriminami-Cho, Ishida Fushimi-Ku, Kyoto, 601-1495, Japan
| | - Shinya Somiya
- Department of Urology, Ijinkai Takeda General Hospital, 28-1 Moriminami-Cho, Ishida Fushimi-Ku, Kyoto, 601-1495, Japan
| | - Katsuhiro Ito
- Department of Urology, Ijinkai Takeda General Hospital, 28-1 Moriminami-Cho, Ishida Fushimi-Ku, Kyoto, 601-1495, Japan
| | - Takao Haitani
- Department of Urology, Ijinkai Takeda General Hospital, 28-1 Moriminami-Cho, Ishida Fushimi-Ku, Kyoto, 601-1495, Japan
| | - Toru Kanno
- Department of Urology, Ijinkai Takeda General Hospital, 28-1 Moriminami-Cho, Ishida Fushimi-Ku, Kyoto, 601-1495, Japan
| | - Yoshihito Higashi
- Department of Urology, Ijinkai Takeda General Hospital, 28-1 Moriminami-Cho, Ishida Fushimi-Ku, Kyoto, 601-1495, Japan
| | - Hitoshi Yamada
- Department of Urology, Ijinkai Takeda General Hospital, 28-1 Moriminami-Cho, Ishida Fushimi-Ku, Kyoto, 601-1495, Japan
| | - Masaaki Imamura
- Department of Urology, Ijinkai Takeda General Hospital, 28-1 Moriminami-Cho, Ishida Fushimi-Ku, Kyoto, 601-1495, Japan.
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Moretto S, Saita A, Scoffone CM, Talso M, Somani BK, Traxer O, Angerri O, Knoll T, Liatsikos E, Herrmann TRW, Ulvik Ø, Skolarikos A, Cracco CM, Keller EX, Paciotti M, Piccolini A, Uleri A, Tailly T, Carmignani L, Pietropaolo A, Corrales M, Lughezzani G, Lazzeri M, Fasulo V, De Coninck V, Arena P, Nagele U, Ferretti S, Kronenberg P, Perez-Fentes D, Osther PJ, Goumas IK, Acquati P, Ajayi L, Diana P, Casale P, Buffi NM. Ureteral stricture rate after endoscopic treatments for urolithiasis and related risk factors: systematic review and meta-analysis. World J Urol 2024; 42:234. [PMID: 38613692 DOI: 10.1007/s00345-024-04933-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 03/15/2024] [Indexed: 04/15/2024] Open
Abstract
PURPOSE We aimed to accurately determine ureteral stricture (US) rates following urolithiasis treatments and their related risk factors. METHODS We conducted a systematic review and meta-analysis following the PRISMA guidelines using databases from inception to November 2023. Studies were deemed eligible for analysis if they included ≥ 18 years old patients with urinary lithiasis (Patients) who were subjected to endoscopic treatment (Intervention) with ureteroscopy (URS), percutaneous nephrolithotomy (PCNL), or shock wave lithotripsy (SWL) (Comparator) to assess the incidence of US (Outcome) in prospective and retrospective studies (Study design). RESULTS A total of 43 studies were included. The pooled US rate was 1.3% post-SWL and 2.1% post-PCNL. The pooled rate of US post-URS was 1.9% but raised to 2.7% considering the last five years' studies and 4.9% if the stone was impacted. Moreover, the pooled US rate differed if follow-ups were under or over six months. Patients with proximal ureteral stone, preoperative hydronephrosis, intraoperative ureteral perforation, and impacted stones showed higher US risk post-endoscopic intervention with odds ratio of 1.6 (P = 0.05), 2.6 (P = 0.009), 7.1 (P < 0.001), and 7.47 (P = 0.003), respectively. CONCLUSIONS The overall US rate ranges from 0.3 to 4.9%, with an increasing trend in the last few years. It is influenced by type of treatment, stone location and impaction, preoperative hydronephrosis and intraoperative perforation. Future standardized reporting and prospective and more extended follow-up studies might contribute to a better understanding of US risks related to calculi treatment.
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Affiliation(s)
- S Moretto
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy.
| | - A Saita
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - C M Scoffone
- Department of Urology, Cottolengo Hospital, Turin, Italy
| | - M Talso
- Department of Urology, Luigi Sacco University Hospital, Milan, Italy
| | - B K Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - O Traxer
- Department of Urology, Sorbonne Université, Paris, France
| | - O Angerri
- Department of Urology, Fundació Puigvert Univ. Autonoma de Barcelona, Barcelona, Spain
| | - T Knoll
- Department of Urology, Sindelfingen Medical Center, University of Tübingen, Tübingen, Germany
| | - E Liatsikos
- Department of Urology, University Hospital of Patras, Patras, Greece
| | - T R W Herrmann
- Department of Urology, Spital Thurgau AG, Frauenfeld, Switzerland
- Hannover Medical School, Hannover, Germany
- Division of Urology, Department of Surgical Sciences, Stellenbosch University, Western Cape, South Africa
| | - Ø Ulvik
- Department of Urology, Haukeland University Hospital, Bergen, Norway
| | - A Skolarikos
- Second Department of Urology, Sismanoglio Hospital, National and Kapodistrian University of Athen, Athens, Greece
| | - C M Cracco
- Department of Urology, Cottolengo Hospital, Turin, Italy
| | - E X Keller
- Department of Urology, University Hospital Zurich, Zurich, Switzerland
| | - M Paciotti
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - A Piccolini
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - A Uleri
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - T Tailly
- Department of Urology, University Hospital Ghent, Ghent, Belgium
| | - L Carmignani
- Department of Urology, University of Milan, Milan, Italy
| | - A Pietropaolo
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - M Corrales
- Department of Urology, Sorbonne Université, Paris, France
| | - G Lughezzani
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - M Lazzeri
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - V Fasulo
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - V De Coninck
- Department of Urology, AZ Klina, Brasschaat, Belgium
| | - P Arena
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - U Nagele
- Department of Urology, General Hospital Hall in Tirol, Hall in Tirol, Austria
| | - S Ferretti
- Department of Urology, Azienda Ospedaliero-Universitaria di Modena, Baggiovara, Italy
| | - P Kronenberg
- Department of Urology, Hospital CUF Descobertas, Lisbon, Portugal
| | - D Perez-Fentes
- Department of Urology, University Hospital Complex of Santiago de Compostela, Santiago, Spain
| | - P J Osther
- Department of Urology, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - I K Goumas
- Department of Urology, Istituto Clinico Beato Matteo, Vigevano, Italy
| | - P Acquati
- Department of Urology, IRCCS Policlinico San Donato, Milan, Italy
| | - L Ajayi
- Department of Urology, Royal Free London NHS Foundation Trust, London, UK
| | - P Diana
- Department of Urology, Fundació Puigvert Univ. Autonoma de Barcelona, Barcelona, Spain
| | - P Casale
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - N M Buffi
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
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Wang X, Shi G, Li G, Tang G. Systematic review of the risk of urolithiasis following parathyroidectomy in patients with primary hyperparathyroidism. Int Urol Nephrol 2024; 56:1217-1225. [PMID: 38038823 DOI: 10.1007/s11255-023-03882-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/04/2023] [Indexed: 12/02/2023]
Abstract
OBJECTIVE Parathyroidectomy (PTX) is the conclusive therapy for primary hyperparathyroidism (PHPT), but its effect on the risk of urolithiasis is inconclusive. We comprehensively reviewed the currently available research to investigate the impact of PTX on the likelihood of urolithiasis among individuals suffering PHPT. METHODS Internet-based articles in English language released on Cochrane, PubMed, Scopus, Web of knowledge, and Embase up to September, 2023 were comprehensively reviewed. Each publication in contrast to the incidence, occurrence, or recurrence of urolithiasis after PTX versus medical treatment in PHPT patients was included. The outcome with pooled relative risks (RRs) and corresponding 95% confidence intervals (CIs) was examined employing DerSimonian and Laird's model of random effects. To determine the range of the real effect size of a future study in 95% of all populations, a prediction interval (PI) was also established. RESULTS Finally, ten studies involving 74,190 patients were included. Results from randomized-controlled trials (RCTs) and observational studies (OSs) both revealed that PTX did not substantially lessen the vulnerability of urolithiasis among individuals with PHPT (RCTs: pooled relative risk [RR] 0.42, 95%CI 0.13-1.41, p = 0.163; OSs: pooled RR 1.37, 95%CI 0.96 to 1.97, p = 0.084). The PI (RCT: 0.03 to 5.96; OSs: 0.44-4.20) containing 1.0 suggested the possibility of consistent results in future studies. Subgroup and sensitivity analyses supported the above findings, and no evidence showed publication bias. CONCLUSION Our analysis from the available RCTs or OSs did not give adequate or exact proof that the average effect of PTX lowers the incidence of urolithiasis among PHPT persons based on the random-effects model. Future research shall take into account the common effect of PTX as well as the prerequisites of preventive stone procedures, which will further help us assess the effectiveness of PTX in reducing kidney calculus comorbidity and develop techniques to avoid stone sequelae in these individuals.
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Affiliation(s)
- Xingmu Wang
- Clinical Laboratory Center, Shaoxing People's Hospital, Shaoxing, Zhejiang, People's Republic of China
| | - Ge Shi
- Clinical Laboratory Center, Shaoxing People's Hospital, Shaoxing, Zhejiang, People's Republic of China
| | - Gangfeng Li
- Clinical Laboratory Center, Shaoxing People's Hospital, Shaoxing, Zhejiang, People's Republic of China
| | - Guiliang Tang
- Department of Urology, Shaoxing People's Hospital, No. 568, Zhongxing North Road, Yuecheng District, Shaoxing, 312000, Zhejiang, People's Republic of China.
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Assimos DG. Urolithiasis/Endourology. J Urol 2024; 211:636-638. [PMID: 38241204 DOI: 10.1097/ju.0000000000003780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 10/30/2023] [Indexed: 01/21/2024]
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Abdelfatah Zaza MM, Farouk Salim A, El-Mageed Salem TA, Mohammed Ezzat A, Hassan Ali M. Impact of ureteric access sheath use during flexible ureteroscopy: A comparative study on efficacy and safety. Actas Urol Esp 2024; 48:204-209. [PMID: 37838327 DOI: 10.1016/j.acuroe.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 08/19/2023] [Accepted: 08/21/2023] [Indexed: 10/16/2023]
Abstract
OBJECTIVES This study evaluates the impact of using an access sheath (AS) during flexible ureteroscopy (fURS) for urolithiasis treatment, focusing on outcomes such as stone-free rate, operation time, and complications. METHODS This prospective, randomized study was carried out at Badr Hospital, Helwan University, and Ain Shams University hospitals from August 2021 to August 2022. Patients were systematically randomized into two groups (fURS with AS: 33 patients and without AS: 31 patients) and underwent preoperative and postoperative assessments, including lab tests and imaging. Possible procedure-associated risks, such as failed stone access, pain, bleeding, and sepsis, were monitored. RESULTS The two groups were found to be comparable in terms of demographic characteristics or preoperative stone findings (p > 0.05 for all). However, operation duration was shorter in the No Sheath group (79.4 ± 15.3 min vs. 90.4 ± 16.7 min in the Sheath group, p = 0.008). Intraoperative complication rates, including failed access, operation termination, ureteric injury, and bleeding, were comparable in both groups (p > 0.05). Postoperative stone-free rates (78.8% vs. 71.0%, p = 0.305) and mean residual stone size (2.7 ± 3.5 mm vs. 3.1 ± 3.1 mm, p = 0.687) showed no significant differences. CONCLUSIONS The present study suggests that fURS without an access sheath may offer an efficient and equally effective option for managing upper ureteric and renal stones. However, more studies with larger sample sizes and longer follow-up periods are required to validate these findings and to establish more precise indications for this approach.
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Affiliation(s)
- M M Abdelfatah Zaza
- Departamento de Urología, Facultad de Medicina, Universidad de Helwan, El Cairo, Egypt
| | - A Farouk Salim
- Departamento de Urología, Facultad de Medicina, Universidad de Ain Shams, El Cairo, Egypt
| | - T A El-Mageed Salem
- Departamento de Urología, Facultad de Medicina, Universidad de Helwan, El Cairo, Egypt
| | - A Mohammed Ezzat
- Departamento de Urología, Facultad de Medicina, Universidad de Helwan, El Cairo, Egypt.
| | - M Hassan Ali
- Departamento de Urología, Facultad de Medicina, Universidad de Helwan, El Cairo, Egypt
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DI Bari S, Stella G, Benedetti M, Talso M, Saita A, Zaraca C, Ferrari R, Acquati P, Lombardo R, Ferretti S, Puliatti S, Cormio L, Micali S. Stone centers: a national survey on surgical techniques performed in Italy. Minerva Urol Nephrol 2024; 76:230-234. [PMID: 38742556 DOI: 10.23736/s2724-6051.24.05778-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
BACKGROUND Recurrent and complex stone disease may be considered a challenging disease. In 2018, the Calculus group of the SIU (Italian Society of Urology) set itself the goal of establishing the minimum requirements for a center that could continuously manage urolithiasis pathology, named a Stone Center. In this study we present the results of a pilot survey carried out in 2019 with the aim of drawing a map of the situation of Italian urological centers dealing with urinary stones. METHODS A total of 260 national urology departments dealing with urolithiasis surgery were contacted for this study. A survey was issued to each of the centers to determine the number of patients treated for urinary stones and the amount of procedures performed per year: 1) extracorporeal shock wave lithotripsy ESWL; 2) ureterorenoscopy URS; 3) retrograde intrarenal surgery RIRS; 4) percutaneous nephrolithotomy PCNL. RESULTS Out of 260 centers contacted, 188 fulfilled the survey. Outcomes were quite variable, with approximately 37% of the centers lacking a lithotripter, and 46% of those that did have it performing fewer than 100 treatments per year. In terms of endoscopic procedures, more than 80% of the centers contacted performed URS or RIRS; however, when it came to percutaneous lithotripsy, these numbers dropped significantly; 33% of the centers contacted did not perform PCNL, and of those who did, 18% had less than 5 years of experience as a center. CONCLUSIONS Our survey shows a very heterogeneous national picture about urolithiasis treatments. Our goal is to create national paradigms to be able to define stone centers where the patient suffering from complex urinary stones can find a network of professionals with an adequate armamentarium suitable for the management of their pathology.
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Affiliation(s)
- Stefano DI Bari
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Giuseppe Stella
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Mattia Benedetti
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Michele Talso
- SIU working group: Urinary Stones and Endourology, Rome, Italy
- Department of Urology, ASST Fatebenefratelli-Sacco, Luigi Sacco University Hospital, Milan, Italy
| | - Alberto Saita
- SIU working group: Urinary Stones and Endourology, Rome, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Carlo Zaraca
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Riccardo Ferrari
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Pietro Acquati
- SIU working group: Urinary Stones and Endourology, Rome, Italy
- Department of Urology, IRCCS Policlinico San Donato, Milan, Italy
| | - Riccardo Lombardo
- SIU working group: Urinary Stones and Endourology, Rome, Italy
- Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | | | - Stefano Puliatti
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Luigi Cormio
- SIU working group: Urinary Stones and Endourology, Rome, Italy
- Department of Urology, University of Foggia, Foggia, Italy
| | - Salvatore Micali
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy -
- SIU working group: Urinary Stones and Endourology, Rome, Italy
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Gloor C, Schweighauser A, Rytz U, Francey T. Placement of a subcutaneous ureteral bypass in a Miniature Pinscher with presumed xanthine urolithiasis as a result of allopurinol treatment. SCHWEIZ ARCH TIERH 2024; 166:207-215. [PMID: 38572822 DOI: 10.17236/sat00422] [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: 04/05/2024]
Abstract
INTRODUCTION This case report describes the long-term success of a subcutaneous ureteral bypass device in a dog for treatment of a ureteral obstruction. The suspected xanthine urolithiasis was secondary to treatment with allopurinol for leishmaniasis. The dog presented initially with lethargy, anuria and abdominal pain. Mild azotemia was found on biochemical analysis and abdominal ultrasound revealed bilateral ureteral obstruction. A subcutaneous ureteral bypass was subsequently placed using a standard surgical technique. The dog recovered uneventfully and the azotemia resolved within days. Follow-up examinations were performed every trimester for over three years and no complications like obstruction of the bypass tubes, urinary tract infection or azotemia were recognized during this follow-up period. Allopurinol was replaced with domperidone as long-term treatment against Leishmaniasis which resulted in a mild increase of the leishmania serum antibody titer. The subcutaneous ureteral bypass placement was successful and safe in this dog and is a valuable alternative in cases of ureteral obstruction also in dogs.
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Affiliation(s)
- C Gloor
- Department for Clinical Veterinary Medicine, Vetsuisse Faculty, University of Berne
| | - A Schweighauser
- Department for Clinical Veterinary Medicine, Vetsuisse Faculty, University of Berne
| | - U Rytz
- Department for Clinical Veterinary Medicine, Vetsuisse Faculty, University of Berne
| | - T Francey
- Department for Clinical Veterinary Medicine, Vetsuisse Faculty, University of Berne
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Lombardo R, Tzelves L, Geraghty R, Davis NF, Neisius A, Petřík A, Gambaro G, Türk C, Somani B, Thomas K, Skolarikos A. Follow-up of urolithiasis patients after treatment: an algorithm from the EAU Urolithiasis Panel. World J Urol 2024; 42:202. [PMID: 38546854 DOI: 10.1007/s00345-024-04872-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/08/2024] [Indexed: 04/02/2024] Open
Abstract
OBJECTIVE To develop a follow-up algorithm for urinary stone patients after definitive treatment. MATERIALS AND METHODS The panel performed a systematic review on follow-up of urinary stone patients after treatment (PROSPERO: CRD42020205739). Given the lack of comparative studies we critically evaluated the literature and reached a consensus on the follow-up scheme. RESULTS A total of 76 studies were included in the analysis, including 17 RCTs. In the stone-free general population group, 71-100% of patients are stone-free at 12 months while 29-94% remain stone-free at 36 months. We propose counselling these patients on imaging versus discharge after the first year. The stone-free rate in high-risk patients not receiving targeted medical therapy is < 40% at 36 months, a fact that supports imaging, metabolic, and treatment monitoring follow-up once a year. Patients with residual fragments ≤ 4 mm have a spontaneous expulsion rate of 18-47% and a growth rate of 10-41% at 12 months, supporting annual imaging follow-up. Patients with residual fragments > 4 mm should be considered for surgical re-intervention based on the low spontaneous expulsion rate (13% at 1 year) and high risk of recurrence. Plain film KUB and/or kidney ultrasonography based on clinicians' preference and stone characteristics is the preferred imaging follow-up. Computed tomography should be considered if patient is symptomatic or intervention is planned. CONCLUSIONS Based on evidence from the systematic review we propose, for the first time, a follow-up algorithm for patients after surgical stone treatment balancing the risks of stone recurrence against the burden of radiation from imaging studies.
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Affiliation(s)
| | - Lazaros Tzelves
- National and Kapodistrian University of Athens, Chairman of the EAU Urolithiasis Guidelines, Department of Urology, Sismanogleio Hospital, Athens, Greece
| | - Robert Geraghty
- Department of Urology, Freeman Hospital, Newcastle-Upon-Tyne, UK
- Institute of Genetic Medicine, Newcastle University, Newcastle-Upon-Tyne, UK
| | - Niall F Davis
- Department of Urology, Connolly Hospital, Blanchardstown, Dublin 15, Ireland
| | - Andreas Neisius
- Department of Urology, Hospital of the Brothers of Mercy Trier, Medical Campus University Mainz, Trier, Germany
| | - Ales Petřík
- Department of Urology, Region Hospital, Ceske Budejovice, Czech Republic
- Department of Urology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Giovanni Gambaro
- Division of Nephrology and Dialysis, Department of Medicine, University of Verona, Verona, Italy
| | - Christian Türk
- Department of Urology, Hospital of the Sisters of Charity, Vienna, Austria
- Urologische Praxis, Vienna, Austria
| | - Bhaskar Somani
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Kay Thomas
- Department of Urology, Guy's and St Thomas' Hospital, London, UK
| | - Andreas Skolarikos
- National and Kapodistrian University of Athens, Chairman of the EAU Urolithiasis Guidelines, Department of Urology, Sismanogleio Hospital, Athens, Greece.
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11
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Graf S, Somani BK. Ureterorenoscopy for stone disease in pregnancy: a literature review and update. Curr Opin Urol 2024; 34:128-134. [PMID: 37727900 DOI: 10.1097/mou.0000000000001133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
PURPOSE OF REVIEW Management of stone disease in pregnancy poses a challenge for all healthcare professionals involved in their care. During pregnancy, there is an increase in the incidence of urolithiasis. Major technological and procedural advances have been seen in the last decade for endoscopic management of urolithiasis. The purpose of this review is to provide a comprehensive workup of available literature on use of ureteroscopy for stone treatment during pregnancy. RECENT FINDINGS We identified 268 articles on screening, of which 28 were included in the final review. Overall adverse event rates were low, with no severe complications reported in the included studies. On multivariate analysis, the only significant correlation was an inverse relationship between calculated caseload and adverse obstetric events. No further correlation could be found between caseload, operation technique and adverse event rates. Data quality was low among the included studies. SUMMARY While ureteroscopy is a relatively safe and effective option for active stone treatment during pregnancy, they should be performed in experienced endourology centres in conjunction with obstetric teams.
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Affiliation(s)
- Sebastian Graf
- Department of Urology and Andrology, Kepler University Hospital, Linz, Austria
| | - Bhaskar K Somani
- Department of Urology, University Hospital Southampton, Southampton, UK
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12
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Protoshchak V V, Orlov D N, Paronnikov M V, Karpushchenko E G. [Prognosis of ureteral dilatation during procedures using a ureteral access sheath in patients with urolithiasis]. Urologiia 2024:17-23. [PMID: 38650401] [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: 04/25/2024]
Abstract
AIM To improve the results of treatment of patients with urolithiasis who underwent endoscopic interventions using a ureteral access sheath (UAS) by developing a predictive model of ureteral dilatation without pre-stenting. MATERIALS AND METHODS A total of 180 patients with kidney stones up to 20 mm were included in the study. They were divided into two groups: in the group 1 (n=79) UAS of 12/14 Ch was used, while in group II (n=101) UAS of 10/12 Ch was inserted. In group I, 48 (60.8%) patients underwent micropercutaneous nephrolithotomy and in 31 (39.2%) retrograde intrarenal surgery was done, compared to 42 (41.6%) and 59 (58, 4%) of patients in group 2. A non-inclusion criterion was a history of ureteral stenting. At the stage of preoperative diagnosis, 60 minutes before the X-ray examination, the patient took a single dose of 80 mg of furosemide per os to improve visualization of the upper urinary tract. After digital processing of computed tomography data and 3D-reconstruction of the upper urinary tract using the DICOM image processing program "RadiAnt DICOM Viewer," a visual assessment of the ureter was carried out to exclude significant deviations and strictures. The ureteral width was measured at three points: pyeloureteral segment, the level of the iliac bifurcation and intramural part. The number of cases of successful insertion of UAS and the rate of damage to the ureteral wall according to the classification proposed by O. Traxer and A. Thomas (2012) were analyzed. The prediction of successful insertion of a UAS was carried out using ROC analysis. RESULTS In group 1, successful insertion of UAS was observed in 37 (46.8%) patients compared to 84 (83.2%) patients in group 2. In the remaining 42 (53.2%) and 17 (16.8%) cases, respectively, placement of UAS was not possible due to significant tissue resistance and high risk of traumatic injury. The average ureteral diameter at the points of physiological narrowing in patients with successful insertion of 12/14 Ch UAS were 2.0+/-0.1 mm, compared to 1.2+/-0.4 mm in those with failed insertion (p<0.05). In the group 2, similar indicators were 1.6+/-0.1 mm and 1.2+/-0.5 mm, respectively (p<0.05). According to ROC analysis, the diagnostic efficiency of the predictive model when using 12/14 Ch and 10/12 Ch UAS was confirmed by high AUC values (0.925 [95% CI 0.871-0.98] and 0.944 [95% CI 0.89=0.97], respectively). The total number of patients with ureteral injuries was 35 (44.3%) and 40 (39.6%) in groups with 12/14 Ch and 10/12 Ch UAS, respectively. At the same time, complications of the I degree were observed in 24 (30.4%) patients of the group 1 and in 31 (30.7%) patients of the group 2, while injuries of II degree were detected in 10 (12.7%) and 9 (8.9%) cases, respectively (p>0.05). Only in 1 (1.3%) patient, when 12/14 Ch UAS was inserted, grade III damage to the ureteral wall was determined. CONCLUSION The proposed technique for measuring the cross-section of the ureter allows to predict the successful insertion of UAS at the preoperative stage. The probability of successful passage of UAS of 10/12 and 12/14 Ch in patients with ureteral diameter in physiological narrowings of more than 1.6 mm and 2 mm, respectively, is 95%. An insertion of UAS is a safe procedure, and most complications are classified as grades I or II.
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Affiliation(s)
- V Protoshchak V
- FGBVOU VO S.M. Kirov Military Medical Academy of the Ministry of Defense of Russian Federation, Saint Petersburg, Russia
| | - N Orlov D
- FGBVOU VO S.M. Kirov Military Medical Academy of the Ministry of Defense of Russian Federation, Saint Petersburg, Russia
| | - V Paronnikov M
- FGBVOU VO S.M. Kirov Military Medical Academy of the Ministry of Defense of Russian Federation, Saint Petersburg, Russia
| | - G Karpushchenko E
- FGBVOU VO S.M. Kirov Military Medical Academy of the Ministry of Defense of Russian Federation, Saint Petersburg, Russia
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13
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Mulyani GT, Pramono AB, Pangestiningsih TW. Diagnosis and treatment of urolithiasis in a Toy Poodle dog. Open Vet J 2024; 14:937-940. [PMID: 38682149 PMCID: PMC11052625 DOI: 10.5455/ovj.2024.v14.i3.23] [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: 01/10/2024] [Accepted: 02/23/2024] [Indexed: 05/01/2024] Open
Abstract
Background Urolithiasis in dogs is a disorder of the urinary tract caused by the development of crystals. These crystals are composed of minerals such as phosphates, oxalates, urates, cystine, carbonates, and silica. It can be fatal if the diagnosis and treatment are inaccurate. This report aims to report a case of urolithiasis in a Toy Poodle dog. Case Description A 2-year-old male Toy Poodle dog weighing 4.2 kg with black hair, and having trouble urinating was presented to Prof. Soeparwi Animal Hospital, Universitas Gadjah Mada, Indonesia. The dog is examined physically and, in the laboratory, diagnosed and continued with operative therapy. The history and physical examination revealed that the dog had been experiencing hematuria, stranguria, and oliguria for 2 months, with the last few days accompanied by decreased appetite. The dog exhibited decreased skin turgor, a capillary refill time (CRT) of less than 2 seconds, signs of pain and distress during urination, and palpation of distended urinary vesicles. Ultrasound scans revealed uroliths in the urinary vesica, which were identified by an acoustic shadow. Blood tests indicated a decrease in hematocrit and erythrocytes along with an increase in leukocytes. Urolithiasis was diagnosed in the case dog based on anamnesis, physical examination, hematological examination, and ultrasonography. Subsequently, a cystotomy was performed, and uroliths located in urinary vesicles were removed. The dog received ceftriaxone injections at 15 mg/kg body weight and vitamin B-complex injections at a concentration of 10 mg/kg body weight for 5 days. Four days post-surgery, the case dog was able to successfully urinate and pass clean urine. Conclusion The Toy Poodle dog was diagnosed with silica urolithiasis in the urinary vesicles and the urolith is quite large. Cystotomy was performed to remove the urolith. Postoperative care were included the administration of antibiotics and vitamins to facilitate the healing process. The condition of the Poodle toy dog improved.
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Affiliation(s)
- Guntari Titik Mulyani
- Department of Internal Medicine, Faculty of Veterinary Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Agung Budi Pramono
- Prof. Soeparwi Animal Hospital, Faculty of Veterinary Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Tri Wahyu Pangestiningsih
- Departement of Anatomy, Faculty of Veterinary Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
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14
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Assimos DG. Urolithiasis/Endourology. J Urol 2024; 211:494-496. [PMID: 38088338 DOI: 10.1097/ju.0000000000003747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 09/29/2023] [Indexed: 02/09/2024]
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15
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Best SL. Ho:YAG laser and dusting-high power vs low power: there is no difference. World J Urol 2024; 42:96. [PMID: 38386126 DOI: 10.1007/s00345-024-04788-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/10/2024] [Indexed: 02/23/2024] Open
Abstract
The introduction of the Ho:YAG laser 3 decades ago revolutionized the endoscopic treatment of urolithiasis. Since then, a variety of innovations have continued to evolve these devices, including the development of high-power lasers capable of high-frequency lithotripsy. The clinical utility of high-frequency lithotripsy, however, has not necessarily lived up to the potential suggested by in vitro studies. A review of the relevant literature, confirming strong similarities between the outcomes associated with high and lower power laser lithotripsy, follows.
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Affiliation(s)
- Sara L Best
- Department of Urology, School of Medicine and Public Health, University of Wisconsin, 1685 Highland Ave MFCB 3rd Floor, Madison, WI, 53705, USA.
- Litholink Corporation, Laboratory Corporation of America Holdings, Chicago, IL, USA.
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16
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Oman RE, Rivero L, Weaver LF, Simpson KM. Modified tube cystostomy technique for management of obstructive urolithiasis in small ruminants: procedure and outcome in 17 sheep and goats. J Am Vet Med Assoc 2024; 262:256-262. [PMID: 38244281 DOI: 10.2460/javma.23.07.0427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 09/25/2023] [Indexed: 01/22/2024]
Abstract
OBJECTIVE To describe the surgical technique and clinical outcome of small ruminants treated for obstructive urolithiasis using a modified tube cystostomy (MTC) technique. ANIMALS 15 goats and 2 sheep treated with an MTC between March 2018 and February 2023. CLINICAL PRESENTATION Animals were diagnosed with obstructive urolithiasis on the basis of history, physical examination, and ultrasonographic examination. An MTC was performed with sedation and a local block. Postoperative medical management was instituted to help reestablish urethral patency, and Foley catheters were removed after successful urination. RESULTS Animals were hospitalized an average of 3 nights (range, 0 to 14 nights). Complications included urine spillage in the abdomen and accidental deflation of the Foley balloon. Six animals were euthanized due to poor prognosis or failure to regain urethral patency. Foley catheters were removed an average of 15.7 days postoperatively in animals that regained urethral patency. Long-term (> 1-month) follow-up was available for 8 animals, with an average postoperative survival time of 19.4 months (range, 1 to 58 months). Four animals were lost to long-term follow-up. CLINICAL RELEVANCE This MTC technique is an effective means of catheterizing the urinary bladder in small ruminants. It can be performed under field conditions and serve as a standalone procedure for providing temporary urine egress. Patient size is limited by the length of the introducer, and an intact, distended urinary bladder and plan for reestablishing urethral patency are important considerations.
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Affiliation(s)
- Rachel E Oman
- 1College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO
| | - Luis Rivero
- 2College of Veterinary Medicine, University of Missouri, Columbia, MO
| | - Leslie F Weaver
- 3College of Veterinary Medicine, Kansas State University, Manhattan, KS
| | - Katharine M Simpson
- 1College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO
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17
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Ortner G, Somani BK, Güven S, Kitzbichler G, Traxer O, Giusti G, Proietti S, Liatsikos E, Kallidonis P, Krambeck A, Goumas IK, Duvdevani M, Kamphuis GM, Ferretti S, Dragos L, Ghani K, Miernik A, Juliebø-Jones P, Jung H, Tailly T, Pietropaolo A, Hamri SB, Papatsoris A, Sarica K, Scoffone CM, Cracco CM, Keller EX, Durutovic O, Pereira S, Herrmann TRW, Nagele U, Gözen AS, Tokas T. Experts' recommendations in laser use for the treatment of urolithiasis: a comprehensive guide by the European Section of Uro-Technology (ESUT) and Training-Research in Urological Surgery and Technology (T.R.U.S.T.)-Group. World J Urol 2024; 42:33. [PMID: 38217743 DOI: 10.1007/s00345-023-04726-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 10/30/2023] [Indexed: 01/15/2024] Open
Abstract
PURPOSE To identify laser lithotripsy settings used by experts for specific clinical scenarios and to identify preventive measures to reduce complications. METHODS After literature research to identify relevant questions, a survey was conducted and sent to laser experts. Participants were asked for preferred laser settings during specific clinical lithotripsy scenarios. Different settings were compared for the reported laser types, and common settings and preventive measures were identified. RESULTS Twenty-six laser experts fully returned the survey. Holmium-yttrium-aluminum-garnet (Ho:YAG) was the primary laser used (88%), followed by thulium fiber laser (TFL) (42%) and pulsed thulium-yttrium-aluminum-garnet (Tm:YAG) (23%). For most scenarios, we could not identify relevant differences among laser settings. However, the laser power was significantly different for middle-ureteral (p = 0.027), pelvic (p = 0.047), and lower pole stone (p = 0.018) lithotripsy. Fragmentation or a combined fragmentation with dusting was more common for Ho:YAG and pulsed Tm:YAG lasers, whereas dusting or a combination of dusting and fragmentation was more common for TFL lasers. Experts prefer long pulse modes for Ho:YAG lasers to short pulse modes for TFL lasers. Thermal injury due to temperature development during lithotripsy is seriously considered by experts, with preventive measures applied routinely. CONCLUSIONS Laser settings do not vary significantly between commonly used lasers for lithotripsy. Lithotripsy techniques and settings mainly depend on the generated laser pulse's and generator settings' physical characteristics. Preventive measures such as maximum power limits, intermittent laser activation, and ureteral access sheaths are commonly used by experts to decrease thermal injury-caused complications.
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Affiliation(s)
- Gernot Ortner
- Department of Urology and Andrology, General Hospital Hall I.T., Milser Straße 10, 6060, Hall in Tirol, Austria.
- Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria.
| | - Bhaskar Kumar Somani
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, England
| | - Selcuk Güven
- Department of Urology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Gerhard Kitzbichler
- Department of Urology and Andrology, General Hospital Hall I.T., Milser Straße 10, 6060, Hall in Tirol, Austria
| | - Olivier Traxer
- Sorbonne University, GRC N°20 Lithiase Renale, AP-HP, Hôpital Tenon, Paris, France
| | - Guido Giusti
- Department of Urology, San Raffaele Hospital, Milan, Italy
| | | | | | | | | | | | - Mordechai Duvdevani
- Department of Urology, Hadassah Ein-Kerem University Hospital, The Hebrew University, Jerusalem, Israel
| | - Guido M Kamphuis
- Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Stefania Ferretti
- Department of Urology, Hospital, University of Modena, Modena, Italy
| | - Laurian Dragos
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Khurshid Ghani
- Department of Urology, University of Michigan, Ann Arbor, USA
| | - Arkadiusz Miernik
- Department of Urology, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany
| | | | - Helene Jung
- Department of Urology, Hospital Lillebaelt, University of Southern Denmark, Vejle, Denmark
| | - Thomas Tailly
- Department of Urology, University Hospital Ghent, Ghent, Belgium
| | - Amelia Pietropaolo
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, England
| | - Saeed Bin Hamri
- Urology Department at Specialized Medical Center SMC2, Riyadh, Saudi Arabia
| | - Athanasios Papatsoris
- 2nd Department of Urology, Sismanoglio Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Kemal Sarica
- Department of Urology, Medical School, Health Sciences University, Prof Dr I. Varank Training and Educational Hospital, Istanbul, Turkey
| | | | | | | | - Otas Durutovic
- Department of Urology, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Sergio Pereira
- Department of Urology, North Lisbon University Hospital, Lisbon School of Medicine, Lisbon, Portugal
| | - Thomas R W Herrmann
- Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria
- Department of Urology, Kantonspital Frauenfeld, Spital Thurgau AG, Frauenfeld, Switzerland
| | - Udo Nagele
- Department of Urology and Andrology, General Hospital Hall I.T., Milser Straße 10, 6060, Hall in Tirol, Austria
- Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria
| | - Ali Serdar Gözen
- Department of Urology, Medius Kliniken, Ruit, Baden-Württemberg, Germany
| | - Theodoros Tokas
- Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria
- Department of Urology, University General Hospital of Heraklion, University of Crete, Medical School, Heraklion, Greece
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18
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Nedjim SA, Biyouma MDC, Kifle AT, Ziba OJD, Mahamat MA, Idowu NA, Mbwambo OJ, Cassel A, Douglas A, Kalli M, Gebreselassie KH, Khalid A, Wadjiri MM, Hoby R, Muhawenimana E, Marebo TS, Ngwa-Ebogo TT, Salissou M, Adoumadji K, Nzeyimana I, Odzèbe AWS, Barry MI, Rimtebaye K, Choua O, Niang L, Honoré B, Samnakay S, Bowa K, Lazarus J, Coulibaly N, Ndoye AK, Makon ASN, Aboutaieb R. Place of urolithiasis in the spectrum of urological pathologies, practices and use of endourological procedures in the management of calculi of the upper urinary tract: results of a survey of referral centres in Africa. Urolithiasis 2024; 52:26. [PMID: 38216696 DOI: 10.1007/s00240-023-01519-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 12/04/2023] [Indexed: 01/14/2024]
Abstract
Our aim was to determine the current trend of endourology in the management of upper urinary tract calculi in Africa reference centres. We conducted an online multiple-choice questionnaire survey involving 46 centres from 27 countries using a structured well-designed Google Form (®) questionnaire. The questionnaires were distributed to the head of service through their emails. The questions collected demographic data about the centre, the epidemiology of urolithiasis, diagnostic means and management of upper urolithiasis, especially access to endourology procedures and their practices. Descriptive analyses were performed. The participation rate was 77.9%. Urinary lithiasis was one of the three main pathologies encountered in 42/46 centres. 33 centres had easy access to CT scanners and 34 had operating theatres equipped with endo-urological surgery equipment. Of these 34 centres, 30 perform endourology for the management of upper urinary tract stones. Rigid ureteroscopy is the main technique used by the centres. It is the only endourology technique used for stone management by 12 centres (40%). 7/30 (23.3%) have the option of performing rigid ureteroscopy, flexible ureteroscopy and percutaneous nephrolithotomy. The frequency of procedures varies widely, with 43.3% rarely performing endourological surgery. Seventeen centres have their operating theatre equipped with a fluoroscope and 6/42 centres have extracorporeal lithotripsy. Open surgery is still used in 29/42 centres (69.1%). Laparoscopy is available in 50% of centres, but none reported performing laparoscopic lithotomy. In Africa, urinary lithiasis plays an important role in the activities of referral centres. Modern management techniques are used to varying degrees (not all centres have them) and with very variable frequency. Open surgery is still widely performed as a management. Rigid ureteroscopy is the main endourological technique. It is essential to develop the practice of modern urology in Africa, mainly endourology.
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Affiliation(s)
- Saleh Abdelkerim Nedjim
- Modern Urology For Africa*, Casablanca, Morocco.
- Centre Hospitalier Universitaire Ibn Rochd, Casablanca, Morocco.
| | - Marcella D C Biyouma
- Modern Urology For Africa*, Casablanca, Morocco
- Hôpital Laquintinie, Douala, Cameroon
| | - Anteneh Tadesse Kifle
- Modern Urology For Africa*, Casablanca, Morocco
- PCEA Chogoria Hospital, Chogoria, Kenya
| | - Ouima Justin Dieudonné Ziba
- Modern Urology For Africa*, Casablanca, Morocco
- Centre Hospitalier National Yalgado Ouedraogo, Ouagadougou, Burkina Faso
| | - Mahamat Ali Mahamat
- Modern Urology For Africa*, Casablanca, Morocco
- Hôpital Général de Référence Nationale, Ndjamena, Chad
| | - Najeem Adedamola Idowu
- Modern Urology For Africa*, Casablanca, Morocco
- Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Nigeria
| | - Orgeness Jasper Mbwambo
- Modern Urology For Africa*, Casablanca, Morocco
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Ayun Cassel
- Modern Urology For Africa*, Casablanca, Morocco
- John F. Kennedy Medical Center, Monrovia, Liberia
| | - Arthur Douglas
- Modern Urology For Africa*, Casablanca, Morocco
- University of Cape Coast College of Health and Allied Sciences, Cape Coast, Ghana
| | - Moussa Kalli
- Modern Urology For Africa*, Casablanca, Morocco
- Hôpital Général de Référence Nationale, Ndjamena, Chad
| | | | - Abdullahi Khalid
- Modern Urology For Africa*, Casablanca, Morocco
- Usmanu Danfodiyo University College of Health Sciences, Sokoto, Nigeria
| | - Mac Mansou Wadjiri
- Modern Urology For Africa*, Casablanca, Morocco
- Centre National Hospitalier Et Universitaire Hubert Koutoukou MAGA, Cotonou, Benin
| | - Rambel Hoby
- Modern Urology For Africa*, Casablanca, Morocco
- Centre Hospitalier Universitaire d'Antananarivo, Anatananarivo, Madagascar
| | - Emmanuel Muhawenimana
- Modern Urology For Africa*, Casablanca, Morocco
- Centre Hospitalier Universitaire de Kigali, Kigali, Rwanda
| | - Toto Shareba Marebo
- Modern Urology For Africa*, Casablanca, Morocco
- Centre Hospitalier Universitaire de Kamenge, Bujumbura, Burundi
| | | | - Mahamane Salissou
- Modern Urology For Africa*, Casablanca, Morocco
- Hôpital Amirou Boubacar Diallo, Niamey, Niger
| | - Kouldjim Adoumadji
- Modern Urology For Africa*, Casablanca, Morocco
- Hôpital La Rénaisssance, N'djamena, Chad
| | - Innocent Nzeyimana
- Modern Urology For Africa*, Casablanca, Morocco
- Centre Hospitalier Universitaire de Kigali, Kigali, Rwanda
| | - Anani Wencesl Sévérin Odzèbe
- Modern Urology For Africa*, Casablanca, Morocco
- Centre Hospitalier Et Universitaire de Brazzaville, Brazzaville, Congo
| | - Mamadou Ii Barry
- Modern Urology For Africa*, Casablanca, Morocco
- Hôpital National Ignace Deen, Conakry, Equatorial Guinea
| | - Kimassoum Rimtebaye
- Modern Urology For Africa*, Casablanca, Morocco
- Hôpital Général de Référence Nationale, Ndjamena, Chad
| | - Ouchemi Choua
- Modern Urology For Africa*, Casablanca, Morocco
- Hôpital Général de Référence Nationale, Ndjamena, Chad
| | - Lamine Niang
- Modern Urology For Africa*, Casablanca, Morocco
- Hôpital Général Idrissa Pouye, Dakar, Senegal
| | - Berthé Honoré
- Modern Urology For Africa*, Casablanca, Morocco
- Centre Hospitalier Universitaire du Point G, Bamako, Mali
| | - Saeed Samnakay
- Modern Urology For Africa*, Casablanca, Morocco
- Aga Khan University Hospital Nairobi, Nairobi, Kenya
| | - Kasonde Bowa
- Modern Urology For Africa*, Casablanca, Morocco
- Levy Mwanawasa University Teaching Hospital, Lusaka, Zambia
| | - John Lazarus
- Modern Urology For Africa*, Casablanca, Morocco
- Groote Schuur Hospital, Cape Town, South Africa
| | - Noel Coulibaly
- Modern Urology For Africa*, Casablanca, Morocco
- University Hospital Medical Center at Treichville, Abidjan, Côte d'Ivoire
| | - Alain Khassim Ndoye
- Modern Urology For Africa*, Casablanca, Morocco
- Hôpital Aristide Le Dantec, Dakar, Senegal
| | | | - Rachid Aboutaieb
- Modern Urology For Africa*, Casablanca, Morocco
- Centre Hospitalier Universitaire Ibn Rochd, Casablanca, Morocco
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19
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Allinder M, Tynan B, Martin C, Furbish A, Austin G, Bartges J, Lourenço BN. Uroliths composed of antiviral compound GS-441524 in 2 cats undergoing treatment for feline infectious peritonitis. J Vet Intern Med 2024; 38:370-374. [PMID: 38032049 PMCID: PMC10800210 DOI: 10.1111/jvim.16954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 11/13/2023] [Indexed: 12/01/2023] Open
Abstract
Feline infectious peritonitis (FIP) historically has been a fatal disease in cats. Recent unlicensed use of antiviral medication has been shown to markedly improve survival of this infection. An 8-month-old female spayed domestic short-haired cat undergoing treatment for presumptive FIP with the antiviral nucleoside analog GS-441524 developed acute progressive azotemia. Abdominal ultrasound examination identified multifocal urolithiasis including renal, ureteral, and cystic calculi. Unilateral ureteral obstruction progressed to suspected bilateral ureteral obstruction and subcutaneous ureteral bypass (SUB) was performed along with urolith removal and submission for analysis. A 2-year-old male neutered domestic medium-haired cat undergoing treatment for confirmed FIP with GS-441524 developed dysuria (weak urine stream, urinary incontinence, and difficulty expressing the urinary bladder). This cat also was diagnosed sonographically with multifocal urolithiasis requiring temporary tube cystostomy after cystotomy and urolith removal. In both cases, initial urolith analysis showed unidentified material. Additional testing confirmed the calculi in both cats to be 98% consistent with GS-441524. Additional clinical studies are required to determine best screening practices for cats presented for urolithiasis during treatment with GS-441524.
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Affiliation(s)
- Marissa Allinder
- Clinical Veterinary PharmacyCharleston Veterinary Referral CenterCharlestonSouth CarolinaUSA
| | - Beth Tynan
- Critical CareCharleston Veterinary Referral CenterCharlestonSouth CarolinaUSA
| | - Cara Martin
- Small Animal Medicine and Surgery, College of Veterinary MedicineUniversity of GeorgiaAthensGeorgiaUSA
| | - Amelia Furbish
- Dept. of Drug Discovery and Biomedical Sciences, College of PharmacyMedical University of South CarolinaCharlestonSouth CarolinaUSA
| | | | - Joe Bartges
- Small Animal Medicine and Surgery, College of Veterinary MedicineUniversity of GeorgiaAthensGeorgiaUSA
| | - Bianca N. Lourenço
- Small Animal Medicine and Surgery, College of Veterinary MedicineUniversity of GeorgiaAthensGeorgiaUSA
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20
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Lasorsa F, Caliolo C, Silecchia A, Laricchiuta N, Raguso M, Ditonno P, Lucarelli G. Management of Pediatric Urolithiasis in an Italian Tertiary Referral Center: A Retrospective Analysis. Medicina (Kaunas) 2023; 59:2165. [PMID: 38138268 PMCID: PMC10745114 DOI: 10.3390/medicina59122165] [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] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/09/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023]
Abstract
Background and Objectives: In recent years, the prevalence of pediatric urolithiasis has increased in North America and Western countries, though it is endemic in developing countries. The aim of this study is to describe the experience of a tertiary pediatric referral center in the surgical management of pediatric urolithiasis. Materials and Methods: We retrospectively reviewed the experience of patients ≤ 16 years old affected by urinary stones who underwent surgery. Results: From April 2021 to September 2023, 31 pediatric patients underwent surgical procedures for stone diseases at our department: 13 preschool-aged (1-5 years) and 18 school-aged (6-16 years) children. During this period, 12 URSs, 17 RIRSs, and 2 PCNLs were recorded. Five patients had residual fragments at first, so three of them underwent a second endourological lithotripsy (2 RIRSs and 1 URS). Complete clearance was finally achieved in 27 patients. The stone composition was evaluated in 25 cases. Conclusions: Numerous innovations in the surgical treatment of pediatric urolithiasis have resulted from the development of smaller devices and new technology. Our results show how, in experienced centers, retrograde and percutaneous lithotripsy are safe and effective procedures for use in pediatric populations.
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Affiliation(s)
- Francesco Lasorsa
- Department of Precision and Regenerative Medicine and Ionian Area-Urology, Andrology and Kidney Transplantation Unit, University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Claudia Caliolo
- Urologic Pediatric Surgery Unit, Pediatric Hospital “Giovanni XXIII”, 70124 Bari, Italy
| | - Antonia Silecchia
- Urologic Pediatric Surgery Unit, Pediatric Hospital “Giovanni XXIII”, 70124 Bari, Italy
| | - Nicola Laricchiuta
- Urologic Pediatric Surgery Unit, Pediatric Hospital “Giovanni XXIII”, 70124 Bari, Italy
| | - Michele Raguso
- Department of Precision and Regenerative Medicine and Ionian Area-Urology, Andrology and Kidney Transplantation Unit, University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Pasquale Ditonno
- Department of Precision and Regenerative Medicine and Ionian Area-Urology, Andrology and Kidney Transplantation Unit, University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Giuseppe Lucarelli
- Department of Precision and Regenerative Medicine and Ionian Area-Urology, Andrology and Kidney Transplantation Unit, University of Bari “Aldo Moro”, 70124 Bari, Italy
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21
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Wales R, Munshi F, Penukonda S, Sanford D, Pareek G. The Surgical Management of Urolithiasis: A Review of the Literature. R I Med J (2013) 2023; 106:36-40. [PMID: 38015783] [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: 11/30/2023]
Abstract
The incidence of stone disease has increased significantly in the past 30 years, with a reported prevalence of 11% of the U.S. population in 2022, up from 9% in 2012 and 5.2% in 1994.1 While prevention is a vital aspect of management, many patients present with symptomatic urolithiasis requiring surgical management. Emerging advances in endoscopy and technology has led to a dynamic shift in the surgical management of stone disease. This paper will serve as a comprehensive review to inform urologic and non-urologic medical professionals alike, as well as the layperson, on the surgical treatment of nephrolithiasis, starting from the initial evaluation, laboratory and radiographic studies, and various surgical options. Additionally, the nuances of managing the pediatric and pregnant patient with nephrolithiasis will be explored. Using the most up-to-date urologic data, our aim is to provide a comprehensive resource for readers who interact with patients experiencing acute episodes of urolithiasis.
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Affiliation(s)
| | - Faizanahmed Munshi
- Resident, Division of Urology, Warren Alpert Medical School of Brown University
| | - Suhas Penukonda
- Resident, Division of Urology, Warren Alpert Medical School of Brown University
| | - Daniel Sanford
- Resident, Division of Urology, Warren Alpert Medical School of Brown University
| | - Gyan Pareek
- Chief of Urology, Division of Urology, Department of Surgery, Warren Alpert Medical School of Brown University
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Tonyali S, Pietropaolo A, Emiliani E, Ortac M, Von Bargen MF, Turan S, Glienke M, Hamid Z, Tailly T. Factors associated with ureteral strictures following ureteroscopy for impacted ureteral stones? A multicenter study by EAU-YAU endourology and urolithiasis working party. Actas Urol Esp 2023; 47:631-637. [PMID: 37086846 DOI: 10.1016/j.acuroe.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/06/2023] [Accepted: 03/10/2023] [Indexed: 04/24/2023]
Abstract
OBJECTIVE To determine the relation between ureteral stone impaction and ureteral stricture formation and associated factors. MATERIAL AND METHODS We retrospectively analyzed the medical records of all patients who underwent endoscopic ureteral stone surgery for impacted ureteral stone at three academic institutions in Turkey, United Kingdom and Spain between June 2019 and January 2022. Examined parameters included patient demographics, stone side, size and localization, time between initiation of symptoms and surgery, type of ureteroscopy (rigid/flexible), presence of nephrostomy or double-J stent prior to URS, intraoperative complications (avulsion/perforation, stone-free status, number of procedures required for stone-free status, postoperative imaging results. RESULTS A total of 41 patients whom 25 were male and 16 were female, from 3 institutions were included the study. The mean age of the patients was 48.2 ± 13.5 years. The median largest diameter of the stones was 9 mm (IQR: 8 mm). Total 14 (34.1%) patients developed ureteral strictures following ureteroscopy. There was no difference between patients who developed ureteral strictures and patients who did not developed strictures in terms of stone laterality, stone location, hydronephrosis and multiplicity, p = 0.58, p = 0.14, p = 0.79 and p = 0.31. Patients who developed ureteral strictures had a higher rate of preoperative urinary diversion such as nephrostomy or DJS, p = 0.000. CONCLUSION Interruption of urine passage through ureter via urinary diversion such as nephrostomy or DJS stent prior to ureteral stone surgery might lead ureteral stricture formation in the postoperative period.
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Affiliation(s)
- S Tonyali
- Servicio de Urología, Facultad de Medicina de la Universidad de Estambul, Estambul, Turkey.
| | - A Pietropaolo
- Servicio de Urología, Hospital Universitario Southampton NHS Trust, Southampton, United Kingdom
| | - E Emiliani
- Servicio de Urología, Fundació Puigvert, Universidad Autónoma de Barcelona, Spain
| | - M Ortac
- Servicio de Urología, Facultad de Medicina de la Universidad de Estambul, Estambul, Turkey
| | - M F Von Bargen
- Servicio de Urología, Centro Médico de la Universidad de Friburgo, Germany
| | - S Turan
- Servicio de Urología, Facultad de Medicina de la Universidad de Estambul, Estambul, Turkey
| | - M Glienke
- Servicio de Urología, Centro Médico de la Universidad de Friburgo, Germany
| | - Z Hamid
- Servicio de Urología, Escuela de Medicina Father Muller, Mangalore, India
| | - T Tailly
- Servicio de Urología, Hospital Universitario de Gante, Gante, Belgium
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23
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Assimos DG. Urolithiasis/Endourology. J Urol 2023; 210:924-926. [PMID: 37774380 DOI: 10.1097/ju.0000000000003663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 08/10/2023] [Indexed: 10/01/2023]
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Gabrigna Berto F, Wang P, McClure JA, Bjazevic J, Golomb D, Filler G, Diaz-Gonzalez de Ferris M, Welk B, Razvi H, Dave S. A population-based retrospective cohort study of surgical trends and outcomes of pediatric urolithiasis in Ontario, Canada (2002-2019). J Pediatr Urol 2023; 19:784-791. [PMID: 37739819 DOI: 10.1016/j.jpurol.2023.08.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 08/06/2023] [Accepted: 08/31/2023] [Indexed: 09/24/2023]
Abstract
INTRODUCTION The worldwide incidence of pediatric urinary stone disease (PUSD) is increasing. However, there is no commensurate data on whether this translates to an increasing need for surgical intervention for PUSD, given the role of conservative management. OBJECTIVE We aimed to evaluate the trends and outcomes of clinically significant PUSD, using administrative databases to identify patients surgically treated for PUSD. STUDY DESIGN This retrospective population-based cohort study assessed the incidence and trends of surgically treated PUSD and outcomes in Ontario, Canada in patients <18 years of age who underwent their first PUSD procedure between 2002 and 2019 utilizing administrative databases held at the Institute of Clinical Evaluative Sciences (ICES). We assessed the incidence of surgically treated PUSD, demographics, initial surgical treatment and imaging modality, and risk factors for repeat intervention within 5 years. Statistical analyses summarized demographics, surgical trends, and logistic regression was used to identify risk factors for repeat surgical intervention. RESULTS We identified 1149 patients (mean age 11.3 years), with 59.6% older than 12 years. There was a decrease in the number of PUSD procedures performed per year that was close to statistical significance (p = 0.059) and a trend towards increased utilization of ureteroscopy (URS) compared with Shockwave Lithotripsy (SWL). In addition, there was a significant increase in the proportion of females surgically treated with PUSD (p = 0.001). In the 706 patients followed for 5 years, 17.7% underwent a repeat procedure within 6 months, while 20.4% underwent a repeat procedure from 6-months to 5 years. Renal stone location (OR 2.79, 95% confidence interval (CI) 1.62-4.80, p = 0.0002) and index SWL (OR 1.66, 95% CI 1.20-2.31, p = 0.0025) were risk factors for repeat surgical intervention within the first 6-months. There was an increasing utilization of ultrasound (US) compared to computerized tomography (CT) (p = 0.0008). DISCUSSION Despite the literature reporting increasing PUSD incidence, we observed a non-significant decrease in the number of surgical PUSD procedures performed. Exclusion of those treated conservatively may explain our results. The increase in the proportion of females treated reflects the narrowing gender gap in stone disease. A trend towards increased URS utilization was observed and re-intervention rates were similar to previous studies. CONCLUSION The overall rate of surgically treated PUSD did not show an increasing trend in Ontario, Canada from 2002 to 2019. URS was the most common surgical treatment modality, with a corresponding decline in SWL rates. PUSD was associated with a high surgical re-intervention rate within 6 months.
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Affiliation(s)
| | - Peter Wang
- Department of Surgery, Division of Urology, Western University, London, Ontario, Canada; Division of Pediatric Surgery and Division of Urology, Western University, London, Ontario, Canada
| | - J Andrew McClure
- Department of Surgery, London Health Sciences Centre, London, Ontario, Canada
| | - Jennifer Bjazevic
- Department of Surgery, Division of Urology, Western University, London, Ontario, Canada
| | - Dor Golomb
- Urology Department, Assuta Ashdod Hospital, Ashdod, Israel
| | - Guido Filler
- Department of Pediatrics, Division of Pediatric Nephrology, Western University, London, Ontario, Canada
| | | | - Blayne Welk
- Department of Surgery, Division of Urology, Western University, London, Ontario, Canada
| | - Hassan Razvi
- Department of Surgery, Division of Urology, Western University, London, Ontario, Canada
| | - Sumit Dave
- Department of Surgery, Division of Urology, Western University, London, Ontario, Canada; Division of Pediatric Surgery and Division of Urology, Western University, London, Ontario, Canada.
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25
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Kim HW, Lee SJ, Lee DS. 24-h urine collection in patients with urolithiasis: perspective on renal function. Urolithiasis 2023; 52:5. [PMID: 37982866 DOI: 10.1007/s00240-023-01500-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 10/24/2023] [Indexed: 11/21/2023]
Abstract
A prospective observational study involving consecutive patients diagnosed with symptomatic urolithiasis was conducted to evaluate the serial change of urinary protein and 24-h urine chemistry with time after surgical procedures for urolithiasis. A consecutive 24-h urine samples, including calcium, uric acid and citrate were collected before surgical treatments, 4 ~ 8 weeks after surgery and 6 months after surgery. The urinary protein to creatinine ratio was also repeated at each timepoint. Forty-seven patients completed the study. The quantity of 24-h urine chemistry, including calcium, uric acid and citrate, changed over time and tended to increase (p = 0.013, 0.076 and 0.004, respectively), but the changes were not prominent during short-term follow-up. In contrast, the urinary protein to creatinine ratio decreased (p < 0.001) after surgical treatment for symptomatic renal stones, and the change was reflected in short-term follow-up. However, the serial changes in the urinary protein to creatinine ratio were significantly related to the serial changes in the 24-h urinary chemistry (p < 0.001). Surgical decompression for symptomatic urolithiasis could decrease the urinary protein to creatinine ratio, indicating improvement from renal damage, which may be reflected in the increase in 24-h urinary chemistry, including calcium, uric acid and citrate. These results strengthen the previous guidelines for the timing of 24-h urine collection and provide new insight into the optimal timing from the perspective of renal function.
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Affiliation(s)
- Hyung Wook Kim
- Department of Nephrology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, South Korea
| | - Seung-Ju Lee
- Department of Urology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, 93-6 Ji-dong, Paldal-gu, Suwon, 16247, South Korea
| | - Dong Sup Lee
- Department of Urology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, 93-6 Ji-dong, Paldal-gu, Suwon, 16247, South Korea.
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26
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Panthier F, Abid N, Hoznek A, Traxer O, Meria P, Almeras C. 2022 Recommendations of the AFU Lithiasis Committee: Laser - utilization and settings. Prog Urol 2023; 33:825-842. [PMID: 37918982 DOI: 10.1016/j.purol.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/27/2023] [Accepted: 08/01/2023] [Indexed: 11/04/2023]
Abstract
Endocorporeal lithotripsy has progressed thanks to the development of lasers. Two laser sources are currently available: Holmium:YAG (Ho:YAG) and more recently Thulium Fiber Laser (TFL). The settings generally used are dusting, fragmentation, and "pop-corning". These are the first recommendations on laser use for stone management and their settings. Settings must be modulated and can be changed during the treatment according to the expected and obtained effects, the location and stone type that is treated. METHODOLOGY: These recommendations have been developed using two methods: the Clinical Practice Recommendation (CPR) method and the ADAPTE method, depending on whether or not the question was considered in the European Association of Urology (EAU) recommendations (https://uroweb.org/guidelines/urolithiasis [EAU Guidelines on urolithiasis. 2022]) and their adaptability to the French context.
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Affiliation(s)
- F Panthier
- GRC lithiase, AP-HP, Sorbonne université, Paris, France; Laboratoire PIMM, arts et métiers Paris Tech, Paris, France
| | - N Abid
- Department of Urology and Transplantation Surgery, Hospices Civils de Lyon, Edouard-Herriot Hospital, Lyon, France
| | - A Hoznek
- Service d'urologie, hôpital Henri-Mondor, AP-HP, université Paris Est Créteil, Paris, France
| | - O Traxer
- GRC lithiase, AP-HP, Sorbonne université, Paris, France; Laboratoire PIMM, arts et métiers Paris Tech, Paris, France
| | - P Meria
- Service d'urologie, hôpital Saint-Louis, AP-HP, centre université Paris Cité, Paris, France
| | - C Almeras
- UroSud, clinique La Croix du Sud, Quint-Fonsegrives, France.
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27
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Meria P, Almeras C. 2022 Recommendations of The AFU Lithiasis Committee: Open surgery and laparoscopy. Prog Urol 2023; 33:864-870. [PMID: 37918985 DOI: 10.1016/j.purol.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/27/2023] [Accepted: 08/01/2023] [Indexed: 11/04/2023]
Abstract
Only few hundred interventions are performed in France each year to remove upper urinary tract stones using a laparoscopic/robotic transperitoneal or retroperitoneal approach. These interventions are proposed to patients with large (>20mm) and complex stones, sometimes after failure of endoscopic techniques or in the presence of malformations that can be treated at the same time. The major interest of these interventions is the possibility to remove the whole stone without prior fragmentation. Some anatomical situations can increase the technical difficulty, particularly the presence of an intrarenal pelvis and the presence of pelvic and periureteral adhesions. The reported complications are essentially urinary fistula and ureteral stenosis, the risks of which are reduced by the use of double J stenting. As struvite stones are more friable, their whole removal is more difficult and may lead to dispersion of fragments, particularly during laparoscopy. Conventional open surgery has a higher stone-free rate, but comes with a greater kidney function loss. METHODOLOGY: These recommendations were developed using two methods: the Clinical Practice Recommendation (CPR) method and the ADAPTE method, depending on whether the question was considered in the European Association of Urology (EAU) recommendations (https://uroweb.org/guidelines/urolithiasis) (EAU Guidelines on urolithiasis. 2022) and their adaptability to the French context.
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Affiliation(s)
- P Meria
- Service d'urologie, hôpital Saint-Louis, AP-HP, centre université Paris-Cité, Paris, France
| | - C Almeras
- UroSud, clinique La Croix du Sud, Quint-Fonsegrives, France.
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Davis NF, Tzelves L, Geraghty R, Lombardo R, Yuan C, Petrik A, Neisius A, Gambaro G, Jung H, Shepherd R, Tailly T, Somani B, Skolarikos A. Comparison of Treatment Outcomes for Fluoroscopic and Fluoroscopy-free Endourological Procedures: A Systematic Review on Behalf of the European Association of Urology Urolithiasis Guidelines Panel. Eur Urol Focus 2023; 9:938-953. [PMID: 37277273 DOI: 10.1016/j.euf.2023.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 04/25/2023] [Accepted: 05/23/2023] [Indexed: 06/07/2023]
Abstract
CONTEXT Endourological procedures frequently require fluoroscopic guidance, which results in harmful radiation exposure to patients and staff. One clinician-controlled method for decreasing exposure to ionising radiation in patients with urolithiasis is to avoid the use of intraoperative fluoroscopy during stone intervention procedures. OBJECTIVE To comparatively assess the benefits and risks of "fluoroscopy-free" and fluoroscopic endourological interventions in patients with urolithiasis. EVIDENCE ACQUISITION A systematic review of the literature from 1970 to 2022 was performed using the MEDLINE/PubMed, Embase, and Cochrane controlled trials databases and ClinicalTrials.gov. Primary outcomes assessed were complications and the stone-free rate (SFR). Studies reporting data on ureteroscopy and percutaneous nephrolithotomy (PCNL) were eligible for inclusion. Secondary outcomes were operative duration, hospital length of stay, conversion from a fluoroscopy-free to a fluoroscopic procedure, and requirement for an auxiliary procedure to achieve stone clearance. EVIDENCE SYNTHESIS In total, 24 studies (12 randomised and 12 observational) out of 834 abstracts screened were eligible for analysis. There were 4564 patients with urolithiasis in total, of whom 2309 underwent a fluoroscopy-free procedure and 2255 underwent a comparative fluoroscopic procedure for treatment of urolithiasis. Pooled analysis of all procedures revealed no significant difference between the groups in SFR (p = 0.84), operative duration (p = 0.11), or length of stay (p = 0.13). Complication rates were significantly higher in the fluoroscopy group (p = 0.009). The incidence of conversion from a fluoroscopy-free to a fluoroscopic procedure was 2.84%. Similar results were noted in subanalyses for ureteroscopy (n = 2647) and PCNL (n = 1917). When only randomised studies were analysed (n = 12), the overall complication rate was significantly in the fluoroscopy group (p < 0.001). CONCLUSIONS For carefully selected patients with urolithiasis, fluoroscopy-free and fluoroscopic endourological procedures have comparable stone-free and complication rates when performed by experienced urologists. In addition, the conversion rate from a fluoroscopy-free to a fluoroscopic endourological procedure is low at 2.84%. These findings are important for clinicians and patients, as the detrimental health effects of ionising radiation are negated with fluoroscopy-free procedures. PATIENT SUMMARY We compared treatments for kidney stones with and without the use of radiation. We found that kidney stone procedures without the use of radiation can be safely performed by experienced urologists in patients with normal kidney anatomy. These findings are important, as they indicate that the harmful effects of radiation can be avoided during kidney stone surgery.
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Affiliation(s)
- Niall F Davis
- Department of Urology, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Lazaros Tzelves
- Department of Urology, Sismanogleio Hospital, National and Kapodistrian University of Athens, Athens, Greece; Department of Urology/Uro-oncology, University College of London Hospitals NHS Trust, London, UK
| | - Robert Geraghty
- Department of Urology, Freeman Hospital, Newcastle-upon-Tyne, UK
| | - Riccardo Lombardo
- Department of Urology ,Sant' Andrea Hospital, Sapienza University, Rome, Italy
| | - Cathy Yuan
- Division of Gastroenterology, McMaster University and Cochrane UGPD Group, Hamilton, Canada
| | - Ales Petrik
- First Faculty of Medicine, Charles University, Prague, Czechia
| | - Andrea Neisius
- Department of Urology, Bruederkrankenhaus Trier, Johannes Gutenberg University, Mainz, Germany
| | - Giovanni Gambaro
- Department of Medicine, Nephrology and Dialysis Unit, University of Verona, Verona, Italy
| | - Helene Jung
- Department of Urology, Lillebaelt and Vejle Hospitals, University of Southern Denmark Odense, Denmark
| | - Robert Shepherd
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | - Thomas Tailly
- Department of Urology, University Hospital Ghent, Ghent, Belgium
| | - Bhaskar Somani
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Andreas Skolarikos
- Department of Urology, Sismanogleio Hospital, National and Kapodistrian University of Athens, Athens, Greece.
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Gauhar V. Technological innovations and evolving trends in endourological management for urolithiasis and benign prostatic hypertrophy. World J Urol 2023; 41:2879-2880. [PMID: 37897514 DOI: 10.1007/s00345-023-04692-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/30/2023] Open
Affiliation(s)
- Vineet Gauhar
- Ng Teng Fong General Hospital, NUHS, Singapore, Singapore.
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Khoshrang H, Damavand RS, Nasseh H, Tavakoli AA, Esmaeili S, Ghaffari M, Shakiba M. Comparing spinal anesthesia approaches for transurethral lithotripsy in patients with proximal ureteral stones: A randomized clinical trial of bupivacaine alone versus bupivacaine with fentanyl. J Med Life 2023; 16:1508-1513. [PMID: 38313179 PMCID: PMC10835565 DOI: 10.25122/jml-2023-0109] [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: 05/07/2023] [Accepted: 08/14/2023] [Indexed: 02/06/2024] Open
Abstract
Despite the benefits of spinal anesthesia and the preference of anesthesiologists for this technique, it is less accepted by urologists due to the proximity of the stone place in the ureter and the possibility of pain, restlessness, and occasional movements of the patient during surgery. The current study investigated the success of bupivacaine plus intrathecal fentanyl in patients undergoing transurethral lithotripsy (TUL). In this randomized clinical trial, from April 2021 to September 2021, 54 patients with proximal urolithiasis candidates for TUL were enrolled. Patients were randomly categorized into two groups: group A received bupivacaine 10 mg and 0.5 ml of normal saline, while group B received bupivacaine 10 mg with 0.5 ml (25µg) of intrathecal fentanyl. According to our findings, about 74% of the patients were men, and the mean age of the patients was 66.14±22.46 years. The onset time of the sensory block, sensory block level, pain score, degree of relaxation, depth of the motor block, occurrence of anesthesia complications, oxygen saturation, and mean arterial blood pressure were not significantly different between the two groups. However, the duration of the motor block in group B was longer than in group A (p<0.001). Also, retropulsion was observed only in five patients (18.5%) in group A, significantly higher than in group B (p=0.019). Bupivacaine with fentanyl 25µg provided adequate spinal anesthesia with lower retropulsion in patients with urolithiasis who are candidates for TUL.
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Affiliation(s)
- Hossein Khoshrang
- Anesthesiology Research Center, Alzahra Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Reza Shahrokhi Damavand
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Hamidreza Nasseh
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Ardalan Akhavan Tavakoli
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Samaneh Esmaeili
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Mehdi Ghaffari
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Maryam Shakiba
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
- Cardiovascular Diseases Research Center, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
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Solano C, Corrales M, Panthier F, Candela L, Doizi S, Traxer O. Navigating urolithiasis treatment: assessing the practicality and performance of thulium fiber laser, holmium YAG, and thulium YAG in real-world scenarios. World J Urol 2023; 41:2627-2636. [PMID: 37468656 DOI: 10.1007/s00345-023-04487-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 06/07/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND The management of urolithiasis has undergone significant advancements with the introduction of pulsed lasers, particularly the holmium:yttrium-aluminum-garnet (Ho:YAG) laser, which is currently considered the gold standard in endourology. However, the Ho:YAG laser has certain limitations, such as the inability to support small laser fibers (150 μm) and the requirement of a heavy water cooling system, making it challenging to transfer between operating rooms. These limitations have led to the emergence of new laser technologies, including the thulium fiber laser (TFL) and the thulium:yttrium-aluminum-garnet laser (Tm:YAG), as potential alternatives to the Ho:YAG laser. METHODS In this review, we aimed to evaluate the effectiveness and safety of TFL, Ho:YAG, and Tm:YAG lasers in real-life scenarios by comparing clinical trial data with laboratory findings. A literature review was conducted, and relevant in vitro studies and clinical trials until March 2023 were analyzed. RESULTS The findings indicate that TFL has demonstrated high ablation efficiency for stones of any composition, size, and location, superior the capabilities of Ho:YAG lasers. TFL has shown superior dusting and fragmentation abilities, lower retropulsion, and increased patient safety. The laser parameters, such as ablation efficiency, speed, operative time, dust quality, retropulsion, visibility, temperature safety, and stone-free rate, were compared between laboratory studies and clinical outcomes. CONCLUSION Although the number of studies on TFL is limited, the available evidence suggests that TFL represents a significant advancement in laser technology for lithotripsy. However, further research is needed to fully explore the implications and limitations of TFL and Tm:YAG lasers.
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Affiliation(s)
- Catalina Solano
- GRC n20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
- Department of Endourology, Uroclin S.A.S, Medellín, Colombia
| | - Mariela Corrales
- GRC n20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
| | - Frederic Panthier
- GRC n20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
| | - Luigi Candela
- GRC n20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
- Division of Experimental Oncology/Unit of Urology, URI-Urological Research Institute IRCCS Ospedale San Raffaele, Milan, Italy
| | - Steeve Doizi
- GRC n20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France
| | - Olivier Traxer
- GRC n20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020, Paris, France.
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, 4 Rue de la Chine, 75020, Paris, France.
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Assimos DG. Urolithiasis/Endourology. J Urol 2023; 210:713-714. [PMID: 37490602 DOI: 10.1097/ju.0000000000003628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 07/11/2023] [Indexed: 07/27/2023]
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Laranjo Tinoco C, Coutinho A, Cardoso A, Araújo AS, Matos R, Anacleto S, Mota P. Efficacy and safety of fluoroless ureteroscopy and retrograde intrarenal surgery for the treatment of urolithiasis: A comparative study. Actas Urol Esp 2023; 47:535-542. [PMID: 37207987 DOI: 10.1016/j.acuroe.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/22/2023] [Accepted: 03/26/2023] [Indexed: 05/21/2023]
Abstract
INTRODUCTION Ureteroscopy (URS) and retrograde intrarenal surgery (RIRS) are traditionally guided by fluoroscopy, but the risks of exposure to ionizing radiation may present a matter of concern for patients and urologists. The aim of this study was to evaluate the efficacy and safety of fluoroless URS and RIRS compared with conventional fluoroscopy-guided procedures for the treatment of ureteral and renal stones. MATERIAL AND METHODS Patients treated with URS or RIRS for urolithiasis between August 2018 and December 2019 were retrospectively evaluated and grouped according to the use of fluoroscopy. Data was collected from individual patient records. The main outcomes were stone-free rate (SFR) and complications, compared between the fluoroscopy and fluoroless groups. A subgroup analysis by type of procedure (URS and RIRS) and a multivariate analysis to identify predictors of residual stones were conducted. RESULTS A total of 231 patients met the inclusion criteria: 120 (51.9%) in the conventional fluoroscopy group and 111 (48.1%) in the fluoroless group. No significant differences were found between groups regarding SFR (82.5% vs 90.1%, p=.127) or postoperative complication rate (35.0% vs 31.5%, p=.675). In the subgroup analysis these variables did not present significant differences, regardless of the procedure considered. In the multivariate analysis the fluoroless technique was not an independent predictor of residual lithiasis (OR 0.991; 95% IC 0.407-2.411; p=.983), when adjusted for procedure type, stone size and stone number. CONCLUSION URS and RIRS can be done without fluoroscopic guidance in selected cases, without affecting the efficacy or safety of the procedure.
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Affiliation(s)
| | - A Coutinho
- Urology Department, Hospital de Braga, Braga, Portugal
| | - A Cardoso
- Urology Department, Hospital de Braga, Braga, Portugal
| | - A S Araújo
- Urology Department, Hospital de Braga, Braga, Portugal
| | - R Matos
- Urology Department, Hospital de Braga, Braga, Portugal
| | - S Anacleto
- Urology Department, Hospital de Braga, Braga, Portugal
| | - P Mota
- Urology Department, Hospital de Braga, Braga, Portugal; School of Medicine, University of Minho, Braga, Portugal; Centro Clínico Académico (2CA-Braga), Braga, Portugal
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Taghavi K, Kusel A, Webb N, McCahy P, Badawy M, Ditchfield M. The burden of radiation exposure in children requiring percutaneous nephrolithotomy. J Pediatr Urol 2023; 19:559.e1-559.e7. [PMID: 37302924 DOI: 10.1016/j.jpurol.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 05/15/2023] [Accepted: 05/17/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND Children undergoing investigation and management for complex upper tract urolithiasis often require multimodal imaging. The significance of related radiation exposure in stone care pathways has received little attention in the published literature. STUDY DESIGN Medical records of paediatric patients undergoing percutaneous nephrolithotomy were retrospectively analysed to ascertain the modalities used and determine extent of radiation exposure occurring during each care pathway. Radiation dose simulation and calculation was performed a priori. The cumulative effective dose (mSv) and cumulative organ dose (mGy) for radiosensitive organs was calculated. RESULTS A total of 140 imaging studies were included from the care pathways of 15 children with complex upper tract urolithiasis. Median follow-up was 9.6 years (range: 6.7-16.8 years). The average number of imaging studies with ionising radiation per patient was nine, with a cumulative effective dose of 18.3 mSv across all modalities. The most common modalities were: mobile fluoroscopy (43%), x-ray (24%), and computed tomography (18%). The cumulative effective dose per study type was greatest for CT (4.09 mSv), followed by fixed and mobile fluoroscopy (2.79 mSv and 1.82 mSv, respectively). CONCLUSION There is high general awareness of radiation exposure involved in CT scanning with resultant caution in employing this modality in paediatric patients. However, the significant radiation exposure relating to fluoroscopy (whether fixed or mobile) is less well documented in children. We recommend implementing steps to minimise radiation exposure by optimisation and avoidance of certain modalities where possible. Paediatrics urologists must employ strategies to minimise radiation exposure in children with urolithiasis, given the significant exposures encountered.
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Affiliation(s)
- Kiarash Taghavi
- Department of Paediatric Urology, Monash Children's Hospital, Monash Health, Melbourne, Australia; Department of Paediatrics, Monash University, Melbourne, Australia.
| | - Amanda Kusel
- Department of Paediatric Urology, Monash Children's Hospital, Monash Health, Melbourne, Australia
| | - Nathalie Webb
- Department of Paediatric Urology, Monash Children's Hospital, Monash Health, Melbourne, Australia; School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Philip McCahy
- Department of Urology, Monash Health, Melbourne, Australia; School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Mohamed Badawy
- Monash Health Imaging, Monash Health, Clayton, Victoria, Australia; Department of Medical Imaging and Radiation Sciences, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Michael Ditchfield
- Department of Paediatrics, Monash University, Melbourne, Australia; Monash Health Imaging, Monash Health, Clayton, Victoria, Australia
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Grammatico-Guillon L, Laurent E, Fuhrman J, Gaborit C, Vallée M, Dinh A, Sotto A, Bruyere F. Factors associated with urinary diversion and fatality of hospitalised acute pyelonephritis patients in France: a national cross-sectional study (FUrTIHF-2). Epidemiol Infect 2023; 151:e161. [PMID: 37721009 PMCID: PMC10600899 DOI: 10.1017/s0950268823001504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 09/04/2023] [Accepted: 09/05/2023] [Indexed: 09/19/2023] Open
Abstract
Acute pyelonephritis (AP) epidemiology has been sparsely described. This study aimed to describe the evolution of AP patients hospitalised in France and identify the factors associated with urinary diversion and fatality, in a cross-sectional study over the 2014-2019 period. Adult patients hospitalised for AP were selected by algorithms of ICD-10 codes (PPV 90.1%) and urinary diversion procedure codes (PPV 100%). 527,671 AP patients were included (76.5% female: mean age 66.1, 48.0% Escherichia coli), with 5.9% of hospital deaths. In 2019, the AP incidence was 19.2/10,000, slightly increasing over the period (17.3/10,000 in 2014). 69,313 urinary diversions (13.1%) were performed (fatality rate 6.7%), mainly in males, increasing over the period (11.7% to 14.9%). Urolithiasis (OR [95% CI] =33.1 [32.3-34.0]), sepsis (1.73 [1.69-1.77]) and a Charlson index ≥3 (1.32 [1.29-1.35]) were significantly associated with urinary diversion, whereas E. coli (0.75 [0.74-0.77]) was less likely associated. The same factors were significantly associated with fatality, plus old age and cancer (2.38 [2.32-2.45]). This nationwide study showed an increase in urolithiasis and identified, for the first time, factors associated with urinary diversion in AP along with death risk factors, which may aid urologists in clinical decision-making.
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Affiliation(s)
- Leslie Grammatico-Guillon
- Public Health and Prevention Department, Unit of Regional Clinical Epidemiology, Teaching Hospital of Tours, Medical School, University of Tours, Tours, France
| | - Emeline Laurent
- Public Health and Prevention Center, Unit of Regional Clinical Epidemiology, Teaching Hospital of Tours, Research Team “Education, Ethics and Health”, University of Tours, Tours, France
| | - Joseph Fuhrman
- Public Health and Prevention Department, Unit of Regional Clinical Epidemiology, Teaching Hospital of Tours, Medical School, University of Tours, Tours, France
| | - Christophe Gaborit
- Public Health and Prevention Department, Unit of Regional Clinical Epidemiology, Teaching Hospital of Tours, Tours, France
| | - Maxime Vallée
- Service of Urology, Teaching Hospital of Poitiers, Medical School, University of Poitiers, Poitiers, France
| | - Aurélien Dinh
- Service of Infectious Diseases, AP-HP, Medical School, University of Paris, Paris, France
| | - Albert Sotto
- Service of Infectious Diseases, Teaching Hospital of Nimes, Medical School, University of Nimes, Nimes, France
| | - Franck Bruyere
- Service of Urology, Teaching Hospital of Tours, Medical School, University of Tours, Tours, France
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Okada T, Hamamoto S, Taguchi K, Okada S, Inoue T, Ando R, Okada A, Yasui T. Quality of life after urinary stone surgery based on Japanese Wisconsin Stone Quality of Life questionnaire: multicenter analysis from SMART study group. Urolithiasis 2023; 51:113. [PMID: 37707652 DOI: 10.1007/s00240-023-01486-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 08/23/2023] [Indexed: 09/15/2023]
Abstract
We aimed to evaluate the impact of surgical treatment for urinary stones on perioperative health-related quality of life (HRQOL) using the Japanese Wisconsin Stone Quality of Life questionnaire (J-WISQOL), an HRQOL measure designed for patients with urinary stones. This study prospectively enrolled 123 patients with urinary stones who visited three academic hospitals for stone treatment. The participants completed the J-WISQOL within 4 weeks before and after the urinary stone treatment. Treatments included shock wave lithotripsy (SWL), ureteroscopy lithotripsy, and endoscopic combined intrarenal surgery. J-WISQOL was assessed for age, stone size and location, type of treatment, stone-free status, postoperative ureteral stent placement, hospital stay, and complications in all patients. Patients with stones in the ureter had significantly greater social impact D1 and disease impact D3 than those with stones in the kidney. In a comparison of pre- and postoperative J-WISQOL, patients without postoperative ureteral stent placement scored significantly higher on social impact D1 and disease impact D3. Patients with shorter hospital stays had significantly higher social impact D1 and disease impact D3 (p < 0.001) than those with longer hospital stays. SWL significantly improved the total score, social impact D1, and disease impact D3 compared with other treatments. Perioperative HRQOL in patients with urinary stones is particularly affected by the type of treatment, ureteral stent placement, and hospital stay, which should be considered in surgical selection and patient decision-making.
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Affiliation(s)
- Tomoki Okada
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Shuzo Hamamoto
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan.
| | - Kazumi Taguchi
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Shinsuke Okada
- Department of Urology, Gyotoku General Hospital, Chiba, Japan
| | - Takaaki Inoue
- Department of Urology, Hara Genitourinary Hospital, Hyogo, Japan
| | - Ryosuke Ando
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Atsushi Okada
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Takahiro Yasui
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
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Burger NC, Devriendt N, Serrano G, Stock E, Rooster HD, Paepe D. Dogs with congenital extrahepatic portosystemic shunts that have persistent shunting after surgery have a higher prevalence of urolithiasis. J Am Vet Med Assoc 2023; 261:1337-1344. [PMID: 37217177 DOI: 10.2460/javma.23.02.0087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 04/18/2023] [Indexed: 05/24/2023]
Abstract
OBJECTIVE To report the presence of urolithiasis in dogs long-term after gradual attenuation of congenital extrahepatic portosystemic shunts (cEHPSS). ANIMALS 25 client-owned dogs that underwent gradual attenuation of a cEHPSS, of which 19 had a closed cEHPSS and 6 developed multiple acquired portosystemic shunts (MAPSS) following surgery. PROCEDURES A retrospective study with prospective follow-up was performed. Dogs that underwent cEHPSS surgery and had their postoperative cEHPSS status determined by transsplenic portal scintigraphy or CT angiography 3 months postoperatively were prospectively contacted and invited for a long-term follow-up visit (a minimum of 6 months postoperatively). Retrospective data were collected, and during the prospective follow-up visit a thorough history, blood tests and urinalysis, and ultrasonography of the urinary tract were performed to assess the presence of urinary signs and urolithiasis. RESULTS Of 25 included dogs, 1 of 19 (5%) dogs with closed cEHPSS and 4 of 6 (67%) dogs with MAPSS had urolithiasis at long-term follow-up. Three (50%) dogs with MAPSS developed new uroliths. Long-term, dogs with closed cEHPSS that initially presented with and without urolithiasis had significantly less urolithiasis compared to dogs with MAPSS (P = .013 and P = .010, respectively). In the 4 dogs with closed cEHPSS that initially presented with nephrolithiasis, nephroliths became smaller or were no longer visible at the long-term follow-up visit. CLINICAL RELEVANCE Dogs that developed MAPSS following cEHPSS surgery are at greater risk of urolithiasis compared to those with closed cEHPSS. Furthermore, ammonium urate uroliths might dissolve if portosystemic shunting ceases to exist.
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Affiliation(s)
- Nienke C Burger
- 1Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Nausikaa Devriendt
- 1Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Gonçalo Serrano
- 1Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Emmelie Stock
- 2Department of Morphology, Imaging, Orthopedics, Rehabilitation and Nutrition, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Hilde de Rooster
- 1Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Dominique Paepe
- 1Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
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Laminette PJ, Trout NJ, Noonan B, Viani E. Ureteroneocystostomy for treatment of struvite urolithiasis in a ferret. J Am Vet Med Assoc 2023; 261:1-4. [PMID: 37217174 DOI: 10.2460/javma.23.01.0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 04/25/2023] [Indexed: 05/24/2023]
Abstract
OBJECTIVE To assess the clinical outcome of a ferret undergoing a ureteroneocystostomy for treatment of urolithiasis. ANIMAL A 10-month-old spayed female ferret. CLINICAL PRESENTATION, PROGRESSION, AND PROCEDURES The ferret was evaluated for straining to urinate and defecate, hematochezia, and a rectal prolapse. Plain radiographs revealed large cystic and ureteral calculi. Clinicopathologic analyses indicated the ferret was anemic with an elevated creatinine concentration. Exploratory laparotomy defined bilateral ureteral calculi that were unable to be successfully moved into the bladder. A cystotomy was performed to remove a large cystic calculus. Serial abdominal ultrasonographic examinations showed progressive hydronephrosis of the left kidney and persistent pyelectasia of the right kidney secondary to bilateral ureteral calculi. This confirmed a left ureteral obstruction secondary to the distal calculus while the right ureter remained patent. TREATMENT AND OUTCOME A ureteroneocystostomy was performed to allow for left renal decompression. The ferret recovered well despite worsening hydronephrosis of the left kidney in the perioperative period. The ferret was discharged from the hospital 10 days after initial evaluation. At 3-week follow-up, abdominal ultrasonography confirmed resolution of hydronephrosis and ureteral dilation of the left kidney and ureter. CLINICAL RELEVANCE A ureteroneocystostomy successfully allowed renal decompression and ureteral patency in a ferret with urolithiasis. To the authors' knowledge, this is the first time this procedure has been reported in a ferret for treatment of a ureteral calculus obstruction and may result in good long-term outcome.
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Goumas IK, Tondelli E, Bevilacqua L, Oliva I, Orecchia L, Wroclawski ML, Giusti G, Proietti S, Miano R, Ventimiglia E. Laparoscopic Pyelolithotomy for treating urolithiasis in ectopic pelvic kidneys. Int Braz J Urol 2023; 49:646-647. [PMID: 37351906 PMCID: PMC10482470 DOI: 10.1590/s1677-5538.ibju.2023.0148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 04/12/2023] [Indexed: 06/24/2023] Open
Abstract
INTRODUCTION The management of urolithiasis ectopic pelvic kidneys (EPK) can be challenging because of the aberrant anatomy (1-4). We demonstrate the step-by-step technique of the laparoscopic approach for treating urolithiasis in EPK. PATIENTS AND METHODS Three men with EPK (2 left, 1 right) underwent laparoscopic pyelolithotomy through a transperitoneal approach. After establishing the pneumoperitoneum, the parietal peritoneum was opened at the parietal colic sulcus and the bowel displaced medially. The kidney was identified in the retroperitoneum and the renal pelvis exposed after removal of the perirenal adipose tissue. The renal pelvis was opened, and the stones were identified and retrieved with forceps in 2 cases and with a flexible nephroscope in 1 case. The renal pelvis was closed with a 3/0 running barbed suture. A DJ stent was placed in all patients. RESULTS For the first time, a laparoscopic technique for treating stones in the ectopic kidney is demonstrated in detail. Mean patient age was 52.6 years (44-58). The mean stone size was 22.3 mm (20-24 mm). Stones were in the renal pelvis in 2 cases and in the inferior calyx in 1 case. Mean operative time was 146 minutes (135-155 min). Mean estimated blood loss was 116 ml (60-140 ml). No complications were observed. The mean hospital stay was 3 days. The DJ stents were removed after 3 weeks. All patients were stone free at the postoperative CT scan with a mean follow-up of 3.3 months (1-6 months). CONCLUSIONS Laparoscopic pyelolithotomy can be an effective and reproducible minimally invasive technique for treating urolithiasis in EPK.
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Affiliation(s)
- Ioannis Kartalas Goumas
- Istituto Clinico Beato MatteoDivision of UrologyVigevanoItalyDivision of Urology, Istituto Clinico Beato Matteo, Vigevano, Italy
| | - Elena Tondelli
- Istituto Clinico Beato MatteoDivision of UrologyVigevanoItalyDivision of Urology, Istituto Clinico Beato Matteo, Vigevano, Italy
| | - Luigi Bevilacqua
- Istituto Clinico Beato MatteoDivision of UrologyVigevanoItalyDivision of Urology, Istituto Clinico Beato Matteo, Vigevano, Italy
| | - Isabella Oliva
- Istituto Clinico Beato MatteoDivision of UrologyVigevanoItalyDivision of Urology, Istituto Clinico Beato Matteo, Vigevano, Italy
| | - Luca Orecchia
- University of Rome Tor VergataDivision of UrologyDepartment of Surgical SciencesRomeItalyDivision of Urology, Department of Surgical Sciences, University of Rome Tor Vergata, Rome, Italy
| | - Marcelo Langer Wroclawski
- Hospital Israelita Albert EinsteinSão PauloSPBrasiHospital Israelita Albert Einstein, São Paulo, SP, Brasi
| | - Guido Giusti
- IRCCS San Raffaele HospitalDepartment of UrologyMilanItalyDepartment of Urology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Silvia Proietti
- IRCCS San Raffaele HospitalDepartment of UrologyMilanItalyDepartment of Urology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Roberto Miano
- University of Rome Tor VergataDivision of UrologyDepartment of Surgical SciencesRomeItalyDivision of Urology, Department of Surgical Sciences, University of Rome Tor Vergata, Rome, Italy
| | - Eugenio Ventimiglia
- Urological Research InstituteDivision of Experimental OncologyUnit of UrologyMilaItalyDivision of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
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Assimos DG. Urolithiasis/Endourology. J Urol 2023; 210:560-562. [PMID: 37334537 DOI: 10.1097/ju.0000000000003574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 05/31/2023] [Indexed: 06/20/2023]
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Bortnick E, Kurtz MP, Cilento BG, Nelson CP. Is cerebral palsy associated with successful ureteral access during the initial attempt at ureteroscopy for urolithiasis in children and young adults? J Pediatr Urol 2023; 19:369.e1-369.e6. [PMID: 37149475 PMCID: PMC10524291 DOI: 10.1016/j.jpurol.2023.04.014] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/23/2023] [Accepted: 04/13/2023] [Indexed: 05/08/2023]
Abstract
BACKGROUND Ureteroscopy is a common treatment for urolithiasis, but initial ureteral access is not always possible, particularly in pediatrics. Clinical experience suggests that neuromuscular conditions such as cerebral palsy (CP) may facilitate access, thus avoiding the need for pre-stenting and staged procedures. OBJECTIVE We sought to determine if probability of successful ureteral access (SUA) during initial attempted ureteroscopy (IAU) is higher in pediatric patients with CP vs. without CP. STUDY DESIGN We reviewed IAU cases for urolithiasis (2010-2021) at our center. Patients with pre-stenting, prior ureteroscopy, or urologic surgical history were excluded. CP was defined using ICD-10 codes. SUA was defined as scope access to urinary tract level sufficient to reach stone. Association of CP and other factors with SUA were evaluated. RESULTS 230 patients (45.7% male, median age: 16 years [IQR: 12-18 y], 8.7% had CP) underwent IAU, with SUA in 183 (79.6%). SUA occurred in 90.0% of patients with CP vs. 78.6% of those without CP (p = 0.38). SUA was 81.7% in patients >12 years (vs. 73.8% in those <12), and the highest SUA was in those >12 years with CP (93.3%), but these differences were not statistically significant. Renal stone location was significantly associated with lower SUA (p = 0.007). Among patients with renal stone only, SUA in those with CP was 85.7% vs. 68.9% in those without CP (p = 0.33). SUA did not differ significantly by gender or BMI. CONCLUSIONS CP may facilitate ureteral access during IAU in pediatric patients, but we were unable to show a statistically significant difference. Further study of larger cohorts may demonstrate whether CP or other patient factors are associated with successful initial access. Improved understanding of such factors would help preoperative counseling and surgical planning for children with urolithiasis.
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Affiliation(s)
- Eric Bortnick
- Department of Urology, Boston Children's Hospital, Boston, MA, USA.
| | - Michael P Kurtz
- Department of Urology, Boston Children's Hospital, Boston, MA, USA
| | | | - Caleb P Nelson
- Department of Urology, Boston Children's Hospital, Boston, MA, USA
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Cimen S, Eraslan A, Mohamed AH, Mohamed AI, Gur M, Kokurcan A, Uysal FS, Kaymak S, Dogan AE, Baylan B. Clinical characteristics and short-term outcomes of adult patients with urolithiasis: first report from Somalia. Eur Rev Med Pharmacol Sci 2023; 27:7127-7133. [PMID: 37606123 DOI: 10.26355/eurrev_202308_33286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
OBJECTIVE This study aimed to investigate the data of adult patients admitted to the only tertiary care center in Somalia with the diagnosis of urolithiasis and to present the first report from this Sub-Saharan African country. PATIENTS AND METHODS This study was designed as a retrospective single-center study conducted in Somalia Turkiye Training and Research Hospital. Adult patients who received the diagnosis of urolithiasis and who were admitted to the urology department constituted the target population. Reviewed data included demographic parameters, stone features, type of surgical procedure, intraoperative and early postoperative complications, and inpatient mortality. RESULTS Overall, 3,680 patients were admitted during the study period. Among these, 620 (17%) patients were admitted due to urolithiasis. There was a significant male predominance with a male-to-female ratio of 3.4:1. Urinary bladder was the most common stone location (n=253, 40.8%), followed by the kidney (n=223, 35.9%). The mean stone diameter was 22.41 (5-64); most (39.4%) of the patients had a stone diameter between 20 and 30 mm, while 27.5% had stones with diameters between 10 and 20 mm. Minimally invasive procedures were the primary surgical modality in 52.6% (n=326) of our patients. However, 45.9% (n=285) of the patients underwent open surgery. CONCLUSIONS The rate of adults with urolithiasis is relatively high in Somalia, as in many other African countries, with a significant male predominance. Although open surgery is rarely used for treating adult urolithiasis in industrialized countries, this approach is still commonly used in Somalia, similar to other parts of Africa.
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Affiliation(s)
- S Cimen
- Department of Urology, Somalia Turkiye Training and Research Hospital, Mogadishu, Somalia.
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Oh KT, Jun DY, Choi JY, Jung DC, Lee JY. Predicting Urinary Stone Composition in Single-Use Flexible Ureteroscopic Images with a Convolutional Neural Network. Medicina (Kaunas) 2023; 59:1400. [PMID: 37629690 PMCID: PMC10456355 DOI: 10.3390/medicina59081400] [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] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 07/25/2023] [Accepted: 07/28/2023] [Indexed: 08/27/2023]
Abstract
Background and Objectives: Analysis of urine stone composition is one of the most important factors in urolithiasis treatment. This study investigated whether a convolutional neural network (CNN) can show decent results in predicting urinary stone composition even in single-use flexible ureterorenoscopic (fURS) images with relatively low resolution. Materials and Methods: This study retrospectively used surgical images from fURS lithotripsy performed by a single surgeon between January 2018 and December 2021. The ureterorenoscope was a single-use flexible ureteroscope (LithoVue, Boston Scientific). Among the images taken during surgery, a single image satisfying the inclusion and exclusion criteria was selected for each stone. Cases were divided into two groups according to whether they contained any calcium oxalate (the Calcium group) or none (the Non-calcium group). From 506 total cases, 207 stone surface images were finally included in the study. In the CNN model, the transfer learning method using Resnet-18 as a pre-trained model was used, and only endoscopic digital images and stone classification data were input to achieve minimally supervised learning. Results: There were 175 cases in the Calcium group and 32 in the Non-calcium group. After training and validation, the model was tested using the test set, and the total accuracy was 81.8%. Recall and precision of the test results were 88.2% and 88.2% in the Calcium group and 60.0% and 60.0% in the Non-calcium group, respectively. The area under the receiver operating characteristic curve of the model, which represents its classification performance, was 0.82. Conclusions: Single-use flexible ureteroscopes have financial benefits but low vision quality compared with reusable digital flexible ureteroscopes. As far as we know, this is the first artificial intelligence study using single-use fURS images. It is meaningful that the CNN performed well even under these difficult conditions because these results can further expand the possibilities of its use.
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Affiliation(s)
- Kyung Tak Oh
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (K.T.O.); (D.Y.J.)
| | - Dae Young Jun
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (K.T.O.); (D.Y.J.)
| | - Jae Young Choi
- Department of Urology, Yeungnam University College of Medicine, Daegu 42415, Republic of Korea;
| | - Dae Chul Jung
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul 03722, Republic of Korea;
| | - Joo Yong Lee
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (K.T.O.); (D.Y.J.)
- Center of Evidence Based Medicine, Institute of Convergence Science, Yonsei University, Seoul 03722, Republic of Korea
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Üntan İ. How did COVID-19 affect acute urolithiasis? An inner Anatolian experience. ULUS TRAVMA ACIL CER 2023; 29:780-785. [PMID: 37409918 PMCID: PMC10405038 DOI: 10.14744/tjtes.2023.36067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 12/26/2022] [Indexed: 07/07/2023]
Abstract
BACKGROUND The COVID-19 pandemic has changed the number of patients seeking medical help from the emergency service (ES) with non-COVID complaints, consequencing in postponed presentations of different surgical and medical situations. Acute urinary stone disease is one of these situations and needs to be investigated in terms of the effect of COVID-19 on its presentation to the ES. METHODS In this observational, retrospective, and single-center study, we scanned each abdominopelvic computed tomography requested in ES for possible acute urolithiasis during 1 year before and after the outbreak of COVID-19. We searched to state the number of abdominopelvic computed tomographies applied and the number of ratifying urinary stone positivity. We enrolled patients' gender, age, stone location, and stone size. We also recorded C-reactive protein, leukocyte count, and creatinine and noted how long the patients suffering from pain, the duration until the intervention, and the management option selected for each case. RESULTS Total number of abdominopelvic computed tomographies performed was 1089. Of these, 517 were pre-pandemic and 572 were peri-pandemic. The number of pre and peri-pandemic stone-positive scans were, respectively, 363 (70.2%) and 379 (66.2%) (P=0.643). The females' percentage in the COVID-19 period (37.2%) was significantly lower than in the pre-pandemic period (54.3%) (P=0.013). The median size of ureter stones of the pre and peri-pandemic groups were, respectively, 4.8 mm and 3.9 mm depicting no significant difference (P=0.197). No significant difference was sighted between the pre and peri-pandemic groups concerning stone locations, blood parameters, painful duration, treatment options, and time to intervention. CONCLUSION The COVID-19 pandemic resulted in neither sicker nor fewer patients suffering from acute ureteric colic in the ES.
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Affiliation(s)
- İbrahim Üntan
- Department of Urology, Ahi Evran University Training and Research Hospital, Kirsehir-Türkiye
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Assimos DG. Urolithiasis/Endourology. J Urol 2023; 210:213-214. [PMID: 37115187 DOI: 10.1097/ju.0000000000003462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 04/05/2023] [Indexed: 04/29/2023]
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Sierra A, Castillo C, Carbonell E, Muní M, Martinez C, López JM, Peri L, Alcaraz A, Luque MP, Musquera M. Living donor-gifted allograft lithiasis: surgical experience after bench surgery stone removal and follow-up. Urolithiasis 2023; 51:91. [PMID: 37358636 PMCID: PMC10293412 DOI: 10.1007/s00240-023-01463-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 06/04/2023] [Indexed: 06/27/2023]
Abstract
This study presents the surgical experience and long-term outcomes of living donor kidney transplantations involving asymptomatic kidney stones, using ex vivo flexible ureterorenoscopy (f-URS) during bench surgery for stone removal. Out of 1743 living kidney donors assessed between January 2012 and October 2022, 18 (1%) were diagnosed with urolithiasis. Among them, 12 donors were rejected, and 6 were accepted for kidney donation. Stone removal was successfully performed using f-URS during bench surgery, with no immediate complications or acute rejections observed. The study analyzed six living kidney transplants, of which 4 (67%) donors and three recipients were female, and 4 (67%) donors were blood-related to the recipient. The median age for donors and recipients was 57.5 and 51.5 years, respectively. The stones, primarily located in the lower calyx, had a median size of 6 mm. The median cold ischemia time during surgery was 41.6 min, and ex vivo f-URS ensured complete stone removal in all cases. After a median follow-up of 120 months, the remaining grafts were functioning well, and no urinary stone recurrence was observed in either the recipients or living donors. The findings suggest that bench f-URS is a safe approach for managing urinary stones in kidney grafts, providing good functional outcomes without stone recurrence in selected cases.
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Affiliation(s)
- Alba Sierra
- Division of Kidney Transplant, Department of Urology, Hospital Clinic, Barcelona, Spain
| | - Carlos Castillo
- Division of Transplant Surgery, Department of General Surgery, Hospital General Plaza de la Salud, Santo Domingo, Dominican Republic
| | - Enric Carbonell
- Division of Kidney Transplant, Department of Urology, Hospital Clinic, Barcelona, Spain
| | - Maria Muní
- Division of Kidney Transplant, Department of Urology, Hospital Clinic, Barcelona, Spain
| | - Carmen Martinez
- Division of Kidney Transplant, Department of Urology, Hospital Clinic, Barcelona, Spain
| | - Juan Manuel López
- Division of Kidney Transplant, Department of Urology, Hospital Clinic, Barcelona, Spain
| | - Lluís Peri
- Division of Kidney Transplant, Department of Urology, Hospital Clinic, Barcelona, Spain
| | - Antonio Alcaraz
- Division of Kidney Transplant, Department of Urology, Hospital Clinic, Barcelona, Spain
- Departament de Cirurgia i Especialitats Medicoquirúrgiques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
| | - Maria Pilar Luque
- Division of Kidney Transplant, Department of Urology, Hospital Clinic, Barcelona, Spain
- Departament de Cirurgia i Especialitats Medicoquirúrgiques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
| | - Mireia Musquera
- Division of Kidney Transplant, Department of Urology, Hospital Clinic, Barcelona, Spain.
- Departament de Cirurgia i Especialitats Medicoquirúrgiques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain.
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Ecer G, Sönmez MG, Güven S, Balasar M. RE: Wang, D. (2023). Re: comparison of retrograde intrarenal stone surgery with and without a ureteral access sheath using kidney injury molecule-1 (KIM-1) levels: a prospective randomized study by Gökhan Ecer, Mehmet Giray Sönmez, Arif Aydın, Cemile Topçu, Haider Nihad Izaddin Alalam, Selçuk Güven, and Mehmet Balasar. Urolithiasis, 51(1), 44. Urolithiasis 2023; 51:81. [PMID: 37133619 DOI: 10.1007/s00240-023-01450-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 04/16/2023] [Indexed: 05/04/2023]
Affiliation(s)
- Gökhan Ecer
- Konya State Hospital, Urology Department, Konya, Turkey.
| | - Mehmet Giray Sönmez
- Necmettin Erbakan University Meram Medical Faculty, Urology Department, Konya, Turkey
| | - Selçuk Güven
- Necmettin Erbakan University Meram Medical Faculty, Urology Department, Konya, Turkey
| | - Mehmet Balasar
- Necmettin Erbakan University Meram Medical Faculty, Urology Department, Konya, Turkey
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Hameed BMZ, Shah M, Pietropaolo A, De Coninck V, Naik N, Skolarikos A, Somani BK. The technological future of percutaneous nephrolithotomy: a Young Academic Urologists Endourology and Urolithiasis Working Group update. Curr Opin Urol 2023; 33:90-94. [PMID: 36622261 DOI: 10.1097/mou.0000000000001070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE OF REVIEW With advancements in surgical technology along with procedural techniques, this article throws light on the latest developments and applications of artificial intelligence (AI), extended reality, 3D (three-dimensional) printing and robotics in percutaneous nephrolithotomy (PCNL). RECENT FINDINGS This review highlights the applications of AI in PCNL over the past 2 years. Mostly studies have been reported on development of machine learning (ML) based predicting models and identification of stone composition using deep learning convolutional neural network (DL-CNN). But owing to the complexity of the models and lack of generalizability, it is still not incorporated in the routine clinical practice. Extended reality based simulation and training models have enabled trainees to enhance their skills and shorten the learning curve. Similar advantages have been reported with the use of 3D printed models when used to train young and novice endourologists to improve their skills in percutaneous access (PCA). Applications of robotics in PCNL look promising but are still in nascent stages. SUMMARY Future research on PCNL should focus more on generalizability and adaptability of technological advancements in terms of training and improvement of patient outcomes.
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Affiliation(s)
- B M Zeeshan Hameed
- Department of Urology, Father Muller Medical College, Mangalore, Karnataka, India
- European Association of Urology - Young Academic Urologists (EAU-YAU) Urolithiasis and Endourology Working Group, Arnhem, The Netherlands
- iTRUE (International Training and Research in Uro-Oncology and Endourology) Group, Manipal, Karnataka
| | - Milap Shah
- iTRUE (International Training and Research in Uro-Oncology and Endourology) Group, Manipal, Karnataka
- Department of Urology, Aarogyam Speciality Hospital, Ahmedabad, India
| | - Amelia Pietropaolo
- European Association of Urology - Young Academic Urologists (EAU-YAU) Urolithiasis and Endourology Working Group, Arnhem, The Netherlands
- Department of Urology, University Hospital Southampton, Southampton, UK
| | - Vincent De Coninck
- Department of Urology, AZ Klina, Brasschaat, Belgium
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
| | - Nithesh Naik
- European Association of Urology - Young Academic Urologists (EAU-YAU) Urolithiasis and Endourology Working Group, Arnhem, The Netherlands
- Department of Mechanical and Industrial Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education
- Curiouz TechLab Private Limited, Manipal Government of Karnataka Bioincubator, Manipal, Karnataka, India
| | - Andreas Skolarikos
- Department of Urology, National and Kapodistrian University of Athens, Athens, Greece
| | - Bhaskar K Somani
- Department of Urology, University Hospital Southampton, Southampton, UK
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Halawani A, Koo KC, Wong VKF, Chew BH. Preoperative patient optimization for endourological procedures: the current best clinical practice. Curr Opin Urol 2023; 33:122-128. [PMID: 36354124 DOI: 10.1097/mou.0000000000001060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE OF REVIEW Despite technological advancements in endourological surgery, there is room for improvement in preoperative patient optimization strategies. This review updates recent best clinical practices that can be implemented for optimal surgical outcomes. RECENT FINDINGS Outcome and complication predictions using novel scoring systems and techniques have shown to assist clinical decision-making and patient counseling. Innovative preoperative simulation and localization methods for percutaneous nephrolithotomy have been evaluated to minimize puncture-associated adverse events. Novel antibiotic prophylaxis strategies and further recognition of risk factors that attribute to postoperative infections have shown the potential to minimize perioperative morbidity. Accumulating data on the roles of preoperative stenting and selective oral alpha-blockers adds evidence to the current paradigm of preventive measures for ureteral injury. SUMMARY Ample tools and technologies exist that can be utilized preoperatively to improve surgical outcomes. The combination of these innovations, along with validation in larger-scale studies, presents the cornerstone of future urolithiasis management.
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Affiliation(s)
- Abdulghafour Halawani
- Department of Urological Sciences, University of British Columbia, Stone Centre at Vancouver General Hospital, Vancouver, British Columbia, Canada
- Department of Urology, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Kyo Chul Koo
- Department of Urological Sciences, University of British Columbia, Stone Centre at Vancouver General Hospital, Vancouver, British Columbia, Canada
- Department of Urology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Victor K F Wong
- Department of Urological Sciences, University of British Columbia, Stone Centre at Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Ben H Chew
- Department of Urological Sciences, University of British Columbia, Stone Centre at Vancouver General Hospital, Vancouver, British Columbia, Canada
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