Auxiliary Procedures Research Articles

Feasibility of Pure Ultrasonography Guided Percutaneous Nephrolithotomy in Flank Position

Background: Although percutaneous nephrolithotomy is most commonly performed with fluoroscopic access, yet, phobia and risks of radiation exposure are 2 important dilemmas. Herein the feasibility of flank position ultrasound guided percutaneous nephrolithotomy for management of renal stones was assessed. Methods: Between September 2012 and June 2016, 250 cases (134 males and 116 females) with renal stone underwent ultrasonography-guided percutaneous nephrolithotomy under lateral decubitus position. The exclusion criteria were active urinary tract infection and bleeding status. The peri-operative surgical outcomes were recorded and analyzed. Results: The mean age of patients was 42.0 ± 13.4 years. Twelve patients were children under 12 years old. Mean size of the stones was 4.2 ± 1.1 cm (range from 2.5 to 5.3 cm). Mean access and operative times were 15.5 ± 2.3 and 68 ± 14.5 minutes, respectively. In 45% of patients, superior calyx was selected for access. History of previous open stone surgery was obtained in 24 cases. Early complete stone free rate (SFR) was 68%, and after auxiliary procedures (SWL and TUL), this increased to 88%. The mean hemoglobin reduction was 1.9 ± 0.9 gr/dL. Blood transfusion was needed in 6 cases (2.4%). Prolonged or delay hemorrhage did not occur in any of the patients. One patient was complicated by moderate degree of pneumothorax and managed with chest tube insertion. Solid or viscus abdominal organ injury had not happened. Conclusions: This study suggested that the feasibility and outcomes of ultrasonography-guided percutaneous nephrolithotomy are comparable with the standard fluoroscopic approach. Also flank position can facile this procedure.

Extracorporeal shock wave lithotripsy (ESWL) monotherapy in children: Predictors of successful outcome

Although extracorporeal shock wave lithotripsy (ESWL) is the first choice for pediatric renal calculi <2cm, the success rate after the first session is low. This is in contrast to other minimally invasive procedures like percutanous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS), which have higher rates of success. Therefore, the present study sought to identify predictors of success after one session of ESWL. A prospective study including 100 children with renal stone burden <2cm who underwent ESWL at the present institution. The success rate after the first session was analyzed, and the predictors of success were investigated. The success of ESWL monotherapy was defined by absence of any residual fragments after 3 months, on non-contrast spiral computerized tomography (NCCT) scan, without need of any additional intervention. Between January 2013 and October 2015, 100 children were treated with a Dornier Gemini lithotripter at the present institution. The mean patients age and stone size were 6 years (range: 1.8-14) and 13.1mm (range: 6-20), respectively. After one session, 47% of patients showed complete clearance 3 months postoperative, those patients versus those who required an additional session or auxiliary procedures were younger in age, with smaller stone size and lower density. On multivariate analysis, only patient age was an independent predictor of success (odds ratio (OR) 0.9; P < 0.001). Patient's age was an important predictor for response after ESWL monotherapy: not only did children respond better than adults, but age was also an independent predictor within the pediatric group.

Comparative analysis between percutaneous nephrolithotomy and flexible ureteroscopy in kidney stones of 2–3 cm

IntroductionTo compare percutaneous nephrolithotomy and flexible ureterorenoscopy for treating kidney stones between 2 and 3cm. Material and methodsA prospective, comparative, nonrandomised study was conducted with 108 patients with kidney stones between 2 and 3cm. Fifty-four patients underwent percutaneous nephrolithotomy and 54 underwent flexible ureteroscopy. We compared the following variables: lithiasis-free rate (%), surgical time, the need for an auxiliary process, postoperative complications, hospital stay, readmission rates and recovery time. ResultsThere were no differences in the lithiasis-free rate between the 2 surgical techniques (76% for ureteroscopy vs. 87% for nephrolithotomy; p=0.1) or in the complications (29% for nephrolithotomy vs. 27% for ureteroscopy; p=0.4). A larger number of auxiliary process were needed for the ureteroscopy group (20%) than for the nephrolithotomy group (7%) (p=0.04).The surgical time was longer for the nephrolithotomy group (121±52min) than for the ureteroscopy group (93±42min) (p=0.004).The ureteroscopy group had shorter hospital stays (2.1±1.6 vs. 3.9±1.9 days; p=0.002), shorter convalescence (8.1±4.9 vs. 13.3±4.2 days; p=0.005) and higher readmission rates (7.4% vs. 0%, p=0.05) than the nephrolithotomy group. ConclusionsNephrolithotomy and ureteroscopy have similar efficacy for treating kidney stones measuring 2–3cm, with no differences in complications.Ureteroscopy results in shorter hospital stays, quicker recoveries but more readmissions and a greater need for auxiliary procedures.

High single scrotal-incision orchidopexy as the standard technique in infants aged 6–24 months

ObjectiveTo prospectively investigate the effectiveness of high single scrotal-incision orchidopexy (HSSIO) for palpable undescended testis (PUDT) in infants aged 6–24months. Patients and methodsFrom March 2012 to July 2014, 46 age range-restricted (6–24months) infants with 57 PUDT underwent HSSIO after obtaining written consent from their parents. The exclusion criteria were ectopic, retractile testes and recurrent cases. All infants were examined before surgery in the outpatient department and after anaesthesia induction immediately before surgery. All infants had general anaesthesia with a caudal block. The operative time, intraoperative and postoperative complications, and follow-up of the infants at 0.5, 3 and 6months were recorded and analysed. ResultsThe mean (SD; range) operative time was 23.45 (3.28; 18–29)min. A hernia sac was found in 39 (68.4%) UDTs. For postoperative complications, only one infant developed a scrotal haematoma that was managed conservatively. The procedure was successful in 56/57 PUDT (98%). An auxiliary procedure was needed in one case, to obtain more length of the cord by extension of the incision to the external ring. ConclusionHSSIO is a safe and feasible technique, with many benefits, and as such should be considered as the standard technique for orchidopexy in infants aged 6–24months.

Non-Fluoroscopic Uretero-Lithotripsy for Distal and Mid Ureteric Stone: Is it Safe and Feasible? Single Center Experience

Objective: To assess safety and feasibility of completely non-fluoroscopic ureteroscopy for treatment of mid and distal ureteric stone in term of stone free-rate and complications.Material and Methods: Over study period between January 2014 and January 2015, ninety-one complete fluoroscopy-less semirigid ureteroscopies were performed for treatment of symptomatic ureteric stones. Age, sex, stone size, location, side, operative time, auxiliary procedures, stonefree rate and complications, all were assessed. A Stone-free rate was defined as the lack of radiographic evidence of residual stone at 4 weeks. Postoperative imaging, and complications were grading according to modified Clavien classification system, which used initially to grade complications of general surgery.Results: The average age of our subjects was 32.9, with male and right side predominant, 68 % and 64.8% respectively. The average stone size and operative time were 10.07 and 32.08 respectively. Fifty six semirigid retrograde ureteroscopies were done for distal ureteric and 35 for mid ureteric stones, achieving 91.2% stone –free rate, with overall intraoperative complications of 18.6%. All cases were managed on day case basis, ureters were stenting preoperatively in 37 patients and all cases were stenting with an appropriate size of double J.Conclusion: Zero fluoroscopic semirigid retrograde ureteroscopy is a safe and feasible treatment modality for management of distal and mid ureteric stones.Bangladesh Journal of Medical Science Vol.16(1) 2017 p.48-52

The \u201cGuidewire-Coil\u201d-Technique to prevent retrograde stone migration of ureteric calculi during intracorporeal lithothripsy

BackgroundStone retropulsion represents a challenge for intracorporeal lithotripsy of ureteral calculi. The consequences are an increased duration and cost of surgery as well as decreased stone-free rates. The use of additional tools to prevent proximal stone migration entails further costs and risks for ureteral injuries. We present the simple technique of using a coil of the routinely used guidewire to prevent stone retropulsion.MethodsWe retrospectively evaluated all patients with mid-to-proximal ureteral stones in 2014, which were treated by ureteroscopic lithotripsy (Ho: YAG and/or pneumatic lithotripsy). The preoperative stone burden was routinely assessed using low dose CT scan (if available) and/or intravenous pyelogram.ResultsThe study population consisted of 55 patients with 61 mid-to-proximal calculi. Twentyseven patients underwent semirigid ureterorenoscopy using the “Guidewire-Coil-Technique”, the second group (n = 28) served as control group using the guidewire as usual. There has been a statistically significant reduction of accidental stone retropulsion (2/27 vs. 8/28, p < 0.05) as well as a decreased use of auxiliary procedures (p < 0.05) compared to the control group. No difference was observed in operative time. One ureteral injury in the control group required a prolonged ureteral stenting.ConclusionThe “Guidewire-Coil-Technique” is a simple and safe procedure that may help to prevent proximal calculus migration and therefore may increase stone-free rates without causing additional costs.

Outcome of percutaneous nephrolithotomy in anomalous kidney: Is it different?

Introduction:Various anomalous kidneys such as horseshoe kidney, crossed ectopic kidney, simple ectopic kidney, pelvic ectopic kidney, kidney with duplex system, and malrotated kidney are frequently associated with stone disease. Percutaneous nephrolithotomy (PCNL) is a challenging procedure in these patients because of abnormal orientation of kidney.Patients and Methods:Since 2005–2015, 86 patients underwent PCNL for stone removal in anomalous kidneys. Stone characteristics, type of calyceal puncture, number of punctures, need of relook procedures, mean hemoglobin drop, blood transfusion, mean operative time complications, mean hospital stay, stone free rate, and auxiliary procedure were analyzed.Results:Totally 91 sessions of PCNL was done in 86 patients including five of horseshoe kidney who had bilateral stone disease. Mean age, duration of symptoms, stone size, and hospital stay was 29.6 ± 12.6 years, 2.18 ± 1.41 years, 4.40 ± 1.16, and 4.17 ± 2.11 days, respectively. Sixteen patients underwent relook procedure, out of which only 6 could have complete stone clearance.Conclusion:PCNL in anomalous kidney is a safe and feasible procedure similar to normally located kidney, but requires careful preoperative planning and intra- and post-operative vigilance.

概率学习的两种认知过程研究

目的：在重复预测任务中，决策者倾向于根据事件发生的概率匹配他们的预测频率，该行为违背了理性决策理论的最优化假设。以往的研究结论支持了匹配概率行为的两种假说：其一是基于简单的联结学习过程，即重复成功/回避失败的策略；其二是来自于更老练的模式搜索策略，比如赌徒谬误信念。本研究尝试利用记忆辅助操纵实现对认知过程的分离。方法：招募50名大学生，在重复预测任务中增加动态窗口反馈，更新近期出现的事件，窗口容量设置为3和9两个条件(各25人)。结果：1) 对连续事件敏感的行为模式表现出正近因效应(倾向于重复最近一次事件)和负近因(倾向于预测相反事件)的共存；2) 与低容量条件相比，高容量条件下负近因效应持续的时间(试次数)更长；3) 随着实验的进行，负近因效应逐渐被正近因所取代。结论：本研究采用新的实验操纵手段，为分离概率学习的认知过程提供了方法上的改良，为匹配概率行为的两种假说提供了直接的证据。 Probability matching is a classical behavioral anomaly observed in lab and field studies. When asked to make predictions of two mutually exclusive random events from Bernoulli process re-peatedly, people tend to match their predictive frequencies to observed event frequencies, which violate maximization assumption in rational decision theory. Previous studies suggest there are two independent psychological processes that lead to this behavior: Associative learning, pattern searching. Previous researchers’ attempts to distinguishing these two processes are failed because of the confounding of latent variables. Our study tried to use a cognitive auxiliary procedure, a dynamic feedback window, to extend short-term memory capacity of recent events. By manipulating the length of this window (at the level of 3 and 9), we can separate cognitive process of probability learning. The results showed that: First, by checking how responses are sensitive to streaks/runs of events, we find that the recency curve showed a complex wavy form: A mixture of the positive and negative recency effect. Secondly, as subjects gained experiences, negative part of the curve is gradually replaced by the positive effect, suggesting that the process of pattern searching is overturned a process of associative learning process. Third, the pattern of recency curve also changed when window length is increased (from 3 to 9): at the high-probability-event end of the curve, the shifting from decreasing to increasing occurred early in the condition of 3, but latter in the condition of 9; but at the low-probability-event end, the opposite is true. This result implies that the process of searching patterns may embed in the strategies of encoding and inferencing of streaks of events, which are sensitive to task situations. In conclusion, by using a dynamic feedback design to manipulate short-term memory, our studies separated cognitive process during probability learning, provided new evidence to associative learning and pattern searching hypothesis of probability learning. These are both meaningful from theoretical and methodological views.

A CCA and ICA-Based Mixture Model for Identifying Major Depression Disorder.

The fMRI signals are usually filtered before processing and analyzing. This process can result in the loss of information carried by the higher frequency in the low frequency fluctuation. ICA and CCA are two classical methods in fMRI. ICA finds the statistically independent components of the observed data, however these components are usually physiologically uninterpretable without auxiliary procedures. CCA decomposes two sets of data into component pairs in some order, however these components may be mixtures of real signals and noise. In order to obtain statistically independent components and avoid the loss of information in the process of filtering, we propose a mixed model based on ICA and CCA, which does not need to filter the data. It is shown by the experiments that the new model has some advantages compared with the classical ICA and CCA. The components obtained by the new model is statistically independent. The useful information included in the low frequency fluctuation can be preserved. Experiments on synthetic data show satisfying results. As an application, this new model is used to design an algorithm to discriminate the major depressions from normal controls, with encouraging experimental results.

Comparison of Mini-percutaneous Nephrolithotomy and Retrograde Intrarenal Surgery in Preschool-aged Children

To compare the outcomes of mini-percutaneous nephrolithotomy (m-PCNL) and retrograde intrarenal surgery (RIRS) in treating renal stones in preschool-aged children. Forty-five patients treated with m-PCNL and 32 patients treated with RIRS for renal stones were compared retrospectively. The operative and postoperative outcomes of both groups were analyzed retrospectively. The mean age and gender were similar between the groups. The mean stone size was 19.30 ± 4.21 mm for the RIRS group and 21.06 ± 5.61 mm for the PCNL group (P = .720). The mean operative times, fluoroscopy times, and hospitalization times were statistically higher in the PCNL group. The stone-free rates (SFRs) after a single procedure were 84.4% in the PCNL group and 75% in the RIRS group (P = .036). After auxiliary procedures, the overall SFRs reached 91.1% for the PCNL group and 90.6% for the RIRS group (P = .081). No major complications were observed for both groups. Minor complication (Clavien 1-3) rates were 15.5% and 12.5% for the PCNL and RIRC group, respectively (P = .385). RIRS has some advantages over PCNL such as shorter hospitalization times, shorter fluoroscopy times, and shorter operative time in treating renal stones. However, PCNL achieves higher SFR after a single session.

Miniperc vs Shockwave Lithotripsy for Average-Sized, Radiopaque Lower Pole Calculi: A Prospective Randomized Study.

Introduction: To detect safety and feasibility of miniperc and extracorporeal shockwave lithotripsy (SWL) for treatment of average-sized (1-2 cm), radiopaque lower pole calculi in a prospective randomized manner. Patients and Methods: In the period from January 2014 to June 2015, 150 patients were attached to this study with single lower pole radiopaque stone ranging from 10 to 20 mm. Patients were divided randomly into two groups using computer-generated randomization in an equal manner. First group patients were subjected to miniperc procedure, while second group patients underwent SWL. Patient's characters, stones' characters, fluoroscopic time, operative time, blood transfusion, hospital stay, retreatment, auxiliary procedure (AP), and complications using modified Clavien grading are tabulated and analyzed. Results: This study included two equal groups with 75 patients in each group. With regard to age (37.75 ± 11.25 vs 40.55 ± 10.55), body mass index (26.92 ± 2.26 vs 27.29 ± 2.87), and stone size (1.55 ± 0.28 vs 1.57 ± 0.26), there was no significant statistical difference in both groups. Stone-free rate (SFR) (76% vs 96%), operative time (44.81 ± 7.06 vs 93.37 ± 12.29 minutes), fluoroscopy time (53 ± 2.45 vs 180 ± 7.31 seconds), hospital stay (5.72 ± 1.01 vs 45.19 ± 8.48 hour), and blood transfusion were significantly more in the miniperc group. Retreatment rate (45.3% vs 2.7%) and AP (24% vs 4%) were significantly greater in the SWL group. Conclusion: SWL is less invasive than percutaneous stone removal, but it is also less effective for lower pole radiopaque calculi. Miniperc has better SFR and lower auxiliary and retreatment rates; however, it resulted in more drawbacks.

Análisis comparativo entre nefrolitotomía percutánea y ureteroscopia flexible en litiasis renal de 2-3 cm

IntroductionTo compare percutaneous nephrolithotomy and flexible ureterorenoscopy for treating kidney stones between 2 and 3cm. Material and methodsA prospective, comparative, nonrandomised study was conducted with 108 patients with kidney stones between 2 and 3cm. Fifty-four patients underwent percutaneous nephrolithotomy and 54 underwent flexible ureteroscopy. We compared the following variables: lithiasis-free rate (%), surgical time, the need for an auxiliary process, postoperative complications, hospital stay, readmission rates and recovery time. ResultsThere were no differences in the lithiasis-free rate between the 2 surgical techniques (76% for ureteroscopy vs. 87% for nephrolithotomy; P=.1) or in the complications (29% for nephrolithotomy vs. 27% for ureteroscopy; P=.4). A larger number of auxiliary process were needed for the ureteroscopy group (20%) than for the nephrolithotomy group (7%) (P=.04).The surgical time was longer for the nephrolithotomy group (121±52min) than for the ureteroscopy group (93±42min) (P=.004).The ureteroscopy group had shorter hospital stays (2.1±1.6 vs. 3.9±1.9 days; P=.002), shorter convalescence (8.1±4.9 vs. 13.3±4.2 days; P=.005) and higher readmission rates (7.4% vs. 0%, P=.05) than the nephrolithotomy group. ConclusionsNephrolithotomy and ureteroscopy have similar efficacy for treating kidney stones measuring 2-3cm, with no differences in complications.Ureteroscopy results in shorter hospital stays, quicker recoveries but more readmissions and a greater need for auxiliary procedures.

Endoscopic Combined Intrarenal Surgery for Simultaneous Renal and Ureteral Stones: A Retrospective Study.

The management of simultaneous renal and ureteral calculi usually require staged procedure or change of position from supine lithotomy for ureterorenoscopic lithotripsy to prone for conventional percutaneous nephrolithotomy (PCNL). We review our experience with endoscopic combined intrarenal surgery (ECIRS) in the management of this condition. A total of 43 patients with simultaneous renal and ureteral calculi underwent ECIRS in Galdakao-modified supine Valdivia (GMSV) position from June 2012 to March 2016. Relevant demographic and clinical data were analyzed retrospectively. Clinical outcomes such as stone-free rate, complications, and hospital stay were evaluated. Factors predicting stone-free rate were also evaluated. The mean ureteral stone size was 9.79 ± 2.11 mm and the mean renal stone size was 28.0 ± 11.4 mm. All patients with ureteral calculus were stone free after first intervention. The overall immediate renal stone success rate was 81.4%, which increased to 97% after auxiliary procedure. The overall complication rate was 32.5% with majority of complications (86%) classified under Clavien grade 1 and 2. Two patients had Clavien grade 3 complication with no grade 4 or 5 complications. The mean operative room occupation time was 132.09 ± 35.3 minutes. The median hospital stay was 6 days (range: 2-31). On analyzing for risk factors, only the number of involved calices by stone was significantly associated with stone-free rate following ECIRS (p = 0.03). ECIRS is a novel and excellent approach for the treatment of simultaneous renal and ureteral calculi with stone clearance and morbidity profile comparable to traditional prone PCNL. We believe that the advantage provided by this approach to the surgeon, patient, and anesthetist may lead to widespread adaptability of this technique in the management of complex urolithiasis.

Semi-rigid ureteroscopic lithotripsy versus laparoscopic ureterolithotomy for large upper ureteral stones: a meta - analysis of randomized controlled trials.

ABSTRACTIntroduction:To provide a systematic review and meta-analysis of randomized controlled trials (RCT) comparing semi-rigid ureteroscopic lithotripsy (URS) with laparoscopic ureterolithotomy (LU) for the treatment of the large proximal ureteral stone.Materials and methods:A systematic literature review was performed in June 2015 using the PubMed, Scopus, and Web of Science databases to identify relevant studies. Article selection proceeded according to the search strategy based on Preferred Reporting Items for Systematic Reviews and Meta-analysis criteria.Results:Six RCT including 646 patients were analyzed, 325 URS cases (50.3%) and 321 LU cases (49.7%). URS provided a significantly shorter operative time (weighted mean difference [WMD] = −31.26 min; 95%CI −46.88 to −15.64; p<0.0001) and length of hospital stay (WMD = −1.48 days; 95%CI −2.78 to −0.18; p=0.03) than LU. There were no significant differences in terms of overall complications (OR = 0.78; 95%CI 0.21-2.92; p=0.71) and major complications – Clavien ≥3 – (OR = 1.79; 95%CI 0.59-5.42; p=0.30). LU led to a significantly higher initial stone-free rate (OR = 8.65; 95%CI 4.18-17.91; p<0.00001) and final stone-free rate (OR = 6.41; 95%CI 2.24-18.32; p=0.0005) than URS. There was a significantly higher need for auxiliary procedures in URS cases (OR = 6.58; 95%CI 3.42-12.68; p<0.00001).Conclusions:Outcomes with LU for larger proximal ureteral calculi are favorable compared to semi-rigid URS and should be considered as a first-line alternative if flexible ureteroscopy is not available. Utilization of flexible ureteroscopy in conjunction with semi-rigid ureteroscopy may impact these outcomes, and deserves further systematic evaluation.

Autologous Fat Grafting in Cosmetic Breast Augmentation: A Systematic Review on Radiological Safety, Complications, Volume Retention, and Patient/Surgeon Satisfaction.

Autologous fat grafting (AFG) is increasingly used in cosmetic surgery. However, its efficacy and safety are still ambiguous. Both a comprehensive overview and recapitulation of the relevant literature provide current evidence on the efficacy and outcomes of AFG in cosmetic breast surgery. This review provides an up-to-date overview of the literature on AFG in cosmetic breast augmentation. A systematic review of the literature on AFG used for cosmetic breast augmentation was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. This study included selected studies that were published between January 1996 and February 2016 and reported on 10 patients or more who had a minimal mean follow-up period of 1 year. In this study, 22 articles that reported on 3565 patients with follow-up periods ranging from 12 to 136 months were included. A complication rate of 17.2% (95% CI 15.9-18.5) was seen. Indurations were the most frequent complication (33.3%, 95% CI 20.4-46.3), followed by persistent pain (25%, 95% CI 0.5-49.5), and hematoma (16.4%, 95% CI 14.5-18.4). Mammograms revealed micro-calcifications (9.0%, 95% CI 6.4-11.5) and macro-calcifications (7.0%, 95% CI 3.8-10.2). The mean volume retention was 62.4% (range, 44.7-82.6%), with a satisfaction rate of 92% in patients and 89% in surgeons. AFG is a promising method in achieving autologous cosmetic breast augmentation with satisfactory volume retention and satisfaction rates in eight and six studies, respectively. Complications and radiological findings are comparable to those after implant augmentation. Future studies should focus on cancer occurrence and detection to further substantiate AFG safety. In addition, grafting methods and the use of auxiliary procedures to identify factors leading to better outcomes in terms of volume retention should be investigated. Finally, objective questionnaires are needed to represent patient satisfaction. 3 Therapeutic.

Role of flexible uretero-renoscopy in management of renal calculi in anomalous kidneys: single-center experience.

Flexible uretero-renoscopy (FURS) is an accepted modality for management of renal calculi in orthotopically placed kidney. Though it has been used in management of calculi in anomalous kidneys, the literature is scarce. To define the role of FURS in the management of stones in anomalous kidneys. We performed a retrospective analysis of all the patients with anomalous kidneys who primarily underwent FURS from January 2010 to December 2015 at our institute. In our study, we included patients with anomalies of lie, fusion and rotation. A total of twenty-five patients with twenty-five renal units having renal calculi in anomalous kidneys were evaluated. Indications for FURS included stone size less than or equal to 2cm, contraindication to PCNL like bleeding tendencies, patients on anticoagulants or patients who refused ESWL and PCNL. Complete clearance of stone was defined as no residual fragment greater than 2mm at the end of 4weeks. The parameters evaluated were patient demographics, type of renal anomaly, stone size, location, laterality, patient's presentation, need for preoperative stenting, operative time, need for postoperative DJ stent, hospital stay, analgesic requirement, number of stages or auxiliary procedures required for stone clearance, success rate and complications. Twenty-five patients with calculi in anomalous kidneys were managed with FURS. These 25 patients had a total of 37 stones. Out of 25 patients, 14 had ectopic kidneys with 19 stones, 5 had malrotated kidneys with 6 stones, 5 had horseshoe kidneys with 11 stones and one had a left-to-right crossed fused ectopia with a single stone. Average age of presentation was 38.28±12.59years. Majority of the patients had the stones located in pelvis (n=11) or lower calyx (n=11). Eight stones were in middle calyx (n=8), five in upper calyx (n=5) and two in upper ureter (n=2). Fifteen patients had a single stone, and 10 of them had 2 or more stones. Average size of stone was 14.71±4.11mm and average density being 1210.8±237.7 Hounsfield units. Five patients had a preplaced DJ stent. Average Operative time was 74±21.2min, and patients had an average hospital stay of 59.48±17.8h. DJ stent was placed postoperatively in 21 patients, and four were managed with a ureteric catheter. Complete clearance was achieved in 22 (88%) patients, three patients required two stages and one required the third stage. Three patients (12%) could not be managed with FURS and required percutaneous stone clearance. Primary FURS is an effective and less invasive modality for management of renal calculi less than 2cm in kidneys with anomalies of lie, fusion and rotation. It can offset the low clearance rate and high complication rate of ESWL and PCNL, respectively. Ureteral access sheath is an important tool to overcome anatomical challenges of anomalous kidney. Basket and Laser are indispensable accessories for FURS in anomalous kidneys.

Lower calyceal and renal pelvic stones in preschool children: A comparative study of mini-percutaneous nephrolithotomy versus extracorporeal shockwave lithotripsy.

To compare outcomes of the mini-percutaneous nephrolithotripsy technique and extracorporeal shockwave lithotripsy for lower calyceal and renal pelvic stones in preschool children. From January 2010 to December 2014, single renal pelvic or lower calyceal calculi 10-25 mm in size in children (age ≤6 years) treated by either extracorporeal shockwave lithotripsy (64 patients) or the mini-percutaneous nephrolithotripsy technique (54 patients) were included. Extracorporeal shockwave lithotripsy was carried out by using a Dornier electromagnetic lithotripter. The mini-percutaneous nephrolithotripsy technique was through 14-Fr renal access using a 9.5-Fr semirigid ureteroscope with holmium:yttrium aluminium garnet lithotripsy. The two study groups were compared using Mann-Whitney, χ(2) -test or Fisher's exact test. Stone parameters were similar in the mini-percutaneous nephrolithotripsy technique and extracorporeal shockwave lithotripsy groups in all patients, and in the pelvic (39 Miniperc, 52 extracorporeal shockwave lithotripsy) and lower calyceal (15 Miniperc, 12 extracorporeal shockwave lithotripsy) subgroups. Stone-free rates in the mini-percutaneous nephrolithotripsy technique and extracorporeal shockwave lithotripsy groups were 88.9% versus 43.8% (P < 0.001) and 94.4% versus 81.2% (P = 0.032) after first and last sessions, respectively. In the renal pelvis, they were 87.2% versus 50% (P < 0.001) and 94.9% versus 84.6% (P = 0.179), whereas in the lower calyx, they were 93.3% versus 16.7% (P < 0.001) and 93.3% versus 66.7% (P = 0.139) after first and last sessions, respectively. Retreatment rates in the mini-percutaneous nephrolithotripsy technique versus extracorporeal shockwave lithotripsy were 7.4% versus 50% (P < 0.001), 7.7% versus 46.2% (P < 0.001), and 6.7% versus 66.7% (P = 0.003) in all patients, renal pelvic and lower calyceal stones, respectively. No significant difference was found in complications (P = 0.521). Auxiliary procedures were required in 9.4% and 1.9% of children in the extracorporeal shockwave lithotripsy and mini-percutaneous nephrolithotripsy technique groups, respectively. The mini-percutaneous nephrolithotripsy technique has significantly higher stone-free rates than extracorporeal shockwave lithotripsy for renal pelvic and lower calyceal stones (10-25 mm), with a lower retreatment rate and without a significant increase in complications.

Impact of previous open renal surgery on the outcomes of subsequent percutaneous nephrolithotomy: a meta-analysis

ObjectiveThe aim of this study was to systematically compare the perioperative outcomes of percutaneous nephrolithotomy in patients with or without previous ipsilateral open renal surgery (POS).DesignSystematic searches of the PubMed,...

MP54-09 COMPARISON OF EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY FOR UROLITHIASIS BETWEEN CHILDREN AND ADULTS: A SINGLE CENTRE STUDY.

INTRODUCTION AND OBJECTIVES: To retrospectively evaluate the effectiveness of extracorporeal shock wave lithotripsy (ESWL) for urolithiasis and compare the results between children and adults. METHODS: From January 2011 to January 2015, ESWL was performed in 102 children and 605 adults for urolithiasis. We used Modulith SL X lithotripter 4th generation Storz medical equipment for ESWL. The stone free rates, number of ESWL sessions required, complication rates and auxiliary procedures used were evaluated in a comparative manner. RESULTS: Mean Stone size was 1.28 61 cm in adults while 1.08 0.59cm in children. Post ESWL stone clearance was 86.60% for children and 69% for the adults. In children group second session was required in 19 (23.5%) patients and third session was required in 3 (3.7%) patients while in adult group 2 sessions in 122 (20.1%) and 3 sessions in 48(7.9%) patients. In adults complications included steinstrasse in 12 patients (1.98%), fever in 30(4.95%), hematuria in 38(6.28%) and sepsis in 12(1.98%) patients while in children steinstrausse in 2 patients (2.5%), mild fever in 2 patients (2.5%), hematuria in 6 patients (7.4%) and sepsis was seen in 4 patients (4.9%). Complication rates were almost similar in both groups. In ancilliary procedures including DJ stent was used in 13 patients (16.04%) in children while in 29% of adults. CONCLUSIONS: The results of ESWL for urolithiasis in adults remains inferior to that of children. Children can achieve high stone-free rates. Complication rates were almost similar in both children and adult ESWL group in our study.

MP54-18 EMERGENCY EXTRACORPOREAL SHOCKWAVE LITHOTRIPSY (EESWL) FOR ACUTE RENAL COLIC DUE TO URETERAL STONES

You have accessJournal of UrologyStone Disease: Shock Wave Lithotripsy1 Apr 2016MP54-18 EMERGENCY EXTRACORPOREAL SHOCKWAVE LITHOTRIPSY (EESWL) FOR ACUTE RENAL COLIC DUE TO URETERAL STONES Paolo Umari, Stefano Bucci, Michele Rizzo, Nicola Pavan, Giovanni Liguori, Diego Marega, and Carlo Trombetta Paolo UmariPaolo Umari More articles by this author , Stefano BucciStefano Bucci More articles by this author , Michele RizzoMichele Rizzo More articles by this author , Nicola PavanNicola Pavan More articles by this author , Giovanni LiguoriGiovanni Liguori More articles by this author , Diego MaregaDiego Marega More articles by this author , and Carlo TrombettaCarlo Trombetta More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.588AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The aim of this study is to understand the role of extracorporeal shockwave lithotripsy (ESWL) as first-line treatment in patients with acute renal colic due to obstructive ureteral stones. METHODS We prospectively studied 70 patients presenting with their first episode of ureteric colic undergone extracorporeal shockwave lithotripsy (ESWL) over a 14 months period. Patients were randomized to emergency ESWL within 12 hours (eESWL group) or deferred ESWL until 20 days (dESWL group). Inclusion criteria were: acute renal colic, ureteral radiolucent or hyperechogenic stones from 5 to 20mm, no urinary infection or acute renal failure. Follow up included ultrasound or CT-scan at 24 hours, 7 days, 1 and 3 months. When it was necessary, repeated ESWL (re-ESWL) or ureteroscopy (URS) was performed. Preoperative and postoperative data between the two groups were compared and stone free rate (SFR) and efficiency quotient (EQ) were evaluated. Analyses were performed using SAS (9.3 version) statistical software. RESULTS 36 patients from eESWL group and 34 patients from dESWL group were well matched for age, gender, BMI and clinical and pathological characteristics. The mean patient age was 48.7 (range 24-81). Mean stone size was 9,8 mm (range 5-20mm). 25 stones (35.7%) were located in the upper and 45 (64.3%) in the distal ureter. Mean ESWL energy was 19,2 kV (range 14-24kV) and mean number of shock waves was 2650 (range 1000-3600). ESWL treatment lasted on average 44 minutes (range 17-60 minutes). All the procedures were conducted at the frequency of 1 Hz. No treatment was interrupted because of poor tolerance. Patients in the dESWL group spent more time in the hospital (2.21 vs 1.36 days) and the complication rates were paragonable in both groups (p<0.05). eESWL patients needs less auxiliary URS than dESWL patients, 11.1% vs 44.1% respectively and less re-ESWL 8.3% vs 32.4% respectively (p<0.05). The SFR at 24 hours was 52.8% and 11,8% in the eESWL and dESWL group respectively (p<0.05). The SFR at 3 months was 94.4% and 79.4% (p=0.07) and EQ was 79.1% and 57.5% in the eESWL and dESWL group respectively (p<0.01). CONCLUSIONS eESWL is a safe procedure and delivers high SFR even within 24 hours. It offers effective decompression of the collecting system and pain relief independently on the degree of hydronephrosis and especially in smaller stones (<10mm). It is able to reduce the number of auxiliary procedures and hospitalization. We believe that emergency timing of the precedure is of remarkably importance because of progressive development of ureteral edema and stone impactation. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e733-e734 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Paolo Umari More articles by this author Stefano Bucci More articles by this author Michele Rizzo More articles by this author Nicola Pavan More articles by this author Giovanni Liguori More articles by this author Diego Marega More articles by this author Carlo Trombetta More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...