Flexible Ureteroscopy For Renal Stones Research Articles

Re: Application of Suctioning Ureteral Access Sheath During Flexible Ureteroscopy for Renal Stones Decreases the Risk of Postoperative Systemic Inflammatory Response Syndrome

Re: Application of Suctioning Ureteral Access Sheath During Flexible Ureteroscopy for Renal Stones Decreases the Risk of Postoperative Systemic Inflammatory Response Syndrome

Comparison Between Holmium:YAG Laser with MOSES Technology vs Thulium Fiber Laser Lithotripsy in Retrograde Intrarenal Surgery for Kidney Stones in Adults: A Propensity Score-matched Analysis From the FLEXible Ureteroscopy Outcomes Registry.

We evaluated stone-free rate and complications after flexible ureteroscopy for renal stones, comparing thulium fiber laser and holmium:YAG laser with MOSES technology. Data from adults who underwent flexible ureteroscopy in 20 centers worldwide were retrospectively reviewed (January 2018-August 2021). Patients with ureteral stones, concomitant bilateral procedures, and combined procedures were excluded. One-to-one propensity score matching for age, gender, and stone characteristics was performed. Stone-free rate was defined as absence of fragments >2 mm on imaging within 3 months after surgery. Multivariable logistic regression analysis was performed to evaluate independent predictors of being stone-free. Of 2,075 included patients, holmium:YAG laser with MOSES technology was used in 508 patients and thulium fiber laser in 1,567 patients. After matching, 284 patients from each group with comparable baseline characteristics were included. Pure dusting was applied in 6.0% of cases in holmium:YAG laser with MOSES technology compared with 26% in thulium fiber laser. There was a higher rate of basket extraction in holmium:YAG laser with MOSES technology (89% vs 43%, P < .001). Total operation time and lasing time were similar. Nine patients had sepsis in thulium fiber laser vs none in holmium:YAG laser with MOSES technology (P = .007). Higher stone-free rate was achieved in thulium fiber laser (85% vs 56%, P < .001). At multivariable analysis, the use of thulium fiber laser and ureteral access sheath ≥8F had significantly higher odds of being stone-free. Lasing time, multiple stones, stone diameter, and use of disposable scopes showed significantly lower odds of being stone-free. This real-world study favors the use of thulium fiber laser over holmium:YAG laser with MOSES technology in flexible ureteroscopy for renal stones by way of its higher single-stage stone-free rate.

Learning curve in flexible ureteroscopy for renal stones: A propensity score-matched study

To assess the learning curve and evaluate the impact of surgical experience related to the outcomes of flexible ureteroscopy (fURS) for upper urinary tract stones. We evaluated retrospectively lithiasis fURS performed in our institution between January 2004 and December 2020. Patients were divided into two groups by the number of procedures performed by surgeon. Group 1 (G1) included the first 50 procedures, and group 2 (G2) the next cases. These groups were matched on baseline characteristics by a propensity score. Stones free rate (SFR) and complication rate (CR) were compared. Learning curves were realized using logistic curve with 95% confidence interval. After criteria exclusion and propensity score matching, 1548 procedures were analyzed (1:1, G1 and G2, n=774 procedures). A total of 29 surgeons were evaluated. The overall SFR was 68.4% without statistical difference between the two groups (G1=67.9% vs. G2=68.8%, P=0.72). The surgeon's experience was not associated with SFR (OR=1.15, 95% CI: 0.90-1.47), except in subgroup stones>2cm (OR=2.89, 95% CI: 1.29-6.46). The overall CR was 12.5%, mainly Clavien-Dindo grade I-II complications (96.2%). Surgical experience was not associated with CR (OR=1.06, 95% CI: 0.77-1.45). The overall logistic curves for probability of stone clearance and complication tended to be a flat slope. Impact of surgical experience on fURS for UUTS was not associated with SFR and CR. However, for stones larger than 2cm, surgeon's experience tended to be associated with SFR, but without impact on overall complications.

Improving Outcomes of Same-sitting Bilateral Flexible Ureteroscopy for Renal Stones in Real-world Practice—Lessons Learnt from Global Multicenter Experience of 1250 Patients

BackgroundBilateral kidney stones are commonly treated in staged procedures. ObjectiveTo evaluate outcomes after same-sitting bilateral retrograde intrarenal surgery (SSB-RIRS) for renal stones. Design, setting, and participantsData from adults who underwent bilateral RIRS in 21 centers were retrospectively reviewed (from January 2015 to June 2022). The inclusion criteria were unilateral/bilateral symptomatic bilateral stone(s) of any size/location in both kidneys and bilateral stones on follow-up with symptom/stone progression. Stone-free rate (SFR) was defined as absence of any fragment >3 mm at 3 mo. Outcome measurements and statistical analysisContinuous variables are presented as medians and 25–75th percentiles. A multivariable logistic regression analysis was performed to evaluate independent predictors of sepsis and bilateral SFR. Results and limitationsA total of 1250 patients were included. The median age was 48.0 (36–61) yr. Of the patients, 58.2% were prestented. The median stone diameter was 10 mm on both sides. Multiple stones were present in 45.3% and 47.9% of the left and right kidneys, respectively. Surgery was stopped in 6.8% of cases. The median surgical time was 75.0 (55–90) min. Complications were transient fever (10.7%), fever/infection needing prolonged stay (5.5%), sepsis (2%), and blood transfusion (1.3%). Bilateral and unilateral SFRs were 73.0% and 17.4%, respectively. Female (odds ratio [OR] 2.97, 95% confidence interval [CI] 1.18–7.49, p = 0.02), no antibiotic prophylaxis (OR 5.99, 95% CI 2.28–15.73, p < 0.001), kidney anomalies (OR 5.91, 95% CI 1.96–17.94, p < 0.001), surgical time ≥100 min (OR 2.86, 95% CI 1.12–7.31, p = 0.03) were factors associated with sepsis. Female (OR 1.88, 95% CI 1.35–2.62, p < 0.001), bilateral prestenting (OR 2.16, 95% CI 1.16–7.66, p = 0.04), and the use of high-power holmium:YAG laser (OR 1.63, 95% CI 1.14–2.34, p < 0.01) and thulium fiber laser (OR 2.50, 95% CI 1.32–4.74, p < 0.01) were predictors of bilateral SFR. Limitations were retrospective study and no cost analysis. ConclusionsSSB-RIRS is an effective treatment with an acceptable complication rate in selected patients with kidney stones. Patient summaryIn this large multicenter study, we looked at outcomes after same-sitting bilateral retrograde intrarenal surgery (SSB-RIRS) for renal stones in a large cohort. We found that SSB-RIRS was associated with acceptable morbidity and good stone clearance after a single session.

Do Hounsfield Units have any significance in predicting intra- and postoperative outcomes in retrograde intrarenal surgery using Holmium and Thulium fiber laser? Results from the FLEXible ureteroscopy Outcomes Registry (FLEXOR).

To evaluate outcomes of flexible ureteroscopy for renal stones by comparing hard versus soft stones based on their attenuation on computed tomography (Hounsfield Units-HU). Patients were divided into two groups according to the type of laser employed [Holmium:YAG (HL) or Thulium fiber laser (TFL)]. Residual fragments (RF) were defined as > 2mm. Multivariable logistic regression analysis was performed to evaluate factors associated with RF and RF needing further intervention. 4208 patients from 20 centers were included. In whole series, age, recurrent stones, stone size, lower pole stones (LPS), and multiple stones were predictors of RF at multivariable analysis and LPS and stone size with RF requiring further treatment. HU and TFL were associated with lesser RF and RF requiring an additional treatment. In HU < 1000 stones, recurrent stones, stone size, and LPS were predictors of RF at multivariable analysis, whereas TFL was less likely associated with RF. Recurrent stones, stone size, and multiple stones were predictors of RF requiring further treatment, while LPS and TFL were associated with lesser RF requiring further treatment. In HU ≥ 1000 stones, age, stone size, multiple stones, and LPS were predictors of RF at multivariable analysis, while TFL was less likely associated with RF. Stone size and LPS were predictors of RF requiring further treatment, whereas TFL was associated with RF requiring further treatment. Stone size, LPS, and use of HL are predictors of RF after RIRS for intrarenal stones regardless of stone density. HU should be considered an important parameter in predicting SFR.

Impact of ureteral access sheath use on outcomes of flexible ureteroscopy for renal stones

Introduction and objective: Improvements in endoscopic technologies have led to an expansion of flexible ureteroscopy indications in the treatment of renal and ureteral stones. Ureteral access sheath (UAS) was introduced in the clinical practice to facilitate endoscopic access into the upper urinary tract, reduce intrarenal pressure during the procedure and allow the extraction of fragments. The objective of this study is to analyze the impact of UAS on the efficacy and safety of flexible ureteroscopy (fURS) for the treatment of renal stones. Material and methods: a prospectively collected database including 251 consecutive patients treated with fURS between January 2018 and November 2022 was analyzed. Patients were divided into two groups: group 1 – without UAS, 21 patients (8.3%) and group 2 – with UAS, 231 patients (91.7%). UAS was used at the surgeon’s discretion and 3 patients (1.2%) underwent a sheathless procedure due to failure of UAS insertion. Data on patients’ preoperative characteristics and fURS efficacy and safety were compared. Results: There were no statistically significant differences in patients’ preoperative characteristics except for stone size and surface, which were significantly larger in group 2 (9.6±4.1 vs 13.8±5.2 mm; р&lt;0.001 and 68.6±74.2 vs 128.3±109.3 mm2, p=0.002, respectively). Operating time was significantly longer in group 2 (33.6±12.9 vs 42.0±12.9 min, p=0.005). Stone-free rate after a single procedure and at 3rd postoperative month was similar between groups (95.2% vs 87%, p=0.486 and 95.2% vs 88.7%, p=0.709, respectively). The intra- and postoperative complication rates were higher for group 1 (4.8% vs 0.8%, р=0.011 and 14.3% vs 12.1%, p=0.062, respectively). Multivariate regression model identified stone surface (р&lt;0.001), number of stones (p=0.005) and calcium oxalate monohydrate stone composition (р=0.005), but not UAS use (p=0.580), as independent predictors for stone-free rate following fURS. Conclusions: The results of this study suggest that UAS use has no impact on the efficacy of fURS and is not associated with an increased rate of intra- and postoperative complications.

PD55-06 DOES DRAINAGE METHOD AFTER FLEXIBLE URETEROSCOPY FOR RENAL STONES AFFECT THE TREATMENT OUTCOMES OR QUALITY OF LIFE?

You have accessJournal of UrologyCME1 May 2022PD55-06 DOES DRAINAGE METHOD AFTER FLEXIBLE URETEROSCOPY FOR RENAL STONES AFFECT THE TREATMENT OUTCOMES OR QUALITY OF LIFE? Amr Elsawy, Nasr El-Tabey, Mohamed Zahran, and Ahmed Shoma Amr ElsawyAmr Elsawy More articles by this author , Nasr El-TabeyNasr El-Tabey More articles by this author , Mohamed ZahranMohamed Zahran More articles by this author , and Ahmed ShomaAhmed Shoma More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002635.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To prospectively study the impact of different drainage methods after FURS on treatment outcomes and health related quality of life (HRQoL) using validated questionnaire. METHODS: A prospective study on adult patients who underwent FURS for renal stones was carried out. Drainage at the end of the procedure was done either by ureteral catheter or double J (DJ) stent according to surgeon decision. We compared the perioperative characteristics, surgical outcomes, and HRQoL using Short Form 36-Item Survey (SF-36) questionnaire among the two groups. RESULTS: Between January 2020 and July 2021, 340 FURS procedures were performed. Ureteral catheter and indwelling DJ stent were utilized as the drainage method at the end of the procedures in 162 and 178 patients, respectively. There were no significant differences in patients' demographics such as age, gender, body mass index, stone burden, and kidney criteria. Operative time, perioperative complications, post-operative pain and stone free rate were comparable did not show any significant difference between the two groups (all less than <0.05). Furthermore, unplanned visits and hospital readmission did not differ significantly between the two groups (P=0.09). Only 303 patients who showed favorable stone free status at POD1 CT assessment were included in the final analysis of HRQoL. Preoperatively, both groups were comparable in all domains of SF-36 survey with improvement of all domains of SF-36 survey post-operatively. On multivariate analysis, ureteral catheter group showed significant improvement as regard to general health impression and social health interference subdomains when compared to the DJ group (p=0.02). CONCLUSIONS: Our study suggested that the drainage types after FURS using a DJ stent or ureteral catheter were equally safe and efficacious, but patients who received a ureteral catheter had better HRQoL. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e949 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Amr Elsawy More articles by this author Nasr El-Tabey More articles by this author Mohamed Zahran More articles by this author Ahmed Shoma More articles by this author Expand All Advertisement PDF DownloadLoading ...

Application of Suctioning Ureteral Access Sheath during Flexible Ureteroscopy for Renal Stones Decreases the Risk of Postoperative Systemic Inflammatory Response Syndrome.

Purpose To clarify the efficiency and outcomes of suctioning ureteral access sheath (UAS) during flexible ureteroscopic lithotripsy (fURL) for the management of renal stones. Methods Between January 2017 and January 2019, a total of 444 patients with renal stones undergoing fURL were divided into suctioning UAS and nonsuctioning UAS groups. The outcomes of patients in both groups were compared using a matched-pair analysis (1 : 1 scenario). Furthermore, a directed acyclic graph (DAG) was drawn to guide the multivariate logistic regression model and analyze the protective effect of suctioning UAS on the incidence of postoperative systemic inflammatory response syndrome (SIRS). Results Before propensity score matching, significant differences were observed between the two groups in blood white cell counts, urine white cell counts, preoperative fever, preoperative indwelling stents, and laterality (P < 0.05). Eighty-one patients in the suctioning UAS group were successfully matched with 81 patients in the nonsuctioning group. The stone-free rate (SFR) on postoperative day 1 after fURL in the suctioning group was higher than that in the nonsuctioning group (86.4% vs. 71.6%; P=0.034), whereas it was comparable between the two groups 1 month after the surgery (88.9% vs. 82.7%; P=0.368). The incidence of postoperative fever or SIRS was lower in the suctioning group (fever: 3.70% vs. 14.8%; P=0.030; SIRS: 1.23% vs. 12.3%; P=0.012). However, the operative duration was similar in both groups (mean (SD)) (72.9 (28.1) min vs. 80.0 (29.5) min; P=0.121). The result of the multivariate logistic regression model guided by DAG revealed that the application of nonsuctioning UAS (odds ratio: 5.28 [1.38–35.07], P=0.034) during fURL was associated with postoperative SIRS. Conclusions The application of suctioning UAS during fURL was associated with higher SFR on day 1 after surgery and a lower incidence of postoperative fever or SIRS.

A1040 - Does drainage method after flexible ureteroscopy for renal stones affect the treatment outcomes or quality of life?

A1040 - Does drainage method after flexible ureteroscopy for renal stones affect the treatment outcomes or quality of life?

Failure of ureteral access sheath insertion in primary flexible ureteroscopy for renal stones: is there any relation with inflammation?

To investigate the relationship between failure to insert a ureteral access sheath (UAS) with inflammation and other clinical parameters in patients treated with flexible ureteroscopy for renal stones. This study included patients who underwent flexible ureteroscopy for the treatment of renal stones in our centre between 2015 and 2020. Patients who underwent any surgical procedure on the ipsilateral ureter and had a history of spontaneous stone passage were excluded. Patients were divided into two groups based on UAS insertion success (group 1) or failure (group 2). Both groups were compared with a view to clinical characteristics, preoperative neutrophil, lymphocyte, monocyte and platelet counts and ratios of these counts, all being considered inflammatory markers. A multivariate logistic regression analysis was performed to determine the independent variables affecting UAS insertion success. There were 113 (59.1%) patients in group 1, while group 2 consisted of 78 (40.9%) patients. The rates of male gender, coronary artery disease and preoperative ipsilateral hydronephrosis were significantly higher in group 2, while platelet counts and platelet-lymphocyte ratios were significantly lower. Our analysis revealed four independent predictors for UAS insertion failure: female gender (odds ratio [OR]=2.1) increased the rate of UAS insertion success, while hydronephrosis (OR=1.6), low platelet counts and PLR increased the rate of UAS insertion failure (OR=0.99, OR=0.98, respectively). Our results suggest that male gender and ipsilateral hydronephrosis are associated with increased UAS insertion failure. Although we found a relationship between relatively low platelet levels and UAS insertion failure, we think that further studies are needed to investigate this matter.

Predictors of Repeat Surgery and Stone-related Events After Flexible Ureteroscopy for Renal Stones

To evaluate the risk of repeat surgery and stone-related events after flexible ureteroscopy (fURS) for renal stones, and to identify their predictive factors. This was a single-center, retrospective cohort study of patients (n=664) who underwent fURS for renal stones with or without concomitant ureteral stones between January 2012 and December 2019. The primary outcomes were time to ipsilateral stone-related surgical intervention and any stone-related event (including ipsilateral renal colic, symptomatic ureteral calculi, obstructive urinary tract infection, and surgical intervention). During median follow-up of 31.1 months, 103 (15.5%) and 135 (20.3%) patients experienced surgical intervention and any stone-related event, respectively. The estimated 2-year intervention-free survival and stone-event-free survival was 86.9% and 81.6%, respectively. On Cox multivariate analysis, younger age (hazard ratio [HR] 0.96), history of stone surgery (HR 2.17), larger preoperative stone burden (HR 1.03), and larger residual fragment (HR 1.09) showed an association with future intervention. Use of the four identified risk factors (age ≤60, history of stone surgery, stone burden ≥20 mm, and residual fragment ≥4 mm) allowed stratification of patients based on the risk of future intervention (low [score: 0-1], intermediate [2], and high [3-4] risk). The estimated 2-year intervention-free survival rates in low-, intermediate-, and high-risk groups were 96.2%, 86.4%, and 71.3%, respectively. Patients undergoing fURS are at risk of future ipsilateral surgical intervention and stone-related events. Our simple predictive tool can facilitate treatment decision-making by identifying patients who are at high risk of recurrence.

How do we assess the efficacy of Ho:YAG low-power laser lithotripsy for the treatment of upper tract urinary stones? Introducing the Joules/mm3 and laser activity concepts.

To estimate the total energy needed to ablate 1mm3 of stone volume (Joules/mm3) during flexible ureteroscopic lithotripsy using a low-power Ho:YAG laser device, as a proxy of lithotripsy efficacy. We selected 30 patients submitted to flexible ureteroscopy for renal stones whose volume was bigger than 500mm3. A 35W Ho:YAG laser (Dornier Medilas H Solvo 35, Germany) was used for every procedure with a 272µm laser fiber. We recorded laser parameters, the total energy delivered by the laser fiber, the time from the first laser pulse until the last one (lithotripsy time), and the active laser time as provided by the machine. We then estimated J/mm3 values and determinants, along with ablation speed (mm3/s), and laser activity (ratio between laser active time and lithotripsy time). Median (IQR) stone volume and stone density were respectively 1599 (630-3502) mm3 and 1040 (753-1275) Hounsfield units (HU). In terms of laser parameters, median (IQR) energy and frequency were 0.6 (0.4-0.8) J and 15 (15-18) Hz. Median (IQR) total delivered energy and lithotripsy time were 37,050 (13,375-57,680) J and 68 (36-88) min, respectively. Median (IQR) J/mm3 and ablation speed were, respectively, 19 (14-24) J/mm3 and 0.7 (0.4-0.9)mm3/s. The laser was active during 84% (70-95%) of the total lithotripsy time. HU density > 1000 was associated with reduced efficacy. It is possible to perform laser lithotripsy using a low-power laser device with a virtually continuous laser activity. The estimation of the pre-operative parameters as well as the J/mm3 values are fundamental for a proper pre-operatory planning.

Effects of Silicone Hydrocoated Double Loop Ureteral Stent on Symptoms and Quality of Life in Patients Undergoing Flexible Ureteroscopy for Kidney Stone: A Randomized Multicenter Clinical Study.

We compared the hydrocoated silicone stent (Coloplast Imajin® hydro) to Percuflex™ Plus stent (Boston Scientific) in terms of patient comfort and quality of life after flexible ureteroscopy for stone disease over a 5-week prospective followup. This is a multicenter, single-blind, prospective, randomized trial of 141 patients treated with flexible ureteroscopy for renal stones. Primary outcome was Ureteral Stent Symptom Questionnaire (USSQ) Body Pain Index recorded before Double-J® stent removal at day (D) 20. Secondary endpoints were USSQ scores at intermediate dates (D2, D7, D20) and 2 weeks after stent withdrawal (D35), occurrence of adverse events and stent encrustation. The trial was completed by 113 (80.1%) patients. Mean (SD) USSQ body pain scores were 25% lower at D20 for the silicone stent at 18.7 (11.4) vs 25.1 (14.2) (p=0.015). No difference in terms of adverse events and safety profile was observed. USSQ urinary symptoms scores at D2, D7 and D20 were lower in the silicone stent group at 26.4 (7.7) vs 31.8 (8.1) at D20 (p <0.001). The use of USSQ self-questionnaires was associated with a limited number of missing or incomplete answers. The primary results of this large sample prospective randomized controlled study comparing the silicone Imajin hydro stents to the Percuflex Plus stent show that silicone stents are associated with significantly less patient discomfort. We would recommend their use in patients who require stenting for stone disease.

Development and internal validation of a nomogram to predict perioperative complications after flexible ureteroscopy for renal stones in overnight ureteral catheterization cases.

To identify risk factors by developing and internally validating a nomogram for preventing perioperative complications in overnight ureteral catheterization cases after fURS for kidney stones. We retrospectively examined 309 patients with overnight ureteral catheterization after single fURS procedures for renal stones. fURS procedures were performed based on the fragmentation technique. The ureteral catheter was removed on postoperative day 1. Within this group, patients who experienced perioperative complications (complication group) were compared with those who did not experience complications (non-complication group). The complication group included 77 patients whose Clavien-Dindo classification score was I, II, III, or IV and/or those whose body temperature during hospitalization was over 37.5°C. The overall stone volume, stone-free rate, incidence of perioperative complications, and procedure duration were 1.39mL, 94.8%, 24.9%, and 62min, respectively. Severe complications of a Clavien-Dindo level III or IV were observed in only four cases (1.3%). Multivariate assessment revealed five independent predictors of perioperative complications after fURS with overnight catheterization: age (p = 0.11), sex (p = 0.067), stone volume (p = 0.33), Hounsfield units (p = 0.16), and narrow ureter (p = 0.018). We developed a nomogram to predict perioperative complications after fURS using these parameters. We developed a predictive model for perioperative complications of patients with overnight catheterization after fURS for renal stones. This model could select patients who were at a low risk of complications.

P017 - Impact of preoperative ureteral stenting on the efficacy and safety of flexible ureteroscopy for renal stones

P017 - Impact of preoperative ureteral stenting on the efficacy and safety of flexible ureteroscopy for renal stones

Stone-free Outcomes of Flexible Ureteroscopy for Renal Calculi Utilizing Computed Tomography Imaging

To assess stone-free rates following ureteroscopy (URS) for renal calculi at our institution using low-dose renal only computed tomography (CT). A retrospective review of patients undergoing flexible URS for renal stones only with subsequent CT scan within 3 months. Meticulous basketing of all stone fragments was performed whenever possible. A "true" zero-fragment stone-free rate was determined by reviewing the CT scan and radiologist's report. Patients with nephrocalcinosis (as determined by visual inspection of papilla at the time of URS) were assigned the "stone-free" category. Flexible URS was performed in 288 renal units of 214 patients with renal calculi from 2013 to 2016. Median preoperative stone size was 6.2 mm with the average kidney containing 6.4 stones. An access sheath was used in 92% of cases. A total of 73% (209/288) renal units were completely stone free by CT assessment. Patients with residual fragments were as follows: 1 mm in 2% (7/288), 2-4 mm in 16% (46/288), and >4 mm in 9% of kidneys (26/288). The true stone-free rate in patients undergoing flexible URS for renal calculi utilizing active basketing of fragments as determined by strict CT assessment was 73%. In patients with residual fragments, the majority are 2-4 mm in size making URS a treatment option for renal calculi with excellent stone-free results.

Efficacy and functional outcome of flexible ureteroscopy for renal stones in patients with a solitary kidney

AimThe aim of the present study was to evaluate the efficacy and functional outcome of flexible ureteroscopy (fURS) for renal stones in patients with a solitary kidney.Patients and MethodsFrom February 2011 to February 2015, 60 patients with a solitary kidney underwent fURS for the treatment of renal stones. Factors, such as operation duration, complications and stone‐free rate (SFR), were analysed. Changes in the renal function were evaluated by comparing preoperative and postoperative glomerular filtration rates (GFR) and serum creatinine. The stage of chronic kidney disease (CKD) was measured to evaluate the influence of fURS on renal function.ResultsThe total SFR were 76.67 per cent and 93.33 per cent after the first and final procedures, respectively. Postoperative minor complications, classified as Clavien grade II, were recorded in 4.2 per cent (2/48) and 25 per cent (3/12) of patients with renal stones &lt; 2 cm and &gt; 2 cm, respectively. Serious complications, classified as Clavien grade III, occurred in 8.3 per cent (1/12) with renal stones &gt; 2 cm. For patients with renal stones &lt; 2 cm, the preoperative and postoperative mean GFR, as well as serum creatinine, had statistical difference (P &lt; 0.05). For patients with a solitary kidney with stage 5 CKD, fURS did not improve the renal function regardless of the stone size.ConclusionfURS is a more effective and safer procedure, with a higher SFR and a lower rate of complications in treating stones &lt; 2 cm in a solitary kidney than those &gt; 2 cm. For patients with a solitary kidney with stage 5 CKD, fURS did not improve the renal function regardless of the stone size.

Clinical factors prolonging the operative time of flexible ureteroscopy for renal stones: a single-center analysis.

The objective of the study was to evaluate the clinical factors affecting the operative time of flexible ureteroscopy (fURS). We retrospectively evaluated 233 patients with renal stones who had been treated successfully and had stone-free status 3 months after fURS and holmium laser lithotripsy between December 2009 and December 2013 at a single institute. Operative time was divided into three periods (total, before fragmentation, and after starting fragmentation), and associations between possible factors and these periods were analyzed by a multivariate logistic regression model with backward selection. The mean total operative time was 74.0 ± 32.0 min. There were significant differences in the following clinical factors: sex, body height, stone volume, maximum and mean Hounsfield units (HUs), diameter of the ureteral access sheath, and experience of the surgeon, between patients who underwent procedures with a total operative time of less or more than 90 min. A multivariate assessment revealed four independent factors influencing total operative time (P < 0.05): stone volume (P < 0.001), experience of the surgeon (P < 0.001), maximum HUs (P = 0.014), and lack of preoperative stenting (P = 0.027). Larger stone volume, lower experience level of the surgeon, higher HUs, and the absence of preoperative stenting were identified as parameters prolonging the total operative time of fURS and, in particular, the operative time after starting fragmentation. On the other hand, operative time before starting fragmentation, which represented the time required to identify the stone by ureteroscopy and insert the access sheath, was more difficult to predict preoperatively.

MP80-04 CULTURING THE RIGHT MICROORGANISMS IN PATIENTS UNDERGOING PERCUTANEOUS NEPHROLITHOTOMY (PCNL) AND FLEXIBLE URETEROSCOPY (FURS) FOR RENAL STONES – CAN WE DO ANY MORE?

You have accessJournal of UrologyStone Disease: Evaluation II1 Apr 2015MP80-04 CULTURING THE RIGHT MICROORGANISMS IN PATIENTS UNDERGOING PERCUTANEOUS NEPHROLITHOTOMY (PCNL) AND FLEXIBLE URETEROSCOPY (FURS) FOR RENAL STONES – CAN WE DO ANY MORE? Rehan Khan, Sarah Hunt, Holly Bekarma, Alison Ramsay, and Sarath Krishna Nalagatla Rehan KhanRehan Khan More articles by this author , Sarah HuntSarah Hunt More articles by this author , Holly BekarmaHolly Bekarma More articles by this author , Alison RamsayAlison Ramsay More articles by this author , and Sarath Krishna NalagatlaSarath Krishna Nalagatla More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2840AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES PCNL and FURS for renal stones can be a morbid procedure in view of urosepsis. Endourologists treat all positive pre-operative urine cultures with appropriate antibiotics. However, patients can still develop sepsis in the post-operative period and knowledge of the right microorganisms is not only invaluable but can also be lifesaving. Intraoperative stone cultures described as a tool to cultures the right microorganisms. Aim of this study is to assess if post op urine cultures add any information regarding culturing the right microorganisms in patients undergoing PCNL and FURS for renal stones. METHODS We prospectively collected data for patient undergoing PCNL and FURS for renal stones in our unit between August 2013 and May 2014. Demographics, details about pre-operative urine, intra- operative stone as well as post-operative urine culture were collected. Data was analysed to assess positive culture rates in each group and specifically assessed if post op urine cultures add anything to our microbiological information. RESULTS Data was collected for a total of 60 patients over the study period of 10 month period. Subsequently, only patients who had information available regarding pre-operative urine culture, intra-operative stone culture and postoperative urine cultures were included. This criteria led to exclusion of 19 patients and 41 patients were included in the final analysis. Mean age was 57 years with age range of 26 to 86 years. Pre-operative urine culture was positive in 13/41 patients (32). Intraoperative stone culture was positive in 8/41 patients (20%). Postoperative urine culture was positive in 6/41 patients (15%). One patient had exclusively postoperative urine culture and negative pre-operative urine and intraoperative stone culture and this correlated with postoperative sepsis. CONCLUSIONS Our study indicates that postoperative urine cultures add to our knowledge regarding the right microorganisms in patients undergoing PCNL and FURS for kidney stones and should be carried out routinely to allow appropriate management of postoperative urinary sepsis. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e1020 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rehan Khan More articles by this author Sarah Hunt More articles by this author Holly Bekarma More articles by this author Alison Ramsay More articles by this author Sarath Krishna Nalagatla More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Development and internal validation of a nomogram for predicting stone-free status after flexible ureteroscopy for renal stones.

To develop and internally validate a preoperative nomogram for predicting stone-free status (SF) after flexible ureteroscopy (fURS) for renal stones, as there is a need to predict the outcome of fURS for the treatment of renal stone disease. We retrospectively analysed 310 fURS procedures for renal stone removal performed between December 2009 and April 2013. Final outcome of fURS was determined by computed tomography 3 months after the last fURS session. Assessed preoperative factors included stone volume and number, age, sex, presence of hydronephrosis and lower pole calculi, and ureteric stent placement. Multivariate logistic regression analysis with backward selection was used to model the relationship between preoperative factors and SF after fURS. Bootstrapping was used to internally validate the nomogram. Five independent predictors of SF after fURS were identified: stone volume (P < 0.001), presence of lower pole calculi (P = 0.001), operator with experience of >50 fURS (P = 0.026), stone number (P = 0.075), and presence of hydronephrosis (P = 0.047). We developed a nomogram to predict SF after fURS using these five preoperative characteristics. Total nomogram score (maximum 25) was derived from summing individual scores of each predictive variable; a high total score was predictive of successful fURS outcome, whereas a low total score was predictive of unsuccessful outcome. The area under the receiver operating characteristics for nomogram predictions was 0.87. The nomogram can be used to reliably predict SF based on patient characteristics after fURS treatment of renal stone disease.