High Stone Clearance Rate Research Articles

For upper ureteral stone, semirigid ureteroscopy or flexible ureteroscopy? Strengths and weaknesses

BackgroundFlexible and semirigid ureteroscopy are two often used modalities in treating for upper ureteral stone. How about the outcome of each procedure?MethodsA retrospective cohort study among 167 patients who underwent flexible or semirigid ureteroscopic lithotripsy was performed. The pre-, intra-, postoperative and one-year follow-up outcomes were taken into comparison.ResultsSignificantly higher instant stone-clearance rate (81.3% vs. 92.4%, p = .032) and less operative time (62.1 ± 27.6 min vs. 44.1 ± 24.6 min, p<.001) were found in semirigid ureteroscopy. However, the stone-clearance rate at one month (90.7% vs. 93.5%, p = .500) was similar. Baseline characteristics including patient demographics, stone characteristics, duration of stone symptoms, hospital stay, expense, and complications between groups were approximately same. Three cases of stricture were found in the flexible ureteroscopy, and two in the semirigid ureteroscopy. Outcomes showed no significant difference. Further analysis showed that flexible ureteroscopy was likely more negatively affected by hydronephrosis and stone size, and semirigid ureteroscopy was more affected by stone location.Conclusionflexible ureteroscopy and semirigid ureteroscopy both had high stone clearance rate in the treatment for upper ureteral stones. They had similar outcomes and follow-up results. However, they also had their each most suitable application object.

Percutaneous nephrolithotomy or flexible ureteral lithotripsy, which one is better for patients with upper ureteral calculi of 1.5–2.0 cm in diameter

PurposeFirst research to evaluate the clinical efficacy and safety of flexible ureteral lithotripsy (FURSL) and percutaneous nephrolithotomy (PCNL) in the treatment of the upper ureteral stone is between 1.5 cm and 2.0 cm in diameter since there is no consensus with such ureteral stone yet.MethodsFrom December 2018 to October 2022, 104 patients with calculi in the upper ureter received percutaneous nephrolithotomy (PCNL)or flexible ureteroscopic lithotripsy (FURSL) in our institution. The clinical data of the patients in the two groups were retrospectively searched. Stone removal rate, operation time, blood loss, postoperative pain score, postoperative inflammatory factor, postoperative complication rates and ureteral obstruction three months after the operation were compared between the two groups.ResultsA total of 104 patients were included in the study. The stone clearance rate and the secondary surgery rate were 88.89% and 7.41% in the FURSL group, the figures were 97.96% and 2.0% in the PCNL group (p = 0.067, 0.497). Regarding ureteral obstruction three months after the operation, there were 2 patients in FURSL group and 0 patients in PCNL group(p = 0.497).Compared to patients in FURSL group, patients in the PCNL group had shorter operation time(PCNL 71.81 ± 18.94 min vs. FURSL 86.80 ± 22.49 min, p = 0.0004), fewer complications(PCNL 20.37% vs. FURSL 6.12%), and lower postoperative inflammatory factor(p = 0.0004), yet they got more hemoglobin drop (PCNL 13.14 ± 9.81 g/L vs. FURSL 4.77 ± 3.55 g/L, p < 0.0001), higher postoperative pain scores(p = 0.0017) in the first three postoperative days and longer hospital stay (PCNL 4.96 ± 1.21 days vs. FURSL 3.60 ± 0.83 days).ConclusionBoth FURSL and PCNL were effective methods for treating upper ureteral stones of 1.5–2.0 cm in diameter given the extremely high stone clearance rate and a very low secondary surgery rate, as long as rare ureteral obstruction in medium-long term observation. Additionally, FURSL can effectively reduce surgical bleeding, postoperative pain, and hospital stay, while PCNL can decrease operation time, the risk of infection, and complications. Therefore, doctors could select suitable surgical treatment for those patients depending on their different clinical situations based on these findings.

Assessing the Efficacy of Mini-PCNL Versus Standard PCNL for Management of Staghorn Calculi &gt;2cm: A Prospective Study in Peshawar

Background: Staghorn stones pose a significant challenge in urology, given their complex nature and potential for causing substantial renal damage. Traditional management has often involved standard percutaneous nephrolithotomy (PCNL), known for its efficacy in stone clearance but also associated with considerable complication rates. Recent advancements have led to the development of mini-PCNL, aiming to reduce these complications while maintaining high stone clearance rates. Objective: This study aims to compare the efficacy, safety, and outcomes of standard and mini-PCNL in the management of staghorn stones, with a focus on complication rates, stone clearance, and hospital stay durations. Methods: A prospective study was conducted at the Institute of Kidney Diseases, Hayatabad, Peshawar, involving 162 patients undergoing PCNL for staghorn stones from January 2020 to December 2023. Patients were categorized into standard PCNL (n=69) and mini-PCNL (n=93) groups based on the procedural approach. Pre-operative, intra-operative, and post-operative data were collected, including patient demographics, stone size and density, operative findings, post-operative complications, and stone clearance rates. Statistical analysis was performed using SPSS version 25. Results: The mini-PCNL group demonstrated a significantly smaller average stone size (26.8 ± 5.8 mm) compared to the standard PCNL group (32.3 ± 10.3 mm, p=0.037). Single tract use was more prevalent in mini-PCNL (87.1%) than in standard PCNL (71.0%, p=0.016). Stone clearance rates were higher in the mini-PCNL group (87.1%) versus the standard group (73.9%, p=0.041). The average hospital stay was shorter for mini-PCNL patients (2.4 ± 1.0 days) compared to those undergoing standard PCNL (3.0 ± 1.1 days, p=0.030). Complications, including post-operative hematuria requiring transfusion, were more common in the standard PCNL group. Conclusion: Mini-PCNL offers a safer and more effective alternative to standard PCNL in the management of staghorn stones, with lower complication rates, higher stone clearance rates, and shorter hospital stays. These findings support the adoption of mini-PCNL as a preferred approach for managing complex renal calculi.

Outcomes of ultraminipercutaneous nephrolithotomy in infants: our experiences at a single center in an endemic region.

In this study, we aimed to contribute to the literature by sharing the perioperative and postoperative outcomes of infants (0-24months) who underwent ultra-mini percutaneous nephrolithotomy (PNL) for kidney stones in our clinic. Infants under 24months old with kidney stones of 2cm and larger, who applied to our clinic between January 2018 and May 2023, were included in the study. The patients' demographic and clinical characteristics were obtained from the medical records. The collected data were analyzed retrospectively. A total of 26 patients were included in the study. The mean age of the patients was 17.3±3.90 (12-24) months. The mean operation time was 50.7±6.43min. The mean stone size was 2.66±0.59cm. Stone-free was achieved in 23 patients (88.5%). In one patient (3.8%) with residual fragments, SWL was performed, and in two patients (7.7%), RIRS was performed to achieve stone-free. Postoperatively, fever was observed in 3 patients (11.5%). There were no patients requiring blood transfusion. In experienced centers, ultra-mini-PNL performed by experienced surgeons is an effective and reliable treatment option for infants under 24months of age with kidney stones larger than 2cm. It provides high-stone clearance rates and low complication rates.

Transitioning from a mobile to on-site extracorporeal shockwave lithotripsy service: Is it worth it?

Objectives: The aim of this study was to compare the efficiency and effectiveness of a previous mobile versus current on-site lithotripsy service at a tertiary referral centre. Methods: Patient demographics, stone properties and service provision data were collected; retrospectively for mobile extracorporeal shockwave lithotripsy service (mESWL) between December 2017 and December 2018, and prospectively for on-site extracorporeal shockwave lithotripsy service (osESWL) between March 2019 and March 2020. Results: The overall stone clearance rate for mESWL was 57.1% (68/119) and 79.2% (164/207) for osESWL ( p &lt; 0.01). The overall osESWL ureteric stone clearance was 86.5% (77/89). The renal stone clearance rate with osESWL was greater than mESWL; 73.7% (87/118) versus 55.9% (62/111), p &lt; 0.01. Waiting time for osESWL treatment to renal calculi was significantly lower than mESWL (35 versus 47 days), p &lt; 0.01. To achieve stone clearance, mESWL required a larger proportion (25/111, 22.5%) of additional procedures compared to osESWL (16/118, 13.6%), p = 0.08. There was no significant difference in complication rates with mESWL versus osESWL. Over 5 years, there was a projected cost saving of £627,030 with osESWL compared to £158,660 with mESWL. Conclusion: With increased treatment capacity, higher stone clearance rate and shorter waiting times, the on-site lithotripter delivers a better service compared to a visiting mobile lithotripter. Furthermore, it may cut costs in the long term. Level of evidence: Not applicable.

Efficacy and safety of minimally invasive percutaneous nephrolithotomy versus retrograde intrarenal surgery in the treatment of upper urinary tract stones (> 1 cm): a systematic review and meta-analysis of 18 randomized controlled trials

BackgroundThe advantages and disadvantages of retrograde intrarenal surgery (RIRS) and minimally invasive percutaneous nephrolithotomy (mPCNL) for treatment of upper urinary tract calculi have not been conclusively determined.MethodsIn this meta-analysis, We comprehensively evaluated the performance of the two surgical approaches in treatment of upper urinary calculi. We searched the Pubmed, Embase, Cochrane and Web of science databases for randomized controlled trial (RCT) articles on RIRS and mPCNL upto December 2022. Data were extracted by two independent reviewers and subjected to the meta-analysis using the Stata 15.1 software (StataSE, USA).ResultsA total of 18 eligible RCTs involving 1733 patients were included in this study. The meta-analysis revealed that mPCNL of 1–2 cm or 2–3 cm stones had a higher stone clearance rate (RR:1.08, 95%CI (1.03, 1.14), p = 0.002) and shorter operation time (WMD : -10.85 min, 95%CI (-16.76, -4.94), p<0.001). However, it was associated with more hospital stay time (WMD :1.01 day, 95%CI(0.53, 1.5), p<0.001), hemoglobin drops (WMD :0.27 g/dl, 95%CI (0.14, 0.41), p<0.001), blood transfusion rate (RR:5.04, 95%CI(1.62, 15.65), p = 0.005), pain visual analogue score (WMD:0.75, 95%CI (0.04, 1.46), p = 0.037), hospital costs (SMD :-0.97, 95%CI (-1.19, -0.76), p<0.001) and major complications (RR:1.89, 95%CI(1.01, 3.53), p = 0.045).ConclusionTherefore, in terms of surgical effects and operation time, mPCNL is superior to RIRS, but is inferior with regards to other perioperative parameters. These factors should be fully considered in clinical decision making.

Application of image overlapping in percutaneous nephrolithotomy.

To investigate the application of ultrasound and CT image overlap in percutaneous nephrolithotomy (PCNL). A total of 140 patients with complicated kidney stones requiring PCNL were prospectively enrolled, from January 2020 to December 2022. These patients were randomly divided into 2 groups, with 70 patients each in the research group and the control group. All participants underwent dual-source, non-contrast CT scan of both kidneys and pelvis before surgery. Preoperative three-dimensional CT reconstruction and simulated puncture were performed in patients from the research group. The best puncture path was determined through ultrasound and CT image overlap. Puncture guided by regular CT and ultrasound was conducted in patients from the control group. Differences in the surgical outcomes between the two groups were compared. Compared to the control group, the research group had higher stone clearance rate in stage I PCNL, success rate of one-time puncture, less percutaneous channels, less reduction of hemoglobin and shorter procedure time. Complications in stage I PCNL were comparable in the two groups, and there was no significant change in the final stone clearance rates between the two groups. An optimal puncture channel can be chosen using ultrasound and CT image overlap. PCNL can be achieved with precise puncturing, thus achieving coincidence between imaging and anatomy and reducing the amount of blood loss during stage I of PCNL. It also shortens the procedure time and improves stone clearance rate of PCNL.

Comparative Analysis of Surgical Outcomes of Flexible Ureteroscopy and Da Vinci Robotic Surgery in Community Patients with Renal Pelvic Stones Larger than 2 cm.

Background and Objectives: This study evaluated and compared the surgical outcomes of retrograde intrarenal surgery (RIRS) lithotripsy versus robot-assisted laparoscopic pyelolithotomy (RAPL) in community patients with renal pelvic stones larger than 2 cm. Materials and Methods: A total of 77 patients who underwent RIRS (RIRS group, n = 50) or RAPL (RAPL group, n = 27) at our institution between December 2016 and July 2022 were recruited. A single surgeon performed all surgical operations. Preoperative, operative, and postoperative data were recorded. The study evaluated various clinical outcomes, namely, urinary tract infections, analgesic use, emergency room readmissions, stone clearance rates, surgical complications, and medical expenditures associated with the treatment courses, and compared them between the groups. Results: The RAPL group had a larger mean stone diameter and higher degree of hydronephrosis than the RIRS group did. The RIRS group had superior outcomes regarding operative time, length of postoperative hospital stay, surgical wound pain, and medical expenditures. Regarding postoperative outcomes, comparable rates of postoperative urinary tract infection, prolonged analgesic use, and emergency room readmissions were observed between the groups. However, the RAPL group had a higher stone clearance rate than the RIRS group did (81.5% vs. 52.0%, p = 0.014). Conclusions: For the surgical treatment of renal pelvis stones larger than 2 cm, RAPL has a superior stone clearance rate than RIRS; however, RIRS achieves superior outcomes in terms of medical expenditures, length of hospital stay, and surgical wound pain. Both procedures were equally safe.

Clinical application of novel integrated suctioning semi-rigid ureteroscopic lithotripsy

Introduction Urinary calculi are frequently encountered in urology. Traditionally, the lack of a perfect water injection and drainage system means the observation field is affected during ureteroscopy. Here, we explored the effect and clinical value of a new integrated suctioning semi-rigid ureteroscopic lithotripsy (URSL) for treating ureteral calculi. Material and methods A total of 180 patients were successfully enrolled in this study (60 in each group). Group A included patients who underwent a traditional semi-rigid URSL, group B included patients who underwent a suctioning semi-rigid URSL with a sheath being connected to a vacuum device, and group C included patients who underwent a new type of suctioning integrated rigid URSL with a novel designed ureteroscope. Results In total, 164 cases of URSL were completed in one stage. Compared with group A, group C had a higher stone-clearance rate at 30 days postoperatively, shorter operation time, and fewer hospitalization days (p < .05); compared with group B, group C had a higher one-stage operation success rate, shorter operation time, and fewer hospitalization days (p < .05). Conclusions Comparatively, the new suctioning integrated semi-rigid URSL is advantageous for treating upper urinary calculi, considering the reduced operation time, length of hospital stay, and low invasiveness.

Facilitated ureteroscopy using DJ stent implantation in ureterolithiasis: A retrospective study

To investigate the impact of preoperative double J (DJ) stent insertion on outcomes of retrograde semi-rigid ureteroscopy (URS) in patients with upper small and medium sized ureteral stones. Between April 2018 and September 2019, we retrospectively reviewed the medical register of Hillel Yaffe tertiary reference Centre (HYMC) for patients who had undergone retrograde semi-rigid URS for urolithiasis. Patients were separated into two groups depending on whether they accepted the DJ stent placement before URS (Group A) or not (Group B). Operating time, stone clearance rate, number of 'rescue' DJ stents, duration of 'rescue' stents, complication rate and requirement for repeat URS were compared between groups. 318 procedures undertaken in 290 patients were included (Group A, 83 procedures in 80 patiants; Group B, 235 procedures in 210 patients). By comparison with the non-stented group, patients in the preoperative DJ stented group had a higher stone clearance rate, lower complication rate, less need for postoperative 'rescue' DJ stent, lower duration of 'rescue' stent and lower re-operative URS requirement, including application of a flexible URS. Facilitated semi-rigid URS with upstream DJ stenting for small and medium size ureteral stones has favourable periprocedural outcomes compared with primary URS.

Laparoscopic common bile duct exploration to treat choledocholithiasis in situs inversus patients: A technical review.

Situs inversus (SI) is a rare congenital condition characterized by a mirror-image transposition of the major visceral organs. Since the 1990s, more than one hundred SI patients have been reported to have successfully undergone laparoscopic cholecystectomy. In these cases, the major problem is to overcome is the left-right condition for right-handed surgeons. Laparoscopic common bile duct exploration (LCBDE), an alternative to treat patients with bile duct stones, has shown equivalent efficacy and is less likely to cause pancreatitis than endoscopic retrograde cholangiopancreatography. Recent updated meta-analyses revealed that a shorter postoperative hospital stay, fewer procedural interventions, cost-effectiveness, a higher stone clearance rate, and fewer perioperative complications are additional advantages of LCBDE. However, the technique is technically demanding, even for skilled laparoscopic surgeons. Conducting LCBDE in patients with difficult situations, such as SI, is more complex than usual. We herein review published SI patients with choledocholithiasis treated by LCBDE, including our own experience, and this paper focuses on the technical aspects.

Silodosin as a medical expulsive therapy for distal ureteral stones: A systematic review and meta-analysis.

Tamsulosin is the most commonly used medical expulsive therapy (MET). However, it does not alleviate ureteral colic. It is important to develop MET that can reduce ureteral colic while maintaining a high stone clearance rate. Silodosin is an α1A adrenoceptor with high affinity and selectivity for the distal ureter, which may reduce ureteral colic and enable stone expulsion for distal ureteral stones. Therefore, we performed this systematic review and meta-analysis to evaluate the efficacy of silodosin as MET and its role in reducing ureteral colic among patients with distal ureteral stones. This research was conducted in accordance with the Cochrane Handbook for Systematic Review and Intervention, in adherence with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, and was registered in the International Prospective Register of Systematic Reviews (PROSPERO CRD42021249003). A comprehensive literature search was performed in several databases including Medline, EMBASE, and Scopus up to July 2021 for randomized trials comparing silodosin with placebo for MET. RevMan 5.4 was used for data analysis. A total of six randomized controlled trials were included in this analysis with a total of 907 patients. Our analysis revealed that the patients who received silodosin had significantly higher stone expulsion rate (SER) (odds ratio [OR] 3.33, 95% confidence interval [CI] 2.34, 4.76, P < 0.01), significantly shorter stone expulsion time (SET) (mean difference -3.79, 95% CI -4.51, -3.06, P < 0.01), and lower analgesic use (OR 0.4, 95% CI 0.23, 0.69, P < 0.01) compared to the group receiving placebo. Silodosin showed significantly higher SER, lower SET and lower analgesic use in patients with distal ureteral stones as compared to a placebo.

Endoscopic sphincterotomy vs papillary large balloon dilation vs combination modalities for large common bile duct stones: a network meta-analysis.

Background and study aims The optimal technique for removal of large common bile duct (CBD) stones (≥ 10 mm) during endoscopic retrograde cholangiopancreatography (ERCP) remains unclear. We aimed to perform a comparative analysis between different endoscopic techniques. Methods Adhering to PRISMA guidelines, a stringent search of the following databases through January 12, 2021, were undertaken: PubMed/Medline, Embase, Web of Science, and Cochrane. Randomized controlled trials comparing the following endoscopic techniques were included: (1) Endoscopic sphincterotomy (EST); (2) Endoscopic papillary large balloon dilation (EPLBD); and (3) EST plus large balloon dilation (ESLBD). Stone clearance rate (SCR) on index ERCP was the primary outcome/endpoint. Need for mechanical lithotripsy (ML) and adverse events were also evaluated as secondary endpoint. Random effects model and frequentist approach were used for statistical analysis. Results A total of 16 studies with 2545 patients (1009 in EST group, 588 in EPLBD group, and 948 patients in ESLBD group) were included. The SCR was significantly higher in ESLBD compared to EST risk ratio [RR]: 1.11, [confidence interval] CI: 1.00-1.24). Lower need for ML was noted for ESLBD (RR: 0.48, CI: 0.31-0.74) and EPLBD (RR: 0.58, CI: 0.34-0.98) compared to EST. All other outcomes including bleeding, perforation, post-ERCP pancreatitis, stone recurrence, cholecystitis, cholangitis, and mortality did not show significant difference between the three groups. Based on network ranking, ESLBD was superior in terms of SCR as well as lower need for ML and adverse events (AEs). Conclusions Based on network meta-analysis, ESLBD seems to be superior with higher SCR and lower need for ML and AEs for large CBD stones.

Thoracic Complications in Supracostal Percutaneous Nephrolithotomy

Due to the risk of pleural injury leading to thoracic complications, many urologist still hesitate to perform supracostal puncture during percutaneous nephrolithotomy. Our aim of this study was to evaluate the thoracic complications in supracostal access percutaneous nephrolithotomy. This is a retrospective analysis of 101 patients who were treated with supracostal access percutaneous nephrolithotomy at our institute from September 2013 and December 2019. Indications for supracostal punctures were staghorn 28(27.7%), middle calyceal stones 10(9.9%), pelvic stones 29(28.7%), complex inferior calyceal stones 26(25.7%), upper calyceal stone 10(9.9%)and upper ureteric stone17(16.8%).The intercostal space between the 11th and 12th ribs was used in all the cases. Among the 101 patients who undergone percutaneous nephrolithotomy by supracostal access, three patients (2.97%) had pleural injury. Among them one patient developed hydrothorax and needed chest tube insertion and remaining two patients had minimal pneumo thorax with blunting of costo-phrenic angle, which was managed conservatively. The lung parenchymal or other viscera injury was not observed in our study. Most punctures were, a single supracostal superior calyceal access 18(17.8%) and middle posterior calyceal access 88(82.2%), except for staghorn and multiple complex lower calyceal calculi needed multiple tracts 23(22.8%). Complete clearance was observed in 77(76.2%) patients. The supracostal puncture was a safe and effective approach with high stone clearance rate and acceptable morbidity in selected cases of staghorn, upper ureteral, and upper calyceal calculi. It should be adapted whenever needed and should not be avoided due to fear of chest complications.

Superior calyceal access vs. other calyceal access in percutaneous nephrolithotomy: A systematic review and meta-analysis.

PurposeTo evaluate the superior calyceal access’s performance and safety in relation to other calyceal access during percutaneous nephrolithotomy (PCNL).MethodsThe suggested reporting items for systematic reviews and meta-analysis were used to conduct this meta-analysis (PRISMA). To find pertinent studies for this meta-analysis, we searched PubMed, Embase, Web of Science, and China National Knowledge Infrastructure (CNKI). Operation time and hospital stay are two secondary outcomes, whereas failed stone clearance and complication events are the two major outcomes. Utilizing Stata 15.0, RevMan 5.3, and R 4.0.2, relative data were extracted and evaluated.ResultsThis meta-analysis was based on 16 studies with 8,541 individuals. Pooled results suggested that superior calyceal access could offer fewer failed stone clearance [odds ratio (OR): 0.64, 95% confidence interval (CI), 0.47–0.88, P = 0.006] and lower additional puncture rate (OR: 0.35, 95% CI, 0.24–0.51, P < 0.001) than other calyceal access. No complication difference was found (OR: 1.10, 95% CI, 0.78–1.56, P = 0.57). Superior calyceal access could offer shorter operation time [standard mean difference (SMD): −0.57, 95% CI, −0.98 to −0.15, P = 0.007]. No hospital stay difference was found (SMD: 0.07, 95% CI, −0.09 to 0.22, P = 0.38). Large heterogeneity was detected in stone clearance comparison (I2 = 71%, P < 0.001) and operation time (I2 = 97%, P < 0.001). The stone clearance comparison also identified significant publication bias (P = 0.026). These defects weaken the credibility of the results.ConclusionSuperior calyceal access in PCNL may result in a higher stone clearance rate, a lower rate of subsequent punctures, and a faster operation duration with no increase in postoperative complications or hospital stay for kidney stone patients, despite the significant heterogeneity and publication bias. By conducting bigger randomized controlled studies, this discovery still has to be confirmed.

MP02-20 DECREASED RISK OF URINARY INFECTION IS ASSOCIATED WITH SINGLE USE URETEROSCOPES

You have accessJournal of UrologyCME1 May 2022MP02-20 DECREASED RISK OF URINARY INFECTION IS ASSOCIATED WITH SINGLE USE URETEROSCOPES Rei Unno, Xavier Cortez, Leslie Charondo, Kevin Chang, Nizar Hakam, Carter Chan, Heiko Yang, Gregory Hosier, Fadl Hamouche, David Bayne, Marshall Stoller, and Thomas Chi Rei UnnoRei Unno More articles by this author , Xavier CortezXavier Cortez More articles by this author , Leslie CharondoLeslie Charondo More articles by this author , Kevin ChangKevin Chang More articles by this author , Nizar HakamNizar Hakam More articles by this author , Carter ChanCarter Chan More articles by this author , Heiko YangHeiko Yang More articles by this author , Gregory HosierGregory Hosier More articles by this author , Fadl HamoucheFadl Hamouche More articles by this author , David BayneDavid Bayne More articles by this author , Marshall StollerMarshall Stoller More articles by this author , and Thomas ChiThomas Chi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002514.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Although single-use ureteroscopes have been shown to be comparable with reusable ureteroscopes in terms of intraoperative maneuverability, visual image quality, as well as stone-related clinical outcomes, there are few large scale reports regarding clinical outcomes related to single-use ureteroscopes. In the current study, we aimed to understand the impact of single-use ureteroscopes on clinical outcomes for ureteroscopic stone removal and whether their use reduced postoperative urinary tract infection (UTI) risk. METHODS: This was a single-center, retrospective cohort study designed to compare single-use with reusable flexible ureteroscopes regarding peri- and postoperative outcomes between June 2012 and March 2021. The primary endpoint was postoperative UTI. The secondary endpoints were intraoperative outcomes (operative time and stone clearance), perioperative complications, hospitalization time, and re-presentation to the hospital (telephone call, ED visit, and re-admission) after URS. RESULTS: A total of 991 patients were analyzed, 500 patients in the single-use URS group (50.4%) and 491 patients in the reusable group (49.6%). On univariate analysis, patients in the single-use URS group were more often male and had lower BMI and presented with more bilateral stones than those in the reusable group. Single-use URS was associated with a lower chance of postoperative UTI (6.5% vs 11.9%, p=0.018) as well as a higher stone clearance rate (90.0% vs 83.9%, p=0.005) and fewer postoperative telephone calls (19.2% vs 29.2%, p=0.002). There were no significant differences in operative time, perioperative complications, ED visits, and re-admission between the two groups. On multivariate analysis, single-use URS remained a strong factor associated with stone clearance rate and decreased risk of postoperative UTI and postoperative telephone calls (Table 1). Postoperative sepsis, perioperative complications, and re-admission were associated with a positive preoperative urine culture. CONCLUSIONS: These data show that the single-use URS is beneficial in reducing postoperative UTI and telephone calls as well as increasing the stone clearance rate. These results provide a clinical justification for their routine use during ureteroscopic stone removal. Source of Funding: none © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e18 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rei Unno More articles by this author Xavier Cortez More articles by this author Leslie Charondo More articles by this author Kevin Chang More articles by this author Nizar Hakam More articles by this author Carter Chan More articles by this author Heiko Yang More articles by this author Gregory Hosier More articles by this author Fadl Hamouche More articles by this author David Bayne More articles by this author Marshall Stoller More articles by this author Thomas Chi More articles by this author Expand All Advertisement PDF DownloadLoading ...

Potential Risk of Calcified Nanoparticles for Recurrent Urinary Tract Infection after Minimally Invasive Percutaneous Nephrolithotomy for Renal Calculi.

Among urolithiasis, urolithiasis is a more extensive and difficult to treat disease. In recent years, with the development of endoscopic equipment and related surgical methods, a new treatment, namely minimally invasive percutaneous nephrolithotomy, appears and is widely used in the treatment of renal calculi. It has been developed for more than 50 years since its appearance. Its advantages are a high stone clearance rate, small surgical trauma, fewer intraoperative and postoperative complications, and a short recovery time for postoperative patients. It is widely used in clinical treatment. The purpose of this paper is to study the potential risk factors of recurrence and the possibility of urinary tract infection in patients with renal calculi after minimally invasive percutaneous nephrolithotomy (MPCNL) with calcified nanoparticles, so as to obtain correct nursing knowledge and reduce recurrence and infection. In order to explore the renal calculi caused by calcified nanoparticles (CNPs), we established a rat model of renal calculi, injected CNPs into rats, collected experimental samples after a specified time, and determined NGAL, OPN and MCP-1 by enzyme-linked immunosorbent assay (ELISA) and compared them with the formation of crystallization. In the study of the possible influencing factors of septic shock after PCNL, we established a multivariate regression analysis and model, used statistical methods and professional statistical software, and used the method of classified data analysis to find out the influencing factors. After the experiment, we found that positive urine culture (P < 0.05) and preoperative urinary tract infection (P < 0.05) were significant influencing factors, and the total accuracy was 99.2%. At the same time, it is concluded that calcium nanoparticles can promote the retention, adhesion and aggregation of calcium salt crystals in the kidney, and then lead to the formation of stones.

PNEUMATIC URETEROSCOPIC LITHOTRIPSY VERSUS LAPAROSCOPIC URETEROLITHOTOMY FOR LARGE UPPER URETERAL STONES- AN INITIAL EXPERIENCE.

Objective: The treatment of choice for large upper ureteral stones is controversial. In the developing nations, semi rigid ureteroscopy is the preferred treatment modality for ureteric stones even in upper ureter. However, Laparoscopic ureterolithotomy has started gaining acceptance for the treatment of large proximal ureteral stones. This study was done to compare solely the outcomes of semi-rigid pneumatic ureterolithotripsy (URSL) and transperitoneal laparoscopic ureterolithotomy (LU) for large upper ureteric stones. Methods: In all, 30 patients who met the inclusion criteria were randomised into 2 groups: URSLand LU. The groups were compared for stone clearance rate, operative time, complication rates.Results: LU had signicantly higher stone clearance rate both at discharge (p=0.014) and at 3 weeks post operatively (p = 0.033) than URSL. On the other hand, URSLhad signicantly shorter mean operating time (p&lt;0.0001), length of hospital stay (p=0.0013) and required less auxiliary procedures than LU group. No major complications were observed and the complication rate was not statistically signicant among the groups (p=0.41).Conclusion: Laparoscopic ureterolithotomy was associated with higher stone clearance rate but with longer hospital stay and operative time than URSL, however the complications were similar. Consequently, the procedure of choice for large proximal ureteric calculi should be based on the expertise of the surgeon, patient's choice and the availability of equipments.

Clinical study on the minimally invasive percutaneous nephrolithotomy treatment of upper urinary calculi.

BACKGROUNDUpper urinary tract stones are very common in my country, with an incidence of 1% to 5% in the North and an even higher incidence of 5% to 10% in the south. The incidence rate in the south is higher than that in the north, mainly due to the water quality, climate and eating habits of the region. From the perspective of sex, incidence is more likely in males than females. In the high-incidence population, young adults are most prone to stones. Men in the age range of 25 to 40 years are more likely to have stones.AIMTo observe the therapeutic effect of minimally invasive percutaneous nephrolithotomy (mPCNL) on upper urinary tract stones and its influence on the renal function of patients.METHODSPatients with upper urinary tract stones who were treated in our hospital from February 2017 to March 2018 were selected as research subjects and were divided into the PCNL group and the mPCNL group according to the random number table method. The general conditions of the two groups of patients were observed during the perioperative period, and the differences in stone clearance, pain, renal function indicators and complication rates were compared between the two groups to determine which were statistically significant (P < 0.05).RESULTSThe operation time of the mPCNL group was longer than that of the PCNL group (t = -34.392, P < 0.001), and the intraoperative blood loss of the mPCNL group was more than that of the PCNL group (t = 34.090, P < 0.001). There was no difference in renal function indices between the two groups of patients before treatment, and there was no difference in the levels of serum creatinine, β2 microglobulin or retinol binding protein in the mPCNL group after treatment. The visual analog scale score of patients in the mPCNL group was lower than that of the PCNL group (t = 12.191, P < 0.001), and there was no significant difference in the stone clearance rate between the two groups (χ2 value = 1.013, P = 0.314). There was no significant difference in the incidence of urine extravasation, dyspnea and peripheral organ damage between the two groups (χ2 value = 1.053, P = 0.305). At 1 mo after treatment and 3 mo after treatment, the quality of life of the mPCNL group was lower than that of the PCNL group, and the Qmax level of the mPCNL group was higher than that of the PCNL group.CONCLUSIONmPCNL has a good therapeutic effect on upper urinary tract stones, with a high stone clearance rate without causing kidney damage or increasing the incidence of complications, and thus has good application value.

Percutaneous nephrolithotomy for large renal stones in anomalous kidneys

Background: Percutaneous nephrolithotomy (PCNL) is an important surgical method for managing renal stones of any size. Anomalous kidneys pose additional technical challenge to the operating surgeon to perform PCNL in these anatomically abnormal kidneys especially if the stone load is large. The aim of this study is to present the efficacy and limitations of PCNL in managing stones &gt;2 cm in size in anomalous kidneys.Methods: This was a retrospective single centre study of PCNL in anomalous kidneys with stones &gt;2 cm in size.Results: 30 patients of kidney stones &gt;2 cm underwent PCNL. Our series of patients included 19 (63.32%) cases of horseshoe kidneys, 9 (30%) malrotated kidneys, 1 (3.34%) pelvic and 1 (3.34%) crossed fused ectopia. We achieved complete stone clearance in 26 (86.67%) patients. Presence of staghorn calculus was the most important statistically significant factor limiting complete clearance.Conclusion: PCNL is an effective procedure for management of patients with large stones in anomalous kidneys. Appropriate preoperative evaluation especially imaging, appropriate selection of cases and most importantly excellent technical expertise is needed to achieve high stone clearance rates with minimal morbidity.