Need For Auxiliary Procedures Research Articles

A proposed mathematical model to help preoperative planning between RIRS and MiniPerc for renal stones between 10 and 20mm using holmium:Yag laser (Cyber Ho): the stone management according to size-hardness (SMASH) score.

To evaluate the performance of a mathematical model to drive preoperative planning between RIRS and MiniPerc (MP) for the treatment of renal stones between 10 and 20mm. Patients with a renal stone between 10 and 20mm were enrolled. A mathematical model named Stone Management According to Size-Hardness (SMASH) score was calculated: hounsfield units (HU) χ stone maximum size (cm)/100. Patients were divided into 4 groups: RIRS with score < 15 (Group A), RIRS with score ≥ 15 (Group B), MP with score < 15 (Group C), MP with score ≥ 15 (Group D). Cyber Ho device was always used. Stone free rate (SFR) was assessed after 3 months. Complication rate and need for auxiliary procedures were evaluated. Between January 2019 and December 2021, 350 patients were enrolled (87, 88, 82 and 93 in Groups A, B, C and D). Mean stone size was 13.1 vs 13.3mm in Group A vs B (p = 0.18) and 16.2 vs 18.1mm in Group C vs D (p = 0.12). SFR was 82%, 61%, 75% and 85% for Groups A, B, C and D. SFR was comparable between Groups C and D (p = 0.32) and Groups A and C (p = 0.22). SFR was significantly higher in Group A over B (p = 0.03) and in Group D over B (p = 0.02). Complication rate was 2.2%, 3.4%, 12.1%, 12.9% for Groups A, B, C, D. RIRS and MP are both safe and effective. The mathematical model with the proposed cut-off allowed a proper allocation of patients between endoscopic and percutaneous approaches.Registration number of the study ISRCTN55546280.

Prospective Comparative Analysis of Supine Versus Prone Percutaneous Nephrolithotomy in Patients with Complex Renal Stone Disease and Difficult Anatomy.

In complex renal stone disease, few studies have shown that supine percutaneous nephrolithotomy (PCNL) is not inferior to prone PCNL. In our study, we evaluated the safety and efficacy of supine versus prone PCNL in patients with complex renal stone disease and patients with difficult anatomy. We prospectively analyzed 106 patients over 15 months from October 2022 to December 2023 and divided them as group S (Calcutta position supine arm) and group P (classical prone arm) by simple randomization. The measured data included body mass index (BMI), stone size, location of stone, number of punctures/ access, tract length, bleeding, operative time, stone-free rate (SFR), length of hospital stay, and postoperative complications. The operative time was 104.722 ± (34.48) versus 124.30 ± (22.67) minutes (group S vs. group P), which was significant (P=.01). The nephroscopy time was 89.722 ± 34.55 in group S vs. 92.212 ± 20.18 minutes, which was also significant (P = .01). The mean postoperative hospital stay was 3.889 ± 1.09 and 4.558 ± 1.33 days in supine and prone group (P = .021), respectively. Four patients in group S required re-look PCNL in comparison to 8 in group P. Overall SFR at 1 month was 76.92% and 68.51% (P .331), respectively in case of group S and P. The study revealed that supine position in Calcutta position is a viable alternative to classical prone position even in patients with complex renal stone and patients with difficult anatomy as major complications are less, SFR is higher, and need of auxiliary procedures are rare.

A novel double-sheath negative-pressure versus conventional minimally invasive percutaneous nephrolithotomy for large kidney stone

This study aims to evaluate the therapeutic efficacy of a novel double-sheath negative-pressure minimally invasive percutaneous nephrolithotomy (D-mPCNL) compared to conventional minimally invasive percutaneous nephrolithotomy (C-mPCNL) for large kidney stones. A total of 132 patients diagnosed with large kidney stones in our hospital were included in the study. Among them, sixty-eight patients underwent D-mPCNL, while sixty-four underwent C-mPCNL. Parameters such as operative duration, stone-free rate, incidence of postoperative complications, and the need for auxiliary procedures were evaluated between the two groups. Compared to the C-mPCNL group, the D-mPCNL group demonstrated a significantly shorter operative time (41.97 ± 8.24 min vs. 52.30 ± 13.72 min; P < 0.000), lower rates of auxiliary procedures (5.9% vs. 17.2%; P = 0.041), and lower fever rates (2.9% vs. 14.1%; P = 0.021). The group also had a significantly higher primary stone-free rate (85.3% vs. 70.3%; P = 0.038). However, there were no statistically significant advantages in terms of the final stone-free rate, hemoglobin drops, and stone composition in the D-mPCNL group (P > 0.05). D-mPCNL is a novel surgical method that is safe and effective, reducing operative time, improving stone-free efficiency, and decreasing postoperative complications.

MP35-19 A PROSPECTIVE RANDOMISED CONTROLLED STUDY BETWEEN MINIPCNL AND RIRS USING THULIUM FIBER LASER FOR LOWER POLE STONES 10-20 MM

You have accessJournal of UrologyCME1 Apr 2023MP35-19 A PROSPECTIVE RANDOMISED CONTROLLED STUDY BETWEEN MINIPCNL AND RIRS USING THULIUM FIBER LASER FOR LOWER POLE STONES 10-20 MM Chandra Mohan Vaddi, Ramakrishna Paidakula, Siddalinga Swamy P. M., Soundarya Ganesan, Hemnath U. A., Manas Babu B., and Rakesh Panda Chandra Mohan VaddiChandra Mohan Vaddi More articles by this author , Ramakrishna PaidakulaRamakrishna Paidakula More articles by this author , Siddalinga Swamy P. M.Siddalinga Swamy P. M. More articles by this author , Soundarya GanesanSoundarya Ganesan More articles by this author , Hemnath U. A.Hemnath U. A. More articles by this author , Manas Babu B.Manas Babu B. More articles by this author , and Rakesh PandaRakesh Panda More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003269.19AboutAbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Abstract INTRODUCTION AND OBJECTIVE: Percutaneous nephrolithotomy (PCNL) has been recommended as the first choice for lower pole stone >10 mm. The objective of the study is to analyse whether Retrograde intrarenal surgery (RIRS) with newly upcoming Thulium fiber laser (TFL) can be an equally effective alternative. Primary Aim: To compare the different treatment modalities in terms of efficacy (stone free rate, need for auxiliary procedures) and safety (complication rate).Secondary aim: To compare the perioperative outcomes (operative time, fluoroscopic time, length of hospitalization). METHODS: Study Design: Prospective randomised controlled study Study period: October 2021 – May 2022 Study Population: Patients with lower pole stones 10-20 mm Group A - RIRS, Group B – Mini PCNL The energy source used was 60 W TFL (IPG Photonics, Massachusetts, United States) in both Group A and B. NCCT KUB was done at 2 months post operatively to calculate stone free rate. Institutional Ethics Committee approval was obtained. RESULTS: Mean stone size was 13.93±2.92 mm in Group A and 15.04±3.18 mm in Group B. In Group A, fluoroscopy time was significantly lower (31.96±14.34 vs 337.68±131.85, p<0.001), hospital stay was significantly lower (1.37±0.63 vs 3.24±1.01, p<0.001) and stone free rate (SFR) was comparable to Group B (88.9% vs 92.3%, p=1.000). There was no significant difference in operative time, complication rate or need for auxiliary procedure (Table 1). The ablation speed was significantly higher (9.47±5.61 vs 1.55±1.95, p<0.001), the laser efficacy was significantly lower (3.18±3.83 vs 16.43±7.07, p<0.001) and the laser time was significantly lower (141.04±86.98 vs 992.63±488.30, p<0.001) in Group B, as fragmentation rather than dusting was done with TFL. Table 1 CONCLUSIONS: RIRS with TFL for lower pole stones has SFR comparable to MiniPCNL, lower fluoroscopy time and hospital stay. No significant difference was found in operative time, complication rate or requirement of auxiliary procedure. Thus, RIRS with TFL is an effective alternative to miniPCNL for lower pole stones 10-20 mm Parameter RIRS with TFL (n=25) MiniPCNL with TFL(n=25) P value Age (years) 44.52 ± 14.21 48.64 ± 12.70 0.5091 Stone Size (mm) 13.93 ± 2.92 15.04 ± 3.18 0.1441 Volume (mm³) 1016.72 ± 341.11 1037.08 ± 428.83 0.4641 Density (HU) 1111.44 ± 252.61 1181.12 ± 288.14 0.3603 Operative Time (Minutes) 48.63 ± 8.57 50.80 ± 15.13 0.4521 Fluoroscopy Time (sec)*** 31.96 ± 14.34 337.68 ± 131.85 <0.0011 Complication rate 4/27 (14.8%) 5/25 (20%) 0.2134 Hospital Stay (Days)*** 1.37 ± 0.63 3.24 ± 1.01 <0.0011 Duration of Follow-Up 7.97 ± 2.47 8.29 ± 2.66 0.6503 Auxiliary Procedure (Yes) 2 (7.4%) 1 (4.0%) 1.0004 Overall Stone free rate 88.9% 92.3% 1.0004 ***Significant at p<0.05, 1: Wilcoxon-Mann-Whitney U Test, 2: Chi-Squared Test, 3: t-test, 4: Fisher's Exact Test Source of Funding: Self © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e477 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Chandra Mohan Vaddi More articles by this author Ramakrishna Paidakula More articles by this author Siddalinga Swamy P. M. More articles by this author Soundarya Ganesan More articles by this author Hemnath U. A. More articles by this author Manas Babu B. More articles by this author Rakesh Panda More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Complication rate after pediatric shock wave lithotripsy according to Clavien-Dindo grading system: results from a systematic review and meta-analysis of the existing literature.

Shockwave lithotripsy (SWL) is a minimally invasive technique utilized for renal and ureteric stones in children. Despite being considered safe, certain complications have been recorded. We performed this systematic review and meta-analysis to provide a pooled analysis of Clavien-Dindo graded complications after SWL in children. MEDLINE/PubMed, Scopus and Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews, were screened from inception to 12/02/2022 by two authors independently. Only randomized controlled trials providing Clavien-Dindo classification or relevant clinical information were considered eligible. Overall complications were calculated using the aggregate number of each complication divided by the total number of patients in studies with data. Pooled analysis revealed that from children treated with SWL, 27.7% [95% CI 13.1-49.4] suffered Clavien I complications, 4.9% [95% CI 3.1-7.6] Clavien II complications, 2.7% [95% CI 1.6-4.7] Clavien III complications, 2.3% [95% CI 1.3-4] Clavien IV complications, while no Clavien V complications were recorded. In total, 28.1% [95% CI 15.6-45.3] of children suffered minor complications (Clavien-Dindo I-II), while 3% [95% CI 1.8-5] major complications (Clavien-Dindo III-V). Pooled analysis revealed that 10.7% [95% CI 3.2-30.1] of patients suffered macroscopic hematuria, 7.3% [95% CI 2.1-22.7] pain, 5.5% [95% CI 3.3-9] steinstrasse, 5.3% [95% CI 3-9.3] fever, 2.2% [95% CI 0.8-5.6] sepsis, 1.1% [95% CI 0.3-3.7] urinoma, 1% [95% CI 0.4-2.7] symptomatic hematoma and 1% [95% CI 0.3-2.7] asymptomatic hematoma. Need for re-treatment was 42.6% [95% CI 31.4-54.7] and need for auxiliary procedures was 11.8% [95% CI 8.5-16.1]. SWL is an irreplaceable tool for treating urolithiasis in children. Although a minimally invasive technique, parents and children should be adequately informed about the risk of minor/major complications.

Use of retrograde intrarenal surgery (RIRS) compared with mini-percutaneous nephrolithotomy (mini-PCNL) in pediatric kidney stones

ObjectiveWe aimed to compare the cost-effectiveness and safety of retrograde intrarenal surgery (RIRS) and mini-percutaneous nephrolithotomy (mini-PCNL) for pediatric kidney stones management.Patients and methodsNinety pediatric patients with single or multiple renal stones 1–3 cm in diameter were collected prospectively and equally divided into two groups to undergo RIRS or mini-PCNL. The groups were compared for fluoroscopy and operative time, postoperative hospital stay time, stone-free rate (SFR), need for auxiliary procedures, and cost as well as complications.ResultsThere were no differences found between RIRS and mini-PCNL groups with regard to operative time and postoperative DJ stent application, while the mean of fluoroscopy time and postoperative hospital stay was significantly shorter in the RIRS than in the mini-PCNL group. The SFR, auxiliary treatment on residual stones, and complications were comparable. In both groups, no major (Clavien IV–V) complications were observed. The mean cost of RIRS was $1210 and $733 for the mini-PCNL.ConclusionsBoth RIRS and mini-PCNL are effective and safe treatment modalities for pediatric renal stones 10–30 mm in size. However, mini-PCNL is more cost-effective making it a viable alternative to RIRS.

Impact of forced diuresis on retropulsion of disintegrated ureteral calculi during semi-rigid ureteroscopy: a double-blind randomized-controlled study

The objective of this study is to assess the safety and efficacy of forced diuresis as an antiretropulsion strategy during the pneumatic disintegration of solitary lower ureteric stones with semi-rigid ureteroscopy (URS). A prospective randomized double-blind study was carried out from March 2019 to June 2021 for patients presented with unilateral solitary radiopaque lower ureteric stones ≤ 20 mm. Patients were randomized for URS into two groups, according to the use of forced diuresis using furosemide 1 mg/kg (GII) or not (GI). Perioperative parameters were compared between both groups, including retropulsion rate, stone-free rate (SFR), and need for auxiliary procedures and complications. A total of 148 patients were included; 72 (48.6%) in GI and 76 in the GII (51.4%), with respective stone size of 11.8 ± 2.6 vs.12.1 ± 2.4 mm. Both groups were comparable in demographic and baseline data, with a mean age of 47 ± 16 and 50 ± 14 years for GI and GII, respectively. GII had a significantly shorter disintegration time (10.5 ± 1.3 vs. 4.2 ± 2.1 min, p < 0.001), shorter operative time (33.1 ± 10.1 vs. 40.8 ± 9.1 min, p < 0.001), lower stone fragments migration rate during disintegration (6.5% vs. 18.1%, p = 0.04), lower retropulsion rate (1.3% vs. 11%, p = 0.02), higher SFR (96.1% vs. 86.1%, p = 0.04), and lower auxiliary procedures (3.9% vs. 13.8%, p = 0.03). Intraoperative and 6-h postoperative changes in heart rate and mean systolic blood pressure were comparable between both groups. Ephedrine injection (6–18 mg) was needed in significantly more GII patients (39.5% vs. 20.8%, p ≤ 0.01). It seems that forced diuresis during pneumatic lithotripsy of the lower ureteric stones is a safe and effective antiretropulsion technique. This would expand the alternative options to the antiretropulsion strategy, especially in centers where the laser and flexible ureteroscopes are not available.

Supracostal percutaneous nephrolithotomy, a safe and effective approach: A clinical audit.

To emphasize on safety principles through anatomic approach in Supracostal Percutaneous nephrolithotomy (PCNL). Data of patients who underwent PCNL from June 2004 to August 2014 at the Kidney Centre Karachi, Pakistan were reviewed. Patients above 14 years of age with Supracostal Access were included in study. PCNL was performed in prone position with 'Bull's Eye Technique'. Nephrostomy was placed after completion of the procedure in most cases. Data on demographic details, stone burden, stone clearance with primary PCNL and combination and complications rate was assessed using Modified Clavien Grades 1 through 5. Total 426 patients underwent PCNL. Seventy (70) out of 426 underwent PCNL through Supracostal Approach. Fifty (71.4 %) patients were Stone Free after PCNL and 64 (91.4%) patients were stone free after auxiliary procedures (ESWL, SECONDARY PCNL). The overall complication rate was 4.7% with 3 (4.3%) patients requiring Tube Thoracostomy and 1 (1.4%) each for angioembolisation, pulmonary oedema/ Ventilation and ICU admission due to urosepsis and renal dysfunction. Supracostal PCNL is a safe and effective approach for multiple stones in pelvicalyceal system. Due anatomic consideration can decrease the complication rate. In complex stones with huge burden, an elaborate and thorough counseling regarding delayed clearance and need for auxiliary procedures including secondary PCNL is mandatory.

MINI PERCUTANEOUS NEPHROLITHOTOMY VERSUS EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY IN TREATMENT OF NON LOWER POLAR HIGH DENSITY RENAL STONE 10-20 MM (A PROSPECTIVE RANDOMIZED STUDY)

Background: The optimal management of medium sized renal stones differs from one patient to another according to different factors. Stone attenuation value (SAV) is one of these factors which affect stone free rate (SFR) after extracorporeal shock wave lithotripsy (ESWL) with limited effect on mini-percutaneous nephrolithotomy (mini-PCNL). Objective: To compare safety and SFR of mini-PCNL and ESWL in the treatment of non-lower pole renal stones with high density and size of 10-20 mm. Patients and Methods: This prospective randomized study was carried out at Sayed Galal, Al Azhar University Hospital, Cairo, Egypt from November 2019 to October 2020 and included 70 patients with non-lower pole renal calculi 10 to 20 mm. Patients were randomly allocated in 2 equal groups: Group A was treated by mini-PCNL and group B was treated by ESWL. The primary end point was SFRs (no stone or residual 3>mm) in ESWL and mini-PCNL in this category of stone. The secondary end points were the complication rate, retreatment rate, and need for auxiliary procedures in each group. Results: The overall operative time was significantly lower in mini-PCNL group (median: 50.00; IQR: 20.00) compared to ESWL group (median: 55.00; IQR: 28.00) (p= 0.001). The overall fluoroscopy time was significantly lower in mini-PCNL than ESWL (3.2 versus 3.6 minutes, p=0.040). In mini-PCNL group, 32 out of 34 (94.1%) patients were stone free. In ESWL group, 10 out of 33 (30.1%) were rendered stone free after the third ESWL session. The SFR was significantly higher in mini-PCNL group (p < 0.001). In mini-PCNL group, none of cases needed a second look PCNL. The 2 failed cases had significant residual fragments that migrated into inaccessible calyx during pneumatic lithotripsy. In ESWL group, all cases had normal hemoglobin (Hb) level at each follow-up visit. In mini-PCNL group, when comparing pre- and post-operative Hb, a very highly significant differences were observed between pre- and post-operative Hb level (p < 0.001). Conclusions: Mini-PCNL is superior to ESWL in treatment of non-lower pole medium sized renal stones of high density with high SFR, and low complication rate as need for re-hospitalization or need for auxiliary procedure.

Efficiency and Clinical Outcomes of Moses Technology with Flexible Ureteroscopic Laser Lithotripsy for Treatment of Renal Calculus

Objective: The aim of the study was to compare the efficiency and clinical outcomes of Moses contact mode (MCM) and regular dusting mode (RDM) during flexible ureteroscopic lithotripsy (FURL) for treatment of renal calculus. Methods: This retrospective analysis examined 216 patients with renal calculus who underwent FURL with MCM or RDM between March 2015 and January 2020. Stone characteristics, including size, volume, and density, were collected. Laser parameters, including laser type, laser working time, laser pause time, and foot-pedal use, were automatically recorded by the lithotripter work panel. The percentages of laser working time and laser pause time, stone fragmentation efficiency (SFE; volume/laser working time), postoperative complications, including fever and acute renal failure (ARF), stone-free rate (SFR), and the need for auxiliary procedures were determined. Results: There were no significant differences in preoperative demographic and stone characteristics between the MCM group and the RDM group. The MCM group had a shorter laser working time (4.99 ± 1.06 vs. 5.94 ± 0.96 min, p < 0.001) and a greater SFE (137.86 [163.78–114.38] versus 114.94 [132.06–101.34] mm³/min, p < 0.001), which shortened the overall operative time (18.39 ± 5.13 vs. 21.17 ± 6.78 min, p = 0.001). There were no differences in postoperative complications, including fever and ARF, SFR (86.8 vs. 85.3%, p = 0.743), and auxiliary procedures between the 2 groups. Conclusions: Using Moses laser technology with FURL significantly reduced laser working time and increased SFE, which shortened overall operative time. Urologists should consider this new instrument for the clinical management of renal calculus.

Effect of tamsulosin versus tamsulosin plus tadalafil on renal calculus clearance after shock wave lithotripsy: An open-labelled, randomised, prospective study

ObjectivesTo compare the efficacy of tamsulosin versus tamsulosin plus tadalafil in achieving clearance of fragments after shock wave lithotripsy (SWL) to treat renal calculi. MethodsBetween January 2016 to December 2017, 140 patients with solitary, non-branched, non-lower calyceal renal calculus and measuring less than 20 mm and treated with SWL were randomized to tamsulosin (group A) or tamsulosin plus tadalafil (group B). Therapy was given for a period of 4 weeks. Stone clearance rate, analgesic requirement, occurrence of steinstrasse, need for auxiliary procedures (endoscopic treatment), and adverse effects of drugs were recorded. ResultsThe overall clearance rate was 72.5% (50/69) in the group A and 90.1% (64/71) in the group B (p=0.007). For stones up to 12 mm, the difference in the clearance rate was significant (p=0.039) while it was not so for stones larger than 12 mm (p=0.151). There was no statistically significant difference between the two groups with regards to analgesic requirement (p=0.94), occurrence of steinstrasse (p=0.101), need for auxiliary procedures (p=0.76), and adverse effects of the drugs (p=0.148). ConclusionOur study shows that adjunctive medical expulsive therapy with tamsulosin and tadalafil achieves better clearance rate than tadalafil alone in patients receiving SWL for renal stones.

Role of tamsulosin in patients undergoing ESWL for renal and ureteric stones

Background: To determine the effect of tamsulosin, as adjunctive medical therapy on the outcome of extracorporeal shock wave lithotripsy (ESWL) for solitary renal and ureteric calculi.Methods: From January 2017 onwards, a prospective, randomized controlled study was conducted in patients with solitary renal or ureteral calculus measuring less than 20 mm undergoing ESWL. The study group (n=62) received 0.4 mg of tamsulosin daily till stone clearance or a maximum period of 12 weeks and control group (n=58) received ESWL only. Parameters assessed were stone size, composition, location, stone clearance, mean time to clearance, analgesic requirement, steinstrasse, need for hospitalization and/or auxiliary procedures.Results: There was no difference between the 2 groups with regards to age, stone size, location or composition. The complete clearance rate for renal stones was 62.7% and 36.5% (p=0.004) and for ureteric stone was 89.4% and 58.8% (p=0.03) in study and control groups, respectively. The control group had a higher rate of clinically insignificant residual fragments (CISF i.e. &lt;3 mm), 12.9% versus 35.4% (p=0.002). There was no significant difference in the mean time to stone clearance (p=0.07) or in the incidence of steinstrasse formation (p=0.12). The mean analgesic requirement (p=0.01), need for auxiliary procedures and hospitalization (p=0.03) was significantly was higher in the control group.Conclusions: Tamsulosin increase the complete clearance rate and decrease the incidence of CISF. It also reduces analgesic requirement, need of additional procedures and hospitalization rate and might be useful as a routine adjunctive therapy following ESWL.

Outcomes of Flank-Free Modified Supine Percutaneous Nephrolithotomy Based on BMI

Objective: To evaluate the impact of body mass index (BMI) on the outcomes of percutaneous nephrolithotomy (PCNL) in the flank-free modified supine position. Patients and Methods: A prospective study was carried out in the urology department during the period from May 2015 to October 2019 on 464 patients admitted for PCNL. The patients were divided into 4 matched groups according to their BMI: group A, normal weight with 18.5 ≤ BMI <25 kg/m²; group B, overweight with 25 ≤ BMI <30 kg/m²; group C, obese with 30 ≤ BMI <40 kg/m²; and group D, morbid obesity with BMI ≥40 kg/m². All operative data as well as postoperative outcomes are recorded and compared to each other. Results: The 4 studied groups were matched regarding age. The comorbidities were slightly higher in groups C and D. The operative time and fluoroscopy time were slightly high in obese and morbid obese groups but with no significant difference. The rate of complications either major or minor was comparable in all groups. No significant difference was seen among all groups regarding hemoglobin loss, stone-free rate, hospital stay, and need for auxiliary procedures. Conclusions: The outcome of PCNL in flank-free modified supine position is not affected by changes in BMI. The procedure can be performed in obese and morbid obese patients safely with results similar to and comparable to nonobese patients.

Comparative Study Between Holmium: Yag Laser and Pneumatic Lithotripsy in the Management of Upper Ureteric Stone

Background:Among various intracorporeal lithotripters, Pneumatic lithotriptorhas become the widely used tool for the treatment of ureteric stones. Recently the Holmium:YAG laser has been used with a wide range of potential urological applications, including intracorporeal lithotripsy of ureteric stones. Objective: To compare the treatment of upper ureteric stone between laser and pneumatic lithotripsy. Materials and methods: One hundred patients with upper ureteric stone who underwent ureteroscopic lithotripsy in the Department of Urology, CMH, Dhakafrom October 2012 to September 2015 were enrolled in this study. Patients were divided into two groups. Group A (LL) were treated with holmium: YAG laser and Group B (PL) were treated with pneumatic lithotripsy. Two procedures were compared in term of stone fragmentation, stone clearance rate, duration of lithotripsy, complications and duration of post operativehospital stay. Patients were monitored as outpatients after one month and after three months with a kidney ureter and bladder radiograph and ultrasonograph. Patients with migrated fragments or incomplete clearance underwent an auxiliary procedure such as Extra Corporeal shock wave lithotripsy (ESWL). Results: Mean stone size was 1.36 ± 0.36 cm in group A (LL) and 1.37± 0.36 cm in group B (PL). The immediate stone clearance rate was significantly higher inGroup A (94.0%) than Group B (76.0%). Fragments proximal migration were 6.0% in LL group and 24.0% in PL group. Use of stone retrieval equipments (baskets, forceps) was 16.0% and 64.0% in LL and PL group respectively (p&lt;0.05) and stone fragments clearance requiring auxiliary procedures were 6% and 24% (p&lt;0.05) in LL and PL group respectively. The mean lithotripsy time 40.46 ± 19.25 min and 36.86 ± 14.83 min and mean period of post operative hospital stay was 2.32 ± 1.22 days and 2.44 ± 1.18 days in the LL and PL group respectively. Periprocedural complications like hemorrhage, mucosal disruption/ perforation were almost same in both groups. Conclusion: In this study stone clearance and fragmentation of stone in Holmium:YAG assisted ureteroscopy was significantly higher than pneumatic lithotripsy group. The need for auxiliary procedure like ESWL for proximally migrated fragments was significantly less inHolmium:YAG assisted ureterocopy compared with pneumatic lithotripsy. Bangladesh Journal of Urology, Vol. 22, No. 2, July 2019 p.160-165

Semi-Rigid Ureteroscopic Pneumatic Lithotripsy Versus Holmium:Yag Laser Lithotripsy for the Treatment of Single Ureteral Stones: A Prospective Study in a Single Institute

Objective: To compare the success rates and complications of Lithoclast and holmium laser-assisted ureterorenoscopy (URS) in managing ureteral stones. Material and Methods: We prospectively analyzed the records of 35 patients with ureteral stone who underwent ureteroscopic lithotripsy at our institution from January 2018 to February 2019. In 15 patients (mean stone size 12.6 mm), pneumatic lithotripsy was used; in 20 patients (mean stone size 11.6 mm), laser lithotripsy was performed. Patients were monitored as outpatients at 3 weeks and at 3 months with a kidneys, ureters, and bladder radiograph and ultrasonography. Patients with migrated stones or incomplete clearance underwent an auxiliary procedure such as shockwave lithotripsy (ESWL) or repeated URS. Results: Successful fragmentation included complete stone clearance seen on a KUB radiograph or USG at 3 weeks after URS. This occurred in 11/15 (73.3%) patients in the Lithoclast group and in 18/20 (90%) in the laser group. Auxiliary procedures included ESWL 2 patients in the Lithoclast group and 1 patient in the laser group) or repeated URS (two in the Lithoclast group). Urosepsis after URS occurred in 2/15 (13.3%) patients in the Lithoclast group and 2/20 (10.0%) patients in the laser group. Conclusion: In our study, the fragmentation rates of holmium laser-assisted ureteroscopy were significantly better. The complications and the need for auxiliary procedures were significantly less for holmium laser-assisted ureteroscopy when compared with pneumatic lithotripsy. Bangladesh Journal of Urology, Vol. 22, No. 1, January 2019 p.36-40

Evaluation of the Management of Urolithiasis with Clinical Study

Background: Urolithiasis encompasses both renal and ureteric stones. It is estimated that up to 5% of the world population is affected by this disease and the lifetime risk of getting urinary stone is 8-15%. The aim of this study is to look for epidemiological patterns in the disease distribution, understand the causative factors of the disease and assess the existing surgical modalities of treatment of this disease. Subjects and Methods: In the present study 68 cases of Urolithiasis fulfilling the study parameters were admitted and subsequently operated in Medical College and Research Hospital. Results: 65% of the patients were between age group 18-40. The most common site of urinary calculus was lower 1/3ureter followed by lower pole kidney. Diet, fluid intake, diabetes and obesity were significant predisposing factors for urolithiasis. PCNL was the treatment of choice for renal calculus while ECSWL was treatment of choice in upper ureteric calculi and ureteroscopy for lower ureteric calculi. Conclusion: For renal calculi, PCNL is the best treatment modality as of now, but it is associated with greater post-operative morbidity. For stone less than 1cm size, ECSWL is a good alternative to PCNL, but has poor clearance rate and thus greater need for auxiliary procedure. For ureteric calculi, both ECSWL and ureteroscopy have given good results but ECSWL is better tolerated by the patients.

Efficacy and safety of fURS in stones larger than 20 mm: is it still the threshold?

IntroductionThe aim of this article was to evaluate the safety and efficiency of flexible ureteroscopy (fURS) in the management of renal calculi larger than 20 mm.Material and methodsA total of 92 cases with renal calculi were managed with fURS and divided into two groups depending on the size of the stones; <20 mm and >20 mm (Group 1 and Group 2, respectively). The groups were compared with respect to treatment-related parameters including success, complication rates, hospitalization period and need for auxiliary procedures with an emphasis on the rate of infections. Success rates were also compared in each group according to stone location.ResultsOverall success rates after 3 months showed that stone-free rates in both groups were 84.1% (< 20 mm) and 58.33% (>20 mm) respectively (p = 0.008). The success rates of upper/mid pole (100% vs. 80%) and pelvis stones (83.3% vs. 75%) showed no statistically significant difference (p = 0.5, p = 0.51 respectively). Success rates for stones located in the lower pole were 75% vs. 14.28% respectively (p = 0.008). The rate of infectious complications was significantly higher in cases undergoing fURS for relatively larger stones (22.9%) as compared to smaller calculi (6.8%) (p = 0.032). No complications were recorded in Group 1, while 2 cases in Group 2 (4.1%) developed ureteral stricture.ConclusionsDespite the relatively low stone-free rates in lower pole stones, our current results indicate that fURS can be an effective and safe treatment alternative to PNL in larger renal stones (>20 mm) located in the pelvis and in the upper part of the calyceal system of the involved kidney.

Stone-free rate after semirigid ureteroscopy with holmium laser lithotripsy versus laparoscopic ureterolithotomy for upper ureteral calculi: a multicenter study

BackgroundDifferent treatment options were used to treat upper ureteral calculi. The aim of our study is to compare the stone-free rate and postoperative outcomes between semirigid ureteroscope with holmium laser lithotripsy and laparoscopic ureterolithotomy for the management of large solitary upper ureteral stones. Sixty-seven patients with a solitary upper ureteral stone who had LU or semirigid ureteroscopy in the period between January 2014 and March 2017 were included in our study. Out of the sixty-seven patients, 37 patients had semirigid ureteroscopy and holmium laser lithotripsy (Group A) and 30 patients had laparoscopic ureterolithotomy (Group B). Both groups were compared regarding operative time, intraoperative complications, need for auxiliary procedures, hospital stays, postoperative complications and stone-free rate.ResultsThe mean stone size was 1.84 ± 0.12 cm in Group A and 1.79 ± 0.17 cm in Group B, P value = 0.2. The mean operative time was 61.5 ± 3.5 min in Group A and 63 ± 4.2 min in Group B, P value = 0.13. Stone migration was recorded in five cases (14%) in Group A while no cases in Group B had stone migration. Flexible ureteroscope was used as an auxiliary measure in five patients (14%) in Group A at the same session. No auxiliary measures were used in the LU group.ConclusionThe stone-free rates after semirigid URS and laser lithotripsy are comparable to those following LU, especially when flexible URS is used to manage migrating stone fragments at the same session.

Laparoscopic ureterolithotomy versus ureteroscopic laser lithotripsy for large proximal ureteral stones: a systematic review and meta-analysis.

To review current studies and conduct a meta-analysis on the topic of laparoscopic ureterolithotomy (LU) versus ureteroscopic lithotripsy (URSL) with holmium laser for large proximal ureteral stones. A systematic research of PubMed, Ovid, Scopus (up to March 2019), and citation lists was performed to identify eligible comparative studies. All studies comparing LU versus URSL with holmium laser in proximal ureteral stones were included. Statistical analyses were performed using the Cochrane Collaboration's Review Manager (RevMan) 5.3 software. Overall, seven studies were included in analysis involving 884 patients (LU 387; URSL 497). Our meta-analysis showed that LU group had bigger stone size than URSL group (WMD 0.19 cm; P=0.001). LU group was associated with longer operative time (WMD 36.29 min; P<0.001), and length of hospital stay (WMD 1.24 d; P=0.04). However, LU group showed better initial stone-free rate (OR 11.03; P<0.001), and final stone-free rate (OR 22.37; P<0.001). There were no significant differences in all complications (RR 1.06; P=0.76). While, LU group had fewer Clavien Dindo score ≥3 complications (RR 0.21; P=0.002), fewer ureteral stricture (RR 0.26; P=0.04), and lower need of auxiliary procedures (RR 0.09; P<0.001) compared with URSL group. LU could provide a higher stone-free rate and fewer severe complications compared with URSL with holmium laser for large proximal ureteral stones. More importantly, LU could also reduce the postoperative ureteral stricture rate.

Retrograde intrarenal surgery versus mini-percutaneous nephrolithotripsy to treat renal stones 20 mm or larger in diameter using holmium:YAG laser

Objective To evaluate the efficacy and safety of mini-percutaneous nephrolithotripsy (mini-PCNL) and retrograde intrarenal surgery (RIRS) in the treatment of renal stones 20 mm or larger in the longest diameter using holmium:YAG laser. Patients and methods This was a prospective randomized study that included 40 patients who were divided into two groups, with 20 patients each. Group A underwent mini-PCNL using holmium:YAG laser lithotripsy for renal pelvic and calyceal stones. Group B underwent RIRS in which flexible ureteroscopy was used for pelvic and calyceal stones, and semi-rigid ureteroscope was used for only renal pelvic and upper calyceal stones using holmium:YAG laser. In both groups, the procedure outcomes in terms of operative time, blood loss, hospital stay, complications using modified Clavien grading system, the need of auxiliary procedures, and stone-free rates (SFRs) after 3 weeks by using CTUT were evaluated statistically. Results Statistical analysis of the data showed that there was significant difference in the operative time, which was higher in RIRS group compared with mini-PCNL group, whereas the blood loss in terms of mean±SD change in pre-treatment and post-treatment hemoglobin levels and the hospital stay were significantly higher in mini-PCNL group compared with RIRS group. The complications using modified Clavien grading system were higher in mini-PCNL group compared with RIRS group. The SFR was higher in mini-PCNL group. Conclusion In patients with renal stones 20 mm or larger, results showed that mini-PNCL has significantly shorter operative time with higher blood loss and longer hospital stay compared with RIRS. In both groups, the SFR and the need of the auxiliary procedures were comparable.