Postoperative Stone-free Rate Research Articles

Assessment of Outcomes andAnatomical Changes in the Upper Urinary Tract Following Flexible Ureteroscopy With a Flexible and Navigable Suction Ureteral Access Sheath: 3-Month Results From a Multicenter Study.

To study the long-term outcomes of the flexible and navigable suction ureteral access sheath (FANS) in flexible ureteroscopy (FURS). FANS has well-established efficiency and 30-day perioperative safety; however, its influence on pelvicalyceal and ureteric anatomy remains to be investigated. This was a prospective study of patients with normal renal anatomy who underwent FURS with FANS for renal stones from April 2023 to August 2024 in 16 centers worldwide. Thirty-day postoperative stone-free rate and delayed complications after 3 months were analyzed with a non-contrast CT scan and contrasted CT urogram respectively. The primary aim was to report if FANS could potentially cause pelviureteric junction, pelvicalyceal or ureteric complications. Three hundred-tenpatients were analyzed. Median age was 51; median stone volume was 1584mm3. Disposable scopes were used in 58.1%. Predominant laser energies were Thulium fiber laser (56.1%) followed by Thulium-YAG laser (20.6%). Median laser time was 14minutes, median ureteroscopy time was 30minutes, and median total operation time was 45minutes. Ureteric injury occurred in 11 patients (3.5%), of which 10 were Traxer-Thomas Grade 1. On 30-day NCCT, 63.5% of patients had zero residual fragments; overall stone-free status was seen in 95.1%. Thirty-day reintervention rate was 4.2% (13 cases). Three-month CT urogram showed ureteric stenosis in only 1 patient (0.3%) who was managed by dilatation and stenting. No other anatomical anomalies were recorded. The extremely low rates of 3-month adverse outcomes, high immediate SFR, and low 30-day reintervention rates further strengthen the evidence for safety and effectiveness of FANS.

Novel pressure- and temperature-controlled flexible ureteroscope system with a suction ureteral access sheath: a multicenter retrospective feasibility study.

The purpose of this study was to assess the feasibility of a pressure-controlled and temperature-controlled flexible ureteroscope system (PT Scope™) during flexible ureteroscopy. We developed the PT Scope™, a novel ureteroscope system with capabilities for monitoring and controlling intrarenal pressure and temperature to maintain them within set parameters. Data were retrospectively collected from 48 consecutive patients diagnosed with upper urinary tract stones who underwent flexible ureteroscopic lithotripsy using the PT Scope™ across five centers in China. Analyses focused on 24-h postoperative stone-free rates, intrarenal pressure and temperature measurements, and other procedural data. Among the 48 patients treated with the PT Scope™ system, a significant stone-free rate of 89.6% was achieved within 24h postoperation, without any instances of intraoperative complications such as perforation or mucosal hemorrhage. Only two patients reported mild postoperative pain and were managed with NSAIDs, and there were no cases of postoperative fever or sepsis. The average maximum intrarenal pressure and temperature were recorded at 30.2 ± 4.20mmHg and 36.6 ± 4.27°C, respectively. Notably, during lithotripsy, both the pressure and temperature were maintained below 30mmHg and 43°C for 99% of the procedure duration, respectively. This preliminary investigation indicates that the PT Scope™ is a safe and effective tool for the treatment of upper urinary tract stones, offering the benefit of regulating intrarenal pressure and temperature within predetermined limits. These findings support the feasibility of the system for clinical application.

Analysis of the effectiveness and safety of 7.5 Fr ultra-thin flexible ureteroscope combined with a tip-flexible suctioning ureteral access sheath for the treatment of kidney stones.

To compare the efficacy and safety of using a 7.5 Fr flexible ureteroscope (f-URS) with tip-flexible suctioning ureteral access sheath (TFS-UAS) versus a 9.2 Fr f-URS with traditional ureteral access sheath (T-UAS) in the treatment of kidney stones. A retrospective analysis was conducted on 205 patients with kidney stones measuring 1.0-2.0cm treated with 7.5 Fr and 9.2 Fr f-URS in the Urology Department of The Affiliated Dazu Hospital of Chongqing Medical University from November 2022 to November 2023. The patients were randomly divided into two groups. Among them, 78 patients were selected to use the 7.5 Fr f-URS, which was designated as the GroupA. The remaining 127 patients were selected to use the 9.2 Fr f-URS, which served as the GroupB. The study compared the operation duration, lithotripsy duration, surgical success rate, immediate postoperative stone-free rate (SFR), 1-month postoperative SFR, and the incidence rate of postoperative complications between the two patient groups. In terms of demographic characteristics, the size of calculi, surgical success rate, and 1-month postoperative SFR, there was no statistically significant difference between GroupA and GroupB. However, GroupA demonstrated superior performance compared to GroupB in operation duration (48 (40.55) min vs 74 (56.94) min), lithotripsy duration (35 (27.43) min vs 59 (42.78) min), and immediate postoperative SFR (53.52% (38/71) vs 29.41% (35/119)), with statistically significant differences observed (P < 0.05). In terms of complication occurrence, GroupA reported 10 cases of minor (Grade 1) complications, whereas GroupB had 32 cases of minor (Grade 1) complications and 7 cases of severe complications (including 2 cases of Grade 3 and 5 cases of Grade 4). The difference between the two groups was statistically significant (P < 0.05). The GroupA reported significantly fewer cases of postoperative fever (4) and analgesic treatment (3) compared to GroupB, which had 18 fever cases and 19 analgesic cases (P < 0.05).The GroupA did not experience any cases of septicemia or steinstrasse. Conversely, the GroupB had 5 cases of septicemia and 3 cases of steinstrasse, including 2 patients who underwent reoperation. Both groups also reported cases of ureteral mucosal rupture (5 in GroupA, 10 in GroupB), but these differences were not statistically significant (P > 0.05). Compared with 9.2 Fr f-URS combined with T-UAS, the use of 7.5 Fr f-URS with TFS-UAS in the treatment of kidney stones has higher lithotripsy efficiency and lower complication rate. This combination is safe and effective in the treatment of kidney stones.

Comparative analysis of retro vs. transperitoneal laparoscopic pyelolithotomy for large renal stones.

The objective of this study is to compare the outcomes and complications of retroperitoneal and transperitoneal laparoscopic pyelolithotomy (RLP and TLP, respectively) in the treatment of large kidney stones. In this retrospective cohort effort, data of all patients who underwent laparoscopic pyelolithotomy for renal pelvic stone (N = 273) in three referral urology hospitals were retrieved. Operation duration, length of hospital stay, postoperative stone-free rate, hemoglobin (Hb) and creatinine (Cr) changes and complications were compared between the two groups before and after propensity score matching. A total of 199 TLP and 74 RLP cases were examined. Stone size was significantly higher in the TLP vs. RLP group (29.8 ± 10.9 vs. 26.5 ± 8.8mm; P = .022). Length of operation and hospital stay were comparable (P = .672 and P = .396, respectively). Rate of conversion to open surgery, postoperative blood transfusion rate, postoperative urinary leakage, postoperative stone-free rate, Hb drop and Cr change were similar between the two groups (P = .348, 0.190, 0.828, 0.411, 0.780 and 0.134, respectively). Postoperative fever was significantly more prevalent in TLP compared to RLP (21.6% vs. 0.0%, respectively; P < .001). Propensity score matched analyses showed similar results in all aspects; particularly demonstrating higher postoperative fever in TLP compared to RLP (18.9% vs. 0.0%, respectively; P < .001). RLP can be considered as an alternative to TLP; especially owing to a lower chance of postoperative fever.

Comparison of efficacy and safety of flexible ureteroscopy and mini-percutaneous nephrolithotomy for 2-3 cm renal calculi in women: a single-center study.

This study aimed to compare the efficacy and safety of flexible ureteroscopic lithotripsy (FURSL) and mini-percutaneous nephrolithotomy (mPCNL) in the treatment of 2-3 cm renal calculi in women. Clinical data of 186 patients who underwent mPCNL (n=96) and FURSL (n=90) surgery in our hospital from June 2018 to February 2023 were collected. Several parameters were assessed and compared between the two groups, including operation duration, length of hospital stay, cost of hospitalization, pain intensity measured by the visual analogue scale (VAS), patient comfort assessed using the Bruggrmann Comfort Scale (BCS), decrease in hemoglobin levels, changes in blood urea nitrogen (BUN), fluctuations in serum creatinine (Scr), hypersensitive C-reactive protein (hs-CRP) levels, complication rates, immediate post-operative stone-free rate (RSFR), and long-term stone-free rate (LSFR). The comparative analysis of patient age, body mass index (BMI), stone size, computed X-ray tomography (CT) value of stones, number of stones, and comorbidities revealed no statistically significant differences between the mPCNL and FURSL groups (p>0.05). The mPCNL cohort exhibited a markedly lower duration of operation (p<0.001) and BCS score (p<0.001) compared to the FURSL cohort. Nonetheless, the mPCNL cohort demonstrated significantly higher hospitalization expenses (p<0.001), length of hospital stay (p<0.001), VAS score for pain (p<0.001), and level of hemoglobin decrease (p<0.001) in comparison to the FURSL cohort. Moreover, the immediate post-operative stone-free rate (RSFR) was significantly higher in the mPCNL group (p=0.007). The long-term stone-free rate (LSFR), however, showed no significant difference between the two groups (p=0.160). Furthermore, the FURSL group exhibited significantly fewer overall complications in contrast to the mPCNL group (p=0.006). mPCNL and FURSL are both safe and effective surgical methods for treating 2-3 cm renal calculi in women. However, FURSL holds distinct advantages, including minimally invasive procedure, accelerated recovery, reduced cost, and lower incidence of complications.

Application of tip-bendable ureteral access sheath in flexible ureteroscopic lithotripsy: an initial experience of 224 cases.

During the last decades, the advent of flexible ureteroscopic lithotripsy has revolutionized the management of upper urinary tract stones. We designed a patented tip-bendable ureteral access sheath to facilitate stone clearance. Our current study reported our initial experience of 224 cases. The study is a descriptive, retrospective analysis. The initial 224 cases, operated consecutively by one surgeon during 16 months, were reviewed. The novel tip-bendable ureteral access sheath was applied in the procedure. Demographics, laboratory tests, and peri- and postoperative findings (operation duration, stone-free rate (SFR), utilization of flexible instruments and complications) were analyzed. The median age of the patients was 56 years and the mean stones size was 2.3 ± 1.3cm. There were 63 cases of upper ureteral stone, 93cases of renal stone and 68 cases of ureteral-renal stones. The mean operative time was 69.2 ± 65.2min. The immediate stone-free rate was 76.8% and the 1 month post-operative stone-free rate was 97.3%. Most cases(95.5%)were success in single session. Two patient experienced post-operative fever. There was no unplanned readmission. The frequency of post-operative complications was estimated at 0.89% (Clavien I). Flexible ureteroscopic lithotripsy with tip-bendable ureteral access sheath is a safe and effective procedure, which can achieve excellent stone clearance.

A comparative analysis of the efficacy and safety of mini-percutaneous nephrolithotomy performed in the supine and prone positions for the treatment of pediatric kidney stones: a single-center experience.

Mini-percutaneous nephrolithotomy (MPCNL), which has a smaller tract size (14-20 Fr) than conventional percutaneous nephrolithotomy, has been shown to be safe and effective in pediatric patients with large and complex upper urinary tract stones. This study aimed to compare the efficacy and safety of MPCNL between the supine and prone positions in a pediatric population. The data of pediatric patients who underwent MPCNL at our center between January 2010 and March 2023 were retrospectively analyzed. According to the surgical position, the patients were divided into the prone (Group P) and supine (Group S) groups. In both groups, dilatation was performed using 14-18 Fr metallic dilators. The two groups were compared in terms of perioperative data, postoperative stone-free rates (SFRs), and complications. There were 36 (59%) patients in Group P and 25 (41%) patients in Group S. Stones were mostly located in the pelvis (49.2%) and second most frequently in the lower pole (27.9%). Fluoroscopy time was shorter in Group S but did not statistically significantly differ compared to Group P (p = 0.181). However, operation time was statistically significantly shorter in Group S (73.8 ± 35 vs. 99.8 ± 37.4min, p = 0.008). Although there was no significant difference, relatively higher SFR were detected in Group S (88% vs. 83%, p = 0.725). Endoscopic combined intrarenal surgery (ECIRS) was performed on six (24%) patients in Group S, and the SFR was 100% among these patients. There was no significant difference between the two groups in terms of the presence of complications (16.7% vs. 16%, p = 0.945). Both supine and prone MPCNL appear to be safe and effective in the pediatric age group, with similar stone-free and complication rates. In the supine procedure, the operation time is shortened compared to the prone. In addition, simultaneous retrograde access has the potential to increase the overall success rate of surgery.

Impact of ureteric access sheath use during flexible ureteroscopy: A comparative study on efficacy and safety

ObjectivesThis study evaluates the impact of using an access sheath (AS) during flexible ureteroscopy (fURS) for urolithiasis treatment, focusing on outcomes such as stone-free rate, operation time, and complications. MethodsThis prospective, randomized study was carried out at Badr Hospital, Helwan University, and Ain Shams University hospitals from August 2021 to August 2022. Patients were systematically randomized into two groups (fURS with AS: 33 patients and without AS: 31 patients) and underwent preoperative and postoperative assessments, including lab tests and imaging. Possible procedure-associated risks, such as failed stone access, pain, bleeding, and sepsis, were monitored. ResultsThe two groups were found to be comparable in terms of demographic characteristics or preoperative stone findings (p > 0.05 for all). However, operation duration was shorter in the No Sheath group (79.4 ± 15.3 min vs. 90.4 ± 16.7 min in the Sheath group, p = 0.008). Intraoperative complication rates, including failed access, operation termination, ureteric injury, and bleeding, were comparable in both groups (p > 0.05). Postoperative stone-free rates (78.8% vs. 71.0%, p = 0.305) and mean residual stone size (2.7 ± 3.5 mm vs. 3.1 ± 3.1 mm, p = 0.687) showed no significant differences. ConclusionsThe present study suggests that fURS without an access sheath may offer an efficient and equally effective option for managing upper ureteric and renal stones. However, more studies with larger sample sizes and longer follow-up periods are required to validate these findings and to establish more precise indications for this approach.

Impacto del uso de la vaina de acceso ureteral durante la ureteroscopia flexible: estudio comparativo de eficacia y seguridad

ObjectivesThis study evaluates the impact of using an access sheath (AS) during flexible ureteroscopy (fURS) for urolithiasis treatment, focusing on outcomes such as stone-free rate, operation time, and complications. MethodsThis prospective, randomized study was carried out at Badr Hospital, Helwan University, and Ain Shams University hospitals from August 2021 to August 2022. Patients were systematically randomized into two groups (fURS with AS: 33 patients and without AS: 31 patients) and underwent preoperative and postoperative assessments, including lab tests and imaging. Possible procedure-associated risks, such as failed stone access, pain, bleeding, and sepsis, were monitored. ResultsThe two groups were found to be comparable in terms of demographic characteristics or preoperative stone findings (P>.05 for all). However, operation duration was shorter in the No Sheath group (79.4±15.3minutes vs. 90.4±16.7minutes in the Sheath group, P=.008). Intraoperative complication rates, including failed access, operation termination, ureteric injury, and bleeding, were comparable in both groups (P>.05). Postoperative stone-free rates (78.8% vs. 71.0%, P=.305) and mean residual stone size (2.7±3.5mm vs. 3.1±3.1mm, P=.687) showed no significant differences. ConclusionsThe present study suggests that fURS without an access sheath may offer an efficient and equally effective option for managing upper ureteric and renal stones. However, more studies with larger sample sizes and longer follow-up periods are required to validate these findings and to establish more precise indications for this approach.

Evaluation of validity and reliability of novel rapid measurement for infundibulopelvic angle: a comparison with PACS system

ABSTRACT Background For patients with lower pole renal calculi (LPC), preoperative evaluation of infundibulopelvic angles (IPA) is of great significance; however, conventional measuring method is often inconvenient in clinical setting. Here we introduce a rapid novel method using built-in inclinometer in smartphone which is often used in anatomical parameters evaluating to implement the measurement of IPA. Materials and methods The randomized, self-controlled study on evaluating inclinometer application measured IPA on urography films collected from enrolled LPC patients. Results of statistical analysis for its validity and reliability compared to conventional PACS system are reported. Predictive performance of postoperative stone-free rates by IPA measured with the novel method was also evaluated in this study. Results Bland–Altman plot result shows that there is favorable agreement between IPA values of these two methods. The time required to utilize the PACS was considerably greater than time required to take similar measure using smartphones. The precision–recall curve (PRC) indicates that the new method has similar predictive performance for postoperative clearance rates as PACS. Conclusions In summary, measurement of IPA implemented by integrated inclinometer of smartphone is rapid, convenient, accurate and reliable in evaluating renal anatomy parameters of LPC patients.

Comparative Evaluation of the Choice of the Method of Percutaneous Nephrolithotripsy in Patients with Nephrolithiasis

The objective: to analyze the effectiveness and safety of mini-percutaneous nephrolithotripsy (mPCNL) compared to standard percutaneous nephrolithotripsy (sPCNL) in the treatment of nephrolithiasis. Materials and methods. The study analyzed the results of treatment of 1021 patients with solitary (10–30 mm), coral-like and multiple kidney stones for the period from 2016 to 2022. Patients were divided into two groups: sPCNL (500 patients) and mPCNL (521 patients). The average age of patients in both groups was 44.5±15 years. The results of treatment in both groups were compared with each other according to the following parameters: stone-free rate (SFR), duration of surgery, presence of complications, and length of postoperative hospital stay. Results. Both methods are highly effective in the surgical treatment of nephrolithiasis. At the same time, the duration of the operation in the mPCNL group was longer than in the sPCNL group (81.0±15.5 min vs. 69.1±13.9 min; p&lt;0.001), mCPNL was more often finished with drainageless methods (41.1% vs. 6.8%; p&lt;0.001). The postoperative SFR after mPCNL was generally higher (96.4% vs. 91.8%; p=0.002) both in the treatment of solitary stones (98.5% vs. 97.4%; p&gt;0.05) and in treatment of coral-like (90.1% vs. 77.3%; p&lt;0.05) and multiple nephrolithiasis (89.5% vs. 70.8%; p=0.03). The postoperative hemoglobin decrease was smaller in the mPCNL group (1.1±0.34 g/dL vs. 2.1±0.26 g/dL; p&lt;0.001). The infectious complications frequency and length of postoperative stay in the hospital were less in the mPCNL group than in the sPCNL group – 7.3% vs. 13.2% (p=0.03) and 1.9±0.6 days vs. 4.3± 2.4 days, respectively (p&lt;0.001). Conclusions. Mini-percutaneous nephrolithotripsy (m-PCNL) has been proven to be a safe and effective method of nephrolithiasis treatment. Compared with standard percutaneous nephrolithotripsy (sPCNL), patients after mPCNL have a higher SFR, a lower frequency of postoperative complications and duration of postoperative stay in the hospital. An increase operation time by mPCNL is associated with a decrease in the diameter of the tube.

External validation of Resorlu-Unsal stone score in predicting outcomes after retrograde intrarenal surgery. Experience from a single institution.

Pre-operative assessment of renal stones is essential in selecting treatment options and achieving high success rates for retrograde intrarenal surgery (RIRS). Several nephrolithometric scoring systems have been developed using pre-operative clinical data and stone characteristics. Resorlu-Unsal stone score (RUSS) is composed of four different parameters, and each of them adds 1 point to the final score. One point is added in patients with stone size > 20 mm, lower calyceal stones and infundibulo-pelvic angle < 45°, stone number > 1, and abnormal anatomy, respec-tively. RUSS categorizes patients into four distinct groups and aims to predict stone-free rates (SFR) after RIRS. We externally validated RUSS and evaluated its predictive accuracy. We performed a retrospective analysis of patients who underwent RIRS for renal stones between January 2020 and December 2021. Patient age, pre-operative hydronephrosis, stone size, stone density as Hounsfield Unit (HU), operative time and RUSS were investigated as potential preoperative predictive factors for stone-free status. RUSS was applied to all patients, and the nomogram was externally vali-dated. Area under the curve (AUC) was used for clinical validity assessment. The present study included a total of 79 patients. Mean patient age was 55.1 ± 15.4 years with a mean stone size was 14.2 ± 4.4 mm. Overall, 62/79 (78.4%) patients were stone free after the initial treatment. After applying RUSS, 36 (45.6%), 29 (36.7%), 10 (12.6%), and 4 (5.1%) patients had a score of 0, 1, 2, and 3, respectively. On multivariate logistic regression RUSS (OR = 0.220; 95%CI: 0.086-0.567; p = 0.002) was identified as the only predictor of postoperative stone-free status. RUSS is a user-friendly scoring system that may predict postoperative stone-free rate after RIRS with great effi-cacy and accuracy.

The dilemma of 12/14F ureteral access sheath (UAS) usage: a case control study

BackgroundThe insertion of a ureteral access sheath (UAS) is a frequent procedure during flexible ureteroscopy (fURS) to facilitate kidney stone treatment. The aim of this study was to investigate the influence of 12/14 French (F) UAS on fURS outcomes.MethodsWe performed a retrospective monocentric analysis of fURS procedures conducted at the Department of Urology (University Hospital Schleswig–Holstein, Lübeck, Germany) for kidney stone treatment via lithotripsy or basket stone retrieval between September 2013 and June 2017. Uni- and multivariate analyses were done with the help of RStudio (Version 1.0.136) software.ResultsIn total, 283 consecutive fURS were analyzed. UAS was applied in 98 cases (34.63%). The insertion of UAS was preferred in cases with multiple kidney stones and larger median maximal stone diameter (p < 0.05). UAS usage correlated with elevated radiation exposure in seconds (94 vs. 61; p < 0.0001), prolonged operation time in minutes (99 vs. 66, p < 0.0001), length of hospital stay over 48 h (LOS, 22.49% vs. 10.81%; p = 0.015), more frequent postoperative systemic inflammatory response syndrome (SIRS, 13.27% vs. 4.32%; p = 0.013) and lower postoperative stone-free rates (60.20% vs. 78.92%; p = 0.0013). Moreover, we conducted uni- and multivariate subgroup analysis for cases with multiple kidney stones (≥ 2) and comparable stone burden; UAS was inserted in 48.3% of these cases (71/147). On multivariate logistic regression, UAS insertion was statistically associated with prolonged operation time in minutes (101 vs. 77; p = 0.004). No statistical differences regarding radiation exposure, stone-free rates, postoperative SIRS rates or LOS were noted between UAS and non-UAS patients with multiple kidney stones of similar size (p > 0.05).Conclusions12/14F UAS does not seem to improve overall outcomes in fURS for kidney stones. In patients with multiple kidney stones it may be associated with elevated operation time without a clear benefit in terms of improved stone-free status or reduced perioperative complication rate. Further prospective randomized studies to specify the indications for UAS usage are urgently needed.

Totally tubeless single access tract mini-percutaneous nephrolithotripsy in treatment of large burden\u2009>\u20092-cm and/or complex renal stones: a case series of 62 patients

BackgroundLimited literature has focused on the use of totally tubeless mini-percutaneous nephrolithotomy (PCNL) for the treatment of large renal stones. We present our findings of treating patients with large and/or complex renal stones using single renal access totally tubeless mini-PCNL.MethodsFrom March 2018 to May 2021, 62 consecutive cases in which single tract totally tubeless mini-PCNL was used to treat complex renal stones were enrolled, all with calculi > 2 cm. All procedure of puncture and dilation were guided by fluoroscope. The complexity of stones was assessed according to the Guy’s Scoring System (GSS). The surgical duration, length of hospital stay, analgesia requirement, stone-free rate, and perioperative morbidity were assessed.ResultsThe mean preoperative stone burden was 36.69 ± 19.76 mm (above 2 cm in all cases), mean surgical duration was 61.93 ± 40.84 min (range 15–180 min), and mean hematocrit reduction was 4.67 ± 2.83%. Postoperative Nalbuphine was used in 6 patients. The mean length of stay was 2.46 ± 1.19 days (range 2–8 days), and the postoperative stone-free rate was 83.9% (52/62), and 87.1% (54/62) after auxiliary ESWL. The overall complication rate was 14.5%, the majority of complications being postoperative transient fever.ConclusionFor the treatment of large bursen > 2 cm and/or complex renal stones, totally tubeless single tract mini-PCNL ensures a feasible SFR, low morbidity and short hospital stay. According to the low complication rate in our study, the totally tubeless manner was not associated with an increased risk of postoperative morbidity, and patients benefited from decreased postoperative analgesics use.

The Impact of Ureteral Access Sheath Size on Perioperative Parameters and Postoperative Ureteral Stricture in Retrograde Intrarenal Surgery.

Objective: To investigate the effect of the diameter of ureteral access sheath (UAS) used during retrograde intrarenal surgery (RIRS) on operative parameters, perioperative ureteral injury, and ureteral stricture development. Materials and Methods: The study was designed as a prospective randomized controlled trial and included 320 patients who underwent RIRS. The patients were divided into two groups according to the diameter of UAS (9.5F/11.5F [Group 1] and 12F/14F [Group 2]) placed during the operation. At the end of the operation, ureteral injury was checked visually using semirigid ureterorenoscopy and classified according to the ureter injury scale. In the postoperative first year, the control CT urography images were used to observe newly developing ureteral dilatation. Results: There was no statistical difference between the two groups in terms of patient and stone characteristics, operative time, postoperative stone-free rate, and postoperative infection development parameters. In Group 1, 30 (18.8%) of the patients had low-grade and 8 (5%) of the patients had high-grade ureteral injury, while in Group 2, 44 (27.5%) had low-grade and 19 (11.9%) had high-grade ureteral injury (p = 0.013). In the postoperative period, ureteral stricture was found in 5 (1.6%) patients, of whom 4 (2.5%) were in Group 2 and 1 (0.6%) (p = 0.371). Conclusion: The results of our study showed that the use of a 12F/14F UAS in patients who are not previously stented increases the risk of high-grade ureteral injuries; however, despite this increase there is no difference in ureteral stricture formation.

Comparison of Perioperative Outcomes and Clinical Characteristics of Calcium, Matrix and Struvite Stones From a Single Institution

ObjectiveTo define risk factors and perioperative outcomes for matrix stones and compare these outcomes with struvite and calcium stone cohorts. MethodsA retrospective cohort study comparing matrix stones (n=32), struvite stones (n=23) and a matched, calcium stone control group (n=32) was performed. Two-way ANOVA was used to compare the groups for continuous variables. Chi-square tests were used to compare categorical variables. Significance was set at P <.05. All statistical tests were performed using R (v1.73). ResultsWe identified no differences in age, gender, or BMI between the three groups. Matrix and struvite stones were more likely to have a history of prior stone surgery and recurrent UTIs compared to calcium stones (P=.027 and P <.001, respectively). Struvite stones were more likely to present as staghorn calculi compared to matrix or calcium stones (56.5% vs 21.7% vs 18.8%, P=.006). There were no significant differences in postoperative stone free rates (P=.378). No significant differences in postoperative infectious complications were identified. Matrix stones were more likely to have Candida on stone culture compared to the struvite or calcium stones (P <.0001). ConclusionMatrix and struvite stones were more likely have a history of stone surgery and preoperative recurrent UTIs. Struvite stones were more likely to present as staghorn calculi. Matrix stones were more likely to have Candida present in stone cultures. However, no difference in postoperative infectious outcomes or stone free rates were identified. Further study with larger cohorts is necessary to distinguish matrix stone postoperative outcomes from struvite and calcium stones.

Мини-перкутанная нефролитотомия без катетеризации мочеточника. Сравнение со стандартной методикой

Introduction. Percutaneous nephrolithotomy (PNL) is the method of choice for the treatment of patients with kidney stones larger than 2 cm. Mini-percutaneous nephrolithotomy (mini-PNL) became widespread due to reduction of injury associated with surgical approach. Creation of puncture access to the pelvicalyceal system without ureteral catheterization is also recently described. The main benefits of such technique are reduction of total operative time and the radiation exposure to the patient and medical personnel. The results of using mini-PNL without prior ureteral catheterization remain insufficiently studied, which predetermined the goal of our study. Purpose. Compare the efficacy and duration of mini-PCNL with and without ureteral catheterization. Materials and methods. We analyzed the treatment outcomes of 111 patients with a single kidney stone. Group I included 60 patients who underwent mini-PCNL according to the standard technique. Group II included 51 patients who underwent mini-PCNL without prior catheterization of the ureter. The average stone size was 19.2 0.92 mm and 18.6 0.93 mm in groups I and II, respectively. The puncture of the pyelocaliceal system of the kidney was performed under X-ray control and US guidance using the free-hand technique. Results. In group I, complete elimination of the stone was achieved in 55 (92%) patients and the mean duration of the operation was 108,3 34,85 min (range: 60 to 210). In group II, complete elimination of the stone was achieved in 50 (90%) patients and the mean duration of the operation was 69,7 22 min (range: 25 to 120 min). In all cases, the severity of complications did not exceed grade II according to Clavien classification, and their rate was 6,7% and 5,9% in group I and group II, respectively. Conclusions. According to the results of the study, the compared groups did not differ in their post-operative complication and stone-free rates. Avoidance of routine ureteral catheterization significantly reduces the operation time and hence the anesthetic risk and radiation load.

The effectiveness of percutaneous nephrolithotomy for the treatment of large impacted upper ureteral stones

Objective: To compare the efficacy of semi-rigid or flexible ureteroscopic surgery and percutaneous nephrolithotomy, which is the standard method for the surgery of ≥2 cm upper ureteral impacted stones .&#x0D; Materials and Methods: The data of 123 patients who underwent stone surgery for ≥2 cm impacted ureteral stones in the upper ureter in our clinic were retrospectively analyzed. The patients were divided into two groups as ureteroscopic surgery group (URS, n = 59) and percutaneous nephrolithotomy group (PNL, n = 64) according to the type of operation. Patients with stones impacted in the ureter at the level between the L4 vertebra and ureteropelvic junction were included in the study. Preoperative demographic data and postoperative results of the patients in two groups were compared.&#x0D; Results: Average operation time was similar in both groups (p = 0.147). Mean hospital stay was significantly higher in the PNL group compared to the URS group (3.28 ± 0.57 days vs 1.11 ± 0.32 days, p = 0.001). Mucosal injury was developed in 10 (16.9%) patients in the URS group during the operation, while it was only 3 (4.7%) in the PNL group (p = 0.027). Postoperative urinary tract infection development was found to be similar in URS and PNL groups (8.5% vs 4.7%, p = 0.479). Postoperative stone-free rate was found to be significantly higher in the PNL group compared to the URS group (95.3% vs 79.7%, p = 0.008).&#x0D; Conclusion: PNL is a very effective and safe procedure in the surgical treatment of stones ≥2 cm in diameter impacted in the upper ureter. The complication rate of PNL is comparable with URS; however, it is seen that the PNL is more advantageous than URS in terms of postoperative total stone-free rate.

Factors Affecting Success of Semi-rigid Ureterorenoscopy in Proximal Ureter Stone Treatment

To evaluate the factors affecting the success of semi-rigid ureteroscopy in proximal ureter stones. Descriptive study. Department of Urology, Nevşehir State Hospital, Turkey between March 2017 and October 2019. Patients, who underwent a semi-rigid ureteroscopic lithotripsy (URSL) operation for proximal ureteral stones, were evaluated retrospectively in terms of gender, age, stone side, stone size, stone density, the type of lithotripsy, placement of the stone cone, the type of anesthesia and postoperative stone-free rates, which were recorded. The diameter of the ureter with the stones and the distances of the stones to the ureteropelvic junction (UPJ) were measured. Patients who had stone-free status after the URSL were labelled as group I. Patients whose stones were pushed back during URSL were labelled as group II. The distance of the stone to the UPJ was statistically significantly higher in group I (p=0.006). The rate of using stone cone in patients in group I was statistically significantly higher than in patients in group II (p=0.001). The rate of stones in the middle ureter in group I was statistically higher than group II (p<0.001). The rate of using laser lithotriptor in group I was statistically higher than group II (p=0.007). Semi-rigid URSL is a useful technique in the proximal ureter stones. The distance of the stone to the UPJ affects the success; and using laser lithotripsy and stone cone increases the success. Key Words: Ureteral stone, Ureterorenoscopy, Laser lithotriphsy, Pnomotic lithotripsy.

Comparison of single-use flexible URS and re-usable flexible URS: Effectiveness, reliability, cost-efficiency analysis

Comparison of Single-use Flexible Ureterorenoscopy (SF-URS) with Reusable Fiberoptic Flexible Ureterorenoscopy (RF-URS) is one of the most popular subject in Endourology. Flexible Ureterorenoscopy (F-URS) is the gold standard method used in the treatment of kidney and ureteral stones smaller than 2 cm and together with ESWL.SF-URS has been widely used along with RF-URS. Our study aims to analyze retrospectively RF-URS and SF-URS in terms of effectiveness, reliability and cost. 200 patients who underwent F-URS due to renal stones were included in our study. Patients were divided into 2 groups: 100 patients who underwent SF-URS and 100 patients who underwent RF-URS. Mean age of the two groups was 49.58, 50.24 in the RF-URS and SF-URS groups, respectively. The presence of hypertension and diabetes, Body Mass-Index (BMI), and stone characteristics were recorded, and postoperative stone-free rates, duration of hospital stay, duration of operation, postoperative hemoglobin loss, postoperative urosepsis, and auxiliary procedures were evaluated. A cost effective analysis was carried out. The demographic data and stone characteristics of both groups were similar and there was no statistically significant difference (p> 0.05). The SF-URS group was found to be more advantageous in terms of the duration of operation (p0.05). The RF-URS group was found to be more advantageous after a cost-effective analysis (p