Proximal Ureteral Stones Research Articles

Ultrasound-Guided Mini Percutaneous Nephrolithotomy with Suction Sheath.

The mini percutaneous nephrolithotomy (PCNL) is a mainstay in the treatment of kidney calculi, particularly in case of >2 cm kidney stones, large lower pole stones, large impacted proximal ureteral stones, and residual stones after failed extracorporeal shockwave lithotripsy or retrograde intrarenal surgery. An accurate renal access represents a fundamental part of the procedure, modalities to guide the percutaneous tract preparation include ultrasound, fluoroscopy, or their combination. Both ultrasound and fluoroscopy offer several advantages and some limitations. The combined utilization of ultrasound and fluoroscopy is less adopted nowadays; however, this strategy has its merits particularly in cases where the puncture can be problematic with one imaging modality alone. Ultrasound can easily identify the posterior renal calix and surrounding visceral structures, although some situations such as obese patients, undilated collecting system or complex stones may represent a challenge. Intracaliceal blood clots and air may reflect ultrasound, reducing significantly the image quality. Therefore, the assessment of the intrarenal anatomy, the stone identification, and the ability of guiding the needle during access may decrease significantly, particularly in cases with complex stones, when multiple tracts are required. In these cases, fluoroscopy could determine the relationship between the angle and depth of the puncture needle and the target calices by rotating the C-arm to help the needle puncture and tract dilation. Therefore, the benefits of dual guidance would be beneficial during PCNL. In addition to an improved accuracy of puncture and dilation, the combined approach improves the detection of residual stones, facilitating the achievement of a stone-free state. Herein we describe our experience with this technique, describing surgical steps and troubleshooting tips of mini-PCNL in the accompanying video. Further high-quality studies are needed to demonstrate the advantages of combined utilization of ultrasound and fluoroscopy during PCNL and its optimal indications.

Complementary Ureterorenoscopy after extracorporeal Shock Wave Lithotripsy in proximal ureteral stones: success and complications.

SUMMARYOBJECTIVE:The aim of this study was to demonstrate the effect of extracorporeal shock wave lithotripsy application on the success and complications of ureteroscopic lithotripsy in proximal ureter stones.METHODS:The data of 87 patients who did not respond to shock wave lithotripsy and underwent ureteroscopic lithotripsy were retrospectively analyzed and classified as group I, and 99 patients who received ureteroscopic lithotripsy as primary treatment were classified as group II. Demographic features, response to treatment, and preoperative and postoperative complications were compared between the two groups.RESULTS:There was no difference between the two groups in terms of gender, operation times, stone sizes, and ureteroscope diameters. (p>0.05). Infective complications such as postoperative fever, pyelonephritis, and urosepsis were similar in both groups (p=0.142, p=0.291, and p=0.948). Stone migration was observed in 10 (11.5%) and 6 (6.1%) patients in groups I and II, respectively (p=0.291). Impacted stone was seen in 47 (54%) patients in group I and in 15 (15.2%) patients in group II (p<0.0001). Mucosal laceration occurred in 11 (12.6%) and 3 (3%) patients in groups I and II, respectively (p=0.028). Ureteral perforation was detected in 3 (3.4%) patients in group I and 1 (1%) patient in group II, whereas ureteral avulsion was not observed in either group (p=0.524).CONCLUSIONS:It was concluded that the application of shock wave lithotripsy before ureteroscopic lithotripsy in proximal ureter stones did not affect the success. Although the results are similar in terms of postoperative infection, shock wave lithotripsy application has been found to increase the risk of stone impaction into the mucosa and ureteral laceration.

Percutaneous antegrade management of large proximal ureteral stones using non-papillary puncture

ObjectiveTo evaluate the feasibility and the safety of medial non-papillary percutaneous nephrolithotomy (npPCNL) for the management of large proximal ureteral stones. MethodsWe evaluated prospectively collected data of 37 patients with large proximal ureteral stones more than 1.5 cm in diameter treated by prone npPCNL. Depending on stone size, in-toto stone removal or lithotripsy using the Lithoclast® Trilogy (EMS Medical, Nyon, Switzerland) was performed. Perioperative parameters including operative time (from start of puncture to the skin suturing), stone extraction time (from the first insertion of the nephroscope to the extraction of all stone fragments), and the stone-free rate were evaluated. ResultsTwenty-one males and 16 females underwent npPCNL for the management of large upper ureteral calculi. The median age and stone size of treated patients were 58 (interquartile range [IQR]: 51–69) years and 19.3 (IQR: 18.0–22.0) mm, respectively. The median operative time and stone extraction time were 25 (IQR: 21–29) min and 8 (IQR: 7–10) min, respectively. One case (2.7%) of postoperative bleeding and two cases (5.4%) of prolonged fever were managed conservatively. The stone-free rate at a 1-month follow-up was 94.6%. ConclusionThe npPCNL provides a straight route to the ureteropelvic junction and proximal ureter. Approaching from a dilated portion of the ureter under low irrigation pressure with larger diameter instruments results in effective and safe stone extraction within a few minutes.

Efficacy of ultrasound monitoring during extracorporeal shock wave lithotripsy: A multi-institutional propensity score-matched study.

To evaluate the efficacy of ultrasound-assisted monitoring during shock wave lithotripsy for kidney and proximal ureteral calculi. We retrospectively reviewed 535 patients who initially underwent shock wave lithotripsy for renal or proximal ureteral calculi between January 2012 and December 2021. The patients were divided into the X-ray group (n = 294) and ultrasound plus X-ray group (n = 241) based on the methods of targeting and monitoring calculi during shock wave lithotripsy. Because of differences in patient backgrounds, 1:1 propensity score-based matching was performed. The primary endpoint was the stone-free rate. In the final 1:1 matched cohort, 192 kidney stone cases and 162 proximal ureteral stone cases were analyzed. For patients with kidney calculi, the stone-free rate of the ultrasound plus X-ray group was significantly higher than that of the X-ray group (66.7% vs. 47.9%; P = 0.013). In the multivariate analysis, a large stone area (odds ratio 2.37), lower caliceal stones (odds ratio 3.37), and X-ray monitoring alone (odds ratio 0.49) were independently associated with shock wave lithotripsy failure. For patients with proximal ureteral stones, there was no significant difference in the stone-free rate between the ultrasound plus X-ray group and X-ray group (71.6% and 58.0%, respectively; P = 0.100). During the multivariate analysis, high computed tomography attenuation (odds ratio 2.31) and large stone area (odds ratio 2.18) were independent factors associated with residual stones after shock wave lithotripsy. Ultrasound-assisted monitoring may contribute to a higher stone-free rate for patients with kidney calculi, but not for those with proximal ureteral calculi.

Are the current nomograms sufficient to predict shockwave lithotripsy outcomes?

Introduction and objectivesTo investigate factors affecting SWL outcomes, validate three current nomograms (Kim JK, Triple D and S3HoCKwave) and compare the predictive ability of the nomograms for SWL outcomes in upper urinary tract stones. Patients and methodsMedical records of patients with renal and proximal ureteral stones treated with SWL between March 2013 and October 2020 were retrospectively reviewed. Factors affecting SWL success were analyzed with multivariate logistic regression analysis and the three predictive scoring systems compared with the area under the curve (AUC). ResultsA total of 580 patients were included in our study. The overall stone free rate was 61% and 144/580 patients (24.8%) were stone free after one session. In multivariate logistic regression analysis, stone location at upper calyx (OR:2.988; 95%Cl: 1.350–6.612; p = 0.007), middle calyx (OR:3.036; 95%Cl: 1.472–6.258; p = 0.003), and lower calyx (OR:2.131; 95%Cl: 1.182–3.839; p = 0.012), as well as number of stones (OR:1.663; 95%Cl: 1.140–2.425; p = 0.008), maximum diameter of stone (OR:1.156; 95%Cl: 1.098–1.217; p < 0.001) and maximum Hounsfield Unit (OR:1.001; 95%Cl: 1.001–1.002; p < 0.001) were independent risk factors of SWL failure. The AUCs of the Kim JK, Triple D and S2HoCKwave scores for predicting SWL success were 0.678, 0.548, and 0.626 respectively. ConclusionsStone location, number, maximal diameter, and maximum HU were independent predictive factors for SWL outcome in the treatment of upper urinary tract stones. Current nomograms, “Kim JK nomogram”, “Triple D score” and “S3HoCKwave score” can predict treatment success after SWL, but all of them have poor discrimination according to AUC analysis.

Clinical Features and Surgical Outcomes of the Children With Urolithiasis at a Tertiary Care Hospital: First Report From Somalia.

IntroductionThere are very few studies regarding pediatric urolithiasis (PU) reported from Africa, and to date, no data have been presented from Somalia. This study evaluated the sociodemographic and radiological characteristics, treatment, and outcome data of the PU patients treated at Somalia's only tertiary care center.MethodThe data of all patients diagnosed with urolithiasis during a 6-year period were reviewed. Only pediatric (age <18) urolithiasis patients were included. Demographic parameters, radiological features, stone characteristics, treatment, and outcome data were collected and analyzed.ResultsOverall, 227 (127 male, 100 female) patients were included. The rate of PU was 8.1%. The mean patient age was 12.7 ± 3.2. More than two-thirds of the patients (n = 161, 70.9%) were adolescents. The stones were located in the kidney in 50.7%, the ureter in 33%, and the bladder in 14.5%. Distal ureteral stones (36%) accounted for the majority of ureteral stones, followed by the ureterovesical junction (26.7%) and proximal ureteral (24%) stones. The mean stone size was 16.2 mm. Most (42.3%) stones had a 10–20 mm diameter, while 23.3% were sized between 6 and 10 mm. Renal insufficiency was present in 5.3%. Among 227 patients, 101 (44.5%) underwent minimally invasive procedures including ureterorenoscopic lithotripsy (n = 40, 18%), retrograde intrarenal surgery (n = 30, 13.2%) and percutaneous nephrolithotomy (n = 31, 14%). Open pyelolithotomy was the most common surgery performed (n = 53, 22.3%). Surgical site infection developed following 3.5% of the open surgery cases. The stone-free rate was 91.3%. It was significantly higher in open cases (98%) compared to the cases performed via a minimally invasive approach (83%) (p = 0.02).ConclusionIn Somalia, PU is more common than in many other countries. Open surgery continues to be the primary treatment modality for children with urolithiasis due to the restricted endourology resources. However, minimally invasive approaches have evolved over the last years.

¿Son suficientes los nomogramas actuales para predecir los resultados de la litotricia por ondas de choque?

Introduction and objectivesTo investigate factors affecting SWL outcomes, validate three current nomograms (Kim JK, Triple D and S3HoCKwave) and compare the predictive ability of the nomograms for SWL outcomes in upper urinary tract stones. Patients and methodsMedical records of patients with renal and proximal ureteral stones treated with SWL between March 2013 and October 2020 were retrospectively reviewed. Factors affecting SWL success were analyzed with multivariate logistic regression analysis and the three predictive scoring systems compared with the area under the curve (AUC). ResultsA total of 580 patients were included in our study. The overall stone free rate was 61% and 144/580 patients (24.8%) were stone free after one session. In multivariate logistic regression analysis, stone location at upper calyx (OR:2.988; 95%Cl: 1.350–6.612; p=0.007), middle calyx (OR:3.036; 95%Cl: 1.472–6.258; p=0.003), and lower calyx (OR:2.131; 95%Cl: 1.182–3.839; p=0.012), as well as number of stones (OR:1.663; 95%Cl: 1.140–2.425; p=0.008), maximum diameter of stone (OR:1.156; 95%Cl: 1.098–1.217; p<0.001) and maximum Hounsfield Unit (OR:1.001; 95%Cl: 1.001–1.002; p<0.001) were independent risk factors of SWL failure. The AUCs of the Kim JK, Triple D and S2HoCKwave scores for predicting SWL success were 0.678, 0.548, and 0.626 respectively. ConclusionsStone location, number, maximal diameter, and maximum HU were independent predictive factors for SWL outcome in the treatment of upper urinary tract stones. Current nomograms, Kim JK nomogram, Triple D score and S3HoCKwave score can predict treatment success after SWL, but all of them have poor discrimination according to AUC analysis.

Efficacy of medical expulsive therapy using the traditional Japanese medicine (kampo) choreito for the spontaneous passage of proximal ureteric stones: A retrospective analysis

AbstractAimUrolithiasis is a common disorder of the urinary tract. Medical expulsive therapy is recommended for calculi with diameters &lt;10 mm. This study was conducted to determine the effect of choreito, an herbal medication with discharging effects, on the spontaneous passage of urinary calculi.MethodsThis retrospective observational study included 109 adult patients with urinary calculi who were admitted to Hirao Hospital between April 2016 and March 2017. Choreito (7.5 g/day) was administered to 55 participants in the choreito group but not to the 54 participants of the control group. All patients were monitored until the calculi passed naturally. The period of spontaneous passage of the calculi was compared between the choreito and control groups, and the factors associated with this duration were identified using multivariate analysis.ResultsCompared to the control group, the period of spontaneous passage of the proximal ureteric stones was significantly shorter in the choreito group (14 days vs 36 days, p = 0.0262). Calculus diameter (&lt;3 mm) and choreito administration were identified as independent factors associated with a shorter period for spontaneous calculi passage.ConclusionOral administration of choreito may promote the spontaneous passage of proximal ureteric stones without the need for surgical intervention.

Therapeutic Living Donor Nephrectomy for Proximal Ureteral Pathology: A Longitudinal Case Series

ObjectiveTo raise awareness that patients with proximal ureteral stricture who elect for nephrectomy can consider donating the kidney. We present a series of patients undergoing therapeutic living donor nephrectomy (TLDN), a scenario in which a patient undergoing nephrectomy for an underlying medical problem donates the kidney to a person with end-stage renal disease. This practice is underutilized, and only a single TLDN with proximal ureteral stricture has been previously described. We aim to help define the indications, risks, and benefits for patients. MethodsThis is a retrospective case series of seven therapeutic donors with proximal ureteral pathology and stone disease. Patient characteristics, donor work up, operative details, and donor and recipient outcome were collected. ResultsAll seven donors had proximal ureteral pathology, and six of the seven had nephrolithiasis or ureterolithiasis. After electing for nephrectomy, the mean time to TLDN was 57.9 days. No recipients experienced delayed graft function . Mean follow up was 40.1 months (range 8-131), and the most recent follow-up mean creatinine was 1.08 (mg/dL). Graft and recipient survival is 100%. No recipients developed recurrence of ureteral stricture or stones. ConclusionThis is the first series demonstrating patients with proximal ureteral stricture, even with concomitant stone disease, may donate kidneys for transplantation. Recipient outcomes suggest this practice is safe, and appropriately selected patients that have already elected for nephrectomy should receive counseling about this opportunity. Importantly, patients who donate a kidney receive waiting list priority if they ever need a kidney transplant in the future.

MP44-17 COMPARISON OF OPERATIVE EFFICIENCY AND EFFECTIVENESS BETWEEN A DUAL LUMEN AND SINGLE LUMEN URETEROSCOPE FOR URETEROSCOPIC STONE REMOVAL

You have accessJournal of UrologyCME1 May 2022MP44-17 COMPARISON OF OPERATIVE EFFICIENCY AND EFFECTIVENESS BETWEEN A DUAL LUMEN AND SINGLE LUMEN URETEROSCOPE FOR URETEROSCOPIC STONE REMOVAL Andrew Brevik, Rohit Bhatt, Kalon Morgan, Sohrab Ali, Akhil Peta, Sina Zarandi, Luke Limfueco, Rajiv Karani, Lillian Xie, Raphael Arada, John Sung, Francis Jefferson, Egor Parkhomenko, Daniel Lama, Shoaib Safiullah, Pengbo Jiang, Roshan Patel, Ralph Clayman, and Jaime Landman Andrew BrevikAndrew Brevik More articles by this author , Rohit BhattRohit Bhatt More articles by this author , Kalon MorganKalon Morgan More articles by this author , Sohrab AliSohrab Ali More articles by this author , Akhil PetaAkhil Peta More articles by this author , Sina ZarandiSina Zarandi More articles by this author , Luke LimfuecoLuke Limfueco More articles by this author , Rajiv KaraniRajiv Karani More articles by this author , Lillian XieLillian Xie More articles by this author , Raphael AradaRaphael Arada More articles by this author , John SungJohn Sung More articles by this author , Francis JeffersonFrancis Jefferson More articles by this author , Egor ParkhomenkoEgor Parkhomenko More articles by this author , Daniel LamaDaniel Lama More articles by this author , Shoaib SafiullahShoaib Safiullah More articles by this author , Pengbo JiangPengbo Jiang More articles by this author , Roshan PatelRoshan Patel More articles by this author , Ralph ClaymanRalph Clayman More articles by this author , and Jaime LandmanJaime Landman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002610.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Dual lumen flexible ureteroscopes (DLFU) have yet to be compared head-to-head in a clinical trial with single lumen flexible ureteroscopes (SLFU). Our prospective, randomized study sought to evaluate the efficacy, efficiency, and surgeon device preference during upper urinary tract stone management with SLFU vs. DLFU. METHODS: Seventy-nine patients undergoing flexible ureteroscopy and laser lithotripsy for proximal ureteral or renal stones between 2016 and 2020 were randomized to either SLFU or DLFU. The overall time for ureteroscopy, laser lithotripsy, and stone basketing were recorded. Procedural efficiency and effectiveness based on stone clearance rate and stone-free status were calculated using preoperative and postoperative computed tomography (CT) imaging and 3D Slicer CT-based, stone volume determination. Postoperative surgeon surveys addressed ergonomics and overall ureteroscope performance. RESULTS: Although linear stone burden was not statistically different between the two groups, preoperative stone volume was almost two-fold greater in the dual lumen group (267 mm3 vs. 132 mm3, p = 0.03). Despite the larger stone volume, DLFU provided a 4-minute shorter lithotripsy time than SLFU (2 min vs. 6 min, p = 0.02) with a significantly better stone clearance rate (7.1 mm3/min vs. 3.7 mm3/min, p = 0.03). True stone-free rate, specifically a complete absence of stone fragments as seen on postoperative CT, was 48% for DLFU compared to 26% for SLFU (p = 0.05). The dual lumen exceeded the single lumen ureteroscope in all surgeon-evaluated performance metrics. CONCLUSIONS: DLFU surpassed SLFU in surgical efficiency and effectiveness by providing a faster lithotripsy procedure and a higher absolute stone-free rate. Based on surgeon questionnaires, DLFU was also ergonomically superior to SLFU. Source of Funding: The UCI Urology Curiosity and Innovation Laboratory has received support from Richard Wolf Endoscopy® in the form of funding and ureteroscopes © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e759 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Andrew Brevik More articles by this author Rohit Bhatt More articles by this author Kalon Morgan More articles by this author Sohrab Ali More articles by this author Akhil Peta More articles by this author Sina Zarandi More articles by this author Luke Limfueco More articles by this author Rajiv Karani More articles by this author Lillian Xie More articles by this author Raphael Arada More articles by this author John Sung More articles by this author Francis Jefferson More articles by this author Egor Parkhomenko More articles by this author Daniel Lama More articles by this author Shoaib Safiullah More articles by this author Pengbo Jiang More articles by this author Roshan Patel More articles by this author Ralph Clayman More articles by this author Jaime Landman More articles by this author Expand All Advertisement PDF DownloadLoading ...

MP028 - Efficacy and safety of retrograde ureteroscopy for the treatment of impacted proximal ureteral stones larger than 10 mm

MP028 - Efficacy and safety of retrograde ureteroscopy for the treatment of impacted proximal ureteral stones larger than 10 mm

Incidence of Urosepsis in Patients Undergoing Flexible Ureteroscopy

Introduction: Urosepsis is a systemic response to and potentially life-threatening sequela of urogenital tract infection. Objectives: The main objective of the study is to find the incidence of urosepsis in patients undergoing flexible ureteroscopy. Material and methods: This cross sectional study was conducted in Fatima Jinnah Medical University during June 2021 to January 2022. 241 patients full filling the inclusion criteria was included through the Emergency / OPD of hospital. An informed consent was obtained from patients. Demographic data (Name, age, gender, and stone size) was recorded. Results: The data was collected from 241 patients. Out of 241 there were 118 males and 123 female patients. There was a significant difference in age between patients who developed sepsis and patients who did not develop sepsis. Patients who developed sepsis also had albumin concentrations &lt;35 g/L, globulin concentrations ≥30 g/L, AGR &lt;1.2, pre-operative fever, WBC count ≥10,000 cells/µL, pre-operative positive UC, positive urine WBC, and positive urine nitrite. Conclusion: It is concluded that patients with solitary proximal ureteral stones are more likely to have post-fURS sepsis when they have positive pre-operative UC or low pre-operative AGR.

A Novel Nomogram for Predicting Post-Operative Sepsis for Patients With Solitary, Unilateral and Proximal Ureteral Stones After Treatment Using Percutaneous Nephrolithotomy or Flexible Ureteroscopy.

BackgroundThe postoperative sepsis is a latent fatal complication for both flexible ureteroscopy (fURS) and percutaneous nephrolithotomy (PNL). An effective predictive model constructed by readily available clinical markers is urgently needed to reduce postoperative adverse events caused by infection. This study aims to determine the pre-operative predictors of sepsis in patients with unilateral, solitary, and proximal ureteral stones after fURS and PNL.MethodsWe retrospectively enrolled 910 patients with solitary proximal ureteral stone with stone size 10–20 mm who underwent fURS or PNL from Tongji Hospital's database, including 412 fURS cases and 498 PNL cases. We used the least absolute shrinkage and selection operator (LASSO) regression and multivariate logistic regression analysis to identify the risk factors for sepsis. Finally, a nomogram was assembled utilizing these risk factors.ResultsIn this study, 49 patients (5.4%) developed sepsis after fURS or PNL surgery. Lasso regression showed postoperative sepsis was associated with gender (female), pre-operative fever, serum albumin (<35 g/L), positive urine culture, serum WBC (≥10,000 cells/ml), serum neutrophil, positive urine nitrite and operation type (fURS). The multivariate logistic analysis indicated that positive urine culture (odds ratio [OR] = 5.9092, 95% CI [2.6425–13.2140], p < 0.0001) and fURS (OR = 1.9348, 95% CI [1.0219–3.6631], p = 0.0427) were independent risk factors of sepsis and albumin ≥ 35g/L (OR = 0.4321, 95% CI [0.2054–0.9089], p = 0.0270) was independent protective factor of sepsis. A nomogram was constructed and exhibited favorable discrimination (area under receiver operating characteristic curve was 0.78), calibration [Hosmer–Lemeshow (HL) test p = 0.904], and net benefits displayed by decision curve analysis (DCA).ConclusionsPatients who underwent fURS compared to PNL or have certain pre-operative characteristics, such as albumin <35 g/L and positive urine culture, are more likely to develop postoperative sepsis. Cautious preoperative evaluation and appropriate operation type are crucial to reducing serious infectious events after surgery, especially for patients with solitary, unilateral, and proximal ureteral stones sized 10–20 mm.

Prospective, Randomized Comparison of Dual-Lumen vs Single-Lumen Flexible Ureteroscopes in Proximal Ureteral and Renal Stone Management.

Introduction: We sought to compare the safety, efficacy, efficiency, and surgeon experience during upper urinary tract stone management with single-lumen (SLFU) vs dual-lumen flexible ureteroscopes (DLFU). Materials and Methods: Seventy-nine patients with proximal ureteral or renal stone burden <2 cm were randomized to a SLFU or DLFU. We recorded times for ureteroscopy (URS), laser lithotripsy, stone basketing, as well as intraoperative and postoperative complications. The rate of stone clearance and stone free status were calculated using CT imaging. Surgeons completed a survey after each procedure rating various metrics regarding ureteroscope performance. Results: Thirty-five patients from the single-lumen group and 44 patients from the dual-lumen group had comparable median URS time (37 vs 35 minutes, p = 0.984) and basketing time (12 vs 19 minutes; p = 0.584). Median lithotripsy time was decreased in the dual-lumen group (single: 6 vs dual: 2 minutes, p = 0.017). The stone clearance rate was superior in the dual-lumen group (single: 3.7 vs dual: 7.1 mm3/min, p = 0.025). The absolute stone-free rate (SFR) was superior for the dual-lumen group (single: 26% vs dual: 48%, p = 0.045). No differences in intraoperative (single: 0% vs dual: 2%; p = 0.375) and postoperative complications (single: 7% vs dual: 11%, p = 0.474) were observed. Surgeons' ratings of the dual-lumen ureteroscope was superior for visibility, comfort, ease of use, and overall performance. Conclusions: The use of the dual-lumen ureteroscope in patients with renal and proximal ureteral stones <2 cm provided shorter lithotripsy time, higher stone clearance rates, improved SFR, and superior surgeon ratings when compared with SLFUs.

Cost-effectiveness of anti-retropulsive devices varies according to the locations of proximal ureteral stones: a retrospective cohort study

BackgroundAnti-retropulsive devices are often used to prevent stone migration in the treatment of proximal ureteral calculi. They are helpful. However, in the meantime, they also add extra expenses. This study was carried out to investigate the best criteria for treating proximal ureteral stones with anti-retropulsive devices.MethodsData from all patients who underwent ureteroscopic holmium: YAG laser lithotripsy for solitary upper ureteral stones in 2018 were collected. Patients who encountered stone retropulsion during the process of inserting the ureteroscope were excluded. Patients were divided into either group URS or group URS + ARD depending on whether the anti-retropulsive device was used. Then, the stone-free rate, expenses and other criteria were compared between groups according to stone location. Stone-free was defined as no stones present.ResultsFor stones located ≤ 30 mm from the ureteropelvic junction (UPJ), the stone-free rates for the URS group were 80% and 80% at one day and one month after the operation, respectively. Those for the URS + ARD group were 71.4% and 78.6% at one day and one month, respectively. For stones located 31–90 mm from the UPJ, the stone-free rates were 84.7% and 84.7% for the URS group and 89.6% and 95.5% for the URS + ARD group at one day and one month, respectively. A statistically significant difference occurred at one month. For stones located > 90 mm from the UPJ, the two groups were both stone free. In the URS + ARD group, expenses were higher. In addition, the mean diameter of residual stones derived from stones located at 31–90 mm from the UPJ was statistically smaller, and 4 of 7 residual stones passed spontaneously within one month, which was obviously more than that in other locations and the URS group. Other outcomes, including operation time and postoperative stay, showed no significant difference between the groups.ConclusionAnti-retropulsive devices are indeed helpful, but they might be cost-effective for stones located solely in the middle part of the upper ureter, not for those too close to or far from the ureteropelvic junction.

Stenting versus non-stenting before extracorporeal shock wave lithotripsy for proximal ureteric stones: A prospective interventional study

Background: Extracorporeal shock wave lithotripsy (ESWL) has become the first-line treatment for stones in the upper urinary tract measuring &lt;2cm. It is the minor invasive treatment for calculi of the upper urinary tract. Aims and Objectives: This study aims to identify the effect of the presence and absence of a ureteric stent on the outcome of ESWL in patients with proximal ureteric stones. Materials and Methods: This was a prospective cohort study done on 300 patients and wasdivided into two equal groups of 150 each. Group A patients were selected for ESWL with DJ stent, and Group B patients werefor ESWL without DJ stent. Non-contrast CT KUB was done as a functional study along with plainX-ray KUB and ultrasound before the intervention. All treatments were done with Direx Compact XL (electromagnetic generator) device as an outpatient procedure. Patients were followed up radiographically at 15 days, 1 month, 2 months, and in 3 months. Hematuria, steinstrasse, fever, ureteric colic, lower urinary tract symptoms (LUTS), stone clearance, number of ESWL sessions, and secondary procedures were recorded for each group. DJ stent was taken out when the stone disappeared or at the end of 3 months. Variables were compared with Chi-square test. Results: The overall stone-free rate at 3 months was 90.6% (272/300). Clearance after the first sitting, second sitting, and the third sitting wasnot significant between the two groups(P&gt;0.05).There was no significant difference between the two groups in regard to clearance according to the size of the stones. A total of 9.3%(28/300) of patients did not have a successful outcome and were termed as ESWL failures. Post- ESWL complications were significant between the both groups in terms of hematuria and ureteric colic. All the ureteric colic patients had a stone size larger than 13 mm, P=0.0005, which was more in the non-stented (Group B) patients. Most of the lower urinary tract symptoms were seen in stented (Group A) patients, P&lt;0.0001 significant between the two groups, and dysuria was also significant between the two groups with P=0.0033. Conclusion: Pre-ESWL ureteral stenting provides no additional benefit over no stent in situ, although ureteral stents are associated with more irritative symptoms.

A retrospective observational study compared the efficacy of pneumatic and holmium laser ureteroscopic lithotripsy for treatment of ureteral stones

Purpose: To compare the efficacy and complications of holmium laser lithotripters and pneumatic lithotripters, the two most commonly used lithotripters in the endoscopic treatment of ureteral stones, at all ureteral levels. Material and method: Retrospective data on 510 patients who had ureterorenoscopic lithotripsy performed by a single surgeon between January 2018 and 2021 were studied. Patients were divided into two groups: those who received a holmium laser lithotripter and those who received a pneumatic lithotripter. Demographic information, stone-free rates, double-j (JJ) stent usage, JJ stent removal time, type of anesthesia, operation time, hospital stay, and complication rates were all examined. Results: The patient numbers in the holmium laser and pneumatic groups were 265 and 245, respectively. The overall success rate in group 1 was found to be significantly higher than in group 2 (98.5 percent vs 93.9 percent; p=0.006). Group 1 had a significantly higher success rate in proximal ureteral stones (94.4 percent vs 68.9 percent; p=0.001). Patients in group 1 had a significantly higher rate of not using any ureteral stent (29.8 percent vs 17.6 percent; p<0.001). There was no difference between the two groups in terms of mid-ureter and distal ureter stones, anesthesia type, operation time, hospital stay, JJ stent removal time, and complications. Conclusion: For ureteral stones, ureterorenoscopic lithotripsy is the chosen therapeutic approach. The location of the stone in the ureter as well as the type of lithotripters used can have an impact on the outcome. Because of its great efficiency and lack of need for ureteral stents, holmium laser lithotripsy may be preferred for the treatment of proximal ureteral stones.

The Ureteral Stone Cone is A Useful Device for the Prevention of Calculi Retropulsion during Holmium Laser Lithotripsy for Proximal and Mid-Ureteric Stones. A Nigerian Experience

Background: Retropulsion and stone fragment migration is a problem with lithotripsy especially for proximal and mid-ureteric calculi during ureteroscopy, leading to increased operative time, costs, and additional procedures. To overcome this drawback, many strategies have been developed, one of which is the use of anti-retropulsion devices like the stone cone. Objective: To describe our initial experience with the use of the stone cone during holmium laser lithotripsy in a patient with proximal and mid-ureteric stone for preventing retropulsion. Method: This is a retrospective study carried out on six consecutive patients with proximal with uncommon proximal ureteric stone over a 2year period ureteric stone. TPatients with distal ureteric stone were excluded. The Boston Scientific Stone Cone Nitinol Retrieval Coil was passed beyond the stone and deployed under fluoroscopy to prevent proximal stone and fragment migration. Holmium laser lithotripsy was then carried out. The fragments were removed with graspers and the stone cone was then removed. A double J stent was passed in all cases for about two to a month week and removed. The total operating time was noted. The data on the patient’s age, sex, stone size, Hounsfield, and stone clearance was analyzed using SPSS version 20. Results: There were six patients, five male, and one female with a mean age of 37.5years with an age range between 27 – 54years. The stone sizes ranged from 7-15mm with a mean dimension of 11.17mm. The Hounsfield of the stones ranged from 539 to 1171HU with a mean of 765.5HU. The operating time ranged from 55 – 90minutes with a mean of 67.5minutes. None had retropulsion with 100% stone clearance. Conclusion: The stone cone is a safe device and is useful during ureteroscopy and lithotripsy for mid-and proximal ureteric stone in preventing retropulsion and improving stone clearance.

A novel model using computed tomography parameters to predict shock wave lithotripsy success in ureteral stones at different locations

ObjectiveTo combine non-contrast computerized tomography (NCCT)-based parameters with stone and patient characteristics that are already known to affect shock wave lithotripsy (SWL) success and assess this novel model’s effectiveness in predicting SWL success for single ureteral stones in different locations. Materials and methodsData of patients treated by SWL for a single ureteral stone between January 2017 and January 2019 were retrospectively reviewed. Demographic parameters of patients and stone characteristics were combined with NCCT-based parameters. NCCT-based parameters included the presence or absence of hydronephrosis, perinephric stranding, periureteral edema, diameter of the proximal ureter, ureteral wall thickness (UWT) at ureteral stone site. The logistic regression method was used for the development of a useful predictive model. Subsequently, the receiver operating curve was used to determine cut-off levels, and a scoring system was developed for prediction of SWL success. ResultsStone-free rate was 77,1% (267/346) in the entire cohort. Univariate analysis revealed that age, stone volume, density, perinephric stranding, diameter of proximal ureter, and UWT, were associated with SWL success. In multivariate analysis, proximal ureteral stone location, stone volume, density, and UWT were independent predictors of SWL success. The formula used during logistic regression analysis was: 1/[1 + exp {−8.856 + 0.008 (stone volume) + 0.002 (stone density) + 0.673 (UWT) + 1026 (proximal ureteral stone)}]. The scores of 0, 1, 2, 3 and 4 were associated with 97,8%, 83,4%, 60,8%, 33,2% and 11,1% success rates, respectively, in the prediction model based on these parameters. ConclusionWe conclude that our model can facilitate decision-making for SWL treatment of ureteral stones in different locations.

The use of 14/16Fr ureter access sheath for safe and effective management of large upper ureteral calculi.

To evaluate the effectiveness of ureteroscopic lithotripsy for the management of large proximal ureteral stones > 10mm using 14/16 Fr ureteral access sheath (UAS). Patients' data from prospective database undergoing ureteroscopic laser lithotripsy with a use of 14/16Fr UAS were collected. All patients were pre-stented prior to the procedure. The fragmentation was performed with a semi-rigid ureteroscope using holmium laser energy with a power setting of 35W (frequency-35Hz; energy-1J). Follow-up was scheduled at 4 weeks and 3 months postoperatively. In total 78 patients, 43 males and 35 females, were included in the study. The mean age of the patients was 59.5 ± 13.3 with a mean maximal stone diameter of 13.4 ± 2.1. The mean operative time was 35.7 ± 9.7 and the mean hospital stay was 2 ± 0.7days. The primary SFR at 4 weeks was 73 patients (93.6%), while all 78 patients (100%) were stone free at 3-month follow-up, 2 of the patients receiving additional treatment. In total, 8 (10.2%) patients experienced Grade II complications. Intraoperative ureteral lesions were observed in 41 (52.6%) cases. Out of them 31 patients (39.7%) developed Grade 1, 8 patients (10.3%) Grade 2 and only 3 patients (2.6%) Grade 3 lesions. The use of 14/16Fr ureteral access sheath on pre-stented patients was associated with successful outcomes. A high stone-free rate of 93.6% was achieved at 4-week follow-up. The procedure was not associated with increased rate of postoperative complications and intraoperative ureteral injury.