Rigid Ureterorenoscopy Research Articles

The effect of routine ureteral stent placement on post-ureteroscopy complications: A prospective study from a resource limited setting

Background: Rigid ureterorenoscopy (URS) stands as a highly successful treatment for ureteral stones. The current guidelines from the European Association of Urology (EAU) recommends selective double J (DJ) stent placement post-URS to mitigate major complications. However, in resource-limited hospital setups, executing selective stent placement poses substantial risks in preventing complications and reducing readmission rates. This study aims to unveil the ramifications of our routine stent replacement approach after ureteric stone surgery on surgical outcomes in a resource-constrained setting.Materials and Methods: This prospective study was conducted at a urological unit within a tertiary care center in Sri Lanka, over a one-year period, involving 112 diagnosed patients. Patients underwent routine DJ stenting following rigid URS for ureteral stone management, without additional intervention. Data collected from clinical records encompassed demographics, stone characteristics, and complications. Postoperative complications linked to routine DJ stenting were assessed using the Clavien-Dindo classification system. Descriptive statistics were employed for data summary using SPSS version 23.0.Results: The mean age of patients was 47.3±14.9 years (range: 13-76 years), with 67.9% being males. The mean stone size was 15.35±6.58 mm (range: 4.5-35 mm), distributed across right (48.2%), left (44.6%), and bilateral (7.1%) ureters, of which 52.7% were proximal, 30.4% distal, and 17% mid ureteric stones. Postoperative evaluation revealed 26.8% of patients experiencing Clavien-Dindo grade I complications (e.g.,dysuria, haematuria, loin pain, and lower urinary tract symptoms), managed conservatively. Moreover, 4.5% encountered Clavien-Dindo grade II complications, predominantly postoperative fever, necessitating hospital readmission specifically for intravenous antibiotic administration.Conclusion: Despite guidelines advocating selective stent placement, this study underscores the safety and efficacy of routine DJ stent implementation after the URS laser procedure. The findings showcase a notable reduction in postoperative complications alongside decreased hospital readmission rates in resourcelimited environments. Embracing routine DJ stenting post- URS in such settings could serve as a pragmatic approach, potentially enhancing patient outcomes and minimizing healthcare burdens.

COVID-19 effect on perioperative findings of flexible/semi-rigid ureterorenoscopic lithotripsy: A match-pair analysis.

If not treated on time with proper management options, urolithiasis cause serious morphologic and functional alterations in the involved renal units. Like many other pathologies, the diagnosis, treatment, and follow-up principles of patients with urinary stones have been negatively affected by the unestimated changes in the healthcare systems dealing intensively with COVID-19 patients. In this present study, we aimed to evaluate and present the possible effects of COVID-19 infection on the ureterorenoscopic stone treatment. Clinical and procedural characteristics of 96 patients undergoing flexible and/or rigid ureterorenoscopy because of urolithiasis between March 2020 and January 2021 were evaluated in a retrospective manner. Obtained data were evaluated after match-pair analysis in a comparative manner between cases with a positive medical history of COVID-19 infection (Group 1, n: 48) and those without any COVID-19 infection (Group 2, n: 48). There was no statistically significant difference between the two groups of cases with respect to age, gender, associated comorbidities, and stone characteristics (p > 0.05). The mean serum creatinine level was determined to be higher in Group 1 than in Group 2 (1.15 ± 0.59 mg/dl, 0.83 ± 0.21 mg/dl, p = 0.007, respectively). Evaluation of the operative parameters revealed longer mean time from diagnosis to surgery (33.5 ± 14.27 vs 12.12 ± 6.33 days, p = 0.001), operating time, median length of stay in hospital along with higher additional intervention rates, and Clavien-Dindo complication scores again in Group 1 (p < 0.05). Our results indicate that the presence of COVID-19 infection anamnesis may affect the clinical and operative parameters of ureteroscopic stone management in cases with urolithiasis due to the possible effects of renal units damage and longer waiting time. Urologists may be aware of these unestimated problems during and after the intervention to take necessary measures for a safe and successful ureteroscopic stone removal.

Double ureteric obstruction mimicking bowel obstruction managed by minimal invasive surgery

This case highlights bowel obstruction like symptoms post-laparoscopic pyeloplasty for pelvi-ureteric junction obstruction (PUJO), caused by concomitant vesico-ureteric-junction obstruction (VUJO). The endoscopic management is presented along with a review of the literature. A 16-month-old-girl was diagnosed antenatally with a left hydronephrosis. The post-natal scan confirmed severe left pelvi-calyceal dilatation with cortical thinning, no ureteric dilatation, and a 32 mm anterior-posterior (AP) renal pelvis. The mercaptoacetyltriglycine (MAG-3) renogram demonstrated thinned cortex with steady accumulation of contrast and poor drainage along with split renal function of 26% on left side. The patient underwent a laparoscopic pyeloplasty for PUJO, with some difficulty in passing the JJ stent distally. Postoperatively, the patient developed symptoms of ileus, that were progressively unsettled with bilious vomiting and abdominal distension. An ultrasound examination revealed the distal end of stent still positioned in the distal ureter with stable upper tract dilatation. Serial radiographs showed progressive distended bowel loops with the stent coiled in ureter. On the fourth day; as symptoms did not improve, emergency laparoscopy was performed that confirmed no mechanical cause of obstruction and no bowel injury. Cystourethroscopy in the same session revealed ipsilateral VUJO. The left ureteral orifice was cannulated with difficulty using a 0.0014 inch guide wire, following which the vesico-ureteric junction was dilated with 4Fr ureteric catheter and a 3.7Fr JJ stent was placed. The newly inserted JJ stent displaced the existing stent into the renal pelvis. Post-operative course showed dramatic improvement in obstructive symptoms. Both JJ stents were subsequently removed after 3 months using a cystoscope and rigid uretero-renoscope. Pre-operative diagnosis of coexistent VUJO and to PUJO is clinically challenging and requires high level of suspicion especially when postoperative recovery is not smooth. With the availability of endo-ureterotomy procedures PUJO and VUJO could be managed together without the risk of endangering ureteric vascularity.

Efficacy of Alpha Blockers in Relieving Symptoms of JJ Stent

Introduction: JJ stenting has been routinely used in endourology with a wide variety of implications. These stents have beneficial effects in postoperative period improving surgical outcome. Though they are widely used in urology practice, JJ stents cause lower urinary tract symptoms (LUTS) in majority of patients. The objective of this study was to test the hypothesis that alpha blockers reduce lower urinary tract symptoms (LUTS) after rigid ureterorenoscopy in postoperative time period up to 3 weeks. Study Design: It was a randomized clinical trial (RCT). Setting: The study was conducted in KRL hospital, Islamabad. Patients presenting in outpatient / emergency department were selected for the study. Duration of Study: Six months (15th July 2016 to 15th Jan’ 2017) Methods: A prospective randomized study was conducted in total 100 patients undergoing rigid ureterorenoscopy (URS). Patients were randomized into an intervention Group A and Control Group B. In Group A tamsulosin 0.4mg was given after rigid ureterorenoscopy, while in Group B no tamsulosin was given except placebo. Primary outcome were lower urinary tract symptoms (LUTS), which were measured by international prostate symptoms score (IPSS) up to 3 weeks postoperatively. Results: The mean IPSS at 3rd week in postoperative phase of rigid URS for Group A was 4.76± 4.14315 and in Group B was 27.28 ± 5.03879 with the P value of 0.0001 which was statistically significant and also less than 0.05. So IPSS was statistically lower in Group A as compared to Group B up to 3 weeks post operatively. In conclusion, a significant statistical difference was found for Double J (DJ) stent related symptoms between the two groups. Conclusion: Alpha blockers reduce lower urinary tract symptoms (LUTS) in postoperative period of rigid ureterorenoscopy up to 3 weeks.

Application of integrated flexible and rigid ureterorenoscope in upper ureter or renal pelvis stones

Objective To study the efficacy and safety of the integrated flexible and rigid ureterorenoscope in the treatment of upper ureter or renal pelvis stones. Methods The clinical data of 48 patients with upper ureter or renal pelvis stones were retrospectively analyzed between January 2015 and July 2017. Twenty-five cases were treated with integrated flexible and rigid ureterorenoscope(integrated group), while 23 cases were treated with minimally invasive percutaneous nephrolithotomy lithotripsy(mPCNL group). The operative effect and safety of both groups were compared. Results In the integrated group, stone finding rate was 96% and 100% in the mPCNL group. The blood loss of the integrated group was (6.83±2.60)mL lower than that of the mPCNL group (75.57±18.85)mL (P 0.05). There was no significant difference in postoperative complications between the two groups. Conclusions The integrated flexible and rigid ureterorenoscope is safe and effective in the treatment of the upper ureter and renal pelvis stones. With a high stone clearance rate, it can achieve the similar clear stone effect of mPCNL. Compared with mPCNL, the integrated flexible and rigid ureterorenoscope has less bleeding, shorter operative time, lower cost of treatment, faster recovery after surgery, less complications, with broad prospects for the use. Key words: Ureteral Calculi; Kidney Calculi; Ureteroscopy; Lasers, Solid-State

Hospital Readmissions Due to Subcapsular Renal Hematoma After Flexible and Rigid Ureterorenoscopy

Hospital Readmissions Due to Subcapsular Renal Hematoma After Flexible and Rigid Ureterorenoscopy

Bilateral Complete Ureteral Duplication with Bilateral Ureteral Calculi

A 35-year-old female came with right renal colic. Ultrasonography showed left hydroureteronephrosis. Intravenous urography showed bilateral complete duplication with the right upper moiety ureteric calculus and left lower moiety ureteric calculus. Both were treated with rigid ureterorenoscopy. This is first such presentation in the world. Only two cases of complete duplication with urolithiasis, but different presentation are reported so far.

Should Flexible Ureterorenoscopy be the First-line Treatment Option for Renal Calculi?

While first-line treatment option for pediatric renal calculi, 1.5-2 cm in size, was open surgery in the past, percutaneous nephrolithotomy (PNL) is now the first-line treatment option in accordance with EUA pediatric guidelines. However, mini rigid ureterorenoscopy (URS) and the laser props of flexible URS have started to be used in the removal of these calculi. The present study aimed at conveying our experience in using flexible URS and laser on the removal of right renal calculus, 16 mm in size, in a 1-year-old male pediatric patient.

Flexible ureterorenoscopy results: Analysis of 279 cases

In this study, the outcomes of 279 cases in whom we performed retrograde intrarenal surgery (RIRS) were evaluated retrospectively. RIRS was performed on 279 cases with the aid of access sheath of guidewire between March 2011 and February 2015. All patients were operated in the standard lithotomy position. A hydrophilic guidewire was inserted with the aid of rigid ureterorenoscopy and we checked whether there were any residual ureteral stones and other pathologies. Fluoroscopy was used routinely in all cases. Stone fragments smaller than 3 mm were left off but those bigger than 3 mm were removed by grasper after stone fragmentation. Controls of the patients were assessed by plain films (KUB), urinary tract ultrasonography (US) and/or computed tomography (CT) 1 month after the operation. Success rate of the procedure was defined as the stone-free status or presence of residual fragments less than 3 mm. 152 of the patients were male and 127 were female. The median ages of the male and female patients were 47.7 (1-86) ve 45.9 (3-79) years respectively. The median stone size was 13.5 mm (8-25). Preoperatively 34 (12.1%) patients had double-J ureteral stent. 19 (6.8%) patients were operated while they were still receiving antithrombotic and antiplatelet therapy Solitary kidney was present in 24 patients while the remaining patients had kyphoscoliosis (n=3), rotation anomaly (n=6), pelvic kidney (n=2), double collecting system (n=3), and horseshoe kidney (n=6). In 264 patients access sheath was used, in 15 patients operation was performed with the help of the guidewire. Double-J stents were inserted to 14 patients because of ureteral stricture and they underwent operation after 2 weeks later. Renal stones of 219 patients among all cases were fragmented completely and the patients were discharged as stone free (SF). Our success rate (SF or presence of clinically insignificant residual [CIRF]) was 78.4%. Stone size (p=0.029), stone number (p=0.01), stone location (p=0.023) had significant influence on the stone-free rate after RIRS The mean operation and floroscopy time was 62.5 min. (40-180) and 29.8 sec (4-96), respectively. The mean hospitalization time was 26.4 hours (12-72). Double J stents were placed to 253 patients for more stone burden and ureteral edema. Any complication was not observed for all cases except perioperative developed infection for two patients. With advances in laser technology and flexible ureterorenoscopy, kidney stones can be treated with lower morbidity and high success rates.

Retrograde endoscopic lithotripsy using the innovative nanosecond electropulse method

PurposeThe purpose of this clinical study is to assess the safety and efficiency of a novel lithotripsy method for endoscopic treatment of urinary stones throughout the urinary tract via semi-rigid and flexible endoscopes. This new method is based on the transfer of nanosecond high voltage electric pulses to the stones through flexible probes of various sizes.MethodsThe study involved 879 patients aged 19-88 with renal, ureter and bladder calculi. Gender distribution: 46.3% female and 53.7% male. The prospective single-arm study took place at three centers. The goal of the clinical study was to evaluate the safety and efficacy of a novel lithotripsy method. All treatments were performed retrograde transurethrally. A variety of probes were used for stone fragmentation at different locations. Auxiliary treatments and adverse events were recorded as per protocol. Statistical analysis was conducted using SPSS software.ResultsNanosecond electropulse lithotripsy (NEPL) was found to be technically feasible for all patients with stones located in the kidney, UPJ, ureter and bladder. It requires only a few dozen pulses to disintegrate stones while causing only minor stone migration. The overall stone-free rate in the study was 96%. The average time required for executing the entire procedure was 45±28 min. The overwhelming majority of intraoperative complications occurred due to endoscopic manipulation when using a rigid ureterorenoscope and not due to lithotripsy impact.ConclusionsNEPL is a new, efficient and safe method for urinary stone disintegration that can be used throughout the urinary tract using rigid and flexible endoscopes. Intraoperative complications of the NEPL procedure do not exceed the percentage of adverse effects observed in other lithotripsy methods. The main advantages of relatively low-cost NEPL are fast stone fragmentation requiring only a few dozen pulses to disintegrate stones, tissue safety and availability of highly flexible probes for treating stones in the lower pole through a flexible ureterorenoscope.

A simple technique for ureteral orifice dilatation in rigid ureterorenoscopy for distal ureteral stones

We describe a simple technique for ureteral orificedilatation before rigid ureterorenoscopy for distalureteral stones.

A simple technique for ureteral orifice dilatation in rigid ureterorenoscopy for distal ureteral stones.

We describe a simple technique for ureteral orifice dilatation before rigid ureterorenoscopy for distal ureteral stones.

Influence of endourological devices on 3D reconstruction image quality using the Uro Dyna-CT

The urological Dyna-CT (Uro Dyna-CT) was established in clinical use for classical imaging as well as for interventional surgery. To evaluate whether irradiation artefacts may occur during interventional surgery, we analysed the impact of different instruments on 3D reconstruction in the Uro Dyna-CT. Ten different endourological instruments [ureterorenoscope (URS)-fibrescope, percutaneous nephrolithotomy (PCNL) working sheath] and accessory equipments such as ureteral catheter, guide wires and stents (DJ, MJ) were introduced in a porcine renal pelvis either retrograde via the ureter or transparenchymally. Subsequently, digital fluoroscopy, standard X-ray and an Uro Dyna-CT were performed. Three colleagues evaluated the image quality independent from each other. There were basically no limitations regarding image quality in digital fluoroscopy and standard X-ray. In the Uro Dyna-CT, only with the URS fiberscope and the PCNL working sheath, small artefacts and irradiations were detected, whereas ureteric catheter with and without wire, as well as the hydrophilic guide wire, showed no artefacts at all. The remaining material demonstrated minimal artefacts, which did not affect the image quality. The Uro Dyna-CT can be used for all interventional endourological procedures using the common armamentarium and instruments without significant limitation of image quality. There are only minor limitations according a PCNL working sheath and the rigid URS. These instruments should be removed out of the examination field before performing the computed tomography and be replaced afterwards by using a safety wire.

In young adults with a low body mass index ultrasonography is sufficient as a diagnostic tool for ureteric stones

• To identify additional factors that might improve the diagnosis of ureteric stones using ultrasonography (US) as the primary diagnostic method. • We performed a retrospective study of 228 patients who underwent rigid ureterorenoscopy (URS) for obstructive ureteric stones. • Patient age, sex, body mass index (BMI) and stone location and size were recorded. • All patients underwent US for stone detection before surgery. • If no cause of the flank pain was found by US, computer tomography (CT) was performed to confirm the absence of ureteric stones. • In 57 (25%), 15 (6.6%) and 156 (68.4%) patients a stone was localized on the proximal, mid- and distal ureter, respectively. • In 96 (42.1%), 122 (53.5%) and 10 (4.4%) patients the stone measured 0-5, 6-10 and >10 mm, respectively. • The mean (range) BMI of the patients was 24.7 (17.3-37.2) kg/m(2). • The overall stone detection rate using US was 86.4% overall, and 96.4% in adults ≤ 35 years. In 72/197 patients (36.5%) the stones found using US measured ≤ 5 mm and in 24/31 patients (77.4%) the stones found using CT measured ≤ 5 mm. • Age (P= 0.008), stone size (P < 0.001) and BMI (P= 0.013) were factors that independently affected ureteric stone diagnosis using US. • Although CT has served as the 'gold standard' for stone detection, its high costs and radiation dose, together with the high detection rate of US in the hands of experienced radiologists, lead us to conclude that US should be the first choice for primary diagnostic purposes, especially in young slim adults as no patient ≤ 35 years with a BMI ≤ 24 kg/m(2) needed unenhanced CT for ureteric stone diagnosis.

The difficult ureter: what is the incidence of pre-stenting?

Difficulty may be encountered with retrograde access for rigid and flexible ureterorenoscopy (URS) due to anatomic abnormalities, a narrow ureteric lumen, tortuous ureteric path or previous instrumentation. Ureteric dilatation using a balloon or tapered dilator can occasionally fail and will usually lead to the placement of a ureteric stent. We present our experience and incidence of pre-stenting after failed standard access and dilatation techniques, the aim being to quote a figure for the patient at the time of consent. Data were collected prospectively from a single surgeon at a regional tertiary referral stone unit. The outcomes of those patients pre-stented, for failed access, were recorded. Between December 2007 and December 2008, a total of 119 patients underwent flexible and rigid URS. Mean patient age was 49 years (range, 19-86 years). Of these, 107 cases were undertaken for urolithiasis and 12 cases for diagnosis of upper tract malignancy. 12% (13/107) of cases were for pain and non-diagnostic imaging and 8.4% (9/107) of patients were pre-stented because of failed access, without complication, and subsequently had successful interval treatment. Of the remaining successful cases of confirmed urolithiasis, 33% (28/85) and 67% (56/85) were undertaken for ureteric and renal calculi, respectively. Stone clearance rates were 83% (19/23) and 75% (3/4) for lower pole renal calculi 5-10 mm and > 10 mm in size, respectively. The overall clearance rate for lower pole calculi was 81% (22/27). The ureteric stone clearance rate was 86% (24/28) rising to 92% (24/26) in those solitary stones less than 10 mm in size. The incidence of ureteric pre-stenting in a tertiary referral unit was 8% and should be considered and indeed discussed with patients when obtaining pre-operative consent, especially for purely elective, non-urgent, upper tract cases. The alternative for these difficult, tight ureters is extensive balloon dilatation, with the risk of trauma and the potential for long-term stricture formation.

Inicio y desarrollo de la ureterorrenoscopia

In this paper we describe the history of the development of rigid ureterorenoscopy. It started in 1979 and today is a reality in most urological departments of the world. From the first ureterorenoscope with a extraordinarily large caliber and no dilation or operative systems, the current technique have developed, so that from hydraulic water pump to laser fragmentation have enabled to make ureterorenoscopy a common procedure for the resolution of urinary stones, extraction of foreign bodies in the ureter or kidney, treatment of stenosis, diagnosis of unilateral hematuria and endourological treatment of selected urothelial tumors.

298: Rigid ureterorenoscopy and anesthetic experience in a secondary care hospital

298: Rigid ureterorenoscopy and anesthetic experience in a secondary care hospital

Rigid ureterorenoscopy and anesthetic experience in a secondary care hospital

Rigid ureterorenoscopy and anesthetic experience in a secondary care hospital

Hematuria esencial unilateral: diagnóstico, tratamiento endoscópico y nuevo algoritmo diagnostico-terapéutico

To perform a long-term evaluation of 15 patients with unilateral essential hematuria, with the aim of determining the causes of bleeding and the response to endoscopic treatment. To design a diagnostic-therapeutic algorithm for patients with unilateral essential hematuria. We retrospectively review the clinical data of 15 patients with unilateral essential hematuria evaluated by rigid ureterorenoscopy (15 cases), flexible ureteropyelocalycoscopy (15 cases) and percutaneous nephroscopy (3 cases). In 4 patients electric fulguration of the pyelocalicial lesions was carried out. 14 of the 15 patients were successfully treated endoscopically. Only one patient presented recurrence of the hematuria. Mean follow-up time was 64 months (4-168 months). No patient suffered any relevant complication secondary to the endoscopic treatment. The cause of bleeding in patients with unilateral essential hematuria is determined only in a few, but endoscopic treatment is successful in a high percentage of cases. We consider that upper urinary tract endoscopy, mainly flexible ureteropyelocalycoscopy, has strongly impacted the diagnosis and treatment of essential unilateral hematuria. We present a new diagnostic-therapeutic algorithm, based on the usefulness of flexible instrumentation.

MP-05.03: Management of large (more than 1.5cm) upper third ureteric calculi with rigid URS and ESWL on daycare

Various options for the management of large upper third ureteric calculi include ureterolithotomy, PCN with antegrade URS, retroperioteoscopy and retrograde URS with ESWL. We present our series of large upper third ureteric calculi managed on day care basis with retrograde rigid ureterorenoscopy and pneumatic lithotripsy and ESWL.