Rigid Ureteroscope Research Articles

Outcome of Rirs for Renal Pelvic Stones 1.5 to 2.0 cm using Semi-Rigid Uretero-Renoscopy

Background Retrograde Intrarenal Surgery (RIRS) is among the recommended treatment modality for stones located in renal pelvis and is of less than 2 cm. Renal Stones with Hounsfield units more than 1000 have low stone free rate with ESWL. Objective To determine the outcome of retrograde intrarenal surgery using semirigid ureteroscope in fragmentation of renal pelvic stone. Methods Patients with 1.5-2.0 cm stone located in renal pelvis of more than 1000 HU who underwent retrograde intrarenal surgery as primary procedure at Sindh Institute of Urology And Transplantation were included. Stone fragmentation was achieved with holmium-yttrium aluminum garnet laser. Secondary procedure was performed if complete stone fragmentation was not achieved. Statistical analysis was performed by SPSS version 20. Result Total 82 patients with mean size of pelvic renal stones 1.7 ± 0.53 cm were included. The mean operating time was 32.1±12.9 mins. The stone clearance rate at six weeks after the first procedure was 79.3%. Minor complications including flank pain, fever and hematuria were reported. Conclusion Retrograde intrarenal surgery performed with semi rigid ureteroscope in renal pelvic stones of more than 1000 HU is a technically safe and effective procedure. Keywords: Retrograde intrarenal surgery; Pelvic stone; Flexible ureteroscopy and holmium laser.

MP67-16 LONG-TERM IMPACT OF THE ENDOCKSCOPE SYSTEM: A GLOBAL ASSESSMENT

You have accessJournal of UrologyGlobal Health/Humanitarian (MP67)1 Sep 2021MP67-16 LONG-TERM IMPACT OF THE ENDOCKSCOPE SYSTEM: A GLOBAL ASSESSMENT Andrew Afyouni, Mitchell O'Leary, Zhamshid Okhunov, Akhil Peta, Andrew Brevik, Maged Ayad, Renai Yoon, Roshan Patel, Benjamin Dolan, Jaime Landman, and Ralph Clayman Andrew AfyouniAndrew Afyouni More articles by this author , Mitchell O'LearyMitchell O'Leary More articles by this author , Zhamshid OkhunovZhamshid Okhunov More articles by this author , Akhil PetaAkhil Peta More articles by this author , Andrew BrevikAndrew Brevik More articles by this author , Maged AyadMaged Ayad More articles by this author , Renai YoonRenai Yoon More articles by this author , Roshan PatelRoshan Patel More articles by this author , Benjamin DolanBenjamin Dolan More articles by this author , Jaime LandmanJaime Landman More articles by this author , and Ralph ClaymanRalph Clayman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002028.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Traditional endoscopic equipment is expensive (i.e., >$40,000 for state-of-the-art camera, visual towers, and high-powered light source). This cost limits the practice of endoscopy by many urologists in underserved countries. The Endockscope System (ES) is a $45 smartphone alternative to conventional endoscopic equipment. It consists of a 3D printed set of smartphone-to-endoscope attachments, 8x lens, and a portable, self-contained, detachable 1,000-lumen diode (LED) light source. METHODS: Forty complimentary ES kits were distributed to urologists from 23 countries at the 2019 Congress of Société Internationale d'Urologie (8-month group) and at the 2016 World Congress of Endourology (4-year group) (Figures 1 and 2). Each participant was trained on how to use the ES. In 2020, questionnaires were sent to all 40 urologists regarding the use of the ES in their practice. RESULTS: All 18 urologists (100%) in the 8-month group and 10/22 urologist (45%) in the 4-year group completed the questionnaire. ES was utilized by 83% (15/18) of urologists in the 8-month group and by 80% (8/10) of urologists in the 4-year group. Among the urologists who used the ES, 67% of the 8-month group and 57% of the 4-year group noted that the ES performed equal or better than their traditional endoscopic equipment. Of note, the greatest impact was among urologists from the most impoverished countries; in the 8 month and 4-year groups, 100% of urologists from these countries reported using the ES system. Lastly, although specifically developed for use with a fiberoptic cystoscope, participants also used the ES for rigid cystoscopy, rigid and flexible ureteroscopy, and laparoscopy. CONCLUSIONS: The Endockscope System is an inexpensive and practical advance that empowers urologists in underserved countries to successfully expand their endoscopic services. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e515-e516 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Andrew Afyouni More articles by this author Mitchell O'Leary More articles by this author Zhamshid Okhunov More articles by this author Akhil Peta More articles by this author Andrew Brevik More articles by this author Maged Ayad More articles by this author Renai Yoon More articles by this author Roshan Patel More articles by this author Benjamin Dolan More articles by this author Jaime Landman More articles by this author Ralph Clayman More articles by this author Expand All Advertisement Loading ...

OUR RESULTS FOR RIGID URETEROSCOPY AND LASER LITHOTRIPSY IN PEDIATRIC AGE GROUP

Objective: Urolithiasis is an important disease that can lead to permanent kidney dysfunction and severe clinical symptoms in pediatric patients. We aimed to present our findings of rigid ureteroscopy combined with Holmium YAG laser lithotripsy.Material and Methods: We retrospectively reviewed the ultrasonography, and medical records of pediatric patients with urolithiasis who were operated in Sutcu Imam University Department of Pediatric Surgery, Kahramanmaraş between April 2018 and December 2019.Results: Sixty-one pediatric patients (M/F=38/23) with urolithiasis were enrolled in this study. The mean age was 6.7±4.9 years (range 3 month-17 years). Thirteen (34.2%) male patients need an urgent operation (rigid ureteroscopy combined with Holmium YAG laser lithotripsy) while the corresponding number was 4 (17.4%) in female patients. The difference between two sexes was statistically non-significant (p=0.156). Thirty-two male patients (84.2%) and 12 (52.2%) females patients had a successful operation (rigid ureteroscopy combined with Holmium YAG laser lithotripsy). The difference between the two sexes was statistically significant (p=0.019). The ratio of female patients with right-sided stone was significantly greater than the corresponding rates of male patients (p=<0.001). There was no difference between infants (<3 years of age) and toddlers (>3 years of age) with respect to gender, side of stone, procedural success, and need for urgent surgery (p>0.05). Regression analysis showed that female gender was a risk factor for a failed attempt (OR=-0.313, 95% CI: 0.052 – 0.528; p=0.0018).Conclusion: Safe and effective stone treatment can be performed considering that more than one operation can be performed in infants and children with mini ureteroscopy and holmium laser. However, while evaluating this treatment option in female patients, alternative treatment methods such as flexible or percutaneous nephrolithotomy may be preferred.

Combination of transurethral resection of the prostate and flexible and rigid ureteroscopy for benign prostatic hyperplasia and ureteral calculus.

BackgroundCombination of transurethral resection of the prostate (TURP) and flexible and rigid ureteroscopy (URS/RIRS) is a successful approach for patients with benign prostatic hyperplasia (BPH) and ureteral calculus (UC), and the sequence is URS/RIRS followed by TURP. This research aims to compare TURP followed by URS/RIRS with URS/RIRS followed by TURP in terms of clinical efficiency and safety.MethodsFrom June 2009 to June 2021, 173 patients with BPH and upper urinary tract stones were recruited through the Harrison International Peace Hospital and were divided into intervention (TURP followed by URS/RIRS) and control groups (URS/RIRS followed by TURP). We collected demographic data, primary outcomes including urinary function, and secondary outcomes including surgical parameters and complications. SPSS 21.0 was used to analyze data.ResultsWhen comparing the surgical parameters, the intervention group showed better results than the control group regarding surgery time and length of hospitalization. When comparing urinary function and complications, there were no differences between the intervention and control groups.ConclusionsAlthough the intervention of TURP followed by URS/RIRS had similar clinical effects compared with URS/RIRS followed by TURP in the control group; the intervention saves surgery time, and decreases the length of stay and medical costs. It may therefore be a good choice for patients with BPH and UC.

Rigid ureteroscopy and holmium laser combined with high bile duct incision to treat complex hepatic calculus

Rigid ureteroscopy and holmium laser combined with high bile duct incision to treat complex hepatic calculus

Implementation of Supine Percutaneous Nephroscopic Surgery to Remove an Upward Migration of Ureteral Catheter in Infancy: A Case Report

BackgroundDouble-J stents are favorably utilized after pyeloplasty. In rare situations, the stent may migrate upward. Here, we demonstrate the implementation and result of a supine percutaneous nephroscopic surgery (PNS) to retrieve a proximately migrated ureteral catheter in a pediatric patient.Patient and MethodsA 1-year-old boy was suffering from an upward migration of a ureteric catheter into the right ureter after an open Anderson-Hynes pyeloplasty. The child was placed in the Galdakao-modified supine Valdivia (GMSV) position and a PNS procedure was performed. The calyceal access was carefully punctured by ultrasonographic guidance. The nephrostomy tract was dilated with a metal dilator using a one-step technique. An exploratory nephroscopy of the renal pelvis was conducted with a 12Fr miniature nephroscope and the migrated ureteral catheter was removed. A hybrid guidewire was retrogradely inserted into the ureteric orifice using a rigid ureteroscope. An antegrade double J stent was inserted in the proper position and a percutaneous nephrostomy was performed.Results and ConclusionThis is the first report of a successfully removed upwardly migrated ureteral catheter with concurrent insertion of an antegrade double J stent by supine PNS in the GMSV position in an infant. The patient recovered well after surgery with no adverse event, demonstrating that this operation can be carried out safely on pediatric patients.

Rigid and flexible ureteroscopy (URS/RIRS) management of paediatric urolithiasis in a not endemic country.

In the last years due to miniaturization of endoscopic instruments and percutaneous surgery, endourology has become very popular in paediatric urinary stone managment. We reported our single-centre experience in retrograde endoscopic procedures in children. Results and complications of URS/RIRS are discussed. We retrospectively reviewed our experience in patients ≤ 16 years old affected by urinary stones who underwent URS/RIRS procedures performed by two surgeons with expertise in endourology. A total of 30 renal Units (RUs) underwent endoscopic procedures (URS, RIRS or both). Surgical complications according to the ClavienDindo's classification and stone-free rate were evaluated at 3 months follow-up. Success of URS was defined as stone-free status after single procedure while RIRS success rate was considered as presence of residual stone fragments smaller than 4 mm at first procedure. The mean age of our patients was 8 years, range 2- 16 years. A total of 30 renal units (RUs) underwent 40 endourological procedures (23 URS and 17 RIRS; 10 children underwent both procedures at the same time). 17/30 (56.6%) RUs were pre-stented before surgery. The stone-free status was achieved in 23/30 renal units treated, with a 76.6% success rate. The remaining 7 patients had residual stones greater than 4 mm and underwent further treatments. After a second surgery the stone-free rate turned out to be 93.3% (28/30 renal units). Rigid and flexible ureteroscopy (URS/RIRS) is a reliable technique for treatment of < 2 cm urinary stones in paediatric age group. It shows low rate of major complications and promising results in terms of stone-free rate.

COMPARATIVE EFFICACY OF EXTRACORPOREAL SHOCKWAVE LITHOTRIPSY AND RETROGRADE INTRARENAL SURGERY IN THE TREATMENT OF CALCIUM OXALATE NEPHROLITHIASIS

Objective To evaluate the results of extracorporeal shockwave lithotripsy (ESWL) versus retrograde intrarenal surgery (RIRS) for the treatment of calcium oxalate nephrolithiasis, as well as the damaging effects on renal function, taking into account the dynamics of blood cystatin C and urine beta2-microglobulin.Material and Methods Of 94 patients with calcium oxalate nephrolithiasis aged 23–78 included in the study, 42 patients were classified as having undergone ESWL (group I) and 52 patients as having undergone RIRS (group II). Group II patients were then stratified into subset 2A (n = 32) as having undergone RIRS through rigid ureteroscope and subset 2B (n = 20) as having undergone RIRS through flexible ureteroscope. We performed plain urography and nephrosonography at 24–48 hours postoperatively and unenhanced computed tomography 4–6 weeks after surgery. We measured concentrations of serum cystatin C and urinary beta2-microglobulin as a marker for kidney damage. In group I, samples of peripheral blood andurine were taken before and after the first, third sessions and 30 days after the last ESWL session. In group II, samples were analyzed before surgery, on the first and 30th postoperative days.Results The average size of calculi in the group with RIRS was 16.91 ± 2.79 mm, in the group with ESWL 12.31 ± 2.27 mm. The need for reoperation after RIRS was 19.2%, which was lower than after ESWL. Stone-free effect (no stones, or residual stones less than 3 mm) was observed in 95% of cases in patients with RIRS, and in 78% with ESWL. Group I patients demonstrated an increase in the blood leukocytes total number more often than subsets 2A (rigid RIRS) and 2B (flexible RIRS) patients. Leukocyturia was also a more common complication in group I. In the RIRS group, there was no statistically significant change in the level of blood cystatin C and urine beta2-microglobulin, on the contrary, a moderate increase in the endogenous marker of cystatin C was noted after one ESWL session. The increase in urine beta2-microglobulin levels in patients after the first and third ESWL sessions was significantly higher than after RIRS.Conclusion Flexible RIRS may be suggested as the preferred procedure for patients requiring additional protection of renal function in the treatment of renal stones less than 20 mm. ESWL of stones less than 20 mm can be used as an alternative treatment, since it is characterized by a rather long period of stone eradication from the urinary tract, a high frequency of residual calculi after the procedure, and also has a damaging effect on the renal tissue.

Study of efficacy and safety of surgical treatment of mid and lower ureteric calculi with rigid ureteroscope and pneumatic lithotriptor in adult patient

Study of efficacy and safety of surgical treatment of mid and lower ureteric calculi with rigid ureteroscope and pneumatic lithotriptor in adult patient

Intraluminal Lithotripsy with Rigid Ureteroscopy for Proximal and Distal Ureteral Stones: Results of a Single Center in Cameroon

Intraluminal Lithotripsy with Rigid Ureteroscopy for Proximal and Distal Ureteral Stones: Results of a Single Center in Cameroon

In situ Management of Large Upper Ureteric Calculus by Mini-Percutaneous Nephrolithotomy in the Era of Retrograde Intrarenal Surgery.

PurposeThe aim of the study is to demonstrate the ease and success of in situ management of large upper ureteric stones with mini percutaneous nephrolithotomy (PCNL).MethodsThis was a prospective observational study conducted in the Department of Urology between January 2018 and June 2019. All patients underwent standard prone mini PCNL with 15Fr amplatz with 80 cases of fluoroscopic and 12 cases of ultrasound guided access. In three cases of tortuous ureters, wire was passed via retrograde catheter and retrieved via amplatz to straighten the ureter. Calculi fragmented with laser.ResultsA total of 77 patients were included in this study, 62 unilateral and 15 bilateral cases (92 renal units). The mean age was 45.4±13.7 years (range 17–71), male to female ratio was 61:16, the disease laterality (left: right) was 28:34. The mean stone size was 17.6±1.4 mm. Mean operative time was 22.4±1.5 min. 88% patients were discharged as day care. Complication rate was 6.5%, three patients had transient fever and two patients had distal migration of small fragments and they were extracted at the time of DJ stent removal by rigid ureteroscopy (100%).ConclusionWe conclude that it is easy and effective to deal with large upper ureteric calculus when it is in a fixed position. In situ management of large upper ureteric calculus by mini-PCNL can be done safely and effectively as it is a fast procedure, prevents unnecessary manoeuvres, less complication rates and has good stone clearance rates.

Endoscopic lithotripsy with a SuperPulsed thulium-fiber laser for ureteral stones: A single-center experience.

To estimate the efficacy and safety of SuperPulsed thulium-fiber laser ureteral lithotripsy and to identify optimal laser settings. Patients with solitary stones were prospectively included. Lithotripsy was performed with a SuperPulsed thulium-fiber laser (NTO IRE-Polus, Fryazino, Russia) using a rigid ureteroscope 7.5 Ch (Richard Wolf, Knittlingen, Germany). We analyzed the efficacy of lithotripsy by measuring total energy required for stone disintegration, "laser-on" time, ablation speed, ablation efficacy, and energy consumption. Stone retropulsion and visibility were assessed using a three-point Likert scale. Complications were assessed using the Clavien-Dindo classification system. A total of 149 patients were included. The mean stone density was 985±360 Hounsfield units, the median (interquartile range) stone volume was 179(94-357) mm3 . The median (interquartile range) total energy was 1 (0.4-2)kJ, and laser-on time 1.2 (0.5-2.7)min. The median (interquartile range) stone ablation speed was 140(80-279) mm3 /min, energy for ablation of 1mm3 was 5.6 (3-9.9)J/mm3 and energy consumption was 0.9 (0.6-1)J/min. A correlation was found between retropulsion and the energy used (r=0.5, P<0.001). Multivariable analysis showed energy to be a predictor of increased retropulsion (odds ratio 65.7, 95% confidence interval 1.6-2774.1; P=0.028). No predictors for worse visibility were identified. The SuperPulsed thulium-fiber laser provides effective and safe lithotripsy during ureteroscopy regardless of stone density. Fiber diameter and laser frequency do not influence visibility or safety. Optimal laser settings are 0.5J×30Hz for fragmentation and 0.15J×100Hz for dusting.

Outcome of Lower Ureteric Stone Fragmentation by Laser in Comparison with Pneumatic Lithotripsy

Background: Several different modalities are available for ureteral stone fragmentation. From them pneumatic and holmium: yttrium-aluminum-garnet (Ho: YAG) lithotripsy have supportive outcomes. Aims: To see the outcome of lower ureteric stone fragmentation by laser in comparison with pneumatic lithotripsy. Methods: The prospective clinical study was conducted during the period from July 2012 to June 2014 in Dhaka Medical College Hospital. From the patient admitted in Dhaka medical college hospital a total of 60 patient were selected using purposive sampling methods. Selected patients were numbered chronologically and odd number group as group A (laser lithotripsy) and even number group B (pneumatic lithtripsy). Cystoscopy followed by ureterescopy with the help of guide wire was done and stone fragmentation done by either laser lithotripsy (done in general operation theatre in Dhaka Medical College Hospital) or pneumatic lithotripsy (done in Urology operation theatre in Dhaka Medical College Hospital). Collected data were processed and analyzed using computer software SPSS (statistical package for social science), version-18. Un-pair t-test, chisquare test and Fishers Exact probability test were used to analyze the data. The findings of the study showed age and sex are almost identically distributed in both groups. Results: The mean age of group A and group- B were 35.63±11.66 and 38.90±11.21 years respectively. A male predominance was observed in both groups with 70% male in group- A and 53.3% in group-B. Stone size was also observed identically in both groups. 43% of stone are larger than 10mm in group- A and 47% stone are larger than 10mm. None of other baseline variable found very between groups. Immediate stone clearance was much higher in group-A (96.7%) then that in group- B (80%). Although both the groups demonstrated 100% clearance after 1 month. Immediate complications were higher in group B then those of group- A. Ureteral perforation in group B was found 6.7% as opposed to none in group-A. Fever in group A (6.7%) was observed to be more than 3 times higher than in group- B (23.3%). Comparison of complications after 1 and 3 months shows some differences (higher in group-B) but that is not significant. Ureteral stricture developed in 3 patients in group- B compared to nil in group- A. More than 90% of patients of group-A were released from the hospital within 3 days after operation, in contrast about 40% in group-B left the hospital within 3 days. Conclusion: So, laser lithotripsy is better option for the management of lower ureteric stone by using semi rigid ureteroscope, in term of stone migration, rate of stone fragmentation and clearance, operation time, hospital stay and complication. Bangladesh Journal of Urology, Vol. 23, No. 2, July 2020 p.169-175

Letter to the Editor re: Successful treatment of a rare Cowper’s bulbourethral gland syringocele in an adult with endoscopic laser deroofing using a rigid ureteroscope, Patel and Rai, J Clin Urol, https://doi.org/10.1177/2051415820949390

Letter to the Editor re: Successful treatment of a rare Cowper’s bulbourethral gland syringocele in an adult with endoscopic laser deroofing using a rigid ureteroscope, Patel and Rai, <i>J Clin Urol</i>, https://doi.org/10.1177/2051415820949390

Ureteroscopy in the day case setting: it’s worth it! Retrospective single surgeon outcomes analysis during service relocation (inpatient to daycase) in a DGH

Objective: Due to advances in surgical techniques and anaesthesia, day surgery is now becoming the standard care pathway for many complex procedures traditionally treated through inpatient pathways. Our aim was to study outcomes for patients undergoing rigid and flexible ureteroscopy before and after moving this service from a district general hospital to a day surgery unit. Methods: This was a retrospective observational study of 136 consecutive patients undergoing elective ureteroscopy for stone treatment. Half of the patients ( n=68, inpatient group) underwent treatment according to the standard inpatient pathway, while the other half underwent treatment following relocation of this service to a day case unit ( n=68, day case group). Outcomes were length of stay, readmission rate and complications. Results: In the inpatient group, 12 patients (17.6%) were discharged home the day of surgery (day 0), 42 patients (61.8%) stayed in hospital for one night. In the day case group, 58 patients (85.3%) were discharged on day 0, nine patients (13.2%) stayed for one night. Length of stay in the day case group was significantly shorter ( P&lt;0.001). Rates of postoperative complications and readmissions were not significantly different. Conclusion: Day case ureteroscopy for stone treatment is feasible and safe. It is associated with a significantly reduced length of stay without an increase in postoperative complications or readmission.

Comparative Analysis of Semi Rigid Ureterolithotripsy and Extracorporeal Shock Wave Lithotripsy for the Treatment of Upper Ureteric Calculi

Objectives: To find out the better treatment option between semi rigid ureteroscopy with ICPL and ESWL for upper ureteric calculi. To compare stone free rate, complications and re treatment between ureterolithotripsy and ESWL in upper ureteric calculi. Materials and Method: This prospective comparative study was conducted in the department of urology BSMMU and Kidney and urology hospital, Dhaka from June 2009 to May 2010. Fifty patients were enrolled and 25 on each group as ESWL and ICPL Inclusion criteria was adult patients with single radiopaque stone of 06-15 mm, and no obstruction distal to stone. We exclude Stone size &gt; 1.5cm, PUJ stone, patients with DJ stent and nephrostomies, infection, pregnancy, hemostatic, disorders, and morbid obesity. Identified postoperative urological complications pain, haematuria, fever, stone migration, obstruction, infections, and postoperative hospital stays recorded accordingly. X- ray KUB and in some cases ultrasound of kidney ureter and bladder with prostate with PVR were done. Those with residual calculi sized less than 2 mm were considered stone free. Those patients whom stone not cleared or stone migrated they again sent for ESWL or ureterolithotripsy. Stone free patient of ureterolithotripsy sent for removal of Double J stent under local anesthesia at 4 weeks. Results: Three months postoperatively, 21 out of 25 Patients (85%) in the ureterolithotripsy group were stone free. In ureterolithotripsy group, all failures were due to upward calculus migration. After calculus migration, this was mandated double- J stenting and send for ESWL. These patients were referred for ESWL, all of whom were stone free after this procedure. DJ stent removed under local anesthesia. 22 out of 25 Patients (88%) in the ESWL group were stone free and 10 patients need two sessions. Re-ESWL had done after 3 weeks. All failures in ESWL group were due to hard in constancy and small stone size. Failed cases were referred for ureterolithotripsy and DJ stenting, all of whom were stone free after this procedure. Using statistical data by chi square test and analytical test level of significance as set at 0.05 and p&lt; 0.05 was consider significant. Conclusion: Upper ureteral calculi up to 1.5 cm can be safely and effectively managed by using semi rigid ureteroscopy and pneumatic lithotripsy. However, the ESWL approach has still its role in treating upper ureteric calculi. Finally, postoperative home rest in the ESWL group was more due to the repeated treatment. Bangladesh Journal of Urology, Vol. 20, No. 2, July 2017 p.54-60

Successful treatment of a rare Cowper’s bulbourethral gland syringocele in an adult with endoscopic laser deroofing using a rigid ureteroscope

Cystic dilatation of Cowper’s glands, also known as a syringocele, is a well-known condition of childhood, with increased recognition as a rare presentation of urinary tract symptoms in adults. Surgical techniques for its treatment vary, with several described in the literature. However, consensus on optimal treatment is unclear. We present a rare case of a Cowper’s gland syringocele successfully treated with laser deroofing with a previously undescribed method using a rigid ureteroscope, and we also review techniques in the literature. Level of evidence: Level 5.

Comparison of Pain Scores During Retrieval of Ureteral Stents Using Rigid Cystoscope Versus Rigid Ureteroscope in an Office Setting: A Prospective Study

Comparison of Pain Scores During Retrieval of Ureteral Stents Using Rigid Cystoscope Versus Rigid Ureteroscope in an Office Setting: A Prospective Study

Management of Migrated or Residual Stones Following Laparoscopic Pyelolithotomy and Ureterolithotomy in Abnormal Kidneys: A Prospective and Randomized Comparison.

Objective: To conduct a prospective and randomized controlled trial comparing contemporaneous transabdominal rigid ureteroscopy (TRU) with postoperative extracorporeal shockwave lithotripsy (SWL) in the management of migrated or residual stones during laparoscopic pyelolithotomy and ureterolithotomy in kidneys with either intrinsic or extrinsic abnormalities. Materials and Methods: From February 2016 to December 2019, 45 patients with migrated or residual stones following laparoscopic pyelolithotomy and ureterolithotomy were accrued and randomly divided into two groups. These patients all had either urinary tract obstruction distal to the stone or concomitant ipsilateral intrinsic or extrinsic pathology requiring laparoscopic intervention. Twenty-three patients underwent contemporaneous TRU, and 22 patients underwent postoperative SWL. Patients' demographics, perioperative variables, and follow-up data were collected. The primary outcome was the final stone-free rate (SFR) at the 2-month follow-up. Secondary outcomes included blood loss, operative time, change in serum creatinine, complications per Clavien-Dindo grading system, renal colic occurrence rate (RCOR), and postoperative hospitalization. Results: There was no significant difference in gender, age, body mass index, location, or stone burden between the two groups (p > 0.05). At the 2-month follow-ups, the SFR was higher in the TRU than the SWL group (p = 0.002), and the RCOR was lower in the TRU than the SWL group (p = 0.005). Postoperative hospitalization was also shorter for the TRU group. No significant difference was noted in the operative time, blood loss, change in serum creatinine, or perioperative complications (p > 0.05). Conclusion: Contemporaneous TRU is more effective and equally safe compared to postoperative SWL in the management of residual or migrated stones during laparoscopic pyelolithotomy and ureterolithotomy in kidneys with either intrinsic or extrinsic abnormalities.

Negative-Pressure Ureteroscopic Holmium-YAG Laser Lithotripsy for Ureteral Stones

Objectives: The aim of this study was to describe a novel negative-pressure laser lithotripsy device to overcome the deficiencies of the conventional procedure. Patients and Methods: Between August 2018 and March 2019, 78 patients with a single ureteral stone underwent retrograde ureteroscopy with a Wolf 8F/9.8F rigid ureteroscope and a 200-μm holmium-YAG laser. The mean stone size was 11.8 mm, measured for the maximum length. The negative-pressure laser lithotripsy device consists of an F5 ureter catheter and a T joint. The closed tip of an F5 ureter catheter is cut off, and it is then inserted within one opening of the T joint. The 200-μm laser fiber is introduced into the ureteral catheter through the other opening of the T joint. The third opening of the T joint is connected to the negative-pressure pipe. The valve end of the Foley catheter is used for sealing the cap. Continuous suction and active irrigation throughout the lithotripsy could maintain adequate visibility. Results: All ureteroscopic procedures were successful. The negative-pressure device showed good stone retention capabilities, with no observed stone migration. We did not observe any major complications. The stone-free rate was 97.44% (76/78), demonstrated on plain radiography of the kidney-ureter-bladder on the first postoperative day. The stone-free rate after 1 month was 100%. Conclusions: The negative-pressure ureteroscopic lithotripsy is easy and safe management for the ureteral stones. It might reduce the risk of stone fragment retropulsion, improve surgical vision, shorten the operative time, and decrease the renal pelvic pressure.