Semirigid Ureteroscope Research Articles

Comparative Study Between Holmium Laser Versus Pneumatic Lithotripsy for the Treatment of Lower Ureteric Calculi

Objective: To compare the efficacy of Holmium laser and pneumatic lithotripsy for the treatment of lower ureteric calculi. Methods: The study included total of 218 patients divided into two groups of laser lithotripsy (LL) and pneumatic lithotripsy (PL). Study was conducted between October 2014 and September 2018. Inclusion criteria were patients with a lower ureteric single stone of size 0.8 to 1 cm and negative urine culture. An x-ray KUB and USG of KUB was mandatory. IVU also done when required. Procedures were done under spinal anesthesia. A 9.5 Fr. semi rigid ureteroscope was used for ureteroscopy in all cases. Holmium laser with 550 ìm fiber was employed in laser group and frequency was set between 20-30 Hz at energy of 0.5 to 1 Joule. Storz lithotripter was used in PL group. Postoperatively patients underwent radiography at 4th week of follow up to assess stone clearance. Results: The mean patient age in LL and PL group was 38.8±9.1(15-58) and 41.2±10.3(16-62) years, male to female ratio 1.75:1and 1.57:1 and stone size 8.94±0.98 and 8.94±0.91 mm respectively. Stone free rate at 4 weeks was 96.36 % in LL group as compared to 88.83 % in PL group(p=0.033). Stone migration up in pelvicalyceal system occurred in one (0.90%) patients of LL group while in five (4.63%) patients of PL group (p= 0.0929). DJ Stent was placed in 43(39.09%) patients in LL group whereas 64(59.25%) patients required it in PL group (p=0.0030). Complication rate was 18.18% (20) in LL group whereas it was 38.88% (42) in PL group (p=0.0038) Conclusion: Holmium laser lithotripsy is a superior technology compared to pneumatic lithotripsy in terms of rate of stone clearance and complications for lower ureteric stones. Bangladesh J. Urol. 2021; 24(1): 14-19

A dual neglected double J stent: a rare case report

BackgroundA neglected ureteric stent with encrustations is an uneasy problem for the patient and treating urologist. We report a rare case of single urinary system retained dual ureteric stents that was complicated by extensive encrustation.Case presentationA 36-year male patient referred from prison hospital with intermittent left loin pain and burning micturition. Pelvi-abdominal ultrasonography, plain X-ray and non-contrast computed tomography revealed neglected dual double J stents on the left side with large renal and urinary bladder stone burden and heavy ureteral encrustation. Staged endoscopic management was planned. At first session, both bladder and renal calculus was fragmented and removed by mechanical cystolithotripsy and percutaneous nephrolithotomy, respectively. After one week; the lower, middle and upper ureteral encrustations were cleared carefully using Holmium YAG Laser lithotripsy through 7 Fr. distal tip semi-rigid ureteroscopy. Both neglected double J were removed successfully and the patient was asymptomatic.ConclusionsNeglected ureteral stents are complicated by massive encrustation and need combined staged endoscopic procedures. Patient and health service provider should be learned for importance of stent removal.

Predicting narrow ureters before ureteroscopic lithotripsy with a neural network: a retrospective bicenter study.

In some patients, the passage of semi-rigid ureteroscopes up the ureter is impossible due to narrow ureteral lumen. We established a neural network to predict the inability of the ureter to accommodate the semi-rigid ureteroscope and the need for active or passive dilatation using non-contrast computed tomography (CT) images. Data were collected retrospectively from two centers of 1989 eligible patients who underwent ureteroscopic lithotripsy with ureteral stones. Patients were categorized into two groups: control and narrow ureter. The network was designed and trained for predicting a narrow ureter during initial ureteroscopic lithotripsy, which integrated multi-scale features of the ureter. The predictive efficacy of neural networks DenseNet3D, ResNet3D, ResNet3D MC, and TimeSformer was compared. Furthermore, a previous ureteroscopy or a history of double-J stent placement, ureteral wall thickness and Hounsfield unit (HU) density of the ureter under the stone were compared. Model performance was assessed based on the accuracy, area under the receiver operating characteristic curve (AUC ROC), etc. The DenseNet3D-based network achieved an AUC ROC score of 0.884 and an accuracy of 85.29%, followed by the ResNet3D-based network, the ResNet3D MC-based network, and the TimeSformer-based network. The DenseNet3D-based network significantly outperformed other candidate predictors. Furthermore, the networks were validated in an external test set. Decision curve analysis showed the clinical utility of the neural network. The neural network provides an individualized preoperative prediction of narrow ureter based on non-contrast CT images, which could be employed as part of a surgical decision-making support system.

Intravesical aminophylline instillation as an alternative for balloon dilatation prior to semi-rigid ureteroscopic management of distal ureteral stones

PurposeIn a randomized controlled trial, we evaluated the effect of intravesical aminophylline instillation (IVAI) on intraureteral pressure of lower ureter and its use as an alternative to balloon dilatation after failure of advancing semi-rigid ureteroscope through the ureteric orifice without endodilatation.MethodsOur study included 83 patients with juxta-vesical distal ureteral calculi requiring endodilatation after unsuccessfully introducing the semi-rigid ureteroscope through the ureteric orifice. Patients were randomized into two groups: group A (study group) included 41 patients, where IVAI was used to dilate the ureter and facilitate ureteroscopy (the intraureteral pressure was measured using a pressure transducer connected to an invasive pressure monitor before and 5 min after IVAI), whereas group B (control group) included 42 patients, where balloon dilatation was used prior to ureteroscopy. Perioperative surgical outcomes of ureteroscopy were evaluated in both groups.ResultsA statistically significant decrease in mean intraureteral pressure of intravesical ureter was found after IVAI from 12.34 mmHg ± 1.94 before injection to 8.46 mmHg ± 1.94 after injection (P < 0.001). Ureteral injuries, postoperative pain and hematuria were statistically significantly less among the study group compared to the control group (P < 0.05). We did not find statistically significant differences in operative time, need for DJ ureteral stenting or stone-free rate between both groups and no perioperative side effects were associated with IVAI.ConclusionIn ureteroscopic management of distal ureteral stones, intravesical aminophylline instillation is safe, inexpensive and effective in reducing intraureteral pressure and achieves comparable outcomes to balloon dilatation with less ureteral injuries, postoperative pain and hematuria.

Ureteroscopy under General Anesthesia Versus Spinal Anesthesia: Stone Clearance and Morbidity

Objectives: To compare stone clearance by ureteroscopy carried out under General anesthesia versus Spinal anesthesia for the treatment of ureteric Stone. Place and duration: For two years from Feb 2019 to Feb 2022, in the Urology department of Islam Medical College Sialkot. Methods: Total 42 patients were selected for study. Males were 26, and Females were 16. Age ranges from 20 years to 56 years. All subjects endured ureteroscopic method for ureteric Stone with semi rigid ureteroscope 8/8.4 fr. The two groups of 21 patients equally were formed. Group A were given General Anesthesia and Group B receiving Spinal Anesthesia. The hospital stays, operative Time, clearance of stones, post-operative and intra operative complications were noted. Results: There were 21 patients in both groups, 16 (76.2%) men in group A (general anesthesia), and 18 (85.7%) men in group B (spinal anesthesia). There were 5 (23.8%) women in A group and 3 (14.3%) women in B group. The patients mean age was 34.1 and 37.2 years in groups A and B, correspondingly. The mean size of stone was 0.80 cm in A group and in group B, it was 1.21 cm (p = 0.001). The surgery duration in group A was 40.9 ± 1.30 mints and for group B; 31.4 ± 2.09 minutes (p = 0.031). The mean stay in hospital was 20.8 and 17.4 hours in groups A (range 8 to 48 hours) and B group (range 6 to 24 hours, p = 0.074), correspondingly (p = 0.073). The mean visual-analog pain score was 3.2 in group A and for group B, VAS was 1.7. Conclusion: In this series, ureteroscopy under spinal anesthesia shortened the duration of surgery and hospital stay and did not carry the risk of additional serious complications. Keywords: Ureteroscopy (URS), Ureteric stone, General anesthesia and spinal anesthesia.

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

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

The lumbosacral angle is a significant predictor for using a semi-rigid ureteroscopic approach in middle ureteral stones.

BackgroundUreteroscopy for middle ureteral stones is often difficult from an anatomical view. This study aimed to evaluate the pelvic anatomy in three dimensions and investigate the relationship between the pelvic anatomy and potential semi-rigid ureteroscopic approach for treating middle ureteral stones.MethodsFrom a total of 967 patients who underwent ureteroscopy from December 2017 to January 2021, 124 patients who had middle ureteral stones were included in this retrospective cohort study. The pelvic transverse diameter, pelvic vertical diameter, pelvic depth, and lumbosacral angle were measured through preoperative non-contrast computed tomography to define the shape of the pelvic cavity. The relationship between the reachability of the middle ureteral stone using a semi-rigid ureteroscope and the aforementioned anatomical factors, as well as treatment outcomes, was examined retrospectively.ResultsThe lumbosacral angle and female sex were significant predictors of the possibility of a semi-rigid ureteroscopic approach to middle ureteral stones [odds ratio =1.08; 95% confidence interval (CI): 1.03–1.14; P=0.003, and odds ratio =3.23; 95% CI: 1.12–9.32; P=0.03, respectively]. The cutoff value of the lumbosacral angle was 149.9°, with a sensitivity of 55.1% and a specificity of 72.7%. The time to reach the stone was longer in the lumbosacral angle <150° group than in the lumbosacral angle ≥150° group (P=0.049).ConclusionsIn this study, gradual lumbosacral angle and female sex are positive predictors of the reachability of the middle ureteral stone with a semi-rigid ureteroscope.

The non-biological simulator with the ability to regulate the position of the kidney and bone landmarks: use for training puncture access in percutaneous nephrolithotripsy

Introduction. The non-biological simulators presented in the literature are far from the real human anatomy and are primarily aimed at developing the skill of the pyelocalyceal system (PCS) puncture without the possibility of imitating various intraoperative scenarios.Purpose of the study. To describe the manufacturing and initial testing of the ultrasound-guided PCS puncture simulator with arbitrary placement of bone landmarks and a kidney model, along with the use of a retrograde view during PCS puncture.Materials and methods. This study included training for 5 resident and 2 urologists. Each participant performed the puncture 5 times using an 18-gauge ultrasound-guided needle. A comparison was made between the number of attempts to form access, the duration of the puncture and its correctness (puncture into the small calyx through the papilla), as well as the correctness of determining the target calyx. The trajectory of the needle was retrogradely assessed using a semi-rigid ureteroscope, and the anatomical identification of the selected calyx was assessed using our mobile application.Results. The total number of attempts was 49 and 14 among residents and urologists, respectively. The average duration of the puncture step was 25.2 and 12.0 seconds. In 9/25 cases, residents were able to correctly analyze visual ultrasound information to determine the target calyx. When a contrast agent was injected into the PCS after 63 punctures, no contrast leakage was found.Conclusion. The proposed PCS puncture simulator allows to develop to develop all the necessary skills for cost-effective training of young urologists in the technique of percutaneous access.

Predictive Value of Preoperative High-Sensitive C-reactive Protein (hs-CRP)/Albumin Ratio in Systemic Inflammatory Response Syndrome (SIRS) After Semi-rigid Ureteroscopy.

Objective: To determine the predictive value of high-sensitive C-reactive protein (hs-CRP)/albumin ratio in systemic inflammatory response syndrome (SIRS) after semi-rigid ureteroscopy (URS).Material and Methods: Between April 2021 and October 2021, 148 patients who had ureteral stone treatment with a ureteroscope in our hospital were included. Preoperative hs-CRP/albumin ratio was obtained by dividing the hs-CRP level by the albumin level. High-sensitivity modified Glasgow prognostic score (hs-mGPS) was obtained according to hs-CRP and albumin values. Two groups were identified as post-URS SIRS positive and negative. Inflammation biomarkers were evaluated in groups.Results: There was a statistically significant difference between groups in terms of preoperative hs-CRP, albumin, and hs-CRP/albumin ratio (p < 0.001, p = 0.003, and p < 0.001, respectively). The optimal cutoff value for the hs-CRP/albumin ratio was 0.04651. While the risk of developing SIRS after surgery was 72.73% in patients with a hs-CRP/albumin ratio higher than 0.04651, the chance of not developing SIRS was 87.5% in patients below this value. The probability of developing SIRS was found to be significantly different in hs-mGPS (p < 0.001).Conclusion: Our study indicated that hs-CRP/albumin ratio can predict post-URS SIRS. Larger-scale, multicentric prospective studies should certainly be done to validate the predictive value of hs-CRP/albumin ratio in post-URS SIRS.

Ultra-Mini-Percutaneous Nephrolithotomy in Flank-Free Modified Supine Position vs Prone Position in Treatment of Pediatric Renal Pelvic and Lower Caliceal Stones.

Objectives: To report the safety and efficacy of ultra-mini-percutaneous nephrolithotomy (UMPCNL) in flank-free modified supine (FFMS) and prone positions in management of pediatric renal calculi. Patients and Methods: This prospective randomized study included 55 pediatric patients with symptomatic renal stones and suitable for UMPCNL. They were randomized into two groups. Group A included 28 patients who were treated by UMPCNL in FFMS position (with a pad below the ipsilateral shoulder and buttocks, putting ipsilateral upper limb over the chest, and crossing the extended ipsilateral lower limb over the flexed contralateral one) and Group B included 27 patients treated by UMPCNL in the prone position. In both groups dilatation was done to 13F sheath allowing the introduction of 6/7.5F semirigid ureteroscope and fragmentation of stones by Holmium: yttrium-aluminum-garnet laser with a 550-μm fiber laser lithotripter. Results: The operation time in FFMS position UMPCNL group was significantly shorter than prone position UMPCNL group (84.3 ± 9.87 vs 99.3 ± 8.75 minutes) with p = 0.022. There was no significant difference between both groups in terms of stone-free rate (89.3% vs 88.9%), overall complication rate (including transient fever; 21.4% vs 18.5%), postoperative pain (visual analog scale score; 3.4 ± 0.8 vs 3.3 ± 0.9), or hospital stay (3.53 ± 0.8 vs 4.1 ± 1.1 days). Conclusion: Both UMPCNL in FFMs and prone positions are feasible, safe, and effective in treatment of pediatric renal stones with relatively shorter operative time in FFMS position.

Contribution of Ureteral Access Sheath Use to the Efficacy of Semirigid Ureterorenoscopy in Upper Ureteral Stones Smaller than 2 cm: Experiences of a Single Center

Objective: The aim of our paper is to answer the question that during the ureteroscopy procedure if ureteral access sheath could facilitate operation, could decrease complication rates,operation time,requirement of additional surgery. Method: The patients were randomly divided into two groups. Group 1 contained 44 patients for whom a UAS was not used and Group 2 consisted of 70 patients for whom a UAS was used during the URS procedure. The operation was continued using the semirigid ureteroscope within the UAS. Results: There were no statistically significant differences between the two groups in terms of the mean age, BMI, ASA score, mean stone density, previous unsuccessful interventions, history of stone disease, mean grade of hydronephrosis in renal pelvis and mean stone size. the mean operation time was 41 minutes for Group 1 and 30 minutes for Group 2, with a statistically significant difference (p < 0.001), consistent with the literature. Similarly, the difference in the mean fluoroscopy time was statistically significant, being determined as six minutes for Group 1 and three minutes for Group 2 (p < 0.001). Conclusions: Use of UAS was statistically significantly superior in terms of many parameters, such as increased stone-free rate, shorter operation time, and reduced requirement of additional surgery. Furthermore, the complication rates did not significantly differ between the UAS and non-UAS groups. We also consider that the advantages of a higher stone-free rate and reduced requirement of secondary interventions make the cost of UAS acceptable.

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.

Application of ureteral access sheath in the operation of middle and lower ureteral calculi in patients with massive benign prostatic hyperplasia

Objective: To examine the effectiveness and safety of application of the ureteral access sheath in the treatment of middle or lower ureteral calculi in patients with large-volume benign prostatic hyperplasia above grade Ⅲ, which is expected to avoid the simultaneous or staged treatment of benign prostatic hyperplasia via eliminate the difficult angle and resistance of ureteroscopy caused by severe prostatic hyperplasia. Methods: From April 2018 to December 2020, the clinical data of 27 patients with massive benign prostatic hyperplasia above grade Ⅲ and middle and lower ureteral calculi treated with indwelling ureteral access sheath plus ureteroscopy holmium laser lithotripsy at Department of Urology, Zhejiang Quhua Hospital were retrospectively analyzed and followed up. All the patients were male, aged (69.7±12.8) years (range: 55 to 87 years). Prostate volume measured by transrectal ultrasound was (94.8±16.2) cm3 (range: 85 to 186 cm3). The ureteral access sheath was indwelled in advance, and then the semirigid ureteroscopy was introduced through the working channel of the sheath. Holmium laser lithotripsy was performed, and intraoperative and postoperative complications were recorded. Urinary abdominal plain X-ray or CT urography were performed at 1-and 2-month postopaerative to evaluate the residual stones and clinical efficacy. Results: The ureteral access sheath was placed and holmium laser lithotripsy under a semirigid ureteroscopy was performed successfully in all the 27 patients. In 2 patients, a second session of auxiliary procedure was required due to the large load of preoperative stones and residual stones after surgery, among whom 1 patient received extracorporeal shock wave lithotripsy and 1 patient underwent extracorporeal shock wave lithotripsy plus ureteroscopic lithotripsy. The stone free rate at 1-and 2-month postoperative were 92.6% (25/27) and 100% (27/27), respectively. There were no severe complications such as ureteral avulsion and perforation, perirenal hematoma, septic shock, severe hematuria, urinary retention, iatrogenic ureteral stricture occurred during and after the surgery. The ureteral calculus was wrapped by polyps heavily in 1 patient, he was diagnosed as ureteral stenosis 1 month postoperative, receiving laparoscopic resection of ureteral stricture plus anastomosis 3 months postoperative. Conclusions: In the operations of middle and lower ureteral calculi in patients with large-volume prostatic hyperplasia above grade Ⅲ, the ureteral access sheath can be placed first to effectively eliminate the difficult angle and resistance of ureteroscopy caused by severe prostatic hyperplasia, and then semirigid ureteroscopic lithotripsy can be safely performed. It could avoid the treatment of benign prostatic hyperplasia at the same time or by stages.

PNEUMATIC URETEROSCOPIC LITHOTRIPSY VERSUS LAPAROSCOPIC URETEROLITHOTOMY FOR LARGE UPPER URETERAL STONES- AN INITIAL EXPERIENCE.

Objective: The treatment of choice for large upper ureteral stones is controversial. In the developing nations, semi rigid ureteroscopy is the preferred treatment modality for ureteric stones even in upper ureter. However, Laparoscopic ureterolithotomy has started gaining acceptance for the treatment of large proximal ureteral stones. This study was done to compare solely the outcomes of semi-rigid pneumatic ureterolithotripsy (URSL) and transperitoneal laparoscopic ureterolithotomy (LU) for large upper ureteric stones. Methods: In all, 30 patients who met the inclusion criteria were randomised into 2 groups: URSLand LU. The groups were compared for stone clearance rate, operative time, complication rates.Results: LU had signicantly higher stone clearance rate both at discharge (p=0.014) and at 3 weeks post operatively (p = 0.033) than URSL. On the other hand, URSLhad signicantly shorter mean operating time (p&lt;0.0001), length of hospital stay (p=0.0013) and required less auxiliary procedures than LU group. No major complications were observed and the complication rate was not statistically signicant among the groups (p=0.41).Conclusion: Laparoscopic ureterolithotomy was associated with higher stone clearance rate but with longer hospital stay and operative time than URSL, however the complications were similar. Consequently, the procedure of choice for large proximal ureteric calculi should be based on the expertise of the surgeon, patient's choice and the availability of equipments.

A0042 - Predictive value of preoperative high sensitive C-reactive protein/ albumin ratio in systemic inflammatory response syndrome after semi-rigid ureteroscopy

A0042 - Predictive value of preoperative high sensitive C-reactive protein/ albumin ratio in systemic inflammatory response syndrome after semi-rigid ureteroscopy

Comparison of stented versus non-stented patients of ureteric calculi after intracorporeal lithotripsy

Background: A ureteric stent is a tube that is inserted into the ureter to treat and prevent urinary blockage. Stenting is most commonly used to treat stone disease in the ureter during definitive procedures such as ureteroscopy and extracorporeal shock wave lithotripsy. The stent that remains in place frequently causes urinary tract infection and discomfort in the suprapubic area. We report results of our study which attempted to assess stent-related complaints following semirigid ureteroscopy and intracorporeal lithotripsy.Methods: A total of 70 individuals were randomised to stented(n=35) and non-stented group (n=35) between September 2017 and March 2020. Under spinal anaesthesia URSL was performed. Patients' success, operation time, postoperative pain score, analgesic demand, stent-related symptoms, and risk of ureteral stricture development were all evaluated.Results: There was no statistically significant difference between the two treatment groups in terms of ureteral dilation, intracorporeal lithotripsy, or the incidence of intraoperative and postoperative problems. It was found that non-stented group was cost effective as compared to stented group, Furthermore, removal of the stent using local anaesthesia was more painful than the initial ureteroscopy procedure using regional (spinal) anaesthesia. Postoperative pain in non-stented group (n=6) was less than stented group (n=17).Conclusions: Routine placement of ureteral stent is not necessary in uncomplicated cases of ureteric calculi following ureteroscopy, the decision being made on the basis of intra operative findings, where the risks clearly outweigh the benefits offered by stenting.

Comparison of the Safety and Efficacy of Laser Versus Pneumatic Intracorporeal Lithotripsy for Treatment of Bladder Stones in Children.

This study aimed to compare the safety and efficacy of laser lithotripsy and pneumatic lithotripsy, the two most commonly used transurethral lithotripsy methods for treating bladder stones in children in Iraq. Between January 2013 and December 2016, 64 children with bladder stones were included in this prospective randomized study, after ethical committee approval and written consent from the children’s parents or caregivers were obtained. Patients were assigned randomly by computer software to two groups treated with either pneumatic cystolithotripsy or laser lithotripsy. A 9 Fr. semirigid ureteroscope was used to pass the lithotripter through and fragment the stone. A catheter of 8–12 Fr. was then introduced and kept in place for 24 h. All children were hospitalized for 24 h, and the catheter was removed the next morning. Outpatient follow-up was maintained for 6–12 months. In terms of operation outcomes and complications, the laser lithotripsy group had a significantly longer duration of operation (74.5 ± 26.6 min vs. 51.5 ± 17.2 min, p = 0.001), whereas the number of patients requiring an extended hospital stay was significantly higher in the pneumatic lithotripsy group (48.5% vs. 16.1%, p = 0.006). Moreover, pneumatic lithotripsy was associated with a significantly greater risk of having at least one adverse effect (64% greater than that in the laser group). Stone clearance rates did not significantly differ between treatment groups. In conclusion, both pneumatic and laser lithotripters can be used to treat children with bladder stones with high efficacy and safety.

Laparoscopic Management of Common Bile Duct Stones using Semi-rigid Ureteroscope- a Single Centre Prospective Observational Study

Background: Minimally invasive and endoscopic techniques are increasingly being used by surgeons nowadays in the management of patients with cholelithiasis and choledocholithiasis. However, there is a high failure rate in the extraction of large impacted stones using the conventional flexible choledochoscope by the laparoscopic approach. Improvisation of this technique will reduce the failure rate. The present study explored the safety, feasibility, and efficacy of a semirigid ureteroscope (SRUS) in the laparoscopic management of common bile duct (CBD) stones. Methods: A prospective observational clinical study was carried out in an experienced GI surgical unit from January 2020 to December 2021. It included 36 patients diagnosed with radiologically proven gallstone disease with bile duct calculi who underwent Laparoscopic CBD exploration (LCBDE) and stone extraction using SRUS with lap cholecystectomy (LC) as a single-stage procedure. The success rate in terms of complete CBD clearance is the primary outcome measure. Post-procedure complications, 24 hr pain score, in-hospital stay, and patient satisfaction score are the secondary outcome measures. Results: Mean age of the study subjects was 50.45±9.12 years. The most common clinical symptom was biliary colic followed by jaundice. The primary outcome measure of complete CBD clearance was achieved in 94%. A complication following surgery was bile leak in one patient (3%). There were no surgical site infections or T-tube related complications. The average WHO 24-hour pain score was 4.9±1.9. The mean in-hospital stay was 3.3±1.4 and the mean patient satisfaction score was 2.42±0.3. Conclusion: Laparoscopic approach avoids the complications of endoscopic retrograde cholangiopancreatography (ERCP) sphincterotomy/sphinteroplasty and keeps the sphincter of Oddi (SOD) intact. LCBDE with SRUS is a safe and effective single-stage approach without any radiation hazards. The pneumatic lithotripter with its pneumatic ballistic effect is more efficacious, cost-effective, and safe as compared to other lithotripsy techniques. This lithotripter is capable of dealing with different varieties of stones regardless of their composition, size and degree of impaction. However, future comparative studies are needed to prove the superiority of this technique.

Learning curve of semi-rigid ureteroscopy for small calculi: how many cases are necessary?

semi-rigid ureteroscopy is the procedure of choice for the treatment of ureterolithiasis, but it requires a learning curve to be performed safely. To describe an estimate of the learning curve for performing semi-rigid ureterorenolithotripsy in patients with small-sized ureterolithiasis and to estimate the minimum number of procedures necessary to safely perform the surgical procedure. this is a prospective study evaluating the learning curve of a resident of urology in the first 60 semirigid ureteroscopies in patients with ureterolithiasis up to 1cm. The patients were divided into three groups: Group I one to twenty surgeries, Group II twenty one to forty surgeries and Group III forty one to sixty surgeries. The surgeries were recorded and analyzed by two urologists experienced in endourology. A qualitative analysis was performed based on a previously validated tool and a quantitative analysis. all qualitative variables had significant variation between Groups I and II (p<0.001), and between Groups I and III (p<0.001). There was a difference in time to access the ureter, passage of a double J catheter and total operative time between Groups I and II (p<0.001) and Groups I and III (p<0.001). after 40 cases there seems to be little increase in both quantitative as well as qualitative evaluation in surgical performance for performing semi-rigid ureterolithotripsy safely in calculations up to 1cm.

Transurethral Holmium Laser Cystolithotripsy Under Local Anaesthesia in Adult Patients: A Prospective Observational Study at a Tertiary Care Centre in North-east India

Introduction: Urinary bladder stones comprise 5% of all urinary stones. Various modalities for the treatment of symptomatic bladder stones are available. They are open cystolithotomy, extra corporeal shock wave lithotripsy, cystolitholapaxy, suprapubic or transurethral cystolithotripsy using various energy sources. Presently transurethral Holmium laser cystolithotripsy is considered as the treatment of choice for symptomatic bladder stones. Aim: To report the experience of holmium laser cystolithotripsy for the treatment of symptomatic urinary bladder stones under local anaesthesia in adult patients. Materials and Methods: This prospective observational study was conducted on 86 patients at Department of Urology, NorthEastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong, Meghalaya, India, between June 2016 and August 2019. It included consecutive adult patients with symptomatic bladder stones of size upto 4 cm who underwent transurethral holmium laser cystolithotripsy under local anaesthesia during the study period. Laser energy was delivered through a 9.5F semi rigid ureteroscope using 365 µm or 550 µm end-firing fibre. Pain during the procedure was assessed using Visual Analogue Scale (VAS). Descriptive statistics was used for analysis of the results. Results: During the study period, 86 patients (84 men, 2 women) underwent transurethral Holmium laser cystolithotripsy under local anaesthesia. Complete fragmentation of the stones was achieved in all patients. The mean stone size was 15.04 mm and the mean operating time was 23.81 minutes. The procedure was well tolerated by the patients and the mean pain score was 3.26. It was associated with minor complications only. There was no major complication or mortality during the study. Conclusion: Transurethral holmium laser cystolithotripsy under local anaesthesia is a safe procedure. It is well tolerated by adult patients and it can be used for the treatment of bladder stones of size upto 4 cm.