Semirigid Ureterorenoscopy Research Articles

A retrospective comparison of Sun’s tip-flexible semirigid ureterorenoscopy, super-mini percutaneous nephrolithotomy and flexible ureteroscopy applied to treat upper urinary tract calculi

BackgroundThis retrospective study was conducted to compare the safety and efficacy of Sun’s tip-flexible semirigid ureterorenoscopy (tf-URS), super-mini percutaneous nephrolithotomy (SMP) and flexible ureteroscopy (FURS) in treating upper urinary tract calculi, including upper ureteral or renal calculi.MethodsWe included patients with upper ureteral calculi or renal calculi 1.0–2.0 cm in size, who underwent tf-URS, SMP or FURS, respectively. The indicators reflecting safety and efficacy were compared among the three surgical techniques.ResultsSMP presented with higher single stone crushing success rate, but longer operation time and postoperative hospital stay, more blood loss, and higher postoperative pain score compared with FURS and tf-URS (P < 0.05). The hospitalization cost of tf-URS group was lower than that of SMP and FURS groups (P < 0.05). The incidence of postoperative fever in tf-URS group was significantly higher than that in SMP group (P < 0.05). No significant difference was found in mucosal injury, perirenal hematoma, and stone-free rate at 3 months after surgery (P > 0.05).Conclusionstf-URS and FURS have the advantages in minimal invasion, hospitalization cost, patient comfort, and hospital stay while SMP has higher stone-free rate. These three surgical techniques are safe, reliable and complementary, which should be selected according to the actual situation.

Prospective randomized study to evaluate and compare the post-procedural sexual function in patients undergoing semi-rigid ureterorenoscopy for distal ureteric stones in three different operating room settings

ObjectiveTo evaluate and compare the effect of semi-rigid ureterorenoscopy on post-procedural sexual function with three different operating room settings. MethodsIn this prospective randomized study, consecutive sexually active patients with normal pre-operative sexual function undergoing uncomplicated semi-rigid ureterorenoscopy for distal ureteric stones were randomized into three groups, with three different operating room settings. Procedure-related anxiety and sexual function were assessed pre-operatively using Amsterdam Preoperative Anxiety and Information Scale and Brief Sexual Function Inventory (in males) and Female Sexual Function Index-6 (in females), respectively. All the participants were stented following the procedure, and the stent was removed after 3 weeks. Post-procedural sexual function and general discomfort were assessed and compared between three groups at 1 week, 3 weeks, and 12 weeks. The effect of surgery-related anxiety, preoperative sexual function, age, and general discomfort (including stent-related discomfort) on post-procedural sexual function were analyzed using multiple regression analysis. A p-value of less than 0.05 was considered statistically significant. ResultsTotally, 327 eligible patients were randomized into three groups. The group of patients who underwent the procedural with a screen separating the operating area from the patient vision, while the patient could watch the endoscopy through a separate monitor, had better post-procedural sexual function compared to those who had total vision of the operating area as well as to those whose eyes were blocked. This difference was statistically significant. This post-procedural reduction in sexual function could not be attributed to in situ stent alone. ConclusionsOur study showed that semi-rigid ureterorenoscopy can have significant negative effect on sexual function, which can be reduced with proper preoperative counseling and an ideal operating room settings.

Semirigid Ureteroscopy Therapy against Childhood Kidney Stones.

Objective The purpose of the current study was to assess the effectiveness of semirigid ureterorenoscopy (URS) as first-line therapy for early childhood patients with <20 mm stones in the pelvic, middle, or upper calices. Methods In all, 61 pediatric kidney stone patients who had flexible ureteroscopy (fURS) between January 1, 2010, and December 31, 2019, were included in this study. Before fURS, semirigid URS employed the UreTron or holmium: YAG (Ho : YAG) laser was conducted. When semirigid URS was unsuccessful, fURS was used for retrograde intrarenal surgery (RIRS). All participants were monitored clinically for a minimum of three months after each procedure. Results The patient's mean age was 4.52 ± 1.53 years, and 52 (83.61%) participants underwent semirigid URS successfully. Mean procedural duration of semirigid URS was 36.49 ± 7.72 min. The stone-free rate after semirigid URS was 92.16% (47/51). During the postprocedural medical observation, there were no serious adverse effects. Conclusions Based on the present study's findings, semirigid URS is a low-risk, effective therapy for kidney stones in selected pediatric patients.

Risk Factors for Febrile Urinary Tract Infection after Transurethral Ureterolithotripsy : ANALYSIS of Treatment Outcomes of 1,235 Patients at a Single Center

Recently, ureteroscopic lithotripsy remains the standard treatment for urolithiasis, with postoperative febrile upper urinary tract infection (fUTI) being one of its most significant complications. The current study sought to investigate the treatment outcomes of ureterorenoscopy (URS), morbidity and risk factors of postoperative fUTI at our hospital. A total of 1,235 patients who underwent URS (including those who underwent only semi-rigid URS) for upper urinary tract stones at our hospital between October 2011 and December 2019 were retrospectively analyzed. Patients had a median age of 63 years and a median stone length of 11.4 mm. F-URS was performed in 1,188 cases (96.2%) among whom 92.1% were stone-free or had stones that fractured into dust. Postoperative fUTI and sepsis occurred in 127 (10.3%) and 18 (1.5%) patients, respectively. Multivariate analysis identified female sex, American Society of Anesthesiologists (ASA) score ≥ 3, calculus length ≥ 20 mm, history of diabetes mellitus, and history of obstructive pyelonephritis as risk factors for postoperative fUTI. The scoring system (range 0-4) were positively correlated with the postoperative fUTI rate (score 0 : 3.1%, 1 : 12.4%, 2 : 14.1%, 3 : 23.7%, 4 : 40%). A significant difference in the rates was noted between those with a score of 0 (low-risk group), 1-2 (intermediate-risk group), and 3-4 scores (high-risk group). In conclusion, the overall incidence of postoperative fUTI was 10.3%, which was associated with sex, poor ASA scores, stone size, presence of diabetes mellitus, and history of pyelonephritis. The scoring system created using these factors can be useful in predicting postoperative fUTI.

Effect of endoscopic urethral procedures applied after robotic radical prostatectomy on urinary incontinence: A prospective cohort pilot study.

The most common complications after radical prostatectomy (RP) are erectile dysfunction (ED) and urinary incontinence (UI). After RP, patients may require endoscopic urethral procedures (EUP) for other urological diseases such as hematuria, urinary system stone disease, and suspicion of bladder tumor. In clinical practice we observed that EUP performed after robot assisted RP (RARP) can cause an increase in the UI level. In this study, we investigated whether there is a change in the UI level in patients that underwent EUP after RARP and whether this change was affected by the duration of the procedure and type of endoscopic device used. Twenty-six patients were included who underwent EUP after RARP in this study. The patients were divided into three groups based on the endoscopic device used: group 1 rigid cystoscopy (n = 9), group 2 flexible cystoscopy (n = 7), and group 3 semi-rigid ureterorenoscopy (URS) (n = 10). The Turkish version of the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-SF) and the number of pads used daily was questioned before the EUP and 1 month after the procedure. While a significant increase in ICIQ-SF score was observed in group 1 (p = 0.027), no significant increase was observed in group 2 and group 3 (p > 0.05). No significant difference was observed between the number of pads used preoperatively and the postoperative first month in all groups (p > 0.05). There was no significant correlation between increased operation time and both the pad usage and ICIQ-SF score (p > 0.05). The use of small diameter endoscopic instruments and flexible instruments is important for patient comfort and to avoid damage to urethrovesical anastomosis in patients who need to undergo EUP after RP.

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

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

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.

A COMPARISON OF URETEROSCOPY WITH SUPINE-TRANS-GLUTEAL EXTRA-CORPOREAL SHOCK-WAVE LITHOTRIPSY FOR THE MANAGEMENT OF DISTAL URETERIC CALCULUS.

Background: Uro-lithiasis is one of the most frequent urological disorders seen on a daily basis. Ureterorenoscopic Lithotripsy has traditionally been used to treat distal ureteric calculus (URSL). Extra-corporeal Shock-wave Lithotripsy (ESWL) using a trans-gluteal route has recently been investigated. Aims &amp; objectives: The goal of this study is to see how supine trans-gluteal ESWL works on distal ureteric calculus and compare it to semi-rigid ureterorenoscopy in the management of distal ureteric calculus. Material &amp; methods: A total of 240 subjects were included in our trial, which lasted a year and was randomly separated into two categories by an independent observer. After collecting consents, taking a full history and doing clinical examinations as needed, and conducting the necessary biochemical and radiological studies, Category A was offered ESWL while Category B was offered URSL. After 15 days after the procedure, the subjects were followed up on. Results: Many subjects, especially the elderly, obese, and those with physical disabilities or poor mobility, prefer the supine posture SWL. When the patient and calculus characteristics were compared, there was no discernible difference between the two categories. In both categories, males make up the bulk of the subjects (82 percent). The supine trans-gluteal SWL category had an 89 percent calculus-free rate. Conclusion: We conclude that ESWL management has a low morbidity and high effectiveness, and that the results are comparable to those of uretero-scopy with intra-corporeal lithotripsy, with the added benefits of an outpatient operation, no need for anaesthesia, and the use of DJ stents. Keywords: Distal Ureteric Calculus, URSL, Trans-gluteal ESWL, Calculus clearance.

Ureteral wall thickness at the stone site: A critical predictor of success and complications in children undergoing semi-rigid ureteroscopy

We retrospectively assessed the role of ureteral wall thickness (UWT) at the ureteral stone site in predicting the stone-free status and the complication rates in children undergoing semi-rigid ureterorenoscopy (URS). The children who underwent URS and had undergone non-contrast abdominal computerized tomography before the URS were included in the study. The following protocol was used to determine the outcome. Immediately before removing the stent, all children were evaluated by ultrasound (US) and plain film (KUB) for residual stones in the upper urinary tract and after removing the double J stent, the presence of stone fragments in the ureter was checked with URS. The children were considered stone-free if no residual fragments were identified in radiologic imaging and the evaluation of the ureter by URS. The case was accepted as a failure if any fragments were seen on immediate US, KUB, and/or during URS just after the stent removal. The patients who could not complete the standard primary URS procedure due to stone-related reasons (patients for whom we could not pass the safety guidewire behind the stone and/or the procedure was terminated due to pyuria during the procedure) were also accepted as a failure. The possible factors related to the patient, stone, ureter, and the operation that could affect the outcome and the complications following the URS were evaluated. The children's median age was six years (1-17 years). Among the 89 children included in the study, 69 (78%) were stone-free, and 20 (22%) presented residual stone after the first URS session. The ROC analysis revealed that a UWT value of 4.5mm (sensitivity 60%, specificity 92%) was the optimal cut-off value predictive of the URS outcome. The regression analysis revealed UWT >4.5mm (p=0.006) and multiple stone presentation (p=0.005) as independent risk factors for residual stone. Complications were detected in 15 (17%) children. Thick ureteral wall (p=0.012) and longer operative time (p=0.016) were defined as the independent risk factors for complications. Increased UWT is associated with the adverse outcomes of URS due to tissue hypertrophy, edema, and mucosal bleeding may cause difficulty in removing the stone. The thick ureteral wall might increase the risk of complications due to the necessity of manipulating the instruments or the involuntary forceful use of instruments while removing the stone. UWT was the only independent variable affecting both increased failure and complication rates in children undergoing URS.

PD26-10 CORRELATION BETWEEN EXPOSURE OF ENDOUROLOGISTS AND PATIENT EXPOSURE DURING FLUOROSCOPY-GUIDED ENDOUROLOGICAL PROCEDURES

You have accessJournal of UrologyStone Disease: Surgical Therapy III (PD26)1 Sep 2021PD26-10 CORRELATION BETWEEN EXPOSURE OF ENDOUROLOGISTS AND PATIENT EXPOSURE DURING FLUOROSCOPY-GUIDED ENDOUROLOGICAL PROCEDURES Jenia Vassileva, Anna Zagorska, Sofia Bulgaria, Dragoslav Basic, Nis Serbia, Andreas Karagiannis, Kremena Petkova, Sofia Bulgaria, Kubilav Sabuncu, Ilya Saltirov, Sofia Bulgaria, Kemal Sarica, Andreas Skolarikos, Sotir Stavridis, Skopje Macedonia, Alberto Trinchieri, Lazaros Tzelves, Ismail Ulus, and Emrah Yuruk Jenia VassilevaJenia Vassileva More articles by this author , Anna ZagorskaAnna Zagorska More articles by this author , Sofia BulgariaSofia Bulgaria More articles by this author , Dragoslav BasicDragoslav Basic More articles by this author , Nis SerbiaNis Serbia More articles by this author , Andreas KaragiannisAndreas Karagiannis More articles by this author , Kremena PetkovaKremena Petkova More articles by this author , Sofia BulgariaSofia Bulgaria More articles by this author , Kubilav SabuncuKubilav Sabuncu More articles by this author , Ilya SaltirovIlya Saltirov More articles by this author , Sofia BulgariaSofia Bulgaria More articles by this author , Kemal SaricaKemal Sarica More articles by this author , Andreas SkolarikosAndreas Skolarikos More articles by this author , Sotir StavridisSotir Stavridis More articles by this author , Skopje MacedoniaSkopje Macedonia More articles by this author , Alberto TrinchieriAlberto Trinchieri More articles by this author , Lazaros TzelvesLazaros Tzelves More articles by this author , Ismail UlusIsmail Ulus More articles by this author , and Emrah YurukEmrah Yuruk More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002019.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Minimally invasive endourological procedures often need X-ray fluoroscopy guidance. Endourologists, may focus on their own exposure but underestimate the patient exposure. However, patient is exposed to primary X-ray beam, the intensity of which is much higher, compared to operator’s exposure from scattered radiation. This multicenter study of the South-Eastern European Group for Urolithiasis Research (SEGUR) aims to study radiation exposure of patients, during fluoroscopy guided endourological procedures in correlation withexposure factors and related staff radiation doses. METHODS: Seven clinical centers from the SEGUR group contributed to collection of relevant data for all standard percutaneous nephrolithotomy (PCNL), mini PCNL, retrograde intrarenal surgery (RIRS), semirigid ureterorenoscopy (URS) and flexible URS performed during a 3 month period, with paralell measurement of operators’ body and eye lens dose.The median total radiation dose in terms of dose area product (DAP) was calculated for every center and procedure, while fluoroscopy time, pulse rate and number of images were also recorded. Pearson’s correlation and chi-square/ Fisher’s exact tests, were used for statistical analysis, as appropriate. RESULTS: A strong correlation (r2 0.91-0.99) was found between endourologist eye dose and correponding total patient dose in terms of DAP. Reduced patient dose was associated with the use of lower pulse rate (12.5 pulse per second or lower), lower fluoroscopy time and lower number of recorded radiographic images. Lower dose in PCNL was associated with the use of prone compared to supine patient position. The highest patient dose was observed for a multiple access PCNL for kidney stone with pulsed fluoroscopy with 30 p/s, fluoroscopy time of 14 min and 156 recorded images. Dose values for RIRS were significantly lower compared to PCNL.No correlation was found between the concrement size and dose. Median patient exposure per center varied between 2 and 29-fold, with highest variations for the flexible and semi-rigid URS and lowest for RIRS, demonstrating a high potential for reduction of exposure of patients and urological team.Highest dose to patient skin from fluoroscopy was 377 mGy that is much below the dose treshold of 2 Gy needed to induce skin injury. CONCLUSIONS: Radiation exposure in patients during endourologic procedures, poses the risk of stochastic effects and increased cancer risk,which can be reduced by lowering patient dose through proper fluoroscopy. use. Source of Funding: Nothing to declare © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e441-e441 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jenia Vassileva More articles by this author Anna Zagorska More articles by this author Sofia Bulgaria More articles by this author Dragoslav Basic More articles by this author Nis Serbia More articles by this author Andreas Karagiannis More articles by this author Kremena Petkova More articles by this author Sofia Bulgaria More articles by this author Kubilav Sabuncu More articles by this author Ilya Saltirov More articles by this author Sofia Bulgaria More articles by this author Kemal Sarica More articles by this author Andreas Skolarikos More articles by this author Sotir Stavridis More articles by this author Skopje Macedonia More articles by this author Alberto Trinchieri More articles by this author Lazaros Tzelves More articles by this author Ismail Ulus More articles by this author Emrah Yuruk More articles by this author Expand All Advertisement Loading ...

Where is it logical to break-up a ureter stone with endoscopic surgery?

Background/Aim: Today, we have the technology to break up a ureter stone in the ureter, as well as in the renal pelvis, with ureterorenoscopic procedures. In the past, when this option was not available, the surgeons improved several techniques and antiretropulsion devices to let the stone migrate through the renal pelvis. This study was conducted to clarify whether it is more advantageous to dust a stone in the ureter where it is impacted or in a wider area such as the renal pelvis. Methods: The data of 134 patients who underwent semirigid ureterorenoscopy (srURS) due to single and primary upper ureteral stones were included and analyzed in this retrospective cohort study. The patients were divided into two groups according to the development of spontaneous push-up during surgery (Group 1: The non-push-up group, Group 2: The push-up group). Results: While hemoglobin levels lowered significantly in both groups after the surgery, creatinine levels increased (P 0.05). Operation times were similar in both groups, in contrast with the literature. Stone-free rates were significantly higher in srURS than in intrarenal surgery (RIRS) (P=0.03). Complication rates were also similar in this study. Conclusion: The application of srURS after fixing an upper ureter stone at its location using a Stone Cone® results in higher stone-free rates than pushing it back to dust it in renal pelvis. We recommend srURS supported by an antiretropulsion method as a treatment for upper ureteral stones.

The SIMULATE ureteroscopy training curriculum: educational value and transfer of skills

ObjectiveDifferent simulation modalities may be utilised in a curricular fashion to benefit from the strengths of each training model. The aim of this study is to evaluate a novel multi-modality ureterorenoscopy (URS) simulation curriculum in terms of educational value, content validity, transfer of skills and inter-rater reliability.MethodsThis international prospective study recruited urology residents (n = 46) with ≤ 10 URS experience and no prior simulation training. Participants were guided through each phase of the expert-developed SIMULATE URS curriculum by trainers and followed-up in the operating room (OR). Video recordings were obtained during training. A post-training evaluation survey was distributed to evaluate content validity and educational value, using descriptive statistics. Performance was evaluated using the objective structured assessment of technical skills (OSATS) scale to measure improvement in scores throughout the curriculum. Pearson’s correlation coefficient and Cohen’s kappa tests were utilised to investigate correlation and agreement between raters.ResultsParticipants reported gaining OR-transferrable skills (Mean: 4.33 ± 0.67) and demonstrated marked improvement in throughout the curriculum, transferred to the OR for both semi-rigid URS (p = 0.004) and flexible URS (p = 0.007). 70% of participants were successfully followed-up in the OR (n = 32). No differences were identified with the additional use of fresh frozen cadavers (p = 0.85, p = 0.90) and the URO Mentor VR simulator (p = 0.13, p = 0.22). A moderate level of correlation was noted on the video OSATS assessments, between two expert assessors (r = 0.70), but a poor agreement with the live rating.ConclusionThe SIMULATE URS training curriculum received high educational value from participants, who demonstrated statistically significant improvement with consecutive cases throughout the curriculum and transferability of skills to the OR in both semi-rigid and flexible URS.

Evaluation of the results of laser endopyelotomy with two different technique in ureteropelvic junction obstruction

Failed pyeloplasty procedures are caused by large amounts of scarring, and peripelvic fibrosis. This finding has been associated with urinary extravasations to the operation, urosepsis or an excessive tissue reaction. The treatment options for secondary UPJO (Ureteropelvic Junction Obstruction) are the same with the options for primary procedures: in cases of very poor renal function, various pyeloplasty forms (open and laparoscopic), and ureterocalicostomy or sometimes nephrectomy may be considered in severe renal function loss. Whereas, endoscopic treatment can be considered in elective cases. A total of 46 young patients who underwent endopyelotomy due to secondary ureteropelvic obstruction between January 2013 and September 2018 were included in the study. Patients underwent semirigid URS (Ureterorenoscopy) guided laser endopyelotomy until July 2015, and the patients had flexible URS guided laser endopyelotomy since July 2015. The mean age of the patients was found as 17.7±4.2 and 16.9±5.7 years in the SURSLE (Semirigid Ureterorenoscopy Laser Endopyelotomy), and FURSLE (Flexible Ureterorenoscopy Laser Endopyelotomy) groups, respectively. Success of the procedure was confirmed in 20 (83%) patients in the SURSLE group, and 19 (86%) patients in the FURSLE group who had no obstructive symptoms based on USG, GFR and excretion curves on the renogram ordered in the 24th month. Four (16%) patients in the SURSLE group, and 3 (14%) patients in the FURSLE group were accepted as failed, their treatments were arranged for additional surgical procedures, and these patients were taken under the follow-up protocol. This is one of the first studies comparing endopyelotomy with semirigid URS and flexible URS in patients with ureteropelvic stenosis. Long-term results with a large series of patients are not known, and our approach can be considered only as an individual method. There are different treatment options in UPJO. The use of fluoroscopy has advantages in endourologic operations. Therefore, lower radiation exposure can be a rational approach for protecting a person. Similarly, providing necessary protection also for physicians and operating room personnel is essential. In our study, shorter fluoroscopy time with SURSLE provided an advantage over FURSLE in terms of radiation exposure. Of semirigid and flexible URS techniques that have no superiority over each other in terms of success, preferring semi-rigid URS guided laser endopyelotomy with lower ionizing radiation used, is more rational.

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

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

Radiation exposure of patients during endourological procedures: IAEA-SEGUR study

Fluoroscopy is increasingly used to guide minimally invasive endourological procedures and optimised protocols are needed to minimise radiation exposure while achieving best treatment results. This multi-center study of radiation exposure of patients was conducted by the South-Eastern European Group for Urolithiasis Research (SEGUR), in cooperation with the International Atomic Energy Agency. Seven clinical centers from the SEGUR group collected data for 325 procedures performed within a three-months period, including standard percutaneous nephrolithotomy (PCNL), mini PCNL, retrograde intrarenal surgery (RIRS), semirigid ureterorenoscopy (URS) and flexible URS. Data included: air kerma area product (P KA), air kerma at the patient entrance reference point (K a,r), fluoroscopy time (FT), number of radiographic images (N) and fluoroscopy pulse rate, as well as total procedure duration, size and location of stones. Data were centrally analysed and statistically compared. Median P KA values per center varied 2-fold for RIRS (0.80–1.79 Gy cm2), 7.1 fold for mini-PCNL (1.39–9.90 Gy cm2), 7.3 fold for PCNL (2.40–17.50 Gy cm2), 19 fold (0.13–2.51 Gy cm2) for semi-rigid URS and 29-fold for flexible URS (0.10–2.90 Gy cm2). Lower P KA and K a,r were associated with use of lower FT, N and lower fluoroscopy pulse rate. FT varied from 0.1 to 14 min, a small fraction of the total procedure time, ranging from 10 to 225 min. Higher N was associated with higher P KA and K a,r. Higher median P KA in PCNL was associated with the use of supine compared to prone position. No correlation was found between the concrement size and procedure duration, FT, P KA or K a,r. Dose values for RIRS were significantly lower compared to PCNL. The maximum K a,r value of 377 mGy was under the threshold for radiation induced skin erythema. The study demonstrated a potential for patient dose reduction by lowering FT and N, using pulsed fluoroscopy and beam collimation.

Holmium laser lithotripsy with semirigid ureterorenoscopy in treatment of upper ureteral and renal pelvis stones under spinal anesthesia

Extracorporeal shockwave lithotripsy and especially flexible ureterorenoscopy (URS) are first-choice treatments of upper ureteral and renal pelvis stones. In our study, we aimed to demonstrate that the treatment of upper ureteral and renal pelvis stones smaller than 2 cm could be performed by semirigid URS under spinal anesthesia. The data of 292 patients were retrospectively analyzed. Stones were localized in upper ureter and renal pelvis in 191 (65.4%) and 101 (34.6%) patients, respectively. The stone-free rate was found to be 72.6%. The final stone-free rate was 95.2% after additional treatments administered to 80 patients with residues. While no peri-operative complication was observed, hematuria was observed in three patients during the post-operative period, high fever was observed in 27 patients and sepsis was observed in four patients. It is a well-known fact that flexible URS is the first-choice surgical method in the treatment of upper ureteral and renal pelvis stones. In the current study, we aimed to investigate whether laser lithotripsy with semirigid URS could also be a good and cheap alternative in clinical practice, and if upper urinary tract surgeries could be performed with spinal anesthesia especially in patients with a high risk of general anesthesia. Level of evidence:

A modified basket catheter technique with semi-rigid ureterorenoscopy in the prevention of migration of proximal ureteral stones

Objectives: Although proximal ureteral stones are common, some difficulties are encountered in semi-rigid ureterorenoscopy (URS) treatment, especially as a result of stone migration to the kidney. In this paper, we present a different use of a basket catheter for the treatment of proximal ureteral stones. Methods: Between September 2016 and January 2019, 101 patients over 18 years of age detected to have a maximum 15-mm proximal ureteral stone were retrospectively evaluated, and 93 patients fulfilling the criteria were included in the study. Semi-rigid URS and a modified basket catheter were used together in 44 patients while no auxiliary equipment was utilized for the remaining 49 patients. In the study group, a 3F zero-tip basket catheter was disintegrated and positioned in a way to capture and retrieve the stone from the semi-rigid ureterorenoscope. Results: No difference was found between the two groups in terms of age, body mass index, gender, and stone characteristics. The duration of operation was shorter in the basket catheter group ( p < 0.001). The rates of stone migration, requirement to switch to flexible ureterorenoscopy (FURS), and double J-stent (JJ-stent) placement were significantly higher in the control group ( p < 0.005). There were no significant differences between the two groups concerning operation success and complications ( p = 0.068 and p = 0.772, respectively). Conclusions: The modified basket catheter technique with semi-rigid URS was successful in preventing the migration of proximal ureteral stones. This method can be considered as an alternative in cases where FURS is not available.

Ureteral Access Sheath Applicatıon Without Fluoroscopy in Retrograde Intrarenal Surgery.

To compare the results and complications of the two techniques of ureteral access sheath application, with and without using fluoroscopy. A comparative study. Department of Urology, Karabuk University Medical Faculty Training and Research Hospital and Ankara Diskapi Yildirim Beyazid Training and Research Hospital between April 2014 and January 2018. Retrospective evaluation was made of patients applied with retrograde intrarenal surgery using ureteral access sheath (UAS). In Group 1, defined method were used for UAS application without using scopy. In Group 2, following semi-rigid ureterorenoscopy, localisation of guidewire was checked with fluoroscopy. UAS was advanced to ureter over guidewire under fluoroscopy imaging. Success rate of UAS placement was similar in both groups (p=0.747). The time of UAS placement was 14.75 secs in Group 1 and 14.99 secs in group 2 (p=0.073). Fluoroscopy was not used at all during UAS placement in Group 1. In Group 2, the mean duration of fluoroscopy use was 9.93±3.89 secs. Total stone-free rate was 82.09% and 83.28% in Group 1 and 2, respectively. (p=0.653). The method described in this paper provides protection against radiation exposure for both the patient and the operating team; and prevents potential complications by enabling clear evaluation of ureteral orifice. Key Words: Renal stone surgery, Retrograde ıntrarenal surgery, Radiation protection, Flouroscopy, Radiation free.

Efficacy of semirigid ureterorenoscopy with the use of ureteral acsess sheath in the treatment of impacted ureteral stones: A prospective randomized study

Aim: To investigate the advantages of using Ureteral Access Sheat (UAS) with semirigid ureterorenoscopy in patients with impacted ureteral stones. Materials and Methods: One hundred and 22 adult patients that presented to our clinic with the complaint of impacted stones in the middle and upper parts of the ureter and were scheduled for surgical treatment. The procedure was performed without UAS in control group and using UAS in study group. Results: No significant difference was found between the two groups in terms of age, gender, stone disease history, presentation complaint, stone side, size, density and localization, degree of renal hydronephrosis, complications and length of hospital stay. Stone migration, operation time, duration of fluoroscopy, and postoperative additional surgical intervention rates were significantly lower in the UAS group [26.2% (n = 16) vs 11.5% (n = 7), p = 0.037; 35.46 ± 5.3 min vs 25.56 ± 4.2 min, p < 0.001, 5.50 ± 0.86 sec vs 3.24 ± 0.69 sec, p < 0.001; and 19.7% (n = 12) vs 6.6% (n = 4), p = 0.032, respectively]. The operation was successful in 48 (78.7%) patients in the control group and 57 (93.4%) in the UAS group, with a statistically significant difference (p = 0.019). Conclusion: The use of UAS in the treatment of middle-upper impacted ureteral stones presents as an advantageous method due to the shorter operation time and lower rates of intraoperative stone migration and high success rates of the operation.

Is spinal anesthesia an alternative and feasible method for proximal ureteral stone treatment?

IntroductionWe investigated the clinical, operational, and pain parameters of patients who underwent semirigid ureterorenoscopy (sURS) under spinal anesthesia (SA) and general anesthesia (GA) for proximal ureter stones.Material and methodsPatients treated with sURS after diagnosis of proximal ureter stones between January 2014 and May 2017 were reviewed retrospectively. The patients were divided into two groups (the SA group and the GA group) based on the type of anesthesia used. Perioperative variables and operation results were evaluated and compared. Success was defined as the patient being stone-free as observed on low-dose non-contrast computed tomography performed in the first month postoperatively.ResultsThe SA and GA groups had 40 and 32 patients, respectively. There were no statistically significant differences between the groups in terms of age (p = 0.593), gender (p = 0.910), average stone size (p = 0.056), side (p = 0.958), or density (p = 0.337). Based on the Clavien classification system, complication rates between the two groups were similar. The postoperative visual pain scale in the SA group was statistically significantly lower (p <0.05) than in the GA group. Success rates in the SA and GA groups were found to be 90% (36/40) and 93.7% (30/32), respectively, with no significant difference between the groups (p = 0.819).ConclusionsUreterorenoscopy, which is performed for proximal ureter stone treatment in adult patients, is a reliable surgical method that can be performed under both SA and GA. SA offers the advantage of reduced postoperative pain as compared to GA.