Stone-free Patients Research Articles

Effect of infundibulopelvic angle on outcomes of ureteroscopy: a systematic review and meta-analysis

PurposeThe infundibulo-pelvic angle (IPA) is reportedly a predictor of successful ureteroscopy for lower pole renal stones, however there is uncertainty at which IPA success is likely. We therefore aimed to perform a meta-analysis and determine at which the angle of likely success and failure.MethodsWe performed a systematic review and meta-analysis as per Cochrane guidelines in accordance to the PRISMA statement. The review was registered with PROSPERO prior to commencement (ID: CRD42022296732). We included studies reporting on outcomes of ureteroscopy for lower pole stones, with IPA. We excluded patients undergoing alternative treatments for lower pole stones, anatomical abnormalities and studies with < 10 patients. We assessed bias with the Newcastle-Ottawa scale. We performed meta-analysis in R, and summarised the findings as per GRADE.ResultsOverall, there were 13 studies included, with 10 included for meta-analysis. These studies covered n = 1964 patients (71% stone free). Overall, the stone free patients had a significantly less acute mean IPA (52o ± 9o), compared to the non-stone free patients (39o ± 7o), on meta-analysis (REM MD = -13.0, 95% CI: -18.7 to -7.2, p < 0.001). On examination of forest plots, at IPA < 30o no patients were stone free, whilst > 50o all were stone free. Risk of bias was moderate, and certainty of evidence was ‘very low’.ConclusionWith a very low certainty of evidence, we demonstrate that at an IPA of < 30o no patient is stone free, whilst > 50o all patients (in this review) are stone free. More evidence is therefore needed.

Comparison between Guy’s Stone Score and S.T.O.N.E. Score System in Predicting Stone Free Rate after PCNL

Abstract Background PCNL is the gold standard treatment modality of large and complex kidney stones. We compared the stone free status predicting ability of Guy’s stone score and S.T.O.N.E. score system. Objective To compare to compare between Guy’s stone score and S.T.O.N.E score system in predicting stone free rate after PCNL. Patients and Methods A total number of 40 patients underwent PCNL in the period between December 2021 and May 2022. All cases were evaluated and graded using both Guy score and S.T.O.N.E. score based on preoperative computerized plain ctut. The post operative stone free status was evaluated using post operative plain KUB xray and ctut. Statistical analysis was done to determine relation of the scores with the post-operative stone free status. Also receiver operating characteristics curves (ROC) was drawn and area under the curve was calculated to assess the scores predictability of post-operative stone free status. Results The overall stone free rate of our study was 80%. Mean age of study population was 43 years (±SD10.60). we found that stone free patients had lower mean Guy score (2.00 vs 3.38) and lower mean S.T.O.N.E. score (7.84 vs 9.75). both scores had statistically significant relation with stone free status the P value was 0.001 for Guy score and 0.022 for S.T.O.N.E. score. The post operative stone free status predictability of both scores was assessed by drawing receiver operating characteristics curves (ROC) and the area under the curve was calculated by ROC curve. When comparing area under the curve for both scores we found no great difference between guy score and S.T.O.N.E. score (0.867 – 95% CI 0.735-1.000) vs (0.760– 95% CI 0.569-0.951). Conclusion The study shows that both Guy score and S.T.O.N.E. score systems have similar predicting ability of post PCNL stone free status with strong correlation with post operative stone free status.

Assessment of Factors Responsible for Stone-Free Status After Retrograde Intrarenal Surgery.

Aim The study aimed to evaluate the predictive factors that determined stone-free rate (SFR) after retrograde intrarenal surgery (RIRS). Materials and methods This prospective study was conducted on 183 patients undergoing RIRS for renal stones. Patients were categorized into two groups, depending on stone-free status one month following the procedure. SFRwas defined as the complete absence of stones or stones <4 mm. The parameters studied included patient demographics, presence of hydronephrosis, presence of preoperative double J-stent, abnormal renal anatomy, and stone characteristics (stone burden, stone number, stone density, stone location, lower pole infundibulopelvic angle, and lower pole renal infundibular length (RIL)). Univariate and multivariate analyses were performed to identify risk factors for residual stones. We assessed the predictive ability of the RIRS score and Resorlu-Unsal stone score (RUSS) for evaluating SFR utilizing receiver operating characteristic (ROC) analysis. Results 183 patients were included inthe study with a median age of 51 years. 131 (71.6%) patients were declared stone-free after the procedure. The mean stone size and density were 16.9 SD±7.5 mm and 1038 SD±342 Hounsfield units (HU) respectively. Stone-free patients had lower stone size (14.3 mm vs. 23.6 mm, p<0.01) and stone density (970 HU vs. 1211 HU, p<0.01) compared to non-stone-free patients. Patients with residual stones had steeper lower pole renal infundibulopelvic angle (RIPA) (31.3° vs. 40.7°, p<0.01) and longer RIL(26.6 mm vs. 21.1 mm, p<0.01). Stone multiplicity (p<0.01), lower pole stone location (p<0.01), and renal malformations (p<0.01)were significant influencing factors for residual renal stones after RIRS. Multivariate analysis revealed stone size, stone density (HU), and stone location as independent predictors for SFR after RIRS. Among the scoring systems, the RIRS score had the highest diagnostic accuracy for SFR (area under the curve (AUC): -0.882, 95% CI-0.828-0.936). Conclusion Stone size, stone density (HU), and stone number are important predictors of SFR after RIRS. Lower pole stone location and abnormal renal anatomy play a substantial role in determining SFR after RIRS. In lower pole stones, a long RIL and acute RIPA negatively influence SFR. Additionally, the RIRS score was found to be a better predictor for SFR than the RUSS score.

A machine learning approach using stone volume to predict stone-free status at ureteroscopy.

To develop a predictive model incorporating stone volume along with other clinical and radiological factors to predict stone-free (SF) status at ureteroscopy (URS). Retrospective analysis of patients undergoing URS for kidney stone disease at our institution from 2012 to 2021. SF status was defined as stone fragments < 2mm at the end of the procedure confirmed endoscopically and no evidence of stone fragments > 2mm at XR KUB or US KUB at 3months follow up. We specifically included all non-SF patients to optimise our algorithm for identifying instances with residual stone burden. SF patients were also randomly sampled over the same time period to ensure a more balanced dataset for ML prediction. Stone volumes were measured using preprocedural CT and combined with 19 other clinical and radiological factors. A bagged trees machine learning model with cross-validation was used for this analysis. 330 patients were included (SF: n = 276, not SF: n = 54, mean age 59.5 ± 16.1years). A fivefold cross validated RUSboosted trees model has an accuracy of 74.5% and AUC of 0.82. The model sensitivity and specificity were 75% and 72.2% respectively. Variable importance analysis identified total stone volume (17.7% of total importance), operation time (14.3%), age (12.9%) and stone composition (10.9%) as important factors in predicting non-SF patients. Single and cumulative stone size which are commonly used in current practice to guide management, only represented 9.4% and 4.7% of total importance, respectively. Machine learning can be used to predict patients that will be SF at the time of URS. Total stone volume appears to be more important than stone size in predicting SF status. Our findings could be used to optimise patient counselling and highlight an increasing role of stone volume to guide endourological practice and future guidelines.

The significance of clinically insignificant residual fragments after percutaneous nephrolithotomy: an analysis into the relevance of complete stone clearance

PurposeAfter treatment for kidney stones, residual fragments with a diameter of ≤ 4 mm are traditionally referred to as ‘clinically insignificant residual fragments’. We hypothesize that patients with these fragments are at an increased risk for stone-related morbidity, such as complaints, hydronephrosis, and stone regrowth, when compared to stone-free patients. This study aimed to investigate the relevance of complete stone clearance in surgical treatment of urolithiasis.MethodsWe conducted a single-center retrospective cohort study. Patients who underwent percutaneous nephrolithotomy between 2015 and 2020 were included if a CT-scan was available within 6 months after the procedure, and the follow-up duration was at least 1 year. The stone-free status at the end of the first stone episode during the study period was categorized as fully stone-free, not stone-free with small residual fragments (≤ 4 mm) and not stone-free with large residual fragments (> 4 mm). Follow-up data were collected, including stone-related events and re-intervention rates.ResultsA total of 103 subjects were included with a median follow-up of 21.4 months. Stone-related events occurred in 10 (29.4%) of the fully stone-free subjects, 20 (58.8%) of the subjects with small residual fragments and 25 (71.4%) of the subjects with large residual fragments. The stone-related event-free survival per subgroup resulted in a significantly different survival distribution in a log rank test (p = 0.008).ConclusionA complete stone-free status seems to be of fundamental importance for decreasing stone-related morbidity. Further developments and research should focus on optimizing the full clearance of stone material during PCNL.

The Role of Scoring Systems in Predicting Surgical Success in Percutaneous Nephrolithotomy: Results from a Single Center

Objective: In this study, we aimed to determine the effectiveness of Guy’s score, S.T.O.N.E score, and CROES nomogram, the most widely used models in percutaneous nephrolithotomy (PNL) for predicting stone-free status, and to determine which model predicts stone-free status more successfully. Materials and Methods: The data of patients older than 18 years of age who underwent PNL for kidney stones at our tertiary academic center between 2009 and 2018 were retrospectively analyzed. Examined parameters included the demographic data of patients, stone characteristics, Guy’s score, S.T.O.N.E. score, CROES nomogram, surgical duration, transfusion rate, length of stay, and stone-free status. Prediction values for stone-free status were determined using receiver operating characteristic (ROC) curve analysis. Results: A total of 200 patients were included in the study. The mean age of the patients was 43.7 ± 14.6 years. The mean stone scores of the patients were as follows: Guy’s score: 2.11 ± 1.01; S.T.O.N.E. score: 7.54 ± 1.73; and CROES nomogram: 194 ± 62.7. The stone-free rate was determined to be 66%. The Guy’s and S.T.O.N.E. scores were significantly higher, and the CROES nomogram was significantly lower in non-stonefree patients compared to stone-free patients (p&amp;lt;0.001, p&amp;lt;0.001, and p&amp;lt;0.001, respectively). The cut-off value and area under curve (AUC) were 2.5 and 0.770 for Guy’s score, 7.5 and 0.722 for S.T.O.N.E score, and 185 and 0.843 for CROES nomogram, respectively. Conclusion: Guy’s score, S.T.O.N.E score, and CROES nomogram are effective models in predicting stonefree status in PNL.

Finding the optimal anesthetic technique during PCNL for renal stone disease: A comparison of general, spinal, and combined spinal epidural anesthesia

Background: Renal stone disease is prevalent worldwide. Percutaneous nephrolithotomy (PCNL) has become an important mode of treatment for large size renal stones. Various anesthetic techniques have described for performing PCNL, with each having its own merits and demerits. There is lacuna in evidence for the ideal mode of anesthesia with best results and least associated complications. Aims and Objectives: PCNL is a common procedure for renal stones. It can be performed under various anesthesia techniques. Selection of an appropriate anesthetic technique is essential for successful outcome. In this study, we compared three anesthesia techniques during PCNL and their outcomes. Materials and Methods: Retrospective and observational study involved all cases of PCNL performed from February 2022 to January 2023. Baseline clinical and anesthesia parameters were recorded. Three groups based on anesthesia method were made; Group A for general anesthesia (GA), B for spinal anesthesia (SA), and C for combined spinal epidural anesthesia (CSEA). Intraoperative variables including heart rate (HR), blood pressure, operation time, and analgesia adequacy were noted. Post-operative pain level, hospital stay, stone free rate (SFR), complications, patient, and surgeon satisfaction were recorded. Results: Seventy-two cases (56 Male and 16 Female) with a mean age of 36.2±15.9 years were included in the study. Age and body mass index were lower in Group A, while ASA status and comorbidities were comparable. Intraoperative HR and mean blood pressure were higher in Group A than in B and C (P=0.000, P=0.003). Hypotension was more frequent in Group B (24.1%, P=0.046). Operation time, hospital stay, transfusion rates, SFR, and overall patient satisfaction were similar. Group A patients experienced more post-procedure pain (Visual analogue scale 4.1 vs. 2.2 vs. 2.1; P=0.001). Nausea-vomiting and shivering episodes were also higher in Group A (P=0.033, P=0.021). Anesthetic effect weaned-off in 6 patients of SA. Post-operative headache was higher but non-significant in Group B and C (P=0.621). Conclusion: CSEA appears a superior alternative to both SA and GA, with additional adequate post-operative comfort.

Analyzing the Effectiveness of Laser and Pneumatic Lithotripsy in the Treatment of Ureteral Stones Smaller than 1.05 Centimetres in Diameter a Multi-Center Study

Objective: aims to compare the success rates of laser lithotripsy with pneumatic lithotripsy for removing ureteric stones less than 1.5 cm at a tertiary care hospital. Method: This Multi-Center study was conducted in the urology department of Lady Reading Hospital in Peshawar total of 265 patients (125 in the PL group and 140 in the LL category) with ureteral stones were treated with ureteroscopic lithotripsy. The study's authors aimed to compare factors such as rates of stone-free patients, operation length, patient recovery time, length of hospital stay, stone migration, and complication rates. Results: Age distribution, gender distribution, typical stone size, stone point, and level of complexity were all comparable between the two groups. The LL group stood out from the rest regarding stone repositioning, SFR, and MHS. Conclusion: The [PL and LL] methods worked well and were safe for ureteral stones. However, the [LL] group may have had a greater SFR. Keywords: comparing, pneumatic lithotripsy, ureteral stones

Ureteral wall thickness and distal ureteral density in patients with residual fragments after Ho:YAG laser semi-rigid ureterolithotripsy.

Recent data suggest that greater ureteral density distal to ureteral stones or increased ureteral wall thickness (UWT) can predict impacted stones. The aim of our study was to evaluate if patients with residual fragments present with greater ureteral density and larger UWT when compared to stone-free patients. From January onward, a consecutive series of patients undergoing semi rigid Ho:YAG laser ureterolithotripsy (ULT) for ureteral stones were enrolled. A non-contrast enhanced computed tomography (CT) scan was performed before the procedure to evaluate distal ureteral density (DUD) and wall ureteral thickness (UWT) at the site of ureteral stones. Patients with residual fragments were compared to stone-free patients using a matched-pair analysis (1:1 scenario). Cases were matched sequentially using the following criteria: age, gender, body mass index (BMI), stone length, hydronephrosis, location of stones, and mean Hounsfield unit (HU) of the stone. Overall, 160 patients were enrolled, mean age was 57.9 ± 14years, mean BMI was 25.8 ± 4kg/m2, mean length of the stone was 10.6 ± 4.9mm, and mean UWT was 1.4 ± 1.6mm. A total of 150/160 (94%) patients presented hydronephrosis; mean HU stone was 868 ± 327; mean DUD was 54 ± 17.8 HU. Ureteral distal density (51.7 vs 56.6; p = 0.535) and ureteral distal thickness (1.39 vs 1.54; p = 0.078) were similar in both groups of patients. In our study, the evaluation of distal ureteral density does not predict stone-free rate. Further studies should evaluate the role for preoperative computer tomography in predicting surgery outcome.

The effects of stone density on surgical outcomes of retrograde intrarenal stone surgery.

Several pre-operative parameters have been studied to estimate stone-free rate (SFR) following retrograde intrarenal surgery (RIRS) procedures. The objective of this study was to evaluate the effects of stone density on surgical outcomes of RIRS. This retrospective study included 30 stone-free patients (Group SF) and 30 patients with residual fragments (Group RF). Patients' age and gender, laterality, non-contrast CT findings, including size and density of the kidney stones, infundibular pelvic angle (IPA), operational time, and post-operative pain were recorded and compared between the two groups. The stone density was measured by free hand region of interest (ROI) determination coincident with the stone borders and expressed as Hounsfield units (HUs). The rate of single stones was significantly higher in Group SF compared to Group RF (p < 0.001). The mean stone size was found as 11.93 ± 7.81 mm in Group SF and 16.27 ± 7.29 mm in Group RF with the difference being statistically significant (p < 0.001). The mean IPA was 53.87 degrees in Group SF and 50.33 degrees in Group RF. The mean density was measured as 748.17 ± 318.14 HU in Group SF and 945.90 ± 345.30 HU in Group RF. The mean stone density was statistically significantly higher in patients with residual fragments compared to the stone-free patients (p < 0.001). This study revealed that stone density as measured as HU affects the treatment outcomes with RIRS procedure and the mean density is significantly higher in patients with residual stone fragments. Studies about the effects of HUs on stone-free rate are limited in the literature. Stone density affects the treatment outcomes with RIRS procedure and the mean density is significantly higher in patients with residual stone fragments.

MO128: Predisposing Metabolic Factors to Urinary System Stone Formation in Patients with Autosomal Dominant Polycystic Kidney Disease

Abstract BACKGROUND AND AIMS The risk of urinary tract stone formation in patients with autosomal dominant polycystic kidney disease (ADPKD) is 20%, twice as high as in the normal population. The most important reason for this increased tendency to stone disease is thought to be anatomic changes in the kidney. To investigate metabolic factors that predispose to urinary system stone formation in individuals with ADPKD. METHOD A total of 180 volunteers who applied to our outpatient clinic between December 2019 and May 2021 were included in the study. Four groups were formed: patients with ADPKD and urinary system stones (ADPKD + STONE) (n = 42), patients with ADPKD but no stones (ADPKD + STONE FREE) (n = 43), stone patients without ADPKD (STONE) (n = 47) and healthy controls (HEALTHY) (n = 48) groups. Spot urine pH, 24-h urine volume, calcium, uric acid, oxalate, citrate, sodium and magnesium parameters were measured. STONE group data were obtained retrospectively. Along with these parameters, serum electrolyte, parathormone (PTH), ferritin, albumin, creatinine, urea and uric acid values were also compared. A P value of &amp;lt;.05 was considered significant for statistical analysis. RESULTS There was no statistically significant difference between the four groups in terms of age and gender (P &amp;gt; .05). The citrate value in 24-h urine was significantly lower in the ADPKD + STONE and ADPKD + STONE-FREE groups than the STONE and HEALTHY groups (P &amp;lt; .05). The citrate value in the 24-h urine was significantly lower in the STONE group than in the HEALTHY group (P &amp;lt; .05). The citrate value in 24-h urine did not differ significantly between the ADPKD + STONE and ADPKD + STONE FREE groups (P &amp;gt; .05). In the ADPKD + STONE and ADPKD + STONE-FREE groups, the 24-h urinary calcium value was significantly lower than the STONE and HEALTHY groups (P &amp;lt; .05). In the STONE group, the 24-h urinary calcium value was significantly higher than the HEALTHY group (P &amp;lt; .05). There was no significant difference in the 24-h urinary calcium value between the ADPKD + STONE and ADPKD + STONE FREE groups (P &amp;gt; .05). The uric acid level in 24-h urine was significantly lower in the ADPKD + STONE and ADPKD + STONE-FREE groups than in the HEALTHY group (P &amp;lt; .05). The uric acid value in the 24-h urine did not differ significantly between the ODPBH + STONE, ADPKD + STONE-FREE and STONE groups (P &amp;gt; .05). The uric acid value in 24-h urine did not differ significantly between the STONE and HEALTHY groups (P &amp;gt; .05). Oxalate, sodium and magnesium values in 24-h urine and 24-h urine volume did not differ significantly between the groups (P &amp;gt; .05). Urine pH value was significantly lower in the ADPKD + STONE, ADPKD + STONE-FREE and STONE groups than in the HEALTHY group (P &amp;lt; .05). The pH value did not differ significantly between ADPKD + STONE, ADPKD + STONE-FREE and STONE groups (P &amp;gt; .05). Serum PTH values were significantly higher in the ADPKD + STONE and ADPKD + STONE-FREE groups than in the HEALTHY group (P &amp;lt; .05). The PTH values did not differ significantly between the STONE and HEALTHY groups (P &amp;gt; .05). PTH values did not differ significantly between ODPBH + STONE, ADPKD + STONE-FREE and STONE groups (P &amp;gt; .05). There was no significant difference between the groups in terms of serum ferritin, sodium, potassium, calcium, phosphorus, magnesium and uric acid values (P &amp;gt; .05). CONCLUSION In our study, 24-h urine citrate level was found to be significantly lower in both ADPKD + STONE and ADPKD + STONE-FREE patients compared to the volunteers in the STONE and HEALTHY groups (P &amp;lt; .05). In conclusion, patients with ADPKD should also be evaluated for hypocitraturia in the outpatient clinic.

MP06-16 EFFICIENCY ANALYSIS OF AN INCREASE OF FOCAL SHOCK WAVE ENERGY THROUGH AN EXPANDED NUMBER OF SHOCKWAVES PER SESSION FOR TREATING URINARY STONES UP TO 2 CM WITH EXTRACORPOREAL SHOCKWAVE LITHOTRIPSY

You have accessJournal of UrologyStone Disease: Surgical Therapy I (MP06)1 Sep 2021MP06-16 EFFICIENCY ANALYSIS OF AN INCREASE OF FOCAL SHOCK WAVE ENERGY THROUGH AN EXPANDED NUMBER OF SHOCKWAVES PER SESSION FOR TREATING URINARY STONES UP TO 2 CM WITH EXTRACORPOREAL SHOCKWAVE LITHOTRIPSY Jose Daniel Löpez-Acón, Javier Díaz-Carnicero, Alberto Budía, Domingo Guzman Ordaz, Pilar Bahilo-Mateu, David Vivas-Consuelo, and Francisco Boronat Jose Daniel Löpez-AcónJose Daniel Löpez-Acón More articles by this author , Javier Díaz-CarniceroJavier Díaz-Carnicero More articles by this author , Alberto BudíaAlberto Budía More articles by this author , Domingo Guzman OrdazDomingo Guzman Ordaz More articles by this author , Pilar Bahilo-MateuPilar Bahilo-Mateu More articles by this author , David Vivas-ConsueloDavid Vivas-Consuelo More articles by this author , and Francisco BoronatFrancisco Boronat More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001973.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To evaluate the efficiency, in terms of cost-effectiveness, and safety of increasing focal shock wave energy through an expanded number of shockwaves per session in treating urinary lithiasis with extracorporeal lithotripsy. METHODS: a randomized, prospective and comparative study was carried out on patients with renal or ureteral lithiasis up to 2 cm and an indication of extracorporeal lithotripsy, between january 2011 and december 2019. Patients were included into two groups: group A (437 patients) was subjected to a standard treatment with 3500 waves per session, and group B (536 patients) was treated to an expanded treatment with 7000 waves per session. A Siemens Lithoskop Litotripter was used in both groups. Stone-free patients were considered after treatment when there was no lithiasis or it was expulsable (≤ 4 mm) on radiography or non-enhanced contrast TC. The study variables were: age, gender and body mass index (BMI) of the patient, side, location, size and Hounsfield Units (HU) of the stone, number of waves per session, total waves applied to resolution, number of sessions required, stone-free rate (SFR), and major and minor complication rate (Clavien-Dindo classification). A decision tree analysis was modelled for each alternative. Using this model, we estimated the incremental cost effectiveness ratio (ICER) and we conducted a Monte Carlo Simulation for a probabilistic sensitivity analysis RESULTS: Both groups were comparable in terms of age, gender and BMI of the patient, side, HU, location and size of lithiasis. The global SFR was 74.5% and 80.01% in groups A and B respectively (p=0.001). There were no differences in the complication rate (31.12% vs 30.04%, p=0.76) and severity between the two groups. The average cost of the SWL in group B was 1172.31 vs 1191.21 euros in group A. The estimated ICER showed that SWL with an extended number of shockwaves (group B) was dominant versus standard SWL treatment (group A), mainly in renal location and urinary stones bigger than 1 cm (ICER—1608 and—778, respectively). After performing the Monte Carlo simulation, the dominance of extended SWL treatment prevailed regardless of the size or location (renal or ureteral) of stone. CONCLUSIONS: The increase of focal shock wave energy through an expanded number of shockwaves per session in treating urinary lithiasis with extracorporeal lithotripsy is more cost-effective than standard treatment with similar safety. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e96-e96 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jose Daniel Löpez-Acón More articles by this author Javier Díaz-Carnicero More articles by this author Alberto Budía More articles by this author Domingo Guzman Ordaz More articles by this author Pilar Bahilo-Mateu More articles by this author David Vivas-Consuelo More articles by this author Francisco Boronat More articles by this author Expand All Advertisement Loading ...

Does Access Location Influence Outcome of Percutaneous Nephrolithotomy in Staghorn Stones?

To assess the effect of lower and middle calyceal accesses on the outcomes of percutaneous nephrolithotomy (PCNL) in staghorn stones. Observational study. Department of Urology, University of Health Sciences, Izmir Bozyaka Training and Research Hospital, Turkey, from April 2012 to January 2019. Patients who underwent PCNL for staghorn stones were retrospectively analysed. The patients were grouped as Group-1 (middle calyceal access) and Group-2 (lower calyceal access). Demographic and stone characteristics (size, density), perioperative and postoperative data, and stone-free rates were compared between these two groups. Postoperative detection of > 4 mm stones was defined as residual stones. There were 249 patients in the study; 108 in middle calyceal access group and 141 in lower calyceal access group. The mean stone burden was 765 (524-1322) and 777 (490-1445) mm2 in group-1 and group-2, respectively (p=0.876). The number of stone-free patients was 50 (46.3%) in middle calyceal access group and 93 (66.0%) in lower calyceal access group. The rate of stone-free status was significantly higher in lower calyceal access group (p=0.002). The overall complication rate was similar between the groups (p=0.132). The binary analysis showed that stone burden, and calyx of entry were predictive factors for success. Although the choice of the calyx to be entered does not affect the complication rate in staghorn stones, the stone-free rate is significantly higher in lower calyceal access. Key Words: Percutaneous nephrolithotomy, Staghorn stones, Clavien scoring system, Calyx, Access.

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

Does Previous Open Stone Surgery Affect the Outcome of Shock Wave Lithotripsy Treatment in Children?

Introduction: The aim of the study was to evaluate the efficiency of shock wave lithotripsy (SWL) in children who previously underwent ipsilateral open renal stone surgery (ORSS). Methods: A total of 315 renal units (RUs) with renal stones underwent SWL treatment in our department over a period of 18 years. A total of 274 RUs (87%) with no history of ORSS were categorized as group 1 and 41 RUs (13%) with a history of ORSS were categorized as group 2. The characteristics of the patients and renal stones, as well as the treatment modalities, were reviewed retrospectively, and the results were compared in terms of the rates of stone-free patients and complications. Results: The stone-free rates were statistically lower in patients with an existing history of ORSS (p = 0.002), especially for stones located at the lower calyx (p = 0.006). However, there were no differences between groups in the rate of complications (p = 0.75). History of ipsilateral ORSS, age, and stone burden were independent risk factors that predicted a stone-free status in the regression analysis (p = 0.016, p = 0.045, and p = 0.001, respectively). Conclusion: The overall stone-free rate after SWL was found to be significantly lower in children with a history of ORSS than in those without, and this finding was significantly prominent for lower calyx stones. In spite of the possible difficulties in achieving surgical access due to anatomical changes in retrograde intrarenal surgery or mini-/micro-percutaneous nephrolithotomy, we believe that these techniques might be good alternatives for SWL in future cases.

The Comparison of Outcome in Treating Proximal Ureteric Stones of Size 10 mm to 15 mm Using Extracorporeal Shock Wave Lithotripsy as Compared to Ureterorenoscopic Manipulation Using Holmium Laser

Urinary stone disease or nephrolithiasis, the third most common disease of the urinary tract, is a major health issue due to its high prevalence, occurrence, and recurrence. The hallmark of a stone that obstructs the ureter or renal pelvis is excruciating, intermittent pain that radiates from the flank to the groin or to the inner thigh. Stone size influences the rate of spontaneous stone passage.Our aim was to compare the efficacy &amp; the frequency of stone-free patients after intervention at 1 week after extracorporeal shock wave litho-tripsy (ESWL) and ureterorenoscopic (URS) manipulation for proximal ureteric stone (10–15 mm size).This randomized control trial was done in the department of Urology, KRL Hospital Islamabad from 18th Nov 2019 to 18th May 2020. After meeting the inclusion criteria, 100 patients were enrolled and were divided into two groups. The first group was treated with ESWL and the other with URS. Then, procedures were done. Follow-up was noted after 1 week in the stone clinic.The average age of the patients was 39.71 ± 10.17 years. Efficacy in the ESWL group was found in 68% cases while in the URS group, efficacy was noticed in 76% cases (P &gt; 0.05). Male patients were three times at a higher risk of recurrence as compared to females.This study concluded that both ESWL and URS are equally effective statistically in terms of the frequency of stone-free patients at 1 week for proximal ureteric stone (10–15 mm size).

PD15-12 USE OF ULTRA-LOW DOSE COMPUTED TOMOGRAPHY VERSUS ABDOMINAL PLAIN FILM FOR ASSESSMENT OF STONE-FREE RATES AFTER SHOCK-WAVE LITHOTRIPSY (SWL): IMPLICATIONS ON SUBSEQUENT EMERGENCY ROOM VISITS, SURGICAL PROCEDURES AND COST-EFFECTIVENESS

You have accessJournal of UrologyStone Disease: Shock Wave Lithotripsy (PD15)1 Apr 2020PD15-12 USE OF ULTRA-LOW DOSE COMPUTED TOMOGRAPHY VERSUS ABDOMINAL PLAIN FILM FOR ASSESSMENT OF STONE-FREE RATES AFTER SHOCK-WAVE LITHOTRIPSY (SWL): IMPLICATIONS ON SUBSEQUENT EMERGENCY ROOM VISITS, SURGICAL PROCEDURES AND COST-EFFECTIVENESS Akshay Sood*, Philip Wong, Alex Borchert, Jacob Keeley, Isaac Palma-Zamora, Natalija Kovacevic, Philip Olson, Guillaume Farah, Firas Abdollah, Wooju Jeong, Hans Stricker, Craig G. Rogers, Mani Menon, James O. Peabody, Raymond Littleton, and David A. Leavitt Akshay Sood*Akshay Sood* More articles by this author , Philip WongPhilip Wong More articles by this author , Alex BorchertAlex Borchert More articles by this author , Jacob KeeleyJacob Keeley More articles by this author , Isaac Palma-ZamoraIsaac Palma-Zamora More articles by this author , Natalija KovacevicNatalija Kovacevic More articles by this author , Philip OlsonPhilip Olson More articles by this author , Guillaume FarahGuillaume Farah More articles by this author , Firas AbdollahFiras Abdollah More articles by this author , Wooju JeongWooju Jeong More articles by this author , Hans StrickerHans Stricker More articles by this author , Craig G. RogersCraig G. Rogers More articles by this author , Mani MenonMani Menon More articles by this author , James O. PeabodyJames O. Peabody More articles by this author , Raymond LittletonRaymond Littleton More articles by this author , and David A. LeavittDavid A. Leavitt More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000858.012AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Ultra-low dose computed tomography (ULD-CT) provides a much superior stone detection accuracy compared to an abdominal plain film (KUB), for equivalent radiation exposure. To evaluate stone-free rates post-SWL using ULD-CT versus KUB, and assess the impact of imaging modality utilized on subsequent emergency department (ED) visits, unplanned/planned surgical procedures and overall cost-effectiveness. METHODS: We performed a retrospective review of patients undergoing SWL between 2013-2016 (n=417) at two high-volume surgical centers. Outcomes studied were: 1) ED utilization, 2) unplanned surgeries, and 3) planned surgeries, for a 3 month post-imaging period. Univariable and multivariable adjusted analyses studied the impact of imaging modality on outcomes. Markov decision-tree analysis was performed to identify a clinical scenario that achieved a cost advantage for ULD-CT over KUB. A p<0.05 was considered significant. RESULTS: Of the 417 patients studied, 57 (13.7%) underwent ULD-CT while the remaining 360 underwent KUB for follow-up imaging. The stone-free rates were 63.2% (n=36 of 57) and 77.2% (n=278 of 360) in the ULD-CT and KUB groups (p=0.019), respectively. A 5.6% (n=2 of 36) of the patients deemed stone-free on ULD-CT, and an 18% (n=50 of 278) deemed stone-free on KUB returned to the ED within the study-period (p=0.040). Similarly, 2.8% (n=1 of 36) of the stone-free patients in the ULD-CT group and 15.1% (n=42 of 278) in the KUB group needed an unplanned surgery (p=0.027). ULD-CT use was associated with significantly reduced odds of ED visits and unplanned procedures in multivariable analyses, with odds ratios of 0.19 and 0.10, p<0.05 for both, respectively. There were no differences in the rates of planned procedures in patients deemed not stone-free (ULD-CT 19% vs KUB 14.6%; p=0.418). With regards to cost-effectiveness analysis, significant variation was noted in online-reported ULD-CT charges ($382 to $2000). At low ULD-CT charges, the ULD-CT follow-up pathway was economically more favorable, but with increasing ULD-CT charges, the KUB follow-up pathway superseded. CONCLUSIONS: ULD-CT provides a more ‘true’ estimate of stone-free status, and in consequence mitigates unwanted emergency and operating room visits. Further, at low ULD-CT costs, it may also be economically more favorable. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e361-e362 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Akshay Sood* More articles by this author Philip Wong More articles by this author Alex Borchert More articles by this author Jacob Keeley More articles by this author Isaac Palma-Zamora More articles by this author Natalija Kovacevic More articles by this author Philip Olson More articles by this author Guillaume Farah More articles by this author Firas Abdollah More articles by this author Wooju Jeong More articles by this author Hans Stricker More articles by this author Craig G. Rogers More articles by this author Mani Menon More articles by this author James O. Peabody More articles by this author Raymond Littleton More articles by this author David A. Leavitt More articles by this author Expand All Advertisement PDF downloadLoading ...

Validation of S.T.O.N.E nephrolithometry and Guy's stone score for predicting surgical outcome after percutaneous nephrolithotomy.

Background:The aim of this study was to validate and compare Guy's and S.T.O.N.E. scoring systems in predicting perioperative and postoperative outcome following percutaneous nephrolithotomy (PCNL).Materials and Methods:From November 2015 to June 2017, 190 patients with renal stones who underwent single tract unilateral PCNL in the prone position were included in our study. Guy's and S.T.O.N.E. nephrolithometry scores were calculated in each case based on preoperative computed tomography images. The association of these scoring systems with stone-free status, length of hospital stay, operative time, and postoperative complications was studied. Regression analysis was done, and receiver operating characteristic curves were plotted.Results:Mean S.T.O.N.E. and Guy's stone scores were 8.76 ± 2.29 and 2.70 ± 1.0, respectively. When compared with patients with residual stones, stone-free (SF) patients had significantly lower mean Guy's score (2.58 ± 1.01 vs. 3.23 ± 0.77 [P < 0.001]) and S.T.O.N.E. scores (8.44 ± 2.24 and 10.17 ± 2.0 [P < 0.001]), respectively. On logistic regression analysis, both Guy's score (odds ratio [OR] = 0.48, P = 0.001) and S.T.O.N.E score (OR = 0.78, P = 0.001) were found to be significantly associated with SF status. Both of these scoring systems were also significantly associated with longer operative time (>90 min), prolonged hospital stay (>3 days) and overall complications. No significant difference was found in the area under curve for both scoring systems for stone clearance.Conclusion:Both the S.T.O.N.E and Guy's scoring systems were found to predict the outcome of PCNL, either of these could be used in the routine clinical practice for patients' counseling.

Evaluation of Modified STONE Score in Patients Presenting to the Emergency Department with Flank Pain

Purpose: Renal colic due to urinary system stone disease is one of the main complaints in emergency department (ED) admissions. The STONE score is the most used model. The “race” item in the nomogram is not useful for communities where the Black race is not dominant. Therefore, we aimed at investigating the diagnostic value of a new modified scoring system, in which we replaced the “race” item in the original nomogram by “obstruction = pelvicalyceal dilation.” Materials and Methods: The study included patients who were admitted to a tertiary university ED with flank pain and underwent ultrasonography (US) from June 2017 to November 2017. Patients' demographic data such as US findings and the STONE score parameters were recorded. “Obstruction (pelvicalyceal dilation)” replaced the “race” item of the original STONE score. The diagnostic value of the modified system was investigated by categorizing the scores as low risk (0–5 points), moderate risk (6–9 points), and high risk (10–13). Results: The study included 305 patients who met the inclusion criteria. The mean age was 39.45 ± 13.83 years, and 170 patients (55.7%) were male. Pelvicalyceal dilation was detected on US at a statistically significantly higher percentage in patients with stones compared to stone-free patients (P &lt; 0.001). The modified STONE score was statistically significantly higher in patients with stones compared to stone-free patients (P &lt; 0.001). Conclusion: We suggest that the replacement of the race parameter of the original STONE score by the US finding of pelvicalyceal dilation will enhance the diagnostic value of scoring in societies mostly comprising a non-Black population.

Treatment strategy of hilar and intraglandular stones in wharton's duct: A 12-year experience.

To suggest a strategy for transoral removal of hilar and intraparenchymal submandibular stones. Retrospective case series. Retrospective evaluation was performed for 514 consecutive patients with hilar and intraparenchymal submandibular stones treated via endoscopy-assisted surgery from January 2006 to June 2018. Three patients had bilateral stones. The stones were classified as: hilar (type I), posthilar (type II), intraparenchymal (type III), and multiple stones (type IV). The affected glands included 311 with type I, 84 with type II, 65 with type III, and 57 with type IV stones. Stones were successfully removed in 478 glands (92.5%, 478/517). Main treatment techniques included hilum ductotomy in 311 glands, intraparenchymal ductotomy in 68, submandibulotomy in 14, intraductal retrieval in 74, and hilum ductotomy accompanied by intraductal retrieval in 11. At a mean 40-months follow-up of 478 successful cases, clinical outcomes were good in 425, fair in 27, and poor in 26 glands. Postoperative sialograms in 75 stone-free patients were categorized as: type I, normal (n = 6); type II, ectasia or stenosis in the main duct and no persistent contrast on functional films (n = 44); type III, ectasia or stenosis in the main duct and mild contrast retention (n = 15); and type IV, poor shape of the main duct and evident contrast retention (n = 10). Postoperative sialometry of 32 patients revealed no significant differences of the gland function between the two sides. Appropriate use of various endoscopy-assisted approaches helps preserve the gland and facilitates recovery of gland function in patients with different depths of hilo-parenchymal submandibular stones. 4 Laryngoscope, 130:2360-2365, 2020.