Stone Obstruction Research Articles

The Non-Accessible Ureter: Can History, Gender, Age, BMI, Radiology and Stone Size Predict the Requirement of Pre-Stenting in Narrow Ureters

Abstract: Background: The difficulty in access to the ureter during stone removal surgery enhances the chances of redo-surgery, DJ stenting, and associated complications, this failure leads to mistrust in the doctor-patient relationship. Objective: This study aims to provide a comprehensive evaluation of the incidence & management of narrow ureters after failure to negotiate retrograde access of rigid or flexible Ureteroscope (6/7.5 Fr ). Materials and Methods: This is a Prospective, cross-sectional study, conducted at the urology department of Tabba Kidney Institute, from June 2022 to June 2023. The minimum required sample size was 250. Patients aged between > 18 to <60 diagnosed with Unilateral and bilateral ureteric stones and hydronephrosis without ureteric stone obstruction were included in the study. SPSS 22 was used to analyze the data, the chi-square test was applied, with p-value <0.05 as significant. Result: The overall mean age of the study population was estimated as 40.71 ± 12 years, while gender distribution indicated 138 (55.2%) male and 112 (44.8%) female patients. Group distribution identified 172 (68.8%) patients with negotiable ureter (Group A), while 78 (31.2%) with non-negotiable ureter (Group B). Conclusion: We conclude that in our population there is a higher incidence of narrow ureters, as compared to other studies which are not accessible even using the same dilatation technique, so it is safe to counsel the patients pre-operatively about the possibility of the narrow ureter and need for pre-stenting. Tabba Ureter Accessibility (TUA) score can be used as a tool to predict the possibility of a narrow ureter. Keywords: Narrow ureter, Ureteric stone, DJ stent, Ureterorenoscope, Dehydration, Hematuria.

Application of novel burst wave lithotripsy and ultrasonic propulsion technology for the treatment of ureteral calculi in a bottlenose dolphin (Tursiops truncatus) and renal calculi in a harbor seal (Phoca vitulina)

Marine mammals may develop kidney stones, which can be challenging to treat. We describe burst wave lithotripsy (BWL) and ultrasonic propulsion to treat ureteral calculi in a 48-year-old female bottlenose dolphin (Tursiops truncatus) and to reduce renal stone burden in a 23-year-old male harbor seal (Phoca vitulina). BWL and ultrasonic propulsion were delivered transcutaneously in sinusoidal ultrasound bursts to fragment and reposition stones. Targeting and monitoring were performed with real-time imaging integrated within the BWL system. Four dolphin stones were obtained and fragmented ex vivo. The dolphin case received a 10-min and a 20-min BWL treatment conducted approximately 24 h apart to treat two 8–10 mm partially obstructing right mid-ureteral stones, using oral sedation alone. For the harbor seal, while under general anesthesia, retrograde ureteroscopy attempts were unsuccessful because of ureteral tortuosity, and a 30-min BWL treatment was targeted on one 10-mm right kidney stone cluster. All 4 stones fragmented completely to < 2-mm fragments in < 20 min ex vivo. In the dolphin case, the ureteral stones appeared to fragment, spread apart, and move with ultrasonic propulsion. On post-treatment day 1, the ureteral calculi fragments shifted caudally reaching the ureteral orifice on day 9. On day 10, the calculi fragments passed, and the hydroureter resolved. In the harbor seal, the stone cluster was observed to fragment and was not visible on the post-operative computed tomography scan. The seal had gross hematuria and a day of behavior indicating stone passage but overall, an uneventful recovery. BWL and ultrasonic propulsion successfully relieved ureteral stone obstruction in a geriatric dolphin and reduced renal stone burden in a geriatric harbor seal.

Case report of unusual complication following thread lifting: an obstructive stone in the parotid duct

Advances in plastic surgery have included a shift toward less invasive procedures. To improve outcomes and avoid incisional surgery, numerous noninvasive face-lifting techniques have been studied. This includes thread-lifting, a technique that promises to correct facial aging with limited scarring, rapid recovery, and minimal complications. As the population ages, an increasing number of ordinary people in South Korea are undergoing thread lifting procedures for the purpose of rejuvenation. The procedure involves insertion of a thread under the skin into the subcutaneous tissue, using a long needle as a guide. Dents or barbs prevent the thread from slipping and provide uniform aggregation of soft tissue to create a new volume contour when the thread is lifted. This procedure has gained worldwide popularity and is frequently performed. However, some minor complications have been reported. In this paper, we report an unusual complication: an obstructive stone in the parotid (Stensen) duct after a thread-lifting procedure using nonabsorbable anchoring threads.

Influence of Frailty in Patients Undergoing Endoscopic Retrograde Cholangiopancreatography for Biliary Stone Disease: A Nationwide Study.

Pancreaticobiliary diseases are common in the elderly. To this end, frailty represents a state of vulnerability that should be considered when assessing the risks and benefits of therapeutic endoscopic procedures. We aim to determine the rate of readmissions and clinical outcomes using the validated Hospital Frailty Risk Score in patients undergoing endoscopic retrograde cholangiopancreatography (ERCP). Using the National Readmissions Database, we identified patients with an admission diagnosis of cholangitis with obstructive stone from 2016 to 2019. Patients were determined to be of low frailty risk with a score of < 5, while patients of medium to high frailty risk had a score of > 5. During the study period, 5751 patients were identified with acute cholangitis with obstructing stone. Mean age of index admissions was 69.4years and 51.8% were female. From the total cohort, 5119 (89.2%) patients underwent therapeutic ERCP, 38.0% (n = 1947) of whom were regarded as frail (risk score > 5). Following ERCP, frail patients had a less but statistically insignificant readmission rate compared to non-frail patients (2.76% vs 4.05%, p = 0.450). However, compared to non-frail patients, frail patients experienced higher post-ERCP complications (6.20% vs 14.63%, p < 0.001). Frail patients were more likely to have longer lengths of stay, higher hospital cost, and mortality risk. ERCP is not a risk factor for readmission among frail patients. However, frail patients are at higher risk for procedure-related complications, healthcare utilization, and mortality.

#3616 NON-ANESTHETIC STENTING IS AN EQUIVALENTLY EFFECTIVE METHOD COMPARED WITH PERCUTANEOUS NEPHROSTOMY IN ACHIEVING EARLY RECOVERY IN STONE INFECTED PATIENTS

Abstract Background and Aims The prevalence of urinary tract stones is increasing. Although the importance of urgent decompression in managing this condition is well established, preferences for drainage methods (stenting vs. percutaneous nephrostomy [PCN]) differ depending on the treating institution. We therefore analyzed the effects of different drainage methods on early recovery. Method We retrospectively reviewed the medical records of patients hospitalized for infection with urinary obstruction due to urinary calculi at Gangneung Asan Hospital between January 2011 and December 2020. All patients underwent stenting or PCN. Early recovery was defined as subsided fever or discharge within 3 days after the procedure. Results A total of 178 patients, including 98 treated with double J stents and 80 treated with PCN were included. Univariate analysis revealed male sex, diabetes mellitus, coronary heart disease, mid ureter stone, upper ureter stone, stone size of 10-20 mm, and renal stone concomitance as significant prognostic factors for early recovery. In contrast, multivariate analysis revealed male sex (P=0.036), diabetes mellitus (P=0.031), mid ureter stone (P=0.007), upper ureter stone (P=0.026) as significant prognostic factors for early recovery (Table 2). When stenting was compared with PCN, the recovery period of fever and C-reactive protein and white blood cell levels showed similar trends. Conclusion Male patients and those without risk factors for stone-related complications tended to recover more easily after the procedure. The results demonstrate that non-anesthetic stenting is an effective method, compared with PCN, to achieve early recovery in infected patients due to stone obstruction.

MP23-05 NONINVASIVE ACOUSTIC FORCEPS USING ULTRASOUND TO MANIPULATE OBJECTS IN THE URINARY TRACT

You have accessJournal of UrologyCME1 Apr 2023MP23-05 NONINVASIVE ACOUSTIC FORCEPS USING ULTRASOUND TO MANIPULATE OBJECTS IN THE URINARY TRACT Mohamed Ghanem, Arturo Holmes, Adam Maxwell, Michael Bailey, Mathew Sorensen, and Jonathan Harper Mohamed GhanemMohamed Ghanem More articles by this author , Arturo HolmesArturo Holmes More articles by this author , Adam MaxwellAdam Maxwell More articles by this author , Michael BaileyMichael Bailey More articles by this author , Mathew SorensenMathew Sorensen More articles by this author , and Jonathan HarperJonathan Harper More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003248.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Ultrasonic propulsion has been demonstrated in clinical trials to noninvasively reposition renal stones along the direction of the probe. However, extracorporeal manipulation of stones causing ureteral stone obstruction requires controlled movement along a complex path in the urinary tract. Here, we evaluate the safety and utility of a method for controlled manipulation of stone models in vivo in a complex three-dimensional (3D) path using focused ultrasound beams. METHODS: A multi-element ultrasound array transducer with a 12-cm focus was used to produce an acoustic trap around a stone model (3 mm glass sphere) in the bladder of three pigs under anesthesia. The array was coupled to the pig by a water bath and synchronized with a P6-3 ultrasound imaging probe for targeting. A cystoscope was inserted into the bladder to visualize the motion. The sphere was acoustically trapped and steered along three different paths (Figure 1a-c). Deviation of the measured from the intended path was calculated to quantify the accuracy. The total energy exposure to manipulate the stone was low; at 1.5 MHz, the maximum exposure had a maximum peak pressure of 1.4 MPa and a pulse average intensity of 133 W/cm2. The bladder was then evaluated histologically. RESULTS: Spheres were levitated and moved in the three paths in all pigs for a total of 26 manipulations. The spheres were lifted and moved 1) laterally 3 mm and back down, 2) in a horizontal, and 3) in a vertical loop of 3 mm radius. The average discrepancy between the desired path and that observed on ultrasound was 0.24±0.07 mm, and by the cystoscope was 0.17±0.09 mm. The sphere was dragged for 5 cm along the bladder wall by moving the array mechanically (Figure 1d). The skin to stone depth was 2±0.5 cm. Histology showed no signs of injury to the bladder wall. CONCLUSIONS: This work demonstrated the controlled, noninvasive manipulation of stone models in vivo at safe ultrasound power levels. This work potentiates the use of noninvasive ultrasound tweezers to facilitate movement of stones in any direction which could expand the capabilities of ultrasonic propulsion alone. Source of Funding: Work supported by NIDDK P01 DK043881, K25 DK132416 © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e307 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mohamed Ghanem More articles by this author Arturo Holmes More articles by this author Adam Maxwell More articles by this author Michael Bailey More articles by this author Mathew Sorensen More articles by this author Jonathan Harper More articles by this author Expand All Advertisement PDF downloadLoading ...

Retrograde ureteral catheterization under local anesthesia for emergency drainage in patients with infection and hydronephrosis secondary to ureteral calculi: Experience from a tertiary care hospital.

The aim is to evaluate the safety and efficacy of retrograde ureteral catheterization under local anesthesia in patients with urinary tract infections complicated by hydronephrosis caused by ureteral stone obstruction. From October 2020 to September 2021, a retrospective analysis of patients' medical records was performed. Records of past history, physical examination, laboratory tests, and imaging investigations were reviewed. Retrograde ureteric stent (RUS) was performed under local anesthesia using cystoscopes and guided by portable fluoroscopy. Real-time fluoroscopy was used to verify the double-J stent position and confirm a smooth process. The postoperative recovery and length of admission were also recorded. A total of 14 patients with ureteral stone obstruction with infective hydronephrosis received 15 total emergency RUS procedures (one bilateral). Intraoperative findings, operation times, and infection signs were recorded and analyzed. All patients met systemic infection criteria, with a mean body temperature of 38.7°C ± 1.7°C. Leukocytosis was noted in 8 (57.1%) patients. Elevated C-reactive protein (8.5 ± 6.3 mg/L) and procalcitonin (24.1 ± 22.0 ng/mL) were found in 13 (92.9%) and 9 (64.3%) patients, respectively. Mean stone size was 8.5 ± 6.3 mm, mostly localized to the upper ureter (upper: 12; middle: 0; lower: 3). Mean operation time was 14.1 ± 4.3 min. After emergency drainage, all patients improved and were discharged after infection was controlled. The average length of admission was 6.2 ± 2.2 days. RUS under local anesthesia is safe and effective for treating infective hydronephrosis due to ureteral stone obstruction. A randomized controlled trial with a large sample remains necessary to validate these findings.

Management of Patients with Urinary Stone Obstruction a Single-Center Study

Aim: This study aims to characterize the clinical manifestations, location of the obstruction, and surgical intervention results of individuals with obstructive urethral stones. Study design: A single-center study Place and Duration: IKD Peshawar, Departboyst of Urology, from January 1, 2020, to January 1, 2021. Methods: 124 obstructive urethral stones were treated at IKD Peshawar. 4 to 14-year-old patients Obstructive urethral stones were treated surgically by removing the stone from the external urethral meatus (stone retrieval) with or without Meatotomy, retrograde manipulation (push back), and then cystolithoclasty or cystolitholapaxy, depending on the stone's position and size. Results: The mean age was 04±12.14 was between 10 and 12 years old. A total of 118 boys (98%), together with 06 girls (02%), were aged 13 and above. Sixty boys had stones in the proximal urethra (prostatic and membranous) or bulbar urethra, while 24 boys had stones in the external urethral meatus. Stones were found in the external urethral meatus of 60 boys individuals. Conclusion: For the most part, obstructive urethral stones may be managed with endoscopic therapy, but in certain situations, a minor operation like a meatotomy is necessary. Keywords: urethral obstruction, managment t, outcome, surgery, intervention

QSOFA and SOFA scores are valuable tools for predicting postoperative sepsis resulting from ureteroscopic lithotripsy (URSL)

The sequential organ failure assessment (SOFA) and quick sequential organ failure assessment (qSOFA) scores are new tools which are used to assess sepsis based on the Third International Consensus Definitions for Sepsis and Septic Shock Task Force. This study aimed to evaluate the feasibility of using the SOFA and qSOFA to predict post-ureteroscopic lithotripsy (URSL) sepsis. Patients who underwent URSL due to ureteral stone obstruction were retrospectively reviewed using SOFA and qSOFA scores. Patient characteristics including age, gender, comorbidities, American Society of Anesthesiologists Classification, stone burden, stone location, hydronephrosis status, infectious status, preoperative SOFA and qSOFA score were collected. Preoperative factors were analyzed to determine if they were correlated with postoperative sepsis. A total of 830 patients were included in this study, of whom 32 (3.9%) had postoperative sepsis. Multivariate analysis revealed that older age, proximal ureteral stones, severe hydronephrosis, and high preoperative qSOFA or SOFA score were significantly associated with postoperative sepsis. The areas under the curves of a qSOFA score ≥ 1 and SOFA score ≥ 2 for predicting postoperative sepsis were 0.754 and 0.823, respectively. Preoperative qSOFA and SOFA scores are convenient and effective for predicting post-URSL sepsis. Further preventive strategies should be performed in these high-risk patients.

Should renal resistive index be considered as a routine predictor in newly diagnosed acute hydronephrosis in patients with unilateral renal colic?

Urinary tract stones are the most common causes of urinary tract obstruction, leading to patient hospitalization in the emergency room. This study is aimed to evaluate the use of the mean resistance index (mRI) to predict hydronephrosis in patients admitted for acute renal colic. This prospective study was performed on 100 patients who were admitted to the emergency department (ED) with unilateral renal colic (RC) problem. At the first visit, the following was done for all patients: 1. blood was taken from them for laboratory studies; 2. ECG and cardiological test; 3. plain film of the urinary tract; 4. аbdominal US; 5. bilateral color doppler ultrasound (CDUS) with renal RI measurement. Based on the information collected at different times during the experiment, patients were divided into two groups: the group that showed signs of dilatation (group A) and the group with hydronephrosis (group B). The obtained data were analyzed statistically by SPSS version 20. A mRI with a 0.68 cut off value was the most accurate (AUC:0.878), and Sensitive (90%) cut-off value for prediction of hydronephrosis development among patients presenting with RC and renal stone. This cut-off value also provided the highest positive (94%) and negative (76%) predictive values. CDUS with RI measurement is an easy and non-invasive method that provides useful information about urinary tract obstruction stones in patients with unilateral RC. In our study, this method was able to predict successfully the onset of acute renal dilatation. This was done with different levels of sensitivity, specificity, accuracy and diagnostic efficiency that were higher than ultrasound. Daily use of CDUS in ED can improve ultrasound, especially when other methods are contraindicated. For example, the methods by which the patient is exposed to radiation (pregnancy, allergies, renal failure, etc.) or intravenous injection of contrast agents (urography and CT).

Community-onset urosepsis: incidence and risk factors for 30-day mortality – a retrospective cohort study

Background Urosepsis is a life-threatening condition that needs to be addressed without delay. Two critical issues in its management are: (1) Appropriate empirical antibiotic therapy, considering the patients general condition, comorbidity, and the pathogen expected; and (2) Timing of imaging to identify obstruction requiring decompression. Objectives To identify risk factors associated with 30-day mortality in patients with urosepsis. Methods From a cohort of 1,605 community-onset bloodstream infections (CO-BSI), 282 patients with urosepsis were identified in a Swedish county 2019–2020. Risk factors for mortality with crude and adjusted odds ratios were analysed using logistic regression. Results Urosepsis was found in 18% (n = 282) of all CO-BSIs. The 30-day all-cause mortality was 14% (n = 38). After multivariable analysis, radiologically detected urinary tract disorder was the predominant risk factor for mortality (OR = 4.63, 95% CI = 1.47–14.56), followed by microbiologically inappropriate empirical antibiotic therapy (OR = 4.19, 95% CI = 1.41–12.48). Time to radiological diagnosis and decompression of obstruction for source control were also important prognostic factors for survival. Interestingly, 15% of blood cultures showed gram-positive species associated with a high 30-day mortality rate of 33%. Conclusion The 30-day all-cause mortality from urosepsis was 14%. The two main risk factors for mortality were hydronephrosis caused by obstructive stone in the ureter and inappropriate empirical antibiotic therapy. Therefore, early detection of any urinary tract disorder by imaging followed by source control as required, and antibiotic coverage of both gram-negative pathogens and gram-positive species such as E. faecalis to optimise management, is likely to improve survival in patients with urosepsis.

The Role of Testosterone Hormone on Crystal Formation Through the Renal Expression of Osteopontin in Male Wistar Rat

This study aims to investigate the role of testosterone hormone on crystal formation through osteopontin expression. This was an experimental study with post-test only control design. A total of 12 rats aged 10 weeks were divided into two groups which are male rats group fed with water containing EG (Ethylene Glycol) 0.75% and male rats group fed with water containing EG (Ethylene Glycol) 0.75% and were injected with testosterone hormone. Furthermore, the rats were observed and fed with standard diet for 30 days. Then, both groups were terminated. The kidneys were extracted and examined for Osteopontin expression. Histopathology examination was also performed in both groups The result of the study showed that the mean kidney osteopontin expression in male rats fed with water containing EG 0.75% and received testosterone hormone injection were significantly higher (29.16 ± 9.072) compared to male rat groups fed with water containing EG 0.75% alone (11.42 ± 3.692) with p value 0.001. Histopathology examination with HE stain revealed that both groups demonstrated the presence of stone in kidney tubules, kidney swelling and pelvic ectasis. This feature suggested the presentation of hydronephrosis as a result of stone obstruction. As a conclusion, this study shed light on the role of hormonal sex of testosterone involving in crystal formation through osteopontin expression. Keywords: urolithiasis, testosterone, sex hormone, osteopontin

Design of a fully intraureteral stent and proof-of-concept in vivo evaluation.

BackgroundUreteral stents are employed regularly to facilitate urine drainage and ureteral healing in a wide variety of endourological procedures, associated mainly with ureteral stone obstruction. However, stent use frequently impairs patient quality of life, which is generally attributed to the presence of anchoring stent curls in the bladder and/or kidney. The purpose of this study was to examine the potential effectiveness and safety of a newly designed, fully intraureteral stent, in an initial proof-of-concept in vivo evaluation.Methods“Yoticurl” stents were synthesized from copolymeric, commercially-available ureteral stents. A first test to confirm the intended expansion of the spiral curls in a ureter was performed on a pig cadaver. Subsequently, a preliminary in vivo evaluation in a single pig model was completed to test stent viability, over a period of 25 days. Two stents were inserted to fully intraureteral positions into the two ureters, by standard human endourological procedure. Daily observational checks of the pig, and regular radiographic analyses were performed; the animal was then euthanized and examined by explorative laparotomy, followed by histological analysis of kidney, ureter and bladder tissue samples.ResultsThe pig displayed normal activity, appetite and sleep patterns, and radiography indicated free flow of urine, and no significant stent migration nor anatomical abnormalities. Subsequent histology found only mild inflammation in the ureter.ConclusionsThe innovative stent design tested here, if ultimately proven safe and effective for human use, may offer an alternative to currently available stents for multiple indications.

MP034 - Can Urinary KIM-1 and NGAL predict management endoscopic surgery in acute unilateral obstructive stone disease? Results from a Prospective Cohort Study.

MP034 - Can Urinary KIM-1 and NGAL predict management endoscopic surgery in acute unilateral obstructive stone disease? Results from a Prospective Cohort Study.

Acute kidney injury due to ammonium acid urate stones in a patient with adenovirus gastroenteritis: a case report

BackgroundAdenovirus gastroenteritis is a common cause of diarrhea and vomiting in infants, resulting in prerenal acute kidney injury (AKI). However, postrenal AKI due to urinary stones associated with adenovirus gastroenteritis is extremely rare. Here, we describe postrenal AKI due to obstructive ammonium acid urate stones associated with adenovirus gastroenteritis.Case presentationA previously healthy 6-month-old boy had an 11-day history of severe diarrhea and a 5-day history of vomiting. His stool was positive for adenovirus antigens. We initiated fluid replacement therapy. On the second hospital day, he suddenly developed anuria. Abdominal computed tomography revealed bilateral hydronephrosis, left ureteral stones, and right bladder ureteral junction stones. Laboratory data showed that the creatinine level increased to 1.00 mg/dL. We diagnosed postrenal AKI due to obstructive bilateral urinary stones. Urination with stable urine volume resumed spontaneously after hydration. A few stones were found in the urine, which consisted of ammonium acid urate (> 98%). The serum creatinine level improved to 0.25 mg/dL. He was discharged nine days after admission.ConclusionsWe suggest that adenovirus gastroenteritis be considered in pediatric patients with postrenal AKI due to urinary stones.

Quality of life after sialendoscopy: prospective non-randomized study

BackgroundThe symptomatic (swelling and pain) salivary gland obstructions are caused by sialolithiasis and salivary duct stenosis, negatively affecting quality of life (QOL), with almost all candidates for clinical measures and minimally invasive sialendoscopy. The impact of sialendoscopy treatment on the QOL has been little addressed nowadays. The objective is to prospectively evaluate the impact of sialendoscopy on the quality of life of patients undergoing sialendoscopy due to benign salivary obstructive diseases, measured through QOL questionnaires of xerostomia degree, the oral health impact profile and post sialendoscopy satisfaction questionnaires.Result37 sialendoscopies were included, most young female; there were 64.5% sialolithiasis and 35.4% post-radioiodine; with 4.5 times/week painful swelling symptoms and 23.5 months symptom duration. The pre- and post-sialendoscopy VAS values were: 7.42 to 1.29 (p < 0.001); 86.5% and 89.2% were subjected to sialendoscopy alone and endoscopic dilatation respectively; 80.6% reported improved symptoms after sialendoscopy in the sialolithiasis clinic (p < 0.001). The physical pain and psychological discomfort domain scores were mostly impacted where sialendoscopy provided relief and improvement (p < 0.001). We found a positive correlation between sialendoscopy and obstructive stone disease (p < 0.001) and no correlation in sialendoscopy satisfaction in xerostomia patients (p = 0.009).ConclusionsWe found improved symptoms with overall good satisfaction after sialendoscopy correlated with stones; and a negative correlation between xerostomia. Our findings support the evident indication of sialendoscopy for obstructive sialolithiasis with a positive impact on QOL and probably a relative time-dependent indication for stenosis/other xerostomia causes that little improved QOL satisfaction.Level of evidence2b—Prospective non-randomized study.Trial registration: WHO Universal Trial Number (UTN): U1111-1247-7028; Brazilian Clinical Trials Registry (ReBeC): RBR-6p8zfs.

Comparative Analysis of Robot Assisted Laparoscopy and Laparoscopic Pyeloplasty in the Treatment of Ureteropelvic Junction Obstruction

Through the comparison with laparoscopic pyeloplasty, this paper discusses the clinical value of robot assisted laparoscopic pyeloplasty in the treatment of ureteropelvic junction obstruction (UPJO). 82 patients with UPJO admitted to the First Affiliated Hospital of Medical College of Zhejiang University from January 2012 to December 2018 were retrospectively analyzed, including 43 patients who underwent robot assisted laparoscopic pyeloplasty (RALP group); Laparoscopic pyeloplasty was performed in 39 cases (LP group). The operation time, reconstruction suture time, intraoperative bleeding, postoperative drainage, postoperative intestinal recovery time, postoperative hospitalization time, hospitalization expenses, surgical complications and follow-up were compared and analyzed between the two groups. There was no significant difference between the two groups in operation time, renal pelvis reconstruction time, intraoperative bleeding, postoperative drainage tube stopping time, postoperative drainage volume and intestinal recovery time (P > 0.05); and the postoperative indwelling time of urinary catheter and postoperative hospital stay in RALP group were shorter than those in LP group (P < 0.05); The hospitalization cost in RALP group was significantly higher than that in LP group. Clavien Grade II complications occurred in 8 cases in LP group, Clavien Grade II complications occurred in 2 cases in RALP group, and there was 1 case of Grade III complications in both groups. The complication rate was 6.79% in RALP group and 23.07% in LP group. There was significant difference between the two groups (P < 0.05). During the postoperative follow-up, hydronephrosis was aggravated in 1 patient in RALP group half a year after operation, and hydronephrosis was aggravated in 1 patient in LP group due to ureteral stone obstruction. Another patient in LP group was found to have more hydronephrosis than before. The success rate was 97.7% in RALP group and 94.8% in LP group. There was no significant difference between the two groups (P > 0.05). Compared with laparoscopy, robot assisted laparoscopic pyeloplasty is a better surgical option. With the reduction of cost, it will gradually replace laparoscopic pyeloplasty.

Pyonephrosis complicated with pleural empyema – case report

Pyonephrosis is defined as the infection of the dilated renal collector system, with a variety of etiological agents. The accumulation of pus may cause the destruction of renal parenchyma, leading to renal insufficiency. The symptoms may occur early or late in the disease’s progress and can be of a great variability. We present a case report of a 53-year-old female which suffered of low back pain, fever and nausea. The ultrasound and CT examination revealed 4th stage pyonephrosis caused by stone obstruction. It was also observed right encysted pleural empyema and pericardial fluid as pyonephrosis’ complications. The first part of the treatment consisted of inserting a percutaneous nephrostomy (PCN) probe along with the administration of antibiotics for the next two months, followed by radical right nephrectomy in renal insufficiency context. The postoperative evolution was favorable with no repercussions.

Modern vision on the problem of urolithiasis in children: Epidemiology, etiopathogenesis, clinical, diagnostics, treatment, metaphylaxis

According to the study literature, urolithiasis remains one of the most common nosologies among the child population. In connection with the global changes in the health status of the population of our planet, the social significance of urolithiasis has recently acquired new relevance. The mechanism of stone formation is a complex process; stones are formed as a result of urine saturation with oxalates, calcium, uric acid, cystine. Most stones in children are located in the upper urinary tract. In 15%-25% of cases in children, urolithiasis may be asymptomatic. Diagnostics today are not difficult. If urolithiasis is suspected, first, among the instrumental research methods, ultrasound examination of the urinary tract is used, which identifies both X-ray-positive and X-ray-negative stones. Nowadays, not all standards for treating obstructing stones of the upper urinary tract in children of various sizes and localizations, as well as the type of pelvis structure, have been defined. Simultaneously, new trends in treatment may change already existing standards. It should be noted that in the modern world, and ways of metaphylaxis urolithiasis in children studied insufficiently. In the world literature, there is insufficient information on predicting the occurrence of recurrence of urolithiasis and ways to eliminate them. This literature review examines the epidemiology, etiopathogenesis of urolithiasis, diagnosis, existing treatment standards and metaphylaxis. Methods of active tactics of treatment of obstructive stones of the upper urinary tract are analysed in more detail.

Can Urinary KIM-1 and NGAL Predict Management Endoscopic Surgery in Acute Unilateral Obstructive Stone Disease? Results from a Prospective Cohort Study

Introduction: Kidney injury molecule-1 (KIM-1) and neutrophil gelatinase-associated lipocalin (NGAL) are the leading novel biomarkers used efficiently in acute kidney injury (AKI). The levels of these biomarkers increase especially in the early period of nephrotoxic and ischemic renal damage. In this study, we aimed to investigate the clinical importance of NGAL and KIM-1 biomarkers used in the effective evaluation of kidney functions in patients with acute unilateral obstructive stone disease (AUOSD) in the management of endoscopic surgery. Materials and Methods: We prospectively included patients who underwent endoscopic surgery due to AUOSD between January 2018 and December 2019. Urine KIM-1 and NGAL values of the patients were measured preoperative period, postoperative 4th h, and postoperative 7th day. The patients were evaluated according to the location and size of the stone, the degree of renal hydronephrosis, the duration of the operation, complications, and JJ stent placement. Results: The study enrolled 50 patients. Urinary KIM-1/Cr and urinary NGAL/Cr ratios were higher in postoperative 4th h than in others (p < 0.001). Also, we found that urinary KIM-1/Cr and urinary NGAL/Cr ratios with Grade 2 and higher hydronephrosis were statistically higher than Grade 0–1 hydronephrosis (p < 0.001 and p: 0.042, respectively). Additionally, a preoperative urinary KIM-1 value of 1.24 ng/mL had a sensitivity of 78% and a specificity of 63% to predict the presence of hydronephrosis. When urine KIM-1 and NGAL results were compared with surgery time, stone size and location, serum creatinine (sCr) value, and Post-Ureteroscopic Lesion Scale grade, the difference was not statistically significant. Postoperative 7th day NGAL/Cr and KIM-1/Cr ratios were statistically higher in those with JJ stents placed (p: 0.03 and p: 0.004, respectively). Conclusion: KIM-1 and NGAL can be used in our assessment of renal function in patients with AUOSD, even if sCr is normal. Also, these biomarkers can predict the presence of hydronephrosis. It can be helpful in determining the time of surgical treatment, as well as providing information in the follow-up of patients with JJ stents after treatment.