Stone Surgery Research Articles

Place For Percutaneous Nephrolithotomy In Contemporary Era

Background : Percutaneous nephrolithotomy (PCNL) and its miniaturized modifications are usually considered the standard surgical options for large (>20 mm) stag horn and infected stones. Moreover, PCNL is a viable alternative to retrograde intrarenal surgery (RIRS) for smaller stones (<20 mm) in the presence of anatomical malformations or inaccessible lower pole stones. However, due to theinnovations in stone fragmentation devices and optical technologies, RIRS is expanding its indications with the potential benefits of lower complications and a shorter hospital stay. Recent research papers presently published confirm the significance of this procedure and its potential role in the treatment of large and complex stones. On the other hand miniaturized PCNL has become more competitive, gaining space among classic indications of flexible ureteroscopy. Considering all recent progress incorporated in performance of this procedure, we can conclude that PCNL is definitely time tested procedure and is here to maintain its cutting edge supremacy in the foreseeable future. Key words: Percutaneous Nephrolithotomy ,Kidney Stones, Urological Surgery

Is There Any Effect of Retrograde Intrarenal Stone Surgery on Renal Functions in Childhood?

Purpose In this study, we aimed to demonstrate whether retrograde intrarenal stone surgery (RIRS) performed due to renal stones during the childhood period has any detrimental impact on renal functions. Materials and methods We retrospectively analyzed 121 patients aged 2 to 16 years who underwent RIRS for renal stones between March 2018 and February 2023. Data were available for 41 patients. The estimated glomerular filtration rate (eGFR) was computed using the modification of diet in renal disease (MDRD) formula on the day preceding the surgery and the third month after the surgery. We employed the National Kidney Foundation's chronic kidney disease (CKD) classification to categorize the glomerular filtration rate (GFR) into five groups. Preoperative and postoperative eGFR values of pediatric patients were compared by analyzing changes in CKD groups. Results Of the patients included in the study, 21 (51.2%) were male, while 20 (48.8%) were female children. No significant difference was found between the preoperative median eGFR and the postoperative median eGFR values (p=0.958). In the 3rd month after surgery, it was observed that 5 (12.1%) patients showed an improvement in their CKD stage, while deterioration was noted in 1 (2.4%) patient. Although a negative correlation was observed between the median eGFR change and both the operation time and the stone volume in Pearson correlation analysis, it was determined that this change did not create a significant difference (p=0.213 and p=0.295, respectively). Conclusion Stone surgery conducted with RIRS appears to yield positive outcomes on kidney function in the pediatric population. Nevertheless, being particularly attentive to patients with prolonged operation times and larger stone volumes is essential.

Comparison Between Holmium:YAG Laser With MOSES Technology vs Thulium Fiber Laser Lithotripsy in Retrograde Intrarenal Surgery for Kidney Stones in Adults: A Propensity Score-Matched Analysis From the FLEXible Ureteroscopy Outcomes Registry. Reply.

Comparison Between Holmium:YAG Laser With MOSES Technology vs Thulium Fiber Laser Lithotripsy in Retrograde Intrarenal Surgery for Kidney Stones in Adults: A Propensity Score-Matched Analysis From the FLEXible Ureteroscopy Outcomes Registry. Reply.

Nomogram to predict the risk of adverse outcomes in patients with residual stones following percutaneous nephrolithotomy.

To investigate the risk factors associated with adverse outcomes in patients with residual stones after percutaneous nephrolithotomy (PCNL) and to establish a nomogram to predict the probability of adverse outcomes based on these risk factors. We conducted a retrospective review of 233 patients who underwent PCNL for upper urinary tract calculi and had postoperative residual stones. The patients were divided into two groups according to whether adverse outcomes occurred, and the risk factors for adverse outcomes were explored by univariate and multivariate analyses. Finally, we created a nomogram for predicting the risk of adverse outcomes in patients with residual stones after PCNL. In this study, adverse outcomes occurred in 125 (53.6%) patients. Multivariate logistic regression analysis indicated that the independent risk factors for adverse outcomes were the diameter of the postoperative residual stones (P < 0.001), a positive urine culture (P = 0.022), and previous stone surgery (P = 0.004). The above independent risk factors were used as variables to construct the nomogram. The nomogram model was internally validated. The calculated concordance index was 0.772. The Hosmer-Lemeshow goodness-of-fit test was performed (P > 0.05). The area under the ROC curve of this model was 0.772. Larger diameter of residual stones, positive urine culture, and previous stone surgery were significant predictors associated with adverse outcomes in patients with residual stones after PCNL. Our nomogram could help to assess the risk of adverse outcomes quickly and effectively in patients with residual stones after PCNL.

Patient compliance for metabolic evaluation and medical treatment (CoMET) in calcium-oxalate stone patients: prospective study by EULIS eCORE study group.

In this study, we aimed to identify the compliance rates of calcium-oxalate stone patients for metabolic evaluation, diet and medical treatment and also determine the factors that are associated with poor compliance rates. This study was conducted by the EULIS eCORE working group prospectively. In the initial visit, demographic and stone-related characteristics were recorded. Patients were suggested metabolic evaluation, dietary advices and medical treatment. Follow-up visit was performed after 3months and compliance rates were recorded. Logistic regression analysis was performed to determine factors associated with poor compliance to metabolic evaluation, diet and medical treatment. Data of 346 patients from nine centers were analyzed. Compliance rates were 71.7%, 65.3%, and 63.7% for metabolic evaluation, diet, and medical treatment, respectively. In multivariate analysis, level of education (p = 0.003), history of emergency department visit (p = 0.04), number of stone surgeries (p = 0.03), patient care in dedicated stone clinic (p = 0.03), and history of shock wave lithotripsy (p = 0.005) were detected as independent predictors of compliance to metabolic analysis. Level of education (p < 0.001) and history of emergency department visit (p = 0.01) were detected as independent predictors of patient compliance to diet. Number of stone episodes (p = 0.03), family history of stones (p = 0.02), and polypharmacy (p < 0.001) were detected as independent predictors of patient compliance to medical treatment. Patient compliance to metabolic evaluation, diet, and medical therapy is important for successful management of urolithiasis. Dietary advices and medications should be personalized by taking in to account the factors associated with poor compliance.

Comparative Effectiveness Randomized Clinical Trial Using Next-generation Microbial Sequencing to Direct Prophylactic Antibiotic Choice Before Urologic Stone Lithotripsy Using an Interprofessional Model

BackgroundNext-generation sequencing (NGS) methods for microbial profiling have increased sensitivity to detect urinary pathogens. ObjectiveTo determine whether NGS microbial profiling can be used to guide antibiotic prophylaxis and reduce infection compared with the standard of care. Design, setting, and participantsA prospective randomized controlled clinical trial of patients undergoing urologic stone interventions at an academic health center from December 2019 to January 2022 was conducted. Urine was collected at the preoperative visit for standard culture and intervention NGS diagnostics. Evaluable patients were culture negative, met 2-wk follow-up, and did not cancel surgery. Of 240 individuals (control = 121, intervention = 119), 83 control and 74 intervention patients were evaluable. InterventionMicrobial findings (paired quantitative polymerase chain reaction and NGS) were sent to an infectious disease pharmacist to recommend prophylactic antimicrobial regimen. Outcome measurements and statistical analysisThe primary outcome was postoperative urinary infection within the follow-up period (Fisher’s exact test). The primary outcome was analyzed by modified intent-to-treat (mITT) and per-protocol analyses. Secondary endpoints considered included positive culture concordance, antibiotic use, and adverse events. Additional post hoc analyses investigated factors contributing to infection (univariate logistic regression). Results and limitationsThe intervention significantly reduced postsurgical urinary infection risk by 7.1% (–0.73%, 15%) compared with the standard of care in the mITT analysis (1.4% vs 8.4%, p = 0.045) or by 8.5% (0.88%, 16%) compared with the per-protocol analysis (0% vs 8.5%, p = 0.032). NGS-guided treatment altered the distribution of antibiotics used (p = 0.025), and antibiotics poorly matched with NGS findings were associated with increased infection odds (odds ratio [OR] = 5.9, p = 0.046). Women were at greater odds to develop infection (OR = 10, p = 0.03) and possessed differentiated microbial profiles (p < 0.001). ConclusionsUrinary microbial NGS-guided antibiotic prophylaxis before endoscopic urologic stone lithotripsy improves antibiotic selection to reduce healthcare-associated urinary infections; however, treatment efficacy may be limited by the ability to adhere to the recommended protocol. Patient summaryWe investigated whether microbial DNA sequencing could improve the selection of antibiotics before kidney stone surgery in patients not known to have any bacteria in the urine on standard culture. We found that using microbe DNA to guide antibiotic choices decreased postoperative infection rate and may encourage individualized use of available antibiotics.

Opioid-free percutaneous nephrolithotomy: an initial experience.

The opioid epidemic in the United States is an ongoing public health crisis that is in part fueled by excessive prescribing by physicians. Percutaneous nephrolithotomy (PCNL) is a procedure that conventionally involves opioid prescriptions for adequate post-operative pain control. We aimed to evaluate the feasibility of a non-opioid pain regimen by evaluating post-operative outcomes in PCNL patients discharged without opioids. As a quality improvement measure to reduce opioid consumption our department began routinely prescribing oral ketorolac instead of oxycodone-acetaminophen for pain control after PCNL. We retrospectively compared patients undergoing PCNL who had received ketorolac prescriptions (NSAID) to those who received oxycodone-acetaminophen prescriptions (NARC). Demographic, operative, and post-operative factors were obtained and compared in both groups. Peri-operative factors and demographics were compared using either Chi-squared tests, Mann-Whitney U tests. Surgical outcomes were compared between the two groups using Chi-squared tests and Fisher's exact tests. Multivariate logistic regression analysis was performed to determine whether ketorolac use was an independent predictor of post-surgical pain-related encounters. Primary outcome was unplanned pain-related healthcare encounters inclusive of office phone calls, unscheduled office visits, and emergency department (ED) visits. Secondary outcome measures were non-pain-related healthcare encounters, hospital readmissions, pain-related rescue medications prescribed, and post-op complications. There were similar demographics and peri-operative characteristics amongst patients in both cohorts. There was no significant difference identified between NSAID and NARC regarding unplanned pain-related encounters (8/70, 11.4% vs. 10/70, 14.3%, p = 0.614). However, NARC experienced more unplanned phone calls (42, 60% vs. 24, 34.3%, p = 0.004). Multivariate analysis revealed only prior stone surgery was predictive of pain-related encounters after PCNL (p = 0.035). Our results show that there were no significant differences in pain-related encounters between those who received ketorolac and oxycodone-acetaminophen following PCNL. A non-opioid pathway may mitigate the potential risk associated with opioid prescription without compromising analgesia. Prospective comparative studies are warranted to confirm feasibility.

Üreteral stent ilişkli semptomlarda 4.0 Fr’e karşın 4.8 Fr double J stentler: ankete dayalı karşılaştırmalı bir çalışma

Purpose: The aim was to investigate the difference in Ureteral Stent-Related Symptom Questionnaire (USSQ) scores with the use of different stent diameters (4.0 Fr versus 4.8 Fr).&#x0D; Materials and methods: Between August 2022 and January 2023, patients with double J stent insertion after endoscopic ureteral stone and retrograde intrarenal surgery in two different centers were included in the study. The patients were divided into two groups according to stent size of 4.0 Fr and 4.8 Fr. All of the patients were called for check-up in the 2nd week after discharge and were questioned using the USSQ. &#x0D; Results: A total of 228 patients, 112 in the 4.0 Fr group and 116 in the 4.8 Fr group, were included in the study. At the 2nd week visit, the total USSQ scale scores were 73.9 ± 8.9, and 80.0 ± 9.8 for the 4.0 Fr and 4.8 Fr groups, respectively (p&lt; 0.001). Stent dislocation was detected in 10 (8.1%) patients in the 4.0 Fr group and in 3 patients (2.5%) in the 4.8 Fr group (p=0.049). The symptom score scale was analyzed separately based on subdomains. The mean value for the urinary index score was 24.5 ± 3.6 for the 4.0 Fr group and 27.6 ± 3.4 for the 4.8 Fr group (p&lt; 0.001). Body pain index score was 16.4±3.8 and 18.6±3.8 for the 4.0 Fr and 4.8 Fr groups, respectively (p

Does age impact outcomes of retrograde intrarenal surgery in the elderly? Results from 366 patients from the FLEXible ureteroscopy outcomes registry (FLEXOR)

BackgroundThere has been a consistent increase in the last decades in prevalence of renal stones in elderly.AimsTo evaluate outcomes of retrograde intrarenal surgery (RIRS) for renal stones in elderly and factors associated with postoperative complications and residual fragments (RFs).MethodsData from 12 centers were retrospectively reviewed. Inclusion criteria: ≥ 75 years, renal stones only, normal renal anatomy. Patients were divided into three groups; Group 1: patients aged 75–79 years; Group 2: age 80–84 years; Group 3: age ≥ 85 years. Multivariable logistic regression analyses were performed to assess factors associated with perioperative complications, sepsis, and RFs.Results366 patients were included. There were 189 patients in Group 1, 113 in Group 2, and 64 in Group 3. There was no difference between groups regarding stone features and total surgical time. Median length of stay was significantly longer in Group 3 (6.0 days, vs 2.0 days in Group 2 vs 2.5 days in Group 1, p = 0.043). There was no significant difference in postoperative complications and RFs between the groups. At multivariable logistic regression analysis, female gender (OR 2.82) and maximum stone diameter (OR 1.14) were associated with higher odds of sepsis, while surgical time (OR 1.12) and the use of a reusable ureteroscope (OR 6.51) with overall complications. Stone size (OR 1.23) was associated with higher odds of RFs.ConclusionRIRS showed safety and efficacy for kidney stones in elderly patients. Surgical time should be kept as short as possible to avoid higher odds of postoperative complications, particularly in females.

Combined Laparoscopic Pyelolithotomy with RIRS in a Patient with Horseshoe Kidney Anomaly and Kidney Stone: A Case Report

Horseshoe Kidney is the most prevalent congenital kidney fusion anomaly, affecting 0.25 percent of the general population and occurring in 1 in 400 to 1600 births. Approximately forty percent of patients develop kidney stones due to anomalies. In our case, we aimed to perform combined laparoscopic pyelolithotomy with RIRS instead of PCNL in a patient with horseshoe anomaly. This procedure enabled us to detect the location of the mobile stone with RIRS and then successfully extract it with laparoscopic pyelolithotomy. Laparoscopic pyelolithotomy combined with RIRS is a reasonable additional treatment option for complicated stone surgery due to horseshoe kidney anomalies.

1063 Prioritising Primary Ureteroscopy: Getting It Right First Time in Patients with Obstructing Urolithiasis by Using a New Treatment Pathway

Abstract Aim Obstructing urolithiasis should be cleared on first attempt, minimising the need for multiple treatments and associated morbidity. Achieving this primary ureteroscopy (P-URS) standard is paramount in the post-pandemic era, where elective waiting lists cannot afford to accommodate ‘stent and wait’ patients. This project aims to evaluate the efficiency of our modified stone treatment pathway which focusses on P-URS. Method We conducted 3 audit cycles in the years 2018, 2020 and 2022 including all patients listed for emergency stone surgery. Extracted data included age, sex, stone number, location and size, and presence of sepsis. Between 2018 and 2022, all Urologists were encouraged to follow a modified stone treatment pathway with an emphasis on P-URS. Results P-URS and attempted URS increased from 7.4% to 62.7%. The average waiting time for subsequent treatment in those who did not have primary/attempted URS was 135 days (23- 412) in 2020 and 95 days (23 -152) in 2022. Sepsis as justification for not attempting P-URS accounted for 19% of cases in 2018 and 21% in 2022. Stent insertion led to subsequent URS in &amp;gt; 95% of cases, ESWL was rarely used. Spontaneous stone after stenting occurred in only 3% of patients. There was no significant difference in WCC, CRP, age, sex or stone distribution between the cycles. No P-URS patients re-presented with complications. Conclusions Limited spontaneous stone passage means P-URS is necessary. Furthermore, it is safe and reduces long waiting times for almost certain subsequent surgery, benefiting both patients and the NHS.

789 Primary Ureteroscopy in the Emergency Setting: Our Experience from a District General Hospital

Abstract Aim The aim of this study is to evaluate how many patients with ureteric stone disease underwent primary ureteroscopy in the emergency setting (eP-URS) and how many of them had their stone retrieved successfully. In those patients in whom eP-URS was not attempted, we assessed if a reason for not doing so was documented. In addition, we analyzed the possible factors influencing the decision to perform a primary ureteroscopy in the emergency setting. Method This is a retrospective observational study of patients presenting to the emergency department of our district general hospital between January and December 2022 with ureteric stone disease requiring emergency surgical intervention in the form of eP-URS or emergency stenting. Results Out of 160 patients presenting with ureteric stone disease, eP-URS was attempted in 35% (n = 56) of patients and in the majority of these patients (64.3%, n = 36), the stone was retrieved successfully. On the other hand, eP-URS was not attempted in 65% patients (n = 104), and a decision for emergency stenting alone was made. A reason for this was clearly documented in 46.1%(n = 48) patients: urosepsis, mucky urine, impacted stone, patient factors, obstructed infected system, while in 53.8% (n = 56) cases no reason was mentioned. In our study, the location of the stone and the presence of consultant in theatre were found to significantly influence the decision to definitive stone surgery (p-value &amp;lt;0.05). Conclusions Despite clear guidance and potential benefits of definitive treatment of ureteric stones, eP-URS is yet to become an everyday practice. Reasons for not attempting eP-URS should be clearly documented.

A systematic review of postoperative outcomes of kidney stone surgery and meta-analysis of outcomes of percutaneous nephrolithotomy in individuals with spinal cord injury.

Systematic review and meta-analysis. To evaluate outcomes of surgical treatment for nephrolithiasis in individuals with spinal cord injury (SCI). We systematically reviewed the Ovid MEDLINE, Embase, CENTRAL, and Web of Science databases for studies examining outcomes of kidney stone procedures in individuals with SCI. Our primary outcomes were stone-free rate (SFR) and complications as categorized by Clavien-Dindo classification. A meta-analysis of comparative studies was performed to assess differences in SFR and complication rate between individuals with and without SCI following PCNL. A total of 27 retrospective and observational articles were included. Interventions for kidney stones included PCNL, shockwave lithotripsy (SWL), and ureteroscopy. Pooled SFR in individuals with SCI was 54%, for SWL, 74% for PCNL, and 36% for ureteroscopy. Meta-analyses found that there was higher rate of grades I (OR 9.54; 95% CI, 3.06 to 29.79), II (OR 3.38; 95% CI, 1.85 to 6.18), and III-V (OR 2.38; 95% CI, 1.35 to 4.19) complications in individuals with SCI compared to non-SCI individuals following PCNL. The rate of infectious complications was also higher in individuals with SCI (OR 6.15; 95% CI, 1.86 to 20.39). However, there was no difference in SFR (OR 0.64; 95% CI, 0.15 to 2.64) between groups. Individuals with SCI are at higher risk of minor, major, and infectious complications following PCNL compared to non-SCI individuals. There was no significant difference between groups in SFR following PCNL, suggesting that PCNL is an effective surgery for kidney stones in individuals with SCI.

Comparison of the efficacy of thulium fiber laser and holmium laser lithotripsy in the treatment of upper urinary tract stones

Objective: To compare the efficacy of thulium fiber laser (TFL) and holmium laser (HL) in the treatment of upper urinary tract stones. Methods: A total of 76 patients diagnosed with upper urinary tract stones by radiographic examination and who required ureteroscopy lithotripsy or retrograde intrarenal stone surgery were prospectively enrolled from the Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine between January 2022 and June 2022. Patients were divided into TFL group (n=38) and HL group (n=38) in a 1∶1 ratio according to the randomization schedule. The perioperative outcomes and stone-free rate of two groups were recorded and compared. Results: Finally, the clinical data of 71 patients were completely collected, including 55 males and 16 females, with a mean age of (45.7±14.1) years old. There were 36 patients in TFL group and 35 patients in HL group, and there was no significant difference in age, body mass index, gender, Charlson comorbidity index, stone site, stone location, stone size and stone density between two groups (all P>0.05). All the surgeries were successfully performed with no intraoperative complications. There were no significant differences between the two groups in terms of operation time, stone displacement during lithotripsy, visual field clarity, changes in hemoglobin, leukocyte, and C-reactive protein, and length of postoperative hospital stay (all P>0.05), but the laser action time[M (Q1,Q3)] in the TFL group was 30.0 (20.0, 48.8)s, which was significantly shorter than that in the HL group [90.0 (50.0, 120.0)s, P<0.001]. The stone-free rates of TFL group and HL group were 97.2% (35/36) and 88.6% (31/35), and there was no significant difference (P=0.337). The postoperative complication incidences of TFL group and HL group were 36.1% (13/36)and 22.9% (8/35), respectively, and the difference was not significant either (P=0.221). For ureter stones, the laser action time in TFL group was 22.5 (20.0, 43.8)s, which was significantly shorter than that in HL group [80.0 (50.0, 120.0)s, P<0.001]. For stones with maximum diameter≤10 mm, the laser action time in TFL group was 20.0 (10.0, 25.0)s, which was significantly shorter than that in HL group [50.0 (40.0, 80.0)s, P<0.001]. For stones with maximum diameter>10 mm, the laser action time in TFL group was 60.0(42.5, 180.0)s, which was significantly shorter than that in HL group [180.0(120.0, 210.0)s, P=0.035]. For stones with density≤1 000 CT, the laser action time in TFL group was 30.0 (20.0, 45.0)s, which was significantly shorter than that in HL group [95.0 (47.5, 120.0), P=0.001]. For stones with density>1 000 CT, the laser action time in TFL group was 30.0 (20.0, 90.0)s, which was significantly shorter than that in HL group [80.0 (55.0, 180.0)s, P=0.033]. Conclusion: TFL lithotripsy is an effective and safe surgical procedure for the treatment of upper urinary tract stones, with similar clinical efficacy but shorter laser action time compared to HL lithotripsy.

Comparison of Percutaneous Nephrolithotomy Success Rate and Complications in Patients with a History of Different Therapeutic Interventions for Kidney Stone

Background: Percutaneous nephrolithotomy (PCNL) is one of the five interventions offered to patients with renal stones. Objectives: This study compared the effects of previous therapeutic interventions for renal stones on subsequent PCNL regarding success rate and complications. Methods: In this descriptive-analytical study, the data from 375 patients who had undergone PCNL were reviewed retrospectively. Patients were categorized into four groups based on their previous therapeutic interventions as no history of open renal stone surgery (n = 196), PCNL (n = 64), extracorporeal shockwave lithotripsy (ESWL) (n = 88), and open surgery (n = 27). We compared surgery duration, the surgical procedure's success rate, complications, as well as the site and size of the stone between the groups. Results: The mean operation duration was significantly longer in the fourth group (61.66 ± 19.85), while there were no statistically significant differences in surgery duration between other groups (P = 0.88). The mean hospital stay, stone size, and site were also similar between the groups. All groups had a high number of pelvic stones, and the rate of upper calyceal stones was higher than middle calyceal and ureteral stones in all groups. Access time was higher in groups one and four, but no significant difference was observed (P = 0.31). Grade 1 and 2 complications were frequent among the patients. The overall immediate success rate was high in all groups. Conclusions: The present study indicates that patients with a history of open surgery for kidney-related conditions may have higher blood loss and longer surgery duration, likely due to anatomical and histological changes in the kidney.

Differential impact of COVID-19 on urological surgeries in public and private institutions between 2019 and 2021 in France.

The COVID-19 pandemic disrupted all routine health care services in 2020. To date, data regarding adjustment and coverage of surgical backlog in the post-COVID era actually remains scarce. The aim of this study was to compare the number of urological procedures coded between 2019 and 2021 in public and private institutions to (i) quantify the variation in surgical activity linked to the shutdown in 2020 and (ii) study the adjustment of procedures over the year 2021. This is a comprehensive retrospective analysis of all urological surgeries coded between January 1, 2019 and December 31, 2021 in France. Data were extracted from the open access dataset of the national Technical Agency for Information on Hospital Care (ATIH) website. In total, 453 urological procedures were retained and allocated in 8 categories. Primary outcome was the impact of COVID-19 analyzed by the 2020/2019 variation. The secondary outcome was the post-COVID catch-up analyzed by the 2021/2019 variation. Surgical activity in public hospitals dropped by 13.2% in 2020 compared to 7.6% in the private sector. The most impacted areas were functional urology, stones and BPH. Incontinence surgery did not recover at all in 2021. BPH and stone surgeries were far less impacted in the private sector, with even explosive activity in 2021, post-COVID period. Onco-urology procedures were roughly maintained with a compensation in 2021 in both sectors. The recovery of surgical backlog was much more efficient in the private sector in 2021. The pressure on the health system associated to the multiple COVID-19 waves may generate a gap between public and private surgical activity in the future.

Comparison of three techniques in bladder stone surgery: Which technique is more effective and safe?

In our study, we aimed to compare the success and complication rates of percutaneous cystolithotripsy (PCCL), transurethral cystolithotripsy (TUCL), and Ho: YAG laser lithotripsy in the surgery of bladder stones that occurred due to various reasons. Patients diagnosed with single or multiple bladder stones with long axis larger than 2 cm, resulting for various reasons, were included in ou study. Sizes of the stones, cystolithotripsy and discharge times, catheter removal times, complications observed, and the visual pain scale (VPS) were retrospectively evaluated separately from the surgical techniques implemented for accompanying patients and their data. TUCL (group 1) was implemented in 40, PCCL (group 2) was implemented in 44, and transurethral Ho: YAG laser lithotripsy (group 3) was implemented in 30 of the 121 patients included in the study. The bladder stone long axe group 1 average was 3,7 cm (2,2-5,3), group 2 average was 3,74 cm (2,1-5,1), and group 3 average was 3,7 cm (2,3-4,7). Urethral stricture evolved in two patients who underwent TUCL. A statistically significant difference was observed on behalf of PCCL in terms of operation time. There was significance in the Ho: YAG laser cystolithotripsy group in comparison with VPS scores. No significant differences were found in terms of age, stone size, urethral catheter removal times, and discharge times. The average follow-up time was 6 months. Although all three methods were quite successful in bladder stone surgery, average cystolithotripsy times were significantly low in the PCCL technique. Thinking that the most common cause of bladder stone is BPH, it is stated that the suprapubic inserted tube ease the bladder drainage during transurethral resection of the prostate (TUR-P). In this way, the duration of the most common accompanying surgeries is shortened and performed more safely.

Selection criteria for minimally invasive endoscopic treatment of urolithiasis depending on stone characteristics

Introduction. According to the guidelines, the stone maximum diameter is one of the main criteria for choosing the method of nephrolithotripsy. When planning an operation, the surgeon focuses not only on the diameter, but also on the renal pelvis anatomy, stone density and number of it, the presence of hydronephrosis, a history of surgery, etc. The maximum diameter is not an exhaustive characteristic that allows you to choose the optimal treatment.Objective. To evaluate the effect of stone volume (compared to its maximum diameter) on the duration of minimally invasive endoscopic nephrolithotripsy.Materials &amp; methods. The study was retrospective. The study included 55 patients (22 women, 33 men), the average age was 47.0 ± 1.9 years. All patients underwent minimally invasive thulium fiber laser nephrolithotripsy for stones up to 20 mm (mean maximum diameter — 13.3 ± 0.6 mm, mean density — 1041.0 ± 48.0 HU). Minimally invasive endoscopic interventions such as retrograde intrarenal surgery (RIRS, n = 30), minipercutaneous and micropercutaneous nephrolithotripsy (miniPNL, n = 16 and microPNL, n = 9, respectively) were performed. Patients with urinary system abnormalities, acute urinary tract infections and patients without stone-free status were excluded from the study. In addition to evaluating standard indicators, the stone volume was calculated in all patients using the formula of a scalene ellipsoid (median volume — 287 [144; 538] mm3). Spearman's rank correlation coefficient (r) with an assessment of the significance level was calculated for the stone maximum diameter and volume for the total sample of patients and for each surgical intervention method separately.Results. The analysis of the total sample of patients reliably revealed a weak correlation (r = 0.39) between the stone maximum diameter and surgery time. And a moderate correlation was found between the stone volume and surgery time (r = 0.53). A similar relationship with the linear distribution was also observed in the analysis in all groups.Conclusion. When choosing minimally invasive laser nephrolithotripsy, it is advisable to focus not only on the stone maximum diameter, density, and localisation, but also on the stone volume, which has a great correlation with the surgery time.

Impact of frailty on clinical outcomes and resource utilization of hospitalizations for renal stone surgery.

Frailty is reportedly associated with poorer outcomes among surgical patients. Using a coding-based frailty tool, we investigated the impact of frailty on clinical outcomes and resource utilization for urolithiasis hospitalizations. A cohort study using the 2018 National Inpatient Sample database. All adult elective hospitalizations for urolithiasis were included in the study. The study population was categorized into FRAIL and non-frail (nFRAIL) cohorts using the Johns Hopkins Adjusted Clinical Groups frailty clusters. The association between frailty and clinical and financial outcomes was evaluated using multivariate regression models. About 1028 (14.9%) out of 6900 total hospitalizations were frail. Frailty was not associated with a significant increase in the odds of in-hospital mortality (adjusted odds ratio (aOR) 1.73, 95% CI 0.15-20.02) or length of hospital stay, but was associated with a lower chance of surgery within 24h of admission (aOR 0.65, 95% CI 0.48-0.90, P = 0.008). A higher Charlson index was independently associated with an over 100% increase in the odds of in-hospital mortality (aOR 2.091, 95% CI 1.53-2.86, P < 0.001). Frail patients paid $15,993 higher in total hospital costs and had a higher likelihood of non-home discharges (aOR 4.29, 95% CI 2.74-6.71, P < 0.001) and peri-operative complications (aOR 1.77, 95% CI 1.14-2.73, P = 0.01). Frailty was correlated with unfavorable outcomes, except mortality and prolonged hospital stay. Incorporating frailty evaluation into risk models has the potential to enhance patient selection and preparation for urolithiasis intervention.

The real world experience of pediatric primary hyperoxaluria patients in the PEDSnet clinical research network.

The rarity of primary hyperoxaluria (PH) challenges our understanding of the disease. The purpose of our study was to describe the course of clinical care in a United States cohort of PH pediatric patients, highlighting health service utilization. We performed a retrospective cohort study of PH patients < 18years old in the PEDSnet clinical research network from 2009 to 2021. Outcomes queried included diagnostic imaging and testing related to known organ involvement of PH, surgical and medical interventions specific to PH-related renal disease, and select PH-related hospital service utilization. Outcomes were evaluated relative to cohort entrance date (CED), defined as date of first PH-related diagnostic code. Thirty-three patients were identified: 23 with PH type 1; 4 with PH type 2; 6 with PH type 3. Median age at CED was 5.0years (IQR 1.4, 9.3years) with the majority being non-Hispanic white (73%) males (70%). Median follow-up between CED and most recent encounter was 5.1years (IQR 1.2, 6.8). Nephrology and Urology were the most common specialties involved in care, with low utilization of other sub-specialties (12%-36%). Most patients (82%) had diagnostic imaging used to evaluate kidney stones; 11 (33%) had studies of extra-renal involvement. Stone surgery was performed in 15 (46%) patients. Four patients (12%) required dialysis, begun in all prior to CED; four patients required renal or renal/liver transplant. Conclusion: In this large cohort of U.S. PH children, patients required heavy health care utilization with room for improvement in involving multi-disciplinary specialists. What is Known: • Primary hyperoxaluria (PH) is rare with significant implications on patient health.Typical involvement includes the kidneys; however, extra-renal manifestations occur. • Most large population studies describe clinical manifestations and involve registries. What is New: • We report the clinical journey, particularly related to diagnostic studies, interventions, multispecialty involvement, and hospital utilization, of a large cohort of PH pediatric patients in the PEDSnet clinical research network. • There are missed opportunities, particularly in that of specialty care, that could help in the diagnosis, treatment, and even prevention of known clinical manifestations.