Ureteral Catheter Research Articles

PD54-06 STRIKING A BALANCE: OUTCOMES OF SHORT-TERM MONO-J PLACEMENT FOLLOWING URETERORENOSCOPY

You have accessJournal of UrologyStone Disease: Surgical Therapy IV (PD54)1 Sep 2021PD54-06 STRIKING A BALANCE: OUTCOMES OF SHORT-TERM MONO-J PLACEMENT FOLLOWING URETERORENOSCOPY Alina Reicherz, Verena Maas, Mirco Brehmer, Moritz Reike, Joachim Noldus, and Peter Bach Alina ReicherzAlina Reicherz More articles by this author , Verena MaasVerena Maas More articles by this author , Mirco BrehmerMirco Brehmer More articles by this author , Moritz ReikeMoritz Reike More articles by this author , Joachim NoldusJoachim Noldus More articles by this author , and Peter BachPeter Bach More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002081.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: American and European guidelines do not recommend routine double-J insertion after uncomplicated ureterorenoscopy, however clinical practice and guidelines deviate. The EAU guideline, as an alternative to ureteral stenting, states that ureteral catheter can be inserted for one day with similar results. We evaluated factors affecting the outcomes of short-term mono-J insertion for six hours following ureteroscopic stone removal. METHODS: Patients treated with a mono-J for six hours after ureterorenoscopy and stone removal were analysed. FaST 1 and 2, two consecutive single academic centre studies, were conducted between August 2014 and April 2018. In each study, we randomized patients with renal or ureteral calculi to two groups before ureterorenoscopy. FaST 1 compared a mono-J insertion for six hours versus double-J insertion for three to five days after ureterorenoscopy. FaST 2 compared a mono-J insertion to a tubeless procedure in the same clinical setting. All patients were pre-stented for three to five days before ureterorenoscopy. The study endpoint was stent-related symptoms as assessed by a validated questionnaire (USSQ). Results were stratified by clinical parameters, stone characteristics and operation details. RESULTS: 108 of 156 initially randomized patients undergoing ureterorenoscopy were included. USSQ scores covering the time three to five weeks after stone removal showed significantly reduced urinary symptoms and pain index compared to the scores before ureterorenoscopy. USSQ results before and after stone removal did not correlate with stone size or operation time and did not differ significantly depending on stone localization, the treating endourologist, or ureterorenoscopic device used (p > 0.05). Six patients (5 %) required reintervention. CONCLUSIONS: Following secondary ureterorenoscopy a ureteral drainage with a mono-J for six hours provides a high quality of life, independent of stone size and localization, operation time, the treating endourologist, and the URS device used. Source of Funding: No funding © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e924-e925 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alina Reicherz More articles by this author Verena Maas More articles by this author Mirco Brehmer More articles by this author Moritz Reike More articles by this author Joachim Noldus More articles by this author Peter Bach More articles by this author Expand All Advertisement Loading ...

MP18-13 ENDOUROLOGY FOR STONES DURING COVID-19

INTRODUCTION AND OBJECTIVE: Guidelines for endourological procedures during COVID-19 have suggested to defer nonobstructed stones, while obstructed/ infected stones should be considered emergencies.1,2 In our centre, screening protocols (as per Ministry of Health's guidelines)3 were implemented with prioritization strategies so that elective care could safely continue, albeit at deescalated rates. COVID or septic patients underwent decompression with stent or nephrostomy insertion, while non-COVID and non-septic patients underwent primary ureteroscopy (URS) or retrograde intrarenal surgery (RIRS). All interventions were done only by consultants, and surgical precautions such as donning of personal protective equipment were undertaken.4 We aim to report the outcomes of endourological surgery for stone disease in our centre during COVID. METHODS: We conducted a prospective review of all endourological surgeries for stones in our centre between 23 Jan and 31 Aug 2020, when all non-necessary surgeries were deferred. RESULTS: 201 surgeries were performed on 159 patients (93 emergencies, 108 electives)- 36 (17.9%) stent insertions, 116 (57.7%) URS and 49 (24.4%) RIRS. 34 patients were females and 125 males. Median age of patients was 50, with 37% ≥ 60. 31 patients were ASA ≥ 3. None were COVID positive. Mean single stone size was 8.17 mm (1-38) and cumulative stone size was 10.63 mm(1-84). 44 patients had multiple stones. The index stone location was proximal ureter in 111 (55.2%), mid ureter 19 (9.45%), distal ureter 67 (33.3%), renal 4 (1.99%). 55 (27.4%) procedures were carried out due to previously stented stones, 10 (4.98%) bilateral obstruction/ single kidney, 77 (38.3%) failed MET/ persistently symptomatic stone, 16 (7.96%) intractable colic, 14 (6.96%) AKI, and 20 (9.95%) sepsis. 166 (66.6%) patients had stent inserted post operatively- 15 with threads that precluded the need for scope guided removal. 27 (10.8%) had a ureteric catheter that was removed prior to discharge. The overall stone free rate was 97.4%;95 (59.7%) were stone free with 1 procedure. 60 (37.7%) required staged procedures. An average of 1.41 procedures/ patient was needed to be stone free. 2 (0.99%) patients had Clavien Dindo Grade III complications. 9 (4.48%) were readmitted- 7 for UTI and 1 for stent symptoms. Median length of stay was 2 days (0- 43). CONCLUSIONS: Our centre demonstrated favourable outcomes in patients undergoing endourological surgery for stone diseases during COVID by following strict screening protocols and surgical precautions. The results support the continuation of endourological surgery with the proposed framework in regions with similar COVID trends.

HF01-04 THE WAX-TIPPED CATHETER: DIAGNOSING URETERAL AND RENAL CALCULI PRIOR TO RADIOGRAPHY

You have accessJournal of UrologyHistory of Urology Forum I (HF01)1 Sep 2021HF01-04 THE WAX-TIPPED CATHETER: DIAGNOSING URETERAL AND RENAL CALCULI PRIOR TO RADIOGRAPHY Sutchin R Patel, and Stephen Y Nakada Sutchin R PatelSutchin R Patel More articles by this author , and Stephen Y NakadaStephen Y Nakada More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001992.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Imagine a time without computed tomography, ultrasonography and x-ray. How would you diagnose an obstructing ureteral or renal stone? METHODS: We researched Howard Kelly and his seminal paper on the development of the wax-tipped catheter and searched the literature to evaluate the adoption of Kelly's technique by urologists in that era. RESULTS: In 1901, Howard Atwood Kelly (1858-1943) published "Scratch-Marks on the Wax-Tipped Catheter as a Means of Determining the Presence of Stone in the Kidney and in the Ureter." Kelly stated "There is no other means of ascertaining the presence of calculus in the urinary tract as direct as my method of passing a wax-tipped catheter up the ureter into the kidney." He described the preparation of the wax-tip (a mixture of dental wax and olive oil) and the technique of ureteral catheterization. A diagnosis was made if scratch-marks were found on the wax-tip. Kelly also stated that the stone sometimes created a "grating sensation as the catheter is withdrawn," that fragments of stone may become embedded in the wax tip and that as "the catheter passes a ureteral stone, or enters the renal pelvis there is often an immediate discharge of urine far in excess of possible secretion" (hydronephrotic drip). He further chronicles eleven cases where a dignosis was made using the wax-tipped catheter and then verified with open surgery.Ben Kirkendall (1882-1968) in 1915, further adapted Kelly's technique by using a loose fitting rubber tube which protected the wax-tipped catheter during its passage prior to ureteral cannulation.Hugh Hampton Young (1870-1945) in his text Practice of Urology (1926) wrote that "the diagnosis of renal calculus has been made a matter of great exactness by the introduction of the x-ray and the wax-tipped ureteral catheter." He further discussed three different methods of passing the wax-tipped catheter in detail.Abraham Ravich (1899-1984) in 1933 published his series of 758 ureteral calculi and stated that "the wax-tipped catheter was as important a diagnostic measure as x-ray and in uric acid stones was often the only means whereby a diagnosis could be made. The meticulous skill required to perform the wax-tipped catheter technique in order to prevent false positive results and the improvements in radiography eventually made the technique obsolete. CONCLUSIONS: Howard Kelly's wax-tipped catheter technique was the first reliable test to help diagnose ureteral and renal calculi prior to radiography. It would continue to have utility in diagnosing radiolucent stones until improvements in the quality of intravenous and retrograde pyelography. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e228-e228 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sutchin R Patel More articles by this author Stephen Y Nakada More articles by this author Expand All Advertisement Loading ...

MP18-11 ENDOUROLOGICAL PROCEDURES UNDER LOCAL ANESTHESIA, DURING SARS COV 2 PANDEMIA.

INTRODUCTION AND OBJECTIVE: Endourological procedures are generally performed under general anesthesia, presenting a high risk of viral infection during intubation in SARS Cov2 positive patients. During the Covid 19 pandemic, an attempt was made to reduce the exposure of operating room personnel, so a protocol was started with local anesthesia for these surgeries1. The objective of this work is to evaluate the feasibility of performing these procedures with local anesthesia, analyzing pain through the Visual Analogue Scale (VAS), the stone-free rate, and the correct position of the double j stent. METHODS: Descriptive prospective study conducted between March 2020 and January 2021, all patients undergoing endoscopic procedures were included. Patients who were admitted for outpatient surgery for placement or replacement of a double-j stent, or ureteroscopy for ureteral lithiasis were selected. Patients with previous pathologies such as diabetes, hypertension, neuropathies, neurological pathologies, hypersensitivities, trauma and psychiatric disorders were excluded. The local anesthesia protocol consisted of placing a urinary catheter, instilling 40 ml of lidocaine 2% solution without epinephrine 20 minutes before starting the procedure, associated with analgesia with Ketorolac 30 mg (IV) and Dexamethasone 8 mg (IV), prior to the same2. The visual analog pain scale was performed after the procedure. Its assessment is mild if the patient scores pain less than 3. Moderate pain if the assessment is between 4 and 7, and severe pain if the assessment is equal to or greater than 8 points on the scale. The stone-free rate and the correct position of the double j catheters were analyzed with a simple radiograph of the urinary tree. The patients were asked if they would recommend the procedure and would undergo it again, if necessary. RESULTS: Eighteen patients were included, with an average age of 39.6 years (≥ 12.4 years), 11 (61%) female, submitted to 19 endoscopic procedures in our institution;URS were performed in 4 (22.2%) patients, 5 (27.7%) required URS = double j catheter, 4 (22.2%) patients received double j catheter only, 3 (16.6%) patients had double j catheter exchange and 1 (5.5%) required bilateral exchange. The average VAS value was 6.4 (≥ 1.5, mode=7), 16 patients reported moderate pain (VAS 4-7), and only 2 referred severe pain (VAS ≥ 8), which had to be suspended due to pain intolerance (1 URS and 1 double jot), for which they required general anesthesia. The stone-free rate was 90% for the URS, and 100% of the double j catheters were normally positioned in the radiological control. The procedures were completed with a success rate of 88%. 14 patients would recommend repeating the procedure to others, 7 patients answered that they would not repeat the procedure, if necessary. CONCLUSIONS: Endourological procedures such as URS and placement of a ureteral catheter under local anesthesia were well tolerated by the patients. It had a high success rate and acceptance.

V13-01 EXTENDED URETERAL MEATOTOMY FOR OUTPATIENT CHEMOTHERAPY ADMINISTRATION AND URETEROSCOPY IN PATIENTS WITH UPPER TRACT UROTHELIAL CARCINOMA

You have accessJournal of UrologyBladder & Upper Tract Urothelial Oncology (V13)1 Sep 2021V13-01 EXTENDED URETERAL MEATOTOMY FOR OUTPATIENT CHEMOTHERAPY ADMINISTRATION AND URETEROSCOPY IN PATIENTS WITH UPPER TRACT UROTHELIAL CARCINOMA Nikhil Gopal, Sameh Naim, Bertie Zhang, John Phillips, and Majid Eshghi Nikhil GopalNikhil Gopal More articles by this author , Sameh NaimSameh Naim More articles by this author , Bertie ZhangBertie Zhang More articles by this author , John PhillipsJohn Phillips More articles by this author , and Majid EshghiMajid Eshghi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002100.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Patients with ureteral tumors managed endoscopically often benefit from adjuvant immuno-chemotherapy and require interval upper tract surveillance with ureteroscopy. However, both often require general anesthesia, which can be problematic for a predominantly elderly population with multiple co-morbidities. Here we describe an endoscopic technique of ureteral meatotomy to not only predictably allow for reflux of intravesical agents through the ureter, but also to allow upper tract endoscopy to be performed in the office setting. METHODS: From 2015-2021, we performed ureteral meatotomy on 10 patients. All patients who underwent this procedure had upper tract urothelial tumors deemed suitable for primary endoscopic management, based on patient’s clinical characteristics; tumor number; size; location; and/or biopsy grade.Under general anesthesia, a 10 F dual lumen ureteral catheter or 6-12 F Nottingham dilator was inserted into the distal ureter in order to allow for alignment of the ureter towards the bladder neck and to ensure the orifice is incised in the correct direction. Using either a Holmium laser or Collin’s knife, a full-thickness 2 cm incision was made on the distal intramural ureter at the 12 o’clock position, until the anterior portion of the catheter was visualized. Intraoperative cystogram was used to confirm ureteral reflux. A double J stent was then left in place for 3 weeks for mucosal healing and reshaping of the distal ureteral segment. Postoperatively, patients underwent 6 cycles of mitomycin, either via indwelling Foley catheter or nephrostomy tube. Lower and upper urinary tract surveillance was performed using flexible cystoscope and/or ureteroscope in the office every 3-6 months for the first two years and annually thereafter. RESULTS: 10 patients with average age of 77 years, 40% of whom were male, underwent ureteral meatotomy between 2015 and 2021. 90% of tumors were either in the distal ureter or UPJ/renal pelvis. Average tumor size was 1.6 cm. 70% of tumors were low grade on biopsy. 3 patients had concomitant bladder cancer. There were no complications associated with chemotherapy instillation. Of the patients who had only upper tract disease, none developed a new recurrence in the bladder. CONCLUSIONS: We describe a novel anterior intramural ureteral incision technique in patients with ureteral tumors managed endoscopically that reliably allows for both chemotherapy administration and upper tract surveillance in an office setting. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1078-e1078 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nikhil Gopal More articles by this author Sameh Naim More articles by this author Bertie Zhang More articles by this author John Phillips More articles by this author Majid Eshghi More articles by this author Expand All Advertisement Loading ...

MP65-02 STENT SYNDROME. DOES THE DIAMETER MATTER? RESULTS OF A PROSPECTIVE TRIAL

You have accessJournal of UrologyStone Disease: Surgical Therapy V (MP65)1 Sep 2021MP65-02 STENT SYNDROME. DOES THE DIAMETER MATTER? RESULTS OF A PROSPECTIVE TRIAL Pablo Contreras, María Florencia Frascheri, Nicolás Bonanno, Sofía Butori, Leandro Blas, and Carlos Ameri Pablo ContrerasPablo Contreras More articles by this author , María Florencia FrascheriMaría Florencia Frascheri More articles by this author , Nicolás BonannoNicolás Bonanno More articles by this author , Sofía ButoriSofía Butori More articles by this author , Leandro BlasLeandro Blas More articles by this author , and Carlos AmeriCarlos Ameri More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002105.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Ureteral catheter related symptoms may vary amongst people, depending on many factors. Our objective was to compare the symptoms produced by three different catheter diameters and the impact in the quality of life using a validated questionnaire. METHODS: Between June 2016 and February 2021 we conducted a prospective trial of 180 adults patients with a single ureteral stone who required an ureteral stent placement as a primary treatment. Patients were randomized 1:1:1 depending on catheter´s diameter: 4.7, 6 or 7 Fr, 60 patients in each group. A 26 cm Universa® stent was used in every cases. During the seventh and fourteenth day after the surgery, patients were requested to answer the ureteral stent symptoms questionnaire (USSQ). Results were compared using the unidirectional ANOVA test. RESULTS: The mean age was 48.3 years (±14.9), male/female relation was 2.37/1. Most of the patients referred pain: 93% claim being unable to live with symptoms, 47% could not engage in sexual activity and 70% would be very unhappy in case of requiring another stent again. After the statistical analysis, 4.7 Fr. stents produced significantly less urinary symptoms than 6 and 7 Fr. catheters. CONCLUSIONS: Ureteral catheter related symptoms deeply affected the quality of life in most cases. The 4,7 Fr. catheter produced significantly less urinary symptoms than 6 and 7 Fr. catheters. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1119-e1119 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Pablo Contreras More articles by this author María Florencia Frascheri More articles by this author Nicolás Bonanno More articles by this author Sofía Butori More articles by this author Leandro Blas More articles by this author Carlos Ameri More articles by this author Expand All Advertisement Loading ...

V05-04 STONE DISSOLUTION: CURRENT SAFE AND EFFECTIVE USE OF RENACIDIN

You have accessJournal of UrologyUrolithiasis & Endourology (V05)1 Sep 2021V05-04 STONE DISSOLUTION: CURRENT SAFE AND EFFECTIVE USE OF RENACIDIN Egor Parkhomenko, Vivian Williams, and Michael Kurtz Egor ParkhomenkoEgor Parkhomenko More articles by this author , Vivian WilliamsVivian Williams More articles by this author , and Michael KurtzMichael Kurtz More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002012.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Struvite stones cause significant morbidity in urologic congenitalism. Though stone-free rates have improved with advanced endoscopic equipment, some anatomic circumstances make complete stone clearance impossible. Renacidin (Citric Acid, Glucono Delta-Lactone, and Magnesium Carbonate solution) to treat upper tract stones was popular in the 1960s, but after 6 deaths it was banned by the FDA and not re-approved until the 1990s. We wished to treat a patient in an extraordinary circumstance, which presented challenges as Renacidin therapy had not been used at our institution in 30 years. We present our experience and a step-by-step guide to infusion. METHODS: We conducted a literature review and collected national expert opinion. Key stakeholders from nursing, pharmacy, nephrology, infectious diseases, intensive care unit (ICU), and biomedical engineering developed a safe protocol for renacidin infusion. The patient was monitored on a 1:1 staff to patient ratio in the ICU initially. As the medication is in vials with non-sterile exteriors, pharmacy cleaned the vials and pooled it under a sterile hood. The biomedical engineering team recommended a gravity drip, elevated to 30 cm H2O above PCN tube entry site infused at 120 ml/hour (20 drips/minute) or 60 ml/hr (drop factor 10 drips/minute). A mock infusion was completed with a multidisciplinary team prior to the patient’s admission. A 27yF with severe scoliosis, reconstructed bladder, and tortuous ureter from prior ureterostomies leading to limited options for renal access had struvite stone recurrence after bilateral percutaneous nephrolithotomy. Bilateral nephrostomy tubes, an antegrade ureteral catheter, and a urethral catheter were placed. Daily electrolytes and urine cultures were drawn, and weekly CT scans performed to assess stone burden. Renacidin was infused unilaterally at full or half rate, depending on patient tolerance, during the day; nocturnal infusions were with normal saline. Continuous culture-directed IV antibiotics were administered throughout the infusion. RESULTS: Infusion was carried out for 60 days, initially on the left for 30 days (larger stone burden), and 30 days on the right. Total hospital stay was 71 days. The patient has been stone-free since end of Renacidin therapy for ∼150 days. There were no episodes of mucosal hemorrhage or sepsis. CONCLUSIONS: Renacidin infusion can be performed safely and effectively and may eliminate upper tract recurrent struvite stones in patients who have failed endoscopic therapy. An inpatient monitoring program and multidisciplinary collaboration is required for safe infusion. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e387-e387 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Egor Parkhomenko More articles by this author Vivian Williams More articles by this author Michael Kurtz More articles by this author Expand All Advertisement Loading ...

Spontaneous Upper Urinary Tract Rupture Caused by Ureteric Stones: Clinical Characteristics and Validation of a Radiological Classification System.

Background: This study seeks to validate a radiological classification system of spontaneous upper urinary tract rupture (sUUTR) and to analyse its relationship with clinical, laboratory and radiological characteristics of sUUTR. Methods: We analysed data from 66 patients with a computerised tomography (CT)-proven sUUTR treated with ureteral or nephrostomy catheter positioning. Comorbidities were scored with the Charlson Comorbidity Index (CCI). All CT scans were reviewed by two experienced radiologists and one urologist, who classified sUUTR in (a) local spread, (b) free fluid and (c) urinoma. Interobserver agreement for radiological score was evaluated with the Intraclass Correlation Coefficient (ICC) and Cohen’s Kappa analyses. Descriptive statistics and logistic regression models verified the association between clinical variables and sUUTR severity. Results: The interobserver agreement for sUUTR classification was high among radiologists and between the radiologists and the urologist (all Kappa > 0.7), with an overall high interrater reliability (ICC 0.82). Local spread, free fluid and urinoma were found in 24 (36.4%), 39 (59.1%) and 3 (4.5%) cases, respectively. Patients with free fluid/urinoma had higher rate of CCI ≥ 1 than those with local spread (40.5% vs. 16.7%, p = 0.04). Intraoperative absence of urine extravasation was more frequently found in patients with local spread than those with free fluid/urinoma (66.7% vs. 28.6%, p < 0.01). Multivariable logistic regression analysis revealed that local spread (OR 4.5, p < 0.01) was associated with absence of contrast medium extravasation during pyelography, after accounting for stone size, fever and CCI. Conclusions: The analysed sUUTR classification score had good inter/intra-reader reliability among radiologists and urologists. Absence of urine extravasation was five times more frequent in patients with local spread, making conservative treatment feasible in these cases.

Forget Forgotten Stents: Review of Ureteral Stent Tracking Systems.

Our objective was to assess existing systems for tracking ureteral stents after urological surgery and determine if these systems impact the rate of retained and forgotten stents. We performed a scoping review using the search terms ("ureteral stents" "ureteral catheters" "nephroureteral stents" "nephroureteral catheters" or "double J stents") and ("tracking" or "lost stents" or "forgotten stents"). Two of the authors individually selected relevant articles based on title and abstract and performed full review of manuscripts and references. Nine different studies focusing on forgotten ureteral stents were identified. Tracking mechanisms included electronic medical records algorithms, cellphone, chat or computer-based applications. Rates of lost or delayed removal of stents in hospitals prior to using a tracking system were 0%-13%. With a tracking mechanism, the rate of lost or delayed removal was reduced to 1% or less in the studies we identified. Stent tracking systems successfully reduced delayed removal of ureteral stents and reduced the rates of retained stents; however, these systems are institution specific, and no universal solution is readily available. Such a solution would be beneficial for the urological community to investigate further and for industry partners to invest in.

Ureteral catheterization for uterine cancer

Analyzing the issue of the treatment of inoperable uterine cervix cancers with the danger of uremia, Holz (Zentr f. Gyn., 1924, No. 13) does not agree with HoIzbach, who proposed, in order to avoid uremia due to compression of the ureters by tumor masses, their preventive preparation.

Fluorescence vessel and ureter navigation during laparoscopic lateral lymph node dissection.

Lateral lymph node metastasis in lower rectal cancer is considered a local disease in Japan, and guidelines suggest lateral lymph node dissection (LLND). However, laparoscopic procedures are relatively difficult. The ureter and hypogastric fascia must be dissected from the vesicohypogastric fascia to preserve the autonomic nerve and ureter. Additionally, lymph node dissection around the internal iliac artery is complex because many patterns of branching from the internal iliac artery exist. We investigated the utility of fluorescence ureter and vessel navigation using a near-infrared ray fluorescent ureteral catheter (NIRFUC) and indocyanine green (ICG). Fourteen patients who underwent laparoscopic LLND using fluorescence navigation were included. Eleven patients had rectal cancer, 1 had anal cancer, and 2 exhibited recurrence of rectal cancer. Eleven patients underwent NIRFUC insertion before surgery. Fluorescence vessel navigation (FVN) was performed with intraoperative ICG injections in 14 patients, with a total of 18 sides. The outcome measures were ureter navigation visibility, detection of the branch form from the internal iliac artery with FVN, differences between the fluorescence findings and anatomy of the internal iliac artery determined after LLND, and the surgical outcome. In all 11 patients, the ureters were clearly identified as fluorescent before dissection around the ureter. FVN revealed the internal iliac, umbilical, and superior vesical arteries in all patients. The branch from the internal iliac artery according to the Adachi classification was revealed on 16 sides (89%). The time from intravenous ICG injection to fluorescence of the internal iliac artery was 38 (17-57) s. The time from intravenous injection to when the vessels were observed as fluorescent was 113 (65-661) s. No ureteral or vessel injuries occurred. Fluorescence navigation of vessels and the ureter is feasible in laparoscopic LLND and has the potential to increase safety. Examination of fluorescence navigation for laparoscopic colorectal cancer surgery Research Ethics Committee of the Kawaguchi Municipal Medical Center (Saitama, Japan) approval number: 2020-3. https://kawaguchi-mmc.org/wp-content/uploads/clinicalresearch-r02.pdf.

Feasibility of injected indocyanine green for ureteral identification during robotic left-sided colorectal resections

BackgroundUreteral identification is essential to performing safe colorectal surgery. Injected immunofluorescence may aid with ureteral identification, but feasibility without ureteral catheterization is not well described. MethodsCase series of robotic colorectal resections where indocyanine green (ICG) injection with or without ureteral catheter placement was performed. Imaging protocol, time to ureteral identification, and factors impacting visualization are reported. ResultsFrom 2019 to 2020, 83 patients underwent ureteral ICG injection, 20 with catheterization and 63 with injection only. Main indications were diverticulitis (52%) and cancer (36%). Median time to instill ICG was faster with injection alone than with catheter placement (4min vs 13.5min, p < 0.001). Median time [IQR] to right ureter (0.3 [0.01–1.2] min after robot docking) and left ureter (5.5 [3.1–8.8] min after beginning dissection) visualization was not different between injection alone and catheterization. ConclusionICG injection alone is faster than with indwelling catheter placement and equally reliable at intraoperative ureteral identification.

Complications Of Peri-Operative Ureteral Catheter Placement: Experience at A Major Cancer Center

ObjectiveTo evaluate risks of peri-operative ureteral catheter placement in a consecutive patient-series. MethodsPatients who underwent peri-operative ureteral catheter placement at a single institution in 2018 were included. A retrospective review was conducted to evaluate patient and procedure related characteristics, including data on technique, perceived placement difficulty, operative details, and complications. Outcome Measurements and Statistical AnalysisUrologic complications within 30 days were evaluated using the Clavien-Dindo system. Statistical analysis for association was conducted using the X2 test or fisher's exact tests. Results413 patients were included. 50/413 (12.1%) cases had urologic complications within 30 days. 43 were Clavien-Dindo grade I-II. Six were grade III. 5/6 patients had oliguric, obstructive AKI. One had flank pain with hydronephrosis. Two patients each underwent placement of unilateral nephrostomy tube, bilateral double-J stent placement, and unilateral stent placement. One patient had a Grade V complication. They developed multi-system organ failure including renal failure with hydronephrosis.All patients who required re-intervention had bilateral peri-operative catheterization with use of a wire. Intraoperative difficulty with placement was associated with high-grade complication (P<.01)). Limitations include retrospective,single center study design. ConclusionsRate of acute complication following ureteral catheter placement is 12%. 1.7% of patients develop post-operative ureteral obstruction requiring intervention within 30 days. Future studies are needed to determine patients most at risk for post-ureteral stent complication.

Neoadjuvant chemotherapy combined with radical surgery for stage IB2/IIA2 cervical squamous cell carcinoma: a prospective, randomized controlled study of 35 patients

ObjectiveThis study aimed to evaluate the clinical outcomes for patients with stage IB2/IIA2 cervical squamous cell carcinoma treated with neoadjuvant chemotherapy combined with radical surgery.MethodsA total of 68 patients with cervical squamous cell carcinoma were randomly divided into the experimental group (n = 35) and the control group (n = 33). The patients in the experimental group received paclitaxel plus cisplatin neoadjuvant chemotherapy for two cycles, then underwent radical hysterectomy and bilateral adnexectomy at 2 weeks post-chemotherapy. The control group only underwent radical hysterectomy and bilateral adnexectomy after the diagnosis of cervical squamous cell carcinoma. The toxic and side effects of chemotherapy in the experimental group were observed. Also, the operation method, operation time, blood loss, grade of wound healing, complications, and postoperative pathology were noted in the two groups. Primary foci and pelvic lymph node recurrence and distant metastasis were observed, and 3-year and 5-year survival rates were calculated.ResultsOnly one patient in the experiment had grade III bone marrow suppression; no other grade III and IV chemotherapy toxic reactions were observed. The operation was successfully completed in all patients. The operation time, intraoperative blood loss, placement of the ureteral catheter, bladder injury, ureteric injury, postoperative urinary tub, pelvic drainage tube indwelling time, anal exhaust time, postoperative complications, and metastatic ratio of lymph nodes were not significantly different between the two groups (P > 0.05). The number of dissected lymph nodes, deep myometrial invasion, and vascular tumor emboli showed a significant difference in the experimental group compared with the control group (P < 0.05). The 3-year disease-free survival (82.9% vs 81.9%), 5-year disease-free survival (71.4% vs 60.6%), 3-year overall survival (91.4% vs 87.8%), and 5-year overall survival (82.9% vs 75.6%) were not statistically significantly different between the experimental group and the control group (P > 0.05).ConclusionsNeoadjuvant chemotherapy in IB2/IIA2 stage cervical squamous cell carcinoma showed low toxic side effects. Radical surgery after chemotherapy is safe and feasible. It plays a coordinating role in reducing the tumor infiltration depth of the deep muscle layer and the incidence of vascular tumor emboli, reducing the use of postoperative adjuvant therapy, and improving the quality of life of patients, but does not improve the 3-year/5-year survival rate.

Percutaneous antegrade ureterolithotripsy for proximal ureteral stones: overview own experience use

Introduction. Currently, a large number of techniques are used in the treatment of patients with ureteral stones: extracorporeal shock-wave lithotripsy (ESWL), retrograde ureterolithotripsy (RULT), laparoscopic and retro-peritoneoscopic ureterolithotomy.Purpose of the study. To evaluate the possibilities and effectiveness of percutaneous antegrade ureterolithotripsy in the treatment of patients with proximal ureteral stones in comparison with transurethral contact ureterolithotripsy.Materials and methods. Twenty-eight patients with urolithiasis were treated, who underwent percutaneous antegrade ureterolithotripsy (PAULT) and 27 patients of the control group, who underwent RULT. All patients included in the study underwent a standard preoperative examination: complete blood count and urine analysis, bacteriological urine culture, biochemical tests, and X-ray research methods. Plain urography, renal ultrasound, computed tomography were used as imaging methods. The OLYMPUS URF-V3 8.4 Ch (Olympus Europa SE &amp; Co. KG., Germany) video uretero-renoscope was used for PAULT in patients of the main group; lithotripsy was performed using thulium laser. The results of the study were subjected to statistical processing in order to determine the statistical significance of the differences between the data obtained. Quantitative variables were described using the arithmetic mean (M) and standard deviation (5). Qualitative variables were estimated by absolute and relative frequencies (percentages). The data were considered reliable at p values &lt; 0.05.Results. The average time of surgical intervention in patients of the main group from the moment of placement of the ureteral catheter was 47 ± 12 min, with access without preliminary renal catheterization: 28 ± 4 min. Average time of surgical intervention in patients of the control group: 42.0 ± 10.7 minutes. The presented data indicate a significant (p &lt; 0.05) greater cases' number of complete stone removal among patients of the main group compared with patients in the control group (74.0%).Conclusion. PAULT is preferred among choice treatment methods for patients with proximal ureteral large stones, for whom RULT and ESWL cannot be performed with a high level of “stone-free” rate and a minimum number of complications.

Мини-перкутанная нефролитотомия без катетеризации мочеточника. Сравнение со стандартной методикой

Introduction. Percutaneous nephrolithotomy (PNL) is the method of choice for the treatment of patients with kidney stones larger than 2 cm. Mini-percutaneous nephrolithotomy (mini-PNL) became widespread due to reduction of injury associated with surgical approach. Creation of puncture access to the pelvicalyceal system without ureteral catheterization is also recently described. The main benefits of such technique are reduction of total operative time and the radiation exposure to the patient and medical personnel. The results of using mini-PNL without prior ureteral catheterization remain insufficiently studied, which predetermined the goal of our study. Purpose. Compare the efficacy and duration of mini-PCNL with and without ureteral catheterization. Materials and methods. We analyzed the treatment outcomes of 111 patients with a single kidney stone. Group I included 60 patients who underwent mini-PCNL according to the standard technique. Group II included 51 patients who underwent mini-PCNL without prior catheterization of the ureter. The average stone size was 19.2 0.92 mm and 18.6 0.93 mm in groups I and II, respectively. The puncture of the pyelocaliceal system of the kidney was performed under X-ray control and US guidance using the free-hand technique. Results. In group I, complete elimination of the stone was achieved in 55 (92%) patients and the mean duration of the operation was 108,3 34,85 min (range: 60 to 210). In group II, complete elimination of the stone was achieved in 50 (90%) patients and the mean duration of the operation was 69,7 22 min (range: 25 to 120 min). In all cases, the severity of complications did not exceed grade II according to Clavien classification, and their rate was 6,7% and 5,9% in group I and group II, respectively. Conclusions. According to the results of the study, the compared groups did not differ in their post-operative complication and stone-free rates. Avoidance of routine ureteral catheterization significantly reduces the operation time and hence the anesthetic risk and radiation load.

Internal Coating of Ureteral Stents with Chemical Vapor Deposition of Parylene

Ureteral balloon catheters and ureteral stents are implanted in large quantities on a daily basis. They are the suspected cause for about a quarter of all the nosocomial infections, which lead to approx. 20,000 deaths in Germany alone. To fight these infections, catheters should be made antibacterial. A technique for an antibacterial coating of catheters exhibiting an aspect ratio of up to 200 consists of a thin silver layer, which is deposited out of an aqueous solution, which is followed by a second step: chemical vapor deposition (CVD) of an organic polymeric film, which moderates the release rate of silver ions. The main concern of the second step is the longitudinal evenness of the film. For tubes with one opening as balloon catheters, this issue can be solved by applying a descendent temperature gradient from the opening to the end of the catheter. An alternative procedure can be applied to commercially available ureteral stents, which exhibit small drainage openings in their middle. The same CVD as before leads to a longitudinal homogeneity of about ±10%—at very low costs. This deposition can be modeled using viscous flow.

Ultrasonographic percutaneous nephrolithotomy, with or without ureteral catheter

Introduction: Access by ultrasonography rather than fluoroscopy in addition to reducing radiation exposure to the patient and staff, is safe and effective. Access by ultrasonography is bi-planar and real-time compared to fluoroscopy, because it provides fewer side effects and more stone free rate. Objectives: To study the complications and outcome of PCNL (percutaneous nephrolithotomy) with or without using ureteral catheter. Patients and Methods: We studied 59 patients with at least 2 cm diameter of renal stone from January to December of 2018. After general anesthesia, 35 patients in the ureteral stent group were prepared in bladder lithotomy position. Then 5-French (Fr) ureteral catheters were introduced endoscopically in stone affected side and fixed to 16 Fr urethral Foley catheters in the patients. Other 24 patients in the non-stent group following anesthesia were directed to prone position instantly. In all of the patients, ultrasonography was performed in posterior auxiliary line below the ribs in prone position. Retrograde instillation of normal saline was performed through ureteral catheter in stent-group. Then we inserted 18G Chiba needle to desired calyx without needle holder guidance in all patients. Our approach according to probe was transverse. Results: Our patients comprised of 24 men and 35 women aged 24 to 66 years. Thirteen of them had no hydronephrosis and their stone sizes ranged from 21 mm to 65 mm. Patients in the ureteral stent group were more obese compared to the non-stent group (P=0.02) in addition to significantly more operation time (P=0.03). However hydronephrosis was not significantly different between groups (P=0.3). Postoperative residual stone rate, hospital stay days and complications (Fever, blood transfusion) were the same between both groups. Only urinary leak was more common in the non-stent group (P=0.04) Conclusion: Ultra-sonographic-PCNL without inserting ureteral catheter before surgery is conceivable especially in patients with lower body mass index (BMI). Advantages and complications are same in ureteral stent and non-stent patients except urinary leak that is more common in non-stent patients.

Is Flexible Ureteroscopy and Laser Lithotripsy the New Gold Standard for Pediatric Lower Pole Stones? Outcomes from Two Large European Tertiary Pediatric Endourology Centers.

Introduction: Although pediatric ureteroscopy has been increasingly performed, the evidence for its use in pediatric lower pole stones (LPS) is sparce. In this study we look at the effectiveness and outcomes of flexible ureteroscopy and laser lithotripsy (FURSL) in the management of LPS for a pediatric population. Materials and Methods: Data were collected from two large European tertiary endourology centers that specialize in pediatric kidney stone management. The study was registered as an audit at the respective hospitals. All data were cross-checked and analyzed using electronic operative notes, discharge records, laboratory systems, and patient correspondence. The inclusion criteria were patients ≤16 years with LPS having an FURSL procedure. Results: A total of 57 pediatric patients underwent FURSL for LPS. The mean age was 10.1 ± 4.7 years (range: 1-16.9 years) with a male-female ratio of 2:3. The mean single stone size was 9.45 ± 3.9 mm (range: 3-20 mm) and 31 (54.4%) had multiple stones. A preoperative stent was present in 18 (31.6%) patients and a postoperative stent or ureteral catheter was left behind in 32 (56.1%) patients. The initial and final stone-free rates were 82.4% and 98.2%, respectively, with 1.19 procedures per patient performed to be stone free. Although there were no intraoperative complications, there were only four (7%) minor complications (Clavien I) noted that were all simple urinary infections. No long-term complications were noted. Conclusion: Flexible ureteroscopy and lasertripsy achieve excellent outcomes for treatment of pediatric LPS. Although some patients might need a second procedure for complete stone clearance, FURSL may be considered as the first-line treatment of LPS.

Ureteral navigation using a fluorescent ureteral catheter during laparoscopic colorectal surgery.

Ureteral injury is the most common urological complication of pelvic surgery, with a reported incidence during colon resection of 0.3-1.5%. Ureteral stenting is commonly performed preoperatively to prevent ureteral injury. Because tactile sensation is not reliable during laparoscopic surgery, the effect of the ureteral stent is considered limited. Recently, fluorescence imaging has been used in laparoscopic surgery. The Near-Infrared Ray Catheter (NIRC™) fluorescent ureteral catheter (NIRFUC) is a new catheter with built-in NIR fluorescent resin. This pilot study was performed to evaluate the utility of fluorescence ureteral navigation using the NIRFUC during laparoscopic colorectal surgery. We evaluated the intraoperative utility of the NIRFUC and the short-term outcomes in 20 patients treated with colorectal surgery at Kawaguchi Municipal Medical Center between February and July 2020. In all, 18 patients with malignant tumors and 2 patients with benign disease, i.e., a sigmoid colovesical fistula, were included. Ten patients developed preoperative intestinal obstruction. One patient experienced preoperative perforation. Nine patients developed preoperative peritumoral abscesses. Laparoscopic surgery was performed with the VISERA ELITE2 system. In all cases, the ureters were very clearly identified as fluorescent without the need for dissection. In all cases, only a moment was required to identify the ureter by fluorescence observation. In all cases, R0 resection was performed. The mean surgical duration was 334min (161-1014), the mean blood loss was 10ml (1-500), and the mean postoperative hospital stay was 11days (8-47). There were no cases of ureteral injury. The NIRFUC was very clearly identified as fluorescent in a moment during surgery without dissection around the ureter. Fluorescence ureteral navigation using the NIRFUC may make colorectal surgery easier and facilitate completion of complex minimally invasive surgery, especially during surgery in patients with invasion of the surrounding tissue or a history of pelvic surgery or radiation.