Ureteral Lithiasis Research Articles

Impact of COVID-19 outbreak on urology surgical waiting lists and waiting lists prioritization strategies in the post-COVID-19 era

IntroductionThe suspension of most elective surgeries during COVID-19 pandemic caused the lengthening of urology surgical waiting lists. The objective of this study is to evaluate the impact of COVID-19 pandemic on urology surgical waiting list in a high-volume hospital. MethodsAn observational descriptive study was designed. All patients included in the urology surgical waiting list of our high-volume center on May 1st 2020 (46 days after the suspension of elective surgery) were analyzed. Baseline variables, priority on the waiting list, main urological disease, type of scheduled surgery, and waiting time were recorded. Other variables recorded were the presence of a urinary catheter, number of accesses to the emergency department, evidence of COVID-19 infection, number of deaths and their cause. The waiting time for each disease was compared with the time to surgery in 2019. ResultsA total of 350 patients were included. The mean (SD) time on the waiting list was 97.33 (55.47) days. Priority 1 patients, who normally should undergo surgery within 30 days, were on the waiting list for a mean (SD) time of 60.51 (20.14) days. They were mainly patients with ureteral lithiasis (25.6%), high-risk or muscle-invasive bladder cancer (20.9%) and high-risk prostate cancer (13.9%). The mean waiting time had already significantly exceeded the mean time to surgery in 2019 for radical cystectomy (p = 0.04) and URS (p = 0.003). ConclusionsThe suspension of most elective surgeries due to COVID-19 had a significant impact on urology surgical waiting list of our high-volume center, especially in priority 1 group.

Impacto del brote de COVID-19 en las listas de espera de cirugía urológica y estrategias de priorización en la era post-COVID-19

IntroductionThe suspension of most elective surgeries during COVID-19 pandemic caused the lengthening of urology surgical waiting lists. The objective of this study is to evaluate the impact of COVID-19 pandemic on urology surgical waiting list in a high-volume hospital. MethodsAn observational descriptive study was designed. All patients included in the urology surgical waiting list of our high-volume center on May 1st 2020 (46 days after the suspension of elective surgery) were analyzed. Baseline variables, priority on the waiting list, main urological disease, type of scheduled surgery, and waiting time were recorded. Other variables recorded were the presence of a urinary catheter, number of accesses to the emergency department, evidence of COVID-19 infection, number of deaths and their cause. The waiting time for each disease was compared with the time to surgery in 2019. ResultsA total of 350 patients were included. The mean (SD) time on the waiting list was 97.33 (55.47) days. Priority 1 patients, who normally should undergo surgery within 30 days, were on the waiting list for a mean (SD) time of 60.51 (20.14) days. They were mainly patients with ureteral lithiasis (25.6%), high-risk or muscle-invasive bladder cancer (20.9%) and high-risk prostate cancer (13.9%). The mean waiting time had already significantly exceeded the mean time to surgery in 2019 for radical cystectomy (p = 0.04) and URS (p = 0.003). ConclusionsThe suspension of most elective surgeries due to COVID-19 had a significant impact on urology surgical waiting list of our high-volume center, especially in priority 1 group.

Comparative analysis of direct and indirect costs of two minimally invasive techniques for the treatment of renal/ureteral calculi smaller than 2 cm

ObjectiveTo perform a comparative analysis of indirect and direct costs of two minimally invasive techniques (extracorporeal shock wave lithotripsy (ESWL) vs. ureteroscopy with holmium laser (URS/RIRS)) for the treatment of renal/ureteral calculi smaller than 2 cm. Material and methodsProspective, comparative, non-randomized study of 84 patients treated for kidney stones smaller than 2 cm between January and December 2016. Of these, 38 (45.67%) were treated with ESWL (18 renal lithiasis and 20 ureteral lithiasis) and 46 (54.32%) with URS/RIRS (22 renal lithiasis and 24 ureteral lithiasis). A total of 19 (41.3%) patients in the URS/RIRS group and 15 (39.5%) patients in the ESWL group were actively working before treatment. The variables analyzed were sex, age, number and size of lithiasis, time (days) off from work due to treatment, estimate of indirect cost due to labor productivity loss and direct treatment costs including follow-up (total number of procedures, ancillary care, visits and diagnostic tests). The 2015 Wage Structure Survey (INE) was used to estimate the indirect cost. In addition, the “Work Productivity and Activity Impairment” (WPAI) questionnaire was also used to determine the level of perceived productivity loss. ResultsThe mean number of sessions until lithiasis resolution was achieved was 2.57 for the ESWL group and 1.04 for the URS. The mean number of days off from work in the URS group was 7.16 days and 3.18 (p = 0.034) in the ESWL group. The total indirect costs resulting from productivity loss were EUR 621.55 and EUR 276.05 for the URS and ESWL, respectively. Direct costs in the ESWL group were EUR 1382.9 and EUR 2317.71 in the URS group. The level of work impairment perceived by patients undergoing URS was 18.88% and 21.33% in the ESWL group. The degree of impairment for performing activities of daily living was 24.44% in the URS and 15% in ESWL. ConclusionsThe ESWL technique requires a higher number of sessions for the resolution of kidney stones under 2 cm, but it has a lower impact on total costs and on the perceived degree of affectation.

Análisis comparativo de costes directos e indirectos de dos técnicas mínimamente invasivas, para el tratamiento de la litiasis renoureteral menor de 2 cm

ObjectiveTo perform a comparative analysis of indirect and direct costs of two minimally invasive techniques (extracorporeal shock wave lithotripsy (ESWL) vs. ureteroscopy with holmium laser (URS/RIRS)) for the treatment of renal/ureteral calculi smaller than 2 cm. Material and methodsProspective, comparative, non-randomized study of 84 patients treated for kidney stones smaller than 2 cm between January and December 2016. Of these, 38 (45.67%) were treated with ESWL (18 renal lithiasis and 20 ureteral lithiasis) and 46 (54.32%) with URS/RIRS (22 renal lithiasis and 24 ureteral lithiasis). A total of 19 (41.3%) patients in the URS/RIRS group and 15 (39.5%) patients in the ESWL group were actively working before treatment. The variables analyzed were sex, age, number and size of lithiasis, time (days) off from work due to treatment, estimate of indirect cost due to labor productivity loss and direct treatment costs including follow-up (total number of procedures, ancillary care, visits and diagnostic tests). The 2015 Wage Structure Survey (INE) was used to estimate the indirect cost. In addition, the «Work Productivity and Activity Impairment» (WPAI) questionnaire was also used to determine the level of perceived productivity loss. ResultsThe mean number of sessions until lithiasis resolution was achieved was 2.57 for the ESWL group and 1.04 for the URS. The mean number of days off from work in the URS group was 7.16 days and 3.18 (p = 0.034) in the ESWL group. The total indirect costs resulting from productivity loss were EUR 621.55 and EUR 276.05 for the URS and ESWL, respectively. Direct costs in the ESWL group were EUR 1,382.9 and EUR 2,317.71 in the URS group. The level of work impairment perceived by patients undergoing URS was 18.88% and 21.33% in the ESWL group. The degree of impairment for performing activities of daily living was 24.44% in the URS and 15% in ESWL. ConclusionsThe ESWL technique requires a higher number of sessions for the resolution of kidney stones under 2 cm, but it has a lower impact on total costs and on the perceived degree of affectation.

Rare Complication of Urinoma: Hydrocele Resolved with Ureteral Stenting

Urinoma is a possible complication of ureteral lithiasis. Urine extravasation is normally localized in the retroperitoneum. We describe a rare case of hydrocele secondary to urinoma, resolved with ureteral stenting.

Priapismo en anestesia para cirugía urológica: alternativas terapéuticas intraquirúrgicas

Introducción: El priapismo puede definirse como la erección persistente a lo largo del tiempo y en ausencia de estimulo sexual, constituye una emergencia médica, dentro de su etiología clínica pueden considerarse de dos tipos: venoso isquémico y arterial no isquémico, siendo el primero mucho más frecuente.
 La ocurrencia de priapismo dentro del período intraquirúrgico es poco frecuente y puede presentarse tanto bajo anestesia general como neuroaxial, no existe literatura florida sobre este tema, por lo que se realiza una presentación de caso clínico con actualización de alternativas terapéuticas farmacológicas y anestésicas.
 Objetivo: Describir un caso clínico de priapismo en anestesia para cirugía urológica.
 Material y métodos: Estudio descriptivo retrospectivo, presentación de caso clínico.
 Resultados: Se describe un caso clínico de paciente masculino de 33 años de edad con diagnóstico de litiasis ureteral izquierda programado para colocación de catéter doble J, litotripsia intracorpórea y cistoureteroscopia, quien presenta erección peneana permanente que no cede a profundidad anestésica y relajación muscular que imposibilitan el procedimiento quirúrgico por dificultad en la manipulación, responde adecuadamente a la administración de epinefrina intracavernosa, sin evidenciarse crisis adrenérgica ni compromiso vascular distal. 
 Conclusiones: El priapismo intraquirúrgico, no es común, puede presentarse por diversas etiologías (estímulo táctil, anestesia neuroaxial y general) puede ser ocasionante de suspensiones quirúrgicas de no ser tratado pronta, adecuada y oportunamente. En la realidad de nuestro medio la técnica de inyección inracavernosa de 10 – 20 mcg de epinefrina es un método sencillo, fácil y con resultados inmediatos que permitirán la manipulación del pene para procedimientos urológicos.

Outcomes of ileal conduit urinary diversion in patients with multiple sclerosis.

The objective of this study was to report the long-term outcomes and complications of patients with multiple sclerosis (MS) who underwent noncontinent urinary diversion to treat lower urinary tract symptoms (LUTS). A retrospective study included all adult patients with MS who underwent an ileal conduit urinary diversion between 2000 and 2015. Early postoperative complications were reported as well as long-term complications, reoperation rates, and renal function. Overall, 91 patients were included. The surgery was indicated for refractory urinary incontinence (n = 73), renal failure (n = 8), major perineal skin ulcer due to urinary incontinence (n = 6), and recurrent urinary tract infections (n = 4). The median follow-up was 50 months (range, 3-158 months). A significant reduction (P < .05) of postoperative nonobstructive pyelonephritis rate was observed. There was no significant difference between preoperative and postoperative renal function (P = .32). Early postoperative complications were reported in 24 patients (26%): 4 Clavien I, 6 Clavien II, 9 Clavien III, 4 Clavien IV, and 1 Clavien V. Nine patients required reoperation for these complications (9.9%). Late complications were reported in 28 patients (30.8%): 8 ureteral anastomosis stenosis, 2 stoma stenosis, 2 incisional hernias, 6 kidney or ureteral lithiasis, and 10 pyelonephritis. Among them, 15 patients (16.5%) required reoperation for late complications. Noncontinent urinary diversion using ileal conduit appears to be an effective end-stage solution in MS patients. The perioperative morbidity rate of 26% and the late complication rate of 31% should be considered to better inform patients before the surgery.

Síndrome de dolor lumbar agudo no traumático de origen renal: cólico renoureteral

The most frequent low back pain syndrome of renal origin is the renal-ureteral colic (RUC), secondary to ureteral lithiasis in 90% of cases. In emergency unit, proper management and the knowledge of complication criteria are mandatory. The pain in RUC and remaining acute renal pathologies is originated by the distention or irritation of the renal capsule. Regarding colic pain, it is caused by the release of vasodilators in response to offset the fall in glomerular filtration rate due to renal hypertension. Complication criteria are: fever, acute renal failure, incoercible pain (despite stepped analgesia) and urinoma. Diagnosis is clinical. If complication is suspected imaging tests are required. Analgesics of choice are nonsteroidal anti-inflammatory drugs. Urgent urinary diversion with ureteral catheter or percutaneous nephrostomy is a priority in complicated cases.

Interest of URS-L in the Treatment of Ureterolithiasis in Preschool Children

Urolithiasis can affect all children even preschool ones. Diagnostic difficulties in the youngest children are due to the problems in locating pain and determining its character and severity. In keeping with the ALARA (As Low As Reasonably Achievable) protocol, the number of imaging tests possible to perform is very limited. Ultrasound is the first line exam of choice. After diagnosis of the presence of a stone, ESWL (Extracorporeal Shock Wave Lithotrypsy) should always be considered and offered to parents due to its high effectiveness and minimal invasiveness. If ESWL is contraindicated or not well-accepted by parents, authors suggest another minimal invasive approach: URS-L (Uretherorenoscopy–Lithotrypsy). Our study clinically analyzes 87 children, which were treated between 2009 and 2017 using the URS-L procedure. URS-L treatments were performed using Lithoclast until 2009, and after that time, using the holmium laser Ho:YAG. The overall effectiveness of treatments was 93.3%. There was no failure in the access to the stones. A macroscopic hematuria (Clavien-Dindo I grade) was observed through the second post-operative day in 9.2% of treated patients. No urosepsis was observed. Full metabolic evaluation was performed on all patients. Children remained under constant urological and nephrological observation. A recurrence of urolithiasis was observed in 35.6% of the cases. Treating ureteral lithiasis in young infants remains a big challenge. Our series shows that modern minimal invasive techniques used by very experienced pediatric urologists in high volume centers gives excellent results. In most cases, surgery should no longer need to be an option.

Large Hepatic Subcapsular Hematoma Secondary to Double-J Stent Placement

Introduction and Background: Urinary diversion with the endoscopic Double-J stent is a frequent procedure; complications can include irritation, suprapubic or flank pain, vesicoureteral reflux, hematuria, or urinary infection. We report a case of hepatic subcapsular hematoma secondary to Double-J stent placement. Case Presentation: A 28-year-old woman presented with a history of Sjögren's disease, nephrocalcinosis, and chronic kidney disease (CKD). The patient underwent multiple percutaneous and endoscopic procedures during the previous 2 years: right kidney: extracorporeal shock wave lithotripsy (SWL) × 4, ureteroscopic lithotripsy × 2, percutaneous nephrolithotomy (PCNL), and retrograde intrarenal surgery; left kidney: SWL × 2, ureteroscopic lithotripsy × 5, and PCNL. Ultrasound imaging showed severe dilation in the right kidney and moderate dilation in the left kidney. CT scanning without contrast revealed a right pyelourethral dilation caused by a 13 mm ureteral lithiasis; also, cortical atrophy was observed. Urosepsis with exacerbated CKD was diagnosed and bilateral 7F Double-J stents were placed on both sides under general anesthesia. On postoperative day (POD) 8, the patient presented with pain in the right hemithorax and dullness to percussion. CT scans showed a heterogeneous hepatic subcapsular collection, of 15 × 7 × 23 cm, of hematic aspect, displacing vascular structures, and no active bleeding. Treatment was expectant and symptomatic. On POD 16, a new CT scan ruled out progression of the hematoma. The patient was finally discharged on POD 19. Four months later, bilateral semirigid ureteroscopy showed a right ureteral lithiasis of 8 × 7 mm, which was fragmented with a holmium laser. Nineteen months after the first episode, the patient is asymptomatic, with no residual lithiasis or hepatic hematoma. Conclusion: This case shows a very rare complication of Double-J stent placement that could be managed by conservative treatment.

110 - Does pre-operative ureteral stenting for middle and distal ureteral lithiasis improves the stone free rates after semi-rigid ureteroscopy?

110 - Does pre-operative ureteral stenting for middle and distal ureteral lithiasis improves the stone free rates after semi-rigid ureteroscopy?

PUK20 - COST-UTILITY ANALYSIS OF EXTRACORPOREAL LITHOTRIPSY VERSUS URETERORENOSCOPY-HOLMIUM LASER FOR TREATMENT OF URINARY STONES

The objective od this study is to compare the cost-utility profile of ureterorenoscopy-holmium laser (URS) versus extracorporeal lithotripsy (ESWL) in the treatment of urinary stones smaller than 20mm. A total of 525 patients treated between 2012-2014 were included in the study. Of these, 229 (43.6%) were treated with URS and 296 (56.3%) with ESWL. For QALYs calculation, a sample of 78 patients (32 treated with ESWL and 46 with URS) were evaluated prospectively (January 2016-December 2016) using a quality of life survey (Euroqol 5QD-3L) before and after treatment. A Markov model (SWL + URS salvage vs primary URS) was constructed for the calculation of the quality of life in each possible state of the patient (lithiasis without double J stent, lithiasis with stent, free of lithiasis without stent and free of lithiasis with stent). A Monte Carlo simulation was performed as probabilistic sensitivity analysis to confirm the robustness of the results. Of the 525 patients, 345 (65.71%) were treated for renal lithiasis (41.7% by URS and 58.26% by SWL) and 180 for ureteral lithiasis (47.2% by URS and 52.7% by ESWL). Mean cost per patient treated with ESWL and URS 1.733,96 € and 2.337,31 € euros respectively. Renal stone-free rate was 91.7% for URS and 79.16% for ESWL and ureteral stone-free rate was 94% and 81%, respectively. The cost-utility analysis showed higher cost but incremental QALYS of 0.011 for URS, thus, the ICER was 50.829,82 €/QUALY, above the acceptability threshold. According to our results, ESWL showed to be a more efficient tool in cost-utility terms compared to URS in the treatment of reno-ureteral lithiasis smaller than 20 mm.

Outpatient Microureteroscopy for Distal Ureteral Stone–A True Minimally Invasive Procedure

To describe microureteroscopy, a novel minimally invasive approach for treating distal ureteral lithiasis. Seven female patients with distal ureteral stones ≤ 10 mm were operated by microureteroscopy. The microureteroscope consist on a 4.85 Fr (16-gauge) sheath, a 0.9 mm diameter flexible optic system, and a 3-arm Luer-lock adapter to connect the sheath and insert the optics. Patients are placed in lithotomy position. Under sedative anesthesia and antimicrobial coverage, we performed microureteroscopy in patients with distal ureteral stones, describing key steps and perioperative and postoperative outcomes. Stone clearance was assessed using X-ray plain abdominal film of KUB at 15 days. Mean patients age was 54.5 years, and mean stone size was 7.98 mm. Stone-free rate was 100%. Patients were discharged 2-4 hours after the procedure without intraoperative or major perioperative complications. Microureteroscopy was developed to reduce dilation and ureteral wall damage and, thus, to decrease postoperative stenting and hospital stay.

V04-12 ROBOT-ASSISTED PARTIAL NEPHRECTOMY AND BILATERAL PYELOLYTHOTOMY OF ECTOPIC PELVIC KIDNEYS

You have accessJournal of UrologyReconstruction - Upper Urinary Tract1 Apr 2018V04-12 ROBOT-ASSISTED PARTIAL NEPHRECTOMY AND BILATERAL PYELOLYTHOTOMY OF ECTOPIC PELVIC KIDNEYS Carlotta Palumbo, Maria Furlan, Stefania Zamboni, Alessandro Veccia, Angelo Peroni, Alessandro Antonelli, and Claudio Simeone Carlotta PalumboCarlotta Palumbo More articles by this author , Maria FurlanMaria Furlan More articles by this author , Stefania ZamboniStefania Zamboni More articles by this author , Alessandro VecciaAlessandro Veccia More articles by this author , Angelo PeroniAngelo Peroni More articles by this author , Alessandro AntonelliAlessandro Antonelli More articles by this author , and Claudio SimeoneClaudio Simeone More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1029AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Ectopic kidney is congenital abnormality of position and rotation, frequently associated with urolithiasis. In case of large stones, the percutaneous treatment has some specific difficulties related to the anatomy of the kidneys and the pelvis, that viceversa represents the ideal condition for a transperitoneal surgical access.The case here presented, in addition was affected by a bilateral renal lithiasis and an enhancing parenchymal mass of the right lower pole: with the aim to perform a “one-stage” treatment, we planned a robotic surgery. METHODS A 44-years old male admitted because of recurrent left back pain. Past medical history was consistent bilateral pelvic kidneys and ureteral lithiasis spontaneously passed 1 year before.Abdominal contrast enhanced CT scan showed a 17 mm stone in the left renal pelvis, a 12 mm stones in the right pelvis and a 34x27 mm enhancing right lower pole renal mass, with a strict relationship with the prevesical ureter; the angiographic phases revealed a vascular supply to the right kidney from the common iliac artery. A robotic surgery was indicated. Patient was placed in trendelenburg position with Da Vinci® port configuration as for transperitoneal radical prostatectomy, using a 30° lens. The right kidney was firstly approached: after complete isolation of the ureter and its dissection from the tumor, suspension of the renal artery at its emergence from the iliac, a clampless partial nephrectomy was performed; then through a longitudinal pyelotomy was extracted the renal stone. To minimize the opening in the posterior peritoneum and the sigmoid mesentery, covering the left kidney, the site of the pelvis and stone were identified by an intraoperative ultrasound; then, through a longitudinal pyelotomy the stone was extracted. At the end, the peritoneum was sutured. A Jackson-Pratt drainage was place through the inferior robotic port. RESULTS The operative time was 240 minutes, with 190 minutes of console time. Estimated blood loss was 50 mL. No intra or post-operative complications were reported. The drain was removed on the second postoperative day and the length of stay was 4 days. At discharge, the patient had serum creatinine of 0.93 mg/dL and haemoglobin of 12.5 g/dL. Final histopathology showed a pT1a G2 clear cell renal cell carcinoma with a negative surgical margin, while stone analysis showed calcium oxalate stones. CONCLUSIONS With the availability of robotic technology, the indications for minimally invasive surgery may be safely expanded to include concomitant morbidities in uncommon presentations. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e410 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Carlotta Palumbo More articles by this author Maria Furlan More articles by this author Stefania Zamboni More articles by this author Alessandro Veccia More articles by this author Angelo Peroni More articles by this author Alessandro Antonelli More articles by this author Claudio Simeone More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Semirigid ureteroscopy prior retrograde intrarenal surgery (RIRS) helps to select the right ureteral access sheath.

To evaluate ureteral compliance through semirigid ureteroscopy (sURS) in order to select the proper ureteral access sheath (UAS) size for retrograde intrarenal surgery (RIRS). In a prospective study, 100 consecutive patients selected for elective sURS or RIRS were recruited. Each patient, initially underwent 9.5 Fr sURS with a safety guidewire 3Fr, in order to estimate ureteral compliance. If the ureter was compliant, a gently passage of a 12/14Fr UAS was attempted. If the ureter was not deemed compliant, passage of either a smaller UAS or a smaller semirigid 7Fr or a flexible 7.5Fr or a digital 8.5Fr scope with and without safety guidewire, was attempted. Age, gender, disease location, prestenting, previous RIRS and/or stone elimination, hydronephrosis, ureteral strictures, unsuccessful procedures, and complications, were analyzed as possible correlated factors of ureteral compliance. In 77 patients the ureter was deemed compliant ≥ 14Fr. Of the preoperative factors that were examined, stent placement before RIRS (P < 0.002), previous RIRS (P = 0.000) and previous stone elimination (P = 0.004), correlated with ureter ≥ 14Fr. Ureteral lithiasis (P < 0.001), ureteral strictures (P < 0.05), unsuccessful procedures (P < 0.005) and complications (P = 0.01) correlated with ureter < 14Fr. The complication rate was 10% (10 patients) with ureteral injuries grade I in 9 patients and grade III in 1 patient according to the endoscopic grading system. Age, gender, hydronephrosis and urothelial carcinoma (UC) had no influence. sURS performed before RIRS allows selection of the right ureteral access sheath (UAS) and avoidance of major complications. Pre-stenting, previous RIRS and stone elimination history are all factors correlating with a compliant ureter.

Renal Impairment in Young Patients with Unilateral Ureteral Lithiasis Obstruction: What Factors can be Responsible?

In the literature, occurrence of acute kidney injury (AKI) in young patients with unilateral ureteral lithiasic obstruction and without previous renal impairment is not very often reported, and the underlined pathophysiological mechanisms are poorly known; according to some studies, it is a false kidney failure, the increase in serum creatinine being due to absorbtion of obstructed urine in the affected kidney. We have conducted a retro and prospective study in order to identify the possible risk factors that can cause renal function impairment in young patients (18-40 years) with unilateral ureteral lithiasis obstruction and a normal contralateral kidney. Results. From 402 patients included in the study, 20.64% (83 cases) presented with serum creatinine ] 1.3 mg/dL. In patients with renal impairment, prevalence of male gender and history of NSAIDS use before admission were significantly higher than in non-AKI group. Serum urea/creatinine ratio, and estimated glomerular filtration rate (MDRD formula) were significantly higher, and respectively lower in AKI group. We found no significant differences between the two groups regarding age, prevalence of urinary tract infection after relief of obstruction, C-reactive protein value, and the duration of hospitalization. Conclusions. AKI in young patients with unilateral ureteral lithiasis obstruction and normal contralateral kidney is not quite a rare finding in our region. NSAIDs use can influence development of AKI, and should be used cautiously even in young patients with renal colic. In our opinion, the presence of AKI in patients with unilateral hydronephrosis demands urgent endourological intervention. Choosing conservative therapy in these patients, especially treatment with NSAIDS may aggravate the renal dysfunction.

Complications of non-continent cutaneous urinary diversion in adults with spinal cord injury: a retrospective study.

Retrospective cohort study. To report the long-term complications of non-continent cutaneous urinary diversion (NCCUD) in adult patients with spinal cord injury (SCI). Hospital in Paris, France. A retrospective single center study included all adult patients with SCI who underwent an ileal conduit between 1997 and 2014. Early complications were reported according to Clavien-Dindo classification. Long-term complications and reoperation rates were recorded, as well as stoma management and autonomy improvement related to urinary function. One hundred and two patients were included. The surgical indications included failure of intermittent catheterization (n = 43), urethral fistulae due to skin ulcers (n = 50), renal failure (n = 8), recurrent urinary tract infections (n = 9), lithiasis (n = 3), and bladder tumors (n = 2). There were 67 early postoperative complications for 44 patients (43%) leading to an additional surgery in 15 cases: 30 grade I-II, 30 grade III, 6 grade IV, and 1 grade V. A total of 37 late complications were reported for 36 patients (35%): 17 ureteral anastomosis stenosis, 3 stoma hernia, 3 pyocystis (3/15 patients), 7 pyelonephritis, 2 renal failures, 2 ureteral lithiasis, 1 uterine prolapse, 1 incisional hernia, and 1 tumor recurrence. Renal function remained unchanged (p = 0.53). Autonomy related to urinary function was improved in 88% of patients. The correct fitting of the stoma was possible for 81% of the patients. Despite a perioperative morbidity rate of 43% and a late complication rate of 35%, as a last resort procedure, NCCUD is an end-stage solution in patients with SCI to preserve renal function and achieve autonomy.

21 - The safety and efficacy of flexible and semirigid ureteroscopy as a minimally invasive treatment for challenging cases of renal and ureteric lithiasis: Our clinical experience in 72 difficult cases

21 - The safety and efficacy of flexible and semirigid ureteroscopy as a minimally invasive treatment for challenging cases of renal and ureteric lithiasis: Our clinical experience in 72 difficult cases

Is extracorporeal shock wave lithotripsy a current treatment for urolithiasis? A systematic review

IntroductionTechnological advances have prompted a change in the management of urolithiasis. Endourological techniques are gaining importance because they are highly effective treatments. The aim of this study was to answer the question of whether extracorporeal shock wave lithotripsy (ESWL) is still a competitive alternative compared with other therapeutic modalities. Acquisition of evidenceWe conducted a literature search of articles published in the past 5 years. We identified 12 randomized and comparative studies and assessed the methodology and results of the study variables. We performed a narrative synthesis of the included studies. To summarize the variables, we used the mean and standard deviation for continuous variables and absolute numbers and percentages for the qualitative variables. Analysis of the evidenceOf the studies reviewed, 7 evaluated the various treatments for nephrolithiasis and 5 evaluated the treatments for ureteral lithiasis. At the renal level, a stone-free rate of 33.33–91.5% at 3 months was reached with ESWL, while a rate of 90.4–100% was achieved with the other endourological techniques, without finding statistically significant differences in the studies. At the ureteral level, a stone-free rate of 73.5–82.2% at 3 months was reached with ESWL, while a rate of 79–94.1% was achieved with the other endourological techniques, without finding statistically significant differences in the studies. ConclusionThere is a lack of homogeneity among the published studies. ESWL is a minimally invasive treatment that with an appropriate technique and patient selection achieves high effectiveness, thus maintaining an important role at this time.

Review: In patients with ureteric lithiasis, α-blockers increase stone expulsion.

Source Citation Raison N, Ahmed K, Brunckhorst O, Dasgupta P. Alpha blockers in the management of ureteric lithiasis: a meta-analysis. Int J Clin Pract. 2017;71:e12917. 28097758