Size Of Ureteroscope Research Articles

Randomized comparison of 4.5/6 Fr versus 6/7.5 Fr ureteroscopes for laser lithotripsy of lower/middle ureteral calculi: towards optimization of efficacy and safety of semirigid ureteroscopy

Background and purposeTo compare 4.5/6 Fr versus 6/7.5 Fr semirigid ureteroscopes in terms of safety and efficacy in adult non-obese patients with middle or lower ureteric stones.Materials and methodsA total of 198 patients with middle/lower ureteric stone and a BMI ≤ 30 kg/m2 were recruited. Patients were randomized according to the size of ureteroscope into two groups: group 1 where a 4.5/6 Fr semi-rigid ureteroscope was used, and group 2 where a 6/7.5 Fr semi-rigid ureteroscope was used. Patient’s demographic, stone characteristics, intraoperative and postoperative outcomes including stone-free rate (SFR) and complications were compared.ResultsPreoperative characteristics in terms of age, sex, BMI, and stone location, side, size, and HU were comparable between both groups (p values > 0.05). The overall SFR was significantly higher in group 1 (0.004). Balloon dilatation was not required in all patients of group-1 compared with 33% of group-2 (p = 0.0001). The JJ stent was required in 10% of group-1 compared with 30% of group-2 (p = 0.0004). Failure to reach the stone due to tight ureter occurred in 8% of group 2 (p = 0.003), respectively. Traxer’s grade 1 ureteral injury occurred in 2% of group-1 versus 14% of group-2 (p = 0.001). Consequently, hematuria was significantly lower in group-1 (1% vs. 8%; p = 0.01), respectively. The hospital stay < 9 h was significantly higher in group 1 (p = 0.0001).ConclusionsThe 4.5/6 Fr semi-rigid Ureteroscope was associated with significantly higher SFR and shorter hospital stay, with lower ureteral injury, fewer double-J stenting, and without the need for intraoperative balloon dilatation for the ureter.

Pediatric ureteroscopy in underprivileged preschool patients: Single-center perspective

Background: The incidence of stone disease in the pediatric age group dramatically increased in developing countries like Sudan. Despite, the challenges in the management of ureteral stone in the aforementioned age group, ureteroscopy (URS), lithotripsy using Holmium Laser (HO) has been reported as standard effective and safe. The aim of this study is to assess the outcome of URS lithotripsy using HO in preschool patients younger than 5 years of age. Materials and Methods: The results of treatment in 42 patients, who had undergone intervention for ureter stones at Gezira Hospital for Renal Disease and Surgery-Sudan, were prospectively evaluated. Miniscopes with an HO were used for lithotripsy. Results: The mean patient's age was 2.5 ± 1.2 years (1–4 years). The success rate was 69.9% after an average follow-up of 16 months (range 10–24). The majority 81% ( n = 34) of study cases were presented with ureteric stones, which comprised 52.4% ( n = 22) unilateral and 28.6% ( n = 12) bilateral. The cases of unilateral and bilateral stricture include 6 and 2 cases, respectively. After the procedure, the ureteric stenting (double J) was used in 81% of the cases. The perioperative complication rate was 31.0%, and the most common complication was a failure of cannulation followed by the false passage. The mortality rate was zero. Conclusion: URS is considered safe and effective method for pediatric ureteric stones. The size of ureteroscope has an important role in the outcome and complications.

Flexible Ureteroscopy and Laser Lithotripsy Intervention for the Management of Stone Disease

Background: The role of ureteroscopy has dramatically evolved over the past twenty years driven by profound enhancement in various factors and assisting techniques such as the ureteroscope size, deflection capabilities, video-imaging, and in lithotripsy (stone breakage) with the advent of holmium laser, however, the stone size plays a critical role in determining outcomes and operative approach. Aim of the work: we conducted a systematic review of the literature to look at the safety and efficacy of flexible utereroscopy and laser lithotripsy intervention in patients with stone disease; particularly those with stones larger than 2 cm. Methods: A systematic search was performed in the scientific database particularlyMEDLINE (2000–2017), EMBASE (2000– 2017), Cochrane Central Register of Controlled Trials, CINAHL (2000–2017), Google Scholar, and individual urologic journals. Results: The search yielded eight studies involving 392 patients, (390 renal units) were reportedly treated with FURSL. The mean operative time was 80.7 minutes (26-215 min). The mean stone-free rate was 91.2% (77%-96.7%), with an average of 1.6 procedures per patient. The mean stone size was 2.5 cm except for one most recent study which reported stones size less than 0.5 cm. An overall complication rate was 8.1%. Major complications developed in 21 (4.2%) patients and minor complications developed in 19 (3.9%) patients. Conclusion: Flexible Ureteroscopy and Laser Lithotripsy intervention has proven to be not only a less invasive treatment but also a successful with a low complication and stone free rate (SFR) for renal calci larger than 2 cm. FURSL may represent an alternative therapy to standard percutaneous nephrolithotomy (PCNL) with satisfactory efficacy and low morbidity.

The effect of ureteroscope size in the treatment of ureteral stone: 15-year experience of an endoscopist.

We aimed to investigate the ureter stone treatment results performed by using different- caliber semirigid ureteroscopes (URS). Adult patients who were treated for ureteral stones by a single endoscopist between January 2000 and March 2015 were analyzed. The patients were divided into 3 groups in accordance with the caliber of the ureteroscope used: 10/10.5 F Storz (Karl Storz, Tuttlingen, Germany) (January 2002-January 2005) URS was used in group 1, 8.9/9.8 F Storz (February 2005-December 2011) URS was used in group 2, and 6/7.5 FWolf (Richard Wolf, Knittlingen, Germany) (January 2012-March 2015) URS was used in group 3. Patients' age and gender, size and site of stones, stone-free rates (SFR), intra- and perioperative complication rates, and durations of surgery were compared among the groups. Intraoperative complications were classified according to modified Satava, and perioperative complications were classified according to modified Clavien classification systems. A total of 2461 patients treated for ureteral stones were analyzed. There were 583 patients in group 1 (10/10.5 F Storz), 1302 patients in group 2 (8.9/9.8 F Storz), and 576 patients in group 3 (6/7.5 F Wolf). SFR were 83.7%, 87.4%, and 92.2% in groups 1, 2, and 3, respectively (p=0.01). Duration of surgery was 30.34±10.36 min in group 1, 31.61±10.10 min in group 2, and 42.40±7.35 min in group 3 (p=0.01). The overall complication rates classified according to modified Satava classification were 10.8%, 7.6%, and 6.9% (p=0.01) while grade 3 modified Satava complication rates were 1.9%, 1.5%and 0.5% in groups 1, 2, and 3, respectively (p=0.01). In this study, we found that more frequent use of a small- caliber URS resulted in a longer duration of surgery and an increased rate for JJ stent insertion, however it facilitated a safer and more successful ureteroscopy procedure.

RE: Semi-rigid ureteroscopy - Proximal versus distal ureteral stone.

I read with great interest the article “Semi‑rigid ureteroscopy: Proximal versus distal ureteral stone” by Alameddine et al.[1] This article highlights important findings regarding common endourology procedure which is ureteroscopy. Since development of semi‑rigid ureteroscope, various studies had been done to evaluate the safety and efficacy of ureteroscopy. In this study, the authors found that stone‑free rate was comparable between proximal (89%) and distal (98.2%) ureteric stone with insignificant difference in complication rate. This study was retrospective in nature which had some limitations. The limitation found in this study was the selection of ureteroscope size. The authors stated that the ureteroscope size used ranged between 8 and 11 French.[1] These ranges were including almost all sizes of available ureteroscopes. Whereas, in other study by Molina Escudero et al., the ureteroscope size used was only 7 French.[2] These created a bias in this study. Without precise selection of the ureteroscope size, the author concluded that the use of smaller caliber semi‑rigid ureteroscopy combined with holmium‑yttrium‑aluminum‑garnet laser for proximal ureteral calculi is safe.[1] In my opinion, the conclusion made by the authors was not proved by this study.

Holmium:YAG laser ureteroscopic lithotripsy for ureteric calculi in children: predictive factors for complications and success

To evaluate the impact of age, stone size, location, radiolucency, extraction of stone fragments, size of ureteroscope and presence and degree of hydronephrosis on the efficacy and safety of holmium:YAG (Ho:YAG) laser lithotripsy in the ureteroscopic treatment of ureteral stones in children. Between October 2011 and May 2013, a total of 104 patients were managed using semirigid Ho:YAG ureterolithotripsy. Patient age, stone size and site, radiolucency, use of extraction devices, degree of hydronephrosis and size of ureteroscope were compared for operative time, success and complications. In all, 128 URS were done with a mean age of 4.7 years. The mean stones size was 11 mm. Success rate was 81.25 %. Causes of failure were 12.5 % access failure, 1.5 % extravasation and 4.7 % stone migration. Overall complications were 23.4 %. Failure of dilatation and extravasation were detected only in children <2 years old. Extravasation was significantly higher in smaller ureters and cases with stone size >15 mm. Stone migration was significantly higher in upper ureteric stones. Failure and complications rates in Ho:YAG ureterolithotripsy were significantly affected by younger age (<2 years), upper ureteric stones and smaller ureters but were not related to stone radiolucency or degree of hydronephrosis. Larger stones (>15 mm) were associated with increased complications. After multivariate analysis, the age of the patients remained significant predictor for failure of dilatation and stone migration, while size of the ureter was the only significant predicting factor for failure.

A Review of Studies Reporting on Complications of Upper Urinary Tract Stone Ablation Using the Holmium:YAG Laser

Purpose: A review of the literature of studies reporting complications of ureteroscopic urinary tract stone ablation using the holmium:YAG laser was performed. Patients and methods: Electronic databases were searched using specific keywords to identify relevant studies. Reference lists of identified articles were scrutinised for other studies and searches were conducted using the names of authors known to have published widely in this field. Two reviewers assessed retrieved articles for inclusion criteria. Patients &lt;16 years old were excluded. Results: Overall, 48 studies published between 1994 and 2007 were included. Half were published since 2000. In total, 4454 patients were identified. Around half of studies were performed in North America (25). The number of patients per study varied from 8 to 598. The study populations were very heterogeneous in terms of stone position and size, and ureteroscope size and rigidity. Overall, 303 (6.8%) complications were identified. Post-operative ureteric stricture and perforation rates were both 1.0%. There were only six major complications identified (0.1%). The post-operative sepsis rate was 2% and one death was reported. Conclusions: Upper urinary tract stone ablation using the holmium:YAG laser is both safe and reliable. Follow-up imaging to detect procedure-specific complications would not appear to be routinely indicated given this low complication rate.

Ureteric access with flexible ureteroscopes: effect of the size of the ureteroscope

To determine the optimum size of a flexible ureteroscope (FU) to minimize the need for ureteric dilatation. FUs from several different manufacturers and with different shaft diameters were used for ureteroscopy in adults. An initial attempt was made to pass one of the larger diameter FUs; if this was unsuccessful, the smaller 7.5 F FU was used. The results were reviewed retrospectively. Flexible ureteroscopy was used in 115 consecutive patients at two different institutions. The ability to pass the FUs with no formal dilatation was directly related to the FU diameter. The rate of failing to pass with no formal dilatation was 37% for the 9.0 F, 8.5% for the 8.6 F, 5% for the 8.4 F and 0.9% for the 7.4 F ureteroscope. Although other factors influence the overall effectiveness of the FU, the ability to pass FUs is directly related to their outer diameter. When only the ease of introduction is considered, the ideal ureteroscope outer diameter is 7.4 F.

Ureteroscopic management of renal calculi in anomalous kidneys

To review our experience with ureteroscopy in treating patients with renal calculi in anomalous kidneys and to evaluate the efficacy of this approach. Eight patients with renal calculi in anomalous kidneys who were managed by ureteroscopic procedures were identified. Demographic information, preoperative stone burden, operative information (ureteroscope size, lithotrite used, instruments used, duration of surgery, complications, stenting), follow-up imaging, and complications were obtained from the medical record. This information was analyzed to determine the most frequently used instruments and stone-free rates. Our cohort consisted of 4 patients with horseshoe kidneys (HSK) and 4 patients with pelvic kidneys (PK) (6 male, 2 female, mean age, 50.6 years). The average preoperative stone burden of the 11 treated calculi was 1.4 cm, with 5 stones located in the renal pelvis, 2 in the upper pole, and 4 in lower pole calyces. A 7.5F flexible ureteroscope, holmium laser lithotripsy, and nitinol baskets and graspers were used in all patients. Six patients had complete clearance of the stone on postoperative imaging (75% HSK, 75% PK), with 88% of patients asymptomatic after their procedure. No patients required additional surgical intervention. Flexible ureteroscopy with holmium laser lithotripsy and the use of nitinol baskets and graspers provides a reasonable alternative to shock wave lithotripsy in the management of patients harboring renal calculi in anomalous kidneys. In addition, ureteroscopy can be considered a primary option for managing select patients with symptomatic stones in PKs before a percutaneous surgical approach.

An Assessment of the Pulsed Dye Laser for Fragmenting Calculi in the Pig Ureter

The pulsed dye laser was used to fragment ureteric calculi in 10 pig ureters, compared to electrohydraulic disintegration in six pig ureters. The stones were impacted in the proximal ureter and approached by rigid ureteroscopy. Four ureters did not have stones impacted but had uretero-scopes passed. The stones were fragmented and the particles left to pass spontaneously. The degree of inflammatory reaction was graded at the site of fragmentation as well as in the middle and lower ureter. The degree of inflammation seen at the site of fragmentation was significantly less in the laser group than in the electrohydraulic group (p = 0.0027). It was noted that the degree of inflammation seen in the lower ureter was significantly greater than that seen at the site of fragmentation (p = 0.01), and that this grade of inflammation correlated well with the size of ureteroscope used (p = 0.0026). Further, the degree of dilatation of the ureter and pelvicalyceal system was significantly greater when the larger calibre ureteroscope had been used (p = 0.0056) ranging up to hydronephrosis with flattening of the papillae. If there is any parallel which can be drawn between the pig ureter and the human ureter then it suggests that ureteroscopy is more significant than the modality of fragmentation used. The contribution of the laser may therefore be more by the miniaturisation of instrumentation which will be made possible than by any advantage it may have as a fragmenter.