Ureteroscopic Lithotripsy Group Research Articles

Efficacy and Safety of Treatment Options for Large Upper Ureteral Stone

Background: There are three minimally invasive methods for the treatment of large (>1 cm) upper ureteral stones: ureteroscopic lithotripsy (URSL), percutaneous nephrolithotomy (PCNL) and laparoscopic ureterolithotomy (LUL). With multiple surgical options, the controversy of choosing the best option for a given patient lies. Objective: To compare efficacy and safety between URSL, PCNL and LUL to determine the best choice. Methodology: This study was conducted from March 2020 to February 2022 with 120 patients who had upper ureteral stones admitted at NIKDU. They were randomized into 3 equal URSL, PCNL & LUL groups, 40 patients in each group. The primary outcome was a stone-free rate after 1 month of surgery, and the secondary outcomes were the duration of surgery, length of hospital stay, and complication rate postoperatively. Result: Eight patients needed auxiliary PCNL after URSL and 1 patient after LUL, but none after PCNL. The stone-free rate was 78.1% (25/32) in the URSL group, 95% (38/ 40) in the PCNL group and 100% (39/39) in the LUL group. Operation time was the shortest with URSL and the longest with LUL (all p <0.05). Hospital stay was shorter in the URSL group compared with PCNL & LUL group (p=0.0001). Operation-related complications were almost similar among the three groups. Conclusion: Laparoscopic ureterolithotomy followed by PCNL is the most efficacious modality for treating large upper ureteral stones with a superior stone-free rate and lesser need for auxiliary treatments compared to URSL. Bangladesh J. Urol. 2022; 25(2): 93-97

Comparison of the Efficacy of Different Surgical Approaches for Complicated Impacted Proximal Ureteral Calculi Based on a New Scoring Standard: A Matched-Pair Analysis.

Objective: To compare the clinical efficacy of ureteroscopic lithotripsy (URSL) and percutaneous nephrolithotomy (PCNL) in the treatment of complicated impacted proximal ureteral calculi using a new scoring standard. Methods: The data of 45 patients with complicated impacted proximal ureteral calculi (score ≥3 points) who underwent URSL were collected in this retrospective study between January 2015 and April 2021. The definition and scoring standards for preoperative high-risk factors associated with stones included whether the diameter of the stone was >2 cm, stone density was >1000 HU, there was a history of lithotripsy, the degree of hydronephrosis was greater than moderate, and there was an infection. Scores for stones were then assigned (yes = 1, no = 0), and the complicated stone case was defined as a total stone score ≥3 points. During the same period, PCNL was used in 171 patients with complicated impacted proximal ureteral calculi. Forty-five patients were selected as the control group and matched at a 1:1 ratio to index URSL cases regarding age, sex, and body mass index. Perioperative data were compared between the two groups. Results: All 90 operations were completed effectively. Compared to the URSL group, the surgical duration of the PCNL group was significantly shorter (53.69 ± 25.07 vs 73.46 ± 27.12 minutes, p < 0.05), stone-free rate (SFR) was significantly higher (93.3% vs 68.9%, p < 0.05), and total treatment cost was lower (US $1678.61 ± 714.86 vs US $3901.45 ± 1069.46, p < 0.05). Conversely, the URSL group had a shorter hospital stay (3.68 ± 2.70 vs 6.39 ± 3.34 days, p < 0.05). There was a significant difference in complication rate between the two groups regarding Clavien grade I, II, or III complications (20.0% in URSL group vs 8.9% in PCNL group, p = 0.037). Conclusion: PCNL had a better SFR and higher surgical efficacy, whereas URSL had a shorter perioperative period, but a lower initial SFR. PCNL is often more advantageous for complicated impacted proximal ureteral calculi.

PD55-07 OUTCOMES AND PROCEDURAL COSTS FOLLOWING MINI-PERCUTANEOUS NEPHROLITHOTOMY OR FLEXIBLE URETEROSCOPIC LITHOTRIPSY FOR KIDNEY STONES BETWEEN 1-2CM: DATA FROM A PROSPECTIVE, RANDOMIZED CLINICAL TRIAL

You have accessJournal of UrologyCME1 May 2022PD55-07 OUTCOMES AND PROCEDURAL COSTS FOLLOWING MINI-PERCUTANEOUS NEPHROLITHOTOMY OR FLEXIBLE URETEROSCOPIC LITHOTRIPSY FOR KIDNEY STONES BETWEEN 1-2CM: DATA FROM A PROSPECTIVE, RANDOMIZED CLINICAL TRIAL Rahul Dutta, Prabhakar Mithal, Ilan Klein, Manish Patel, and Jorge Gutierrez-Aceves Rahul DuttaRahul Dutta More articles by this author , Prabhakar MithalPrabhakar Mithal More articles by this author , Ilan KleinIlan Klein More articles by this author , Manish PatelManish Patel More articles by this author , and Jorge Gutierrez-AcevesJorge Gutierrez-Aceves More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002635.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Both percutaneous nephrolithotomy (PCNL) and flexible ureteroscopic lithotripsy (URS) are options in treating patients with kidney stones that are unlikely to pass spontaneously. We sought to compare outcomes and hospital costs for patients randomized to mini-percutaneous nephrolithotomy (mPCNL, tract size 16.5 French) and URS for nephrolithiasis. METHODS: Patients who were candidates for both mPCNL and URS with a kidney stone between 1-2 cm located in the kidney were consented, enrolled, and randomized to a treatment group. Post-operative stone burden was assessed with low-dose CT scan between day 1 and 30 post-operatively. Hospital costs for operating room time, anesthesia time, and equipment (including equipment repairs) for the procedure were obtained. RESULTS: A total of 97 patients were randomized to either mPCNL or URS. There were no significant differences between patient demographics, aside from a higher body mass index in the URS group (p=0.0200). The pre-operative stone burden was slightly higher in the mPCNL group (15.4 vs 13.9mm, p=0.0348). Fluoroscopy time was significantly higher in mPCNL procedures. There was no difference in intra-op complication rate or pre to post-operative creatinine change (p>0.05). Residual stone burden was lower in mPCNL group (1.4mm vs 3.5mm, p = 0022), though complications and necessity for secondary procedures did not vary (p>0.05). Operating room and anesthesia costs were higher for the mPCNL group, while equipment costs were higher for the URS group. Total direct and indirect costs were higher for the mPCNL group. CONCLUSIONS: In this prospective randomized study, we found a lower residual stone burden in patients treated with mPCNL over URS for intrarenal stones 1-2cm in size. There were no differences in reoperations or complications. Total costs were higher for patients who underwent mPCNL. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e950 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rahul Dutta More articles by this author Prabhakar Mithal More articles by this author Ilan Klein More articles by this author Manish Patel More articles by this author Jorge Gutierrez-Aceves More articles by this author Expand All Advertisement PDF DownloadLoading ...

Effect of Tamsulosin and URSL on Renal Function and Stone Free Rate in Unilateral Solitary Ureteric Stone: A Prospective Interventional Study

Introduction: Stones are common cause of obstructive uropathy which may lead to decrease in renal function. Though endourological procedure like Ureteroscopic Lithotripsy (URSL) is commonly done yet Medical Expulsive Therapy (MET) is often offered as a first line therapy for mid and distal ureteric stones of size less than one cm. Aim: To compare the effect of Tamsulosin and URSL on renal function and stone free rate for solitary mid and distal ureteric stone. Materials and Methods: This prospective interventional study was done in IPGME&amp;R and SSKM Hospital, Kolkata, West Bengal, India, from May 2020 to October 2020, on the total study population of 50 patients with 26 patients in MET and 24 patients in URSL group. Parameters measured and compared were changes in Glomerular Filtration Rate (GFR) and stone free rate after six weeks of intervention. Numerical variables and categorical variables were compared between two groups using independent t-test and chi square test respectively. Results: The mean age of patients in MET (n=26) and URSL group (n=24) was 37.12 years and 33.63 years respectively. GFR was significantly increased after completion of treatment in individual groups (p-value=0.01) and in final study population but change in GFR was not significant when compared between the groups (p-value=0.372). Difference in stone clearance rate between two groups was also insignificant (p-value=0.902) whereas within the groups was significant (p-value&lt;0.05). Conclusion: Tamsulosin for six weeks does not result in significant functional loss in the affected kidney and proved as effective as URSL for mid and distal solitary ureteric stone upto one cm in size with similar stone free rate.

MP18-10 AN EFFICIENCY DECISION-TREE FOR TREATING UROLITHIASIS UP TO 3 CM BASED ON A COST-EFFECTIVENESS ANALYSIS

You have accessJournal of UrologyStone Disease: Surgical Therapy II (MP18)1 Sep 2021MP18-10 AN EFFICIENCY DECISION-TREE FOR TREATING UROLITHIASIS UP TO 3 CM BASED ON A COST-EFFECTIVENESS ANALYSIS Adrián Bernal Gómez, Francisco Gómez Palomo, Gema Romeu Magraner, Javier Pérez Ardavín, Pilar Bahílo, Marta Trassierra Villa, Oriol Dagà Martínez, Daniel López Acón, Domingo Guzmán Ordaz Jurado, Oriol Colet, Iván Sáez Moreno, Juan Ortiz, Jaime Bolón, and Alberto Budía Adrián Bernal GómezAdrián Bernal Gómez More articles by this author , Francisco Gómez PalomoFrancisco Gómez Palomo More articles by this author , Gema Romeu MagranerGema Romeu Magraner More articles by this author , Javier Pérez ArdavínJavier Pérez Ardavín More articles by this author , Pilar BahíloPilar Bahílo More articles by this author , Marta Trassierra VillaMarta Trassierra Villa More articles by this author , Oriol Dagà MartínezOriol Dagà Martínez More articles by this author , Daniel López AcónDaniel López Acón More articles by this author , Domingo Guzmán Ordaz JuradoDomingo Guzmán Ordaz Jurado More articles by this author , Oriol ColetOriol Colet More articles by this author , Iván Sáez MorenoIván Sáez Moreno More articles by this author , Juan OrtizJuan Ortiz More articles by this author , Jaime BolónJaime Bolón More articles by this author , and Alberto BudíaAlberto Budía More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002003.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Our objective is to compare the cost-effectiveness of shock wave lithotripsy (SWL), ureteroscopic lithotripsy (URS), retrograde intrarrenal surgery (RIRS) and percutaneous nephrolithotomy (PNL) for treating ureteral and kidney stones up to 3 cm, building a decision tree algorithm based on the efficiency. METHODS: Patients treated for urolithiasis up to 3 cm from 2012 to 2018 were retrospectively reviewed. Treatment modality (SWL, URS, RIRS or PNL) was chosen depending on size, location and radiodensity of the stone. Effectiveness was assessed by the stone-free rate (SFR) at 3 months follow-up. In case of residual stones, retreatment up to four SWL sessions or a second URSL/RIRS/PCNL were included. Average cost per patient were calculated from individual cost of SWL sessions, surgical material and procedures, days of hospitalization, complications and follow-up tests and consultations. A cost-effectiveness analysis was performed and a decision tree algorithm was created. The incremental cost-effectiveness ratio (ICER) was calculated and a Monte Carlo Simulation for a probabilistic sensitivity analysis was carried out. Our study was approved by Ethical Committee. RESULTS: A total of 608 patients were included. In 180 cases of ureteral stones, 95 (52.8%) patients were treated with SWL and 85 (47.2%) patients underwent URS. SWL as first line had a better SFR (99.7%) than URS (97.6%) for ureteral stones regardless of location or size. The overall cost for SWL was 1,445.86 € and for URS group was 2,369.21 €.Among 345 patients with kidney stones <2cm, SWL was used in 201 (58.3%) patients, while 144 (41.7%) patients underwent RIRS. SFR was higher with RIRS (93.8%) than after SWL (80.05%). The average cost of SWL was 1,078.59 €, whereas RIRS expenses were 2,630.86 €. With an estimated ICER of 119 € per extra 1% in SFR, SWL was more efficient in terms of cost-effectiveness than RIRS for kidney stones <2cm. In 83 cases with 2-3 cm renal stones, 62 (74.7 %) patients underwent PCNL and 21 (25.3 %) patients underwent RIRS. SFR for PCNL and RIRS was 95,16% and 95,25 %, respectively. RIRS produced a significantly higher overall cost (6,520.58 €) due to more frequent retreatments than PCNL (3,550.15 €), with an ICER of 16,870.93 €. Sensitivity analysis (Montecarlo simulation) confirmed the results in each comparison. CONCLUSIONS: SWL is the most efficient option in terms of cost-effectiveness for treating ureteral stones and kidney stones <2 cm, while PCNL is more efficient than RIRS for 2-3 cm kidney stones. RIRS may be used to treat stones <2 cm when SWL is not feasible. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e321-e322 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Adrián Bernal Gómez More articles by this author Francisco Gómez Palomo More articles by this author Gema Romeu Magraner More articles by this author Javier Pérez Ardavín More articles by this author Pilar Bahílo More articles by this author Marta Trassierra Villa More articles by this author Oriol Dagà Martínez More articles by this author Daniel López Acón More articles by this author Domingo Guzmán Ordaz Jurado More articles by this author Oriol Colet More articles by this author Iván Sáez Moreno More articles by this author Juan Ortiz More articles by this author Jaime Bolón More articles by this author Alberto Budía More articles by this author Expand All Advertisement Loading ...

Comparison of Percutaneous Nephrolithotomy and Ureteroscopic Lithotripsy for Upper Ureteral Calculi

This study aimed to investigate the efficacy, safety and cost of ureteroscopic lithotripsy (URSL) and percutaneous nephrolithotomy (PCNL) for large proximal ureteral calculi. We retrospectively reviewed the outcomes of 205 subjects with ureteral stones size ≥ 1 cm from January 2011 to December 2017. We divided URSL into two groups including URSL + S with Stone Cone and URSL without Stone Cone. Ninety subjects were treated with URSL, fifty subjects were treated with URSL + S and sixty-five subjects were treated with PCNL. The success rate was 73.3%, 96.0% and 96.6% in URSL, URSL+ S and PCNL groups, respectively. The treatment time in PCNL group (77.3 ± 19.1 minutes) was longer than URSL group (42.0 ± 16.6 minutes) and URSL+S group (55.6± 20.3 minutes), and the hospital stay was longer in PCNL (9.5 ± 1.6 days) group than in URSL group (2.4 ± 4.8 days) and URSL + S group (2.0 ± 2.4 days). The cost-effectiveness ratio was 124.6, 159.1 and 135.3 in URSL, URSL + S and PCNL groups, respectively. In conclusion, Stone Cone could increase treatment success rate but incur higher cost. URSL is considered as the best cost-effective option, and the patients without medical insurance tend to choose PCNL because of high success rate of treatment.

Laparoscopic ureterolithotomy versus ureteroscopic laser lithotripsy for large proximal ureteral stones: a systematic review and meta-analysis.

To review current studies and conduct a meta-analysis on the topic of laparoscopic ureterolithotomy (LU) versus ureteroscopic lithotripsy (URSL) with holmium laser for large proximal ureteral stones. A systematic research of PubMed, Ovid, Scopus (up to March 2019), and citation lists was performed to identify eligible comparative studies. All studies comparing LU versus URSL with holmium laser in proximal ureteral stones were included. Statistical analyses were performed using the Cochrane Collaboration's Review Manager (RevMan) 5.3 software. Overall, seven studies were included in analysis involving 884 patients (LU 387; URSL 497). Our meta-analysis showed that LU group had bigger stone size than URSL group (WMD 0.19 cm; P=0.001). LU group was associated with longer operative time (WMD 36.29 min; P<0.001), and length of hospital stay (WMD 1.24 d; P=0.04). However, LU group showed better initial stone-free rate (OR 11.03; P<0.001), and final stone-free rate (OR 22.37; P<0.001). There were no significant differences in all complications (RR 1.06; P=0.76). While, LU group had fewer Clavien Dindo score ≥3 complications (RR 0.21; P=0.002), fewer ureteral stricture (RR 0.26; P=0.04), and lower need of auxiliary procedures (RR 0.09; P<0.001) compared with URSL group. LU could provide a higher stone-free rate and fewer severe complications compared with URSL with holmium laser for large proximal ureteral stones. More importantly, LU could also reduce the postoperative ureteral stricture rate.

Clinical study of ureteroscopy with internally 4F ureteral catheter combined with holmium laser lithotripsy in treatment of ureteral infection stones

Objective To study the clinical value of ureteroscopy with internally 4F ureteral catheter combined with holmium laser lithotripsy in treatment of ureteral infection stones. Methods All 70 patients of ureteral infection stones undergoing holmium laser lithotripsy during January 2016 to March 2018, 36 patients who were treated with ureteroscopy with internally 4F ureteral catheter combined with holmium laser lithotripsy, and 34 patients who were treated with ureteroscopic lithotripsy. The operation date, postoperative infection were observed and compared between the two groups. Results The success rate of the two groups of surgical lithotripsy was 100%. The intra-ureteral pressure of operating, operation time and postoperative hospital stay of ureteroscopy with internally 4F ureteral catheter combined with holmium laser lithotripsy group were lower than that of ureteroscopic lithotripsy group (P<0.05), and postoperative fever, fever continued times were lower than that of ureteroscopic lithotripsy group (P<0.05). Conclusions Ureteroscopy with internally 4F ureteral catheter combined with holmium laser lithotripsy in treatment of ureteral infection stones is safe and effective for the treatment of ureteral infection stones, and can reduce the incidence of postoperative infection. Key words: Ureteral Calculi; Infection; Ureteroscopy; Lasers, Solid-State

Comparison of antegrade percutaneous versus retrograde ureteroscopic lithotripsy for upper ureteric calculus for stone clearance, morbidity, and complications

Introduction:The optimal management of upper ureteric calculus remains controversial. We compare the outcomes of antegrade percutaneous ureterolithotripsy (APCUL) with retrograde ureteroscopic lithotripsy (URSL) for upper ureteric calculus with respect to stone clearance, morbidity, and complication rates.Materials and Methods:This prospective study was carried out from December 2014 to June 2016. A total of 117 patients with upper ureteric calculus sized (10–20) mm who underwent APCUL or URSL were included in the study.Results:APCUL and URSL were performed in 64 and 53 patients, respectively. The mean age and stone size were comparable between the two groups. The stone clearance rate at 1-month follow-up was 93.75% in the antegrade group and 81.13% in the retrograde group (P = 0.036). Mean anaesthesia time was significantly longer for the APCUL group while the actual mean operative time was significantly longer for the URSL group (P < 0.001). The overall complication rate was higher in antegrade group (P = 0.804), whereas most of the major complications (Clavien Grade III or more) occurred only in the URSL group (P = 0.007). Blood transfusion was required only in the APCUL group (7.8% versus 0%; P = 0.50). In the URSL group, stone retropulsion occurred in four patients, of which three subsequently required shock wave lithotripsy and one required percutaneous nephrolithotomy in a second sitting.Conclusion:APCUL has better stone-free rates as compared to URSL for an upper ureteric calculus of size 10–20 mm. Although the postoperative minor complications are higher in the antegrade group, severe complications occurred only in the retrograde group. Hence, antegrade approach can be considered as the preferred option to achieve better stone clearance in a single sitting with acceptable morbidity and complication rates.

Analysis of the influence of ureteroscopic pneumatic lithotripsy on the serum levels of CRP, IL-1 and TNF-αin patients with upper ureteral calculi

Objective To investigate the therapeutic effect of ureteroscopic pneumatic lithotripsy (URSL) on ureteral calculi and the effect on serum CRP, IL-1, TNF-αlevels. Methods Retrospective analysis of clinical data of patients with upper ureteral calculi from February 2015 to October 2016 in our hospital was performed. All patients were divided into ureteroscopy lithotripsy group (URSL group) and percutaneous nephrolithotomy group.The general situation of the two groups were observed. The levels of serum inflammatory factors, urinary function and quality of life were compared between the two groups before and after operation. Results The operation time and hematuria time of URSL group were shorter than those of percutaneous nephrolithotomy (t=27.415, 12.018, P<0.001). The stone free rate was higher than that in the percutaneous nephrolithotomy group.The level of inflammatory factors in the two groups had no difference before treatment, after treatment, the level of CRP, TNF-α, NF-κB alpha and IL-1 of the URSL group were lower than those of percutaneous nephrolithotomy group. The IPSS score of patients in URSL group was lower than that of percutaneous nephrolithotomy group at 1 month and 3 months after operation, and Qmax was higher than that of percutaneous nephrolithotomy group.There was no difference in quality of life between the two groups before operation. After operation, the quality of life score of URSL group was higher than that of percutaneous nephrolithotomy group in the 3 months after operation. Conclusions URSL has a good effect on the treatment of upper ureteral calculi, it can reduce postoperative serum CRP, IL-1, TNF-αlevel, im- prove the quality of life. Key words: Ureteral Calculi; Nephrostomy, Percutaneous; Ureteroscopy; Calcitonin Gene-Related Peptide; Interleukin-1; Tumor Necrosis Factor-alpha

The comparation of effects and security of double-J stent retention and ureteroscopy lithotripsy in the treatment of symptomatic ureteral calculi during pregnancy

ObjectiveTo describe the efficacy of double-J stent retention and ureteroscopy lithotripsy, we performed a study to evaluate the management of symptomatic ureteral calculi during pregnancy. Materials and MethodsFrom January 2005 and June 2015, 53 pregnant women with symptomatic ureteral calculi were admitted and treated in our hospital. According to the treatment techniques, there were divided into two groups: double-J stent retention group (30 cases) and ureteroscopy lithotripsy group (23 cases). We collected the characteristics and treatment outcome of the patients. ResultsDouble-J stent retention was performed on 30 patients. And the stents were successfully inserted in 25 patients (83.3%). 4 cases got complication in double-J group (16%). The mean operating time, medical cost and hospitalization time of double-J group were 20.6 min, 1632 yuan and 1.3 days. Ureteroscopy lithotripsy was performed on 23 patients. 20 patients were operated successfully (87.0%). 2 cases got complication in ureteroscopy group (10.0%). The mean operating time, medical cost and hospitalization time of ureteroscopy group were 41.5 min, 2792 yuan and 6.0 days. ConclusionIn summary, both double-J stent retention and ureteroscopy lithotripsy are effective and safe in the managation of ureteral calculi during pregnancy.

Comparison of YAG Laser Lithotripsy and Extracorporeal Shock Wave Lithotripsy in Treatment of Ureteral Calculi: A Meta-Analysis

Objective: To evaluate the clinical efficiency and safety of ureteroscopy lithotripsy (URSL) with holmium laser technology and extracorporeal shock wave lithotripsy (ESWL) on ureteral calculi using systematic reviews. Methods: Randomized controlled trials and prospective controlled trials accorded with inclusion among PubMed Database, EmBase Database, Cochrane Library and China National Knowledge Infrastructure were collected. Review Manager 5.0 was adopted to estimate the effects of the results among selected articles. Forest plots, sensitivity analysis and bias analysis for the articles included were also conducted. Pooled estimate of risk ratios and standard mean difference (SMD) with 95% CIs were used as measures of effect sizes. Results: Finally 1,770 patients were included in the 14 studies, which eventually satisfied the eligibility criteria. The number of patients in URSL group and ESWL group were 885 and 885, respectively. The results of heterogeneity test suggested that complication events (RR 1.12 (95% CI 0.63-2.00), p = 0.70), hospital days (SMD = -0.08 (95% CI -1.14 to 0.98), p = 0.88) and efficiency quotient (RR 1.31 (95% CI 0.96-1.80), p = 0.09) were insignificantly different, while the stone-free rate (RR 1.15 (95% CI 1.06-1.26), p = 0.002) and operation time (SMD = -2.27 (95% CI -3.42 to -1.11), p = 0.0001) between ESWL and URSL were significantly different. Conclusion: Although both URSL and ESWL have its own advantages and drawbacks, URSL is relatively a more efficient and safe method to treat ureteric stones, since it has shorter operation time and a better stone-free rate.

Percutaneous Nephrolithotomy Increases the Risk of New-onset Hypertension: A Nationwide 6-Year Follow-up Study

To determine whether percutaneous nephrolithotomy or ureteroscopic lithotripsy leads to the development of hypertension, using the Taiwan National Health Insurance database. Data were sourced from the Longitudinal Health Insurance Database (LHID2000) of Taiwan, Republic of China, compiled by the Taiwan National Health Insurance database from 1996 to 2010. Percutaneous nephrolithotomy and ureteroscopic lithotripsy were studied as time-dependent covariates in a Cox proportional hazard model to estimate the hazard ratio for the effect of new-onset hypertension. A total of 2552 patients were included, with 232 PNL percutaneous nephrolithotomy, 1160 ureteroscopic lithotripsy patients, and 1160 comparison patients. There was a significant difference between the incidence of new-onset hypertension between the percutaneous nephrolithotomy and comparison groups (adjusted hazard ratio 1.48, 95% confidence interval 1.13-1.95, P = .005). The percutaneous nephrolithotomy group also had a higher incidence of new-onset hypertension than the ureteroscopic lithotripsy group (adjusted hazard ratio 1.39, 95% confidence interval 1.06-1.83, P = .018). The incidence rate of new hypertension during the follow-up period was 44.5 per 1000 person-years in the percutaneous nephrolithotomy group, 33.0 per 1000 person-years in the ureteroscopic lithotripsy group, and 30.2 per 1000 person-years in the comparison group. An association exists between nephrolithiasis patients who were treated with percutaneous nephrolithotomy and subsequent hypertension diagnosis. Although the exact mechanisms for this phenomenon are not clear, patients who undergo percutaneous nephrolithotomy may need close monitoring of blood pressure during postoperative follow-up.

Ten-year experience in the management of distal ureteral stones greater than 10 mm in size

Extracorporeal shock wave lithotripsy (ESWL) and semirigid ureteroscopy lithotripsy (URSL) have become standards of treatment for ureteral calculi. The aim of this retrospective study was to compare ESWL vs. URSL in terms of safety and efficacy for treatment of large distal ureteral stones ≥ 1cm. This investigation assessed 637 patients with distal ureteral stones (10 to 15mm in size). 313 in the ESWL group were treated on an outpatient basis using the LithoDiamond machine without anaesthesia. URSL was performed in 324 patients with a 6-8 Fr semirigid ureterorenoscope and YAG laser under spinal anaesthesia. A successful outcome was defined as the patient being stone free 1 month after treatment. For all patients the parameters, including stone-free rate, operation time, complications, were inserted retrospectively in this study after review of medical records and operating room logs. The stone-free rate after URSL was 77.5% and 45.4% after ESWL treatment (p<0.001). The mean operative time between two groups was 74.7±9.8 for URSL group and 38.3±7.6 for ESWL group. The average number of office visits was 4.2 and 2.6 in patients treated with ESWL and URSL, respectively. Double j stents were inserted in 28.7% of patients. Twenty-one patients needed rehospitalisations for major complications. However, the differences in the overall complication rate were not statistically significant, with a rate of 16.3% for URSL and 14.4% for ESWL (p=0.246). We have shown that URSL has enough safety and efficacy for the treatment of distal ureteral stones ≥ 1cm. URSL is associated with higher stone clearance rate as compared with ESWL.

Retroperitoneal laparoscopic ureterolithotomy in comparison with ureteroscopic lithotripsy in the management of impacted upper ureteral stones larger than 12 mm.

To compare the results of ureteroscopic lithotripsy (URSL) with retroperitoneal laparoscopic ureterolithotomy (RPLU) as two minimally invasive techniques in the management of proximal ureteral stones larger than 12 mm. From January 2009 to October 2013, patients with impacted unilateral upper ureteral stones larger than 12 mm were enrolled including 182 males and 93 females with a medium age of 40 years (22-72 years). Patients were randomized to receive URSL (139 cases) with semirigid ureteroscope or RPLU (136 cases). Stone size was similar in RPLU and URSL groups (13.8 ± 1.9 vs 13.6 ± 1.4 mm, P = 0.312). Operating time and hospitalizing days in URSL group were significantly shorter than those in RPLU group (P < 0.001), whereas stone clearance rate was significantly higher in RPLU group (97.1 vs 89.9 %, P = 0.017). Ureteral strictures happened higher in URSL group (5 patients, 3.6 %) than RPLU group (2 patients, 1.5 %) with no statistical significance, while the strictures requiring surgical intervention were significantly higher in URSL group (4 cases) (2.9 vs 0 %, P = 0.046). RPLU could provide better stone clearance rate than semirigid URSL for upper ureteral impacted stones larger than 12 mm. It may also reduce the chance of surgical intervention for postoperative ureteral stricture.

MP38-08 DETERMINANTS OF HEALTH-RELATED QUALITY OF LIFE FOR PATIENTS AFTER URINARY LITHOTRIPSY: URETEROSCOPIC VERSUS SHOCK WAVE LITHOTRIPSY

You have accessJournal of UrologyStone Disease: Surgical Therapy IV1 Apr 2015MP38-08 DETERMINANTS OF HEALTH-RELATED QUALITY OF LIFE FOR PATIENTS AFTER URINARY LITHOTRIPSY: URETEROSCOPIC VERSUS SHOCK WAVE LITHOTRIPSY Shuzo Hamamoto, Takahiro Yasui, Naoko Okuda, Satoshi Koiwa, Atsushi Okada, Hiroyuki Kamiya, Yoshihiro Hashimoto, Keiichi Tozawa, Yutaka Iwase, and Kenjiro Kohri Shuzo HamamotoShuzo Hamamoto More articles by this author , Takahiro YasuiTakahiro Yasui More articles by this author , Naoko OkudaNaoko Okuda More articles by this author , Satoshi KoiwaSatoshi Koiwa More articles by this author , Atsushi OkadaAtsushi Okada More articles by this author , Hiroyuki KamiyaHiroyuki Kamiya More articles by this author , Yoshihiro HashimotoYoshihiro Hashimoto More articles by this author , Keiichi TozawaKeiichi Tozawa More articles by this author , Yutaka IwaseYutaka Iwase More articles by this author , and Kenjiro KohriKenjiro Kohri More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1383AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Shock wave lithotripsy (SWL) and ureteroscopic lithotripsy (URSL) are well-established procedures for fragmentation of stones using a lithotripter; however, the morbidity, hospitalization, and days lost from daily work can negatively affect the health-related quality of life (HRQoL) of patients. Recently, there has been increasing recognition that the selection of therapeutic modality for urinary lithotripsy should be based not only on the stone free rate, but also on the future HRQoL. Thus, we here aimed to compare longitudinal HRQoL between SWL and URSL patients after surgical intervention, and to evaluate the factors affecting the HRQoL of these patients. METHODS In this institutional review board-approved study we prospectively interviewed 262 consecutive patients who underwent SWL (n=61) or URSL (n=201) for treatment of upper urinary tract calculi between June 2012 and October 2013. All patients were prospectively administered the Short-Form 36-item survey (SF-36) to assess the HRQoL at discharge, 1 month, and 6 months after lithotripsy. The stone-free rate, hospital stay, complications, and analgesia requirements were evaluated to compare the effects of surgery on the HRQoL between the groups. RESULTS At the day of discharge, patients in the URSL group had significantly lower mean scores on 6 different subscales of the SF-36 questionnaire, namely physical functioning, role-physical, body pain, social functioning, role-emotional, and mental health. The stone-free rate at 3 months after lithotripsy was significantly lower in the SWL group (72.1% vs. URSL, 93.0%; p<0.01). The hospital stay was shorter in the SWL group (2.1 ± 0.07 vs. URSL, 4.1 ± 0.13 days; p<0.001), and the analgesia requirements were also lower in the SWL group (0.3 ± 0.08 vs. URSL, 0.9 ± 0.20; p<0.001). The multivariate analyses identified several variables that were significantly associated with the low HRQoL after lithrotripsy, including age (p=0.04) and the use of analgesic agents. CONCLUSIONS The post-lithotripsy HRQoL is better for SWL than URSL patients, despite the lower stone-free rate of SWL. The higher postoperative pain appear to be responsible for the lower HRQoL in URSL. For the appropriate decision regarding the treatment approach, it is important to understand not only the surgical outcomes and recurrence rates, but also the HRQoL associated with each treatment strategy. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e449 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Shuzo Hamamoto More articles by this author Takahiro Yasui More articles by this author Naoko Okuda More articles by this author Satoshi Koiwa More articles by this author Atsushi Okada More articles by this author Hiroyuki Kamiya More articles by this author Yoshihiro Hashimoto More articles by this author Keiichi Tozawa More articles by this author Yutaka Iwase More articles by this author Kenjiro Kohri More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Minimally invasive surgical treatment for large impacted upper ureteral stones: Ureteroscopic lithotripsy or percutaneous nephrolithotomy?

The management of patients with large impacted upper ureteral stones is difficult; there is no standard treatment. We compared the outcomes of percutaneous nephrolithotomy (PCNL) and ureteroscopic lithotripsy (UL) to treat large (≥1.5 cm), impacted, upper ureteral stones. In total, 86 patients with large impacted upper ureteral stones were included in this study. Of these patients 41 underwent UL and 45 underwent PCNL. The inclusion criteria were: longest diameter of stone ≥1.5 cm, the localization of stone between the lower border of L4 spine and ureteropelvic junction and impacted stone. In the UL group, we were unable to reach the stone in 3 patients because of ureteral stricture and edema despite balloon dilation. Of these 3 patients, we were unable to optimally visualize the stone in 2 patients due to bleeding and mucosal injury following balloon dilation. The stricture was too firm and could not be passed in the third patient. Also in the UL group, 15 patients had stones or big fragments which migrated into the renal collecting system. In the PCNL group, 21 patients had concurrent renal stones <1 cm and stones were successfully removed in all patients. No statistically significant difference was found between groups in terms of operation time. Mean hospital stay was significantly shorter in the UL group. Success rates were 82.3% in the UL group and 97.6% in the PCNL group (p = 0.001). The recent study confirms that PCNL is a safe and effective minimally invasive procedure with acceptable complication rates in the treatment of patients with large, impacted upper ureteral stones.

Comparative study of therapeutic effects between retroperitoneoscopic ureterolithotomy and ureteroscopic lithotripsy for upper ureteral calculi

Objective To compare the effect of retroperitoneoscopic ureterolithotomy (RPUL) and ureteroscopic lithotripsy (URL) for upper ureteral calculi.Methods One hundred and twenty cases treated by RPUL and 108 cases by URL from January 2002 to October 2012 were reviewed.In RPUL and URL group,the diameter of stone was (1.56 ± 0.52) cm vs (1.44 ± 0.46) cm,ipsilateral hydronephrosis was (2.85 ± 0.86) cm vs (2.76 ± 0.82) cm,body mass index was (23.65 ± 2.80) kg/m2 vs (22.54 ± 2.68) kg/m2.There were no signficant differences.Data on the operation time,the hospital stay after operation,the operation,successsful rate,complication incidence and stone-free rate were compared between the 2 groups.Results Comparisons between RPUL group and URL group included the following:the operation time was (75.5 ± 25.8) min vs (62.5 ± 15.3) min,the hospital stay after operation was (6.2 ± 1.2) d vs (4.0 ± 0.8) d.There were significant differences.The operation successful rate was 95.0％ (114/120) in RPUL group and 85.2％ (92/108) in URL group.The complications incidence rate was 3.5％ (4/114) in RPUL group and 17.4％ (16/92) in URL group.The stone-free rate was 100.0％ (114/114) in RPUL group and 89.1％ (82/92) in URL group.The differences were significant (P ＜ 0.05).Conclusions RPUL and URL had the advantages of less trauma and blood loss and rapid recovery.RPUL had fewer complication and higher success rate than URL,and could be a minimally invasive option for the treatment of ureteral calculi. Key words: Ureteral calculi; Laparoscopy; Ureteroscopy; Lithotripsy; Treatment outcome

Compare the outcome of ureteroscopic lithotripsy with ureteroscopic management after failed extracorporeal shock wave lithotripsy for ureteral calculi

To compare the efficacy and complication of ureteroscopic lithotripsy and ureteroscopic management for ureteral calculi after failed extracorporeal shock wave lithotripsy (ESWL). One hundred and thirty-six cases with ureteral calculi after failed ESWL and 189 cases with ureteral calculi were treated with ureteroscopic lithotripsy (URSL). Clinical data of two groups were analyzed retrospectively. The mean operating time and therapeutic time in ESWL-URSL group was longer than that in URSL group, while the rate of polypi hyperplasia and open-surgery in ESWL-URSL group was 34.6%, 5.88% versus 28.3%, 1.59% in URSL group. There is no significant statistical difference in stone-free rate between two groups. Ureteroscopic management can be preferred for the patients with disadvantage of ESWL in some condition.

Combined Removal of Stones with Resection of Concurrent Pathologic Ureter May Be a Preferred Treatment for Impacted Ureteral Stones with Stricture Lesions

We investigated ureteral lesions associated with impacted stones and compared the long-term outcomes after ureteroscopic lithotripsy (URSL) with a holmium laser with open ureterolithotomy, resection of concurrent pathologic ureter, and ureteroureterostomy (OUU) for patients with impacted ureteral stone. Between January 2004 and December 2007, 86 patients with impacted ureteral stones were treated with URSL (61) or OUU (25) because of tortuous ureter or failed access to stones. The stone size, location, impaction, ureteral lesions, and long-term outcomes were recorded. Mean stone size for the URSL group and the OUU group was 11.8 +/- 2.6 mm and 15.3 +/- 4.2 mm, respectively (P = 0.078). The impaction duration was 8.5 +/- 1.1 months for the URSL group and 17.2 +/- 3.8 months for the OUU group (P < 0.001). Endoscopic observation revealed two types of ureteral lesions that were defined as villous or polypoid protrusion (type 1) and edematous hemispheric lesions (type 2). Stone-free rates for the URSL group and the OUU group were 91.8% and 100%, respectively (P = 0.140). URSL was associated with a higher incidence of stricture (26.2% v 4.0%; P = 0.019) and worse recovery of hydronephrosis (P < 0.001). Stricture occurred more frequently in patients with type II lesions in the URSL group (P = 0.022). Stone recurrence for the URSL group and the OUU group were 13.1% and 4%, respectively (P = 0.210). Chronically impacted stones are frequently associated with ureteral polyp or stricture lesions. Our results reveal that combined removal of stones with resection of the pathologic ureter may achieve better long-term outcomes for patients with impacted stones with stricture lesions.