Ureteroscopic Stone Research Articles

Sedation vs. general anesthesia in stone ureteroscopy: Comparison of efficacy and safety, a post COVID-19 report

IntroductionUreterorenoscopy (URS) for ureteral or renal stones is traditionally performed under general anesthesia (GA). Sedation is an alternative to GA, allowing control of the level of consciousness, spontaneous ventilation, and faster recovery. Our aim was to compare sedation and GA for patients undergoing ureterorenoscopy. Endpoints were stone-free rate (SFR) and complication rates. MethodMonocentric comparative retrospective study including all consecutive ureterorenoscopies for ureteral or renal stone. The inclusion period was dichotomized in two 6-months periods due to the COVID-19 pandemic: from January 1 to July 1, 2019 (URS under GA) and from January 1 to July 1, 2021 (URS under GA or sedation). Stone-free (SF) status was defined as the absence of stone or fragment>4mm after the first ureterorenoscopy. Complication rates were assessed according to the Satava (perioperative complications) and Clavien-Dindo (postoperative complications) classifications. Statistical analysis was performed by Chi-square test. ResultsA total of 185 patients were included for a total of 206 ureterorenoscopies; 82 underwent ureterorenoscopy under GA and 103 under sedation. The median stone size was 10 [7–16] mm. In all, 150 (81%) patients had at least one intrarenal stone. The SFR was similar between the two groups (67% GA group, 69% sedation group, P=0.912). In the sedation group, the mean SFR in ureter was 83.7% vs. 92.5% in the GA group. In renal cavities, the mean SFR was 46.4% in the sedation group vs. 42.5% in the GA group. Satava grade I, IIa, and IIb complications were 5 (6%), 5 (6%), and 1 (1%) in the GA group and 6 (6%), 1 (1%), and 3 (3%) in the sedation group, respectively (P=0.214). The grade I, II, III, and IV Clavien complications were 6 (7%), 3 (4%), 0 (0%), and 2 (2%) in the GA group and 6 (6%), 4 (4%), 1 (1%), and 4 (4%) in the sedation group, respectively (P=0.928). ConclusionOur post COVID-19 study showed no difference in efficacy and safety between ureterorenoscopy under sedation and GA for patients with renal stones. Our results confirm the interest of the sedation procedure, particularly in the context of outpatient surgery. Level of evidence4.

MP44-11 URETEROSCOPY VS. SHOCKWAVE LITHOTRIPSY FOR LOWER POLE RENAL STONES: TREATMENT VARIATION AND OUTCOMES IN A SURGICAL COLLABORATIVE

You have accessJournal of UrologyCME1 May 2022MP44-11 URETEROSCOPY VS. SHOCKWAVE LITHOTRIPSY FOR LOWER POLE RENAL STONES: TREATMENT VARIATION AND OUTCOMES IN A SURGICAL COLLABORATIVE John Michael DiBianco, Stephanie Daignault-Newton, Eric Stockall, Spencer Hiller, Hyung Joon Kim, Hector Pimentel, Casey A. Dauw, and Khurshid R. Ghani John Michael DiBiancoJohn Michael DiBianco More articles by this author , Stephanie Daignault-NewtonStephanie Daignault-Newton More articles by this author , Eric StockallEric Stockall More articles by this author , Spencer HillerSpencer Hiller More articles by this author , Hyung Joon KimHyung Joon Kim More articles by this author , Hector PimentelHector Pimentel More articles by this author , Casey A. DauwCasey A. Dauw More articles by this author , and Khurshid R. GhaniKhurshid R. Ghani More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002610.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: American Urological Association guidelines recommend ureteroscopy (URS) or shockwave lithotripsy (SWL) for lower pole (LP) renal stones ≤1cm, and URS for stones >1-2cm. However, data guiding these recommendations are from select centers. We examined treatment variation, unplanned healthcare utilization and stone-free rates (SFR) in the diverse practices comprising the Michigan Urological Surgery Improvement Collaborative (MUSIC). METHODS: Using the MUSIC registry we identified URS and SWL cases for LP stones ≤2cm from 2016-2021. We assessed practice and surgeon frequency of performing URS or SWL. A treatment modality was considered favored if the procedure rate was >50%. Emergency department (ED) visits, hospitalization and SFRs were assessed according to stone size (≤1, >1-2cm). RESULTS: 3,645 procedures were performed across 35 practices and 209 surgeons; 1358 (37.3%) URS and 2287 (62.7%) SWL. 80.2% of stones were ≤1cm. There was practice variation in performing URS (0 to 100%; p<0.001) and SWL (0 to 100%; p<0.001). 74.2% of surgeons favored SWL; 10% performed SWL, and 5.7% URS exclusively (Figure). For stones ≤1cm, ED visits (9.5% vs 2.5%, p<0.001) and hospitalizations (3.5% vs 0.4%, p<0.001) were higher after URS, as were SFRs (URS 56.4% vs SWL 38.8%; p<0.001). There were no significant differences between URS and SWL for ED visits, hospitalizations, or SFRs, for >1-2cm stones. Multivariable analysis revealed significantly increased odd of having an ED visit and being stone-free for all LP stones ≤2cm and ≤1cm treated with URS (Table). CONCLUSIONS: In Michigan, SWL is the favored treatment modality for LP stones ≤2cm. Over 15% of surgeons used one modality exclusively. URS provided better SFRs but with a 4-fold increase in ED visits and hospitalization for stones ≤1cm but no difference for >1-2cm stones. Our findings demonstrate the need for quality efforts to address treatment selection and improve outcomes. Source of Funding: Blue Cross Blue Shield of Michigan © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e756 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information John Michael DiBianco More articles by this author Stephanie Daignault-Newton More articles by this author Eric Stockall More articles by this author Spencer Hiller More articles by this author Hyung Joon Kim More articles by this author Hector Pimentel More articles by this author Casey A. Dauw More articles by this author Khurshid R. Ghani More articles by this author Expand All Advertisement PDF DownloadLoading ...

PD54-02 THE IMPACT OF URETERAL STENT OMISSION AND AN OPIATE-FREE PROTOCOL ON PATIENT REPORTED OUTCOMES FOLLOWING URETEROSCOPY

You have accessJournal of UrologyStone Disease: Surgical Therapy IV (PD54)1 Sep 2021PD54-02 THE IMPACT OF URETERAL STENT OMISSION AND AN OPIATE-FREE PROTOCOL ON PATIENT REPORTED OUTCOMES FOLLOWING URETEROSCOPY Spencer C. Hiller, Stephani Daignault-Newton, Bronson Conrado, John M. Hollingsworth, William W. Roberts, Sapan N. Ambani, Khurshid R. Ghani, and Casey A. Dauw Spencer C. HillerSpencer C. Hiller More articles by this author , Stephani Daignault-NewtonStephani Daignault-Newton More articles by this author , Bronson ConradoBronson Conrado More articles by this author , John M. HollingsworthJohn M. Hollingsworth More articles by this author , William W. RobertsWilliam W. Roberts More articles by this author , Sapan N. AmbaniSapan N. Ambani More articles by this author , Khurshid R. GhaniKhurshid R. Ghani More articles by this author , and Casey A. DauwCasey A. Dauw More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002081.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: A variety of factors impact the patient experience following ureteroscopy (URS), notably ureteral stent placement as well as postoperative pain management. Our institution has moved toward stent omission (SO) and an opiate-free (OF) protocol, if appropriate. Patient reported outcomes (PRO) following URS are underreported, thus the impact of these interventions is unclear. We sought to better understand the impact of a SO or OF approach on PRO. METHODS: We prospectively administered the PROMIS® (Patient-Reported Outcomes Measurement System) questionnaire to patients undergoing URS for stones at our institution (2019-2020). This instrument measures pain intensity and interference. PROMIS® was completed preoperatively and 7-10 days postoperatively. Scores were translated into normed T-scores for intensity and interference (50 is the population mean). Consideration of SO or OF protocol was at the discretion of the surgeon. The SO analysis was limited to stent naïve patients, with accrual set to have 80% power to detect the clinically significant difference in T-scores of 6. Bivariate statistics compare T-scores across pathways. A multivariable regression model was used to adjust for clinical and operative factors and estimate differences in T-scores postoperatively for both SO and OF patients. RESULTS: 167 patients completed the baseline and 7-day survey (60% response rate). An OF protocol was used in 82% (137). In stent naïve patients (n=114), SO occurred in 38% (43). SO and stented patients had similar baseline T-scores. SO patients had significantly less pain intensity and interference postoperatively (Figure 1B) which persisted on multivariable regression (intensity: -9.49, p<0.001; interference: -10.09, p<0.001). T-scores of OF and non-OF patients were clinically similar for pain intensity and interference at baseline and 7 days (Figure 1B), even after controlling for stenting (intensity: -1.89, p=0.3; interference: -1.51, p=0.5). CONCLUSIONS: Following URS, SO improves PRO measures while an OF pathway did not result in a significant difference. These results provide insight into the factors impacting the patient experience following URS and should stimulate efforts to further define those most appropriate for a SO or OF protocol. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e922-e922 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Spencer C. Hiller More articles by this author Stephani Daignault-Newton More articles by this author Bronson Conrado More articles by this author John M. Hollingsworth More articles by this author William W. Roberts More articles by this author Sapan N. Ambani More articles by this author Khurshid R. Ghani More articles by this author Casey A. Dauw More articles by this author Expand All Advertisement Loading ...

Is Preoperative Pyuria Associated with Postoperative Febrile Complication after Ureteroscopic Ureter or Renal Stone Removal?

Is Preoperative Pyuria Associated with Postoperative Febrile Complication after Ureteroscopic Ureter or Renal Stone Removal?

Ureteral stricture after ureteroscopy for stones: A prospective study for the incidence and risk factors.

Context:A ureteral stricture is a serious complication of ureteroscopy (URS) that was reported in the literature in highly variable rates from 0.2% to 24%.Aims:Our aims are to estimate the incidence and to detect the risk factors of ureteral stricture after URS.Settings and Design:This is a prospective, case-series study.Materials and Methods:During the period from May 2015 to August 2016, 251 adult patients underwent 263 URS for the treatment of 304 ureteral stones. Postoperative regular follow-up was done for 12 months by ultrasound. Computed tomography urography and diuretic renogram were performed for the cases developed hydronephrosis to confirm and detect the level of the stricture.Statistical Analysis:IBM SPSS Statistics for Windows, Version 19.0, Armonk, NY: IBM Corp. used for data analysis. Chi-square and Fisher's exact tests were used to compare between qualitative variables. Mann–Whitney test was used to compare between two quantitative variables in case of nonparametric data. Multiple logistic regression analysis was done to measure the risk factors. P value was considered statistically significant when <0.05.Results:The mean age was 43.5 years (standard deviation [SD]: ±13.6), and the mean body mass index was 28.39 (±3.96). The mean total stone burden was 12.8 mm (SD: ±5.9). Bilateral URS was performed in 12 cases. The mean operative time was 54.8 min (SD: ±22.68). Initial and final stone-free rates were 83.3% and 100%, respectively. The overall complications rate was 28.1%. Stricture occurred in four cases (1.5%).Conclusions:In our experience, the incidence of post-URS ureteral stricture is low. The impacted stone is the most common cause of URS complications and hence stricture formation.

Results of day-case ureterorenoscopy (DC-URS) for stone disease: prospective outcomes over 4.5\xa0years

PurposeTo investigate the prospective outcomes of day-case ureterorenoscopy (DC-URS) for stone disease. With the rising prevalence of stone disease in the face of finite resources, there is increasing pressure to undertake procedures as a day case avoiding in-patient stay. There are a limited number of studies reporting on the feasibility of ureteroscopy as a day-case procedure. This study aimed to investigate the prospective outcomes and predictors precluding to DC-URS for stone disease in patients treated in our university teaching hospital.Materials and methodsBetween March 2012 and July 2016, consecutive cases of adult stone ureteroscopy performed or supervised by a single surgeon were recorded in a prospective database. Patients underwent pre-operative counselling in a specialist stone clinic and were admitted to a dedicated ‘Surgical day unit’ on the day of surgery. A standardised anaesthetic protocol was adhered to in all cases. Data on patient demographics, stone parameters, pre-operative assessment, operative details, length of stay, stone-free rate and complication rates were collected and analysed.ResultsA total of 544 consecutive adult ureteroscopy for stone disease were conducted over the study period with a day-case rate of 77.7%. Thirty-nine percent of failed day-case ureteroscopy were due to late completion of ureteroscopy and due to associated social circumstances of patients. The mean stone size, operating time duration and post-operative stent insertion rates for DC-URS patients were 14 mm, 46 min and 96.5%, respectively. Post-operatively, the mean stone-free rate (SFR), unplanned re-admissions and complications for DC-URS patients were 95, 4 and 4%, respectively. A higher failure of DC-URS was related to patient’s age (p = 0.003), positive pre-operative urine culture (p < 0.001), elevated pre-operative serum creatinine (p < 0.001) and higher mean operating time (p < 0.02).ConclusionBased on our results, a day-case ureteroscopy rate of nearly 78% can be achieved. With its acceptable complication rate, and low re-admission rates, DC-URS is a safe and feasible option in a majority of patients with stone disease.

PD30-03 SAME SESSION BILATERAL URETEROSCOPY FOR MULTIPLE STONES: RESULTS FROM THE CLINICAL RESEARCH OFFICE OF ENDOUROLOGICAL SOCIETY (CROES) URETEROSCOPY (URS) GLOBAL STUDY

You have accessJournal of UrologyStone Disease: Surgical Therapy III1 Apr 2017PD30-03 SAME SESSION BILATERAL URETEROSCOPY FOR MULTIPLE STONES: RESULTS FROM THE CLINICAL RESEARCH OFFICE OF ENDOUROLOGICAL SOCIETY (CROES) URETEROSCOPY (URS) GLOBAL STUDY Kenneth Pace, Tad Kroczak, Nienke Wijnstok, Guido Kamphuis, Tarik Esen, Chrysovalantis Toutziaris, Benjamin Silva, and Jean de la Rosette Kenneth PaceKenneth Pace More articles by this author , Tad KroczakTad Kroczak More articles by this author , Nienke WijnstokNienke Wijnstok More articles by this author , Guido KamphuisGuido Kamphuis More articles by this author , Tarik EsenTarik Esen More articles by this author , Chrysovalantis ToutziarisChrysovalantis Toutziaris More articles by this author , Benjamin SilvaBenjamin Silva More articles by this author , and Jean de la RosetteJean de la Rosette More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1368AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We present an international experience with ipsilateral ureteroscopy (I-URS) for multiple ureteric and renal stones and bilateral URS (B-URS) for multiple, bilaterial ureteric and renal stones, using data collected from the Clinical Research Office of the Endourological Society (CROES) Ureteroscopy Global Study. Our objective was to compare I-URS and B-URS treatment characteristics and outcomes as well as the outcomes of multiple single-session stone treatments (I-URS and B-URS) with single stone URS treatments. METHODS The CROES Ureteroscopy Global Study includes 114 centers in 32 countries. Patients undergoing B-URS, I-URS, and URS for a single stone were identified from January, 2010 to October, 2012. Intra-operative characteristics and post-operative outcomes were identified for each patient. Univariate regression analysis and inverse-probability weighted regression adjustment (IPWRA) analyses were used to compare outcomes and adjust for difference between centres. RESULTS The CROES URS Global Study consists of 11885 patients. A total of 2153 (18.7%) patients were treated for multiple stones with 1880 (87.3%) and 273 (12.7%) patients undergoing I-URS and B-URS respectively. The univariate and IPWRA models for B-URS versus I-URS and multiple versus single stone treatments show that patients with B-URS and multiple stone treatments have lower stone free rates, higher re-treatment rates, and longer operating times compared to patients whom underwent I-URS and single stone treatment. There was no difference in complication rates between B-URS, I-URS, and single stone ureteroscopy. CONCLUSIONS This study represents the largest series of patients undergoing URS for bilateral and multiple ipsilateral stones. Our findings suggest a decrease in stone free rates, increased re-treatment rates, increased operating time and a longer hospital admission in patients treated for multiple stones. The treatment of multiple stones and B-URS is safe when compared to single stone and I-URS. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e578 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Kenneth Pace More articles by this author Tad Kroczak More articles by this author Nienke Wijnstok More articles by this author Guido Kamphuis More articles by this author Tarik Esen More articles by this author Chrysovalantis Toutziaris More articles by this author Benjamin Silva More articles by this author Jean de la Rosette More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

A Comparison of Treatment Modalities in Renal and Ureteral Calculi

In the decades, since the advent of shockwave lithotripsy, instrumentation and techniques in both ureteroscopic and percutaneous stone management have improved exponentially, leading to both increased success and lower complication rates. As a result, there have been some controversies revolving around the therapeutic modality of choice for specific stones in terms of their size and location. This review seeks to provide some clarity to the decision-making process with emphasis on patient comfort and choice and due consideration being given to the potential complications associated with the various treatment modalities.

The Influence of Body Mass Index on Outcomes in Ureteroscopy: Results from the Clinical Research Office of Endourological Society URS Global Study.

Although ureteroscopy (URS) has been established as a viable treatment for stones in obese patients, its safety and success has not been fully elucidated. The current study describes the worldwide prevalence of obesity in patients with urolithiasis and examines trends in URS outcomes, safety, and efficacy. This study utilized the Clinical Research Office of the Endourological Society (CROES) URS Global Study, which was a prospective, multicenter study including 11,885 patients treated with URS for urinary stones at 1 of 114 urology departments across 32 countries. The relationship between body mass index (BMI), diabetes, and creatinine, with retreatment, stone-free rates, complications, and long hospital stay, was examined with a multivariate logistic regression analyses. Of the 10,099 URS patients with BMI data, 17.4% were obese and 2.2% were super obese. Overall, 86.7% patients were stone free and 16.8% required retreatment. Higher BMI was associated with lower stone-free rates, and any deviation from normal weight was associated with higher retreatment rates. In multivariate analysis controlling for several variables including stone size, the association between BMI and lower stone-free rates with higher retreatment rates persisted. Intraoperative complications occurred in 518 (5.1%) patients, and 343 (3.4%) experienced a postoperative complication. Postoperative complications were more frequent in the underweight and super obese subjects, and there was no relationship between BMI and intraoperative complications. Although URS for stone disease was found to be an overall safe procedure for obese and super obese patients, efficacy of the procedure may be lower compared with normal-weight subjects and higher retreatment rates may be necessary.

Ureteroscopy for stones in solitary kidney: Preferred not just a standard option.

We thank the editor Dr. Bres-Niewada for her comments on our papers [1, 2] on the efficacy and outcomes for ureteroscopy in patients with solitary kidney. URS and RIRS have now been shown to be effective in all types of patient groups including paediatric patients [4]. Our results support successful use of this technique for patients with solitary kidney, as a day case procedure with some improvement in their renal function post-operatively [3].

V64 The new stone age: Ureteroscopic stone “Dusting” with a 120-Watt holmium laser

V64 The new stone age: Ureteroscopic stone “Dusting” with a 120-Watt holmium laser

In-Vitro Assessment of a New Portable Ballistic Lithotripter with Percutaneous and Ureteroscopic Models

The EMS Swiss LithoBreaker is a new, portable, electrokinetic lithotripter. We compared its tip velocity and displacement characteristics with a handheld, pneumatic lithotripter LMA StoneBreaker.™ We also evaluated fragmentation efficiency using in vitro models of percutaneous and ureteroscopic stone fragmentation. Displacement and velocity profiles were measured for 1-mm and 2-mm probes using a laser beam aimed at a photo detector. For the percutaneous model, 2-mm probes fragmented 10-mm spherical BegoStone phantoms until the fragments passed through a 4-mm mesh sieve. The ureteroscopic model used 1-mm probes and compared the pneumatic and electrokinetic devices to a 200-μm holmium laser fiber. Cylindrical (4-mm diameter, 4-mm length) BegoStone phantoms were placed into silicone tubing to simulate the ureter; fragmented stones passed through a narrowing in the tubing. For both 1-mm and 2-mm probes, the electrokinetic device had significantly higher tip displacement and slower tip velocity, P<0.01. In the percutaneous model, the electrokinetic device needed an average of 484 impulses over 430 seconds to fragment one BegoStone, while the pneumatic device needed 29 impulses over 122 seconds to fragment one stone. Both clearance times and number of impulses needed for percutaneous stone clearance were significantly different at P<0.01. Ureteroscopically, the mean clearance time was 97 seconds for the electrokinetic lithotripter, 145 seconds for the pneumatic lithotripter, and 304 seconds for the laser. Comparing the pneumatic device with the electrokinetic device ureteroscopically, there was no significant difference in clearance time, P=0.55. Both the pneumatic and electrokinetic lithotripters, however, demonstrated decreased clearance times compared with the laser, P=0.027. The portable electrokinetic lithotripter may be better suited for ureteroscopy instead of percutaneous nephrolithotomy. It appears to be comparable to the portable pneumatic device in the ureter. Further clinical studies are needed to confirm these findings in vivo.

Comparison of the effect of ureteroscopic lithotripsy and extracorporeal shock wave lithotripsy for ureteral stones

Objective To compare the effect of ureteroscopic pneumatic lithotripsy(URL) and extracorporeal shock wave lithotripsy(ESWL) for ureteral stones.Methods 90 patients with ureteral stones were randomly divided into group A( URL group),group B( ESWL group),each group 45 cases.The effect of surgical treatment was compared between the two groups.Results The one-time success rate of gravel,stone free after 4 weeks of A group was significantly higher than that of group B( x2 =9.680,5.414,all P ＜0.05),but there was no significant difference in the surgical time and hospital stay of the two groups( t =1.010,0.909,all P ＞ 0.05 ).The postoperative renal colic,fever and other complications of group A were significantly lower than that of group B ( x2 =6.049,5.075,all P ＜0.05),but the gross heraturia and ureteral injury of group A was higher than that of group B(x2 =5.874,3.873,all P ＜ 0.05 ).Conclusion The ureteroscopic pneumatic lithotripsy and extracorporeal shock wave lithotripsy in the treatment of ureteral stones all have good effect,but ureteroscopic pneumatic lithotripsy and stone rubble drain success rate are significantly higher than extracorporeal shock wave lithotripsy,and postoperative complications are relatively less than extracorporeal shock wave lithotripsy. Key words: Ureteral stones; Ureteroscopic; Extracorporeal; Lithotripsy

Trends in urological stone disease

To summarize the changes in prevalence and treatment of upper urinary tract stone disease in the UK over the last 10 years. Data from the Hospital Episode Statistics (HES) website (http://www.hesonline.nhs.uk) were extracted, summarized and presented. The number of upper urinary tract stone hospital episodes increased by 63% to 83,050 in the 10-year period. The use of shock wave lithotripsy (SWL) for treating all upper tract stones increased from 14,491 cases in 2000-2001 to 22,402 cases in 2010 (a 55% increase) with a 69% increase in lithotripsy for renal stones. There was a 127% increase in the number of ureteroscopic stone treatments from 6,283 to 14,242 cases over the 10-year period with a 49% increase from 2007/2008 to 2009/2010. There was a decline in open surgery for upper tract stones from 278 cases in 2000/2001 to 47 cases in 2009/2010 (an 83% reduction). Treatment for stone disease has increased substantially in comparison with other urological activity. In 2009/2010, SWL was performed almost as frequently as transurethral resection of the prostate or transurethral resection of bladder tumour, ureteroscopy for stones was performed more frequently than nephrectomy, radical prostatectomy and cystectomy combined, and percutaneous nephrolithotomy was performed more frequently than cystectomy. The present study highlights the increase in prevalence and treatment of stone disease in the UK over the last 10 years. If this trend continues it has important implications for workforce planning, training, service delivery and research in the field of urolithiasis.

Stentless pediatric ureteroscopic holmium: YAG laser stone disintegration: is gravels retrieval an issue?

To evaluate the safety and efficacy of stentless pediatric ureteroscopic holmium laser stone disintegration without gravels retrieval. From Feb 2007 to Feb 2010, 21 children (12 boys and 9 girls) with unilateral single stone ureter, with an average age of 8.5 years (range 4-12 years), were treated with 6.9 Fr semirigid ureteroscope for a stone size ranged from 5 to 10 mm (mean 6.5 mm). All the stones were radioopaque, located in the upper ureter in 2 cases (9.5%), in the middle ureter in 5 cases (24%), and in the lower ureter in 14 cases (66.5%). Complete holmium laser stone disintegration was applied in all cases without gravels removal. No postoperative ureteral stent was inserted in any case. The stones were successfully approached and completely disintegrated in a single session in 20 cases (95.2%). All the procedures were done without ureteral orifice dilatation apart from 3 cases where another working guide wire was applied. No intraoperative complications were recorded in the form of mucosal injury, ureteral perforation, or urinary extravasation. There is no early postoperative complication in the form of urinary tract infection or colic apart from single case of hematuria which was successfully treated conservatively. Two weeks postoperatively, KUB (kidney, ureter, and bladder) films were completely free from any significant gravel (>3 mm) and US showed no hydronephrosis. Stentless ureteroscopic holmium laser disintegration without gravels removal is a safe and effective method for pediatric ureteral stone less than 10 mm in diameter.

Extra Corporal Shock Wave Lithotripsy (ESWL) compared to ureteroscopic (URS) stone removal in small distal ureteral stones less than 6MM in size

Extra Corporal Shock Wave Lithotripsy (ESWL) compared to ureteroscopic (URS) stone removal in small distal ureteral stones less than 6MM in size

A COMPARISON OF URETEROSCOPY TO IN SITU EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY FOR THE TREATMENT OF DISTAL URETERAL CALCULI

The optimal treatment for distal ureteral calculi remains controversial. Most urologists offer extracorporeal shock wave lithotripsy (ESWL) or ureteroscopy for stones that require intervention. We present data from our institution on these modalities since 1990. We treated 187 distal ureteral calculi with ESWL (91 cases) on a Dornier HM3 or MFL 5000 lithotriptor, or with ureteroscopy (96 cases) using basket extraction with or without pulsed dye laser lithotripsy. Fragmentation and stone-free rates for ESWL were 80 and 73%, respectively, with no complications. For ureteroscopy the stone-free rate was 95% with a 5.2% short-term complication rate and no long-term complications. At our institution ureteroscopy is more efficacious than ESWL for the treatment of distal ureteral calculi.

Ureteroscopic Results and Complications: Experience with 130 Cases

Since its introduction for general use, the role of rigid ureteroscopy in the diagnosis and therapy of urological disease has been in evolution. We evaluated retrospectively the experience at our institution with rigid ureteroscopy from January 1983 to July 1986 in an attempt to identify clinical situations or techniques that tended to increase the incidence of either success or complications. We determined that ureteroscopic complications were rare in procedures performed for diagnosis compared to those performed for calculi (2 of 33 or 6 per cent versus 27 of 99 or 27 per cent, p less than 0.025). The likelihood of failure or complication was greater for stones above than for those below the pelvic brim (15 of 25 or 60 per cent versus 26 of 75 or 35 per cent, p less than 0.05). Major complications were more common early in our experience (9 of 63 or 14 per cent versus 2 of 69 or 3 per cent for the combined years 1983 and 1984 compared to 1985 and 1986, p less than 0.05). Our success rates in the treatment of calculous disease were similar to those reported previously, and they were somewhat better for stones located below (62 of 75 or 83 per cent) than for those above (17 of 25 or 68 per cent) the pelvic brim. Based on our findings we conclude that carefully performed diagnostic ureteroscopy has little potential for major complications, ureteroscopy for stones above the pelvic brim should be avoided when possible, and an increased rate of complications and failures is expected early in any series owing at least partly to the learning curve effect.