Ureteroscopy For Ureteral Calculi Research Articles

Analysis of uroseptic shock after ureteroscopy for ureteral calculi during pregnancy: a case report

BackgroundUroseptic shock secondary to ureteral calculi during pregnancy is rare. It is characterized by rapid onset, rapid progression, aggressive disease, limited treatment, poor prognosis, and a mortality rate higher than 20% with improper or delayed management. A clear diagnosis is made based on typical clinical symptoms and abdominal ultrasound, often requiring combined multidisciplinary treatment and the simultaneous release of the obstruction. The high mortality rate is mainly related to inappropriate early treatment of stones and infections or failure to intervene in a timely manner.Case presentationA 21-year-old first-time pregnant patient with uroseptic shock was admitted to our intensive care unit. The patient was successfully treated at our hospital with multidisciplinary cooperation, high-dose vasoactive drugs, IABP, CRRT, VA-ECMO, and termination of pregnancy.ConclusionsTimely relief of obstructions, termination of pregnancy, and the provision of IABP, CRRT, and VA-ECMO when necessary in critically ill patients with uroseptic shock during pregnancy can improve the success rate of resuscitation.

Primary versus delayed ureteroscopy for ureteric stones: A systematic review and meta-analysis

Background: Ureteric colic is a major clinical and economic burden on the National Health Service. There has been a recent paradigm shift to consider definitive surgery as the primary intervention at the time of initial presentation. Objective: To systematically evaluate the outcomes of primary/emergency ureteroscopy versus delayed/elective ureteroscopy. Methods: We performed a critical review of MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials–CENTRAL, CINAHL, Clinicaltrials.gov, Google Scholar and individual urological journals in April 2020. A robust database search was performed using a combination of the terms ‘primary ureteroscopy’, ‘immediate ureteroscopy’, ‘delayed ureteroscopy’ and ‘emergency ureteroscopy’. Adult patients (> 16 years) with ureteric stones presenting as an emergency were included. Results: Twelve studies met the inclusion criteria, with 4 studies directly comparing primary/emergency to delayed/elective ureteroscopy for an acute presentation of ureteric colic. Across the studies, 1708 patients underwent primary/emergency ureteroscopy for ureteric calculi and 990 underwent delayed ureteroscopy. No significant differences in stone-free rates were found between both groups with primary/emergency achieving 85% and delayed/elective 91% ( p = 0.68). The majority of stones treated were located in the distal ureter in both groups. Overall, there were no differences in complications between the groups ( p = 0.42) or major complications (0.17). However, there were fewer minor complications in the primary URS group ( p = 0.02). Ureteral catheter or double-J stent insertion was used in 71% of delayed/elective ureteroscopy cases, compared to 46.8% of primary/emergency cases (p = 0.001). For patients undergoing primary/emergency ureteroscopy, 6.4% patients required auxiliary procedures. In the delayed/elective group, 7.6% required further definitive treatment (NS). Conclusion: Primary ureteroscopy is a safe and feasible procedure, when performed in suitable patients in the acute setting. It is associated with significantly lower stent usage, equivalent stone clearance, no increase in overall or major complications including sepsis, and fewer minor complications when compared to delayed/elective ureteroscopy. Prospective studies will do well to explore this area further but on current evidence, primary ureteroscopy is the safe procedure. Level of evidence: Not applicable

1027 Radiation exposure of the patient submitted to ureteroscopy for ureteral calculi: The impact of the different factors

1027 Radiation exposure of the patient submitted to ureteroscopy for ureteral calculi: The impact of the different factors

Re: Re: The efficacy and safety of ureteroscopy for ureteral calculi in pregnancy: our experience in 32 patients

The aim of this study was to investigate the efficacy and safety of ureteroscopy (URS) in pregnant women. A retrospective analysis was performed on 32 pregnant patients referred to our center between April 2005 and November 2010 with hydronephrosis requiring surgical intervention. A semirigid URS of 9.5 F was used in all patients. The mean age of patients was 27.8 years (range 20–39), and the mean gestation duration was 24 weeks (15–34). The ultrasound findings were diagnostic of obstructive ureteral calculi in 16 (50%) patients and the mean stone diameter was 8 mm. Spinal anaesthesia was performed in 22 (68.8%) patients, while general anaesthesia was performed in 7 (21.8%) patients. Ureteric stones were found in 27 (84.3%) patients during endoscopy, 10 being distal, 9 middle and 8 proximal. There were no stones in five patients. The stones were fragmented with pneumatic lithotripsy in 8 patients and with holmium laser in 17 patients and the fragments were retracted with forceps. Of the 32 patients, 19 (59.4%) required JJ stent insertion peroperatively. There was no serious complication intraoperatively, while urinary tract infection developed in four and renal colic in two patients postoperatively. In one patient, sepsis developed postoperatively, and improved with appropriate treatment. All babies were born normally. Semirigid ureteroscopy for diagnosing and treating ureteral calculi by intracorporeal pneumatic or holmium laser lithotripsy is a safe and reasonable treatment option for pregnant patients.

The Dretler Stone Cone: A Device to Prevent Ureteral Stone Migration—The Initial Clinical Experience

Retrograde stone migration during ureteroscopic lithotripsy occurs in 5% to 40% of proximal and distal ureteral stone cases. This migration increases morbidity and the need for auxiliary procedures. The Dretler stone cone (Medsource, Norwell, Massachusetts) is a novel device to prevent proximal stone migration and facilitate fragment extraction during ureteroscopic lithotripsy. We assessed the safety and efficacy of the Dretler stone cone in the clinical setting and compared it prospectively with a conventional flat wire basket during ureteroscopy for ureteral calculi. To our knowledge we report the initial clinical use of the Dretler stone cone in 50 consecutive patients with ureteral calculi undergoing ureteroscopic extraction. Calculi were situated above the sacroiliac joint in 24 cases, over the sacroiliac joint in 15 and below the sacroiliac joint in 11. Pneumatic lithotripsy was done in 42 cases. In the remaining 8 cases ureteroscopic (3) or fluoroscopic (5) intact stone extraction was performed. The later 23 cases using the Dretler stone cone were prospectively compared with 20 of ureteroscopic intracorporeal lithotripsy using a standard flat wire basket. The Dretler stone cone was successfully placed in all 50 cases. In 41 patients it was placed via cystoscopy under fluoroscopic guidance, while 9 impacted stones required ureteroscopic placement. Six patients in whom the Dretler stone cone was used had residual fragments less than 3 mm. No patient required auxiliary procedures. In the prospective trial no patients in Dretler stone cone group had residual fragments greater than 3 mm. or required auxiliary procedures. However, in the flat wire basket group residual stones greater than 3 mm. were present in 6 cases (30%, p <0.001), while auxiliary procedures were required in 4 (20%, p <0.01). The Dretler stone cone represents a new generation of basketry that minimizes proximal ureteral stone migration and allows safe extraction of fragments during ureteroscopic lithotripsy. In our experience it is associated with a lower incidence of significant residual fragments and fewer auxiliary procedures than conventional flat wire baskets.