Ureteroscopy For Ureteral Stones Research Articles

Predictive factors for prolonged operative time in ureteroscopic lithotripsy for ureteral stones A retrospective cohort study.

A prolonged operative time of lithotripsy with ureteroscopy for urolithiasis increases the risk of infectious complications; however, few reports have investigated the factors prolonging the operative time for ureteral stones. We investigated the factors associated with longer operative time in ureteroscopy for ureteral stones. This retrospective cohort study analyzed patients who underwent retrograde ureteroscopic lithotripsy for ureteral stones and achieved an endoscopic stone-free status between April 2019 and July 2022. Patients were classified into two groups based on an operative time of ≥90 minutes or <90 minutes. We compared the patient and stone characteristics and surgical outcomes, and investigated the factors associated with a prolonged operative time. The cohort comprised 519 patients, with 58 patients in the group with an operative time of ≥90 minutes. Compared to the shorter operative time group, the longer operative time group had a significantly greater proportion of males, stone diameter, stone volume, and Hounsfield units of stone; additionally, the longer operative time group had higher prevalences of endoscopic findings of edema, polyps, and mucosa-stone adherence. Multivariable analysis showed that stone size >10 mm (odds ratio 4.05), polyps (odds ratio 2.40), and mucosal adherence (odds ratio 3.51) were significantly associated with an operative time exceeding 90 minutes. There were no significant differences between the two groups in the incidences of postoperative fever and systemic inflammatory response syndrome. Stone size, endoscopic findings of polyps, and mucosa-stone adherence were independent factors associated with a longer operative time.

Infection after ureteroscopy for ureteric stones: analysis of 71 305 cases in the Hospital Episode Statistics database.

To investigate the burden of infectious complications following ureteroscopy (URS) for ureteric stones on a national level in England using data from the Hospital Episodes Statistics (HES) data warehouse. A retrospective cohort was identified and followed up in HES during the period April 2013 to March 2020 for all procedure codes relating to ureteroscopic stone treatment (M27.1, M27.2, M27.3). Treatment episodes relating to the first URS ('index ureteroscopy') for each patient were further analysed. All subsequent admissions within 30 days were also captured. The primary outcome was diagnosis of urinary tract infection (UTI; including all codes relating to a UTI/sepsis within the first 30 days of index URS). Secondary outcomes were critical care attendance, attendance at the accident and emergency department (A&E) within 30 days, and mortality. A total of 71 305 index ureteroscopies were eligible for analysis. The median age was 55 years, and 81% of procedures were elective and 45% were undertaken as day-cases. At the time of index URS, 16% of patients had diabetes, 0.5% had coexisting neurological disease and 40% had an existing stent/nephrostomy. Overall, 6.8% of the cohort (n = 4822) had a diagnosis of UTI within 30 days of index URS (3.9% immediately after surgery). A total of 339 patients (0.5%) required an unplanned stay in critical care during their index URS admission; 8833 patients (12%) attended A&E within 30 days. Overall mortality was 0.18% (60 in-hospital, 65 within 30 days); 40 deaths (0.056%) included infection as a contributing cause of death. We present the largest series evaluating infectious complications after ureteroscopic stone treatment. The procedure is safe, with low inpatient infective complication and critical care admission rates.

Transvesicoscopic ureteral reimplantation and ureteroscopy for management of primary obstructed non-refluxing megaureter with ureteral calculus.

IntroductionPrimary obstructed non‐refluxing megaureter, a type of congenitally dilated ureter, often resolves spontaneously. Surgery may be indicated in symptomatic cases; however, there are no reports of transvesicoscopic ureteral implantation and ureteroscopy for ureteral stones. Therefore, we describe the treatment of primary obstructed non‐refluxing megaureter and ureteral calculi using this technique.Case presentationA 6‐year‐old Japanese girl was referred for abdominal pain and gross hematuria due to right megaureter with multiple stones in the renal lower‐pole calyces and ureter. She was diagnosed with primary obstructed non‐refluxing megaureter and ureterovesical junction obstruction. The stones were removed using mini‐percutaneous nephrolithotomy and transvesicoureteroscopic surgery, respectively. A narrow segment of the right ureter was cut, and transvesicoscopic ureteral plication and reimplantation were performed. The procedures were successful without postoperative complications.ConclusionTransvesicoscopic ureteral reimplantation with ureteroscopy may be a safe, effective and minimally invasive surgical option for ureterovesical junction obstruction with ureteral stones.

Surgical and radiological predictive factors for ureteric stricture formation in patients treated with ureteroscopy for ureteric stones

Background Ureteric stricture is a potential complication of impacted ureteric stones. This study investigates surgical and radiological factors that could predict ureteric stricture formation after ureteroscopic treatment of impacted ureteric stones. Materials and method Intraoperative and radiological data for patients who underwent ureteroscopic treatment of ureteric stones impaction over a 5-year period were reviewed retrospectively. Patients who had previous ureteroscopic treatment or strictures were excluded. Results Between January 2014 and May 2019, 1,340 patients presented as emergency renal colic secondary to ureteric stones. A total of 297 ureteroscopy procedures were performed for impacted calculi. The mean age was 53 years. The stricture rate was 3.3%. Analysis of radiological and surgical factors revealed that the degree of hydronephrosis, residual fragments and intraoperative ureteric injury were significant predictors for stricture formation (p = 0.018, 0.01 and 0.02, OR = 10, 47 and 1776, respectively). None of the other factors significantly predicted ureteric stricture formation. Conclusion Our study found the presence of severe hydronephrosis, residual stone fragments after surgery and intraoperative ureteric injury are significant predictive factors for ureteric stricture formation. The high-risk patients should be monitored with routine postoperative renal ultrasound.

MP63-05 THE ROLE OF URETERAL STENTING FOLLOWING UNCOMPLICATED URETEROSCOPY FOR URETERAL AND RENAL STONES: A RANDOMIZED, CONTROLLED TRIAL

You have accessJournal of UrologyStone Disease: Surgical Therapy VI (MP63)1 Apr 2020MP63-05 THE ROLE OF URETERAL STENTING FOLLOWING UNCOMPLICATED URETEROSCOPY FOR URETERAL AND RENAL STONES: A RANDOMIZED, CONTROLLED TRIAL Amy Reed* and Christopher Allam Amy Reed*Amy Reed* More articles by this author and Christopher AllamChristopher Allam More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000938.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: It is well established that uncomplicated distal ureteroscopy can be safely performed without leaving a ureteral stent. However, there is a paucity of data regarding the utility of stent placement for proximal ureteral or renal stones following ureteroscopy. We designed a prospective, randomized controlled trial to evaluate the role of ureteral stent placement following ureteroscopy and pyeloscopy in proximal ureteral and renal stones. Primary objective was short term complications and secondary objectives evaluated analgesic use and postoperative pain. METHODS: Seventy-one patients with proximal ureteral or renal stones 1.5cm or under were prospectively randomized into stented (35) or unstented (36) groups. Stones were managed with a combination of semi-rigid ureteroscopy or flexible ureteroscopy. Patients tracked postoperative analgesic use and completed validated pain questionnaires on postoperative days 1, 3, 7 and 30. Patients with stents had removal on postoperative day 7. Postoperative follow up imaging was obtained at four weeks. RESULTS: Overall complication rate between the stent and unstented group were not significantly different (p .9). In the stented group, there was an overall complication rate of 37% including 3 readmissions for pain (8.5%), 7 visits to the ED for pain (20%), 4 UTIs (11.4%) and 1 urinary retention (2.8%). In the unstented groups, overall complication rate was 23% including 3 readmissions for stent placement (8%) and 5 ED visits for pain (15%). Mean stone size was 7.8mm. Operative time was longer in the stented group (p<.03). Younger patient age was associated with postoperative complications (p <.002). Patients in the stented group had significantly more irritative urinary symptoms (p <.0001) and pain (p<.0001), more days off work (p<.01) and more narcotic use (p<.0005). Postoperative imaging was available in 53 patients (76.8%) with no obvious strictures and stone free rate (SFR) of 94%. CONCLUSIONS: Patients without stents after ureteroscopy have less pain and urinary symptoms, miss fewer days of work and have decreased narcotic use postoperatively. For the majority of patients, it may be possible to safely omit ureteral stents following uncomplicated ureteroscopy for proximal ureteral and renal stones, although further studies with larger patient cohorts are warranted. Source of Funding: The views expressed are those of the [author(s)] [presenter(s)] and do not reflect the official views or policy of the Department of Defense or its Components. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e955-e956 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Amy Reed* More articles by this author Christopher Allam More articles by this author Expand All Advertisement PDF downloadLoading ...

Adjunction of tamsulosin or mirabegron before semi-rigid ureterolithotripsy improves outcomes: prospective, randomized single-blind study.

To evaluate efficiency and safety of adjunct tamsulosin and mirabegron therapy before semi-rigid ureteroscopy for ureteral stones. In this prospective, randomized, single-blind and multicentric study, participants were randomized into three groups. Group 1 was the control, participants in Group 2 used tamsulosin, and those in Group 3 used mirabegron. Operations were performed 7days after drug administration. In all clinics, a 6/7.5-Fr ureteroscope with a laser power source for lithotripsy was used. After excluding participants whose stones spontaneously passed, who discontinued medication due to adverse events and who were lost to follow-up, 186 participants were included in the final analysis. Mean age, gender, laterality, stone distribution and mean stone surface area were similar between groups. The number of participants requiring balloon dilatation was higher in the control group (23.8%) than in the tamsulosin (8.2%) and mirabegron (6.5%) groups (p = 0.006). Successful access rate was lower in the control group (81%) than in the tamsulosin (96.7%) and mirabegron (95.2%) groups (p = 0.003). Stone-free rate was lower in the control group (77.8%) than in the tamsulosin (90.2%) and mirabegron (95.2%) groups (p = 0.01). Complication rates were similar among groups. Tamsulosin or mirabegron use for 1week before semi-rigid ureteroscope increases stone access and the stone-free rate. Tamsulosin or mirabegron can be used with safety and efficacy before ureteroscopy for ureteral stones.

Assessment of Patient and Surgical Variables Including Residency Training Level on Adverse Events After Ureteroscopy for Ureteral Stones: A Multivariate Analysis.

With advances in technology, ureteroscopy (URS) is increasingly utilized for the management of urolithiasis. Previous studies have attempted to characterize the post-operative complication and readmission rates relative to the technical difficulty of the procedure. There is limited data exploring the resident level of training and its effect on adverse outcomes in these cases. We review our experience with URS to create a model to predict factors, including resident experience, that affect rates of post-operative complications. We reviewed ureteroscopies performed at our academic facility from January 2009 to December 2013. Ureteral-only stones were examined for demographics, stone characteristics, operative techniques, and resident training level. Post-operative adverse events requiring urology consultation, clinic or emergency department visits, hospital admission, prolonged post-operative hospitalization, or unplanned repeat surgery within 30 days of the procedure were identified and analyzed. Four hundred seventeen cases of URS for ureteral-only stones were included for study. We identified 53 (12.7%) involving an unexpected post-operative course. Several logistic regression models were created to make a predictive model of adverse events. One model found only lack of stone clearance to be significant for increasing the likelihood of an adverse event. A second model determined that no residency year showed higher odds of adverse outcomes. URS has increased in prevalence in recent years, but overall complication rates are low. Resident level of experience does not appear to impact adverse event rate. Stone clearance during initial surgery appears to be the most important in avoiding adverse events. Further expansion of the database over time will improve our ability to predict adverse outcomes in this common procedure.

Outcomes of Ureterorenoscopic Stone Treatment in 301 Patients with a Solitary Kidney.

Objectives: To determine the stone-free rates and intra- and postoperative complication rates and grades of ureterorenoscopic stone treatment in patients with a solitary kidney. Methods: This study is a subanalysis of the Clinical Research Office of the Endourological Society (CROES) ureterorenoscopy (URS) study, which is a prospective international multicenter observational study. Over a 1-year period, consecutive patients treated with ureterorenoscopy for urinary stones were included. Patients entered in this analysis were those with a solitary functioning kidney. Descriptive data on patient characteristics, stone-free rates, complication rates, and grades were evaluated for three separate groups: patients treated with ureteroscopy for ureteral stones, for renal stones, and a combination of renal and ureteral stones. Results: A total of 301 patients were treated for stones in a solitary kidney; 219 were treated for ureteral stones. In this group, the stone-free rate was 88.6%, with an intraoperative complication rate of 7.4% and postoperative complication rate of 4.1%. Totally, 57 patients were treated for renal stones. In this group, the stone-free rate was 56.4%, with an intraoperative complication rate of 7.0% and postoperative complication rate of 10.5%. There were 25 patients who were treated for renal stones in combination with ureter stones. In this group, the stone-free rate was 60.0%, with an intraoperative complication rate of 12.0% and postoperative complication rate of 10.5%. Within the three groups, 72% of the postoperative complications were classified as Clavien I and II. Conclusions: Ureteroscopy is an effective and safe treatment modality for the removal of ureteral and renal stones in patients with a solitary kidney. Stone location as well as total stone burden seems to be important factors influencing the ability to render patients stone free. Moreover, single session ureteroscopic stone removal was less effective for the treatment of larger renal stones or renal stones in combination with ureteral stones.

MP66-15 EFFECTIVENESS OF SURGICAL MANAGEMENT FOR PEDIATRIC URETERAL STONES: SYSTEMATIC REVIEW AND META-ANALYSIS

You have accessJournal of UrologyPediatrics: Testis, Varicocele & Stones1 Apr 2017MP66-15 EFFECTIVENESS OF SURGICAL MANAGEMENT FOR PEDIATRIC URETERAL STONES: SYSTEMATIC REVIEW AND META-ANALYSIS Hsin-Hsiao S. Wang, Ruiyang Jiang, J. Todd Purves, John S. Wiener, and Jonathan C. Routh Hsin-Hsiao S. WangHsin-Hsiao S. Wang More articles by this author , Ruiyang JiangRuiyang Jiang More articles by this author , J. Todd PurvesJ. Todd Purves More articles by this author , John S. WienerJohn S. Wiener More articles by this author , and Jonathan C. RouthJonathan C. Routh More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2030AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES With the rising incidence of pediatric nephrolithiasis, the management debate between ureteroscopy (URS) and shockwave lithotripsy (SWL) has become more important. To date, success and complication rates for both have been based on single-institution reports. The aim of this study was to analyze the reported data on the effectiveness of SWL and URS for ureteral stones in children. METHODS We searched Cochrane Controlled Trials Register, clinicaltrials.gov, MEDLINE, and EMBASE for reports in any language. Inclusion criteria were age <18 yrs with ureteral stones who underwent surgical treatment (URS vs SWL) with clearly defined success and complication rate. Manuscripts were then assessed and data abstracted in duplicate, with differences resolved by the senior author. Bias was assessed using standardized instruments. Pooled success and complication rates were estimated. RESULTS We identified a total of 3,356 studies: 99 met inclusion criteria. The overall success rate was 0.80 (95% CI: 0.76-0.83) for SWL and 0.89 (95% CI: 0.86-0.91) for URS. The success rate for URS increased with more distal location: 0.83 (95% CI: 0.73-0.90) for proximal; 0.96 (95% CI: 0.87-0.99) for mid; and 0.94 (95% CI: 0.91-0.97) for distal ureteral stones. By contrast, SWL success decreased more distally: proximal 0.90 (95%CI: 0.83-0.95), mid 0.87 (95% CI: 0.79-0.92), and distal ureter 0.83 (95% CI: 0.72-0.90), respectively. The overall complication rate was not significantly different between the two modalities (SWL 0.04 (95% CI: 0.03-0.06) vs URS 0.06 (95% CI: 0.04-0.09)). Statistically significant heterogeneity was detected in all groups and subgroups of studies (p<0.001). However, little significant publication bias was detected. CONCLUSIONS Compared to SWL, URS was associated with higher overall success rate and similar risk of complications. URS was associated with higher success in treating mid-distal ureteral stones. By contrast, SWL was most successful in treating proximal ureteral stones. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e867 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Hsin-Hsiao S. Wang More articles by this author Ruiyang Jiang More articles by this author J. Todd Purves More articles by this author John S. Wiener More articles by this author Jonathan C. Routh More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Characteristics and outcomes of ureteroscopic treatment in 2650 patients with impacted ureteral stones

PurposeTo describe stone-free rates and complications of ureteroscopic treatment for impacted compared with non-impacted ureteral stones and evaluate predictive variables for impaction.MethodsThe Clinical Research Office of the Endourological Society prospectively collected 1 consecutive year of data from 114 centers worldwide. Patients eligible for inclusion were patients treated with ureteroscopy for ureteral stones. Patient characteristics, treatment details, and outcomes were compared with regard to stone impaction. Logistic regression analyses were conducted to explore predictive variables for ureteral stone impaction and to analyse the effect of impaction on outcomes.ResultsOf the 8543 treated patients, 2650 (31%) had impacted and 5893 (69%) non-impacted stones. The stone-free rate was 87.1% for impacted stones, which is lower compared with 92.7% for non-impacted stones (p < 0.001). Intra-operative complication rates were higher for impacted stones (7.9 versus 3.0%, p < 0.001). Significantly higher ureteral perforation- and avulsion rates were reported in the impacted stone group compared with the non-impacted stone group. No association between stone impaction and post-operative complications could be shown. Female gender, ASA-score >1, prior stone treatment, positive pre-operative urine culture, and larger stones showed to be predictive variables for stone impaction.ConclusionsUreteroscopic treatment for impacted stones is associated with lower stone-free rates and higher intra-operative complication rates compared with treatment for non-impacted stones. The predictive variables for the presence of stone impaction may contribute to the identification of stone impaction during the diagnostic process. Moreover, identification of stone impaction may aid the selection of the optimal treatment modality.

Ureteral Stenting Following Uncomplicated Ureteroscopy for Ureteric Stones: A Randomized Controlled Trial

Objective: The objective is to assess the benefits and adverse effects of routine ureteral stenting after uncomplicated ureteroscopic lithotripsy. Material and Methods: Sixty patients with ureteric calculi amenable to ureteroscopic lithotripsy were randomized to an unstented (30 patients) or a stented (30 patients) treatment group, standard ureteroscopic lithotripsy done using 8 French semirigid ureteroscope, and pneumatic lithotripter used to fragment the stones. They were followed up for postoperative flank pain, lower urinary tract symptoms (LUTS) and hematuria. Results: There was no significant difference in the mean age (stenting 37.8 year and 33.5 year unstenting) of patients, gender and stone size in both groups. No significant difference in the mean flank pain within 3 days postoperative, while at day 14 postoperative flank pain for stenting group was significant (P = 0.03). Dysuria and urgency were high for stenting group (P = 0.002 and 0.011). Hematuria within 3 and 14 days was higher in the stenting group. Conclusion: After uncomplicated ureteroscopy, stents can be safely omitted. Unstented patients have significantly fewer LUTS, haematuria and flank pain.

PD28-03 COST-SAVINGS PROTOCOL IN THE ENDOUROLOGY SUITE DECREASES HEALTH CARE EXPENDITURES WITHOUT COMPROMISING QUALITY OF CARE

You have accessJournal of UrologyStone Disease: Evaluation I1 Apr 2014PD28-03 COST-SAVINGS PROTOCOL IN THE ENDOUROLOGY SUITE DECREASES HEALTH CARE EXPENDITURES WITHOUT COMPROMISING QUALITY OF CARE Dilan Gupta, August Matteis, Fotima Askarova, Chad Ritch, and Mantu Gupta Dilan GuptaDilan Gupta More articles by this author , August MatteisAugust Matteis More articles by this author , Fotima AskarovaFotima Askarova More articles by this author , Chad RitchChad Ritch More articles by this author , and Mantu GuptaMantu Gupta More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2114AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Cost-containment strategies are imperative to the financial well being of physician practices and hospital systems. Disposable equipment represents a significant portion of the cost of endourological procedures. We investigated if a cost-saving protocol could lead to decreased expense without compromising quality of care. METHODS We retrospectively analyzed actual disposable equipment costs of 4 categories of Endourology procedures performed by 3 surgeons: percutaneous nephrolithotomy (PCNL, N=30), ureteroscopy for renal stones (URSR, N=30), ureteroscopy for ureteral stones (URSU, N=30), and ureteroscopy with biopsy (URSB, N=20). We also reviewed operative times (ORT), estimated blood loss, (EBL) length of stay (LOS), need for stents, complications, need for ancillary procedures, and stone-free rates (SFR). We created cost sheets detailing actual costs of each piece of available disposable equipment available by category (guidewires, access devices, dilators, stents, etc.). Finally, we implemented a prospective cost-savings protocol wherein each surgeon would be apprised of the cost of each piece of equipment requested along with the costs of alternatives. Costs were analyzed as well as outcomes after implementation of the protocol. RESULTS The average cost per patient before and after the protocol were as follows: PCNL $1222 vs. $719 (p<.001), URSR $926 vs. $516 (p<.001), URSU $814 vs. $463 (p<.001), and URSB $880 vs. $417 (p<.001). There was no statistical difference in ORT, EBL, LOS, SFR, complications, or need for stents or ancillary procedures. Savings realized by category showed the biggest cost savings to be in type of laser fiber and dilation devices used, but savings were realized in every category. Extrapolated over one year, the total cost savings for our Endourology suite alone would be in excess of $300,000. CONCLUSIONS Implementation of a cost-savings protocol leads to substantial decrease in health care expenditures in the Endourology suite without compromising quality of care. Similar initiatives throughout the country have the potential to significantly impact health care costs. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e770 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Dilan Gupta More articles by this author August Matteis More articles by this author Fotima Askarova More articles by this author Chad Ritch More articles by this author Mantu Gupta More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Ureteroscopic stone management in prepubertal children

Ureteroscopy for treating ureteric stones in prepubertal children has become more common with the advent of smaller endoscopes. We retrospectively reviewed our experience with ureteroscopy for ureteric stone in this cohort of patients. During the period Jan 2001 and June 2005, we performed 22 ureteroscopic procedures in 20 children. Ureteroscopy was done in a manner similar to that in adults. Ureteral dilatation was done in all cases. A stent was placed postoperatively if there was significant stone burden, ureteral trauma, impaction and edema of ureteric orifice. Of the 20 children, 18 were male and 2 were females. Average age was 5.2 years (range 3-9). Stones were 4-14 mm in size (average 6 mm). Overall 90% of the children were rendered stone free after one procedure and 100% after two procedures. Ureteroscopy for ureteric stones in prepubertal children is safe and effective first line treatment in whom conservative therapy fails. Routine ureteral stent placement postoperatively is not always necessary.

Lithotripsy with miniscope: Clinical results of 193 consecutive patients

A retrospective analysis was carried out on 193 patients who underwent ureteroscopy for ureteral stones with a miniscope associated with either an electrohydraulic or a pneumatic lithotriptor. Complete stone fragmentation with spontaneous expulsion of the fragments occurred with just one session in 89.1% of cases. Nine patients underwent ureterolithotomy. The only complications were 3 ureteral lesions without perforation. The authors consider that with these mini instruments, there is a very low rate of morbidity connected with this procedure, which can therefore be given first option in the treatment of lower ureteral stones.