Ureteroscopy For Urolithiasis Research Articles

Ureteroscopy for urolithiasis in bedridden patients: it is feasible and acceptable.

To investigate the safety of transurethral ureteroscopy (URS) for urolithiasis in bedridden patients and to identify bedridden patient-specific risk factors for postoperative complications. The patients who underwent URS for urolithiasis were divided into bedridden patients and good performance status (PS) patients, and the groups were compared regarding their clinical characteristics and postoperative complications. A multivariable logistic regression analysis was performed to evaluate independent predictors of postoperative febrile urinary tract infection (fUTI). A total of 1626 patients were included, 276 in the bedridden patient group, and 1350 in the good PS patient group. The bedridden patient group had a significantly higher age and higher proportion of females and had multiple comorbidities. In 77 patients (27.9%), 88 postoperative complications developed for the bedridden patient group. Clavien-Dindo grade III or IV complications were observed in only 8 patients. No grade V complications were observed. The most common complication was fUTI. The frequency of fUTI with grade III or IV for the bedridden patient group (2.2%) was higher compared with the good PS patient group (0.5%), but the difference was not statistically significant (p = 0.13). Bedridden patient-specific risk factors for fUTI included female sex, diabetes mellitus, cerebrovascular comorbidities, lower extremity contracture, and prolonged operative time. URS for urolithiasis is a feasible and acceptable procedure in bedridden patients, despite the moderate rate of postoperative complications. The identified risk factors provide a framework for risk stratification and individualized care in this unique patient population.

Is cerebral palsy associated with successful ureteral access during the initial attempt at ureteroscopy for urolithiasis in children and young adults?

Ureteroscopy is a common treatment for urolithiasis, but initial ureteral access is not always possible, particularly in pediatrics. Clinical experience suggests that neuromuscular conditions such as cerebral palsy (CP) may facilitate access, thus avoiding the need for pre-stenting and staged procedures. We sought to determine if probability of successful ureteral access (SUA) during initial attempted ureteroscopy (IAU) is higher in pediatric patients with CP vs. without CP. We reviewed IAU cases for urolithiasis (2010-2021) at our center. Patients with pre-stenting, prior ureteroscopy, or urologic surgical history were excluded. CP was defined using ICD-10 codes. SUA was defined as scope access to urinary tract level sufficient to reach stone. Association of CP and other factors with SUA were evaluated. 230 patients (45.7% male, median age: 16 years [IQR: 12-18y], 8.7% had CP) underwent IAU, with SUA in 183 (79.6%). SUA occurred in 90.0% of patients with CP vs. 78.6% of those without CP (p=0.38). SUA was 81.7% in patients >12 years (vs. 73.8% in those <12), and the highest SUA was in those >12 years with CP (93.3%), but these differences were not statistically significant. Renal stone location was significantly associated with lower SUA (p=0.007). Among patients with renal stone only, SUA in those with CP was 85.7% vs. 68.9% in those without CP (p=0.33). SUA did not differ significantly by gender or BMI. CP may facilitate ureteral access during IAU in pediatric patients, but we were unable to show a statistically significant difference. Further study of larger cohorts may demonstrate whether CP or other patient factors are associated with successful initial access. Improved understanding of such factors would help preoperative counseling and surgical planning for children with urolithiasis.

Effect of asymptomatic bacteriuria on readmissions and rate of urosepsis after ureterorenoscopy for urolithiasis

Objective: This study aims to assess whether the rate of readmissions after ureterorenoscopy (URS) is dependent on results of urine microscopy, culture and sensitivity (MC&amp;S) or nitrite dipstick test performed before the procedure. Patients and Methods: All patients attending for ureteroscopy for stone disease over 12 months were included and had urine dipstick performed immediately prior to the surgery with mid-stream urine (MSU) sample sent for culture. Asymptomatic bacteriuria (ABU) was not treated before ureteroscopy. All included patients received standard antibiotic prophylaxis. Readmissions within 30 days of the procedure were evaluated. Results: A total 120 ureteroscopies were included, of which 20% had ABU. Eight patients (6.67%) were readmitted due to all procedure-related complications; among them, five (4.17%) were readmitted with urinary tract infection (UTI). Readmission rates with UTIs were similar for patients with sterile urine and those who had untreated ABU. Of those patients who were readmitted with UTI, all had a negative nitrite result on preoperative urine dipstick specimens. Most patients (54.17%) who had ABU also had a negative urinary nitrite test. Conclusions: Screening and routine treatment of ABU before ureteroscopy for urolithiasis may be unnecessary provided patients have standard antibiotic prophylaxis. Moreover, urine nitrite testing before ureteroscopy may not be a useful screening test for ABU before ureteroscopy. Level of evidence: 2

Efficacy of one-surgeon basketing technique for stone extraction during flexible ureteroscopy for urolithiasis

ABSTRACT Objective: To evaluate the safety and efficacy of using one-surgeon basketing technique by a solo surgeon for stone extraction during flexible ureteroscopy (f-URS) for urolithiasis. Patients and methods: This retrospective study enrolled patients with urinary calculus who underwent f-URS at two institutions in Japan between September 2014 and March 2020. A total of 100 patients were operated by one experienced surgeon using the one-surgeon basketing technique. With this approach, the f-URS apparatus was manipulated with the non-dominant hand and the basket catheter was manipulated with the dominant hand. We retrospectively examined the perioperative results, complications, and stone-free rate [with ‘stone free’ defined as ≤2 mm with kidney–ureter–bladder (KUB) at 1 month after f-URS] to estimate the safety and efficacy for comparison with the results of conventional retrieval basketing technique. Results: Among our study population, the median stone size was 14 mm and median operative time was 74 min. A stone-free status was achieved in 91 patients (91%). The median stone fragmentation time was 15 min and stone retrieval time was 30 min. All included patients were treated using the one-surgeon basketing technique. Complications related to stone retrieval were identified in two patients (2%); the degree of ureteral injury was classified as Clavien–Dindo Grade IIIa. Conclusion: The one-surgeon basketing technique is safe and effective for the extraction of stone fragments during f-URS for urolithiasis. This technique does not require assistance for basketing; therefore, f-URS with active retrieval basketing can be completed by a solo surgeon. Abbreviations: BMI: body mass index; KUB: kidney–ureter–bladder; SFR: stone-free rate; UAS: ureteral access sheath; f-URS: flexible ureteroscopy

Double J stenting evaluation after ureteroscopy for urolithiasis

During ureteroscopy for urolithiasis, postoperative ureteral drainage with double J stent is frequently used. It may reduce acute postoperative pain and late ureteral stenosis. Double J stent can have negative impact on life quality. After uncomplicated intervention, double J stent is not mandatory. Objective of our study was to evaluate pain and complications after ureteroscopy with or without stent. We retrospectively analyzed ureteroscopy performed between May 2014 and January 2017. Interventions were compared regarding ureteral drainage with double J stent or not. Our primary outcome was early postoperative pain evaluated with an oral pain scale form 1 to 10 on day one after intervention. Clinical characteristics, per- and postoperative data were collected. We also looked for risks factors of complications. Three hundred and sixty-six interventions were included, 259 (70.8%) with and 107 (29.2%) without double J stent. Stone burden was higher in stented group (18.3 vs 9.4mm, P<0.0001). Patients without postoperative stents had more ureteral preparation with double J stent (78.5% vs 62.5%, P=0.0032) and had more ambulatory interventions (75.7% vs 52.5%, P<0.0001). Postoperative pain was not different (22% vs 17.75%, P=0.398). Complication rate was similar (29% vs 20.5%, P=0.1181), so was rehospitalization rate (0.8% vs 0.9%, P=1). In multivariate analysis, complications factors were unprepared ureter, experienced surgeons and access sheath. Not stenting after ureteroscopy do not increase pain or complications. Stenting should not be used after uncomplicated interventions for centimetric stones. 4.

Psychiatric Diagnoses and Other Factors Associated with Emergency Department Return within 30 Days of Ureteroscopy

PurposeEmergency department(ED) visits after ureteroscopy(URS) are costly and inconvenient. To better understand those at risk, we aim to identify patient demographic, medical and surgical factors associated with 30-day ED presentation following URS for urolithiasis with particular attention paid to those with a history of a psychiatric diagnosis(PD). Materials and MethodsWe retrospectively reviewed 1576 cases on 1395 adults who underwent stone-related URS over 3 years at two hospitals. We collected patient demographics, medical history, and operative details. The primary outcome was return to ED within 30 days of ureteroscopy. Logistic regression was performed to examine factors associated with ED presentation. Results613(43.9%) patients had a history of PD. 12.6% of URS encounters returned to the ED within 30 days of their ureteroscopy procedure. Of those, 58.8% had a history of PD. On multivariable analysis, variables associated with ED return included: history of PD(OR 1.57,p=0.012), uninsured status(OR 2.46,p=0.001), and stone only in the kidney(OR 1.76,p=0.022). Patients who returned to the ED had more ED visits in the year prior to surgery(OR 1.40,p<0.001). On univariable analysis, older patients and those with longer OR times were more frequently admitted from the ED(OR 1.03,p=0.002; OR 1.96,p=0.03 respectively) while uninsured patients were admitted less frequently(OR 0.19,p=0.013). No difference in admissions between those with a PD and all others(60.7% vs 55.8%;p=0.48). ConclusionsWe identified factors associated with ED return after ureteroscopy, including history of PD, uninsured status, and ED visits in the year before surgery. These patients may benefit from targeted interventions to help avoid unnecessary ED visits.

Establishment and Evaluation of Patient-Specific Virtual Ureteroscopy in Assisting Flexible Ureteroscopy for Urolithiasis.

To establish virtual ureteroscopy (VU) through computed tomography urography (CTU) data from patients with upper urinary tract (UUT) stones indicated for flexible ureteroscopy (fURS) and to validate its effectiveness. Patient-specific VU generation was accomplished through incorporating CTU data into specialized software (Crusher) developed on the open access Visualization Tools Kit (VTK). These were then presented to fURS experts and novice urologists for evaluation and comparison using modified Likert-type questionnaire of 10-point rating scales (1 = not at all useful/not at all realistic/poor, 10 = very useful/very realistic/ excellent). Face and content validation of VU from 5 fURS experts in 3 different centers: overall usefulness 7.4 ± 0.5, graphics 7.4 ± 0.5, intrarenal anatomy 8.4 ± 0.5, stone details 7.8 ± 0.4, usefulness in surgical planning and training 7.6 ± 0.9. Significant increase of detection in the number of calyces and stones was found from using CTU only to CTU-VU combined in the novice group ( P = .000). Before VU observation, novices found much fewer calyces and stones than experts ( P = .004 and .000, respectively). However, this gap disappeared after VU observation ( P = .327 and .292, respectively). VU feedback from the novices was superb. Establishing patient-specific VU through CTU data from renal stone patients is feasible. The present VU can significantly improve novice urologists' comprehension of intrarenal anatomy and stone information before fURS procedures. Face and content validity is also proved. This novel modality may serve as an important tool for fURS surgical planning, navigation, and training.

Examining Pediatric Cases From the Clinical Research Office of the Endourological Society Ureteroscopy Global Study

To evaluate the characteristics and outcomes of ureteroscopy (URS) in children treated in several hospitals participating in the Clinical Research Office of the Endourological Society (CROES) Study, and to present the overall results of pediatric URS compared with adults. The CROES Study collected data on consecutive patients treated with URS for urolithiasis at each participating center over a 1-year period. The collected prospective global database includes data for 11,885 patients who received URS at 114 centers in 32 countries. Of these URS-treated patients, 192 were ≤18 years old. Of the 114 centers participating in the study, 42% had conducted pediatric URS. Among the pediatric cases, 7 were infants, 53 were small children, 59 were school-aged children, and 73 were adolescents. A considerable number (37%) of the pediatric cases had previously undergone URS treatment. No differences in the surgical outcomes of the adults and children were reported. The URS-treated children had a greater number of positive preoperative urine cultures when compared with adult cases treated. A semirigid scope was used in the vast majority of pediatric cases (85%). According to the present data, within the group of URS-treated children, the younger the child, the more readmissions occurred. URS is as efficient and safe in children as it is in adults. The data suggest that readmissions among URS-treated children are associated with age, with the likelihood of readmissions greater among younger age groups.

Do ureteric stent extraction strings affect stent-related quality of life or complications after ureteroscopy for urolithiasis: a prospective randomised control trial.

To determine whether ureteric stent extraction strings affect stent-related quality of life (QoL) or increase complications after ureteroscopy (URS) for stone disease. In all, 68 patients undergoing URS (October 2011 to May 2013) for stone disease were randomised to receive a ureteric stent with or without an extraction string. Patients completed the Ureteric Stent Symptom Questionnaire (USSQ) on postoperative days 1 and 6, and 6 weeks after stent removal. Pain was assessed at stent removal. Adverse events, including early stent removal, stent migration, retained stent, urinary tract infection (UTI), emergency room (ER) visits and postoperative phone calls were monitored. There was no difference in stent-related QoL as measured by the USSQ between those with and without a stent extraction string, pain at stent removal between those who pulled their stent independently vs those who underwent cystoscopy for stent removal, or in the rate of UTIs, ER visits or phone calls between groups. Five patients (four female, one male) removed their stent early by inadvertently pulling the string; none required replacement. Patients without a string had a significantly longer period with the postoperative ureteric stent (10.6 vs 6.3 days, P < 0.001). One patient without a stent string retained her ureteric stent for 6 months, which was removed by cystoscopy without incident. Ureteric stent extraction strings may offer several advantages without increasing stent-related urinary symptoms, complications, or postoperative morbidity.

E156 Complications for ureteroscopy for urolithiasis in pregnancy: A systematic review

E156 Complications for ureteroscopy for urolithiasis in pregnancy: A systematic review

Single-center clinical comparison of two reinforced ureteral access sheaths for retrograde ureteroscopic treatment of urinary lithiasis

Ureteral access sheaths (UAS) are used to facilitate ureteroscopic procedures. Difficulties in use, including sheath distortion, buckling, and difficulty in placement, have been reported. However, few clinical comparisons have been performed. We present the first large-scale comparison of the Applied ForteXE(®) and ACMI-Gyrus Uropass(®) UAS. We retrospectively compared patients who underwent ureteroscopy for urolithiasis with one of two types of UAS: Applied Forte XE(®) or ACMI-Gyrus Uropass(®). Demographics, operative parameters, and outcomes were assessed. Statistical analysis was performed. In 125 (64.4%) male and 69 (35.6%) female patients, 194 UAS were used. One hundred and thirteen (58.2%) Applied Forte XE(®) and 81 (41.8%) ACMI-Gyrus Uropass(®) were utilized. Success rates for sheath deployment were as follows: overall = 186/194 (95.8%); Applied Forte XE(®) = 107/113 (94.7%); and ACMI-Gyrus Uropass(®) = 79/81 (97.5%) (P = 0.472). Of the 194 patients 131 (67.5%) had a pre-existing stent. Sheath deployment failures occurred in 7 men and 1 woman, of which 4/8 (50%) had no pre-existing stent. Limitations of deployed sheaths occurred at low frequency in both Applied Forte XE 17/107 (15.9%) and ACMI-Gyrus 6/79 (7.6%), with no significant difference observed (P = 0.120). Limitations in use was high in men (P = 0.019). At a mean follow-up of 41 months, no ureteral strictures were noted. No significant differences were seen in overall success rates for both sheaths. Both sheaths had high deployment success rates and a similar low frequency of sheath-related limitations. We noted increased limitations in the use of deployed sheaths in men. Successful sheath use may depend on both the sheath itself and patient/operative parameters.

Computed Tomography-Determined Stone-Free Rates for Ureteroscopy of Upper-Tract Stones

Most series on ureteroscopy for urolithiasis use postoperative plain radiography of the kidneys, ureters, and bladder (KUB) or intravenous urography (IVU) to determine outcomes. These imaging modalities, however, are not very sensitive and may overestimate stone-free rates (SFRs). The aim of our study was to assess SFRs after ureteroscopy for urolithiasis using CT follow-up. A total of 92 patients underwent 113 ureteroscopic procedures for either renal or ureteral stones. Success of ureteroscopy was then determined by the absence of any stone fragments (stone-free). Stone-clearance rates (SCRs) were also calculated for < or = 2 mm and < or = 4 mm residual stone fragments. Each renal unit contained a mean of 1.87 stones with a mean stone diameter of 8 +/- 6 mm. The overall SFR was 50.4%. SFRs were significantly higher for ureteral stones (80%) than renal stones (34.8%) (P = 0.0001). Renal units with multiple stones were less likely to be stone free than those with single stones (P = 0.011). No difference in SFRs was found between lower pole and non-lower-pole stones. Overall SFRs by CT were lower than SFRs reported by radiography of the KUB or IVU criteria. Further studies to identify the clinical significance and natural history of residual stone fragments on CT scan after ureteroscopy are needed.

Ureteroscopy For The Treatment Of Urolithiasis In Children

Ureteroscopy for treating urolithiasis in prepubertal children has become more common with the advent of smaller instruments. We reviewed our experience with ureteroscopy for urolithiasis in this cohort of patients as well as the literature using this treatment modality in children. Between 1994 and 2000 we performed 27 ureteroscopic stone extractions in 25 children. Ureteroscopy was done in a manner similar to that in adults. Ureteral dilation was performed when necessary to access the ureter. A stent was placed postoperatively if there was significant ureteral trauma. Of the 25 children 13 were male and 12 were female. Average age was 9.2 years (range 3 to 14). Stones were 2 to 12 mm. in greatest diameter (average 6). Of the 27 procedures the ureteral orifice was dilated before stone treatment in 15 (56%), while in 19 (70%) a stent was placed afterward. No intraoperative and 2 postoperative complications were identified. Overall 92% of the children were rendered stone-free after 1 procedure and 100% were stone-free after 2. Ureteroscopy for urolithiasis in prepubertal children is safe and effective. Routine ureteral dilation and ureteral stent placement are not always necessary in these patients.