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Inoue T, Hamamoto S, Okada S, Imai S, Yamamichi F, Fujita M, Tominaga K, Fujisawa M. Pelvicalyceal anatomy on the accessibility of reusable flexible ureteroscopy to lower pole calyx during retrograde intrarenal surgery. Int J Urol 2023; 30:220-225. [PMID: 36305835 DOI: 10.1111/iju.15091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 10/19/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study aimed to evaluate the pelvicalyceal anatomy on accessibility of reusable flexible ureteroscopy (fURS) to the lower pole calyx during retrograde intrarenal surgery (RIRS). METHODS Here, 854 patients with ureteral or kidney stones with access to a renal collecting system using reusable fURS were classified into either the accessible group, in whom the deepest lower pole calyces could be touched; and the inaccessible group, in whom the deepest lower calyces could not be touched. We measured the infundibulopelvic angle (IPA), infundibular width (IW), infundibular length (IL), and calyceal pelvic height (CPH) using retrograde pyelograms and performed intergroup comparisons. RESULTS The median IPA, IW, IL, and CPH in the accessible and inaccessible group were 60.5° and 45.6° (p < 0.001), 10.8 and 9.4 mm (p < 0.001), 33.2 and 36.4 mm (p < 0.001), and 25.9 and 30.9 mm (p < 0.001), respectively. IPA (OR 0.963, 95% CI 0.952-0.974, p < 0.001) and IW (OR 0.519, 95% CI 0.331-0.816, p = 0.004) were significant risk factors of renal pelvicalyceal anatomy related to the accessibility of the lower pole calyces. The cut-off value for IPA and IW was 45.8°(p < 0.001) and 7.8 mm (p < 0.001), respectively. CONCLUSIONS IPA < 45.8° and IW <7.8 mm were negative predictors to access the lower pole calyces when using reusable fURS during RIRS.
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Affiliation(s)
- Takaaki Inoue
- Department of Urology and Stone Center, Hara Genitourinary Hospital, Kobe, Japan.,Division of Urology, Department of Surgery Related, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shuzo Hamamoto
- Department of Urology, Medical School, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Shinsuke Okada
- Department of Urology, Gyotoku General Hospital, Ichikawa, Japan
| | - Satoshi Imai
- Department of Urology, Konan Medical Center, Kobe, Japan
| | - Fukashi Yamamichi
- Department of Urology and Stone Center, Hara Genitourinary Hospital, Kobe, Japan
| | - Masaichiro Fujita
- Department of Urology and Stone Center, Hara Genitourinary Hospital, Kobe, Japan
| | - Koki Tominaga
- Department of Urology and Stone Center, Hara Genitourinary Hospital, Kobe, Japan
| | - Masato Fujisawa
- Division of Urology, Department of Surgery Related, Kobe University Graduate School of Medicine, Kobe, Japan
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Esperto F, Juliebø-Jones P, Keller EX, Tailly T, Mykoniatis I, DE Coninck V, Pietropaolo A, Talso M, Sener ET, Tonyali S, Zeeshan Hameed BM, Faiella E, Damiano R, Papalia R, Scarpa RM. Future perspectives to improve outcomes associated with percutaneous nephrolithotomy for anterior calyceal stones: does ECIRS hold the answers? Minerva Urol Nephrol 2022; 73:866-867. [PMID: 35144374 DOI: 10.23736/s2724-6051.21.04815-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Francesco Esperto
- Department of Urology, Campus Bio-Medico University, Rome, Italy - .,Unit of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy -
| | - Patrick Juliebø-Jones
- Department of Urology, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Etienne X Keller
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Thomas Tailly
- Department of Urology, University Hospitals Ghent, Ghent, Belgium
| | - Ioannis Mykoniatis
- School of Medicine, Department of Urology, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | | | - Michele Talso
- Department of Urology, ASST Fatebenefratelli-Sacco, Luigi Sacco University Hospital, Milan, Italy
| | - Emre T Sener
- School of Medicine, Department of Urology, Marmara University, Istanbul, Turkey
| | - Senol Tonyali
- Istanbul School of Medicine, Department of Urology, Istanbul University, Istanbul, Turkey
| | | | - Eliodoro Faiella
- Unit of Diagnostic Imaging, Campus Bio-Medico University, Rome, Italy
| | - Rocco Damiano
- Unit of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Rocco Papalia
- Department of Urology, Campus Bio-Medico University, Rome, Italy
| | - Roberto M Scarpa
- Department of Urology, Campus Bio-Medico University, Rome, Italy
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Sahan A, Dincer E, Ozkaptan O, Cubuk A, Ertas K, Eryildirim B, Akca O. The impact of anterior calyceal stones on the outcomes of percutaneous nephrolithotomy for complex kidney stones: a comparative study. Minerva Urol Nephrol 2020; 73:815-822. [PMID: 33200898 DOI: 10.23736/s2724-6051.20.04002-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND This study aimed to evaluate the possible effect of anterior calyceal stones on the surgical outcomes of percutaneous nephrolithotomy. METHODS Consecutive patients with complex kidney stones from 2012 to 2020 were evaluated retrospectively. In total, 219 patients were divided into 2 groups based on the presence of anterior calyceal stones (group 1; N.=89) or not (group 2; N.=130). The groups were compared in terms of surgical outcomes (i.e., stone-free rate [SFR], operation time, and hemoglobin drop) and complications. RESULTS The patient demographics and stone characteristics were similar between the groups. Multiple access was more frequently done in group 1 than it was in group 2 (47.2% vs. 30.8%; P=0.014), and the SFR was lower in group 1 (51.7%) than it was in group 2 (67.7%; P=0.017). Of the anterior calyceal stones in group 1, 42.6% could not be cleaned. However, when excluding patients who have only anterior residual stones from the statistical analysis, the groups had similar SFRs (68.5% vs. 67.7% for group 1 and group 2, respectively). CONCLUSIONS The presence of complex kidney stones with anterior calyceal extension are associated with higher residual stones rates in the anterior calyx. Also, it increases multiple access, the operation time, and level of hemoglobin drop.
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Affiliation(s)
- Ahmet Sahan
- Department of Urology, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey -
| | - Erdinc Dincer
- Department of Urology, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - Orkunt Ozkaptan
- Department of Urology, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - Alkan Cubuk
- Department of Urology, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - Kasim Ertas
- School of Medicine, Department of Urology, Yuzuncu Yil University, Van, Turkey
| | - Bilal Eryildirim
- Department of Urology, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - Oktay Akca
- Department of Urology, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
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Kalkanli A, Cilesiz NC, Fikri O, Ozkan A, Gezmis CT, Aydin M, Tandoğdu Z. Response to the Letter to the Editor: "Impact of Anterior Kidney Calyx Involvement of Complex Stones on Outcomes for Patients Undergoing Percutaneous Nephrolithotomy". Urol Int 2020; 105:165-166. [PMID: 32871576 DOI: 10.1159/000510138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 07/11/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Arif Kalkanli
- Department of Urology, Taksim Education and Research Hospital, Istanbul, Turkey,
| | - Nusret Can Cilesiz
- Department of Urology, Taksim Education and Research Hospital, Istanbul, Turkey
| | - Onur Fikri
- Department of Urology, Taksim Education and Research Hospital, Istanbul, Turkey
| | - Arif Ozkan
- Department of Urology, Taksim Education and Research Hospital, Istanbul, Turkey
| | | | - Memduh Aydin
- Department of Urology, Taksim Education and Research Hospital, Istanbul, Turkey
| | - Zafer Tandoğdu
- Department of Urology, Newcastle University, Northern Institute For Cancer Research, Newcastle Upon Tyne, United Kingdom
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Kalkanli A, Cilesiz NC, Fikri O, Ozkan A, Gezmis CT, Aydin M, Tandoğdu Z. Impact of Anterior Kidney Calyx Involvement of Complex Stones on Outcomes for Patients Undergoing Percutaneous Nephrolithotomy. Urol Int 2020; 104:459-464. [PMID: 32155628 DOI: 10.1159/000505822] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 01/07/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION A number of factors that can impact the outcomes of percutaneous nephrolithotomy (PCNL) procedures have previously been investigated. Complex stones that extend to the anterior calyx could affect the success and complication rates of PCNL. OBJECTIVE We analyzed the effect of anterior calyx involvement on the outcomes of patients with complex stones treated with PCNL. METHODS A total of 132 consecutive patients who underwent PCNL due to complex stones (multiple, partial staghorn, or staghorn stones) between 2015 and 2017 were enrolled in this study. They were stratified into two groups based on whether the stone extended to the anterior calyx (group 1, n = 45) or not (group 2, n = 87). The stratification was achieved through contrast-enhanced computerized tomography (CT). Demographics, laboratory tests, and peri- and postoperative findings (operation and fluoroscopy duration, hospital stay, utilization of flexible instruments, access numbers, total blood count change, stone-free rate [SFR], and complications) were compared between the groups. The SFR was evaluated by plain kidney-ureter-bladder radiography or CT. RESULTS The demographics, operation and fluoroscopy duration, access number, and hospital stay were similar between the groups (p < 0.05). A higher drop in the hemoglobin level in group 1 was identified (group 1 [2.14 ± 1.49 g/dL] vs. group 2 [1.43 ± 1.31 g/dL]) (p = 0.006). The SFR among the patients with extension to the anterior calyx was 60%, compared to 77% among the patients with no extension to the anterior calyx (p = 0.041). Flexible instruments were utilized in 60% of the patients of group 1, which was a higher rate than for group 2 (36%) (p = 0.007). Complication rates were similar in the two groups according to the Clavien-Dindo classification (p > 0.05). CONCLUSIONS Our study demonstrated that complicated stones with extension to the anterior calyx are more challenging than cases without extension to the anterior calyx. This was noted by a lower SFR, a more prominent drop in total blood count, and more frequent utilization of flexible scopes.
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Affiliation(s)
- Arif Kalkanli
- Department of Urology, Taksim Education and Research Hospital, Istanbul, Turkey,
| | - Nusret Can Cilesiz
- Department of Urology, Taksim Education and Research Hospital, Istanbul, Turkey
| | - Onur Fikri
- Department of Urology, Taksim Education and Research Hospital, Istanbul, Turkey
| | - Arif Ozkan
- Department of Urology, Taksim Education and Research Hospital, Istanbul, Turkey
| | | | - Memduh Aydin
- Department of Urology, Taksim Education and Research Hospital, Istanbul, Turkey
| | - Zafer Tandoğdu
- Department of Urology, Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, United Kingdom
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