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Meria P, Raynal G, Denis E, Plassais C, Cornet P, Gil-Jardiné C, Almeras C. 2022 Recommendations of the AFU Lithiasis Committee: Management of symptomatic urinary stones. Prog Urol 2023; 33:791-811. [PMID: 37918980 DOI: 10.1016/j.purol.2023.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/27/2023] [Accepted: 08/01/2023] [Indexed: 11/04/2023]
Abstract
The acute situation, caused by an obstructive stone, is defined by a renal colic that may be uncomplicated, complicated, or at risk in specific conditions. Its management may be medical or require interventional treatment by extracorporeal shockwave lithotripsy, endoscopic removal, or ureteroscopy. METHODOLOGY: These recommendations were developed using two methods, the Clinical Practice Recommendations (CPR) and the ADAPTE method, in function of whether the question was considered in the European Association of Urology (EAU) recommendations (https://uroweb.org/guidelines/urolithiasis) [EAU Guidelines on urolithiasis. 2022] and whether they could be adapted to the French context.
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Affiliation(s)
- P Meria
- UroSud, clinique La Croix du Sud, Quint-Fonsegrives, France
| | - G Raynal
- Clinique Métivet, department of urology, Saint-Maur-des-Fossés, France
| | - E Denis
- Centre hospitalier Saint-Joseph Saint-Luc, Lyon, France
| | - C Plassais
- Department of Urology, Hôpitaux Universitaires Pitié-Salpêtrière, Paris, France
| | - P Cornet
- Department of General Medicine, Sorbonne University, SFMG, Paris, France
| | - C Gil-Jardiné
- Pôle Urgences adultes - SAMU, Hôpital Pellegrin, CHU de Bordeaux, SFR-SIGU, Bordeaux, France; Inserm U1219, Bordeaux Population Health Research Centre, IETO Team, Bordeaux University, ISPED, Bordeaux, France
| | - C Almeras
- UroSud, clinique La Croix du Sud, Quint-Fonsegrives, France.
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Hebert KJ, Matta R, Fendereski K, Horns JJ, Paudel N, Das R, Viers BR, Hotaling J, McCormick BJ, Myers JB. Genitourinary Radiation Injury Following Prostate Cancer Treatment: Assessment of Cost and Health Care System Burden. Urology 2023; 179:166-173. [PMID: 37263424 DOI: 10.1016/j.urology.2023.03.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/23/2023] [Accepted: 03/27/2023] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To evaluate the healthcare resource impact of radiation injury following prostate cancer treatment. METHODS Using IBM MarketScan, we performed a retrospective study of men with prostate cancer who were treated with radiotherapy and subsequently developed low-grade (LGRI) and high-grade radiation injury (HGRI). Radiation injury diagnoses included bladder neck stenosis, hematuria/cystitis, fistula, ureteral stricture, and incontinence. LGRI and HGRI included injury diagnosis without intervention and with intervention, respectively. Health care visits and costs were measured over 5 time periods including 2 years before radiation, 1 year before radiation, radiation to injury diagnosis, injury diagnosis to first intervention (LGRI), and following first intervention (HGRI). Negative binomial regression modeling was used to assess the effect of radiation injury on average cost adjusting for demographics and comorbidities. RESULTS Between 2008 and 2017, we identified 121,027 men who received radiotherapy following prostate cancer diagnosis of which 10,057 (8.3%) experienced a HGRI. The frequency of urologic visits and average costs were similar in those without injury and LGRI. However, men with HGRI experienced higher visit frequency and monthly costs. Amongst high-grade injuries, urinary fistula had the highest frequency of visit utilization at 378 visits before first intervention and 245 visits after first intervention. Following radiation injury diagnosis, the average monthly cost was twice as high in those with HGRI ($85.78) compared to LGRI ($38.66). CONCLUSIONS HGRI was associated with increased urologic health care use and average monthly cost when compared to those who experienced LGRI or no injury. Urinary fistula was associated with the largest resource burden.
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Affiliation(s)
- Kevin J Hebert
- Division of Urology, University of Utah, Salt Lake City, UT.
| | - Rano Matta
- Division of Urology, University of Utah, Salt Lake City, UT
| | | | - Joshua J Horns
- Surgical Population Analysis Research Core, University of Utah, Salt Lake City, UT
| | - Niraj Paudel
- Surgical Population Analysis Research Core, University of Utah, Salt Lake City, UT
| | - Rupam Das
- Surgical Population Analysis Research Core, University of Utah, Salt Lake City, UT
| | - Boyd R Viers
- Department of Urology, Mayo Clinic, Rochester, MN
| | - James Hotaling
- Division of Urology, University of Utah, Salt Lake City, UT
| | | | - Jeremy B Myers
- Division of Urology, University of Utah, Salt Lake City, UT
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Lin Y, Xu Z, Ding X, Chen L, Dai K. Development and validation of a clinical diagnostic model for pregnant women with renal colic in the emergency department in China: a protocol for a retrospective cohort study. BMJ Open 2022; 12:e056510. [PMID: 35501078 PMCID: PMC9062803 DOI: 10.1136/bmjopen-2021-056510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Urolithiasis affects many people throughout their lives. Among the maternal population, although the morbidity of acute urolithiasis in pregnant women is unremarkable, it is the leading cause of hospitalisation during pregnancy. There is no effective clinical diagnostic tool to help doctors diagnose diseases. Our primary aim was to develop and validate a clinical prediction model based on statistical methods to predict the probability of having disease in pregnant women who visited the emergency department because of urolithiasis-induced colic. METHODS AND ANALYSIS We will use multivariate logistic regression analysis to build a multivariate regression linear model. A receiver operating characteristic curve plot and calibration plot will be used to measure the discrimination value and calibration value of the model, respectively. We will also use least absolute shrinkage and selection operator regression analysis combined with logistic regression analysis to select predictors and construct the multivariate regression model. The model will be simplified to an application that has been reported before, and users will only need to enter their clinical parameters so that risk probability is automatically derived. ETHICS AND DISSEMINATION The review and approval documents of the clinical research ethics committee have been received from the ethics committee of our hospital (The Third Affiliated Hospital of Wenzhou Medical University). We will disseminate research findings through presentations at scientific conferences and publication in peer-reviewed journals.
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Affiliation(s)
- YuZhan Lin
- Department of Clinical Laboratory, Ruian People's Hospital, Ruian, China
| | - ZhiKai Xu
- Department of Ultrasound Imaging, Ruian People's Hospital, Ruian, China
| | - XiangCui Ding
- Gynecology Department, Ruian People's Hospital, Ruian, China
| | - Lei Chen
- Department of Clinical Laboratory, Ruian People's Hospital, Ruian, China
| | - KangWei Dai
- Department of Clinical Laboratory, Ruian People's Hospital, Ruian, China
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Miller NL. EDITORIAL COMMENT. Urology 2021; 151:52-53. [PMID: 33972032 DOI: 10.1016/j.urology.2020.06.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 06/28/2020] [Indexed: 11/27/2022]
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Shalaby EA, Ragab AA, Tawfiek ER, Faisal M. Ultrasound Diagnosis and Active Ureteroscopy for Obstructive Ureteral Calculi during Pregnancy: Multicenter Experience. J Endourol 2021; 35:1460-1466. [PMID: 33769887 DOI: 10.1089/end.2020.1128] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Objectives: To evaluate the safety and efficacy of ultrasound (US) and primary ureteroscopy (URS) in the management of symptomatic obstructive ureteric stones during pregnancy. Patients and Methods: A prospective multicenter study was performed between June 2013 and December 2019, including all consecutive pregnant patients admitted to three urology centers with intractable renal colic with obstructed ureter secondary to obstructive ureteral calculi. Color Doppler ultrasound was used to evaluate renal Resistive Index (RI) and ureter jet. Primary URS was performed to remove the blocking stones. The safety and effectiveness of the procedures were assessed, as well as the stone-free rate (SFR) and the condition of the upper tract after delivery. Results: A total of 111 pregnant patients were included with a mean age of 27.4 ± 4.4 years and a mean renal RI of 0.78 ± 0.02. US diagnosed stones in 46.8% of patients, while 100 (90%) patients had altered lower ureter urinary jet, including 86.5% who had URS-confirmed ureteric stones; SFR was 95.8% with no serious urologic, fetal, or obstetric complications. Nine percent of patients had premature delivery, which was significantly correlated with postoperative urinary tract infection and premature uterine contraction (p ˂ 0.0001). In the third-month follow-up of US, all patients showed no residual hydronephrosis. Postoperative follow-up procedures were required in 15.3% of patients. Conclusion: Obstructive ureteral stones during pregnancy can be detected safely and appropriately with a combined elevated renal RI and absent ureteral jet detected by Doppler US. Definitive URS is an efficient and safe alternative option for those who fail in conservative management.
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Affiliation(s)
- Essam A Shalaby
- Department of Urology, Suez Canal University, Ismailia, Egypt
| | | | | | - Mahmoud Faisal
- Department of Urology, Al-Azhar University, Cairo, Egypt
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Thakur APS, Sharma V, Ramasamy V, Choudhary A, Patel P, Singh S, Parol S. Management of ureteric stone in pregnancy: a review. AFRICAN JOURNAL OF UROLOGY 2020. [DOI: 10.1186/s12301-020-00070-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Urolithiasis in pregnancy is a major health concern and is one of the most common causes for non-obstetrical abdominal pain and subsequent hospital admission during pregnancy. The incidence of urinary calculi during pregnancy varies in the range of 1/200 to 1/2000. Acute ureteric colic in pregnancy is associated with significant potential risks to both mother and fetus. Significant anatomic and functional changes occur in pregnancy which not only lead to stone formation but also create diagnostic dilemma. The diagnosis of ureteric calculi can be incorrect in about 28% of pregnant patients.
Main body
Management of ureteric stone during pregnancy is remaining to be a challenge for the treating urologist. Because of the inability to use good imaging options for the diagnosis confirmation and more invasive approach for the treatment, management continues to be difficult. The main threats are preterm labor with delivery and premature rupture of membranes. Other pregnancy complications are obstructive uropathy, gestational diabetes mellitus, recurrent abortions and pre-eclampsia. Management of diagnosed ureteric stone is unique in the pregnant population and requires multi-disciplinary care. It should be individualized for each patient and moves preferably from conservative to invasive approaches sequentially. With continued advancements in endourological techniques, few definitive treatment options are also available for such patients.
Conclusion
There are several lacunae related with the diagnostic imaging, medical expulsive therapy, reliability of ureteral stent/percutaneous nephrostomy insertions and safety of ureteroscopy during pregnancy. Herein, we review the management of ureteric stone during pregnancy, the various diagnostic modalities and treatment options with their advantages and disadvantages. We also proposed our management algorithm to deal with such clinical scenario in this particular population.
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Dai JC, Nicholson TM, Chang HC, Desai AC, Sweet RM, Harper JD, Sorensen MD. Nephrolithiasis in Pregnancy: Treating for Two. Urology 2020; 151:44-53. [PMID: 32866511 DOI: 10.1016/j.urology.2020.06.097] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 06/12/2020] [Accepted: 06/28/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To review the literature regarding the epidemiology of stone disease and develop a management algorithm based on current evidence and societal guidelines. METHODS A structured literature review was performed to determine highest quality of evidence guiding care for pregnant patients with symptomatic nephrolithiasis. PUBMED and EMBASE databases were searched using terms "pregnancy," "nephrolithiasis," or "pregnancy" and "renal colic" alone and in combination with "stone", "kidney stone," "ultrasound," "MRI," "CT," "percutaneous nephrostomy," "ureteral stent," or "ureteroscopy." All English-language abstracts were reviewed for relevance and full-length articles were reviewed for content. Articles published prior to 1990 were excluded, and priority for inclusion was given to multi-institutional studies and larger institutional studies, reflecting the highest level of current available evidence and most contemporaneous practice patterns. RESULTS Symptomatic nephrolithiasis affects less than 1% of pregnancies but poses unique diagnostic challenges due to the physiologic changes of pregnancy and risks of ionizing radiation exposure to the fetus. Ultrasound remains the imaging modality of choice. Most patients may be managed non-operatively, but drainage with percutaneous nephrostomy or ureteral stent may be performed if warranted. Growing evidence also supports the safety and efficacy of definitive stone treatment. CONCLUSIONS Though rare, symptomatic nephrolithiasis poses significant clinical challenges due to the need to minimize risk for both mother and fetus with diagnostic and therapeutic interventions. A multi-disciplinary approach is paramount, as is shared decision making with the patient at each step of care.
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Affiliation(s)
- Jessica C Dai
- Department of Urology, University of Washington, Seattle, WA.
| | | | - Helena C Chang
- Department of Urology, Kaiser Permanente Santa Clara Medical Center, Santa Clara CA
| | - Alana C Desai
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, MO
| | - Robert M Sweet
- Department of Urology, University of Washington, Seattle, WA
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Valovska MTI, Pais VM. Contemporary best practice urolithiasis in pregnancy. Ther Adv Urol 2018; 10:127-138. [PMID: 29560029 DOI: 10.1177/1756287218754765] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Accepted: 12/31/2017] [Indexed: 01/10/2023] Open
Abstract
Urolithiasis is the most common nonobstetric complication in the gravid patient. The experience can provoke undue stress for the mother, fetus, and management team. The physiologic changes of pregnancy render the physical exam and imaging studies less reliable than in the typical patient. Diagnosis is further complicated by the need for careful selection of imaging modality in order to maximize diagnostic utility and minimize obstetric risk to the mother and ionizing radiation exposure to the fetus. Ultrasound remains the first-line diagnostic imaging modality in this group, but other options are available if results are inconclusive. A trial of conservative management is uniformly recommended. In patients who fail spontaneous stone passage, treatment may be temporizing or definitive. While temporizing treatments have classically been deemed the gold standard, ureteroscopic stone removal is now acknowledged as a safe and highly effective definitive treatment approach. Ultimately, a multidisciplinary, team-based approach involving the patient, her obstetrician, urologist, radiologist, and anesthesiologist is needed to devise a maximally beneficial management plan.
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Affiliation(s)
| | - Vernon M Pais
- Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, New Hampshire 03756-1000, USA
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Haddad L, Corriveau S, Rousseau E, Blouin S, Pasquier JC, Ponsot Y, Roy-Lacroix MÈ. Impact of tamsulosin and nifedipine on contractility of pregnant rat ureters in vitro. J Matern Fetal Neonatal Med 2017; 31:191-196. [DOI: 10.1080/14767058.2017.1280017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Lisette Haddad
- Department of Obstetrics and Gynecology, Urology Division, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada
| | - Stéphanie Corriveau
- Department of Obstetrics and Gynecology, Urology Division, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada
| | - Eric Rousseau
- Department of Obstetrics and Gynecology, Urology Division, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada
| | - Simon Blouin
- Department of Obstetrics and Gynecology, Urology Division, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada
| | - Jean-Charles Pasquier
- Department of Obstetrics and Gynecology, Urology Division, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada
| | - Yves Ponsot
- Department of Surgery, Urology Division, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada
| | - Marie-Ève Roy-Lacroix
- Department of Obstetrics and Gynecology, Urology Division, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada
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