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Bayrak O, Demirbas A, Doluoglu OG, Karakan T, Resorlu B, Kardas S, Tepeler A, Tangal S, Adanur S, Celik O. Is a contrast study really necessary prior to ureteroscopy? ACTA ACUST UNITED AC 2016; 49:e4855. [PMID: 26577846 PMCID: PMC4678656 DOI: 10.1590/1414-431x20154855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 07/23/2015] [Indexed: 11/22/2022]
Abstract
This study aimed to evaluate the effect of preoperative imaging techniques on the
success and complication rates of ureteroscopy. We performed a retrospective analysis
of 736 patients (455 males and 281 females), with a mean age of 45.5±15.2 years
(range, 1-88 years), who underwent rigid ureteroscopic procedures for removal of
ureteral stones. Patients were divided into 4 groups according to the type of imaging
modality used: group I, intravenous urography (n=116); group II, computed tomography
(n=381); group III, computed tomography and intravenous urography (n=91), and group
IV, ultrasonography and abdominal plain film (n=148). Patients’ demographics, stone
size and location, prior shock wave lithotripsy, lithotripsy technique, operation
time, success rate, and rate of intraoperative complications were compared among the
groups. There were no significant differences in success and complication rates among
the groups. The stone-free rate after primary ureteroscopy was 87.1% in group I,
88.2% in group II, 96.7% in group III, and 89.9% in group IV (P=0.093). The overall
incidence of intraoperative complications was 11.8%. According to the modified Satava
classification system, 6.1% of patients had grade 1, 5.1% had grade 2, and 0.54% had
grade 3 complications. Intraoperative complications developed in 12.1% of patients in
group I, 12.6% of patients in group II, 7.7% of patients in group III, and 12.2% of
patients in group IV (P=0.625). Our findings clearly demonstrate that ureteroscopic
treatment of ureteral stones can be safely and effectively performed with no use of
contrast study imaging, except in doubtful cases of anatomical abnormalities.
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Affiliation(s)
- O Bayrak
- Department of Urology, School of Medicine, Gazi University, Ankara, Turkey
| | - A Demirbas
- Department of Urology, Ankara Training and Research Hospital, Ankara, Turkey
| | - O G Doluoglu
- Department of Urology, Ankara Training and Research Hospital, Ankara, Turkey
| | - T Karakan
- Department of Urology, Ankara Training and Research Hospital, Ankara, Turkey
| | - B Resorlu
- Department of Urology, Ankara Training and Research Hospital, Ankara, Turkey
| | - S Kardas
- Department of Urology, Faculty of Medicine, Bezmialem University, Istanbul, Turkey
| | - A Tepeler
- Department of Urology, Faculty of Medicine, Bezmialem University, Istanbul, Turkey
| | - S Tangal
- Department of Urology, Faculty of Medicine, Ufuk University, Ankara, Turkey
| | - S Adanur
- Department of Urology, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - O Celik
- Department of Urology, Tepecik Training and Research Hospital, Izmir, Turkey
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Soydan H, Akyol I, Senkul T, Ates F, Uguz S, Yilmaz O, Baykal K. Postshockwave Lithotripsy Outcome Evaluation in Ureteral Stones: Comparison Between Noncontrast Computed Tomography and Plain Abdominal Radiography. J Endourol 2012; 26:803-6. [DOI: 10.1089/end.2011.0624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Hasan Soydan
- Urology Department, GATA Haydarpasa Teaching Hospital, Istanbul, Turkey
| | - Ilker Akyol
- Urology Department, GATA Haydarpasa Teaching Hospital, Istanbul, Turkey
| | - Temucin Senkul
- Urology Department, GATA Haydarpasa Teaching Hospital, Istanbul, Turkey
| | - Ferhat Ates
- Urology Department, GATA Haydarpasa Teaching Hospital, Istanbul, Turkey
| | - Sami Uguz
- Urology Department, GATA Haydarpasa Teaching Hospital, Istanbul, Turkey
| | - Omer Yilmaz
- Urology Department, GATA Haydarpasa Teaching Hospital, Istanbul, Turkey
| | - Kadir Baykal
- Urology Department, GATA Haydarpasa Teaching Hospital, Istanbul, Turkey
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Resorlu B, Kara C, Resorlu EB, Unsal A. Effectiveness of ultrasonography in the postoperative follow-up of pediatric patients undergoing ureteroscopic stone manipulation. Pediatr Surg Int 2011; 27:1337-41. [PMID: 21953523 DOI: 10.1007/s00383-011-2979-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/12/2011] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To evaluate the effectiveness of ultrasonography and to determine whether ionizing radiation is necessary in the postoperative follow-up of children undergoing ureteroscopy. METHODS We reviewed the charts of 49 children who underwent 51 ureteroscopic procedures for ureteral calculi. Renal ultrasound and intravenous urography were performed in all patients at 3 months after surgery for postoperative evaluation. RESULTS In three cases, stones migrated to the kidney. Retrograde intrarenal surgery was performed in two patients and one patient required shockwave lithotripsy to become stone-free. Fourty-six children were completely stone-free and 3 had residual fragments on plain film in the postoperative 3 month. The sensitivity, specificity, negative and positive predictive values of ultrasonography for detecting hydronephrosis were 85.7, 100, 97.7 and 100%, respectively. Two patients under observation and three patients under medical expulsive therapy had resolution of hydronephrosis on follow-up. One patient required ureteroscopy for residual obstructing fragments. CONCLUSIONS Ultrasonography has limited accuracy for detecting residual ureteral stones, but it is a highly specific and reasonably sensitive test for detecting hydronephrosis. A combination of ultrasonography and plain film is a safe and effective imaging procedure in postoperative follow-up of children undergoing ureteroscopy.
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Affiliation(s)
- Berkan Resorlu
- Ministry of Health, Kecioren Training and Research Hospital, Ankara, Turkey.
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Manger JP, Mendoza PJ, Babayan RK, Wang DS. Use of Renal Ultrasound to Detect Hydronephrosis After Ureteroscopy. J Endourol 2009; 23:1399-402. [DOI: 10.1089/end.2009.0392] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jules P. Manger
- Department of Urology, Boston University School of Medicine, Boston, Massachusetts
| | - Pierre J. Mendoza
- Department of Urology, Boston University School of Medicine, Boston, Massachusetts
| | - Richard K. Babayan
- Department of Urology, Boston University School of Medicine, Boston, Massachusetts
| | - David S. Wang
- Department of Urology, Boston University School of Medicine, Boston, Massachusetts
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Abstract
The management of urolithiasis has radically changed over the last two decades. Open surgery has been almost completely replaced by minimally invasive procedures, mainly extracorporeal shock wave lithotripsy (ESWL) and ureteroscopy (URS). Although these treatment modalities have been proven to be very safe and effective, serious complications can occur. Prompt diagnosis is often essential and may even be lifesaving. Radiologists play an important role in this setting, since many of these complications can be readily diagnosed by imaging. Awareness of the wide spectrum of complications may be crucial in interpreting imaging studies of patients who have undergone one of these procedures. This article reviews the contemporary management of ureteric stones with ESWL and URS and illustrates the radiological findings of complications of these procedures.
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Affiliation(s)
- G Gayer
- Department of Diagnostic Imaging, Assaf Harofeh Medical Center, Zrifin 70300, Israel.
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Poletti PA, Platon A, Rutschmann OT, Verdun FR, Schmidlin FR, Iselin CE, Vermeulen B, Sarasin FP, Buhler LH, Becker CD. Abdominal plain film in patients admitted with clinical suspicion of renal colic: should it be replaced by low-dose computed tomography? Urology 2006; 67:64-8. [PMID: 16413334 DOI: 10.1016/j.urology.2005.07.042] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2005] [Revised: 06/25/2005] [Accepted: 07/20/2005] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To evaluate a low-dose abdominal computed tomography (LDCT) protocol, delivering a radiation dose close to that delivered by an abdominal plain film (APF), in patients with a clinical suspicion of renal colic. METHODS A total of 139 patients for whom an APF was requested for suspicion of renal colic were randomized into two groups. The patients in group 1 (n = 68) underwent an admission LDCT scan delivering a 2.1-mSv radiation dose to women and 1.6 mSv to men, instead of the APF. Patients in group 2 (n = 71) underwent an APF. Clinical and radiologic follow-up data were obtained for each patient. The number of additional abdominal ultrasound and CT scans performed to reach a confident final diagnosis and determine the proper treatment was compared between the two groups. A mean effective radiation dose was obtained in each group. RESULTS Of the 68 patients in group 1 (LDCT), 10 (15%) underwent ultrasonography, 9 (13%) conventional abdominal CT, and 2 (3%) both. In group 2 (APF), the corresponding percentages were 27% (19 of 71), 28% (20 of 71), and 23% (16 of 71). Of the 68 patients in group 1, 47 (69%) did not require any additional examinations compared with 16 (23%) of the 71 patients in group 2 (P < 0.0001). The mean effective dose was 3.5 and 6.9 mSv in groups 1 and 2, respectively (P < 0.0001). CONCLUSIONS In patients with suspicion of renal colic, replacing the admission APF with our LDCT protocol will significantly reduce the need for additional CT or ultrasonography. Also, our LDCT protocol decreases by almost 50% the mean radiation dose per patient.
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Kluner C, Hein PA, Gralla O, Hein E, Hamm B, Romano V, Rogalla P. Does ultra-low-dose CT with a radiation dose equivalent to that of KUB suffice to detect renal and ureteral calculi? J Comput Assist Tomogr 2006; 30:44-50. [PMID: 16365571 DOI: 10.1097/01.rct.0000191685.58838.ef] [Citation(s) in RCA: 122] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The objective of this study was to evaluate the diagnostic yield of multislice CT using a radiation dose equivalent to that of conventional abdominal x-ray (KUB). One hundred forty-two patients were prospectively examined with ultrasound and a radically dose-reduced CT protocol (120 kV, 6.9 eff. mAs). Number and size of calculi, presence of urinary obstruction, and alternative diagnoses were recorded and confirmed by stone removal/discharge or by clinical and imaging follow-up. The mean effective whole-body dose was 0.5 mSv in men and 0.7 mSv in women. The sensitivity and specificity in detecting patients with calculi was 97% and 95% for CT and 67% and 90% for ultrasound. Urinary obstruction was similarly assessed, whereas CT identified significantly more alternative diagnoses than ultrasound (P<0.001). With regard to published data for standard-dose CT, the present CT protocol seems to be comparable in its diagnostic yield in assessing patients with calculi, and its radiation dose is equivalent to that of KUB.
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Affiliation(s)
- Claudia Kluner
- Department of Radiology, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany.
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