1
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Corkill J, Sale A, Gallegos C, Jefferies E. Is traditional stone clinic the optimal use of NHS resources? Urolithiasis 2024; 52:29. [PMID: 38300331 DOI: 10.1007/s00240-023-01523-6] [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: 11/29/2023] [Accepted: 12/13/2023] [Indexed: 02/02/2024]
Abstract
There is no clear guidance on the efficacy of stone follow-up. NICE have been unable to make recommendations with current published evidence. The aim of this study was to understand the patient journey resulting in surgical intervention, and whether traditional stone follow-up is effective. A retrospective review of patients undergoing ureteroscopy (URS) or percutaneous nephrolithotomy (PCNL) over a 3 year period identified 471 patients who underwent these procedures to treat stone disease. Records were interrogated for the following: symptoms, mechanism of booking, reason for intervention, stone size, stone location, risk factors and previous follow-up. Of 471 patients who underwent intervention, 168 were booked from stone clinic follow-up (36%). Of these, 96% were symptomatic and 4% were asymptomatic. When risk factors were removed, this figure was reduced to 1%. Sepsis rate for emergency admissions differs between those followed up (13%) versus new presentations (19)%. There was no statistically significant difference in the outpatient imaging frequency between patients booked from an emergency admission (80% having imaging every 6 months) and those from the clinic (82%). Our Hospital provides on average 650 stone clinic appointments a year with a cost of £93,000. Given the low rate of intervention in patients with asymptomatic renal stones, a symptomatic, direct-access emergency stone clinic could be a better model of care and use of NHS resources. Urgent research is required in this area to further assess if this is the case.
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Affiliation(s)
- Joel Corkill
- Royal United Hospital Bath NHS Trust (JC, CG, EJ), Swansea Bay University Health Board NHS Trust (AS), Bath, UK.
| | - Adrian Sale
- Royal United Hospital Bath NHS Trust (JC, CG, EJ), Swansea Bay University Health Board NHS Trust (AS), Bath, UK
| | - Christopher Gallegos
- Royal United Hospital Bath NHS Trust (JC, CG, EJ), Swansea Bay University Health Board NHS Trust (AS), Bath, UK
| | - Edward Jefferies
- Royal United Hospital Bath NHS Trust (JC, CG, EJ), Swansea Bay University Health Board NHS Trust (AS), Bath, UK
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2
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Almeras C, Meria P. 2022 Recommendations of the AFU Lithiasis Committee: Summary of indications. Prog Urol 2023; 33:901-910. [PMID: 37918991 DOI: 10.1016/j.purol.2023.08.001] [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 spontaneous elimination rate of ureteral stones decreases with their size, but also in function of their location. The objectives of stone surveillance are to detect the occurrence of a complication (e.g., fever, clinical tolerance) and to verify the potential stone migration/elimination. The use of urological procedures and the choice of technique are based on many different factors. Kidney stone surveillance is proposed mainly to people with low risk of progression or complications (size<4mm and/or lower calyx location and non-infection stone). Surveillance may be extended to patients with larger stones, in function of the clinical context and comorbidities. Conversely, a urological procedure may also be proposed to patients with stones<4mm for professional (e.g., soldier, pilot, expatriate) or social reasons or if travelling is planned. The choice of technique is based on the stone composition (if already known) and density, the advantages and limitations of each technique, and also the clinical context, while trying to choose the least invasive procedure for a stone-free objective. METHODOLOGY: These recommendations were developed using two methods: the Clinical Practice Recommendations method (CPR) and the ADAPTE method, depending on whether the question was considered in the European Association of Urology (EAU) recommendations (https://uroweb.org/guidelines/urolithiasis) [EAU 2022] and their adaptability to the French context. This chapter is based on the references used in the chapters on the different techniques (extracorporeal shock wave therapy, ureteroscopy, percutaneous nephrolithotomy, medical expulsive therapy, postural therapy, chemolysis by alkalinization) as well as the American Urological Association (AUA) and EAU recommendations.
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Affiliation(s)
- C Almeras
- UroSud, clinique La Croix du Sud, Quint-Fonsegrives, France.
| | - P Meria
- Service d'urologie, hôpital Saint-Louis, AP-HP, centre université Paris Cité, Paris, France
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3
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Gao M, Chen Z, Chen J. Re: Removal of Small, Asymptomatic Kidney Stones and Incidence of Relapse. Eur Urol 2023; 83:94. [PMID: 36511269 DOI: 10.1016/j.eururo.2022.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 10/13/2022] [Indexed: 02/03/2023]
Affiliation(s)
- Meng Gao
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Zhiyong Chen
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China.
| | - Jinbo Chen
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China.
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4
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Alessandria E. Editorial Comment to Usefulness of ureteroscopic lithotripsy in Izuo position for patients with difficulty opening legs. Int J Urol 2022; 29:1242. [PMID: 36000574 DOI: 10.1111/iju.14983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Eugenio Alessandria
- Department of Urology, Azienda Ospedaliera Santa Croce e Carle, Cuneo, Italy
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5
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Jannello LMI, Turetti M, Silvani C, Galbiati G, Garbagnati S, Pozzi E, Malfatto M, Zanetti SP, Longo F, De Lorenzis E, Albo G, Salonia A, Montanari E, Boeri L. Urologists are optimistic surgeons: prevalence and predictors of discordance between intraoperative stone-free rate and cross-sectional imaging evaluation after vacuum-assisted mini-percutaneous nephrolithotomy. World J Urol 2022; 40:2331-2338. [PMID: 35831471 PMCID: PMC9427905 DOI: 10.1007/s00345-022-04091-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 06/30/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose To assess how accurate are urologists in predicting stone-free status (SFS) after vacuum-assisted mini-PCNL (vamPCNL) compared to computed tomography (CT) and clinical predictors of discordant SFS. Methods Data from 235 patients who underwent vamPCNL were analysed. Patient’s demographics, stones’ characteristics and operative data were recorded. SFS was evaluated intraoperatively by the treating urologist (iSFS) and with non-contrast CT 3 months after vamPCNL (ctSFS). SFS was defined as no residual stones. Stone complexity was scored with the Guy’s score. Descriptive statistics and logistic regression models were used to identify clinical factors associated with discordant SFS (namely iSFS not confirmed at CT). Results iSFS and ctSFS were 88.5% and 65.5%, respectively, with 54 (23%) cases resulting in discordant evaluation of SFS between the surgeon and CT imaging. Patients with discordant SFS had larger stone volume (p < 0.001), higher rate of multiple stones (p = 0.03) and higher rate of multiple calyceal groups affected by stones (p < 0.001) than those with concordant SFS. The use of flexible ureteroscopes to look for residual stones after lithotripsy was more frequently reported in cases with concordant SFS (p = 0.001). Multivariable logistic regression analysis revealed that stones in > 2 calyceal groups (OR 10.2, p < 0.001), Guy’s score II (OR 5.8, p < 0.01) and not using flexible ureteroscopes after lithotripsy (OR 2.9, p = 0.02) were independent predictors of discordant SFS. Conclusion One out of five patients is erroneously considered SF after vamPCNL. Urologist should carefully evaluate patients with multiple calyceal stones and consider using flexible ureteroscopes to complete lapaxy of migrated fragments in order to improve their prediction of SFS.
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Affiliation(s)
- Letizia Maria Ippolita Jannello
- Department of Urology, Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via della Commenda 15, 20122, Milan, Italy
| | - Matteo Turetti
- Department of Urology, Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via della Commenda 15, 20122, Milan, Italy
| | - Carlo Silvani
- Department of Urology, Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via della Commenda 15, 20122, Milan, Italy
| | - Gilda Galbiati
- Department of Urology, Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via della Commenda 15, 20122, Milan, Italy
| | - Susanna Garbagnati
- Department of Urology, Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via della Commenda 15, 20122, Milan, Italy
| | - Efrem Pozzi
- Department of Urology, Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via della Commenda 15, 20122, Milan, Italy
| | - Matteo Malfatto
- Department of Urology, Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via della Commenda 15, 20122, Milan, Italy
| | - Stefano Paolo Zanetti
- Department of Urology, Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via della Commenda 15, 20122, Milan, Italy
| | - Fabrizio Longo
- Department of Urology, Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via della Commenda 15, 20122, Milan, Italy
| | - Elisa De Lorenzis
- Department of Urology, Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via della Commenda 15, 20122, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Giancarlo Albo
- Department of Urology, Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via della Commenda 15, 20122, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology, URIIRCCS Ospedale San RaffaeleUniversity Vita-Salute San Raffaele, Milan, Italy
| | - Emanuele Montanari
- Department of Urology, Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via della Commenda 15, 20122, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Luca Boeri
- Department of Urology, Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via della Commenda 15, 20122, Milan, Italy.
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6
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Li S, Quarrier S, Serrell EC, Penniston KL, Nakada SY. Should we treat asymptomatic concurrent contralateral renal stones? A longitudinal analysis. Urolithiasis 2021; 50:71-77. [PMID: 34272594 DOI: 10.1007/s00240-021-01281-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 07/06/2021] [Indexed: 11/29/2022]
Abstract
The objective is to explore the need for future surgery among patients treated for asymptomatic concurrent contralateral stones versus those that were not. Upon IRB approval, we retrospectively reviewed records of patients who underwent stone surgeries (SWL, URS, PCNL) from 2009 to 2018. Patients were included if they were greater than 18 years old, had a minimum follow-up of 2 years, and had pre-operative imaging. Patients were divided into three groups: bilateral surgery, ipsilateral surgery with, and without asymptomatic concurrent contralateral stones. Cox regression was used to analyze patients' need for future surgery while controlling demographic and comorbid characteristics. Of the 1666 patients included, 51.9% were men. They were 59.7 ± 15 years and had a BMI of 31.3 ± 8.2 kg/m2. During the follow-up of 5.2 ± 2.2 years (range 2-11 years), patients who had bilateral surgery and patients who had ipsilateral surgery without treatment of the asymptomatic concurrent contralateral stones had no difference in the need for future surgery (41.7% vs. 43%, p = 0.585). When stratified by stone size, patients with contralateral stones > 6 mm were more likely to require future surgical treatment than those treated bilaterally (p < 0.001). Our study demonstrates that treating asymptomatic concurrent contralateral stones does not lower the need for future surgical interventions. However, asymptomatic concurrent contralateral stones > 6 mm may portend earlier need for treatment. Therefore, bilateral treatment should be considered at presentation.
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Affiliation(s)
- Shuang Li
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Medical Foundation Centennial Building, 1685 Highland Avenue, Madison, WI, 53705, USA.
| | - Scott Quarrier
- Department of Urology, University of Rochester Medical Center, Rochester, NY, USA
| | - Emily C Serrell
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Medical Foundation Centennial Building, 1685 Highland Avenue, Madison, WI, 53705, USA
| | - Kristina L Penniston
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Medical Foundation Centennial Building, 1685 Highland Avenue, Madison, WI, 53705, USA
| | - Stephen Y Nakada
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Medical Foundation Centennial Building, 1685 Highland Avenue, Madison, WI, 53705, USA
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7
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Streeper NM. Should Asymptomatic Renal Stones Be Surgically Treated? Pro-Observation. J Endourol 2021; 35:570-572. [PMID: 33794665 DOI: 10.1089/end.2021.0102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Necole M Streeper
- Division of Urology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
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8
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Kallidonis P, Adamou C, Ntasiotis P, Pietropaolo A, Somani B, Özsoy M, Liourdi D, Sarica K, Liatsikos E, Tailly T. The best treatment approach for lower calyceal stones ≤ 20 mm in maximal diameter: mini percutaneous nephrolithotripsy, retrograde intrarenal surgery or shock wave lithotripsy. A systematic review and meta-analysis of the literature conducted by the European Section of Uro-Technology and Young Academic Urologists. Minerva Urol Nephrol 2021; 73:711-723. [PMID: 34156200 DOI: 10.23736/s2724-6051.21.04388-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The highest in quality data in the literature which compared mini percutaneous nephrolithotripsy (mPCNL), retrograde intrarenal surgery (RIRS) and shock wave lithotripsy (SWL) for the management of lower pole stone (LPS) with a maximal diameter ≤20mm were investigated by means of systematic review (SR) and meta-analysis. EVIDENCE ACQUISITION A SR of the literature was conducted on PubMed®, Cochrane, SCOPUS® and EMBASE® in January 2020. The study complied with the PRISMA statement and recommendations of the EAU Guidelines office. Only randomized controlled trials (RCTs) comparing retrograde intrarenal surgery (RIRS), shock wave lithotripsy (SWL) and mini-percutaneous nephrolithotripsy (mPCNL) were selected for the meta-analysis. The endpoints were the efficacy of each modality, measured by stone-free rate (SFR), operative time and retreatment rate and the safety of each method, based on hospitalization time and complications. Subgroup analyses for stones with a maximal diameter <10mm and 10-20 mm were performed. EVIDENCE SYNTHESIS Twenty-one RCTs were included in the meta-analysis. mPCNL had the highest SFR and the lowest retreatment rate among the three modalities, while SWL had the lowest SFR and the highest retreatment rate. The operative and hospitalization time were shorter in the case of SWL, whereas they were similar in the case of mPCNL and RIRS. The highest complication rate was observed in mPCNL group, which accounted for 8.3-22.4%, while RIRS and SWL had similar complication rates, which ranged between 1.3-31.4% and 0-48.5%, respectively. Further classification of the complications according to Clavien-Dindo system revealed that SWL had lower grade II complication rates compared to mPCNL and RIRS. Regarding stones <10mm, SWL and RIRS had similar SFR, complication rate, operation and hospitalization time. SWL had higher retreatment rate. CONCLUSIONS For LPSs ≤20mm, mPCNL provides the highest SFR and the lowest retreatment rate. This modality has a higher complication rate and longer hospital stay in comparison to the other modalities. SWL provides the lowest SFR with the highest retreatment rate. RIRS has similar complication rate to SWL and could be preferred over SWL. For stones up to 10mm, SWL may provide a valid alternative. Despite a higher retreatment rate, its SFR is similar to RIRS.
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Affiliation(s)
- Panagiotis Kallidonis
- Department of Urology, University of Patras, Patras, Greece - .,European Section of Uro-Technology, European Association of Urology, Arnhem, The Netherlands - .,European Section of Urolithiasis, European Association of Urology, Arnhem, The Netherlands - .,Young Academic Urologists - Endourology and Lithiasis Working group, European Association of Urology, Arnhem, The Netherlands -
| | | | | | - Amelia Pietropaolo
- Young Academic Urologists - Endourology and Lithiasis Working group, European Association of Urology, Arnhem, The Netherlands.,Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Bhaskar Somani
- European Section of Uro-Technology, European Association of Urology, Arnhem, The Netherlands.,Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Mehmet Özsoy
- European Section of Urolithiasis, European Association of Urology, Arnhem, The Netherlands.,Young Academic Urologists - Endourology and Lithiasis Working group, European Association of Urology, Arnhem, The Netherlands.,Department of Urology, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | | | - Kemal Sarica
- European Section of Urolithiasis, European Association of Urology, Arnhem, The Netherlands.,Department of Urology, School of Medicine, Medicana Bahcelievler Hospital, Biruni University, Istanbul, Turkey
| | - Evangelos Liatsikos
- Department of Urology, University of Patras, Patras, Greece.,European Section of Uro-Technology, European Association of Urology, Arnhem, The Netherlands
| | - Thomas Tailly
- European Section of Uro-Technology, European Association of Urology, Arnhem, The Netherlands.,Young Academic Urologists - Endourology and Lithiasis Working group, European Association of Urology, Arnhem, The Netherlands.,Department of Urology, Ghent University Hospital, Ghent, Belgium
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9
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Lovegrove CE, Geraghty RM, Yang B, Brain E, Howles S, Turney B, Somani B. Natural history of small asymptomatic kidney and residual stones over a long-term follow-up: systematic review over 25 years. BJU Int 2021; 129:442-456. [PMID: 34157218 DOI: 10.1111/bju.15522] [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] [Received: 02/26/2021] [Revised: 06/16/2021] [Accepted: 06/20/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To systematically review the natural history of small asymptomatic kidney and residual stones, as the incidental identification of small, asymptomatic renal calculi has risen with increasing use of high-resolution imaging. MATERIALS AND METHODS We reviewed the natural history of small asymptomatic kidney and residual stones using the Cochrane and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. We searched MEDLINE, Scopus, EMBASE, EBSCO, Cochrane library and Clinicaltrials.gov using themes of 'asymptomatic', 'nephrolithiasis', 'observation', 'symptoms', 'admission', 'intervention' and similar allied terms for all English language articles from 1996 to 2020 (25 years). Inclusion criteria were studies with ≥50 patients, stones ≤10 mm, and a mean follow-up of ≥24 months. Primary outcomes were occurrence of symptoms, emergency admission, and interventions. RESULTS Our literature search returned 2247 results of which 10 papers were included in the final review. Risk of symptomatic episodes ranged from 0% to 59.4%. Meta-analysis did not identify any significant difference in the likelihood of developing symptoms when comparing stones <5 mm to those >5 mm, nor those <10 mm to those >10 mm. Risk of admission varied from 14% to 19% and the risk of intervention from 12% to 35%. Meta-analysis showed a significantly decreased likelihood of intervention for stones <5 vs >5 mm and <10 vs >10 mm. Studies had variable risk of bias due to heterogeneous reporting of outcome measures with significant likelihood that observed differences in results were compatible with chance alone (Symptoms: I2 =0%, Cochran's Q = 3.09, P = 0.69; Intervention: I2 =0%, Cochran's Q = 1.76, P = 0.88). CONCLUSIONS The present systematic review indicates that stone size is not a reliable predictor of symptoms; however, risk of intervention is greater for stones >5mm vs <5 mm and >10 vs <10 mm. This review will inform urologists as they discuss management strategies with patients who have asymptomatic renal stones and offer insight to committees during the development of evidence-based guidelines.
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Affiliation(s)
- Catherine E Lovegrove
- Department of Urology, Oxford University Hospitals NHS Trust, Oxford, UK.,Department of Surgical Sciences, University of Oxford Nuffield, Oxford, UK
| | - Robert M Geraghty
- Department of Urology, Freeman Hospital, UK.,Translational and Clinical Research Institute, Faculty of Medical Sciences, International Centre for Life, Newcastle University, UK
| | - Bingyuan Yang
- Department of Urology, Oxford University Hospitals NHS Trust, Oxford, UK
| | | | - Sarah Howles
- Department of Urology, Oxford University Hospitals NHS Trust, Oxford, UK.,Department of Surgical Sciences, University of Oxford Nuffield, Oxford, UK.,Academic Endocrine Unit, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Ben Turney
- Department of Urology, Oxford University Hospitals NHS Trust, Oxford, UK.,Department of Surgical Sciences, University of Oxford Nuffield, Oxford, UK
| | - Bhaskar Somani
- Department of Urology, University Hospital Southampton, Southampton, UK
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10
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Ito K, Takahashi T, Kanno T, Okada T, Higashi Y, Yamada H. Decreased Recurrence of Urolithiasis After Simultaneous Ureteroscopic Surgery for Ureter and Ipsilateral Renal Calculi: Comparison to Shockwave Lithotripsy for Ureter Calculi Alone. Urology 2020; 147:74-80. [PMID: 33181120 DOI: 10.1016/j.urology.2020.10.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 10/20/2020] [Accepted: 10/28/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To compare follow-up outcomes of ureteroscopy (URS) and shockwave lithotripsy (SWL) for ureter calculi in the setting of asymptomatic renal calculi <15 mm. METHODS This study included 789 patients who underwent URS (n = 301) or SWL (n = 488) as primary treatment for ureter calculi and who had ipsilateral renal calculi <15 mm between January 2012 and December 2019. For the URS group, all renal calculi were simultaneously treated unless contraindicated. One-to-one matching was performed using the propensity score (PS). RESULTS After PS matching, analysis included 262 matched pairs of URS and SWL patients. The stone-free rate for ureter calculi without auxiliary procedure was 97.3% in the URS group and 93.9% in the SWL group. Any complication rates were 11.0% and 9.2% in the URS and SWL group, respectively; 1.1% of the URS patients experienced complications classified as Clavien-Dindo ≥IIIb. The estimated 2-year intervention-free survival was 88.1% in the URS group and 84.2% in the SWL group (P = 0.045). The estimated 2-year stone-event-free survival was 80.1% in the URS group and 71.0% in the SWL group (P = 0.009). Cox multivariate analysis showed that the hazard ratios of URS were 0.62 (P = 0.025) for surgical interventions and 0.64 (P = 0.008) for stone-related events after adjusting for baseline variables. CONCLUSION For patients with symptomatic ureter calculi and asymptomatic renal calculi <15 mm, URS with active treatment for renal calculi reduces future ipsilateral surgical intervention and stone-related events compared with SWL for ureter calculi.
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Affiliation(s)
- Katsuhiro Ito
- Department of Urology, Ijinkai Takeda General Hospital, Ishida Fushimi-ku, Kyoto, Japan.
| | - Toshifumi Takahashi
- Department of Urology, Ijinkai Takeda General Hospital, Ishida Fushimi-ku, Kyoto, Japan
| | - Toru Kanno
- Department of Urology, Ijinkai Takeda General Hospital, Ishida Fushimi-ku, Kyoto, Japan
| | - Takashi Okada
- Department of Urology, Ijinkai Takeda General Hospital, Ishida Fushimi-ku, Kyoto, Japan
| | - Yoshihito Higashi
- Department of Urology, Ijinkai Takeda General Hospital, Ishida Fushimi-ku, Kyoto, Japan
| | - Hitoshi Yamada
- Department of Urology, Ijinkai Takeda General Hospital, Ishida Fushimi-ku, Kyoto, Japan
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11
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Kanno T, Takahashi T, Ito K, Okada T, Higashi Y, Yamada H. The Natural History of Asymptomatic Renal Stones ≤5 mm: Comparison with ≥5 mm. J Endourol 2020; 34:1188-1194. [DOI: 10.1089/end.2020.0336] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Toru Kanno
- Department of Urology, Ijinkai Takeda General Hospital, Kyoto, Japan
| | | | - Katsuhiro Ito
- Department of Urology, Ijinkai Takeda General Hospital, Kyoto, Japan
| | - Takashi Okada
- Department of Urology, Ijinkai Takeda General Hospital, Kyoto, Japan
| | - Yoshihito Higashi
- Department of Urology, Ijinkai Takeda General Hospital, Kyoto, Japan
| | - Hitoshi Yamada
- Department of Urology, Ijinkai Takeda General Hospital, Kyoto, Japan
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12
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Hughes T, Pietropaolo A, Archer M, Davis T, Tear L, Somani BK. Lessons Learnt (Clinical Outcomes and Cost Savings) from Virtual Stone Clinic and Their Application in the Era Post-COVID-19: Prospective Outcomes over a 6-Year Period from a University Teaching Hospital. J Endourol 2020; 35:200-205. [PMID: 32731751 DOI: 10.1089/end.2020.0708] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: We introduced a nurse-led telephone-based virtual stone clinic (VSC) follow-up for the surveillance of patients with asymptomatic renal calculi or those at a high risk of recurrent kidney stone disease (KSD). The aim of this study was to look at the outcomes of VSC and its role in the post-COVID era. Methods: Prospective outcomes audit was done for all patients referred to the VSC for a 6-year period (March 2014-April 2020). VSC is led by specialist stone nurses for on-going surveillance of KSD patients. Results: A total of 290 patients were seen (468 individual appointments; 1.6 ± 1.0 per patient), with a mean age of 57.0 ± 15.8 years (range: 17-92) and a men-women ratio of 3:2. The referral was for surveillance of asymptomatic small renal stones (230, 79.3%); history of recurrent stone disease (45, 15.5%); solitary kidneys (5, 1.7%); cystine stones; young age; and other conditions (10, 3.4%). The mean stone size was 5.0 ± 2.7 mm, followed up with kidney, ureter, and bladder radiograph (225, 77.6%) and ultrasound scan (USS) (65, 22.4%), for median duration of 12 months (range: 3-24 months). At the end, 132 patients (45.6%) remained in VSC, 106 (36.6%) were discharged, 47 (16.2%) returned to face-to-face clinic or treatment, and 5 (1.7%) had emergency admissions. Of 47 patients who returned, 23 (48.9%) developed new symptoms, 21 (44.6%) had stone growth, and 3 defaulted to face-to-face appointment. Thirty-five patients needed surgical intervention (URS-21, SWL-13, and PCNL-1) and 10 were managed conservatively. VSC reduced the cost per clinic appointment from £27.9 to £2 per patient (93% reduction), equating to a total saving of £12,006 for the study period. Conclusion: Nurse-led VSC not only provided a safe follow-up but also allowed to substantially reduce the cost of treatment by allowing patients to be either discharged or return to a face-to-face clinic or surgical intervention if needed. Post-COVID, this model using telemedicine will have a much wider uptake and further help to optimize health care resources.
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Affiliation(s)
- Thomas Hughes
- Department of Urology, University Hospital Southampton, Southampton, United Kingdom
| | - Amelia Pietropaolo
- Department of Urology, University Hospital Southampton, Southampton, United Kingdom
| | - Matthew Archer
- Department of Urology, University Hospital Southampton, Southampton, United Kingdom
| | - Tania Davis
- Department of Urology, University Hospital Southampton, Southampton, United Kingdom
| | - Loretta Tear
- Department of Urology, University Hospital Southampton, Southampton, United Kingdom
| | - Bhaskar K Somani
- Department of Urology, University Hospital Southampton, Southampton, United Kingdom
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Schembri M, Pietropaolo A, Somani BK. Treatment of isolated small renal stones leads to resolution of symptoms and should be routinely offered to patients: retrospective outcomes from a university hospital. Scand J Urol 2020; 54:339-343. [PMID: 32686567 DOI: 10.1080/21681805.2020.1793810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Treatment of smaller renal stones and the symptomatic value it offers to patients is often debated. We wanted to analyse surgical outcomes for treatment of small renal stones and whether treatment resulted in symptom resolution. MATERIALS AND METHODS All patients who underwent ureterorenoscopy (URS) for isolated symptomatic small renal stones ≤10 mm over a 7-year period were retrospectively included and subdivided into those with stones of ≤7 mm (Group A) and stones of 8-10 mm (Group B). Patients with multiple renal stones, ureteric stones, or combined renal and ureteric stones were excluded. Based on the symptoms, the patient groups were those with pain, urinary tract infection (UTI) and haematuria. Resolution of symptoms was defined as no symptoms during the follow-up period. RESULTS A total of 109 patients with a single small renal stone ≤10 mm underwent URS and stone treatment, with mean age of 50 years and a male:female ratio of 1:1.2. The mean operative time was significantly longer in Group B (55.9 min vs 33.07 min, p = 0.001). In total, 97.2% (n = 70) of patients in Group A and 83.7% (n = 31) of patients in Group B were stone free (p = 0.017). Complete resolution of symptoms was seen in 63 (92.6%), 24 (85.7%) and 13 (100%) patients with pain, UTI and haematuria, respectively. There were no statistically significant differences in symptom resolution between patients with stones ≤7 mm and those with stones 8-10 mm in size. CONCLUSION Ureteroscopic treatment is a feasible option for small symptomatic stones, since it may lead to symptom resolution. Based on our study we would recommend that patients with symptomatic small renal stones are offered endoscopic treatment.
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Affiliation(s)
- M Schembri
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - A Pietropaolo
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - B K Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
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