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Uğur R, Yağmur İ. Urgent ureterorenoscopy as a primary treatment for ureteral stone: why not? Urolithiasis 2024; 52:69. [PMID: 38653876 DOI: 10.1007/s00240-024-01569-0] [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: 08/30/2023] [Accepted: 04/03/2024] [Indexed: 04/25/2024]
Abstract
To evaluate the feasibility of urgent ureteroscopy (uURS) and elective ureteroscopy (eURS) in the management of patients with renal colic due to ureteral stones. Patients who were operated for ureteral stones between September 2020 and March 2022 were determined retrospectively. The patients who were operated within the first 24 h constituted the uURS group, while the patients who were operated after 24 h were classified as eURS. No limiting factors such as age, gender and concomitant disease were determined as inclusion criteria. Patients with bilateral or multiple ureteral stones, bleeding diathesis, patients requiring emergency nephrostomy or decompression with ureteral JJ stent, and pregnant women were not included. The two groups were compared in terms of stone-free rate, complications, and overall outcomes. According to the inclusion-exclusion criteria, a total of 572 patients were identified, including 142 female and 430 male patients. There were 219 patients in the first group, the uURS arm, and 353 patients in the eURS arm. The mean stone size was 8.1 ± 2.6. The stone-free rate was found to be 87.8% (502) in general, and 92 and 85% for uURS and eURS, respectively. No major intraoperative or postoperative complications were observed in any of the patients. Urgent URS can be performed effectively and safely as the primary treatment in patients with renal colic due to ureteral stones. In this way, the primary treatment of the patient is carried out, as well as the increased workload, additional examination, treatment and related morbidities are prevented.
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Affiliation(s)
- Ramazan Uğur
- Department of Urology, University of Health Sciences, Başakşehir Çam and Sakura City Hospital, Başakşehir Olympic Boulevard Road, 34480, Başakşehir, Istanbul, Turkey.
| | - İlyas Yağmur
- Department of Urology, Yenişehir, Viranşehir State Hospital, Viranşehir - Ceylanpınar Street, No:3, 63700, Viranşehir, Şanlıurfa, Turkey
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Gofrit ON, Abudi R, Lorber A, Duvdevani M. Predicting urine culture results in candidates for lithotripsy. Curr Urol 2023; 17:113-117. [PMID: 37691989 PMCID: PMC10489201 DOI: 10.1097/cu9.0000000000000117] [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: 03/14/2021] [Accepted: 04/06/2021] [Indexed: 11/26/2022] Open
Abstract
Background Urological guidelines assert that "urine culture should be obtained" before surgical management of ureteral or kidney stones. Thus, many surgeries are delayed by 1-3 days until the results of urine culture are available. During this time, the patient frequently experience pain and possible kidney damage. We investigated the hypothesis that it is possible to predict the results of urine culture in candidates for surgical intervention using parameters that are accessible immediately upon admission. Materials and methods A database of 1000 patients who underwent either percutaneous nephrolithotomy (PCNL) or ureteroscopy/retrograde intrarenal surgery was analyzed. Eleven parameters potentially related to urinary infections and accessible to the clinician at the emergency department were correlated with the preoperative urine culture results. Results Of the patients, 234 (23.4 %) had positive cultures. On multivariate analysis, only sex, hydronephrosis grade, and history of previous nephrolithotomy were significantly associated with a positive preoperative urine culture. The risk of a positive culture can be easily determined from a simple table or an Excel-based calculator. This risk could be as low as 0.45% for a man without a history of PCNL and no hydronephrosis (4% in a woman with similar parameters) or as high as 79.5% in a man with a history of PCNL and hydronephrosis (85% in a woman with similar parameters). Conclusions The risk of preoperative positive urine culture can be predicted using 3 parameters that are accessible upon admission. In low-risk cases, prompt surgical treatment can be provided, eliminating the anticipation time for urine culture results.
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Affiliation(s)
- Ofer N. Gofrit
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel; Department of Urology, Hadassah University Hospital, Jerusalem, Israel
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Qin L, Xu J, Tang Y, Zhang H, Yi X, Jin W, Fu X, Zhu G, Hu W, Li M. Value of noncontrast computer tomography in predicting the characteristics of obstructive uropathy. Clin Imaging 2021; 82:53-57. [PMID: 34773812 DOI: 10.1016/j.clinimag.2021.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/26/2021] [Accepted: 10/19/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To explore the diagnostic value of noncontrast computed tomography (NCCT) in differentiating pyonephrosis from nonpyogenic hydronephrosis on the basis of CT values (in Horsfield unit [HU]). METHODS Data from patients diagnosed with obstructive uropathy at the First affiliated hospital of University of South China from November 2017 to January 2021 were subjected to retrospective analysis. In accordance with the gold standard-the presence of pus during the operation-all patients were divided into the nonpyogenic hydronephrosis group and the pyonephrosis group. The relationship between CT values and the presence or absence of pyonephrosis was performed using binary logistic regression. A receiver operating characteristic (ROC) curve was constructed to determine threshold values for classification on the basis of mean HU. RESULTS A total of 207 patients, including 100 males and 107 females, were enrolled. Out of the 207 cases, 124 cases of obstructive uropathy were nonpyogenic hydronephrosis and 83 cases were of pyonephrosis. The CT values of the pyonephrosis group were significantly higher than that of the nonpyogenic hydronephrosis group (t = 9.15, P < 0.05). The CT values were dependent on the presence or absence of pyonephrosis (P < 0.05). A HU threshold value of 9.75 could be applied to diagnose the presence of pyonephrosis. CONCLUSION The CT values of hydronephrosis might predict the presence of pyonephrosis in the kidney, and the CT value of 9.75 HU might be the appropriate threshold for its prediction.
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Affiliation(s)
- Long Qin
- The First Affiliated Hospital, Urology Department, Hengyang Medical School, University of South China, No. 69, chuanshan Road, Shigu District, Hengyang 421001, Hunan Province, China
| | - Jieru Xu
- School of Public Health, The University of South China, No. 28, Changsheng West Road, Zhengxiang District, Hengyang 421001, Hunan Province, China
| | - Yunhui Tang
- The First Affiliated Hospital, Urology Department, Hengyang Medical School, University of South China, No. 69, chuanshan Road, Shigu District, Hengyang 421001, Hunan Province, China
| | - Hu Zhang
- The First Affiliated Hospital, Urology Department, Hengyang Medical School, University of South China, No. 69, chuanshan Road, Shigu District, Hengyang 421001, Hunan Province, China
| | - Xuan Yi
- The First Affiliated Hospital, Urology Department, Hengyang Medical School, University of South China, No. 69, chuanshan Road, Shigu District, Hengyang 421001, Hunan Province, China
| | - Wei Jin
- The First Affiliated Hospital, Urology Department, Hengyang Medical School, University of South China, No. 69, chuanshan Road, Shigu District, Hengyang 421001, Hunan Province, China
| | - Xiaowen Fu
- The First Affiliated Hospital, Urology Department, Hengyang Medical School, University of South China, No. 69, chuanshan Road, Shigu District, Hengyang 421001, Hunan Province, China
| | - Guoqiang Zhu
- The First Affiliated Hospital, Urology Department, Hengyang Medical School, University of South China, No. 69, chuanshan Road, Shigu District, Hengyang 421001, Hunan Province, China
| | - Wei Hu
- The First Affiliated Hospital, Urology Department, Hengyang Medical School, University of South China, No. 69, chuanshan Road, Shigu District, Hengyang 421001, Hunan Province, China
| | - Mingyong Li
- The First Affiliated Hospital, Urology Department, Hengyang Medical School, University of South China, No. 69, chuanshan Road, Shigu District, Hengyang 421001, Hunan Province, China.
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Mazzucchi E, Torricelli FCM, Vicentini FC, Marchini GS, Danilovic A, Batagello CA, Srougi M, Nahas WC. The impact of COVID-19 in medical practice. A review focused on Urology. Int Braz J Urol 2021; 47:251-262. [PMID: 32840335 PMCID: PMC7857770 DOI: 10.1590/s1677-5538.ibju.2020.99.08] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 05/04/2020] [Indexed: 12/22/2022] Open
Abstract
COVID-19 pandemic is a rapidly spreading virus that is changing the World and the way doctors are practicing medicine. The huge number of patients searching for medical care and needing intensive care beds led the health care system to a burnout status especially in places where the care system was already overloaded. In this setting, and also due to the absence of a specific treatment for the disease, health authorities had to opt for recommending or imposing social distancing to relieve the health system and reduce deaths. All other medical specialties non-directly related to the treatment of COVID-19 had to interrupt or strongly reduce their activities in order to give room to seriously ill patients, since no one knows so far the real extent of the virus damage on human body and the consequences of doing non deferrable procedures in this pandemic era. Despite not been a urological disease, the urologist needs to be updated on how to deal with these patients and how to take care of himself and of the medical team he works with. The aim of this article is to review briefly some practical aspects of COVID-19 and its implications in the urological practice in our country.
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Affiliation(s)
- Eduardo Mazzucchi
- Universidade de São PauloFaculdade de MedicinaHospital das ClínicasSão PauloSPBrasilSetor de Endourologia, Divisão de Urologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP, Brasil.,Correspondence address: Eduardo Mazzucchi, MD, Setor de Endourologia, Divisão de Urologia, Faculdade de Medicina de São Paulo da Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255 / 7 andar, sala 710 F, São Paulo, SP, 05403-000, Brasil. E-mail:
| | - Fabio C. M. Torricelli
- Universidade de São PauloFaculdade de MedicinaHospital das ClínicasSão PauloSPBrasilSetor de Endourologia, Divisão de Urologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP, Brasil.
| | - Fabio C. Vicentini
- Universidade de São PauloFaculdade de MedicinaHospital das ClínicasSão PauloSPBrasilSetor de Endourologia, Divisão de Urologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP, Brasil.
| | - Giovanni S. Marchini
- Universidade de São PauloFaculdade de MedicinaHospital das ClínicasSão PauloSPBrasilSetor de Endourologia, Divisão de Urologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP, Brasil.
| | - Alexandre Danilovic
- Universidade de São PauloFaculdade de MedicinaHospital das ClínicasSão PauloSPBrasilSetor de Endourologia, Divisão de Urologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP, Brasil.
| | - Carlos A. Batagello
- Universidade de São PauloFaculdade de MedicinaHospital das ClínicasSão PauloSPBrasilSetor de Endourologia, Divisão de Urologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP, Brasil.
| | - Miguel Srougi
- Universidade de São PauloFaculdade de MedicinaHospital das ClínicasSão PauloSPBrasilSetor de Endourologia, Divisão de Urologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP, Brasil.
| | - William C. Nahas
- Universidade de São PauloFaculdade de MedicinaHospital das ClínicasSão PauloSPBrasilSetor de Endourologia, Divisão de Urologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP, Brasil.
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Huang X, Hu Z, Yue X, Cui Y, Cui J. Expression of Inflammatory Factors in Critically Ill Patients with Urosepticemia and the Imaging Analysis of the Severity of the Disease. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:6659435. [PMID: 33688422 PMCID: PMC7914102 DOI: 10.1155/2021/6659435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/06/2021] [Accepted: 02/15/2021] [Indexed: 11/17/2022]
Abstract
Urine sepsis is a complex inflammatory response of the body to infection with a high fatality rate. It is one of the main causes of death in noncardiovascular intensive care units. Nevertheless, in daily clinical practice, early sepsis is often not detected. In this paper, discharged cases of urinary sepsis from the Department of Urology and Critical Care Medicine of a university hospital were collected as the observation group, and common urinary tract infection cases were selected as the control group. We sorted and summarized the discharged case information of the observation group and the control group. The results of the study showed that, after renal pelvis perfusion, the expression of HMGB1 protein and mRNA increased, and the expression of TLR4 increased; inhibiting HMGB1 can reduce the expression of inflammatory factors caused by perfusion and reduce the infiltration of neutrophils and macrophages caused by perfusion. In addition, r HMGB1 treatment can promote the expression of inflammatory factors caused by perfusion and aggravate the infiltration of neutrophils and macrophages caused by perfusion. We found that inhibition of HMGB1 can inhibit the expression of TLR4/My D88 signaling molecules and r HMGB1 treatment can enhance the expression of TLR4/My D88 signaling molecules.
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Affiliation(s)
- Xia Huang
- Department of Critical Care Medicine Neurosurgery, Chongqing University Three Gorges Hospital, Wanzhou, Chongqing 404000, China
| | - Zongjun Hu
- Department of Critical Care Medicine Neurosurgery, Chongqing University Three Gorges Hospital, Wanzhou, Chongqing 404000, China
| | - Xi Yue
- Department of Critical Care Medicine Neurosurgery, Chongqing University Three Gorges Hospital, Wanzhou, Chongqing 404000, China
| | - Yong Cui
- Department of Critical Care Medicine Neurosurgery, Chongqing University Three Gorges Hospital, Wanzhou, Chongqing 404000, China
| | - Jiwen Cui
- Department of Critical Care Medicine Neurosurgery, Chongqing University Three Gorges Hospital, Wanzhou, Chongqing 404000, China
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Bakr M, Abdelhalim KM. Response to Maheshwari and Arora re: "Safety and Efficacy of Emergency Ureteroscopy with Intracorporeal Lithotripsy in Patients Presented with Urinary Tract Infection with Mild Sepsis" by Bakr and Abdelhalim. J Endourol 2020; 34:1273-1274. [PMID: 33090048 DOI: 10.1089/end.2020.29100.mba] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Mohamed Bakr
- Urology Department, Port-Said University, Port-Said, Egypt
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Maheshwari PN, Arora A. Re: "Safety and Efficacy of Emergency Ureteroscopy with Intracorporeal Lithotripsy in Patients Presented with Urinary Tract Infection with Mild Sepsis" by Bakr and Abdelhalim. J Endourol 2020; 34:1272. [PMID: 32483984 DOI: 10.1089/end.2020.0251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Amandeep Arora
- Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
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