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Teke K, Çakir H, Siddikoğlu D, Özman O, Başataç C, Akgül HM, Çinar Ö, Şimşekoğlu MF, Tuna MB, Sancak EB, Yazici CM, Akpinar H, Önal B. Is Psoas Muscle Mass Associated with Failure of Ureteral Access Sheath Insertion and Complications from Retrograde Intrarenal Surgery? A Case-Control Study from RIRSearch group. J Laparoendosc Adv Surg Tech A 2024; 34:329-338. [PMID: 38422189 DOI: 10.1089/lap.2023.0512] [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] [Indexed: 03/02/2024] Open
Abstract
Objective: To investigate the association between psoas muscle mass (PMM) and failure of ureteral access sheath (UAS) insertion and complications from retrograde intrarenal surgery (RIRS). Materials and Methods: A multicenter retrospective case-control study was conducted that included patients who underwent RIRS despite failure of UAS insertion (Cohort 1) and confounder-matched control patients who underwent RIRS after successful UAS insertion (Cohort 2). For morphometric analysis of PMM, ipsilateral psoas muscle areas (iPMAs) were measured using the coreslicer.com webkit. After comparing demographic, clinical, and complication rates and iPMAs between cohorts, gender-specific median iPMAs were also determined to further subdivide patients in each cohort as either low iPMAs or high iPMAs. Thereafter, patients were also compared in terms of RIRS complications. Results: Cohort 1 included 86 patients whereas Cohort 2 consisted of 124 matched cases. The median (interquartile range) iPMAs were similar between the cohorts: Cohort 1, 11.05 (6.82-14.44) cm2 versus 11.12 (6.97-13.69) cm2 for Cohort 2 (P ˃ .05). There was a significant inverse relationship between iPMAs with age (r = -0.222) and Charlson comorbidity index (r = -0.180) for all patients (P ˂ .05). Perioperative and postoperative complication rates were 8.1% and 16.3% for Cohort 1 and 6.5% and 21% for Cohort 2, respectively. The complication rates were not statistically different between patients with high iPMAs and those with low iPMAs, in male or female patients (P > .05). Conclusions: These results show that failure of UAS was not associated with PMM. Furthermore, since the complication rates were similar between patients with high PMM and low PMM, RIRS may be a reliable treatment choice for sarcopenic patients as well as in nonsarcopenic patients.
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Affiliation(s)
- Kerem Teke
- Department of Urology, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Hakan Çakir
- Department of Urology, Fulya Acıbadem Hospital, İstanbul, Turkey
| | - Duygu Siddikoğlu
- Department of Biostatistics and Çanakkale Onsekiz Mart University, Çanakkale, Turkey
| | - Oktay Özman
- Department of Urology, Bahçelievler Memorial Hospital, İstanbul, Turkey
| | - Cem Başataç
- Department of Urology, Group Florence Nightingale Hospitals, İstanbul, Turkey
| | - Hacı Murat Akgül
- Department of Urology, Tekirdağ Namık Kemal University, Tekirdağ, Turkey
| | - Önder Çinar
- Department of Urology, MEDICANA International, Samsun, Turkey
| | | | | | - Eyüp Burak Sancak
- Department of Urology, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
| | - Cenk Murat Yazici
- Department of Urology, Tekirdağ Namık Kemal University, Tekirdağ, Turkey
| | - Haluk Akpinar
- Department of Urology, Group Florence Nightingale Hospitals, İstanbul, Turkey
| | - Bülent Önal
- Department of Urology, Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
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Tang X, Wu S, Li Z, Wang D, Lei C, Liu T, Wang X, Li S. Comparison of Thulium Fiber Laser versus Holmium laser in ureteroscopic lithotripsy: a Meta-analysis and systematic review. BMC Urol 2024; 24:44. [PMID: 38374098 PMCID: PMC10875760 DOI: 10.1186/s12894-024-01419-6] [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: 12/22/2022] [Accepted: 01/29/2024] [Indexed: 02/21/2024] Open
Abstract
OBJECTIVES To compare the efficacy and safety of thulium fiber laser (TFL) to holmium: YAG (Ho: YAG) laser in ureteroscopic lithotripsy for urolithiasis. METHODS PubMed, Web of Science, Embase, CENTRAL, SinoMed, CNKI database, VIP and Wanfang Database were systematically searched for all relevant clinical trials until September 2023. References were explored to identify the relevant articles. Meta-analysis was carried out for the retrieved studies using RevMan5.4.1 software, and the risk ratio, mean difference and 95% confidence interval were expressed. Statistical significance was set at p < 0.05. The main outcomes of this meta-analysis were stone-free rate (SFR), perioperative outcomes and intraoperative or postoperative complications. RESULTS Thirteen studies, including 1394 patients, were included. According to the results of pooled analysis, TFL was associated with significantly higher stone-free rate (SFR) [0.52, 95% CI (0.32, 0.85), P = 0.009], shorter operation time [-5.47, 95% CI (-8.86, -2.08), P = 0.002], and less stone migration [0.17, 95% CI (0.06, 0.50), P = 0.001]. However, there was no significant difference in terms of the laser time, duration of hospital stay, drop of hemoglobin level, total energy, postoperative ureteral stenting, the incidence of intraoperative complications or postoperative complications between TFL and Ho: YAGs. CONCLUSION The findings of this study demonstrated several advantages of TFL in terms of higher SFR, shorter operative time and less stone migration. TRIAL REGISTRATION The protocol of this systematic review was listed in PROSPERO ( www.crd.york.ac.uk/PROSPERO ) (Protocol number: CRD42022362550).
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Affiliation(s)
- Xiaoyu Tang
- Department of Urology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, China
- Department of Biological Repositories, Cancer Precision Diagnosis and Treatment and Translational Medicine Hubei Engineering Research Center, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Shaojie Wu
- Department of Urology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, China
| | - Zhilong Li
- Department of Urology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, China
| | - Du Wang
- The Institute of Technological Sciences, Wuhan University, Wuhan, 430072, China
| | - Cheng Lei
- The Institute of Technological Sciences, Wuhan University, Wuhan, 430072, China
| | - Tongzu Liu
- Department of Urology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, China
| | - Xinghuan Wang
- Department of Urology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, China.
| | - Sheng Li
- Department of Urology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, China.
- Department of Biological Repositories, Cancer Precision Diagnosis and Treatment and Translational Medicine Hubei Engineering Research Center, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.
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Keat WOL, Somani BK, Pietropaolo A, Chew BH, Chai CA, Inoue T, Ragoori D, Biligere S, Galosi AB, Pavia MP, Milanese G, Ahn T, More S, Sarica K, Traxer O, Teoh JYC, Gauhar V, Castellani D. Do Hounsfield Units have any significance in predicting intra- and postoperative outcomes in retrograde intrarenal surgery using Holmium and Thulium fiber laser? Results from the FLEXible ureteroscopy Outcomes Registry (FLEXOR). World J Urol 2023; 41:2881-2888. [PMID: 36929407 DOI: 10.1007/s00345-023-04362-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 02/27/2023] [Indexed: 03/18/2023] Open
Abstract
PURPOSE To evaluate outcomes of flexible ureteroscopy for renal stones by comparing hard versus soft stones based on their attenuation on computed tomography (Hounsfield Units-HU). METHODS Patients were divided into two groups according to the type of laser employed [Holmium:YAG (HL) or Thulium fiber laser (TFL)]. Residual fragments (RF) were defined as > 2 mm. Multivariable logistic regression analysis was performed to evaluate factors associated with RF and RF needing further intervention. RESULTS 4208 patients from 20 centers were included. In whole series, age, recurrent stones, stone size, lower pole stones (LPS), and multiple stones were predictors of RF at multivariable analysis and LPS and stone size with RF requiring further treatment. HU and TFL were associated with lesser RF and RF requiring an additional treatment. In HU < 1000 stones, recurrent stones, stone size, and LPS were predictors of RF at multivariable analysis, whereas TFL was less likely associated with RF. Recurrent stones, stone size, and multiple stones were predictors of RF requiring further treatment, while LPS and TFL were associated with lesser RF requiring further treatment. In HU ≥ 1000 stones, age, stone size, multiple stones, and LPS were predictors of RF at multivariable analysis, while TFL was less likely associated with RF. Stone size and LPS were predictors of RF requiring further treatment, whereas TFL was associated with RF requiring further treatment. CONCLUSION Stone size, LPS, and use of HL are predictors of RF after RIRS for intrarenal stones regardless of stone density. HU should be considered an important parameter in predicting SFR.
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Affiliation(s)
| | - Bhaskar Kumar Somani
- Department of Urology, University Hospitals Southampton, NHS Trust, Southampton, UK
| | - Amelia Pietropaolo
- Department of Urology, University Hospitals Southampton, NHS Trust, Southampton, UK
| | - Ben Hall Chew
- Department of Urology, University of British Columbia, Vancouver, Canada
| | - Chu Ann Chai
- Department of Surgery, Urology Unit, University Malaya, Kuala Lumpur, Malaysia
| | - Takaaki Inoue
- Department of Urology and Stone Center, Hara Genitourinary Hospital, Kobe City, Hyogo, Japan
| | - Deepak Ragoori
- Department of Urology, Asian Institute of Nephrology and Urology, Irram Manzil Colony, Hyderabad, Telangana, India
| | - Sarvajit Biligere
- Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Andrea Benedetto Galosi
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica Delle Marche, Via Conca 71, 60127, Ancona, Italy
| | - Maria Pia Pavia
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica Delle Marche, Via Conca 71, 60127, Ancona, Italy
| | - Giulio Milanese
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica Delle Marche, Via Conca 71, 60127, Ancona, Italy
| | - Thomas Ahn
- Department of Urology, Toowoomba Base Hospital, Toowoomba, QLD, Australia
| | - Sumit More
- Department of Urology, Sarvodaya Hospital and Research Center, Faridabad, India
| | - Kemal Sarica
- Department of Urology, Biruni University Medical School, Istanbul, Turkey
| | - Olivier Traxer
- Department of Urology AP-HP, Sorbonne University, Tenon Hospital, Paris, France
| | - Jeremy Yuen-Chun Teoh
- Department of Surgery, Faculty of Medicine, S.H. Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, China
| | - Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Daniele Castellani
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica Delle Marche, Via Conca 71, 60127, Ancona, Italy.
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Özman O, Başataç C, Akgül HM, Çınar Ö, Burak Sancak E, Özden SB, Elmaağaç B, Çakır H, Yazıcı CM, Önal B, Akpınar H. External validation of Modified Seoul National University Renal Stone Complexity Score to predict outcome and complications of retrograde intrarenal surgery: a RIRSearch Group study. MINIM INVASIV THER 2022; 31:917-922. [DOI: 10.1080/13645706.2021.2025112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Oktay Özman
- Gaziosmanpasa Training and Research Hospital, Urology Clinic, İstanbul, Turkey
| | - Cem Başataç
- Department of Urology, Group Florence Nightingale Hospitals, İstanbul, Turkey
| | - Hacı Murat Akgül
- Department of Urology, School of Medicine, Tekirdağ Namık Kemal University, Tekirdağ, Turkey
| | - Önder Çınar
- Department of Urology, School of Medicine, Zonguldak Bulent Ecevit University, Zonguldak, Turkey
| | - Eyüp Burak Sancak
- Department of Urology, School of Medicine, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
| | - Sami Berk Özden
- Department of Urology, Cerrahpaşa Medical Faculty, İstanbul University-Cerrahpaşa, İstanbul, Turkey
| | | | | | - Cenk Murat Yazıcı
- Department of Urology, School of Medicine, Tekirdağ Namık Kemal University, Tekirdağ, Turkey
| | - Bülent Önal
- Department of Urology, Cerrahpaşa Medical Faculty, İstanbul University-Cerrahpaşa, İstanbul, Turkey
| | - Haluk Akpınar
- Department of Urology, Group Florence Nightingale Hospitals, İstanbul, Turkey
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