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Cruz JACS, Danilovic A, Vicentini FC, Brito AH, Batagello CA, Marchini GS, Torricelli FCM, Nahas WC, Mazzucchi E. Ureteral access sheath. Does it improve the results of flexible ureteroscopy? A narrative review. Int Braz J Urol 2024; 50:346-358. [PMID: 38498688 PMCID: PMC11152322 DOI: 10.1590/s1677-5538.ibju.2024.9907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 01/20/2024] [Indexed: 03/20/2024] Open
Affiliation(s)
- José Agustin Cabrera Santa Cruz
- Universidade de São Paulo – USPHospital das Clínicas da Faculdade de MedicinaSão PauloSPBrasilDivisão de Urologia - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo – USP, São Paulo, SP, Brasil
| | - Alexandre Danilovic
- Universidade de São Paulo – USPHospital das Clínicas da Faculdade de MedicinaSão PauloSPBrasilDivisão de Urologia - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo – USP, São Paulo, SP, Brasil
| | - Fabio Carvalho Vicentini
- Universidade de São Paulo – USPHospital das Clínicas da Faculdade de MedicinaSão PauloSPBrasilDivisão de Urologia - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo – USP, São Paulo, SP, Brasil
| | - Artur Henrique Brito
- Universidade de São Paulo – USPHospital das Clínicas da Faculdade de MedicinaSão PauloSPBrasilDivisão de Urologia - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo – USP, São Paulo, SP, Brasil
| | - Carlos Alfredo Batagello
- Universidade de São Paulo – USPHospital das Clínicas da Faculdade de MedicinaSão PauloSPBrasilDivisão de Urologia - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo – USP, São Paulo, SP, Brasil
| | - Giovanni Scalla Marchini
- Universidade de São Paulo – USPHospital das Clínicas da Faculdade de MedicinaSão PauloSPBrasilDivisão de Urologia - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo – USP, São Paulo, SP, Brasil
| | - Fabio César Miranda Torricelli
- Universidade de São Paulo – USPHospital das Clínicas da Faculdade de MedicinaSão PauloSPBrasilDivisão de Urologia - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo – USP, São Paulo, SP, Brasil
| | - William Carlos Nahas
- Universidade de São Paulo – USPHospital das Clínicas da Faculdade de MedicinaSão PauloSPBrasilDivisão de Urologia - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo – USP, São Paulo, SP, Brasil
| | - Eduardo Mazzucchi
- Universidade de São Paulo – USPHospital das Clínicas da Faculdade de MedicinaSão PauloSPBrasilDivisão de Urologia - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo – USP, São Paulo, SP, Brasil
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Pissaia TB, Belkovsky M, Passerotti CC, Artifon ELDA, Otoch JP, da Cruz JAS. Diameter of ureteral access sheath and ureteral stenosis development: a systematic review. Acta Cir Bras 2023; 38:e387423. [PMID: 37909598 PMCID: PMC10637340 DOI: 10.1590/acb387423] [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: 08/13/2023] [Accepted: 09/22/2023] [Indexed: 11/03/2023] Open
Abstract
PURPOSE Ureteral access sheaths (UAS) are widely used in ureteroscopy. UAS are believed to pose a significant risk for ureteral stenosis due to ureteral mucosal compression, but little evidence supports this claim. Our systematic review aimed to investigate the relationship between different UAS diameters and stenosis risk. METHODS A systematic search was conducted in PubMed, Embase, Web of Science, Scopus, and Cochrane, from its inception to May 2023. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Cochrane guidelines were followed. χ2 test was performed to compare the prevalence within the groups. RESULTS Six nonrandomized trials and one randomized, with a total of 962 patients, were included. The overall incidence of ureteral stenosis of 0.9%. UAS sizes were: 9.5/11.5Fr, 10/12Fr, 11/13Fr, 12/14Fr, and 14/16Fr. Within each subgroup, the incidence of ureteral stenosis was: 0.4, 8, 0, 1, and 1% (p = 0.099). No trend for stenosis was observed among larger UAS. CONCLUSIONS In this systematic review, no relationship between UAS diameter and incidence of ureteral stenosis was observed. Nonetheless, additional randomized controlled trials are required to support this finding.
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Affiliation(s)
| | - Mikhael Belkovsky
- Universidade de São Paulo – Medical School – Surgical Technique Department – São Paulo (SP) – Brazil
| | - Carlo Camargo Passerotti
- Hospital Alemão Oswaldo Cruz – Prostate Institute – Urology Department – São Paulo (SP) – Brazil
| | | | - Jose Pinhata Otoch
- Universidade de São Paulo – Medical School – Surgical Technique Department – São Paulo (SP) – Brazil
| | - José Arnaldo Shiomi da Cruz
- Universidade Nove de Julho – Urology Department – São Paulo (SP) – Brazil
- Universidade de São Paulo – Medical School – Surgical Technique Department – São Paulo (SP) – Brazil
- Hospital Alemão Oswaldo Cruz – Prostate Institute – Urology Department – São Paulo (SP) – Brazil
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Agrawal S, Survase P, Singh AG, Ganpule AP, Sabnis RB, Desai MR. Initial experience of comparison between two slimmest single-use flexible ureteroscopes: Indoscope Sleek (Bioradmedisys™) Versus Uscope PU3033A (Pusen™): A single-center prospective study. World J Urol 2023; 41:2817-2821. [PMID: 37543971 DOI: 10.1007/s00345-023-04532-7] [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: 05/07/2023] [Accepted: 07/07/2023] [Indexed: 08/08/2023] Open
Abstract
PURPOSE A single-use digital flexible ureteroscope (fURS) has become a cost-effective alternative option to reusable fURS. The requirement of large-diameter access sheath for passage of 9.5 Fr single-use fURS has not always achieved in the first attempt in all cases leading to stage stone clearance. Recently, two slimmest single-use digital disposable fURSs have been introduced by Bioradmedisys™ and Pusen™ to mitigate the accessibility problem, without or with small size access sheath. Primary objective was to compare in vivo performance and surgical outcomes with two single-use fURS: 7.5Fr Indoscope (Bioradmedisys™, Pune, India) and 7.5Fr Uscope PU3033A (Pusen, Zhuhai, China). METHODS 60 patients undergoing Retrograde Intrarenal Surgery (RIRS) with < 2 cm renal stones were prospectively randomized into: Group A (30 patients) for Indoscope and Group B (30 patients) for Uscope PU3033A. Pre-operative, intra-operative, and post-operative parameters were evaluated. In vivo visibility and maneuverability were rated on 5-point Likert scale by the operating surgeon. At one-month stone clearance was assessed with ultrasound and X-ray KUB. Data were analyzed using SPSS 23.0. RESULTS Patient demographics and stone characteristics were comparable in both groups. Indoscope had significantly higher visibility (p < 0.05) than Uscope; however, the maneuverability scores were comparable between both the groups (p > 0.05). 28 patients in group A and 26 patients in group B achieved complete stone clearance (p = 0.38). Scope failure was observed in 1 case of group B (p = 0.31). CONCLUSION We conclude that 7.5Fr Indoscope has better vision than 7.5Fr Uscope and the rest of in vivo performances were comparable with similar outcomes and complications among both scopes.
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Affiliation(s)
- Shashank Agrawal
- Department of Urology, Muljibhai Patel Urological Hospital, Dr Virendra Desai Road, Nadiad, Gujarat, 387991, India.
| | - Pavan Survase
- Department of Urology, Muljibhai Patel Urological Hospital, Dr Virendra Desai Road, Nadiad, Gujarat, 387991, India
| | - Abhishek G Singh
- Department of Urology, Muljibhai Patel Urological Hospital, Dr Virendra Desai Road, Nadiad, Gujarat, 387991, India
| | - Arvind P Ganpule
- Department of Urology, Muljibhai Patel Urological Hospital, Dr Virendra Desai Road, Nadiad, Gujarat, 387991, India
| | - Ravindra B Sabnis
- Department of Urology, Muljibhai Patel Urological Hospital, Dr Virendra Desai Road, Nadiad, Gujarat, 387991, India
| | - Mahesh R Desai
- Department of Urology, Muljibhai Patel Urological Hospital, Dr Virendra Desai Road, Nadiad, Gujarat, 387991, India
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Zeng G, Zhao Z, Mazzon G, Pearle M, Choong S, Skolarikos A, Denstedt J, Seitz C, Olvera Pasada D, Fiori C, Bosio A, Papatsoris A, Méndez Probst CE, Perez Fentes D, Ann Git K, Wu Q, Wiseman O, Emiliani E, Farahat Y, Ilker Gökce M, Giannakopoulos S, Goumas Kartalas I, Somani B, Knoll T, de la Rosette J, Zhong J, Vinicius Maroccolo M, Saltirov L, Chew B, Wang K, Lahme S, Giusti G, Ferretti S, Yong Cho S, Geavlete P, Cansino R, Kamphuis GM, Smith D, Matlaga BR, Ghani KD, Bernardo N, Silva AD, Ng ACF, Yang S, Gao X, Traxer O, Miernik A, Liatsikos E, Priyakant Parikh K, Duvdevani M, Celia A, Yasui T, Aquino A, Alomar M, Choonhaklai V, Erkurt B, Glass J, Sriprasad S, Osther PJ, Keeley FX, Preminger GM, Cepeda Delgado M, Beltran Suarez E, Ye Z, Sarica K. European Association of Urology Section of Urolithiasis and International Alliance of Urolithiasis Joint Consensus on Retrograde Intrarenal Surgery for the Management of Renal Stones. Eur Urol Focus 2022; 8:1461-1468. [PMID: 34836838 DOI: 10.1016/j.euf.2021.10.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 10/01/2021] [Accepted: 10/20/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Retrograde intrarenal surgery (RIRS) has become the preferred treatment modality for nephrolithiasis. However, because of ongoing uncertainties regarding the optimal perioperative management, operative technique, and postoperative follow-up, as well as a lack of standardization for outcome reporting, consensus is needed to achieve more uniform clinical practice worldwide. OBJECTIVE To develop recommendations for RIRS on the basis of existing data and expert consensus. DESIGN, SETTING, AND PARTICIPANTS A protocol-driven, three-phase study was conducted by the European Association of Urology Section of Urolithiasis (EULIS) and the International Alliance of Urolithiasis (IAU). The process included: (1) a nonsystematic review of the literature to define domains for discussion; (2) a two-round modified Delphi survey involving experts in this field; and (3) an additional group meeting and third-round survey involving 64 senior representative members to formulate the final conclusions. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The results from each previous round were returned to the participants for re-evaluation of their decisions during the next round. The agreement threshold was set at 70%. RESULTS AND LIMITATIONS The panel included 209 participants who developed 29 consensus statements on the following topics of interest: (1) perioperative infection management; (2) perioperative antithrombotic therapy; (3) fundamentals of the operative technique; and (4) standardized outcome reporting. Although this consensus can be considered as a useful reference for more clinically oriented daily practice, we also acknowledge that a higher level of evidence from further clinical trials is needed. CONCLUSIONS The consensus statements aim to guide and standardize clinical practice and research on RIRS and to recommend standardized outcome reporting. PATIENT SUMMARY An international consensus on the best practice for minimally invasive surgery for kidney stones was organized and developed by two international societies. It is anticipated that this consensus will provide further guidance to urologists and may help to improve clinical outcomes for patients.
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Affiliation(s)
- Guohua Zeng
- Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
| | - Zhijian Zhao
- Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Giorgio Mazzon
- Department of Urology, San Bassiano Hospital, Vicenza, Italy
| | - Margaret Pearle
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Simon Choong
- Institute of Urology, University College Hospital London, London, UK
| | - Andreas Skolarikos
- Second Department of Urology, Sismanoglio General Hospital, Athens, Greece
| | - John Denstedt
- Division of Urology, Western University, London, ON, Canada
| | - Christian Seitz
- Department of Urology, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Daniel Olvera Pasada
- Department of Urology, Hospital Zambrano Hellion, TecSalud, San Pedro Garza García, Mexico
| | - Cristian Fiori
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Andrea Bosio
- Department of Urology, Città della Salute e della Scienza, Molinette University Hospital, Turin, Italy
| | | | | | - Daniel Perez Fentes
- Department of Urology, University Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
| | - Kah Ann Git
- Department of Urology, Pantai Hospital, Penang, Malaysia
| | - Qinghui Wu
- Urology Center, National University Hospital, Singapore
| | - Oliver Wiseman
- Department of Urology, Cambridge University Hospitals, Cambridge, UK
| | | | - Yasser Farahat
- Department of Urology, Sheikh Khalifa General Hospital, Umm Al Quwain, United Arab Emirates
| | - Mehmet Ilker Gökce
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | | | | | - Bhaskar Somani
- Department of Urology, University Hospital Southampton, Southampton, UK
| | - Thomas Knoll
- Department of Urology, Mannheim University Hospital, Mannheim, Germany
| | - Jean de la Rosette
- Department of Urology, Medipol Mega University Hospital, Istanbul Medipol University, Istanbul, Turkey
| | - Jiehui Zhong
- Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | | | - Lliya Saltirov
- Department of Urology and Nephrology, Military Medical Academy, Sofia, Bulgaria
| | - Ben Chew
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Kunjie Wang
- Department of Urology, West China Hospital of Sichuan University, Chengdu, China
| | - Sven Lahme
- Department of Urology, Siloah St. Trudpert Hospital, Pforzheim, Germany
| | - Guido Giusti
- Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Stefania Ferretti
- Department of Urology, Hospital and University of Parma, Parma, Italy
| | - Sung Yong Cho
- Department of Urology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Petrisor Geavlete
- Department of Urology, Saint John Emergency Clinical Hospital, Bucharest, Romania
| | - Ramon Cansino
- Department of Urology, La Paz University Hospital, Madrid, Spain
| | - Guido M Kamphuis
- Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Daron Smith
- Institute of Urology, University College Hospital London, London, UK
| | - Brian R Matlaga
- Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Khurshid D Ghani
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Norberto Bernardo
- Department of Urology, Hospital de Clinicas Jose de San Martin, Buenos Aires, Argentina
| | - Andres D Silva
- Department of Urology, Hospital del Salvador, Salvador, Chile
| | - Anthony C F Ng
- SH Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Sixing Yang
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xiaofeng Gao
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | | | - Arkadiusz Miernik
- Department of Urology, Faculty of Medicine, University of Freiburg Medical Centre, Freiburg, Germany
| | - Evangelos Liatsikos
- Department of Urology, University Hospital of Patras, University of Patras, Patras, Greece
| | - Kandarp Priyakant Parikh
- Department of Genitourinary Surgery, Minimal Access Surgery Training Institute, Shyam Urosurgical Hospital, Ahmedabad, Gujarat, India
| | - Mordechai Duvdevani
- Department of Urology, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Antonio Celia
- Department of Urology, San Bassiano Hospital, Bassano del Grappa, Italy
| | - Takahiro Yasui
- Department of Nephrourology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Albert Aquino
- Department of Urology, Jose R. Reyes Memorial Medical Center, Manila, Philippines
| | - Mohammad Alomar
- Department of Urology, King Khalid University Hospital & Research Centre, Riyadh, Saudi Arabia
| | | | - Bulent Erkurt
- Department of Urology, Istanbul Medipol University, Istanbul, Turkey
| | - Jonathan Glass
- Department of Urology, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Seshadri Sriprasad
- Department of Urology, Darent Valley Hospital, Dartford and Gravesham NHS Trust, Dartford, UK
| | - Palle J Osther
- Department of Urology, Lillebaelt Hospital, Vejle, Denmark
| | - Francis X Keeley
- Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK
| | - Glenn M Preminger
- Department of Urology, Duke University Medical Center, Durham, NC, USA
| | | | - Edgar Beltran Suarez
- Department of Urology, Specialty Hospital La Raza, National Medical Center of the Mexican Institute of Social Security, Mexico City, Mexico
| | - Zhangqun Ye
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kemal Sarica
- Department of Urology, Biruni University, Medical School, Istanbul, Turkey.
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5
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De Coninck V, Somani B, Sener ET, Emiliani E, Corrales M, Juliebø-Jones P, Pietropaolo A, Mykoniatis I, Zeeshan Hameed BM, Esperto F, Proietti S, Traxer O, Keller EX. Ureteral Access Sheaths and Its Use in the Future: A Comprehensive Update Based on a Literature Review. J Clin Med 2022; 11:jcm11175128. [PMID: 36079058 PMCID: PMC9456781 DOI: 10.3390/jcm11175128] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 08/27/2022] [Accepted: 08/29/2022] [Indexed: 11/21/2022] Open
Abstract
Ureteral access sheaths (UASs) are part of urologist’s armamentarium when performing retrograde intrarenal surgery (RIRS). Recently, the world of RIRS has changed dramatically with the development of three game-changers: thulium fiber laser (TFL), smaller size single use digital flexible ureterosopes and intraoperative intrarenal pressure (IRP) measurement devices. We aimed to clarify the impact of UASs on IRP, complications and SFRs and put its indications in perspective of these three major technological improvements. A systematic review of the literature using the Medline, Scopus and Web of Science databases was performed by two authors and relevant studies were selected according to PRISMA guidelines. Recent studies showed that using a UAS lowers IRP and intrarenal temperature by increasing irrigation outflow during RIRS. Data on the impact of a UAS on SFRs, postoperative pain, risk of infectious complications, risk of ureteral strictures and risk of bladder recurrence of urothelial carcinoma after diagnostic RIRS were inconclusive. Prestenting for at least one week resulted in ureteral enlargement, while the influence of pre-operative administration of alpha-blockers was unclear. Since TFL, smaller single use digital ureteroscopes and devices with integrated pressure-measuring and aspiration technology seemed to increase SFRs and decrease pressure and temperature related complications, indications on the use of a UAS may decrease in the near future.
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Affiliation(s)
- Vincent De Coninck
- Department of Urology, AZ Klina, 2930 Brasschaat, Belgium
- Young Academic Urologists (YAU), Urolithiasis & Endourology Working Party, 6846 Arnhem, The Netherlands
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), 75020 Paris, France
- Correspondence: ; Tel.: +32-3-650-50-56
| | - Bhaskar Somani
- Department of Urology, University Hospital Southampton, Southampton SO16 6YD, UK
| | - Emre Tarik Sener
- Young Academic Urologists (YAU), Urolithiasis & Endourology Working Party, 6846 Arnhem, The Netherlands
- Department of Urology, Marmara University School of Medicine, Istanbul 34854, Turkey
| | - Esteban Emiliani
- Young Academic Urologists (YAU), Urolithiasis & Endourology Working Party, 6846 Arnhem, The Netherlands
- Department of Urology, Fundacio Puigvert, Autonomous University of Barcelona, 08025 Barcelona, Spain
| | - Mariela Corrales
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), 75020 Paris, France
- Service d’Urologie, AP-HP, Hôpital Tenon, Sorbonne Université, 75020 Paris, France
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020 Paris, France
| | - Patrick Juliebø-Jones
- Department of Urology, Haukeland University Hospital, N-5021 Bergen, Norway
- Department of Clinical Medicine, University of Bergen, N-5021 Bergen, Norway
| | - Amelia Pietropaolo
- Young Academic Urologists (YAU), Urolithiasis & Endourology Working Party, 6846 Arnhem, The Netherlands
- Department of Urology, University Hospital Southampton, Southampton SO16 6YD, UK
| | - Ioannis Mykoniatis
- Young Academic Urologists (YAU), Urolithiasis & Endourology Working Party, 6846 Arnhem, The Netherlands
- Department of Urology, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Belthangady M. Zeeshan Hameed
- Young Academic Urologists (YAU), Urolithiasis & Endourology Working Party, 6846 Arnhem, The Netherlands
- Department of Urology, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal 576104, India
| | - Francesco Esperto
- Young Academic Urologists (YAU), Urolithiasis & Endourology Working Party, 6846 Arnhem, The Netherlands
- Department of Urology, Campus Bio-Medico University, 00128 Rome, Italy
- Unit of Urology, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
| | - Silvia Proietti
- Department of Urology, IRCCS San Raffaele Hospital, 20132 Milan, Italy
| | - Olivier Traxer
- Service d’Urologie, AP-HP, Hôpital Tenon, Sorbonne Université, 75020 Paris, France
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, 75020 Paris, France
| | - Etienne Xavier Keller
- Young Academic Urologists (YAU), Urolithiasis & Endourology Working Party, 6846 Arnhem, The Netherlands
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), 75020 Paris, France
- Department of Urology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
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6
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Aykanat C, Balci M, Senel C, Ozercan AY, Coser S, Aslan Y, Guzel O, Asfuroglu A, Karabulut E, Tuncel A. The Impact of Ureteral Access Sheath Size on Perioperative Parameters and Postoperative Ureteral Stricture in Retrograde Intrarenal Surgery. J Endourol 2022; 36:1013-1017. [PMID: 35229631 DOI: 10.1089/end.2021.0751] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To investigate the effect of the diameter of UAS used during RIRS on operative parameters, perioperative ureteral injury, and ureteral stricture development. MATERIAL AND METHOD The study was designed as a prospective randomized controlled trial and included 320 patients who underwent RIRS. The patients were divided into two groups according to UAS diameter (9.5/11.5 Fr (Group 1) and 12/14 Fr (Group 2)) were used during the operation. At the end of the operation, ureteral injury was checked visually using semi-rigid ureterorenoscopy and classified according to the ureter injury scale. In the postoperative first year, the control CT urography images used to newly developed ureteral dilation. RESULTS There was no statistical difference between the two groups in terms of patient and stone characteristics, operative time, postoperative stone-free rate, and postoperative infection development parameters. In Group 1, 30 (18.8%) of the patients had low-grade and 8 (5%) of the patients had high-grade ureteral injury while in Group 2, 44 (27.5%) had low-grade and 19 (11.9%) had high-grade ureteral injury (p=0.013). In the postoperative period, ureteral stricture was found in 5 (1.6%) patients, of whom 4 (2.5%) were in Group 2 and 1 (0.6%) (p=0.371). CONCLUSION The results of our study showed that the use of a 12/14 Fr UAS in patients who are not previously stented, increases the risk of high grade ureteral injuries, however, despite this increase there is no difference in ureteral stricture formation.
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Affiliation(s)
| | - Melih Balci
- Ankara Numune Training and Research Hospital, 64134, Urology, Talatpasa Blv, Ankara, Turkey, 06100;
| | - Cagdas Senel
- numune eğitim ve araştırma hastanesi b blok 3.kat üroloji a kliniğiAnkara, Turkey, 06100;
| | | | | | | | | | | | - Erdem Karabulut
- Hacettepe University Faculty of Medicine, 64005, Biostatistics, Ankara, Ankara, Turkey;
| | - Altug Tuncel
- Ankara Numune Research and Training Hospital, urology, Sihhiye, Ankara, Turkey, 06120.,Turkey;
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7
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Tsaturyan A, Kalogeropoulos G, Lattarulo M, Adamou C, Pagonis K, Peteinaris A, Liourdi D, Vrettos T, Liatsikos E, Kallidonis P. The use of 14/16Fr ureter access sheath for safe and effective management of large upper ureteral calculi. World J Urol 2022; 40:1217-1222. [PMID: 35150299 DOI: 10.1007/s00345-022-03949-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 01/24/2022] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE To evaluate the effectiveness of ureteroscopic lithotripsy for the management of large proximal ureteral stones > 10 mm using 14/16 Fr ureteral access sheath (UAS). MATERIALS AND METHODS Patients' data from prospective database undergoing ureteroscopic laser lithotripsy with a use of 14/16Fr UAS were collected. All patients were pre-stented prior to the procedure. The fragmentation was performed with a semi-rigid ureteroscope using holmium laser energy with a power setting of 35 W (frequency-35 Hz; energy-1 J). Follow-up was scheduled at 4 weeks and 3 months postoperatively. RESULTS In total 78 patients, 43 males and 35 females, were included in the study. The mean age of the patients was 59.5 ± 13.3 with a mean maximal stone diameter of 13.4 ± 2.1. The mean operative time was 35.7 ± 9.7 and the mean hospital stay was 2 ± 0.7 days. The primary SFR at 4 weeks was 73 patients (93.6%), while all 78 patients (100%) were stone free at 3-month follow-up, 2 of the patients receiving additional treatment. In total, 8 (10.2%) patients experienced Grade II complications. Intraoperative ureteral lesions were observed in 41 (52.6%) cases. Out of them 31 patients (39.7%) developed Grade 1, 8 patients (10.3%) Grade 2 and only 3 patients (2.6%) Grade 3 lesions. CONCLUSION The use of 14/16Fr ureteral access sheath on pre-stented patients was associated with successful outcomes. A high stone-free rate of 93.6% was achieved at 4-week follow-up. The procedure was not associated with increased rate of postoperative complications and intraoperative ureteral injury.
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Affiliation(s)
- Arman Tsaturyan
- Department of Urology, University of Patras Medical School, Rio, 26500, Patras, Greece.
| | - George Kalogeropoulos
- Department of Urology, University of Patras Medical School, Rio, 26500, Patras, Greece
| | - Marco Lattarulo
- Department of Urology, University of Patras Medical School, Rio, 26500, Patras, Greece
| | - Constantinos Adamou
- Department of Urology, University of Patras Medical School, Rio, 26500, Patras, Greece
| | - Konstantinos Pagonis
- Department of Urology, University of Patras Medical School, Rio, 26500, Patras, Greece
| | - Angelis Peteinaris
- Department of Urology, University of Patras Medical School, Rio, 26500, Patras, Greece
| | - Despoina Liourdi
- Department of Urology, University of Patras Medical School, Rio, 26500, Patras, Greece
| | - Theofanis Vrettos
- Department of Anesthesiology and ICU, University of Patras, Patras, Greece
| | - Evangelos Liatsikos
- Department of Urology, University of Patras Medical School, Rio, 26500, Patras, Greece.,Department of Urology, Medical University of Vienna, Vienna, Austria.,Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Panagiotis Kallidonis
- Department of Urology, University of Patras Medical School, Rio, 26500, Patras, Greece
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8
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Jiang P, Afyouni AS, Brevik A, Peta A, King T, Dinh ST, Ayad M, Larson K, Limfueco L, Kosmala CM, Sharifi H, Patel RM, Landman J, Clayman R. The Impact of One Week of Pre-stenting on Porcine Ureteral Luminal Circumference. J Endourol 2022; 36:885-890. [PMID: 35044235 DOI: 10.1089/end.2021.0771] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES Larger ureteral access sheaths (UAS) have the potential to improve ureteroscopic stone removal outcomes, but are often avoided by surgeons due to concerns of ureteral injury. Using our novel UAS force sensor and previously defined force thresholds for ureteral injury, we sought to evaluate the impact of one week of stenting on the maximum safe dilation of ureteral luminal circumference. METHODS Twelve juvenile female Yorkshire pigs (24 ureters) were evaluated. The inner (i.e. luminal) circumference of each ureter was determined using Cook urethral dilators ranging from 8-24Fr in 2Fr increments, 37cm in length. Each dilator was sequentially passed while applying the UAS force sensor to measure insertion force before and after one week of stent placement. Each ureter was randomized to receive either a 4.7Fr or 7.0Fr stent (20cm). Maximum ureteral luminal circumference was defined as successful passage of the dilator to the ureteropelvic junction with <6 newtons (N) of force (the force threshold previously defined by porcine and clinical studies to avoid ureteral damage). Following passage of the largest dilator at 6N, flexible ureteroscopy was performed and a post-ureteroscopic lesion score (PULS) was recorded. RESULTS After one week of stent placement, the median ureteral luminal circumference increased to 15Fr representing a mean increase of 3.8Fr + 2.8 (p<0.001). Twenty-one (88%) of the pre-stented ureters had an increase in luminal circumference, with 12 ureters (50%) dilated to >16Fr (p=0.032), six ureters (25%) dilated to >18Fr, and in two cases a maximum size of 24Fr was recorded. The PULS grade was < 2 in all cases, indicating no high grade ureteral injuries. Laterality and stent size did not impact ureteral luminal circumference after pre-stenting (p=0.232 and p=0.337, respectively). CONCLUSIONS One week of ureteral stenting resulted in nearly a 4Fr increase in the luminal circumference of porcine ureters.
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Affiliation(s)
- Pengbo Jiang
- University of California Irvine, 8788, Urology, Orange, California, United States;
| | - Andrew S Afyouni
- University of California Irvine, 8788, Urology, Orange, California, United States;
| | - Andrew Brevik
- University of California Irvine, 8788, Urology, Orange, California, United States;
| | - Akhil Peta
- University of California Irvine, 8788, Urology, Orange, California, United States;
| | - Tori King
- University of California Irvine, 8788, Urology, Orange, California, United States;
| | - Samantha T Dinh
- University of California Irvine, 8788, Urology, Orange, California, United States;
| | - Maged Ayad
- University of California Irvine, 8788, Urology, Orange, California, United States;
| | - Krista Larson
- University of California Irvine, 8788, Urology, Orange, California, United States;
| | - Luke Limfueco
- University of California Irvine, 8788, Urology, Orange, California, United States;
| | - Christina M Kosmala
- University of California Irvine, 8788, Urology, Orange, California, United States;
| | - Hossein Sharifi
- University of California Irvine, 8788, Urology, Orange, California, United States;
| | - Roshan M Patel
- University of California Irvine, 8788, Urology, Orange, California, United States;
| | - Jaime Landman
- University of California Irvine, 8788, Urology, Orange, California, United States;
| | - Ralph Clayman
- University of California Irvine, 8788, Urology, Orange, California, United States;
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9
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Al-Aown A, Asutay M, Lattarulo M, Liourdi D, Pagonis K, Nedal N, Pietropaolo A, Emiliani E, Liatsikos E, Kallidonis P. Does ureteral access sheath have an impact on ureteral injury? Urol Ann 2022; 14:1-7. [PMID: 35197695 PMCID: PMC8815358 DOI: 10.4103/ua.ua_163_20] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 07/19/2021] [Indexed: 11/25/2022] Open
Abstract
Objective: To present a well-organized review about ureteral access sheath impact on ureteral injury. Materials and Methods: Systemic search on literature was done. Total of 3766 studies observed by two urologists and results were unified. A Prisma diagram was used for eliminating irrelevant studies and at the end of elimination process 28 studies were found eligible for this review. Results: Not only clinical studies but also comparative experimental animal studies show that there is no significant data to claim that ureteral access sheath insertion causes more ureteral injury. Pre-stented patients were found to be at lower risk for ureteral injury. Risk of progression to ureteral injury seems to be low even if ureteral injury occurs with insertion of ureteral access sheath. Conclusion: Summary of studies’ results indicate that use of ureteral access sheath doesn’t increase ureteral injury. This review may help understanding safety profile of ureteral access sheath on evidence-based level. There is not enough data to make a statement that ureteral access sheath prevents ureteral injury.
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10
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Kati B, Pelit ES, Demir M, Yagmur I, Tuncekin A, Ciftci H. Do we have a limit for retrograde intrarenal surgery for solitary kidney stone? Arch Ital Urol Androl 2021; 93:318-322. [PMID: 34839637 DOI: 10.4081/aiua.2021.3.318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 06/27/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The management of urolithiasis in patients with a solitary kidney is challenging for urologists. This study aimed to evaluate the safety of retrograde intrarenal surgery (RIRS) in the treatment of stones in patients with solitary kidney and to reply to the question if there is any limit for this surgery. METHODS Between January 2016 and December 2019, we enrolled 52 patients who had a solitary kidney and underwent RIRS. We collected data on preoperative patient characteristics, stone dimensions, and postoperative outcomes. Stone size, duration of operation, duration of fluoroscopy, type of anesthesia, and degree of surgical complication were evaluated retrospectively. Surgeries performed in less and more than 60 minutes and with and without complications were compared. RESULTS A total of 52 patients with a kidney stone and a solitary kidney were evaluated. The mean stone size was 14 ± 0.4 cm and surgical success rate was 87.3%. In our study, 13 patients (24.5%) had grade 1 minor complications, and none required a blood transfusion. The mean operation time was 51.9 ± 17.3 minutes. The postoperative creatinine value increased in 6 patients. The duration of operation in the group with complications was significantly higher than that in the group without complications. In patients who underwent an operation lasting ≥ 60 minutes, stone size, fluoroscopy time, and complication rate were significantly higher than in patients who underwent an operation lasting ≤ 60 minutes. CONCLUSION Our opinion is to be careful in patients with a solitary kidney with a big stone and we recommend assigning these procedure to experienced hands for not exceeding 60 minutes in one session.
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Affiliation(s)
- Bulent Kati
- Harran University, Faculty of Medicine, Urology Department, Sanliurfa.
| | - Eyyup Sabri Pelit
- Harran University, Faculty of Medicine, Urology Department, Sanliurfa.
| | - Mehmet Demir
- Harran University, Faculty of Medicine, Urology Department, Sanliurfa.
| | - Ismail Yagmur
- Harran University, Faculty of Medicine, Urology Department, Sanliurfa.
| | - Adem Tuncekin
- Harran University, Faculty of Medicine, Urology Department, Sanliurfa.
| | - Halil Ciftci
- Harran University, Faculty of Medicine, Urology Department, Sanliurfa.
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Gupta R, Mahajan A, Gupta S, Masood S. Outcomes of flexible uretrorenoscopy for solitary renal stones up to 15 mm, hits and misses: A single-surgeon experience. Urol Ann 2021; 13:258-262. [PMID: 34421261 PMCID: PMC8343271 DOI: 10.4103/ua.ua_51_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 08/16/2020] [Accepted: 11/27/2020] [Indexed: 11/12/2022] Open
Abstract
Abstract: Introduction: In this study, we retrospectively evaluated the outcomes of flexible uretrorenoscopy (fURS) for removal of solitary renal stones sized up to 15 mm. Material and Methods: We evaluated the data of 115 patients who underwent fURS at our unit between Jan 2018 and Dec 2019. All fURS were performed by a single surgeon using Flex-2 flexiscope. Ureteral Access sheath (UAS) of size 9/11 fr was used in all patients. Stones were fragmented using 20 watts laser. Few fragments were retrieved using Nitinol zero tip basket for assessment of the passability of remaining dust and sent for stone analysis. Data pertaining to demographic characteristics, stone size, stone site, operative time, intra and post operative complications were retrieved from the records. Results: Of the 115 patients who underwent fURS, 71 (61.7%) were male and 44 (38.2%) were female. Average age of patients was 32.9±8.9 years; the average body mass index was 22.9±3.9 kg/m2. Average size of the stone was 11.0±1.5 × 10.2±1.3 mm. The stone free rates at the end of 3 weeks and 3 months were 97% and 99%, respectively. Conclusion: fURS is an effective minimally-invasive procedure for removal of single stones up to 15 mm in size. We observed minimal morbidity rates and acceptable stone free rates in our series.
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Affiliation(s)
- Rahul Gupta
- Department of Urology, Government Medical College, Jammu, Jammu and Kashmir, India
| | - Arti Mahajan
- Department of Anaesthesia, Government Medical College, Jammu, Jammu and Kashmir, India
| | - Sunana Gupta
- Department of Anaesthesia, ASCOMS, Jammu, Jammu and Kashmir, India
| | - Suhail Masood
- Department of Anaesthesia, Government Medical College, Jammu, Jammu and Kashmir, India
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12
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Sancak EB, Basatac C, Akgul HM, Cinar O, Ozman O, Yazıcı CM, Akpinar H. The effect of optical dilatation before retrograde intrarenal surgery on success and complications: Results of the RIRSearch group study. Int J Clin Pract 2021; 75:e14335. [PMID: 33960069 DOI: 10.1111/ijcp.14335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 05/03/2021] [Indexed: 11/26/2022] Open
Abstract
AIM The guidelines propose optical dilatation before retrograde intrarenal surgery (RIRS), but there are currently no evidence-based studies concerning the impact of optical dilatation with semirigid ureteroscopy (sURS). The aim of this study was to evaluate the effect of optical dilatation through sURS prior to the RIRS procedure on the success and complications of RIRS. METHODS A total of 422 patients were included in the retrospective multicentre study. The patients were divided into two groups according to whether sURS was to be performed. Patients' demographics, stone parameters and operative outcomes were compared. Surgical success was defined as no or up to 3-mm residual stone fragments without the need for additional procedures. The independent predictors for surgical success were determined with a multivariable logistic regression model. RESULTS Of the 422 patients, 133 (31.5%) were in the sURS group and 289 (68.5%) were in the non-sURS group. Stone characteristics and patients' demographics were similar between the groups. Operation time in the sURS group was significantly longer (compared with the non-sURS group, P < .0001). A ureteral access sheath (UAS) could not be placed in four (3.0%) patients in the sURS group, nor in 25 (8.7%) patients in the non-sURS group (P = .03). Compared with the non-sURS group, the intraoperative complication rate was lower in the sURS group (14 [4.8%] vs 1 [0.8%], P = .04). The surgical success rate was higher in the sURS group (P = .002). Nevertheless, sURS had no independent effect on surgical success. We found two independent predictors for surgical success rate: stone number (P < .0001, OR:2.28) and failed UAS placement (P = .035, OR:3.49). CONCLUSIONS Optical dilatation with sURS before RIRS increases surgical success by raising the rate of UAS placement and reducing the rate of intraoperative complications. We suggest that this method can be routinely applied to patients who have not been passively dilated with a JJ stent.
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Affiliation(s)
- Eyup Burak Sancak
- Department of Urology, Canakkale Onsekiz Mart University Faculty of Medicine, Canakkale, Turkey
| | - Cem Basatac
- Department of Urology, Florence Nightingale Hospital, Istanbul, Turkey
| | - Hacı Murat Akgul
- Department of Urology, Tekirdag Namık Kemal Faculty of Medicine, Tekirdag, Turkey
| | - Onder Cinar
- Department of Urology, Zonguldak Bulent Ecevit University Faculty of Medicine, Zonguldak, Turkey
| | - Oktay Ozman
- Department of Urology, Istanbul Gaziosmanpasa Training and Research Hospital, Istanbul, Turkey
| | - Cenk Murat Yazıcı
- Department of Urology, Tekirdag Namık Kemal Faculty of Medicine, Tekirdag, Turkey
| | - Haluk Akpinar
- Department of Urology, Florence Nightingale Hospital, Istanbul, Turkey
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13
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Meier K, Hiller S, Dauw C, Hollingsworth J, Kim T, Qi J, Telang J, Ghani KR, Jafri SMA. Understanding Ureteral Access Sheath Use Within a Statewide Collaborative and Its Effect on Surgical and Clinical Outcomes. J Endourol 2021; 35:1340-1347. [PMID: 33827269 DOI: 10.1089/end.2020.1077] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Introduction: Ureteral access sheaths (UASs) are frequently used during ureteroscopy (URS), but their use is not without potential risk. We investigated patterns of UAS use and associated outcomes across practices in Michigan within a quality improvement collaborative. Methods: The Michigan Urological Surgery Improvement Collaborative (MUSIC) Reducing Operative Complications from Kidney Stones (ROCKS) initiative maintains a web-based, prospective clinical registry of patients undergoing URS for urinary stone disease (USD). We analyzed all patients undergoing primary URS for renal and ureteral stones from June 2016 to July 2018 in the ROCKS registry. We determined rates of UAS usage across practices and associated outcomes, including 30-day emergency department (ED) visits and hospitalization, as well as stone-free rates. Using multivariate logistical regression, we determined the predictors of UAS use as well as outcomes, including stone-free rates, ED visits, and hospitalizations, associated with UAS use. Results: Of the 5316 URS procedures identified, UASs were used in 1969 (37.7%) cases. Stones were significantly larger and more likely to be located in the kidney in cases with UAS use. UAS use during URS varied greatly across practices (1.9%-96%, p < 0.05). After adjusting for clinical and surgical risk factors, UAS use significantly increased the odds of postoperative ED visits (odds ratio [OR] = 1.50, 95% confidence interval [CI] 1.17-1.93, p < 0.05) and hospitalization (OR = 1.77, 95% CI 1.22-2.56, p < 0.05) as well as decreased the odds of being stone free (OR = 0.75, 95% CI 0.57-0.99, p < 0.05). Conclusions: In the current study, UAS use during URS for USD was not associated with an increased likelihood of being stone free; moreover, it increased the odds of a postoperative ED visit and or hospitalization. Our findings demonstrate that UAS use is not without risk and should be employed judiciously.
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Affiliation(s)
- Kristen Meier
- Department of Urology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA
| | - Spencer Hiller
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Casey Dauw
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Tae Kim
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Ji Qi
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Jaya Telang
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Khurshid R Ghani
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - S Mohammad A Jafri
- Department of Urology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA
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14
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Agrawal S, Patil A, Sabnis RB, Singh AG, Ganpule AP, Desai MR. Initial experience with slimmest single-use flexible ureteroscope Uscope PU3033A (PUSEN™) in retrograde intrarenal surgery and its comparison with Uscope PU3022a: a single-center prospective study. World J Urol 2021; 39:3957-3962. [PMID: 33970313 DOI: 10.1007/s00345-021-03707-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 04/19/2021] [Indexed: 01/13/2023] Open
Abstract
PURPOSE Single-use disposable digital flexible ureterorenoscope has become an attractive option to reusable scope with many advantages. Currently available single-use digital fURS have outer shaft diameter above 9 Fr which requires large access sheath insertion and sometimes double J stent placement. Recently, 7.5 Fr single-use digital fURS is introduced in market by Pusen. Objective of this study is to compare two Pusen single-use scopes in the clinical setting: 7.5 Fr Uscope PU3033A and 9.5 Fr Uscope PU3022A. METHODS 30 patients, having renal stones < 2 cm, planned for RIRS were prospectively randomized to two groups: group 1 had 15 patients in which 7.5 Fr Uscope PU3033A and group 2 had 15 patients in which 9.5 Fr Uscope PU3022A was used. The various pre-operative, intra-operative, and post-operative parameters at 1 month along with complications were evaluated for both the scopes by a single surgical team. RESULTS Pre-operative parameters including stone characteristics were comparable in both the groups. Three patients in group 2 needed ureteric dilatation prior to 11/13 access sheath insertion, while 10/12 Fr access sheath was placed in all patients in group 1 without manipulation (p = 0.06). Intra-operative vision was comparable in both scopes with an empty working channel and with laser. Hazy vision while lasing in two and one patient in group 1 and group 2, respectively (p = 0.54). In group 1, one had fever and UTI, while in group 2, one had fever post-operatively. CONCLUSION 7.5 Fr Uscope PU3033A could be introduced with smaller access sheath. The vision, deflection, maneuverability is comparable to 9.5 Fr Uscope PU3022a.
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Affiliation(s)
- Shashank Agrawal
- Muljibhai Patel Urological Hospital, Nadiad, India.
- Department of Urology, Muljibhai Patel Urological Hospital, Dr. Virendra Desai Road, Nadiad, Gujarat, 387991, India.
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15
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Ergani B, Ozbilen MH, Yalcın MY, Boyacıoglu H, Ilbey YO. The effect of hydronephrosis grade on stone-free rate in retrograde intrarenal stone surgery with flexible ureterorenoscopy. AMERICAN JOURNAL OF CLINICAL AND EXPERIMENTAL UROLOGY 2021; 9:194-201. [PMID: 34079853 PMCID: PMC8165711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 01/20/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Hydronephrosis, which may be caused by kidney stones in the collecting system, may induce permanent flank pain and damage to kidney function. In this study, we aimed to examine whether the presence of hydronephrosis in the patient has an effect on the stone-free rates in flexible ureterorenoscopy (FURS) applications. METHOD The study was carried out retrospectively with 164 patients. Stone size was calculated as volume in computed tomography. Preoperative patient demographic data, radiographic stone characteristics, operational findings, complication status and postoperative 1st month results were recorded. RESULT The mean stone-free rate was found to be 61.5%. It was determined that age, gender, side, number, size and the Hounsfield Unit of the stone, the presence of preoperative extracorporeal shock wave lithotripsy (ESWL) history and the presence of hydronephrosis and its degree did not affect the stone-free rate. However, it was concluded that preoperative percutaneous nephrolithotomy (PNL) application and prolonged operation time were found to affect statistically significant stone-free rate. In addition, '2' was found to be the cut-off value for hydronephrosis in the receiver operating characteristic analysis. CONCLUSION The presence of preoperative hydronephrosis does not decrease the success of FURS. However, it can be expected that the success of FURS will decrease as grade 2 or more severe grade of hydronephrosis. Therefore, we think that other treatment modalities such as ESWL and PNL should be prioritized in patients with grade 2 and more severe grade of hydronephrosis.
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Affiliation(s)
| | - Mert Hamza Ozbilen
- University Of Health Sciences Tepecik Training and Research Hospital Urology ClinicIzmir, Turkey
| | - Mehmet Yigit Yalcın
- University Of Health Sciences Tepecik Training and Research Hospital Urology ClinicIzmir, Turkey
| | - Hayal Boyacıoglu
- Ege University Faculty of Science, Department of StatisticsIzmir, Turkey
| | - Yusuf Ozlem Ilbey
- University Of Health Sciences Tepecik Training and Research Hospital Urology ClinicIzmir, Turkey
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16
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Ather MH, Sulaiman MN. Flexible ureteroscopy versus miniaturized percutaneous nephrolithotomy for renal stones of 1-2 cm. Fac Rev 2020; 9:29. [PMID: 33659961 PMCID: PMC7886059 DOI: 10.12703/r/9-29] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Technological advances and innovation in endourology have significantly reduced the indications of extracorporeal shockwave lithotripsy in the management of moderate-sized renal stones. In the last decade, we have witnessed a trend towards the use of finer scopes for percutaneous procedures instead of standard percutaneous nephrolithotomy (PCNL) (≥22 Fr). Miniaturized PCNL (mPCNL), i.e. miniPCNL (12–20 Fr), ultra-miniPCNL (11–13 Fr), mini-microPCNL (8 Fr), and microPCNL (<5 Fr), is increasingly being used. Concomitant developments in laser technology have provided a safe and effective stone fragmentation modality for use via flexible ureteroscopes (fURS). Technological advances in the design of fURS have improved not only the optics (fiber optic to chip-on-the-tip technology digital image) but also the ergonomics. Both the endourological techniques are extremely effective and safe, as shown in a multitude of good-quality studies. There are some differences in stone-free rate and complications. mPCNL in general has a higher stone-free rate, albeit with a slightly higher incidence of hemorrhagic complications. fURS often requires longer stenting time and longer period to achieve stone clearance, whereas mPCNL often needs ureteral catheter for only 24 hours and has a higher first day stone-free rate. fURS is a 1 day procedure compared to mPCNL, which requires patients to stay hospitalized for 2–3 days. It is therefore important to tailor the indications of these two procedures to the individual patient’s needs.
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Affiliation(s)
- M Hammad Ather
- Department of Surgery, Aga Khan University, Karachi, Pakistan
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17
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Shvero A, Zilberman DE, Dotan ZA, Laufer M, Fridman E, Winkler H, Kleinmann N. Endoscopic management of upper tract urothelial carcinoma-tips and tricks. Transl Androl Urol 2020; 9:1815-1820. [PMID: 32944545 PMCID: PMC7475684 DOI: 10.21037/tau.2020.01.07] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Ureteroscopic methods have been rapidly evolving in the last several decades. With advances in flexible devices, optics and laser technologies, the endourologic surgeon has now the tools to treat high-volume tumors, in difficult locations, with good oncologic outcome. This makes radical nephroureterectomy unnecessary in some cases. Endoscopy in the setting of UTUC will surely continue to evolve and become applicable to a wider selection of patients. In this review we describe the surgical technique and provide tips and tricks which we use in our practice of endoscopic retrograde treatment of upper-tract urothelial carcinoma.
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Affiliation(s)
- Asaf Shvero
- Department of Urology, Sheba Medical Center, Ramat Gan, Israel Affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dorit E Zilberman
- Department of Urology, Sheba Medical Center, Ramat Gan, Israel Affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Zohar A Dotan
- Department of Urology, Sheba Medical Center, Ramat Gan, Israel Affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Maneham Laufer
- Department of Urology, Sheba Medical Center, Ramat Gan, Israel Affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eddie Fridman
- Department of Pathology, Sheba Medical Center, Ramat Gan, Israel Affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Harry Winkler
- Department of Urology, Sheba Medical Center, Ramat Gan, Israel Affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nir Kleinmann
- Department of Urology, Sheba Medical Center, Ramat Gan, Israel Affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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