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Alharbi AS, Gameraddin M, Gareeballah A, Shrwani ZJ, Sindi MA, Alsaedi HI, Qurashi AA, Aloufi KM, Alshamrani AFA, Alzain AF. Assessment of Hounsfield Units and Factors Associated with Fragmentation of Renal Stones by Extracorporeal Shock Wave Lithotripsy: A Computerized Tomography Study. Tomography 2024; 10:90-100. [PMID: 38250954 PMCID: PMC10821390 DOI: 10.3390/tomography10010008] [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: 10/23/2023] [Revised: 01/06/2024] [Accepted: 01/09/2024] [Indexed: 01/23/2024] Open
Abstract
The success rate of extracorporeal shock wave lithotripsy (ESWL) is influenced by various factors, including stone density, and is determined through computed tomography scans in terms of Hounsfield units (HU). MATERIALS AND METHODS This retrospective single-center study was conducted in the King Fahad Hospital. Sixty-seven adult patients with renal and ureteric stones were selected randomly and enrolled in the study. Their ages ranged from 20 to 69 years. The patients were examined with non-contrast enhancement (NCCT) to assess the HU of their stones and were consequently treated with ESWL. RESULTS Of the 67 patients, 37.3% had stones that were completely fragmented, while 62.7% had stones that were partially fragmented. The HU, location of the stone, multiplicity of the stone, and patient age were found to be significant factors contributing to stone fragility (p-values < 0.05). The HU data were found to have a positive significant linear correlation with serum calcium (r = 0.28, p-value = 0.036), while serum acid had a negative correlation (r = -0.55, p-value < 0.001). Thus, the probability of calcium-containing stone formation increases with increased HU. In contrast, uric acid stone formation likely develops with decreasing HU with serum uric acid. Renal stones in patients with diabetes mellitus and hypertension were not completely fragmented compared to those without clinical history. CONCLUSIONS Mean HU, location of the stone, laterality, stone status, and the number of ESWL sessions are the most significant factors affecting stone fragility. CT attenuation values can predict the composition of stones from serum calcium and uric acid examinations. Hypertension and diabetes mellitus are risk factors for renal stone fragmentation.
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Affiliation(s)
- Abdallah Saud Alharbi
- Medical Imaging Department, King Fahad Hospital, Al-Madinah 42210, Saudi Arabia (Z.J.S.)
| | - Moawia Gameraddin
- Department of Diagnostic Radiology Technology, College of Applied Medical Sciences, Taibah University, Al-Madinah 41477, Saudi Arabia; (A.G.)
- Department of Diagnostic Radiology, Faculty of Radiological Sciences and Medical Imaging, Alzaiem Alazhari University, Khartoum 13311, Sudan
| | - Awadia Gareeballah
- Department of Diagnostic Radiology Technology, College of Applied Medical Sciences, Taibah University, Al-Madinah 41477, Saudi Arabia; (A.G.)
- Department of Diagnostic Radiology, Faculty of Radiological Sciences and Medical Imaging, Alzaiem Alazhari University, Khartoum 13311, Sudan
| | - Zahra Jibril Shrwani
- Medical Imaging Department, King Fahad Hospital, Al-Madinah 42210, Saudi Arabia (Z.J.S.)
| | - Moa’ath Abdullah Sindi
- Medical Imaging Department, King Fahad Hospital, Al-Madinah 42210, Saudi Arabia (Z.J.S.)
| | | | - Abdulaziz A. Qurashi
- Department of Diagnostic Radiology Technology, College of Applied Medical Sciences, Taibah University, Al-Madinah 41477, Saudi Arabia; (A.G.)
| | - Khalid M. Aloufi
- Department of Diagnostic Radiology Technology, College of Applied Medical Sciences, Taibah University, Al-Madinah 41477, Saudi Arabia; (A.G.)
| | - Abdullah Fahad A. Alshamrani
- Department of Diagnostic Radiology Technology, College of Applied Medical Sciences, Taibah University, Al-Madinah 41477, Saudi Arabia; (A.G.)
| | - Amel F. Alzain
- Department of Diagnostic Radiology Technology, College of Applied Medical Sciences, Taibah University, Al-Madinah 41477, Saudi Arabia; (A.G.)
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Comparison of Fragmentation and Dusting Modality Using Holmium YAG Laser during Ureteroscopy for the Treatment of Ureteral Stone: A Single-Center's Experience. J Clin Med 2022; 11:jcm11144155. [PMID: 35887919 PMCID: PMC9324266 DOI: 10.3390/jcm11144155] [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: 05/25/2022] [Revised: 07/06/2022] [Accepted: 07/15/2022] [Indexed: 12/10/2022] Open
Abstract
Laser ureteroscopic lithotripsy (URSL) is an efficacious treatment for ureteral stones. There have been few previous studies comparing the different energy and frequency settings for URSL in a single center. We compared these two laser modalities, which were simultaneously used in our medical center for the treatment of ureteral stones. Patients who underwent fragmentation or dusting laser URSL between September 2018 and June 2020 were retrospectively reviewed. We compared patients who underwent fragmentation and dusting laser and assessed the enhancing factors for stone free rate. There were a total of 421 patients with ureteral stones who met the study criteria. There was no significant difference between the characteristics of both groups. The fragmentation group had a better stone free rate and a lower retropulsion rate compared with the dusting group. Multivariate analysis revealed that stone basket use, no upper ureteral stone or pyuria significantly improved the stone free rate. Both laser modes were effective and safe for ureteral lithotripsy although the fragmentation system showed slightly higher effectiveness and lower complication rate.
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Yitgin Y, Altınkaya N, Turaliev N, Guven S, Ergul RB, Boyuk A, Verep S, Tefik T, Karagoz MA, Ibis MA, Gokce MI, Sarıca K. Evaluation of the optimal duration for retrograde intrarenal stone surgery to prevent postoperative complications. Scott Med J 2022; 67:121-125. [PMID: 35535417 DOI: 10.1177/00369330221099621] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate retrograde intrarenal surgery (RIRS) outcomes and to determine the effect of operative time on complications of RIRS. METHODS Patients undergoing RIRS for renal stones were evaluated. These patients were divided into two groups according to the operation time (Group 1<60 minutes and Group 2>60 minutes). Peroperative outcomes such as fluoroscopy time, stone-free rates, complications and duration of hospitalization were compared. RESULTS Group 1 consisted of 264 patients and Group 2 consisted of 297 patients. SFR rates, duration of hospitalization, and postoperative urinary tract infection rates were similar in both groups. Fluoroscopy time was 7.8±7.3 (0-49) sec in group 1 and 13.1±9.8 (0-81) sec in group 2. Complications according to modified Clavien-Dindo classification system (MCDCS) were 13 and 32 patients (Grade 1), 31 and 63 patients (Grade 2), 1 and 1 patient (Grade 3) in group 1 and 2, respectively. There was statistical difference between the two groups in terms of duration of fluoroscopy time and the MCDCS. Although duration of hospitalization and UTI rates were higher in group 2, no statistical significance was observed among groups. CONCLUSION Limiting the operation time to 60 minutes in RIRS seems to be important in reducing postoperative complications.
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Affiliation(s)
- Yasin Yitgin
- Faculty of Medicine, Department of Urology, 469683Istinye University, Istanbul, Turkey
| | - Nurullah Altınkaya
- Faculty of Medicine of Meram, Department of Urology, 226846Necmettin Erbakan University, Konya, Turkey
| | - Nurmanbet Turaliev
- Faculty of Medicine of Meram, Department of Urology, 226846Necmettin Erbakan University, Konya, Turkey
| | - Selcuk Guven
- Faculty of Medicine of Meram, Department of Urology, 226846Necmettin Erbakan University, Konya, Turkey
| | - Rifat Burak Ergul
- Istanbul Faculty of Medicine, Department of Urology, Istanbul University, Istanbul, Turkey
| | - Abubekir Boyuk
- Department of Urology, Ethica Incirli Hospital, Istanbul, Turkey
| | - Samed Verep
- Department of Urology, University of Health Sciences, Van Training and Research Hospital, Van, Turkey
| | - Tzevat Tefik
- Istanbul Faculty of Medicine, Department of Urology, Istanbul University, Istanbul, Turkey
| | - Mehmet Ali Karagoz
- Department of Urology, University of Health Sciences, Prof. Dr Cemil Tascıoglu City Hospital, Istanbul, Turkey
| | - Muhammed Arif Ibis
- Department of Urology, University of Health Sciences, Kecioren Training and Research Hospital, Ankara, Turkey
| | - Mehmet Ilker Gokce
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Kemal Sarıca
- Department of Urology, Biruni University, Medical School, Istanbul, Turkey
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Kozyrakis D, Soukias G, Karagiannis D, Zarkadas A, Perikleous S, Chatzistamou SE, Katsaros I, Skriapas K, Lardas M, Mertziotis N, Kratiras Z. Prognostic factors for the safety and efficacy of retrograde laser lithotripsy: Data from a contemporary series of 155 consecutive patients with single and multiple lithiasis of the urinary tract. Exp Ther Med 2022; 23:294. [DOI: 10.3892/etm.2022.11221] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 12/17/2021] [Indexed: 11/05/2022] Open
Affiliation(s)
- Diomidis Kozyrakis
- Department of Urology, ‘Achillopoulio’ General Hospital, Volos 32222, Greece
| | - Georgios Soukias
- Department of Urology, ‘Achillopoulio’ General Hospital, Volos 32222, Greece
| | | | - Anastasios Zarkadas
- Department of Urology, ‘Achillopoulio’ General Hospital, Volos 32222, Greece
| | - Stefanos Perikleous
- Department of Urology, ‘Achillopoulio’ General Hospital, Volos 32222, Greece
| | | | - Ilias Katsaros
- Department of Urology, ‘Achillopoulio’ General Hospital, Volos 32222, Greece
| | | | - Michael Lardas
- Department of Urology, ‘Metropolitan’ General Hospital, Athens 15562, Greece
| | - Nikolaos Mertziotis
- Department of Urology, ‘Metropolitan’ General Hospital, Athens 15562, Greece
| | - Zisis Kratiras
- Department of Urology, ‘Achillopoulio’ General Hospital, Volos 32222, Greece
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Cai H, Wu X, Chen X, Chen W. Comparison of the effects of general, spinal and epidural anesthesia on ureter access and surgical outcomes during flexible ureterorenoscopy for transurethral single stone removal surgeries: a monocentric retrospective study. Ann Med 2021; 53:2110-2119. [PMID: 34779319 PMCID: PMC8592613 DOI: 10.1080/07853890.2021.1998596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 10/19/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND In ureterorenoscopy, anaesthesiologists are preferring regional anaesthesia to avoid postoperative complications, while surgeons are preferring general anaesthesia to avoid ureteral trauma. China has not published its guidelines and not referring to the European Association of Urology guidelines. The objectives of study were to evaluate the effects of general, spinal, and epidural anaesthesia on ureter access and surgical outcomes of ureterorenoscopy. METHODS Charts of a total of 392 patients with the American Society of Anaesthesiologists grade I or II, and underwent flexible ureterorenoscopy for removal of the proximal, middle, or distal ureteral single stone under general anaesthesia (GA group; n = 145) or spinal anaesthesia (SA group; n = 131) or epidural anaesthesia (EA group; n = 116) were reviewed retrospectively. RESULTS The dilatation time for patients of GA group was fewer than those of SA (104.01 ± 12.77 sec/patient vs. 130.55 ± 22.53 sec/patient, p < .0001, q = 17.0350) and EA (104.01 ± 12.77 sec/patient vs. 147.03 ± 18.76 sec/patient, p < .0001, q = 26.7240) groups. The time to reach to stone for patients of GA group was fewer than those of SA (126.68 ± 12.59 sec/patient vs. 137.60 ± 17.84 sec/patient, p < .0001, q = 8.4510) and EA (126.68 ± 12.59 sec/patient vs. 149.44 ± 14.85 sec/patient, p < .0001, q = 17.0350) groups. The lithotripsy time (p = .359), operation time (p = .449), intraoperative complications (p = .058), and length of hospital stays (p = .057) of patients were same among groups. Visual analog scale pain scores of patients of the GA group found higher among groups. General anaesthesia caused nausea and vomiting. CONCLUSIONS This study suggests general anaesthesia for flexible ureterorenoscopy if there is no contraindication.KEY MESSAGEGeneral anaesthesia facilitates early dilatation of ureters and access to the stone.No strong correlation of the anaesthesia method of choice with lithotripsy time, operation time, intraoperative complications, stone-free conditions, and length of hospital stays.Epidural and spinal anaesthesia have advantages of fewer postoperative pain and better postoperative outcomes for flexible ureterorenoscopy.
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Affiliation(s)
- Haoliang Cai
- Department of Anesthesiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiaohui Wu
- Department of Anesthesiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xi Chen
- Department of Anesthesiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wenting Chen
- Department of Anesthesiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Ventimiglia E, Pauchard F, Quadrini F, Sindhubodee S, Kamkoum H, Jiménez Godínez A, Doizi S, Traxer O. High- and Low-Power Laser Lithotripsy Achieves Similar Results: A Systematic Review and Meta-Analysis of Available Clinical Series. J Endourol 2021; 35:1146-1152. [PMID: 33677987 DOI: 10.1089/end.2020.0090] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Purpose: There is no clear evidence that high-power (HP) laser generators perform better than low-power (LP) ones in terms of lithotripsy outcomes. We aimed to perform a systematic review of literature to compare the efficacy outcomes of both HP and LP during ureteroscopic lithotripsy. Materials and Methods: A computerized bibliographic search of the Medline, Embase, and Cochrane databases was performed for all studies reporting perioperative outcomes of HP and LP lithotripsy. Using the methodology recommended by the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, we identified 22 nonrandomized noncomparative retrospective studies published between 2015 and 2019 that were eligible for inclusion in this systematic review. Because of the lack of comparative studies, we decided to perform two separate meta-analytic syntheses for LP and HP studies, then we compared them using a Wald-type test. Results: Overall, the selected studies included 6403 patients. Study design, exposure assessment, selection criteria, and outcome of interest were heterogeneous. LP studies were more common (n = 17, 77%), whereas HP studies were more common in the latest inclusion period. Faster lithotripsy (32.9 minutes vs 63.9 minutes, p < 0.01) was observed in HP studies. However, stone volume resulted twofold higher (2604 mm3 vs 1217 mm3, p = 0.048) in LP studies. Pooled stone-free rate was similar in both LP and HP studies, 81% and 82%, respectively, p > 0.05. No difference in complication rate was observed between the two groups, p = 0.12. Conclusions: HP laser lithotripsy appears to require shorter operative time, with similar stone-free and complication rates as compared with LP traditional lithotripsy. However, when taking into account stone burden, this advantage seems to be lost, or at least not to be comparable with what observed in laboratory studies. Because of the lack of high-level comparative evidence, further clinical studies are needed to elucidate the benefits of using HP laser generators during ureteroscopic stone treatment.
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Affiliation(s)
- Eugenio Ventimiglia
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, Paris, France.,Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, Paris, France.,Division of Experimental Oncology/Unit of Urology, URI-Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Felipe Pauchard
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, Paris, France.,Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, Paris, France.,Department of Urology, Hospital Carlos Van Buren, Valparaiso, Chile
| | - Francesca Quadrini
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, Paris, France.,Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, Paris, France
| | - Sermsin Sindhubodee
- Division of Urology, Department of Surgery, Rajavithi Hospital, Bangkok, Thailand
| | - Hatem Kamkoum
- Urology Department, Hazm Mebaireek General Hospital (HMGH), Doha, Qatar
| | | | - Steeve Doizi
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, Paris, France.,Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, Paris, France
| | - Olivier Traxer
- GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, Paris, France.,Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, Paris, France
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