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Castellani D, Brocca C, Fuligni D, Giulioni C, Antezza A, Cormio A, Rubino A, Pitoni L, De Stefano V, Milanese G, Cormio L, Somani BK, Gauhar V, Galosi AB. Extracorporeal shock wave lithotripsy, ureterolithotripsy, and percutaneous nephrolithotripsy challenges in managing spinal cord neuropathy patients. Lessons learned from a scoping review. Cent European J Urol 2024; 77:89-110. [PMID: 38645817 PMCID: PMC11032027 DOI: 10.5173/ceju.2023.123] [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: 07/03/2023] [Revised: 10/27/2023] [Accepted: 11/13/2023] [Indexed: 04/23/2024] Open
Abstract
Introduction We aim to review the outcomes of shock wave lithotripsy (SWL), ureteroscopy, and percutaneous nephrolithotripsy (PCNL) for renal and ureteral stones in spinal cord neuropathy patients (SNP). Material and methods A literature search was performed on 8th March 2023 using PubMed, EMBASE, and Google Scholar with no date limit. Preclinical/animal studies, reviews, letters to the editor, case reports, and meeting abstracts were excluded. Only English papers were accepted. Results Thirty-five articles were accepted. Five studies focused on SWL, 17 on PCNL, and 6 on ureteroscopy. The remaining articles employed more than one procedure. Stone composition has shifted from struvite to the more common calcium phosphate. SWL showed a very poor stone-free rate (SFR) likely due to challenges in patient positioning, stone visualization, localization, and inability to pass fragments spontaneously. Flexible ureteroscopy and PCNL were associated with a high incidence of infectious complications, long hospital stays, high blood transfusion rate, and intensive care admissions. There were also cases of death. Both procedures were challenging due to genitourinary reconstruction, scoliosis and kyphosis, rib-cage deformity, lower limb contractures, and severe comorbidity which also affected anesthesia. SFR was lower than in non-neurological patients. Conclusions SWL, ureterolithotripsy, and PCNL should be considered challenging procedures in SNP due to positioning issues, an increased risk of intra and peri-operative morbidity, and even mortality. Computed tomography should be recommended to assess residual fragments as it becomes imperative to minimize a re-intervention in SNP who should be preferably treated in referral centers.
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Affiliation(s)
- Daniele Castellani
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
| | - Carlo Brocca
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
| | - Demetra Fuligni
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
| | - Carlo Giulioni
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
| | - Angelo Antezza
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
| | - Angelo Cormio
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
| | - Arianna Rubino
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
| | - Lucia Pitoni
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
| | - Virgilio De Stefano
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
| | - Giulio Milanese
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
| | - Luigi Cormio
- Department of Urology and Renal Transplantation, Policlinico Riuniti, University of Foggia, Foggia, Italy
- Department of Urology, Bonomo Teaching Hospital, Andria, Italy
| | - Bhaskar Kumar Somani
- Department of Urology, University Hospitals Southampton, NHS Trust, Southampton, United Kingdom
| | - Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Andrea Benedetto Galosi
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
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Yousefi Darestani MR, Lange D, Chew BH, Takahata K. Electromechanically Functionalized Ureteral Stents for Wireless Obstruction Monitoring. ACS Biomater Sci Eng 2023. [PMID: 37276260 DOI: 10.1021/acsbiomaterials.3c00114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
While millions of ureteral stents are placed in patients with urinary tract issues around the world every year, hydronephrosis still poses great danger to these patients as a common complication. In the present work, an intelligent double-J ureteral stent equipped with a micro pressure sensor and antenna circuitry is investigated and prototyped toward enabling continuous wireless monitoring of kidney pressure to detect a ureteral obstruction and the resultant hydronephrosis via the indwelling stent. This electromechanically functionalized "intelligent" ureteral stent acts as a radiofrequency resonator with a pressure-sensitive resonant frequency that can be interrogated using an external antenna to track the local pressure. The prototype passes mechanical bending tests of up to 15 cm radius of curvature and shows wireless sensing with a sensitivity of 3.1 kHz/mmHg in artificial urine, which represents 25× enhancement over the preceding design, using an in vitro model with test tissue layers and a pressure range that functions within the conditions found in hydronephrotic conditions. These promising results are expected to propel intelligent ureteral stent technology into further clinical research.
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Affiliation(s)
| | - Dirk Lange
- The Stone Centre at Vancouver General Hospital, Department of Urologic Sciences, University of British Columbia, Vancouver V5Z1M9, Canada
| | - Ben H Chew
- The Stone Centre at Vancouver General Hospital, Department of Urologic Sciences, University of British Columbia, Vancouver V5Z1M9, Canada
| | - Kenichi Takahata
- Department of Electrical and Computer Engineering, School of Biomedical Engineering, University of British Columbia, Vancouver V6T 1Z4, Canada
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Incidence and safety outcomes associated with active stone removal procedures (ASRP): a comparison between neurological and non-neurological patients using the French National Health Data Base. World J Urol 2022; 40:1821-1827. [PMID: 35665842 DOI: 10.1007/s00345-022-04054-8] [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: 03/14/2022] [Accepted: 05/09/2022] [Indexed: 10/18/2022] Open
Abstract
PURPOSE To compare the incidence and the safety outcomes associated with active stone removal procedure (ASRP) between neurological and non-neurological patients. MATERIALS AND METHODS The present study was conducted using the data issued from the French National Health Data Base. All patients that have been hospitalized to undergo an ASRP between January 1 2012 and December 31 2018 were included and allocated to four neurological groups (multiple sclerosis, spinal dysraphism, paraplegia, tetraplegia) and one non-neurological group. The primary outcome was the rate of patients hospitalized at least once to undergo an ASRP over the study period. The secondary outcomes included the type of ASRP performed, the length of hospital stay, the rates of post-operative UTI, of early re-admission and re-treatments. Multivariate logistic regression was used to estimate odd ratios, the four neurological groups being compared to the non-neurological group. RESULTS During the study period, 45,745,055 patients were hospitalised, with 151,850 of them presenting with an underlying neurological disease. Among the non-neurological patients, 0.89% underwent an ASRP, while 1.39% neurological patients did. Neurological patients presented with a lower rate of ESWL associated with a higher rate of PCNL, while the length of hospital stay, the rate of post-operative UTI, of early re-admission and of re-treatment were systematically increased (p < 0.001), when compared to non-neurological patients, regardless of the type of ASRP considered. CONCLUSIONS The results presented here confirm and clarify the incidence and the safety outcomes associated with ASRP within the neurological population and advocate for the emergence of a dedicated research field focusing on neuro-urolithiasis.
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Dupuis H, Khene ZE, Surlemont L, Saout K, Bakayoko A, Ducousso H, Bugel H, Pfister C, Cornu JN. Preoperative risk factors for complications after flexible and rigid ureteroscopy for stone disease: A French multicentric study. Prog Urol 2022; 32:593-600. [DOI: 10.1016/j.purol.2022.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 02/07/2022] [Accepted: 02/17/2022] [Indexed: 10/18/2022]
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Sampogna G, Maltagliati M, Rocco B, Micali S, Montanari E, Spinelli M. Shock wave lithotripsy for a renal stone in a tetraplegic patient as a trigger for life-threatening posterior reversible encephalopathy syndrome. Urol Case Rep 2020; 31:101204. [PMID: 32322524 PMCID: PMC7160185 DOI: 10.1016/j.eucr.2020.101204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 04/07/2020] [Accepted: 04/08/2020] [Indexed: 11/16/2022] Open
Abstract
Shock wave lithotripsy (SWL) is considered a non-invasive treatment for urinary stones and usually advocated for frail patients with spinal cord injury (SCI). We report a life-threatening complication, called posterior reversible encephalopathy syndrome (PRES), in a tetraplegic person who underwent SWL for a small renal stone. Based on our experience, we recommend performing SWL with caution in SCI patients and in tertiary referral hospitals that can promptly manage similar severe complications.
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Affiliation(s)
- Gianluca Sampogna
- Urology Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, University of Milan, Via della Commenda 15, 20122, Milano, MI, Italy
- Neuro-urology Unit, ASST Grande Ospedale Metropolitano Niguarda, Piazza dell’Ospedale Maggiore 3, 20162 Milano, MI, Italy
| | - Matteo Maltagliati
- Urology Unit, Ospedale Policlinico e Nuovo Ospedale Civile S. Agostino-Estense, University of Modena and Reggio Emilia, Via Pietro Giardini 1355, 41126 Baggiovara, MO, Italy
| | - Bernardo Rocco
- Urology Unit, Ospedale Policlinico e Nuovo Ospedale Civile S. Agostino-Estense, University of Modena and Reggio Emilia, Via Pietro Giardini 1355, 41126 Baggiovara, MO, Italy
| | - Salvatore Micali
- Urology Unit, Ospedale Policlinico e Nuovo Ospedale Civile S. Agostino-Estense, University of Modena and Reggio Emilia, Via Pietro Giardini 1355, 41126 Baggiovara, MO, Italy
| | - Emanuele Montanari
- Urology Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, University of Milan, Via della Commenda 15, 20122, Milano, MI, Italy
| | - Michele Spinelli
- Neuro-urology Unit, ASST Grande Ospedale Metropolitano Niguarda, Piazza dell’Ospedale Maggiore 3, 20162 Milano, MI, Italy
- Corresponding author.
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