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Yildiz AK, Varan A, Kurt H, Doluoglu OG, Ozgur BC. How has the COVID-19 pandemic changed treatment preferences of patients with proximal ureteral stones? Curr Urol 2024; 18:66-70. [PMID: 38505151 PMCID: PMC10946634 DOI: 10.1097/cu9.0000000000000143] [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: 03/21/2022] [Accepted: 05/23/2022] [Indexed: 11/27/2022] Open
Abstract
Background The impact of the coronavirus disease 2019 (COVID-19) pandemic on patient decision making remains uncertain. This study aimed to investigate the effect of the pandemic on treatment preferences of patients with proximal ureteral stones. Materials and methods Retrospective data regarding treatment preferences of patients diagnosed with symptomatic proximal ureteral stones between July 2018 and November 2021 at a single center were analyzed. Data from 493 patients were analyzed according to 2 groups, including patients diagnosed during the COVID-19 pandemic and those diagnosed during an equivalent period of time before the pandemic. Results Preference for conservative treatment increased during the COVID-19 pandemic (p = 0.009). In patients who had previously undergone shock wave lithotripsy (SWL), the preference for SWL decreased and the preference for conservative treatment increased during the COVID-19 pandemic (p = 0.042). Multiple logistic regression analysis revealed a significant correlation between a preference for conservative treatment during the pandemic and no prior spontaneous stone passage (p = 0.003; odds ratio [OR], 2.48; 95% confidence interval [CI], 1.45-4.23), no hydronephrosis (p = 0.035; OR, 3.57; 95% CI, 1.34-9.49), and a visual analog scale score of 4 or less (p = 0.018; OR, 1.97; 95% CI, 1.15-3.38). Conclusions A significant increase in the preference for conservative treatment was observed among patients diagnosed during the pandemic, and patients with a history of SWL demonstrated a preference shift from SWL to conservative treatment.
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Affiliation(s)
- Ali Kaan Yildiz
- Department of Urology, University of Medical Sciences, Ankara Training and Research Hospital, Ankara, Turkey
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Lubana AS, Priyadarshi S, Sharma G, Bansal S, Agarwal N, Vyas N. Effects of administration of local aminophylline on patients undergoing ureteroscopic lithotripsy. Urologia 2023:3915603231216141. [PMID: 38041571 DOI: 10.1177/03915603231216141] [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: 12/03/2023]
Abstract
INTRODUCTION The presence of ureteral stones can cause pain, infections of urinary tract and hydronephrosis, resulting in the loss of renal function. For two decades, Ureteroscopy and laser stone fragmentation (URSL) attained a big rise and is the first line management for large ureteric stones and renal stones up to 2 cm. The present study was conducted to assess the success rate of ureteroscopic lithotripsy in treatment of ureteric calculus after local administration of aminophylline. MATERIALS AND METHODS 100 patients having ureteric calculi <20 mm in size, aged 20-60 years were included in the study and randomly divided into Group A (n = 50) with administration of local aminophylline and Group B (n = 50) with administration of saline infusion. Ureteroscopy was performed after 5 min of administration of the solution. URSL was done using pneumatic lithoclast and/or laser. Various parameters like duration of procedure, ease of ureteral access, requirement of DJ Stent and need of further operative interventions were compared between case and control groups. The data was collected and then subjected to statistical analysis using IBM SPSS 20.0 version at significance level of p < 0.05. RESULTS The mean age of study subjects having ureteral stones was found to be between 31 and 40 years of age with males being more affected. We observed less mean duration of surgery, higher success rate, easy ureteral access (p-value < 0.05) with aminophylline use than control group. The need of ureteral stent and Auxiliary procedures was significantly higher in the control than in the case group (38%). CONCLUSION The use of aminophylline has been found to be highly useful and effective in reducing the need of stents and secondary surgery, decreased pain, and increased success rate. Thus, the use of aminophylline is recommended during URSL procedure for the successful management of ureteral calculi.
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Affiliation(s)
| | - Shivam Priyadarshi
- Department of Urology, SMS Superspeciality Hospital, Jaipur, Rajasthan, India
| | - Govind Sharma
- Department of Urology, SMS Superspeciality Hospital, Jaipur, Rajasthan, India
| | - Somendra Bansal
- Department of Urology, SMS Superspeciality Hospital, Jaipur, Rajasthan, India
| | - Neeraj Agarwal
- Department of Urology, SMS Superspeciality Hospital, Jaipur, Rajasthan, India
| | - Nachiket Vyas
- Department of Urology, SMS Superspeciality Hospital, Jaipur, Rajasthan, India
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Zhong Y, Xie D, Luo C, Liao X, Liu T, Deng X, Zhu L, Song L. Clinical application of flexible ureteroscopic sheath with controllable intraluminal pressure in treating ureteral stones. Asian J Urol 2023; 10:166-171. [PMID: 36942124 PMCID: PMC10023535 DOI: 10.1016/j.ajur.2021.08.007] [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: 08/02/2020] [Revised: 10/12/2021] [Accepted: 11/24/2021] [Indexed: 11/27/2022] Open
Abstract
Objective The purpose of the study was to assess the clinical efficacy and safety of a combined perfusion suction platform with pressure feedback control function and an ureteroscopic suction sheath that can measure the ureteropelvic pressure in implementing lithotripsies. Methods Fifty-two patients who underwent lithotripsy under intelligent monitoring of ureteral intraluminal pressure from June 2016 to January 2018 were retrospectively recruited. The inclusion standard was stone diameter >1.5 cm but <2.5 cm. After the 12/14 Fr suction sheath was placed, manometer interface and suction interface of the sheath were connected to the platform via the pressure sensor and suction tube, respectively. The ureteroscope was connected to the platform perfusion pump, and the crushed stones were aspirated out under negative pressure. Results According to the location of the stone, 21 (40.4%) cases were classified as upper ureteral stones, 19 (36.5%) were midureteral stones, and 12 (23.1%) were lower ureteral stones. Forty-seven patients underwent successful primary sheath placement and lithotripsy with a mean operative time of 34.5 (standard deviation 18.3) min. Retrograde stone migration did not occur. There were eight patients with hematuria postoperatively. Serious complication was 1.9% with one case of ureteral perforation. Stone clearance was 95.7% at Day 1-2 postoperatively, and 100% at Day 30 postoperatively. Conclusion Ureteroscopic lithotripsy with intelligent pressure control using our device improved the efficiency of the lithotripsy and rate of stone clearance. The safety of the operation can be ensured. It is worth popularization and application in clinical practice.
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Affiliation(s)
- Yuming Zhong
- Department of Urology, The Affiliated Ganzhou Hospital of Nanchang University, Ganzhou, Jiangxi, China
| | | | - Chunxiang Luo
- Department of Urology, The Affiliated Ganzhou Hospital of Nanchang University, Ganzhou, Jiangxi, China
- Liaobu Township Community Health Service Center, Dongguan, Guangdong, China
| | - Xiaohui Liao
- Department of Urology, The Affiliated Ganzhou Hospital of Nanchang University, Ganzhou, Jiangxi, China
- Gan County District Dermatology Institute, Ganzhou, Jiangxi, China
| | - Tairong Liu
- Department of Urology, The Affiliated Ganzhou Hospital of Nanchang University, Ganzhou, Jiangxi, China
| | - Xiaoling Deng
- Department of Urology, The Affiliated Ganzhou Hospital of Nanchang University, Ganzhou, Jiangxi, China
| | - Lunfeng Zhu
- Department of Urology, The Affiliated Ganzhou Hospital of Nanchang University, Ganzhou, Jiangxi, China
| | - Leming Song
- Department of Urology, The Affiliated Ganzhou Hospital of Nanchang University, Ganzhou, Jiangxi, China
- Corresponding author.
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Durmus E, Ok F. Comparative analysis of ureteroscopic laser lithotripsy and extracorporeal shock wave lithotripsy in the treatment of childhood proximal ureteral stones. Pediatr Surg Int 2022; 39:62. [PMID: 36565334 DOI: 10.1007/s00383-022-05349-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/15/2022] [Indexed: 12/25/2022]
Abstract
PURPOSE This study aims to make a comparative analysis of the superiority of ESWL and URS in proximal ureteral stones in children. METHODS A total of 155 patients under the age of 15 were included in the study. The patients were divided into two groups as Group 1 (n = 80, ESWL) and Group 2 (n = 75, URS) according to the type of procedure performed. The patients in both groups were evaluated in terms of age, gender, lateralization, stone size, stone volüme, stone density, and preoperative hydronephrosis. In addition, both methods used were compared in terms of success rate, time, cost, hospitalization and complications. RESULTS The mean age were 7.4 ± 2.1 in Group-1 and 8.1 ± 1.8 in Group-2. Demographic, clinical and laboratory data of both groups were similar. The hospitalization time, procedure time, success rate and cost were significantly higher in Group-2. The complication rate was significantly higher in Group-2 (p < 0.001). There was a significant negative correlation between ESWL success and stone volume (ρ - 0.375, p = 0.001) and stone density (ρ - 0.283, p = 0.011). CONCLUSION ESWL can be performed as the first line treatment of proximal ureteral stones in children due to its daily use, low cost, short procedure time and low complication rate. Increasing stone volume and density reduces the success of ESWL.
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Affiliation(s)
- Emrullah Durmus
- Department of Urology, Siirt Training and Research Hospital, 56100, Siirt, Turkey.
| | - Fesih Ok
- Department of Urology, Siirt Training and Research Hospital, 56100, Siirt, Turkey
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Eslahi A, Ahmed F, Rahimi M, Jafari SH, Hosseini SH, Al-Wageeh S, Shirazi PMZ, Al-Naggar K, Al-Shami E, Taghrir MH. Outcome of Transperitoneal Laparoscopic Ureterolithotomy (TPLU) for proximal ureteral stone > 15 mm: Our experience with 60 cases. Arch Ital Urol Androl 2021; 93:330-335. [PMID: 34839640 DOI: 10.4081/aiua.2021.3.330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 07/09/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE We aim to review our experience of transperitoneal laparoscopic ureterolithotomy (TPLU) for proximal ureteric stone more than 15 mm. PATIENTS AND METHODS Between June 2017 to December 2020, sixty patients with a history of unsuccessful Extracorporeal shock wave lithotripsy (ESWL) and/or failed ureteroscopy for impacted ureteral calculi more than 15 mm who accepted TPLU were enrolled in our study. The patients' demographic information and post-treatment results were gathered and analyzed, retrospectively. RESULTS The patients' mean age was 46.25 ± 12.56 years. The mean size of the stone was 20.11 ± 4.76 mm. 37 (61.7%) patients had severe hydronephrosis (HDN) and 46 (76.7%) stones were radio-opaque. Almost all of the patients underwent TPLU by a single urologist. The mean operation time was 72.86 ± 6.07 minutes without intraoperative complication (only 3 stones had upward migration to the pyelocaliceal system). The main operative blood loss was 88.86 ml. The average length of stay in the hospital was 45.8 ± 8.11 hours. The stone free rate (SFR) at discharge was 57 (95%). The overall complication rate was 27 (45%). Regarding early complications, fever was found in 8 (13.3%) patients, and 3 patients (5%) had paralytic ileus. The rate of urine leak was 8.3%, and 8 (13.3%) patients required blood transfusions. In multivariate analysis, the multiple stones, bigger stone in size, incomplete SFR, longer duration of hospital admission, and severe HDN were associated with a high early complication rate (p = 0.05, 0.04, < 001, 0.03, and 0.01, respectively). CONCLUSIONS TPLU is a harmless option for managing proximal ureteric stone as a primary procedure or salvage procedure with good outcomes and acceptable complication rates.
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Affiliation(s)
- Ali Eslahi
- Department of Urology, School of medicine, Shiraz University of Medical Sciences, Shiraz; Shiraz Geriatric Research Center, Shiraz University of Medical Sciences, Shiraz.
| | - Faisal Ahmed
- Urology research center, Al-Thora hospital, Department of Urology, Ibb University of Medical Since, Ibb.
| | - Mohammad Rahimi
- Department of Urology, School of medicine, Shiraz University of Medical Sciences, Shiraz.
| | - Seyed Hamed Jafari
- Medical Imagining Research Center, Shiraz University of Medical Sciences, Shiraz.
| | | | - Saleh Al-Wageeh
- Department of General Surgery, Ibb University of Medical Science, Ibb.
| | | | - Khalil Al-Naggar
- Urology research center, Al-Thora hospital, Department of Urology, Ibb University of Medical Since, Ibb.
| | - Ebrahim Al-Shami
- Urology research center, Al-Thora hospital, Department of Urology, Ibb University of Medical Since, Ibb.
| | - Mohammad Hossein Taghrir
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz.
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Wang Y, Chang X, Li J, Han Z. Efficacy and safety of various surgical treatments for proximal ureteral stone ≥10mm: A systematic review and network meta-analysis. Int Braz J Urol 2021; 46:902-926. [PMID: 32459455 PMCID: PMC7527111 DOI: 10.1590/s1677-5538.ibju.2019.0550] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 12/08/2019] [Indexed: 12/23/2022] Open
Abstract
Purpose Various surgical options are available for large proximal ureteral stones, such as extracorporeal shock wave lithotripsy (ESWL), ureteroscopic lithotripsy (URSL), percutaneous nephrolithotomy (PCNL) and laparoscopic ureterolithotomy (LU). However, the best option remains controversial. Therefore, we conducted a network meta-analysis comparing various surgical treatments for proximal ureteral stones ≥10mm to address current research deficiencies. Materials and methods We searched PubMed, Ovid, Scopus (up to June 2019), as well as citation lists to identify eligible comparative studies. All clinical studies including patients comparing surgical treatments for proximal ureteral stones ≥10mm were included. A standard network meta-analysis was performed with Stata SE 14 (Stata Corp, College Station, TX, USA) software to generate comparative statistics. The quality was assessed with level of evidence according to the Oxford Centre for Evidence-based Medicine and risk of bias with the Cochrane Collaboration’s Review Manager (RevMan) 5.3 software. Results A total of 25 studies including 2.888 patients were included in this network meta-analysis. Network meta-analyses indicated that LU and PCNL had better stone-free rates and auxiliary procedures. PCNL could result in major complications and severe bleeding. In initial stone-free rate, final stone-free rate, and auxiliary procedures results, SUCRA ranking was: LU> PCNL> URSL> ESWL. In Clavien Dindo score ≥3 complications, SUCRA ranking was: LU> ESWL> URSL> PCNL. In fever, SUCRA ranking was: ESWL> LU> URSL> PCNL. In transfusion, SUCRA ranking was: LU> URSL> ESWL> PCNL. In Cluster analysis, LU had the highest advantages and acceptable side effects. Considering the traumatic nature of PCNL, it should not be an option over URSL. ESWL had the lowest advantages. Conclusions LU have the potential to be considered as the first treatment choice of proximal ureteral stone ≥10mm.
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Affiliation(s)
- Yaxuan Wang
- Department of Urology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xueliang Chang
- Department of Urology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jingdong Li
- Department of Urology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhenwei Han
- Department of Urology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
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Nour HH, Kamel AI, Elmansy H, Badawy MH, Shabana W, Abdelwahab A, Elbaz A, Eleithy T, Rushdy M. Pneumatic vs laser lithotripsy for mid-ureteric stones: Clinical and cost effectiveness results of a prospective trial in a developing country. Arab J Urol 2020; 18:181-186. [PMID: 33029429 PMCID: PMC7473316 DOI: 10.1080/2090598x.2020.1749800] [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] [Indexed: 11/25/2022] Open
Abstract
Objective To compare the management of large ureteric stones (>10 mm) with ureterorenoscopy (URS) and laser or pneumatic lithotripsy, and their associated costs. Patients and methods Our prospective study followed the tenets of the Declaration of Helsinki and included 101 patients with large mid-ureteric stones eligible for URS and lithotripsy, and was conducted between January 2018 and August 2019. Patients were randomly divided into two groups: Group 1 had laser lithotripsy, while the Group 2 had lithotripsy using a pneumatic energy source. Results Operative time was significantly longer in cases using pneumatic lithotripsy (P < 0.001). The stone-free rate (SFR) on the first postoperative day was 94% and 92.5% for laser and pneumatic lithotripsy respectively, and there were no statistically significant differences in terms of early (day 1) or late (day 30) SFRs between the groups. Complications were classified according to the Clavien–Dindo Grading System, all complications were Grade <III, with no statistically significant difference between the groups (P = 0.742). The use of pneumatic lithotripsy had lower treatment costs. The number of auxiliary procedures required to reach a stone-free status was statistically equivalent in both groups. Conclusion The type of lithotripsy did not affect the SFR or complications. However, laser lithotripsy was much more expensive than pneumatic lithotripsy. Abbreviations KUB: plain abdominal radiograph of the kidneys, ureters and bladder; SFR: stone-free rate; SWL: shockwave lithotripsy; URS: Ureterorenoscopy; US: ultrasonography
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Affiliation(s)
- Hani H Nour
- Department of Urology, Theodor Bilharz Research Institute, Giza, Egypt
| | - Ahmed I Kamel
- Department of Urology, Theodor Bilharz Research Institute, Giza, Egypt
| | - Hazem Elmansy
- Department of Urology, Thundar Bay Regional Health Sciences Center, Thunder Bay, ON, Canada
| | - Mohamad H Badawy
- Department of Urology, Theodor Bilharz Research Institute, Giza, Egypt
| | - Waleed Shabana
- Department of Urology, Zagazig University, Zagazig, Egypt
| | - Ayman Abdelwahab
- Department of Urology, Theodor Bilharz Research Institute, Giza, Egypt
| | - Ahmed Elbaz
- Department of Urology, Theodor Bilharz Research Institute, Giza, Egypt
| | - Tarek Eleithy
- Department of Urology, Theodor Bilharz Research Institute, Giza, Egypt
| | - Mamdouh Rushdy
- Department of Urology, Theodor Bilharz Research Institute, Giza, Egypt
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Li J, Chang X, Wang Y, Han Z. Laparoscopic ureterolithotomy versus ureteroscopic laser lithotripsy for large proximal ureteral stones: a systematic review and meta-analysis. MINERVA UROL NEFROL 2019; 72:30-37. [PMID: 31692305 DOI: 10.23736/s0393-2249.19.03557-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION To review current studies and conduct a meta-analysis on the topic of laparoscopic ureterolithotomy (LU) versus ureteroscopic lithotripsy (URSL) with holmium laser for large proximal ureteral stones. EVIDENCE ACQUISITION A systematic research of PubMed, Ovid, Scopus (up to March 2019), and citation lists was performed to identify eligible comparative studies. All studies comparing LU versus URSL with holmium laser in proximal ureteral stones were included. Statistical analyses were performed using the Cochrane Collaboration's Review Manager (RevMan) 5.3 software. EVIDENCE SYNTHESIS Overall, seven studies were included in analysis involving 884 patients (LU 387; URSL 497). Our meta-analysis showed that LU group had bigger stone size than URSL group (WMD 0.19 cm; P=0.001). LU group was associated with longer operative time (WMD 36.29 min; P<0.001), and length of hospital stay (WMD 1.24 d; P=0.04). However, LU group showed better initial stone-free rate (OR 11.03; P<0.001), and final stone-free rate (OR 22.37; P<0.001). There were no significant differences in all complications (RR 1.06; P=0.76). While, LU group had fewer Clavien Dindo score ≥3 complications (RR 0.21; P=0.002), fewer ureteral stricture (RR 0.26; P=0.04), and lower need of auxiliary procedures (RR 0.09; P<0.001) compared with URSL group. CONCLUSIONS LU could provide a higher stone-free rate and fewer severe complications compared with URSL with holmium laser for large proximal ureteral stones. More importantly, LU could also reduce the postoperative ureteral stricture rate.
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Affiliation(s)
- Jingdong Li
- Department of Urology, the 2nd Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xueliang Chang
- Department of Urology, the 2nd Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yaxuan Wang
- Department of Urology, the 2nd Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhenwei Han
- Department of Urology, the 2nd Hospital of Hebei Medical University, Shijiazhuang, China -
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Analysis of the clinical effect and long-term follow-up results of retroperitoneal laparoscopic ureterolithotomy in the treatment of complicated upper ureteral calculi (report of 206 cases followed for 10 years). Int Urol Nephrol 2019; 51:1955-1960. [DOI: 10.1007/s11255-019-02252-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 07/30/2019] [Indexed: 01/16/2023]
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Can intervals in extracorporeal shock wave lithotripsy sessions affect success in the treatment of upper ureteral stones? Wideochir Inne Tech Maloinwazyjne 2018; 13:507-511. [PMID: 30524622 PMCID: PMC6280089 DOI: 10.5114/wiitm.2018.75873] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 04/12/2018] [Indexed: 12/04/2022] Open
Abstract
Introduction Managing upper ureteral stones with shock wave lithotripsy (SWL) has been done for many years. However, no conclusive data have been found on the intervals required between repeated SWL sessions. Aim To identify the most optimal intervals between SWL sessions. Material and methods Between September 2015 and December 2016, 80 patients undergoing elective outpatient lithotripsy who required repeated SWL sessions for ureteral stones were evaluated. These patients were categorised into two groups according to different SWL session intervals. The intervals between SWL sessions (n = 40) for the first group lasted one day, whereas those for the second group (n = 40) lasted 1 week. The data recorded during SWL included visual analogue scale (VAS) scores, total number of shocks, total energy used and number of sessions. The stone clearance rates, number of urinary tract infections, complication rates and VAS scores were compared between the two groups. Results All patients’ clinical outcomes after SWL therapy are shown in Table I. The stone clearance rate for group 1 was 70%, whereas that for group 2 was 72.5% (p = 0.805). Additionally, the number of urinary tract infections, complications and VAS scores were similar for both groups. In group 1, 3 patients had steinstrasse, two suffered from severe renal colic, and one had a urinary tract infection. In group 2, 3 patients endured steinstrasse, and 2 patients experienced severe renal colic during the study. Conclusions Short-interval SWL sessions are safe and effective for treating upper ureteral stones, and such sessions do not increase complication rates.
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Zhou R, Han C, Hao L, Chen B, Zang G, Fan T, Zhou J, Dong Y, Ma W, Pang K. Ureteroscopic lithotripsy in the Trendelenburg position for extracting obstructive upper ureteral obstruction stones: a prospective, randomized, comparative trial. Scand J Urol 2018; 52:291-295. [PMID: 30334631 DOI: 10.1080/21681805.2018.1492966] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To introduce a new position for ureteroscopic holmium laser lithotripsy for patients with upper ureteral calculi. MATERIALS AND METHODS Between June 2014 and May 2017, 192 patients were enrolled in this study. Patients were randomly assigned to one of two groups: group A, ureteroscopic lithotripsy (URSL) in the Trendelenburg position; or group B, URSL in the standard position. Baseline information, including gender, age, body mass index (BMI), stone side, stone size and hydronephrosis grade, was collected and determined preoperatively. Stone-free rate (SFR) was evaluated 3 weeks after surgery and was defined by the absence of residual stones or the presence of residual stones <2 mm in diameter. Operation time, hospital stay, stone migration, operative complications and SFR were assessed and compared between the two groups. RESULTS There were no statistically significant differences in gender, age, BMI, stone side, stone size, serum creatinine or hydronephrosis grade between the two groups (all p > 0.05). There were no significant differences in the postoperative hospital stay or postoperative complications between the two groups (all p > 0.05), but the differences in operative time, stone migration and SFR between the two groups were statistically significant (p < 0.05). CONCLUSION This study introduced a new position for ureteroscopic holmium laser lithotripsy for patients with upper ureteral calculi. The Trendelenburg position can improve the SFR and may provide an optional surgical method for treating upper ureteral calculi.
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Affiliation(s)
- Rongsheng Zhou
- a Department of Urology , Xuzhou Central Hospital , Xuzhou , PR China
| | - Conghui Han
- a Department of Urology , Xuzhou Central Hospital , Xuzhou , PR China
| | - Lin Hao
- a Department of Urology , Xuzhou Central Hospital , Xuzhou , PR China
| | - Bo Chen
- a Department of Urology , Xuzhou Central Hospital , Xuzhou , PR China
| | - Guanghui Zang
- a Department of Urology , Xuzhou Central Hospital , Xuzhou , PR China
| | - Tao Fan
- a Department of Urology , Xuzhou Central Hospital , Xuzhou , PR China
| | - Jiahe Zhou
- a Department of Urology , Xuzhou Central Hospital , Xuzhou , PR China
| | - Yang Dong
- a Department of Urology , Xuzhou Central Hospital , Xuzhou , PR China
| | - Weiming Ma
- a Department of Urology , Xuzhou Central Hospital , Xuzhou , PR China
| | - Kun Pang
- a Department of Urology , Xuzhou Central Hospital , Xuzhou , PR China
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Xu L, Zhang Y, Wang Z, Li G, Yu S. Comparison of combined laparoscopic ureterolithotomy and flexible ureteroscopy with percutaneous nephrolithotomy for removing large impacted upper ureteral stones with concurrent renal stones. LAPAROSCOPIC, ENDOSCOPIC AND ROBOTIC SURGERY 2018. [DOI: 10.1016/j.lers.2018.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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Iqbal N, Malik Y, Nadeem U, Khalid M, Pirzada A, Majeed M, Malik HA, Akhter S. Comparison of ureteroscopic pneumatic lithotripsy and extracorporeal shock wave lithotripsy for the management of proximal ureteral stones: A single center experience. Turk J Urol 2018; 44:221-227. [PMID: 29733796 DOI: 10.5152/tud.2018.41848] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 02/23/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate and compare the effectiveness of ureteroscopic (URS) pneumatic lithotripsy versus extracorporeal shock wave lithotripsy (ESWL) in the management of the proximal ureteral stones in terms of stone- free rates, complications and costs involved. MATERIAL AND METHODS We included 200 patients in Group 1 who underwent ESWL and 200 patients in Group 2 who underwent URS intervention. We used Modulith SL X lithotripter 3rd generation Storz medical for ESWL group while Swiss pneumatic lithoclast was used to break the stone in the URS group. Stone-free status was defined as stone fragment of less than 4 mm on follow- up kidney ureter and bladder X-ray after 3 months of procedure. SPSS version 16 was used for statistical analysis. RESULTS The mean age in ESWL and URS groups were 39.21±13.36, and 43.13±13.65 years respectively. Mean stone size was 10.47±3.7 mm (ESWL) and 13.6±6.6 mm (URS). Stone- free rate after single procedure was (125/200 patients) 62.5% for ESWL and (168/200 patients) 84% for URS group (p=0.001). Complications included post procedure sepsis in 3 (1.5%) patient of ESWL, while 7 (3.5%) patients of URS groups. Steinstrasse was seen in 4 (2%) patients of ESWL group. No mortality was seen in both groups. Mean costs for ESWL were US $320±50 while US $1100±150 for URS group (p=0.001). CONCLUSION The stone-free rates after single procedure were significantly higher for the URS group while the complication rates were comparable in both groups. Treatment costs were significantly lower for the ESWL group.
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Affiliation(s)
- Nadeem Iqbal
- Department of Urology, Shifa International Hospital Islamabad, Islamabad, Pakistan
| | | | | | | | | | - Mehr Majeed
- Shifa College of Medicine, Islamabad, Pakistan
| | | | - Saeed Akhter
- Department of Urology, Shifa International Hospital Islamabad, Islamabad, Pakistan
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14
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Wang Y, Zhong B, Yang X, Wang G, Hou P, Meng J. Comparison of the efficacy and safety of URSL, RPLU, and MPCNL for treatment of large upper impacted ureteral stones: a randomized controlled trial. BMC Urol 2017; 17:50. [PMID: 28662708 PMCID: PMC5492714 DOI: 10.1186/s12894-017-0236-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 06/12/2017] [Indexed: 12/11/2022] Open
Abstract
Background There are three minimally invasive methods for the management of large upper impacted ureteral stones: mini-percutaneous nephrolithotomy (MPCNL), transurethral ureteroscope lithotripsy (URSL), and retroperitoneal laparoscopic ureterolithotomy (RPLU). This study aimed to compare MPCNL, URSL, and RPLU, and to evaluate which one is the best choice for large upper impacted ureteral stones. Methods Between January 2012 and December 2015, at the Department of Urology, Huai’an First People’s Hospital, 150 consecutively enrolled patients with a large upper impacted ureteral stone (>15 mm) were included. The patients were randomly divided (1:1:1) into the MPCNL, URSL, and RPLU groups. The primary endpoint was success of stone removal measured 1 month postoperatively and the secondary endpoints were intraoperative and postoperative parameters and complications. Results Fifteen patients needed auxiliary ESWL after URSL, and 3 patients after MPCNL, but none after RPLU. The stone clearance rate was 96% (48/50) in the MPCNL group and 72% (33/46) in the URSL group. In the RPLU group the stones were completely removed and the stone clearance rate was 100% (48/48) (P = 0.021 vs. URSL; P = 0.083 vs. MPCNL). Operation-related complications were similar among the three groups (all P > 0.05). Hospital stay was shorter in the URSL group compared with MPCNL (P = 0.003). Operation time was the shortest with URSL and the longest with MPCNL (all P < 0.05). Conclusions MPCNL and RPUL are more suitable for upper ureteral impacted stones of >15 mm. URSL could be considered if the patient is not suitable for general anesthesia, or the patient requests transurethral uretroscopic surgery. Trial registration This study was registered with the Chinese Clinical Trial Registry (Registration number: ChiCTR-INR-17011507; Registration date: 2017–5-22).
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Affiliation(s)
- Yunyan Wang
- Department of Urology, Huai'an First People's Hospital, Nanjing Medical University, No. 6 West Beijing Road, Huai'an, Jiangsu, 223300, China
| | - Bing Zhong
- Department of Urology, Huai'an First People's Hospital, Nanjing Medical University, No. 6 West Beijing Road, Huai'an, Jiangsu, 223300, China
| | - Xiaosong Yang
- Department of Urology, Huai'an First People's Hospital, Nanjing Medical University, No. 6 West Beijing Road, Huai'an, Jiangsu, 223300, China
| | - Gongcheng Wang
- Department of Urology, Huai'an First People's Hospital, Nanjing Medical University, No. 6 West Beijing Road, Huai'an, Jiangsu, 223300, China
| | - Peijin Hou
- Department of Urology, Huai'an First People's Hospital, Nanjing Medical University, No. 6 West Beijing Road, Huai'an, Jiangsu, 223300, China
| | - Junsong Meng
- Department of Urology, Huai'an First People's Hospital, Nanjing Medical University, No. 6 West Beijing Road, Huai'an, Jiangsu, 223300, China.
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15
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Kallidonis P, Ntasiotis P, Knoll T, Sarica K, Papatsoris A, Somani BK, Greco F, Aboumarzouk OM, Álvarez-Maestro M, Sanguedolce F. Minimally Invasive Surgical Ureterolithotomy Versus Ureteroscopic Lithotripsy for Large Ureteric Stones: A Systematic Review and Meta-analysis of the Literature. Eur Urol Focus 2017; 3:554-566. [PMID: 28753887 DOI: 10.1016/j.euf.2017.04.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Revised: 03/28/2017] [Accepted: 04/07/2017] [Indexed: 11/26/2022]
Abstract
CONTEXT The management of large ureteric stones represents a technical and clinical challenge. OBJECTIVE To investigate the safety and efficacy of minimally invasive surgical ureterolithotomy (MISU) in comparison with ureteroscopic lithotripsy (URS) for the treatment of large ureteric stones. EVIDENCE ACQUISITION The Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guidelines were followed for the conduction of the study, which was registered in the PROSPERO database. Search string was "(laparoscop* OR retroperito* OR robot*) AND ureterolitho*"; database scope included PubMed, SCOPUS, Cochrane, and EMBASE. Primary end points were the stone-free (SFR) and complications rates. Secondary end points included operative time and hospital stay. Subgroup analyses were performed for stones 1-2 and >2cm, as well as different lithotripters and ureteroscopes. Meta-analysis and forest-plot diagrams were performed with the RevMan 5.3.5 software. EVIDENCE SYNTHESIS After screening 673 publications, seven randomized controlled trials were eligible to be included in the meta-analysis. A total of 778 patients were pooled after the elimination of the dropouts. No robotic cohorts were found. Only upper ureteral stones were treated in the included studies. The SFR at discharge and 3 mo was higher with MISU with odds ratios of 6.30 (95% confidence interval [CI]: 3.05, 13.01; I2=0%) and 5.34 (95% CI: 2.41, 8.81; I2=0%), respectively. The most common complications for MISU and URS were conversion to open surgery and stone migration to the renal pelvis, respectively. Favorable results in terms of operative time were observed in the case of URS with a mean difference of 29.5min (95% CI: 14.74, 44.26; I2=98%). Hospitalization time was favorable in the case of URS with a mean difference of 2.08 days (95% CI: 0.96, 3.20; I2=99%). CONCLUSIONS This meta-analysis showed a significantly higher SFR at discharge and 3 mo for MISU in comparison with URS when upper ureteral stones were treated. Operative and hospitalization time favored URS over MISU. PATIENT SUMMARY The current study investigated the literature on the minimally invasive management of large ureteric stones. The available evidence shows that both ureteroscopic lithotripsy and minimally invasive surgical ureterolithotomy could be considered for the treatment of these stones with similar results. The selection of the approach should be based on the advantages and disadvantages of each technique.
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Affiliation(s)
| | | | - Thomas Knoll
- Department of Urology, Klinikum Sindelfingen-Böblingen, University of Tübingen, Sindelfingen, Germany
| | - Kemal Sarica
- Department of Urology, Dr Lufti Kirdar Kartal Research and Training Hospital, Istanbul, Turkey
| | | | - Bhaskar K Somani
- Department of Urology, University Hospital Southampton, Southampton, Wessex, UK
| | - Francesco Greco
- Department of Urology and Minimal Invasive Surgery, Romolo Hospital, Crotone, Italy
| | | | | | - Francesco Sanguedolce
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Spain; Department of Urology, King's College London, King's College Hospital, UK
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