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Qu Y, Fu Q, Qin X, Zhuo Y, Chen Z, Qu L. The initial experience of 4.5/6.5 Fr ureteroscopic laser lithotripsy under topical intraurethral anesthesia supplemented by preoperative and intraoperative medications. Int Urol Nephrol 2023:10.1007/s11255-023-03629-7. [PMID: 37179520 DOI: 10.1007/s11255-023-03629-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 05/08/2023] [Indexed: 05/15/2023]
Abstract
PURPOSE To assess the safety and effectiveness of the 4.5/6.5 Fr ureteroscopic laser lithotripsy (URSL) under topical intraurethral anesthesia (TIUA) compared to spinal anesthesia (SA). METHODS A retrospective study was conducted on 47 (TIUA: SA = 23:24) patients receiving 4.5/6.5 Fr URSL from July 2022 to September 2022. For the TIUA group, atropine, pethidine, and phloroglucinol were used apart from lidocaine. In the SA group, patients received lidocaine and bupivacaine. We compare the two groups including stone-free rate (SFR), procedure time, anesthesia time, overall operative time, hospital stay, anesthesia failure, intraoperative pain, need for additional analgesia, cost, and complications. RESULTS The conversion rate in the TIUA group was 4.35% (1/23). SFR was 100% in both groups. Surgical waiting time and anesthesia time were longer in the SA group (P < 0.001). There were no statistical differences in operational time and intraoperative pain. Patients developed grade 0-1 ureteral injuries. Post-surgical time out of bed was noticeably faster in the TIUA group (P < 0.001). The post-operative complication rate including vomiting and back pain was lower in the TIUA group (P = 0.005). CONCLUSION TIUA had an equal surgical success rate and controlled patients' intraoperative pain as SA. It was superior in terms of TIUA's patient admission, waiting time for surgery, anesthesia time, post-operative time out of bed, low complications, and costs, especially for females.
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Affiliation(s)
- Yuan Qu
- Department of Urology, The First Affiliated Hospital of Jinan University, 613 W. Huangpu Avenue No. 4 Bldg, 6th floor, Guangzhou, China
| | - Quansheng Fu
- Department of Urology, The First Affiliated Hospital of Jinan University, 613 W. Huangpu Avenue No. 4 Bldg, 6th floor, Guangzhou, China
| | - Xiaoping Qin
- Department of Urology, The First Affiliated Hospital of Jinan University, 613 W. Huangpu Avenue No. 4 Bldg, 6th floor, Guangzhou, China
| | - Yumin Zhuo
- Department of Urology, The First Affiliated Hospital of Jinan University, 613 W. Huangpu Avenue No. 4 Bldg, 6th floor, Guangzhou, China
| | - Zheng Chen
- Department of Urology, The First Affiliated Hospital of Jinan University, 613 W. Huangpu Avenue No. 4 Bldg, 6th floor, Guangzhou, China.
| | - Lijun Qu
- Department of Urology, The First Affiliated Hospital of Jinan University, 613 W. Huangpu Avenue No. 4 Bldg, 6th floor, Guangzhou, China.
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Peng CX, Lou YK, Xu L, Wu GH, Zhou XL, Wang KE, Ye CH. Efficacy of emergency extracorporeal shock wave lithotripsy in the treatment of ureteral stones: a meta-analysis. BMC Urol 2023; 23:56. [PMID: 37016405 PMCID: PMC10074806 DOI: 10.1186/s12894-023-01226-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 03/26/2023] [Indexed: 04/06/2023] Open
Abstract
OBJECTIVE To compare the clinical efficiency and safety of emergency extracorporeal shock wave lithotripsy (eESWL) and delayed extracorporeal shock wave lithotripsy (dESWL) in the treatment of ureteral stones. METHODS Cochrane Library, PubMed, Google Scholar, and Web of Science were searched from January 1, 1992 to September 30, 2022, and all comparative studies involving eESWL and dESWL for ureteral calculi were included. Statistical analysis was performed using Review Manager 5.3 software. Funnel plot was used to evaluated publication bias. RESULTS A total of 9 articles involving 976 patients diagnosed with ureteral stones were included. The results showed that the stone-free rate (SFR) after four weeks was significantly higher in the eESWL group than in the dESWL group [relative risk (RR) = 1.22, 95% confidence interval (CI): 1.13-1.32, P < 0.01]. In subgroup analysis of different stone locations, proximal ureteral calculi [RR = 1.25, 95% CI: 1.14-1.38, P < 0.01] and mid-to-distal ureteral calculi [RR = 1.18, 95% CI: 1.03-1.34, P < 0.05] all showed a higher SFR in the eESWL group. eESWL significantly shortened the stone-free time(SFT) [mean difference (MD) = -5.75, 95% CI: -9.33 to -2.17, P < 0.01]. In addition, eESWL significantly reduced auxiliary procedures [RR = 0.53, 95% CI: 0.40-0.70, P < 0.01]. No significant difference in complications was found between the two groups [RR = 0.90, 95% CI: 0.69-1.16, P > 0.05]. CONCLUSION eESWL can significantly improve SFR, shorten SFT, and reduce auxiliary procedures.
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Affiliation(s)
- Cheng-Xia Peng
- Department of Urology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, 310015, China
| | - Yi-Kai Lou
- School of Medicine, Hangzhou Normal University, Hangzhou, 310016, China
| | - Li Xu
- School of Medicine, Hangzhou Normal University, Hangzhou, 310016, China
| | - Guang-Hao Wu
- School of Medicine, Hangzhou Normal University, Hangzhou, 310016, China
| | - Xie-Lai Zhou
- Department of Urology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, 310015, China
| | - Kang-Er Wang
- Department of Urology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, 310015, China
| | - Chun-Hua Ye
- Department of Urology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, 310015, China
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Grossmann NC, Ardizzone D, Hermanns T, Keller EX, Fankhauser CD. Is conservative management safe in patients with acute ureterolithiasis and perirenal stranding? Urolithiasis 2023; 51:40. [PMID: 36810953 PMCID: PMC9944580 DOI: 10.1007/s00240-023-01411-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 02/01/2023] [Indexed: 02/24/2023]
Abstract
In patients presenting with ureterolithiasis, perirenal stranding is frequently observed in non-contrast computed tomography. Because perirenal stranding may be caused by tears in the collecting system, previous studies have described an increased risk of infectious complications and suggested broad empiric antibiotic therapy and immediate decompressing of the upper urinary tract. We hypothesized that these patients can also be managed conservatively. Therefore, we retrospectively identified patients with ureterolithiasis and perirenal stranding and compared diagnostic and treatment characteristics as well as treatment outcomes between patients undergoing conservative versus interventional management by ureteral stenting, percutaneous drainage or primary ureteroscopic stone removal. We classified perirenal stranding as mild, moderate or severe based on its radiological extent. Of 211 patients, 98 were managed conservatively. Patients in the interventional group had larger ureteral stones, more proximal ureteral stone location, more severe perirenal stranding, higher systemic and urinary infectious parameters, higher creatinine levels, and received more frequent antibiotic therapy. The conservatively managed group experienced a spontaneous stone passage rate of 77%, while 23% required delayed intervention. In the interventional and conservative groups, 4% and 2% of patients, respectively, developed sepsis. None of the patients in either group developed a perirenal abscess. Comparison of perirenal stranding grade between mild, moderate and severe in the conservatively treated group showed no difference in the spontaneous stone passage and infectious complications. In conclusion, conservative management without prophylactic antibiotics for ureterolithiasis and perirenal stranding is a valid treatment option as long as no clinical or laboratory signs of renal failure or infections are observed.
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Affiliation(s)
- Nico C Grossmann
- Department of Urology, University Hospital Zurich, Frauenklinikstr. 10, 8091, Zurich, Switzerland.
| | - Davide Ardizzone
- Department of Urology, University Hospital Zurich, Frauenklinikstr. 10, 8091, Zurich, Switzerland
| | - Thomas Hermanns
- Department of Urology, University Hospital Zurich, Frauenklinikstr. 10, 8091, Zurich, Switzerland
| | - Etienne X Keller
- Department of Urology, University Hospital Zurich, Frauenklinikstr. 10, 8091, Zurich, Switzerland
| | - Christian D Fankhauser
- Department of Urology, University Hospital Zurich, Frauenklinikstr. 10, 8091, Zurich, Switzerland
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Demirelli E, Öğreden E, Tok DS, Demiray Ö, Karadayi M, Oğuz U. Complementary Ureterorenoscopy after extracorporeal Shock Wave Lithotripsy in proximal ureteral stones: success and complications. Rev Assoc Med Bras (1992) 2022; 68:1068-1072. [PMID: 36134836 PMCID: PMC9574975 DOI: 10.1590/1806-9282.20220237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 05/06/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The aim of this study was to demonstrate the effect of extracorporeal shock wave lithotripsy application on the success and complications of ureteroscopic lithotripsy in proximal ureter stones. METHODS The data of 87 patients who did not respond to shock wave lithotripsy and underwent ureteroscopic lithotripsy were retrospectively analyzed and classified as group I, and 99 patients who received ureteroscopic lithotripsy as primary treatment were classified as group II. Demographic features, response to treatment, and preoperative and postoperative complications were compared between the two groups. RESULTS There was no difference between the two groups in terms of gender, operation times, stone sizes, and ureteroscope diameters. (p>0.05). Infective complications such as postoperative fever, pyelonephritis, and urosepsis were similar in both groups (p=0.142, p=0.291, and p=0.948). Stone migration was observed in 10 (11.5%) and 6 (6.1%) patients in groups I and II, respectively (p=0.291). Impacted stone was seen in 47 (54%) patients in group I and in 15 (15.2%) patients in group II (p<0.0001). Mucosal laceration occurred in 11 (12.6%) and 3 (3%) patients in groups I and II, respectively (p=0.028). Ureteral perforation was detected in 3 (3.4%) patients in group I and 1 (1%) patient in group II, whereas ureteral avulsion was not observed in either group (p=0.524). CONCLUSIONS It was concluded that the application of shock wave lithotripsy before ureteroscopic lithotripsy in proximal ureter stones did not affect the success. Although the results are similar in terms of postoperative infection, shock wave lithotripsy application has been found to increase the risk of stone impaction into the mucosa and ureteral laceration.
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Affiliation(s)
- Erhan Demirelli
- Giresun University, Faculty of Medicine, Department of Urology - Giresun, Turkey
| | - Ercan Öğreden
- Giresun University, Faculty of Medicine, Department of Urology - Giresun, Turkey
| | - Doğan Sabri Tok
- Giresun University, Faculty of Medicine, Department of Urology - Giresun, Turkey
| | - Özay Demiray
- Prof. Dr. A. İlhan Özdemir Training and Research Hospital, Department of Urology - Giresun, Turkey
| | - Mehmet Karadayi
- Giresun University, Faculty of Medicine, Department of Urology - Giresun, Turkey
| | - Ural Oğuz
- Giresun University, Faculty of Medicine, Department of Urology - Giresun, Turkey
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Pricop C, Ivanuta M, Radavoi GD, Toma CV, Cumpanaş A, Jinga V, Bacalbaşa N, Puia D. Determining whether previous SWL for ureteric stones influences the results of ureteroscopy as the second-line treatment: A clinical study. Exp Ther Med 2021; 23:38. [PMID: 34849153 DOI: 10.3892/etm.2021.10960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 09/20/2021] [Indexed: 11/06/2022] Open
Abstract
The purpose of the study was to establish whether shock wave lithotripsy (SWL) is a potential harmful first-line treatment for ureteric stones where ureteroscopy (URS) is necessary as a second-line treatment. Medical records of patients with ureteric stones who underwent either URS as the only therapy applied or SWL followed by URS over two years were retrospectively evaluated. In total, 158 patients were included: 79 patients in Group A (no SWL) and 79 in Group B (prior SWL before URS). There was no difference in major complications, Group A had higher stone-free rates, Group B had higher rates of ureteral edema and similar intraoperative ureteral lesions. In conclusion, the failure of SWL for lumbar or pelvic ureteral lithiasis does not appear to have a negative effect on the rate of intraoperative complications or the success rate of semi-rigid retrograde URS for this category of calculi, with the same safety profile as first-line endourological intervention.
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Affiliation(s)
- Cătălin Pricop
- Department of Urology, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iași, Romania.,Department of Urology, 'C. I. Parhon' Hospital, 700503 Iași, Romania
| | - Marius Ivanuta
- Department of Urology, 'C. I. Parhon' Hospital, 700503 Iași, Romania
| | - George Daniel Radavoi
- Department of Urology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Urology, 'Prof. Dr. Theodor Burghele' Clinical Hospital, 050653 Bucharest, Romania
| | - Cristian-Valentin Toma
- Department of Urology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Urology, 'Prof. Dr. Theodor Burghele' Clinical Hospital, 050653 Bucharest, Romania
| | - Alin Cumpanaş
- Department of Urology, 'Victor Babeş' University of Medicine and Pharmacy, 300041 Timișoara, Romania.,Department of Urology, 'Pius Brînzeu' County Emergency Clinical Hospital Timiş, 300723 Timișoara, Romania
| | - Viorel Jinga
- Department of Urology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Urology, 'Prof. Dr. Theodor Burghele' Clinical Hospital, 050653 Bucharest, Romania
| | - Nicolae Bacalbaşa
- Department of Urology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Visceral Surgery, Center of Excellence in Translational Medicine, 'Fundeni' Clinical Institute, 022328 Bucharest, Romania
| | - Dragoş Puia
- Department of Urology, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iași, Romania.,Department of Urology, 'C. I. Parhon' Hospital, 700503 Iași, Romania
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Qu LG, Chan G, Gani J. Clinician training level impacts prescribing practices for the conservative management of acute renal colic: a contemporary update. Int Urol Nephrol 2020; 53:661-667. [PMID: 33104951 DOI: 10.1007/s11255-020-02686-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 10/14/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Given the current and increasing awareness of the opioid crisis, this study aimed to characterise the types of analgesic prescription for conservatively managed renal colic. METHODS This was a retrospective cohort study of consecutive patients presenting to the Emergency Department (ED) in 2014-2019. Patients were included if they had radiographically confirmed obstructing calculus, managed conservatively without intervention, and were given a prescription for analgesia on discharge. Patient demographics were recorded and analysed. Opioid, non-opioid, and alpha-blocker medications were compared according to patient and disease parameters, and clinician training. Oral morphine equivalents (OMEs) were used to compare prescribed quantities. Subgroup analyses of stone size and location were performed. RESULTS Our analysis included 1761 patients with confirmed renal colic: median age of 50 years (16-96). Altogether, 88% of included patients were prescribed opioids on discharge, while only 68% were prescribed non-opioids (p < 0.001). Oxycodone immediate release was the most frequently prescribed analgesic. Logistic regression modelling controlling for patient and disease characteristics significantly predicted more non-opioid (p < 0.001) and alpha-blocker (p = 0.037) prescription with clinician training < 3 years. Linear regression modelling demonstrated that clinicians training < 3 years predicted lower OMEs per prescription compared to clinicians with ≥ 3 years of training (p = 0.001). Subgroup analyses supported similar predictions with training. CONCLUSIONS Prescribing patterns are associated with different clinician experience levels. However, a substantial amount of opioids are still given overall on patient discharge regardless of the clinician experience. Educational interventions aimed at reducing the opioid prescription rate and quantities may be considered for clinicians of all training levels.
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Affiliation(s)
- Liang G Qu
- Department of Urology, Austin Health, 145-161 Studley Rd, Heidelberg, VIC, 3084, Australia. .,Department of Surgery, University of Melbourne, Melbourne, VIC, Australia.
| | - Garson Chan
- Department of Urology, Austin Health, 145-161 Studley Rd, Heidelberg, VIC, 3084, Australia.,Department of Surgery, University of Melbourne, Melbourne, VIC, Australia.,Department of Surgery, University of Saskatchewan, Saskatchewan, Canada
| | - Johan Gani
- Department of Urology, Austin Health, 145-161 Studley Rd, Heidelberg, VIC, 3084, Australia.,Department of Surgery, University of Melbourne, Melbourne, VIC, Australia.,Department of Urology, Western Health, Footscray, VIC, Australia
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Alshoabi SA, Alhamodi DS, Gameraddin MB, Babiker MS, Omer AM, Al-Dubai SA. Gender and side distribution of urinary calculi using ultrasound imaging. J Family Med Prim Care 2020; 9:1614-1616. [PMID: 32509660 PMCID: PMC7266222 DOI: 10.4103/jfmpc.jfmpc_1153_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 02/11/2020] [Accepted: 02/14/2020] [Indexed: 01/29/2023] Open
Abstract
Introduction: Urinary calculi constitute a significant medical problem worldwide. Due to lack of previous studies on gender and side distribution of urinary calculi, the current study was conducted. Patients and Methods: This retrospective study involved 590 urinary calculi from the electronic reports of 266 patients. Gender and side distribution were compared using Chi-square test. Relationship between gender and side of urinary calculi was analyzed using cross tabulation test. Results: This study involved 590 urinary calculi reported in 266 patients. Among 590 calculi; 565 (95.8%) were in adults, and 25 (4.2%) were in children. Urinary calculi were in male in 397 (67.3%) and in female in 193 (32.7%). Calculi were 304 (51.5%) in right side, and 286 (48.5%) in left side. Exactly 507 (85.9%) of calculi were in the kidneys, and 83 (14.1%) in the ureters. No significant relationship between gender and side of the calculi (P = 0.238), (Odds ratio 0.869, 95% Confidence interval 0.615-1.226). Conclusion: Urinary calculi affect male more than female and adults more than children. No significant relationship between calculi and right or left side of the body.
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Affiliation(s)
- Sultan Abdulwadoud Alshoabi
- Department of Diagnostic Radiology Technology, College of Applied Medical Sciences, Taibah University, Kingdom of Saudi Arabia
| | - Dahhan Saleh Alhamodi
- Unit of Ultrasound Imaging, Department of Radiology, Amran Hospital, Amran, Republic of Yemen
| | - Moawia Bushra Gameraddin
- Department of Diagnostic Radiology Technology, College of Applied Medical Sciences, Taibah University, Kingdom of Saudi Arabia
| | - Mahmoud S Babiker
- Department of Diagnostic Radiology Technology, College of Applied Medical Sciences, Taibah University, Kingdom of Saudi Arabia
| | - Awatef Mohammed Omer
- Department of Diagnostic Radiology Technology, College of Applied Medical Sciences, Taibah University, Kingdom of Saudi Arabia
| | - Sami A Al-Dubai
- Joint Program of Family Medicine Postgraduate Studies, Joint Program of Preventive Medicine Postgraduate Studies, Almadinah Almunawwarah, Kingdom of Saudi Arabia
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