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Ventimiglia E, Quadrini F, Pauchard F, Villa L, Candela L, Proietti S, Giusti G, Pietropaolo A, Somani BK, Goumas IK, Salonia A, Doizi S, Traxer O. Pattern of key opinion leaders talks at major international urological meetings reflects the main differences in flexible ureteroscopy and PCNL diffusion. World J Urol 2023; 41:229-233. [PMID: 36445371 DOI: 10.1007/s00345-022-04209-7] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 11/01/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To analyze the pattern of speaker activity related to both flexible ureteroscopy (fURS) and percutaneous nephrolithotomy (PCNL) during plenary sessions at the main (endo)urological international meetings over the last 10 years. METHODS We reviewed the meeting programs of the main endourological international meetings (EAU, AUA, WCE, and SIU) during 2011-2019. We detected all invited speakers at plenary sessions regarding fURS or PCNL. The proportion of fURS and PCNL talks was evaluated yearly during the study period. In order to analyze plenary session speaker composition, we estimated and compared the mean number of talks per speaker according to surgical technique. We also analyzed possible differences in age distribution according to the topic of the talk as well as the presence of young (i.e., < 45 years) speakers. Data were analyzed using descriptive statistics. RESULTS During the last 10 years, a total of 498 plenary talks were found. Of those, 260 (52.2%), 211 (42.4%), and 27 (5.4%) discussed PCNL, fURS, or both, respectively. PCNL was more frequently discussed at the beginning and the end of the study period. Mean [SD] number of talks per speaker was higher for PCNL (2.9 [3.4] vs 1.6 [1.4], p < 0.001), meaning that a wider variety of speakers was invited to give fURS talks. Speakers discussing fURS were younger (median [interquartile range, IQR] age 48 [44-56] vs 52 [47-60] years, p < 0.001), and a higher proportion of young speakers was observed in the fURS group (26% vs 15% p < 0.001). PCNL speakers were more commonly discussing fURS than fURS speakers discussing PCNL (23% vs 17%, p = 0.43). CONCLUSIONS We found a wider variety of speakers at fURS plenary sessions as compared to PCNL ones. It is easier and quicker to become an internationally recognized expert in the field of fURS rather than PCNL. PCNL speakers were able to master fURS more frequently than the other way around.
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Affiliation(s)
- Eugenio Ventimiglia
- Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, GRC n°20, 75020, Paris, France
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, 4 rue de la Chine, 75020, Paris, France
- Division of Experimental Oncology/Unit of Urology, URI-Urological Research Institute, IRCCS Ospedale San Raffaele, 20132, Milan, Italy
| | - Francesca Quadrini
- Department of Urology, Ausl Bologna-Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy
| | - Felipe Pauchard
- Department of Urology, Hospital Carlos Van Buren, Valparaiso, Chile
| | - Luca Villa
- Division of Experimental Oncology/Unit of Urology, URI-Urological Research Institute, IRCCS Ospedale San Raffaele, 20132, Milan, Italy
| | - Luigi Candela
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, 4 rue de la Chine, 75020, Paris, France
- Division of Experimental Oncology/Unit of Urology, URI-Urological Research Institute, IRCCS Ospedale San Raffaele, 20132, Milan, Italy
- Vita-Salute San Raffaele University, 20132, Milan, Italy
| | - Silvia Proietti
- Department of Urology, European Training Center in Endourology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Guido Giusti
- Department of Urology, European Training Center in Endourology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Amelia Pietropaolo
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - Bhaskar K Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | | | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology, URI-Urological Research Institute, IRCCS Ospedale San Raffaele, 20132, Milan, Italy
- Vita-Salute San Raffaele University, 20132, Milan, Italy
| | - Steeve Doizi
- Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, GRC n°20, 75020, Paris, France
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, 4 rue de la Chine, 75020, Paris, France
| | - Olivier Traxer
- Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, GRC n°20, 75020, Paris, France.
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, 4 rue de la Chine, 75020, Paris, France.
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Anan G, Hirose T, Kikuchi D, Takahashi C, Endo A, Ito H, Sato S, Nakayama S, Hashimoto H, Ishiyama K, Kimura T, Takahashi K, Sato M, Mori T. Inhibition of sodium-glucose cotransporter 2 suppresses renal stone formation. Pharmacol Res 2022; 186:106524. [PMID: 36349594 DOI: 10.1016/j.phrs.2022.106524] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 10/24/2022] [Accepted: 10/25/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND AIMS Nephrolithiasis is a common renal disease with no effective medication. Sodium-glucose cotransporter-2 (SGLT2) inhibitors, an anti-diabetic agent, have diuretic and anti-inflammatory properties and could prevent nephrolithiasis. Here, we investigated the potential of SGLT2 inhibition against nephrolithiasis using large-scale epidemiological data, animal models, and cell culture experiments. METHODS This study included the data of diabetic patients (n = 1,538,198) available in the Japanese administrative database and divided them according to SGLT2 inhibitor prescription status. For animal experiments, renal calcium oxalate stones were induced by ethylene glycol in Sprague-Dawley rats, and phlorizin, an SGLT1/2 inhibitor, was used for the treatment. The effects of SGLT2-specific inhibition for renal stone formation were assessed in SGLT2-deficient mice and a human proximal tubular cell line, HK-2. RESULTS Nephrolithiasis prevalence in diabetic men was significantly lower in the SGLT2 inhibitor prescription group than in the non-SGLT2 inhibitor prescription group. Phlorizin attenuated renal stone formation and downregulated the kidney injury molecule 1 (Kim1) and osteopontin (Opn) expression in rats, with unchanged water intake and urine volume. It suppressed inflammation and macrophage marker expression, suggesting the role of the SGLT2 inhibitor in reducing inflammation. SGLT2-deficient mice were resistant to glyoxylic acid-induced calcium oxalate stone formation with reduced Opn expression and renal damages. High glucose-induced upregulation of OPN and CD44 and cell surface adhesion of calcium oxalate reduced upon SGLT2-silencing in HK-2 cells. CONCLUSION Overall, our findings identified that SGLT2 inhibition prevents renal stone formation and may be a promising therapeutic approach against nephrolithiasis.
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Affiliation(s)
- Go Anan
- Department of Urology, Tohoku Medical and Pharmaceutical University, Sendai, Japan; Department of Urology, Yotsuya Medical Cube, Tokyo, Japan
| | - Takuo Hirose
- Division of Nephrology and Endocrinology, Tohoku Medical and Pharmaceutical University, Sendai, Japan; Division of Integrative Renal Replacement Therapy, Tohoku Medical and Pharmaceutical University, Sendai, Japan; Department of Endocrinology and Applied Medical Science, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Daisuke Kikuchi
- Department of Pharmacy, Tohoku Medical and Pharmaceutical University Hospital, Sendai, Japan
| | - Chika Takahashi
- Division of Integrative Renal Replacement Therapy, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Akari Endo
- Division of Nephrology and Endocrinology, Tohoku Medical and Pharmaceutical University, Sendai, Japan; Department of Endocrinology and Applied Medical Science, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroki Ito
- Division of Nephrology and Endocrinology, Tohoku Medical and Pharmaceutical University, Sendai, Japan; Department of Endocrinology and Applied Medical Science, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shigemitsu Sato
- Division of Integrative Renal Replacement Therapy, Tohoku Medical and Pharmaceutical University, Sendai, Japan; Department of Endocrinology and Applied Medical Science, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shingo Nakayama
- Division of Nephrology and Endocrinology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Hideaki Hashimoto
- Division of Nephrology and Endocrinology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Katsuya Ishiyama
- Division of Nephrology and Endocrinology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Tomoyoshi Kimura
- Division of Nephrology and Endocrinology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Kazuhiro Takahashi
- Department of Endocrinology and Applied Medical Science, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Makoto Sato
- Department of Urology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Takefumi Mori
- Division of Nephrology and Endocrinology, Tohoku Medical and Pharmaceutical University, Sendai, Japan; Division of Integrative Renal Replacement Therapy, Tohoku Medical and Pharmaceutical University, Sendai, Japan
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Green BW, Labagnara K, Feiertag N, Gupta K, Donnelly J, Watts KL, Crivelli JJ, Assimos DG, Small AC. Financial Toxicity of Nephrolithiasis: The First Assessment of the Economic Stresses of Kidney Stone Treatment. Urology 2022; 170:46-52. [PMID: 36183747 DOI: 10.1016/j.urology.2022.08.042] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 08/02/2022] [Accepted: 08/17/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To investigate the financial toxicity (FT) related to kidney stone treatment. METHODS We performed a cross-sectional cohort study with multi-institutional in-person and online cohorts of stone formers. Participants were surveyed using the validated COST tool (COmprehensive Score for financial Toxicity). The maximum score is 44 and lower scores indicate increased FT. "Moderate FT" was defined by COST scores between 25-14 points and "severe FT" for scores <14. Descriptive statistics, X2 tests, T tests, Spearman correlation, and logistic regression were performed using SPSS v28. RESULTS 241 participants were surveyed, including 126 in-person participants and 115 online. 60% of participants reported at least moderate FT (COST score <26) and 26% reported severe FT (COST score <14). Patients who reported moderate to severe FT were younger than those with low FT by a median difference of 8 years (95%CI = 4, 12). There was a significant correlation between out-of-pocket expense and COST scores, such that as out-of-pocket expenses increased, COST scores decreased, (Spearman's rho =-0.406, p = <0.001). Participants with moderate to severe FT tended to miss more workdays (p = 0.002), and their caretakers tended to miss more workdays (p = 0.007) due to their stone disease. CONCLUSIONS Most participants reported moderate to severe FT. As prior studies have shown that patients with "moderate FT" employ cost-coping strategies (i.e., medication rationing) and those with "severe FT" have worse health outcomes, urologists need to be sensitive to the financial burdens of treatment experienced by such patients undergoing kidney stone treatment.
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Affiliation(s)
| | | | | | - Kavita Gupta
- Department of Urology, Montefiore Medical Center, Bronx, NY
| | | | - Kara L Watts
- Department of Urology, Montefiore Medical Center, Bronx, NY
| | - Joseph J Crivelli
- Department of Urology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL
| | - Dean G Assimos
- Department of Urology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL
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Geavlete B, Mareș C, Mulțescu R, Georgescu D, Geavlete P. Hybrid flexible ureteroscopy strategy in the management of renal stones - a narrative review. J Med Life 2022; 15:919-926. [PMID: 36188640 PMCID: PMC9514813 DOI: 10.25122/jml-2022-0110] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/02/2022] [Indexed: 11/21/2022] Open
Abstract
The introduction of single-use flexible ureteroscopes (suFURSs) in daily practice tends to overcome the main limitations of reusable ureteroscopes (reFURSs), in terms of high acquisition costs, maintenance, breakages and repairing costs, reprocessing and sterilization, as retrograde intrarenal surgery (RIRS) is promoted as first-line treatment of renal stones in most cases. A hybrid strategy implies having both instruments in the armamentarium of endourology and choosing the best strategy for cost-efficiency and protecting expensive reusable instruments in selected high-risk for breakage cases such as large stones of the inferior calyx, a steep infundibulopelvic angle or narrow infundibulum, or abnormal anatomy as in horseshoe and ectopic kidney. In terms of safety and efficiency, data present suFURSs as a safe alternative considering operating time, stone-free, and complication rates. An important aspect is highlighted by several authors about reusable instrument disinfection as various pathogens are still detected after proper sterilization. This comprehensive narrative review aims to analyze available data comparing suFURSs and reFURSs, considering economic, technical, and operative aspects of the two types of instruments, as well as the strategy of adopting a hybrid approach to selecting the most appropriate flexible ureteroscope in each case.
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Affiliation(s)
- Bogdan Geavlete
- Department of Urology, Sanador Hospital, Bucharest, Romania
- Department of Urology, Emergency Clinical Hospital Sfântul Ioan, Bucharest, Romania
| | - Cristian Mareș
- Department of Urology, Emergency Clinical Hospital Sfântul Ioan, Bucharest, Romania
| | - Răzvan Mulțescu
- Department of Urology, Sanador Hospital, Bucharest, Romania
- Department of Urology, Emergency Clinical Hospital Sfântul Ioan, Bucharest, Romania
| | - Dragoș Georgescu
- Department of Urology, Sanador Hospital, Bucharest, Romania
- Department of Urology, Emergency Clinical Hospital Sfântul Ioan, Bucharest, Romania
| | - Petrișor Geavlete
- Department of Urology, Sanador Hospital, Bucharest, Romania
- Department of Urology, Emergency Clinical Hospital Sfântul Ioan, Bucharest, Romania
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Mahmoud MA, Shawki AS, Abdallah HM, Mostafa D, Elawady H, Samir M. Use of retrograde intrarenal surgery (RIRS) compared with mini-percutaneous nephrolithotomy (mini-PCNL) in pediatric kidney stones. World J Urol 2022; 40:3083-3089. [PMID: 36244014 PMCID: PMC9712365 DOI: 10.1007/s00345-022-04186-x] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 10/05/2022] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE We aimed to compare the cost-effectiveness and safety of retrograde intrarenal surgery (RIRS) and mini-percutaneous nephrolithotomy (mini-PCNL) for pediatric kidney stones management. PATIENTS AND METHODS Ninety pediatric patients with single or multiple renal stones 1-3 cm in diameter were collected prospectively and equally divided into two groups to undergo RIRS or mini-PCNL. The groups were compared for fluoroscopy and operative time, postoperative hospital stay time, stone-free rate (SFR), need for auxiliary procedures, and cost as well as complications. RESULTS There were no differences found between RIRS and mini-PCNL groups with regard to operative time and postoperative DJ stent application, while the mean of fluoroscopy time and postoperative hospital stay was significantly shorter in the RIRS than in the mini-PCNL group. The SFR, auxiliary treatment on residual stones, and complications were comparable. In both groups, no major (Clavien IV-V) complications were observed. The mean cost of RIRS was $1210 and $733 for the mini-PCNL. CONCLUSIONS Both RIRS and mini-PCNL are effective and safe treatment modalities for pediatric renal stones 10-30 mm in size. However, mini-PCNL is more cost-effective making it a viable alternative to RIRS.
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DeWitt-Foy ME, Gao T, Schold J, Abouassaly R. Stones and Moans: Higher Number of Nephrolithiasis Related Encounters Increases the Odds of Opioid Misuse. Urology 2021; 160:75-80. [PMID: 34653430 DOI: 10.1016/j.urology.2021.09.023] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 08/29/2021] [Accepted: 09/01/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To evaluate the association between kidney stones and risk of subsequent opioid misuse. METHODS The Healthcare Cost and Utilization Project's (HCUP) inpatient, ambulatory, and emergency department databases from 4 states were queried to identify associations with a primary diagnosis code related to kidney stones followed by a diagnosis of opioid abuse, dependence, or overdose between 2005, and 2015. Logistic regression was performed to determine the strength and significance of the relationship between number of primary kidney stone episodes and subsequent diagnosis of opioid misuse. RESULTS The final cohort included 783,929 patients across 4 states. On multivariable analysis the number of primary stone encounters (PSE) was strongly associated with the risk of developing an opioid-related disorder (ORD) when adjusting for relevant covariates (odds ratio 1.3). Patients seen in the emergency department (OR 1.4) and those treated in Iowa (OR 2.9) were at higher risk for ORD than those seen in different contexts or states. Younger age increased the strength of this association. Higher income (OR 0.7) and non-white race (OR 0.7) reduced the risk of ORD, while a diagnosis of chronic pain (OR 3.5) increased risk. CONCLUSION Risk of subsequent diagnosis of ORD is increased in patients who have multiple episodes of care related to kidney stones.
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Affiliation(s)
- Molly E DeWitt-Foy
- Cleveland Clinic Foundation, Glickman Urologic and Kidney Institute, Cleveland, OH.
| | | | - Jesse Schold
- Cleveland Clinic Foundation, Glickman Urologic and Kidney Institute, Cleveland, OH
| | - Robert Abouassaly
- Cleveland Clinic Foundation, Glickman Urologic and Kidney Institute, Cleveland, OH
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Monmousseau F, Ramillon J, Dubnitskiy-Robin S, Faivre d’Arcier B, Le Verger M, Le Fol T, Bruyère F, Rusch E, Brunet-Houdard S, Pradère B. Relevance of Adopting a Hybrid Strategy Mixing Single-Use and Reusable Ureteroscopes for Stones Management: An Economic Study to Support the Best Strategy. J Clin Med 2021; 10:jcm10122593. [PMID: 34208267 PMCID: PMC8230737 DOI: 10.3390/jcm10122593] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 05/11/2021] [Revised: 06/01/2021] [Accepted: 06/03/2021] [Indexed: 11/23/2022] Open
Abstract
Endoscopic procedures such as ureteroscopy (URS) have seen a recent increase in single-use devices. Despite all the advantages provided by disposable ureteroscopes (sURSs), their cost effectiveness remains questionable, leading most teams to use a hybrid strategy combining reusable (rURS) and disposable devices. Our study aimed to create an economic model that estimated the cut-off value of rURS procedures needed to support the profitability of a hybrid strategy (HS) for ureteroscopy. We used a budget impact analysis (BIA) model that estimated the financial impact of an HS compared to 100% sURS use. The model included hospital volume, sterilization costs and the private or public status of the institution. Although the hybrid strategy generally remains the best economic and clinical option, a predictive BIA model is recommended for the decision-making. We found that the minimal optimal proportion of rURS procedures in an HS was mainly impacted by the activity volume and overall number of sterilization procedures. Private and public institutions must consider these variables and models in order to adapt their HS and remain profitable.
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Affiliation(s)
- Fanny Monmousseau
- Health-Economic Evaluation Unit, CHU de Tours-Bretonneau, 2 Boulevard Tonnellé, 37044 Tours, France; (J.R.); (S.D.-R.); (E.R.); (S.B.-H.)
- EA 7505—Education Ethics Health, Faculty of Medicine, University of Tours, 2 Boulevard Tonnellé, 37044 Tours, France
- Correspondence:
| | - Julien Ramillon
- Health-Economic Evaluation Unit, CHU de Tours-Bretonneau, 2 Boulevard Tonnellé, 37044 Tours, France; (J.R.); (S.D.-R.); (E.R.); (S.B.-H.)
| | - Sophie Dubnitskiy-Robin
- Health-Economic Evaluation Unit, CHU de Tours-Bretonneau, 2 Boulevard Tonnellé, 37044 Tours, France; (J.R.); (S.D.-R.); (E.R.); (S.B.-H.)
- Inserm UMR1246 SPHERE, Universities of Nantes and Tours, CHU de Tours-Bretonneau, 2 Boulevard Tonnellé, 37044 Tours, France
| | - Benjamin Faivre d’Arcier
- Department of Urology, CHU de Tours-Bretonneau, 2 Boulevard Tonnellé, 37044 Tours, France; (B.F.d.); (F.B.); (B.P.)
| | - Martine Le Verger
- Pharmacy, CHU de Tours-Trousseau, Avenue de la République, 37170 Chambray-les-Tours, France;
| | - Tanguy Le Fol
- Biomedical Unit, CHU de Tours-Trousseau, Avenue de la République, 37170 Chambray-les-Tours, France;
| | - Franck Bruyère
- Department of Urology, CHU de Tours-Bretonneau, 2 Boulevard Tonnellé, 37044 Tours, France; (B.F.d.); (F.B.); (B.P.)
- PRES Centre Val de Loire, University of Tours, 60 Rue du Plat d’Étain, 37000 Tours, France
| | - Emmanuel Rusch
- Health-Economic Evaluation Unit, CHU de Tours-Bretonneau, 2 Boulevard Tonnellé, 37044 Tours, France; (J.R.); (S.D.-R.); (E.R.); (S.B.-H.)
- EA 7505—Education Ethics Health, Faculty of Medicine, University of Tours, 2 Boulevard Tonnellé, 37044 Tours, France
| | - Solène Brunet-Houdard
- Health-Economic Evaluation Unit, CHU de Tours-Bretonneau, 2 Boulevard Tonnellé, 37044 Tours, France; (J.R.); (S.D.-R.); (E.R.); (S.B.-H.)
- EA 7505—Education Ethics Health, Faculty of Medicine, University of Tours, 2 Boulevard Tonnellé, 37044 Tours, France
| | - Benjamin Pradère
- Department of Urology, CHU de Tours-Bretonneau, 2 Boulevard Tonnellé, 37044 Tours, France; (B.F.d.); (F.B.); (B.P.)
- Comprehensive Cancer Center, Department of Urology, Medical University of Vienna, Spitalgasse 23, 1090 Wien, Austria
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Taguchi K, Hamamoto S, Osaga S, Sugino T, Unno R, Ando R, Okada A, Yasui T. Comparison of antegrade and retrograde ureterolithotripsy for proximal ureteral stones: a systematic review and meta-analysis. Transl Androl Urol 2021; 10:1179-1191. [PMID: 33850753 PMCID: PMC8039618 DOI: 10.21037/tau-20-1296] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background Antegrade percutaneous ureterolithotripsy (URSL) could be a treatment option for large and/or impacted proximal ureteral stones, which are difficult to treat. To review the current approach and treatment outcomes and to compare the efficacy of retrograde and antegrade URSL for large proximal ureteral stones, we evaluated the unique perspectives of both surgical modalities. Methods This systematic literature review and meta-analysis was performed in July 2020. Articles on human studies and treatment of ureteral stones with URSL were extracted from the PubMed, MEDLINE, Embase, Cochrane Library, Scopus, and the Japan Medical Abstracts Society databases without any language restrictions. The risks of bias for randomized controlled trials (RCTs) and non-randomized controlled trials (non-RCTs) were assessed using the Cochrane risk of tool and the Risk of Bias in Non-randomized Studies- of Interventions tool, respectively. Results A total of 10 studies, including seven RCTs and three non-RCTs, were selected for the analysis; 433 and 420 cases underwent retrograde and antegrade URSL, respectively. The stone-free rate (SFR) was significantly higher in antegrade URSL than in retrograde URSL (SFR ratio: 1.17, 95% CI: 1.12-1.22; P<0.001), while the hospital stay was significantly longer in antegrade URSL than in retrograde URSL (standardized mean difference: 2.56, 95% CI: 0.67-4.46; P=0.008). There were no significant differences in the operation time and the overall complication rate between the two approaches. Conclusions Despite the heterogeneity of data and bias limitations, this latest evidence reflects real practice data, which may be useful for decision making.
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Affiliation(s)
- Kazumi Taguchi
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Shuzo Hamamoto
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Satoshi Osaga
- Clinical Research Management Center, Nagoya City University, Nagoya, Japan
| | - Teruaki Sugino
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Rei Unno
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Ryosuke Ando
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Atsushi Okada
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Takahiro Yasui
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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Abstract
Technological advances and innovation in endourology have significantly reduced the indications of extracorporeal shockwave lithotripsy in the management of moderate-sized renal stones. In the last decade, we have witnessed a trend towards the use of finer scopes for percutaneous procedures instead of standard percutaneous nephrolithotomy (PCNL) (≥22 Fr). Miniaturized PCNL (mPCNL), i.e. miniPCNL (12–20 Fr), ultra-miniPCNL (11–13 Fr), mini-microPCNL (8 Fr), and microPCNL (<5 Fr), is increasingly being used. Concomitant developments in laser technology have provided a safe and effective stone fragmentation modality for use via flexible ureteroscopes (fURS). Technological advances in the design of fURS have improved not only the optics (fiber optic to chip-on-the-tip technology digital image) but also the ergonomics. Both the endourological techniques are extremely effective and safe, as shown in a multitude of good-quality studies. There are some differences in stone-free rate and complications. mPCNL in general has a higher stone-free rate, albeit with a slightly higher incidence of hemorrhagic complications. fURS often requires longer stenting time and longer period to achieve stone clearance, whereas mPCNL often needs ureteral catheter for only 24 hours and has a higher first day stone-free rate. fURS is a 1 day procedure compared to mPCNL, which requires patients to stay hospitalized for 2–3 days. It is therefore important to tailor the indications of these two procedures to the individual patient’s needs.
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Affiliation(s)
- M Hammad Ather
- Department of Surgery, Aga Khan University, Karachi, Pakistan
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Amirhosseini M, Dehghan M, Mangolian Shahrbabaki P, Pakmanesh H. Effectiveness of Aromatherapy for Relief of Pain, Nausea, and Vomiting after Percutaneous Nephrolithotomy: A Randomized Controlled Trial. Complement Med Res 2020; 27:440-448. [PMID: 32575103 DOI: 10.1159/000508333] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 12/06/2019] [Accepted: 04/29/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Postoperative pain, nausea, and vomiting are common side effects of percutaneous nephrolithotomy. Nowadays, non-pharmacological and complementary therapies have been noticed. Therefore, a study was conducted to determine the effectiveness of lavender and clary sage on the pain, nausea, and vomiting after percutaneous nephrolithotomy. METHODS This is a randomized clinical trial study on 79 patients undergoing percutaneous nephrolithotomy. Patients were randomly divided into three groups of lavender aromatherapy (n = 27), clary sage aromatherapy (n = 26), and a control group (n = 26). Each of the intervention groups received the inhalation aromatherapy immediately and 3 and 6 h after the operation. Pain, nausea, and emetic episodes in patients of the three groups were measured before the intervention and 30 min after each intervention using a visual analog scale and checklist. RESULTS Pain decreased significantly in the clary sage aromatherapy group. Nausea had a downward trend in the two groups of aromatherapy. The lavender aromatherapy group had the lowest incidence of emetic episodes compared to the other groups. CONCLUSION Regarding the annoying pain, nausea, and vomiting after percutaneous nephrolithotomy for patients, and taking into account the complications of drug therapy, the use of complementary non-pharmacological methods can help increase the comfort of patients.
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Affiliation(s)
- Mojdeh Amirhosseini
- Shahid Bahonar Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Mahlagha Dehghan
- Nursing Research Center, Department of Critical Care Nursing, Razi Faculty of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran
| | - Parvin Mangolian Shahrbabaki
- Nursing Research Center, Department of Critical Care Nursing, Razi Faculty of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran,
| | - Hamid Pakmanesh
- Department of Urology, Shahid Bahonar Hospital, Kerman University of Medical Sciences, Kerman, Iran
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Dubnitskiy-Robin S, Pradère B, Faivre d'Arcier B, Watt S, Le Fol T, Bruyère F, Rusch E, Monmousseau F, Brunet-Houdard S. Switching to Single-use Flexible Ureteroscopes for Stones Management: Financial Impact and Solutions to Reduce the Cost Over a 5-Year Period. Urology 2020; 143:68-74. [PMID: 32540300 DOI: 10.1016/j.urology.2020.05.062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 05/24/2020] [Accepted: 05/28/2020] [Indexed: 02/01/2023]
Abstract
OBJECTIVES To assess the financial impact of switching to single-use ureteroscopes (sURS) in urolithiasis management for a hospital, over a 5-year period, and to identify possible solutions to contain or reduce it. METHODS A Budget Impact (BI) model was designed for a public hospital performing around 200 ureteroscopies or extracorporeal shockwave lithotripsies per year. The BI was estimated as the difference between financial balances (between costs and revenues) of 2 environments (with and without sURS). The population was defined as adults treated for urolithiasis. The BI model was based on assumptions about the expected progression in the incidence of urolithiasis, and the expected change in clinical practices due to the availability of sURS. We considered the costs and revenues of hospital stays, the purchase price of sURS and the costs of digital or fiberoptic reusable ureteroscopes (rURS). Univariate and multivariate sensitivity analyses were performed. RESULTS The cumulative 5-year financial impact of switching completely to sURS was €807,824 and €649,677 in comparison with fiberoptic and digital rURS respectively. This impact could be reduced by half or more if the health-care facility were to adopt different solutions, including negotiating the purchase price of sURS, developing outpatient activity and reducing production costs for ureteroscopy procedures. CONCLUSION The BI model gives decision-makers a more accurate picture of the financial impact of switching to sURS and highlights ways to reduce the expected additional cost.
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Affiliation(s)
- Sophie Dubnitskiy-Robin
- Health-economic Evaluation Unit, University Hospital of Tours, France; Geriatric Unit, University Hospital of Tours, France; EA 7505 Education, Ethics, Health, University of Tours, France
| | - Benjamin Pradère
- Department of Urology, University Hospital of Tours, France; PRES Centre-Val de Loire, University of Tours, France
| | | | - Sophie Watt
- Pharmacy, University Hospital of Tours, France
| | - Tanguy Le Fol
- Biomedical Unit, University Hospital of Tours, France
| | - Franck Bruyère
- Department of Urology, University Hospital of Tours, France; PRES Centre-Val de Loire, University of Tours, France
| | - Emmanuel Rusch
- Health-economic Evaluation Unit, University Hospital of Tours, France; EA 7505 Education, Ethics, Health, University of Tours, France; PRES Centre-Val de Loire, University of Tours, France; Medical Information Department, University Hospital of Tours, France
| | - Fanny Monmousseau
- Health-economic Evaluation Unit, University Hospital of Tours, France; EA 7505 Education, Ethics, Health, University of Tours, France
| | - Solène Brunet-Houdard
- Health-economic Evaluation Unit, University Hospital of Tours, France; EA 7505 Education, Ethics, Health, University of Tours, France.
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12
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Geraghty RM, Cook P, Walker V, Somani BK. Evaluation of the economic burden of kidney stone disease in the UK: a retrospective cohort study with a mean follow-up of 19 years. BJU Int 2020; 125:586-594. [PMID: 31916369 DOI: 10.1111/bju.14991] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To estimate the cost of kidney stone disease (KSD) in England. PATIENTS AND METHODS We conducted a retrospective cohort study of patients with KSD, referred to a metabolic stone clinic between 1990 and 2007 using electronic records of patients with KSD in a tertiary referral centre, to determine cost using UK National Health Service (NHS) tariff, with subsequent extrapolation to the entire England population. Those with no documentation and <5 years follow-up were excluded. The outcome measure was calculation of cost (as per 2018 NHS tariff) presented as lower and higher estimates for: per episode; total within the cohort; and estimation of initial, 5-,10- and 15-year costs for the cohort and total population in England. Linear regression was used to examine for significant predictors of per episode and total cost. RESULTS A total of 781 patients were included in the study after 1000 records were screened for inclusion, with a mean follow-up of 19 years. The mean (SD) overall costs per episode were between £1277 (1724) and £2887 (2492). Total initial costs for the cohort were between £950 842 and £2 336 442, rising to between £1.43 million and £3.02 million at 15 years of follow-up. Estimated cost in 2010 in England alone was between £190 million and £324 million. CONCLUSION KSD is a costly disease, comparable to the combined cost of prostate and bladder cancer in UK.
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Affiliation(s)
| | - Paul Cook
- University Hospital Southampton, Southampton, UK
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Jin L, Yang B, Zhou Z, Li N. Comparative Efficacy on Flexible Ureteroscopy Lithotripsy and Miniaturized Percutaneous Nephrolithotomy for the Treatment of Medium-Sized Lower-Pole Renal Calculi. J Endourol 2019; 33:914-919. [PMID: 31596612 DOI: 10.1089/end.2019.0504] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Lianchao Jin
- Department of Urology, Peking University Shougang Hospital, Beijing, China
| | - Bing Yang
- Department of Urology, Peking University Shougang Hospital, Beijing, China
| | - Zhe Zhou
- Department of Urology, Peking University Shougang Hospital, Beijing, China
| | - Ningchen Li
- Department of Urology, Peking University Shougang Hospital, Beijing, China
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Pietropaolo A, Bres-Niewada E, Skolarikos A, Liatsikos E, Kallidonis P, Aboumarzouk O, Tailly T, Proietti S, Traxer O, Giusti G, Rukin N, Özsoy M, Talso M, Emre ST, Emiliani E, Atis G, Somani BK. Worldwide survey of flexible ureteroscopy practice: a survey from European Association of Urology sections of young academic urologists and uro-technology groups. Cent European J Urol 2019; 72:393-397. [PMID: 32015909 PMCID: PMC6979553 DOI: 10.5173/ceju.2019.0041] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 09/24/2019] [Accepted: 10/09/2019] [Indexed: 12/21/2022] Open
Abstract
Introduction To understand the current practice of flexible ureteroscopy (fURS), we conducted a worldwide survey among urologists with a special interest in endourology. Material and methods A 42-question survey was designed after an initial consultation with European Association of Urology young academic urologists (YAU) and uro-technology (ESUT) groups. This was distributed via the SurveyMonkey® platform and an ESUT meeting to cover practice patterns and techniques in regard to ureteroscopy usage worldwide. Results A total of 114 completed responses were obtained. A safety guidewire was reportedly used by 84.5% of endourologists, an access sheath was always or almost always used by 71% and a reusable laser fibre was used by two-thirds of respondents. While a combination of dusting and fragmentation was used by 47% as a preferred mode of intra-renal stone treatment, some used dusting (43%) or fragmentation with basketing (10%). Disposable scopes were only used by 40% and three quarters of them used it for challenging cases only. Antibiotic prophylaxis was limited to a single peri-operative dose by two-thirds (67%) of respondents. The procedural time was limited to between 1–2 hours by two-thirds (70%) of respondents and very rarely (7.4%) it exceeded 2 hours. The irrigation method varied between manual pump (46%), mechanical irrigation (22%) or gravity irrigation (27%). Conclusions Our survey shows a wide variation in the available endourological armamentarium and surgical practice amongst urologists. However, there seems to be a broad agreement in the use of peri-operative antibiotics, access sheath usage, method of stone treatment and the use of post-operative stent.
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Affiliation(s)
- Amelia Pietropaolo
- University Hospital Southampton NHS Foundation Trust, Department of Urology, Southampton, United Kingdom
| | - Ewa Bres-Niewada
- Roefler Memorial Hospital, Department of Urology, Pruszków, Poland
| | | | | | | | - Omar Aboumarzouk
- NHS Greater Glasgow and Clyde, Department of Urology, Glasgow, United Kingdom
| | - Thomas Tailly
- Universitair Ziekenhuis Gent, Department of Urology, Gent, Belgium
| | - Silvia Proietti
- IRCCS San Raffaele Scientific Institute, Ville Turro Division, Department of Urology, Milan, Italy
| | - Oliver Traxer
- Tenon Hospital, Assitance Publique-Hopitaux De Paris, Pierre et Marie Curie University, Department of Urology, Paris, France
| | - Guido Giusti
- IRCCS San Raffaele Scientific Institute, Ville Turro Division, Department of Urology, Milan, Italy
| | - Nick Rukin
- Metro North Hospitals and Health Service, Brisbane, Australia
| | - Mehmet Özsoy
- Medical University of Vienna, Vienna General Hospital, Department of Urology, Vienna, Austria
| | - Michele Talso
- ASST Vimercate Hospital, Department of Urology, Vimercate, Monza Brianza, Italy
| | | | | | - Gokhan Atis
- Istanbul Medeniyet University, Department of Urology, Istanbul, Turkey
| | - Bhaskar K Somani
- University Hospital Southampton NHS Foundation Trust, Department of Urology, Southampton, United Kingdom.,University of Southampton, Southampton, United Kingdom of Great Britain and Northern Ireland
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