Anuric renal failure after same-session bilateral atraumatic flexible ureteroscopy

SIMULTANEOUS BILATERAL ENDOSCOPIC SURGERY (SBES): IS IT READY FOR PRIME TIME?

Introduction To date, some data available in literature on simultaneous bilateral endoscopic surgery (SBES) have shown good outcomes in terms of both effectiveness and safety. The aim of this study was to report the outcomes pertaining to the effectiveness and safety of SBES performed in our series of patients with bilateral renal stones. Materials and Methods A prospective analysis of consecutive patients who underwent SBES for bilateral renal stones at our institution between June 2017 and September 2021 was performed. Routine preoperative and 1-month postoperative work-up included history, physical examination, urinalysis, urine culture, and blood tests, including the evaluation of estimated glomerular filtration rate (eGFR) using the Cockcroft-Gault equation. An abdominal non-contrast computerized tomography (NCCT) scan was performed in all cases preoperatively and 1-month postoperatively. Peri/postoperative complications were reported according to the Clavien-Dindo classification system. The primary endpoint of the study was stone-free rate (SFR), and the secondary endpoints were Clavien-Dindo complications grade 1 or higher. Results Altogether, 101 patients met the inclusion criteria and were enrolled in the study. SFR for all renal units was achieved in 82 patients (81.1%) at the 1-month follow-up. Twelve patients underwent additional flexible ureteroscopy for residual fragments, and seven asymptomatic patients with single small residual fragment were observed. Eighteen patients (17.8%) experienced Clavien-Dindo Grade I-II complications, whereas one patient (1%) experienced Clavien-Dindo Grade IIIa complication (renal arteriovenous fistula embolization under local anesthesia). Conclusions SBES is a safe and effective procedure for the treatment of bilateral renal stones. Further randomized studies with larger populations are needed to confirm these favorable outcomes of SBES to establish it as an alternative to staged surgeries in patients with bilateral renal stones. Appropriate patient selection is of paramount importance for achieving good outcomes without experiencing severe complications.

The efficacy and safety of bilateral same-session ureteroscopy with holmium laser lithotripsy in the treatment of bilateral ureteral stones

BACKGROUND

A staged ureteroscopic procedure is the generally preferred method in the treatment of bilateral ureteral stones due to the risk of bilateral injury. In this study we aimed to evaluate the safety and efficacy of bilateral same-session ureteroscopy (BS-URS) in terms of complications, operation time, serum creatinine, hospital stay and stone-free rates.

METHODS

A total of 75 patients who underwent BS-URS and holmium laser lithotripsy were evaluated, retrospectively. The patients were re-evaluated postoperatively after four weeks with ultrasonography, X-ray or computed tomography. Pre- and postoperative variables were analyzed. The results of BS-URS were also compared with unilateral URS cases performed in the same time period.

RESULTS

BS-URS was performed in 58 men and 16 women with a mean age of 46.3 years. The mean operating time was 69 min. In patients with stone burden ≥20 mm, the mean operative time was longer. Intraoperative complications were observed in eight patients, Clavien grade I in seven, and Clavien grade IIIb in one. Early postoperative complications included fever and hematuria were seen in 10.6% of the patients. One patient underwent secondary URS for residual stone. Stone free rate after four weeks was 98.6%. Overall complication and and stone-free rates were similar in BS-URS and unilateral URS groups (P>0.05). The mean operating time was significantly longer in BS-URS patients (P=0.001).

CONCLUSIONS

BS-URS is as safe and efficient procedure as unilateral ureteroscopy with high stone-free and minimal morbidity rates in the treatment of bilateral ureteral stones in appropriate patients.

Bilateral Same-Session Ureteroscopy for Treatment of Ureteral Calculi: A Systematic Review and Meta-Analysis

INTRODUCTION

The traditional procedure for the management of bilateral ureteral stones is staged ureteroscopic lithotripsy (URS). However, in recent years particularly, some urologists advocate same-session bilateral URS on the ground of success rates and minimal morbidity. This systematic review is to evaluate the efficacy and safety of same-session bilateral ureteroscopy for the treatment of ureteral calculi.

MATERIALS AND METHODS

We conducted a bibliographic search using MEDLINE (1980 to August 2015) and EMBASE (1980 to August 2015). Review articles and abstract data were excluded and only studies in English reporting on outcomes of bilateral URS were included in this meta-analysis. Two reviewers independently assessed the quality of each included studies and extracted data. STATA 12.0 was used for meta-analysis.

RESULTS

In 11 studies, 431 patients were reportedly treated with bilateral URS. Most of the stone sizes were not larger than 20 mm. The mean stone-free rate is 96% for the distal ureter, 85% for the middle ureter, and 72% for the proximal ureter. The mean operative time ranged from 45 to 100 minutes with an average hospital stay from 2 to 4 days. The overall complications rates were 17%, with the incidence of postoperative fever 4%, postoperative pain 20%, and gross hematuria 4%. Other complications, including urosepsis, urinary tract infection, small mucosal laceration, stone migration, and ureteral perforation, accounted for 6% of overall complications.

CONCLUSIONS

This meta-analysis found that bilateral same-session ureteroscopy could achieve a high overall stone-free rate. There might be a relatively higher complication incidence, but most of the complications are minor. For selected cases, bilateral URS could be safe and effective.

A Fatal Mycotic Sepsis after Retrograde Intrarenal Surgery: A Case Report and Literature Review

Purpose

The retrograde intrarenal surgery (RIRS) is a procedure that sees an increase in its use every day and is supported by excellent results in terms of safety and feasibility. We report the first case of fatal mycotic septic complication in a neurological patient for renal stone disease.

Case Presentation

The case of a woman 44 year-old, with left solitary kidney and history of advanced multiple sclerosis, epilepsy, bedridden and percutaneous endoscopic gastrostomy was described. She was hospitalized for the presence of recurrent lower urinary tract infections. The computed tomography (CT) scan control revealed a 1.7 cm obstructive renal pelvic stone and multiple stones in the bladder. After the refusal of a percutaneous approach, a RIRS was planned and done. No intraoperative complications were observed. In the postoperative period, she developed a urinary sepsis with progressive deterioration of the general conditions. She died 6 days after the RIRS for septic shock with a blood culture positive for Candida glabrata.

Discussion

A Pubmed search for fatal complications after RIRS shows only two cases not fully elucidated.

Conclusions

The use of flexible ureteroscopes and holmium lasers has a high succes rate;nevertheless, the possibility of a major complication should be kept in mind in order to evaluate all the risk factors, to adopt all the preventive measures for the safety of the patients.

Same-session bilateral retrograde intrarenal surgery for upper urinary system stones: safety and efficacy

PURPOSE

We present our experience with same-session retrograde intrarenal surgery (RIRS) for the management of bilateral upper urinary system stones (UUSS) in terms of clearance of stones, operative times, duration of hospital stay, and complications.

MATERIALS AND METHODS

Between November 2007 and January 2013, a total of 44 simultaneous bilateral RIRS were performed at our hospital. Initially, symptomatic sides of the patients were operated on, and, when asymptomatic, the greater stone burden was treated first. Having completed stone fragmentation with a holmium:YAG laser, larger fragments were extracted with a nitinol basket. All patients underwent noncontrast CT scanning or urinary ultrasonography 2 months after the removal of the stent to detect any residual fragments. The stone-free status was defined as no fragments and/or the presence of asymptomatic fragments <4 mm in the urinary system.

RESULTS

The total stone number was 201 with a mean stone burden per patient of 30.0±15.4 mm (range 10-85 mm). The overall stone-free rate (SFR) was 88.6% after all procedures. The patients in this study were divided into two groups according to stone burden: Although the overall SFR was 100% for a stone burden <25 mm, the SFR was 80% for a stone burden ≥25 mm (P=0.006). A Double-J stent was not placed in two patients, and they developed postoperative anuria; both cases were treated with Double-J stent placement.

CONCLUSION

Bilateral same-session RIRS is a safe and effective procedure that can be considered a first-line treatment for bilateral UUSS in select patients. The SFR is satisfactory, especially in patients with a stone burden <25 mm. At minimum a unilateral Double-J stent should be placed in patients undergoing bilateral RIRS to avoid postrenal failure.

Same session bilateral ureteroscopy is safe and efficacious

PURPOSE

Bilateral ureteroscopy can be done in 1 sitting, obviating the need for multiple procedures. We analyzed our experience with same session bilateral ureteroscopy to determine its safety and efficacy.

MATERIALS AND METHODS

In this retrospective study of a 9-year period at Emory University Hospital 1,575 consecutive ureteroscopic procedures were done, of which 95 (6.0%) were done as same session bilateral ureteroscopy, thus constituting our study cohort. Bilateral procedures were performed for urolithiasis in 71 cases, urothelial carcinoma in 9, ureteral stricture in 2 and another indication in 13. Patients were followed at least 1 month postoperatively to evaluate procedural success and assess perioperative complications.

RESULTS

Mean age of the 44 male and 40 female patients was 49.8 years. Multiple procedures were done in 9 patients and same session bilateral ureteroscopy was done in 93 of 95 (98%). Intraoperative and postoperative (greater than 1 month) bilateral stone-free rates were 86% and 64%, respectively. The mean change in serum creatinine postoperatively was 0.02 mg/dl (range -0.9 to 1.3). No patient had acute postoperative azotemia. Postoperative complications in 9.7% of patients included pain necessitating an emergency room visit in 4, pyelonephritis/urinary tract infection in 2, and urinary retention, intractable stent pain leading to early removal and urosepsis/death in 1 each.

CONCLUSIONS

Same session bilateral ureteroscopy is efficacious and safe to evaluate and treat upper tract pathology. While most complications are minor, they may be higher than that typically reported for unilateral ureteroscopic procedures.