Factors Predicting Operating Room Time in Ureteroscopy and Ureterorenoscopy

Backgrounds/Aims

Operation room (OR) time is of great value affecting surgical outcome, complications and the daily surgical program with financial implications.

Methods

We retrospectively evaluated 570 consecutive patients submitted to ureteroscopy or ureterorenoscopy for the treatment of ureteral or renal stones. Demographic parameters, patient's stones characteristics, type of ureteroscope, surgeon experience and surgical theater characteristics were analyzed. OR time was calculated from the initiation of anesthesia to patient extubation. Multivariate analysis was conducted using a linear regression test with multiple parameters to identify predictors of OR time.

Results

Eight factors were identified as significant. These include total stones volume, ureteroscope used, stone number, nurses experience, radio-opacity of the stone on kidney-ureter-bladder X-ray, main surgeon experience, operating room type, and having a nephrostomy tube prior to surgery.

Conclusions

The surgical team experience and familiarity with endourological procedure, and the surgical room characteristics has a crucial impact on OR time and effectiveness.

Single lower calyceal percutaneous tract combined with flexible nephroscopy: A valuable treatment paradigm for staghorn stones

INTRODUCTION

We evaluated the efficacy and safety of single lower calyceal tract combined with flexible nephroscopy for the management of staghorn renal stones by percutaneous nephrolithotomy.

METHODS

The medical records of patients who underwent percutaneous nephrolithotomy for the management of staghorn stones were analyzed. We included patients aged >18 years, while patients with incomplete data and renal anatomical anomalies were excluded from the study. Stone-free rate, postoperative complications, procedure duration, fluoroscopy time, and length of hospitalization were recorded. Postoperative outcomes were evaluated by non-contrast computed tomography scan 4-6 weeks after the operation. Stone-free status was defined as the absence of residual stones >4 mm.

RESULTS

The study cohort consisted of 103 consecutive patients. Stone-free rate was 65.0%. No complications were observed in 69.9% of the cases; most postoperative complications were Grade 1 (13.6%) and 2 (10.7%). Five patients (4.9%) suffered a Grade 3a complication and another patient (1.0%) suffered a Grade 3b complication.

CONCLUSIONS

Percutaneous nephrolithotomy through a single lower calyceal tract combined with flexible nephroscopy can be a valuable treatment option for the treatment of staghorn calculi, providing efficacy and safety. Nevertheless, the present study is limited by both its retrospective nature and being conducted at a single centre and, thus, proper prospective studies with head-on comparisons are needed to prove or disprove the advantages and disadvantages of either approach.

Interobserver Reliability and Reproducibility of the Clinical Research Office of the Endourological Society Nomogram in Predicting Percutaneous Nephrolithotomy Results

OBJECTIVE

To assess interobserver reliability and reproducibility of the Clinical Research Office of the Endourological Society (CROES) nephrolithometric nomogram.

PATIENTS AND METHODS

Preoperative data and postoperative outcomes of 100 consecutive patients who underwent percutaneous nephrolithotomy were obtained. Patients' data were reviewed separately by 4 independent urologists of different academic level: an experienced attending endourologist, a graduated fellow, a young fellow, and a resident. Each rater adjusted a CROES score in all 100 patients. Interobserver reliability was analyzed by assessing intraclass correlation (ICC) and kappa coefficient among and between all different raters.

RESULTS

Assessment of interobserver reliability showed good or excellent agreement among all raters. Moderate agreement was only found between the raters for the "presence of staghorn" score. ICCs among all raters expressed excellent levels for each independent CROES parameter and reached great statistical significance. The highest correlation was noticed for "stone burden" in contrast to "presence of staghorn" parameter that showed the lowest. ICC for the final CROES score revealed good to excellent agreement among all raters and all pairs of raters.

CONCLUSION

CROES nephrolithometry is a reproducible nomogram. Reproducible results were obtained within a single institution by multiple reviewers of varying experience within a short period of time after undergoing standardized training.