Application of the direct in-scope suction technique in antegrade flexible ureteroscopic lithotripsy for the removal of a large ureteric calculus in a kidney transplant recipient: A case report

The occurrence of a large ureteric calculus in a transplanted kidney, originating from a donor, is a rare but significant complication. It poses risks such as urinary obstruction, septicemia, and potential loss of allograft function. In this case, we report our first use of the direct in-scope suction technique during antegrade flexible ureteroscopy lithotripsy. This method successfully removed a donor-derived ureteric calculus in a kidney transplant recipient. The procedure resulted in complete stone removal, and the patient experienced a favorable postoperative recovery without additional adverse events.

Simultaneously combining a thulium fiber laser and holmium:YAG laser in vacuum-assisted mini-endoscopic combined intrarenal surgery on a complex renal calculus: A case report

Employing percutaneous nephrolithotomy to manage a complex renal calculus has always been challenging due to the blood transfusion requirement and the frequent necessity of using multiple access tracts. We report a novel treatment modality in the case of a 65-year-old male with a complex, large-volume renal calculus who was successfully treated by vacuum-assisted miniaturized endoscopic combined intrarenal surgery using the combination of a thulium fiber laser in retrograde fashion with a holmium:YAG laser in antegrade fashion. The kidney stone was entirely cleared, and the patient fully recovered with no adverse event.

Mini ECIRS with BotX: our single-case experience

Minimally invasive endoscopic combined intrarenal surgery has become the gold standard procedure for the treatment of large kidney stones. However, one of the most important critical success factors is the level of precision during renal accession, which requires a long learning curve. Robot-assisted fluoroscopy-guided renal access has been developed to address this difficulty. We report here the case of a 63-year-old woman presenting with a very large renal calculus whose treatment was successful using a robot-assisted fluoroscopy-guided minimally invasive endoscopic combined intrarenal surgery with suction sheath. The entire stone was cleared, and the patient recovered well with an absence of adverse events.

Retrograde vacuum-assisted MiniPCNL system for large distal ureteric calculus removal: A case report

Large ureteral calculi are commonly associated with severe colic pain, complex urinary tract infections, severe hematuria, hydronephrosis, and renal deterioration, often requiring immediate surgical intervention. Ureteroscopy is a favored treatment due to its higher stone-free rates; however, it encounters difficulties in cases of a high burden of distal ureteral stones. We present a case where a patient with a significant ureteral calculus was effectively treated with a vacuum-assisted mini-percutaneous nephrolithotomy system in retrograde approach. This intervention enabled the complete removal of the stone, leading to the patient's full recovery without complications.

Massive haemothorax from percutaneous nephrolithotomy requiring video-assisted thoracoscopic surgery: A case report

INTRODUCTION

Massive haemothorax can occur following percutaneous nephrolithotomy (PCNL), which is a significant adverse event and a life-threatening condition.

PRESENTATION OF CASE

A 65-year-old male who presented with a full right staghorn stone was treated with PCNL. Two days later, he developed massive haemothorax and conservative management with intercostal drainage failed. The patient successfully underwent video-assisted thoracoscopic surgical decortication (VATSD).

DISCUSSION

PCNL is the mainstay procedure for complex renal stones. Because it is aggressive, it can also have serious complications. Tube thoracostomy drainage is the initial approach for managing haemothorax. However, retained haemothorax still occurs and can cause additional complications. VATSD is frequently applied in the modern era because of its good visualization and reduced morbidity compared with conventional thoracotomy.

CONCLUSION

VATSD is a safe and effective surgical technique that can be easily applied to manage retained haemothorax as a result of PCNL.

Tubeless mini-percutaneous nephrolithotomy to remove a staghorn stone concurrent with proximal ureteral calculus in an elderly patient: A case report

A complex staghorn calculus that is concurrent with an impacted large proximal ureteric calculi is rarely found in elderly patients, and morbidity and mortality rates are much higher if left untreated. We report the case of an 88-year-old female with complex high-volume renal and ureteral calculus who was treated successfully using a tubeless mini-percutaneous nephrolithotomy. The entire stone was retrieved, and the patient fully recovered without any complications.

Chronic urine ascites secondary to proximal migrating of double-J ureteral stent into peritoneal cavity: A case report

Implanting of a prophylactic double J stent during ureteroneocystostomy has been adopted as routine procedure for preventing anastomotic complications. In extremely rare events, the coiled distal end of the stent migrates upward through ureterovesical anastomosis into the peritoneal cavity. We report below a case that presented with chronic urinary ascites secondary to ureteral stent displacement which was successfully treated by endoscopic intervention.

A giant ureteric calculus successfully removed by mini-endoscopic combined intrarenal surgery: A case report

Giant ureteric calculi are extreme rare and associated with a subsequent decline in the function of the affected kidney. We report the case of a 58-year-old male with a huge opaque ureteral calculus found during a routine medical check-up. Computed tomography revealed an 11 × 12 × 67 mm³ ureteral stone at the right proximal ureter with mild hydronephrosis. The patient was treated successfully by mini-endoscopic combined intrarenal surgery, and the entire stone was retrieved. The patient recovered fully without additional complications.

Prospective randomized controlled trial to evaluate effectiveness of virtual reality to decrease anxiety in office-based flexible cystoscopy patients

PURPOSE

To evaluate the effectiveness of immersive VR distraction technology in alleviating anxiety and pain during flexible cystoscopy.

METHODS

We prospectively recruited 270 study participants who qualified for flexible cystoscopy and randomly assigned them to experimental and control groups. The experimental group consisted of 135 patients who employed a VR set during flexible cystoscopy, and the control group consisted of 135 patients who underwent the procedure without a VR set. Patient anxiety was determined quantitatively according to the State-Trait Anxiety Inventory. A visual analog scale for assessing pain intensity, satisfaction, and willingness to repeat the procedure was evaluated. In addition, difference in the hemodynamic parameter was also examined.

RESULTS

The study findings demonstrated that the use of a VR set during flexible cystoscopy significantly improved the anxiety level over that of the control group (p = 0.001). Furthermore, this intervention led to a significantly increased level of satisfaction and willingness to repeat the procedure and a decrease in hemodynamic variables, specifically, systolic pressure, diastolic pressure, and heart rate (p = 0.001 in each case). Nonetheless, there were no significant differences between the groups with respect to the basic characteristic data, pain intensity, or oxygen saturation.

CONCLUSIONS

Based on the present study, immersive VR can measurably decrease anxiety and increase satisfaction and willingness to repeat the procedure during flexible cystoscopy.

TRIAL REGISTRATION DATE

14 September 2019; number: TCTR20190914002.

Efficacy of the Orally Disintegrating Strip Sildenafil for the Treatment of Erectile Dysfunction: A Prospective, Randomized Trial

Introduction

Phosphodiesterase 5 inhibitors are the predominant treatment option for erectile dysfunction.

Aim

This study evaluates the efficacy and safety of sildenafil orally disintegrating strips for the treatment of erectile dysfunction.

Methods

One hundred twenty erectile dysfunction patients were enrolled in a prospective, randomized, controlled crossover study and allocated into 2 groups of 60 participants. Patients were either treated with sildenafil strips or tablets for 8 weeks after which they crossed over into the alternate treatment formulation for another 8 weeks following a 4-week wash-out period. Each participant was assessed 8 times throughout the study period and their formulation preference registered at the end of the study.

Main outcomes and measures

Changes in the abridged International Index of Erectile Function (IIEF-5) score and Erection Hardness Score (EHS) resulting from sildenafil orally disintegrating strip or tablet treatments were the primary end points, with differences in onset of action, duration of action, and incidence of adverse events between the 2 formulations included as secondary end points.

Results

Both sildenafil formulations were effective in treating patients with erectile dysfunction. There was significant improvement of erectile function in term of IIEF-5 score and EHS from both formulations. The number and type of adverse events were also comparable. Likewise, there were no statistically significant differences between the earliest onset of action times and longest duration of action times. However, the results showed a 7.1-minute earlier onset of action time for orally disintegrating strips that may be considered as clinically meaningful by some patients.

Conclusion

Sildenafil orally disintegrating strips are a safe and effective alternative to the conventional tablet formulation for the treatment of erectile dysfunction. Sangkum P, Sirisopana K, Matang W, et al. Efficacy of the Orally Disintegrating Strip Sildenafil for the Treatment of Erectile Dysfunction: A Prospective, Randomized Trial. Sex Med 2021;9:100453.

Implementation of Supine Percutaneous Nephroscopic Surgery to Remove an Upward Migration of Ureteral Catheter in Infancy: A Case Report

Background

Double-J stents are favorably utilized after pyeloplasty. In rare situations, the stent may migrate upward. Here, we demonstrate the implementation and result of a supine percutaneous nephroscopic surgery (PNS) to retrieve a proximately migrated ureteral catheter in a pediatric patient.

Patient and Methods

A 1-year-old boy was suffering from an upward migration of a ureteric catheter into the right ureter after an open Anderson-Hynes pyeloplasty. The child was placed in the Galdakao-modified supine Valdivia (GMSV) position and a PNS procedure was performed. The calyceal access was carefully punctured by ultrasonographic guidance. The nephrostomy tract was dilated with a metal dilator using a one-step technique. An exploratory nephroscopy of the renal pelvis was conducted with a 12Fr miniature nephroscope and the migrated ureteral catheter was removed. A hybrid guidewire was retrogradely inserted into the ureteric orifice using a rigid ureteroscope. An antegrade double J stent was inserted in the proper position and a percutaneous nephrostomy was performed.

Results and Conclusion

This is the first report of a successfully removed upwardly migrated ureteral catheter with concurrent insertion of an antegrade double J stent by supine PNS in the GMSV position in an infant. The patient recovered well after surgery with no adverse event, demonstrating that this operation can be carried out safely on pediatric patients.

External Validation of the S.T.O.N.E. Score in Predicting Stone-Free Status After Rigid Ureteroscopic Lithotripsy

Background

The Size, Topography, Obstruction, Number, and Evaluation of Hounsfield units (S.T.O.N.E.) scoring system has been proposed as a novel prognostic surgical classification for urolithiasis in predicting success rate and complications.

Objective

We carried out an externally validated S.T.O.N.E. score on rigid ureteroscopic lithotripsy (rURS).

Materials and Methods

The data of patients who had undergone rURS between 2012 and 2019 at a tertiary referral center were audited retrospectively. The S.T.O.N.E. score was calculated based on factors determined through preoperative computed tomography images and was analyzed in association with stone-free rate (SFR), operating time, surgical complications, and length of stay (LOS).

Results

A total of 155 patients were included in the study with a median stone size of 10 mm (7–12) and a median S.T.O.N.E. score of 9 (8–10). The overall SFR was 89.68%. SFRs were 100.0%, 97.83%, and 77.42% in low (5), moderate (6–9), and high (10–13) score groups, respectively. The S.T.O.N.E. score (p = 0.002) and stone size (p = 0.037) were predictive factors for SFR in multivariate analysis. Moreover, there was a significant correlation between the S.T.O.N.E. score and operative time, LOS, and presence of complications (r = 0.22, p = 0.006; r = 0.30, p < 0.001; and r = 0.27, p < 0.001, respectively). The area under the curve of the receiving operator characteristics’ curve for the S.T.O.N.E. score was 0.815.

Conclusion

The S.T.O.N.E. scoring system is simple and effective in predicting postoperative outcomes; therefore, this score would be a valuable tool in clinical planning for every patient who undergoes rURS.

Prospective Randomized Controlled Trial to Evaluate the Effectiveness of Watching Movies to Decrease Anxiety During Extracorporeal Shock Wave Lithotripsy

Background

Extracorporeal shock wave lithotripsy (ESWL) is the only non-invasive treatment for urolithiasis; however, it can cause anxiety and pain for patients. Several new nonpharmacological adjuvant approaches have been developed to reduce adverse events.

Objective

To analyze the efficacy of watching movies during ESWL to relieve anxiety and pain.

Methods

A total of 84 patients were randomly divided into two groups. The experimental group consisted of 42 patients who watched their own selected movies during the ESWL session, while the control group included 42 patients who did not watch movies. Basic characteristics, hemodynamic parameters, State-Trait Anxiety Inventory, Visual Analog Scale for pain, willingness to repeat the procedure, and patient satisfaction rates were collected and analyzed.

Results

After watching movies during ESWL, patients had a significantly lower anxiety level (p = 0.001) and a higher satisfaction rate (p = 0.021). No statistically significant differences were found in terms of demographic data, hemodynamic parameters, pain scores, or willingness to repeat the procedure.

Conclusion

Watching self-selected movies during an ESWL can effectively reduce anxiety and improve satisfaction.

Peri-Operative Factors Affecting Blood Transfusion Requirements During PCNL: A Retrospective Non-Randomized Study

Background

Percutaneous nephrolithotomy (PCNL) is accepted as the gold standard of care for the treatment of large renal calculi. Kidney hemorrhage, which requires blood transfusion, is one of the most common complications after percutaneous kidney stone surgery.

Objective

To evaluate perioperative factors associated with transfusion requirements during PCNL.

Materials and Methods

A total of 226 patients with kidney calculi undergoing PCNL between January 2011 and December 2019 were reviewed retrospectively. We analyzed the impact of perioperative clinical factors on the necessity of blood transfusion during PCNL.

Results

The overall blood transfusion rate was 9.29%. Multiple perioperative determinants were significantly correlated with the application of packed red blood cells (PRCs), including larger stone size (p = 0.006), multiple tract punctures (p = 0.029), presence of staghorn calculi (p = 0.026), and long operative time (OT; p = 0.017). Multivariate analysis demonstrated that only multiple tract punctures independently affected blood transfusion requirements during PCNL (p = 0.038).

Conclusion

In accordance with the present study, only the multiple tract punctures were associated with blood transfusion requirements in PCNL.

Laparoscopic Bilateral Nephro-Ureterectomy Approach for Complete Urinary Tract Extirpation for the Treatment of Multifocal Urothelial Carcinoma in a Kidney Transplant Patient: A Case Report and Literature Review

BACKGROUND

Urothelial carcinoma of the transitional epithelium is the most common malignancy in the Thai kidney transplant population.

METHODS

We report our experience in managing simultaneous upper and lower urinary tract urothelial cancer in a post-kidney transplant recipient through the use of laparoscopic bilateral nephron-ureterectomy and anterior pelvic exenteration with the use of a Studer orthotopic neobladder. A 35-year-old woman with end-stage renal disease underwent living related kidney transplantation in 2009. She presented with gross hematuria 5 years later. Enhanced computer tomography revealed diffuse bladder wall thickening with an intravesical polypoid soft tissue mass at the right ureterovesical junction extending to the right distal ureter. Hydronephrosis of the left native kidney without any demonstrable cause of obstruction was also noted. On trans-urethral resection, the pathological finding was high-grade, non-invasive urothelial cell carcinoma.

RESULTS

The operation was successfully performed without intra- or post-operative complications. The patient could ambulate independently on post-operative day 2. The kidney graft function did not change from her pre-operative baseline. At 6 months' follow-up, the patient had no tumor recurrence, returned to normal activities, and was able to void spontaneously without any need of intermittent catheterization.

CONCLUSIONS

Laparoscopic bilateral nephron-ureterectomy for complete urinary tract extirpation is feasible, safe, and associated with low morbidity. This technique avoids a large abdominal midline incision or a bilateral flank incision for nephron-ureterectomy and is a good alternative surgical technique in post-kidney transplant patients who require complete urinary tract extirpation.