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Zhong W, Osther P, Pearle M, Choong S, Mazzon G, Zhu W, Zhao Z, Gutierrez J, Smith D, Moussa M, Pal SK, Saltirov I, Ahmad M, Hamri SB, Chew B, Aquino A, Krambeck A, Khadgi S, Sur RL, Güven S, Gamal W, Li J, Liu Y, Ferretti S, Kamal W, Ye L, Bernardo N, Almousawi S, Abdelkareem M, Durutovic O, Kamphuis G, Maroccolo M, Ye Z, Alken P, Sarica K, Zeng G. International Alliance of Urolithiasis (IAU) guideline on staghorn calculi management. World J Urol 2024; 42:189. [PMID: 38526675 DOI: 10.1007/s00345-024-04816-6] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 01/16/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND The stone burden based management strategy reported in the guidelines published by different associations is well known for a long time. Staghorn calculi, representing the largest burden and most complex stones, is one of the most challenging cases to practicing urologists in clinical practice. The International Alliance of Urolithiasis (IAU) has released a series of guidelines on the management of urolithiasis. PURPOSE To develop a series of recommendations for the contemporary management management of staghorn calculi and to provide a clinical framework for urologists treating patients with these complex stones. METHODS A comprehensive literature search for articles published in English between 01/01/1976 and 31/12/2022 in the PubMed, OVID, Embase and Medline database is performed. A series of recommendations are developed and individually graded following the review of literature and panel discussion. RESULTS The definition, pathogenesis, pathophysiology, preoperative evaluation, intraoperative treatment strategies and procedural advice, early postoperative management, follow up and prevention of stone recurrence are summarized in the present document. CONCLUSION A series of recommendations regarding the management of staghorn calculi, along with related commentary and supporting documentation offered in the present guideline is intended to provide a clinical framework for the practicing urologists in the management of staghorn calculi.
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Affiliation(s)
- Wen Zhong
- Department of Urology and Key Laboratory of Guangdong, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Palle Osther
- Department of Urology, Lillebaelt Hospital, University of Southern Denmark, Vejle, Denmark
| | - Margaret Pearle
- Department of Urology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Simon Choong
- Department of Urology, Westmoreland Street Hospital, University College Hospital London, London, UK
| | - Giorgio Mazzon
- Department of Urology, San Bassiano Hospital, Vicenza, Italy
| | - Wei Zhu
- Department of Urology and Key Laboratory of Guangdong, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhijian Zhao
- Department of Urology and Key Laboratory of Guangdong, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jorge Gutierrez
- Department of Urology, Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - Daron Smith
- Department of Urology, Westmoreland Street Hospital, University College Hospital London, London, UK
| | - Mohamad Moussa
- Department of Urology, Al Zahraa Hospital University Medical Center and Lebanese University, Beirut, Lebanon
| | | | - Iliya Saltirov
- Department of Urology and Nephrology, Military Medical Academy, Sofia, Bulgaria
| | - Mumtaz Ahmad
- Department of Urology, Ganga Ram Hospital, Ganga Ram Hospital and Fatima Jinnah Medical University, Lahore, Punjab, Pakistan
| | - Saeed Bin Hamri
- Division of Urology, Department of Surgery, Ministry of the National Guard Health Affairs, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Ben Chew
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Albert Aquino
- Department of Urology, Jose R. Reyes Memorial Medical Center, Manila, Philippines
| | - Amy Krambeck
- Department of Urology, The Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Sanjay Khadgi
- Department of Urology, Vayodha Hospital, Kathmandu, Nepal
| | - Roger L Sur
- Department of Urology, University of California San Diego Comprehensive Kidney Stone Center, San Diego, CA, USA
| | - Selcuk Güven
- Department of Urology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Wael Gamal
- Department of Urology, Sohag University Hospital, Sohâg, Egypt
| | - Jianxing Li
- Department of Urology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Yongda Liu
- Department of Urology and Key Laboratory of Guangdong, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | | | - Wissam Kamal
- Department of Urology, King Fahad Hospital, Jeddah, Saudi Arabia
| | - Liefu Ye
- Urology Department, Fujian Provincial Hospital, Fujian, China
| | - Norberto Bernardo
- Department of Urology, Hospital de Clinicas Jose de San Martin, Buenos Aires, Argentina
| | - Shabir Almousawi
- Department of Urology, Sabah Al-Ahmad Urology Centre, Kuwait City, Kuwait
| | - Mohamed Abdelkareem
- Department of Urology, Hazm Mebaireek General Hospital (HMGH), Hamad Medical Corporation (HMC), Doha, Qatar
| | - Otas Durutovic
- Department of Urology, Clinic of Urology, University of Belgrade, Belgrade, Serbia
| | - Guido Kamphuis
- Department of Urology, Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands
| | - Marcus Maroccolo
- Department of Urology, Hospital de Base of the Federal District, Brasília, Brazil
| | - Zhangqun Ye
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Peter Alken
- Department of Urology, University Clinic Mannheim, Mannheim, Germany.
| | - Kermal Sarica
- Department of Urology, Medical School, Biruni University, Istanbul, Turkey.
| | - Guohua Zeng
- Department of Urology and Key Laboratory of Guangdong, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
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Liu K, Zhao H, Ng CF, Teoh JYC, Laguna P, Gontero P, Saltirov I, de la Rosette J. The Prognostic Role of Body Mass Index on Oncological Outcomes of Upper Tract Urothelial Carcinoma. Cancers (Basel) 2023; 15:5364. [PMID: 38001624 PMCID: PMC10670636 DOI: 10.3390/cancers15225364] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 10/26/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023] Open
Abstract
(1) Objective: The aim of this study was to evaluate whether overweight and obese upper urinary tract carcinoma (UTUC) patients have better or worse survival outcomes. (2) Methods: The Clinical Research Office of the Endourology Society Urothelial Carcinomas of the Upper Tract (CROES-UTUC) Registry was used to extract the data of normal-weight or overweight/obese UTUC patients between 2014 and 2019. Patients with a BMI between 18.5 and 24.9 kg/m2 were defined as normal weight, while those with a BMI ≥ 25.0 kg/m2 were considered as overweight/obese group. We compared baseline characteristics among groups categorized by different BMIs. The Kaplan-Meier plots with the log-rank test were used to explore the overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS). Propensity score matching was performed to eliminate the differences in clinicopathologic features. The Declaration of Helsinki was followed during this study. (3) Results: Of 1196 UTUC patients, 486 patients (40.6%) were normal weight, while 710 patients (59.4%) presented with a BMI ≥ 25.0 kg/m2. After propensity score matching, all baseline characteristics were balanced. For normal weight and overweight/obese patients, 2-year overall survival rates were 77.8% and 87.2%, 2-year cancer-specific survival rates were 85.2% and 92.7%, and 2-year recurrence rates were 50.6% and 73.0%, respectively. The overweight patients obtained a better RFS (p = 0.003, HR 0.548, 95% CI 0.368-0.916) while their OS (p = 0.373, HR 0.761, 95% CI 0.416-1.390) and CSS (p = 0.272, HR 0.640, 95% CI 0.287-1.427) were similar to normal weight patients. (4) Conclusions: Being overweight/obese (BMI ≥ 25.0 kg/m2) was associated with a decreased risk of recurrence in UTUC patients but not overall survival or cancer-specific survival.
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Affiliation(s)
- Kang Liu
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong 999077, China; (K.L.); (H.Z.); (C.-F.N.)
| | - Hongda Zhao
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong 999077, China; (K.L.); (H.Z.); (C.-F.N.)
| | - Chi-Fai Ng
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong 999077, China; (K.L.); (H.Z.); (C.-F.N.)
| | - Jeremy Yuen-Chun Teoh
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong 999077, China; (K.L.); (H.Z.); (C.-F.N.)
| | - Pilar Laguna
- Department of Urology, Medipol Mega University Hospital, Istanbul Medipol University, 34000 Istanbul, Turkey; (P.L.); (J.d.l.R.)
| | - Paolo Gontero
- Department of Urology, University of Turin, 10124 Turin, Italy;
| | - Iliya Saltirov
- Department of Urology and Nephrology, Military Medical Academy, 1000 Sofia, Bulgaria;
| | - Jean de la Rosette
- Department of Urology, Medipol Mega University Hospital, Istanbul Medipol University, 34000 Istanbul, Turkey; (P.L.); (J.d.l.R.)
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Baard J, Shariat SF, Roupret M, Yoshida T, Saita A, Saltirov I, Burgos JR, Celik O, de la Rosette J, Laguna P. Adherence to guideline recommendations in the management of upper tract urothelial carcinoma: an analysis of the CROES-UTUC registry. World J Urol 2022; 40:2755-2763. [PMID: 36197507 DOI: 10.1007/s00345-022-04168-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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 09/23/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The European Association of Urology provides Clinical Practice Guideline on upper tract urothelial carcinoma (UTUC). Due to the rarity of UTUC, guidelines are necessary to help guide decision-making based on the highest quality of care evidence available. OBJECTIVES To evaluate guideline adherence in the management of UTUC by assessing recommendations on diagnostics needed for risk classification and subsequent treatment selection; to assess predictors for the latter. PARTICIPANTS Data from the Clinical Research Office of the Endo Urology Society UTUC-registry were included for analysis. STATISTICAL ANALYSIS Overall compliance were evaluated by cross-tables, differences in risk groups characteristics and treatment selection were assessed by Chi-square tests, predictors for treatment selection by logistic regression analysis. RESULTS Data from 2380 patients were included. Imaging by CT-scan had highest adherence (85%) but was low for other diagnostics (17.7-49.7%). Multivariable regression analysis showed higher odds of receiving radical nephroureterectomy in patients with large tumours (OR 5.45, 95% CI 3.77-7.87, p < 0.001), signs of invasion (OR 3.07,CI 2.11-4.46, p < 0.001), high tumour grade (OR 2.05, CI 1.38-3.05, p < 0.001) and multifocality (OR 1.76,CI 1.05-2.97, p =0.032). CONCLUSIONS CT-imaging is the most used and most impactful decision tool for risk-stratification and treatment selection in UTUC. Due to the low compliance in most of the diagnostic recommendations, proper risk stratification is not possible in a significant group of patients raising the question whether current stratification is deemed applicable in daily practice. Established prognostic factors on survival guides decision-making regarding radical versus kidney-sparing surgery. Tumour size was the most influencing factor on treatment decision. CLINICAL TRIAL REGISTRATION The study was registered at ClinicalTrials.gov (ClinicalTrials.gov NCT02281188; https://clinicaltrials.gov/ct2/show/NCT02281188 ).
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Affiliation(s)
- Joyce Baard
- Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Shahrokh F Shariat
- Department of Urology, Medical University of Vienna, Vienna, Austria
- Comprehensive Cancer Center, Department of Urology, Medical University of Vienna, Vienna, Austria
- Department of Urology, Weill Cornell Medical College New York, New York, USA
- Department of Urology, University of Texas Southwestern, Dallas, TX, USA
- Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan
| | - Morgan Roupret
- Sorbonne University, GRC 5 Predictive Onco-Uro, AP-HP, Urology, Pitie-Salpetriere Hospital, Paris, France
| | - Takashi Yoshida
- Department of Urology and Andrology, Kansai Medical University, Osaka, Japan
| | - Alberto Saita
- Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Iliya Saltirov
- Department of Urology and Nephrology, Military Medical Academy, Sofia, Bulgaria
| | - Javier Revilla Burgos
- Department of Urology, Ramon y Cajal Hospital, Alcala University. IRYCIS, Madrid, Spain
| | - Orcun Celik
- Department of Urology, Ekol International Hospital Urology Clinic Izmir, Izmir, Turkey
| | - Jean de la Rosette
- Department of Urology, Istanbul Medipol Mega University Hospital, Istanbul, Turkey
| | - Pilar Laguna
- Department of Urology, Istanbul Medipol Mega University Hospital, Istanbul, Turkey.
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Petkova K, Petrova D, Petrov P, Hristoforov S, Gatsev O, Saltirov I. Emergency ureteroscopy as first-line treatment in patients with acute kidney injury due to ureteral stones. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)00147-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Todorova V, Petkova K, Petrova D, Gatsev O, Petrov P, Hristoforov S, Saltirov I. Efficacy and safety of emergency ureteroscopy as first-line treatment for patients with renal colic due to ureteral stones in the COVID-19 pandemic. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)00199-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Gatsev O, Mangaldjev R, Dimcheva M, Parvanova V, Nedev K, Zahariev Z, Robev B, Sergieva S, Petkova K, Saltirov I. SPECT-CT imaging with 99mTc-PSMA for the diagnosis of prostate cancer recurrence. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)00136-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Hristoforov S, Gatsev O, Petrov P, Petkova K, Saltirov I. Compаrative study of transperineal MRI/US fusion biopsy and systematic transrectal ultrasound guided biopsy in patients with a history of prior negative prostate biopsy. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)00134-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Saltirov I, Petkova K, Petrova D, Gatsev O, Petrov P, Hristoforov S. Comparative study of bleeding complications following standard and miniaturized percutaneous nephrolithotomy for renal stones smaller than 30 mm. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)00188-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Petrov P, Hristoforov S, Gatsev O, Petkova K, Saltirov I. Safety and efficacy of retrograde intrarenal surgery in elderly patients. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)00156-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Hristov K, Petkova K, Petrova D, Petrov P, Hristoforov S, Gatsev O, Saltirov I. Efficacy and safety of retrograde ureteroscopy for the treatment of impacted proximal ureteral stones larger than 10 mm. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)00146-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Halinski A, Bhatti KH, Boeri L, Cloutier J, Davidoff K, Elqady A, Fryad G, Gadelmoula M, Hui H, Petkova K, Popov E, Rawa B, Saltirov I, Spivacow FR, Belthangady Monu Zeeshan Hameed, Trinchieri A, Buchholz N. Stone composition of renal stone formers from different global regions. Arch Ital Urol Androl 2021; 93:307-312. [PMID: 34839635 DOI: 10.4081/aiua.2021.3.307] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 08/25/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To study urinary stone composition patterns in different populations around the world. MATERIALS AND METHODS Data were collected by reviewing charts of 1204 adult patients of 10 countries with renal or ureteral stones (> 18 years) in whom a stone analysis was done and available. Any method of stone analysis was accepted, but the methodology had to be registered. RESULTS In total, we observed 710 (59%) patients with calcium oxalate, 31 (1%) with calcium phosphate, 161 (13%) with mixed calcium oxalate/calcium phosphate, 15 (1%) with carbapatite, 110 (9%) with uric acid, 7 (< 1%) with urate (ammonium or sodium), 100 (9%) with mixed with uric acid/ calcium oxalate, 56 (5%) with struvite and 14 (1%) with cystine stones. Calciumcontaining stones were the most common in all countries ranging from 43 to 91%. Oxalate stones were more common than phosphate or mixed phosphate/oxalate stones in most countries except Egypt and India. The rate of uric acid containing stones ranged from 4 to 34%, being higher in Egypt, India, Pakistan, Iraq, Poland and Bulgaria. Struvite stones occurred in less than 5% in all countries except India (23%) and Pakistan (16%). Cystine stones occurred in 1% of cases. CONCLUSIONS The frequency of different types of urinary stones varies from country to country. Calcium-containing stones are prevalent in all countries. The frequency of uric acid containing stones seems to depend mainly on climatic factors, being higher in countries with desert or tropical climates. Dietary patterns can also lead to an increase in the frequency of uric acid containing stones in association with high obesity rates. Struvite stones are decreasing in most countries due to improved health conditions.
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Affiliation(s)
- Adam Halinski
- Private Medical Center "Klinika Wisniowa" Zielona Gora.
| | | | - Luca Boeri
- Department of Urology, IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan.
| | | | | | | | | | | | - Hongyi Hui
- Department of Urology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai.
| | - Kremena Petkova
- Department of Urology and Nephrology, Military Medical Academy, Sofia.
| | | | - Bapir Rawa
- Smart Health Tower, Sulaymaniyah, Kurdistan region.
| | - Iliya Saltirov
- Department of Urology and Nephrology, Military Medical Academy, Sofia.
| | - Francisco R Spivacow
- Instituto de Investigaciones Metabólicas (IDIM Department of Urology), Buenos Aires.
| | | | | | - Noor Buchholz
- U-merge Ltd (Urology for emerging countries), London.
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Popov E, Almusafer M, Belba A, Bello JO, Bhatti KH, Boeri L, Davidoff K, Hameed BZ, Halinski A, Pfeferman Heilberg I, Hui H, Petkova K, Rawa B, Guedes Rodrigues F, Saltirov I, Spivacow FR, Trinchieri A, Buchholz N. Obesity rates in renal stone formers from various countries. ACTA ACUST UNITED AC 2021; 93:189-194. [PMID: 34286554 DOI: 10.4081/aiua.2021.2.189] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To collect evidence on the rate of obesity in renal stone formers (RSFs) living in different climatic areas and consuming different diets. MATERIALS AND METHODS Data of adult renal stone formers were retrospectively collected by members of U-merge from 13 participant centers in Argentina, Brazil, Bulgaria (2), China, India, Iraq (2), Italy (2), Nigeria, Pakistan and Poland. The following data were collected: age, gender, weight, height, stone analysis and procedure of stone removal. RESULTS In total, 1689 renal stone formers (1032 males, 657 females) from 10 countries were considered. Average age was 48 (±14) years, male to female ratio was 1.57 (M/F 1032/657), the average body mass index (BMI) was 26.5 (±4.8) kg/m2. The obesity rates of RSFs in different countries were significantly different from each other. The highest rates were observed in Pakistan (50%), Iraq (32%), and Brazil (32%), while the lowest rates were observed in China (2%), Nigeria (3%) and Italy (10%). Intermediate rates were observed in Argentina (17%), Bulgaria (17%), India (15%) and Poland (22%). The age-adjusted obesity rate of RSFs was higher than the age-adjusted obesity rate in the general population in Brazil, India, and Pakistan, whereas it was lower in Argentina, Bulgaria, China, Italy, and Nigeria, and similar in Iraq and Poland. CONCLUSIONS The age-adjusted obesity rate of RSFs was not higher than the age-adjusted obesity rate of the general population in most countries. The relationship between obesity and the risk of kidney stone formation should be reconsidered by further studies carried out in different populations.
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Affiliation(s)
- Elenko Popov
- U-merge Ltd. (Urology for emerging countries), London, UK; Acibadem City Clinic Tokuda Hospital, Sofia.
| | - Murtadha Almusafer
- U-merge Ltd. (Urology for emerging countries), London, UK; College of Medicine, University of Basrah, Basrah.
| | - Arben Belba
- U-merge Ltd. (Urology for emerging countries), London, UK; Ospedale Santo Stefano, Prato and Casa di Cura Villa Donatello, Sesto Fiorentino.
| | - Jibril O Bello
- U-merge Ltd. (Urology for emerging countries), London, UK; Department of Surgery, Urology Unit, University of Ilorin Teaching Hospital.
| | - Kamran Hassan Bhatti
- U-merge Ltd. (Urology for emerging countries), London, UK; Urology Department, Hamad Medical Corporation, Doha.
| | - Luca Boeri
- U-merge Ltd. (Urology for emerging countries), London, UK; Department of Urology, IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan.
| | - Kaloyan Davidoff
- U-merge Ltd. (Urology for emerging countries), London, UK; Acibadem City Clinic Tokuda Hospital, Sofia.
| | - Bm Zeeshan Hameed
- U-merge Ltd. (Urology for emerging countries), London, UK; Department of Urology, Kasturba Medical College, Manipal, Karnataka.
| | - Adam Halinski
- U-merge Ltd. (Urology for emerging countries), London, UK; Private Medical Center "Klinika Wisniowa" Zielona Gora.
| | - Ita Pfeferman Heilberg
- U-merge Ltd. (Urology for emerging countries), London, UK; Nephrology Division, Universidade Federal de São Paulo (UNIFESP), São Paulo.
| | - Hongyi Hui
- U-merge Ltd. (Urology for emerging countries), London, UK; Department of Urology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai.
| | - Kremena Petkova
- U-merge Ltd. (Urology for emerging countries), London, UK; Department of Urology and Nephrology, Military Medical Academy, Sofia.
| | - Bapir Rawa
- U-merge Ltd. (Urology for emerging countries), London, UK; Smart Health Tower, Sulaymaniyah, Kurdistan region.
| | - Fernanda Guedes Rodrigues
- U-merge Ltd. (Urology for emerging countries), London, UK; Nephrology Division, Universidade Federal de São Paulo (UNIFESP), São Paulo.
| | - Iliya Saltirov
- U-merge Ltd. (Urology for emerging countries), London, UK; Department of Urology and Nephrology, Military Medical Academy, Sofia.
| | - Francisco R Spivacow
- U-merge Ltd. (Urology for emerging countries), London, UK; Instituto de Investigaciones Metabólicas (IDIM), Buenos Aires.
| | | | - Noor Buchholz
- U-merge Ltd. (Urology for emerging countries), London.
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Skolarikos A, Vassileva J, Zagorska A, Basic D, Karagiannis A, Petkova K, Sabuncu K, Saltirov I, Sarica K, Stavridis S, Trinchieri A, Tzelves L, Ulus I, Yuruk E. Correlation between exposure of endourologists and patient exposure during fluoroscopy-guided endourological procedures. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00644-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Zeng G, Zhong W, Pearle M, Choong S, Chew B, Skolarikos A, Liatsikos E, Pal SK, Lahme S, Durutovic O, Farahat Y, Khadgi S, Desai M, Chi T, Smith D, Hoznek A, Papatsoris A, Desai J, Mazzon G, Somani B, Eisner B, Scoffone CM, Nguyen D, Ferretti S, Giusti G, Saltirov I, Maroccolo MV, Gökce MI, Straub M, Bernardo N, Lantin PL, Saulat S, Gamal W, Denstedt J, Ye Z, Sarica K. European Association of Urology Section of Urolithiasis and International Alliance of Urolithiasis Joint Consensus on Percutaneous Nephrolithotomy. Eur Urol Focus 2021; 8:588-597. [PMID: 33741299 DOI: 10.1016/j.euf.2021.03.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [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: 10/21/2020] [Revised: 12/10/2020] [Accepted: 03/02/2021] [Indexed: 02/07/2023]
Abstract
CONTEXT Although percutaneous nephrolithotomy (PCNL) has been performed for decades and has gone through many refinements, there are still concerns regarding its more widespread utilization because of the long learning curve and the potential risk of severe complications. Many technical details are not included in the guidelines because of their nature and research protocol. OBJECTIVE To achieve an expert consensus viewpoint on PCNL indications, preoperative patient preparation, surgical strategy, management and prevention of severe complications, postoperative management, and follow-up. EVIDENCE ACQUISITION An international panel of experts from the Urolithiasis Section of the European Association of Urology, International Alliance of Urolithiasis, and other urology associations was enrolled, and a prospectively conducted study, incorporating literature review, discussion on research gaps (RGs), and questionnaires and following data analysis, was performed to reach a consensus on PCNL. EVIDENCE SYNTHESIS The expert panel consisted of 36 specialists in PCNL from 20 countries all around the world. A consensus on PCNL was developed. The expert panel was not as large as expected, and the discussion on RGs did not bring in more supportive evidence in the present consensus. CONCLUSIONS Adequate preoperative preparation, especially elimination of urinary tract infection prior to PCNL, accurate puncture with guidance of fluoroscopy and/or ultrasonography or a combination, keeping a low intrarenal pressure, and shortening of operation time during PCNL are important technical requirements to ensure safety and efficiency in PCNL. PATIENT SUMMARY Percutaneous nephrolithotomy (PCNL) has been a well-established procedure for the management of upper urinary tract stones. However, according to an expert panel consensus, core technical aspects, as well as the urologist's experience, are critical to the safety and effectiveness of PCNL.
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Affiliation(s)
- Guohua Zeng
- Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wen Zhong
- Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Margaret Pearle
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Simon Choong
- Institute of Urology, University College Hospital, London, UK
| | - Ben Chew
- Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Evangelos Liatsikos
- Department of Urology, University Hospital of Patras, University of Patras, Patras, Greece
| | | | - Sven Lahme
- Department of Urology, Siloah St. Trudpert Hospital, Pforzheim, Germany
| | - Otas Durutovic
- Department of Urology, Clinic of Urology, University of Belgrade, Belgrade, Serbia
| | - Yasser Farahat
- Department of Urology, Sheikh Khalifa General Hospital, Umm Al Quwain, United Arab Emirates
| | - Sanjay Khadgi
- Department of Urology, Vayodha Hospital, Kathmandu, Nepal
| | - Mahesh Desai
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, India
| | - Thomas Chi
- Department of Urology, University of California, San Francisco, CA, USA
| | - Daron Smith
- Institute of Urology, University College Hospital, London, UK
| | - Andras Hoznek
- Department of Urology, Mondor Hospital, Créteil, France
| | | | - Janak Desai
- Department of Urology, Samved Hospital, Ahmedabad, India
| | - Giorgio Mazzon
- Department of Urology, San Bassiano Hospital, Vicenza, Italy
| | - Bhaskar Somani
- Department of Urology, University Hospital Southampton, Southampton, UK
| | - Brian Eisner
- Deparment of Urology, Massachusetts General Hospital, Boston, MA, USA
| | | | | | - Stefania Ferretti
- Department of Urology, Hospital and University of Parma, Parma, Italy
| | - Guido Giusti
- Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Iliya Saltirov
- Department of Urology and Nephrology, Military Medical Academy, Sofia, Bulgaria
| | | | - Mehmet Ilker Gökce
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Michael Straub
- Department of Urology, Technical University Munich, Munich, Germany
| | - Norberto Bernardo
- Department of Urology, Hospital de Clinicas Jose de San Martin, Buenos Aires, Argentina
| | | | - Sherjeel Saulat
- Department of Urology, Sindh Institution of Urology and Transplantation, Karachi, Pakistan
| | - Wael Gamal
- Department of Urology, Sohag University Hospital, Sohag, Egypt
| | - John Denstedt
- Division of Urology, Western University, London, Ontario, Canada
| | - Zhangqun Ye
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Kemal Sarica
- Department of Urology, Biruni University, Medical School, Istanbul, Turkey.
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Choong S, DE LA Rosette J, Denstedt J, Zeng G, Sarica K, Mazzon G, Saltirov I, Pal SK, Agrawal M, Desai J, Petrik A, Buchholz N, Maroclo MV, Gordon S, Sridhar A. Classification and standardized reporting of percutaneous nephrolithotomy (PCNL): International Alliance of Urolithiasis (IAU) Consensus Statements. Minerva Urol Nephrol 2021; 74:110-118. [PMID: 33439573 DOI: 10.23736/s2724-6051.20.04107-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND The aim of this study was to reach a consensus in the classification and standardized reporting for the different types of PCNLs. METHODS The RAND/UCLA appropriateness methodology was used to reach a consensus. Thirty-two statements were formulated reviewing the literature on guidelines and consensus on PCNLs, and included procedure specific details, outcome measurements and a classification for PCNLs. Experts were invited to two rounds of input, the first enabled independent modifications of the proposed statements and provided the option to add statements. The second round facilitated scoring of all statements. Each statement was discussed in the third round to decide which statements to include. Any suggestion or disagreement was debated and discussed to reach a consensual agreement. RESULTS Twenty-five recommendations were identified to provide standardized reporting of procedure and outcomes. Consensual scoring above 80% were strongly agreed upon by the panel. The top treatment related outcomes were size of sheath used (99.1%) and position for PCNL (93.5%). The highest ranked Outcome Measures included definition of postoperative hospital length of stay (94.4%) and estimated blood loss (93.5%). CONCLUSIONS The consensus statements will be useful to clarify operative technique, in the design of clinical trials and standardized reporting, and presentation of results to compare outcomes of different types of PCNLs.
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Affiliation(s)
- Simon Choong
- Institute of Urology, University College London Hospitals, London, UK
| | | | - John Denstedt
- Division of Urology, University of Western Ontario, London, ON, Canada
| | - Guohua Zeng
- Department of Urology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Kemal Sarica
- School of Medicine, Department of Urology, Biruni University, Istanbul, Turkey
| | - Giorgio Mazzon
- Department of Urology, San Bassiano Hospital, Bassano del Grappa, Vicenza, Italy -
| | - Iliya Saltirov
- Department of Urology and Nephrology, Military Medical Academy, Sofia, Bulgaria
| | - Shashi K Pal
- Department of Urology, Apollo Group of Hospitals and Holy Family Hospital, New Delhi, India
| | - Madhu Agrawal
- Department of Urology, Center for Minimally-Invasive Endourology, Global Rainbow Healthcare, Agra, India
| | - Janak Desai
- Department of Urology, Samved Hospital, Ahmedabad, India
| | - Aleš Petrik
- Department of Urology, Region Hospital Ceske Budejovice, Prague, Czech Republic
| | - Noor Buchholz
- Department of Urology, Sobeh's Vascular and Medical Center, Dubai Healthcare City, Dubai, United Arab Emirates
| | - Marcus V Maroclo
- Unit of Endourology, Hospital de Base of the Federal District, Brasília, Brazil
| | - Stephen Gordon
- Department of Urology, Epsom and St. Helier University Hospitals NHS Trust, Surrey, UK
| | - Ashwin Sridhar
- Institute of Urology, University College London Hospitals, London, UK
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16
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Choong S, de la Rosette J, Denstedt J, Zeng G, Sarica K, Mazzon G, Saltirov I, Pal SK, Agrawal M, Desai J, Petrik A, Buchholz N, Maroclo MV, Gordon S, Sridhar A. Classification and Standardized Reporting of Percutaneous Nephrolithotomy (PCNL): International Alliance of Urolithiasis (IAU) consensus statements. Minerva Urol Nephrol 2021. [PMID: 33439573 DOI: 10.23736/s0393-2249.20.04107-7] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND To reach a consensus in the classification and standardized reporting for the different types of PCNLs. METHODS The RAND/UCLA appropriateness methodology was used to reach a consensus. Thirty-two statements were formulated reviewing the literature on guidelines and consensus on PCNLs, and included procedure specific details, outcome measurements and a classification for PCNLs. Experts were invited to two rounds of input, the first enabled independent modifications of the proposed statements and provided the option to add statements. The second round facilitated scoring of all statements. Each statement was discussed in the third round to decide which statements to include. Any suggestion or disagreement was debated and discussed to reach a consensual agreement. RESULTS Twenty-five recommendations were identified to provide standardised reporting of procedure and outcomes. Consensual scoring above 80% were strongly agreed upon by the panel. The top treatment related outcomes were size of sheath used (99.1%) and position for PCNL (93.5%). The highest ranked Outcome Measures included definition of post-operative hospital length of stay (94.4%) and estimated blood loss (93.5%). CONCLUSIONS The consensus statements will be useful to clarify operative technique, in the design of clinical trials and standardized reporting, and presentation of results to compare outcomes of different types of PCNLs.
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Affiliation(s)
- Simon Choong
- Institute of Urology, University College London Hospitals, London, UK
| | | | - John Denstedt
- Division of Urology, University of Western Ontario, London, Canada
| | - Guohua Zeng
- Department of Urology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Kemal Sarica
- Department of Urology, Biruni University, Medical School in Istanbul, Turkey
| | - Giorgio Mazzon
- Department of Urology, San Bassiano Hospital, Bassano del Grappa, Vicenza, Italy -
| | - Iliya Saltirov
- Department of Urology and Nephrology, Military Medical Academy, Sofia, Bulgaria
| | - Shashi K Pal
- Department of Urology, Apollo group of Hospitals & Holy Family Hospital at New Delhi, India
| | - Madhu Agrawal
- Department of Urology & Centre for Minimally-invasive Endourology, Global Rainbow Healthcare, Agra, India
| | - Janak Desai
- Department of Urology, Samved Hospital, Ahmedabad, India
| | - Aleš Petrik
- Department of Urology, Region Hospital Ceske Budejovice, Prague, Czech Republic
| | - Noor Buchholz
- Department of Urology, Sobeh's Vascular & Medical Center, Dubai Healthcare City, Dubai, United Arab Emirates
| | - Marcus V Maroclo
- Endourology Unit, Hospital de Base of the Federal District, Brasília, Brazil
| | - Stephen Gordon
- Department of Urology, Epsom & St. Helier University Hospitals NHS Trust, Surrey, UK
| | - Ashwin Sridhar
- Institute of Urology, University College London Hospitals, London, UK
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17
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Vassileva J, Zagorska A, Basic D, Karagiannis A, Petkova K, Sabuncu K, Saltirov I, Sarica K, Skolarikos A, Stavridis S, Trinchieri A, Tzelves L, Ulus I, Yuruk E. Radiation exposure of patients during endourological procedures: IAEA-SEGUR study. J Radiol Prot 2020; 40:1390-1405. [PMID: 33086202 DOI: 10.1088/1361-6498/abc351] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 10/21/2020] [Indexed: 06/11/2023]
Abstract
Fluoroscopy is increasingly used to guide minimally invasive endourological procedures and optimised protocols are needed to minimise radiation exposure while achieving best treatment results. This multi-center study of radiation exposure of patients was conducted by the South-Eastern European Group for Urolithiasis Research (SEGUR), in cooperation with the International Atomic Energy Agency. Seven clinical centers from the SEGUR group collected data for 325 procedures performed within a three-months period, including standard percutaneous nephrolithotomy (PCNL), mini PCNL, retrograde intrarenal surgery (RIRS), semirigid ureterorenoscopy (URS) and flexible URS. Data included: air kerma area product (PKA), air kerma at the patient entrance reference point (Ka,r), fluoroscopy time (FT), number of radiographic images (N) and fluoroscopy pulse rate, as well as total procedure duration, size and location of stones. Data were centrally analysed and statistically compared. MedianPKAvalues per center varied 2-fold for RIRS (0.80-1.79 Gy cm2), 7.1 fold for mini-PCNL (1.39-9.90 Gy cm2), 7.3 fold for PCNL (2.40-17.50 Gy cm2), 19 fold (0.13-2.51 Gy cm2) for semi-rigid URS and 29-fold for flexible URS (0.10-2.90 Gy cm2). LowerPKAandKa,rwere associated with use of lower FT,Nand lower fluoroscopy pulse rate. FT varied from 0.1 to 14 min, a small fraction of the total procedure time, ranging from 10 to 225 min. HigherNwas associated with higherPKAandKa,r. Higher medianPKAin PCNL was associated with the use of supine compared to prone position. No correlation was found between the concrement size and procedure duration, FT,PKAorKa,r. Dose values for RIRS were significantly lower compared to PCNL. The maximumKa,rvalue of 377 mGy was under the threshold for radiation induced skin erythema. The study demonstrated a potential for patient dose reduction by lowering FT andN, using pulsed fluoroscopy and beam collimation.
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Affiliation(s)
- Jenia Vassileva
- Radiation Protection of Patients Unit, International Atomic Energy Agency, Vienna, Austria
| | - Anna Zagorska
- Second Nuclear Medicine Department, Acibadem City Clinic UMHAT, Sofia, Bulgaria
| | | | - Andreas Karagiannis
- 2nd Department of Urology, Sismanoglio Hospital, Athens, Greece
- Department of Urology, Athens Euroclinic Hospital, Athens, Greece
| | - Kremena Petkova
- Department of Urology and Nephrology, Military Medical Academy, Sofia, Bulgaria
| | - Kubilay Sabuncu
- Karacabey State Hospital, Department of Urology, Bursa, Turkey
| | - Iliya Saltirov
- Department of Urology and Nephrology, Military Medical Academy, Sofia, Bulgaria
| | - Kemal Sarica
- Department of Urology, Biruni University, Medical School, Istanbul, Turkey
| | | | - Sotir Stavridis
- University Clinic of Urology, Medical Faculty Skopje, Skopje, North Macedonia
| | - Alberto Trinchieri
- Department of Urology, Manzoni Hospital, Lecco, Italy
- Department of Urology, IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Lazaros Tzelves
- 2nd Department of Urology, Sismanoglio Hospital, Athens, Greece
| | - Ismail Ulus
- Department of Urology, BHT ClinicIstanbul Tema Hospital, Istanbul, Turkey
| | - Emrah Yuruk
- Department of Urology, BHT ClinicIstanbul Tema Hospital, Istanbul, Turkey
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18
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Vassileva J, Zagorska A, Karagiannis A, Petkova K, Sabuncu K, Saltirov I, Sarica K, Skolarikos A, Stavridis S, Trinchieri A, Tzelves L, Ulus I, Yuruk E. Radiation Exposure of Surgical Team During Endourological Procedures: International Atomic Energy Agency-South-Eastern European Group for Urolithiasis Research Study. J Endourol 2020; 35:574-582. [PMID: 32791856 DOI: 10.1089/end.2020.0630] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 01/16/2023] Open
Abstract
Introduction: Fluoroscopy-guided endourology procedures require proper radiation protection to minimize radiation risk. This multicenter study aimed at investigating radiation protection practice and related radiation exposure of operating team members. Materials and Methods: Six endourology centers from the South-Eastern European Group for Urolithiasis Research answered questionnaires and collected data of 315 procedures performed within a 3-months period, with simultaneous measurement of dose to staff and dose area product (DAP) to patient. A pair of calibrated personal dosimeters, one for body and one for eye-lens dose, was worn by all key staff members. Dosimeters were centrally calibrated, measured, and analyzed. Results: The annual workload ranged from 173 to 865 procedures per center. Practice of personal dose monitoring and use of radiation protection shielding was found to be inconsistent. Lead aprons and thyroid collars were used by all, whereas protective eyewear was used in only half of centers. Due to the regular use of protective aprons, the whole-body dose of all 44 monitored staff members was safely below the regulatory dose limits. Eye-lens dose of 17 (14 urologists and 3 assisting staff) was above the dosimeter detection level, and dose per procedure varied from <10 to 63 μSv. The highest annual eye-lens dose of 13.5 mSv was found for the surgeon in the busiest department by using an over-the-couch X-ray tube without a ceiling suspended screen. Working closer to patient body with no protection resulted in a six-time higher eye-lens dose per DAP for a surgeon compared with others in the same center. Lower eye-dose per procedure was associated with lower DAP to patient and with the use of an under-the-couch tube, lower fluoroscopy pulse rate, collimation, fluoroscopy time, and acquired images. Conclusions: The study results call for the need to establish standard protocols about use of fluoroscopy during endourology procedures and to increase radiation protection knowledge and awareness of surgical staff.
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Affiliation(s)
- Jenia Vassileva
- Radiation Protection of Patients Unit, International Atomic Energy Agency, Vienna International Centre, Vienna, Austria
| | - Anna Zagorska
- Second Nuclear Medicine Department, Acibadem City Clinic UMHAT, Sofia, Bulgaria
| | - Andreas Karagiannis
- Second Department of Urology, Sismanoglio Hospital, Athens, Greece.,Department of Urology, Athens Euroclinic Hospital, Athens, Greece
| | - Kremena Petkova
- Department of Urology and Nephrology, Military Medical Academy, Sofia, Bulgaria
| | - Kubilay Sabuncu
- Department of Urology, Karacabey State Hospital, Bursa, Turkey
| | - Iliya Saltirov
- Department of Urology and Nephrology, Military Medical Academy, Sofia, Bulgaria
| | - Kemal Sarica
- Department of Urology, Biruni University, Medical School, Istanbul, Turkey
| | | | - Sotir Stavridis
- Medical Faculty Skopje, University Clinic of Urology, Skopje, North Macedonia
| | - Alberto Trinchieri
- Department of Urology, Manzoni Hospital, Lecco, Italy.,Department of Urology, IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Lazaros Tzelves
- Second Department of Urology, Sismanoglio Hospital, Athens, Greece
| | - Ismail Ulus
- Department of Urology, BHT Clinic Istanbul Tema Hospital, Istanbul, Turkey
| | - Emrah Yuruk
- Department of Urology, BHT Clinic Istanbul Tema Hospital, Istanbul, Turkey
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19
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De Lorenzis E, Alba AB, Cepeda M, Galan JA, Geavlete P, Giannakopoulos S, Saltirov I, Sarica K, Skolarikos A, Stavridis S, Yuruk E, Geavlete B, García-Carbajosa, Hristoforov S, Karagoz MA, Nassos N, Jurado GO, Paslanmaz F, Poza M, Saidi S, Tzelves L, Trinchieri A. Bacterial spectrum and antibiotic resistance of urinary tract infections in patients treated for upper urinary tract calculi: a multicenter analysis. Eur J Clin Microbiol Infect Dis 2020; 39:1971-1981. [PMID: 32557326 DOI: 10.1007/s10096-020-03947-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 03/20/2020] [Accepted: 06/09/2020] [Indexed: 12/23/2022]
Abstract
The purpose of this study is to collect information on the bacterial resistance to antibiotics of bacteria isolated from urine cultures of patients treated for upper urinary tract calculi. Data of patients with urinary tract infection and urolithiasis were retrospectively reviewed to collect information on age, gender, stone size, location, hydronephrosis, procedure of stone removal and antibiotic treatment, identification and susceptibility of pathogens, symptoms, and infectious complications. A total of 912 patients from 11 centers in 7 countries (Bulgaria, Greece, Italy, North Macedonia, Spain, and Turkey) were studied. Mean age was 54 ± 16 years and M/F ratio 322/590. Out of 946 microbial isolates, the most common were E. coli, Gram-positive, KES group (Klebsiella, Enterobacter, Serratia), Proteus spp., and P. aeruginosa. Carbapenems, piperacillin/tazobactam and amikacin showed low resistance rates to E. coli (2.5%, 7%, and 3.6%) and Proteus spp. (7.7%, 16%, and 7.4%), but higher rates were observed with Klebsiella spp., P. aeruginosa, and Gram-positive. Fosfomycin had resistance rates less than 10% to E. coli, 23% to KES group, and 19% to Gram-positive. Amoxicillin/clavulanate, cephalosporins, quinolones, and TMP/SMX showed high resistance rates to most bacterial strains. High rates of antibiotic resistance were observed in patients candidate to stone treatment from South-Eastern Europe. The empirical use of antibiotics with low resistance rates should be reserved to the most serious cases to avoid the increase of multidrug resistant bacteria. Basing on our results, carbapenems, piperacillin/tazobactam, and amikacin may be a possible option for empiric treatment of urinary stone patients showing systemic symptoms.
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Affiliation(s)
- Elisa De Lorenzis
- Dept. of Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via della Commenda 15, 20122, Milan, Italy. .,Department of Clinical Sciences and Community Health, University of Milan, Via della Commenda 15, 20122, Milan, Italy.
| | - Alberto Budia Alba
- Lithotripsy and Endourology Unit, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Marcos Cepeda
- Urology Unit, Hospital Universitario Río Hortega, Valladolid, Spain
| | - Juan Antonio Galan
- Urolithiasis and Endourology Unit, General University Hospital, Alicante, Spain
| | | | | | - Iliya Saltirov
- Department of Urology and Nephrology, Military Medical Academy, Sofia, Bulgaria
| | - Kemal Sarica
- Department of Urology, Biruni University, Medical School, Istanbul, Turkey
| | - Andreas Skolarikos
- 2nd Department of Urology, University of Athens, Sismanoglio Hospital, Athens, Greece
| | - Sotir Stavridis
- University Clinic of Urology, Medical Faculty Skopje, Skopje, North Macedonia
| | - Emrah Yuruk
- Department of Urology, The Ministry of Health, University of Health Sciences, Bagcilar Training & Research Hospital, Istanbul, Turkey
| | | | - García-Carbajosa
- Urolithiasis and Endourology Unit, General University Hospital, Alicante, Spain
| | - Stefan Hristoforov
- Department of Urology and Nephrology, Military Medical Academy, Sofia, Bulgaria
| | - M Ali Karagoz
- Department of Urology, Kafkas University Medical School, Kars, Turkey
| | - Nikolaos Nassos
- Department of Urology, Democritus University of Thrace, Dragana, Alexandroupolis, Greece
| | - Guzmán Ordaz Jurado
- Lithotripsy and Endourology Unit, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Filip Paslanmaz
- Department of Urology, The Ministry of Health, University of Health Sciences, Bagcilar Training & Research Hospital, Istanbul, Turkey
| | - Marina Poza
- Urology Unit, Hospital Universitario Río Hortega, Valladolid, Spain
| | - Skender Saidi
- University Clinic of Urology, Medical Faculty Skopje, Skopje, North Macedonia
| | - Lazaros Tzelves
- 2nd Department of Urology, University of Athens, Sismanoglio Hospital, Athens, Greece
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20
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Karagiannis A, Skolarikos A, Alexandrescu E, Basic D, Geavlete P, Maletta A, Muslumanoglu AY, Papatsoris A, Petkova K, Saidi S, Skakic A, Saltirov I, Sarica K, Stavridis S, Yilmaz O, Trinchieri A. Epidemiologic study of urolithiasis in seven countries of South-Eastern Europe: S.E.G.U.R. 1 study. ACTA ACUST UNITED AC 2017; 89:173-177. [PMID: 28969396 DOI: 10.4081/aiua.2017.3.173] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 07/15/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To investigate some epidemiological aspects of kidney stones in the South- Eastern European area. MATERIALS AND METHODS From September 2015 to December 2015, 538 consecutive patients were treated and evaluated for reno-ureteral stones in eight departments in Bulgaria, Greece, Italy, FYR Macedonia, Romania, Serbia and Turkey. RESULTS The age of onset was lower in Turkey and higher in Italy. The rate of recurrent patients was higher in Romania and Serbia, while first renal stone formers were more frequent in Italy. The previous history of kidney stones, the characteristics of the stones and the dietary habits of the patients were different in different countries. In Bulgaria, Greece and Romania larger calculi from recurrent patients were more frequent. In Italy and Turkey smaller calculi from first renal stone formers were more frequent. CONCLUSIONS The previous history of kidney stones, the characteristics of the stones and the dietary habits of the patients were different in different countries. A common dietary pattern associated with the formation of kidney stones was not observed, but each country showed different risk factors.
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Petrova D, Petkova K, Vasilev S, Saltirov I. MP015PATTERNS OF PREOPERATIVE URINARY INFECTION IN A CONTEMPORARY SERIES OF STRUVITE STONE FORMERS UNDERGOING PERCUTANEOUS NEPHROLITHOTOMY. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx160.mp015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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22
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Hristova-Popova J, Zagorska A, Saltirov I, Petkova K, Vassileva J. Risk of radiation exposure to medical staff involved in interventional endourology. Radiat Prot Dosimetry 2015; 165:268-71. [PMID: 25855076 DOI: 10.1093/rpd/ncv089] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
The aim is to estimate the possibility the new annual dose limit for eye lens to be exceeded and to study the impact of protective shield. Radiation exposure to medical personnel was evaluated with EDD-30 dosemeter in positions of operating surgeon, assisting doctor and nurse. At the operator's typical position for diagnosis and treatment of the urinary tract, the lens dose rates were 0.9 mSv h(-1) and 0.06 mSv h(-1) without and with lead shield. At the operator's position typical for percutaneous intervention dose rates were 1.9 and 0.02 mSv h(-1), respectively. At typical workload, the annual eye lens dose to the main operator without protective screen was estimated to be 29 mSv. With lead screen, operator lens dose can be reduced by a factor of 15-95 according to the procedure. Installation and use of lead screen and use of lead glasses were recommended to the endourology medical team.
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Affiliation(s)
- J Hristova-Popova
- National Centre of Radiobiology and Radiation Protection, Sofia, Bulgaria
| | - A Zagorska
- National Centre of Radiobiology and Radiation Protection, Sofia, Bulgaria Medical University, Sofia, Bulgaria
| | - I Saltirov
- Department of Urology and Nephrology, Military Medical Academy, Sofia, Bulgaria
| | - K Petkova
- Department of Urology and Nephrology, Military Medical Academy, Sofia, Bulgaria
| | - J Vassileva
- National Centre of Radiobiology and Radiation Protection, Sofia, Bulgaria
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Panchev P, Slavov C, Mladenov D, Georgiev M, Yanev K, Paskalev E, Simeonov P, Gerassi R, Bogov B, Saltirov I. [A multicenter comparative observation on the effectiveness and the rapidness of the effect of Cystostop Rapid versus antibiotic therapy in patients with uncomplicated cystitis]. Akush Ginekol (Sofiia) 2012; 51:49-55. [PMID: 23610918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
UNLABELLED The currently available treatment for uncomplicated urinary tract infections includes only antibiotics and chemotherapeutic agents. Experience in the management of acute uncomplicated infections using non-antibiotic products is very limited. The aim of this observation was to study to what extent the response to Cystostop Rapid would be more rapid and more effective compared to antibiotic therapy in patients with acute uncomplicated urinary bladder infections. The secondary objective was to determine the time to improvement of cystitis symptoms following the start of treatment, as well as the duration of patients' disablement. A total of 158 female subjects were included, assessed microbiologically, and evaluated for incidence and severity of symptoms, before the start of treatment and after completion of treatment. A visual analogue scale was used for patient self-assessment of the severity of symptoms, the improvement of symptoms, as well as the time to improvement of symptoms. RESULTS 158 females, eligible according to the inclusion criteria of the study, were allocated to one of the two groups according to time of enrollment: Group A included 86 subjects: assigned to Cystostop Rapid for 3 days and administered according to the manufacturer's recommended regimen; and Group B included 72 women: assigned to ciprofloxacin 500 mg twice daily for 3 days according to the Product Registration File with the BDA. The clinical and microbiological effectiveness of Cystostop Rapid was comparable to that of ciprofloxacin, providing a two-fold more rapid improvement of cystitis symptoms, at a mean time to improvement of 24 hours (p < 0.02) versus 46 hours for ciprofloxacin. Clinical improvement within 48 hours of Cystostop Rapid regimen occurred in 97% (p < 0.02) of patients, vs. 65.3% of patients on ciprofloxacin. Improvement of symptoms within 12 hours was reported in 36% of patients on Cystostop Rapid vs. 5.5% of patients in the ciprofloxacin group (p < 0.02). No adverse events or intolerability to the therapy were reported throughout the course of the study.
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Abstract
The purpose of this work is to study doses to patients undergoing interventional endourological procedures. The study was performed in a modern Clinic of Endourology and Shockwave Lithotripsy, equipped with two dedicated X-ray systems. The following information was recorded for each patient: type of the procedure, patient age, fluoroscopy time, number of images acquired and patient dose in air kerma-area product, P(KA), measured with KAP-meters integrated in the X-ray units. Eleven types of procedures were included. From the collected sample of 429 patients for all procedures, the mean fluoroscopy time varied between 0.2 and 4 min. The highest values of mean P(KA) 457 and 590 cGy cm(2) were found for percutaneous nephrolithotripsy and ureteroscopy, respectively. The mean values of P(KA) for rest of the procedures investigated were between 58 and 398 cGy cm(2). Individual patient doses varied between 2 and 2440 cGy cm(2) and fluoroscopy time--between 0.1 and 13.7 min. The first study in interventional endourology in Bulgaria demonstrated big variations in patient doses depending on the type and the complexity of procedure, operator's experience and exposure modes.
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Affiliation(s)
- J Hristova-Popova
- National Centre of Radiobiology and Radiation Protection, Sofia, Bulgaria.
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Saltirov I, Petkov T, Petkova K. S82 CURRENT TRENDS IN THE TREATMENT OF UROLITHIASIS: OUR 10 YEARS EXPERIENCE WITH ENDOSCOPIC AND MINIMALLY INVASIVE TREATMENT MODALITIES. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/s1569-9056(10)61367-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Saltirov I, Petkov T, Georgiev G, Belokonski E. [Padua ileal bladder--surgical technique for bladder replacement with continent ileal reservoir]. Khirurgiia (Mosk) 2003; 59:17-21. [PMID: 15641555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
A new technique for detubularized and originally reshaped ileal total bladder replacement following radical cystectomy for bladder cancer is described. The operative method is named "Padua ileal bladder". For first time it is described by Prof. Pagano et al., from the Institute of Urology, Padua University, Italy. The operative method was performed on a patient with invasive bladder carcinoma. The result was evaluated clinically, radiologically and urodinamically with follow-up from 6 months. The patient had perfect daytime and nighttime continence. The reservoir features were: high capacity of 550 ml, low pressure of 17 cm H2O and 30-50 cm H2O at the micturation. There was no ureteral reflux and we achieved complete emptying of the bladder using abdominal straining and perineal relaxation.
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Saltirov I, Terziev T, Genadiev T. [The current diagnosis of tumors of the upper urinary tract]. Khirurgiia (Mosk) 1998; 50:13-6. [PMID: 9379611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The treatment results and survivorship of patients with upper urinary tract tumors (UUTT) are largely dependent on the early diagnosis of the lesions. Twenty-eight patients presenting UUTT are studied and treated in the Clinic of Urology over the period 1987 through 1995. The diagnostic protocol includes both standard radiographic and cytological techniques, and endoscopic methods allowing for visualization and histopathological characterization of the neoplasm. The diagnostic relevance of the various methods and their efficacy are assayed, with emphasis on the necessity of their use in the differential diagnosis. The diagnostic approach described contributes to mace precise early diagnosis with preoperative determination of the degree of tumor differentiation which has an essential practical bearing on the choice of operative procedure and prognosis of the disease.
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Dragiev D, Savov E, Lilov A, Tsenova Z, Saltirov I, Atanasova I. [The clinical and microbiological study of the preparation perfloxacin in treating urologic infections]. Khirurgiia (Mosk) 1993; 46:49-51. [PMID: 8041098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Experience with Pefloxacin treatment of thirty-nine patients presenting urinary tract infection, over the period 1992-1993, is shared. The drug is administered per os at dosage--800 mg, divided in two doses given at 12-hour intervals. As shown by the results of assaying the clinical symptoms, laboratory indicators and microbiological findings in the urine, the therapeutic effect is very good. A clinical cure is recorded in 76 cases (92 per cent), and healing of the bacteriological agent--in 92.31 per cent. Side effects are rarely observed and mildly manifested. The results of Pefloxacin treatment warrant the assumption that the drug synthesized is encouraging, suitable for both out- and inpatient treatment of urinary tract infections, and therefore it should be introduced in the daily routine practice.
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Lilov A, Patrashkov T, Saltirov I, Mikhaĭlov P. [Ureteroscopy in the treatment of ureteral stones]. Urol Nefrol (Mosk) 1989:28-31. [PMID: 2617733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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