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Kankaria S, Gali KV, Chawla A, Bhaskara SP, Hegde P, Somani B, de la Rosette J, Laguna P. Super-mini PCNL (SMP) with suction versus standard PCNL for the management of renal calculi of 1.5 cm-3 cm: a randomized controlled study from a university teaching hospital. World J Urol 2024; 42:257. [PMID: 38658395 PMCID: PMC11043203 DOI: 10.1007/s00345-024-04954-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 03/27/2024] [Indexed: 04/26/2024] Open
Abstract
PURPOSE To assess the safety and efficacy of super-mini PCNL (SMP, 14 Fr) when compared to standard PCNL (sPCNL, 24-30 Fr) in the management of renal calculi of size ranging from 1.5 to 3 cm. METHODS From February 2021 to January 2022, a total of 100 patients were randomized to either SMP group or sPCNL group in a 1:1 ratio (50 in each group) using computer-generated simple randomization. Demographic data, stone characteristics, operative times, perioperative complications, blood transfusions, postoperative drop in haemoglobin, postoperative pain, duration of hospital stay and stone-free rates were compared between the two groups. RESULTS Mean stone volume (2.41 cm2 vs 2.61 cm2) and stone-free rates (98% vs 94%, p = 0.14) were similar in both the SMP and sPCNL groups, respectively. The SMP group had significantly longer mean operative times (51.62 ± 10.17 min vs 35.6 ± 6.8 min, p = 0.03). Intraoperative calyceal injury (1/50 vs 7/50, p = 0.42) and mean postoperative drop in haemoglobin (0.8 ± 0.7 g/dl vs 1.2 ± 0.81, p = 0.21) were lower in the SMP group, but not statistically significant. SMP group showed significantly lower mean postoperative pain VAS scores (5.4 ± 0.7 vs 5.9 ± 0.9, p = 0.03) and mean duration of hospital stay (28.38 ± 3.6 h vs 39.84 ± 3.7 h, p = 0.0001). Complications up to Clavien grade 2 were comparable, with grade ≥ 3 complications higher in the standard group, but not statistically significant. CONCLUSION Super-mini PCNL is equally effective as standard PCNL in treating renal calculi up to 3 cm, with significantly reduced postoperative pain and duration of hospital stay and lower risk of Clavien grade ≥ 3 complications, although with higher operative times.
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Affiliation(s)
- Sanket Kankaria
- Department of Urology and Renal Transplant, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India
| | - Kasi Viswanath Gali
- Department of Urology and Renal Transplant, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India
| | - Arun Chawla
- Department of Urology and Renal Transplant, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India.
| | - Sunil Pillai Bhaskara
- Department of Urology and Renal Transplant, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India
| | - Padmaraj Hegde
- Department of Urology and Renal Transplant, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India
| | - Bhaskar Somani
- Department of Urology, University Hospital Southampton, Southampton, UK
| | | | - Pilar Laguna
- Department of Urology, Istanbul Medipol University, Istanbul, Turkey
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Robles-Medranda C, Alcivar-Vasquez J, Raijman I, Kahaleh M, Puga-Tejada M, Del Valle R, Alvarado H, Cifuentes-Gordillo C, Binmoeller KF, Baptista AJ, Barreto-Perez J, Rodriguez J, Egas-Izquierdo M, Cunto D, Calle-Loffredo D, Lukashok H, Baquerizo-Burgos J, Tabacelia D. Accurate and safe diagnosis and treatment of neoplastic biliary lesions using a novel 9F and 11F digital single-operator cholangioscope. Endosc Int Open 2024; 12:E498-E506. [PMID: 38585021 PMCID: PMC10997424 DOI: 10.1055/a-2282-6678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 02/15/2024] [Indexed: 04/09/2024] Open
Abstract
Background and study aims Digital single-operator cholangioscopy (DSOC) allows the diagnosis of biliary duct disorders and treatment for complicated stones. However, these technologies have limitations such as the size of the probe and working channel, excessive cost, and low image resolution. Recently, a novel DSOC system (eyeMAX, Micro-Tech, Nanjing, China) was developed to address these limitations. We aimed to evaluate the usefulness and safety of a novel 9F and 11F DSOC system in terms of neoplastic diagnostic accuracy based on visual examination, ability to evaluate tumor extension and to achieve complete biliary stone clearance, and procedure-related adverse events (AEs). Patients and methods Data from ≥ 18-year-old patients who underwent DSOC from July 2021 to April 2022 were retrospectively recovered and divided into a diagnostic and a therapeutic cohort. Results A total of 80 patients were included. In the diagnostic cohort (n = 49/80), neovascularity was identified in 26 of 49 patients (46.9%). Biopsy was performed in 65.3% patients with adequate tissue sample obtained in 96.8% of cases. Biopsy confirmed neoplasia in 23 of 32 cases. DSOC visual impression achieved 91.6% sensitivity and 87.5% specificity in diagnosing neoplasms. In the therapeutic cohort (n = 43/80), 26 of 43 patients required lithotripsy alone. Total stone removal was achieved in 71% patients in the first session. Neither early nor late AEs were documented in either the diagnostic or therapeutic cohort. Conclusions The novel DSOC device has excellent diagnostic accuracy in distinguishing neoplastic biliary lesions as well as therapeutic benefits in the context of total stone removal, with no documented AEs.
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Affiliation(s)
- Carlos Robles-Medranda
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas - IECED, Guayaquil, Ecuador
| | - Juan Alcivar-Vasquez
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas - IECED, Guayaquil, Ecuador
| | - Isaac Raijman
- Gastroenterology, Digestive Associates of Houston, Houston, United States
| | - Michel Kahaleh
- Gastroenterology, Robert Wood Johnson Medical School, New Brunswick, United States
| | - Miguel Puga-Tejada
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas - IECED, Guayaquil, Ecuador
| | - Raquel Del Valle
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas - IECED, Guayaquil, Ecuador
| | - Haydee Alvarado
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas - IECED, Guayaquil, Ecuador
| | | | | | | | - Jonathan Barreto-Perez
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas - IECED, Guayaquil, Ecuador
| | - Jorge Rodriguez
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas - IECED, Guayaquil, Ecuador
| | - Maria Egas-Izquierdo
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas - IECED, Guayaquil, Ecuador
| | - Domenica Cunto
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas - IECED, Guayaquil, Ecuador
| | - Daniel Calle-Loffredo
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas - IECED, Guayaquil, Ecuador
| | - Hannah Lukashok
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas - IECED, Guayaquil, Ecuador
| | - Jorge Baquerizo-Burgos
- Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas - IECED, Guayaquil, Ecuador
| | - Daniela Tabacelia
- Gastroenterology, Elias Emergency University Hospital, Bucuresti, Romania
- Gastroenterology, Carol Davila University of Medicine and Pharmacy, Bucuresti, Romania
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Cui Y, Almario JA, Bejjani M, Khashab MA, Irani S. Primary anastomosis closure after endoscopic ultrasound-directed transgastric intervention. Endosc Int Open 2024; 12:E526-E531. [PMID: 38628391 PMCID: PMC11018386 DOI: 10.1055/a-2272-0927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 02/14/2024] [Indexed: 04/19/2024] Open
Abstract
Background and study aims Endoscopic ultrasound-directed transgastric intervention (EDGI) is a technique that creates an anastomosis between the gastric pouch or jejunum to the excluded stomach in Roux-en-Y gastric bypass (RYGB) anatomy to allow access to the pancreaticobiliary system. Thus far, management of anastomosis closure at the time of lumen-apposing metal stent (LAMS) removal has varied widely. This study aimed to assess the efficacy of primary closure at the time of LAMS removal using a through-the-scope (TTS) tack-based suture system. Patients and methods This was a two-center retrospective study of RYGB patients who underwent single-stage EDGI using a 20-mm LAMS and subsequent primary anastomosis closure with the X-tack system at the time of stent removal. Patient demographics, procedure details, clinical outcomes, and imaging findings are reported. Results Nineteen patients (median age 63 years, 84% female) underwent single-stage EDGI with a median follow-up of 31.5 months. Adverse events occurred in two patients (11%) who had abdominal pain requiring hospitalization. The median LAMS dwell time was 32 days (range 16-86). All patients (100%) who underwent follow-up studies after LAMS removal had confirmed anastomosis closure (n = 18). Most patients had documented weight loss at the time of LAMS removal and at last follow-up (68%, n = 13). Conclusions Single-stage EDGI is an effective approach to managing RYGB patients with pancreaticobiliary pathology. Thus far, endoscopic TTS tack-based suturing appears to have a high success rate in anastomosis closure after LAMS removal and should be considered as a primary method for preventing chronic fistulae.
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Affiliation(s)
- YongYan Cui
- Gastroenterology, Virginia Mason Medical Center, Seattle, United States
| | | | - Michael Bejjani
- Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, United States
| | - Mouen A. Khashab
- Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, United States
| | - Shayan Irani
- Gastroenterology and Hepatology, Virginia Mason Medical Center, Seattle, United States
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Faure A, Paye Jaouen A, Demede D, Juricic M, Arnaud A, Garcia C, Charbonnier M, Abbo O, Botto N, Blanc T, Leclair MD, Loubersac T. Safety and feasability of ureteroscopy for pediatric stone, in children under 5 Years (SFUPA 5): A French multicentric study. J Pediatr Urol 2024; 20:225.e1-225.e8. [PMID: 38030430 DOI: 10.1016/j.jpurol.2023.11.016] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 11/09/2023] [Accepted: 11/15/2023] [Indexed: 12/01/2023]
Abstract
INTRODUCTION Ureteroscopy (URS) can be proposed as first-line therapy for the management of pelvic stones from 10 to 20 mm and for lower ureteric stones in children. However, little is known about the success and the morbidity of URS in young children. Ureteroscopic treatment may present matters in young children because of the small size of the pediatric kidney and the small size of the collecting system. OBJECTIVE To assess safety and efficacy of URS for the treatment of urinary stones in children aged of 5 years or less. STUDY DESIGN After the institutional ethical board approval was obtained, we conducted a retrospective, analytic, multicentric study that included all URS performed between January 2016 and April 2022 in children aged of 5 years or less. In this non-comparative case series, anonymized pooled data were collected from 7 tertiary care centers of pediatric patients. Endpoints were the one-session SFR at 3 months and per and postoperatives complications. Descriptive statistics were applied to describe the cohort. RESULTS Eighty-three patients were included. For them, 96 procedures were performed at the median age of 3.5 years (IQR: 0.8-5) and median weight of 14 Kg (6.3-23). Median stone size was 13 mm (4-45). There were 65 (67 %) renal stones treated with flexible URS, most of which were in the renal pelvis (30 %) and in the lower calix (33 %). A ureteral access sheath was used in 91 % procedures. Preoperative ureteral stent was placed in 52 (54 %) of patients. None of patients had ureteral dilatation. The single-session SFR was 67.4 % (56.3 and 89.2 % for flexible URS and semi-rigid URS respectively) and children require 1.4 procedures to achieve complete stone clearance. The overall complication rate was 18.7 %, most of them were minor (Clavien I-II). Intraoperative perirenal extravasation (Clavien IIIb) due to forniceal rupture was documented in 6.2 % of cases, related to an increased intrapelvic pressure (IPP) performed in a closed pelvicalyceal system. DISCUSSION Pediatric urologists should be aware of forniceal rupture based on the presence of extravasation of contrast during endourological procedures especially when they have difficulties to reach lower caliceal stone in small patient. CONCLUSION URS in patients aged of 5 years or less, is a complex minimally invasive procedure with reasonable efficacy and low morbidity. Intrarenal stones treated by RIRS in young children carries the risk of additional procedures to complete stone clearance.
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Affiliation(s)
- A Faure
- APHM, Aix Marseille University, Timone Enfants, Department of Pediatric Surgery, Marseille, France.
| | - A Paye Jaouen
- APHP, Robert-Debré University Hospital, National Reference Center for Rare Urinary Tract Diseases "MARVU", Pediatric Urology, Paris, France
| | - D Demede
- University Hospital of Lyon, Pediatric Urology, Lyon, France
| | - M Juricic
- University Hospital of Rennes, Pediatric Urology, Rennes, France
| | - A Arnaud
- University Hospital of Rennes, Pediatric Urology, Rennes, France
| | - C Garcia
- University Hospital of Toulouse, Pediatric Urology, Toulouse, France
| | - M Charbonnier
- APHM, Aix Marseille University, Timone Enfants, Department of Pediatric Surgery, Marseille, France
| | - O Abbo
- University Hospital of Toulouse, Pediatric Urology, Toulouse, France
| | - N Botto
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - T Blanc
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France; Université Paris Cité, Paris, France
| | - M D Leclair
- Nantes Université, Pediatric Urology, Nantes, France
| | - T Loubersac
- Nantes Université, Pediatric Urology, Nantes, France
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Campbell P, Mudd B, Craig K, Daugherty M, Vanderbrink B, DeFoor W, Minevich E, Reddy P, Strine A. One and done: Feasibility and Safety of Primary Ureteroscopy in a Pediatric Population. J Pediatr Urol 2024; 20:224.e1-224.e7. [PMID: 37957074 DOI: 10.1016/j.jpurol.2023.10.031] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/24/2023] [Accepted: 10/27/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Pediatric urolithiasis has been increasing at rate of 4-10 % annually in the United States, most notably within adolescents and females. A significant number of patients will require surgical management of their stones. Primary ureteroscopy (URS) affords the opportunity to treat stones under a single anesthetic with lower re-treatment rates or anatomical and stone characteristic limitations compared to shockwave lithotripsy. Previous studies evaluating primary URS have been largely underpowered, are limited by stone location, and/or are not representative of the stone population in the United States. OBJECTIVES Primary study outcomes were the success of primary URS and patient characteristics associated with success. Secondary outcomes were the stone-free rate (SFR), 30-day emergency department (ED) visits, 30-day readmissions, and complications. METHODS We performed a retrospective cohort study of patients less than 18 years of age from 2011 to 2023 who underwent primary URS. Patients were excluded if a ureteral stent was placed prior to URS or diagnostic URS was performed. A successful primary URS was considered if access to the ureter was obtained and treatment of the stone(s) completed. In failed primary URS, a ureteral stent was placed for staged management. RESULTS A total of 196 patients were included and primary URS was performed or attempted on 224 renal units. The median age was 15.8 (IQR 13.4-16.9) years and median follow up 8.4 (IQR 1.1-24.6) months. The success rate of primary URS was 79 %. No significant characteristics were appreciated for successful primary URS based on: overall age, <14 vs > 14 years of age, sex, body mass index, history of stones, history of endourologic procedures, preoperative alpha blockade, location of stone(s), multiple stones, type of URS, or acute treatment. In successful primary URS, the SFR was 88 % with stone size (p = 0.0001) the only predictor of having residual stones. The 30-day ED rate was 21.4 %, 30-day unplanned readmission rate was 12.5 %, and complication rate was 7.5 %. No long-term complications were appreciated. DISCUSSION Our success of primary URS compares favorably to previously published literature. Our SFR rate, 30-day ED visits, 30-day unplanned readmission, and complication rates are similar to other studies. Limitations of the study are its retrospective design, selection bias, and intermediate follow-up. CONCLUSIONS Primary URS can be completed safely in the majority of pediatric patients without any patient characteristics associated with success. We advocate for primary URS when possible due to the excellent SFR and potential of treating stones under a single anesthetic.
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Affiliation(s)
- Paul Campbell
- Cincinnati Children's Hospital Medical Center, Department of Urology, Cincinnati, OH, 3333 Burnet Avenue, Cincinnati, OH 45229, USA.
| | - Brandon Mudd
- University of Cincinnati, Department of Urology, Cincinnati, OH, 231 Albert Sabin Way, Cincinnati, OH 45267, USA.
| | - Kiersten Craig
- Cincinnati Children's Hospital Medical Center, Department of Urology, Cincinnati, OH, 3333 Burnet Avenue, Cincinnati, OH 45229, USA.
| | - Michael Daugherty
- Cincinnati Children's Hospital Medical Center, Department of Urology, Cincinnati, OH, 3333 Burnet Avenue, Cincinnati, OH 45229, USA.
| | - Brian Vanderbrink
- Cincinnati Children's Hospital Medical Center, Department of Urology, Cincinnati, OH, 3333 Burnet Avenue, Cincinnati, OH 45229, USA.
| | - William DeFoor
- Cincinnati Children's Hospital Medical Center, Department of Urology, Cincinnati, OH, 3333 Burnet Avenue, Cincinnati, OH 45229, USA.
| | - Eugene Minevich
- Cincinnati Children's Hospital Medical Center, Department of Urology, Cincinnati, OH, 3333 Burnet Avenue, Cincinnati, OH 45229, USA.
| | - Pramod Reddy
- Cincinnati Children's Hospital Medical Center, Department of Urology, Cincinnati, OH, 3333 Burnet Avenue, Cincinnati, OH 45229, USA.
| | - Andrew Strine
- Cincinnati Children's Hospital Medical Center, Department of Urology, Cincinnati, OH, 3333 Burnet Avenue, Cincinnati, OH 45229, USA.
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Minguez Ojeda C, Laso García I, López Curtis D, Duque Ruiz G, Mata Alcaraz M, Santiago González M, Artiles Medina A, Hevia Palacios M, Arias Fúnez F, Burgos Revilla FJ. Is extracorporeal lithotripsy a first-line treatment for urinary stones today? Actas Urol Esp 2024; 48:134-139. [PMID: 37657709 DOI: 10.1016/j.acuroe.2023.08.006] [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: 04/25/2023] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 09/03/2023]
Abstract
OBJECTIVE To evaluate the efficacy and complications of extracorporeal lithotripsy (SWL) as a first-line treatment for renal and ureteral stones METHODS: Retrospective and observational study of all the patients treated with lithotripsy in a third level center between January 2014 and January 2021; characteristics of the patients, the stones, complications and results of SWL is recollected. Multivariate logistic regression of the factors associated with stone size reduction was performed. A statistical analysis of the factors associated with additional treatment after SWL and factors associated with complications is also executed. RESULTS 1727 patients are included. Stone mean size was 9,5mm. 1540 (89.4%) patients presented reduction in stone size. In multivariate analysis, stone size (OR=1.13; p=0.00), ureteral location of the lithiasis (OR=1.15; p=0.052) and number of waves (p=0.002; OR=1.00) used in SWL are the factors associated with reduction of stone size. Additional treatment after lithotripsy was needed in 665 patients (38.5%). The factors associated with the need for retreatment were stone size (OR=1.131; p=0.000), number of waves (OR=1.000; p=0.000), energy (OR=1.005; p=0.000). 153 patients (8.8%) suffered complications after SWL. A statistically significant association was found between the size of the lithiasis (p=0.024, OR=1.054) and the previous urinary diversion (P=0.004, OR=0.571). CONCLUSION Lithotripsy remains an effective treatment as the first line of therapy for reno-ureteral lithiasis with a low percentage of complications.
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Affiliation(s)
- C Minguez Ojeda
- Servicio de Urología, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid. Spain.
| | - I Laso García
- Servicio de Urología, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid. Spain
| | - D López Curtis
- Servicio de Urología, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid. Spain
| | - G Duque Ruiz
- Servicio de Urología, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid. Spain
| | - M Mata Alcaraz
- Servicio de Urología, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid. Spain
| | - M Santiago González
- Servicio de Urología, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid. Spain
| | - A Artiles Medina
- Servicio de Urología, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid. Spain
| | - M Hevia Palacios
- Servicio de Urología, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid. Spain
| | - F Arias Fúnez
- Servicio de Urología, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid. Spain
| | - F J Burgos Revilla
- Servicio de Urología, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid. Spain
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Kronenberg P. Alpha-blockers: the magic pill for endourology-The great delusion. World J Urol 2024; 42:109. [PMID: 38421483 DOI: 10.1007/s00345-024-04785-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 01/10/2024] [Indexed: 03/02/2024] Open
Abstract
PURPOSE The present paper takes a different and more critical look at the role of alpha-blockers, sometimes nicknamed as "magical pills", in particular for stone disease and medical expulsive therapy (MET). METHODS A non-systematic narrative review was performed, synthesizing pertinent information from selected articles, and critically evaluating their conclusions. Sometimes different views on alpha-blockers were laid bare, including curiosities or other entertaining nuances suitable to the present topic, but always maintaining sharp objectivity and the foremost scientific rigor. RESULTS AND CONCLUSIONS Alpha-blockers seem to be a panacea, being used to treat a wide variety of non-urological diseases and conditions. Urological applications include erectile dysfunction to benign prostatic hyperplasia, from incontinence to urinary retention, or even to facilitate urinary stone passage along the urinary tract. Due to its versatility, alpha-blockers appear to be the Swiss army knife of urological medications. However, the efficacy of alpha-blockers for MET, pain management, or facilitating upper tract access is very disappointing, bringing no, or in some instances, only marginal benefits. Their treatment results are far from being significant or impressive let alone magical. Regular sexual intercourse is an effective alternative to alpha-blockers, providing faster ureteral stone expulsion rates and reducing the need for pain medication. Most of the research supporting alpha-blockers has been based on single-center, underpowered, low-quality studies. These low-quality studies biased several subsequent meta-analyses, contaminating them with their low-quality data, enhancing and prolonging this delusion. These results emphasize the need for large, multi-centric, unbiased, randomized, double-blinded, placebo-controlled trials to prevent future year-long delusions that may afflict any medical field.
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Affiliation(s)
- Peter Kronenberg
- CUF Descobertas Hospital, Member of PETRA UroGroup (Progress in Endourology, Technology and Research Association), Lisbon, Portugal.
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8
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Buchanan WW, Rainsford KD, Kean CA, Kean WF. Medical aspects of the tour by Martin Martin (c 1660-1719) of the Western and Northern Islands of Scotland, Circa 1695. Inflammopharmacology 2024; 32:83-92. [PMID: 37676413 DOI: 10.1007/s10787-023-01334-6] [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: 08/24/2023] [Accepted: 08/24/2023] [Indexed: 09/08/2023]
Abstract
This review is based investigations on the Western Isles, Scotland, by Martin Martin, a notable Scottish Highlander, academic and medical doctor, of the 17th-18th century. His extensive observations of the geography and peoples of these Isles were recorded in his books, "On the Description of the Western Islands of Scotland Circa 1695" and "A Late Voyage to St Kilda". In these books and subsequent papers there were some noteworthy observations on the occurrence (and as he says non-occurrence) of "epidemical" diseases and conditions afflicting the peoples of The Isle of Skye and the Western Isles of Scotland in this period, and these are discussed in this review. Martin also gives details of a wide variety of remedies that were observed or reported by inhabitants around that time. Some of these remedies are interesting for their relevance to the period but others are of doubtful merit. These are reviewed here more for their significance in the understanding of the diseases and conditions of humans and even in some cases animals at that time. Introductions by Charles Withers and R.W. Munro, 11 and re-assessments of the contributions of Martin and colleagues of that time have given insight into the health and condition of peoples of the Western Isles of Scotland(the Occidental) (Martin 1695; Martin 1716).
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Affiliation(s)
- W Watson Buchanan
- Department of Medicine, McMaster University, Hamilton, ON, L8P 1H6, Canada
| | | | - Colin A Kean
- Haldimand War Memorial Hospital, 400 Broad Street, Dunnville, ON, N1A 2P7, Canada
| | - Walter F Kean
- Department of Medicine, McMaster University, Hamilton, ON, L8P 1H6, Canada.
- Haldimand War Memorial Hospital, 400 Broad Street, Dunnville, ON, N1A 2P7, Canada.
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Masuda S, Jinushi R, Imamura Y, Kubota J, Kimura K, Shionoya K, Makazu M, Sato R, Kako M, Kobayashi M, Uojima H, Koizumi K. Association of short-course antimicrobial therapy and bacterial resistance in acute cholangitis: Retrospective cohort study. Endosc Int Open 2024; 12:E307-E316. [PMID: 38420157 PMCID: PMC10901644 DOI: 10.1055/a-2230-8229] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 12/08/2023] [Indexed: 03/02/2024] Open
Abstract
Background and study aims Although the number of resistant bacteria tends to increase with prolonged antimicrobial therapy, no studies have examined the relationship between the duration of antimicrobial therapy and increase in the number of resistant bacteria in acute cholangitis. We hypothesized that the short-term administration of antimicrobial agents in acute cholangitis would suppress bacterial resistance. Patients and methods This was a single-center, retrospective, observational study of patients with acute cholangitis admitted between January 2018 and June 2020 who met the following criteria: successful biliary drainage, positive blood or bile cultures, bacteria identified from cultures sensitive to antimicrobials, and subsequent cholangitis recurrence by January 2022. The patients were divided into two groups: those whose causative organisms at the time of recurrence became resistant to the antimicrobial agents used at the time of initial admission (resistant group) and those who remained susceptible (susceptible group). Multivariate analysis was used to examine risk factors associated with the development of resistant pathogens. Multivariate analysis investigated antibiotics used with the length of 3 days or shorter after endoscopic retrograde cholangiopancreatography (ERCP) and previously reported risk factors for the development of bacterial resistance. Results In total, 89 eligible patients were included in this study. There were no significant differences in patient background or ERCP findings between the groups. The use of antibiotics, completed within 3 days after ERCP, was associated with a lower risk of developing bacterial resistance (odds ratio, 0.17; 95% confidence interval, 0.04-0.65; P =0.01). Conclusions In acute cholangitis, the administration of antimicrobials within 3 days of ERCP may suppress the development of resistant bacteria.
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Affiliation(s)
- Sakue Masuda
- Gastroenterology, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Ryuhei Jinushi
- Gastroenterology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Yoshinori Imamura
- Division of Medical Oncology/Hematology, Department of Medicine, Kobe University, Kobe, Japan
| | - Jun Kubota
- Gastroenterology, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Karen Kimura
- Gastroenterology, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Kento Shionoya
- Gastroenterology, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Makomo Makazu
- Gastroenterology, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Ryo Sato
- Gastroenterology, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Makoto Kako
- Gastroenterology, Shonan Kamakura General Hospital, Kamakura, Japan
| | | | - Haruki Uojima
- Department of Gastroenterology, Internal Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Kazuya Koizumi
- Gastroenterology, Shonan Kamakura General Hospital, Kamakura, Japan
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Dalal A, Kamat N, Maydeo A, Patil G, Vadgaonkar A, Parekh S, Vora S. Assessment of pancreatic ductal stone density on non-contrast computed tomography for predicting the outcome of extracorporeal shock wave lithotripsy. Endosc Int Open 2024; 12:E274-E281. [PMID: 38420153 PMCID: PMC10901651 DOI: 10.1055/a-2226-1464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 12/05/2023] [Indexed: 03/02/2024] Open
Abstract
Background and study aims The utility of stone density at non-contrast computed tomography (NCCT) for predicting the effectiveness of extracorporeal shock wave lithotripsy (ESWL) in chronic calcific pancreatitis (CCP) is relatively unexplored. Patients and methods This was a prospective observational study of patients with CCP. Hounsfield units (HU) were determined for the largest pancreatic ductal stone during pretreatment NCCT. All patients underwent ESWL until the largest stone was fragmented to <3mm, followed by endoscopic retrograde cholangiopancreatography (ERCP) for stone extraction. The predictive factors following ESWL for successful stone extraction were studied and the receiver operating characteristic (ROC) curve determined the HU optimal cut-point. Results Eighty-two patients with a median (interquartile range) age of 36 years (range, 29-55); majority male 45 (54.9%), were included. Idiopathic CCP was noted in 78 patients (95.1%). The median stone density (SD) was 1095 HU (range, 860.7-1260.7) and the number of ESWL sessions was 2 (range, 2-3). Complete stone removal at index ERCP was achieved in 55 patients (67.1%). Those with partial clearance (n=27) needed a repeat ERCP, which was successful in 26 (96.3%); one patient (3.7%) underwent surgery. There was a significant, positive correlation between number of ESWL sessions and SD (r=0.797; P <0.001). On bivariate analysis, SD and the number of ESWL sessions revealed a significant association with complete ductal clearance. The optimal cut-point for complete stone removal by the ROC curve was 1106.5 HU (Youden index 0.726), with a sensitivity of 93% and a specificity of 80%. Conclusions The SD is a significant predictor of ESWL success followed by ductal clearance at ERCP, and <1106.5 HU is a predictor of good candidates for ESWL therapy.
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Affiliation(s)
- Ankit Dalal
- Institute of Gastrosciences, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, India
| | - Nagesh Kamat
- Institute of Gastrosciences, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, India
| | - Amit Maydeo
- Institute of Gastrosciences, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, India
| | - Gaurav Patil
- Institute of Gastrosciences, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, India
| | - Amol Vadgaonkar
- Institute of Gastrosciences, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, India
| | - Sanil Parekh
- Institute of Gastrosciences, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, India
| | - Sehajad Vora
- Institute of Gastrosciences, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, India
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Corrales M, Panthier F, Solano C, Candela L, Traxer O. Laser safety, warnings, and limits in retrograde intrarenal surgery. Actas Urol Esp 2024; 48:19-24. [PMID: 37356576 DOI: 10.1016/j.acuroe.2023.06.009] [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: 04/17/2023] [Accepted: 04/19/2023] [Indexed: 06/27/2023]
Abstract
OBJECTIVE To analyze the current information about laser safety in retrograde intrarenal surgery (RIRS), focusing on the two main laser technologies that we use in urology, the holmium:yttrium-aluminum-garnet (Ho:YAG) laser, and the thulium fiber laser (TFL). METHODS Narrative overview of the most relevant articles published in MEDLINE and Scopus databases about this subject. RESULTS TFL and Ho:YAG laser at similar settings (0.2 J/40 Hz) have similar volume-averaged temperature increase and the average heating rate increase proportionally to laser power, especially when high frequencies are used. Recent preclinical data, comparing both laser technologies at different laser settings, agreed that when the delivered energy increases in expenses of higher frequencies, the thermal damage increases too. Higher frequencies, despite of the rise of temperature in the irrigation medium, can cause accidental thermal lasering lesions. CONCLUSION The use of low frequency settings and a proper irrigation is critical to avoid thermal injury in endoscopic laser lithotripsy. In addition, the use of laser safety eyeglasses is recommended in Ho:YAG and TFL ELL.
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Affiliation(s)
- M Corrales
- GRC n.° 20, Grupo de Investigación Clínica Litiasis Urinaria, Hospital Tenon, Universidad de La Sorbona, París, France; Servicio de Urología, Universidad de La Sorbona, Hospital Tenon (AP-HP), Paris, France.
| | - F Panthier
- GRC n.° 20, Grupo de Investigación Clínica Litiasis Urinaria, Hospital Tenon, Universidad de La Sorbona, París, France; Servicio de Urología, Universidad de La Sorbona, Hospital Tenon (AP-HP), Paris, France
| | - C Solano
- GRC n.° 20, Grupo de Investigación Clínica Litiasis Urinaria, Hospital Tenon, Universidad de La Sorbona, París, France; Servicio de Urología, Universidad de La Sorbona, Hospital Tenon (AP-HP), Paris, France
| | - L Candela
- GRC n.° 20, Grupo de Investigación Clínica Litiasis Urinaria, Hospital Tenon, Universidad de La Sorbona, París, France; Servicio de Urología, Universidad de La Sorbona, Hospital Tenon (AP-HP), Paris, France; Division de Oncología Experimental/Unidad de Urología, URI, IRCCS Hospital San Raffaele, Milán, Italy
| | - O Traxer
- GRC n.° 20, Grupo de Investigación Clínica Litiasis Urinaria, Hospital Tenon, Universidad de La Sorbona, París, France; Servicio de Urología, Universidad de La Sorbona, Hospital Tenon (AP-HP), Paris, France
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12
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Koutlas NJ, Pawa S, Russell G, Ferris T, Ponnatapura J, Pawa R. EUS-guided hepaticogastrostomy versus percutaneous transhepatic biliary drainage after failed ERCP: A propensity score-matched analysis. Endosc Int Open 2024; 12:E108-E115. [PMID: 38250165 PMCID: PMC10798845 DOI: 10.1055/a-2220-2740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 11/16/2023] [Indexed: 01/23/2024] Open
Abstract
Background and study aims Percutaneous transhepatic biliary drainage (PTBD) is the traditional second-line option after unsuccessful endoscopic retrograde cholangiopancreatography (ERCP). Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HG) is a viable alternative to PTBD. Our study aimed to compare outcomes of EUS-HG and PTBD for benign and malignant biliary diseases following failed ERCP. Patients and methods This single-center study retrospectively analyzed patients undergoing EUS-HG and PTBD for benign and malignant biliary disorders. A propensity score-matched analysis was performed using age, sex, and Charlson Comorbidity Index. The primary outcome was clinical success, which we defined as a decrease in total bilirubin by ≥ 50% at 2 weeks for malignant disease and resolution of the biliary disorder for benign disease. Results In total, 41 patients underwent EUS-HG and 138 patients underwent PTBD. After propensity score matching in a 1:2 ratio, 32 EUS-HG patients were matched with 64 PTBD. Technical success was achieved in 29 of 32 (91%) for EUS-HG and 63 of 64 (98%) for PTBD ( P =0.11). Clinical success was 100% for EUS-HG and 75% for PTBD ( P =0.0021). EUS-HG was associated with a lower adverse event rate (EUS-HG 13% vs. PTBD 58%, P <0.0001), shorter procedure duration (median 60 vs. 115 minutes, P <0.0001), shorter post-procedure length of stay (median 2 vs. 4 days, P <0.0001), and fewer reinterventions (median 1 vs. 3, P <0.0001). Conclusions Our results suggest that EUS-HG is superior to PTBD in the treatment of benign and malignant biliary disorders after failed ERCP.
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Affiliation(s)
- Nicholas J Koutlas
- Gastroenterology, Wake Forest School of Medicine, Winston-Salem, United States
| | - Swati Pawa
- Gastroenterology, Wake Forest School of Medicine, Winston-Salem, United States
| | - Greg Russell
- Biostatistics, Wake Forest School of Medicine, Winston-Salem, United States
| | - Taylor Ferris
- Department of Medicine, Wake Forest School of Medicine, Winston-Salem, United States
| | | | - Rishi Pawa
- Gastroenterology, Wake Forest School of Medicine, Winston-Salem, United States
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Emmanuel J, Hsin DCC, Bt Wan Abdullah WZA, See LT. EUS-guided laser lithotripsy for pancreatic duct stones after failed conventional pancreatic endotherapy. Endosc Int Open 2024; 12:E135-E138. [PMID: 38304353 PMCID: PMC10834106 DOI: 10.1055/a-2187-7263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 09/22/2023] [Indexed: 02/03/2024] Open
Abstract
The central dogma of pain in patients with chronic pancreatitis revolves around the pathophysiology of ductal hypertension owing to stones that obstruct the pancreatic duct. Conventional modalities available to decompress the pancreatic duct are occasionally limited by failed selective pancreatic duct cannulation during endoscopic retrograde cholangiopancreatography. We describe a novel endoscopic approach of EUS-guided laser lithotripsy to assist in pancreatic duct (PD) stone fragmentation in two symptomatic patients with underlying chronic pancreatitis who had failed PD cannulation and extracorporeal shock wave lithotripsy (ESWL). In both cases, a 365-micrometer LightTrail TracTip Holmium laser fiber was advanced within a 19G endoscopic ultrasound aspiration needle (Expect Slimline (SL), Boston Scientific, Marlborough, Massachusetts, United States) under endoscopic ultrasound (EUS) guidance to fragment the PD stones. There were no procedure-related complications encountered and follow-up after 1 month of the procedure revealed significant reduction in abdominal pain scores. To the best of our knowledge, these are the first reported cases of EUS-guided laser lithotripsy performed for PD stones. Our approach of performing laser lithotripsy under EUS guidance obviates the need for an ESWL procedure; however, it is technically more challenging and requires precision to avoid injury to the pancreas. Further prospective studies are required to evaluate the safety and efficacy of this novel approach and its applicability as either a rescue procedure or in tandem with conventional pancreatic endotherapy modalities.
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Affiliation(s)
- James Emmanuel
- Gastroenterology and Hepatology, Queen Elizabeth Hospital, Kota Kinabalu, Malaysia
| | | | | | - Lee Tiong See
- Gastroenterology and Hepatology, Hospital Selayang, Batu Caves, Malaysia
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14
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Masciangelo G, Cecinato P, Bacchilega I, Masetti M, Ferrari R, Zagari RM, Napoleon B, Sassatelli R, Fusaroli P, Lisotti A. Urgent ERCP performed with single-use duodenoscope (SUD) in patients with moderate-to-severe cholangitis: Single-center prospective study. Endosc Int Open 2024; 12:E116-E122. [PMID: 38250162 PMCID: PMC10798844 DOI: 10.1055/a-2219-0826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/10/2023] [Indexed: 01/23/2024] Open
Abstract
Background and study aims To assess the outcomes of urgent endoscopic retrograde cholangiopancreatography (ERCP) performed with a single-use duodenoscope (SUD) in patients with moderate-to-severe cholangitis. Patients and methods Between 2021 and 2022 consecutive patients with moderate-to-severe cholangitis were prospectively enrolled to undergo urgent ERCP with SUD. Technical success was defined as the completion of the planned procedure with SUD. Multivariate analysis was used to identify factors related to incidence of adverse events (AEs) and mortality. Results Thirty-five consecutive patients (15 female, age 81.4±6.7 years) were enrolled. Twelve (34.3%) had severe cholangitis; 26 (74.3%) had an American Society of Anesthesiologists (ASA) score ≥3. Twenty-eight patients (80.0%) had a naïve papilla. Biliary sphincterotomy and complete stone clearance were performed in 29 (82.9%) and 30 patients (85.7%), respectively; in three cases (8.6%), concomitant endoscopic ultrasound-gallbladder drainage was performed. Technical and clinical success rates were 100%. Thirty-day and 3-month mortality were 2.9% and 14.3%, respectively. One patient had mild post-ERCP pancreatitis and two had delayed bleeding. No patient or procedural variables were related to AEs. ASA score 4 and leucopenia were related to 3-month mortality; on multivariate analysis, leukopenia was the only variable independently related to 3-month mortality (odds ratio 12.8; 95% confidence interval 1.03-157.2; P =0.03). Conclusions The results of this "proof of concept" study suggest that SUD use could be considered safe and effective for urgent ERCP for acute cholangitis. This approach abolishes duodenoscope contamination from infected patients without impairing clinical outcomes.
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Affiliation(s)
| | - Paolo Cecinato
- Gastroenterology and Endoscopy Unit, Arcispedale Santa Maria Nuova di Reggio Emilia, Reggio Emilia, Italy
| | - Igor Bacchilega
- Gastroenterology Unit, Hospital of Imola, University of Bologna, Imola, Italy
| | - Michele Masetti
- Gastroenterology Unit, Hospital of Imola, University of Bologna, Imola, Italy
| | - Rodolfo Ferrari
- Gastroenterology Unit, Hospital of Imola, University of Bologna, Imola, Italy
| | | | | | - Romano Sassatelli
- Gastroenterology and Endoscopy Unit, Arcispedale Santa Maria Nuova di Reggio Emilia, Reggio Emilia, Italy
| | - Pietro Fusaroli
- Gastroenterology Unit, Hospital of Imola, University of Bologna, Imola, Italy
| | - Andrea Lisotti
- Gastroenterology Unit, Hospital of Imola, University of Bologna, Imola, Italy
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Tao L, Wang H, Guo Q. Single-operator cholangioscopy system for management of acute cholecystitis secondary to choledocholithiasis. Endosc Int Open 2023; 11:E1138-E1142. [PMID: 38221948 PMCID: PMC10785000 DOI: 10.1055/a-2201-6871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 10/27/2023] [Indexed: 01/16/2024] Open
Abstract
This study aimed to investigate the safety and efficacy of endoscopic retrograde cholangiopancreatography (ERCP) + EyeMax (single-operator cholangioscopy system; SOC) (i.e., ERCP+SOC) for the treatment of choledocholithasis-associated acute cholecystitis. Twenty-five patients were evaluated between January 2022 and June 2023. The success rate (technical + clinical), procedure time, postoperative recovery, postoperative length of hospital stay, and complications rates were recorded. The procedure and clinical success rates were 92% (23/25) and 96% (24/25), respectively. The mean procedure time was 36.6±10 minutes (standard deviation [SD]). The average postoperative hospitalization was 2±0.8 days. No adverse events such as bleeding, perforation, or bile leakage occurred. Cholecystitis did not recur during the 2 to 18 months of follow-up. ERCP+SOC may be a feasible, safe, and effective alternative treatment for acute cholecystitis secondary to choledocholithiasis. ERCP+SOC was able to simultaneously resolve both biliary tract and gallbladder problems via natural orifice endoscopy. Its advantages included no skin wound, reduced postoperative pain, quick recovery, limited to no exposure to x-rays, and a short hospital stay.
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Affiliation(s)
- Liying Tao
- Department of Gastroenterology, Jilin People's Hospital, Jilin, China
- Digestive Endoscopy Center, Jilin People’s Hospital, Jilin, China
| | - Hongguang Wang
- Department of Gastroenterology, Jilin People's Hospital, Jilin, China
- Digestive Endoscopy Center, Jilin People’s Hospital, Jilin, China
| | - Qingmei Guo
- Department of Gastroenterology, Jilin People's Hospital, Jilin, China
- Digestive Endoscopy Center, Jilin People’s Hospital, Jilin, China
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Szczesniewski JJ, Boronat Catalá J, García-Cano Fernández AM, Rodríguez Castro PM, Torres Pérez D, Llanes González L. Vacuum-assisted access sheath in supine mini-percutaneous nephrolithotomy (mini-PCNL). Actas Urol Esp 2023; 47:681-687. [PMID: 37355205 DOI: 10.1016/j.acuroe.2023.06.004] [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: 03/15/2023] [Revised: 04/25/2023] [Accepted: 04/26/2023] [Indexed: 06/26/2023]
Abstract
INTRODUCTION The vacuum-assisted access sheath is a new device for the treatment of kidney stones with percutaneous nephrolithotomy (PCNL). OBJECTIVE Our aim was to compare the stone-free rate (SFR) and complications between standard mini percutaneous nephrolithotomy (Mini-PCNL) and vacuum-assisted PCNL (Va-PCNL). METHODS Retrospective study of patients undergoing Mini-PCNL and Va-PCNL from January 2018 to June 2022. Va-PCNL was performed with a disposable sheath (ClearPetra®) with continuous high-flow irrigation and vacuum fluid dynamics for easier stone fragment removal. Baseline patient characteristics, surgical outcomes, perioperative and postoperative data were collected. We compared SFR and complications. RESULTS A total of 136 patients were identified, 57 (41,9%) underwent Va-PCNL and 79 (58,15%) Mini-PCNL. Mean operative time was significantly shorter in the Va-PCNL group (95 min.) than in Mini-PCNL (146 min; P = ,001) group. The tubeless technique was performed more frequently in Va-PCNL group (61,4% vs. 34,2%; P = ,002). We did not observe any differences in postoperative complications. The mean hospital stay was significantly lower in Va-PCNL with 1,7 ± 1,9 days per patient compared with 2,7 ± 1,5 days in the Mini-PCNL group (P = ,001). There were no differences in SFR at 3 months between Va-PCNL (71,9%) and Mini-PCNL (71,8%; P =v ,848). CONCLUSION Patients treated with Va-PCNL had comparable results to Mini-PCNL, showing equal SFR with similar infectious complications rates. Potential benefits of Va-PCNL include shorter operative time and postoperative stay.
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Affiliation(s)
- J J Szczesniewski
- Servicio de Urología, Hospital Universitario de Getafe, Getafe, Madrid, Spain.
| | - J Boronat Catalá
- Servicio de Urología, Hospital Universitario de Getafe, Getafe, Madrid, Spain
| | | | | | - D Torres Pérez
- Servicio de Urología, Hospital Universitario de Getafe, Getafe, Madrid, Spain
| | - L Llanes González
- Servicio de Urología, Hospital Universitario de Getafe, Getafe, Madrid, Spain; Facultad de Medicina, Universidad Francisco de Vitoria, Madrid, Spain
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El Menabawey T, Mulay A, Graham D, Phillpotts S, Sethi A, Webster GJ. Predictors of success of conventional ERCP for bile duct stones and need for single-operator cholangioscopy. Endosc Int Open 2023; 11:E943-E951. [PMID: 37818453 PMCID: PMC10562053 DOI: 10.1055/a-2164-8557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 08/28/2023] [Indexed: 10/12/2023] Open
Abstract
Background and study aims The characteristics of difficult stones requiring cholangioscopy-assisted lithotripsy are poorly defined. We sought to determine clinician perception of these characteristics and decision-making in biliary endoscopy. Methods One hundred twenty-four delegates attending an online course were invited to assess 20 clinical stone cases. Each image was graded on a 4-point Likert for: grading of stone difficulty, confidence of clearance with conventional endoscopic retrograde cholangiopancreatography (ERCP) methods, likelihood of needing cholangioscopy-assisted lithotripsy, and confidence of clearance with one session of lithotripsy. An independent reviewer rated each case on largest stone size, stone number, presence of stricture distal to stone, size of stone relative to distal duct size, and acute common bile duct (CBD) angulation < 135°. Multilevel (mixed) statistical methods with a two-level model were utilized with multilevel ordinal logistic regression. Results Stone size and location, stricture and stone diameter:duct ratio impacted perceived procedural difficulty P < 0.01). Stone:duct ratio (< 50% odds ratio [OR] 0.22, P < 0.001), stricture (OR 7.26, P < 0.001) and stone location impacted confidence of clearance with conventional ERCP. Intrahepatic and cystic duct stones were least likely to engender confidence ( P < 0.01). The same factors plus CBD angulation < 135° predicted cholangioscopy requirement ( P < 0.01). Stone number did not influence procedure difficulty or cholangioscopy requirement. Strictures (OR 0.29, P < 0.001) and location, especially intrahepatic (OR 0.42, P < 0.001) impaired confidence in clearance with one cholangioscopy session. Conclusions Ductal anatomy, the presence of a stricture distal to a stone, cystic and intrahepatic stones and stones larger than the distal duct are considered by endoscopists to be significant predictors of requiring cholangioscopy-assisted lithotripsy.
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Affiliation(s)
- Tareq El Menabawey
- Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Akhilesh Mulay
- Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - David Graham
- Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Simon Phillpotts
- Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Amrita Sethi
- Gastroenterology and Hepatology, Columbia University Medical Center, New York, United States
| | - George J Webster
- Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
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Yamaguchi A, Kato N, Sugata S, Hamada T, Furuya N, Mizumoto T, Tamaru Y, Kusunoki R, Kuwai T, Kouno H, Kohno H. Efficacy of a novel integrated biliary stent and nasobiliary catheter system for accidental tube deviation in biliary drainage. Endosc Int Open 2023; 11:E859-E865. [PMID: 37719800 PMCID: PMC10504041 DOI: 10.1055/a-2125-3896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 06/29/2023] [Indexed: 09/19/2023] Open
Abstract
Background and study aims Endoscopic nasobiliary drainage is accompanied by a risk of accidental removal of the nasobiliary drainage (NBD) tube, especially through self-removal in elderly patients. We studied the usefulness of an integrated biliary stent and nasobiliary catheter system (UMIDAS NB stent) for biliary drainage in case of accidental NBD tube removal. Patients and methods From April to November 2022, we placed a UMIDAS NB stent in 30 patients with acute cholangitis or obstructive jaundice. We evaluated the plastic stent (PS) position at the time of accidental stent removal and before the planned endoscopic procedure. In addition, we studied the ratio of successful biliary drainage and complications based on the usage of UMIDAS. Results All 11 patients with accidental stent removal exhibited correct PS position in X-ray fluoroscopy. Of the 19 patients with planned NBD tube removal, three had complete PS migration into the common bile duct and three had incomplete migration (the duodenal side flap entered the bile duct). In summary, 80% (24/30) of PS were in the correct position, and all patients had successful biliary drainage and no complications. Conclusions The UMIDAS NB stent might be useful for biliary drainage in patients with a high risk of NBD tube self-removal.
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Affiliation(s)
- Atsushi Yamaguchi
- Gastroenterology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Japan
| | - Naohiro Kato
- Gastroenterology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Japan
| | - Syuhei Sugata
- Gastroenterology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Japan
| | - Takuro Hamada
- Gastroenterology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Japan
| | - Nao Furuya
- Gastroenterology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Japan
| | - Takeshi Mizumoto
- Gastroenterology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Japan
| | - Yuzuru Tamaru
- Gastroenterology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Japan
| | - Ryusaku Kusunoki
- Gastroenterology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Japan
| | - Toshio Kuwai
- Gastroenterology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Japan
| | - Hirotaka Kouno
- Gastroenterology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Japan
| | - Hiroshi Kohno
- Gastroenterology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Japan
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19
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Toogood K, Pike T, Coe P, Everett S, Huggett M, Paranandi B, Bassi V, Toogood G, Smith A. The role of cholecystectomy following endoscopic sphincterotomy and bile duct stone removal. Ann R Coll Surg Engl 2023; 105:607-613. [PMID: 35950513 PMCID: PMC10471440 DOI: 10.1308/rcsann.2022.0027] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Accepted: 02/16/2022] [Indexed: 09/02/2023] Open
Abstract
INTRODUCTION Choledocholithiasis is common, with patients usually treated with endoscopic retrograde cholangiopancreatography (ERCP) and subsequent cholecystectomy to remove the presumed source of common bile duct (CBD) stones. However, previous investigations into the management of patients following ERCP have focused on recurrent CBD stones, negating the risks of cholecystectomy. This article appraises the role of cholecystectomy following successful endoscopic clearance of bile duct stones. METHODS Patients undergoing ERCP and CBD clearance for choledocholithiasis at St James's University Hospital January 2015-December 2018 were included. Patients were divided into those who received cholecystectomy and those managed non-operatively. Readmissions, operative morbidity, mortality and treatment costs were investigated. RESULTS Eight hundred and forty-four patients received ERCP and CBD clearance with 3.9 years follow-up. Two hundred and nine patients underwent cholecystectomy with 15% requiring complex surgery. Three hundred and seventy-three patients were non-operatively managed. Unplanned readmissions occurred in 15% following ERCP, mostly within two years. There was no difference in readmissions between the two groups. Accounting for the entire patient pathway, non-operative management was less expensive. CONCLUSIONS The majority of patients do not require readmission following ERCP for CBD stones, and cholecystectomy did not reduce the risk of readmission. Few patients have recurrent CBD stones, but complex biliary surgery is frequently required. Routine cholecystectomy following ERCP needs to be re-evaluated and a more stratified approach to future risk developed.
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Affiliation(s)
| | | | - P Coe
- St James’s University Hospital, UK
| | | | | | | | - V Bassi
- St James’s University Hospital, UK
| | | | - A Smith
- St James’s University Hospital, UK
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20
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Dean NS, Krambeck AE. Contemporary Use of Computed Tomography (CT) Imaging in Suspected Urolithiasis in Pregnancy. Curr Urol Rep 2023; 24:443-449. [PMID: 37314612 DOI: 10.1007/s11934-023-01171-8] [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] [Accepted: 06/08/2023] [Indexed: 06/15/2023]
Abstract
PURPOSE OF REVIEW We aimed to examine the role of low-dose CT (LDCT) in the diagnostic work-up for suspected urolithiasis in pregnancy. We reviewed contemporary urologic recommendations for CT in pregnancy, its utilization for suspected urolithiasis, and explored barriers to its use. RECENT FINDINGS National urologic guidelines and the American College of Obstetricians and Gynecologists recommend the judicious use of LDCT imaging in pregnancy when necessary. We noted inconsistencies in review article management pathways and recommendations for CT imaging for suspected urolithiasis in pregnancy. Overall CT utilization in pregnancy for suspected urolithiasis is low. Proposed barriers to LDCT use in pregnancy include fears of litigation and misperceptions of the harm of diagnostic radiation. Recent advancements in imaging technologies for urolithiasis in pregnancy are limited. More specific diagnostic pathway recommendations from national urologic guideline bodies for when to use LDCT to investigate renal colic in pregnancy may reduce diagnostic and intervention delays.
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Affiliation(s)
- Nicholas S Dean
- Department of Urology, Northwestern University, 676 N. St. Clair, Suite 2300, Chicago, IL, 60611, United States.
| | - Amy E Krambeck
- Department of Urology, Northwestern University, 676 N. St. Clair, Suite 2300, Chicago, IL, 60611, United States
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21
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Moazin M, Altulayqi W, Tolah H, Alkeraithe F. A successful open neocystolithotomy in studer neobladder with Mitrofanoff for multiple large neobladder stones: A case report and review of the literature. Urol Case Rep 2023; 50:102474. [PMID: 37455777 PMCID: PMC10338960 DOI: 10.1016/j.eucr.2023.102474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/03/2023] [Accepted: 06/20/2023] [Indexed: 07/18/2023] Open
Abstract
Urolithiasis is a rare complication of orthotopic neobladder after cystectomy. We report a case of a 25-year-old female with studer neobladder and Monti valve presenting with recurrent urinary tract infections, abdominal pain, and difficult catheterization. Imaging revealed multiple large stones in the neobladder. Neocystolitholapaxy and neocystolithotripsy failed, leading to an open neocystolithotomy with retrieval of 14 large stones. Stone composition analysis showed struvite (30%), carbonate apatite (46%), and whitlockite (24%). Neobladder repair with omental interposition was performed. Follow-up confirmed an intact neobladder without leaks. Neobladder stones may be asymptomatic, and open neocystolithotomy is an effective treatment for multiple neobladder stones.
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Affiliation(s)
- Maher Moazin
- Department of Urology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Waleed Altulayqi
- Department of Urology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Hamza Tolah
- Alrayan Medical Colleges, Medina, Saudi Arabia
| | - Fawaz Alkeraithe
- Department of Urology, King Fahad Medical City, Riyadh, Saudi Arabia
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22
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Yattoo GN, Mushfiq S, Kaushik S, Dar GA, Parveen S, Dhar N. Clinical Profile, Etiology and Role of Endotherapy in Chronic Calcific Pancreatitis: An Experience from North India. Middle East J Dig Dis 2023; 15:190-195. [PMID: 38023463 PMCID: PMC10660324 DOI: 10.34172/mejdd.2023.343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 04/10/2023] [Indexed: 11/14/2023] Open
Abstract
Background: In recent years, we have witnessed an evolving landscape in the management of chronic pancreatitis (CP). Endoscopy plays a pivotal role in CP management. Because the management of CP is problematic, we aimed to review and evaluate the role of endoscopy in the management of CP. Methods: This study was carried out in patients with painful chronic calcific pancreatitis who were admitted to the Department of Gastroenterology at the Sher-I-Kashmir Institute of Medical Sciences (SKIMS), Srinagar. This was an observational prospective study. We included 67 patients with painful chronic calcific pancreatitis and pancreatic duct abnormalities (stones, strictures, or ductal variations) in our study. These patients had to access exocrine and endocrine status before any therapeutic measures. All the patients underwent endoscopic retrograde cholangiopancreatography (ERCP) as a therapeutic measure. After ERCP, the patients were followed up for 2 years to assess improvement in pain (visual analog scale score reduction), endocrine status (HBA1C reduction), or exocrine status (Fecal elastase reduction). Results: 67 patients were included in the study. Among them males were 32 (47.8%), females were 35(52.5%) and the age distribution studied were as in the age group of 15-30 years, patients were 23 (34.3%), in 30-45 years, there was 20 (29.9%), in age group of 45-60 year, patients were 20 (29.9%), and in the age group of 60-75 years, the patients were 4 (6%). Etiology was sought in all patients; alcohol-related CP was seen in three patients (4.5%), genetic in 11 (16.4%), IgG4 in one (1.5%), pancreatic divisum in 6 (9.0%), hyperparathyroidism in on1e (1.5%), and idiopathic in 45 (67.2%). All patients underwent ERCP for their symptoms to reduce ductal pressure, which is postulated as one of the hypotheses for pain in CP. Pancreatic duct (PD) clearance was attempted in all patients (complete in 42 [62.7%], partial in 17 [25.4%], and failed in 8 [11.9%]). These patients were followed for a period of two years after endotherapy, and the important predictors for pain reduction were single PD stones, disease in the head and body, and non-stricturing disease. Conclusion: Endotherapy offers a high rate of success in selected patients, clearance being better in distal disease and CP without PD strictures, suggesting early disease usually gets cleared very easily.
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Affiliation(s)
- G N Yattoo
- Sher-I-kashmir Institute of medical Sciences, Srinagar, J &K, India
| | - Syed Mushfiq
- Sher-I-kashmir Institute of medical Sciences, Srinagar, J &K, India
| | - Saurabh Kaushik
- Sher-I-kashmir Institute of medical Sciences, Srinagar, J &K, India
| | - Gulzar Ahmad Dar
- Sher-I-kashmir Institute of medical Sciences, Srinagar, J &K, India
| | - Shaheena Parveen
- Sher-I-kashmir Institute of medical Sciences, Srinagar, J &K, India
| | - Neeraj Dhar
- Sher-I-kashmir Institute of medical Sciences, Srinagar, J &K, India
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23
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Chiancone F, Persico F, Fabiano M, Meccariello C, Giannella R, Fedelini M, Lughezzani G, Fedelini P. Comparison of laparoscopic versus open simple nephrectomy in patients with xanthogranulomatous pyelonephritis: A singlecenter analysis of outcomes and predictors of surgical approaches and complications. Curr Urol 2023; 17:135-140. [PMID: 37691987 PMCID: PMC10489480 DOI: 10.1097/cu9.0000000000000067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 08/13/2021] [Indexed: 11/26/2022] Open
Abstract
Background The aim of this study was to compare the outcomes of open simple nephrectomy and laparoscopic simple nephrectomy in patients with xanthogranulomatous pyelonephritis (XGP) in a single-institutional retrospective study and to identify predictive factors of surgical approaches and complications. Materials and methods We retrospectively analyzed the data of 67 consecutive patients with a histopathological diagnosis of XGP who underwent either open simple nephrectomy (ON) or laparoscopic simple nephrectomy (LN) from January 2014 to April 2020. The primary endpoint was the evaluation of perioperative outcomes and complications. Secondary endpoints were to define factors influencing the surgical approach and the likelihood of postoperative complications. Results Overall, 44 out of 67 patients (65.67%) underwent ON, while 23 (34.33%) underwent LN. Patients in the ON group experienced more postoperative pain according to the visual analogic scale (p = 0.032). Moreover, time to deambulation and time to return to full daily activities, assessed according to the 12-Item Short Form Survey physical and mental component summary scores questionnaires, were significantly shorter in the LN group (p = 0.021, p < 0.001, and p < 0.001, respectively). Of note, there were no significant differences in intraoperative and postoperative complication rates among the groups (p = 0.258 and p = 0.317, respectively). No conversion to open surgery was described. Logistic regression analysis demonstrated that urgency (p = 0.025) was the only predictor associated with a higher risk of intraoperative complications. However, no independent factors associated with postoperative complications or with the surgical approach of choice were found. Conclusions Based on our results, laparoscopic treatment of XGP represents a feasible alternative to ON, resulting in less postoperative pain and faster recovery. In skilled hands, LN should be considered as the treatment of choice for XGP.
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Affiliation(s)
| | - Francesco Persico
- Department of Urology, A.O.R.N. A. Cardarelli, Naples, Italy
- Department of Urology, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
| | - Marco Fabiano
- Department of Urology, A.O.R.N. A. Cardarelli, Naples, Italy
| | | | | | | | - Giovanni Lughezzani
- Department of Urology, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy
| | - Paolo Fedelini
- Department of Urology, A.O.R.N. A. Cardarelli, Naples, Italy
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24
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Bawari S, Sah AN, Gupta P, Zengin G, Tewari D. Himalayan Citrus jambhiri juice reduced renal crystallization in nephrolithiasis by possible inhibition of glycolate oxidase and matrix metalloproteinases. J Ethnopharmacol 2023; 306:116157. [PMID: 36646157 DOI: 10.1016/j.jep.2023.116157] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 08/13/2022] [Revised: 01/02/2023] [Accepted: 01/06/2023] [Indexed: 06/17/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Citrus fruits are a very rich source of electrolytes and citric acid. They have been used traditionally for treating urinary ailments and renal stones. Citrus jambhiri is indigenously used as a diuretic. AIM OF THE STUDY Present study aimed at establishing the antiurolithiatic potential of the juice of Citrus jambhiri fruits along with the elucidation of the mechanism involved in the urolithiasis disease defying activity. METHODS The antiurolithiatic activity was established by means of nucleation, growth and aggregation assay in the in vitro settings and by means of ethylene glycol mediated calcium oxalate urolithiasis in the male Wistar rats. Docking studies were performed in an attempt to determine the mechanism of the antiurolithiatic action. RESULTS Present study revealed the role of C. jambhiri fruit juice in reducing nucleation, growth and aggregation of calcium oxalate crystals by possible reduction in the urinary supersaturation relative to calcium oxalate and raising the zeta potential of the calcium oxalate crystals. C. jambhiri fruit juice treatment in experimental rats produced significant amelioration of hypercalciuria, hyperoxaluria, hyperphosphaturia, hyperproteinuria, hyperuricosuria, hypocitraturia and hypomagnesiuria and ion activity product of calcium oxalate. It exhibited nephroprotection against calcium oxalate crystals induced renal tubular dilation and renal tissue deterioration. Docking studies further revealed high binding potential of the phytoconstituents of C. jambhiri viz. narirutin, neohesperidin, hesperidin, rutin and citric acid with glycolate oxidase and matrix metalloproteinase-9. CONCLUSION C. jambhiri fruit juice possesses excellent antiurolithiatic activity. The study reveals antiurolithiatic mechanism that involves restoration of equilibrium between the promoters and inhibitors of stone formation; and inhibition of matrix metalloproteinases and glycolate oxidase.
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Affiliation(s)
- Sweta Bawari
- Amity Institute of Pharmacy, Amity University Campus, Sector-125, Noida, 201313, Gautam Buddha Nagar, Uttar Pradesh, India
| | - Archana N Sah
- Department of Pharmaceutical Sciences, Faculty of Technology, Bhimtal, Kumaun University, Nainital, Uttarakhand, 263136, India.
| | - Pawan Gupta
- Department of Pharmaceutical Chemistry, Shri Vile Parle Kelavani Mandal's Institute of Pharmacy, Dhule, Maharashtra, 424001, India
| | - Gökhan Zengin
- Physiology and Biochemistry Research Laboratory, Department of Biology, Science Faculty, Selcuk University, Konya, 42130, Turkey
| | - Devesh Tewari
- Department of Pharmacognosy and Phytochemistry, School of Pharmaceutical Sciences, Delhi Pharmaceutical Sciences and Research University (DPSRU), New Delhi, 110017, India.
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25
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Mille E, El-Khoury E, Haddad M, Pinol J, Charbonnier M, Gastaldi P, Dariel A, Merrot T, Faure A. Comparison of single-use flexible ureteroscopes with a reusable ureteroscope for the management of paediatric urolithiasis. J Pediatr Urol 2023:S1477-5131(23)00017-7. [PMID: 36746718 DOI: 10.1016/j.jpurol.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 01/09/2023] [Accepted: 01/12/2023] [Indexed: 01/20/2023]
Abstract
INTRODUCTION To compare the efficacy, side effects, and cost-effectiveness between a single-use digital flexible ureteroscope and a reusable flexible ureteroscope in the treatment of paediatric renal stones. METHODS This analytic, case-control, monocentric study included all patients undergoing flexible ureterosopies for stone treatment. Between April 2016 and February 2019, a reusable (Flex-XC®, Karl Storz) flexible ureteroscope was used (control group), whereas a single-use (Uscope®, PUSEN Medical©) flexible ureteroscope was used in all procedures from March 2019 to April 2021. Clinical and procedural outcomes, operative times, complication rates, hospital stay, and costs per procedure were evaluated. RESULTS Forty-three cases using a reusable flexible ureteroscope and thirty-nine using a single-use flexible ureteroscope were included in the study. Demographic patient characteristics, stone burden, location and composition, preoperative presence of a double-J stent, procedural outcomes, mean length of postoperative hospital stay, and complications (4.6% versus 5%, p = 0.81) were comparable between the two groups. Median operative duration for stone removal was 93 min (20-170) with reusable versus 81 min (55-107) with the single-use scope (p = 0.18). Scope failure occurred four times with the reusable scope and in no case with the single-use. The total cost per procedure associated with the use of single-use scopes (798 Euros) was lower than a reusable scope (1483.23 Euros). DISCUSSION Single-use flexible ureteroscopes were created to bypass the problems incurred when reusable scopes were damaged and therefore not available for use in surgical procedures. Single-use flexible ureteroscopes are always immediately available and ready to be used, even in urgent cases, as they typically do not require maintenance or sterilization. Compared with their reusable counterparts, single-use flexible ureteroscopes have similar digital performance (270°), image quality and we found no difference in the success and complication rates. Cost analysis of a reusable flexible ureteroscope must consider the purchase price, maintenance and repair costs, and decontamination costs (including handling, detergent, bacterial culture, transportation, and storage costs). In contrast, only purchase price is included in cost analysis for single-use flexible ureteroscopes. Our study suggests that single-use flexible ureteroscopes may be associated with lower costs per procedure than their reusable counterparts. CONCLUSION Single-use flexible ureteroscopes are an interesting alternative to their reusable counterparts, particularly in terms of material resource management. Cost analyses conducted using a low volume of cases representative of a paediatric urology division favour the use of single-use ureteroscopes.
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Affiliation(s)
- Eva Mille
- Aix-Marseille Université, APHM, CHU Hopital La Timone Enfants, Paediatric Surgery Department, 13385, Marseille, France
| | - Eliane El-Khoury
- Aix-Marseille Université, APHM, CHU Hopital La Timone Enfants, Paediatric Surgery Department, 13385, Marseille, France
| | - Mirna Haddad
- Aix-Marseille Université, APHM, CHU Hopital La Timone Enfants, Paediatric Surgery Department, 13385, Marseille, France
| | - Jessica Pinol
- Aix-Marseille Université, APHM, CHU Hopital La Timone Enfants, Paediatric Surgery Department, 13385, Marseille, France
| | - Matthieu Charbonnier
- Aix-Marseille Université, APHM, CHU Hopital La Timone Enfants, Paediatric Surgery Department, 13385, Marseille, France
| | - Pauline Gastaldi
- Aix-Marseille Université, APHM, CHU Hopital La Timone Enfants, Paediatric Surgery Department, 13385, Marseille, France
| | - Anne Dariel
- Aix-Marseille Université, APHM, CHU Hopital La Timone Enfants, Paediatric Surgery Department, 13385, Marseille, France
| | - Thierry Merrot
- Aix-Marseille Université, APHM, CHU Hopital La Timone Enfants, Paediatric Surgery Department, 13385, Marseille, France
| | - Alice Faure
- Aix-Marseille Université, APHM, CHU Hopital La Timone Enfants, Paediatric Surgery Department, 13385, Marseille, France.
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26
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Sbeit W, Abukaes H, Said Ahmad H, Sbeit M, Kalisky I, Katz L, Mari A, Khoury T. The possible association of proton pump inhibitor use with acute cholangitis in patients with choledocholithiasis: a multi-center study. Scand J Gastroenterol 2023; 58:83-87. [PMID: 35930433 DOI: 10.1080/00365521.2022.2106150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Gallstone disease is common worldwide and can lead to severe complications, including cholangitis; thus, it is important to identify modifiable risk factors for cholangitis. Proton pump inhibitors (PPIs) are commonly prescribed to treat gastroenterological disorders. We aimed to explore whether PPI use is associated with an increased risk of acute cholangitis in patients with gallstone disease. METHODS This retrospective multicenter study included all patients arriving to the hospital over a 10-year period with various presentations of choledocholithiasis. We compared active PPI use in two groups: those with cholangitis (group A) vs. without cholangitis (group B). RESULTS Overall, 811 patients were included, 161 in group A and 650 in group B. The average age ± standard deviation (SD) in groups A and B was 74.5 ± 20.6 vs. 61.6 ± 20.9 years, respectively. PPI use in group A was higher vs. group B (42.9% vs. 29.1%, p = 0.001). On univariate analysis, male gender (OR 1.47, 95% confidence interval (CI) 1.04-2.08), age (OR 1.04, 95% CI 1.03-1.05), ischemic heart disease (IHD) (OR 1.68, 95% CI 1.07-2.64), hyperlipidemia (OR 1.59, 95% CI 1.11-2.29), hypertension (OR 1.81, 95% CI 1.28-2.57) and PPI use (OR 1.83, 95% CI 1.28-2.61), all were associated with acute cholangitis. On multivariate analysis, only PPI use kept its association after adjustment for age (OR 1.64, 95% CI 1.2-3.7). CONCLUSIONS Active PPI use was associated with a higher rate of cholangitis among patients with choledocholithiasis. We advocate considering this risk before prescribing PPIs to patients with gallstones. TRIAL REGISTRATION NUMBER NHR-0263-20 received on 14/01/2021 date 'retrospectively registered'.
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Affiliation(s)
- Wisam Sbeit
- Department of Gastroenterology, Galilee Medical Center, Nahariya, Israel.,Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Hani Abukaes
- Department of Gastroenterology, Galilee Medical Center, Nahariya, Israel.,Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Helal Said Ahmad
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.,Gastroenterology and Endoscopy Unit, Nazareth Hospital, EMMS, Nazareth, Israel
| | - Moeen Sbeit
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Itai Kalisky
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,Institute of Gastroenterology and Hepatology, Hadassah University Medical Center, Jerusalem, Israel
| | - Lior Katz
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,Institute of Gastroenterology and Hepatology, Hadassah University Medical Center, Jerusalem, Israel
| | - Amir Mari
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.,Gastroenterology and Endoscopy Unit, Nazareth Hospital, EMMS, Nazareth, Israel
| | - Tawfik Khoury
- Department of Gastroenterology, Galilee Medical Center, Nahariya, Israel.,Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
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Durmus E, Ok F. Comparative analysis of ureteroscopic laser lithotripsy and extracorporeal shock wave lithotripsy in the treatment of childhood proximal ureteral stones. Pediatr Surg Int 2022; 39:62. [PMID: 36565334 DOI: 10.1007/s00383-022-05349-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/15/2022] [Indexed: 12/25/2022]
Abstract
PURPOSE This study aims to make a comparative analysis of the superiority of ESWL and URS in proximal ureteral stones in children. METHODS A total of 155 patients under the age of 15 were included in the study. The patients were divided into two groups as Group 1 (n = 80, ESWL) and Group 2 (n = 75, URS) according to the type of procedure performed. The patients in both groups were evaluated in terms of age, gender, lateralization, stone size, stone volüme, stone density, and preoperative hydronephrosis. In addition, both methods used were compared in terms of success rate, time, cost, hospitalization and complications. RESULTS The mean age were 7.4 ± 2.1 in Group-1 and 8.1 ± 1.8 in Group-2. Demographic, clinical and laboratory data of both groups were similar. The hospitalization time, procedure time, success rate and cost were significantly higher in Group-2. The complication rate was significantly higher in Group-2 (p < 0.001). There was a significant negative correlation between ESWL success and stone volume (ρ - 0.375, p = 0.001) and stone density (ρ - 0.283, p = 0.011). CONCLUSION ESWL can be performed as the first line treatment of proximal ureteral stones in children due to its daily use, low cost, short procedure time and low complication rate. Increasing stone volume and density reduces the success of ESWL.
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Affiliation(s)
- Emrullah Durmus
- Department of Urology, Siirt Training and Research Hospital, 56100, Siirt, Turkey.
| | - Fesih Ok
- Department of Urology, Siirt Training and Research Hospital, 56100, Siirt, Turkey
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28
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Ennis NJ, Dharumadurai D, Sevigny JL, Wilmot R, Alnaimat SM, Bryce JG, Thomas WK, Tisa LS. Draft Genomes Sequences of 11 Geodermatophilaceae Strains Isolated from Building Stones from New England and Indian Stone Ruins found at historic sites in Tamil Nadu, India. J Genomics 2022; 10:69-77. [PMID: 36176899 PMCID: PMC9516006 DOI: 10.7150/jgen.76121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/26/2022] [Indexed: 11/17/2022] Open
Abstract
Metagenomic analysis of stone microbiome from samples collected in New England, USA and Tamil Nadu, India identified numerous Actinobacteria including Geodermatphilaceae. A culture-dependent approach was performed as a companion study with this culture-independent metagenomic analysis of these stone samples and resulted in the isolation of eleven Geodermatphilaceae strains (2 Geodermatophilus and 9 Blastococcus strains). The genomes of the 11 Geodermatphilaceae strains were sequenced and analyzed. The genomes for the two Geodermatophilus isolates, DF1-2 and TF2-6, were 4.45 and 4.75 Mb, respectively, while the Blastococcus genomes ranged in size from 3.98 to 5.48 Mb. Phylogenetic analysis, digital DNA:DNA hybridization (dDDH), and comparisons of the average nucleotide identities (ANI) suggest the isolates represent novel Geodermatophilus and Blastococcus species. Functional analysis of the Geodermatphilaceae genomes provides insight on the stone microbiome niche.
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Affiliation(s)
- Nathaniel J Ennis
- Department of Molecular, Cellular, and Biomedical Sciences, University of New Hampshire, Durham, New Hampshire, USA.,Present address: Seres Therapeutics, Cambridge, MA, USA
| | - Dhanasekaran Dharumadurai
- Department of Molecular, Cellular, and Biomedical Sciences, University of New Hampshire, Durham, New Hampshire, USA.,Departments of Microbiology, Bharathidasan University, Tiruchirappalli, Tamil Nadu, India
| | - Joseph L Sevigny
- Department of Molecular, Cellular, and Biomedical Sciences, University of New Hampshire, Durham, New Hampshire, USA.,Hubbard Center for Genome Studies, University of New Hampshire, Durham, New Hampshire, USA
| | - Ryan Wilmot
- Department of Molecular, Cellular, and Biomedical Sciences, University of New Hampshire, Durham, New Hampshire, USA
| | - Sulaiman M Alnaimat
- Department of Molecular, Cellular, and Biomedical Sciences, University of New Hampshire, Durham, New Hampshire, USA.,Present address: Department of Medical Analysis, Al-Hussein Bin Talal University, Ma'an, Jordan
| | - Julia G Bryce
- Department of Earth Sciences, University of New Hampshire, Durham, NH, USA
| | - W Kelley Thomas
- Department of Molecular, Cellular, and Biomedical Sciences, University of New Hampshire, Durham, New Hampshire, USA.,Hubbard Center for Genome Studies, University of New Hampshire, Durham, New Hampshire, USA
| | - Louis S Tisa
- Department of Molecular, Cellular, and Biomedical Sciences, University of New Hampshire, Durham, New Hampshire, USA
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Sforza S, Crisci A, Cini C, Masieri L. Commentary: Outcomes and lessons learnt from practice of retrograde intrarenal surgery (RIRS) in a paediatric setting of various age groups: a global study across 8 centres. World J Urol 2022; 40:1595-6. [PMID: 35249121 DOI: 10.1007/s00345-022-03981-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 02/28/2022] [Indexed: 12/13/2022] Open
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Mancuso M, Lavoie C, Assmus M, De S. Characterizing patients with multiple same-sided ureteric stones. World J Urol 2022; 40:1763-1767. [PMID: 35622115 DOI: 10.1007/s00345-022-04035-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 05/03/2022] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Patients presenting with multiple same-sided ureteric stones (MSSUS) are a unique population with nuanced prognostic and treatment considerations, which have yet to be characterized in the literature. Therefore, our purpose was to examine outcomes of patients with MSSUS vs those with single ureteric stones (SUS). METHODS A retrospective review of prospectively collected patients included adults (> 18yo) with [Formula: see text] 2 ipsilateral ureteral stones without prior treatment for their current stone burden. A historical comparison group was used as a control population. Univariate logistic regression analyses and descriptive statistics were performed with SPSS® 20.0 (p < 0.05). RESULTS Seventy-nine MSSUS patients were compared to 101 SUS patients. MSSUS patients had 2.21 [Formula: see text] 0.66 ureteric stones and had significantly smaller lead stones (MSSUS 6.4 mm vs SUS 7.2 mm, p = 0.03). MSSUS patients were more likely to have had prior stones (66 vs 42%) and 5.9 times more likely to have had prior stone procedures. Conservative management was successful in 30% MSSUS vs 19% SUS (p = 0.073), and there were no differences in resolution time (p = 0.44). For patients proceeding to intervention, (MSSUS n = 52, SUS n = 78), ureteroscopy was performed on 58% MSSUS vs 51% SUS patients (p = 0.302), and shockwave lithotripsy in 10% MSSUS vs 26% SUS (p = 0.01). MSSUS were more likely to spontaneously pass a stone prior to planned intervention (OR = 41.1; 95% CI = 12.0-140.7; p = 0.0001). CONCLUSION MSSUS patients are more likely recurrent stone formers with extensive stone histories and current stone burdens. Conservative management appears as successful between groups, with no difference in resolution time. When employed, ureteroscopy outcomes do not different between cohorts.
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Affiliation(s)
- Matthew Mancuso
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Callum Lavoie
- Division of Urology, University of Alberta, Edmonton, AB, Canada
| | - Mark Assmus
- School of Medicine, Indiana University, Indianapolis, IN, USA
| | - Shubha De
- Division of Urology, University of Alberta, Edmonton, AB, Canada.
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Masarwe I, Savin Z, Rabinowich A, Lifshitz K, Herzberg H, Marom R, Croitoru S, Mano R, Yossepowitch O, Aviram G, Sofer M. Querying the significance of patient position during computerized tomography on the reliability of pre-percutaneous nephrolithotomy planning. World J Urol 2022. [PMID: 35366108 DOI: 10.1007/s00345-022-03990-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 02/14/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Computerized tomography (CT) is considered indispensable in percutaneous nephrolithotomy (PCNL) planning. We aimed to define the reliability of pre-PCNL CT for planning renal access by assessing renal positional changes between supine and prone CTs. SUBJECTS AND METHODS CT urographies (CTU) of 30 consecutive patients were reviewed for distances upper pole (UP)-diaphragm, UP-diaphragm attachment, renal pelvis (RP)-lateral body wall, RP- posterior body wall, and lower pole (LP)- anterior-superior iliac spine (ASIS). The posterior and lateral renal axes angles were also calculated. RESULTS The most consistent overall movement in transition from prone to supine was backward rotation, as demonstrated by a decrease in distance UP-posterior body wall (p = 0.010) and increase in the posterior renal angle (p < 0.0001). This finding correlated with the patient's body mass index (BMI) (p = 0.029). The left kidney was more mobile than the right one, moving significantly for five of the measured parameters compared to the right kidney which moved significantly for only two parameters. The UP-diaphragm distance of the left kidney correlated with age (p = 0.014), the RP-lateral wall distance correlated with previous abdominal surgery (p = 0.006), and the RP-posterior wall distance with BMI (p = 0.017). On the right, the UP-diaphragm distance correlated with gender (p = 0.002) and the lateral renal rotation was smaller (p = 0.046). CONCLUSIONS Kidneys present significant mobility between supine and prone positions. CT assessment should be performed in the position expected during surgery and should be interpreted with caution, while a real-time imaging modality should be used in the operating room.
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Sierra A, Corrales M, Piñero A, Traxer O. Thulium fiber laser pre-settings during ureterorenoscopy: Twitter's experts' recommendations. World J Urol 2022; 40:1529-1535. [PMID: 35246704 DOI: 10.1007/s00345-022-03966-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 02/14/2022] [Indexed: 10/18/2022] Open
Abstract
INTRODUCTION Thulium fiber laser (TFL) is a novel laser in the field of urology. There is no consensus for optimal parameters. As most urologists use social media, being Twitter the platform with the most dissemination in healthcare, we aim to review the preferred TFL settings chosen by the experts and, to evaluate their pros and cons. MATERIALS AND METHODS A Twitter review was performed from November 2019 (firsts TFL experiences in urology) until October 2021 using the hashtags: "thuliumfiber", "ThuliumFiberLaser", "TFL" "soltive", "fiberdust", "OlympusUrology", "quanta_system", "IPG_Photonics", "rocamed". Only board-certified urologists were considered. The "tweets" selected include information about TFL preferred settings for stone lithotripsy and tissue ablation. Additionally, we also seek information regarding laser technique, fiber size, laser time, stone type and equipment. RESULTS A total of 42 opinions were identified. The 23 endourologists have a median of 2.298 followers (range 202-10.000). Most comments were about TFL settings for kidney stone dusting (61%). There was a significant difference (p < 0.05) for kidney stone dusting settings (dusting, frequency, and power) between endourologists. Only 24% reported their fiber size, 4 reported the stone composition and 2 endourologists mentioned their type of ureteroscope. There was no discussion about technique used (burst or continuous) nor equipment. Surgery time was reported 3 times. CONCLUSION There is no consensus in TFL pre-settings. When a pre-setting is proposed, it should also recommend technique to be used. Settings are personal and related to multiple factors, such as training, technique, equipment and fiber size.
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Affiliation(s)
- Alba Sierra
- Sorbonne University GRC Urolithiasis No. 20 Tenon Hospital, 75020, Paris, France.,Department of Urology AP-HP, Tenon Hospital, Sorbonne University, 75020, Paris, France
| | - Mariela Corrales
- Sorbonne University GRC Urolithiasis No. 20 Tenon Hospital, 75020, Paris, France.,Department of Urology AP-HP, Tenon Hospital, Sorbonne University, 75020, Paris, France
| | - Adrià Piñero
- Sorbonne University GRC Urolithiasis No. 20 Tenon Hospital, 75020, Paris, France.,Department of Urology AP-HP, Tenon Hospital, Sorbonne University, 75020, Paris, France
| | - Olivier Traxer
- Sorbonne University GRC Urolithiasis No. 20 Tenon Hospital, 75020, Paris, France. .,Department of Urology AP-HP, Tenon Hospital, Sorbonne University, 75020, Paris, France.
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Thapaliya S, Brady SL, Somasundaram E, Anton CG, Coley BD, Towbin AJ, Zhang B, Dillman JR, Trout AT. Detection of urinary tract calculi on CT images reconstructed with deep learning algorithms. Abdom Radiol (NY) 2022; 47:265-271. [PMID: 34605964 DOI: 10.1007/s00261-021-03274-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 04/19/2021] [Revised: 09/01/2021] [Accepted: 09/02/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Deep learning Computed Tomography (CT) reconstruction (DLR) algorithms promise to improve image quality but the impact on clinical diagnostic performance remains to be demonstrated. We aimed to compare DLR to standard iterative reconstruction for detection of urolithiasis by unenhanced CT in children and young adults. METHODS This was an IRB approved retrospective study involving post-hoc reconstruction of clinically acquired unenhanced abdomen/pelvis CT scans. Images were reconstructed with six different manufacturer-standard DLR algorithms and reformatted in 3 planes (axial, sagittal, and coronal) at 3 mm intervals. De-identified reconstructions were loaded as independent examinations for review by 3 blinded radiologists (R1, R2, R3) tasked with identifying and measuring all stones. Results were compared to the clinical iterative reconstruction images as a reference standard. IntraClass correlation coefficients and kappa (k) statistics were used to quantify agreement. RESULTS CT data for 14 patients (mean age: 17.3 ± 3.4 years, 5 males and 9 females, weight class: 31-70 kg (n = 6), 71-100 kg (n = 7), > 100 kg (n = 1)) were reconstructed into 84 total exams. 7 patients had urinary tract calculi. Interobserver agreement on the presence of any urinary tract calculus was substantial to almost perfect (k = 0.71-1) for all DLR algorithms. Agreement with the reference standard on number of calculi was excellent (ICC = 0.78-0.96) and agreement on the size of the largest calculus was fair to excellent (ICC = 0.51-0.97) depending on reviewer and DLR algorithm. CONCLUSION Deep learning reconstruction of unenhanced CT images allows similar renal stone detectability compared to iterative reconstruction.
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Affiliation(s)
- Samjhana Thapaliya
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 5031, Cincinnati, OH, 45229, USA
| | - Samuel L Brady
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 5031, Cincinnati, OH, 45229, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Elanchezhian Somasundaram
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 5031, Cincinnati, OH, 45229, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Christopher G Anton
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 5031, Cincinnati, OH, 45229, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Brian D Coley
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 5031, Cincinnati, OH, 45229, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Alexander J Towbin
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 5031, Cincinnati, OH, 45229, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Bin Zhang
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jonathan R Dillman
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 5031, Cincinnati, OH, 45229, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 5031, Cincinnati, OH, 45229, USA.
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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Ryan JR, Nguyen MH, Linscott JA, Nowicki SW, James E, Jumper BM, Ordoñez M, Ingimarsson JP. Ureteroscopy with thulium fiber laser lithotripsy results in shorter operating times and large cost savings. World J Urol 2022; 40:2077-2082. [PMID: 35729369 PMCID: PMC9213046 DOI: 10.1007/s00345-022-04037-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 05/03/2022] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Prolonged ureteroscopy (URS) is associated with complications including ureteral perforation, stricture, and urosepsis. As laser lithotripsy is one of the most common urologic procedures, small cost savings per case can have a large financial impact. This retrospective study was designed to determine if Thulium fiber laser (TFL) lithotripsy decreases operative time and costs compared to standard Holmium:YAG (Ho:YAG) lithotripsy without pulse modulation. METHODS A retrospective review of URS with laser lithotripsy was conducted for 152 cases performed from August 2020 to January 2021. Variables including cumulative stone size, location, chemical composition, prior ureteral stenting, and ureteral access sheath use were recorded for each case. A cost benefit analysis was performed to show projected cost savings due to potentially decreased operative times. RESULTS Compared to Ho:YAG, use of TFL resulted in an average decrease of 12.9 min per case (p = .021, 95% CI [2.03-23.85]). In subgroup analysis of cases with cumulative stone diameter less than 15 mm, the difference was 14.0 min (p = .007, CI [3.95-23.95]). For cases less than 10 mm, the mean difference was 17.3 min in favor of TFL (p = .002, 95% CI [6.89-27.62]). This ~ 13 min reduction in operative time resulted in saving $440/case in direct operating room costs giving our institution a range of $294,000 to $381,900 savings per year. CONCLUSIONS TFL has a significantly shorter operative time and decreased cost when compared to the standard Ho:YAG for equivalent kidney stone and patient characteristics. Longer term follow up is needed to see if recurrence rates are affected.
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Affiliation(s)
- James R. Ryan
- Tufts University School of Medicine, 145 Harrison Ave, Boston, MA 02111 USA
| | - Mitchell H. Nguyen
- Division of Urology, Maine Medical Center, 100 Brickhill Ave, South Portland, ME 04106 USA
| | - Joshua A. Linscott
- Division of Urology, Maine Medical Center, 100 Brickhill Ave, South Portland, ME 04106 USA
| | - Samuel W. Nowicki
- Tufts University School of Medicine, 145 Harrison Ave, Boston, MA 02111 USA
| | - Evelyn James
- Brown School of Public Health, 121 South Main Street, Providence, RI USA
| | - Brian M. Jumper
- Division of Urology, Maine Medical Center, 100 Brickhill Ave, South Portland, ME 04106 USA
| | - Maria Ordoñez
- Division of Urology, Maine Medical Center, 100 Brickhill Ave, South Portland, ME 04106 USA
| | - Johann P. Ingimarsson
- Division of Urology, Maine Medical Center, 100 Brickhill Ave, South Portland, ME 04106 USA
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Valiakos E, Marselos M, Skaltsa H. Inorganic substances and their uses in Nikolaos Myrepsos' Dynameron. Recent applications in modern therapy. Toxicol Rep 2021; 8:1792-1802. [PMID: 34722164 PMCID: PMC8536502 DOI: 10.1016/j.toxrep.2021.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 10/05/2021] [Accepted: 10/09/2021] [Indexed: 11/22/2022] Open
Abstract
Inorganic compounds have been known and used since antiquity. Dynameron is the largest Byzantine medical manuscript divided into 24 sections, in accordance with the letters of the Hellenic alphabet, which contains 2667 recipes. The majority of them contain ingredients of plant origin, followed by animal origin, while fewer inorganic substances are quoted. In the present study, the latter ones are listed. Moreover, the information on the uses of inorganic ingredients in the treatment of many diseases in the late Byzantine era is presented and their evaluation in light of the modern Pharmacology and Toxicology.
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Affiliation(s)
- E. Valiakos
- Faculty of Nursing, School of Health Sciences, University of Thessaly, Gaiopolis, 41500, Larissa, Greece
| | - M. Marselos
- Department of Pharmacology, Medical Faculty, School of Health Sciences, University of Ioannina, 451 10, Ioannina, Greece
| | - H. Skaltsa
- Department of Pharmacognosy and Chemistry of Natural Products, Faculty of Pharmacy, National & Kapodistrian University of Athens, Panepistimiopolis Zografou, 15771, Athens, Greece
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Comite V, Miani A, Ricca M, La Russa M, Pulimeno M, Fermo P. The impact of atmospheric pollution on outdoor cultural heritage: an analytic methodology for the characterization of the carbonaceous fraction in black crusts present on stone surfaces. Environ Res 2021; 201:111565. [PMID: 34192555 DOI: 10.1016/j.envres.2021.111565] [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] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 06/11/2021] [Accepted: 06/12/2021] [Indexed: 06/13/2023]
Abstract
COVID-19 has reduced tourism in both museums and historical sites with negative economic effect. The wellbeing and good preservation of monuments is a key factor to encourage again tourism. Historical monuments exposed to outdoor pollution are subjected to well known degradation phenomenon including the formation on their surface of black crusts (BCs) causing blackening and deterioration of the monuments and, as a consequence, a worst fruition by the visitors. The aim of this research is the development and validation of a novel method to characterize and quantify the various components present in the black crusts. SO2 together with the carbonaceous fraction (i.e. OC, organic carbon, and EC, elemental carbon) represent the main atmospheric pollutants involved in the process of BCs formation which consists in the partial transformation of the carbonate substrate into gypsum where black particles are embedded. A new methodology based on the use of TGA/DSC (Thermogravimetric Analysis/Differential scanning calorimetry) and CHN (Carbon, Hydrogen, Nitrogen) analysis was set up allowing to determine organic carbon and elemental carbon together with other components such as gypsum. Four standard mixtures simulating BCs composition were prepared and analysed by the set-up methodology. The new procedure was subsequently applied to study real BCs samples taken from monuments and historical buildings placed in cities heavily affected by atmospheric pollution and by PCA (principal component analysis) their main features, from the point of view of carbonaceous fraction, were highlighted.
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Affiliation(s)
- Valeria Comite
- Dipartimento di Chimica, University of Milan, Milan, 20133, Italy
| | - Alessandro Miani
- Italian Society of Environmental Medicine, (SIMA), Milan, 20123, Italy; Department of Environmental Science and Policy, University of Milan, Milan, 20133, Italy
| | - Michela Ricca
- Dipartimento di Biologia, Ecologia e Scienze Della Terra (DiBEST), Università Della Calabria, Arcavacata di Rende, 87036, CS, Italy
| | - Mauro La Russa
- Dipartimento di Biologia, Ecologia e Scienze Della Terra (DiBEST), Università Della Calabria, Arcavacata di Rende, 87036, CS, Italy
| | - Manuela Pulimeno
- Staff UNESCO, Chair on Health Education and Sustainable Development, Federico II University of Naples, Naples, 80138, Italy
| | - Paola Fermo
- Dipartimento di Chimica, University of Milan, Milan, 20133, Italy; Italian Society of Environmental Medicine, (SIMA), Milan, 20123, Italy.
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Chase AM, Hines L, Ellis E, Jain R, Quarrier SO. Sulfamethoxazole stone in a patient with extensive history of urolithiasis and recurrent urinary tract infections. Urol Case Rep 2021; 39:101812. [PMID: 34466388 DOI: 10.1016/j.eucr.2021.101812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 08/19/2021] [Indexed: 11/23/2022] Open
Abstract
Although rare, sulfamethoxazole-induced urolithiasis has been reported in patients taking trimethoprim-sulfamethoxazole (TMP/SMX). We present the case of a 79-year-old female who formed sulfamethoxazole stones in the setting of chronic indwelling catheterization with recurrent urinary tract infections (UTIs). The patient was a recurrent stone former with five prior stone composition analyses over a 10-year period varying from calcium phosphate to calcium oxalate, to struvite. We highlight the need for further investigation of this phenomenon given the frequent use of TMP/SMX in stone formers with recurrent infections.
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Abushamma F, Ito H, Aboumarzouk O, Timoney A, Collin N, Keeley FX. Calyceal Diverticula Disease: Diagnosis and Management Options in the Era of Non-Contrast CT Scan. Urol Int 2021; 106:688-692. [PMID: 34515232 DOI: 10.1159/000518051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 06/22/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Calyceal diverticula (CD) are traditionally diagnosed by contrast studies. However, non-contrast CT is the standard imaging modality for kidney stones. Therefore, we aimed to determine if the lack of contrast imaging affected outcomes of the management of symptomatic CD with stone. MATERIALS AND METHODS This is a retrospective study of patients diagnosed with CD with intracalyceal stone from 2000 to 2017 analyzing demographics, clinical data, and success of different treatment options. The timing of CD diagnosis is correlated to the success of the first treatment. RESULTS Forty-eight patients were found. CD was diagnosed prior to intervention in 20 (42%) cases and intraoperatively during flexible ureteroscopy in 17 (35%) and 11 (23%) cases were diagnosed after failed intervention, mainly ESWL. We found that the success rate of treatment was highly affected by the timing and modality of diagnosis. Preoperative diagnosis of CD was associated with 69% success rate of the first intervention. In contrast, there was a 0% success rate of first treatment if CD was not diagnosed with contrast imaging. Furthermore, univariate analysis showed no significant association between sociodemographics and clinical variables and success treatment (p > 0.05). CONCLUSIONS The delay in diagnosing CD with stone contributes significantly to the success rate and the number of treatments.
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Affiliation(s)
- Faris Abushamma
- Department of Medicine, Faculty of medicine and health Sciences, An-Najah National University, Nablus, Palestine.,Department of Urology, An-Najah National University Hospital, Nablus, Palestine.,Bristol Urological Institute, North Bristol NHS Trust, Bristol, United Kingdom
| | - Hiroki Ito
- Department of Urology, Yokosuka Kyosai Hospital, Kanagawa, Japan
| | - Omar Aboumarzouk
- Surgical Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.,School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, United Kingdom
| | - Anthony Timoney
- Bristol Urological Institute, North Bristol NHS Trust, Bristol, United Kingdom
| | - Neil Collin
- Interventional Radiology Department, Southmead Hospital, Bristol, United Kingdom
| | - Francis X Keeley
- Bristol Urological Institute, North Bristol NHS Trust, Bristol, United Kingdom
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Esposito C, Masieri L, Blanc T, Lendvay T, Escolino M. Robot-assisted laparoscopic surgery for treatment of urinary tract stones in children: report of a multicenter international experience. Urolithiasis 2021. [PMID: 33993337 DOI: 10.1007/s00240-021-01271-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 05/04/2021] [Indexed: 11/08/2022]
Abstract
This study aimed to report a multi-institutional experience with robot-assisted laparoscopic surgery (RALS) for treatment of urinary tract stones in children. The medical records of 15 patients (12 boys), who underwent RALS for urolithiasis in 4 international centers of pediatric urology over a 5-year period, were retrospectively collected. The median patient age was 8.5 years (range 4–15). Eleven/fifteen patients (73.3%) had concurrent uretero–pelvic junction obstruction (UPJO) and 2/15 patients (13.3%) had neurogenic bladder. Stones were in the renal pelvis in 8/15 (53.3%), in the lower pole in 3/15 (20%), in the bladder in 2/15 (13.3%), and in multiple locations in 2/15 (13.3%). One patient (6.6%) had bilateral multiple kidney stones. The median stone size was 10.8 mm (range 2–30) in upper tract location and 27 mm (range 21–33) into the bladder. Eleven patients with concomitant UPJO underwent simultaneous robot-assisted pyelolithotomy and pyeloplasty in 12 kidney units. Two patients with isolated staghorn stones received robot-assisted pyelolithotomy. Robot-assisted cystolithotomy was performed in two patients with bladder stones. The median operative time was 131.8 min (range 60–240). The stone-free rate was 80% following initial surgery and 100% after secondary treatment. Clavien 2 complications (hematuria, infections) were recorded in 5/15 patients (33.3%). Three/fifteen patients (20%) with residual renal stones were successfully treated using ureterorenoscopy (Clavien 3b). RALS was a feasible, safe and effective treatment option for pediatric urolithiasis in selected cases such as large bladder stones, bilateral kidney stones, staghorn stones or concomitant anomalies such as UPJO requiring simultaneous pyeloplasty.
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40
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Wang W, Peng L, Di X, Gao X, Wei X. Does previous unsuccessful shockwave lithotripsy influence the outcomes of ureteroscopy?-a systematic review and meta-analysis. Transl Androl Urol 2021; 10:2122-2132. [PMID: 34159093 PMCID: PMC8185663 DOI: 10.21037/tau-21-39] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background To determine whether previous unsuccessful shockwave lithotripsy (SWL) influence the outcomes of ureteroscopy (URS). Methods An exhaustive search of PubMed, EMBASE, Web of Science and Cochrane Library were conducted to find eligible studies before October 2020. Result variables consisting stone-free rate (SFR), operation time and postoperative modified Clavien grade I-IV complications were pooled utilizing RevMan 5.3. Results Seven studies with 2413 individuals were included. Pooled results revealed that the salvage URS after failed SWL was similar to URS performed primarily regarding SFR [odds ratio (OR) =0.84, P=0.15] and operation time [weighted mean difference (WMD) =6.79, P=0.19]. Additionally, no statistically significant differences concerning fever (OR: 1.36; P=0.32), hematuria (OR: 0.81; P=0.75), urinary tract infection (OR: 1.57; P=0.28), renal colic (OR: 1.94; P=0.50), ureteral perforation (OR: 1.44; P=0.46), ureteral avulsion (OR: 1.21; P=0.83), stone migration (OR: 0.92; P=0.86) and sepsis (OR: 0.46; P=0.38) were observed between salvage URS and primary URS group. Discussion The success rates and complications of URS were not impacted by previous unsuccessful SWL. The salvage URS is equally effective and safe to primary URS.
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Affiliation(s)
- Wei Wang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Liao Peng
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xingpeng Di
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiaoshuai Gao
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xin Wei
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Masood Y, Iqbal N, Farooq RM, Iqbal S, Khan F. Intraoperative flexible nephroscopy during percutaneous nephrolithotomy: An 8 years' experience. Pak J Med Sci 2021; 37:716-720. [PMID: 34104154 PMCID: PMC8155419 DOI: 10.12669/pjms.37.3.3565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Objectives: To see the effect of intra operative antegrade flexible nephroscopy during Percutaneous nephrolithotomy on stone free rate. Methods: We retrospectively reviewed electronic medical records of patients who underwent percutaneous nephrolithotomy from 2010 to 2017 for renal stones >2cm. Patients found eligible were divided in, Group-I who did not have intraoperative Flexible nephroscopy and Group-II who had flexible nephroscopy during percutaneous nephrolithotomy. All procedures were done by senior consultants. Variables like Mean age, side, stone size, skin to stone distance and Hounsfield unit were compared. Outcomes like Stone free rate, hospital stay and operative time were compared between the groups. Results: The study included 248 patients, consisting 85 (34.3%) females and 163 (65.7%) males. Mean age ± SD was 45.8±13.8 years. Both group were similar in characteristics like mean age, stone size, skin to stone distance and Hounsfield units. The overall stone free rate was 71%. It was not significantly different between the groups, 76% in Group-II vs. 67% in Group-I. However stone free rate markedly improved with flexible nephroscopy in patients with staghorn calculi. Mean operative time and hospital stay were similar between the groups. Conclusions: Intraoperative flexible nephroscopy during percutaneous nephrolithotomy significantly increases stone free rate in patients with staghorn stones.
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Affiliation(s)
- Yasir Masood
- Yasir Masood Resident Urology, Shifa International Hospital, Islamabad, Pakistan
| | - Nadeem Iqbal
- Nadeem Iqbal Urology, Shifa International Hospital, Islamabad, Pakistan
| | | | - Sajid Iqbal
- Sajid Iqbal Department of Rehabilitation, PNS Hospital, Karachi, Pakistan
| | - Faheemullah Khan
- Faheemullah Khan Resident Diagnostic Radiology, Aga Khan University Hospital, Karachi, Pakistan
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Lesch T, Uphoff J, Mayer W, Winter A, Wawroschek F, Schiffmann J. Stone Localization Is Pivotal for the Success of Percutaneous Nephrolithotomy. Urol Int 2021; 105:574-580. [PMID: 33588413 DOI: 10.1159/000513188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 11/18/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The objective of this study was to predict computed tomography (CT)-controlled treatment success after minimally invasive percutaneous nephrolithotomy (Mini-PCNL). PATIENTS AND METHODS We relied on retrospective single institutional data from 92 kidney stone patients treated with Mini-PCNL. Residual stones after treatment were evaluated by post-Mini-PCNL CT scans. Stone-free status was defined as clinically insignificant residual stones ≤3 mm after surgery. Multivariable logistic regression analyses predicted stone-free status after Mini-PCNL. RESULTS Overall, 53 (57.6%) patients achieved stone-free status after Mini-PCNL treatment. In multivariable logistic regression analyses, stone localization was the strongest predictor for stone-free status after Mini-PCNL. Specifically, patients with exclusively pelvic stones were 7.1-fold more likely to achieve stone-free status than those patients with stones at multiple localizations (OR: 7.1; p = 0.005). Additionally, stone size represented a barrier for stone-free status (OR: 0.9; p = 0.03). CONCLUSIONS Stone localization revealed the highest impact on treatment success after Mini-PCNL. Especially, those patients with exclusively pelvic stones were most likely to achieve stone-free status. Conversely, patients with multiple stone localizations were less likely to achieve stone-free status and need to be informed about higher risk of additional interventions after initial Mini-PCNL.
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Affiliation(s)
- Tammo Lesch
- University Hospital for Urology, Klinikum Oldenburg, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany,
| | - Jens Uphoff
- University Hospital for Urology, Klinikum Oldenburg, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Wolfgang Mayer
- University Hospital for Urology, Klinikum Oldenburg, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Alexander Winter
- University Hospital for Urology, Klinikum Oldenburg, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Friedhelm Wawroschek
- University Hospital for Urology, Klinikum Oldenburg, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Jonas Schiffmann
- University Hospital for Urology, Klinikum Oldenburg, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
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Ennis NJ, Dharumaduri D, Bryce JG, Tisa LS. Metagenome Across a Geochemical Gradient of Indian Stone Ruins Found at Historic Sites in Tamil Nadu, India. Microb Ecol 2021; 81:385-395. [PMID: 32918562 DOI: 10.1007/s00248-020-01598-3] [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] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 09/03/2020] [Indexed: 06/11/2023]
Abstract
Although stone surfaces seem unlikely to be habitable, they support microbial life. Life on these surfaces are subjected to many varying harsh conditions and require the inhabitants to exhibit resistance to environmental factors including UV irradiation, toxic metal exposure, and fluctuating temperatures and humidity. Here we report the effect of hosting stone geochemistry on the microbiome of stone ruins found in Tamil Nadu, India. The microbial communities found on the two lithologies, granite and granodiorite, hosted distinct populations of bacteria. Geochemical composition analysis of sampled stones revealed quartz mineral content as a major driver of microbial community structure, particularly promoting community richness and proportions of Cyanobacteria and Deinococcus-Thermus. Other geochemical parameters including ilmenite, albite, anorthite, and orthoclase components or elemental concentrations (Ti, Fe, Mn, Na, and K) also influenced community structure to a lesser degree than quartz. Core members of the stone microbiome community found on both lithologies were also identified and included Cyanobacteria (Chroococcidiopsaceae and Dapisostemonum CCIBt 3536), Rubrobacter, and Deinococcus. A cluster of taxa including Sphingomonas, Geodermatophilus, and Truepera were mostly found in the granodiorite samples. Community diversity correlated with quartz mineral content in these samples may indicate that the microbial communities that attach to quartz surfaces may be transient and regularly changing. This work has expanded our understanding of built-stone microbial community structure based on lithology and geochemistry.
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Affiliation(s)
- Nathaniel J Ennis
- Department of Molecular, Cellular, and Biomedical Sciences, University of New Hampshire, 46 College Rd., Durham, NH, 03824-2617, USA
| | - Dhanasekaran Dharumaduri
- Department of Molecular, Cellular, and Biomedical Sciences, University of New Hampshire, 46 College Rd., Durham, NH, 03824-2617, USA
- Department of Microbiology, Bharathidasan University, Tiruchirappalli, Tamil Nadu, India
| | - Julia G Bryce
- Department of Earth Sciences, University of New Hampshire, Durham, 03824, NH, USA
| | - Louis S Tisa
- Department of Molecular, Cellular, and Biomedical Sciences, University of New Hampshire, 46 College Rd., Durham, NH, 03824-2617, USA.
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Adoumadji K, Bras Da Silva C, Vega Toro P, Uk P, Barre P, Ravery V. [A long distance between home and hospital does not bother ambulatory surgery for ureteroscopy in French Guyana]. Prog Urol 2021; 31:340-347. [PMID: 33531219 DOI: 10.1016/j.purol.2020.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/16/2020] [Accepted: 11/26/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION French Guyana is 83,500 km2 wide (equivalent to 1/6 of France). Communes are distant. Public urology is set in Kourou only. These particularities led to develop ambulatory urological surgery including for patients living far away from the reference centre. We report our experience with patient ureteroscopy (URS). MATERIAL The study is retrospective (2018-2019), and includes 125 patients. Among these patients, 19.2% live in Kourou, 71.1% live 40 to 100km from the hospital and 9.7% beyond 100km. Every patient had an outpatient procedure for rigid and/or flexible URS to treat stone disease, including in lower calyx [LC] (38.4%). Ambulatory surgery was also proposed to the patients living away with the usual restrictions. Complications, results and switch to conventional hospitalisation (CH) were studied. RESULTS Mean stone size was 10,5mm (4-30), stone density was 1030 UH (470-1700). The postoperative complication rate was 4%. There were 90.4% 'stone free' patients (85.4% for LC). One patient was rehospitalised within 48hours for acute flank pain and 9 patients had a switch of ambulatory to CH: 6 for discharge too late and 3 for complication (fever and/or pain). Distance between home and hospital was linked neither to complication rate, nor to switch to CH. CONCLUSION Ambulatory URS is possible without further complications in selected patients living beyond 100km from the hospital, because of a specific organisation and an appropriate training of the caregivers involved in postoperative patient care. LEVEL OF PROOF 3.
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Affiliation(s)
- K Adoumadji
- Service d'urologie, centre hospitalier de Kourou, BP 703, avenue Léopold-Héder, 97387 Kourou, Guyane française
| | - C Bras Da Silva
- Service d'urologie, centre hospitalier de Kourou, BP 703, avenue Léopold-Héder, 97387 Kourou, Guyane française
| | - P Vega Toro
- Service d'urologie, centre hospitalier de Kourou, BP 703, avenue Léopold-Héder, 97387 Kourou, Guyane française
| | - P Uk
- Service d'urologie, centre hospitalier de Kourou, BP 703, avenue Léopold-Héder, 97387 Kourou, Guyane française
| | - P Barre
- Service d'urologie, centre hospitalier de Kourou, BP 703, avenue Léopold-Héder, 97387 Kourou, Guyane française
| | - V Ravery
- Service d'urologie, centre hospitalier de Kourou, BP 703, avenue Léopold-Héder, 97387 Kourou, Guyane française.
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Tawfeek AM, Elmoazen M, Saafan A, Higazy A, Radwan A, Gad HH. Simultaneous antegrade and retrograde endourological approach in Galdakao-modified supine Valdivia position for the management of missed stents associated with complex renal stones: a non-randomized pilot study. Int Urol Nephrol 2020; 53:211-217. [PMID: 32929666 DOI: 10.1007/s11255-020-02639-z] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 09/05/2020] [Indexed: 12/23/2022]
Abstract
PURPOSE To evaluate the simultaneous antegrade and retrograde endourological approach in the Galdakao-modified supine Valdivia position (GMSVP) for the management of missed stent with complex renal stones. METHODS Over 5 years, patients presented to our clinic or referred to our hospital with missed DJ stent and complex renal stones were included prospectively in our study. Inclusion criteria were patients with neglected DJ stents (more than 6 months) complicated with complex stone burden, in addition to stents that was Fragmented and required renal access for removal. Stent and stone removal were performed using a simultaneous antegrade and retrograde renal approach in the GMSVP. The success rate and any perioperative complications were recorded. RESULTS 45 patients were available for evaluation. The average stone size was 3.9 ± 0.8 cm. Renal stones, ureteric stones, and bladder stones were present in 39, 24, and 10 patients, respectively .Two patients had fragmented DJs. Semirigid ureteroscopy with PCNL was used in 19 (42.2%) cases, ECIRS in 17 (37.7%) cases, Cystolitholapaxy and PCNL in 10 (22.2%) cases. Mean operative time was 70.8 ± 10.2 min, mean hospital stay was 2.3 ± 0.8 days. The stone-free rate was 93.3% after one procedure, two patients needed an auxiliary SWL for residual stones, postoperative complications were seen in 24.4% of patients. CONCLUSION Simultaneous antegrade and retrograde renal approach in the GMSVP is safe and effective in the management of missed DJ stents with a complex stone burden.
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Affiliation(s)
- A M Tawfeek
- Ain Shams University Hospitals, Cairo, 11361, Egypt
| | | | - Ahmed Saafan
- Ain Shams University Hospitals, Cairo, 11361, Egypt
| | - Ahmed Higazy
- Ain Shams University Hospitals, Cairo, 11361, Egypt.
| | - Ahmed Radwan
- Ain Shams University Hospitals, Cairo, 11361, Egypt
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Khoury T, Kadah A, Mari A, Kalisky I, Katz L, Mahamid M, Sbeit W. A validated score predicting common bile duct stone in patients hospitalized with acute calculus cholecystitis: a multi-center retrospective study. Surg Endosc 2020; 35:3709-3715. [PMID: 32748267 DOI: 10.1007/s00464-020-07853-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 07/24/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Concomitant common bile duct (CBD) stone in the setting of acute calculous cholecystitis (ACC) should be suspected once abnormal liver indices are noticed. AIM We aimed to identify predictors of CBD stone in patients hospitalized with ACC. METHODS We performed a retrospective multi-center, case-controlled, study from 1st of January 2016 until the 31th of December 2018. Inclusion criteria included patients with an established diagnosis of ACC based on clinical, laboratory and radiological criteria and who had an endoscopic ultrasound (EUS) for suspected CBD stone. One-hundred and twelve patients were included, of these fifty-three patients (47.3%) were diagnosed with CBD stone by EUS. RESULTS In univariate analysis, Age (OR 1.038, P = 0.001), total bilirubin (mg/dl) (OR 1.429, P = 0.02) and CBD width (mm) by US (OR 1.314, P = 0.01) were statistically significant in predicting CBD stone and remained significant in multivariate regression analysis. We developed a diagnostic score that included these three parameters, with assignment of weights for each variable according to the coefficient estimate. A low cut-off score of 0 was associated with sensitivity of 100% for CBD stone, whereas a high cut-off score of 3 was associated with sensitivity of 10% and specificity of 96.6% with a positive predictive value of 67% (ROC of 0.7558). We validated this score with an independent cohort (ROC of 0.7416) with a sensitivity of 46.6%, a specificity of 91.5% and a PPV of 87.1%. CONCLUSION We recommend incorporating this score as an aid for stratifying patients with ACC into low or high probability for concomitant CBD stone.
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Affiliation(s)
- Tawfik Khoury
- Department of Gastroenterology, Galilee Medical Center, Nahariya, Israel. .,Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel. .,Gastroenterology and Endoscopy Units, The Nazareth Hospital, EMMS, Nazareth, Israel.
| | - Anas Kadah
- Department of Gastroenterology, Galilee Medical Center, Nahariya, Israel.,Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Amir Mari
- Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel.,Gastroenterology and Endoscopy Units, The Nazareth Hospital, EMMS, Nazareth, Israel
| | - Itai Kalisky
- Gastroenterology Department, Hadassah Medical Organization-Hebrew University, Jerusalem, Israel
| | - Lior Katz
- Gastroenterology Department, Hadassah Medical Organization-Hebrew University, Jerusalem, Israel
| | - Mahmud Mahamid
- Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel.,Gastroenterology and Endoscopy Units, The Nazareth Hospital, EMMS, Nazareth, Israel.,Gastroenterology Department, Sharee Zedek Medical Center, Jerusalem, Israel
| | - Wisam Sbeit
- Department of Gastroenterology, Galilee Medical Center, Nahariya, Israel.,Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
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El-Nahas AR, Nabeeh MA, Laymon M, Sheir KZ, El-Kappany HA, Osman Y. Preoperative risk factors for complications of percutaneous nephrolithotomy. Urolithiasis 2021; 49:153-60. [PMID: 32740673 DOI: 10.1007/s00240-020-01203-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 07/24/2020] [Indexed: 12/25/2022]
Abstract
This study was conducted to evaluate preoperative risk factors for development of complications of percutaneous nephrolithotomy (PCNL). All consecutive patients aged ≥ 16 years who underwent PCNL during 2015 were retrospectively reviewed. Non-contrast CT (NCCT) was performed for all patients to evaluate stone complexity. The technique of PCNL was the same for all patients. Intra-operative and postoperative complications were recorded and classified based on modified Clavien system. The differences in preoperative data (patients, renal and stone characteristics including Guy's and STONE scores) between complicated and uncomplicated cases were compared using univariate and multivariate statistical analyses for detection of independent risk factors. The study included 1178 patients (61% were males). Mean age was 50 ± 12 years, and mean BMI was 30.7 ± 5.7 kg/m2. Complicated group included 166 patients (14.1%). Independent risk factors on multivariate analysis were infected preoperative urine culture (RR: 2.098, P 0.001, 95%CI: 1.380-3.189), largest stones diameter 30 mm or more (RR: 2.481, P > 0.001, 95%CI: 1.697-3.627) and number of calyces affected by the stones (RR: 2.431, P 0.002, 95%CI: 1.400-4.222 for affection of two calyces and RR: 2.778, P 0.005, 95%CI: 1.357-5.684 for affection of three calyces). While two scoring systems (Guy's and STONE) were not predictive of complications after PCNL, preoperative risk factors were infected preoperative urine culture, distribution of the stones or stone branches in two or three calyceal groups and stone size 30 mm or more.
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48
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Kadah A, Khoury T, Mahamid M, Assy N, Sbeit W. Predicting common bile duct stones by non-invasive parameters. Hepatobiliary Pancreat Dis Int 2020; 19:266-70. [PMID: 31810810 DOI: 10.1016/j.hbpd.2019.11.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 11/13/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Common bile duct (CBD) stone affect about 10% of patients with symptomatic cholelithiasis. The American Society for Gastrointestinal Endoscopy (ASGE) published a strategy in 2010 for managing patients with suspected choledocholithiasis. This study aimed to assess the performance of different clinical parameters in predicting CBD stones. METHODS A total of 344 patients suspected to suffer from CBD stone and referred to endoscopic ultrasound (EUS) were included. Parameters were collected and their prediction power for CBD stones was assessed. RESULTS One hundred and sixty-seven patients without CBD stone according to EUS (group A) were compared to 177 patients with CBD stones (group B). Several predictive factors for CBD stone were identified on univariate analysis. In multivariate regression analysis, CBD width by US (OR = 1.224, 95% CI: 1.073-1.359; P = 0.0026), age (OR = 1.023, 95% CI: 1.011-1.035; P = 0.0002) and gamma glutamyl transferase (GGT) level (OR = 1.001, 95% CI: 1.000-1.002; P = 0.0018) were significantly correlated with CBD stone, with receiver operator characteristics (ROC) of 0.7259. We generated a diagnostic equation [age (yr) × 0.1 + CBD width (mm) by US × 1 + GGT (U/L) × 0.005] to predict CBD stone with ROC of 0.7287. CONCLUSIONS We suggest this score as a very strong predictor for CBD stones, and to reduce the strength of total bilirubin and transaminases as predictors.
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49
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Khoury T, Kadah A, Mahamid M, Mari A, Sbeit W. Bedside score predicting retained common bile duct stone in acute biliary pancreatitis. World J Clin Cases 2020; 8:1414-1423. [PMID: 32368534 PMCID: PMC7190963 DOI: 10.12998/wjcc.v8.i8.1414] [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] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 03/03/2020] [Accepted: 04/14/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Retained common bile duct (CBD) stone after an acute episode of biliary pancreatitis is of paramount importance since stone extraction is mandatory.
AIM To generate a simple non-invasive score to predict the presence of CBD stone in patients with biliary pancreatitis.
METHODS We performed a retrospective study including patients with a diagnosis of biliary pancreatitis. One hundred and fifty-four patients were included. Thirty-three patients (21.5%) were diagnosed with CBD stone by endoscopic ultrasound (US).
RESULTS In univariate analysis, age (OR: 1.048, P = 0.0004), aspartate transaminase (OR: 1.002, P = 0.0015), alkaline phosphatase (OR: 1.005, P = 0.0005), gamma-glutamyl transferase (OR: 1.003, P = 0.0002) and CBD width by US (OR: 1.187, P = 0.0445) were associated with CBD stone. In multivariate analysis, three parameters were identified to predict CBD stone; age (OR: 1.062, P = 0.0005), gamma-glutamyl transferase level (OR: 1.003, P = 0.0003) and dilated CBD (OR: 3.685, P = 0.027), with area under the curve of 0.8433. We developed a diagnostic score that included the three significant parameters on multivariate analysis, with assignment of weights for each variable according to the co-efficient estimate. A score that ranges from 51.28 to 73.7 has a very high specificity (90%-100%) for CBD stones, while a low score that ranges from 9.16 to 41.04 has a high sensitivity (82%-100%). By performing internal validation, the negative predictive value of the low score group was 93%.
CONCLUSION We recommend incorporating this score as an aid for stratifying patients with acute biliary pancreatitis into low or high probability for the presence of CBD stone.
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Affiliation(s)
- Tawfik Khoury
- Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 1311502, Israel
- Department of Gastroenterology, Galilee Medical Center, Nahariya 22100, Israel
- Gastroenterology and endoscopy units, The Nazareth Hospital EMMS, Nazareth 16100, Israel
| | - Anas Kadah
- Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 1311502, Israel
- Department of Gastroenterology, Galilee Medical Center, Nahariya 22100, Israel
| | - Mahmud Mahamid
- Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 1311502, Israel
- Gastroenterology and endoscopy units, The Nazareth Hospital EMMS, Nazareth 16100, Israel
| | - Amir Mari
- Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 1311502, Israel
- Gastroenterology and endoscopy units, The Nazareth Hospital EMMS, Nazareth 16100, Israel
| | - Wisam Sbeit
- Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 1311502, Israel
- Department of Gastroenterology, Galilee Medical Center, Nahariya 22100, Israel
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50
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MacCraith E, O'Kelly J, Ryan J, Forde JC, Cheema I, McLornan L, Davis NF. Predictors of emergency department attendance following ureterorenoscopy for urolithiasis. Ir J Med Sci 2020; 189:1445-1449. [PMID: 32239425 DOI: 10.1007/s11845-020-02221-7] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 03/23/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND We sought to determine the rate of emergency department (ED) attendance for complications after ureterorenoscopy (URS) for stone disease and to identify risk factors for ED attendance after URS. METHODS An analysis of all patients undergoing URS over 12 months at a single institution was performed. Patient demographics, preoperative and intraoperative variables associated with postoperative complications and subsequent ED attendance were collected. Logistic regression analyses were performed to determine predictors of URS complications presenting to ED. RESULTS In total, 202 ureteroscopies were performed on 142 patients for urolithiasis. The mean age was 50.73 ± 13.93 and 66% were male. The incidence of re-presentation to ED was 14.8% (n = 30). Patients presented with postoperative pain (n = 10; 4.95%), pyrexia (n = 9; 4.46%), urinary tract infection (UTI) (n = 7, 3.47%), haematuria (n = 3, 1.49%) and urosepsis (n = 1; 0.5%). Significant risk factors for ED attendance included preoperative stent dwell time > 30 days (P = 0.004), recently treated positive preoperative urine culture (P < 0.0001), stone size ≥ 13 mm (P = 0.043), stone location mid-ureter (P = 0.036) and female gender (P = 0.005). The following factors did not predict ED attendance, stent omission, access sheath utilization and operation duration. CONCLUSION Risk factors for ED attendance after URS include prolonged pre-stent dwell time, stone size ≥ 13 mm, treatment for a positive preoperative urine culture, mid-ureteric stone location and female gender. Urologists should be aware of these findings to decrease the risk of emergency re-presentation after elective URS surgery.
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Affiliation(s)
- Eoin MacCraith
- Department of Urology, Connolly Hospital, Blanchardstown, Dublin 15, Ireland.
| | - John O'Kelly
- Department of Urology, Connolly Hospital, Blanchardstown, Dublin 15, Ireland
| | - James Ryan
- Department of Urology, Connolly Hospital, Blanchardstown, Dublin 15, Ireland
| | - James C Forde
- Department of Urology, Connolly Hospital, Blanchardstown, Dublin 15, Ireland
| | - Ijaz Cheema
- Department of Urology, Connolly Hospital, Blanchardstown, Dublin 15, Ireland
| | - Liza McLornan
- Department of Urology, Connolly Hospital, Blanchardstown, Dublin 15, Ireland
| | - Niall F Davis
- Department of Urology, Connolly Hospital, Blanchardstown, Dublin 15, Ireland
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