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Moretto S, Saita A, Scoffone CM, Talso M, Somani BK, Traxer O, Angerri O, Knoll T, Liatsikos E, Herrmann TRW, Ulvik Ø, Skolarikos A, Cracco CM, Keller EX, Paciotti M, Piccolini A, Uleri A, Tailly T, Carmignani L, Pietropaolo A, Corrales M, Lughezzani G, Lazzeri M, Fasulo V, De Coninck V, Arena P, Nagele U, Ferretti S, Kronenberg P, Perez-Fentes D, Osther PJ, Goumas IK, Acquati P, Ajayi L, Diana P, Casale P, Buffi NM. Ureteral stricture rate after endoscopic treatments for urolithiasis and related risk factors: systematic review and meta-analysis. World J Urol 2024; 42:234. [PMID: 38613692 DOI: 10.1007/s00345-024-04933-2] [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: 02/20/2024] [Accepted: 03/15/2024] [Indexed: 04/15/2024] Open
Abstract
PURPOSE We aimed to accurately determine ureteral stricture (US) rates following urolithiasis treatments and their related risk factors. METHODS We conducted a systematic review and meta-analysis following the PRISMA guidelines using databases from inception to November 2023. Studies were deemed eligible for analysis if they included ≥ 18 years old patients with urinary lithiasis (Patients) who were subjected to endoscopic treatment (Intervention) with ureteroscopy (URS), percutaneous nephrolithotomy (PCNL), or shock wave lithotripsy (SWL) (Comparator) to assess the incidence of US (Outcome) in prospective and retrospective studies (Study design). RESULTS A total of 43 studies were included. The pooled US rate was 1.3% post-SWL and 2.1% post-PCNL. The pooled rate of US post-URS was 1.9% but raised to 2.7% considering the last five years' studies and 4.9% if the stone was impacted. Moreover, the pooled US rate differed if follow-ups were under or over six months. Patients with proximal ureteral stone, preoperative hydronephrosis, intraoperative ureteral perforation, and impacted stones showed higher US risk post-endoscopic intervention with odds ratio of 1.6 (P = 0.05), 2.6 (P = 0.009), 7.1 (P < 0.001), and 7.47 (P = 0.003), respectively. CONCLUSIONS The overall US rate ranges from 0.3 to 4.9%, with an increasing trend in the last few years. It is influenced by type of treatment, stone location and impaction, preoperative hydronephrosis and intraoperative perforation. Future standardized reporting and prospective and more extended follow-up studies might contribute to a better understanding of US risks related to calculi treatment.
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Affiliation(s)
- S Moretto
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy.
| | - A Saita
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - C M Scoffone
- Department of Urology, Cottolengo Hospital, Turin, Italy
| | - M Talso
- Department of Urology, Luigi Sacco University Hospital, Milan, Italy
| | - B K Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - O Traxer
- Department of Urology, Sorbonne Université, Paris, France
| | - O Angerri
- Department of Urology, Fundació Puigvert Univ. Autonoma de Barcelona, Barcelona, Spain
| | - T Knoll
- Department of Urology, Sindelfingen Medical Center, University of Tübingen, Tübingen, Germany
| | - E Liatsikos
- Department of Urology, University Hospital of Patras, Patras, Greece
| | - T R W Herrmann
- Department of Urology, Spital Thurgau AG, Frauenfeld, Switzerland
- Hannover Medical School, Hannover, Germany
- Division of Urology, Department of Surgical Sciences, Stellenbosch University, Western Cape, South Africa
| | - Ø Ulvik
- Department of Urology, Haukeland University Hospital, Bergen, Norway
| | - A Skolarikos
- Second Department of Urology, Sismanoglio Hospital, National and Kapodistrian University of Athen, Athens, Greece
| | - C M Cracco
- Department of Urology, Cottolengo Hospital, Turin, Italy
| | - E X Keller
- Department of Urology, University Hospital Zurich, Zurich, Switzerland
| | - M Paciotti
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - A Piccolini
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - A Uleri
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - T Tailly
- Department of Urology, University Hospital Ghent, Ghent, Belgium
| | - L Carmignani
- Department of Urology, University of Milan, Milan, Italy
| | - A Pietropaolo
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - M Corrales
- Department of Urology, Sorbonne Université, Paris, France
| | - G Lughezzani
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - M Lazzeri
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - V Fasulo
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - V De Coninck
- Department of Urology, AZ Klina, Brasschaat, Belgium
| | - P Arena
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - U Nagele
- Department of Urology, General Hospital Hall in Tirol, Hall in Tirol, Austria
| | - S Ferretti
- Department of Urology, Azienda Ospedaliero-Universitaria di Modena, Baggiovara, Italy
| | - P Kronenberg
- Department of Urology, Hospital CUF Descobertas, Lisbon, Portugal
| | - D Perez-Fentes
- Department of Urology, University Hospital Complex of Santiago de Compostela, Santiago, Spain
| | - P J Osther
- Department of Urology, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - I K Goumas
- Department of Urology, Istituto Clinico Beato Matteo, Vigevano, Italy
| | - P Acquati
- Department of Urology, IRCCS Policlinico San Donato, Milan, Italy
| | - L Ajayi
- Department of Urology, Royal Free London NHS Foundation Trust, London, UK
| | - P Diana
- Department of Urology, Fundació Puigvert Univ. Autonoma de Barcelona, Barcelona, Spain
| | - P Casale
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
| | - N M Buffi
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy
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Massella V, Pietropaolo A, Gauhar V, Emiliani E, Somani BK. Has fluoroless endourology (URS and PCNL) come of age? Evidence from a comprehensive literature review. Actas Urol Esp 2024; 48:2-10. [PMID: 37330050 DOI: 10.1016/j.acuroe.2023.06.002] [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: 02/23/2023] [Revised: 04/04/2023] [Accepted: 04/21/2023] [Indexed: 06/19/2023]
Abstract
INTRODUCTION Radiation via the use of imaging is a key tool in management of kidney stones. Simple measures are largely taken by the endourologists to implement the 'As Low As Reasonably Achievable' (ALARA) principle, including the use of fluoroless technique. We performed a scoping literature review to investigate the success and safety of fluoroless ureteroscopy (URS) or percutaneous nephrolithotomy (PCNL) procedures for the treatment of KSD. METHODS A literature review was performed searching bibliographic databases PubMed, EMBASE and Cochrane library, and 14 full papers were included in the review in accordance with the PRISMA guidelines. RESULTS Of the 2535 total procedures analysed, 823 were fluoroless URS vs. 556 fluoroscopic URS; and 734 fluoroless PCNL vs. 277 fluoroscopic PCNL. The SFR for fluoroless vs. fluoroscopic guided URS was 85.3% and 77%, respectively (p=0.2), while for fluoroless PCNL vs. fluoroscopic group was 83.8% and 84.6%, respectively (p=0.9). The overall Clavien-Dindo I/II and III/IV complications for fluoroless and fluoroscopic guided procedures were 3.1% (n=71) and 8.5% (n=131), and 1.7% (n=23) and 3% (n=47) respectively. Only 5 studies reported a failure of the fluoroscopic approach with a total of 30 (1.3%) failed procedures. CONCLUSION The ALARA protocol has been implemented in endourology in numerous ways to protect both patients and healthcare workers during recent years. Fluoroless procedures for treatment of KSD are safe and effective with outcomes comparable to standard procedures and could become the new frontier of endourology in selected cases.
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Affiliation(s)
- V Massella
- Servicio de Urología, Hospital Universitario de Southampton, United Kingdom
| | - A Pietropaolo
- Servicio de Urología, Hospital Universitario de Southampton, United Kingdom
| | - V Gauhar
- Servicio de Urología, Hospital General Ng Teng Fong, Singapore
| | - E Emiliani
- Servicio de Urología, Fundación Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - B K Somani
- Servicio de Urología, Hospital Universitario de Southampton, United Kingdom.
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Giulioni C, Castellani D, Traxer O, Gadzhiev N, Pirola GM, Tanidir Y, da Silva RD, Glover X, Giusti G, Proietti S, Mulawkar PM, De Stefano V, Cormio A, Teoh JYC, Galosi AB, Somani BK, Emiliani E, Gauhar V. Experimental and clinical applications and outcomes of using different forms of suction in retrograde intrarenal surgery. Results from a systematic review. Actas Urol Esp 2024; 48:57-70. [PMID: 37302691 DOI: 10.1016/j.acuroe.2023.06.001] [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: 01/25/2023] [Accepted: 02/24/2023] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To identify the latest advances in suction devices and evaluate their effect in Retrograde intrarenal surgery (RIRS) and ureteroscopy for stones. BASIC PROCEDURES A systematic literature search was performed on 4th January 2023 using Scopus, PubMed, and EMBASE. Only English papers were included; both pediatric and adult studies were accepted. Duplicate studies, case reports, letters to the editor, and meeting abstracts were excluded. MAIN FINDINGS Twenty-one papers were selected. Several methods have been proposed for suction use in RIRS, such as through the ureteral access sheath or directly to the scope. Artificial intelligence can also regulate this system, monitoring pressure and perfusion flow values. All the proposed techniques showed satisfactory perioperative results for operative time, stone-free rate (SFR), and residual fragments. Moreover, the reduction of intrarenal pressure (induced by aspiration) was also associated with a lower infection rate. Even the studies that considered kidney stones with a diameter of 20 mm or higher reported higher SFR and reduced postoperative complications. However, the lack of well-defined settings for suction pressure and fluid flow prevents the standardization of the procedure. CONCLUSION Aspiration device in the surgical treatment of urinary stones favours a higher SFR, reducing infectious complications, as supported by the included studies. RIRS with a suction system provided to be a natural successor to the traditional technique, regulating intrarenal pressure and aspirating fine dust.
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Affiliation(s)
- C Giulioni
- Servicio de Urología, Azienda Ospedaliero-Universitaria delle Marche, Universidad Politécnica Marche, Ancona, Italy.
| | - D Castellani
- Servicio de Urología, Azienda Ospedaliero-Universitaria delle Marche, Universidad Politécnica Marche, Ancona, Italy
| | - O Traxer
- Servicio de Urología, Universidad de La Sorbona, Hospital Tenon (AP-HP), París, France
| | - N Gadzhiev
- Servicio de Endourología, Universidad Médica Estatal de San Petersburgo, Saint-Petersburgo, Russia
| | - G M Pirola
- Servicio de Urología, Hospital San Giuseppe, Grupo MultiMedica, Milán, Italy
| | - Y Tanidir
- Departamento de Urología, Facultad de Medicina, Universidad de Marmara, Estambul, Turkey
| | - R D da Silva
- Departamento de Urología, Facultad de Medicina, Universidad de Colorado, United States
| | - X Glover
- Departamento de Urología, Facultad de Medicina, Universidad de Colorado, United States
| | - G Giusti
- Centro Europeo de Entrenamiento en Endourología, Hospital San Raffaele IRCCS, Milán, Italy
| | - S Proietti
- Centro Europeo de Entrenamiento en Endourología, Hospital San Raffaele IRCCS, Milán, Italy
| | - P M Mulawkar
- Servicio de Urología, Hospital Superespecializado de Tirthankar, Akola, India; Universidad de Edimburgo, Edimburgo, United Kingdom
| | - V De Stefano
- Servicio de Urología, Azienda Ospedaliero-Universitaria delle Marche, Universidad Politécnica Marche, Ancona, Italy
| | - A Cormio
- Servicio de Urología, Azienda Ospedaliero-Universitaria delle Marche, Universidad Politécnica Marche, Ancona, Italy
| | - J Y-C Teoh
- Clínica de Urología S.H. Ho, Servicio de Cirugía, Facultad de Medicina, Universidad China de Hong Kong, Hong Kong, China
| | - A B Galosi
- Servicio de Urología, Azienda Ospedaliero-Universitaria delle Marche, Universidad Politécnica Marche, Ancona, Italy
| | - B K Somani
- Servicio de Urología, Hospital Universitario de Southampton, NHS Trust, Southampton, United Kingdom
| | - E Emiliani
- Servicio de Urología, Fundación Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - V Gauhar
- Servicio de Urología, Hospital General Ng Teng Fong, Singapur, Singapore
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Brown G, Somani BK. Atlas of 35 patient reported outcome measures (PROMs) in andrology: a comprehensive overview of literature. World J Urol 2023; 41:371-404. [PMID: 36534155 DOI: 10.1007/s00345-022-04246-2] [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: 08/09/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Disorders of male sexual health and functioning are complex and can have significant deleterious effects on patients psychological wellbeing and interpersonal relationships. It is well recognised that clinicians have an overall poor understanding of the true effect that disease has on their patients and self-reported patient-reported outcome measures (PROMs) aim to better communicate these issues. PROMs are generally welcomed by patients and their use in this highly sensitive area of clinical practice is well recognised. An atlas of available PROMs for key conditions in andrology is presented in this article. METHODS A comprehensive search of world literature was conducted from the inception of databases to June 2022, to identify male-specific PROMs relevant to four key andrological disorders: hypogonadism, erectile dysfunction, penile curvature and disorders of ejaculation. Each tool was evaluated in narrative format. RESULTS 35 PROMs were identified. 6 were designed for the assessment of hypogonadism, 18 for erectile dysfunction, one for penile curvature and 10 for ejaculatory disorders. In general, PROMs were brief, self-administered and user-friendly. There was sufficient scope and variety in all categories (apart from penile curvature) to give the clinician flexibility in tool selection and find an appropriate tool for different scenarios. CONCLUSION A number of PROMs exist within andrology that can be utilised in both research and clinical settings. PROMs enable subjective evaluation of difficult-to-assess aspects of the patient experience.
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Affiliation(s)
- G Brown
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - B K Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK.
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Bowen D, Juliebø-Jones P, Somani BK. Global outcomes and lessons learned in the management of Fournier's gangrene from high-volume centres: findings from a literature review over the last two decades. World J Urol 2022; 40:2399-2410. [PMID: 36059020 DOI: 10.1007/s00345-022-04139-4] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 08/15/2022] [Indexed: 10/14/2022] Open
Abstract
INTRODUCTION Fournier's Gangrene (FG) carries a high mortality and morbidity with underreported short and long-term outcomes. Our aim was to perform a review of the recent literature to evaluate the short and long-term outcomes in patients with FG in the acute setting from large-scale studies. METHODS A PubMed search was performed between January 2000 and December 2021 for studies reporting on patients with FG. Exclusion criteria included small samples (n < 100), review articles and animal studies. Primary outcomes of interest were mortality, number of operative episodes for surgical debridement and admission to intensive care unit (ICU). Other outcomes assessed included rate of faecal and urinary diversion, orchidectomy rate, penectomy rate and length of hospital stay. RESULTS From a total of 1182 studies, 18 were eligible for inclusion and included in this review. In total, data were analysed from 13,903 FG patients. Mean inpatient mortality rate was 7.3% (range 4.7-40.4%). Mean number of surgical debridement operations performed was 1.8 (range 1.5-4.2). On average, 6.8% (range 3.6-50.5%) and 7% (range 1.2-53.2%) underwent faecal and urinary diversions, respectively. Mean rate of orchidectomy was 5.6%, with rate of penectomy being lower at 0.2%. The mean length of hospital stay was 18.5 days (range 13.0-26.6). On average, 17.5% (range 10.1%-67.5%) required ICU admission for at least a single-system support. CONCLUSION Our review from the past twenty years of literature suggests that the mortality for FG, whilst still high, has fallen compared to previous years. Whilst inpatient metrics are well-covered in the literature there is a lack of large-scale studies detailing long-term patient outcomes.
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Affiliation(s)
- Daniel Bowen
- University Hospital Southampton NHS Trust, Southampton, UK
| | - Patrick Juliebø-Jones
- Department of Urology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - B K Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK.
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Law YXT, Teoh JYC, Castellani D, Lim EJ, Chan EOT, Wroclawski M, Pirola GM, Giulioni C, Rubilotta E, Gubbioti M, Scarcella S, Chew BH, Traxer O, Somani BK, Gauhar V. Role of pre-operative ureteral stent on outcomes of retrograde intra-renal surgery (RIRS): systematic review and meta-analysis of 3831 patients and comparison of Asian and non-Asian cohorts. World J Urol 2022; 40:1377-1389. [PMID: 35072738 DOI: 10.1007/s00345-022-03935-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 12/13/2021] [Accepted: 01/07/2022] [Indexed: 12/27/2022] Open
Abstract
PURPOSE To evaluate the outcomes of pre-stented (PS) versus non-pre-stented (NPS) patients who have undergone retrograde intrarenal surgery (RIRS) for renal calculi with subgroup analysis of Asian and non-Asian cohorts. METHODS Protocol is registered in PROSPERO, CRD42021261123. Eligible studies identified from four electronic databases. Meta-analysis was done to enumerate the outcomes of RIRS in between PS and NPS. Secondary sub-analysis was done to look for differences in outcomes in Asian and non-Asian cohorts. RESULTS Fourteen studies involving 3831 patients (4 prospective, 10 retrospective studies) were included. PS patients experienced higher success rates of ureteral access sheath (UAS) insertion than NPS (RR 1.09, 95% CI 1.05-1.13, p < 0.00001). PS patients had lower risk of ureteral injuries from UAS placement (RR 0.69, 95% CI 0.50-0.96, p = 0.03). No significant differences in intra- and postoperative complications between two groups were found. Stone-free rate (SFR) outcomes for residual fragment (RF) cut-off of < 1 mm and < 4 mm favoured the PS patients (RR 1.10, 95% CI 1.04-1.17, p = 0.002 for < 4 mm, RR1.10, 95% CI 1.02-1.19, p = 0.02 for < 1 mm). In the subgroup analysis, PS Asian patients had similar SFR as NPS patients for SFR(< 4 mm) but non-Asian population showed better outcomes in the PS patients for SFR(< 4 mm) (RR 1.31, 95% CI 1.13-1.52, p = 0.0005). CONCLUSIONS This meta-analysis suggests that pre-stenting results in a higher success for UAS placement, minimising intraoperative ureteric injury, with higher overall SFR for any RF cut-off in PS cohorts. In non-Asian cohort, significant differences occurred at SFR < 4 mm but not for SFR < 1 mm. No difference was seen in our Asian cohort for any SFR cut-off in both PS and NPS patients.
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Affiliation(s)
- Y X T Law
- Department of Urology, National University Hospital, National University Health System, Singapore, Singapore.
| | - J Y C Teoh
- S.H. Ho Urology Centre, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - D Castellani
- Urology Division, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Università Politecnica Delle Marche, Ancona, Italy
| | - E J Lim
- Department of Urology, Singapore General Hospital, Singapore, Singapore
| | - E O T Chan
- S.H. Ho Urology Centre, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - M Wroclawski
- Department of Urology, Hospital Israelita Albert Einstein, São Paulo, Brazil.,BP-a Beneficência Portuguesa de São Paulo, São Paulo, Brazil
| | - G M Pirola
- Department of Urology, San Donato Hospital, Arezzo, Italy
| | - C Giulioni
- Urology Division, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Università Politecnica Delle Marche, Ancona, Italy
| | - E Rubilotta
- Department of Urology, A.O.U.I. Verona University, Verona, Italy
| | - M Gubbioti
- Department of Urology, San Donato Hospital, Arezzo, Italy
| | - S Scarcella
- Urology Division, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Università Politecnica Delle Marche, Ancona, Italy
| | - B H Chew
- Department of Urologic Sciences, University of British Columbia, Vancouver, Canada
| | - O Traxer
- Service d'Urologie, Sorbonne Université, Paris, France.,Service d'Urologie, AP-HP, Hôpital Tenon, Paris, France
| | - B K Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - V Gauhar
- Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore
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Vaggers S, Rai BP, Chedgy ECP, de la Taille A, Somani BK. Polyethylene glycol-based hydrogel rectal spacers for prostate brachytherapy: a systematic review with a focus on technique. World J Urol 2021; 39:1769-1780. [PMID: 32840655 PMCID: PMC8217059 DOI: 10.1007/s00345-020-03414-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 08/13/2020] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Radiation dose to the rectum in prostate brachytherapy (PBT) can be reduced by the use of polyethylene glycol (PEG) hydrogel spacers. This reduces the rate of rectal toxicity and allows dose escalation to the prostate. Our objectives were to provide an overview of technique for injection of a PEG hydrogel spacer, reduction in rectal dosimetry, gastrointestinal toxicity and potential complications. METHODS We systematically reviewed the role of PEG hydrogel spacers in PBT using the Cochrane and PRISMA methodology for all English-language articles from January 2013 to December 2019. Data was extracted for type of radiotherapy, number of patients, type of PEG-hydrogel used, mean prostate-rectum separation, rectal dosimetry, acute and late GI toxicity, procedure-related complications and the technique used for hydrogel insertion. RESULTS Nine studies (671 patients and 537 controls) met our inclusion criteria. Of these 4 used DuraSeal® and 5 used SpaceOAR®. The rectal spacing achieved varied between 7.7-16 mm. Failure of hydrogel insertion was seen only in 12 patients, mostly related to failure of hydrodissection in patients undergoing salvage PBT. Where reported, the rectal D2 cc was reduced by between 21.6 and 52.6% and the median rectal V75% cc was reduced by between 91.8-100%. Acute GI complications were mostly limited to grade 1 or 2 toxicity (n = 153, 33.7%) with low levels of grade 3 or 4 toxicity (n = 1, 0.22%). Procedure-related complications were limited to tenesmus (0.14%), rectal discomfort (1.19%), and bacterial prostatitis (0.44%). CONCLUSIONS PEG hydrogel spacers are safe to insert. Gel insertion is easy, fast and has a low rate of failure. These studies convincingly demonstrate a significant reduction in rectal dosimetry. Although the results of spacers in reducing rectal toxicity is promising, these need to be confirmed in prospective randomised trial.
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Affiliation(s)
- S. Vaggers
- University Hospital Southampton NHS Trust, Southampton, UK
| | | | | | - A. de la Taille
- Department of Urology, Robotic and Miniinvasive Surgery, Assistance Publique des Hopitaux de Paris, 94000 Créteil, France
| | - B. K. Somani
- University Hospital Southampton NHS Trust, Southampton, UK
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Premakumar Y, Gadiyar N, Hameed BMZ, Veneziano D, Somani BK. Association of Kidney Stone Disease (KSD) with Primary Gastrointestinal Surgery: a Systematic Review over Last 2 Decades. Curr Urol Rep 2021; 22:34. [PMID: 34027628 PMCID: PMC8141483 DOI: 10.1007/s11934-021-01046-w] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW We aim to provide an up-to-date literature review to further characterise the association of kidney stone disease (KSD) with gastrointestinal (GI) surgery. As KSD is associated with significant morbidity, it is important to quantify and qualify this association to provide better care and management for the patient subgroup. OBJECTIVE To perform a systematic review of the existing literature to evaluate the association of KSD following GI surgery. METHODS A literature search was performed of the following databases: MEDLINE, EMBASE, Scopus, Google Scholar, Key Urology, Uptodate and Cochrane Trials from January 2000 to June 2020. RECENT FINDINGS A total of 106 articles were identified, and after screening for titles, abstracts and full articles, 12 full papers were included. This involved a total of 9299 patients who underwent primary GI surgery. Over a mean follow-up period of 5.4 years (range: 1-14.4 years), 819 (8.8%) developed KSD, varying from 1.2 to 83% across studies. The mean time to stone formation was approximately 3 years (range: 0.5-9 years). In the 4 studies that reported on the management of KSD (n = 427), 38.6% went on to have urological intervention. There is a high incidence of KSD following primary GI surgery, and after a mean follow-up of 3 years, around 9% of patients developed KSD. While the GI surgery was done for obesity, inflammatory bowel disease or cancer, the risk of KSD should be kept in mind during follow-up, and prompt urology involvement with metabolic assessment, medical and or surgical management offered as applicable.
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Affiliation(s)
| | - N. Gadiyar
- Croydon University Hospital NHS Trust, London, UK
| | - B. M. Zeeshan Hameed
- Department of Urology, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka India
| | - D. Veneziano
- Department of Urology and Kidney transplant, Grande Ospedale Metropolitano di Reggio, Reggio di Calabria, Italy
| | - B. K. Somani
- University Hospital Southampton NHS Trust, Southampton, UK
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9
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Mosquera L, Pietropaolo A, Brewin A, Madarriaga YQ, de Knecht EL, Jones P, Bujons A, Griffin S, Somani BK. Safety and Outcomes of using ureteric access sheath (UAS) for treatment of Pediatric renal stones: Outcomes from 2 tertiary endourology centers. Urology 2021; 157:222-226. [PMID: 33891927 DOI: 10.1016/j.urology.2021.04.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 02/15/2021] [Revised: 04/03/2021] [Accepted: 04/09/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To look at the safety and outcomes of using ureteral access sheath (UAS) for pediatric renal stones. The use of UAS is variable in urological practice with very little clinical work on their use in pediatric kidney stone disease. PATIENTS AND METHODS Data was retrospectively collected from 2 large European tertiary endourology centers for all pediatric patients (≤16 years) with renal stones who underwent flexible ureteroscopy and lasertripsy (FURSL) via UAS. Data was collected on patient details, stone demographics and clinical outcomes of the FURSL procedure. RESULTS Forty-eight patients with a mean age of 10.7 years were treated with FURSL for a mean single and cumulative stone size of 10.4 mm and 15 mm respectively, with two-third having multiple stones and stones in the lower pole. The initial and final stone free rate (SFR) was 66.7% and 100% respectively with 1.3 procedures/patient. One patient each had intra-operative grade 1 ureteric injury and post-operative UTI, with no other injuries or complications noted. Over a mean follow-up of 17 months, no other complications were noted. CONCLUSION Ureteral access sheath is safe for treatment of pediatric renal stones with excellent outcomes and are especially useful for larger or multiple stones. While there does not seem to be any medium-term sequalae, to avoid risk of ureteral injury, we would suggest using the smallest size sheath possible. We would argue these procedures are best done in specialist high-volume endourology units for optimal results.
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Affiliation(s)
- L Mosquera
- University Hospital Southampton NHS Trust, Southampton, United Kingdom
| | - A Pietropaolo
- University Hospital Southampton NHS Trust, Southampton, United Kingdom
| | - A Brewin
- University Hospital Southampton NHS Trust, Southampton, United Kingdom
| | | | | | - P Jones
- University Hospital Southampton NHS Trust, Southampton, United Kingdom
| | - A Bujons
- Urology Department, Fundació Puigvert, Barcelona, Spain
| | - S Griffin
- Southampton Children's Hospital NHS Trust, Southampton, United Kingdom
| | - B K Somani
- University Hospital Southampton NHS Trust, Southampton, United Kingdom.
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10
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Siena G, Cindolo L, Ferrari G, Maruzzi D, Fasolis G, Condorelli SV, Varvello F, Visalli F, Rabito S, Toso S, Caroassai S, Mari A, Viola L, Somani BK, Carini M. Water vapor therapy (Rezūm) for lower urinary tract symptoms related to benign prostatic hyperplasia: early results from the first Italian multicentric study. World J Urol 2021; 39:3875-3880. [PMID: 33787986 PMCID: PMC8010783 DOI: 10.1007/s00345-021-03642-4] [Citation(s) in RCA: 21] [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: 11/23/2020] [Accepted: 02/18/2021] [Indexed: 12/20/2022] Open
Abstract
Purpose Rezūm is the latest developed minimally invasive treatment for benign prostatic hyperplasia (BPH). We aimed to carefully assess the functional outcomes of patients treated with Rezūm for BPH. Methods We prospectively followed 135 consecutive patients treated by Rezūm at 5 institutions from June 2019 to August 2020. The International Prostate Symptom Score (IPSS), International Consultation on Incontinence Questionnaire-Short Form (ICIQ-UI SF), the Overactive Bladder Questionnaire-Short Form (OAB-q SF) score, the International Index of Erectile Function (IIEF-5) and questions 9 and 10 to assess ejaculatory dysfunction were recorded. Election criteria were age > 18, no prior prostate interventions, IPSS ≥ 13, post-void residual ≤ 250 mL, prostate volume between 30 and 120 cc. Results The median operative time was 10.5 (IQR 8.7–15) min. All patients were dismissed few hours after surgery with indwelling urinary catheter that was removed after a median of 7 (IQR 7–10) days. A significantly decrease of IPSS from baseline at first (p = 0.001) and third (p < 0.0001) month after surgery was reported. No difference was reported in terms of ICIQ-UI SF score postoperatively. A mild reduction of the OAB-q SF score was reported at 1 month from surgery (p = 0.06) that turned significant at 3 months postoperatively (p < 0.0001). A slight but statistically significant increase of the IIEF-5 score was reported from baseline at 6 months (p = 0.04). Postoperatively, patients reported a significantly decrease of ejaculatory dysfunction after alpha-blocker interruption. Conclusion Rezūm treatment is a feasible minimally invasive option for patients with BPH symptoms and showed optimal early functional outcomes.
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Affiliation(s)
- Giampaolo Siena
- Department of Urology, Careggi Hospital, University of Florence, San Luca Nuovo, Florence, Italy.
| | - L Cindolo
- Department of Urology, Villa Stuart, Private Hospital, Rome, Italy.,Department of Urology, Hesperia Hospital, Cure Group, Modena, Italy
| | - G Ferrari
- Department of Urology, Hesperia Hospital, Cure Group, Modena, Italy
| | - D Maruzzi
- Department of Urology, S. Maria Degli Angeli Hospital, Pordenone, Italy
| | - G Fasolis
- Department of Urology, Michele e Pietro Ferrero Hospital, Alba-Bra, Italy
| | - S V Condorelli
- Department of Urology, Vittorio Emanuele Hospital, Gela, Italy
| | - F Varvello
- Department of Urology, Michele e Pietro Ferrero Hospital, Alba-Bra, Italy
| | - F Visalli
- Department of Urology, S. Maria Degli Angeli Hospital, Pordenone, Italy
| | - S Rabito
- Department of Urology, Hesperia Hospital, Cure Group, Modena, Italy
| | - S Toso
- Department of Urology, Hesperia Hospital, Cure Group, Modena, Italy
| | - S Caroassai
- Department of Urology, Careggi Hospital, University of Florence, San Luca Nuovo, Florence, Italy
| | - A Mari
- Department of Urology, Careggi Hospital, University of Florence, San Luca Nuovo, Florence, Italy
| | - L Viola
- Department of Urology, Careggi Hospital, University of Florence, San Luca Nuovo, Florence, Italy
| | - B K Somani
- University Hospital Southampton NHS Trust, Tremona Road, Southampton, SO16 6YD, Hampshire, UK
| | - M Carini
- Department of Urology, Careggi Hospital, University of Florence, San Luca Nuovo, Florence, Italy
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11
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Schembri M, Pietropaolo A, Somani BK. Treatment of isolated small renal stones leads to resolution of symptoms and should be routinely offered to patients: retrospective outcomes from a university hospital. Scand J Urol 2020; 54:339-343. [PMID: 32686567 DOI: 10.1080/21681805.2020.1793810] [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] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Treatment of smaller renal stones and the symptomatic value it offers to patients is often debated. We wanted to analyse surgical outcomes for treatment of small renal stones and whether treatment resulted in symptom resolution. MATERIALS AND METHODS All patients who underwent ureterorenoscopy (URS) for isolated symptomatic small renal stones ≤10 mm over a 7-year period were retrospectively included and subdivided into those with stones of ≤7 mm (Group A) and stones of 8-10 mm (Group B). Patients with multiple renal stones, ureteric stones, or combined renal and ureteric stones were excluded. Based on the symptoms, the patient groups were those with pain, urinary tract infection (UTI) and haematuria. Resolution of symptoms was defined as no symptoms during the follow-up period. RESULTS A total of 109 patients with a single small renal stone ≤10 mm underwent URS and stone treatment, with mean age of 50 years and a male:female ratio of 1:1.2. The mean operative time was significantly longer in Group B (55.9 min vs 33.07 min, p = 0.001). In total, 97.2% (n = 70) of patients in Group A and 83.7% (n = 31) of patients in Group B were stone free (p = 0.017). Complete resolution of symptoms was seen in 63 (92.6%), 24 (85.7%) and 13 (100%) patients with pain, UTI and haematuria, respectively. There were no statistically significant differences in symptom resolution between patients with stones ≤7 mm and those with stones 8-10 mm in size. CONCLUSION Ureteroscopic treatment is a feasible option for small symptomatic stones, since it may lead to symptom resolution. Based on our study we would recommend that patients with symptomatic small renal stones are offered endoscopic treatment.
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Affiliation(s)
- M Schembri
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - A Pietropaolo
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - B K Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
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12
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Saraogi M, Geraghty RM, Hameed B, Rob S, Pietropaolo A, Sarica K, Gozen A, Liatsikos E, Somani BK. Role of Complementary Medicine (Music, Acupuncture, Acupressure, TENS and Audio-Visual Distraction) in Shockwave Lithotripsy (SWL): A Systematic Review From EAU Sections of Urolithiasis (EULIS) and Uro-Technology (ESUT). Urology 2020; 145:38-51. [PMID: 32640263 DOI: 10.1016/j.urology.2020.06.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 06/21/2020] [Indexed: 11/27/2022]
Abstract
We performed a systematic review to look at the role of alternative or complementary medicine such as music, acupressure, acupuncture, transcutaneous electrical nerve stimulation (TENS) and audiovisual distractions to decrease analgesia requirement and alleviate anxiety during SWL. Twenty-three papers(2439 participants) were included: Music (n = 1056.6%), Acupuncture (n = 517.7%), Acupressure (n = 13.8%), TENS (n = 617.2%), and audiovisual distraction (n = 14.6%). Most of the studies showed that complementary therapy, lowered pain, and anxiety with higher patient satisfaction and willingness to undergo the procedure. With its feasibility and convenience, urological guidelines need to endorse it, and more should be done to promote its use in outpatient urological procedures.
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Affiliation(s)
- M Saraogi
- Faculty of Life and Environmental Sciences, University of Southampton, United Kindom
| | - R M Geraghty
- Department of Urology, University hospital Newcastle, United Kindom
| | - Bmz Hameed
- Department of Urology, Kasturba Medical College Manipal, Manipal Academy of Higher Education (MAHE), Karnataka, India
| | - S Rob
- Department of Urology, University Hospital Southampton NHS Trust, United Kindom
| | - A Pietropaolo
- Department of Urology, University Hospital Southampton NHS Trust, United Kindom
| | - K Sarica
- Department of Urology, Biruni University Medical School, Istanbul, Turkey
| | - A Gozen
- Department of Urology, Klinikum Heilbronn, Heilbronn, Germany
| | - E Liatsikos
- Department of Urology, University of Patras, Patras, Greece
| | - B K Somani
- Department of Urology, University Hospital Southampton NHS Trust, United Kindom.
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13
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Emiliani E, Kanashiro A, Chi T, Pérez-Fentes DA, Manzo BO, Angerri O, Somani BK. Fluoroless Endourological Surgery for Stone Disease: a Review of the Literature—Tips and Tricks. Curr Urol Rep 2020; 21:27. [DOI: 10.1007/s11934-020-00979-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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14
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Veneziano D, Tafuri A, Rivas JG, Dourado A, Okhunov Z, Somani BK, Marino N, Fuchs G, Cacciamani G. Is remote live urologic surgery a reality? Evidences from a systematic review of the literature. World J Urol 2019; 38:2367-2376. [PMID: 31701210 DOI: 10.1007/s00345-019-02996-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 07/25/2019] [Accepted: 10/20/2019] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES The possibility of performing remote-surgery has been the goal to achieve, since the early development of the first surgical robotic platforms. This systematic review aims to analyse the state of the art in the field and to provide an overview of the possible growth of this technology. METHODS All English language publications on Telementoring and Telesurgery for minimally invasive urologic procedures were evaluated. We followed the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) statement to evaluate PubMed®, Scopus®, and Web of Science™ databases (up to June 2019). RESULTS Our electronic search identified a total of 124 papers in PubMed, Scopus, and Web of Science. Of these, 81 publications were identified for detailed review, which yielded 22 included in the present systematic review. Our results showed that remote surgery has been under-utilised until today, mostly due to the lack of appropriate telecommunication technologies. CONCLUSION Remote live surgery is a growing technology that is catalyzing incremental interest. Despite not being yet reliable today on a regular basis in its most advanced applications, thanks to the advent of novel data-transmission technologies, telepresence might become a critical educational methodology, highly impacting the global healthcare system.
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Affiliation(s)
- Domenico Veneziano
- Department of Urology and Kidney Transplant, Grande Ospedale Metropolitano, Reggio Calabria, Italy. .,Department of Urology, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
| | - A Tafuri
- USC Institute of Urology and Catherine and Joseph, University of Southern California, Los Angeles, CA, USA.,Department of Urology, University of Verona, Verona, Italy
| | - J Gomez Rivas
- Department of Urology, Hospital Universitario La Paz, Madrid, Spain
| | - A Dourado
- Department of Urology, Camargo Cancer Center, Sao Paulo, Brasil
| | - Z Okhunov
- Department of Urology, University of California, Irvine, CA, USA
| | - B K Somani
- University Hospital Southampton NHS Trust, Southampton, UK
| | - N Marino
- University of Foggia, Foggia, Italy
| | - G Fuchs
- USC Institute of Urology and Catherine and Joseph, University of Southern California, Los Angeles, CA, USA
| | - G Cacciamani
- USC Institute of Urology and Catherine and Joseph, University of Southern California, Los Angeles, CA, USA
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15
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Mosayyebi A, Lange D, Yann Yue Q, Somani BK, Zhang X, Manes C, Carugo D. Reducing deposition of encrustation in ureteric stents by changing the stent architecture: A microfluidic-based investigation. Biomicrofluidics 2019; 13:014101. [PMID: 30867872 PMCID: PMC6404931 DOI: 10.1063/1.5059370] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 12/18/2018] [Indexed: 05/08/2023]
Abstract
Ureteric stents are clinically deployed to retain ureteral patency in the presence of an obstruction of the ureter lumen. Despite the fact that multiple stent designs have been researched in recent years, encrustation and biofilm-associated infections remain significant complications of ureteral stenting, potentially leading to the functional failure of the stent. It has been suggested that "inactive" side-holes of stents may act as anchoring sites for encrusting crystals, as they are associated with low wall shear stress (WSS) levels. Obstruction of side-holes due to encrustation is particularly detrimental to the function of the stent, since holes provide a path for urine to by-pass the occlusion. Therefore, there is an unmet need to develop novel stents to reduce deposition of encrusting particles at side-holes. In this study, we employed a stent-on-chip microfluidic model of the stented and occluded ureter to investigate the effect of stent architecture on WSS distribution and encrustation over its surface. Variations in the stent geometry encompassed (i) the wall thickness and (ii) the shape of side-holes. Stent thickness was varied in the range 0.3-0.7 mm, while streamlined side-holes of triangular shape were evaluated (with a vertex angle in the range 45°-120°). Reducing the thickness of the stent increased WSS and thus reduced the encrustation rate at side-holes. A further improvement in performance was achieved by using side-holes with a triangular shape; notably, a 45° vertex angle showed superior performance compared to other angles investigated, resulting in a significant increase in WSS within "inactive" side-holes. In conclusion, combining the optimal stent thickness (0.3 mm) and hole vertex angle (45°) resulted in a ∼90% reduction in encrustation rate within side-holes, compared to a standard design. If translated to a full-scale ureteric stent, this optimised architecture has the potential for significantly increasing the stent lifetime while reducing clinical complications.
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Affiliation(s)
| | - D. Lange
- Department of Urologic Sciences, Faculty of Medicine, University of British Columbia, Vancouver V6H 3Y8, Canada
| | - Q. Yann Yue
- Department of Mechanical Engineering, Faculty of Engineering and Physical Sciences, University of Southampton, Southampton SO17 1BJ, United Kingdom
| | - B. K. Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton SO16 6YD, United Kingdom
| | | | - C. Manes
- Department of Environment, Land and Infrastructure Engineering, Politecnico di Torino, Turin 10129, Italy
| | - D. Carugo
- Author to whom correspondence should be addressed:
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16
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Featherstone NC, Somani BK, Griffin SJ. Ureteroscopy and laser stone fragmentation (URSL) for large (≥1 cm) paediatric stones: Outcomes from a university teaching hospital. J Pediatr Urol 2017; 13:202.e1-202.e7. [PMID: 28336220 DOI: 10.1016/j.jpurol.2016.07.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 02/16/2016] [Accepted: 07/19/2016] [Indexed: 12/23/2022]
Abstract
INTRODUCTION The treatment of large renal stones (≥1 cm) in paediatric patients is challenging. The usual treatment options include percutaneous nephrolithotomy (PCNL) or shockwave lithotripsy (SWL). There is a rise in the use of ureteroscopy and laser stone fragmentation (URSL) for paediatric stones; however, outcomes of treatment for large renal stones in this age group are still largely unknown. OBJECTIVE To investigate the outcome of URSL for large paediatric renal stones ≥1 cm treated at the present institution over the last 5 years. METHODS A retrospective review was performed of outcomes from the prospectively maintained stone database. Only paediatric patients undergoing ureteroscopic (rigid or flexible ureteroscopy (URS)) procedures for stones ≥1 cm were included. Patient demographics, operative details, stone burden, hospital stay, complications and stone clearance were recorded and analysed. RESULTS From April 2010 to June 2015, 18 paediatric patients with a mean age of 10.4 years (range 3.6-15) underwent 35 ureteroscopic procedures for large stones (≥1 cm). The stone location was in the kidney (n = 14), ureter (n = 1), and in both the kidney and ureter for the remaining three patients. Nine patients had multiple stones. There was a preceding history of PCNL in four patients, with one patient having URS combined with a PCNL. The mean follow-up was 2.7 years (range 0-5). A postoperative stent was inserted in 21 (60%) patients. The overall stone-free rate (SFR) was 89% for a mean of 1.8 procedures per patient (range 1-4) - see Summary Table below. There was an inability to access stone within a lower pole calyx in one patient, despite maximum deflection of the ureteroscope. No intra- or post-operative complications were noted, and mean hospital stay was 1.1 days (range 0-5). DISCUSSION Published papers in adult literature have shown that ureteroscopy and laser fragmentation (URSL) is a viable alternative to PCNL. Newer equipment and improved techniques have resulted in SFRs being comparable with PCNL. A recent systematic review reported an SFR of 91% for large adult stones (>2 cm) for a mean 1.45 procedures per patient, and an overall complication rate of 8.6%. The present study has also demonstrated excellent outcomes in the use of ureteroscopy and laser fragmentation for the management of large paediatric stones with no complications. CONCLUSION The results show that paediatric URSL for large stones achieves a good SFR with minimal morbidity and is a good treatment option in established endourological units.
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Affiliation(s)
- N C Featherstone
- Department of Paediatric Urology, University Hospital Southampton NHS Trust, Tremona Road, Southampton, UK.
| | - B K Somani
- Department of Urology, University Hospital Southampton NHS Trust, Tremona Road, Southampton, UK
| | - S J Griffin
- Department of Paediatric Urology, University Hospital Southampton NHS Trust, Tremona Road, Southampton, UK
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17
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Somani BK, Giusti G, Sun Y, Osther PJ, Frank M, De Sio M, Turna B, de la Rosette J. Complications associated with ureterorenoscopy (URS) related to treatment of urolithiasis: the Clinical Research Office of Endourological Society URS Global study. World J Urol 2017; 35:675-681. [PMID: 27492012 PMCID: PMC5364249 DOI: 10.1007/s00345-016-1909-0] [Citation(s) in RCA: 110] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 07/25/2016] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Ureterorenoscopy (URS) is a popular and growing option for management of ureteric and renal stones. The CROES URS Global Study was set up to assess the outcomes of URS in a large worldwide cohort of patients involving multiple centres. In this paper, we analysed the database for intra-operative and post-operative complications associated with ureterorenoscopy. METHODS The CROES database was established via collaboration between 114 centres in 32 countries worldwide, and information on both intra-operative and post-operative complications was collected electronically between January 2010 and October 2012. RESULT On analysis of a total of 11,885 patients, the overall complication and stone-free rates were found to be 7.4 and 85.6 %, respectively. The intra-operative and post-operative complication rates were 4.2 and 2.6 %, respectively, and in total 5 deaths were reported in the study period. Taking into account different world economies, there were no differences in the complication rates between the developing and developed nations or between different centres from different continents. CONCLUSION Ureterorenoscopy is a safe and effective procedure for treatment of stones, the outcomes of which are broadly comparable in different parts of the world for similar patient and stone demographics.
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Affiliation(s)
- B K Somani
- Department of Urology, University Hospital Southampton, Southampton, UK
| | - G Giusti
- Department of Urology, IRCCS San Raffaele Scientific Institute, Ville Turro Division, Milan, Italy
| | - Y Sun
- Department of Urology, Changhai Hospital, Shanghai, China
| | - P J Osther
- Department of Urology, Lillebaelt Hospital, Fredericia, Denmark
| | - M Frank
- Department of Urology, City Hospital Number 40, Yekaterinburg, Russia
| | - M De Sio
- Urology Unit, Second University of Naples, Naples, Italy
| | - B Turna
- Department of Urology, Ege University School of Medicine, Izmir, Turkey
| | - J de la Rosette
- Department of Urology, AMC University Hospital, Meibergdreef 9, 1105 AZ, Amsterdam Z-O, The Netherlands.
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18
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Rob S, Bryant T, Wilson I, Somani BK. Ultra-low-dose, low-dose, and standard-dose CT of the kidney, ureters, and bladder: is there a difference? Results from a systematic review of the literature. Clin Radiol 2016; 72:11-15. [PMID: 27810168 DOI: 10.1016/j.crad.2016.10.005] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 09/25/2016] [Accepted: 10/06/2016] [Indexed: 01/26/2023]
Abstract
AIM To investigate whether reducing the radiation dose of computed tomography (CT) of the kidney, ureters, and bladder (KUB) for acute renal colic impacts upon the specificity, sensitivity, and detection of urolithiasis. MATERIALS AND METHODS A systematic review of the literature over a 20-year period between 1995 and 2015 was conducted of all prospective studies in the English language reporting on adult patients who underwent CT KUB or non-contrast CT for renal colic or urolithiasis. Retrospective studies and those that included pregnant females, children, non-human test subjects, cadaveric use, and simulations were excluded. Data were collected using an Excel spreadsheet and ultra-low-dose (ULD CT) and low-dose CT KUB (LD CT) was defined as a radiation dose ≤1.9 and <3.5 mSv, respectively. RESULTS A total of 417 articles were identified, and after screening, seven articles (1,104 patients) were included in the present study with a male:female ratio of 3:2. Of the four studies with ULD CT for both males and females, the prevalence of urolithiasis ranged from 36% and 73%, with additional pathologies found in 12-15%. The effective radiation dose of ULD CT ranged from 0.5-1.9 mSv. Overall, ULD CT and LD CT had a sensitivity of 90-100% and a specificity of 86-100% across all studies. CONCLUSIONS ULD CT and LD CT are effective techniques and yield high sensitivity and specificity. Although they yield comparable results against standard-dose CT KUB in detecting alternative diagnoses, they may not be as effective in detecting stones <3 mm in size or in patients with a body mass index of >30 kg/m2; however, this should be the first-line investigation for the majority of renal colic patients in the modern era.
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Affiliation(s)
- S Rob
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, UK
| | - T Bryant
- Department of Radiology, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, UK
| | - I Wilson
- Department of Radiology, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, UK
| | - B K Somani
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, UK.
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19
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Wells H, Rukin N, Wright A, Somani BK. Outcome-Based Comparison of Percutaneous Procedures for Urinary Lithiasis with Calibre of Instrumentation less than 12Fr. Curr Urol Rep 2016; 16:53. [PMID: 26077356 DOI: 10.1007/s11934-015-0528-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Renal stone disease is becoming increasingly prevalent globally. With a rise in stone disease worldwide, there is also a relative increase in the rates of surgical intervention. Technological advances have allowed a move towards minimising the complications rates and length of stay with a reduction in invasiveness and size of instruments. A trend for minimising the percutaneous tract size has been noted in percutaneous nephrolithotomy (PCNL) for renal stones. The management has shifted from open surgery to standard PCNL, mini-PCNL and the latest ultra-mini and micro-PCNL techniques. There is a need to compare outcomes for the ever-advancing technologies, such as the smaller calibre of instruments, to assess risk-benefit in practice. This review looks at outcome-based comparison of percutaneous procedures for urinary lithiasis with instruments <12Fr in size.
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Affiliation(s)
- H Wells
- University Hospital Southampton NHS Trust, Southampton, UK
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Ishii H, Griffin S, Somani BK. Flexible ureteroscopy and lasertripsy (FURSL) for paediatric renal calculi: results from a systematic review. J Pediatr Urol 2014; 10:1020-5. [PMID: 25241397 DOI: 10.1016/j.jpurol.2014.08.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [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: 01/14/2014] [Accepted: 08/06/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To understand the role, safety and efficacy of flexible ureterorenoscopy and lasertripsy (FURSL) for paediatric renal stones. MATERIAL AND METHODS A systematic review was conducted using studies identified by a literature search between January 1990 and March 2014. All English language articles reporting on a minimum of five patients≤18-years old, treated with flexible ureteroscopy and lasertripsy for stone disease were included. RESULTS A total of six studies (282 patients) were reported, with a mean age of 7.3 years (range 0.25-17 years). The stone sizes ranged from 1 to 30 mm. The mean stone-free rate across the three studies was 85.5% (range 58.0-93.0%) after initial ureteroscopy, with a postoperative stent inserted in 81.8% (range 66.7-98.0%). There were a total of 35 complications (12.4%), with the most severe complication being a Clavien class III (five ureteral injuries, one urinoma). There were no deaths in any of the studies. CONCLUSION The present review shows that FURSL for management of renal calculi in the paediatric population is an effective and safe procedure. To ensure that outcomes keep on improving, these procedures should be undertaken by experienced surgeons who are familiar with the difficulties encountered in the paediatric population.
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Affiliation(s)
- H Ishii
- Department of Urology, University Hospital Southampton NHS Trust, Southampton SO16 6YD, UK
| | - S Griffin
- Department of Paediatric Surgery, University Hospital Southampton NHS Trust, Southampton SO16 6YD, UK
| | - B K Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton SO16 6YD, UK.
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Ngee-Ming G, Tamsin D, Rai BP, Somani BK. Complementary approaches to decreasing discomfort during shockwave lithotripsy (SWL). Urolithiasis 2014; 42:189-93. [DOI: 10.1007/s00240-014-0655-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2013] [Accepted: 03/04/2014] [Indexed: 11/29/2022]
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Green A, Tait C, Aboumarzouk O, Somani BK, Cohen NP. There are calls for a national screening programme for prostate cancer: what is the evidence to justify such a national screening programme? Scott Med J 2013; 58:64-8. [PMID: 23728749 DOI: 10.1177/0036933013482631] [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] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Prostate cancer is the commonest cancer in men and a major health issue worldwide. Screening for early disease has been available for many years, but there is still no national screening programme established in the United Kingdom. OBJECTIVE To assess the latest evidence regarding prostate cancer screening and whether it meets the necessary requirements to be established as a national programme for all men. METHODS Electronic databases and library catalogues were searched electronically and manual retrieval was performed. Only primary research results were used for the analysis. RESULTS In recent years, several important randomised controlled trials have produced varied outcomes. In Europe the largest study thus far concluded that screening reduced prostate cancer mortality by 20%. On the contrary, a large American trial found no reduction in mortality after 7-10 years follow-up. Most studies comment on the adverse effects of screening - principally those of overdiagnosis and subsequent overtreatment. DISCUSSION Further information about the natural history of prostate cancer and accuracy of screening is needed before a screening programme can be truly justified. In the interim, doctors and patients should discuss the risks, benefits and sequelae of taking part in voluntary screening for prostate cancer.
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Affiliation(s)
- A Green
- School of Medicine and Dentistry, University of Aberdeen, Foresterhill, Aberdeen, UK.
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Laing KA, Lam TBL, McClinton S, Cohen NP, Traxer O, Somani BK. Outcomes of ureteroscopy for stone disease in pregnancy: results from a systematic review of the literature. Urol Int 2012; 89:380-6. [PMID: 23147596 DOI: 10.1159/000343732] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Our aim was to evaluate the clinical efficacy and safety of ureteroscopy as a primary treatment for pregnant women with symptomatic ureteric stones who have failed conservative management. MATERIALS AND METHODS A systematic review of the literature from January 1990 to June 2011 was performed, including all English language articles. Outcome measures were clinical efficacy, in terms of stone clearance and need for additional procedures, and safety in terms of complications. RESULTS A total of 239 abstracts were screened and 15 studies were identified reporting on 116 procedures. The surgical methods of stone management employed were stone extraction with basket only (n = 55, 47%), laser fragmentation (n = 27, 23%; holmium, n = 20, pulse dye, n = 7), impact lithotripsy (n = 21, 18%), ureteroscopic lithotripsy (n = 6, 5%) and a combination of methods (n = 6, 5%). A post-operative stent was inserted in 64 of 116 procedures (55%). Complete stone clearance was seen in 100 of the 116 procedures (86%). There were 2 major complications (1 ureteral perforation and 1 case of premature uterine contraction) and 7 minor complications (5 urinary tract infections and 2 cases of post-operative pain). CONCLUSION This review suggests that stone clearance using ureteroscopy is a relatively safe option in pregnancy with a high success rate.
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Affiliation(s)
- K A Laing
- Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK
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Mishriki SF, Vint R, Somani BK. Half of Visible and Half of Recurrent Visible Hematuria Cases have Underlying Pathology: Prospective Large Cohort Study with Long-Term Follow-Up. J Urol 2012:S0022-5347(12)04898-7. [PMID: 22986035 DOI: 10.1016/j.juro.2012.08.213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2012] [Indexed: 11/20/2022]
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Somani BK, Watson G, Townell N. [Testicular torsion]. Praxis (Bern 1994) 2011; 100:599-601. [PMID: 21563097 DOI: 10.1024/1661-8157/a000531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Somani BK, Moseley H, Eljamel MS, Nabi G, Kata SG. Photodynamic diagnosis (PDD) for upper urinary tract transitional cell carcinoma (UT-TCC): evolution of a new technique. Photodiagnosis Photodyn Ther 2010; 7:39-43. [PMID: 20230992 DOI: 10.1016/j.pdpdt.2009.12.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2009] [Revised: 12/13/2009] [Accepted: 12/14/2009] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Transitional cell carcinoma of renal pelvis and ureter account was traditionally treated with nephroureterectomy. With the advent of rigid and flexible ureteroscopes endoscopic access to the ureter and renal pelvis for diagnosis and treatment has become a reality. We did fluorescence ureteroscopy using oral 5-ALA to diagnose upper tract urothelial tumours for four patients. Here we describe this technique and assess its feasibility to diagnose ureteric and renal pelvicalyceal tumours. MATERIALS AND METHODS A prospective pilot study was performed to assess the feasibility of PDD using oral 5-amino levulinic acid (ALA) for upper urinary tract tumours. RESULTS Four patients underwent PDD guided flexible ureteroscopy of the upper urinary tract. Obvious exophytic tumour seen on white light was also seen as red fluorescence on blue light. All areas with red fluorescence were biopsied (including additional areas not seen on white light) and were confirmed to be transitional cell carcinoma. CONCLUSION Photodynamic diagnosis using oral 5-ALA and subsequent treatment of upper tract urothelial tumours is safe and feasible with additional advantages of detecting lesions not visualised on conventional white light endoscopy.
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Affiliation(s)
- B K Somani
- Department of Urology, Ninewells Hospital & Medical School, Dundee DD1 9SY, UK.
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Somani BK, Prita D, Grant S, Nabi G, N'dow J. Herpetiform cutaneous metastases from transitional cell carcinoma of the urinary bladder: immunohistochemical analysis. J Clin Pathol 2007; 59:1331-3. [PMID: 17142578 PMCID: PMC1860531 DOI: 10.1136/jcp.2005.031500] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The case of an 83-year-old woman with an uncommon presentation of cutaneous metastases from muscle-invasive transitional cell carcinoma of the urinary bladder is reported. The band-like eruption of the metastatic lesion can often be misdiagnosed and treated initially as herpes zoster. A detailed immunohistochemical analysis is also described to differentiate metastatic lesions from other sources.
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Affiliation(s)
- B K Somani
- Department of Urology, Aberdeen Royal Infirmary Hospital, Aberdeen, Scotland, UK
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Abstract
PURPOSE The aim of this study was to critically appraise the efficacy and complications of Therapeutic Transarterial Embolisation (TAE) in various benign and malignant renal conditions. MATERIAL AND METHODS The records of all patients who underwent renal embolisation procedures, at a single institution, between March 1992 and March 2004, were reviewed. The patients were identified from hospital records via the procedure coding system and the radiology department procedures book and were analysed retrospectively. Twenty-nine patients were analysed, looking at indications, clinical outcome, complications and long-term results. RESULTS Twenty-nine patients underwent 35 embolisation procedures during this period. Fourteen patients with benign diseases underwent 17 embolisation procedures for haematuria or intractable pain. In the haematuria group, selective embolisation was used to treat bleeding post percutaneous nephrolithotomy (PCNL) (n=4), angiomyolipoma (n=2), arteriovenous (AV) malformation (n=l1), renal artery aneurysm (n=1) and renal trauma (n=2). In the renal pain group (n=3), non-selective embolisation was done. Two of these patients had recurrence of pain despite repeat embolisation and subsequently underwent nephrectomy. Fifteen patients with advanced renal malignancy, who were deemed unfit for surgery, underwent 18 embolisation procedures for symptomatic haematuria. Twelve of the 15 patients had successful outcomes with cessation of haematuria. Three patients required repeat embolisation procedures for continuing haematuria with success. There were no major embolisation-related complications. Minor complications were self-limiting and settled with conservative management. CONCLUSION Renal artery embolisation is effective in managing haematuria in benign and malignant renal conditions where indicated, with minor and easily treatable adverse effects
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Affiliation(s)
- B K Somani
- Department of Urology, Aberdeen Royal Infirmary, Aberdeen, AB25 2WA, UK
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Nabi G, Somani BK, Steven LC, McClinton S. Technique of radiological localisation and endoscopic retrieval of unusual foreign body from urinary bladder. Int Urol Nephrol 2006; 38:251-4. [PMID: 16868692 DOI: 10.1007/s11255-006-0037-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Minimal invasive endoscopic retrieval of an unusual foreign body (Allen key) from urinary bladder in a young female patient is presented. The technique of radiological localisation using plain X-ray, often the only investigation available in small centres, is described.
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Affiliation(s)
- G Nabi
- Department of Urology, Aberdeen Royal Infirmary, AB25 2ZD, Aberdeen, UK.
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Somani BK, Nabi G, Thorpe P, Swami S. Spontaneous life-threatening perirenal haemorrhage: an uncommon urological emergency. Emerg Radiol 2005; 12:55-6. [PMID: 16333610 DOI: 10.1007/s10140-005-0439-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2005] [Accepted: 07/26/2005] [Indexed: 10/25/2022]
Abstract
Spontaneous perirenal haemorrhage is a rare but potentially life-threatening condition and requires urgent management. Diagnosis is based on clinical assessment combined with radiological investigations, as reported by Belville et al. (Radiology 172:733, 1989) and Zagoria et al. (J Urol 145:468, 1991). Reported is a case of spontaneous perirenal haemorrhage diagnosed on computed tomography scan and then successfully embolized using coils.
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Affiliation(s)
- B K Somani
- Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK.
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Somani BK, Nabi G, McClinton S. Successful embolization of symptomatic renal artery aneurysm in solitary kidney. Urology 2005; 65:795-6. [PMID: 15833532 DOI: 10.1016/j.urology.2004.12.055] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2004] [Revised: 12/07/2004] [Accepted: 12/21/2004] [Indexed: 10/25/2022]
Affiliation(s)
- B K Somani
- Department of Urology, Aberdeen Royal Infirmary, Aberdeen, Scotland, United Kingdom.
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