The use of a ureteral access sheath does not improve stone-free rate after ureteroscopy for upper urinary tract stones

Introduction: This single-centre, retrospective study aimed to assess the efficacy and safety of flexible ureteroscopy (FURS) combined with holmium laser lithotripsy in treating children with upper urinary tract stones. Methods: From June 2014 to October 2015, a total of 100 children (74 boys and 26 girls) with upper urinary tract stones were treated using FURS. A 4.7 Fr double-J stent was placed two weeks before operation. Patients were considered stone-free when the absence of residual fragments was observed on imaging studies. The preoperative, operative, and postoperative data of the patients were retrospectively analyzed. Results: A total of 100 pediatric patients with a mean age of 3.51±1.82 years underwent 131 FURS and holmium laser lithotripsy. Mean stone diameter was 1.49±0.92 cm. Average operation time was 30.8 minutes (range 15–60). The laser power was controlled between 18 and 32 W, and the energy maintained between 0.6 and 0.8 J at any time; laser frequency was controlled between 30 and 40 Hz. Complications were observed in 69 (69.0 %) patients and classified according to the Clavien system. Postoperative hematuria (Clavien I) occurred in 64 (64.0 %) patients. Postoperative urinary tract infection with fever (Clavien II) was observed in 8/113 (7.1%) patients. No ureteral perforation and mucosa avulsion occurred. The overall stone-free rate of single operation was 89/100 (89%). Stone diameter and staghorn calculi were significantly associated with stone-free rate. Conclusions: FURS and holmium laser lithotripsy is effective and safe in treating children with upper urinary tract stones.

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Value of Hounsfield Unit in Prediction of Stone Free Rate in Management of Upper Urinary Tract Stones Using Ct and Eswl

JOJ Urology & Nephrology ◽

10.19080/jojun.2015.01.555600 ◽

2017 ◽

Vol 2 (5) ◽

Author(s):

Abdelazim Hussein Khalafalla

Keyword(s):

Urinary Tract ◽

Hounsfield Unit ◽

Upper Urinary Tract ◽

Stone Free Rate ◽

Urinary Tract Stones ◽

Free Rate

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Value of Hounsfield Unit in Prediction of Stone Free Rate in Management of Upper Urinary Tract Stones Using Ct and Eswl

JOJ Urology & Nephrology ◽

10.19080/jojun.2017.2.555600 ◽

2017 ◽

Vol 2 (5) ◽

Author(s):

Abdelazim Hussein Khalafalla

Keyword(s):

Urinary Tract ◽

Hounsfield Unit ◽

Upper Urinary Tract ◽

Stone Free Rate ◽

Urinary Tract Stones ◽

Free Rate

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Comparison of the Efficacy of ShuoTong Ureteroscopy and Simple Flexible Ureteroscopy in the Treatment of Unilateral Upper Ureteral Calculi

Frontiers in Surgery ◽

10.3389/fsurg.2021.707022 ◽

2021 ◽

Vol 8 ◽

Author(s):

Longhui Lai ◽

Wenzhao Zhang ◽

Fangjian Zheng ◽

Tao Wang ◽

Peide Bai ◽

...

Keyword(s):

Postoperative Complications ◽

Operative Time ◽

Ureteral Calculi ◽

Flexible Ureteroscopy ◽

Ureteral Stones ◽

Ureteral Access Sheath ◽

Hospitalization Cost ◽

Access Sheath ◽

Stone Free Rate ◽

Free Rate

Background: ShuoTong ureteroscopy (Sotn-ureteroscopy, ST-URS), a new lithotripsy operation method developed on the basis of ureteroscopy, is widely used to treat ureteral stones in China. Its composition includes rigid ureteral access sheath, standard mirror, lithotripsy mirror, and ShuoTong perfusion aspirator (ST-APM). Here, we compared the efficacy and safety of the ST-URS and the flexible ureteroscope (F-URS) holmium laser lithotripsy in the treatment of unilateral upper ureteral calculi.Methods: Retrospective analysis was conducted on the clinical data of 280 patients who met the inclusion 1) urinary tract CT was diagnosed with unilateral single upper ureteral calculi above the L4 lumbar spine; 2) patient age was from 18 to 80 years old; 3) patients were informed and consented to this study; and 4) patients were approved by the hospital ethics committee (proof number: KY-2019-020) and the exclusion criteria for unilateral upper ureteral calculi in the First Affiliated Hospital of Xiamen University from January 2018 to November 2020, and they were divided into the ST-URS group and the flexible ureteroscopy (F-URS) group.Results: The stone-free rate of 1 day after operation of the ST-URS group was significantly higher than the F-URS group (63.71 vs. 34.62%, P < 0.0001). The operative time (38.45 vs. 46.18 min, P = 0.005) and hospitalization cost (27,203 vs. 33,220 Yuan, P < 0.0001) of the ST-URS group were significantly lower than the F-URS group. There were no significant differences in the success rate of ureteral access sheath placement, operative blood loss, stone-free rate of 1 month after operation, postoperative complications, postoperative hospital stay, and postoperative visual analog scale (VAS) pain score between the two groups (P > 0.05). In subgroups of a diameter of calculi ≥ 1.5 cm, calculi CT numerical value ≥ 1,000 Hounsfield unit and the preoperative hydronephrosis range ≥ 3.0 cm, ST-URS shows more advantages in the operative time, stone-free rate of 1 day after the operation, the hospitalization cost, and the incidence of postoperative complications.Conclusion: In unilateral upper ureteral stones treated with a holmium laser, compared with the simple F-URS, the ST-URS has a shorter operative time, lower hospitalization cost, and a higher stone-free rate of 1 day after the operation, suggesting that the ST-URS could be more widely applied in clinics.

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RELATIONSHIP BETWEEN RENAL STONE LOCATION WITH STONE-FREE RATE AFTER ESWL

Indonesian Journal of Urology ◽

10.32421/juri.v24i1.253 ◽

2017 ◽

Vol 24 (1) ◽

Author(s):

Laudeo Dhanaba Siregar ◽

Syah Mirsya Warli

Keyword(s):

Urinary Tract ◽

Renal Stone ◽

Stone Composition ◽

Patient Medical Record ◽

Extracorporeal Shock Wave ◽

Stone Free Rate ◽

Urinary Tract Stones ◽

Retrospective Study Design ◽

The Relationship ◽

Free Rate

Objective: This study aims to evaluate the relationship between stone location and stone location in kidney stone to the stone-free rate after Extracorporeal Shock Wave Lithotripsy (ESWL) procedure. Material & method: This is a non-experimental research using descriptive analytic method with retrospective study design that takes data from patient medical record diagnosis of urinary tract stones and ESWL action from January 2011 until December 2013 in the Department of Surgery Division of Urology General Hospital H. Adam Malik, Medan. Results: It was found that if the size of the stone only is the only factor that counts in patients who get a urinary tract stones ESWL therapy, it is not found a statistically significant relationship. Stone location plays an important role in the incidence of stone-free patients with urinary tract stones ESWL therapy. Conclusion: ESWL therapeutic efficacy in the treatment of patients with kidney stones is not only determined by the size and location of the stone, but is also determined by the number of stones, stone composition, frequency ESWL is used, and the thickness of the skin of the patient.

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Laser lithotripsy using dusting technique (low energy, high frequency) for symptomatic upper urinary tract stones

African Journal of Urology ◽

10.1186/s12301-021-00259-2 ◽

2021 ◽

Vol 27 (1) ◽

Author(s):

A. Ashmawy ◽

M. Khedr ◽

I. R. Saad ◽

S. Zamel ◽

A. Kassem

Keyword(s):

Urinary Tract ◽

High Frequency ◽

Hounsfield Unit ◽

Spiral Ct ◽

Upper Urinary Tract ◽

Laser Lithotripsy ◽

Low Energy ◽

Stone Size ◽

Stone Free Rate ◽

Free Rate

Abstract Background A prospective study to assess the feasibility of stone dusting technique (low energy and high frequency) during laser lithotripsy in symptomatic upper urinary tract |(UUT) stones. Methods Sixty patients with symptomatic single or multiple UUT stones less than 3 cm in diameter were included. Patients with coagulation disorders and active UTIs were excluded. All patients were clinically evaluated and underwent non-contrast spiral CT (NCSCT) to detect stone site, size, number, Hounsfield unit. A rigid or flexible ureteroscope was used with stone dusting using the Ho: YAG laser at low-energy and high-frequency (0.5 J & 20 Hz) set. Operative and fluoroscopy time, total energy delivered, type of stent, hospitalization time, complications and its grade, and stone-free rate using NCSCT after 4 weeks were recorded. Results The mean stone size ± SD (range) was 1.55 ± 0.55 (0.5–3) cm; out of sixty patients (50 with single stone and 10 with multiple stones), fifty-five patients were stone-free at 4 weeks. Complications had occurred in 11 patients (eight with grade I, one with grade II, and two with grade IIIa) according to Clavien–Dindo grading of surgical complications. Stone size was the only parameter which correlated significantly with stone-free rate. No significant correlation was found between incidence of complications and other parameters (stone size, site, BMI, age and operative time). Conclusions Stone dusting technique is feasible, safe and effective in management of UUT stones.

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RIRS with Vacuum-Assisted Ureteral Access Sheath versus MPCNL for the Treatment of 2-4 cm Renal Stone

BioMed Research International ◽

10.1155/2020/8052013 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8

Author(s):

Dehui Lai ◽

Yongzhong He ◽

Xun Li ◽

Meiling Chen ◽

Xingrong Zeng

Keyword(s):

Renal Stone ◽

Matched Pair ◽

Ureteral Access Sheath ◽

Access Sheath ◽

Matched Pair Analysis ◽

Pain Scores ◽

Stone Free Rate ◽

Significant Difference ◽

Matching Criteria ◽

Free Rate

Objective. Comparison of outcomes between RIRS with vacuum-assisted ureteral access sheath (V-UAS) and MPCNL in the treatment of renal stone. Materials and Methods. 28 patients with 2-4 cm renal stone were treated using RIRS with 14/16 F V-UAS. The outcomes were compared to those who underwent MPCNL with 16 F Amplatz sheath using a matched-pair analysis in a 1 : 2 scenario. Matching criteria included stone size, location and laterality, gender, age, BMI, and degree of hydronephrosis. Patients’ demographics, perioperative and postoperative characteristics, complications, stone-free rate (SFR), and auxiliary procedures were compared. Results. Mean operative times for the RIRS and MPCNL groups were 72.4±21.3 minutes and 67.4±25 minutes (P=0.042). Postoperative pain was significantly less in the RIRS group. The initial SFR was 50% for the RIRS group and 73.2% for the MPCNL group (P=0.035). The final SFR at postoperative three months improved to 89.3% for the RIRS group and 92.9% for the MPCNL group (P=0.681). The auxiliary procedure rates were higher in the RIRS group (42.9% vs. 25%, P=0.095). The overall complication rate in the RIRS group was lower, but the significant difference was not found. Conclusion. In the treatment of 2-4 cm renal stone, using V-UAS in RIRS can improve surgical efficiency with lower postoperative early pain scores. Comparing with MPCNL, its initial SFR was more depressed, and there is still a trend towards requiring more auxiliary procedures to achieve comparable final SFR.

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