Feasibility of Ureteroscopic Lithotripsy and Renal Preservation in Patients with Non-functioning Kidney due to Isolated Ureteric Stone

Abstract Objective to demonstrate the risk factors of developing subcapsular renal hematoma ( SRH) in patients who underwent ureteroscopic lithotripsy for upper ureteric stones. Materials and Methods In a randomized controlled trial, 60 patients with an upper ureteric stone underwent URS lithotripsy either by laser or pneumatic. The inclusion criteria were age above 14 years old, of both sexes with an upper ureteric stone about 2 cm in diameter. Exclusion criteria were age below 14 years old, elevated serum creatinine level, patients with coagulopathies and pregnancy. The perioperative and postoperative outcomes were evaluated and postoperative pelvi-abdominal CT with intravenous contrast was done to detect if a subcapsular hematoma has been developed. Results There is no significant association between the formation of subcapsular renal hematoma and degree of hydronephrosis, chronic kidney disease (CKD), body mass index (BMI), diabetes mellitus (DM), hypertension (HTN) and preoperative bacteriuria as risk factors. Conclusions Subcapsular hematoma post-ureteroscopic lithotripsy (URSL) for impacted upper ureteric stones is a rare but potentially serious complication. A high index of suspicion is needed when patients present with significant loin pain and fever after ureteroscopic lithotripsy for obstructing proximal ureteral stones with thin renal cortices. Stone size, degree of hydronephrosis, operation duration, and perfusion pressure of hydraulic irrigation were associated with an increased risk of SRH formation. Management of post-URSL subcapsular hematomas needs to be customized for each patient.

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Management of intra operative priapism after spinal anesthesia with intravenous glycopyrrolate and intracorporeal injection of ultra low dose of phenylephrine- A case report

Indian Journal of Clinical Anaesthesia ◽

10.18231/j.ijca.2021.065 ◽

2021 ◽

Vol 8 (2) ◽

pp. 348-350

Author(s):

Tshering P Bhutia ◽

Neelima Pradhan ◽

Tsewang D Bhutia ◽

Rajni ◽

Sonam D Bhutia

Keyword(s):

Case Report ◽

Spinal Anesthesia ◽

Low Dose ◽

Ureteric Stone ◽

Successful Management ◽

Ureteroscopic Lithotripsy ◽

The Past ◽

Dorsal Penile Nerve Block ◽

Dorsal Penile Nerve ◽

Intravenous Ketamine

Priapism following neuraxial anesthesia or general anesthesia is a rare but problematic event which may result in delay, complication or even cancellation of scheduled operations in urological endoscopic procedures. We present a case of successful management of intra operative priapism in a 32 years old male under spinal anesthesia posted for Ureteroscopic Lithotripsy (URSL) of bilateral ureteric stone.Different therapies for management of intra operative priapism have been quoted in the past like intracorporeal injection of vasopressors, dorsal penile nerve block, intravenous glycopyrrolate, intravenous ketamine/dexmedetomidine etc. In this case we treated with intravenous glycopyrrolate and intracorporeal injection of ultra low dose phenylephrine.

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Influence of lithotripsy modalities on complication rate

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh0906259r ◽

2009 ◽

Vol 137 (5-6) ◽

pp. 259-265

Author(s):

Slobodan Radulovic ◽

Dragica Milenkovic-Petronic ◽

Aleksandar Vuksanovic ◽

Bozo Vavic

Keyword(s):

Complication Rate ◽

Statistical Difference ◽

Treatment Approach ◽

Therapeutic Option ◽

Ureteric Stone ◽

Ureteroscopic Lithotripsy ◽

Lower Complication ◽

Lower Complication Rate ◽

Stone Treatment ◽

The Difference

Introduction. Localization of ureteric stones and difference in disintegration success are the most important factors in determining the first treatment approach for ureteric stones. Objective. The aim of our study was to evaluate the difference in complication rate between different ureteric stone lithotripsy modalities. Methods. Two hundred sixty patients with ureteric stones were analyzed in a prospective bicentric study that lasted 1 year. The patients were divided into two groups: I - 120 patients who underwent ESWL (extracorporeal shockwave lithotripsy) treatment and II - 140 patients who were treated endoscopically with ballistic lithotripsy. Results. Ureteroscopic lithotripsy of all pelvic and iliac stones was significantly more successful comparing to ESWL, while lumbar ureteric stone treatment with ureteroscopic lithotripsy was not significantly more successful than ESWL, except for lumbar stones larger than 100mm2 that were significantly better treated endoscopically. In the I group complications after lithotripsy were recorded in 64 (59.3%) and in the II group in 58 (42.0%) patients, meaning that complications were statistically significantly more frequent in the I than in the II group. In the II group complications were significantly more often recorded after treatment of proximal comparing to ureteric stones of other localizations, while in the I group complications were significantly more often detected after treatment of impacted stones than in the II group. Conclusion. Being significantly successful comparing to ESWL, ureteric stone treatment with ureteroscopic lithotripsy should be considered as the first therapeutic option for all, especially impacted stones located in the iliac and pelvic ureteric portion. In spite of absent statistical difference in the success rate, ESWL should be chosen as the first treatment option in all cases of lumbar ureteric stones due to lower complication rate except for stones larger than 100mm2 that should be primarily treated endoscopically.

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Outcome of Upper Ureteric Stone Management by Semirigid Ureterorenoscope and Intracorporeal Pneumatic Lithotripsy

Bangladesh Journal of Urology ◽

10.3329/bju.v16i2.45940 ◽

2020 ◽

Vol 16 (2) ◽

pp. 47-50

Author(s):

Md Ruhul Quddus ◽

Md Asaduzzaman ◽

Md shariful Islam ◽

Kaiser Ahmed ◽

MA Awal ◽

...

Keyword(s):

Kidney Diseases ◽

Guide Wire ◽

Ureteral Injury ◽

Ureteric Stone ◽

Stone Clearance ◽

Stone Fragment ◽

Ureteric Calculi ◽

Ureteric Orifice ◽

Distal Obstruction ◽

Ureteric Stricture

Objective: To evaluate the outcome of upper ureteric stone management using semirigid URS + ICPL. Materials and Methods: Patients undergoing URS + ICPL in patient department were included in the study. Total 38 patient were included in the study from March 2009 to June 2010 in National Institute of Kidney diseases & Urology, Dhaka. Stone size was 8 mm to 1.5 cm, patients were with good renal function, well excreation on both side, without any distal obstruction, infection or multiple ureteric calculi. The procedure was done under SAB.Cystoscopy was done for identification of ureteric orifice and guide wire was passed within ureteric orifice under visual monitoring.46 cm 10 Fr Storz Uretroscope was advanced next to the guide wire.At time a tortuous portion of the ureter was encountered a second guide wire was helpful. As soon as the stone was seen the pneymatic probe was pushed toward the stone.After fixing to the stone, pneumatic source was on and stone fragmentation was started. Care was taken to avoid injury of the ureter and keeping eye one stone fragment migration within the ureter was achieved. Placement of D-J stent was done at the conclusion of the procedure in most of the cases Result: The patients were followed upto 3 months post-operatively. Within immediate complications fever occured in 10 (26.3%) patients, severe haematurea occured in 8 (21.3%) patients, ureteral injury in 8 (21.3%) & ureteric perforation in 2 (4.8%) patients underwent URS+ ICPL. Stone clearance rate after 01 month of intervention was 30 (78.9%). Almost half of the patients developed UTI after 01 month of intervention. Pyelonephritis occured in 2 ( 4.8%) patient in this group. After 03 months of intervention 84.2% patients exibited complete clearance of stone. Only 02 (4.8%) patients developed ureteric stricture. Conclusion: For management of selective sized upper ureteric stone ureterorenoscopy with semirigid one using pneumatic source of energy is a good option for it’s high stone clearance & resonably low complications. Bangladesh Journal of Urology, Vol. 16, No. 2, July 2013 p.47-50

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Ureteric Stenting Versus Non-stenting Following Uncomplicated Ureteroscopic Lithotripsy

Case Medical Research ◽

10.31525/ct1-nct04145063 ◽

2019 ◽

Author(s):

Keyword(s):

Ureteroscopic Lithotripsy ◽

Ureteric Stenting

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Faculty Opinions recommendation of Factors affecting complication rates of ureteroscopic lithotripsy in children: results of multi-institutional retrospective analysis by Pediatric Stone Disease Study Group of Turkish Pediatric Urology Society.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.13037957.14356055 ◽

2011 ◽

Author(s):

Julian Wan

Keyword(s):

Retrospective Analysis ◽

Stone Disease ◽

Pediatric Urology ◽

Study Group ◽

Complication Rates ◽

Ureteroscopic Lithotripsy ◽

Factors Affecting ◽

Disease Study

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Ureteroscopic lithotripsy for treatment of ureteral calculi in children: efficacy and safety

Academic Journal of Second Military Medical University ◽

10.3724/sp.j.1008.2009.01389 ◽

2010 ◽

Vol 29 (12) ◽

pp. 1389-1392

Author(s):

Yun-teng HUANG ◽

Mao-sheng XU ◽

Hong-quan GENG ◽

Hua XIE ◽

Guo-feng XU ◽

...

Keyword(s):

Ureteral Calculi ◽

Efficacy And Safety ◽

Ureteroscopic Lithotripsy

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Predictive Factors Affecting the Success of Nephrectomy for the Treatment of Nephrogenic Hypertension: Multicenter Study

Urologia Internationalis ◽

10.1159/000515652 ◽

2021 ◽

pp. 1-6

Author(s):

Ediz Vuruskan ◽

Hakan Ercil ◽

Umut Unal ◽

Ergun Alma ◽

Hakan Anil ◽

...

Keyword(s):

Metabolic Syndrome ◽

Partial Response ◽

Medical Treatment ◽

Predictive Factors ◽

Treatment Success ◽

Complete Response ◽

Response To Treatment ◽

Factors Affecting ◽

Success Of Treatment ◽

Functioning Kidney

Introduction: The aim of our study is to evaluate the predictive factors affecting the success of treatment with nephrectomy in patients with poorly functioning kidney and nephrogenic hypertension. Methods: Data for patients who underwent nephrectomy with a diagnosis of nephrogenic hypertension in 3 centers between May 2010 and January 2020 were analyzed. In the postoperative period, if the blood pressure (BP) was below 140/90 mm Hg without medical treatment, it was accepted as complete response; if the arterial BP was below 140/90 mm Hg with medical treatment or less medication, it was accepted as partial response; and if BP did not decrease to normal values, it was accepted as unresponsive. Demographic characteristics, duration of hypertension, preoperative and postoperative BP values, and presence of metabolic syndrome were statistically evaluated. Results: Our study consisted of 91 patients with a mean preoperative hypertension duration of 23.3 ± 12.1 months. Among patients, 42 (46.2%) had complete response, 18 (19.8%) had partial response, and 31 (34.0%) had no response. Preoperative systolic and diastolic BP values were not effective on treatment success (p = 0.071, p = 0.973, respectively), but the increase in age and hypertension duration (p = 0.030 and p < 0.001, respectively) and the presence of metabolic syndrome (p = 0.002) significantly decreased the complete response rates. Conclusions: Preoperative hypertension duration, advanced age, and presence of metabolic syndrome are predictive factors affecting the response to treatment in patients who undergo nephrectomy due to nephrogenic hypertension.

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