Prospective randomized study of fixed laser settings vs variable laser settings for a better stone free rate

Background: Several modalities are available for upper ureteric stone fragmentation. From them pneumatic and holmium: yttrium-aluminum-garnet lithotripsy has favourable outcomes. In this study we studied 50 patients who underwent ureteroscopic pneumatic lithotripsy or laser lithotripsy. This study aims to to compare the outcome of PL and LL in the management of upper ureteric calculi.Methods: This is a prospective, randomized study of 50 cases; 25 cases of TUL with pneumatic lithotripter and 25 cases of TUL with laser lithotripter over two years. The purpose of this study was to analyze the factors predicting the stone-free rate, assess the complications following PL and LL, and assess the need for a second procedure if retropulsion of calculi occurs.Results: Two groups were similar in age, gender, mean size of stones, retropulsion and complications. There was a statistical difference in terms of stone free rate in favour of LL group (p≤0.05) and mean operative time in favor of the PL group (p≤ 0.05). Conclusions: In conclusion, we found that both the PL and LL approaches were effective and safe for upper ureteric calculi, but the LL method had advantages, especially in stone free rate, over the PL treatment. Another advantage of the LL method was safe stone fragmentation in upper ureteral calculi due to lower retropulsion rate in contrast with the PL method.

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Retrograde Intrarenal Surgery (RIRS) vs Percutaneous Nephrolithotomy (PCNL) in Treatment of Lower Pole Renal Stone

QJM ◽

10.1093/qjmed/hcaa070.006 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

S I Ragy ◽

A A Elshorbagy ◽

M A Alzqzouq

Keyword(s):

Hospital Stay ◽

Renal Stone ◽

Operative Time ◽

Randomized Study ◽

Alternative Therapy ◽

Renal Calculi ◽

Stone Free Rate ◽

Group 2 ◽

Free Rate ◽

Group 1

Abstract Objective Compare the outcomes of RIRS and PCNL for the treatment of 1 to 2 cm lower calyceal renal calculi regarding the stone free rate, operative time, fluoroscopy time, hospital stay and complication rate. Materials and Methods Patients with a single lower calyceal stone with an evidence of a CT diameter between 1 and 2 cm were enrolled in this randomized study. Patients were randomized into two groups: group 1: underwent RIRS (20pts); group 2: underwent PCNL (20 pts). Patients were evaluated with KUB and CT after one month. Results Mean fluoroscopy times and Hospital stay were significantly greater in the PCNL group than in RIRS group, In the RIRS group, the stone-free rate was 85% (17/20 patients); this rate increased to 95% after a second intervention. After a single PCNL procedure, 19 of 20 (95%) patients were completely stone free and For complications, there were minimal differences in both procedures, except for hemorrhage three patients who were treated with PCNL need blood transfusion Conclusions PCNL and RIRS are safe and effective methods for medium-sized LP calculi. For selected patients, RIRS may represent an alternative therapy to PCNL, with acceptable efficacy and low morbidity., RIRS compared to PCNL offers the best outcome in terms of radiation exposure and hospital stay.

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Did we take physical therapy serious after lithotripsy: a meta-analysis of prospective studies

10.21203/rs.2.10956/v1 ◽

2019 ◽

Author(s):

Linjie Peng ◽

Junjun Wen ◽

Guohua Zeng ◽

Wen Zhong

Keyword(s):

Physical Therapy ◽

Prospective Studies ◽

Large Scale ◽

Randomized Study ◽

Medical Intervention ◽

Cochrane Library ◽

Flexible Ureteroscopy ◽

Stone Free Rate ◽

Significant Difference ◽

Free Rate

Abstract Background Stone-free rate (SFR) after lithotripsy was one of the most frequent concerned issue, especially in patients following extracorporeal shockwave lithotripsy (ESWL) and flexible ureteroscopy (retrograde intrarenal surgery, RIRS). Physical therapy including percussion, inversion, physical vibration and their combinations was administrated to improve the SFR, but there was no conclusive evidence to support this theory. To conclude the effectiveness and safety of physical therapy on the SFR in patients received ESWL/RIRS. Methods We systematically reviewed the literature focused on physical therapy in patients after ESWL/RIRS on PubMed, Scopus, Cochrane library and Embase from 2000 to 2019 April. We mainly focused on stone-free rate and complications rate. Results Nine prospective studies including 8 randomized control trials and 1 non-randomized study were enrolled, and 1747 subjects were analyzed. All the physical therapy we enrolled was finally concluded into EPVL (external physical vibration lithecbole) and PDI (percussion, diuresis and inversion). Compared to conventional group, physical therapy provided a higher SFR (OR: 2.68; 95% CI: 1.74–4.12; P = 0.0001), especially SFR in lower calyx stones (OR: 3.60; 95% CI: 2.26-5.73; P= 0.0001). In subgroup analysis, EPVL (OR: 2.28; 95% CI: 1.27–4.07; P =0.005) and PDI (OR: 3.51; 95% CI: 1.96–6.26; P = 0.0001) were both effective. Drinking e enough water before treatment was supposed to increase the SFR (OR: 3.31; 95% CI: 2.39–4.60; p = 0.0001). Otherwise, medical intervention such as furosemide (OR: 5.21; 95% CI: 0.53–50.72; P = 0.156) and tamsulosin (OR: 1.05; 95% CI: 0.61–1.82; P = 0.855) did not improve the SFR. No significant difference was detected in terms of complications rates (OR: 0.83; 95% CI: 0.61–1.14; P = 0.25). Conclusions EPVL or PDI were both effective and safe in increasing the SFR after ESWL/RIRS, but its effectiveness was limited in LCS. Drinking enough water before physical therapy helped to improve the SFR. The role of furosemide and tamsulosin in physical therapy or surgery need to be testified by large-scale, high-quality studies.

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