Failure of ureteral access sheath insertion in primary flexible ureteroscopy for renal stones: is there any relation with inflammation?

2021 ◽  
Author(s):  
Abdullah Hizir Yavuzsan ◽  
Sinan Levent Kirecci ◽  
Musab Ilgi ◽  
Semih Turk ◽  
Kerem Bursali ◽  
...  
Keyword(s):  
Multivariate Logistic Regression Analysis ◽  
Renal Stones ◽  
Male Gender ◽  
Flexible Ureteroscopy ◽  
Ureteral Access Sheath ◽  
Failure Group ◽  
Platelet Counts ◽  
Access Sheath ◽  
Group 2 ◽  
Group 1

Abstract Purpose To investigate the relationship between failure to insert a ureteral access sheath (UAS) with inflammation and other clinical parameters in patients treated with flexible ureteroscopy for renal stones. Methods This study included patients who underwent flexible ureteroscopy for the treatment of renal stones in our centre between 2015 and 2020. Patients who underwent any surgical procedure on the ipsilateral ureter and had a history of spontaneous stone passage were excluded. Patients were divided into two groups based on UAS insertion success (group 1) or failure (group 2). Both groups were compared with a view to clinical characteristics, preoperative neutrophil, lymphocyte, monocyte and platelet counts and ratios of these counts, all being considered inflammatory markers. A multivariate logistic regression analysis was performed to determine the independent variables affecting UAS insertion success. Results There were 113 (59.1%) patients in group 1, while group 2 consisted of 78 (40.9%) patients. The rates of male gender, coronary artery disease and preoperative ipsilateral hydronephrosis were significantly higher in group 2, while platelet counts and platelet-lymphocyte ratios were significantly lower. Our analysis revealed four independent predictors for UAS insertion failure: female gender (odds ratio [OR]=2.1) increased the rate of UAS insertion success, while hydronephrosis (OR=1.6), low platelet counts and PLR increased the rate of UAS insertion failure (OR=0.99, OR=0.98, respectively). Conclusion Our results suggest that male gender and ipsilateral hydronephrosis are associated with increased UAS insertion failure. Although we found a relationship between relatively low platelet levels and UAS insertion failure, we think that further studies are needed to investigate this matter.

scholarly journals Pre-stenting for Retrograde Intrarenal Surgery: Need and Duration: a Prospective Randomized Clinical Study

2020 ◽  
Vol 3 (2) ◽  
pp. 361-365
Author(s):  
Prakash Chhettri ◽  
Anil Shrestha ◽  
Robin Bahadur Basnet ◽  
Parash Mani Shrestha
Keyword(s):  
Controlled Study ◽  
Retrograde Intrarenal Surgery ◽  
Ureteral Access Sheath ◽  
Access Sheath ◽  
Randomized Clinical Study ◽  
Institutional Review ◽  
Group 3 ◽  
Group 2 ◽  
Wall Injury ◽  
Group 1

Introduction: To evaluate if retrograde intrarenal surgery with ureteral access sheath requires prestenting. In case pre-stenting becomes an option, how long does it need to be stented.  Materials and Methods: After obtaining approval from Institutional Review Board and informed consent, a prospective randomized controlled study was conducted in the Department of Urology, Bir Hospital for 18 months. All the patients enrolled for retrograde intrarenal surgery were grouped into 3 groups: Group 1 – without pre-stenting, Group 2 – one week of pre-stenting, and Group 3 – two weeks of pre-stenting. Success was defi ned as an ability to accommodate a 10/12 F ureteral access sheath during retrograde intrarenal surgery. Ureteral access sheath induced ureteric wall injury was also taken into consideration.Results: Among 179 cases, 152 cases were included in the study. In 36 patients out of 53 (67.92%) in group 1, 10/12 F ureteral access sheath was negotiable without pre-stenting, marking the frequency of distensible ureters. In 44 patients out of 47 (93.66%) from group 2 and all 52 patients (100%) from group 3, ureteral access sheath placement was successful after one and two weeks of pre-stenting respectively. Ureteric wall injury of grade1 and 2, was found in 9 patients (5.9%).Conclusions: The majority of ureters (67.92%) are distensible, not requiring pre-stenting before retrograde intrarenal surgery. One and two weeks of pre-stenting carries a success rate of 93.66% and 100% respectively.

Comparison of suctioning and traditional ureteral access sheath during flexible ureteroscopy in the treatment of renal stones

2018 ◽  
Vol 37 (5) ◽  
pp. 921-929 ◽  
Author(s):  
Zewu Zhu ◽  
Yu Cui ◽  
Feng Zeng ◽  
Yang Li ◽  
Zhiyong Chen ◽  
...  
Keyword(s):  
Renal Stones ◽  
Flexible Ureteroscopy ◽  
Ureteral Access Sheath ◽  
Access Sheath

scholarly journals The “no-touch” technique in the flexible ureteroscopic approach of renal stones

2021 ◽  
Vol 14 (4) ◽  
pp. 481-486
Author(s):  
Bogdan Geavlete ◽  
◽  
◽  
◽  
Cosmin Cozma ◽  
...  
Keyword(s):  
Operative Time ◽  
Renal Stones ◽  
Flexible Ureteroscopy ◽  
Significant Difference ◽  
Single Use ◽  
Group 2 ◽  
Sheath Insertion ◽  
Meta Analyses ◽  
Group 1 ◽  
Wall Lesions

Large meta-analyses demonstrated that ureteral access sheaths (UAS) have specific complications during and after flexible ureteroscopy (fURS). The present study focused on the technical aspects, advantages, drawbacks, and limitations of the latest “no-touch” technique (NTT) in the flexible ureteroscopic therapeutic approach of renal stones. A total of 288 patients with a single pyelocaliceal stone (largest diameter between 11 and 29 mm) underwent fURS: 144 using the 12/14 Fr UAS (group 1) and 144 without UAS (group 2). For NTT, we used four types of ureteroscopes: Olympus URF-V2 (8.5 Fr) – 33 cases, Storz Flex X2 (8.4 Fr) – 60 cases, single-use PUSEN PU 3022 (9.5 Fr) – 37 cases, and single-use PUSEN – PU 3033A (7.5 Fr) – 14 cases. For group 1, we used the Olympus URF–V2 ureteroscope in 44 cases, the Storz Flex X2 in 58 cases, and the single-use PUSEN PU 3022 in 42 cases. We compared the operative time, hospitalization periods, and complications. Successful access sheath insertion was noted in 83.3% of cases from group 1, and successful ureteroscope insertion was noted in 90.9% of cases from group 2. The average operative time was slightly higher in group 1 vs. group 2 (47 vs. 39 min). Stone-free rates (SFRs) were overall lower in group 2 (76.3% vs. 86.8%) at 1 month. At 3 months, we did not find a significant difference between these two groups. Superficial mucosal ureteral wall lesions were found in 38.8% of patients from group 1 and 4.1% from group 2. Hospitalization periods were longer in group 1 vs. group 2 (21 vs. 29 hours, respectively). The single-use 7.5 Fr ureteroscope should receive a special mention: the insertion was simple, we did not encounter any mucosal ureteral wall lesions, and all patients were discharged on the same day. Despite the clear advantages of routine UAS usage, there are many adverse events for the patient. Larger diameter sheaths involve a greater risk of ureteral wall injury. NTT seems to improve peri- and postoperative safety while preserving therapeutic efficiency. The new 7.5 Fr ureteroscopes appear to optimize surgical efficiency and diminish complications in the flexible ureteroscopic treatment of renal stones.

scholarly journals Ureteral access sheath use in retrograde intrarenal surgery

2019 ◽  
Vol 91 (2) ◽  
Author(s):  
Mustafa Karaaslan ◽  
Senol Tonyali ◽  
Mehmet Yilmaz ◽  
Sedat Yahsi ◽  
Sedat Tastemur ◽  
...  
Keyword(s):  
Operation Time ◽  
Multivariate Regression Analysis ◽  
Renal Surgery ◽  
Ureteral Access Sheath ◽  
Access Sheath ◽  
Significant Difference ◽  
The Mean ◽  
Group 2 ◽  
Intrarenal Pressure ◽  
Group 1

Objective: To determine if there is a difference between postoperative urinary infection rates after retrograde intra-renal surgery (RIRS) when ureteral access sheath (UAS) was used or not used. Materials and methods: We retrospectively analyzed the medical records of all patients who underwent RIRS at our institution between January 2016 and October 2018. Results: 129 patients were included in the study. The mean age of the patients was 48.8 ± 12.1 years; 94 patients were male and 35 were female. The mean stone size (largest diameter), stone attenuation and stone volume were 15.3 ± 5.8 mm, 1038 ± 368 HU and 1098 ± 1031 mm3, respectively. Out of 129 patients, 81 were treated by using UAS (Group 1) and 48 were treated without use of UAS (Group 2). There was no statistically significant difference between the two groups in terms of post-operative infection (p = 0.608). However, the operative time of patients with post-operative infection was statistically higher than the other patients; 88.35 ± 22.5 min versus 59.37 ± 22.1 min (p = 0.017). In multivariate regression analysis, operation time (p = 0.02, r = 1.07) was found to be the sole predictor of post-operative infection. Conclusions: Using UAS during RIRS might reduce the intrarenal pressure and also has several advantages. However not prolonging the operation time too much could be of higher importance than UAS use in terms of preventing post-operative infection after RIRS.

scholarly journals Flexible Ureteroscopy Can Be More Efficacious in the Treatment of Proximal Ureteral Stones in Select Patients

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Erdal Alkan ◽  
Ali Sarıbacak ◽  
Ahmet Oguz Ozkanli ◽  
Mehmet Murad Basar ◽  
Oguz Acar ◽  
...  
Keyword(s):  
Operative Time ◽  
Flexible Ureteroscopy ◽  
Ureteral Stones ◽  
Significant Difference ◽  
Ureteral Avulsion ◽  
Group 2 ◽  
Stone Characteristics ◽  
Ureteral Rupture ◽  
Treatment Procedures ◽  
Group 1

Purpose. We aimed to compare and evaluate the outcomes and complications of two endoscopic treatment procedures, semirigid ureteroscopy (SR-URS) and flexible ureteroscopy (F-URS), in the treatment of proximal ureteral stones (PUS).Methods. SR-URS (group 1) was done on 68 patients whereas 64 patients underwent F-URS (group 2) for the treatment of PUS. Success rate was defined as the absence of stone fragments or presence of asymptomatic insignificant residual fragments < 2 mm. Outcomes and complications were recorded.Results. The differences were statistically not significant in age, gender, body mass index (BMI), and stone characteristics between groups. Mean ureteral stone size was 9.1 ± 0.4 mm and 8.9 ± 0.5 mm for groups 1 and 2. Mean operative time was 34.1 ± 1.5 min and 49.4 ± 2.3 min for groups 1 and 2 (p=0.001). SFRs were 76.5% and 87.5% for groups 1 and 2 (p=0.078). Two major complications (ureteral avulsion and ureteral rupture) occurred in group 1.Conclusion. F-URS is safer and less invasive than SR-URS in patients with PUS. There is no statistically significant difference in the efficacy of either technique. Nonetheless we recommend F-URS in the management of PUS as a first-line treatment option in select cases of proximal ureteral calculi.

Dual effects of erdosteine on hemostasis via its different metabolites in young rats

2011 ◽  
Vol 30 (10) ◽  
pp. 1644-1648 ◽  
Author(s):  
Vefik Arica ◽  
Murat Tutanc ◽  
Oktay Hasan Ozturk ◽  
Secil Arica ◽  
Fatmagul Basarslan ◽  
...  
Keyword(s):  
Peripheral Blood ◽  
Peripheral Blood Smear ◽  
International Normalized Ratio ◽  
Saline Group ◽  
Oral Gavage ◽  
Blood Samples ◽  
Platelet Counts ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Aim: In the study, we examined erdosteine’s effects on platelet functions and coagulation. Materials and methods: A total 29 young albino Wistar rats were divided into four groups. Control rats ( n = 6) were given saline; Group 1 rats ( n = 7) were given 3 mg/kg erdosteine by oral gavage for 3 days; Group 2 rats ( n = 7) were given 10 mg/kg erdosteine by oral gavage for 3 days; and Group 3 rats ( n = 9) were given 30 mg/kg erdosteine for 3 days. Twenty-four hours after the final dose, blood samples were drawn from a portal vein. Prothrombin time (PT), activated partial thromboplastin time (aPTT) and international normalized ratio (INR) were measured, and platelet counts were examined in a peripheral blood smear by light microscopy. Results: PT and INR values of Group 1 increased compared to the controls but did not change in Group 3. Hemostatic parameters were not measured in Group 2 because the blood samples in Group 2’s tubes clotted rapidly. Platelet counts of the peripheral blood from Group 2 were low but were normal in other groups. Conclusion: We have concluded erdosteine may disrupt hemostasis parameters by its different metabolites in patients. Erdosteine has dual effects on hemostasis via its different metabolites, which occur in different doses.

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