scholarly journals Semi-rigid Ureteroscopy and Holmium laser stone dusting for Proximal Ureteral Stones Does Adjuvant Tamsulosin Therapy Increase the Chance of Success?

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
P H Malky ◽  
A M Emam ◽  
H S Shaker
Keyword(s):  
Success Rate ◽  
Operative Time ◽  
Technical Problem ◽  
Laser Lithotripsy ◽  
Ureteral Stones ◽  
Control Group ◽  
Stone Clearance ◽  
Alpha Blockers ◽  
Group 2 ◽  
Group 1

Abstract Background Alpha blockers decrease peristalsis above and below the stone, which increases the urine bolus and intraureteral pressure above it and lowers intraureteral pressure below it in association with the decrease in basal and micturition pressure, even at the bladder neck; thus, it increases the chance of stone expulsion.We aim to evaluate whether peri-operative tamsulosin in stented ureteroscopic laser lithotripsy for proximal ureteric stones increase the procedure success rate of stone clearance. Since our aim in ureteroscopic treatment of upper ureteric stones is laser dusting rather than stone retrieval, its possible that alpha blockers can improve the access to upper ureter and clearance of fragmented stones. Objective To evaluate whether peri-operative tamsulosin in stented ureteroscopic laser lithotripsy for proximal ureteric stones increase the procedure success rate of stone clearance. Patients and Methods This prospective, randomized, multicenter study included 60 patients and carried out between March 2018 and December 2018 in Police hospital Nasr City and Ain Shams University Hospitals included adult patients (at least 15 years) with proximal ureteral stones (≥ 5mm) scheduled for URS lithotripsy. Results In this study, the overall failure rate was 18.3%. In most cases 8/11(72.7%), failure of the procedure was due to the difficulty experienced in advancing the ureteroscope. We should mention that this technical problem was reported only in 2 (6.7%) patients receiving pre-URS tamsulosin but in 6 (20%) patients of the control group. The mean operative time in this series was significantly shorter operative time in Group 2(51.8min) compared to Group 1(58.8 min).At follow-up 4 weeks after URS, SFR was (86.7% for Group 2 and 66.7% for Group 1). Conclusion Adjunctive tamsulosin therapy prior to laser-assisted semi-rigid URS for the management of proximal ureteral stones improves ureteroscopic access, reduces the operative time and improves the SFR with an acceptable complication rate. Further research should be conducted on a larger scale to evaluate the various predictors of the outcome of URS and analyze the results with different pre-URS tamsulosin time periods in order to consolidate the results and to confirm the conclusion.

scholarly journals Treatment of Complex Whole Liver Intrahepatic Ductal Stones Using a Patented Stone-Clearance Sheath Combined with Nephroscopic Holmium Laser Lithotripsy

2021 ◽  
pp. 1-4
Author(s):  
Yuancai Xie ◽  
Dingwen Zhong ◽  
Yanda LU ◽  
Donghua Xie ◽  
Xianjin Cheng ◽  
...  
Keyword(s):  
Operative Time ◽  
Laser Lithotripsy ◽  
Holmium Laser ◽  
Control Group ◽  
Observation Group ◽  
Clearance Rates ◽  
Stone Clearance ◽  
Second Stage ◽  
Holmium Laser Lithotripsy ◽  
One Year

Purpose: To investigate the clinical efficacy of nephroscopic laser lithotripsy with the aid of a patented suctioning sheath in treating complicated whole-liver dispersed intrahepatic ductal stones. Methods: From September 2013 to September 2017, 150 patients who were diagnosed with whole-liver dispersed intrahepatic ductal stones were included in this study and were divided into two groups randomly. The control group consists of 75 patients who were treated by traditional surgery combined with choledochoscopic laser lithotripsy. The observation group consists of the other 75 patients who were treated by traditional surgery combined with nephroscopic laser lithotripsy with the aid of the patented sheath. Related treatment outcome parameters were compared. Results: There were no significant differences in first surgery operative time, first surgery bleeding amount, complication and stone clearance rates (P>0.05). However, the second surgery operative time was (63.58±9.84) min while the complication rate was 7.5% in the observation group, significantly less than that of control group (P<0.05). There were significantly higher first-stage and second stage sinus ductal stone clearance rates and final stone clearance rate in the observation group compared to that of control group (P<0.05), while operative times, hospitalization duration and cost, and one year stone recurrent rate were significantly lower (P<0.05). Conclusion: The efficacy of using the patented stone-clearance sheath combined with nephroscopic holmium laser lithotripsy was significant, warrants more extensive clinical adoption.

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.

scholarly journals Comparison of efficacy of laser lithotripter with ultrasonic lithotripter in mini percutaneous nephrolithotomy

2016 ◽  
Vol 87 (4) ◽  
pp. 276
Author(s):  
Fatih Akbulut ◽  
Onur Kucuktopcu ◽  
Emre Kandemir ◽  
Erkan Sonmezay ◽  
Abdulmuttalip Simsek ◽  
...  
Keyword(s):  
Cost Analysis ◽  
Success Rate ◽  
Percutaneous Nephrolithotomy ◽  
Operative Time ◽  
Fluoroscopy Time ◽  
Total Operative Time ◽  
Laser Group ◽  
Group 2 ◽  
The Cost ◽  
Group 1

Objective: The aim of the study was to compare the efficacy of the laser lithotripter with the ultrasonic lithotripter in mini percutaneous nephrolithotomy (miniperc). Material and Methods: From June 2013 to January 2014; medical records of 77 consecutive patients who underwent miniperc operation were retrospectively evaluated. Ultrasonic lithotripter was used in 22 patients (Group 1), while laser was used in 55 patients. In the laser group, 22 patients were randomly selected who had same characteristics compared to group 1 (Group 2). Success rate, total operative time, complications according to modified Clavien classification, fluoroscopy time, haemoglobin drop, hospital stays and cost analysis were assessed. Success rates were evaluated on the second postoperative day and after the first month. Results: Total operative time (p = 0.635) and fluoroscopy time (p = 0.248) were not significantly different between the two groups. In the laser group, the success rate (81.8%) was notably more than in the ultrasonic lithotripter group (68.2%) but there was no statistically significance (p = 0.296). Ten reusable ultrasonic probe were used for 22 patients, due to thinness and sensitiveness of the probe. Conversely, one single laser fiber (550 micron) was used for 22 patients. When the cost analysis of lithotripsy was considered, the cost per case was 190 dollar in group 1 and 124 dollar in group 2. (p = 0.154) Complication rate, hospital stay and haemoglobin drop were similar in both groups. Conclusion: Laser lithotripsy seems to be more cost effective than ultrasonic lithotripsy for miniperc but larger number of patients are required to confirm this estimation.

Clinical use of electrical stimulation with the Veinplicity®device and its effect on the first attempt success rate of peripheral intravenous cannulation: A non-randomized clinical trial

2019 ◽  
Vol 20 (6) ◽  
pp. 621-629 ◽  
Author(s):  
Fredericus HJ van Loon ◽  
Freek JP Willekens ◽  
Marc P Buise ◽  
Hendrikus HM Korsten ◽  
Arthur RA Bouwman ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
Success Rate ◽  
Intervention Group ◽  
Control Group ◽  
Success Rates ◽  
Moderate Risk ◽  
Intravenous Access ◽  
Group 2 ◽  
Peripheral Intravenous Access ◽  
Group 1

Background:Peripheral intravenous cannulation is one of the most frequently performed medical procedures. Venodilation, which can be achieved with different techniques, is an important factor for first attempt success. The objective of this study was to compare the first attempt success rates upon peripheral intravenous cannulation after applying a tourniquet, with venous dilation by electrical stimulation using the Veinplicity®device, or a combination of both techniques, in participants at moderate risk of a difficult peripheral intravenous access.Methods:This non-randomized clinical trial was carried out in adult patients divided into three parallel study groups, consisting of cannulation with a tourniquet (control group), cannulation after electrical stimulation without using a tourniquet (intervention group 1), and cannulation after applying electrical stimulation followed by the application of a tourniquet on the selected upper extremity (intervention group 2). The primary outcome was the first attempt success rate of peripheral intravenous catheter placement.Results:In all, 141 participants were included in this study, with an overall success rate of 86%. Success rates of 78%, 88%, and 92% were observed in the control group, intervention group 1, and intervention group 2, respectively ( p = 0.25, χ2 = 2.771, df = 2). A higher first attempt success rate was detected in participants in intervention group 2, when compared to the control group ( p = 0.04, χ2 = 4.63, df = 1).Conclusion:Increase in first attempt success was clinically relevant when electrical stimulation with the Veinplicity®device was combined with the application of a tourniquet in participants at moderate risk of a difficult peripheral intravenous access.

Comparison of three different modalities for the treatment of bladder calculi by size

2021 ◽  
pp. 039156032110204
Author(s):  
Ali Yıldız ◽  
Hakan Anıl ◽  
İbrahim Erol ◽  
Kaan Karamık ◽  
Hakan Erçil
Keyword(s):  
Operative Time ◽  
Operation Time ◽  
Ureteral Stones ◽  
Stone Size ◽  
Postoperative Stay ◽  
Bladder Stones ◽  
Group 3 ◽  
Group 2 ◽  
The Relationship ◽  
Group 1

Purpose: Treatment recommendations for kidney or ureteral stones are based on stone size; however, this is uncertain for bladder stones. This study aims to determine the best approach to bladder stones based on their size. Materials and methods: We retrospectively analyzed 401 patients with bladder stones. Patients were divided into three different groups according to stone size (11–20 mm, 21–30 mm, 31–40 mm as groups 1, 2, and 3 respectively). Patients had transurethral cystolithotripsy (TUCL), percutaneous cystolithotripsy (PCCL), and open cystolithotomy (OCL) performed. Results: Stone fragments were removed completely in all patients. When catheter time, postoperative stay, and hematocrit decrease values were compared, the results were significantly higher for OCL in all three groups ( p: 0.001). When the relationship between stone sizes and operation time is evaluated, TUCL had shorter operation times (34.1 ± 10.6 min) in group 1. However, TUCL had longer operation times in group 2 and group 3 compared to OCL and PCCL. Conclusion: TUCL may be preferable due to better postoperative outcomes and shorter operative time for ⩽2 cm stones. As the stone size increases, PCCL is more favorable in terms of operation time.

scholarly journals Comparative evaluation of intracorporeal lithotripsy techniques during ureteroscopy: a clinical experience

2020 ◽  
Vol 7 (11) ◽  
pp. 3581
Author(s):  
Pankaj Trivedi
Keyword(s):  
Migration Rate ◽  
Operative Time ◽  
Tertiary Care ◽  
Laser Lithotripsy ◽  
Female Ratio ◽  
Pneumatic Lithotripsy ◽  
Significant Difference ◽  
Stone Migration ◽  
Group 2 ◽  
Group 1

Background: The objective of the study was to compare pneumatic lithotripsy and laser lithotripsy techniques for safety, efficacy, and complications in the management of ureteric stone.Methods: Patients underwent ureteroscopy for ureteral stones in a tertiary care teaching hospital were divided into 2 groups of 50 each. Group 1 patients underwent pneumatic lithotripsy and group 2 underwent holmium:yttrium-aluminium-garnet (Ho: YAG) laser lithotripsy. Both the groups were compared regarding demographic characteristics, stone dimensions, number of stones, operative time, stone migration rate, application of post-operative double J (DJ) stent, complications, and stone free rate.Results: Mean age of the patients in the group 1, and group 2 were 45.74±18.49, and 44.5±14.33 years, respectively (p=0.709). There was no significant difference in male to female ratio in both groups. Total operative times were found 29.12±10.83 min, and 28.44±7.49 min in the group 1 and group 2, respectively which was statistically non-significant (p=0.716). The stone free rate was 100% and 98% in group 1 and 2 respectively (p=0.130). Stone migration was also found in 5 (10%) patients in the group 1 and 1 (2%) in group 2 which was found statistically significant (p=0.037). Mucosal damage was found 3 (6%) in laser group as compared to 1 (2%) in pneumatic group. No significant difference between complications was seen in both the groups.Conclusions: This study concluded that pneumatic lithotripsy and laser lithotripsy have similar efficacy in terms of operative time, success rate and hospital stay time. However, stone migration rate was significantly more in pneumatic lithotripsy.

scholarly journals Manipulation of the Wrist for Management of Lateral Epicondylitis: A Randomized Pilot Study

2003 ◽  
Vol 83 (7) ◽  
pp. 608-616 ◽  
Author(s):  
Peter AA Struijs ◽  
Pieter-Jan Damen ◽  
Eric WP Bakker ◽  
Leendert Blankevoort ◽  
Willem JJ Assendelft ◽  
...  
Keyword(s):  
Success Rate ◽  
Large Scale ◽  
Tennis Elbow ◽  
Lateral Epicondylitis ◽  
Control Group ◽  
Muscle Stretching ◽  
Strengthening Exercises ◽  
Group 2 ◽  
Group 1

Abstract Background and Purpose. Lateral epicondylitis (“tennis elbow”) is a common entity. Several nonoperative interventions, with varying success rates, have been described. The aim of this study was to compare the effectiveness of 2 protocols for the management of lateral epicondylitis: (1) manipulation of the wrist and (2) ultrasound, friction massage, and muscle stretching and strengthening exercises. Subjects and Methods. Thirty-one subjects with a history and examination results consistent with lateral epicondylitis participated in the study. The subjects were randomly assigned to either a group that received manipulation of the wrist (group 1) or a group that received ultrasound, friction massage, and muscle stretching and strengthening exercises (group 2). Three subjects were lost to follow-up, leaving 28 subjects for analysis. Follow-up was at 3 and 6 weeks. The primary outcome measure was a global measure of improvement, as assessed on a 6-point scale. Analysis was performed using independent t tests, Mann-Whitney U tests, and Fisher exact tests. Results. Differences were found for 2 outcome measures: success rate at 3 weeks and decrease in pain at 6 weeks. Both findings indicated manipulation was more effective than the other protocol. After 3 weeks of intervention, the success rate in group 1 was 62%, as compared with 20% in group 2. After 6 weeks of intervention, improvement in pain as measured on an 11-point numeric scale was 5.2 (SD=2.4) in group 1, as compared with 3.2 (SD=2.1) in group 2. Discussion and Conclusion. Manipulation of the wrist appeared to be more effective than ultrasound, friction massage, and muscle stretching and strengthening exercises for the management of lateral epicondylitis when there was a short-term follow-up. However, replication of our results is needed in a large-scale randomized clinical trial with a control group and a longer-term follow-up.

Comparative Study between Pneumatic and Holmium Laser Lithotripsy in Treatment of Ureteric Stones

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mohamed Esmat ◽  
Karim Omar Elsaeed ◽  
Moataz Bellah Mohamed Adel
Keyword(s):  
Operating Time ◽  
Laser Lithotripsy ◽  
Early Postoperative Period ◽  
Holmium Laser ◽  
Ureteral Stones ◽  
Pneumatic Lithotripsy ◽  
Randomized Clinical Study ◽  
Holmium Laser Lithotripsy ◽  
Group 2 ◽  
Group 1

Abstract Objective The aim of this study was to compare the efficacy & safety of holmium laser and pneumatic lithotripsy used in the ureteroscopic treatment of ureteral stones. Materials and Methods A prospective randomized clinical study was done using the data of patients to whom ureteroscopic lithotripsy (URL) was applied for ureter stones in our clinic. Then these patients were separated into 2 groups according to the type of lithotriptor used in stone fragmentation as laser lithotripsy (Group 1) and pneumatic lithotripsy (Group 2). Results Statistically, the two groups were similar in respect of the number of stones, stone burden and the number of double J stents applied intra-operatively. Mean operating time was calculated as 62.9 (±7.69) minutes in Group 1 and 50.98 (±6.63) minutes in Group 2. The mean operating time was found to be higher in group 1 than group 2 (P = 0.000). On postoperative day 1 after the URL, the SFR of Group 1 79.0% found to be significantly high compared to the SFR of Group 2 (64.0%) (P = 0.019), while at postoperative month 1, the SFR of both groups (Group 1 84%, Group 2 80%) was found to be similar (P = 0.462). Conclusions Compared to the pneumatic lithotripter, the Ho: YAG laser seems to have a statistically significant higher SFR in the early postoperative period (1 day), even though there are statistically insignificant success rate (after 1 month) and complications (hematuria, mucosa injury, stone migration, stricture and perforation avulsion).

scholarly journals Laser Versus Pneumatic Lithotripsy With Semi-Rigid Ureteroscope; A Comparative Randomized Study

2019 ◽  
Vol 10 (3) ◽  
pp. 185-188
Author(s):  
Seyed Mohammadreza Rabani ◽  
Seyedhossein Rabani ◽  
Najmeh Rashidi
Keyword(s):  
Randomized Study ◽  
Laser Lithotripsy ◽  
Ureteral Stones ◽  
Female Ratio ◽  
Pneumatic Lithotripsy ◽  
Extracorporeal Shock Wave ◽  
Academic Center ◽  
Significant Difference ◽  
Group 2 ◽  
Group 1

Introduction: Ureteral stones are among the most common disorders in the urologic field. Miniaturization of endoscopic devices in urology and extracorporeal shock wave lithotripsy (ESWL) has revolutionized the management of ureteral stones. The aim of this study was to compare the efficacy and results of laser versus pneumatic lithotripsy (PL) with semi-rigid ureteroscope in a randomized prospective clinical trial in removing stones. Methods: 117 adult patients underwent transurethral lithotripsy (TUL) in a single academic center and by a single surgeon. The patients were randomized in 2 groups: In group 1, 58 patients with ureteral stones underwent ureteroscopy and stone fragmentation was done by Ho: YAG laser lithotripsy (LL) and in group 2, 59 patients underwent PL (Swiss LithoClast) by using the same ureteroscope. Results: Mean age was 41.77 years and 41.1years in group one and 2 respectively (P=0.79), there was no significant difference in male to female ratio and mean stone in both groups. The success rate for stone clearance was 79.31% and 77.96% in group 1 and 2 respectively (P=0.52). No difference between complications was seen in both groups, but the duration of operations was different (significantly lower in group 2). Conclusion: In both techniques, acceptable results were achieved. We have found a significant statistical difference in duration of operation between our results (P=0.001) and similar studies, while this was shorter in the pneumatic group in our study, it was longer in other similar ones. This might be a result of more experience in working with PL in our center.

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