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

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.

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

Journal of Medicine and Life ◽

10.25122/jml-2021-0217 ◽

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.

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Use of Holmium YAG laser in circumcision: a novel, less complicated and alternative procedure for adolescent

African Journal of Urology ◽

10.1186/s12301-020-00077-y ◽

2020 ◽

Vol 26 (1) ◽

Author(s):

Pei-Lin Huang ◽

I-Ching Lee ◽

De-Chan Tsai ◽

Jen-Ho Tsai ◽

Vincent F. S. Tsai ◽

...

Keyword(s):

Operative Time ◽

Alternative Procedure ◽

Efficacy And Safety ◽

Yag Laser ◽

Young Males ◽

Estimated Blood Loss ◽

Significant Difference ◽

Average Operative Time ◽

Group 2 ◽

Group 1

Abstract Background To evaluate the efficacy and safety of Holmium YAG laser circumcision in adolescents. Methods Eighty-one patients underwent circumcision for medical reasons, and patients’ requests were collected retrospectively during February 2017 to February 2019. They were divided into two groups: Holmium YAG laser (group 1, n = 41) and conventional group (group 2, n = 40). The guillotine method with a Holmium YAG laser was applied for circumcisions, and all the procedures were performed by a single urologist who was well-experienced with circumcision practices. Results The average age of group 1 was 15.53 ± 7.35 years old, and the average age was 16.34 ± 9.22 years old in group 2. There was no significant difference in age and indications. The average operative time was significantly shorter in group 1 than in group 2 (24.40 ± 3.94 vs. 27.25 ± 4.35 min, p < 0.01). The estimated blood loss was less in group 1 compared to group 2. There were fewer complications in group 1 than in group 2 (3/41 vs. 10/40, p < 0.01) and patients also felt less pain in group 1 (p < 0.01). All patients tolerated this procedure without severe side effects. Conclusions The use of Holmium YAG laser in circumcision is a novel, less complicated, easy, and less painful alternative procedure for circumcision in young males.

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

Urologia Journal ◽

10.1177/03915603211020469 ◽

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.

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

International Surgery Journal ◽

10.18203/2349-2902.isj20204463 ◽

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.

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Retrograde versus Antegrade Approach for the Management of Large Proximal Ureteral Stones

BioMed Research International ◽

10.1155/2016/6521461 ◽

2016 ◽

Vol 2016 ◽

pp. 1-4 ◽

Cited By ~ 3

Author(s):

Stavros Sfoungaristos ◽

Ioannis Mykoniatis ◽

Ayman Isid ◽

Ofer N. Gofrit ◽

Shilo Rosenberg ◽

...

Keyword(s):

Operative Time ◽

Fluoroscopy Time ◽

Ureteral Stones ◽

Ureteroscopic Lithotripsy ◽

Antegrade Approach ◽

Stone Free Rate ◽

Significant Difference ◽

Stone Characteristics ◽

Length Of Hospitalization ◽

Free Rate

Objective. To evaluate and compare the efficacy and safety of retrograde versus antegrade ureteroscopic lithotripsy for the treatment of large proximal ureteral stones.Patients and Methods. We retrospectively analyzed the medical records of patients with proximal ureteral stones >15 mm, treated in our institution from January 2011 to January 2016. Intraoperative parameters, postoperative outcomes, and complications were recorded and compared between the two techniques.Results. Our analysis included 57 patients. Thirty-four patients (59.6%) underwent retrograde and 23 patients (40.4%) underwent antegrade ureteroscopy. There was no significant difference in patients’ demographics and stone characteristics between the groups. Stone-free rate was significantly higher (p=0.033) in the antegrade group (100%) compared to retrograde one (82.4%). Fluoroscopy time, procedure duration, and length of hospitalization were significantly (p<0.001) lower in retrograde approach. On the other hand, the need for postoperative stenting was significantly lower in the antegrade group (p<0.001). No difference was found between the groups (p=0.745) regarding postoperative complications.Conclusions. Antegrade ureteroscopy is an efficient and safe option for the management of large proximal ureteral stones. It may achieve high stone-free rates compared to retrograde ureteroscopy with the drawback of longer operative time, fluoroscopy time, and length of hospitalization.

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The Outcomes of Pre-Stenting on Renal and Ureteral Stones: A Meta-Analysis

Urologia Internationalis ◽

10.1159/000519473 ◽

2021 ◽

pp. 1-9

Author(s):

Han Chen ◽

Yang Pan ◽

Min Xiao ◽

Jingruo Yang ◽

Yong Wei

Keyword(s):

Operative Time ◽

Meta Analysis ◽

Renal Stones ◽

Flexible Ureteroscopy ◽

Ureteral Stones ◽

Ureteroscopic Lithotripsy ◽

Stone Free Rate ◽

Significant Difference ◽

Meta Analyses ◽

Free Rate

Background: Pre-stenting (PS) on the outcomes of semirigid and flexible ureteroscopic lithotripsy for a different upper urinary urolithiasis remains controversial. We performed a meta-analysis comparing the outcomes of ureteroscopic lithotripsy between PS and non-PS. Materials and Methods: Randomized, controlled trials and observational studies comparing PS and non-PS were identified from electronic databases. Stone-free rate (SFR), operative time, and complications were compared by qualitative and quantitative syntheses (meta-analyses). Results: Eleven articles were included in this study. Nearly, all of recently published studies exhibited relatively moderate or high quality during quality assessment. PS was more likely to achieve good SFR compared with non-PS (p < 0.00001). The subgroup results indicated that PS improved the SFR for renal stones and the stones dealt by flexible ureteroscopy (p = 0.0002; p < 0.0001, respectively; some ureteral stones were dealt by flexible ureteroscopy). Ureteral stones and the stones dealt by semirigid ureteroscopy were not influenced by PS (p = 0.62; p = 0.90, respectively). PS is equal as non-PS in terms of operative time for renal stones and the renal and ureteral stones dealt by flexible ureteroscopy (p = 0.47; p = 0.05). No significant difference was found in major complications between the 2 groups for total or for the subgroup of renal stones (p = 0.3; p = 0.69). Conclusions: For ureteral stones or the stones dealt by semirigid ureteroscopy, PS does not show any benefits. For renal stones or the stones dealt by flexible ureteroscopy, PS improves the SFR and may be as safe as non-PS.

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

Journal of lasers in medical sciences ◽

10.15171/jlms.2019.29 ◽

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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Modified Stapled Transanal Rectal Resection Procedure for Limited Rectal Prolapse: A Viable Alternative to the Delorme Operation

Surgical Innovation ◽

10.1177/1553350620929470 ◽

2020 ◽

pp. 155335062092947

Author(s):

Hua-Xian Chen ◽

Zu-Qing Chen ◽

Liang Huang ◽

Chang-Peng Han ◽

Ruo-Xu Dou ◽

...

Keyword(s):

Blood Loss ◽

Rectal Prolapse ◽

Operative Time ◽

Rectal Resection ◽

Stapled Transanal Rectal Resection ◽

Significant Difference ◽

Delorme’S Procedure ◽

Group 2 ◽

Delorme's Procedure ◽

Group 1

Purpose. The optimal surgical approach for full-thickness rectal prolapse (FTRP) remains controversial. In China, patients with limited FTRP (<5 cm in length) are usually managed by perineal surgery. We retrospectively assessed the outcome of Delorme’s procedure and compared it with modified stapled transanal rectal resection (STARR). Methods. The study was conducted in 2 public tertiary referral centers in China with modified STARR or Delorme's procedure performed by experienced surgeons. Outcomes assessed recurrence, operative times, blood loss, complications, length of hospital stay, and continence and constipation scoring. Results. Between December 2012 and May 2019, 65 patients were assessed, including 48 with modified STARR (group 1) and 17 with Delorme’s procedure (group 2). The median follow-up was 22 months (range, 3-86 months). The mean operative time for group 1 was 37.4 ± 17.5 minutes vs 74.3 ± 30.6 minutes for group 2 ( P < .001). The blood loss for group 1 was significantly lower than that for group 2 (17.4 ± 15.9 mL vs 27.8 ± 16.7 mL, respectively; P = .028). There was no significant difference between groups in recurrence (group 1 18.8% vs group 2 23.5%; P = .944) with no effect of operation type. Both procedures showed improvement in constipation and continence scoring with a similar impact. Conclusions. Modified STARR and the Delorme operation are comparable in managing limited FTRP with superior results in operative time and blood loss for STARR.

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

QJM ◽

10.1093/qjmed/hcaa070.004 ◽

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.

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In-vivo evaluation of the effect of cyanoacrylate on prosthetic vascular graft infection – does cyanoacrylate increase the severity of infection?

VASA ◽

10.1024/0301-1526/a000867 ◽

2020 ◽

Vol 49 (4) ◽

pp. 281-284

Author(s):

Atıf Yolgosteren ◽

Gencehan Kumtepe ◽

Melda Payaslioglu ◽

Cuneyt Ozakin

Keyword(s):

Vascular Graft ◽

Graft Infection ◽

Vascular Graft Infection ◽

Group 4 ◽

Significant Difference ◽

Group 3 ◽

Group 2 ◽

Prosthetic Vascular Graft Infection ◽

Group 1

Summary. Background: Prosthetic vascular graft infection (PVGI) is a complication with high mortality. Cyanoacrylate (CA) is an adhesive which has been used in a number of surgical procedures. In this in-vivo study, we aimed to evaluate the relationship between PVGI and CA. Materials and methods: Thirty-two rats were equally divided into four groups. Pouch was formed on back of rats until deep fascia. In group 1, vascular graft with polyethyleneterephthalate (PET) was placed into pouch. In group 2, MRSA strain with a density of 1 ml 0.5 MacFarland was injected into pouch. In group 3, 1 cm 2 vascular graft with PET piece was placed into pouch and MRSA strain with a density of 1 ml 0.5 MacFarland was injected. In group 4, 1 cm 2 vascular graft with PET piece impregnated with N-butyl cyanoacrylate-based adhesive was placed and MRSA strain with a density of 1 ml 0.5 MacFarland was injected. All rats were scarified in 96th hour, culture samples were taken where intervention was performed and were evaluated microbiologically. Bacteria reproducing in each group were numerically evaluated based on colony-forming unit (CFU/ml) and compared by taking their average. Results: MRSA reproduction of 0 CFU/ml in group 1, of 1410 CFU/ml in group 2, of 180 200 CFU/ml in group 3 and of 625 300 CFU/ml in group 4 was present. A statistically significant difference was present between group 1 and group 4 (p < 0.01), between group 2 and group 4 (p < 0.01), between group 3 and group 4 (p < 0.05). In terms of reproduction, no statistically significant difference was found in group 1, group 2, group 3 in themselves. Conclusions: We observed that the rate of infection increased in the cyanoacyrylate group where cyanoacrylate was used. We think that surgeon should be more careful in using CA in vascular surgery.

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