“Steinstrasse” or stone street after extracorporeal lithotripsy

1997 ◽  
Vol 64 (1) ◽  
pp. 26-29
Author(s):  
F. Merlo
Keyword(s):  
Percutaneous Nephrostomy ◽  
Urinary Obstruction ◽  
Stone Free Rate ◽  
Extracorporeal Lithotripsy ◽  
Free Rate

The aim of this work has been to check the frequency and to assess which manoeuvres are necessary in treating the steinstrasse after ESWL in situ. From September 1989 to May 1996, 2400 patients were treated with extracorporeal lithotripsy, 86 (3.6%) developed a steinstrasse in the days immediately after treatment. Only 40% of cases had specific urinary obstruction symptoms. In 52 patients (60%) the steinstrasse was spontaneously eliminated within 4 weeks, while in the remaining 34 an auxiliary treatment was necessary (second ESWL, percutaneous nephrostomy, ureteroscopic management). These therapies required further hospital admittance but didn't cause statistically significant differences in the stone-free rate at 6 months (96% and 97%, p < 0.001). Our experience would indicate that the incidence of steinstrasse after ESWL in situ is quite low (3.6%) and the necessity for auxiliary treatment is extremely rare (1.4%).

scholarly journals The Role of Antegrade Irrigation via Percutaneous Nephrostomy on Surgical Outcomes in Semirigid Ureteroscopy among Patients with Upper Ureteral Stones

2019 ◽  
Vol 2019 ◽  
pp. 1-8
Author(s):  
Wonho Jung ◽  
Hye Jin Byun ◽  
Dong Sup Lee
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Operation Time ◽  
Percutaneous Nephrostomy ◽  
Stone Size ◽  
Stone Free Rate ◽  
Ureter Stones ◽  
Free Rate

Objective. We aimed to investigate the role of antegrade irrigation via percutaneous nephrostomy on surgical outcomes in retrograde ureteroscopy in patients with upper ureter stones. Materials and Methods. In this retrospective study, we analyzed 134 patients who underwent retrograde semirigid ureteroscopy for upper ureter stones between August 2012 and December 2017. Patients were divided into two groups: retrograde irrigation group (conventional URS) and antegrade irrigation group (using percutaneous nephrostomy). Operation time, postoperative hospital stay, complications, and stone-free rate were measured for each patient after ureteroscopy. Results. The mean age in the retrograde irrigation and antegrade irrigation groups was 53.3 and 60.7 years, respectively (p=0.007). The operation time was 60.8 min vs. 43.0 min (p=0.002), and stone-free rate was 82.0 % vs. 95.5 % (p=0.033). Stone size, laterality, the proportion of male patients, and urinary tract infection prevalence were comparable between the groups. In the subgroup analysis of stone size >10 mm, the antegrade irrigation group had a shorter operation time and a higher stone-free rate. For stone size of 5–10 mm, operation time in the antegrade irrigation group was shorter and the stone-free rate between the two groups was comparable. Conclusion. Antegrade irrigation via percutaneous nephrostomy during ureteroscopy has a higher stone-free rate with a shorter operation time without an increased urinary tract infection risk. Therefore, if percutaneous nephrostomy is necessary before ureteroscopy, antegrade irrigation of external fluid via percutaneous nephrostomy is strongly recommended.

Ureteric pelvic stones

1997 ◽  
Vol 64 (1) ◽  
pp. 40-45
Author(s):  
P. Tombolini ◽  
M. Ruoppolo ◽  
C. Bellorofonte ◽  
C. Zaatar ◽  
A. Tagliaferri ◽  
...  
Keyword(s):  
Salvage Procedure ◽  
New Methods ◽  
Electrohydraulic Lithotripsy ◽  
Dormia Basket ◽  
First Choice ◽  
Flexible Ureteroscopes ◽  
Stone Free Rate ◽  
Current Availability ◽  
Free Rate

There is still controversy among urologists on the best treatment for ureteric pelvic stones. Recent advances in ureteroscopy with new methods of stone fragmentation (laser, electrohydraulic and ballistic lithotripsy) and current availability of small semirigid and flexible ureteroscopes have made this procedure rapid, easy and safe. Similarly, improvement in ESWL technology has also facilitated identification and treatment of stones above the iliac bone ring. In just over eight years (3/'88 - 6/'96) we treated 355 ureteral pelvic stones. The first approach was ESWL in 252 cases (by Dornier HM3 in 176, Dornier MPL 9000 in 42, Piezolith Wolf 2300 in 39 and EM plus Dormia basket in 15), ureteroscopy in 38 (by electrohydraulic) lithotripsy in 31, ultrasound lithotripsy in 5 and Lithoclast in 2) and litholapaxy by Dormia basket in 58. The overall stone-free rate was 75.5%, 95.3% and 84.5% respectively. The second line of treatment in unsuccessful cases was ULL or Dormia basket extraction and ESWL in 7 cases only. The overall success rate was 100%. Only 3 patients underwent open surgery (0.7%). There were 5 cases of ureteral perforation during ULL, which did not require surgical repair. No major complications occurred with either ESWL or Dormia basket procedures. We consider in-situ ultrasound-guided ESWL as first choice in managing ureteral pelvic stones, as the procedure is rapid, safe and technically simple. Ureteroscopy is a salvage procedure after ESWL failure. Endoscopic removal by Dormia basket is still a safe, effective procedure for small stones.

Incidence and treatment of the “steinstrasse” after in situ extracorporeal shock wave lithotripsy (ESWL)

1995 ◽  
Vol 62 (1_suppl) ◽  
pp. 103-105
Author(s):  
F. Merlo ◽  
E. Cicerello ◽  
P. Checchin ◽  
L. Faggiano ◽  
G. Anselmo
Keyword(s):  
Shock Wave ◽  
Urinary Tract ◽  
Extracorporeal Shock Wave Lithotripsy ◽  
Shock Wave Lithotripsy ◽  
Ureteral Stones ◽  
Extracorporeal Shock Wave ◽  
Stone Free Rate ◽  
Free Rate

— The aim of this work has been to check the frequency and to assess which manoeuvres are necessary in treating the steinstrasse after ESWL. 1779 patients (1360 with renal and 419 with ureteral stones) underwent in-situ ESWL. 68 patients developed a steinstrasse in the immediate 24 hours following treatment. In 85% of the cases (58/68) there was dilation of the urinary tract. In 39 patients the steinstrasse was spontaneously eliminated within 10 days, while in the remaning 29 an auxiliary manoeuvre was necessary. These manoeuvres required further admittance to hospital or prolungation of stay, but created no statistically significant differences in the stone free rate 2 months after treatment (96 and 97% respectively, p< 0.001). Our experience would indicate that the incidence of steinstrasse after ESWL in situ is quite low (3.8%) and the necessity for auxiliary manoeuvres is extremely rare (1.6%).

Outcome of Percutaneous Nephrostomy in Children With Ureteropelvic Junction Obstruction

2020 ◽  
Vol 20 (2) ◽  
pp. 61-64
Author(s):  
Mohammad Mahfuzur Rahman Chowdhury ◽  
Rifat Zaman ◽  
Md Amanur Rasul ◽  
Akm Shahadat Hossain ◽  
Shafiqul Alam Chowdhury ◽  
...  
Keyword(s):  
Renal Function ◽  
Low Dose ◽  
Ureteropelvic Junction Obstruction ◽  
Percutaneous Nephrostomy ◽  
Ureteropelvic Junction ◽  
College Hospital ◽  
Medical College ◽  
Split Renal Function

Introduction and objectives: Congenital ureteropelvic junction obstruction (UPJO) is the most common cause of hydronephrosis. Management protocols are based on the presence of symptoms and when the patient is asymptomatic the function of the affected kidney determines the line of treatment. Percutaneous nephrostomy (PCN) became a widely accepted procedure in children in the 1990s. The aim of the study was to evaluate the results of performing percutaneous nephrostomy (PCN) in all patients with UPJO and split renal function (SRF) of less than 10% in the affected kidney, because the management of such cases is still under debate. Methods:This prospective clinical trial was carried out at Dhaka Medical College Hospital from January 2014 to December 2016. Eighteen consecutive patients who underwent PCN for the treatment of unilateral UPJO were evaluated prospectively. In these children, ultrasonography was used for puncture and catheter insertion. Local anesthesia with sedation or general anesthesia was used for puncture. Pig tail catheters were employed. The PCN remained in situ for at least 4 weeks, during which patients received low-dose cephalosporin prophylaxis. Repeat renography was done after 4 weeks. When there was no significant improvement in split renal function (10% or greater) and PCN drainage (greater than 200 ml per day) then nephrectomies were performed otherwise pyeloplasties were performed. The patients were followed up after pyeloplasty with renograms at 3 months and 6 months post operatively. Results: All the patients had severe hydronephrosis during diagnosis and 14 patients with unilateral UPJO were improved after PCN drainage and underwent pyeloplasty. The rest four patients that did not show improvement in the SRF and total volume of urine output underwent nephrectomy. In the patients with unilateral UPJO who improved after PCN drainage, the SRF was increased to 26.4% ±8.6% (mean± SD) after four weeks and pyeloplasty was performed. At three and six months follow-up, SRF value was 29.2% ±8.5% and 30.8.2% ±8.8% respectively. Conclusion: Before planning of nephrectomy in poorly functioning kidneys (SRF < 10%) due to congenital UPJO, PCN drainage should be done to asses improvement of renal function. Bangladesh Journal of Urology, Vol. 20, No. 2, July 2017 p.61-64

scholarly journals Efficacy and safety of laparoscopic pyelolithotomy versus percutaneous nephrolithotomy for treatment of large renal stones: a meta-analysis

2021 ◽  
Vol 49 (1) ◽  
pp. 030006052098313
Author(s):  
Tie Mao ◽  
Na Wei ◽  
Jing Yu ◽  
Yinghui Lu
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Percutaneous Nephrolithotomy ◽  
Meta Analysis ◽  
Renal Stones ◽  
Efficacy And Safety ◽  
Complementary Treatment ◽  
Laparoscopic Pyelolithotomy ◽  
Stone Free Rate ◽  
Free Rate

Background We aimed to compare the efficacy and safety of laparoscopic pyelolithotomy (LPL) versus percutaneous nephrolithotomy (PCNL) for treating renal stones larger than 2 cm. Methods We searched the PubMed, Embase, Web of Science, SinoMed, and Chinese National Knowledge Infrastructure databases for studies that compared the surgical outcomes of LPL and PCNL. We conducted a meta-analysis of the retrieved studies, expressed as weighted mean difference or risk ratios with 95% confidence intervals. Results We included 25 studies (1831 patients). LPL was associated with a significantly higher stone-free rate, lower rates of blood loss, complementary treatment, blood transfusion, and complications, and less reduction in hemoglobin level compared with PCNL. LPL and PCNL were similar in terms of duration of hospital stay, conversion rate, changes in glomerular filtration rate and creatinine level, and mean time of postoperative analgesia. However, LPL was associated with a longer operation time than PCNL. Conclusion LPL appears to be more effective and safer than PCNL in patients with large renal stones, by increasing the stone-free rate and reducing blood loss, complementary treatment, blood transfusion, and complications compared with PCNL. LPL may thus be a useful modality for treating patients with large renal stones.

scholarly journals External validation of the R.I.R.S. scoring system to predict stone-free rate after retrograde intrarenal surgery

BMC Urology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Cong Wang ◽  
ShouTong Wang ◽  
Xuemei Wang ◽  
Jun Lu
Keyword(s):  
Scoring System ◽  
Kidney Stone ◽  
Medical Center ◽  
External Validation ◽  
Retrograde Intrarenal Surgery ◽  
Stone Burden ◽  
Stone Free Rate ◽  
Stone Density ◽  
Free Rate ◽  
Free Status

Abstract Background The R.I.R.S. scoring system is defined as a novel and straightforward scoring system that uses the main parameters (kidney stone density, inferior pole stones, stone burden, and renal infundibular length) to identify most appropriate patients for retrograde intrarenal surgery (RIRS). We strived to evaluate the accuracy of the R.I.R.S. scoring system in predicting the stone-free rate (SFR) after RIRS. Methods In our medical center, we retrospectively analyzed charts of patients who had, between September 2018 and December 2019, been treated by RIRS for kidney stones. A total of 147 patients were enrolled in the study. Parameters were measured for each of the four specified variables. Results Stone-free status was achieved in 105 patients (71.43%), and 42 patients had one or more residual fragments (28.57%). Differences in stone characteristics, including renal infundibulopelvic angle, renal infundibular length, lower pole stone, kidney stone density, and stone burden were statistically significant in patients whether RIRS achieved stone-free status or not (P < 0.001, P: 0.005, P < 0.001, P < 0.001, P: 0.003, respectively). R.I.R.S. scores were significantly lower in patients treated successfully with RIRS than patients in which RIRS failed (P < 0.001). Binary logistic regression analyses revealed that R.I.R.S. scores were independent factors affecting RIRS success (P = 0.033). The area under the curve of the R.I.R.S. scoring system was 0.737. Conclusions Our study retrospectively validates that the R.I.R.S. scoring system is associated with SFR after RIRS in the treatment of renal stones, and can predict accurately.

Treatment of Proximal and Midureteral Calculi: A Randomized Trial of In Situ and Pushback Extracorporeal Lithotripsy

1990 ◽  
Vol 4 (4) ◽  
pp. 353-359 ◽  
Author(s):  
A.J.M. HENDRIKX ◽  
A.F. BIERKENS ◽  
G.O.N. OOSTERHOF ◽  
F.M.J. DEBRUYNE
Keyword(s):  
Randomized Trial ◽  
Extracorporeal Lithotripsy

Uretero-Iliac artery fistula: a rare cause of haematuria

2020 ◽  
Vol 13 (9) ◽  
pp. e232189
Author(s):  
Natalia Hernandez ◽  
Bethany Desroches ◽  
Eric Peden ◽  
Raj Satkunasivam
Keyword(s):  
Iliac Artery ◽  
Percutaneous Nephrostomy ◽  
Arterial System ◽  
Endoscopic Evaluation ◽  
Stent Removal ◽  
Retrograde Pyelogram ◽  
History Of ◽  
Gross Haematuria ◽  
Multiple Episodes

A woman in her mid-forties with a history of cervical cancer requiring chemoradiation presented with bilateral ureteral strictures secondary to radiation therapy. The ureteral obstruction was initially relieved with bilateral percutaneous nephrostomy tubes, and subsequently, bilateral ureteral stents. Over the course of 8 months, she presented with multiple episodes of severe gross haematuria. This persisted even after stent removal and conversion back to percutaneous nephrostomy tubes. The initial evaluation, done with concern for an uretero-iliac artery fistula, which included bilateral retrograde pyelograms and CT angiography was non-diagnostic. Given continued haematuria, repeat endoscopic evaluation was undertaken; on retrograde pyelogram, brisk contrast was seen to pass into the arterial system, consistent with a left ureteroarterial fistula. The patient underwent endovascular iliac artery stent placement. Subsequently, the patient underwent resection of the iliac artery with endovascular graft in situ, left distal ureterectomy with proximal ureteral ligation following femoral-to-femoral bypass. This allowed for complete resolution of the patient’s gross haematuria episodes.

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