scholarly journals Factors affecting operative time during ureteroscopy and stone treatment and its effect on outcomes: retrospective results over 6.5 years

2020 ◽  
Vol 12 ◽  
pp. 175628722093440
Author(s):  
Lily Whitehurst ◽  
Amelia Pietropaolo ◽  
Robert Geraghty ◽  
Rena Kyriakides ◽  
Bhaskar K. Somani
Keyword(s):  
Operative Time ◽  
Renal Stones ◽  
Infectious Complications ◽  
Factors Affecting ◽  
Patient Demographics ◽  
Access Sheath ◽  
Stone Free Rate ◽  
Stone Treatment ◽  
Treatment Procedures ◽  
The Relationship

Background: We aimed to evaluate operative time with the outcomes of ureteroscopy (URS) and investigate the relationship between these factors, and assess if longer operative times were associated with a higher risk of complications. Methods: We retrospectively audited consecutive cases of URS done between March 2012 and June 2018. Data were collected for operative times, patient demographics, stone parameters, stent insertions, use of ureteric access sheath, length of stay, stone-free rate (SFR) and complications. Statistical analysis was performed using IBM SPSS version 24. Results: Over 6.5 years, 736 patients with a male:female ratio of 1.8:1 and a mean age of 54.7 years (range: 2–91 years), underwent 860 URS and stone treatment procedures. The mean operative time was 43.5 min (range: 8–160 min), with a stone size of 12.3 mm (range: 3–100 mm) and access sheath was used in 35.8%. The initial and final SFR was 86% and 92.5%, respectively, and 85.6% ( n = 736) patients were discharged the same day of procedure. Treatment of multiple renal stones, ureteric and renal stones, large stones, use of access sheath and post-operative stent were all associated with longer operative times ( p <0.001). Patients who were stone free and those having day-case procedures had shorter operative times ( p <0.001). There were 27 (3.2%) Clavien I/II complications and 8 (0.9%) Clavien ⩾III complications. Clavien score ⩾III ( p = 0.028) and infectious complications ( p <0.001) had significantly longer operative times. Conclusion: Patients with shorter operative times have a higher chance of being discharged home the same day without a post-operative stent. Higher operative times are associated with high-grade, especially infection-related, complications.

scholarly journals Comparison of the Efficacy of ShuoTong Ureteroscopy and Simple Flexible Ureteroscopy in the Treatment of Unilateral Upper Ureteral Calculi

2021 ◽  
Vol 8 ◽  
Author(s):  
Longhui Lai ◽  
Wenzhao Zhang ◽  
Fangjian Zheng ◽  
Tao Wang ◽  
Peide Bai ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Operative Time ◽  
Ureteral Calculi ◽  
Flexible Ureteroscopy ◽  
Ureteral Stones ◽  
Ureteral Access Sheath ◽  
Hospitalization Cost ◽  
Access Sheath ◽  
Stone Free Rate ◽  
Free Rate

Background: ShuoTong ureteroscopy (Sotn-ureteroscopy, ST-URS), a new lithotripsy operation method developed on the basis of ureteroscopy, is widely used to treat ureteral stones in China. Its composition includes rigid ureteral access sheath, standard mirror, lithotripsy mirror, and ShuoTong perfusion aspirator (ST-APM). Here, we compared the efficacy and safety of the ST-URS and the flexible ureteroscope (F-URS) holmium laser lithotripsy in the treatment of unilateral upper ureteral calculi.Methods: Retrospective analysis was conducted on the clinical data of 280 patients who met the inclusion 1) urinary tract CT was diagnosed with unilateral single upper ureteral calculi above the L4 lumbar spine; 2) patient age was from 18 to 80 years old; 3) patients were informed and consented to this study; and 4) patients were approved by the hospital ethics committee (proof number: KY-2019-020) and the exclusion criteria for unilateral upper ureteral calculi in the First Affiliated Hospital of Xiamen University from January 2018 to November 2020, and they were divided into the ST-URS group and the flexible ureteroscopy (F-URS) group.Results: The stone-free rate of 1 day after operation of the ST-URS group was significantly higher than the F-URS group (63.71 vs. 34.62%, P &lt; 0.0001). The operative time (38.45 vs. 46.18 min, P = 0.005) and hospitalization cost (27,203 vs. 33,220 Yuan, P &lt; 0.0001) of the ST-URS group were significantly lower than the F-URS group. There were no significant differences in the success rate of ureteral access sheath placement, operative blood loss, stone-free rate of 1 month after operation, postoperative complications, postoperative hospital stay, and postoperative visual analog scale (VAS) pain score between the two groups (P &gt; 0.05). In subgroups of a diameter of calculi ≥ 1.5 cm, calculi CT numerical value ≥ 1,000 Hounsfield unit and the preoperative hydronephrosis range ≥ 3.0 cm, ST-URS shows more advantages in the operative time, stone-free rate of 1 day after the operation, the hospitalization cost, and the incidence of postoperative complications.Conclusion: In unilateral upper ureteral stones treated with a holmium laser, compared with the simple F-URS, the ST-URS has a shorter operative time, lower hospitalization cost, and a higher stone-free rate of 1 day after the operation, suggesting that the ST-URS could be more widely applied in clinics.

Predictive Factors of Operative Hemodynamic Instability for Pheochromocytoma

2018 ◽  
Vol 84 (6) ◽  
pp. 920-923 ◽  
Author(s):  
Nihat Aksakal ◽  
Orhan Agcaoglu ◽  
Nuri Alper Sahbaz ◽  
Ozgur Albuz ◽  
Ayten Saracoglu ◽  
...  
Keyword(s):  
Tumor Size ◽  
Operative Time ◽  
Hypertensive Crisis ◽  
Hemodynamic Instability ◽  
Study Patient ◽  
Tumor Diameter ◽  
Factors Affecting ◽  
Patient Demographics ◽  
Catecholamine Levels

Pheochromocytoma is an uncommon catecholamine-secreting tumor in which resection is often associated with hemodynamic instability (HI). In this study, we aim to clarify the factors affecting surgical HI in patients who underwent surgery with the diagnosis of pheochromocytoma. All patients who underwent surgery with the diagnosis of pheochromocytoma between 2008 and 2015 were analyzed retrospectively. Patients with inconsistent diagnosis or missing outcomes and follow-up data were excluded. A total of 37 patients were included in this study. Patient demographics, operative time, tumor size, period of medical treatment until surgery, catecholamine levels in urine, and HI patterns were analyzed. There were 23 (62%) male and 14 (38%) female patients. Hemodynamic instability occurred in 13 (35%) patients. Overall, HI was higher in patients with tumor size <6 cm (P < 0.02); moreover, urine catecholamine levels were detected significantly higher than a cutoff value of 2000 mg/24 hours in hemodynamically instable group. In this study, tumor diameter of <6 cm and urine catecholamine levels >2000 mg/24 hours were associated with HI. Preoperative management is essential for preventing hypertensive crisis and HI before or during surgery.

scholarly journals The Safety and Efficacy of Mini Percutaneous Nephrolithotomy During Learning Curve

2019 ◽  
Vol 18 (2) ◽  
pp. 42-47
Author(s):  
Bikash Bikram Thapa ◽  
Bina Basnet ◽  
Bikash Bahadur Rayamajhi ◽  
Narayan Thapa ◽  
Bharat Bhadur Bhandari
Keyword(s):  
Learning Curve ◽  
Percutaneous Nephrolithotomy ◽  
Renal Stone ◽  
Operative Time ◽  
Medium Size ◽  
Stone Size ◽  
Access Sheath ◽  
Stone Free Rate ◽  
The Mean ◽  
Free Rate

Introduction: Since its introduction in 1976, percutaneous renal stone surgery has undergone several modifications. Reduction in size of access sheath was one of them which was first reported by Jackman in 1998. The miniaturisation of access sheath in Mini-Percutaneous Nephrolithotomy surgery has significantly reduced the intervention related morbidity with similar outcome as of standard Percutaneous Nephrolithotomy. Methods: This is a prospective cohort study where a single surgeon without previous experience of independent PCNL surgery performed Mini PCNL under controlled condition for renal stone sized 10 to 30 mm. The outcome was measured in terms of stone free rate and postoperative complications. The association of stone free rate and drop in haemoglobin level with different preoperative and operative variables were calculated with Pearson’s correlation test and p value <0.05 was considered significant. Results: Mini PCNL was performed in total of 63 renal units. The mean age was 37.8 ± 9.9 years with male: female ratio of 1.8:1. The average stone size was 16.8 ± 2.9 mm. The mean operative time was 55.2 ± 19.0 (30-110) minutes. The stone free rate was 98.2 ± 3.6 %. The mean drop in haemoglobin was 1.3 ± 0.8 and blood transfusion rate was 4.7%. The average hospital stay was 2.6 ± 1.3 days. The grade I complications was 15.8% and grade II and III was 7.9% each. Stone free rate was significantly associated with stone number (r = -0.47, p = 0.004). Similarly fall in haemoglobin was associated with total operative time (r = 0.49, p = 0.003). The stone size, hardness of stone (HU) and size of access sheath had no significant association with stone free rate and fall in haemoglobin. Conclusions: Mini PCNL is as effective as standard PCNL with higher safety margin in small and medium size stone (10 to 30 mm) during learning curve of endo-urology procedure.  

scholarly journals Comparison Between Mini PCNL and Standard PCNL in Management of Nephrolithiasis

2020 ◽  
Vol 19 (2) ◽  
pp. 80-83
Author(s):  
Bharat Bahadur Bhandari ◽  
Bikash Bikram Thapa ◽  
Dhirendra Ayer ◽  
Suresh Thapa ◽  
Sanjeeb Bista
Keyword(s):  
Renal Stones ◽  
Infectious Complications ◽  
Bleeding Complications ◽  
Medium Size ◽  
Invasive Approach ◽  
Urine Leak ◽  
Stone Free Rate ◽  
Significant Difference ◽  
The Difference ◽  
Free Rate

Introduction: The incidence of small and medium size renal stones is rising. Stone clearance, bleeding, urine leak and infectious complications are major concerns for urologist.  Urologist chooses best technique from list of armamentarium available. Minimally invasive approach like Percutaneous Nephrolithotomy (PCNL) has significantly influenced the renal stone management since 1976. Miniaturisation of the instruments allow more effective and safer alternatives for urolithasis management. Methods: This is a retrospective study in which the outcome of mini PCNL (mPCNL) was compared with standard PCNL (sPCNL) in management of nephrolithiasis. Result: There were no significant difference in stone free rate between mPCNL and sPCNL (96.2 ± 3.6% vs 95.3 ± 4.8%). The total operative time was longer in mPCNL (55.2 ± 19.0 minute vs 62 ± 21.0 minute) but the difference was not statistically significant. Conclusions: Mini PCNL is as effective as standard PCNL with fewer bleeding complications in management of medium sized nephrolithiasis.

scholarly journals Factors Affecting the Success Rate of Renal Stone Treatment by Extracorporeal Shock Wave Lithotripsy

2018 ◽  
Vol 27 (1) ◽  
pp. 72-78
Author(s):  
Abul Hasanat Muhammad Afzalul Haque ◽  
Md Waliul Islam ◽  
Humayun Kabir Kallol ◽  
Md Shaful Alam Babul ◽  
Muhammad Habibur Rahman ◽  
...  
Keyword(s):  
Shock Wave ◽  
Success Rate ◽  
Shock Wave Lithotripsy ◽  
Renal Stone ◽  
Renal Stones ◽  
Factors Affecting ◽  
Results Of Treatment ◽  
Extracorporeal Shock Wave ◽  
Stone Treatment

ESWL is one of the treatment modalities for kidney stones smaller than 2 cm. However, not all ESWL treatments are successful. The success rate has been reported to be between 50% to 87%, depending on various factors. Aim: This study was conducted to evaluate Factors affecting the success rate of renal stone treatment by extracorporeal shock wave lithotripsy (ESWL). Materials and methods: The study was carried out for a period of one year where total 96 patients with single or multiple radio-opaque renal stones treated with ESWL monotherapy using Stortz Modulith SLX-F2 lithotriptor were included. The results of treatment were evaluated after 3 months of follow-up. Treatment success was defined as complete clearance of the stones or presence of clinically insignificant residual fragments (<4mm). The results of treatment were correlated with the patient characteristics (age, sex, body mass index) and stone features (size, site, number & radio density). Results: At 3-months follow-up, the overall success rate was 76%. Among them, repeated ESWL sessions were required in 19 patients (53.9%). Post-ESWL complications were recorded in 8 patients (12.5%). Four factors had statistically significant impact on the success rate, namely stone site, size (the largest diameter of the stone), stone number, BMI (body mass index) of the patient. The success rate is highest for stones located in the upper calyx (26/26; 100%) and lowest for those located in lower calyx (15/20; 75%) (p=0.019). Stone with a largest diameter of <15mm are associated with a success rate of 93.6% (59/63), compared to 75.82% (25/33) for those with a diameter of >15mm (p=0.01). The success rate is also higher for single stone (76/ 84; 90.5%) than multiple stones (8/12; 66.7%) (p=0.02). Patients with lower BMI (<24) have a better success than higher BMI (>25) (p=0.001).Other factor including age, sex and stone radio density compared to ipsilateral 12th rib have no significant impact on the success rate. Conclusion: The success rate for ESWL for the treatment of renal stones can be predicted by stone size, location, number, and patient BMI. J Dhaka Medical College, Vol. 27, No.1, April, 2018, Page 72-78

scholarly journals To stratify complications of percutaneousnephrolithotomy (PCNL) in a single hospital by use of the modified Clavien grading system

2016 ◽  
Vol 18 (3) ◽  
pp. 40
Author(s):  
Y Limbu ◽  
R Joshi ◽  
UMS Dangol ◽  
DR Singh
Keyword(s):  
Operative Time ◽  
Complete Blood Count ◽  
Demographic Data ◽  
Renal Stones ◽  
Intravenous Urography ◽  
Coagulation Disorder ◽  
Related Complication ◽  
Stone Free Rate ◽  
Mean Size ◽  
Free Rate

Introduction: PCNL is relatively safe but evaluating its complication can be of importance so that we can betteranticipate and act on it.Purpose: To evaluate the complications of percutaneous nephrolithotomy (PCNL).Materials and methods: We prospectively analyzed the patients who underwent conventional PCNL at KMCTH from March 2013 to July 2015. Eighty five cases with renal stones more than 1cm and upper ureteric stones were included in the study. Patients with coagulation disorder were not included in this study. Ten patients who had PCNL converted to open procedures were excluded in the study. Patients underwent PCNL in prone position. Pre-operative complete blood count, urine, ultrasound(USG), intravenous Urography (IVU) was done. CT IVU was also done in few cases. During the period of which Demographic data, stone free rate, hospital stay and complications were assessed.Results: A total of 95 cases were enrolled for the study. Ten cases were excluded. There were 47 (55.29%) were female and 38 (44.71%) were male.Most of the patients had unilateral kidney stones(78.82%).Mean size of the was 1.85cm.There were 38(44.70%) renal pelvi-ureteric junction(PUJ) stones out of 85 cases. Sub-costal approach for PCNL was carried out in 78 (91.77%) patients. Mean operative time was 59.29 minutes with blood loss of 72.58 ml and three patients needed blood transfusion. Twelve patients (14.11%) experienced PCNL related complication. There was 1 mortality. Stone free rate was 91.76% (n-78).Conclusion: PCNL is safe with acceptable complication rate and has an acceptable high stone free rate.

scholarly journals Factors Affecting the Success Rate of Renal Stone Treatment by Extracorporeal Shock Wave Lithotripsy

2019 ◽  
Vol 46 (2) ◽  
pp. 1-6
Author(s):  
Abul Hasanat Muhammad Afzalul Haque ◽  
Md Waliul Islam ◽  
Humayun Kabir Kallol ◽  
Md Shaful Alam Babul ◽  
Muhammad Habibur Rahman
Keyword(s):  
Shock Wave ◽  
Success Rate ◽  
Shock Wave Lithotripsy ◽  
Renal Stone ◽  
Renal Stones ◽  
Factors Affecting ◽  
Results Of Treatment ◽  
Extracorporeal Shock Wave ◽  
Stone Treatment

ESWL is one of the treatment modalities for kidney stones smaller than 2 cm. However, not all ESWL treatments are successful. The success rate has been reported to be between 50% to 87%, depending on various factors. This study was conducted to evaluate factors affecting the success rate of renal stone treatment by extracorporeal shock wave lithotripsy (ESWL). The study was carried out for a period of one year where total 96 patients with single or multiple radio-opaque renal stones treated with ESWL monotherapy using Stortz Modulith SLX-F2 lithotriptor were included. The results of treatment were evaluated after 3 months of follow-up. Treatment success was defined as complete clearance of the stones or presence of clinically insignificant residual fragments (<4mm). The results of treatment were correlated with the patient characteristics (age, sex, body mass index) and stone features (size, site, number and radio density). At 3-months follow-up, the overall success rate was 76%. Among them, repeated ESWL sessions were required in 19 patients (53.9%). Post-ESWL complications were recorded in 8 patients (12.5%). Four factors had statistically significant impact on the success rate, namely stone site, size (the largest diameter of the stone), stone number, BMI (body mass index) of the patient. The success rate is highest for stones located in the upper calyx (26/26; 100%) and lowest for those located in lower calyx (15/20; 75%) (p=0.019). Stone with a largest diameter of <15mm are associated with a success rate of 93.6% (59/63), compared to 75.82% (25/33) for those with a diameter of >15mm (p=0.01). The success rate is also higher for single stone (76/84; 90.5%) than multiple stones (8/12; 66.7%) (p=0.02). Patients with lower BMI (<24) have a better success than higher BMI (>25) (p=0.001).Other factor including age, sex and stone radio density compared to ipsilateral 12th rib have no significant impact on the success rate. The success rate for ESWL for the treatment of renal stones can be predicted by stone size, location, number, and patient BMI. Bangladesh Med J. 2017 May; 46 (2): 1-6

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

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

<b><i>Background:</i></b> 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. <b><i>Materials and Methods:</i></b> 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). <b><i>Results:</i></b> 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 (<i>p</i> &#x3c; 0.00001). The subgroup results indicated that PS improved the SFR for renal stones and the stones dealt by flexible ureteroscopy (<i>p</i> = 0.0002; <i>p</i> &#x3c; 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 (<i>p</i> = 0.62; <i>p</i> = 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 (<i>p</i> = 0.47; <i>p</i> = 0.05). No significant difference was found in major complications between the 2 groups for total or for the subgroup of renal stones (<i>p</i> = 0.3; <i>p</i> = 0.69). <b><i>Conclusions:</i></b> 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.

Sign in / Sign up

Export Citation Format

Share Document