The analysis of late postoperative complications after treatment of ureteral stones using ureteroscopy and contact ultrasonic lithotripsy

The use of intracorporeal lithotripsy for the management of larger ureteral and intrarenal calculi has dramatically improved. Although the choice of intracorporeal fragmentation is frequently based on the location and composition of the stone to be treated, the experience of the clinician and availability of equipment often dictates this decision. Several different modalities of intracorporeal lithotripsy are currently available. Ultrasonic lithotripsy is mainly used for the fragmentation of large renal calculi during percutaneous nephrolithotripsy procedures. Ultrasound is used rarely via an ureteroscopic approach. Significant advances in laser fibres and power generation systems have propelled laser lithotripsy to the treatment of choice for fragmentation of most ureteral stones. Pneumatic lithotripsy consists of a pneumatically driven piston which will fragment stones by direct contact.

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

Frontiers in Surgery ◽

10.3389/fsurg.2021.707022 ◽

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 < 0.0001). The operative time (38.45 vs. 46.18 min, P = 0.005) and hospitalization cost (27,203 vs. 33,220 Yuan, P < 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 > 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.

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Electrohydraulic and Ultrasonic Lithotripsy in 100 Consecutive Cases of Primary Ureteral Stones

Urologia Internationalis ◽

10.1159/000282178 ◽

1991 ◽

Vol 47 (1) ◽

pp. 16-19 ◽

Cited By ~ 3

Author(s):

J. Vicente ◽

J. Caparrós ◽

J. Salvador ◽

L. Parra ◽

G. Rios

Keyword(s):

Ureteral Stones ◽

Ultrasonic Lithotripsy

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Opportunities for Unsalted Management of the Postoperative Period in Patients with Uncomplicated Ureterolithiasis

Health of Man ◽

10.30841/2307-5090.4.2020.225585 ◽

2021 ◽

pp. 32-38

Author(s):

Oleh Nikitin ◽

Yurii Roshchyn ◽

Ihor Komisarenko ◽

Oleksandr Fukszon ◽

Sviatoslav Smikhun

Keyword(s):

Postoperative Complications ◽

Postoperative Period ◽

Upper Urinary Tract ◽

Ureteral Stones ◽

Cost Of Treatment ◽

Results Of Treatment ◽

Technical Advances ◽

Ureteral Stenting ◽

Stent Complications

When performing surgeries for ureteral stones, ureteral stenting is traditionally performed to avoid obstruction of the ureter in the postoperative period due to edema or stone fragments. Modern technical advances allow ureteroscopy to be performed relatively atraumatically and to avoid routine ureteral stenting, which makes it possible to exclude exacerbations of pyelonephritis caused by reflux, reduce stent costs, improve the quality of life in the postoperative period, and avoid cystoscopy for dentition. The objective: studying the possibility of non-drainage management of the postoperative period, identifying risk factors for postoperative complications in patients with uncomplicated ureteral stones. Materials and methods. The analysis of the results of treatment of 198 patients with uncomplicated ureterolithiasis, in whom it was decided to refuse stenting after ureteroscopy, was carried out. Results. The analysis of the condition of patients in the postoperative period was carried out. To identify the factors influencing the decision on non-drainage management of the patient in the postoperative period, as well as factors that could be predictors of postoperative complications, we analyzed various indicators. Conclusions. In the case of uncomplicated ureterolithiasis, in most cases (in 68.2 % of patients) in the postoperative period, there is no need to drain the upper urinary tract using a stent. At the same time, in a number of cases – namely in 31.8 % of patients – upon refusal to install a stent, complications arose that significantly influenced the duration and cost of treatment, in some cases requiring an increase in the volume of therapy, additional procedures – installation stent and puncture nephrostomy.

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Comparison of the Intracorporeal Ultrasonic Lithotripsy and Intracorporeal Pneumatic Lithotripsy in Terms of Stone Removal and Postoperative Complications

Annals of Punjab Medical College ◽

10.29054/apmc/2020.1029 ◽

2020 ◽

Vol 14 (4) ◽

pp. 308-312

Keyword(s):

Postoperative Complications ◽

Pneumatic Lithotripsy ◽

Stone Removal ◽

Ultrasonic Lithotripsy

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Analysis of Postoperative Complications In Urethrolithiasis Treatment Using Intracorporeal Ultrasonic Lithotripsy

Galician Medical Journal ◽

10.21802/gmj.2016.3.15 ◽

2016 ◽

Vol 23 (3) ◽

Author(s):

R.V. Stetsyshyn

Keyword(s):

High Risk ◽

Postoperative Complications ◽

Ureteral Calculi ◽

Bivariate Analysis ◽

Hounsfield Units ◽

Risk Of Failure ◽

Ultrasonic Lithotripsy

The causes of early and late postoperative complications in patients with ureteral calculi during ultrasonic ureterolithotripsy performance were analyzed. 287 early and late postoperative complications of different severity were noted in 204 patients included into the study. During the bivariate analysis of complications causes, the interrelationship with localization in the upper and middle third of the ureter, the size of more than1 cmand a density of more than 1000 Hounsfield units was revealed.Taking into account the high risk of failure and complications, intracorporeal ureterolithotripsy in patients with complicated ureteral calculi, a differentiated approach to the use of devices for the disintegration of the concretion, or other types of surgery should be used in this group of patients.

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Trattamento endoscopico della calcolosi ureterale

Urologia Journal ◽

10.1177/039156039406101s78 ◽

1994 ◽

Vol 61 (1_suppl) ◽

pp. 274-276

Author(s):

N. Loreto ◽

D. Cuscunà ◽

P. Santoro ◽

M. Bonsanto ◽

G. Francario ◽

...

Keyword(s):

Success Rate ◽

Complication Rate ◽

Endoscopic Treatment ◽

Open Surgery ◽

Combined Treatment ◽

Ureteral Stones ◽

Non Invasive ◽

Stone Removal ◽

Ultrasonic Lithotripsy ◽

Invasive Techniques

Non-invasive techniques have revolutionized the treatment of ureteral stones. We report the success rate and the complication rate of ureteral calculosis treatment with ureterorenoscopy. From November 1990 to April 1994 we have treated 121 patients with URS. In all cases we have used a 12.5 F. “Wolf” rigid ureteroscope. 85 patients (70.2%) were treated with ultrasonic lithotripsy; 36 (29.7%) with a Dormia basket; and in 16 cases a combined treatment of both procedures was employed. Complete stone removal was obtained in 96 patients (79.3%) but six of these required further endoscopic treatment. The complication rate was 7.4 per cent (9 patients) and two patients (1.6%) needed open surgery. In our experience ureteroscopy is a good approach to the treatment of ureteral stones.

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Factors affecting intraoperative and postoperative complications of RIRS classified by the Clavien and Satava grading systems

10.22541/au.161590005.56042638/v1 ◽

2021 ◽

Author(s):

Omer Koras ◽

Ibrahim Halil Bozkurt ◽

Nihat Karakoyunlu ◽

Serdar Çelik ◽

Ertugrul Sefik ◽

...

Keyword(s):

Postoperative Complications ◽

Classification System ◽

Intraoperative Complications ◽

Ureteral Stones ◽

Complication Rates ◽

Stone Size ◽

Factors Affecting ◽

Stone Free Rate ◽

Free Rate ◽

Free Status

Objective: To classify intraoperative and postoperative complications using the modified Clavien classification system (MCCS) and modified Satava classification system (SCS) and to evaluate the parameters associated with complications in patients undergoing retrograde intrarenal surgery (RIRS) for renal and proximal ureteral stones. Materials and Methods: We performed a retrospective analysis of 949 patients who underwent RIRS for renal stones and upper ureteral stones at two institutions between March2015 and June2020. Intraoperative complications were assessed using SCC and postoperative complications were graded according to MCCS. Univariate and multivariate analyses were undertaken to determine predictive factors affecting complication rates. Results: The female/male ratio of 949 patients was found to be 346 (36.5)/603(63.5). The median stone size was determined as 13 mm. The stone-free rate was 83.6%after the first intervention, and the final stone-free rate was 94.4% after re-procedure. According to SCS, the intraoperative event and complication incidence was 153(16.1%). MCCS revealed postoperative complications in 121(12.8%) patients. Major complications were observed in 18(1.9%) patients. The rate of complications was higher in patients with renal anomalies (9.9% vs 3.9%, p=0.006). Besides, stone localization, size, number and density were associated with the development of complications (p<0.001, p<0.001, p<0.001 and p=0.002, respectively). In addition, the multivariate analysis revealed that for the patients with grade≥3 complications according to MCCS, only stone-free status was a significant predictor of complication development (p=0.044) whereas for those with grade ≥2b complications according to SCS, significant predictors were stone size (p<0.001), stone density (p=0.022), and fluoroscopy time (p<0.001). Conclusion: This study showed that abnormal kidney anatomy, multiple stones, operative time, and stone-free status were reliable predictors of complication development during and after RIRS. Appropriate preoperative management should be planned according to these predictors to prevent intraoperative and postoperative complications.

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