A prospective comparative study of ureterorenoscopy with and without DJ stenting for the management of ureteric stones

Background: Urolithiasis is the most common urological disease. Surgical treatment of ureteral stones consists of four minimally invasive modalities including ESWL, URS, PCNL, and laparoscopic or robotic-assisted stone surgery. URS and ESWL are the most widely used techniques. However, the use of ureteral stents for the treatment of ureteral stones is still controversial. Herein, we did a comparative study of URS with and without DJ stenting for the management of ureteric stones. Objectives of current study were to compare prevalence of post-operative complications in patients undergoing ureterorenoscopy without ureteral stenting as compared to patients undergoing stenting procedure, to study the frequency of morbidity in patients during post -operative period in both ‘stent’ and ‘no stent’ groups. Stone free-rate, operative time, complications, hospital stay and need for re-treatment in both groups will be determined.Methods: 50 patients with ureteric stones admitted in our hospital-SMIMER fulfilling our inclusion and exclusion criteria were randomly divided in two groups- patients in group A (25) underwent URS without DJ stenting and group B (25) underwent URS with DJ stenting.Results: URS without DJ stenting had less operative time, less postoperative complications like pain, requirement of analgesia, hematuria, UTI, dysuria, fever, less readmission rate and less hospital stay, similar stone free rate compared to URS with DJ stenting but it requires higher surgical endoscopy skills with urological expertise.Conclusions: Thus, after adequate training, URS without DJ stenting can be recommended as a safe alternative procedure than URS with DJ stenting for management of ureteric stones.

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Application of Pneumatic Lithotripter and Holmium Laser in the Treatment of Ureteral Stones and Kidney Stones in Children

BioMed Research International ◽

10.1155/2017/2505034 ◽

2017 ◽

Vol 2017 ◽

pp. 1-6 ◽

Cited By ~ 3

Author(s):

Marcin Życzkowski ◽

Rafał Bogacki ◽

Krzysztof Nowakowski ◽

Bartosz Muskała ◽

Paweł Rajwa ◽

...

Keyword(s):

Operative Time ◽

Treatment Options ◽

Population Based ◽

Holmium Laser ◽

Ureteral Stones ◽

Stone Free Rate ◽

Group A ◽

The Mean ◽

Laser Group ◽

Free Rate

Objective.Treatment options for urolithiasis in children include URSL and RIRS. Various types of energy are used in the disintegration of deposits in these procedures. We decided to evaluate the usefulness of URSL and RIRS techniques and compare the effectiveness of pneumatic lithotripters and holmium lasers in the child population based on our experience.Materials and Methods.One hundred eight (108) children who underwent URSL and RIRS procedures were enrolled in the study and divided into two (2) groups according to the type of energy used: pneumatic lithotripter versus holmium laser. We evaluated the procedures’ duration and effectiveness according to the stone-free rate (SFR) directly after the procedure and after fourteen (14) days and the rate of complications.Results.The mean operative time was shorter in the holmium laser group. A higher SFR was observed in the holmium laser but it was not statistically significant in the URSL and RIRS procedures. The rate of complications was similar in both groups.Conclusions.The URSL and RIRS procedures are highly efficient and safe methods. The use of a holmium laser reduces the duration of the procedure and increases its effectiveness in comparison with the use of a pneumatic lithotripter.

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Introducing in clinical practice a new laser suction handpiece for percutaneous nephrolithotomy

Urologia Journal ◽

10.1177/03915603211031874 ◽

2021 ◽

pp. 039156032110318

Author(s):

Noam Bar-Yaakov ◽

Haim Hertzberg ◽

Ron Marom ◽

Jemal Jikia ◽

Roy Mano ◽

...

Keyword(s):

Operative Time ◽

Statistical Significance ◽

Hounsfield Units ◽

Stone Size ◽

Stone Clearance ◽

Stone Free Rate ◽

Average Operative Time ◽

Group A ◽

Group B ◽

Free Rate

Objective: To assess a novel combined laser suction handpiece (LSH) for performing PCNL in a clinical setting. Methods: The study comprised 40 consecutive PCNLs performed between May 2019 and February 2020. The first 20 procedures (Group A) were performed with conventional ultrasonic or pneumatic devices and the other 20 (Group B) were performed with the use of the new LSH. All patients were treated by tubeless supine PCNL. The groups were compared for demographics, clinical data, operative time, lithotrite effectiveness, stone clearance rate (SCR), and outcome. Results: Groups A and B were similar in age, and in stone size, complexity, and density (Hounsfield units) ( p < 0.05). The average operative time was 99 and 78 min, SCR 143 and 200 mm3/min, hospital stay 1.6 and 1.1 days, and stone-free rate 90% and 95%, respectively. Despite a trend toward better results with the new LSH, none of these comparisons reached statistical significance. Ineffective lithotripsy with the initial device (ultrasonic) requiring conversion to another modality (ballistic) occurred in six (30%) procedures in Group A, while all procedures were effectively accomplished with the LSH in Group B ( p = 0.02). There were two complications in Group A and none in Group B ( p > 0.05). Conclusions: The LSH is as effective and safe as the traditional lithotrites for performing PCNLs. This new tool completes the capabilities of the holmium laser high-power machines, enabling them to serve as the sole platform for all endourological treatments.

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Counter-Irrigation as a Novel Technique versus the Standard Technique in Percutaneous Nephrolithotomy: A Prospective Randomized Trial

Urologia Internationalis ◽

10.1159/000518372 ◽

2021 ◽

pp. 1-7

Author(s):

Ahmed El-Sakka ◽

Abdelnaser Elgamasy ◽

Karim Sallam ◽

Mohamed G. Soliman

Keyword(s):

Blood Transfusion ◽

Hospital Stay ◽

Randomized Trial ◽

Percutaneous Nephrolithotomy ◽

Standard Technique ◽

Prospective Randomized Trial ◽

Stone Free Rate ◽

Group A ◽

Group B ◽

Free Rate

Objective: This study aimed to evaluate the efficacy of our counter-irrigation technique versus the standard technique in percutaneous nephrolithotomy (PCNL) by assessment of the stone-free rate after the procedures and its safety in terms of comparing the intraoperative time, Hb deficit, blood transfusion, length of hospital stay, auxiliary procedures, and perioperative complications with that of the standard one. Methods: This prospective randomized trial was conducted on patients with renal stone 2–3 cm in diameter without contraindications to PCNL. The patients were randomized into group A in which the counter-irrigation technique has been performed and group B who were managed by the standard technique. The preoperative characteristics including demographic data and stone parameters were compared between both groups. The primary outcome was the stone-free rate assessed by noncontrast spiral CT after 3 months. The secondary outcome included intraoperative time, Hb deficit, blood transfusion, hospital stay, auxiliary procedure required, and rate of complications. Results: Forty-eight patients were included in this study. Overall, no significant difference was observed between both groups regarding preoperative characteristics, Hb deficit, and complication rate. Operative time was significantly shorter in group B (p = 0.001). None of our patients required blood transfusion. The stone-free rates at 3 months were significantly better in group A (95% for group A and 70% for group B, p = 0.04). Conclusions: Our results indicate that our counter-irrigation technique has lower stone migration with subsequent significantly better stone-free rate versus the standard technique. We can recommend this technique as a potentially valid option for cases with large stone burden when the access to the upper calyx is feasible to minimize significant residual fragments.

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IS RETROGRADE INTRARENAL SURGERY PREFEREABLE OVER MINI PERCUTANEOUS NEPHROLITHOTOMY IN PATIENTS WITH RENAL CALCULUS OF LESS THAN OR EQUAL TO 2 CM SIZE?

10.36106/gjra/5203171 ◽

2020 ◽

pp. 1-4

Author(s):

Girish H M ◽

Sanman K N ◽

G G Laxman Prabhu ◽

Ranjit Shetty

Keyword(s):

Hospital Stay ◽

Percutaneous Nephrolithotomy ◽

Renal Calculus ◽

Complication Rates ◽

Operative Outcomes ◽

Stone Free Rate ◽

Group A ◽

Laboratory Investigations ◽

Group B ◽

Free Rate

Objective: To compare intraoperative and post-operative outcomes between mini-percutaneous Nephrolithotomy (miniPCNL) and Retrograde intrarenoscopy (RIRS) groups. Materials and methods: A total of 66 patients were alternatively allocated to undergo miniPCNL (33patients, group A) and RIRS (33patients, group B) groups. All patients were evaluated by history, laboratory investigations, X-ray Kidney ureter bladder (KUB), Ultrasonography and computerized tomography (CT) scan to determine stone number, location and size. Operative time, stone free rate, duration of hospital stay and complications were compared between both groups. Results: Demographic parameters were comparable between two groups. Stone free rate was similar in both groups. Mean duration of procedure was less for miniPCNL when compared to RIRS with P < 0.0001. Duration of post-operative stay for miniPCNL was longer when compared to RIRS with P < 0.0001. Complications like intra operative bleeding, post-operative fever and blood transfusion were similar in both groups. The RIRS group patients experienced reasonably less pain postoperatively as per Visual analogue scale (VAS) score when compared to miniPCNL group with P < 0.0001. Conclusion: Though RIRS and miniPCNL have good and comparable stone free rate with low complication rates, favourable pain score and less hospital stay makes RIRS a preferred option over miniPCNL.

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A comparative study between continuous and interrupted sutures in open pyeloplasty

Urologia Journal ◽

10.1177/03915603211015109 ◽

2021 ◽

pp. 039156032110151

Author(s):

Sandeep Gupta ◽

Ankit Verma ◽

Dilip Kumar Pal

Keyword(s):

Comparative Study ◽

Hospital Stay ◽

Operative Time ◽

Postoperative Hospital Stay ◽

Continuous Group ◽

Care Hospital ◽

Time Duration ◽

Group A ◽

Group B ◽

Operative Drainage

Background: Pelvi-ureteric junction obstruction (PUJO) is one of the common causes of obstructive uropathy dealt by urologists around the globe. The management of PUJO requires surgical intervention and pelvi-ureteral anastomosis is most time-consuming step in surgery and suturing plays a critical role for the good outcome of the surgery. Objective: To assess the outcomes of continuous or interrupted suturing in open pyeloplasties done for PUJ obstruction. Materials and methods: This comparative study was conducted in the department of Urology in a tertiary care hospital of eastern India. A total of 60 patients with pelviureteric junction obstruction were included as per inclusion and exclusion criteria and divided into two groups depending upon whether continuous (Group A) or interrupted (Group B) suturing was done. Both groups were compared for mean operative time, mean suturing time, duration of post-operative drainage, mean drain output, post-operative hospital stay, postoperative GFR and improvement in GFR. Results: Out of 60 patients continuous and interrupted suturing was done in 30 patients in both arms. Out of 60 cases there were 46 (76.66%) males and 14 (23.33%) females with a M:F ratio of 1:0.30. The mean age in group A and group B was found to be 30.06 ± 8.28 and 27.63 ± 6.07, respectively. Mean operative time, mean suturing time, duration of post-operative drainage, mean drain output and postoperative hospital stay were found to be higher in interrupted suture group and the difference was found to be statistically highly significant ( p < 0.0001). The complication rates and recurrence rates were found comparable in both the cases with no statistically significant difference ( p > 0.05). Conclusion: Continuous suturing technique for pyeloplasty is preferable as it is found to have a lower mean operative time, mean suturing time, duration of post-operative drainage, mean drain output and postoperative hospital stay.

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Stone-free rate after semirigid ureteroscopy with holmium laser lithotripsy versus laparoscopic ureterolithotomy for upper ureteral calculi: a multicenter study

African Journal of Urology ◽

10.1186/s12301-019-0003-4 ◽

2019 ◽

Vol 25 (1) ◽

Author(s):

Ahmed Issam Ali ◽

Ali M. Abdel-Karim ◽

Ahmed A. Abd El Latif ◽

Amr Eldakhakhny ◽

Ehab M. Galal ◽

...

Keyword(s):

Operative Time ◽

Laser Lithotripsy ◽

Holmium Laser ◽

Holmium Laser Lithotripsy ◽

Stone Free Rate ◽

Stone Migration ◽

Group A ◽

The Mean ◽

Group B ◽

Free Rate

Abstract Background Different treatment options were used to treat upper ureteral calculi. The aim of our study is to compare the stone-free rate and postoperative outcomes between semirigid ureteroscope with holmium laser lithotripsy and laparoscopic ureterolithotomy for the management of large solitary upper ureteral stones. Sixty-seven patients with a solitary upper ureteral stone who had LU or semirigid ureteroscopy in the period between January 2014 and March 2017 were included in our study. Out of the sixty-seven patients, 37 patients had semirigid ureteroscopy and holmium laser lithotripsy (Group A) and 30 patients had laparoscopic ureterolithotomy (Group B). Both groups were compared regarding operative time, intraoperative complications, need for auxiliary procedures, hospital stays, postoperative complications and stone-free rate. Results The mean stone size was 1.84 ± 0.12 cm in Group A and 1.79 ± 0.17 cm in Group B, P value = 0.2. The mean operative time was 61.5 ± 3.5 min in Group A and 63 ± 4.2 min in Group B, P value = 0.13. Stone migration was recorded in five cases (14%) in Group A while no cases in Group B had stone migration. Flexible ureteroscope was used as an auxiliary measure in five patients (14%) in Group A at the same session. No auxiliary measures were used in the LU group. Conclusion The stone-free rates after semirigid URS and laser lithotripsy are comparable to those following LU, especially when flexible URS is used to manage migrating stone fragments at the same session.

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Modified Lift Versus Cutting Seton for Transphincteric Fistula -Experience at Tertiary Care Hospital

10.53350/pjmhs2115123257 ◽

2021 ◽

Vol 15 (12) ◽

pp. 3257-3260

Author(s):

Muhammad Najam Iqbal ◽

Ashfaq Nasir

Keyword(s):

Comparative Study ◽

Anal Incontinence ◽

Complete Healing ◽

Fistula Tract ◽

Fistula Closure ◽

Fistula In Ano ◽

Group A ◽

Prospective Comparative Study ◽

Cutting Seton ◽

Group B

Background: Fistula in ano is a common disease which has high recurrence rate and high fecal incontinence rate after surgery. We compared modified LIFT (Ligation of the intersphincteric fistula tract (LIFT) through lateral approach ) with cutting seton for transphincteric fistula. Aim: This study is aimed at which procedure is better with respect to postoperative complications Study design: It was a prospective comparative study. Methods: This was a prospective comparative study from 01-01-2019 to 30-06-2021 which was conducted on 50 patients who presented with transsphincteric fistula in ano (FIA) in surgical ward of Bahawal Victoria Hospital Bahawalpur. Patients were divided into two groups .Patients of Group A underwent modified lift procedure and patients of group B underwent cutting seton procedure. Data was collected on a proforma which included patients’ name ,age ,sex, age group, comorbid disease like diabetes mellitus ,chronic liver disease, cardiovascular disease and chronic renal failure, fistula tract involving less than 50% or more than 50% external sphincter ,procedure done, healing time of wound, complications like recurrence and incontinence. Patients were followed for 6 months for healing rate ,recurrence and incontinence. Data was analysed on spss 22 version Results: In Group A, complete healing (fistula closure without recurrence) was achieved in 20 patients (80%) out of 25. There was no case of anal incontinence after the procedure. 5 (20%) patients experienced recurrence in 6 months . In Group B, complete healing (fistula closure without recurrence) was achieved in 21 patients (84%), in 6 months follow up . 4(16%) patients were diagnosed as a case of anal incontinence. There were 4 (16%) patients with recurrence. Conclusion: Modified LIFT is better in terms of incontinence where as cutting seton is better in terms of recurrence.it is suggested that for high lying fistula modified LIFT is better procedure and for low lying fistula involving less than 50% sphincter cutting seton is better procedure.. Keywords: Modified LIFT (ligation of ineter sphincteric fistula tract) ,Cutting seton , transphincteric fistula.

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O’CONOR (TRANSABDOMINAL) REPAIR: IS IT ALWAYS NECESSARY TO INTERPOSE A FLAP IN SIMPLE VESICO-VAGINAL FISTULA? A COMPARATIVE STUDY

Pakistan Armed Forces Medical Journal ◽

10.51253/pafmj.v71i1.3599 ◽

2021 ◽

Vol 71 (1) ◽

pp. 347-50

Author(s):

Qamar Zia ◽

Asma Rizwan ◽

Adil Khurshid ◽

Mudassar Sajjad ◽

Muhammad Nawaz ◽

...

Keyword(s):

Comparative Study ◽

Vesicovaginal Fistula ◽

Armed Forces ◽

Vaginal Fistula ◽

Fistulous Opening ◽

Vesicovaginal Fistulae ◽

Group A ◽

Prospective Comparative Study ◽

Group B ◽

Vesico Vaginal Fistula

Objective: To assess morbidity and success of transabdominal (O’Conor) repair of vesicovaginal fistula with orwithout interposition of flap between vagina and urinary bladder. Study Design: Prospective comparative study. Place and Duration of Study: Armed Forces Institute of Urology, Rawalpindi, from Mar 2016 to Jan 2019. Methodology: Fifty five patients were randomized into group A & B by lottery method. An inclusion criterionwas single fistulous opening of ≤3cm. Complex and recurrent fistulae were excluded. Patients in group A underwent O’Conor repair without interpositional flap while in group B vesicovaginal fistulae were repaired with flap interposition. Results: Twenty two patients were randomized in group A while 27 in group B. Mean age of patients was 41.65± 11.93 years. Gynecological and obstetrical surgery was the main cause of fistula. Mean duration of surgerywas 162.7 ± 18.49 minutes. Per-operative ureteric catheterization was done in 9 (16.8%) patients. Seventeen(30.6%) patients had paralytic ileus. There was transient fever in 4 (7.6%) of cases and wound infection was seenin 3 (5.8%) of patients. Mean hospital stay was 3.4 ± 2.3 days. Cystogram was done in 35 (64.5%) of patients before the removal of per-urethral catheter. The overall success rate was 92.9%. Ten (18.2%) of patients developed denovo urgency which was managed conservatively. There was no statistical difference in both groups in terms of morbidity and success. Conclusion: In simple Vesico-vaginal fistulae repair, interposition of flap can be omitted and it does not affect the outcomes in terms of success and morbidity.

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Extracorporeal Shock Wave Lithotripsy verus Rigid Ureteroscopy in Treatment of Mid-Ureteric Stones; Randomized Prospective Study

QJM ◽

10.1093/qjmed/hcaa070.018 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

A S Hegazy ◽

M I Ahmed ◽

A F M Abdelgawad

Keyword(s):

Shock Wave ◽

Urinary Tract ◽

Prospective Study ◽

Hospital Stay ◽

Shock Wave Lithotripsy ◽

Ureteral Stones ◽

Extracorporeal Shock Wave ◽

Stone Free Rate ◽

Operative Complications ◽

Free Rate

Abstract Background Urinary stone disease or nephrolithiasis, the third most common disease of the urinary tract is a major health problem due to its high prevalence, incidence and recurrence. The lifetime incidence of kidney stones for men and women is approximately 13% and 7% respectively. Although stones may be asymptomatic, potential consequences include abdominal and ﬂank pain, nausea and vomiting, urinary tract obstruction, infection, and procedure-related morbidity. Ureteral stones frequently cause renal colic and if left untreated can cause obstructive uropathy. Objectives A prospective randomized study to compare between extracorporeal shock-wave lithotripsy and rigid ureteroscopy in mid-ureteric stone treatment regarding efficacy, stone-free rate, retreatment rates, associated complications (intra-operative and post-operative), operative duration, hospital stay. Patients and Methods This study was performed at Ain Shams University (Urology department) and El Doaah hospital (Urology department), From August 2016 to August 2017, a total of 50 patients having solitary radiopaque middle ureteral stone ranges between 0.5 – 1.5 in size were divided into two groups 25 patients each enrolled in our prospective study. Results In this study the overall stone free rate was considered after two sessions of ESWL (in case of ESWL group) or one trial of ureteroscopy (in case of URS group). ESWL group: 14 cases became stone free after the first session, while the remaining 11 out of 25 patients needed second session, 6 cases became stone free after the second session. ESWL failure occurred in 5 cases and they were successfully managed by ureteroscopy. URS group: 23 cases became stone free after first ureteroscopy, while the remaining 2 patients needed second ureteroscopy due to proximal migration of the stone. In ESWL group, patients were already at outpatient clinic so there were no admission or hospital stay, all cases done without anesthesia, just analgesic ± sedation. While in URS group patients admitted and the hospital stay varies from one day to seven days according to the condition of the case, all URS cases had Spinal anesthesia. ESWL was shown to be less time consuming than URS with a mean operative time of 46.84±3.61 minutes versus 56.20±7.11 minutes respectively. In URS group there were 22 patients had ureteric catheter inserted for 24 to 72 hours postoperatively and 3 patients had double (J) stent inserted for 4 weeks postoperatively, while all the patients who underwent ESWL, no auxiliary procedure done as this procedure is completely non-invasive. Among ESWL cases, No case had an intra-operative complication, while URS group had 3 cases of intra-operative complication. There were 4 cases who had post-operative complications among ESWL group, while there were 5 cases who had post-operative complications among URS group. Conclusion In treatment of mid-ureteral stones range 0.5-1.5 in size, both URS and ESWL modalities are comparable but URS is recommended as a first option as it is more effective than ESWL regarding stone free rate and it provides immediate stone clearance with lower re-treatment rates and higher patient satisfaction, but URS requires anesthesia, longer hospitalization, and associated with a higher incidence of complications.

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Laparoscopic Ureterolithotomy: A Prospective Comparative Study

Medical Journal of Shree Birendra Hospital ◽

10.3126/mjsbh.v16i1.16986 ◽

2017 ◽

Vol 16 (1) ◽

pp. 37-41

Author(s):

Naresh Kumar Giri ◽

Narayan Thapa ◽

Bikash Bikram Thapa ◽

Bharat Bahadur Bhandary ◽

Bhairab Kumar Hamal

Keyword(s):

Comparative Study ◽

Treatment Option ◽

Open Surgery ◽

Operative Time ◽

Primary Treatment ◽

Ureteral Stones ◽

Median Hospital Stay ◽

Non Invasive ◽

Disease Characteristics ◽

Prospective Comparative Study

Introduction: With the developments of non invasive and minimally invasive technology in the management of urolithiasis, the choice of open surgery is rapidly decreasing. The optimal modality of stone management is governed by multiple factors like stone parameters, patient character, availability of technology and surgeon's skill. Open or laparoscopic ureterolithotomy can be used as primary treatment option for large, impacted ureteral stones of more than 1.5 cm or as an adjunct procedure in case of failed ESWL and attempted URS or PCNL.Methods: This is a prospective comparative study to see the outcome of Trans-peritoneal Laparoscopy Ureterolithotomy (TPLU) with Open Ureterolithotomy (OU). Out of 42 patients 21 had undergone laparoscopic ureterolithotomy and same number had undergone open surgery over the period of two and half years. The variables evaluated were age, sex, stone character, operative time, Visual Analogue Scale (VAS) for pain, complications and hospital stay.Results: The patient and disease characteristics in both groups were comparable. Mean operative time was 107.62 ± 32.84 mins in TPLU VS 65.48 ± 15.72 mins in OU group. Median hospital stay was 2.19 ± 1.78 days in TPLU VS 4.62 ± 1.53 days in OU group. The pain score is significantly low in TPLU than OU (p < 0.05).Conclusion: Laparoscopic ureterolithotomy is a safe and feasible treatment option for the selected ureteric stone with comparable outcomes.

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