scholarly journals Romanian National premiere with the new Thulium SuperPulsed Laser in the endourological treatment of urolithiasis

2021 ◽  
Vol 14 (3) ◽  
pp. 316-322
Author(s):  
Bogdan Geavlete ◽  
◽  
◽  
◽  
Razvan Multescu ◽  
...  
Keyword(s):  
Operative Time ◽  
Laser System ◽  
Renal Stones ◽  
Renal Calculi ◽  
Urinary Stones ◽  
Bladder Stones ◽  
Promising Tool ◽  
Clavien Grade ◽  
Thulium Fiber Laser ◽  
Tract Infections

In this paper, we aimed to verify the efficiency and functionality of the new Soltive Thulium Fiber Laser (TFL) in the treatment of urinary stones. The Soltive Laser System was used in 17 urolithiasis cases: 10 renal, 5 ureteral, and 2 bladder stone patients. The average stone size was 13.1 mm (ranging between 11–29 mm) for the kidney, 8 mm (ranging between 6–12 mm) for the ureter, and 31 mm (ranging between 27–34 mm) for the bladder. Only single calculi patients were included in the study. We used 100 and 150 μm core-diameters fibers (CDF). Three settings were applied: 0.15 J/100 Hz for “fine dusting”, 0.5 J/30 Hz for “dusting” and 1 J/15 Hz for the fragmentation mode. The mean operative time was 34 minutes for renal, 21 minutes for ureteral, and 39 minutes for bladder stones. The visibility was optimal in all cases. The stone-free rate at 1 month after treatment was 95% for renal calculi and 100% for ureteral and bladder stones. Very fine dust made of stone fragments smaller than 1 mm in size that passed spontaneously through the access sheath was observed, especially subsequent to the “fine dusting” mode. The complication rate was very low: 1 patient was classified as Clavien grade 1 and 1 patient as Clavien grade 2, and this was the case for renal stones only. No urinary tract infections were observed. The new Soltive TFL appears to be a remarkably promising tool in the therapeutic approach of urolithiasis. Lithotripsy was achieved up to the level of extremely small stone fragments with improved efficiency while also optimizing the operative time.

scholarly journals Mini-percutaneous nephrolithotomy in surgery of nephrolithiasis

2021 ◽  
pp. 44-52
Author(s):  
Аndriy Sahalevych ◽  
Roman Sergiychuk ◽  
Vladislav Ozhohin ◽  
Olexandr Vozianov ◽  
Andriy Khrapchuk ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Percutaneous Nephrolithotomy ◽  
Renal Stones ◽  
Renal Calculi ◽  
Stone Free Rate ◽  
Duration Of Surgery ◽  
Lower Complication ◽  
Lower Complication Rate ◽  
Tract Infections ◽  
Free Rate

Abstract. The present study aimed to assess the effectiveness and safety of mini-percutaneous nephrolithotomy (mPNL) in comparison with standard percutaneous nephrolithotomy (sPNL) for the treatment of complex nephrolithiasis. Methods. During the period from 2012 to 2020, 1021 patients with solitary (10.0-30.0 mm), staghorn and multiple renal calculi were retrospectively divided into two groups: sPNL (500 patients) and mPNL (521 patients). The groups were compared by the stone-free rate (%, SFR), the duration of the surgery, complications and hospital stay. Results. SPNL and mPNL were highly effective procedures for the treatment of nephrolithiasis. The mPNL group had longer operative times (81.0±15.5 vs 69.1±13.9 min, p<0.001) and higher frequency tubeless/totally tubeless procedures (41.1 vs 6.8%, p<0.001). mPNL showed a higher SFR (96.4 vs 91.8%, р=0.002 in patients with complete staghorn (90.1 vs 77.3%, p<0.05) and multiple kidney stones (89.5 vs 70.8%, p=0.03). Postoperative decrease in hemoglobin was lower in mPNL group 1.1±0.34 vs 2.1±0.26 g/dl (p<0.001). The incidence rate of urinary tract infections and postoperative hospital stay was lower in the mPNL group: 7.3 vs 13.2%, p=0.03 and 1.9±0.6 vs 4.3±2.4 days, р<0.001. Conclusions. MPNL is a safe and effective treatment for patients with complex renal stones with an improved stone-free rate and lower complication rate and shorter hospital stay. Smaller diameter tract in mPNL procedures was associated with a longer duration of surgery.

scholarly journals Urolithiasis (Kalladaippu) - An Evidence Based Case Study

2017 ◽  
Vol 8 (1) ◽  
Author(s):  
Shree Devi M S ◽  
Sathiyarajeswaran P ◽  
Siva Lakshmi S ◽  
Daniya Francis
Keyword(s):  
Developing Countries ◽  
Urinary Tract ◽  
Renal Stones ◽  
Renal Calculi ◽  
Western Diet ◽  
Synergistic Action ◽  
Urinary Stones ◽  
Evidence Based ◽  
Diet Habits

“KALLADAIPPU” (Urolithiasis) “KALPIRAMIYAM”(Urolithiasis) are the synonyms in Siddha and the term equated to renal calculi in allopathic system of medicines. An increasing affluence and adaptation of Western diet habits in many developing countries seem likely to contribute to the changes for the development of renal calculi. Siddha medicine describes certain formulations as Lithotriptic and diuretic which is used in the treatment of renal calculi successfully. This case reported again is an example that proves the efficacy of Siddha medicines for expulsion of renal stones. The synergistic action enhanced resulting in disintegration and elimination of urinary stones from urinary tract.

Use of non-contrast computed tomography determined urinary stone fragility in predicting the outcome of extracorporeal shockwave lithotripsy treatment: a single-center study

2020 ◽  
Vol 14 (2) ◽  
pp. 59-63
Author(s):  
Athar Hameed ◽  
Khazir Hayyat Gondal
Keyword(s):  
Shock Waves ◽  
Renal Stone ◽  
Plain Film ◽  
Renal Stones ◽  
Renal Calculus ◽  
Urinary Stone ◽  
Stone Disease ◽  
Urinary Stones ◽  
Fisher Exact Test

Background: Renal stones represent a common urological pathology where standard treatment advised is ESWL in current practice. However, NCCT based determination of stone fragility may help to predict the outcome of ESWL treatment, hence optimizing its clinical use. Therefore, this study evaluated the role of NCCT determined urinary stone fragility in predicting the outcome of ESWL treatment in local clinical settings. Patients and methods: One hundred patients with single renal calculus of 0.6-2 cm in size were included. NCCT based determination of stone fragility in HU units was done for all patients. Patients were then subjected to ESWL, with a maximum of 3000 shock waves given per ESWL session. Plain film and/or ultrasonography was used to monitor ESWL treatment progress with a final NCCT evaluation at 12 weeks to determine the clearance of the calculi for each patient. Association of NCCT based stone fragility and outcome of ESWL was statistically analyzed using Fisher exact test. Results: The mean age of the patients was 37.7 ± 10.9 years with 54% being male. Decreasing stone fragility on NCCT (high = <500HU, moderate = 500-1000HU, and high = 1000HU) required more number and intensity of ESWL sessions (1-2 visits and 3000-6000 shock waves for high stone fragility group, 3-5 visits and 7000-18000 shock waves for the moderate group, and 6 visits and >18000 shock waves for low fragility group, respectively) necessary for clearance of urinary stones (p<0.001). In 98% of patients, the clearance of urinary stones was excellent. Conclusion: Renal stone patients with NCCT determined high and moderate stone fragility show an optimal response after ESWL treatment, whereas, for low fragility renal stones attenuative treatment like percutaneous nephrolithotomy and/or ureteroscopy should be considered instead of ESWL. This approach can enable patient stratification before ESWL therapy ensuring better clinical management of the renal stone disease.

scholarly journals Outcomes of Ureteroscopy and Laser Stone Fragmentation (URSL) for Kidney Stone Disease (KSD): Comparative Cohort Study Using MOSES Technology 60 W Laser System versus Regular Holmium 20 W Laser

2021 ◽  
Vol 10 (13) ◽  
pp. 2742
Author(s):  
Amelia Pietropaolo ◽  
Thomas Hughes ◽  
Mriganka Mani ◽  
Bhaskar Somani
Keyword(s):  
Operative Time ◽  
Laser System ◽  
Stone Fragmentation ◽  
System Versus ◽  
Number Of Patients ◽  
Higher Power ◽  
Group A ◽  
The Mean ◽  
Laser Group ◽  
Second Procedure

Background: For ureteroscopy and laser stone fragmentation (URSL), the use of laser technology has shifted from low power to higher power lasers and the addition of Moses technology, that allows for ‘fragmentation, dusting and pop-dusting’ of stones. We wanted to compare the outcomes of URSL for Moses technology 60 W laser system versus matched regular Holmium 20 W laser cases. Methods: Prospective data were collected for patients who underwent URSL using a Moses 60 W laser (Group A) and matched to historical control data using a regular Holmium 20 W laser (Group B), performed by a single surgeon. Data were collected for patient demographics, stone location, size, pre- and post-operative stent, operative time, length of stay, complications and stone free rate (SFR). Results: A total of 38 patients in each group underwent the URSL procedure. The stones were matched for their location (17 renal and 11 ureteric stones). The mean single and cumulative stone sizes (mm) were 10.9 ± 4.4 and 15.5 ± 9.9, and 11.8 ± 4.0 and 16.5 ± 11.3 for groups A and B, respectively. The mean operative time (min) was 51.6 ± 17.1 and 82.1 ± 27.0 (p ≤ 0.0001) for groups A and B. The initial SFR was 97.3% and 81.6% for groups A and B, respectively (p = 0.05), with 1 and 7 patients in each group needing a second procedure (p = 0.05), for a final SFR of 100% and 97.3%. While there were 2 and 5 Clavien I/II complications for groups A and B, none of the patients in group A had any infection related complication. Conclusions: Use of Moses technology with higher power was significantly faster for stone lithotripsy and reduced operative time and the number of patients who needed a second procedure to achieve a stone free status. It seems that the use of Moses technology with a mid-power laser is likely to set a new benchmark for treating complex stones, without the need for secondary procedures in most patients.

Complex cystine kidney stones treated with combined robot-assisted laparoscopic pyelolithotomy and intraoperative renoscopy

2017 ◽  
Vol 85 (2) ◽  
pp. 76-78 ◽  
Author(s):  
Luca Meggiato ◽  
Francesco Cattaneo ◽  
Fabio Zattoni ◽  
Fabrizio Dal Moro ◽  
Paolo Beltrami ◽  
...  
Keyword(s):  
Kidney Stones ◽  
Renal Stones ◽  
Renal Calculi ◽  
Robot Assisted ◽  
Intraoperative Bleeding ◽  
Laparoscopic Pyelolithotomy ◽  
Urinary Infections ◽  
Hospital Referral ◽  
Combined Technique ◽  
Rare Autosomal Recessive Disease

Introduction: Cystinuria, a rare autosomal recessive disease characterized by a defect in cystine renal reabsorption, can often determine complex cystine renal calculi, leading to important complications such as urinary obstruction, urinary infections, and impaired kidney function. Complex kidney stones can have a difficult management and can be very arduous to treat. Case description: We present the case of a 20-year-old Jeowah’s witness woman with complex cystine renal stones treated with combined robot-assisted laparoscopic pyelolithotomy and intraoperative renoscopy. Conclusions: The combination of robot-assisted laparoscopic pyelolithotomy and intraoperative renoscopy can be useful to achieve an immediate high stone clearance rate also in complex renal stones. This combined technique could be indicated to minimize intraoperative bleeding. Moreover, it can also be used in pediatric cases or when there is no ureteral compliance. However, this strategy can be performed only in hospital referral centers by expert surgeons.

scholarly journals Efficacy of Percutaneous Nephrolithotomy in the Treatment of Renal Calculi of 10 to 20 MM Size: A Comparison With Extracorporeal Shock Wave Lithotripsy

2020 ◽  
Vol 21 (2) ◽  
pp. 98-104
Author(s):  
Muhammad Mahmud Alam ◽  
Mohammad Rezaul Karim ◽  
Mohammad Ohiduzzaman Khan ◽  
Mohammad Mukhlesur Rahman ◽  
Mahfuja Asma ◽  
...  
Keyword(s):  
Shock Wave ◽  
Percutaneous Nephrolithotomy ◽  
Extracorporeal Shock Wave Lithotripsy ◽  
Shock Wave Lithotripsy ◽  
Renal Stones ◽  
Renal Calculi ◽  
Post Procedure ◽  
Extracorporeal Shock Wave ◽  
Significant Difference

Background: Stones in the urinary tract is a common medical problem in the general population. At present, the great expansion in minimally invasive techniques has led to the decrease in open surgery. Extracorporeal shock wave lithotripsy (ESWL) has been introduced as an alternative approach which disintegrates stones in the kidney and upper urinary tract through the use of shock waves. Nevertheless, as there are limitations with the success rate in ESWL, other minimally invasive modalities for kidney stones such as percutaneous nephrolithotomy (PCNL) is also widely applied. There is a trend of using ESWL for treatment of renal stones smaller than 1 cm and PCNL in those with stones greater than 2 cm. Nevertheless, no consensus regarding treatment of renal stones between 1 to 2 cm stones. The objective of this prospective study was to compare the results of ESWL and PCNL for treatment of 1 to 2 cm renal stones. Method : This is a quasi experimental study. This study was conducted to compare the efficacy and safety of percutaneous nephrolithotomy (PCNL) and extracorporeal shock wave lithotripsy (ESWL) in treating 10 to 20 mm sized renal stone among the Bangladeshi population. This prospective study conducted between the periods of September, 2011 to August, 2012 in the department of urology, Bangabandhu Sheikh Mujib medical university (BSMMU) Hospital. All the patients attending the urology outpatient clinic with 10 to 20mm renal calculi were the study population. A total of 70 subjects were enrolled for this study and they were equally divided into two groups so that each group had 35 subjects. The one group received PCNL whereas the other group received ESWL. Statistical analyses of the results were obtained by using window based computer software devised with Statistical Packages for Social Sciences (SPSS-15). Results: There is no statistically significant difference in regarding age, sex, stone side(lt. or rt.), the distribution of stone (upper, middle and lower calyx) and size between the groups (p>0.05). At 3 month follow up among the patients in ESWL group stone cleared and not cleared were 25(71.4%) and 10(28.6%) respectively and at 3 month follow up among the patients in PCNL group stone cleared and not cleared were 33(94.3%) and 2(5.7%)respectively. There is statistically significant difference in stone clearance rate at 3 month follow up between the groups (p<0.05). All patients in ESWL group developed post procedure haematuria 35(100.0%). Other post procedure complications among the ESWL group pain, fever and steinstrasse were 12(34.3%), 07(20.0%) and 03(08.6%) respectively. Common post procedure complications among the patients of PCNL group pain, haematuria and fever were 11(31.4%), 33(94.3%) and 13(37.1%) respectively. Other post procedure complications in PCNL group were vomiting (8.6%), urinary leakage (5.7%), wound infection (11.4%) and urinary cutaneous fistula (5.7%). There was no statistically significant difference post procedure pain, haematuria and fever between the groups (p>0.05), but statistically significant difference observed in steinstrasse and wound infection between the groups (p<0.05). Mean±SD of hospital stay among the patients of ESWL group and PCNL group was 1.37±0.65 and 4.34±1.43 days respectively. There is statistically significant difference in hospital stay between the groups (p<0.05). Conclusion: Though some specific complications which can be treated conservatively are more in PCNL group it may be concluded that the treatment with PCNL is better option than ESWL among the patients having renal calculi 10 to 20 mm. Bangladesh Journal of Urology, Vol. 21, No. 2, July 2018 p.98-104

scholarly journals Simultaneous transurethral resection of the prostate and cystolithotripsy: A urological dilemma examined

2020 ◽  
Vol 15 (7) ◽  
Author(s):  
Sander Mekke ◽  
Hossain Roshani ◽  
Paul Van Zanten ◽  
Lorena Grondhuis Palacios ◽  
Joost Egberts ◽  
...  
Keyword(s):  
Relative Risk ◽  
Urinary Retention ◽  
Transurethral Resection ◽  
Operative Time ◽  
Prostate Volume ◽  
Stone Formation ◽  
Number Needed To Treat ◽  
Bladder Stones ◽  
Significant Difference ◽  
Retrospective Nature

Introduction: Controversy exists over whether transurethral resection of the prostate (TURP) in men with bladder stones prevents recurrence of stone formation and facilitates stone discharge. We sought to evaluate whether TURP in patients who underwent cystolithotripsy led to a lower recurrence of bladder stones for which a re-cystolithotripsy was necessary. Methods: Patients (n=127) who underwent transurethral cystolithotripsy with (n=38) or without simultaneous TURP (n=89) between January 2009 and December 2013 were retrospectively included in five centers in the Netherlands. Median followup was 48 months. The primary endpoint was to compare the relative risk between both groups for re-cystolithotripsy due to recurrent bladder stones. Secondary outcomes were the relative risk of urinary retention, the need for a (re-)TURP and the average time until recurrence. Results: Patients who underwent a cystolithotripsy with a simultaneous TURP had a lower need for re-cystolithotripsy, resulting in a risk reduction of 72%. (relative risk [RR] 0.28 [0.07–1.13], p=0.06, number needed to treat [NNT]=7). The length of in hospital stay (3.4 vs. 1.6 days, p<0.01) and operative time (58 vs. 33 minutes, p<0.01) was longer when a TURP was performed. There was no significant difference in complication rate, occurrence of urinary retention, re-TURP, and re-admission. Eighty-one percent of patients who did not undergo a TURP remained free of bladder stone recurrence. Due the retrospective nature of the study, essential data concerning prostate volume and micturition analysis was lacking. Conclusions: A simultaneous TURP in patients who underwent a cystolithotripsy showed a trend towards a protective effect on the need for re-cystolithotripsy.

scholarly journals Retrograde Intrarenal surgery- Our experience

2020 ◽  
Vol 3 (1) ◽  
pp. 88-92
Author(s):  
Nand Kumar B. Madhekar ◽  
A. Nischal Prasad
Keyword(s):  
Hospital Stay ◽  
Operative Time ◽  
Tertiary Care ◽  
Renal Stones ◽  
Tertiary Care Centre ◽  
Renal Surgery ◽  
Retrograde Intrarenal Surgery ◽  
Residual Stone ◽  
Stone Clearance ◽  
Residual Stones

Background: RIRS has become an important treatment option for kidney stones in pediatric patients with the development of new-generation ureteroscopy and holmium laser. The present study was conducted to assess cases of retrograde intrarenal surgery. Subjects and Methods: The present study was conducted in a tertiary care centre over a period of one year on 120 cases of retrograde intra renal surgery (RIRS) performed in both genders. Renal stone location and stone clearance, laterality, stone size, operative time, hematuria, postoperative pain & fever, urosepsis, hospital stay, residual stones and need of an adjunctive procedure to achieve residual stone clearance. Results: Out of 120 patients, males were 70 and females were 50. Stones were detected in upper calyx in 50 cases, middle calyx in 40, lower calyx in 20 and pelvis in 10 cases. The mean size of stones was 8.1 mm, operative time was 62.1 minutes, hospital stay was 3.6 days, clinically insignificant radiological fragments were seen in 35 cases and residual stones were seen in 20 cases. Maximum cases of CIRF were seen in middle calyx (15) and residual stones were seen in lower calyx (7). The difference was significant (P< 0.05). Common complications were fever in 7, hematuria in 3, flank pain in 4 and urosepsis in 2 cases. Conclusion: Authors found that retrograde intrarenal surgery is a technically safe and effective procedure for the treatment of renal stones.

Fatality From Intravenous Nitrofurantoin

PEDIATRICS ◽  
1958 ◽  
Vol 22 (6) ◽  
pp. 1204-1204
Author(s):  
AVRON Y. SWEET
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Antibacterial Agents ◽  
Renal Calculi ◽  
Metabolic Disturbances ◽  
Intravenous Solution ◽  
Tract Infections

Recently one patient died and another came near death because of severe metabollic acidosis following the administration of Furadantoin® Intravenous Solution. (The brochure accompanying the medication does not indicate that metabolic disturbances might result from its use.) Both patients were adults with severe and extensive paralysis due to poliomyelitis and marked respiratory paralysis as well. Both had renal calculi and urinary tract infections with bacteria which were resistant to all but the more toxic antibacterial agents.

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