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

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

Urologia Internationalis ◽

10.1159/000519473 ◽

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

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

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The use of a ureteral access sheath does not improve stone-free rate after ureteroscopy for upper urinary tract stones

World Journal of Urology ◽

10.1007/s00345-013-1181-5 ◽

2013 ◽

Vol 32 (1) ◽

pp. 229-232 ◽

Cited By ~ 30

Author(s):

Gaetan Berquet ◽

Paul Prunel ◽

Grégory Verhoest ◽

Romain Mathieu ◽

Karim Bensalah

Keyword(s):

Urinary Tract ◽

Upper Urinary Tract ◽

Ureteral Access Sheath ◽

Access Sheath ◽

Stone Free Rate ◽

Urinary Tract Stones ◽

Free Rate

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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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RIRS with Vacuum-Assisted Ureteral Access Sheath versus MPCNL for the Treatment of 2-4 cm Renal Stone

BioMed Research International ◽

10.1155/2020/8052013 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8

Author(s):

Dehui Lai ◽

Yongzhong He ◽

Xun Li ◽

Meiling Chen ◽

Xingrong Zeng

Keyword(s):

Renal Stone ◽

Matched Pair ◽

Ureteral Access Sheath ◽

Access Sheath ◽

Matched Pair Analysis ◽

Pain Scores ◽

Stone Free Rate ◽

Significant Difference ◽

Matching Criteria ◽

Free Rate

Objective. Comparison of outcomes between RIRS with vacuum-assisted ureteral access sheath (V-UAS) and MPCNL in the treatment of renal stone. Materials and Methods. 28 patients with 2-4 cm renal stone were treated using RIRS with 14/16 F V-UAS. The outcomes were compared to those who underwent MPCNL with 16 F Amplatz sheath using a matched-pair analysis in a 1 : 2 scenario. Matching criteria included stone size, location and laterality, gender, age, BMI, and degree of hydronephrosis. Patients’ demographics, perioperative and postoperative characteristics, complications, stone-free rate (SFR), and auxiliary procedures were compared. Results. Mean operative times for the RIRS and MPCNL groups were 72.4±21.3 minutes and 67.4±25 minutes (P=0.042). Postoperative pain was significantly less in the RIRS group. The initial SFR was 50% for the RIRS group and 73.2% for the MPCNL group (P=0.035). The final SFR at postoperative three months improved to 89.3% for the RIRS group and 92.9% for the MPCNL group (P=0.681). The auxiliary procedure rates were higher in the RIRS group (42.9% vs. 25%, P=0.095). The overall complication rate in the RIRS group was lower, but the significant difference was not found. Conclusion. In the treatment of 2-4 cm renal stone, using V-UAS in RIRS can improve surgical efficiency with lower postoperative early pain scores. Comparing with MPCNL, its initial SFR was more depressed, and there is still a trend towards requiring more auxiliary procedures to achieve comparable final SFR.

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The Safety and Efficacy of Mini Percutaneous Nephrolithotomy During Learning Curve

Medical Journal of Shree Birendra Hospital ◽

10.3126/mjsbh.v18i2.21355 ◽

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.

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

International Surgery Journal ◽

10.18203/2349-2902.isj20214753 ◽

2021 ◽

Vol 8 (12) ◽

pp. 3606

Author(s):

Dinesh Prasad ◽

Yogesh Satani ◽

Shivam Singh ◽

Darpen Gajera

Keyword(s):

Comparative Study ◽

Hospital Stay ◽

Operative Time ◽

Ureteral Stones ◽

Safe Alternative ◽

Stone Free Rate ◽

Group A ◽

Prospective Comparative Study ◽

Group B ◽

Free Rate

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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Retrograde versus Antegrade Approach for the Management of Large Proximal Ureteral Stones

BioMed Research International ◽

10.1155/2016/6521461 ◽

2016 ◽

Vol 2016 ◽

pp. 1-4 ◽

Cited By ~ 3

Author(s):

Stavros Sfoungaristos ◽

Ioannis Mykoniatis ◽

Ayman Isid ◽

Ofer N. Gofrit ◽

Shilo Rosenberg ◽

...

Keyword(s):

Operative Time ◽

Fluoroscopy Time ◽

Ureteral Stones ◽

Ureteroscopic Lithotripsy ◽

Antegrade Approach ◽

Stone Free Rate ◽

Significant Difference ◽

Stone Characteristics ◽

Length Of Hospitalization ◽

Free Rate

Objective. To evaluate and compare the efficacy and safety of retrograde versus antegrade ureteroscopic lithotripsy for the treatment of large proximal ureteral stones.Patients and Methods. We retrospectively analyzed the medical records of patients with proximal ureteral stones >15 mm, treated in our institution from January 2011 to January 2016. Intraoperative parameters, postoperative outcomes, and complications were recorded and compared between the two techniques.Results. Our analysis included 57 patients. Thirty-four patients (59.6%) underwent retrograde and 23 patients (40.4%) underwent antegrade ureteroscopy. There was no significant difference in patients’ demographics and stone characteristics between the groups. Stone-free rate was significantly higher (p=0.033) in the antegrade group (100%) compared to retrograde one (82.4%). Fluoroscopy time, procedure duration, and length of hospitalization were significantly (p<0.001) lower in retrograde approach. On the other hand, the need for postoperative stenting was significantly lower in the antegrade group (p<0.001). No difference was found between the groups (p=0.745) regarding postoperative complications.Conclusions. Antegrade ureteroscopy is an efficient and safe option for the management of large proximal ureteral stones. It may achieve high stone-free rates compared to retrograde ureteroscopy with the drawback of longer operative time, fluoroscopy time, and length of hospitalization.

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External validation of the T.O.HO. score and derivation of the modified T.O.HO. score for predicting stone-free status after flexible ureteroscopy in ureteral and renal stones

10.22541/au.162260357.73633474/v1 ◽

2021 ◽

Author(s):

Salih Polat ◽

Yavuz Onur Danacioglu ◽

Mustafa Soytas ◽

Serkan Yarımoğlu ◽

Omer Koras ◽

...

Keyword(s):

External Validation ◽

Predictive Performance ◽

Renal Stones ◽

Turkish Population ◽

Flexible Ureteroscopy ◽

Ureteral Stones ◽

Stone Free Rate ◽

Stone Characteristics ◽

Free Rate ◽

Free Status

Abstract The T.O.HO. scoring system was developed to predict stone-free status after flexible ureterenoscopy (fURS) lithotripsy applied for ureter and renal stones. This study aimed to perform the external validation of the T.O.HO. score in the Turkish population and propose a modification for this system. Material Methods Patients who underwent fURS for kidney and ureteral stones between January 2017 and January 2020 were retrospectively analyzed. The patient and stone characteristics and perioperative findings were noted. The T.O.HO. score was externally validated and compared with the STONE score. Stone-free parameters were evaluated with the multivariate analysis. Based on the results of this analysis, the T.O.HO. score was modified and internally validated. Results A total of 621 patients were included in the study. The stone-free rate was determined as 79.8% (496/621) after fURS. The regression analysis showed that stone area had better predictive power than stone diameter (p=0.025). Lower pole (reference), middle pole [odds ratio (OR)=0.492 p=0.016] and middle ureteral (OR=0.227, p=0.024) localizations, stone density (OR=1.001, p<0.001), and stone volume (OR = 1.008, p <0.001) were determined as independent predictive markers for stone-free status. Based on the effect size of the stone surface area in the nomogram, stone volume was divided into five categories, at 1-point intervals. The AUC values of the T.O.HO., STONE, and modified T.O.HO. score in predicting stone-free status were calculated as 0.758, 0.634, and 0.821, respectively. The modified T.O.HO. created by adding stone volume was statistically significantly superior to the original version (ROC curve comparison, p < 0.001). Conclusion The T.O.HO. score effectively predicted stone-free status after fURS. However, Modified T.O.HO. SS showed the best predictive performance compared with original T.O.HO. SS.

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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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