Endoscopic, Single-Session Management of Encrusted, Forgotten Ureteral Stents

Background and Objectives: Remained or forgotten ureteral double-J stents may cause serious complications. Removing of an encrusted, forgotten stent can be challenging. We present our experience with heavily encrusted ureteral stents and discuss the endourologic treatment options as well as their effectivity. Materials and Methods: Eleven men and six women (mean 48.58 ± 14.48 years of age) with 18 encrusted forgotten stents (mean 16.4 ± 13.25 months of indwelling) were treated at our clinic. All patients underwent the operation after negative urine cultures were obtained. Their medical records were retrospectively reviewed and analyzed in terms of number of interventions required to remove the stent, operation time, complications, hospital stay and stone-free rate. Results: According to the Forgotten-Encrusted-Calcified (FECal) classification, the most common form of stent encrustation was grade III (64.7%) and 17.6% of the stents were fragmented. Four of 17 patients were initially treated with extracorporeal shock-wave lithotripsy. The patients required a mean of two endoscopic interventions for removing the encrusted stent and all stents were removed endoscopically in a single session. The mean operating time was 63.3 ± 41.8 minutes. Cystolithotripsy followed by ureteroscopy was the most common intervention (41.1%). Of the 17 patients, peroperative and postoperative complications were Clavien grade I in two, grade II in two and grade IIIb in one. The mean hospital stay was 1.3 ± 0.99 days. All patients were stone-free after a month of stent removal. Conclusions: The endourological removal of the encrusted forgotten stents in a single session is feasible and effective with a minimal morbidity. The treatment strategy should be to minimize the number of interventions.

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Percutaneous endoscopic treatment of benign and malignant renal pelvis carcinoma: A single-center experience

10.21203/rs.3.rs-41645/v1 ◽

2020 ◽

Author(s):

Xin Zhang ◽

Wu Xiu Han ◽

Sheng Yan Li ◽

Hao Yuan Chen ◽

Zhe Yu Tang ◽

...

Keyword(s):

Blood Loss ◽

Hospital Stay ◽

Renal Pelvis ◽

Operation Time ◽

Laser Evaporation ◽

Pathological Grade ◽

Group I ◽

Grade Ii ◽

The Mean ◽

Group Ii

Abstract Background Percutaneous nephrolithotomy (PCNL) is a safe and efficient treatment for intro-renal diseases, most of which are calculus disease. In this study, we carried out percutaneous endoscopic nephron-sparing ablation for renal carcinoma in carefully selected patients. Our aim was to evaluate whether percutaneous endoscopic nephron-sparing operation was feasible for patients with renal cell carcinoma.Methods A total of 15 patients with renal pelvis carcinoma were treated with laser evaporation under percutaneous endoscopy between January 2015 and September 2019 ( group I ). Another 13 patients who received standard radical nephroureterectomy were recruited as the control group (group II). We recorded demographic data of the patients, the indication for surgery, tumor pathological grade, size and side of tumor, and the intraoperative and postoperative outcome, including the duration of surgery, length of hospital stay, and complication rate, as well as progression-free survival (PFS).Results In both groups, all of the patients received flexible ureteroscopy. In group I, 14 patients had transitional renal cell carcinoma (UCC), four had pathological grade I, nine had grade II, and one had hemangiopericytoma. In group II, all patients had UCC, five had pathological grade I, and eight had grade II. In group I, the mean operation time was 118 min (65–236 min), the mean blood loss was 110 ml (55–220 ml), and the mean hospital stay was 9 days (7–12 days). During follow-up, two patients died and two had recurrence; among them, one had systematic bone metastasis. The PFS rate was 66.7% (10/15). In group II, the mean operation time was 265 min (185–436 min), the mean blood loss was 133 ml (85–240 ml), and the mean hospital stay was 13 days (9–16 days). During the follow-up, two patients died and there was no local or systematic metastasis. The PFS rate was 84.6% (11/13). There was no significant difference in blood loss between the groups. However, the operation time and mean hospital stay were significantly shorter in group I compared with that in group II ( P < 0.05). But the PFS rate was significantly higher in group II than in group I (P < 0.05).Conclusions This study shows that laser evaporation under percutaneous endoscopy for renal pelvis carcinoma is a safe, effective, and technically feasible procedure for treating benign and malignant renal pelvis carcinoma.

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Retrograde Intrarenal Surgery vs. Miniaturised Percutaneous Nephrolithotomy to Treat Lower Pole Renal Stone < 2 cms Diameter in Western Part of Odisha

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2021/257 ◽

2021 ◽

Vol 8 (19) ◽

pp. 1347-1351

Author(s):

Ashok Kumar Nayak ◽

Sanjay Kumar Mahapatra ◽

Braja Mohan Mishra ◽

Dipti Ranjan Dhar ◽

Biswajit Sahu

Keyword(s):

Hospital Stay ◽

Percutaneous Nephrolithotomy ◽

Operating Time ◽

Operation Time ◽

Renal Stones ◽

Analysis Data ◽

Lower Pole ◽

Medical Sciences ◽

Retrograde Intrarenal Surgery ◽

The Mean

BACKGROUND We wanted to compare the outcomes of retrograde intrarenal surgery (RIRS) and miniaturized percutaneous nephrolithotomy (mini-PCNL) in treating lower pole (LP) renal stones with a diameter of < 2 cm in terms of safety, efficacy, and stonefree rate (SFR). METHODS In a retrospective analysis data of 39 patients who underwent mini-PCNL (N = 19) or RIRS (N = 20) for LP stones with a diameter of < 2 cm were reviewed between November 2018 and November 2020 at the Department of Urology in Veer Surendra Sai Institute of Medical Sciences and Research (VSSIMSAR), Odisha. The mean age, sex, stone size, operating time, complications, hospital stay, and SFR were compared between the groups. The success of the procedure was defined as the absence of residual stones or small residuals of size 3mm or less on computed tomography at 12 weeks postoperatively. RESULTS Significant differences were found in the hospital stay duration in hours (103.3 ± 11.7 vs. 145.2 ± 16.4, P < 0.028) between the RIRS and mini - PCNL groups. The mean operation time (in minutes) was also significantly different between the RIRS group (82.5 ± 3.44) and mini PCNL group (86.21 ± 5.90, P = 0.021). The stonefree rates in the postoperative period at three months (RIRS vs. mini - PCNL: 95 % vs. 94 %, P = 0.47) were not significantly different. CONCLUSIONS RIRS and mini-PCNL are both safe and effective methods for treating LP stones with a diameter of < 2 cm. RIRS can be considered as a less invasive alternative to PCNL for the treatment of LP stones of < 2 cm with reasonable SFR with shorter hospital stay. KEYWORDS Retrograde Intrarenal Surgery, Percutaneous Nephrolithotripsy, Lower Pole Kidney Stones, Miniaturized Percutaneous Nephrolithotomy

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Laparoscopic donor nephrectomy: technique and outcome, a single-center experience

African Journal of Urology ◽

10.1186/s12301-021-00254-7 ◽

2021 ◽

Vol 27 (1) ◽

Author(s):

Osama Zaytoun ◽

Moustafa Elsawy ◽

Kareem Ateba ◽

Ayman Khalifa ◽

Ahmed Hamdy ◽

...

Keyword(s):

Hospital Stay ◽

Graft Function ◽

Length Of Hospital Stay ◽

Donor Nephrectomy ◽

Laparoscopic Donor Nephrectomy ◽

Single Center Experience ◽

Clavien Grade ◽

Grade Ii ◽

The Mean ◽

Operative Notes

Abstract Background Laparoscopic donor nephrectomy (LDN) has been established as a surgical standard for living kidney donation. The aim of this work is to report our own experience with LDN regarding outcome and technique. Methods We prospectively identified 110 LDN cases between May 2017 and April 2020. Donor case files and operative notes were analyzed for age, sex, laterality, body mass index, warm ischemia time (WIT), intraoperative and postoperative complications, operative time, and length of hospital stay (LOS). Data were analyzed using SPSS version 10 (SPSS: An IBM Company, IBM Corporation, Armonk, NY, the USA). Results The mean age was 38 years, and 77% were males. Three cases (2.72%) required conversion to conventional open donor nephrectomy (ODN). Nevertheless, none of cases required intraoperative blood transfusion. The mean WIT was 2.6 min. Two cases (1.8%) developed major vascular injury (Clavien grade IIIb) and required conversion to ODN. Postoperatively, one patient (0.9%) needed transfusion of one unit of packed RBCs (Clavien grade II). The mean LOS was 2 days. Most common early postoperative complication was ileus (Clavien grade II) that developed in 4 (3.6%) cases. Incisional hernia (Clavien grade IIIb) was encountered in two (1.8%) cases. Two (1.8%) cases developed wound infection at the incision site and treated conservatively (Clavien grade I). Conclusions LDN is a safe technique with accepted intraoperative and postoperative morbidity. It offers short hospital stay, better cosmesis and early convalescence. In experienced hands, it can effectively deal with various vascular and ureteral anomalies without compromising early graft function.

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Laparoscopy and endoscopy cooperative surgery for gastric tumor.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.4_suppl.168 ◽

2018 ◽

Vol 36 (4_suppl) ◽

pp. 168-168

Author(s):

Ozawa Hiroki ◽

Hirofumi Kawakubo ◽

Shuhei Mayanagi ◽

Kazumasa Fukuda ◽

Osamu Goto ◽

...

Keyword(s):

Hospital Stay ◽

Wedge Resection ◽

Operation Time ◽

Tumor Location ◽

Postoperative Hospital Stay ◽

Submucosal Tumors ◽

Gastric Cancers ◽

Gastric Submucosal Tumors ◽

Grade Ii ◽

The Mean

168 Background: Laparoscopic wedge resection is widely performed for managing gastric submucosal tumors (SMTs) that measure ≤5 cm in diameter. Laparoscopy and endoscopy cooperative surgery (LECS) is performed to ensure a sufficient margin while avoiding deformation or stenosis. Methods: We conducted a retrospective review of the data of 76 patients who underwent LECS for SMTs or early gastric cancers at our institution between April 2012 and July 2017. While Non-exposed Endoscopic Wall-inversion Surgery (NEWS) was performed for tumors with a major axis diameter of ≤5 cm and minor axis diameter of ≤3 cm, for other tumors, we adopted classical LECS or used the combination of laparoscopic approaches to neoplasia with non-exposure technique (CLEAN-NET). Results: The tumor was located in the upper-/middle-/lower-third of the stomach in 49/20/7 cases. The mean operation time was 201.7 ± 66.2 min, and the mean blood loss was 4.7 ± 12.8 ml. The mean tumor size was 28.6 ± 11.6 mm. The histological tumor types included GIST (n = 38), leiomyoma (n = 14), schwannoma (n = 6), early gastric cancer (n = 8) and others (n = 10). The surgical procedure consisted of classical LECS/CLEAN-NET/NEWS in 17/15/44 cases; all early gastric cancers were treated by NEWS. The mean length of postoperative hospital stay was 8.7 ± 3.9 days. The mean serum levels of C-reactive protein on POD1 and POD3 were 3.2 ± 1.9 and 4.4 ± 3.4 mg/dl, respectively. The postoperative complications were anastomotic stenosis (n = 1), delayed gastric emptying (n = 3), pneumonia (>Grade II by the Clavien-Dindo classification) (n = 1) and exacerbation of GERD (>Grade II by the Clavien-Dindo classification) (n = 3). In the patient group that developed complications, the postoperative resumption of water intake was later, and the postoperative hospital stay was longer as compared to the group without complications (p = 0.04, 0.028). No relationship was observed between the likelihood of development of complications and the tumor location. Conclusions: Use of minimally invasive surgical procedures such as LECS could minimize the extent of gastric resection without deformation, stenosis. We consider that for surgical complications the LECS approach can be employed, regardless of the tumor location.

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Sutureless hemorrhoidectomy vs open hemorrhoidectomy: a prospective study in a regional hospital of Western Nepal

Nepal Journal of Medical Sciences ◽

10.3126/njms.v3i2.13456 ◽

2015 ◽

Vol 3 (2) ◽

pp. 121-123

Author(s):

P Ghimire ◽

NV Gurung ◽

PK Upadhaya ◽

S Shrestha ◽

A Gurung ◽

...

Keyword(s):

Hospital Stay ◽

Demographic Data ◽

Operating Time ◽

Operation Time ◽

Regional Hospital ◽

Time Duration ◽

Duration Of Symptoms ◽

Sutureless Technique ◽

Open Hemorrhoidectomy ◽

Early Return

Background: The aim of this study is to compare sutureless Hemorroidectomy with Conventional Open Hemorrhoidectomy in terms of safety and clinical efficacy.Method: A prospective analytical study of 60 operated patients (a nonrandomized cohort) was carried out by following up from admission to 1 month period after hospital discharge in between July, 2013 to February, 2014 in Western Regional Hospital, Pokhara, Nepal. Demographic data, clinical data, mean operation time, duration of hospital stay, number of parenteral analgesic injections and post-operative complications between the two groups were recorded and analyzed.Result: There were no statistically significant differences between the two groups in terms of age, gender, duration of symptoms, grade of the hemorrhoid(s), or number of hemorrhoids resected. The mean operating time for LigaSure sutureless hemorrhoidectomy was significantly shorter than that for the Open hemorrhoidectomy (P < 0.001). Patients treated with the LigaSure technique had less blood loss, a better pain score (P < 0.001), less parenteral analgesic requirement (P < 0.001), shorter hospital stay (P < 0.001), and early return to work (P < 0.01). Conclusion: Sutureless Technique is safe and effective as compared to Conventional Open Hemorrhoidectomy for grade III and IV hemorrhoids.Nepal Journal of Medical Sciences Vol.3(2) 2014: 121-123

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Prone split-leg position to manage encrusted ureteral stents in a single-stage procedure in women: Step-by-step surgical technique

Canadian Urological Association Journal ◽

10.5489/cuaj.2852 ◽

2015 ◽

Vol 9 (7-8) ◽

pp. 494 ◽

Cited By ~ 2

Author(s):

Giovanni Scala Marchini ◽

Fábio Cesar Miranda Torricelli ◽

Eduardo Mazzucchi ◽

Miguel Srougi ◽

Manoj Monga

Keyword(s):

Shock Wave ◽

Open Surgery ◽

Shock Wave Lithotripsy ◽

Treatment Modalities ◽

Flexible Ureteroscopy ◽

Ureteral Stents ◽

Single Session ◽

Extracorporeal Shock Wave ◽

Intracorporeal Lithotripsy ◽

Leg Position

The management of encrusted ureteral stents is costly, time consuming and may be risky for the patient and challenging for the urologist. Treatment modalities for encrusted stents include extracorporeal shock wave lithotripsy, cystolithopaxy, rigid or flexible ureteroscopy with intracorporeal lithotripsy, percutaneous nephrolithotomy, open surgery, and a combination of those methods. In this study we describe the management of severe forgotten encrusted ureteral stents in 3 female patients using a prone splitleg position. This position allows us to effectively treat any site and degree of stent encrustation in a single-session approach with the patient in the same position during the whole procedure. All patients were rendered stent and stone free. No complications occurred.

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Staged Bilateral Hip or Knee Arthroplasties

Journal of Orthopaedic Surgery ◽

10.1177/230949900701500206 ◽

2007 ◽

Vol 15 (2) ◽

pp. 159-162 ◽

Cited By ~ 9

Author(s):

FR Hashmi ◽

K Barlas ◽

CF Mann ◽

FR Howell

Keyword(s):

Hospital Admission ◽

Hospital Stay ◽

Operating Time ◽

Length Of Hospital Stay ◽

Mean Difference ◽

Complication Rates ◽

Early Complication ◽

Early Complications ◽

Hospital Stays ◽

The Mean

Purpose. To compare the operating time, amount of blood transfused, length of hospital stay, and early complications (within 6 months) between 2-week staged bilateral arthroplasties and matched randomised controls undergoing unilateral arthroplasties. Methods. From October 1992 to October 2000, 90 patients who underwent bilateral hip or knee arthroplasties with a 2-week interval were compared with matched randomised controls undergoing unilateral arthroplasties. A single surgeon performed all procedures. Results. After the match-up process, 30 pairs of patients were included in the analysis. There were no significant differences in the operating times, amount of blood transfused, and early complication rates. The mean difference in length of hospital stay was significant ( t= −3.552, df=29, p<0.001). Conclusion. Compared to staged procedures with an interval months apart, staged sequential arthroplasty with a 7- to 10-day interval during one hospital admission is more efficient, as it facilitates earlier rehabilitation without higher complication rates, and entails shorter hospital stays.

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Robot-Assisted Laparoscopic Radical Prostatectomy in the Morbidly Obese Patient

Prostate Cancer ◽

10.1155/2011/618623 ◽

2011 ◽

Vol 2011 ◽

pp. 1-5 ◽

Cited By ~ 4

Author(s):

Jennifer Yates ◽

Ravi Munver ◽

Ihor Sawczuk

Keyword(s):

Blood Loss ◽

Hospital Stay ◽

Operative Time ◽

The United States ◽

Morbidly Obese ◽

Health Issues ◽

Morbidly Obese Patient ◽

Estimated Blood Loss ◽

Clavien Grade ◽

Grade Ii

Introduction. Obesity and prostate cancer are among the more common health issues affecting men in the United States.Methods. We retrospectively reviewed morbidly obese (BMI ≥ 40 kg/m2) patients undergoing RALP between 2004–2009 at our institution. Parameters including operative time, estimated blood loss, hospital stay, pathology, and complication rate were examined.Results. A total of 15 patients were included, with a mean BMI of 43 kg/m2. Mean preoperative PSA was 5.78 ng/dL, and Gleason score was 6.6. Mean operative time was 163 minutes, and mean estimated blood loss was 210 mL. The mean hospital stay was 1.3 days. Positive margins were noted in 2 (13%) patients, each with pT3 disease. There were no blood transfusions, open conversions, or Clavien Grade II or higher complications.Conclusions. In our experience, RALP is feasible in morbidly obese patients. We noted several challenges in this patient population which were overcome with modification of technique and experience.

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Surgical treatment of gastroduodenal ulcer bleeding: Our experience

Acta chirurgica iugoslavica ◽

10.2298/aci0701165k ◽

2007 ◽

Vol 54 (1) ◽

pp. 165-167

Author(s):

S.N. Krstic ◽

T. Alempijevic ◽

M.N. Krstic ◽

Z.D. Lausevic ◽

A. Sijacki ◽

...

Keyword(s):

Hospital Stay ◽

Gastroduodenal Ulcer ◽

Treatment Options ◽

Ulcer Bleeding ◽

Endoscopic Management ◽

Ulcer Disease ◽

Endoscopic Techniques ◽

Clinical Center ◽

The Mean ◽

Gastroduodenal Ulcer Bleeding

Introduction: Acute bleeding from the upper gastrointestinal tract remains the commonest emergency in gastroenterology, and is most often caused by gastroduodenal ulcer disease. Despite introduction of novel endoscopic techniques and pharmacological treatment, 6-15% patients have to be operated. The aim of our investigation is analyze data of patients treated for gastrointestinal ulcer bleeding in our institution, their treatment options and outcome. Patients and methods: We included 2237 patients admitted in the Department for Emergency medicine of Clinical center of Serbia during the period from January 1999 until December 2003. because of gastroduodenal ulcer bleeding. We analyzed age, gender treatment option, hospital stay and mortality. Results: The mean age of our patients was 61.58 years, 1346 male and 891 female. The majority of patients were conservatively treated (84.5%). Operated patients mostly undergo Billroth II resection (57.8%). The mean hospital stay was 7.3 days. Average mortality was 14.4% Conclusions: Despite adequate endoscopic management of bleeding gastroduodenal ulcer, surgeons will continue to treat this patients for emergency surgery.

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Study on outcome of laparoscopic donor nephrectomy

International Surgery Journal ◽

10.18203/2349-2902.isj20173424 ◽

2017 ◽

Vol 4 (8) ◽

pp. 2811

Author(s):

Subha Kanesh S. K. ◽

Govindarajan P.

Keyword(s):

Blood Loss ◽

Hospital Stay ◽

Operating Time ◽

Donor Nephrectomy ◽

Laparoscopic Donor Nephrectomy ◽

Analgesic Requirement ◽

Ischemic Time ◽

Medical College ◽

Duration Of Hospital Stay ◽

The Mean

Background: Laparoscopic donor nephrectomy is being performed in increasing numbers since 1995. Now laparoscopic donor nephrectomy has been accepted as good alternate to open procedure as seen in various other abdominal surgeries. This was the basis of the present study. So, the present study was designed to analyse and compare the outcome of Laparoscopic donor nephrectomy and Open donor nephrectomies.Methods: The prospective and observational study was conducted at Stanley Medical College in Department of Urology in 61 Patients aged between 25-50 years who underwent left donor nephrectomy The Mean operating time, warm ischemic time, blood loss, analgesic requirement and duration of hospital stay were recorded and analysed statistically.Results: Out of 61 donor nephrectomies, 16 kidneys harvested by laparoscopic method with only 2 (12%) conversion to open due bleeding. Mean operating time was 179.9±47.6 minutes. Present study showed mean blood loss of (163±93 ml). Analgesic requirement of the LDN (mean 1.25 days) was significantly lower when compared to open group (mean 3.75 days). The present study shows duration of hospital stay was lower in LDN (mean 5.1days).Conclusions: Laparoscopic donor nephrectomy is an effective, safe and rewarding though it is time consuming and technically challenging. The analgesic requirement, duration of hospital stay and the blood loss were less with the laparoscopic surgery. Results of graft functioning of kidneys in both procedures were equivalent. So laparoscopic donor nephrectomy can be made as the procedure of choice in future.

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