Is routine ureteral stenting really necessary after retrograde intrarenal surgery?

Objectives: To investigate the situations in which ureteral double-J stent should be used after retrograde intrarenal surgery (RIRS). Patients and Methods: Patients with no ureteral double-J stent after RIRS constituted Group 1, and those with double- J stent after RIRS constituted Group 2. Patients’ age and gender, renal stone characteristics (location and dimension), stone-free status, VAS score 8 hours after surgery, post-procedural renal colic attacks, length of hospitalization, requirement for re-hospitalization, time to rehospitalization and secondary procedure requirements were analyzed. Results: RIRS was performed on 162 renal units. Double-J stent was used in 121 (74.6%) of these after RIRS, but not in the other 41 (25.4%). At radiological monitoring at the first month postoperatively after RIRS, complete stone-free status was determined in 122 (75.3%) renal units, while residual stone was present in 40 (24.6%). No significant differences were observed between the groups in terms of duration of fluoroscopy (p = 0.142), operation (p = 0.108) or hospitalization times (p = 0.798). VAS values determined routinely on the evening of surgery were significantly higher in Group 1 than in Group 2 (p = 0.025). Twenty-eight (17.2%) presentations were made to the emergency clinic due to renal colic within 1 month after surgery. Double-J catheter was present in 24 (85.7%) of these patients. Conclusions: Routine double-J stent insertion after RIRS is not essential since it increases costs, morbidity and operation time.

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Percutaneous-Based Management of Staghorn Calculi in Solitary Kidney: Combined Mini Percutaneous Nephrolithotomy versus Retrograde Intrarenal Surgery

Urologia Internationalis ◽

10.1159/000360708 ◽

2014 ◽

Vol 94 (1) ◽

pp. 70-73 ◽

Cited By ~ 8

Author(s):

Wen Zhong ◽

Zhijian Zhao ◽

Liang Wang ◽

Sunil Swami ◽

Guohua Zeng

Keyword(s):

Percutaneous Nephrolithotomy ◽

Operation Time ◽

Solitary Kidney ◽

Retrograde Intrarenal Surgery ◽

Staghorn Calculi ◽

Combined Use ◽

Stone Free Rate ◽

Group 2 ◽

Free Rate ◽

Group 1

Introduction: Mini percutaneous nephrolithotomy (mini-PCNL) and retrograde intrarenal surgery (RIRS) are well-established techniques with little morbidity. The combined use of standard PCNL and the mini-PCNL or the RIRS technique was evaluated and compared to investigate their own role in the management of staghorn calculi in solitary kidney. Materials and Methods: 23 patients received combined standard PCNL and mini-PCNL (group 1), and 22 patients received combined standard PCNL and RIRS (group 2). The treatment results and complications were evaluated and compared. Results: The mean operation time was 128.8 ± 9.1 min in group 1 and 109.8 ± 10.7 min in group 2 (p < 0.001). The decrease in hemoglobin level in group 1 was significantly higher than that in group 2 (3.5 ± 0.6 vs. 2.1 ± 0.5 g/dl, p < 0.001). The final stone-free rate was significantly higher (p = 0.038) in group 2 (90.9%) than in group 1 (65.2%). Conclusions: Combined standard PCNL and RIRS technique can extract the majority of staghorn calculi quickly by PCNL with EMS Lithoclast, and RIRS used simultaneously can reduce the need for multiple tracts and therefore reduce blood loss and potential morbidity related to multiple tracts, shorten the operation time and achieve a high stone-free rate.

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Effect of tamsulosin on lower urinary tract symptoms related to double-J ureteral stent: a randomised, double-blinded, placebo controlled trial

WCET Journal ◽

10.33235/wcet.39.3.26-31 ◽

2019 ◽

Vol 39 (3) ◽

pp. 26-31

Author(s):

Fateme Guitynavard ◽

Shahram Gooran ◽

Parvin Kasiri ◽

Farshad Gholipour ◽

Seyed Mohammad Kazem Aghamir

Keyword(s):

Sexual Activity ◽

Controlled Trial ◽

Stent Insertion ◽

Double J Stent ◽

Urinary Tract Symptoms ◽

Lower Pain ◽

Filling Phase ◽

Group 2 ◽

Double Blinded ◽

Group 1

Objective: To evaluate the effect of tamsulosin on stent-related symptoms in patients undergoing double-J ureteral stenting. Methods: and materials Seventy patients (47 men and 23 women; mean age 42.5 years) who underwent double-J stent placement in adjunct to urological surgery were prospectively randomised into two groups. Group 1 included 35 patients who received 0.4 mg of tamsulosin once daily for 4 weeks; group 2 included 35 patients who received a placebo for the same protocol. All patients were interviewed by the same physician about the frequency of stent-related symptoms at 4 weeks after stent insertion. Results: Patients in group 1 showed a lower score for suprapubic pain during the filling phase and lower pain during sexual activity than group 2, although the overall pain score was not significantly different between two groups. The mean urinary urgency score was less in group 1 in comparison to the placebo group (p=0.030). No statistically significant differences were found between two groups concerning haematuria, urinary incontinence, frequency nor dysuria. Conclusion: Tamsulosin improves symptoms associated with double-J ureteral stents, especially body pain during sexual activity.

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Second-Look Flexible Ureterorenoscopy: A Technique Proposal to Achieve Real Stone Free Status

10.22541/au.161131535.53003454/v1 ◽

2021 ◽

Author(s):

Oguz Ozden Cebeci ◽

Tayyar Alp Özkan ◽

Mustafa Savas Yalcin ◽

Ozdal Dillioglugil ◽

Ibrahim Cevik

Keyword(s):

Flexible Ureteroscopy ◽

Flexible Ureterorenoscopy ◽

Residual Stone ◽

Second Look ◽

Stone Free Rate ◽

The Mean ◽

Group 2 ◽

Free Rate ◽

Free Status ◽

Group 1

Introduction Residual stone fragments remain a challenging topic for urologists following retrograde intrarenal surgery (RIRS). This study investigates the effectiveness of second-look flexible ureterorenoscopy (URS) to achieve a true stone-free status and decrease stone-related events. Material and Method A total of 176 consecutive patients treated with RIRS for kidney stones were included in the study. Patients were divided into two groups, group 1 receiving the standard of care (n=51) and group 2 receiving second-look flexible URS (n=125). In all cases, one or more calyceal stones of 1 to 4 mm were extracted with a basket at the time of stent removal. Unless earlier intervention was necessary, patients were followed up every six months to determine if they had experienced SREs. Results The mean follow-up time for the whole group was 21±11.1 months. The mean number of stones in group 1 and group 2 was 1.25±0.11 and 1.56±0.19, respectively. Postoperative stone-free rate after RIRS for group 1 and group 2 were 37.25% (n=19/51) and 40.8% (n=51/125), respectively. The SFR improved to 93.6% (n=117/125) in group 2. Multivariable analysis showed that type of intervention, stone size, and body mass index were independent prognostic factors for SREs. When group 2 was taken as a reference, the odds ratio for SREs was 8.48 (95% CI: 2.95–24.42) in group 1. Conclusion This study found that second-look flexible URS increased the SFRs and diminished the number of SREs. We propose performing second-look flexible URS following RIRS in the presence or suspicion of RSFs to provide better treatment results, less radiation exposure, and greater patient satisfaction. Key Words Retrograde Intrarenal Surgery, Flexible Ureteroscopy, Stone-free Rate, Residual stone Fragments, Stone-Related Event, Second-look Flexible Ureteroscopy.

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Pre-stenting for Retrograde Intrarenal Surgery: Need and Duration: a Prospective Randomized Clinical Study

Nepalese Medical Journal ◽

10.3126/nmj.v3i2.33050 ◽

2020 ◽

Vol 3 (2) ◽

pp. 361-365

Author(s):

Prakash Chhettri ◽

Anil Shrestha ◽

Robin Bahadur Basnet ◽

Parash Mani Shrestha

Keyword(s):

Controlled Study ◽

Retrograde Intrarenal Surgery ◽

Ureteral Access Sheath ◽

Access Sheath ◽

Randomized Clinical Study ◽

Institutional Review ◽

Group 3 ◽

Group 2 ◽

Wall Injury ◽

Group 1

Introduction: To evaluate if retrograde intrarenal surgery with ureteral access sheath requires prestenting. In case pre-stenting becomes an option, how long does it need to be stented. Materials and Methods: After obtaining approval from Institutional Review Board and informed consent, a prospective randomized controlled study was conducted in the Department of Urology, Bir Hospital for 18 months. All the patients enrolled for retrograde intrarenal surgery were grouped into 3 groups: Group 1 – without pre-stenting, Group 2 – one week of pre-stenting, and Group 3 – two weeks of pre-stenting. Success was defi ned as an ability to accommodate a 10/12 F ureteral access sheath during retrograde intrarenal surgery. Ureteral access sheath induced ureteric wall injury was also taken into consideration.Results: Among 179 cases, 152 cases were included in the study. In 36 patients out of 53 (67.92%) in group 1, 10/12 F ureteral access sheath was negotiable without pre-stenting, marking the frequency of distensible ureters. In 44 patients out of 47 (93.66%) from group 2 and all 52 patients (100%) from group 3, ureteral access sheath placement was successful after one and two weeks of pre-stenting respectively. Ureteric wall injury of grade1 and 2, was found in 9 patients (5.9%).Conclusions: The majority of ureters (67.92%) are distensible, not requiring pre-stenting before retrograde intrarenal surgery. One and two weeks of pre-stenting carries a success rate of 93.66% and 100% respectively.

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Comparison of Inflammatory Reactions Following Two Different Cesarean Section Techniques: The Modified Misgav-Ladach Versus the Pfannenstiel-Kerr; A Prospective Randomized Trial

Gynecology Obstetrics and Reproductive Medicine ◽

10.21613/gorm.2018.811 ◽

2018 ◽

pp. 1

Author(s):

Baris Buke ◽

Hatice Akkaya ◽

Cigdem Karakukcu

Keyword(s):

Cesarean Section ◽

Inflammatory Reaction ◽

Operation Time ◽

Blood Samples ◽

Inflammatory Reactions ◽

Tnf Α ◽

Significant Difference ◽

The Difference ◽

Group 2 ◽

Group 1

Objectives: There is not yet a consensus on the optimal surgical technique for cesarean section. This is the first study comparing two different (Cesarean Section) with respect to the following inflammatory reaction in means of changes in inflammatory marker levels. To evaluate the differences in inflammatory reactions following two different (Cesarean Section) techniques, the modified Misgav-Ladach versus the Pfannenstiel-Kerr technique.Study Desıgn: The study population included 88 pregnant women who met the inclusion criteria. These women were randomized into two groups according to Consolidated Standards of Reporting Trials guidelines: Group 1 (Misgav-Ladach group) and Group 2 (Pfannenstiel Kerr group). To compare the inflammatory reactions following surgery, Interleukin-6 (IL-6) and Tumor Necrosis Factor-α (TNF-α) levels were measured in venous blood samples drawn from the patients just before (0 hour) and 24 hours (24th hour) after the surgery. In 5 women from Group 1 and 2 women from Group 2, the 24th hour blood samples could not be obtained or were lost. Thus, a total of 81 women, 39 women from Group 1 and 42 women from Group 2, comprised the population of study. The differences in inflammatory reactions between the 0 and 24th hours were analyzed by calculating the percent change in IL-6 and TNF-α levels, and these percentages were then compared between the groups.Results: There was a statistically significant difference between Group 1 and Group 2 regarding the serum IL-6 level change between 0 and 24th hour (530±653% and 196±168%, respectively, p=0.022. The difference in TNF-α was also higher in Group 2, but the difference was not statistically significant (229±306% vs. 571±824%, p=0.12). The mean operation time was significantly shorter in Group 1 (9.44 min. vs. 16.86 min, p=0.0001).Conclusions: The results of this study indicate that the modified Misgav-Ladach technique has a weaker inflammatory reaction, which indicates fewer short- and long-term surgical complications.

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Arthroscopic knotless single-row repair preserving full footprint versus tear completion repair for partial articular-sided rotator cuff tear

Journal of Orthopaedic Surgery ◽

10.1177/2309499018770897 ◽

2018 ◽

Vol 26 (2) ◽

pp. 230949901877089 ◽

Cited By ~ 3

Author(s):

Cen Tao Liu ◽

Heng an Ge ◽

Rui Hu ◽

Jing Biao Huang ◽

Yi Chao Cheng ◽

...

Keyword(s):

Rotator Cuff ◽

Pain Score ◽

Operation Time ◽

Clinical Results ◽

Rotator Cuff Tears ◽

Single Row ◽

Repair Technique ◽

Randomized Controlled Studies ◽

Group 2 ◽

Group 1

Background: The comparison of clinical outcomes of arthroscopic footprint-preserving knotless single-row repair with the tear completion repair technique for articular-sided partial-thickness rotator cuff tears (PTRCTs) remains unclear. Methods: A total of 68 patients diagnosed with articular-sided PTRCTs who underwent rotator cuff repair between December 2014 and June 2015 were included. Of the 68 patients, 30 received footprint-preserving knotless single-row repair (group 1) and 38 received the tear completion repair technique (group 2). Preoperative and postoperative assessments were compared. Results: Both groups had significantly improved American Shoulder and Elbow Surgeons (ASES) scores (group 1: 48.2 preoperatively to 81.9 postoperatively, p < 0.001; group 2: 47.1 preoperatively to 84.9 postoperatively, p < 0.001) and visual analog scale (VAS) pain score (group 1: 6.0 preoperatively to 0.93 postoperatively, p < 0.001; group 2: 6.1 preoperatively to 1.1 postoperatively, p < 0.001), showing that the two procedures significantly improved postoperative shoulder function. No significant differences were shown in ASES score or VAS pain score between the two groups ( p > 0.05). The mean operation time was significantly shorter in group 1 with an average of 48.1 min than in group 2 with an average of 60.4 min ( p < 0.001). Conclusions: Footprint-preserving knotless single-row repair obtains similar clinical results compared to tear completion repair in the treatment of articular-sided PTRCTs. Footprint-preserving knotless single-row repair may be a convenient choice for the treatment of articular-sided PTRCTs. Randomized controlled studies are needed to investigate whether the footprint-preserving knotless single-row repair yields better long-term outcomes through the protection of the bursal cuff and restoration of the healthy footprint.

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The effects of previous open renal stone surgery types on PNL outcomes

Canadian Urological Association Journal ◽

10.5489/cuaj.3687 ◽

2016 ◽

Vol 10 (7-8) ◽

pp. 246 ◽

Cited By ~ 1

Author(s):

Faruk Ozgor ◽

Onur Kucuktopcu ◽

Burak Ucpinar ◽

Omer Sarilar ◽

Akif Erbin ◽

...

Keyword(s):

Renal Stone ◽

Complication Rates ◽

Success Rates ◽

Anesthetic Agents ◽

History Of ◽

Renal Stone Surgery ◽

Retrospective Nature ◽

Group 2 ◽

Free Status ◽

Group 1

Introduction: Our aim was to demonstrate the effect of insicion of renal parenchyma during open renal stone surgery (ORSS) on percutaneous nephrolithotomy (PNL) outcomes.Methods: Patients with history of ORSS who underwent PNL operation between June 2005 and June 2015 were analyzed retrospectively. Patients were divided into two groups according to their type of previous ORSS. Patients who had a history of ORSS with parenchymal insicion, such as radial nephrotomies, anatrophic nephrolithotomy, lower pole resection, and partial nephrectomy, were included in Group 1. Other patients with a history of open pyelolithotomy were enrolled in Group 2. Preoperative characteristics, perioperative data, stone-free status, and complications were compared between the groups. Stone-free status was defined as complete clearance of stone(s) or presence of residual fragments smaller than 4 mm. The retrospective nature of our study, different experience level of surgeons, and lack of the evaluation of anesthetic agents and cost of procedures were limitations of our study.Results: 123 and 111 patients were enrolled in Groups 1 and 2, respectively. Preoperative characteristics were similar between groups. In Group 1, the mean operative time was statistically longer than in Group 2 (p=0.013). Stone-free status was significantly higher in Group 2 than in Group 1 (p=0.027). Complication rates were similar between groups. Hemorrhage requiring blood transfusion was the most common complication in both groups (10.5% vs. 9.9%).Conclusions: Our study demonstrated that a history of previous ORSS with parenchymal insicion significantly reduces the success rates of PNL procedure.

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Plasmakinetic vaporization versus plasmakinetic resection to treat benign prostatic hyperplasia: A prospective randomized trial with 1 year follow-up

Canadian Urological Association Journal ◽

10.5489/cuaj.1902 ◽

2014 ◽

Vol 8 (9-10) ◽

pp. 595 ◽

Cited By ~ 1

Author(s):

Mert Ali Karadag ◽

Kursat Cecen ◽

Aslan Demir ◽

Ramazan Kocaaslan ◽

Fatih Altunrende

Keyword(s):

Benign Prostatic Hyperplasia ◽

Statistical Difference ◽

Preoperative Evaluation ◽

Operation Time ◽

Maximum Flow ◽

Prostatic Hyperplasia ◽

Group 2 ◽

Hemoglobin Drop ◽

Group 1

Introduction: We evaluate the efficacy and outcomes of plasmakinetic vaporization (PKVP) and plasmakinetic resection (PKR) to treat benign prostatic hyperplasia (BPH).Methods: A total of 183 patients with BPH underwent plasmakinetic prostatic surgery between 2008 and 2012 at Kars State Hospital and Kafkas University Faculty of Medicine, Turkey. After clinical and preoperative evaluation, the patients were randomized to PKRP or PKVP groups sequentially by using computer-generated numbers. Group 1 included 96 patients treated with PKR. Group 2 included 87 patients treated with PKVP. Patients in both groups were compared in terms of hemoglobin drop, operation time, catheter duration, reobstruction, incontinence and recatheterization.Results: When we compared the maximum flow rates (Qmax values) at the 12th month, there was no statistical difference between 2 groups. Group 1 had a mean Qmax value of 17.92 ± 3.819 and Group 2 had a 18.15 ± 3.832 value (p > 0.05). There was a statistical difference between the groups in terms of hemoglobin drop, catheter duration and operation time. The mean catheter duration in Group 1 was 3.74 ± 1.049 days, and in Group 2 it was 2.64 ± 0.849 days (p < 0.05). Operation time was statistically longer in Group 2 (PKVP) and hemoglobin drop was statistically higher in Group 1 (PKR).Conclusion: PKVP for BPH is safe and effective. When compared with PKRP, it provides a significantly shorter catheter duration and less bleeding due to hemostasis control with similar IPSS and Qmax improvements after 1 year.

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Incidence of Meniscal Tears Accompanying ACL Ruptures

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967114s00121 ◽

2014 ◽

Vol 2 (11_suppl3) ◽

pp. 2325967114S0012

Author(s):

Mehmet Hasan Tatari ◽

Vugar Guliyev

Keyword(s):

Statistical Difference ◽

Meniscal Tear ◽

Operation Time ◽

Variance Analysis ◽

Meniscal Tears ◽

Chi Square ◽

Group 3 ◽

Group 2 ◽

Bucket Handle ◽

Group 1

Objectives: Anterior cruciate ligament (ACL) injury is a common disorder in athletes and in most cases, meniscal tears accompany. These meniscal tears can be the result of the initial trauma or the consecutive injuries in the unoperated patients. The aim of the study was to compare the incidence of meniscal tears in the patients operated because of ACL defficiency in the early or late period after the initial trauma. The age of the patient and meniscal tear pattern were the other subjects compared. Methods: The groups included 42, 72 and 129 patients respectively. Among all groups, it was shown that in 125 cases (% 51.4), a meniscal tear accompanied the ACL tear. In Group 1, 18 cases (% 42.8) had meniscal tears while 29 patients (% 37) in Group 2 and 78 patients (% 60.4) in Group 3 had any kind of meniscal tear. Bucket handle tears constituted 38 % of all tears in Group 1, 53 % in Group 2 and 56 % in Group 3. There was a significant statistical difference between the groups among the presence of meniscal tear and the period between the initial trauma and operation time. When the patients accepted the operation in the first six months after the initial trauma, the incidence of the meniscal injury decreased significantly (chi-square test) (p <0,01). There was no statistical difference between three groups among the percentage of bucket handle tears (variance analysis: p=0,196). The statistical difference was not important between the groups among the age of the patients in relation with the pattern of the meniscal tears (variance analysis: p=0,236). Results: The groups included 42, 72 and 129 patients respectively. Among all groups, it was shown that in 125 cases (% 51.4), a meniscal tear accompanied the ACL tear. In Group 1, 18 cases (% 42.8) had meniscal tears while 29 patients (% 37) in Group 2 and 78 patients (% 60.4) in Group 3 had any kind of meniscal tear. Bucket handle tears constituted 38 % of all tears in Group 1, 53 % in Group 2 and 56 % in Group 3. There was a significant statistical difference between the groups among the presence of meniscal tear and the period between the initial trauma and operation time. When the patients accepted the operation in the first six months after the initial trauma, the incidence of the meniscal injury decreased significantly (chi-square test) (p <0,01). There was no statistical difference between three groups among the percentage of bucket handle tears (variance analysis: p=0,196). The statistical difference was not important between the groups among the age of the patients in relation with the pattern of the meniscal tears (variance analysis: p=0,236) Conclusion: We can say that the incidence of meniscal tears can be decreased if the patients with ACL injury are operated early after the initial trauma. Earlier ACL reconstruction means less meniscal tear.

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Adrenal Incidentalomas: Should We Operate on Small Tumors in the Era of Laparoscopy?

International Journal of Endocrinology ◽

10.1155/2014/658483 ◽

2014 ◽

Vol 2014 ◽

pp. 1-5 ◽

Cited By ~ 4

Author(s):

Michał Pędziwiatr ◽

Michał Natkaniec ◽

Mikhail Kisialeuski ◽

Piotr Major ◽

Maciej Matłok ◽

...

Keyword(s):

Surgical Treatment ◽

Operation Time ◽

Adrenal Tumors ◽

Estimated Blood Loss ◽

Important Argument ◽

Risk Of Malignancy ◽

Potentially Malignant ◽

Group 2 ◽

Histopathological Results ◽

Group 1

Tumor size smaller than 4 cm as an indication for surgical treatment of incidentaloma is still a subject of discussion. Our aim was the estimation of the incidence of malignancy and analysis of treatment outcomes in patients with incidentaloma smaller than 4 cm in comparison to bigger lesions. 132 patients who underwent laparoscopic adrenalectomy for nonsecreting tumors were divided into two groups: group 1 (55 pts., size < = 40 mm) and group 2 (77 pts., size > 40 mm). Operation parameters and histopathological results were analyzed. No differences in group characteristics, mean operation time, and estimated blood loss were noted. Complications in groups 1 and 2 occurred in 3.6% and 5.2% of patients, respectively (P=0.67). Malignancy in groups 1 and 2 was present in 1 and 6 patients, respectively (P=0.13). Potentially malignant lesions were identified in 4 patients in group 1 and 4 patients in group 2 (P=0.39). The results do not allow for straightforward recommendations for surgical treatment of smaller adrenal tumors. The safety of laparoscopy and minimal, but impossible to omit, risk of malignancy support decisions for surgery. On the other hand, the risk of malignancy in smaller adrenal tumors is lower than surgical complications, which provides an important argument against surgery.

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