scholarly journals Stone free rate and clinical complications in patients submitted to retrograde intrarenal surgery (RIRS): Our experience in 571 consecutive cases

2021 ◽  
Vol 93 (3) ◽  
pp. 313-317
Author(s):  
Orazio Maugeri ◽  
Ettore Dalmasso ◽  
Dario Peretti ◽  
Fabio Venzano ◽  
Germano Chiapello ◽  
...  
Keyword(s):  
Laser Lithotripsy ◽  
Urinary Stones ◽  
Flexible Ureteroscopy ◽  
Safe Procedure ◽  
Retrograde Intrarenal Surgery ◽  
Stone Size ◽  
Clinical Complications ◽  
Holmium Laser Lithotripsy ◽  
Stone Free Rate ◽  
Free Rate

Introduction: The purpose of this study is to report the stone free rate (SFR) and clinical complications in patients submitted to retrograde intrarenal surgery (RIRS). Materials and methods: A total of 571 procedures of upper urinary stones treated using flexible ureteroscopy and holmium laser lithotripsy from January 2014 to February 2020 have been analyzed. Overall SFR was evaluated after 3 months following the procedure by means of a non-contrast computed tomography. Success was considered as stone-free status or ≤ 0.4 cm fragments. Results: The overall SFR was 92.3% in group 1 (stone size: < 1 cm), 88.3% in group 2 (stone size: > 1 ≤ 2 cm), 56.7% in group 3 (stone size: 2-3 cm) and 69.6% in group 4 (multiple stones). Post-operative complications, according to the Clavien- Dindo (CD) classification system, were recorded in 32 (5.6%) procedures. The major complications recorded were: one case of subcapsular hematoma (SRH) associated with pulmonary embolism two days after the procedure (CD Grade IIIa) treated conservatively and one case of hemorrhagic shock 2 hour with multiple renal bleedings requiring urgent nephrectomy (CD Grade IVA). Conclusions: The RIRS is an effective and safe procedure with a high SFR significantly correlated with the stone size; at the same time, RIRS could be characterized by severe clinical complications that require rapid diagnosis and prompt treatment.

scholarly journals Split-leg percutaneous nephrolithotomy: A safe and versatile technique

2013 ◽  
Vol 85 (2) ◽  
pp. 82 ◽  
Author(s):  
Eugenio Di Grazia ◽  
Pasquale La Rosa
Keyword(s):  
Ct Scan ◽  
Urinary Stones ◽  
Flexible Ureteroscopy ◽  
Surgical Time ◽  
Retrograde Intrarenal Surgery ◽  
Stone Size ◽  
Stone Free Rate ◽  
Versatile Technique ◽  
Hemoglobin Drop ◽  
Free Rate

Objectives: Percutaneos nephrolithotomy (PCNL) is the gold standard for treatment of urinary stones larger than 2 cm and refractory to ESWL. Nowadays most debate about surgical technique is related to the positioning of patients. We report our expe- rience on prone PCNL with split-leg variant (SL-PCNL) Materials and methods: 30 consecutive patients underwent prone SL-PCNL. Preoperative stone size was deter- mined by measuring stones longest diameter on CT scan. In cases with multiple stones, stone size was determined by the sum of each stone diameter on CT scan. Patients evaluated con- sisted of 20 females and 10 males and median age was 55 (20-72). The average BMI was 27 (24-35). 15 patients had multiple stones, 10 pyelocalicial, 10 pelvic larger than 2 cm, 2 in horseshoe kidneys and 3 staghorn stones. Results: Stone free rate was 87% after first look and 97% after second look. In 2 cases, we used a flexible ureteroscopy 7.5 Fr (Flex 2 - Storz) to treat a calculus in ureter or for a contemporary double access (Endoscopic combined Retrograde Intrarenal Surgery ECIRS). In 28 cases we placed a 20 fr nephrostomy while in two cases procedure was tubeless. In 20 cases we placed a double-J catheter. In 2 cases we performed two tract and in 2 horseshoe kidneys access was close to spine. The average surgical time was about 90 minutes (range 30-120 minutes). Hemoglobin drop was about 1.5 mg/dl (range 1-3 .4 mg/dl) and no major complications were reported. Conclusions: In our experience PCNL in prone with spread-legs variant is a versatile technique and allows to match the advantages you have with same technique in supine, providing at the same time benefits in cases of anatomical abnormalities, challenging cases, or when multi-tract accesses are required.

scholarly journals Treatment of upper urinary tract stones with flexible ureteroscopy in children

2018 ◽  
Vol 13 (3) ◽  
Author(s):  
Jing Xiao ◽  
Xiangyu Wang ◽  
Jun Li ◽  
Miaomiao Wang ◽  
Tiandong Han ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Operation Time ◽  
Upper Urinary Tract ◽  
Laser Lithotripsy ◽  
Holmium Laser ◽  
Flexible Ureteroscopy ◽  
Holmium Laser Lithotripsy ◽  
Stone Free Rate ◽  
Urinary Tract Stones ◽  
Free Rate

Introduction: This single-centre, retrospective study aimed to assess the efficacy and safety of flexible ureteroscopy (FURS) combined with holmium laser lithotripsy in treating children with upper urinary tract stones. Methods: From June 2014 to October 2015, a total of 100 children (74 boys and 26 girls) with upper urinary tract stones were treated using FURS. A 4.7 Fr double-J stent was placed two weeks before operation. Patients were considered stone-free when the absence of residual fragments was observed on imaging studies. The preoperative, operative, and postoperative data of the patients were retrospectively analyzed. Results: A total of 100 pediatric patients with a mean age of 3.51±1.82 years underwent 131 FURS and holmium laser lithotripsy. Mean stone diameter was 1.49±0.92 cm. Average operation time was 30.8 minutes (range 15–60). The laser power was controlled between 18 and 32 W, and the energy maintained between 0.6 and 0.8 J at any time; laser frequency was controlled between 30 and 40 Hz. Complications were observed in 69 (69.0 %) patients and classified according to the Clavien system. Postoperative hematuria (Clavien I) occurred in 64 (64.0 %) patients. Postoperative urinary tract infection with fever (Clavien II) was observed in 8/113 (7.1%) patients. No ureteral perforation and mucosa avulsion occurred. The overall stone-free rate of single operation was 89/100 (89%). Stone diameter and staghorn calculi were significantly associated with stone-free rate. Conclusions: FURS and holmium laser lithotripsy is effective and safe in treating children with upper urinary tract stones.

Flexible Ureteroscopy with Holmium Laser Lithotripsy: A New Choice for Intrarenal Stone Patients

2014 ◽  
Vol 94 (1) ◽  
pp. 93-98 ◽  
Author(s):  
Chen Xu ◽  
Ri-jin Song ◽  
Min-jun Jiang ◽  
Chao Qin ◽  
Xiao-lan Wang ◽  
...  
Keyword(s):  
Renal Stones ◽  
Laser Lithotripsy ◽  
Flexible Ureteroscopy ◽  
Stone Fragment ◽  
Stone Burden ◽  
Holmium Laser Lithotripsy ◽  
Stone Free Rate ◽  
Significant Difference ◽  
Free Rate ◽  
Free Status

Objective: To evaluate the efficiency and safety of flexible ureteroscopy (FURS) and holmium lithotripsy for intrarenal stones and to stratify the efficiency and safety by stone burdens of ≤20, 20-40, and ≥40 mm. Methods: Five hundred eighty-two patients with intrarenal stones were treated with FURS and holmium lithotripsy at a single department from August 2008 to October 2013. Stone size was evaluated by calculating the cumulative stone diameter of all intrarenal stones, and stone-free status was defined as the absence of any stone or stone fragment <1 mm in the kidney. Results: Data analysis revealed a mean stone burden of 21.8 ± 7.6 mm. The overall primary stone-free rate (SFR) was 65.3%, which increased to 89.0% 6 months after the first surgery. Complications developed in 6.7% of patients. A significant difference was found between lower-calyx stones and other stones (p < 0.001; p = 0.006), while noncalcium stones had a much higher SFR than calcium stones (p < 0.001; p = 0.04). Conclusion: Our study showed that the overall renal SFR with the use of FURS and holmium lithotripsy was satisfactory, with a relatively low complication rate. We believe that FURS with holmium lithotripsy could be a valuable choice for patients with renal stones, especially for patients with a cumulative stone burden ≤40 mm.

scholarly journals Comparative study between dusting versus fragmentation of proximal ureteric stones using Holmium Laser Lithotripsy

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
T M Elzayat ◽  
H A Fahim ◽  
M S Abdelaziz
Keyword(s):  
Lower Incidence ◽  
Laser Lithotripsy ◽  
Ureteric Stone ◽  
Medical Problems ◽  
Randomized Clinical Study ◽  
Holmium Laser Lithotripsy ◽  
Stone Free Rate ◽  
Operative Complications ◽  
Free Rate ◽  
Post Operative Complications

Abstract Objective to compare between the outcome and complications of proximal ureteric stone disintegration using dusting versus fragmentation technique with focusing on stone free rate. Materials and Methods in a prospective randomized clinical study, 20 patients will undergo laser disintegration of ureteric stones by dusting technique; another 20 patients will undergo laser disintegration of ureteric stones by fragmentation technique. The inclusion criteria include symptomatic single primary proximal ureteric stone&lt; 2 cm. The Exclusion criteria were pregnant women, children, and patients with coagulation disorders, medical problems that hinder anesthesia, recent active infection, urinary tract abnormalities and previous ureteric surgery. Results Our laser settings in this research were energy 0.5 J and frequency 20 Hz for dusting technique and 2 J energy and 5 Hz frequency for fragmentation technique. Stone free rates of dusting and fragmentation techniques were 75% and 90% respectively. Post operative complications were 15% with dusting technique and 20% with fragmentation group. Conclusions Our study shows that the active retrieval after laser lithotripsy (fragmentation technique) more efficient than waiting tiny fragments to pass spontaneously after laser lithotripsy (dusting technique) as fragmentation technique has lower mean operative time, lower incidence of stone migration during procedure and higher stone free rate than dusting technique. Dusting technique seems to be more efficient than fragmentation in double-J stenting and post-operative complications as it has the lower incidence of jj stenting and post operative complications. To obtain fair and precise results we have to apply this study in larger population.

scholarly journals Comparative Study Between Holmium Laser versus Pneumatic Ureteroscopic Lithotripsy for Proximal Ureteric Stones Close to Pelvi-ureteric Junction (PUJ) -A Prospective Trial

2020 ◽  
Vol 23 (2) ◽  
pp. 188-192
Author(s):  
Harun Or Rashid ◽  
Md Shahidul Islam ◽  
SM Shameem Waheed ◽  
Md Abdur Rakib ◽  
Md Ashif Chowdhury ◽  
...  
Keyword(s):  
Laser Lithotripsy ◽  
Stent Insertion ◽  
Stone Size ◽  
Ureteroscopic Lithotripsy ◽  
Secondary Intervention ◽  
Upward Migration ◽  
Ho:Yag Laser ◽  
Double J Stent ◽  
Stone Free Rate ◽  
Free Rate

Objective: To compare the outcomes of ureteroscopic lithotripsy with pneumatic lithotripter versus Holium:Yttrium-Aluminum-Garnet (Ho:YAG) laser in the management of upper ureteric stones. Materials and methods: Patients who underwent ureteroscopic lithotripsy with pneumatic lithotripter or Ho:YAG laser for upper ureteric stones were reviewed. Patients with urinary tract infection, ,loss of follow-up, concurrent middle or lower third ureteral stones or acute renall failure were excluded. Patient age, stone size and burden (based on KUB or computerized tomography), stone upward migration, double J stent insertion rate, stone free rate and secondary intervention rate for residual stones were compared in both groups. Results: There were 70 patients with upper ureteric stones (35 in pneumatic group and 35 in laser group) meeting the study criteria. Patients’ age, gender, stone size and burden were similar in both groups. The Ho:YAG laser lithotripsy group had better stone free rate, less double J stent insertion rate and less upward migration and secondary intervention rate, sepsis as compared with pneumatic lithotripsy (94.2% vs. 60%; 85% vs. 100%; 5.7% vs 40%; 5.7% vs 34.2%; 2.8 vs 2.8 respectively, all p < 0.05). In patients with stones sizes 8-10 mm, Ho:YAG laser lithotripsy had significantly lower upward migration rate, lower double J stent insertion rate, higher stone free rate and less secondary intervention rate. Conclusions: Ho:YAG laser lithotripsy is better and much effective than pneumatic lithotripsy in the management of upper ureteric stones in terms of, stone free rate and secondary intervention rate for stones of sizes about 8 to 10 mm.Although the access of upper ureter is difficult but our small calibre (4.5 fr) ureteoscope and gentle manuevre have made the procedures safe and successful. Bangladesh Journal of Urology, Vol. 23, No. 2, July 2020 p.188-192

scholarly journals Laser lithotripsy using dusting technique (low energy, high frequency) for symptomatic upper urinary tract stones

2021 ◽  
Vol 27 (1) ◽  
Author(s):  
A. Ashmawy ◽  
M. Khedr ◽  
I. R. Saad ◽  
S. Zamel ◽  
A. Kassem
Keyword(s):  
Urinary Tract ◽  
High Frequency ◽  
Hounsfield Unit ◽  
Spiral Ct ◽  
Upper Urinary Tract ◽  
Laser Lithotripsy ◽  
Low Energy ◽  
Stone Size ◽  
Stone Free Rate ◽  
Free Rate

Abstract Background A prospective study to assess the feasibility of stone dusting technique (low energy and high frequency) during laser lithotripsy in symptomatic upper urinary tract |(UUT) stones. Methods Sixty patients with symptomatic single or multiple UUT stones less than 3 cm in diameter were included. Patients with coagulation disorders and active UTIs were excluded. All patients were clinically evaluated and underwent non-contrast spiral CT (NCSCT) to detect stone site, size, number, Hounsfield unit. A rigid or flexible ureteroscope was used with stone dusting using the Ho: YAG laser at low-energy and high-frequency (0.5 J & 20 Hz) set. Operative and fluoroscopy time, total energy delivered, type of stent, hospitalization time, complications and its grade, and stone-free rate using NCSCT after 4 weeks were recorded. Results The mean stone size ± SD (range) was 1.55 ± 0.55 (0.5–3) cm; out of sixty patients (50 with single stone and 10 with multiple stones), fifty-five patients were stone-free at 4 weeks. Complications had occurred in 11 patients (eight with grade I, one with grade II, and two with grade IIIa) according to Clavien–Dindo grading of surgical complications. Stone size was the only parameter which correlated significantly with stone-free rate. No significant correlation was found between incidence of complications and other parameters (stone size, site, BMI, age and operative time). Conclusions Stone dusting technique is feasible, safe and effective in management of UUT stones.

External Comparison of Recent Predictive Nomograms for Stone-Free Rate Using Retrograde Flexible Ureteroscopy with Laser Lithotripsy

2016 ◽  
Vol 30 (11) ◽  
pp. 1180-1184 ◽  
Author(s):  
Akif Erbin ◽  
Abdulkadir Tepeler ◽  
Ibrahim Buldu ◽  
Harun Ozdemir ◽  
Muhammet Tosun ◽  
...  
Keyword(s):  
Laser Lithotripsy ◽  
Flexible Ureteroscopy ◽  
Stone Free Rate ◽  
Free Rate

scholarly journals Outcomes of fluoroscopy-free retrograde intrarenal surgery and predictive factors of stone-free

2021 ◽  
Vol 93 (4) ◽  
pp. 425-430
Author(s):  
Huseyin Kocakgol ◽  
Hasan Riza Aydin ◽  
Ahmet Ozgur Guctas ◽  
Cagri Akin Sekerci ◽  
Deniz Ozturk Kocakgol ◽  
...  
Keyword(s):  
Operation Time ◽  
Female Gender ◽  
Ureteral Injury ◽  
Preoperative Imaging ◽  
Retrograde Intrarenal Surgery ◽  
Stone Size ◽  
Stone Burden ◽  
Stone Free Rate ◽  
Stone Density ◽  
Free Rate

Objective: To evaluate the outcomes of flouroscopy-free retrograde intrarenal surgery (ffRIRS) and to investigate the factors that may affect stone-free rate. Materials and methods: The charts of patients who underwent ffRIRS between January 2017 and August 2019 were reviewed retrospectively. Patients with missing preoperative imaging and patients with kidney anomalies were excluded from the study. Age, gender, stone size, stone localization, stone density, laterality, operation time, stone-free rate, complications and auxiliary procedures were recorded and analyzed. Results: Study group involved 44 (43.1%) female and 58 (56.8%) male patients. Stone-free rate in a single-session ffRIRS were found to be correlated with stone localization (p = 0.003), stone volume (p = 0.004), and stone density (p = 0.009) but not with age (p = 0.950). Patients with multiple calyceal stones and a stone burden over 520 mm3 were found to be less stone-free. The complication rate in female gender (n = 7) was significantly higher compared to male (n = 1) (p = 0.011). No major complications such as ureteral injury or avulsion were observed. Overall, 13 patients (12.7%) needed auxiliary procedures. The operation time seemed to be affected by stone size and gender (p = 0.005; p = 0.044, respectively). Conclusions: Stone-free rate in ffRIRS were found to be affected by stone density, size, and localization. Patients with multiple caliceal stones and high stone burden (< 520 mm3) have been found to have low stone-free rate, so one can speculate that having fluoroscopy assistance in RIRS might help us to improve surgical success.

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