Guidewire for Retrograde Passive Dilatation of Ureter in Pediatric Patients with Urolithiasis: A Novel Technique from a Tertiary Center in Nepal

Objective of the Study: We sought to evaluate the role of guidewire placement as ureteral stent in passive ureteral dilatation for uretero-renoscope negotiation in pediatric patients. Study Designs: This was a prospective cross-sectional study. Place and Duration of the Study: Department of Urology, Manmohan Memorial Medical College and Teaching Hospital, Kathmandu, Nepal, (December 2019 to November 2020). Methodology: All pediatric patients (<18 years) diagnosed with more than 6mm size of distal ureter stone undergoing ureteroscopic lithotripsy under general anesthesia in which ureteroscope (4.5/6.5 Fr) negotiation and double J (DJ) ureteral stent (4 Fr) insertion could not be successful in first sitting were selected for the study. Data collection included demographics, clinical parameters, and perioperative and postoperative complications of those patients undergoing preoperative ureteral stenting with guidewire for 2 weeks for ureteroscopic management of ureteric stone after removal of guidewire. The statistical analysis of data was done using Microsoft Excel. Results: A total of 12 (41 %) cases underwent passive dilatation of ureter with guidewire. The mean age of the patients and mean stone size were 8.42 ± 1.7 years and 6.1 ±0.65mm respectively. None of the patients developed intraoperative and postoperative complications related to the procedure. Conclusion: Guidewire placement as ureteral stent for 2 weeks would result sufficient passive ureteral dilatation for the ureteroscope negotiation without any complication. PUD with guidewire is safe and effective. Additional research is necessary to determine whether the findings will be similar or not.

Where Is It Logical to Break-Up A Ureter Stone with Endoscopic Surgery?

Aims: Today, we have technology to break up a ureter stone in ureter as well as in renal pelvis during ureterorenoscopic procedures. In the past, when this option was not available, the surgeons improved several techniques and antiretropulsion devices in order not to let the stone migrate through renal pelvis. However, we still do not know whether it is advantageous to dust a stone in ureter where it is impacted or in a wider area such as renal pelvis. This study was carried out to clarify whether it is advantageous to breaking an upper ureter stone up where it is enclaved or in a wider area such as renal pelvis. Study Design: The data of 134 patients who underwent semirigid ureterorenoscopy (srURS) due to single and primary upper ureteral stones were included in our study and analyzed retrospectively. The patients were divided into two groups according to the development of spontaneous push-up during surgery (Group 1: non-push-up group, Group 2: push-up group). Results: Laboratory findings were changed significantly in both groups before and after surgery. However, this change was not significant between the groups. Operation times were statistically similar in both groups in contrast with the literature. Stone-free rates were significantly higher in srURS than in flexible ureterorenoscopy (fURS) (p<0,05). Complication rates were also found similar in this study. Conclusion: The application of srURS after fixing an upper ureter stone at its location using a Stone Cone® results in higher stone-free rates than pushing it back in order to dust it in renal pelvis. We recommend srURS supported by an antiretropulsion method as a treatment for upper ureteral stones.

Retrograde intrarenal surgery or percutaneous nephrolithotomy in the treatment of impacted proximal ureteric calculi

The objective of this study was to compare the clinical efficacy of retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL) in the treatment of impacted proximal ureteric calculi. This was a retrospective study on surgical outcomes of 202 patients with impacted proximal ureteric calculi. Overall, 140 and 62 were treated with RIRS and PCNL, respectively. The effects of the choice of the surgical method on the surgical outcomes were evaluated by preoperatively scoring patients with high-risk factors related to stone characteristics and analyzing these scores. Compared to the RIRS group, the surgical duration of the PCNL group was significantly shorter (51.69 ± 25.07 min vs. 67.46 ± 27.12 min, p < 0.05), stone-free rate (SFR) was significantly increased (98.4% vs. 72.10%, p < 0.05), and total treatment cost was lower (US $1678.61 ± 714.86 vs. US $3901.45 ± 1069.46, p < 0.05). Preoperatively, the efficacy of PCNL was higher than that of RIRS based on the higher scores observed. The results indicated PCNL had a better SFR and higher surgical efficacy, whereas RIRS had higher surgical safety parameters, a shorter perioperative period, but a lower initial SFR. PCNL is often more advantageous for complicated impacted proximal ureter stone.

OPTIMAL CHOICE OF STONE DISEASE’ SURGICAL TREATMENT IN PATIENTS SUFFERED PROSTATE CANCER: RETROSPECTIVE ANALYSIS

There are patients suffered prostate cancer and diagnosed with stone disease in urological centres. These cases represent non-standard issue of choosing the optimal surgical treatment. Currently clinical recommendations haven’t described the particular answer for this answer yet. There is also lack of information published in literature foсused on the issue.Aim of the study was to determine the optimal choice of surgical treatment for patients diagnosed with stone disease and prostate cancer.Materials and methods: Retrospective study of patients diagnosed with prostate cancer and stone disease for the period from 2006 to 2019 was performed. Among 2047 in-patient cases of prostate cancer 71 patients with stone disease were included.Results: 49 of 71 (69%) patients diagnosed with stone disease had indications for surgical treatment at the moment of hospitalisation. Stages of prostate cancer in this group were T1-T2 (91,7%) and T3(8,3%). 25 patients (51%) had kidney stone disease, 23 patients (47%) – ureter stone disease and only 1 patient – kidney and ureter stone disease. 37 patients (75%) presented complains related to stone disease, other cases (25%) were asymptomatic. Surgical treatment of stone disease primarily was performed in the majority of cases (72,2%). Surgical treatment of prostate cancer subsequently included radical prostatectomy in most cases 7 (86,1%). Simultaneous surgical treatment of both diseases haven’t performed in this study.Conclusion: The main factors influencing the decision making of optimal surgical treatment for this group of patients were clinical presentation and group of prostate cancer risk.