Outcome of Extracorporeal Shockwave Lithotripsy as Monotherapy in Upper Urinary Tract Lithiasis

Introduction: Due to its non-invasive nature, extracorporeal shockwave lithotripsy (ESWL) is the preferred treatment modality for uncomplicated renal and ureteral stone < 20 mm in diameter. The success rate of it ranges from 46% to 91% depending on various factors. Objective: To assess the outcome of ESWL as monotherapy in uncomplicated solitary renal and upper ureteric calculus ranging from 10mm to 20mm. Methods: In this retrospective study, the records of 34 patients who underwent Extracorporeal shockwave lithotripsy ESWL inBirat Medical College – Teaching Hospital over a period of one and a half years were reviewed to assess the outcome in terms of stone free rate and complication rate. Results: Mean age of the patients was 30.57±8.44 years and mean calculus size was 14.47±2.68 mm (range 10-20mm). The male and female ratio was 2:1. The success rate was higher for pelvic (83.33%) and upper calyceal (75%) and upper ureteric calculi (75%) compared to other calyces. Clinically significant residual fragment (CSRF) was the most common problem after ESWL (23.33%) at three months after the procedure. Conclusions: The outcome of ESWL as monotherapy for upper urinary tract calculi is acceptable in selected cases three months after the procedure. Keywords: Extracorporeal shockwave lithotripsy; outcome; upper urinary tract calculi.

Efficacy and safety of single-use flexible ureteroscope（ZebraScopeTM）for the treatment of upper urinary tract calculi ≤ 2 cm

Purpose To evaluate the clinical efficacy and safety of a Chinese single-use flexible ureteroscope (ZebraScopeTM) for the treatment of upper urinary tract calculi ≤2 cm based on a retrospective database. Methods Overall, 84 patients with upper urinary tract calculi who underwent FURS at our hospital from July, 2020 to January, 2021 were enrolled and reviewed. Demographic characteristics and perioperative data were evaluated and analyzed. Results We identified 84 patients: 51 male and 33 female. The mean age of the patients was(49.63±12.23)years, and the mean body mass index was༈24.44±3.62༉Kg/m2. The degree of hydronephrosis was absent, mild, moderate and severe in 24, 35, 21 and 4 patients, respectively. The average operation time was༈74.57±42.51༉min, and the average blood loss was༈5.28±4.99༉ml. The catheter retention time was༈1.71±0.99༉day and the double-J tube retention time was༈32.89±13.23༉day. The length of hospital stay was༈4.29±3.28༉day. The stone-free rate was 77.78% after 1-month, and the cost of hospitalization was ¥༈34619±8719.16༉. The overall complication rate was 4.76%. There were significant increase in leukocyte, neutrophils, and decrease in urea nitrogen, albumin and globulin after surgery (P༜0.05), while no significant difference were observed in hemoglobin and creatinine (P༞0.05). Conclusion The Chinese single-use ureteral flexible ureteroscope (ZebraScopeTM)can be considered effective and safe for the treatment of upper urinary tract calculi ≤ 2 cm.

The clinical outcomes of flexible ureteroscopy and laser lithotripsy (FURSL) for treatment of the upper urinary tract calculi

PURPOSE: To evaluate efficacy and safety of flexible ureteroscopy and laser lithotripsy (FURSL) for treatment of the upper urinary tract calculi. METHODS: We retrospectively analyzed 784 patients who underwent FURSL between January 2015 and October 2020 in our unit. All patients were preoperatively evaluated with urine analysis, serum biochemistry, urinary ultrasonography, non-contrast computed tomography and intravenous urography. The procedure was considered as successful in patients with complete stone disappearance or fragments < 4 mm on B ultrasound or computed tomography. The operative parameters, postoperative outcomes and complications were recorded and analyzed respectively. RESULTS: The average operative time and postoperative hospital stay were 46.9±15.8 min and 1.2±1.1 days, respectively, among 784 patients. In addition, 746 patients were followed up and 38 patients were lost. In these patients, 700 (93.8%) cases met the stone removal criteria and 46 cases (6.2%) did not meet the stone removal criteria who need further treatment. The stone free rate (SFR) is 92.5%after 1–3 months and SFR of middle and upper calyceal calculi was higher than that of lower calyceal calculi significantly. The most common complications were fever (58/784, 7.4%), gross hematuria (540/784, 68.9%) and lpsilateral low back pain (47/784, 6.0%). The incidence rate of serious complication was 1.28%(10/784), including 5 cases of septic shock and 5 cases of subcapsular hematoma, which were cured after active treatment. CONCLUSION: FURSL is a reliable treatment for small and medium calculi patients of upper urinary tract. The curative effect of stone removal is clear. The complications are few and the safety is high. However, there are certain limitations to the efficacy in treating larger stone and lower calyceal calculi.

FREQUENCY AND PREDICTORS OF ACCESS FAILURE IN PATIENTS UNDERGOING URETERORENOSCOPY FOR UPPER URINARY TRACT CALCULI

Objective: To determine the frequency and factors responsible for access failure during primary ureteroscopy (URS). Study Design: Cross-sectional study. Place and Duration of Study: Aga Khan University, Karachi Pakistan, from Jan to Jul 2019. Methodology: All patients undergoing Ureterorenoscopy for upper urinary tract urolithiasis were included. Ureterorenoscopy was performed with either semi rigid, rigid digital or fiber opticflexible ureterorenoscope as appropriate. Data was collected for demographics, history of stone passage, previous Ureterorenoscopy /double J stenting and history of stent placement. Preoperative imaging reviewed for stone location, size and number. Level of access failure (proximal/mid/distal ureter) was noted. Post-operative complications and need of ancillary procedure was noted. Results: We included 250 participants undergoing ureteroscopy for the upper urinary tract calculi. Mean age of the patients was 44.15 ± 13.76 years. Mean stone size was 9.12 ± 4.23mm. Overall access failure rate was found to be 8% (20/250), all required an ancillary procedure. None of the patients with previous history of endoscopic intervention or stone passage had access failure. On univariate and multivariate analysis only stone location was found to be significant factor predicting access failure. Conclusion: Failure to access is not uncommon during primary ureteroscopy. Access failure is more common in proximal ureteral stone and in patients with no previous episode of ureteral stones and procedure. Information from this study will help in counseling patients’ pre-operatively and may be a guide to urologists on pre stenting of selected patients at high risk of access failure.

Outcomes of flexible ureteroscopy and laser lithotripsy (FURSL) for treatment of the upper urinary tract calculi: a single center experience

purpose: To evaluate the efficacy and safety of flexible ureteroscopy and laser lithotripsy(FURSL) for treatment of the upper urinary tract calculi. Methods: We retrospectively analyzed 784 patients who underwent FURSL between January 2015 to October 2020 in our unit. The operative parameters, postoperative functional outcomes and complications were recorded respectively. Rusults: All patients underwent successful operation. The mean operative time was 46.9±15.8min. The average postoperative hospital stay was 1.2±1.1 days. The postoperative serum creatinine and hemoglobin were 76.2±10.2umol/L and 133.6±5.1g/L, which compared to preoperative, there were no sigificant statistical difference. Among 784 patients, 746 patients were followed up and 38 patients were lost. 700(93.8%) cases met the stone removal critetia and 46 cases(6.2%) did not meet the stone removal criteria for other treatments, such as extracorporeal shock wave lithotripsy, ureteroscopy and observed regularly. The stone free rate(SFR) is 92.5% after 1-3 months and SFR of middle and upper calyceal calculi was higher than that of lower calyceal calculi significantly. The most common complications were fever(58/784,7.4%),gross hematuria(540/784,68.88%) and lpsilateral low back pain(47/784,5.99). The incidence rate of serious complication was 1.28%(10/784), including 5 cases of septic shock and 5 cases of subcapsular hematoma, which were cured after active treatment. Conclusion: FURSL is a reliable treatment for small and medium calculi patients of upper urinary tract. The curative effect of stone removal is clear,the complications are few and the safety is high. However there are certain limitation to the efficacy in the treatment of large stone and lower calyceal calculi.