Showing papers on "Ureteroscopy published in 2020"
TL;DR: The present overview may help urologists to prevent, recognize and solve complications of ureteroscopy, and stimulate colleagues to perform prospective studies using standardized systems for classifying complications.
Abstract: The aim of this paper was to give a complete overview of all published complications associated with ureteroscopy and their according management and prevention in current urological practice. This review was registered in PROSPERO with registration number CRD42018116273. A bibliographic search of the Medline, Scopus, Embase and Web of Science databases was performed by two authors (V.D.C. and E.X.K.). According to the Population, Intervention, Comparator, Outcome (PICO) study design approach and Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) standards, a consensus between these authors was found relating to the thematic structure of this review. Ureteral stent discomfort, ureteral wall injury and stone migration are the most frequently reported complications. The worst complications include urosepsis, multi-organ failure and death. Incidence rates on these and other complications varied extensively between the reviewed reports. Ureteroscopy seems to be associated with more complications than currently reported. The present overview may help urologists to prevent, recognize and solve complications of ureteroscopy. It may also stimulate colleagues to perform prospective studies using standardized systems for classifying complications. These are warranted to compare results among different studies, to conduct meta-analyses, to inform health care workers and to counsel patients correctly about possible risks of ureteroscopy.
81 citations
TL;DR: It is suggested that almost half of all post-URS complications are related to infectious complications although reported rates of urosepsis were low, and efforts must be taken to minimise them especially in high-risk patients.
Abstract: To present the latest evidence related to the predictors of urinary tract infections (UTIs) and urosepsis after ureteroscopy (URS) for stone disease. Our review suggests that almost half of all post-URS complications are related to infectious complications although reported rates of urosepsis were low. The use of antibiotic prophylaxis, treatment of pre-operative UTI, and low procedural time seem to reduce this risk. However, the risk is higher in patients with higher Charlson comorbidity index, elderly patients, female gender, long duration of pre-procedural indwelling ureteric stents and patients with a neurogenic bladder and with high BMI. Infectious complications following ureteroscopy can be a source of morbidity and potential mortality. Although majority of these are minor, efforts must be taken to minimise them especially in high-risk patients. This includes the use of prophylactic antibiotics, limiting stent dwell and procedural time, prompt identification and treatment of UTI and urosepsis, and careful planning in patients with large stone burden and multiple comorbidities.
60 citations
TL;DR: The primary results of this large sample prospective randomized controlled study comparing the silicone Imajin® hydro stents to the PercuflexTM Plus stent show that silicone stents are associated with significantly less patient discomfort.
32 citations
TL;DR: ASDM appears to reduce the risk of urothelial recurrence in patients affected by low-grade UTUC without bladder tumour, therefore, its use should be evaluated.
Abstract: Purpose: To address the safety and feasibility of adjuvant single-dose upper urinary tract instillation of mitomycin (ASDM) immediately after therapeutic ureteroscopy for upper tract urothelial car...
32 citations
TL;DR: Bladder recurrence after diagnostic ureteroscopy’s+ nephroureterectomy was high despite technical precautions to avoid contact of bladder mucosa with contaminated urine from the upper urinary tract.
Abstract: There have recent reports in the literature of increased rates of bladder recurrence (BR) after radical nephroureterectomy (RNU) when diagnostic flexible ureteroscopy (DFU) was performed before RNU. The technical heterogeneity of DFU was a major bias in these studies. Our purpose was to evaluate the impact of a standardized DFU technique before RNU on the risk of BR. A retrospective monocenter study including patients who underwent RNU for upper tract urothelial carcinoma (UTUC) between 2005 and 2017. 171 patients were identified. 78 patients were excluded owing to a history of bladder cancer before RNU or neo-adjuvant/adjuvant chemotherapy. 93 included patients were stratified according to pre-RNU ureteroscopy (DFU + 70 patients) or no pre-RNU ureteroscopy (DFU—23 patients). The standardized DFU technique consisted of systematic ureteral sheath (ch9–10), flexible ureteroscopy, biopsy, and drainage with a mono-J/bladder catheter to avoid contact of contaminated urine of the upper tract with the bladder. Epidemiological, initial staging, and postoperative tumoral characteristics were similar in both groups. Mean follow-up was 35 months [2–166], 47(50%) BR occurred with 41(87%) in the DFU + group, and pre-RNU–DFU was an independent predictive factor of BR (OR = 4[1.4–11.9], P = 0.01) (Cox regression model). The characteristics of BR were similar in both groups, although BR occurred earlier in DFU + (427 days vs. 226 days (P = 0.07)). Bladder recurrence after diagnostic ureteroscopy + nephroureterectomy was high despite technical precautions to avoid contact of bladder mucosa with contaminated urine from the upper urinary tract. Post-DFU endovesical instillation should be investigated.
26 citations
TL;DR: Good stone-free rates were obtained for large and multiple renal stones with a small risk of minor complications post-operatively and the use of UAS for renal stones is safe with no intra-operative complications noted in this series.
Abstract: To compare the outcomes (stone free rate and complications) of renal stone treatment with and without the use of ureteral access sheath (UAS). The worldwide use of UAS has risen over the last decade; however, questions still remain on the safety and outcomes with its use. We wanted to look at the role of UAS for treatment of consecutive renal stones over a 7-year period. The outcomes of flexible ureteroscopy and stone treatment (FURS) for renal stones with and without the use of UAS was prospectively compared from March 2012 to July 2018. Patients were divided into two groups: group-1 where UAS was used for stone treatment and group-2 where a UAS was not used. Data were collected prospectively on consecutive patients for demographics, stone size, location and number, pre and post-operative stent usage, operative time duration, stone free rate (SFR), length of stay and complications. During the study period, 338 patients underwent FURS for renal stones, of which a UAS was used for 203 (60%) patients. The mean age of patients was 56 years (range 2–89 years) with a male:female ratio of 204:134. The mean cumulative stone size and the mean number of stones was 16.5 ± 10.8 mm and 11.37 ± 8.08 mm (P < 0.001), and 2.17 ± 1.99 and 1.66 ± 1.50 (P = 0.009) for groups 1 and 2 respectively. The pre and post-operative stent insertion rates were similar in the two groups. The procedural time was longer in group-1 (54.8 ± 25.8 min) compared to group-2 (41.3 ± 22.2 min) (P < 0.001). The SFR for group-1 (88%) was slightly lower than group-2 (94%) although this was not statistically significant (P = 0.07). There were no intra-operative complications in either of the groups. Post-operative complications were seen in eight patients in group-1 (7 Clavien I/II and 1 Clavien IVa) and two patients in group-2 (Clavien I) (P = 0.19). The use of UAS for renal stones is safe with no intra-operative complications noted in our series. Good stone-free rates were obtained for large and multiple renal stones with a small risk of minor complications post-operatively.
25 citations
TL;DR: Elective URS achieved excellent outcomes in patients who previously presented with obstructing calculi and sepsis needing emergency decompression, and between American Society of Anaesthesiologists (ASA) grade of patients.
Abstract: Background Elective treatment of ureteric stones is needed after emergency drainage of urosepsis. Objective We wanted to look at the outcomes of elective ureteroscopic stone treatment in patients with prior sepsis and emergency drainage via retrograde ureteric stent (RUS) or percutaneous nephrostomy (PCN). Design, setting, and participants Data of all patients who underwent elective ureteroscopy (URS) for stone disease over 5 yr (March 2012–December 2016) were prospectively collected. Intervention Elective URS following previous emergency RUS or PCN. Outcome measurements and statistical analysis Outcomes were collated for consecutive patients who underwent emergency drainage for urosepsis secondary to stone disease, followed by elective URS. Data was collected regarding patient demographics, stone parameters, and clinical outcomes. Statistical analysis was performed using SPSS version 24. Results and limitations In total, 76 patients underwent 82 elective procedures (six underwent bilateral URS) with a male to female ratio of 1:2 and a mean age of 57 yr. Emergency decompression was achieved via RUS in 63 (83%) and PCN in 13 (17%) patients. A positive urine culture on presentation was obtained in 26 (34%) patients, and 27 (36%) patients were admitted to the intensive care unit (ICU). The mean single and overall stone size was 8.6 (2–23) and 10.8 (2–32) mm, respectively. The mean operating time was 42 (5–129) min with stone-free rate (SFR) of 97% (n = 74). There were three (4%) complications in total, of which two patients developed urinary tract infection needing intravenous antibiotics (Clavien II) and a third developed sepsis (Clavien IV) needing ICU admission. There was no difference in ureteroscopic lithotripsy outcomes (operative time, complications, or SFR) on comparing initial RUS or PCN, admission to ICU or ward, positive or negative urine culture result, presence of single or multiple stones, and between American Society of Anaesthesiologists (ASA) grade of patients. The ASA grade of patients was a significant predictor of day case procedures (p = 0.001). Conclusions Elective URS achieved excellent outcomes in patients who previously presented with obstructing calculi and sepsis needing emergency decompression. Overnight inpatient admission was needed in some patients with a higher ASA grade. Patient summary In this report, we look at the outcomes of planned ureteroscopy procedures for stone disease in patients with previous urosepsis. These patients with previous emergency drainage for urosepsis had excellent outcomes from their planned ureteroscopic surgery. This information will help in preoperative patient optimisation and counselling.
22 citations
TL;DR: The single-use digital f-URS (ZebraScopeTM) appears to be at least noninferior to reusabledigital f- URS (URF-V) regarding the 1-month SFR, the high-quality rate of images, and the eligible rate of operability.
Abstract: Objective: To compare the efficacy and safety of a single-use digital flexible ureteroscope (f-URS) and a reusable digital f-URS (URF-V) for the treatment of renal stones in adults. Patients and Me...
22 citations
TL;DR: A review explores the current trend and surgical management of upper tract urolithiasis in SSA with insight on the available clinical guidelines and regarding the lack of endourological equipment and expertise, most urological centers in these regions still consider open surgery for kidney and ureteral stones.
Abstract: Urolithiasis is a global pathology with increasing prevalence rate The lifetime recurrence of urolithiasis ranges from 10-75% creating a public health crisis in affected regions The epidemiology of urolithiasis in most parts of Africa and Asia remains poorly documented as incidence and prevalence rates in these settings are extrapolated from hospital admissions The surgical management of kidney and ureteral stones is based on the stone location, size, the patient's preference and the institutional capacity To date, the available modalities in the management of urolithiasis includes external shock wave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL), ureterorenoscopy (URS) including flexible and semirigid ureteroscopy However, regarding the lack of endourological equipment and expertise in most parts of Sub-Saharan Africa (SSA), most urological centers in these regions still consider open surgery for kidney and ureteral stones This review explores the current trend and surgical management of upper tract urolithiasis in SSA with insight on the available clinical guidelines
21 citations
TL;DR: Ureteroscopy plays a pivotal role in the setting of a combined approach to staghorn calculi, and technological advances and refinement of techniques suggest a major role of ureteroscope for staghORN calculi treatment in close future.
19 citations
TL;DR: Use of preoperative alpha-blockers demonstrated a significant reduction in the need for ureteric orifice dilation, increase in patient stone-free status at follow-up, and facilitates higher rate of ureTERoscopic access to stones while reducing operative time.
Abstract: Introduction: Preoperative alpha-blockers have been proposed to improve intraoperative outcomes and patient stone-free status after ureteroscopy for ureteral stones. Materials and Methods: We searc...
TL;DR: It is demonstrated that in appropriate setting a high stone-free rate can be achieved with minimal morbidity for paediatric patients and potentially a need to factor the increasing role of URS in future paediatric urolithiasis guidelines.
Abstract: To report the outcomes of paediatric ureteroscopy (URS) for stone disease from a specialist endourology centre in the UK. Ureteroscopy for management of stone disease has increased worldwide and is now being done more commonly in the paediatric age group. Data were analysed retrospectively from a database maintained between April 2010 and May 2018. Consecutive patients ≤ 16 years of age undergoing semi-rigid or flexible URS for stone disease were included. Stone size and stone-free rate (SFR) were routinely assessed using an ultrasound (USS) and/or plain KUB XR. Complications were graded according to the Clavien–Dindo classification and recorded within 30 days post-procedure and readmissions within 90 days after the procedure were also captured. Over the 8-year period between April 2010 and April 2018, 81 patients with a mean age of 8.8 years (range 18 months–16 years) and a male to female ratio 1:1.1 underwent 102 procedures (1.28 procedure/patient to be stone free). Of the 81 patients, 29 (35.8%) had comorbidities, with 26 (32%) having multiple comorbidities. The mean (± SEM) single and overall stone size was 9.2 mm (± 0.48, range 3–30 mm) and 11.5 mm (± 0.74, range 4–46 mm) respectively, with 22 (27.1%) having multiple stones. Thirty-five (34.7%) had stent in situ pre-operatively. The stone location was in the ureter (26.6%), lower pole (35.4%), and renal pelvis (16.5%), with 22/81(27%) having multiple stones and 21/102 (20.5%) where a ureteral access sheath (UAS) was used. With a mean hospital stay of 1.2 days, the initial and final SFR was 73% and 99%, respectively, and 61/102 (60%) had ureteric stent placed at the end of the procedure. While there were no intra-operative complications, the readmission rate was less than 1% and there were only three early complications recorded. This included a case each of prolonged admission for pain control (grade I), urinary retention (grade II) and post-operative sepsis requiring a brief ITU admission (grade IV). Our study demonstrates that in appropriate setting a high stone-free rate can be achieved with minimal morbidity for paediatric patients. There is potentially a need to factor the increasing role of URS in future paediatric urolithiasis guidelines.
TL;DR: While, good stone free rate was obtained for patients irrespective of the treatment modality, the selected intervention needs to be balanced with its safety profile and the need for ancillary procedures.
Abstract: Introduction: Urolithiasis in solitary kidney (SK) presents significant management dilemma as any insult to the kidney or its drainage can lead to significant morbidity. The treatment options include shock wave lithotripsy (SWL), percutaneous nephrolithotomy (PCNL), and ureteroscopy (URS). Our aim was to conduct a systematic review of literature on all available endourologic techniques reporting on the management of stones in an SK. Materials and Methods: We conducted a systematic review according to the Cochrane and PRISMA checklist for all English-language articles from inception to December 2018. All studies with a minimum of 10 patients that reported on endourologic management (SWL, PCNL, or URS) were included. Data were extracted for patient and stone demographics, outcomes including stone-free rate (SFR), adverse events, and renal function. Results: After an initial search of 553 articles, 27 were included for the final review (10 PCNL, 1 mini-PCNL, 9 URS, 1 SWL, and 6 comparative studies). The choice of treatment seemed to be based on stone size, with PCNL, URS, and SWL offered for mean stone sizes between 25-50, 10-28, and 12-15 mm, respectively. PCNL, URS, and SWL were reported in 1445, 792, and 186 patients, respectively, with a final SFR of 67%-97.7%, 43%-100%, and 73%-80% and a complication rate of 26.4%, 15%, and 16.7% across the three groups. The renal function deterioration was reported in 4/16 PCNL studies and in 1/15 URS studies, while it remained unaffected in the SWL study. Conclusions: Our review shows a rise of endourologic techniques in the management of stones in SK. Although PCNL was used for larger stones, it had a higher risk of major complications, including blood transfusion. While a good SFR was obtained for patients irrespective of the treatment modality, the selected intervention needs to be balanced with its safety profile and the need for ancillary procedures.
TL;DR: It is suggested that endourological interventions do not adversely affect renal function and tend to improve it in patients who do not have a poor renal function prior to the procedure, and these patients should be counseled for and followed up appropriately.
Abstract: To present the latest evidence related to the impact of ureteroscopy (URS) and percutaneous nephrolithotomy (PCNL) on the renal function. Our review suggests that the overall renal function is not detrimentally affected by endourological interventions (URS, PCNL). This is however influenced by the preoperative renal function, presence of comorbidities such as diabetes and hypertension. For PCNL procedures, tract multiplicity, preoperative UTI, and postoperative bleeding also contribute to a decline in renal function. This review suggests that endourological interventions do not adversely affect renal function and tend to improve it in patients who do not have a poor renal function prior to the procedure. Several factors including poor preoperative renal function, diabetes, hypertension, and multiple percutaneous tracts appear to predispose patients to declining renal function after procedure, and these patients should be counseled for and followed up appropriately.
TL;DR: Data shows more acute IPA and larger preoperative stone size negatively affect stone-free rate and need for repeat surgery following retrograde flexible ureteroscopy with laser lithotripsy for treatment of renal stones.
Abstract: Objectives: Influence of renal anatomy on success rates for shockwave lithotripsy has been reported in the literature with emphasis on lower pole anatomy. Influence of renal anatomy has not been ev...
TL;DR: Ureteroscopy and ultrasonography-assisted PRA based on EMTS guidance are feasible with the tested AUR or DUR together with the 2D probe, and PFG showed a tendency for higher precision than TTFG.
Abstract: Purpose Electromagnetic tracking systems (EMTSs) have been proposed to assist the percutaneous renal access (PRA) during minimally invasive interventions to the renal system. However, the influence of other surgical instruments widely used during PRA (like ureteroscopy and ultrasound equipment) in the EMTS performance is not completely known. This work performs this assessment for two EMTSs [Aurora® Planar Field Generator (PFG); Aurora® Tabletop Field Generator (TTFG)]. Methods An assessment platform, composed by a scaffold with specific supports to attach the surgical instruments and a plate phantom with multiple levels to precisely translate or rotate the surgical instruments, was developed. The median accuracy and precision in terms of position and orientation were estimated for the PFG and TTFG in a surgical environment using this platform. Then, the influence of different surgical instruments (alone or together), namely analogic flexible ureterorenoscope (AUR), digital flexible ureterorenoscope (DUR), two-dimensional (2D) ultrasound (US) probe, and four-dimensional (4D) mechanical US probe, was assessed for both EMTSs by coupling the instruments to 5-DOF and 6-DOF sensors. Results Overall, the median positional and orientation accuracies in the surgical environment were 0.85 mm and 0.42° for PFG, and 0.72 mm and 0.39° for TTFG, while precisions were 0.10 mm and 0.03° for PFG, and 0.20 mm and 0.12° for TTFG, respectively. No significant differences were found for accuracy between EMTSs. However, PFG showed a tendency for higher precision than TTFG. AUR, DUR, and 2D US probe did not influence the accuracy and precision of both EMTSs. In opposition, the 4D probe distorted the signal near the attached sensor, making readings unreliable. Conclusions Ureteroscopy- and ultrasonography-assisted PRA based on EMTS guidance are feasible with the tested AUR or DUR together with the 2D probe. More studies must be performed to evaluate the probes and ureterorenoscopes' influence before their use in PRA based on EMTS guidance.
TL;DR: Fewer than half of patients in Michigan undergo postoperative imaging after URS for stone disease, and there is substantial variation across providers in post-URS imaging use.
TL;DR: Although ureteroscopy in patients with anomalous kidneys can be technically challenging, advancements in endourological techniques have made it a safe and effective procedure and in these patients the stone-free rates are good with a low risk of major complications.
Abstract: Treatment of stone disease in anomalous kidneys can be challenging. As ureteroscopy (URS) has advanced, the number of studies reporting on outcomes of URS for stone disease in anomalous kidneys has increased. Our objective was to perform a systematic review of the literature to evaluate the outcomes of URS for stone disease in this group of patients. A Cochrane style review was performed in accordance with the PRISMA guidelines using Medline, EMBASE, CINAHL, Cochrane Library, Scopus and individual urologic journals for all English language articles between inception and June 2018. Fourteen papers (413 patients) with a mean age of 43 years and a male to female ratio of 285:128 were included. The underlying renal anomaly was horseshoe kidney (n = 204), ectopic kidney (n = 117), malrotation (n = 86), cross fused ectopia (n = 2) and others (n = 2). With a mean stone size of 16 mm (range 2–35 mm), the majority of stones were in the lower pole (n = 143, 34.6%) or renal pelvis (n = 128, 31.0%), with 18.9% (n = 78) having stones in multiple locations. Treatment modality included the use of flexible ureteroscope in 90% of patients and ureteral access sheath used in 11 studies. With a mean operative time of 61.3 min (range 14–185 min), the initial and final SFR was 76.6% (n = 322) and 82.3% (n = 340), respectively. The overall complication rate was 17.2% (n = 71), of which 14.8% were Clavien I/II and the remaining 2.4% were Clavien ≥ III complications. Although ureteroscopy in patients with anomalous kidneys can be technically challenging, advancements in endourological techniques have made it a safe and effective procedure. In these patients the stone-free rates are good with a low risk of major complications.
TL;DR: Use of UAS did not have a significant impact on development of postoperative hydronephrosis, suggesting UAS is safe for use during URS, and routine upper tract imaging after URS remains a valuable prognostic tool.
TL;DR: Prolonged operative times are linked to increased complication rates in ureteroscopy, and stone complexity, patient risk factors, surgeon experience, bilateral surgery, and instrumentation constitute important factors that can hamper or facilitate a procedure and should be taken into account beforehand.
Abstract: To present the latest evidence related to the impact of increased operative times in retrograde intrarenal surgery and identify possible important factors that can facilitate ureteroscopy procedures. Ureteroscopy constitutes the mainstay treatment of renal stones and is characterized by a huge variation in techniques and instrumentation. It has been suggested that increased operative times can mitigate the outcomes of the procedures by increasing complication rates. Nevertheless, little is known about the time limits, above which complications are likely to occur. Furthermore, complication rates in different procedure durations have not yet been assessed. Prolonged operative times are linked to increased complication rates in ureteroscopy. Stone complexity, patient risk factors, surgeon experience, bilateral surgery, and instrumentation constitute important factors that can hamper or facilitate a procedure and should be taken into account beforehand. Keeping procedural times below 90 min can dissuade potential predicaments and achieve improved stone-free rates.
TL;DR: Children with kidney stones require long term follow-up with periodic assessment of stone forming activity and ascertaining stone burden, and high index of suspicion should be there to diagnose diseases like primary hyperoxaluria, Dent’s disease, renal tubular acidosis (RTA) etc.
Abstract: Although kidney stones are less common in children than in adults, incidence in children is rising. Kidney stones may lead to significant morbidity in addition to escalating medical costs. Clinical presentation is variable. Bilateral kidney stones in a younger child should prompt work-up for primary hyperoxaluria. Metabolic abnormalities are more frequent in children and can result in frequent stone recurrence. Whole exome sequencing data shows genetic defects in about 30% of stone formers. 24 h urine collection should be conducted when patient receives his usual diet and fluid intake with normal activity. Infrared spectroscopy and X-ray diffraction are used for stone analysis. Urine studies should be delayed by 4–6 wk after stone fragmentation or treatment of any stone related complications. The goal of evaluation is to identify modifiable risk factors for which targeted therapy may be instituted. Primary indications for surgical intervention include pain, infection and obstruction. Extracorporeal shockwave lithotripsy (ESWL), ureteroscopy, and percutaneous nephrolithotomy (PCNL) are most commonly used, and selection is based on stone size, anatomy, composition and anatomy. Advances in technology have allowed a shift to minimally invasive surgeries. Comprehensive management requires multidisciplinary team. Children with kidney stones require long term follow-up with periodic assessment of stone forming activity and ascertaining stone burden. High index of suspicion should be there to diagnose diseases like primary hyperoxaluria, Dent’s disease, renal tubular acidosis (RTA) etc. as these diseases have ramifications on kidney function and growth.
TL;DR: The pooled analysis of the eligible studies showed that the management of LPS should probably reside to PCNL or RIRS to achieve stone-free status over a short period and minimal number of sessions.
TL;DR: The hypothesis was that flexible ureteroscopy (FURS) for upper tract stones in children produces good results and FURS allows diagnosis and treatment of unexpected problems.
Abstract: Development of surgical expertise and technology has affected the way renal tract stones are treated. Our hypothesis was that flexible ureteroscopy (FURS) for upper tract stones in children produces good results. Our outcomes were reviewed. A retrospective case note review was performed for children with upper tract calculi who were treated by FURS. There were 56 stone episodes in 36 patients. Median age was 10.6 years. Stones were 3–23 mm (median 8 mm); 64.3% had multiple calculi. Median follow-up was for 17.1 months. After the first FURS there was stone clearance in 42/56 (75%). Although there were no immediate complications, two required re-admission; one with stent symptoms, the other with urinary infection. A second FURS was performed in 11, bringing the cumulative clearance to 89%, although this was often done as “another look” before stent removal. There was no statistically significant difference in stone clearance after first FURS for those with single stones (81.0%) compared to those with multiple stones (72.2%). Clearance rates of more than 70% after first FURS were achieved with stones of up to 17 mm. Unexpected disease was found and treated during FURS in 9 (16.1%) children. FURS is safe in children and good clearance rates are achieved. Multiple stones at different sites may be treated during the same treatment. In addition, FURS allows diagnosis and treatment of unexpected problems.
TL;DR: In this article, the impact of diagnostic ureteroscopy performed before radical nephroureterectomy (RNU) on intravesical recurrence (IVR) in patients with upper tract urothelial carcinoma (UTUC) was evaluated.
Abstract: Purpose To evaluate the impact of diagnostic ureteroscopy performed before radical nephroureterectomy (RNU) on intravesical recurrence (IVR) in patients with upper tract urothelial carcinoma (UTUC). Materials and Methods From May 2003 to December 2018, patients who underwent RNU for UTUC were enrolled and divided into two groups according to whether they underwent preoperative ureteroscopy (Pre-U vs. Non-U). We excluded patients who had a history of bladder cancer and did not receive bladder cuff resection during surgery. Perioperative parameters were compared between the two groups by use of t-tests or chi-square tests. Kaplan-Meier and Cox proportional hazards analyses were used to assess the association between Pre-U and IVR. Results Of the 453 total patients, 226 patients (49.9%, Pre-U group) had received diagnostic ureteroscopy before RNU, and 227 patients (50.1%, Non-U group) had not. IVR occurred in 99 patients (43.8%) in the Pre-U group and 61 patients (26.9%) in the Non-U group (p=0.001). The median time to recurrence was 107 months. The 5-year IVR-free survival rates were 56.2% and 73.1% in the Pre-U and Non-U groups, respectively (log rank test, p<0.001). Multivariate Cox proportional hazards analysis showed that Pre-U was a significant factor (hazard ratio, 1.413; 95% confidence interval, 1.015-1.965; p=0.040) after adjustment for other factors including tumor stage, location, etc. Conclusions Preoperative diagnostic ureteroscopy before RNU was a significant factor for IVR. Therefore, we should carefully consider Pre-U before RNU for nonobvious ureteral lesions. These results should be validated in a prospective study.
TL;DR: Nephrolithiasis is increasing in children with differing urologic management options depending on the clinical scenario, and a shared decision-making process with discussion of risks and benefits should be used to help patients and families choose a treatment option.
Abstract: Purpose of review The purpose of this review is to describe the options and recent developments in the urologic treatment of nephrolithiasis in children. The prevalence of nephrolithiasis in children has increased over time. The urologic treatment of nephrolithiasis ranges from observation to medical expulsive therapy with an alpha blocker for a stone in a ureter to a variety of procedures for stone removal. Recent findings Observation for small, asymptomatic renal stones is a reasonable strategy in children. Medical expulsive therapy with an alpha blocker may have a beneficial effect for passage of ureteral stones in children. Extracorporeal shock wave lithotripsy (ESWL) remains an important treatment for nephrolithiasis in children. Advances in ureteroscopy with clearer digital imaging and single use ureteroscopes have made ureteroscopy more attractive. Percutaneous nephrolithotomy is a more invasive treatment modality but remains a good choice for children with large-stone burdens and instruments are getting smaller. Open or laparoscopic stone surgery should be reserved for unique cases. Summary Nephrolithiasis is increasing in children with differing urologic management options depending on the clinical scenario. A shared decision-making process with discussion of risks and benefits should be used to help patients and families choose a treatment option.
01 Apr 2020
TL;DR: The proposed motion induced U-Net (MI-UNet) architecture consists of two main components: 1) U- net and 2) DVFNet and the quantitative results show consistent performance and improvement over most evaluation metrics, and the qualitative validation illustrates that the complimentary DVF net is able to effectively reduce the effect of surrounding debris in contrast to U-net.
Abstract: Ureteroscopy has evolved into a routine technique for treatment of kidney stones. Laser lithotripsy is commonly used to fragment the kidney stones until they are small enough to be removed. Poor image quality, presence of floating debris and severe occlusions in the endoscopy video make it difficult to target stones during the ureteroscopy procedure. A potential solution is automated localization and segmentation of the stone fragments. However, the heterogeneity of stones in terms of shape, texture, as well as colour and the presence of moving debris make the task of stone segmentation challenging. Further, dynamic background, motion blur, local deformations, occlusions and varying illumination conditions need to be taken into account during segmentation. To address these issues, we compliment state-of-the-art U-Net based segmentation strategy with the learned motion information. This technique leverages difference in motion between the large stones and surrounding debris and additionally tackles problems due to illumination variability, occlusions and other factors that are present in the frame-of-interest. The proposed motion induced U-Net (MI-UNet) architecture consists of two main components: 1) U-Net and 2) DVFNet. The quantitative results show consistent performance and improvement over most evaluation metrics. The qualitative validation also illustrate that our complimentary DVFNet is able to effectively reduce the effect of surrounding debris in contrast to U-Net.
TL;DR: Female gender, pre-operative ureteric stent insertion, diabetes mellitus, positive urine culture results before URS, and operation duration are risk factors for infectious complications after URS.
Abstract: Background: Multiple studies have reported that gender, pre-operative stent insertion, positive pre-operative urine culture results, and diabetes mellitus are associated with infectious complicatio...
TL;DR: This study shows excellent outcomes for upper urinary tract stones with both URS and mPCNL from two tertiary referral centres who specialised in one of these treatments for paediatric stone disease.
Abstract: Introduction: Pediatric upper urinary tract calculi can be treated by ureteroscopy (URS) or mini-percutaneous nephrolithotomy (mPCNL). We wanted to compare outcomes of URS and mPCNL from two tertia...
TL;DR: In selected cases, early Ureteroscopy is an effective and safe method for distal ureteral calculi smaller than 10 mm that are painful and resistant to analgesic treatment.
Abstract: We aimed at comparing the success and complications of early semirigid ureteroscopy (URS) and elective URS in ureteral calculi with renal colic that do not respond to analgesics. We retrospectively analyzed the data of 690 patients with obstructive ureteral stones who underwent URS with stone retrieval. 247 patients who underwent early URS within the first 12 h were classified as group I and 443 patients who underwent elective URS as group II. Both groups were compared in terms of age, sex, creatinine, eGFR, stone size, laterality, location and number of stones, type of lithotriptor, presence of hydronephrosis and success and complication rates. The mean age of the patients was 50.4 (18–89 years) (p > 0.05). There was no statistically significant difference between the groups in terms of age, eGFR, side, presence of hydronephrosis, fever, mucosal damage, stone migration, perforated ureter, ureteral avulsion, ureteral stent insertion at the end of the surgery and sepsis (p > 0.05). Both groups had male dominance (p > 0.05). Creatinine was significantly lower in Group I (p < 0.05). The mean stone size was also significantly lower in Group I (p < 0.05). Middle and proximal ureteral calculi were more common in Group II (p < 0.05). Multiple stones were higher in Group II (p < 0.05). The dominant type of lithotriptor used was pneumatic in Group I and laser in Group II (p < 0.05). Stone-free rates (SFRs) were higher in Group I (98% vs 90% in the first month) (p < 0.05). Postoperative hematuria and infection were more common in Group II (p < 0.05). In selected cases, early ureteroscopy is an effective and safe method for distal ureteral calculi smaller than 10 mm that are painful and resistant to analgesic treatment.
TL;DR: To determine the safety and efficacy of the one‐surgeon basketing technique for stone extraction during flexible ureteroscopy when carried out by novice surgeons under instructor guidance, a large number of patients with deep vein thrombosis were surveyed.
Abstract: Objective To determine the safety and efficacy of the one-surgeon basketing technique for stone extraction during flexible ureteroscopy when carried out by novice surgeons under instructor guidance. Methods We retrospectively compared perioperative results, complications and the "stone-free" rate (defined as ≤2 mm fragments on kidney-ureter-bladder imaging 1 month after flexible ureteroscopy) between experienced (group A, n = 50) and novice (group B, n = 50) surgeons using the one-surgeon basketing technique. Results Baseline patients' characteristics were similar between the two groups. There were no significant differences between groups A and B in operative time (mean 76 min vs 85 min, P = 0.46), stone-free rate (98% vs 92%, P = 0.36), postoperative fever events (4% vs 4%, P = 1.00) and postoperative hospital stay (24 h vs 24 h, P = 1.00). Clavien-Dindo grade IIIa complications (ureter injury) were only observed in two cases (4%) in group B. Conclusions The one-surgeon basketing technique for the extraction of stone fragments during flexible ureteroscopy might be safely and effectively carried out by surgeons with no prior experience under proper guidance.