The Comparison of Outcome in Treating Proximal Ureteric Stones of Size 10 mm to 15 mm Using Extracorporeal Shock Wave Lithotripsy as Compared to Ureterorenoscopic Manipulation Using Holmium Laser

Urinary stone disease or nephrolithiasis, the third most common disease of the urinary tract, is a major health issue due to its high prevalence, occurrence, and recurrence. The hallmark of a stone that obstructs the ureter or renal pelvis is excruciating, intermittent pain that radiates from the flank to the groin or to the inner thigh. Stone size influences the rate of spontaneous stone passage. Our aim was to compare the efficacy & the frequency of stone-free patients after intervention at 1 week after extracorporeal shock wave lithotripsy (ESWL) and ureterorenoscopic (URS) manipulation for proximal ureteric stone (10–15 mm size). This randomized control trial was done in the department of Urology, KRL Hospital Islamabad from 18th Nov 2019 to 18th May 2020. After meeting the inclusion criteria, 100 patients were enrolled and were divided into two groups. The first group was treated with ESWL and the other with URS. Then, procedures were done. Follow-up was noted after 1 week in the stone clinic. The average age of the patients was 39.71 ± 10.17 years. Efficacy in the ESWL group was found in 68% cases while in the URS group, efficacy was noticed in 76% cases (P > 0.05). Male patients were three times at a higher risk of recurrence as compared to females. This study concluded that both ESWL and URS are equally effective statistically in terms of the frequency of stone-free patients at 1 week for proximal ureteric stone (10–15 mm size)

Treatment of Moderate-sized Kidney Stone with Third-generation Electromagnetic Shock Wave Lithotripter

BACKGROUND: The extracorporeal shock wave lithotripsy (ESWL) is a non-invasive method in the treatment of urinary tract stones and its discovery has led to a complete change in the therapeutic strategy for urolithiasis. Due to the low morbidity and excellent fragmentation of the stones, ESWL has proven to be an effective and non-invasive method in the treatment of renal stones. AIM: The aim of this retrospective study is to evaluate the efficacy and safety of the ESWL as a monotherapy in the treatment of moderate size kidney stones with stone area (SA) of 100–300 mm². MATERIALS AND METHODS: We made a retrospective study of 98 patients with moderate size kidney stones with SA of 100–300 mm², divided into two subgroups, into a group with a SA of 100–200 mm² and with 200–300 mm², treated with ESWL in the period of November 2018–December 2019. The patients were treated with a third-generation electromagnetic lithotripter (Lithoskop®, Siemens Medical Systems, Erlangen, Germany), with a source of electromagnetic shocks (Pulso™) and dual ultrasonographic/fluoroscopic system for detection of the stones. The stone location, size, maximum energy used, localization technique, number of shock waves, sessions, re-treatment rate, and additional procedures were reviewed. All the patients before the intervention had a complete laboratory and radiological examinations. Postoperatively, patients were monitored on the 1st, 30th, and 90th post-operative days. RESULTS: Ninety-eight patients with solitary kidney stone with a SA of 100–300 mm² were treated with ESWL. The study included 58 men (59.18%) and 44 women (40.81%). The average length and width of the stone were 15.47 ± 2.68 mm and 12.99 ± 2.83 mm, respectively. The average surface area of the stones in our series was 203.78 ± 72.85 mm². The mean number of treatments for the entire series of patients was 1.82 ± 0.91. The mean number of shock waves for the total series of patients was 3899.11 ± 40. The mean energy used for the overall patient series was 110106.17 ± 21489.61 mJ. The total re-treatment rate was 47.95%. The entire rate of additional procedures was 19.38%. The overall success rate (SR) in our study was 77.55%. The efficiency quotient for the upper-middle and lower calyx was 55.57, 57.15, and 30.81, respectively. CONCLUSION: ESWL is a safe and effective method in the treatment of renal stones, and we recommend as the first method in the treatment of moderate size kidney stone with a surface area of 100–300 mm². The treatment of each patient should be individualized and take into account all favored and non-favored factors that influence the decision to choose extracorporeal lithotripsy as a method of treatment of medium-sized stones

Urinary lithiasis and extracorporeal shock wave lithotripsy: new approachments

While ESWL is generally considered safe and effective, new methods are being created as result of continuous lithotripsy research to enhance the procedure's results. The aim is to conduct a complete and structured analysis of the most current extracorporeal lithotripsy systems in the management of kidney stones, and collect and evaluate the complications associated with using conventional ones.Medicin

Mini percutaneous nephrolithotomy: its role in the management of renal stone and our tertiary care centre experience

Background: Miniaturized percutaneous nephrolithotomy (PCNL) procedures for urolithiasis have gained increased popularity in recent years. To decrease the complications of conventional PCNL by  reduced tract size led to the development of Mini PCNL, which makes the use of 15-18F sheaths in place of 24-30F of conventional PCNL. It has developed rapidly and become a popular technique of renal stone management with reduced morbidity and excellent outcome. Authors report our experience with Mini PCNL for the treatment of renal stone.Methods: In between his August 2015 and January 2018, sixty patients with the diagnosis of unilateral single medium size (8-20mm) renal stone were identified. Patient’s demographical, clinical, diagnostic and procedural data were recorded.  All patients were evaluated by history taking, physical examination and laboratory investigations. Radiological evaluation was done with X ray kidney, ureter and bladder region (KUB) and also with renal ultrasonography followed by computed tomography (CT). All patients underwent Mini PCNL using 12F nephroscope and 16.5/17.5F sheath. Holmium: YAG laser was used for stone fragmentation. No nephrostomy tube was used routinely. Treatment outcome was assessed in terms of operative time, haemoglobin drop, hospital stay and stone free rate.Results: Complete stone fragmentation was achieved in 41 out of 60 patients using Mini PCNL, so initial stone free rate was 68.3%. After 4 weeks of surgery total 53 patients were stone free (88.3%), 5 patients required some auxiliary procedure for complete clearance of stone and other 2 were managed conservatively. The mean operative time was 48.28 min, mean haemoglobin drop was 0.74gm/l and mean postoperative hospital stay was 54.22 hours. After 12 weeks postoperatively all patients were stone free. There were no significant postoperative complications, and all had good quality of life.Conclusion: Mini PCNL technique appears to be safe and effective alternative to conventional PCNL for moderate size renal calculi. It is usually related to less blood loss and shorter hospital stay than the standard method. It can achieve good stone-free rates with minimal complications and low morbidity. Mini PCNL can also be considered as a good alternative to retrograde intrarenal surgery and shockwave lithotripsy in selected cases. However, further high quality studies with larger sample size are required in future

Primary versus deferred ureteroscopy for management of calculus anuria in children: Review article

Background: The incidence of urolithiasis in the pediatric population is on the rise. Urolithiasis in the pediatric age group, although occurring less in adults, causes considerable morbidity. The role of ureteroscopy (URS) in the management of calculus anuria could be primary or deferred. The deferred URS after initial ureteral stenting or percutaneous drainage is the standard one. However, the remarkable progress in the manufacturing of ureteroscopes and lithotripters favored the primary URS.Objective: This study aimed to evaluate the results of primary versus deferred URS for management of obstructive calculus anuria (OCA) in children in previous literatures.Methods: We have searched literature in the American National Center for Biotechnology Information (NCBI), PubMed, Google scholar, Egyptian bank of knowledge, and science direct.Conclusion: Primary URS is a definitive stone management technique and an appropriate option that can reduce hospital stay, prevent multiple anesthesia, and alleviate the costs in children with OCA when performed by skilled endourologists. However the deferred URS is a favored procedure for management of calculus anuria in pediatric patients compared to primary URS

A prospective randomized double blinded placebo controlled trial to study the effect of diuretics on shock wave lithotripsy treatment of renal and upper ureteric calculi

INTRODUCTION: The introduction of shock wave lithotripsy (SWL) treatment for renal and ureteric calculi in 1983 rapidly replaced open surgery for smaller stones. Over time the indications and techniques have been constantly redefined in pursuit of a better outcome. With the arrival of minimally invasive surgical procedures like ureterorenoscopy (URS), percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS) the status of SWL has become all the more threatened. But, the unique stature of SWL as a practically ‘no touch’ approach in the treatment of urolithiasis scores over these minimally invasive techniques. It is therefore imperative, that a continuous effort is made to identify novel methods that can improve the treatment outcome of SWL. One such method proposed is to provide diuresis during the shock wave session to enhance the fragmentation and clearance. This is a prospective randomized double blinded placebo controlled trial that aims to analyse the effect of diuretics on SWL treatment of renal and upper ureteric calculi. MATERIAL AND METHODS: Design and location - This hospital based prospective randomized double blinded placebo controlled trial was conducted at the Department of Urology, Christian Medical College, Vellore. Duration - Between June 2011 and December 2012. Patients - Patients with renal and upper ureteric calculi who satisfied the following inclusion and exclusion criteria were included; Inclusion criteria: Age: adults > 18 years, Non obstructive radio opaque renal and upper ureteric calculi up to 1.5 cm (obstruction – no contrast seen beyond the calculus up to the 1 hour film on intravenous urogram) Sterile or treated urine culture, Normal renal function (creatinine up to 1.4 mg%). Exclusion criteria: Anatomical abnormality, Distal obstruction, Morbid obesity (body mass index > 40), Pregnancy, Coagulopathy, History of any previous intervention on the same side, Significant cardiac history. RESULTS: During the study period from June 2011 to December 2012, a total of 96 patients were included. These comprised both renal and upper ureteric calculi as per inclusion criteria. They were randomised into two groups; Group A: Placebo arm, Group B: 40 mg Furosemide iv arm. The mean age in group A was 39.45 years and group B was 38.56 years. The female to male ratio was almost similar in both groups. There were 30 men and 18 women in group A, whereas in group B it was 31 men and 17 women. The mean weight of the patients in group A was 61.16 kg and in group B was 61.39 kg. The mean calculus size in group A was 9.26 mm and group B was 9.41 mm. CONCLUSIONS: The use of diuretics along with SWL treatment of renal and upper ureteric calculi results in higher fragmentation and clearance rates along with a requirement of lower number of shocks and sessions, though not statistically significant

Residual Fragments after Percutaneous Nephrolithotomy

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Percutaneous nephrolithotomy requiring multiple tracts: comparison of morbidity with single-tract procedures. J Endourol 2006;20:753-60. [CrossRef] 26. Aron M, Yadav R, Goel R, Kolla SB, Gautam G, Hemal AK, et al. Multi tract percutaneous nephrolithotomy for large complete staghorn calculi. UrolInt 2005;75:327-32. [CrossRef] 27. Akman T, Sari E, Binbay M, Yuruk E, Tepeler A, Kaba M, et al. Comparison of Outcomes After Percutaneous Nephrolithotomy of Staghorn Calculi in Those with Single and Multiple Accesses J Endourol. June 2010;24:955-60. 28. Kang DE, Maloney MM, Haleblian GE, et al. Effect of medical management on recurrent stone formation following percutaneous nephrolithotomy. J Urol 2007;177:1785-9. [CrossRef] 29. Lojanapiwat B; Tanthanuch M; Pripathanont C; Ratchanon S; Srinualnad S; Taweemonkongsap T; Kanyok S; Lammongkolkul. Alkaline citrate reduces stone recurrence and regrowth after shockwave lithotripsy and percutaneous nephrolithotomy. 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Ibarluzea G, Scoffone CM, Cracco CM, Poggio M, Porpiglia F, Terrone C, et al. Supine Valdivia and modified lithotomy position for simultaneous anterograde and retrograde endourological access. BJU Int 2007;100:233-6. [CrossRef] 39. Scoffone CM, Cracco CM, Cossu M, Grande S, Poggio M, Scarpa RM. Endoscopic combined intrarenal surgery in Galdakao-modified supine Valdivia position: a new standard for percutaneous nephrolithotomy? EurUrol 2008;54:1393-403. [CrossRef] 40. Hoznek A, Rode J, Ouzaid I, Faraj B, Kimuli M, de la Taille A, et al. Modified Supine Percutaneous Nephrolithotomy for Large Kidney and Ureteral Stones: Technique and Results. EurUrol 2012;61:164-70. [CrossRef] 41. Woodside JR, Stevens GF, Stark GL, Borden TA, Ball WS. Percutaneous stone removal in children.J Urol 1985;134:1166-7. 42. Jackman SV, Hedican SP, Peters CA, Docimo SG. Percutaneous nephrolithotomy in infants and preschool age children: experience with a new technique. Urology 1998;52:697-701. [Cross- Ref] 43. 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Eficiencia de la litotricia extracorpórea y la litotricia neumática endoscópica en pacientes con litiasis urinaria en uréter proximal. Hospital virgen de la puerta Essalud Trujillo. 2019 - 2020

Con la finalidad de determinar la eficiencia de la litotricia extracorpórea y litotricia endoscópica neumática y se realizará un estudio experimental, estudiando dos grupos de 51 pacientes con diagnóstico de litiasis urinaria en uréter proximal que acudan al Hospital de Alta Complejidad Virgen de la Puerta EsSalud de Trujillo durante los años 2019 y 2020, estos serán distribuidos aleatoriamente a recibir uno u otro tratamiento en mención. Un mes posterior al tratamiento cada paciente de ambos grupos será evaluados mediante el Urothem (Tomografía sin contraste) a fin de indagar la tasa libre de cálculos; además se registrará las complicaciones, el requerimiento de retratamiento y uso de analgesia. Para el análisis estadístico se utilizará la prueba de chi cuadrado en las variables cualitativas y z para medias en las cuantitativas, el nivel de significancia será fijado en P<0.05.Trabajo de investigació

Complications and treatment aspects of urological stone surgery

ConclusionsPaper I: Complications in Extracorporeal Shock Wave Lithotripsy (ESWL): A cohort study, conclusion: We conclude that there are few complications to modern ESWL treatment. 1 Hz should be used to reduce complications (p=0.025). As there is no indication that 1Hz is less effective than 1.5 Hz, this strongly implies that 1 Hz should normally be the frequency used.Success rate with ESWL alone was high 71.8% (n=1324). Our data indicate that diabetes and larger stone size increase the risk of complications. The need for antiemetics during ESWL is a factor that deserves special consideration and further study. Distal stones seem to have a lower risk of complications (p=0.017).Paper II: A study of clinical complications and possible risk factors for stone surgery - a population based study, conclusions: URS in a modern setting provides excellent results with high SFR and low morbidity. Preoperative stone size 4≤6 mm was 96.2 % (n=176), for stones >6≤10 mm 84.6 % (n=193), and for stones >10 mm was 68.2 % (n=30). Time of day, or the presence of a urological specialized operating nurse does not affect the risk of complications and we found no other significant risk factors for complications. Regarding bacteria, E. coli is the most common in preoperative cultures. In this study the risk of complications increases with age. We conclude that for patients >65 years this should be considered in preoperative counselling.Paper III: Percutaneous nephrolithotomy and modern aspects of complications and antibiotic treatment conclusions: Stone free rate was 65.6% (n=122) which is acceptable and comparable with other studies. This study has a total complication rate of 16%, with approximately 10% being severe. The most common complication of PCNL was infection at 60% (bleeding 5.4%, reoperation 1.6% and pain 0.5%). Our results regarding levels of E. faecalis in cultures, should be validated in a larger cohort, possibly with a higher rate of antibiotic resistance, before a change of guidelines regarding prophylactic antibiotics could be proposed. We conclude that the high prevalence of E. faecalis needs to be considered.Paper IV: Factors influencing stone free rate of Extracorporeal Shock Wave Lithotripsy (ESWL): A cohort study conclusions: We conclude that stone maximum size/stone volume and age have an impact on stone free rate after ESWL. We are puzzled by age being such a strong predictor for SFR, and this needs to be further investigated

The Urological Association of Asia clinical guideline for urinary stone disease

The Urological Association of Asia, consisting of 25 member associations and one affiliated member since its foundation in 1990, has planned to develop Asian guidelines for all urological fields. The field of stone diseases is the third of its guideline projects. Because of the different climates, and social, economic and ethnic environments, the clinical practice for urinary stone diseases widely varies among the Asian countries. The committee members of the Urological Association of Asia on the clinical guidelines for urinary stone disease carried out a surveillance study to better understand the diversity of the treatment strategy among different regions and subsequent systematic literature review through PubMed and MEDLINE database between 1966 and 2017. Levels of evidence and grades of recommendation for each management were decided according to the relevant strategy. Each clinical question and answer were thoroughly reviewed and discussed by all committee members and their colleagues, with suggestions from expert representatives of the American Urological Association and European Association of Urology. However, we focused on the pragmatic care of patients and our own evidence throughout Asia, which included recent surgical trends, such as miniaturized percutaneous nephrolithotomy and endoscopic combined intrarenal surgery. This guideline covers all fields of stone diseases, from etiology to recurrence prevention. Here, we present a short summary of the first version of the guideline – consisting 43 clinical questions – and overview its key practical issues