Outcomes of ureteral stent placement for hydronephrosis in patients with ureteral stone

Abstract Background Routine ureteral stent placement after ureteroscopy (URS) for ureteral stone treatment is arguable due to the possible stent-related symptoms. Several studies claimed that its use is necessary, while others reported that its use is excessive. Hydronephrosis occurs when urine cannot drain out from the kidney to the bladder due to blockage or obstruction. We aimed to evaluate the role of ureteral stents in hydronephrosis resolution in ureteral stone patients following URS lithotripsy. Methods This was a prospective observational study using secondary data involving 130 ureteral stone patients undergoing URS lithotripsy [99 patients (76.2%) with stent placement and 31 patients (23.8%) without stent]. Data consisting of baseline characteristics, pre-operative status, intraoperative characteristics, and postoperative complications were collected from the medical record database and presented descriptively. The patients were divided into two groups based on stent placement. Comparison of hydronephrosis resolution between the groups was analyzed with Chi-square. Results Ureteral lesions were the most common indication of ureteral stent placement following URS lithotripsy (28.3%). The most bothersome symptoms were dysuria in 18 patients (18.2%); followed by frequency in eight patients (8.1%) and low back pain in six patients (6.1%). All symptoms were successfully treated with oral medications. There were 41 patients (91.1%) with pre-operative hydronephrosis significantly resolved after stent placement compared to 5 (62.5%) patients without stent placement (p=0.027). Conclusion Ureteral stenting significantly resolves pre-operative hydronephrosis after URS lithotripsy in patients with ureteral stone. Ureteral stent placement is the preferred method for the treatment of pre-operative hydronephrosis

Endoscopic Combined Intrarenal Surgery (ECIRS) Versus Percutaneous Nephrolithotomy (PCNL) for Large and Complex Renal Stone: A Systematic Review and Meta-Analysis

Abstract Background: Managing complex and large renal stones with percutaneous nephrolithotomy (PCNL) is difficult because of the likelihood of residual stones and multiple access. Endoscopic combined intrarenal surgery (ECIRS) is introduced as an improvement to the procedure to manage stones in one session. The objective of this systematic review and meta-analysis is to compare the efficacy and safety between ECIRS and PCNL for treating large and complex renal stones. Materials and Methods: We conducted a systematic review in the Embase, Scopus, and MEDLINE databases based on the 2020 Preferred Reporting Items for Systematic Review and Meta-Analyses guideline. Eligible studies comprised both randomized and nonrandomized studies comparing ECIRS and PCNL. Results: A total of five nonrandomized studies and one randomized controlled trial were included. The analysis was divided into two subgroups based on the PCNL type, a conventional PCNL (cPCNL) and a mini-PCNL (mPCNL). The one-step stone-free rate (SFR) of ECIRS were significantly higher compared with both the cPCNL (odds ratio [OR] 5.14, 95% confidence interval [CI] 2.54 to 10.4, p 0.05). The use of auxiliary procedures was significantly higher in both PCNL groups compared with the ECIRS group (OR 0.19, 95% CI 0.13-0.30, p 0.05). Conclusion: ECIRS is an effective and safe treatment particularly for large and complex nephrolithiasis, with significantly higher one-step SFR, a lower necessity for auxiliary procedures, and a lower complication rate compared with PCNL. Keywords: ECIRS; PCNL; endoscopic combined intrarenal surgery; percutaneous nephrolithotomy; renal stone