Renal parenchyma injury after percutaneous nephrolithotomy tract dilatations in pig and cadaveric kidney models

Altres ajuts: This study was partially funded by Rocamed®, who financed the acquisition of the cadaveric kidneys from the Ecole Européenne de Chirurgie (Paris).Miniaturization of instruments has changed the paradigms of percutaneous nephrolithotomy (PCNL). To date, however, few studies have analyzed the possible renal trauma generated by PCNL tract dilation. The purpose of this study is to evaluate and compare systematically the renal injury of all PNCL dilation techniques in pork kidneys (PK) and cadaveric kidney models (CK). Twelve dilation devices were tested (from 4.8 to 30 French (Fr)) including micro- and mini- PCNL kits, the Alken dilation set, 20 and 30 ATM balloons and the Amplatz set. Each device was tested six times in PK and CK. Morphologic analysis of tract defects of the different models and dilators were made measuring the longest axis and the area of renal parenchymal damage. When comparing the PK and CK dilation tract areas to the device areas, major differences were seen with the 20 ATM 30 Fr balloon (p = 0.0001 and 0.008) respectively, the sequential Amplatz dilation to 30 Fr (p = 0.0005 and 0.0006) respectively, and the Alken 30 FR dilation (p = 0.012 and 0.02) respectively. The 30 Fr dilations were 32.76 mm 2 (mean) larger than the instruments themselves, while the ≤24 Fr dilations were 11.6 mm 2 (mean) larger than the instruments themselves. When comparing devices and tract areas, the dilation tract area exceeded device area by 11.6 mm 2 at dilations up to 24 Fr vs. 32.76 mm 2 with dilations of 30 Fr. Overall, PK had significantly larger injuries than CK models

First clinical evaluation of the new single-use flexible and semirigid Pusen ureteroscopes

The purpose of the present study was to clinically evaluate two new single-use Pusen ureteroscopes, one semirigid with a flexible tip (srURS) and one flexible (fURS). During ten consecutive procedures (five srURS and five fURS), we subjectively evaluated on a scale from 0 (poor) to 10 (excellent), the scope's deflection, image quality, and maneuverability prior to, during and after the surgery. Patient demographics, complications with the devices, and troubleshooting were recorded. There were a total of ten patients, five of which were female while the other five were male. Mean age was 58.9 years. Seven patients had a single kidney stone with mean size of 9.6 mm (1.6-20 mm). Half of the patients were pre-stented. For the fURS, the preoperative image quality rating was 8.4 (8-10), compared with 6.8 (4-9) during surgery. The preoperative deflection rating was 9.6+ 0.9 (8-10), while during surgery this decreased to 8.0 (6-10) and to 6.0 (4-8) when using a laser fiber. The srURS had a preoperative image quality rating of 9.2 (8-10), which decreased to 7.6 (6-9) while using the scope. The deflection rating decreased from 9.4 (7-10) preoperatively to 7.0 (1-10) postoperatively, and a similar reduction was observed in the maneuverability rating, from 9.6 (8-10) to 7.4 (1-10). Ureteroscopy was considered as a standard in four of the fURS and three of the srURS procedures. The mean overall satisfaction rating was 6. The two new single-use ureteroscopes, one flexible and one semirigid, were considered to have allowed standard ureteroscopy in four and three out of the five procedures for each scope, respectively. The image quality, deflection, and maneuverability ratings decreased during the procedure for both scopes

Predictors of Ureteral Strictures after Retrograde Ureteroscopic Treatment of Impacted Ureteral Stones: A Systematic Literature Review

BACKGROUND The stricture-formation rate following ureteroscopy ranges from 0.5 to 5% and might amount to 24% in patients with impacted ureteral stones. The pathogenesis of ureteral stricture formation is not yet fully understood. It is likely that the patient and stone characteristics, as well as intervention factors, play a role in this process. In this systematic review, we aimed to determine the potential factors responsible for ureteral stricture formation in patients having impacted ureteral stones. METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) criteria, we conducted systematic online research through PubMed and Web of Science without a time restriction, applying the keywords "ureteral stone", "ureteral calculus", "impacted stone", "ureteral stenosis", "ureteroscopic lithotripsy", "impacted calculus", and "ureteral strictures" singly or in combination. RESULTS After eliminating non-eligible studies, we identified five articles on ureteral stricture formation following treatment of impacted ureteral stones. Ureteral perforation and/or mucosal damage appeared as key predictors of ureteral stricture following retrograde ureteroscopy (URS) for impacted ureteral stones. Besides ureteral perforation stone size, embedded stone fragments into the ureter during lithotripsy, failed URS, degree of hydronephrosis, nephrostomy tube or double-J stent (DJS)/ureter catheter insertion were also suggested factors leading to ureteral strictures. CONCLUSION Ureteral perforation during surgery might be considered the main risk factor for ureteral stricture formation following retrograde ureteroscopic stone removal for impacted ureteral stones

Percutaneous nephrolithotomy in the transplant kidney - a prospective 20 year multicentre experience

Introduction & Objectives: Percutaneous nephrolithotomy (PCNL) in transplanted kidneys presents unique endourological challenges. By pooling the collective experience of three centres, each combining high volume transplant and high volume endourology practices, we aim to accurately and reliably demonstrate the safety and feasibility of this technique

Impact of the adherence to medical treatment on the main urinary metabolic disorders in patients with kidney stones

To assess the effect of the adherence to medical treatment on urinary parameters in the 24-h metabolic study of patients with kidney stones. A retrospective, longitudinal, descriptive, and observational study was carried out by reviewing the hospital electronic medical record from 2014 to 2018. The adherence to drug treatment was measured 6 months after its initiation, and the numerical values of the metabolic studies were compared. Wilcoxon tests were performed to compare the difference before and after treatment. Ninety patients were evaluated, with 73.3% of adherence. The 180-day overall adherence rate was 61.2% in patients treated with a single drug and 85.4% in patients treated with multiple drugs. There is a statistically significant increase in citrate levels in patients with good adherence in comparison with non-adherent patients (p =0.031 vs. p =0.528). Medical treatment and dietary measures in patients with kidney stones have an initial impact at 6 months on the values of the main urinary metabolic alterations that predispose to calculi formation; the most significant is seen in those patients with adherence to medical treatment for hypocitraturia

Does ureteral access sheath have an impact on ureteral injury?

Objective: To present a well-organized review about ureteral access sheath impact on ureteral injury. Materials and Methods: Systemic search on literature was done. Total of 3766 studies observed by two urologists and results were unified. A Prisma diagram was used for eliminating irrelevant studies and at the end of elimination process 28 studies were found eligible for this review. Results: Not only clinical studies but also comparative experimental animal studies show that there is no significant data to claim that ureteral access sheath insertion causes more ureteral injury. Pre-stented patients were found to be at lower risk for ureteral injury. Risk of progression to ureteral injury seems to be low even if ureteral injury occurs with insertion of ureteral access sheath. Conclusion: Summary of studies' results indicate that use of ureteral access sheath doesn't increase ureteral injury. This review may help understanding safety profile of ureteral access sheath on evidence-based level. There is not enough data to make a statement that ureteral access sheath prevents ureteral injury

Ureteroscopy in pregnant women with complicated colic pain: Is there any risk of premature labor?

Objective: Clinical presentation of ureteral stones during pregnancy is generally with renal colic pain. The aim of this study is to present our experience in the management of renal colic during pregnancy in emergency settings. Materials and methods: 208 pregnant patients who presented to emergency department with renal colic pain and underwent ureteroscopy (URS) due to failed conservative therapy were enrolled in the study. Urinary tract stones were diagnosed either with ultrasound (US) examination or during URS. Laser lithotripsy and double J (DJ) stent placement were routinely done in all patients with ureteral stones. The incidence of infective complications and premature uterine contractions (PUC) due to URS were compared. Results: No stone was identified in 36.1% (n = 75) of patients with using US and diagnostic URS. Of the remaining 133 patients, 30 (22.6%) had no stone at US but stones were diagnosed during diagnostic URS. The type of anesthesia had no significant effect on PUC. An increased risk of sepsis and PUC was found in patients with fever at the initial presentation. Interestingly, PUC was more frequent in patients with lower serum magnesium levels. There was a significant correlation with time delay until the intervention and the risk of urosepsis and PUC, individually. Conclusions: Ureteroscopy is a safe option for evaluation of pregnant patients with unresolved renal colic. According to the current findings, timing of the operation is the most important factor affecting the septic risks and abortion threat. Surgical intervention with URS must be planned as soon as possible

Ureteral Access Sheaths and Its Use in the Future: A Comprehensive Update Based on a Literature Review

Ureteral access sheaths (UASs) are part of urologist's armamentarium when performing retrograde intrarenal surgery (RIRS). Recently, the world of RIRS has changed dramatically with the development of three game-changers: thulium fiber laser (TFL), smaller size single use digital flexible ureterosopes and intraoperative intrarenal pressure (IRP) measurement devices. We aimed to clarify the impact of UASs on IRP, complications and SFRs and put its indications in perspective of these three major technological improvements. A systematic review of the literature using the Medline, Scopus and Web of Science databases was performed by two authors and relevant studies were selected according to PRISMA guidelines. Recent studies showed that using a UAS lowers IRP and intrarenal temperature by increasing irrigation outflow during RIRS. Data on the impact of a UAS on SFRs, postoperative pain, risk of infectious complications, risk of ureteral strictures and risk of bladder recurrence of urothelial carcinoma after diagnostic RIRS were inconclusive. Prestenting for at least one week resulted in ureteral enlargement, while the influence of pre-operative administration of alpha-blockers was unclear. Since TFL, smaller single use digital ureteroscopes and devices with integrated pressure-measuring and aspiration technology seemed to increase SFRs and decrease pressure and temperature related complications, indications on the use of a UAS may decrease in the near future

Definition of clinically insignificant residual fragments after percutaneous nephrolithotomy among urologists: a world-wide survey by EAU-YAU Endourology and Urolithiasis Working Group

INTRODUCTION The aim of this article was to evaluate the current perception of urologists as to what size is considered as a clinically insignificant residual fragment (CIRF). MATERIAL AND METHODS A survey was globally distributed to the members of the Endourological Society via SurveyMonkey. RESULTS A total of 385 participants responded to the survey on CIRF. Most participants considered 2 mm (29%) as CIRF threshold, followed by 3 mm (24%), 4 mm (22%), 0 mm (14%), 5 mm (8%) and 1 mm (3%). North American urologists considered CIRF to be smaller than urologists from Asia, Eurasia and South America, (p-values ≤0.001, 0.037 and 0.015 respectively). European urologists identified smaller CIRF in comparison to Asian urologists (p-value = 0.001). Urologists mainly using a pneumatic lithotripter accepted larger fragments as CIRF, compared to urologists mainly using ultrasonic devices or a combination of ultrasonic and pneumatic devices (p-value = 0.026 and 0.005 respectively). Similarly, urologists mainly performing X-Ray and ultrasound as post-operative imaging accepted larger fragments as CIRF in comparison to urologists mainly performing non-contrast computed tomography (p-value = 0.001). CONCLUSIONS What is considered as CIRF varies between urologist from different continents and seems to be associated with the lithotripter used and the post-operative imaging modality of preference to assess treatment success

Laser Ablation Efficiency, Laser Ablation Speed, and Laser Energy Consumption During Lithotripsy: What Are They and How Are They Defined? A Systematic Review and Proposal for a Standardized Terminology

Context Laser performance for lithotripsy is currently reported using units of measurement such as J/mm3, mm3/J, mm3/s, s/mm3, and mm3/min. However, there are no current standardized definitions or terminology for these metrics. This may lead to confusion when assessing and comparing different laser systems. Objective The primary objective was to summarize outcome values and corresponding terminology from studies on laser lithotripsy performance using stone volume in relation to time or energy. The secondary objective was to propose a standardized terminology for reporting laser performance metrics. Evidence acquisition A systematic review of the literature was conducted using the search string (“j*/mm3” OR “mm3/j*” OR “mm3/s*” OR “s*/mm3” OR “mm3/min*” OR “min*/mm3” AND “lithotripsy”) on Scopus, Web of Science, Embase, and PubMed databases. Study selection, data extraction, and quality assessment were performed independently by two authors. Evidence synthesis A total of 28 studies were included, covering holmium:yttrium-aluminum-garnet (Ho:YAG), MOSES, and thulium fiber laser (TFL) technologies. Laser energy consumption values reported for the studies ranged from 2.0 – 43.5 J/mm3 in vitro and from 2.7 – 47.8 J/mm3 in vivo, translating to laser ablation efficiency of 0.023 – 0.500 mm3/J and 0.021 – 0.370 mm3/J, respectively. Laser ablation speeds ranged from 0.3 – 8.5 mm3/s in vivo, translating to lasing time consumption of 0.12 – 3.33 s/mm3. Laser efficacy ranged from 4.35 – 51.7 mm3/min in vivo. There was high heterogeneity for the terminology used to describe laser performance for the same metrics. Conclusions The range of laser performance metric values relating stone volume to energy or time is wide, with corresponding differing terminology. We propose a standardized terminology for future studies on laser lithotripsy, including laser ablation efficiency (mm3/J), laser ablation speed (mm3/s), and laser energy consumption (J/mm3). Laser efficacy (mm3/min) is proposed as a broader term that is based on the total operative time, encompassing the whole technique using the laser. Patient summary We reviewed studies to identify the units and terms used for laser performance when treating urinary stones. The review revealed a wide range of differing units, outcomes, and terms. Therefore, we propose a standardized terminology for future studies on laser stone treatment. Keywords UreteroscopyPercutaneous nephrolithotomyLaserStone diseaseLithotripsyPerformanceUrolithiasi