Is It Worth Upgrading Your Flexible Ureterorenoscope? A Clinical Analysis

The new generation semiflexible ureterorenoscopes (URS) offer an improved deflection of 270 in both directions and a stiffer sheath. It is postulated that stone access and removal are facilitated compared to the conventional devices. In our study, we aimed to determine the difference in efficacy of stone treatment comparing the new and the conventional flexible URS. A total of 90 patients with upper urinary tract stones were included into a retrospective study. 29 cases were treated with the last generation flexible URS (11274 AA, Karl Storz Endoscopy, Germany) between 01/2000 and 07/2003 and 61 cases were treated with the new flexible URS (Flex-X, Karl Storz Endoscopy. Germany) between 12/2005 and 05/2007. The patients underwent standard clinical and radiological work-up before the procedure. Patients' and stone characteristics, stone free rate and complications were compared between the two groups. Treatment success was defined as complete stone removal or insignificant residual fragments <4mm requiring no further intervention. Stone access was possible in 97% and 100% for the conventional and new URS group. Immediate treatment success was 38% for the conventional versus 70% for the new flexible scope (p=0.0032). For the subgroup of lower pole stones mean stone size was 6.6 mm (conventional scope, 16 patients) versus 5.3 trim (new scope, 51 patients). Stone access was possible in 94% versus 100% and treatment success was 31% versus 69% (p=0.0004) for the old compared to the new scope. No major complications were observed. Minor complications were comparable in both groups. Our study suggests an advantage of the new flexible ureterorenoscopes compared to their predecessors. They offer an increased stone free rate especially in the treatment of lower pole stones

Do new generation flexible ureterorenoscopes offer a higher treatment success than their predecessors?

New generation flexible ureterorenoscopes offer an improved deflection mechanism and a stiffer sheath compared to their predecessors. We aimed to determine if these improvements in design lead to a higher efficacy in the treatment of nephrolithiasis. Ninety patients with upper urinary tract calculi were included into a retrospective analysis. Twenty-nine cases were treated with the conventional flexible ureterorenoscope (11274 AA, Karl Storz Endoscopy, Germany) and 61 cases were treated with the new generation device (Flex-X, Karl Storz Endoscopy). Patients' and stone characteristics, intraoperative data, treatment success and complications were retrieved from the charts and compared between the two groups. Preoperative data were comparable in both groups. Whereas stone access was also comparable (97 vs. 100%; n.s.), immediate treatment success was significantly higher for the new flexible scope (70 vs. 38%; p = 0.003). For the subgroup of lower pole stones, stone access was possible in 94 versus 100% (n.s.) and treatment success was 31 versus 69% (p = 0.0004) for the conventional and the new generation device, respectively. No major complications were observed, minor complications were comparable in both groups. Our study suggests an advantage of the new generation flexible ureterorenoscopes compared to their predecessors. They offer an increased stone free rate especially in the treatment of lower pole stones. It seems therefore advisable to switch to the latest generation flexible devices

Intraoperative inspection of the ureteropelvic junction during pyeloplasty is not sufficient to distinguish between extrinsic and intrinsic causes of obstruction: Correlation with histological analysis

Introductio

Can remote ischemic preconditioning counteract the renal functional deterioration attributable to partial nephrectomy under warm ischemia? Results of an animal study

Background To investigate if remote ischemic preconditioning (RIPC) can offer any renoprotective value by counteracting the deleterious effect of partial nephrectomy (PN) under warm ischemia on renal function. Methods Four groups, each with 5 Wistar albino rats, were constructed; RIPC + PN, PN, RIPC and sham. Right nephrectomy was performed to constitute a solitary kidney model. RIPC denoted sequential clamping/declamping of the femoral artery/vein complex. PN was performed under warm-ischemia following RIPC. Blood samples were collected on multiple occasions until euthanasia on day 7. Immunoassays were conducted to measure the serum and tissues levels of kidney injury markers. Kidneys were examined histologically and morphometric analyzes were performed using digital scanning. Results IL-33 levels did not differ significantly between the groups. Serum levels of KIM-1, NGAL, and aldose reductase in RIPC + PN, PN and RIPC groups were significantly lower than that of sham group. Tissue biomarker levels were similar across groups. The observed trend in mean necrosis area of PN group was higher than that of RIPC + PN group (p > 0.05). The transitional zone between necrosis and healthy tissue showed a trend towards increasing width in the rats subjected to RIPC before PN vs. those who underwent PN without RIPC (p > 0.05). Conclusion RIPC failed to counteract the renal functional consequences of PN under warm ischemia in a solitary kidney animal model. The supportive but marginal histological findings in favor of RIPC's renoprotective potential were not supplemented with the changes in serum and tissue biomarker levels

Intraoperative inspection of the ureteropelvic junction during pyeloplasty is not sufficient to distinguish between extrinsic and intrinsic causes of obstruction: Correlation with histological analysis

Introductio