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

Comparison of long-term kidney functions after radical nephrectomy and simple nephrectomy

Objective To determine if there is a difference in proceeding to CKD between patients who had undergone radical nephrectomy (RN) and simple nephrectomy (SN) for different indications by comparing the short- and long-term renal function. Materials and Methods We retrospectively analyzed the records of all patients who underwent nephrectomy (either for malign or benign indications) in our clinic between January 2007 and September 2017. The patients were divided into 2 groups according the type of surgery: 1) Radical nephrectomy Group, 2) Simple Nephrectomy Group. Renal function was evaluated with Glomerular Filtration Rate (GFR) calculated using the MDRD formula. Results A total of 276 patients were included in the study. There were 202 patients in RN Group and 74 patients in SN Group. The mean age of the patients in RN Group and SN Group were age 59,2 ± 11,5 and 49,9 ± 15,1 years, respectively (p = 0.001). GFR levels of patients in RN Group versus SN Group were as follows: Preoperative period: 84.9 vs. 81 mL/min/1.73 m2; postoperative 1st day: 60.5 vs. 84.4 mL/min/1.73 m2, postoperative 1st month 58.9 vs. 76 mL/min/1.73 m2, postoperative 1st year: 59.5 vs. 74.1 mL/min/1.73 m2; at last control 60.3 and 76.1 mL/min/1.73 m2. While preoperative GFR was found to be similar in two groups (p = 0.26), postoperative GFR values were found to be significantly lower in Group RN (p < 0.001). In comparison of the decrease in GFR in two groups at last follow-up, significantly higher decrease was observed in RN Group, 29% vs. 6%, (p < 0.05). Conclusion The decrease in GFR exists more common and intensive after RN compared to SN. In long-term, compensation mechanisms that develop after sudden nephron loss like radical nephrectomy deteriorates kidney function more than gradual nephron loss as in benign etiologies which indicates simple nephrectomy

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

New Technologies in Endourology and Laser Lithotripsy: The Need for Evidence in Comprehensive Clinical Settings

Flexible ureteroscopy (fURS) with laser lithotripsy is currently the gold standard surgical treatment for ureteral and kidney stones with a maximum diameter of 2 cm [...]

Surgical techniques to preserve continence after robot-assisted radical prostatectomy

Radical prostatectomy significantly impacts the inherent anatomy of the male pelvis and the functional mechanisms of urinary continence. Incontinence has a considerable negative influence on the quality of life of patients, as well as their social and psychological wellbeing. Numerous surgical techniques have been demonstrated to support the preservation of continence during robot-assisted radical prostatectomy (RARP). In this in-depth analysis, we give a general summary of the surgical techniques used in RARP and their impact on incontinence rates