Ureteroscopic lithotripsy compared with extracorporeal shockwave lithotripsy in the treatment of urolithiasis

Introduction: Urolithiasis is a common and frequently occurring disease with high recurrence rate. Ureteroscopic lithotripsy [URSL] and extracorporeal shock wave lithotripsy [ESWL] are two most popular modalities in the treatment of urolithiasis. The efficacy of these two methods is reviewed on the treatment of ureteral stones in this systematic review

Method: PubMed was searched for the relevant randomized control trials [RCTs]. Stone-free rate and retreatment rate were extracted from each article as the main outcomes, and Odds ratio was reported in each study

Result: Based on calculated odds ratio of each article, URSL has an odds ratio of <1 for the event of stone-free rate, and odds ratio of >1 for the event of retreatment rate compared with ESWL

Discussion: Performing URSL in the treatment of urolithiasis could be associated with higher stone-free rate and lower retreatment rate; however duration of the surgery seems to be longer during URSL compared with ESWL

Conclusions: There was high discrepancy between included RCTs regarding the study design, stone location, types of ureteroscope, intracorporeal lithotripsy devices, time to follow-up, and surgeon experience, which might affect the decision regarding type of surgery

Nail penetrating trauma: a rare cause of vesicovaginal fistula / 中华创伤杂志(英文版)

Vesicovaginal fistula (VVF) may be caused by prolonged obstructed labor, gynecologic, urologic, or other pelvic surgery, malignancy, radiation, infection and trauma. Here we report a case of VVF caused by nail penetrating trauma in a young woman with genital bleeding after first intercourse. This is a rare etiology of VVF. We also explain the operative technique used to repair the fistula.

Neurologic Complications in Percutaneous Nephrolithotomy

PURPOSE: Percutaneous nephrolithotomy (PCNL) has been the preferred procedure for the removal of large renal stones in Iran since 1990. Recently, we encountered a series of devastating neurologic complications during PCNL, including paraplegia and hemiplegia. There are several reports of neurologic complications following PCNL owing to paradoxical air emboli, but there are no reports of paraplegia following PCNL. MATERIALS AND METHODS: We retrospectively reviewed the medical records of patients who had undergone PCNL in 13 different endourologic centers and retrieved data related to neurologic complications after PCNL, including coma, paraplegia, hemiplegia, and quadriplegia. RESULTS: The total number of PCNL procedures in these 13 centers was 30,666. Among these procedures, 11 cases were complicated by neurologic events, and four of these cases experienced paraplegia. All events happened with the patient in the prone position with the use of general anesthesia and in the presence of air injection. There were no reports of neurologic complications in PCNL procedures performed with the patient under general anesthesia and in the prone position and with contrast injection. CONCLUSIONS: It can be assumed that using room air to opacify the collecting system played a major role in the occurrence of these complications. Likewise, the prone position and general anesthesia may predispose to these events in the presence of air injection.

Kidney transplantation in older adults: does age affect graft survival?

There is a paucity of data on long-term patient and graft survival in the older kidney recipients. Our aim was to evaluate the long-term outcomes of kidney transplantation in patients aged 50 years and older and compare them with outcomes in younger recipients. Forty-seven recipients aged 50 years and older and 47 recipients aged younger than 50 years were randomly assigned to two groups [groups 1 and 2, respectively]. Patients who had received a cadaveric kidney allograft were excluded from the study. Data including demographic and clinical characteristics, early complications, early mortality, and actuarial patient and graft survival rates were collected, and the two groups were compared, accordingly. The rates of early complications and mortality were not different between the two groups. Patient survival rates at 1, 3, 5, and 7 years were 72%, 58%, 41%, and 41% for patients in group 1 and 95%, 86%, 86%, and 86% for patients in group 2, respectively [P=0.007]. Graft survival rates were 72%, 58%, 41%, and 41% for patients in group 1 and 95%, 85%, 85%, and 85% for patients in group 2, respectively [P=0.006]. Graft loss due to patient death was 33.33% in group 1 compared with 4.25% in group 2 [P<0.001]. Kidney transplantation should be considered in patients older than 50 years, since the graft survival rate is acceptable in this population, and early mortality and complications in this group are not different than those of younger recipients. Although older patients have a shorter life expectancy, they benefit from renal transplantation in ways similar to younger kidney transplant recipients