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1.
Int. braz. j. urol ; 48(5): 842-849, Sept.-Oct. 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1394390

ABSTRACT

ABSTRACT Background: We aimed to investigate the clinical efficacy and safety of transurethral flexible ureteroscopic incision and drainage with holmium laser in the treatment of parapelvic renal cysts. Materials and Methods: Between October 2017 and April 2021, the clinical data of 65 patients with parapelvic renal cysts were evaluated retrospectively. Thirty-one patients with parapelvic cysts (Group 1) underwent a transurethral flexible ureteroscopic incision and drainage with a holmium laser, whereas the other 34 patients (Group 2) underwent retroperitoneal laparoscopic unroofing. The patients' clinical features were documented. The surgery time, intraoperative blood loss, hospitalization time, complications and cyst size were recorded and statistically assessed one year following the procedure. Results: All of the patients were successfully treated with flexible ureteroscopic incision and drainage or retroperitoneal laparoscopic unroofing. In terms of clinical parameters, such as age, gender, BMI, location, cyst size, and Bosniak classification of renal cysts, no statistically significant difference was detected between Groups 1 and 2. Compared to the control group (Group 2), Group 1 demonstrated a shorter surgery duration, less intraoperative blood loss, and a shorter hospital stay (p < 0.001). However, no significant differences in complications and cyst size were observed between the two groups one year after the surgery (p > 0.05). Conclusions: Transurethral flexible ureteroscopic incision and drainage with holmium laser in the treatment of parapelvic renal cysts has obvious advantages over traditional surgery, and is worthy of advancement and application, but its long-term effect needs further follow-up studies.

2.
Int. braz. j. urol ; 48(3): 561-568, May-June 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1385116

ABSTRACT

ABSTRACT Purpose: To analyze the 3-dimensional intrarenal anatomy of horseshoe kidneys (HK) and kidney with complete ureteral duplication (CUD), in polyester resin endocasts of the collecting system and in patients submitted to 3D computerized tomography scan (CT-scan). Materials and Methods: We analyzed seven 3-dimensional polyester resin endocasts of the kidney collecting system obtained from 6 fresh adult cadavers (4 with unilateral CUD and 2 with horseshoe kidney) and CT-scan reconstruction images of kidneys from 24 patients: 6 patients with HK, 8 with CUD and 10 patients without renal anomalies that were used as controls. We analyzed the spatial distribution of the calices, the infundibula diameters, the angle between the lower infundibulum and the renal pelvis (LIP) and the angle between the lower infundibulum and the inferior minor calyces (LIICA). Measurements of the width and length of the inferior infundibulum and the infundibula of the minor calyces, as well as the angles (LIP and LIICA) were made with the aid of the LibreOffice 6.3 software. The data were analyzed with the IBM® SPSS® Statistics. Results: There was no statistical difference in the inferior pole measurements between the groups with anomalies and the control group, both in polyester resin endocasts and CT-scan reconstruction images for LIP. When we compared the LIP in the CT-scan between HK versus CUD (p= 0.003), and HK versus the control group (p= 0.035), we observed statistical difference. Conclusions: The knowledge of spatial anatomy of lower pole is of utmost importance during endourologic procedures in patients with kidney anomalies. In the present study we observed that horseshoe kidneys had more restrictive anatomic factors in lower pole than the complete ureteral duplication.

3.
Rev. Col. Bras. Cir ; 49: e20223264, 2022. tab
Article in English | LILACS-Express | LILACS | ID: biblio-1394621

ABSTRACT

ABSTRACT Introduction: retrograde intrarenal surgery (CRIR) is an evolving tool. Its learning curve is not well established, despite the common use of flexible ureteroscopes today. Our aim is to estimate the number of procedures needed for one to perform RIRS consistently. Material and Methods: a urology resident had his first 80 RIRS for nephrolithiasis analyzed quantitatively and qualitatively. The procedures were divided into 4 groups containing 20 surgeries each (I to IV), according to their order, for comparison. Results: there was no difference in stone sizes between groups. All qualitative variables varied significantly between groups (p<0.001), except between III and IV. In the quantitative analysis, there was a difference between groups I and IV in time for double-J catheter placement (p=0.012). There was an increasing difference in sheath placement time (p<0.001) and in total operative time (p=0.004). The time fot stone treatment (p=0.011) was significant only between groups I, II and III. There was difference in total sheath time only between groups I and III (p=0.023). Stone free status did not change between groups. Discussion: the differences between the qualitative and quantitative variables show the relation between number of surgeries performed and proficiency in the procedure. Intergroup comparisons show sequential optimization of parameters. Conclusions: we found that 60 is a reasonable number of surgeries to be performed in order to reach the plateau of RIRSs learning curve.


RESUMO Introdução: a cirurgia retrógrada intrarrenal (CRIR) é ferramenta em evolução. Sua curva de aprendizado não está bem estabelecida, apesar do uso comum dos ureteroscópios flexíveis atualmente. O objetivo é estimar o número de procedimentos necessários para se realizar CRIR consistentemente. Material e Métodos: Um residente de urologia teve suas primeiras 80 CRIR para tratamento de nefrolitíase analisadas quantitativa e qualitativamente. Os procedimentos foram divididos em 4 grupos contendo 20 cirurgias cada (I a IV), de acordo com sua ordem, para comparação. Resultados: Não houve diferença nos tamanhos dos cálculos entre grupos. Todas as variáveis qualitativas apresentaram variação significativa entre os grupos (p<0,001), exceto entre III e IV. Na análise quantitativa houve diferença entre os grupos I e IV no tempo de colocação do cateter duplo J (p=0,012). Houve uma diferença crescente no tempo de colocação da bainha (p<0,001) e no tempo operatório total (p=0,004). O tempo para o tratamento do cálculo (p=0,011) foi significativo apenas entre os grupos I, II e III. Houve diferença no tempo total de bainha apenas entre os grupos I e III (p=0,023). Taxa livre de cálculos não se alterou entre os grupos. Discussão: as diferenças observadas entres as variáveis qualitativas e quantitativas evidenciam a relação entre o número de cirurgias realizadas e a proficiência no procedimento. As comparações intergrupo mostram otimização sequencial dos parâmetros. Conclusões: estima-se que 60 é um número razoável de cirurgias para que se atinja o platô da curva de aprendizado.

4.
Chinese Journal of Urology ; (12): 384-386, 2022.
Article in Chinese | WPRIM | ID: wpr-933237

ABSTRACT

The clinical data of 120 patients admitted to our hospital with renal stones treated by flexible ureteroscopy (FURS) and the imaging-related data measured by virtual reality technology were retrospectively analysed. The results of the univariate analysis showed that stone surface area (S), renal pelvis volume (P), length of calyces funnel (L), pelvic calyceal height (H) and essence of stone (E) were closely related to stone-free rate. The H. L.P.E.S. score was constructed to predict stone-free rate after FURS based on the above factors, and the area under the receiver aperating characteristic curve for the H. L.P.E.S. and S. O.L.V.E. scoring systems was 0.921 and 0.754 respectively.The H. L.P.E.S. scoring system has higher predictive value.

5.
Ethiopian Journal of Health Sciences ; 32(5): 947-954, 5 September 2022. Tables
Article in English | AIM | ID: biblio-1398388

ABSTRACT

Ureteroscopy is a major diagnostic and therapeutic technique for lesions of the ureter and intrarenal collecting system. METHODS: A retrospective chart review was done at St. Paul's Hospital Millennium Medical College, Ethiopia to determine the outcome of ureteroscopy and factors affecting it. The study period was from January 2018 to April 2018. Multivariate analysis was done to determine factors affecting stone clearance and success rate. RESULT: One hundred six patients who underwent semirigid ureteroscopy were included in the study. The male-to-female ratio was 1.8:1. The mean age of the patients was 36.4 years (±12.6). Ninety-six (90.6%) patients were found to have ureteric stones, while 9(8.5%) patients had a ureteric stricture. Ureteroscopy therapeutic interventions for stones were successful in 89 (92.7%) patients. The mean procedure time and postoperative hospital stay were 44 minutes (±23.7) and 2.5 days (±2.5) respectively. Intraoperative complications (ureteric avulsion, hemorrhage, and ureteral perforations) occurred in 6(5.7%) patients. The stone clearance rate was 54.7% (52). The site of obstruction was passed in 93 patients making the success rate of the procedure 87.7%. The absence of intraoperative complications was significantly associated with success rate. Patients with intraoperative complications have low success rate (20%) compared to patients without complications (92.3%), p=0.42. CONCLUSION: Semirigid ureteroscopy had a good success rate, especially for stones in the distal ureter and if there is no flexible ureteroscope, it is an acceptable alternative


Subject(s)
Ureter , Metabolic Clearance Rate , Ureteroscopy , Intraoperative Complications
6.
Int. braz. j. urol ; 47(6): 1198-1206, Nov.-Dec. 2021. tab, graf
Article in English | LILACS | ID: biblio-1340028

ABSTRACT

ABSTRACT Purpose: The objective of this study is to evaluate the impact of a previous standard percutaneous nephrolithotomy (PCNL) on the outcomes of retrograde intrarenal surgery (RIRS). Materials and Methods: Outcomes of RIRS performed from January 2017 to January 2020 in adult patients with residual stone fragments ≤20mm after a standard PCNL (Post-PCNL) and symptomatic adult patients with kidney stones ≤20mm (Control) were prospectively studied. Stone-free rate (SFR) was evaluated on a postoperative day 90 non-contrast computed tomography. Surgical complications based on Clavien-Dindo classification during the 90 days of follow-up were recorded. Results: Outcomes of 55 patients and 57 renal units of the post-PCNL group were compared to 92 patients and 115 renal units of the control group. SFR was lower in post-PCNL group than in control (28/57, 49.1% vs. 86/115, 74.8%, p <0.001). Overall complications were more frequent in post-PCNL group (p=0.004). Infundibula strictures were identified and incised with laser in 15/57 (26.3%) renal units of the post-PCNL group. Thirteen renal units had infundibulum stricture at the site of previous percutaneous tract (13/15; 86.7%, p=0.004) and one renal unit had three infundibula strictures. Postoperative complications were not affected by the treatment of infundibula strictures (p=0.198). Conclusions: Previous standard PCNL significantly impairs the outcomes of RIRS. Infundibula strictures can be found in 26.3% of the patients with residual stone fragments after standard PCNL for large burden kidney stones. The main site of infundibulum stricture after standard PCNL is the infundibulum of the entry calyx.


Subject(s)
Humans , Adult , Nephrostomy, Percutaneous/adverse effects , Kidney Calculi/surgery , Nephrolithotomy, Percutaneous/adverse effects , Treatment Outcome , Kidney/surgery , Kidney/diagnostic imaging
7.
J. bras. econ. saúde (Impr.) ; 13(1): 55-65, Abril/2021.
Article in Portuguese | LILACS, ECOS | ID: biblio-1252727

ABSTRACT

Objetivo: Analisar o custo-efetividade da utilização de ureteroscópios flexíveis descartáveis em comparação com o uso de ureteroscópios flexíveis reprocessáveis. Métodos: Revisão integrativa de literatura realizada nos bancos de dados SciELO, LILACS e MEDLINE, utilizando os descritores "ureteroscopia", "resistência à flexão", "marketing", "análise de custo-benefício" e "esterilização", cujo objeto trata das vantagens custo-efetivas da utilização do ureteroscópio flexível descartável. Resultados: Trinta e cinco artigos foram encontrados, sendo quatro utilizados no estudo. Além disso, características de sete modelos de ureteroscópios flexíveis comercializados no Brasil mais conhecidos atualmente foram apresentadas. Os resultados foram baseados na análise conjunta dos artigos selecionados e características dos modelos de flexíveis apresentados e discutidos em duas categorias: a evolução dos ureteroscópios flexíveis e marketing mix ­ ureteroscópios flexíveis de uso único. Conclusão: Apesar da escassez de pesquisas que se aprofundem em custos de utilização de um ureteroscópio flexível de uso único, comparado a um reprocessável, são notórios os benefícios advindos das inovações agregadas a esses dispositivos, dando retorno positivo tanto para o profissional que faz seu uso deles quanto para o paciente, fazendo-se necessário analisar mais profundamente a possibilidade de migração da "cultura" de uso de ureteroscópios flexíveis reprocessáveis para os descartáveis


Objective: To analyze the cost-effectiveness of using disposable flexible ureteroscopes versus using reprocessable flexible ureteroscopes. Methods: Integrative literature review conducted in the SciELO, LILACS and MEDLINE databases, using the descriptors ureteroscopy, flexion resistance, marketing, cost-benefit analysis, and sterilization, whose object deals with the cost-effective advantages of using the flexible ureteroscope disposable. Results: Thirty-five articles were found and four were used in the study. In addition, characteristics of seven models of flexible ureteroscopes commercialized in Brazil, that are currently better known, were presented. The results were based on a joint analysis of the selected articles and characteristics of the flexible models presented, and discussed in two categories: the evolution of flexible ureteroscopes; and marketing mix - flexible single-use ureteroscopes. Conclusion: Despite the scarcity of research that deepens the costs of using a flexible single-use ureteroscope when compared to a reprocessable one, the benefits arising from the innovations added to these devices are notorious, giving a positive return both to the professional who uses it and to the patient, making it necessary to further analyze the possibility of migration from the "culture" of using flexible reprocessable ureteroscopes to disposable ones


Subject(s)
Sterilization , Cost-Benefit Analysis , Ureteroscopy , Flexural Strength
8.
Arch. argent. pediatr ; 119(2): 83-90, abril 2021. tab
Article in English, Spanish | LILACS, BINACIS | ID: biblio-1151230

ABSTRACT

Introducción. Los pediatras, cirujanos y subespecialistas, como urólogos y nefrólogos pediátricos, participan en el diagnóstico y tratamiento de la nefrolitiasis pediátrica. El objetivo fue determinar los enfoques de distintas disciplinas y evaluar las diferencias en sus protocolos de diagnóstico y tratamiento habituales.Población y métodos. Cuestionario administrado a participantes de sesiones sobre nefrolitiasis en congresos nacionales en 2017 para evaluar las rutinas de diagnóstico y tratamiento de la nefrolitiasis entre distintas especialidades (cirujanos y pediatras) y subespecialidades (nefrólogos pediátricos y urólogos pediátricos).Resultados. Se analizaron 324 cuestionarios de 88 pediatras, 121 urólogos, 23 cirujanos pediátricos, 54 nefrólogos pediátricos y 38 urólogos pediátricos. Ambos grupos coincidieron en la necesidad de una evaluación metabólica. Para los cálculos ureterales distales ≥6 mm, los cirujanos preferían una ureteroscopía; los pediatras, una litotricia por ondas de choque (LOC) (p < 0,001); y los subespecialistas, una ureteroscopía (p = 0,636). Para los cálculos en la parte inferior de los cálices renales < 1 cm, los cirujanos y los subespecialistas preferían la LOC y los pediatras, la hidratación (p < 0,001; p = 0,371). Para los cálculos de entre 1,1 cm y 2 cm, los cirujanos preferían la cirugía retrógrada intrarrenal (CRIR) y la LOC, y los pediatras, la LOC (p = 0,001). Para los cálculos más grandes, los cirujanos y subespecialistas preferían la nefrolitotomía percutánea (NLP) y los pediatras, la LOC (p = 0,458; p = 0,001).Conclusión. Existen diferencias entre las disciplinas que participan activamente en el diagnóstico y tratamiento de la nefrolitiasis


Introduction. Pediatricians, surgeons and subspecialties as pediatric urology and nephrology are involved in the diagnosis and treatment of pediatric renal stone disease (RSD). The aim of this study was to determine diagnostic and treatment approaches, of different disciplines, and to assess differences in their routine diagnostic and treatment protocols.Population and methods. A questionnaire was designed and administered to the participants of the RSD sessions in national congresses of all disciplines in 2017 to evaluate the diagnostic and treatment routines of specialties (surgeons and pediatricians) and subspecialties (pediatric nephrologists and pediatric urologists) for RSD. Results. A total, of 324 questionnaires were analyzed, from 88 pediatricians (27 %), 121 urologists (37 %), 23 pediatric surgeons (7 %), 54 pediatric nephrologists (17 %), and 38 pediatric urologists (12 %). Both groups agreed on the necessity of metabolic evaluation. For distal ureter stones that were ≥ 6 mm; surgeons preferred ureteroscopy (URS), pediatricians preferred shock wave lithotripsy (SWL) (p < 0.001) and subspecialties preferred URS for the treatment (p = 0.636). For lower calix stones less than 1 cm surgeons and subspecialists preferred SWL, while pediatricians preferred hydration (p < 0.001, p = 0.371). For the stone between 1.1 and 2 cm, surgeons preferred intrarenal surgery (RIRS) and SWL, pediatricians preferred SWL (p = 0.001). For larger stones, surgeons and subspecialists preferred percutaneous nephrolithotomy (PCNL), and pediatricians preferred SWL (p = 0.458 p = 0.001). Pediatric urologist chose low-dose computerized tomography as a diagnostic radiologic evaluation (p = 0.029).Conclusion. There are differences between the disciplines who take an active role in diagnosis and treatment of RSD.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Nephrolithiasis/therapy , Pediatrics , Turkey , Surveys and Questionnaires , Ureteroscopy , Nephrolithiasis/diagnosis
9.
Int. braz. j. urol ; 47(2): 350-356, Mar.-Apr. 2021. tab, graf
Article in English | LILACS | ID: biblio-1154451

ABSTRACT

ABSTRACT Purpose: High intra-renal pressures during flexible ureteroscopy have been associated with adverse renal tissue changes as well as pyelovenous backflow. Our objective was to investigate the effect of various intra-renal pressures on histologic changes and fluid extravasation during simulated ureteroscopy. Materials and Methods: Twenty-four juvenile pig kidneys with intact ureters were cannulated with an Olympus flexible ureteroscope with and without a ureteral access sheath and subjected to India ink-infused saline irrigation for 30 minutes at constant pressures ranging from sphygmomanometer settings of 50mm, 100mm and 200mmHg. Renal tissue samples were collected, processed and stained, and were evaluated by a blinded pathologist for depth of ink penetration into renal parenchyma as a percentage of total parenchymal thickness from urothelium to renal capsule. Results: The mean percentage of tissue penetration for kidneys with ink present in the cortical tubules at sphygmomanometer pressure settings of 50, 100, and 200mm Hg without a ureteral access sheath was 33.1, 31.0 and 99.3%, respectively and with ureteral access sheath was 0, 0 and 18.8%, respectively. Overall, kidneys with an access sheath demonstrated a smaller mean tissue penetration among all pressure compared to kidneys without a sheath (6.3% vs. 54.5%, p=0.0354). Of kidneys with sheath placement, 11% demonstrated any ink compared to 56% of kidneys without sheath placement. Conclusions: Pressurized endoscopic irrigation leads to significant extravasation of fluid into the renal parenchyma. Higher intra-renal pressures were associated with increased penetration of irrigant during ureteroscopy in an ex-vivo porcine model.


Subject(s)
Animals , Ureter , Ureteroscopes , Pressure , Swine , Ureteroscopy , Therapeutic Irrigation , Kidney
10.
Int. braz. j. urol ; 47(1): 64-70, Jan.-Feb. 2021. tab, graf
Article in English | LILACS | ID: biblio-1134304

ABSTRACT

ABSTRACT Purpose: We aimed to compare the success and complication rates of the anterograde and retrograde Ureterorenoscopy (URS) for impacted upper ureteral stones in patients > 65 years of age. Materials and Methods: Data of 146 patients >65 years of age and underwent anterograde URS (n=68) in supine position or retrograde URS (n=78) for upper ureteral impacted stones>10 mm between January 2014 and September 2018 were collected prospectively. The groups were compared for success and complication rates, duration of operation, hospital stay, and ancillary procedures. Results: Anterograde and retrograde URS groups were similar for demographic and stone related characteristics. The success rate of the anterograde URS group was significantly higher than the retrograde URS group (97.1% vs. 78.2%, p=0.0007). The complication rates were similar for the two groups (p=0.86). Clavien grade I and II complications were observed in 3 patients in each group. The mean hemoglobin drop was 0.5 g/dL in the anterograde URS group and blood transfusion was not performed in any of the patients. The mean duration of operation was 41.2±12.5 minutes in the mini-PNL group and 59.6±15.1 minutes in the RIRS group and the difference was statistically significant (p=0.02). The median duration of hospitalization was 1 day for both groups. Conclusions: Performing anterograde URS in supine position provided better success rates and similar complication rates compared to retrograde URS. Based on these results anterograde URS shall be considered as one of the primary treatment options for management of impacted upper ureteral stones in the elderly population.


Subject(s)
Humans , Aged , Lithotripsy , Ureteral Calculi/surgery , Retrospective Studies , Treatment Outcome , Ureteroscopy , Length of Stay
11.
Article in Chinese | WPRIM | ID: wpr-910185

ABSTRACT

Objective:To investigate the diagnosis, treatment and prognosis of ureteral endometriosis with hydronephrosis.Methods:A retrospective study was performed of 92 cases diagnosed as ureteral endometriosis with surgery confirmed in Peking University First Hospital from January 2000 to January 2021.Results:The incidence of ureteral endometriosis was 0.9% (92/10 222), with an average age of (40.0±6.0) years. Among 92 cases, urological symptoms and pelvic pain including dysmenorrheal, periodic abdominal pain were the main forms of clinical characteristics, while 11 patients (12%, 11/92) were asymptomatic. All patients with ureteral endometriosis had hydronephrosis and hydroureter before surgery, hydronephrosis were left sided in 48 (52%, 48/92) patients, right sided in 39 (42%, 39/92) patients, both sided in 5 (5%,5/92) patients. The distal and middle sections of ureteral obstructions existed in 73 (79%, 73/92) patients and 19 (21%, 19/92) patients, respectively. Out of the 92 ureteral lesions 71 (77%, 71/92) patients were extrinsic lesions, 21 (23%, 21/92) patients presented intrinsic lesions. Of the 38 cases who took preoperative radionuclide renal dynamic imaging examination, there were 6 (16%, 6/38) cases of mildly damaged, 7 (18%, 7/38) cases of moderately dameged, 14 (37%, 14/38) cases of severely damaged, and 11 (29%, 11/38) cases of normal renal function. Laparotomy was decided in 25 (27%, 25/92) patients, and laparoscopic surgery in 67 (73%, 67/92) patients. In cases of ureteral surgery, ureterolysis, partial ureteral resection and ureterocystoneostomy, partial ureteral resection and end-to-end ureteral anastomosis and nephroureterectomy were undertaken in 52 (57%, 52/92), 20 (22%, 20/92), 12 (13%, 12/92) and 8 (9%, 8/92) patients separately. The median follow up was 108 months (range: 6 to 240 months). During the follow-up period, 68 (87%, 68/78) patients took urinary ultrasound after surgery, and 60 (88%, 60/68) cases of hydronephrosis disappeared, and 8 (12%, 8/68) cases were better than before.Conclusion:Most of the patients with ureteral endometriosis are impaired with renal function, and early surgical treatment could effectively relieve urinary obstruction and promote the recovery of renal function.

12.
Journal of Chinese Physician ; (12): 1506-1509, 2021.
Article in Chinese | WPRIM | ID: wpr-909734

ABSTRACT

Objective:To explore the application of ureteroscope combined with holmium laser in patients with hepatolithiasis complicated with biliary cirrhosis.Methods:The clinical data of 89 patients with hepatolithiasis complicated with biliary cirrhosis treated in the hepatobiliary department of Hunan Provincial People's Hospital from February 2014 to December 2019 were collected and divided into two groups: group A was routine operation group and group B was ureteroscopy and holmium laser technology group. The clinical data of the two groups were compared and analyzed respectively.Results:The operation time in group B was less than that in group A [ (302.6±96.7)min vs (349.2±105.6)min, P<0.05], with statistically significant difference; The amount of intraoperative bleeding in group B was less than that in group A [(227.0±197.3)ml vs (331.4 ± 277.3)ml, P<0.05], with statistically significant difference; The postoperative hospital stay in group B was shorter than that in group A[(11.5±4.1)d vs (13.8±5.1)d, P<0.05], with statistically significant difference; The incidence of postoperative complications in group B was lower than that in group A (2.44% vs 18.75%, P<0.05), with statistically significant difference. The liver resection rate in group B was lower than that in group A (29.27% vs 52.08%, P<0.05). Conclusions:Through the establishment of a reasonable access to the liver, the application of ureteroscope and holmium laser technology in patients with hepatolithiasis complicated with biliary cirrhosis can achieve better diagnosis and treatment results, and this technology can be gradually promoted and applied in the clinic.

13.
Rev. cir. (Impr.) ; 72(6)dic. 2020.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1388768

ABSTRACT

Resumen Objetivo: Establecer validez aparente, de contenido y constructo, de un programa de simulación de ureterorrenoscopía flexible. Materiales y Método: Se desarrolló un modelo de simulación de silicona para ureterorrenoscopía flexible, en el cual se establecieron 8 marcas de colores en los distintos cálices. Para la validación, se reclutaron urólogos expertos y residentes de urología con experiencia variable en este procedimiento. Se separaron en 3 grupos: G1 para residentes sin experiencia en ureteroscopía, G2 para residentes con experiencia variable y G3 para urólogos expertos. Se les solicitó realizar una navegación completa del modelo, en un tiempo máximo de 600 segundos. Al finalizar, cada participante contestó una encuesta respecto a la utilidad y realismo del modelo. Además, se midió tiempo total, número de puntos encontrados y cantidad de veces de reingreso a los cálices para validación de constructo. Resultados: 15 personas participaron en la evaluación. Se obtuvo una mediana de 8,6 puntos para la utilidad del modelo y 6,75 puntos para el realismo de este. Los tiempos totales de navegación fueron 504, 293 y 133 segundos para G1, G2 y G3 respectivamente (p = 0,02). De las 8 marcas, se encontraron en promedio 5,1, 6,6 y 7,3 (p = 0,18), presentando un promedio de 9,5, 3,8 y 1,3 reintentos de exploración de los cálices en los respectivos grupos (p = 0,11). Conclusiones: Se establece validez aparente y contenido para un modelo de ureterorrenoscopía flexible. El programa de simulación de ureterorrenoscopía flexible establecido, permite diferenciar novatos de expertos en cuanto a reducción en los tiempos de navegación.


Aim: To establish the face, content, and construction validity of a flexible ureterorenoscopy simulation program. Materials and Method: A simulation model for flexible ureterorenoscopy was developed using silicone on which eight colored marks were marked on the calyxes. For validation, expert urologists and residents with varying amounts of experience in this procedure were recruited. They were separated into three groups: 1) G1 for residents without experience in ureteroscopy; 2) G2 for residents with variable experience; and 3) G3 for expert urologists. They were asked to perform a full navigation of the model in a maximum time of 600 sec. At the end, each participant answered a survey regarding the usefulness and realistic nature of the model. In addition, total time, number of marks found, and times of re-entry to the calyxes were measured. Results: A median of 8.6 points was obtained for the utility of the model and 6.75 points for its realistic nature. The total navigation times were 504, 293, and 133 seconds for G1, G2, and G3, respectively (p = 0.02). Of the eight marks, an average of 5.1, 6.6, and 7.3, (p = 0.18) were found with an average of 9.5, 3.8, and 1.3 exploration reattempts at the chalices in the corresponding groups (p = 0.11). Conclusions: Face and content validity was established for this simulation model of flexible ureterorenoscopy. This flexible ureterorenoscopy simulation program allowed us to differentiate the level of expertise in terms of reduction in navigation time.

14.
Int. braz. j. urol ; 46(6): 902-926, Nov.-Dec. 2020. tab, graf
Article in English | LILACS | ID: biblio-1134269

ABSTRACT

ABSTRACT Purpose Various surgical options are available for large proximal ureteral stones, such as extracorporeal shock wave lithotripsy (ESWL), ureteroscopic lithotripsy (URSL), percutaneous nephrolithotomy (PCNL) and laparoscopic ureterolithotomy (LU). However, the best option remains controversial. Therefore, we conducted a network meta-analysis comparing various surgical treatments for proximal ureteral stones ≥10mm to address current research deficiencies. Materials and methods We searched PubMed, Ovid, Scopus (up to June 2019), as well as citation lists to identify eligible comparative studies. All clinical studies including patients comparing surgical treatments for proximal ureteral stones ≥10mm were included. A standard network meta-analysis was performed with Stata SE 14 (Stata Corp, College Station, TX, USA) software to generate comparative statistics. The quality was assessed with level of evidence according to the Oxford Centre for Evidence-based Medicine and risk of bias with the Cochrane Collaboration's Review Manager (RevMan) 5.3 software. Results A total of 25 studies including 2.888 patients were included in this network meta-analysis. Network meta-analyses indicated that LU and PCNL had better stone-free rates and auxiliary procedures. PCNL could result in major complications and severe bleeding. In initial stone-free rate, final stone-free rate, and auxiliary procedures results, SUCRA ranking was: LU> PCNL> URSL> ESWL. In Clavien Dindo score ≥3 complications, SUCRA ranking was: LU> ESWL> URSL> PCNL. In fever, SUCRA ranking was: ESWL> LU> URSL> PCNL. In transfusion, SUCRA ranking was: LU> URSL> ESWL> PCNL. In Cluster analysis, LU had the highest advantages and acceptable side effects. Considering the traumatic nature of PCNL, it should not be an option over URSL. ESWL had the lowest advantages. Conclusions LU have the potential to be considered as the first treatment choice of proximal ureteral stone ≥10mm.


Subject(s)
Humans , Male , Ureteral Calculi/surgery , Lithotripsy , Treatment Outcome , Ureteroscopy , Network Meta-Analysis , Nephrolithotomy, Percutaneous/adverse effects
15.
Int. braz. j. urol ; 46(3): 400-408, May-June 2020. tab
Article in English | LILACS | ID: biblio-1090613

ABSTRACT

ABSTRACT Objective: To elucidate the current scenario of endourology in Brazil for the treatment of urinary lithiasis, with an emphasis on regional differences and the reasons why certain techniques are still underutilized. Materials and Methods: An electronic questionnaire was sent by email to the 4,745 members of the Brazilian Urological Society (BSU) in 2016 to collect information on the 3 main endourological procedures used in the treatment of nephrolithiasis: Semi-rigid ureteroscopy (URS), Flexible ureteroscopy (F-URS) and percutaneous nephrolithotripsy (PCNL). Results: A total of 1,267 urologists answered the questionnaire. It was observed that the vast majority perform URS (95.6%), while 80.2% perform F-URS and only 72.1% perform PCNL. Regarding the surgical volume, most perform up to 10 procedures per month (73.4% to 88.2%) and the main impediment was the lack of patients with the pathology (42.1% to 67.7%). The lack of equipment or hospital infrastructure was one of the main limiting factors for rigid (23%) and flexible (38.1%) URS, mainly in the North and Northeast regions of the country. Regarding PCNL, most of them reported lack of practical experience in the method (29.9%). Finally, most urologists expressed interest in taking courses in endourology. Conclusion: Ureteroscopy, rigid or flexible, is already well established in the country, requiring the direction of more resources for its practice, especially in less developed regions. Regarding PCNL a significant part of Brazilian urologists still lack practical experience in this procedure, emphasizing the need for greater investment in teaching this technique.


Subject(s)
Humans , Urology , Kidney Calculi/therapy , Brazil , Surveys and Questionnaires , Ureteroscopy
16.
Article | IMSEAR | ID: sea-212830

ABSTRACT

Background: Urinary calculus disease is one of the 3 most common urological diseases. It affects about 12% of the world population and has become a worldwide health problem. Of all the urinary tract stones 20% are ureteral stones, of which 70% are found in the distal ureter. The objective of the study is to study the effect of silodosin in the passage of calculi in the distal ureter compared to non-steroidal anti-inflammatory drugs (NSAIDs) (diclofenac sodium) and oral fluids.Methods: This study included a total of 90 patients between the study period from October 2016 to October 2018. 45 patients were chosen randomly and advised to take plenty of oral fluids and treated with NSAIDs and the other 45 patients were treated with silodosin 8 mg HS for one month along with oral fluids and NSAIDs. After 1 month if the stone was passed successfully, it was confirmed with ultrasonography, if failed, advised for surgery.Results: Majority of the patients were in the age group of 20-45 yrs. The mean size of the calculus was 5.60 cm on the right side and 5.71 cm on the left side. Out of the 45 patients who were on treatment with silodosin 35 patients had passed the calculi and 10 patients had no results with a success rate of 77.7%. In the 45 patients who were not on silodosin, 8 patients passed the calculi and 37 patients did not pass the calculi. 21 patients among the 45 underwent urethrorenoscopy.Conclusions: Silodosin is an effective and safe drug in the management of calculi in the distal ureter.

17.
Chinese Journal of Urology ; (12): 41-45, 2020.
Article in Chinese | WPRIM | ID: wpr-869589

ABSTRACT

Objective To evaluate efficacy and safety of retrograde intrarenal stone surgery for treatment of upper urinary calculi.Methods The clinical data of 640 patients with upper urinary tract calculi treated by retrograde intrarenal stone surgery (RIRS) in Renmin Hospital of Wuhan University from April 2016 to January 2019 were retrospectively analyzed.There were 424 males and 216 females.The awerage age was (46.2 ± 12.8) years old,ranging 18 to 76 years old.The maximum diameter of the stone is (1.4 ±0.7) cm,ranging 0.6-3.2 cm.There were 126 cases with inferior calculi and 514 cases with non-lurgical calculi.There were 196 cases with unilateral ureteral calculi,118 unilateral ureteral calculi cases with renal calculi,236 cases with unilateral renal stones,and 90 cases with double kidney stones.104 cases were placed with double J tube before operation and 496 cases were not placed before operation.There were 8 cases of horseshoe kidney,30 cases of isolated kidney with renal insufficiency,4 cases of pelvic ectopic kidney with dysplasia,6 cases of congenital ureteral malformation and 2 cases of sponge kidney.Preoperative average hemoglobin was (133.2 + 5.6) g/L,ranging 126-188 g/L.And average serum creatinine was (84.4 + 12.2) μmol/L,ranging 74-242μmol/L before operation.All patients were treated with general anesthesia under the lithotomy position.The ureteroscopy combined with holmium laser lithotripsy was performed.The 200tμm fiber was used,which the parameters were set as 12-45 W(0.5-1.5 J/10-30 Hz).The stone baskets were used to take stones according to actual conditions.The operation was performed by doctors of the same qualifications.Results All patients underwent successful operation.The mean operation time was (45.6 + 14.6) min.The average postoperative hospitalization was (4.8 ± 1.5) d.The postoperative serious complication rate was 0.9%,including(2 cases of sepsis and 1 case of subcapsular hematoma.Of the 640 patients,596 were admitted to the hospital for a double J tube and 44 were lost of follow-up.552 patients met the stone removal criteria,44 patients did not meet the stone removal criteria for other treatments,such as extracorporeal shock wave lithotripsy,ureteroscopy or observed regularly.The stone-free rate (SFR) was 92.6% (552/596) after 1-3 months.On the first postoperative day,serum creatinine was (76.0 ±10.6) (58-156) μmol/L,and postoperative hemoglobin was (126.4 ±9.6) (120-176) g/L.There was no significant difference in preoperative and postoperative hemoglobin (t =2.02,P =0.064).Preoperative and postoperative creatinine (t =64.76,P < 0.05) was statistically significant.Meanwhile,the stone size (x2 =29.569,P < 0.05) and position (x2 =44.949,P < 0.05) versus SFR the impact was statistically significant.Multivariate regression analysis showed that stone size was not an independent risk factor for stone clearance (P =0.639).The stone position was an independent risk factor for stone clearance (P =0.013).Conclusions RIRS is a reliable treatment for small and medium calculi patients of the upper urinary tract.The curative effect of stone removal is clear,the complications are few,the safety is high.However,there are certain limitations to the efficacy in the treatment of large stones and lower calculi.Lower calculi is the independent risk factor for the treatment of efficacy.

18.
Chinese Journal of Urology ; (12): 41-45, 2020.
Article in Chinese | WPRIM | ID: wpr-798861

ABSTRACT

Objective@#To evaluate efficacy and safety of retrograde intrarenal stone surgery for treatment of upper urinary calculi.@*Methods@#The clinical data of 640 patients with upper urinary tract calculi treated by retrograde intrarenal stone surgery (RIRS) in Renmin Hospital of Wuhan University from April 2016 to January 2019 were retrospectively analyzed. There were 424 males and 216 females. The awerage age was (46.2±12.8) years old, ranging 18 to 76 years old. The maximum diameter of the stone is (1.4±0.7) cm, ranging 0.6-3.2 cm. There were 126 cases with inferior calculi and 514 cases with non-lurgical calculi. There were 196 cases with unilateral ureteral calculi, 118 unilateral ureteral calculi cases with renal calculi, 236 cases with unilateral renal stones, and 90 cases with double kidney stones. 104 cases were placed with double J tube before operation and 496 cases were not placed before operation. There were 8 cases of horseshoe kidney, 30 cases of isolated kidney with renal insufficiency, 4 cases of pelvic ectopic kidney with dysplasia, 6 cases of congenital ureteral malformation and 2 cases of sponge kidney. Preoperative average hemoglobin was (133.2±5.6)g/L, ranging 126-188 g/L.And average serum creatinine was (84.4±12.2)μmol/L, ranging 74-242μmol/L before operation. All patients were treated with general anesthesia under the lithotomy position. The ureteroscopy combined with holmium laser lithotripsy was performed.The 200μm fiber was used, which the parameters were set as 12-45 W(0.5-1.5 J/10-30 Hz). The stone baskets were used to take stones according to actual conditions. The operation was performed by doctors of the same qualifications.@*Results@#All patients underwent successful operation. The mean operation time was (45.6±14.6)min. The average postoperative hospitalization was (4.8±1.5)d. The postoperative serious complication rate was 0.9%, including(2 cases of sepsis and 1 case of subcapsular hematoma. Of the 640 patients, 596 were admitted to the hospital for a double J tube and 44 were lost of follow-up. 552 patients met the stone removal criteria, 44 patients did not meet the stone removal criteria for other treatments, such as extracorporeal shock wave lithotripsy, ureteroscopy or observed regularly. The stone-free rate (SFR) was 92.6% (552/596) after 1-3 months. On the first postoperative day, serum creatinine was (76.0±10.6)(58-156) μmol/L, and postoperative hemoglobin was (126.4±9. 6)(120-176) g/L. There was no significant difference in preoperative and postoperative hemoglobin (t=2.02, P=0.064). Preoperative and postoperative creatinine (t=64.76, P<0.05) was statistically significant. Meanwhile, the stone size (χ2=29.569, P<0.05) and position (χ2=44.949, P<0.05) versus SFR the impact was statistically significant. Multivariate regression analysis showed that stone size was not an independent risk factor for stone clearance (P=0.639). The stone position was an independent risk factor for stone clearance (P=0.013).@*Conclusions@#RIRS is a reliable treatment for small and medium calculi patients of the upper urinary tract. The curative effect of stone removal is clear, the complications are few, the safety is high. However, there are certain limitations to the efficacy in the treatment of large stones and lower calculi. Lower calculi is the independent risk factor for the treatment of efficacy.

19.
Article in English | WPRIM | ID: wpr-882159

ABSTRACT

@#In the field of Urology, flexible ureterorenoscopy (fURS) remains a challenging skill for junior residents to develop due to its steep learning curve. Hence, training models were incorporated into simulation-based training to allow for novice trainees to overcome the learning curve without potentially compromising patient outcomes and minimize complications. OBJECTIVE: To describe the design and test the validity of a non-biological three-dimensional (3D) model of the pelvocalyceal system as a tool for simulation-based training for flexible ureterorenoscopy METHODS: This was a prospective, quasi-experimental, surgical innovation research stage 2a study conducted in a tertiary government hospital. The retrograde intrarenal surgery (RIRS) box was composed of four siliconized pelvocalyceal systems which were 3D printed using computed tomography urograms of actual patients. Thirty-two urologists were asked to perform flexible ureteroscopy using the RIRS box and were given a questionnaire to assess face and content validity using the Likert scale. RESULTS: The RIRS Box training model showed good face and content validity. The 3D printed pelvocalyceal system was judged to have a close anatomical resemblance to an actual calyceal system. While performing fURS, the RIRS box provided similar pelvocalyceal visualization and instrument handling as in an actual procedure. Majority of participants considered the training model useful for training (75%) and believed that it may improve the RIRS technique (46.8%). CONCLUSION: The RIRS Box training model may help urologists improve the manner in which they acquire technical knowledge and skills necessary in performing fURS.


Subject(s)
Ureteroscopy , Ureteroscopes , Printing, Three-Dimensional
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